Imperial College London

DrMatthewHarris

Faculty of MedicineSchool of Public Health

Clinical Senior Lecturer in Public Health
 
 
 
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Contact

 

+44 (0)20 7594 7452m.harris

 
 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Publication Type
Year
to

138 results found

Harris P, Kirkland R, Masanja S, Le Feuvre P, Montgomery S, Ansbro E, Woodman M, Harris Met al., 2022, Strengthening the primary care workforce to deliver high quality care for non-communicable diseases in refugee settings: lessons learnt from a UNHCR partnership, BMJ Global Health, Vol: 7, Pages: 1-10, ISSN: 2059-7908

Non-communicable disease (NCD) prevention and care in humanitarian contexts has been a long-neglected issue. Health care systems in humanitarian settings have focused heavily on communicable diseases and immediate life-saving health needs. NCDs are a significant cause of morbidity and mortality in refugee settings, however in many situations NCD care is not well integrated into primary health care services. Increased risk of poorer outcomes from Covid 19 for people living with NCDs has heightened the urgency of responding to NCDs and shone a spotlight on their relativeneglect in these settings. Partnering with the United Nations Refugee Agency (UNHCR) since 2014, Primary Care International (PCI) has provided clinical guidance and Training of Trainer (ToT) courses on NCDs to 649 health professionals working in primary care in refugee settings in 13 countries. Approximately 2,300 healthcare workers (HCW) have been reached through cascade trainings over the last six years. Our experience has shown that, despite fragile health services, high staff turnover and competing clinical priorities, it is possible to improve NCD knowledge, skills, and practice. ToT programmes are a feasible and practical format to deliver NCD trainingto mixed groups of healthcare workers (doctors, nurses, technical officers, pharmacy technicians and community health workers). Clinical guidance must be adapted to local settings whilst co-creating an enabling environment for health workers is essential to deliver accessible, high-quality continuity of care for NCDs. On-going support for non clinical systems change is equally critical for sustained impact. A shared responsibility for cascade training - and commitment from local health partners - is necessary to raise NCD awareness, influence local and national policy and to meet the UNHCR’sobjective of facilitating access to integrated prevention and control of NCDs.

Journal article

Dallera G, Skopec M, Barlow J, Battersby C, Harris Met al., 2022, Review of a frugal cooling mattress to induce therapeutic hypothermia for treatment of hypoxic-ischaemic encephalopathy in the UK NHS, Globalization and Health, Vol: 18, ISSN: 1744-8603

Hypoxic ischaemic encephalopathy (HIE) is a major cause of neonatal mortality and disability in the United Kingdom (UK) and has significant human and financial costs. Therapeutic hypothermia (TH), which consists of cooling down the newborn’s body temperature, is the current standard of treatment for moderate or severe cases of HIE. Timely initiation of treatment is critical to reduce risk of mortality and disability associated with HIE. Very expensive servo-controlled devices are currently used in high-income settings to induce TH, whereas low-income settings rely on the use of low-tech devices such as water bottles, ice packs or fans. Cooling mattresses made with phase change materials (PCMs) were recently developed as a safe, efficient, and affordable alternative to induce TH in low-income settings. This frugal innovation has the potential to become a reverse innovation for the National Health Service (NHS) by providing a simple, efficient, and cost-saving solution to initiate TH in geographically remote areas of the UK where cooling equipment might not be readily available, ensuring timely initiation of treatment while waiting for neonatal transport to the nearest cooling centre. The adoption of PCM cooling mattresses by the NHS may reduce geographical disparity in the availability of treatment for HIE in the UK, and it could benefit from improvements in coordination across all levels of neonatal care given challenges currently experienced by the NHS in terms of constraints on funding and shortage of staff. Trials evaluating the effectiveness and safety of PCM cooling mattresses in the NHS context are needed in support of the adoption of this frugal innovation. These findings may be relevant to other high-income settings that experience challenges with the provision of TH in geographically remote areas. The use of promising frugal innovations such as PCM cooling mattresses in high-income settings may also contribute to challenge the dominant narrative that

Journal article

Price R, Skopec M, Mackenzie S, Nijhoff C, Harrison R, Seabrook G, Harris Met al., 2022, A novel data solution to inform curriculum decolonisation: the case of the Imperial College London Masters of Public Health, Scientometrics: an international journal for all quantitative aspects of the science of science, communication in science and science policy, Vol: 127, Pages: 1021-1037, ISSN: 0138-9130

There is increasing interest within Higher Education Institutions (HEIs) to examine curricula for legacies of colonialism or empire that might result in a preponderance of references to research from the global north. Prior attempts to study reading lists for author geographies have employed resource-intensive audit and data collection methods based on manual searching and tagging individual reading list items by characteristics such as author country or place of publication. However, these manual methods are impractical for large reading lists with hundreds of citations that change over instances the course is taught. Laborious manual methods may explain why there is a lack of quantitative evidence to inform this debate and the understanding of geographic distribution of curricula. We describe a novel computational method applied to 568 articles, representing 3166 authors from the Imperial College London Masters in Public Health programme over two time periods (2017–18 and 2019–20). Described with summary statistics, we found a marginal shift away from global north-affiliated authors on the reading lists of one Masters course over two time periods and contextualise the role and limitations of the use of quantitative data in the decolonisation discourse. The method provides opportunities for educators to examine the distribution of course readings at pace and over time, serving as a useful point of departure to engage in decolonisation debates.

Journal article

Downey LE, Harris M, Jan S, Miraldo M, Peiris D, Buse Ket al., 2021, Global health system resilience is in everyone's interest., BMJ, Vol: 375, Pages: 1-2, ISSN: 1759-2151

Journal article

Donnat C, Bunbury F, Liu D, Kreindler J, Filipidis F, El-Osta A, Esku T, Harris Met al., 2021, Predicting COVID-19 transmission to inform the management of mass events: a model-based approach, JMIR Public Health and Surveillance, Vol: 7, ISSN: 2369-2960

Background:Modelling COVID-19 transmission at live events and public gatherings is essential to control the probability of subsequent outbreaks and communicate to participants their personalised risk. Yet, despite the fast-growing body of literature on COVID transmission dynamics, current risk models either neglect contextual information on vaccination rates or disease prevalence or do not attempt to quantitatively model transmission.Objective:This paper attempts to bridge this gap by providing informative risk metrics for live public events, along with a measure of their uncertainty.Methods:Building upon existing models, our approach ties together three main components: (a) reliable modelling of the number of infectious cases at the time of the event, (b) evaluation of the efficiency of pre-event screening, and (c) modelling of the event’s transmission dynamics and their uncertainty along using Monte Carlo simulations.Results:We illustrate the application of our pipeline for a concert at the Royal Albert Hall and highlight the risk’s dependency on factors such as prevalence, mask wearing, or event duration. We demonstrate how this event held on three different dates (August 20th 2020, January 20th 2021, and March 20th 2021) would likely lead to transmission events that are similar to community transmission rates (0.06 vs 0.07, 2.38 vs 2.39, and 0.67 vs 0.60, respectively). However, differences between event and background transmissions substantially widen in the upper tails of the distribution of number of infections (as denoted by their respective 99th quantiles: 1 vs 1, 19 vs 8, and 6 vs 3 for our three dates), further demonstrating that sole reliance on vaccination and antigen testing to gain entry would likely significantly underestimate the tail risk of the event.Conclusions:Despite the unknowns surrounding COVID-19 transmission, our estimation pipeline opens the discussion on contextualized risk assessment by combining the best tools at hand to as

Journal article

Harris M, Kreindler J, Donnat C, El-Osta A, Filippidis F, Tonu Eet al., 2021, Rapid response to BMJ: Are vaccine passports and covid passes a valid alternative to lockdown?, BMJ: British Medical Journal, Vol: 375, ISSN: 0959-535X

Journal article

Shimizu H, Pacheco Santos L, Sanchez M, Hone T, Millett C, Harris Met al., 2021, Challenges facing the more doctors program (Programa Mais Médicos) in vulnerable and peri-urban areas in Greater Brasilia, Brazil, Human Resources for Health, Vol: 19, Pages: 1-8, ISSN: 1478-4491

BackgroundA shortage of physicians, especially in vulnerable and peri-urban areas, is a global phenomenon that has serious implications for health systems, demanding policies to assure the provision and retention of health workers. The aim of this study was to analyze the strategies employed by the More Doctors Program (Programa Mais Médicos) to provide primary care physicians in vulnerable and peri-urban parts of Greater Brasilia.MethodsThe study used a qualitative approach based on the precepts of social constructivism. Forty-nine semi-structured interviews were conducted: 24 with physicians employed as part of the More Doctors program, five with program medical supervisors, seven with secondary care physicians, twelve with primary care coordinators, and one federal administrator. The interviews occurred between March and September 2019. The transcripts of the interviews were submitted to thematic content analysis.ResultsThe partnership between the Ministry of Health and local authorities was essential for the provision of doctors—especially foreign doctors, most from Cuba, to assist vulnerable population groups previously without access to the health system. There was a notable presence of doctors with experience working with socioeconomically disadvantaged populations, which was important for gaining a better understanding of the effects of the endemic urban violence in the region. The incentives and other institutional support, such as enhanced salaries, training, and housing, transportation, and food allowances, were factors that helped provide a satisfactory working environment. However, the poor state of the infrastructure at some of the primary care units and limitations of the health service as a whole were factors that hampered the provision of comprehensive care, constituting a cause of dissatisfaction.ConclusionsMore Doctors introduced a range of novel strategies that helped ensure a supply of primary care doctors in vulnerable and peri-urb

Journal article

Stefani G, Skopec M, Battersby C, Harris Met al., 2021, Why is Kangaroo Mother Care not yet scaled in the UK? A systematic review and realist synthesis of a frugal innovation for newborn care, BMJ Innovations, Vol: 8, Pages: 9-20, ISSN: 2055-642X

Objective: Kangaroo Mother Care (KMC) is a frugal innovation improving newborn health at a reduced cost compared with incubator use. KMC is widely recommended; however, in the UK, poor evidence exists on KMC, and its implementation remains inconsistent.Design: This Systematic Review and Realist Synthesis explores the barriers and facilitators in the implementation of KMC in the UK.Data source: OVID databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus and Google Scholar were searched.Eligibility criteria: Studies were UK based, in maternity/neonatal units, for full-term/preterm children. First screening included studies on (1) KMC, Kangaroo Care (KC) or skin-to-skin contact (SSC) or (2) Baby Friendly Initiative, Small Wonders Change Program or family-centred care if in relation to KMC/KC/SSC. Full texts were reviewed for evidence regarding KMC/KC/SSC implementation.Results: The paucity of KMC research in the UK did not permit a realist review. However, expanded review of available published studies on KC and SSC, used as a proxy to understand KMC implementation, demonstrated that the main barriers are the lack of training, knowledge, confidence and clear guidelines.Conclusion: The lack of KMC implementation research in the UK stands in contrast to the already well-proven benefits of KMC for stable babies in low-income contexts and highlights the need for further research, especially in sick and small newborn population. Implementation of, and research into, KC/SSC is inconsistent and of low quality. Improvements are needed to enhance staff training and parental support, and to develop guidelines to properly implement KC/SSC. It should be used as an opportunity to emphasise the focus on KMC as a potential cost-effective alternative to reduce the need for incubator use in the UK.

Journal article

Hindocha CN, Antonacci G, Barlow J, Harris Met al., 2021, Defining frugal innovation: a critical review, BMJ Innovations, Vol: 7, Pages: 647-656, ISSN: 2055-8074

Frugal innovation (FI), which has gained traction in various sectors, is loosely defined as developing quality solutions in a resource-constrained environment that are affordable to low-income consumers. However, with its popularity, multiple and diverse definitions have emerged that often lack a theoretical foundation. This has led to a convoluted conceptualisation that hinders research and adoption in practice. Despite this plethora of perspectives and definitions, scholars do agree that there is a need for a unified definition. This critical review across the management, entrepreneurship, business and organisation studies literatures explores the multiple definitions of FI that have appeared in the last two decades and seeks to examine the commonalities and differences. One definition is supported by a theoretical underpinning, and main themes include affordability, adaptability, resource scarcity, accessibility and sustainability, however, there remains significant ambiguity around what constitutes an FI. Defining FI as a concept should not deter from focusing on its core aim and identifying an FI may be best achieved by comparing it to an incumbent alternative, rather than against an ill-defined concept. There is merit in developing a common understanding of FI to support strategies for its successful acceptance and diffusion globally.

Journal article

Harris M, 2021, Book Review: Inflamed: Deep Medicine and the Anatomy of Injustice by Rupa Marya and Raj Patel, Publisher: BMJ Publishing Group, ISBN: 9780374602512

Book

Sharma D, Harris M, Agrawal V, Agarwal Pet al., 2021, Plea for standardised reporting of frugal innovations, BMJ Innovations, Vol: 7, Pages: 642-646, ISSN: 2055-8074

Journal article

Skopec M, Fyfe M, Issa H, Ippolito K, Anderson M, Harris Met al., 2021, Decolonization in a higher education STEMM institution – is ‘epistemic fragility’ a barrier?, London Review of Education, Vol: 19, Pages: 1-21, ISSN: 1474-8460

Central to the decolonial debate is how high-income countries (HICs) have systematically negated ways of knowing from low- and middle-income countries (LMICs), and yet the paucity of empirical decolonization studies leaves educators relatively unsupported as to whether, and how, to address privilege in higher education. Particularly in science, technology, engineering, mathematics and medicine (STEMM) institutions, there are few published examples of attempts to engage faculty in these debates. In 2018–19, we invited faculty on a master’s in public health course to engage with the decolonization debate by providing: (1) descriptive reading list analyses to all 16 module leads in the master’s programme to invite discussion about the geographic representation of readings; (2) an implicit association test adapted to examine bias towards or against research from LMICs; (3) faculty workshops exploring geographic bias in the curriculum; and (4) interviews to discuss decolonization of curricula and current debates. These initiatives stimulated debate and reflection around the source of readings for the master’s course, a programme with a strong STEMM focus, and the possibility of systemic barriers to the inclusion of literature from universities in LMICs. We propose the notion of epistemic fragility, invoking DiAngelo’s (2011) ‘white fragility’, because some of the responses appeared to result from the challenge to perceived meritocracy, centrality, authority, individuality and objectivity of the HIC episteme that this initiative invites. We posit that the effortful reinstatement of a status quo regarding knowledge hierarchies in the global context, although not a representative reaction, can lead to a significant impact on the initiative in general. Efforts to decolonize curricula require actions at both the individual and organizational levels and, in particular, a managed process of careful engagement so that fragility reactions

Journal article

Harris M, Kreindler J, El-Osta A, Esko T, Majeed Fet al., 2021, Safe management of full-capacity live/mass events in COVID19 will require mathematical, epidemiological and economic modelling, Journal of the Royal Society of Medicine, Vol: 114, Pages: 290-294, ISSN: 0141-0768

Journal article

Donnat C, Bunbury F, Kreindler J, Filippos F, El-Osta A, Esko T, Harris Met al., 2021, A Predictive Modelling Framework for COVID-19 Transmission to Inform the Management of Mass Events, Journal of Medical Internet Research, ISSN: 1438-8871

Journal article

Price R, Skopec M, Mackenzie S, Nijhoff A, Seabrook G, Harrison R, Harris Met al., 2021, A novel data solution to analyse curriculum decolonisation – the case of Imperial College London Masters in Public Health

Analyses of reading lists by some UK Higher Education institutions in attempt to identify bias in curricula have found a prevalence of articles from the global north. However, previous studies have employed resource-intensive audit and data collection methods such as the authors or volunteers manually searching for and tagging individual reading list items by characteristic such as author country or place of publication. This can be prohibitive to repeating the study at different time periods or on large reading list data sets, which leads to a gap in evidence-based data to support and inform curriculum decolonisation. We describe a novel computational method applied to 568 articles, representing 3,166 authors from the Imperial College London Masters in Public Health (MPH) programme over two time periods (2017-18 and 2019-20). Using summary statistics, we found a shift in composite geographic distribution of reading lists sources across the two time periods studied and relate this to interventions to decolonise the curriculum at Imperial. Our approach to applying a computational method to produce data as evidence in decolonisation toolkits is discussed.

Working paper

Harris M, Saddi F, Parreira F, Pego R, Coelho G, Lozano R, Mundim P, Peckham Set al., 2021, Exploring front liners’ knowledge, participation and evaluation in the implementation of a pay for performance program (PMAQ) in primary health care in Brazil, Journal of Health, Organization and Management, ISSN: 0268-9235

Journal article

Selhorst S, OToole RV, Slobogean GP, Harris M, Bhatti Y, Enobun B, OHara NNet al., 2021, Is a low-cost drill cover system non-inferior to conventional surgical drills for skeletal traction pin placement?, Journal of Orthopaedic Trauma, Vol: 35, Pages: e433-e436, ISSN: 0890-5339

The Drill Cover system was developed as a low-cost alternative to conventional surgical drills with specific applicability to low- and middle-income countries. However, the system may also be useful for the sterile placement of traction pins in the emergency department of high-income country hospitals. In September 2019, a US-based Level-1 trauma center began using the Drill Cover system to apply skeletal traction pins in patients with femoral shaft fractures. With these data, we performed a retrospective interrupted time series study to determine if the Drill Cover system was non-inferior to conventional surgical drills in terms of infections at the traction pin site. The study included 205 adult patients with femoral shaft fractures initially placed in skeletal traction using a conventional surgical drill (n=150, pre-intervention group) or the Drill Cover system (n=55, post-intervention group). The primary outcome was an infection at the site of skeletal traction pin placement that required surgery or antibiotics was compared between groups using a non-inferiority test with a one-sided alpha of 0.05 and a non-inferiority margin of 3%. No infections at the site of skeletal traction pin placement were found in either the pre-intervention or the post-intervention group (difference 0%, 95% CI: 0.0 to 1.4%, non-inferiority p-value<0.01). The results suggest that the Drill Cover system was non-inferior to conventional surgical drills regarding infections at the site of skeletal traction pins. The Drill Cover system may be a safe alternative to the more expensive surgical drills for skeletal traction pin placement in the emergency room environment.

Journal article

Skopec M, Grillo A, Kureshi A, Bhatti Y, Harris Met al., 2020, Double standards in healthcare innovations: the case of mosquito net mesh for hernia repair, BMJ Innovations, Vol: 7, Pages: 482-490, ISSN: 2055-642X

With over two decades of evidence available including from randomised clinical trials, we explore whether the use of low-cost mosquito net mesh for inguinal hernia repair, common practice only in low-income and middle-income countries, represents a double standard in surgical care. We explore the clinical evidence, biomechanical properties and sterilisation requirements for mosquito net mesh for hernia repair and discuss the rationale for its use routinely in all settings, including in high-income settings. Considering that mosquito net mesh is as effective and safe as commercial mesh, and also with features that more closely resemble normal abdominal wall tissue, there is a strong case for its use in all settings, not just low-income and middle-income countries. In the healthcare sector specifically, either innovations should be acceptable for all contexts, or none at all. If such a double standard exists and worse, persists, it raises serious questions about the ethics of promoting healthcare innovations in some but not all contexts in terms of risks to health outcomes, equitable access, and barriers to learning.

Journal article

Cash-Gibson L, Harris M, Guerra G, Benach Jet al., 2020, A novel conceptual model and heuristic tool to strengthen understanding and capacities for health inequalities research, Health Research Policy and Systems, Vol: 18, Pages: 1-12, ISSN: 1478-4505

BackgroundDespite increasing evidence on health inequalities over the past decades, further efforts to strengthen capacities to produce research on this topic are still urgently needed to inform effective interventions aiming to address these inequalities. To strengthen these research capacities, an initial comprehensive understanding of the health inequalities research production process is vital. However, most existing research and models are focused on understanding the relationship between health inequalities research and policy, with less focus on the health inequalities research production process itself. Existing conceptual frameworks provide valuable, yet limited, advancements on this topic; for example, they lack the capacity to comprehensively explain the health (and more specifically the health inequalities) research production process at the local level, including the potential pathways, components and determinants as well as the dynamics that might be involved. This therefore reduces their ability to be empirically tested and to provide practical guidance on how to strengthen the health inequalities research process and research capacities in different settings. Several scholars have also highlighted the need for further understanding and guidance in this area to inform effective action.MethodsThrough a critical review, we developed a novel conceptual model that integrates the social determinants of health and political economy perspectives to provide a comprehensive understanding of how health inequalities research and the related research capacities are likely to be produced (or inhibited) at local level.ResultsOur model represents a global hypothesis on the fundamental processes involved, and can serve as a heuristic tool to guide local level assessments of the determinants, dynamics and relations that might be relevant to better understand the health inequalities research production process and the related research capacities.ConclusionsThis type of

Journal article

Shimizu HE, Santos LMP, Sanchez MN, Hone T, Millett C, Harris Met al., 2020, Percepções acerca do Programa Mais Médicos e do Processo de Supervisão Acadêmica [Perceptions about the “Mais Médicos” Program and the Academic Supervision Process], Revista Brasileira de Educação Médica, Vol: 44, ISSN: 0100-5502

Abstract: Introduction: This study aims to analyze the perceptions of the involved actors about the “Mais Médicos” Program (PMM) and the academic supervision process, its strengths and weaknesses aiming to improve Primary Heath Care practices. Method: Qualitative study carried out through 05 in-depth interviews with PMM supervising doctors, and 24 interviews with unit managers, 12 Primary Heath Care coordinators, and 07 Secondary Health Care doctors. Results: Three thematic axes emerged from de analysis: benefits of the program for the municipalities and for the population; the challenges of the supervisory process and the difficulties of the fragmented health system. Conclusions: The actors’ perception of the “Mais Médicos” Program are positive, especially because it brought doctors to municipalities with vulnerable areas, where doctors did not go to and where they did not stay. Supervision is an important support for continuing in-service training; however, it requires a better articulation with the different levels of the health system management. The precariousness of the service network limits the performance of both doctors and supervisors, demonstrating that it is necessary to invest in a solid and effective care network. Moreover, it was once again evident that the population will face a shortage of doctors due to changes in health policies. It is necessary to build more comprehensive policies, that will not only result in sporadic provision of medical care. There is a need for continuous actions, better integrated to the healthcare networks, aiming at an efficient and effective healthcare system.

Journal article

Harris M, Bourquin B, Ettehad D, 2020, International crisis-led healthcare innovation in response to the COVID-19 pandemic, London, UK, Publisher: NHS Confederation

The COVID-19 pandemic and associated lockdown measures have permeated close to all aspects of daily life, with immediate and profound effects on population health and its wider determinants. Across the globe there has been an explosion of innovation in response to the crisis, enabled by a sense of common purpose, the unfreezing of rigid organisational structures, processes and regulations, and huge increases in public expenditure.This report outlines some of the crisis-led innovations that have helped countries to cope during the first wave of COVID-19 infections and that may shape the ‘new normal’ in the years to come.It collates a number of innovations into six domains (stuff, staff, space, systems, surveillance and society), an adapted version of Farmer’s 4 S’s, which distils the elements that ‘make all the difference in saving lives during an outbreak’.This paper was written by external authors between June and September 2020. As such, it does not necessarily represent the views of the NHS Confederation or its members.

Report

Al-Saffar M, Hayhoe B, Harris M, Majeed A, Greenfield Get al., 2020, Children as frequent attenders in primary care: a systematic review, BJGP Open, Vol: 4, ISSN: 2398-3795

Background: Frequent paediatric attendances make up a large proportion of the general practitioner (GP) workload. Currently no systematic reviews on frequent paediatric attendances in primary care exists. Aim: To identify the socio-demographic and clinical characteristics of children who attend primary care frequently. Design and setting: A systematic review.Methods: The electronic databases MEDLINE, EMBASE and PsycINFO were searched up to January 2020, using terms relating to frequent attendance in primary care settings. Studies were eligible if they considered children frequently attending in primary care (0-19 years). Relevant data were extracted and analysed by narrative synthesis.Results: Six studies, of overall fair quality, were included in the review. Frequent attendance was associated with presence of psycho-social and mental health problems, younger age, school absence, presence of chronic conditions, and high level of anxiety in their parents.Conclusions: Various sociodemographic and medical characteristics of children were associated with frequent attendance in primary care. Research on interventions needs to account for the social context and community characteristics. Integrating GP services with mental health and social care could potentially provide a response to medical and psycho-social needs of frequently attending children and their families.

Journal article

de Medeiros OL, Barreto JOM, Harris M, Russo LX, da Silva ENet al., 2020, Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil, PLoS One, Vol: 15, ISSN: 1932-6203

BACKGROUND: Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil. OBJECTIVE: To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. METHOD: We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed using data from the Brazilian Ministry of Health (SIAB and CNES) and the Brazilian Institute for Geography and Statistics (IBGE). RESULTS: The average number of antenatal consultations per month were positively associated with PMAQ participating teams, with larger effect in the lower tail (10th and 25th quantiles) of the conditional distribution of the response variable. There was a positive association between PMAQ and the average number of consultations under 2 years old per month in the 10th and 25th quantiles, but a negative association in the upper tail (75th and 90th quantiles). For the average number of physician consultations for children under 1 year old per month, PMAQ participating teams were positively associated with the response variable in the lower tail, but different from the previous models, there is no clear evidence that the second cycle gives larger coefficients compared with first cycle. CONCLUSION: PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of ante

Journal article

Younan H-C, Junghans C, Harris M, Majeed A, Gnani Set al., 2020, Maximising the impact of social prescribing on population health in the era of COVID-19, Journal of the Royal Society of Medicine, Vol: 113, Pages: 377-382, ISSN: 0141-0768

Journal article

Zhou J, Blaylock R, Harris M, 2020, Systematic review and narrative synthesis of the quality of early abortion services provided in low- and middle-income country primary care clinics – potential for reverse innovation and application in the UK context, Globalization and Health, Vol: 16, Pages: 1-11, ISSN: 1744-8603

Background: In the UK, according to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and be performed by doctors within licensed premises. Removing abortion from the criminal framework could permit new service delivery models. We explore service delivery models in primary care settings that can improve accessibility without negatively impacting the safety and efficiency of abortion services. Novel service delivery models are common in low-and-middle income countries (LMICs) due to resource constraints, and services are sometimes by trained, mid-level providers via “task-shifting”. The aim of this study is to explore the quality of early abortion services provided in primary care of LMICs and explore the potential benefits of extending their application to the UK context. Methods: We searched MEDLINE, EMBASE, Global Health, Maternity and Infant Care, CINAHL, and HMIC for studies published from September 1994 to February 2020, with search terms “nurses”, “midwives”, “general physicians”, “early medical/surgical abortion”. We included studies that examined the quality of abortion care in primary care settings of low-and-middle-income countries (LMICs), and excluded studies in countries where abortion is illegal, and those of services provided by independent NGOs. We conducted a thematic analysis and narrative synthesis to identify indicators of quality care at structural, process and outcome levels of the Donabedian model. Results: A total of 21 indicators under 8 subthemes were identified to examine the quality of service provision: law and policy, infrastructure, technical competency, information provision, client-provider interactions, ancillary services, complete abortions, client satisfaction. Our analysis suggests that structural, process and outcome indicators follow a mediation pathway of the Donabedian model. This revie

Journal article

Zhou J, Blaylock R, Harris M, 2020, Systematic review of early abortion services in low- and middle-income country primary care: potential for reverse innovation and application in the UK context., Global Health, Vol: 16

BACKGROUND: In the UK, according to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and be performed by doctors within licensed premises. Removing abortion from the criminal framework could permit new service delivery models. We explore service delivery models in primary care settings that can improve accessibility without negatively impacting the safety and efficiency of abortion services. Novel service delivery models are common in low-and-middle income countries (LMICs) due to resource constraints, and services are sometimes provided by trained, mid-level providers via "task-shifting". The aim of this study is to explore the quality of early abortion services provided in primary care of LMICs and explore the potential benefits of extending their application to the UK context. METHODS: We searched MEDLINE, EMBASE, Global Health, Maternity and Infant Care, CINAHL, and HMIC for studies published from September 1994 to February 2020, with search terms "nurses", "midwives", "general physicians", "early medical/surgical abortion". We included studies that examined the quality of abortion care in primary care settings of low-and-middle-income countries (LMICs), and excluded studies in countries where abortion is illegal, and those of services provided by independent NGOs. We conducted a thematic analysis and narrative synthesis to identify indicators of quality care at structural, process and outcome levels of the Donabedian model. RESULTS: A total of 21 indicators under 8 subthemes were identified to examine the quality of service provision: law and policy, infrastructure, technical competency, information provision, client-provider interactions, ancillary services, complete abortions, client satisfaction. Our analysis suggests that structural, process and outcome indicators follow a mediation pathway of the Donabedian model. This review

Journal article

Abbara A, Joseph L, Ismail S, Gunst M, Jarman K, Prior D, Harris Met al., 2020, A qualitative research study which explores humanitarian stakeholders’ views on healthcare access for refugees in Greece, International Journal of Environmental Research and Public Health, Vol: 17, ISSN: 1660-4601

Introduction: As of January 2020, 115,600 refugees remain in Greece; most are Afghani, Iraqi or Syrian nationals. This qualitative research study explores the views of key stakeholders providing healthcare for refugees in Greece between 2015 and 2018. The focus was on identifying key barriers and facilitators to healthcare access for refugees in Greece. Methods: 16 interviewees from humanitarian and international organisations operating in Greece were identified through purposive and snowball sampling. Semi-structured interviews were conducted between March and April 2018. Data were analysed using the Framework Method. Results: Key themes affecting healthcare access included the influence of socio-cultural factors (healthcare expectations, language, gender) and the ability of the Greek health system to respond to existing and evolving demands; these included Greece’s ongoing economic crisis, human resource shortages, weak primary healthcare system, legal barriers and logistics. The evolution of the humanitarian response from emergency to sustained changes to EU funding, coordination and comprehensiveness of services affected healthcare access for refugees. Conclusion: The most noted barriers cited by humanitarian stakeholders to healthcare access for refugees in Greece were socio-cultural and language differences between refugees and healthcare providers and poor coordination among stakeholders. Policies and interventions which address these could improve healthcare access for refugees in Greece with coordination led by the EU.

Journal article

Tobias R, Schweickardt JC, Harris M, 2020, Access to healthcare in the remote and resource-poor region of the Brazilian Amazon, Healthcare Public Health: Improving health services through population science, Pages: 8-22, ISBN: 9780198837206

Access to healthcare is a particular challenge in extreme, remote contexts, particularly in low-and middle-income countries. In Brazil, the primary care and social care policies of the early 1990s have led to remarkable improvements in healthcare access in urban, peri-urban, and rural contexts. This chapter examines the strategies that the Brazilian government has developed to address access in its most extreme context-the Amazon region. The chapter explores how these policies have had to be adapted to account for the extreme environments of the vast, impenetrable rainforest region of the Amazon and the particular needs of indigenous populations and fluvial communities.

Book chapter

Hone T, Powell-Jackon T, Santos LMP, Soares RDS, Proenço de Oliveira F, Niskier Sanchez M, Harris M, Santos F, Millett Cet al., 2020, Impact of the Programa Mais médicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities, BMC Health Services Research, Vol: 20, ISSN: 1472-6963

BackgroundInvesting in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. The Programa Mais Médicos (PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality.MethodsDifference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008–2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction.ResultsAfter starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of − 1.06 per 100,000 (95%CI: − 1.78 to − 0.34) annually – with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation.ConclusionsPMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.

Journal article

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