Don De Savigny
Datos Biográficos
| ID | 2389775 |
|---|---|
| NOMBRE | Don De Savigny |
| NOMBRES | Don |
| APELLIDO | De Savigny |
| FIRMA | DE SAVIGNY D |
| AFILIACIONES | Swiss Tropical and Public Health Institute |
| ORCID | 0000-0002-6903-4722 |
| VERIFICADO | Sí |
| TOTAL DE OBRAS | 26 |
| TOTAL DE CITAS | 30 |
| TOTAL COMO AUTOR | 26 |
| TOTAL COMO EDITOR | 0 |
| PRIMER AÑO DE PUBLICACIÓN | 1994 |
| AÑO MÁS RECIENTE DE PUBLICACIÓN | 2025 |
| ÍNDICE H | 3 |
Informing ICD-11 implementation
Objectives. To assess challenges and opportunities within the mortality information systems of Ecuador and Trinidad and Tobago to support the implementation of the International Classification of Diseases, 11th revision (ICD-11) coding system. Methods. We applied a qualitative approach using business process mapping, a systems thinking tool that visualizes workflows, stakeholder roles, and information flows. The study had four phases: document re…
The building blocks of community health systems
INTRODUCTION: Almost all sub-Saharan African countries have adopted some form of integrated community case management (iCCM) to reduce child mortality, a strategy targeting common childhood diseases in hard-to-reach communities. These programs are complex, maintain diverse implementation typologies and involve many components that can influence the potential success of a program or its ability to effectively perform at scale. While tools and meth…
A health systems resilience research agenda
Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ab…
Neglected tropical diseases as a barometer for progress in health systems in times of Covid-19
box The year 2020 will be regarded as the year when the SARS-CoV-2 resulted in the COVID-19 pandemic that spread globally, catching most countries unprepared. Amid untold suffering, COVID-19 presents the opportunity to galvanise support for long due social, political and economic reforms to address the root causes of ill-health and inequities, but also to radically transform health and social protection systems to enable more effective performanc…
Estimating causes of death where there is no medical certification
Over the past 70 years, significant advances have been made in determining the causes of death in populations not served by official medical certification of cause at the time of death using a technique known as Verbal Autopsy (VA). VA involves an interview of the family or caregivers of the deceased after a suitable bereavement interval about the circumstances, signs and symptoms of the deceased in the period leading to death. The VA interview d…
The Covid-19 Pandemic
The complex and evolving picture of COVID-19–related mortality highlights the need for data to guide the response. Yet many countries are struggling to maintain their data systems, including the civil registration system, which is the foundation for detailed and continuously available mortality statistics. We conducted a search of country and development agency Web sites and partner and media reports describing disruptions to the civil registrati…
Decentralization of birth registration to Local Government in Tanzania
BACKGROUND: In Tanzania only an estimated one-quarter of births are registered and certified. Birth registration uses a centralized system with geographic and cost barriers for families. A pilot decentralized birth registration system has been trialled in 11 of 26 regions, substantially increasing registration points, and enabling notification, registration and certification to occur in one step. OBJECTIVE: This study compares completeness of bir…
A systems approach to assessing complexity in health interventions
Complexity is inherent to any system or program. This is especially true of integrated interventions, such as integrated community case management (iCCM). iCCM is a child health strategy designed to provide services through community health workers (CHWs) within hard-to-reach areas of low-and-middle-income countries (LMICs). It is comprised of many interlinked program components, processes and stakeholders. Elucidating the complexity of such prog…
Going operational with health systems governance
Improving the quality of care is increasingly recognized as a priority of health systems in low- and middle-income countries. Given the labour-intensive nature of healthcare interventions, quality of care largely depends upon the number, training and management of health workers involved in service delivery. Policies available to boost the performance of health workers—and thus the quality of healthcare—include regulation, incentives and supervis…
The Global Fund’s paradigm of oversight, monitoring, and results in Mozambique
BACKGROUND: The Global Fund is one of the largest actors in global health. In 2015 the Global Fund was credited with disbursing close to 10 % of all development assistance for health. In 2011 it began a reform process in response to internal reviews following allegations of recipients' misuse of funds. Reforms have focused on grant application processes thus far while the core structures and paradigm have remained intact. We report results of dis…
Do surveys with paper and electronic devices differ in quality and cost? Experience from the Rufiji Health and demographic surveillance system in Tanzania
BACKGROUND: Data entry at the point of collection using mobile electronic devices may make data-handling processes more efficient and cost-effective, but there is little literature to document and quantify gains, especially for longitudinal surveillance systems. OBJECTIVE: To examine the potential of mobile electronic devices compared with paper-based tools in health data collection. METHODS: Using data from 961 households from the Rufiji Househo…
Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS)
BACKGROUND: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics…
A global assessment of civil registration and vital statistics systems
Essential evidence for guiding health system priorities and policies
BACKGROUND: Despite indications that infection-related mortality in sub-Saharan Africa may be decreasing and the burden of non-communicable diseases increasing, the overwhelming reality is that health information systems across most of sub-Saharan Africa remain too weak to track epidemiological transition in a meaningful and effective way. PROPOSALS: We propose a minimum dataset as the basis of a functional health information system in countries …
Global health initiative investments and health systems strengthening
BACKGROUND: Millions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how m…
Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring
OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statist…
Implementing new health interventions in developing countries
Although possible that four milestones were not associated with countries beginning implementation, we propose an alternative interpretation; that the milestones were not realized early enough in each intervention's development to shorten the time to beginning implementation. We discuss a framework built upon existing literature for consideration during the development of future interventions. Identifying critical milestones and their timing rela…
Systems thinking for strengthening health systems in LMICs
Health systems are complex. Failing to take this complexity into account will continue to hinder efforts to achieve better and more equitable health outcomes. Understanding and working with complexity requires a paradigm shift from linear reductionist approaches to dynamic and holistic approaches that appreciate the multifaceted and interconnected relationships among health system components as well as the views interests and power of its differe…
Evaluating health systems strengthening interventions in low-income and middle-income countries
In recent years, there have been several calls for rigorous health policy and systems research to inform efforts to strengthen health systems (HS) in low- and middle-income countries (LMICs), including the use of systems thinking concepts in designing and evaluating HS strengthening interventions. The objectives of this paper are to assess recent evaluations of HS strengthening interventions to examine the extent to which they ask a broader set o…
Scaling up antiretroviral therapy in Uganda
BACKGROUND: Strengthened national health systems are necessary for effective and sustained expansion of antiretroviral therapy (ART). ART and its supply chain management in Uganda are largely based on parallel and externally supported efforts. The question arises whether systems are being strengthened to sustain access to ART. This study applies systems thinking to assess supply chain management, the role of external support and whether investmen…
An approach to addressing governance from a health system framework perspective
As countries strive to strengthen their health systems in resource constrained contexts, policy makers need to know how best to improve the performance of their health systems. To aid these decisions, health system stewards should have a good understanding of how health systems operate in order to govern them appropriately. While a number of frameworks for assessing governance in the health sector have been proposed, their application is often hi…
HIV treatment and reproductive health in the health system in Burkina Faso
Organizational changes, increased funding and the demands of HIV antiretroviral (ARV) treatment create particular challenges for governance in the health sector. We assess resource allocation, policy making and integration of the national responses to ARV provision and reproductive health in Burkina Faso, using national and district budgets related to disease burden, policy documents, organizational structures, and coordination and implementation…
How can we achieve and maintain high-quality performance of health workers in low-resource settings?
Impact of Integrated Management of Childhood Illness on inequalities in child health in rural Tanzania
We examined the impact of the Integrated Management of Childhood Illness (IMCI) strategy on the equality of health outcomes and access across socioeconomic gradients in rural Tanzania, by comparing changes in inequities between 1999 and 2002 in two districts with IMCI (Morogoro Rural and Rufiji) and two without (Kilombero and Ulanga). Equity differentials for six child health indicators (underweight, stunting, measles immunization, access to trea…
Inequities among the very poor
Systems thinking for strengthening health systems in LMICs
Health systems are complex. Failing to take this complexity into account will continue to hinder efforts to achieve better and more equitable health outcomes. Understanding and working with complexity requires a paradigm shift from linear reductionist approaches to dynamic and holistic approaches that appreciate the multifaceted and interconnected relationships among health system components as well as the views interests and power of its differe…
Evaluating health systems strengthening interventions in low-income and middle-income countries
In recent years, there have been several calls for rigorous health policy and systems research to inform efforts to strengthen health systems (HS) in low- and middle-income countries (LMICs), including the use of systems thinking concepts in designing and evaluating HS strengthening interventions. The objectives of this paper are to assess recent evaluations of HS strengthening interventions to examine the extent to which they ask a broader set o…
The Covid-19 Pandemic
The complex and evolving picture of COVID-19–related mortality highlights the need for data to guide the response. Yet many countries are struggling to maintain their data systems, including the civil registration system, which is the foundation for detailed and continuously available mortality statistics. We conducted a search of country and development agency Web sites and partner and media reports describing disruptions to the civil registrati…
Impact of Integrated Management of Childhood Illness on inequalities in child health in rural Tanzania
We examined the impact of the Integrated Management of Childhood Illness (IMCI) strategy on the equality of health outcomes and access across socioeconomic gradients in rural Tanzania, by comparing changes in inequities between 1999 and 2002 in two districts with IMCI (Morogoro Rural and Rufiji) and two without (Kilombero and Ulanga). Equity differentials for six child health indicators (underweight, stunting, measles immunization, access to trea…
Going operational with health systems governance
Improving the quality of care is increasingly recognized as a priority of health systems in low- and middle-income countries. Given the labour-intensive nature of healthcare interventions, quality of care largely depends upon the number, training and management of health workers involved in service delivery. Policies available to boost the performance of health workers—and thus the quality of healthcare—include regulation, incentives and supervis…
The economics of tobacco trade
Inequities among the very poor
How can we achieve and maintain high-quality performance of health workers in low-resource settings?
Impact of Integrated Management of Childhood Illness on inequalities in child health in rural Tanzania
We examined the impact of the Integrated Management of Childhood Illness (IMCI) strategy on the equality of health outcomes and access across socioeconomic gradients in rural Tanzania, by comparing changes in inequities between 1999 and 2002 in two districts with IMCI (Morogoro Rural and Rufiji) and two without (Kilombero and Ulanga). Equity differentials for six child health indicators (underweight, stunting, measles immunization, access to trea…
Scaling up antiretroviral therapy in Uganda
BACKGROUND: Strengthened national health systems are necessary for effective and sustained expansion of antiretroviral therapy (ART). ART and its supply chain management in Uganda are largely based on parallel and externally supported efforts. The question arises whether systems are being strengthened to sustain access to ART. This study applies systems thinking to assess supply chain management, the role of external support and whether investmen…
An approach to addressing governance from a health system framework perspective
As countries strive to strengthen their health systems in resource constrained contexts, policy makers need to know how best to improve the performance of their health systems. To aid these decisions, health system stewards should have a good understanding of how health systems operate in order to govern them appropriately. While a number of frameworks for assessing governance in the health sector have been proposed, their application is often hi…
HIV treatment and reproductive health in the health system in Burkina Faso
Organizational changes, increased funding and the demands of HIV antiretroviral (ARV) treatment create particular challenges for governance in the health sector. We assess resource allocation, policy making and integration of the national responses to ARV provision and reproductive health in Burkina Faso, using national and district budgets related to disease burden, policy documents, organizational structures, and coordination and implementation…
Implementing new health interventions in developing countries
Although possible that four milestones were not associated with countries beginning implementation, we propose an alternative interpretation; that the milestones were not realized early enough in each intervention's development to shorten the time to beginning implementation. We discuss a framework built upon existing literature for consideration during the development of future interventions. Identifying critical milestones and their timing rela…
Systems thinking for strengthening health systems in LMICs
Health systems are complex. Failing to take this complexity into account will continue to hinder efforts to achieve better and more equitable health outcomes. Understanding and working with complexity requires a paradigm shift from linear reductionist approaches to dynamic and holistic approaches that appreciate the multifaceted and interconnected relationships among health system components as well as the views interests and power of its differe…
Evaluating health systems strengthening interventions in low-income and middle-income countries
In recent years, there have been several calls for rigorous health policy and systems research to inform efforts to strengthen health systems (HS) in low- and middle-income countries (LMICs), including the use of systems thinking concepts in designing and evaluating HS strengthening interventions. The objectives of this paper are to assess recent evaluations of HS strengthening interventions to examine the extent to which they ask a broader set o…
Global health initiative investments and health systems strengthening
BACKGROUND: Millions of dollars are invested annually under the umbrella of national health systems strengthening. Global health initiatives provide funding for low- and middle-income countries through disease-oriented programmes while maintaining that the interventions simultaneously strengthen systems. However, it is as yet unclear which, and to what extent, system-level interventions are being funded by these initiatives, nor is it clear how m…
Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring
OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statist…
Essential evidence for guiding health system priorities and policies
BACKGROUND: Despite indications that infection-related mortality in sub-Saharan Africa may be decreasing and the burden of non-communicable diseases increasing, the overwhelming reality is that health information systems across most of sub-Saharan Africa remain too weak to track epidemiological transition in a meaningful and effective way. PROPOSALS: We propose a minimum dataset as the basis of a functional health information system in countries …
A global assessment of civil registration and vital statistics systems
The Global Fund’s paradigm of oversight, monitoring, and results in Mozambique
BACKGROUND: The Global Fund is one of the largest actors in global health. In 2015 the Global Fund was credited with disbursing close to 10 % of all development assistance for health. In 2011 it began a reform process in response to internal reviews following allegations of recipients' misuse of funds. Reforms have focused on grant application processes thus far while the core structures and paradigm have remained intact. We report results of dis…
Do surveys with paper and electronic devices differ in quality and cost? Experience from the Rufiji Health and demographic surveillance system in Tanzania
BACKGROUND: Data entry at the point of collection using mobile electronic devices may make data-handling processes more efficient and cost-effective, but there is little literature to document and quantify gains, especially for longitudinal surveillance systems. OBJECTIVE: To examine the potential of mobile electronic devices compared with paper-based tools in health data collection. METHODS: Using data from 961 households from the Rufiji Househo…
Integrating community-based verbal autopsy into civil registration and vital statistics (CRVS)
BACKGROUND: Reliable and representative cause of death (COD) statistics are essential to inform public health policy, respond to emerging health needs, and document progress towards Sustainable Development Goals. However, less than one-third of deaths worldwide are assigned a cause. Civil registration and vital statistics (CRVS) systems in low- and lower-middle-income countries are failing to provide timely, complete and accurate vital statistics…
Going operational with health systems governance
Improving the quality of care is increasingly recognized as a priority of health systems in low- and middle-income countries. Given the labour-intensive nature of healthcare interventions, quality of care largely depends upon the number, training and management of health workers involved in service delivery. Policies available to boost the performance of health workers—and thus the quality of healthcare—include regulation, incentives and supervis…
Decentralization of birth registration to Local Government in Tanzania
BACKGROUND: In Tanzania only an estimated one-quarter of births are registered and certified. Birth registration uses a centralized system with geographic and cost barriers for families. A pilot decentralized birth registration system has been trialled in 11 of 26 regions, substantially increasing registration points, and enabling notification, registration and certification to occur in one step. OBJECTIVE: This study compares completeness of bir…
A systems approach to assessing complexity in health interventions
Complexity is inherent to any system or program. This is especially true of integrated interventions, such as integrated community case management (iCCM). iCCM is a child health strategy designed to provide services through community health workers (CHWs) within hard-to-reach areas of low-and-middle-income countries (LMICs). It is comprised of many interlinked program components, processes and stakeholders. Elucidating the complexity of such prog…
A health systems resilience research agenda
Health system resilience, known as the ability for health systems to absorb, adapt or transform to maintain essential functions when stressed or shocked, has quickly gained popularity following shocks like COVID-19. The concept is relatively new in health policy and systems research and the existing research remains mostly theoretical. Research to date has viewed resilience as an outcome that can be measured through performance outcomes, as an ab…
Neglected tropical diseases as a barometer for progress in health systems in times of Covid-19
box The year 2020 will be regarded as the year when the SARS-CoV-2 resulted in the COVID-19 pandemic that spread globally, catching most countries unprepared. Amid untold suffering, COVID-19 presents the opportunity to galvanise support for long due social, political and economic reforms to address the root causes of ill-health and inequities, but also to radically transform health and social protection systems to enable more effective performanc…
Estimating causes of death where there is no medical certification
Over the past 70 years, significant advances have been made in determining the causes of death in populations not served by official medical certification of cause at the time of death using a technique known as Verbal Autopsy (VA). VA involves an interview of the family or caregivers of the deceased after a suitable bereavement interval about the circumstances, signs and symptoms of the deceased in the period leading to death. The VA interview d…
The Covid-19 Pandemic
The complex and evolving picture of COVID-19–related mortality highlights the need for data to guide the response. Yet many countries are struggling to maintain their data systems, including the civil registration system, which is the foundation for detailed and continuously available mortality statistics. We conducted a search of country and development agency Web sites and partner and media reports describing disruptions to the civil registrati…
The building blocks of community health systems
INTRODUCTION: Almost all sub-Saharan African countries have adopted some form of integrated community case management (iCCM) to reduce child mortality, a strategy targeting common childhood diseases in hard-to-reach communities. These programs are complex, maintain diverse implementation typologies and involve many components that can influence the potential success of a program or its ability to effectively perform at scale. While tools and meth…
Medicine (22 obras) · Global Maternal and Child Health (20 obras) · Nursing (13 obras) · Business (12 obras) · Economics (12 obras) · Economic growth (10 obras) · Political science (10 obras) · Computer Science (9 obras) · Environmental health (9 obras) · Psychological intervention (9 obras)