Developing Strategies to coordinate HEalthcare provision between The GAmbia and Senegal (SHEGAS)

点击翻译按钮获取中文摘要

Despite the fact that there are approximately one billion migrants in the world, and an increasing recognition that healthcare use is not confined to national borders, the literature on health systems adaptation to population movement remains scant. Available studies have mostly investigated patterns and trends, reasons for travel, as well as benefits and challenges of population movement and healthcare use in different countries and world regions. Most of the literature attention has focused on North-to-South and South-to-North travel, whilst most transnational healthcare use actually takes place within regions. When studies on cross-border healthcare use have taken a regional focus, these are mostly focused on high- and middle-, rather than low-income countries. A global research agenda on migration and health urgently called for research on health systems adaptation to population mobility. To our knowledge, no previous study has done this yet. The aim of this project is to develop a health systems strategy to coordinate cross-border healthcare use between The Gambia and Senegal. The Gambia and Senegal provide an ideal setting for this research because they have a common pre-colonial history, the same ethnic groups and close political ties, whilst having different colonial histories leading to differing post-colonial political and health systems. We recently undertook a study of transnational healthcare use between The Gambia and Senegal, and found a large degree of cross-border healthcare use, but a clear lack of coordination between the two health systems, resulting in duplication of care, loss to follow up and feelings of discrimination amongst patients. When we presented our findings to Gambian and Senegalese policymakers, they asked the research team to develop a strategy to coordinate the health systems of the two countries. This study will aim to do that, and will be of use to policymakers in other low- and middle-income countries experiencing a high volume of cross-border healthcare use. The study will be divided into six objectives:1. Assess current levels of cross-border healthcare use between Senegal and The Gambia2. Examine the history of cross-border movement and healthcare use between Senegal and The Gambia3. Analyse different existing arrangements in different regions of The Gambia and Senegal 4. Review health system agreements between different countries in West Africa5. Examine the impact of the Covid-19 has had on population movement and cross-border healthcare, and identify ways a health systems strategy adapted to population movement can increase a country's resilience to pandemics6. Use a participatory approach to design a set of health systems strategies for coordinating the health systems of The Gambia and Senegal.We will study the health system by dividing it into six components: human resources, medicines and technologies, governance, financing, service provision and information. We will use a mix of quantitative and qualitative methods to address the study objectives. We will undertake a survey of all major health centres in border regions and the capital cities of The Gambia and Senegal. The aim of this survey will be to assess the number and type of cross-border patients facilities have seen in the past three years. We will conduct document and literature reviews to assess cross-border healthcare arrangements between border regions in The Gambia and Senegal, and between other countries in West Africa. We will also conduct 130 interviews and 36 focus group discussions with policymakers, healthcare providers and cross-border patients to explore current and past cross-border healthcare practices between The Gambia and Senegal. Finally, we will hold a workshop with policymakers from The Gambia and Senegal to co-design a strategy to coordinate the health systems of both countries.