BACKGROUND
There is recognition of the importance of community resilience in mitigating long-term effects of health emergencies on communities. To guide policy and practice, conceptual clarity is needed on what community resilience involves and how it can be operationalised for community protection in ways that empower and strengthen local agency.
OBJECTIVES
To identify the core components of community resilience to health emergencies using a scoping review methodology.
SEARCH METHODS
PubMed, EMCARE, Scopus, Web of Science, PTSDpubs, APO and ProQuest Dissertations were systematically searched to identify review studies published from 2014.
SELECTION CRITERIA
Studies were included if they reported a review of original research papers investigating community resilience in the context of a health emergency.
DATA COLLECTION AND ANALYSIS
Data were extracted from included studies using a specially developed data extraction form. Qualitative data were subjected to a meta-synthesis consisting of three levels of analysis.
MAIN RESULTS
38 evidence reviews were included. Analysis identified recurring characteristics of community resilience. Six studies reported 10 abilities required for community resilience including: adapt, transform, absorb, anticipate, prepare, prevent, self-organise, include, connect and cope. 25 studies reported 11 types of resources: social, economic, environmental, governance, physical infrastructure, institutional, communication, human capital, health, emergency management and socioeconomic.
CONCLUSIONS
21 components have been identified that can be used as a basis for operationalising and measuring community resilience. In contexts of disaster management, community resilience is a fairly mature concept that reflects a community’s inherent capacity/abilities to withstand and recover from shocks. There is a need to incorporate a ‘resource’ perspective that speaks to a wider enabling environment. There is scope to investigate whether the same set of components identified here has relevance in public health emergencies emanating from disease or human acts of aggression and to articulate resilience logics to critical endpoints for health emergency management.
INTRODUCTION
The Médecins Sans Frontières (MSF) Kiambu People Who Use Drugs (PWUD) project, which started in September 2019, had enrolled 590 PWUD in its Medically Assisted Therapy (MAT) program by April 2022. This project provides a one-stop-shop model, offering a comprehensive range of medical and psychosocial services. This study aimed to explore how PWUD navigate from heroin use to MAT enrolment.
METHODS
The study involved individual, paired and group interviews conducted between August and October 2022. Purposive sampling was applied. Interviews were recorded, transcribed, coded with NVivo and analysed using reflexive thematic analysis. Methodological triangulation enhanced interpretation.
RESULTS
PWUD faced various challenges to engage in the MAT program. Replacing heroin with MAT, the ‘medicine,’ was insufficient to ensure meaningful recovery. Engaging in MAT required personal motivation to exit the hotspots that their lives revolve around. Main barriers were coping with changed lifestyles and behavioural patterns, and the need to develop new perspectives on dealing with ‘idleness.’
CONCLUSION
The study revealed the complex realities PWUD are confronted with when trying to engage in MAT. MAT programs need to address medical, psychosocial, employment and other structural factors while supporting people to restore their broken social conditions.
Access and linkage to care for migrant torture survivors is contingent on their identification and appropriate referral. However, appropriate tools for identification of survivors are not readily available, and the (staff of) reception systems of host countries may not always be equipped for this task. This study explores practices in the identification and case management of torture survivors in the reception structures and in the public health sector in Rome, Italy.
METHOD
Data were analysed manually and codes and themes generated.
RESULTS
A non-homogeneous level of awareness and experience with torture survivors was observed, together with a general lack of knowledge on national and internal procedures for correct identification of torture survivors. Identification and case management of torture survivors was mainly carried out by non-trained staff. Participants expressed the need for training to gain experience in the identification and management of torture survivors’ cases, as well support and increased resources at both the reception and public health system levels.
CONCLUSIONS
The crucial process of identification and prise en charge of survivors of torture among migrant and refugee populations is relegated to nontrained and inexperienced professionals at different levels of the reception system and public health care sector, which may carry a risk of non-identification and possible harm to survivors. Additional resources and structured interventions are urgently needed, in the form of developing procedures, training, and adapted multidisciplinary services.
Antibiotic resistance is a growing public health threat. In Afghanistan, high levels of indiscriminate antibiotic use exist, and healthcare programmes are not informed by understanding of local attitudes towards rational antibiotic use. Médecins Sans Frontières is an international non-governmental organization providing healthcare services to the Ahmad Shah Baba (ASB) District Hospital in Kabul, Afghanistan, since 2009. This mixed-methods study aimed to explore the perceptions and attitudes toward antibiotics among patients, prescribers, and pharmacists in the ASB District hospital outpatient department.
METHODS AND FINDINGS
Knowledge of antibiotics including their purpose and function, how and why they are used, and drivers for choice of antibiotic was examined at patient, prescriber, and provider-level. The first phase of the study, an exploratory qualitative component using an interpretative approach, was used to inform the second phase, a structured survey. Thirty-six interviews were conducted with 39 participants (21 patients or caretakers and 18 hospital health workers). Three hundred and fifty-one (351) patients and caretakers completed the second phase, the structured survey. This study found that poor knowledge of antibiotics and antibiotic resistance is a driving factor for inappropriate use of antibiotics. Participant perceptions of living in a polluted environment drove the high demand and perceived ‘need’ for antibiotics: patients, doctors and pharmacists alike consider dirty and dusty living conditions as causes of ‘disease’ in the body, requiring antibiotics to ‘clean’ and ‘strengthen’ it.
CONCLUSIONS
Findings highlight the need for strategies to improve awareness and knowledge of the general public, improve practice of doctors and pharmacists, regulate antibiotic dispensing in private pharmacies, and implement antibiotic stewardship in hospitals.