What do people buy to eat out-of-home in Britain and where do they buy it?

This summary of our recent published study was written by 12-year old Sophie who was visiting LSHTM for a work experience. We at PHI|Lab think she has done a fantastic job cutting through an academic paper and pulling out the key messages!

Our diets largely influence our health. Diets that contain a high intake of sugars, salts and saturated fats, combined with not much fruit, vegetable and fibre increase the risk of obesity and other diseases.

A recent paper which was published in Social Science & Medicine looked for a correlation between ‘out-of-home’ food expenditure and socio-economic patterning. Kantar Worldpanel (a panel that represents Britain as a nation) records household expenditures at product-level, including food and beverage purchased to be eaten out-of-home. 9,703 respondents, from 8,326 households took part in a 2 and ½ year course where they recorded purchases made. The options of the outlet classification were four groups – cafes & restaurants, takeaway & fast-food outlets, supermarkets & convenience stores and ‘other’ outlets. The food group classification was the option of eight different categories – main meals, quick meals, cold non-alcoholic beverages, hot beverages, sweet snacks, savoury snacks, fruit & veg and ‘other’.

One of the key aspects of this project was to see if there was any correlation between SES (socio-economic status) and the ‘out-of-home’ food they bought. The SES of a household was determined by what jobs they had. This indicates how much pay they had as well as what sort of education they have had. The results were as follows:

  • All SES households spent the highest percentage of their expenditure in cafés & restaurant
  • Low-SES households spent the highest percentage of their expenditure in fast-food & takeaway outlets
  • All SES households spent the lowest percentage of their expenditure in supermarkets & convenience stores.

Age groups also seemed to make a difference to the food group they bought from. For example, compared to 19-29 year olds, 12-18 year olds had a lower expenditure share on meals and hot beverages, but a higher share on non-alcoholic beverages (including soft drinks) as well as both sweet and savoury snacks. The main expenditure on meals eaten ‘out-of-home’ in terms of food groups was main meals, coming in at 42-43% of expenditures. Quick meals and hot beverages came in at 17-19% each. This was then followed by cold non-alcoholic beverages (10-12%) and sweet snacks (8-9%). Surprisingly, savoury snacks, fruit & veg and ‘other’ accounted for a minute amount of expenditure shares (<1% each).

 

Cornelsen, L., Berger, N., Cummins, S., Smith, R., 2019. Socio-economic patterning of expenditures on ‘out-of-home’food and non-alcoholic beverages by product and place of purchase in Britain. Soc. Sci. Med. https://doi.org/10.1016/j.socscimed.2019.112361

Posted in Research | Comments Off on What do people buy to eat out-of-home in Britain and where do they buy it?

Results from three pilots assessing feasibility and acceptability of recency testing (July 2019)

The MeSH Consortium has completed three pilots in different routine service-provisions context Kenya and Zimbabwe. These pilots were conducted in partnership with KEMRI, EDARP, CeSHHAR, UCSF and the ALPHA network.

Information on new infections contributes to tracking the incidence of new infections over time, thereby helping us to assess whether control measures are working and understand better where prevention efforts should be targeted. In recognition of this, the MeSH Consortium, working closely with in-country partners, conducted three pilots of HIV recency testing in a variety of routine service-provision contexts in Kenya and Zimbabwe. At a time when all PEPFAR-supported countries are being strongly encouraged to include recency testing in their national HIV testing strategies, the MeSH Consortium present the results from these three pilots in a joint report. In addition to presenting HIV and recency testing yields, in the report we also assess the feasibility of conducting recency testing in routine settings, present an analysis of the acceptability and utility of recency testing among healthcare workers and participants, present estimates of HIV incidence using a number of methods, and explore potential biases in incidence estimates when using women attending ANC as the surveillance population.

The full report can be found here

Posted in Uncategorized | Comments Off on Results from three pilots assessing feasibility and acceptability of recency testing (July 2019)

CEHC Five Year Meeting – March 2019

The Commonwealth Eye Health Consortium Five Year meeting was held from 26th to 29th March 2019 in London to celebrate the achievements of the Consortium and plan for future global eye health goals. The event marked the fifth year of the Consortium, which was established in 2014. More than 170 eye health experts from 31 Commonwealth countries gathered in London to discuss how eye health services can be strengthened and expanded across the Commonwealth.

To date, the Consortium has doubled the number of eye doctors with a PhD in Africa, provided over 20,000 health professionals with online training in eye health, and screened over 200,000 schoolchildren in Kenya using the smart-phone based vision testing tool, Peek.

Her Royal Highness The Countess of Wessex, Vice-Patron of The Trust, attended the event and spoke with leading ophthalmologists and health professionals about their work which is changing the way eye care is delivered in some of the most under-resourced areas of the Commonwealth. Her Royal Highness also tried out specialist surgical training equipment to simulate eye surgery, which is being used to train eye doctors from all over the Commonwealth.

The following day Her Royal Highness hosted a reception at St. James’s Palace for the Consortium delegates, High Commissioners, policy makers and eye health experts to celebrate the achievements of global eye health leaders. Dr Simon Arunga, Consortium-funded LSHTM research fellow at Mbarara University of Science and Technology in Uganda, gave a speech on the impact the Consortium has had in Uganda and around the Commonwealth.

The Commonwealth Eye Health Consortium at St James’s Palace. © Theodore Wood Photography

Dr Will Dean (research fellow) and Dr Denise Kavuma (MSc PHEC fellow) demonstrate to HRH The Countess of Wessex specialist surgical training equipment to simulate eye surgery which is being used to train eye doctors from all over the Commonwealth. Photo credit: Tara Moore / The Queen Elizabeth Diamond Jubilee Trust

 

Posted in News | Comments Off on CEHC Five Year Meeting – March 2019

CEHC Five Year Meeting

The Commonwealth Eye Health Consortium Five Year meeting was held from 26th to 29th March 2019 in London to celebrate the achievements of the Consortium and plan for future global eye health goals. The event marked the fifth year of the Consortium, which was established in 2014. More than 170 eye health experts from 31 Commonwealth countries gathered in London to discuss how eye health services can be strengthened and expanded across the Commonwealth.

To date, the Consortium has doubled the number of eye doctors with a PhD in Africa, provided over 20,000 health professionals with online training in eye health, and screened over 200,000 schoolchildren in Kenya using the smart-phone based vision testing tool, Peek.

Her Royal Highness The Countess of Wessex, Vice-Patron of The Trust, attended the event and spoke with leading ophthalmologists and health professionals about their work which is changing the way eye care is delivered in some of the most under-resourced areas of the Commonwealth. Her Royal Highness also tried out specialist surgical training equipment to simulate eye surgery, which is being used to train eye doctors from all over the Commonwealth.

The following day Her Royal Highness hosted a reception at St. James’s Palace for the Consortium delegates, High Commissioners, policy makers and eye health experts to celebrate the achievements of global eye health leaders. Dr Simon Arunga, Consortium-funded LSHTM research fellow at Mbarara University of Science and Technology in Uganda, gave a speech on the impact the Consortium has had in Uganda and around the Commonwealth.

The Commonwealth Eye Health Consortium at St James’s Palace. © Theodore Wood Photography

Dr Will Dean (research fellow) and Dr Denise Kavuma (MSc PHEC fellow) demonstrate to HRH The Countess of Wessex specialist surgical training equipment to simulate eye surgery which is being used to train eye doctors from all over the Commonwealth. Photo credit: Tara Moore / The Queen Elizabeth Diamond Jubilee Trust

 

Posted in News | Comments Off on CEHC Five Year Meeting

Opening ceremony of the Keppel Street building

Prince of Wales outside the School

The School was officially opened by HRH The Prince of Wales (who went onto become Edward 8th who abdicated), on 18th July 1929 at 12pm. On arrival he was welcomed by the Chairman of the Board of Management, Lord Melchett; Chairman of the Court of Governors, Sir Holburt Waring; and the Vice-Chancellor of the University of London, Sir Gregory Foster. The Prince was presented to the Architects, Morley Horder and Verner Rees who offered him the key to the building, the Archives has the box in which the key was presented, this is currently on display in the Manson foyer. The Prince did not need to use the key and it is believed that he put it in his pocket.

In the Entrance Hall the Prince was presented to more senior staff and then taken up to the Library where he gave a speech in which he formally declared the building open. At this point, the main doors of the building were opened and a fanfare sounded by the trumpeters of the Coldstream Guards.

HRH Prince of Wales giving a speech in the Library

Here is an extract of part of his speech:

‘You have cause to be proud of this magnificent building, and if the laboratories, museum, and lecture theatre make good the promise of this library, I think you are indeed to be congratulated, and the building will be a notable addition to the homes of learning in London. Reference has been made to the part played by America and the duty which lies on both the British Government and the British people to see that the School is worthily endowed and maintained. The building is a sign that post-graduate education in medicine is about to come into its own. The establishment and endowment of this centre of teaching in preventive medicine is a signal example of the bond between the two great English speaking races of the world. The Chairman has rightly said that there are not territorial frontiers in hygiene. The instruction in the classroom and laboratories of this building will be conveyed by medical practitioners of every nationality to the far corners of the earth. This research will find its results wherever man lives and moves and has his being.’

The Prince was then taken on a tour of the building, the Archives has a note of his route in a document for stewards which was as follows:

The Prince’s tour route

On leaving the library he will ascend by the lift to the third floor and enter the museum. Turning to the right, going round the Tropical Medicine Museum, he will leave by the door entering the Medical Zoology Laboratory. Traversing the cross corridor and descending the Gower Street staircase to the second floor, go through Professor Topley’s laboratory and then through the General Hygiene Museum, take lift to ground floor. Then enter lecture theatre, and after visiting the workmen’s tent, return same way, leaving by main entrance.

The Archives Service recreated this route on a plan of the School which is currently on display in the Manson foyer. The Prince left the building at 12.50pm.

Lunch was served to the guests at 1pm, after which guests were shown around the building by staff and short cinematograph displays were given in the Lecture theatre

The Archives holds records and correspondence relating to the opening ceremony and a letter was found from Sir Ronald Ross. He was the discoverer of the mosquito transmission of malaria and the first Briton to be awarded the Nobel Prize for Medicine. He never worked at the School, working instead at the Liverpool School of Tropical Medicine. However he had worked with many of the London School’s staff or was acquainted with them through his work, and the Ross Institute and Hospital for Tropical Diseases was incorporated into the School in 1934, two years after his death.

He wrote an amusing letter on 20th July 1929, two days after the ceremony to Sir Andrew Balfour, Director of the School in which he states:

Sir Ronald Ross

‘I had every comfort on the occasion of your opening ceremony, and found a lovely luncheon room to ourselves, where Miss Lafford ate too much. She has been grumpy ever since. (Not true, Sir Ronald bagged my fruit). There was only one defect in your ceremony, namely that all of us at our end of the room could not hear what was said. This was due to the arrangement of the seats. The platform should have been at the end of the room instead of half way along, which is a mistake often made. On these occasions I often drop loud words and fear that the Prince may have thought that a bomb was going off. But as for lunch – it was perfect.

Name of Sir Ronald Ross on the frieze

PS Some people are pitching into you for not putting my name outside your new building, but I always explain that this is a pleasure awaiting you when I am dead!,

There was a response from Balfour which says:

‘Many thanks for your amusing note. I am glad to find you in such good spirits. I am afraid the wiseacres who have been miscalling me must have very slight historical knowledge, and I am glad that you have corrected them. Your space is there but I hope it may be a long time before it is necessary to fill it!

PS I am sorry you could not hear but I am afraid that, if the platform had been at one end of the room, the Library acoustics are such that even more people would have been debarred in an auditory sense. The trouble is that our lecture theatre can only hold 270 and we had, as you know, something between 500 and 600 present.’

For more information on the building or the opening ceremony, please contact the Archives Service at:

“Losing a billion dollars a day”: The Cost of Not Breastfeeding

By: Dr. Dylan Walters (Project Director, Health Economics, Nutrition International)
[Interactive infographic below. Download the PDF here: Cost of not breastfeeding]

Recent history has shown us the powerful effect of data in appealing to both the emotional and rational interests of people. Shocking claims of the number of preventable deaths or the economic costs resulting from a government’s policies have been able to seize the attention of the media and mobilize voters. Data, when utilized in the right way, can change the direction of politics and policies for years to come.

Imagine then, the potential impact these numbers could have: we are losing 1,500 lives and $1 billion per day from something preventable.

Would citizens unite to demand action? Would politicians reach across party lines to act decisively to invest, regulate and nudge? Would civil society and private sector support the cause and work together to innovate?

This incredible stat – this immense loss – is the human and economic impact of not breastfeeding. Each year the lack of breastfeeding newborns and young children according to WHO and UNICEF recommendations costs nearly 700,000 lives and $341 billion globally, or 0.7% Gross National Income, in health system costs and lost productivity due to premature deaths, and human capital losses.

Low- and middle-income countries, particularly in sub-Saharan Africa and South Asia, have the most to gain from adopting universal breastfeeding within the first hour of life, exclusively for the first six months, and continued for two years and beyond. But wealthier countries can also expect to see benefits from improving their breastfeeding practices, through cognitive gains and a probable reduction in the burden of childhood obesity, maternal cancers, and type 2 diabetes.

Through a new study on the cost of not breastfeeding (See Walters et al. 2019. The cost of not breastfeeding: global results from a new tool. Health Policy and Planning, 2019, 1–11 https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz050/5522499), we’re able to connect the dots between publicly available big data in a simple tool, the Alive & Thrive Cost of Not Breastfeeding Tool, drawing a larger picture of global impact (available on the Alive and Thrive website: www.aliveandthrive.org/costofnotbreastfeeding/). While the data is not new, for the first time it is now available at country-level for over 100 countries around the world. By presenting it in an easy-to-use and comprehensive way, we’re giving policymakers and advocates the power of data.

Despite the staggering numbers in the study, it’s likely that it doesn’t capture every single cost incurred from sub-optimal breastfeeding practices. We still are unable to capture the costs of unpaid caregiving time associated with not breastfeeding, which are disproportionately incurred by mothers. More research and data are needed to fully capture all the health, human capital and economic costs on the Cost of Not Breastfeeding.

But telling the story of breastfeeding in the 21st century is complex for a number of reasons. We need to be sensitive to the constraints and hardships faced by mothers and families in a world that lacks basic support systems for their physical, psychosocial and economic well-being. Even more, mothers and families are up against a constant barrage of corporate driven marketing of breast milk alternatives and misinformation spread by pseudoscience that undermines a practice that should simply be second nature and not stigmatized by society.

Our hope is that political leaders will wield this tool to fight misinformation, create effective and innovative interventions, and drive policy change towards building an enabling environment that breastfeeding and maternity care in the critical first 1000 days between a woman’s pregnancy and a child’s second birthday.

So what can be done with this information to be a force for positive change?

The answer is a lot. The Global Breastfeeding Collective – an alliance led by UNICEF and the World Health Organization, with partners like Alive & Thrive and Nutrition International – is employing evidence like this research to support governments in mobilizing financial resources. These resources are critical to reaching the World Health Assembly Global Nutrition Target of exclusive breastfeeding prevalence of 50% by 2025. The Collective’s seven policy actions to prevent future health, human capital and economic costs are a great place to start and include:

  1. Increase funding to raise the rate of breastfeeding from birth to 2 years
  2. Adopt and monitor the International Code of Marketing of Breastmilk Substitutes
  3. Enact paid family leave and workplace breastfeeding policies
  4. Implement the ‘Ten Steps to Successful Breastfeeding
  5. Improve access to skilled breastfeeding counselling in health facilities
  6. Strengthen links between health facilities and communities to support breastfeeding
  7. Monitor the progress of policies, programs, and funding for breastfeeding

We hope that this research, data and tool can help persuade policy makers and donors to invest in breastfeeding at the level it deserves. The ability to choose the best start for your child and for your family is a human right, it saves lives, and it improves the prosperity of every single economy in the world.

Funding statement: This research was supported by Alive & Thrive, a global nutrition initiative funded by the Bill & Melinda Gates Foundation.

Image credit: Alive & Thrive

                                        Infographic

11 – 17 July

Peter Piot is interviewed by BBC Radio 4’s Today programme (1hm 37m) about the outbreak of Ebola in the DRC, and the news that a new case was diagnosed this week in Goma. Peter said: “It was due to happen and it will happen again and that is why I am very concerned that this is still not considered a Public Health Emergency of International Concern. Once it takes hold in a city like Goma with two million people, from there it can spread to the rest of DRC, but also neighbouring countries.”

This week Peter also issued a statement about the Ebola epidemic. Peter said, “We at LSHTM commend the major efforts of all local, national, and international actors who are tirelessly working to save lives in North Kivu and Ituri. While these efforts have certainly helped slow the disease’s spread, a change in strategy and intensified efforts are urgently needed. From stronger community engagement, to strengthened diagnosis and real time sequencing, to ring vaccination and primary prevention through broader vaccination in the community – we must use every possible approach. This is why we very much regret the recent decision of the DRC Minister of Health to rule out the deployment of a second vaccine.”

Peter’s comments were picked up by The Telegraph, The Guardian and Science.

Stat News also spoke to Peter, for a piece focusing on the decision by the DRC Minister of Health not to deploy the second vaccine.  

Heidi Larson is featured in a Guardian piece exploring how vaccine hesitancy is ‘contagious’ and what factors could be contributing to the global crisis in vaccine confidence. Heidi said: “There’s the group that didn’t start as an anti-vaccine group, but is now part of that portfolio, intent on raising their children in the most natural, organic manner.”

Helen Weiss provides expert comment to The Telegraph on new research looking and the efficacy of menstrual cups. Helen said: “This is a much-needed review of the use of menstrual cups globally. This study is the first to systematically review experiences of using cups in terms of leakage, cost and safety, and showed that they are an effective and safe alternative to other menstrual products.”

Beate Kampmann speaks to the Mail on Sunday about whether men up to the age of 25 should get the HPV vaccine. Beate said: “The vaccine is most effective before acquisition of the HPV virus, which is usually before people become sexually active. Older boys who are not sexually active would get the benefits, given they would not have encountered HPV.”

Andy Haines is quoted in an opinion piece by Monash University which explores preparing the health sector for the global climate emergency. Andy said:We think the impact is more difficult to quantify because there is also population displacement and a range of additional factors like food production and crop yield, and the increase in heat that will limit labour productivity from farmers in tropical regions that wasn’t taken into account among other factors.”

Sally Bloomfield, Honorary at LSHTM comments in The Telegraph about whether flu masks are effective in preventing viruses. Sally said: “While masks have been proven to work during the flu pandemic, it must be a specific virus mask to have any affect. There is a risk we will breath in cold and flu germs from people and that’s not much we can do about except wearing a medical-grade mask. We can also get colds and flu by getting them onto our hands and then touching our mouths and our nose, particularly rubbing the inside of the nose, and the eyes.”

Martin McKee writes an opinion piece for BMJ about UK politics in 2019.

On social media

This week’s social media highlight comes from the LSHTM Twitter account sharing news that following evidence from the WOMAN trial, Tranexamic Acid has now been added to the WHO essential medicines list for postpartum haemorrhage.

Placing the Public in Public Health – the project book!

THE PROJECT BOOK IS OUT!

Placing the Public in Public Health in Post-War Britain, 1948–2012 is out and available in all good university bookshops, online, & to download Open-access.

The book, like many of the outputs produced by the Placing the Public team, was co-authored, with case studies and analysis provided by Alex Mold, Peder Clark, Gareth Millward & Daisy Payling.

 

 

Divided into four succinct chapters (which can all be downloaded individually as needed), the book tackles some the key questions which our team has been pondering for a while, asking who and what the public in public health actually is. To get at some answers the book asks: What was the place of the public/publics in public health in post-war Britain? How did this change over time, and why does this matter? How were publics imagined and responded to by the state? What was the role of the public in safeguarding its own health, and what was that of the state or other actors? How did different publics respond to state public health efforts?

These questions are answered by drawing on the team’s historical research, which has examined the place of the public in public health in Britain from the establishment of the National Health Service in 1948 to the ‘return’ of public health services to local government in 2012.

The result is four chapters, The Public and Public Health, Imagining Publics, Speaking Back, and Changing Publicness. Drawing on a wide range of primary sources the chapters focus on the changing nature of health education; the public health survey; the response to heart disease; and the development of vaccination policy and practice. These examples were selected as they encompass the key technologies and techniques of public health practice and research, as well as some of the main challenges to population and individual health.

The book was published by Palgrave Macmillan as part of their Medicine and Biomedical Sciences in Modern History series, and is freely available open-access due to the generous support of the Wellcome Trust.

 

Library Feedback

It’s that time of year again, as we come to the end of the academic year, that we ask you how you think we’re doing. You will receive an email from the Library asking you 2 questions:

  1. Overall how satisfied are you with the Library & Archives Service?
  2. Overall how satisfied are you with Library resources?

All you need to do is open the email and click on the link that best describes your level of satisfaction for each question.

 

You’ll then be given the option to leave more detailed feedback if you want to.

The feedback we get from students and staff guides our decision making and helps improve the Library & Archives Service for future users. Some recent changes we’ve made as a result of Library user feedback are:

  1. Installation of a water cooler in Library
  2. More study space provided during the revision period
  3. Changes to food and drink rules
  4. Cards to remind Library users to take their belongings with them when they go for breaks
  5. Lighting in the North Courtyard

Next time you’re in the Library, take a look at our ‘You Said We Did’ display above the water cooler, or visit our feedback responses page on the Student Portal/Staff Intranet. No matter what the time of year, we are always interested in hearing from you and have multiple ways for you to get in touch:

  • In person at the Library Enquiries Desk
  • Through student representatives
  • Using the online feedback form
  • Emailing 
  • Calling +44 (0)20 7927 2276
  • Or via Twitter or Facebook

 

Thank you for your feedback!

Meeting global ICPD Commitments: putting SRH-HIV integration at the heart of health systems strengthening

By Susannah Mayhew (London School of Hygiene & Tropical Medicine) and Charlotte Warren (Population Council)

The UN’s World Population Day (11th July) calls attention to the need for the world to remember its commitments at the International Conference on Population and Development (ICPD) 25 years ago to make reproductive health and gender equity a reality for all. Further, they acknowledge that sexual and reproductive health (SRH) and gender equity are critical for the achievement of sustainable development goals. This means SRH, including HIV, must be seen as central to development and to universal health coverage and health systems strengthening goals.

Health Policy and Planning’s Supplement of November 2017 entitled ‘Integration for stronger health systems: lessons from integrating sexual and reproductive health and HIV services’, uniquely brings together learning from decades of research on integrating HIV, reproductive health and other primary-care services and a health systems lens on understanding health systems challenges and successes in delivering integrated care. We provide a collection of reviews, think pieces and primary data studies to bring systems processes, structures and “software” (its people) under the spotlight to learn lessons for achieving sustained integrated systems that can respond to the ever-changing and inter-connected health needs of diverse populations. Papers show that a key way of strengthening systems to meet ICPD commitments, and address broader sustainable development goals, is to build flexible integrated health systems.

Four key factors to scale-up ICPD

Existing siloed, programme-specific approaches to healthcare need to be transformed if ICPD commitments are to be met. In order to do this, we highlight four key factors that appear as a common theme within the papers in the Supplement:

  1. Invest in the health workforce: Structural integration (i.e. infrastructure/training etc.) is not sufficient for integrated service delivery. If ICPD progress is to be achieved, sensitive management of staff to nurture and support their agency in decision making, team-working and load-sharing is critical to being able to work flexibly to meet the challenges that face providers each day and provide holistic SRH care.
    These findings highlight the need for health systems to support healthcare workers to promote a supportive enabling environment that can facilitate provision of integrated health services. (Mudzengi et al; Mayhew et al; Siapka et al; Mutemwa et al).
  2. Scaling up integrated service delivery requires a system wide, not an adhoc approach: Just focusing on SRH integration at the service delivery level or even the health system level ignores how health policies and strategies influence service delivery. Key policies and strategies therefore need to be integrated with others that have mutual activities and targets to normalise integration throughout the health system. (Mounier-Jack et al; Watts et al; Mudzengi et al; Mayhew et al).
  3. Encourage effective collaboration and coordination: Integrated service delivery is more likely to succeed where health systems encourage effective collaboration and coordination within and between teams, and between staff and patients. It is not just about formal systems and service structures; informal relationships and trust are equally important. Having a ‘go-to’ person who can act as a contact point for everyone involved was also found to be helpful. Critically, a positive, problem-solving culture, with a focus on the patient, their needs and personal circumstances made a difference, as did careful design of appropriate delivery models that can respond to patients’ needs. (Chuah et al; Mayhew et al; Mutemwa et al).
  4. Political will: Lessons from sexual and reproductive health and HIV integration experience points to the need for strong political will to establish clear governance structures with a key role for civil society in holding governments and government agencies accountable for rights-based action on health. It is not only structures, policies and resources that must be linked but the people within the sector or system must also be motivated and enabled to make connections beyond their usual field (and sector) of operation. Thus, a flexible, multi-sectoral approach is essential – especially as the progressive realization of the right to health depends on the development of enabling environments to support the structural linkages for planning and service-delivery across sectors which requires political will and strong leadership. (Hopkins et al; Warren et al).

Conclusion

The papers in this Supplement clearly illustrate the depth of learning from the SRH-HIV integration field for health systems strengthening. as the research in this supplement shows, a focus on integrating health services needs to include a broader systems-wide, people-centred approach if it is to be both successful and sustainable. In this way, ICPD commitments to ensuring reproductive health and gender equity for all are more likely to be met.


RELATED LINKS:

·         EDITORIAL (Mayhew): Building integrated health systems: lessons from HIV and reproductive health integration
·         COMMENTARY (Mounier-Jack et al): Integrated care: learning between high-income, and low- and middle-income country health systems
·         REVIEW (Watts et al): Health systems facilitators and barriers to the integration of HIV and chronic disease services: a systematic review
·         REVIEW ((Chuah et al): Interventions and approaches to integrating HIV and mental health services: a systematic review
·         ORIGINAL MANUSCRIPT (Mudzengi et al): The patient costs of care for those with TB and HIV: A cross-sectional study from South Africa
·         ORIGINAL MANUSCRIPT (Hopkins et al): How linked are national HIV and SRHR strategies? A review of SRHR and HIV strategies in 60 countries
·         ORIGINAL MANUSCRIPT (Mayhew et al): Numbers, systems, people: how interactions influence integration. Insights from case studies of HIV and reproductive health services delivery in Kenya
·         ORIGINAL MANUSCRIPT (Siapka et al): Impact of integration of sexual and reproductive health services on consultation duration times: results from the Integra Initiative
·         ORIGINAL MANUSCRIPT (Mutemwa et al): Does service integration improve technical quality of care in low-resource settings? An evaluation of a model integrating HIV care into family planning services in Kenya
·         COMMENTARY (Warren et al): Health systems and the SDGs: lessons from a joint HIV and sexual and reproductive health and rights response

Image credit: Flynn Warren