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'Working in Health' addresses two key questions related to health workforce policy in developing countries: • What is the impact of government wage bill policies on the size of the health wage bill and on health workforce staffing levels in the public sector? • Do current human resources management policies and practices lead to effective use of wage bill resources in the public sector? Health workers play a key role in increasing access to health services for poor people in developing countries. Global and country level estimates show that staffing levels in many developing countries—particularly in sub-Saharan Africa—are far below what is needed to deliver essential health services to the population. One factor that potentially limits scaling up the health workforce in developing countries is the government overall wage bill policy which sometimes creates restrictions. Through a review of literature, analysis of data, and country case studies in Kenya, Zambia, Rwanda, and the Dominican Republic, this book examines the process that determines the health wage bill budget in the public sector, how this is linked to overall wage bill policies, how this affects staffing levels in the health sector, and the relevant policy options. But staff numbers are not everything and more money for the health wage bill alone will not solve the health workforce problems of developing countries. 'Working in Health' looks at how effectively governments use the available wage bill resources in the health sector and policy options. Policies and practices in recruitment, deployment, promotion, transfer, sanctioning, and remuneration for health workers are reviewed to identify their influence on budget execution rates, geographic distribution, and productivity of health workers.

The world is increasingly getting urbanized and globalized, and the increase in natural resource exploration could have a far-reaching impact on environmental quality. Since most Latin American and Caribbean countries (LACCs) have proximity to the Amazon, they, therefore, rely heavily on agriculture and mining which develop via deforestation which could exacerbate the already increasing carbon dioxide emissions (CO 2 emissions). Therefore, to the best of our knowledge, this study becomes the first to investigate the link between natural resources, globalization, urbanization, and environmental degradation in LACCs countries from 1990 to 2017 with advanced panel data econometric techniques. The unit root tests affirm all the variables to be stationary at first difference, and the Westerlund (Oxf Bull Econ Stat 69(6):709–748, 2007 ) cointegration test confirms the long-run relationship among the variables. The augmented mean group (AMG) and the common correlated effects mean group (CCEMG) results affirm that the aforementioned variables add to CO 2 emissions, while human capital mitigates it. Further findings reveal that human capital performs a moderating role in promoting urbanization sustainability. The country-specific results confirm that economic growth adds to emissions in all the countries, except in the Dominican Republic. A feedback causality exists between economic growth, globalization, urbanization, and CO 2 emissions. This study argues for the development of human capital, a gradual transition to sustainable growth-driven and knowledge-based industries, and the introduction of sustainability practices in the natural resource sector to mitigate CO 2 emissions in LACCs.

Ask three people to describe a special economic zone (SEZ) and three very different images may emerge. The first person may describe a fenced-in industrial estate in a developing country, populated by footloose multinational corporations (MNCs) enjoying tax breaks, with laborers in garment factories working in substandard conditions. In contrast, the second person may recount the 'miracle of Shenzhen,' a fishing village transformed into a cosmopolitan city of 14 million, with per capita gross domestic product (GDP) growing 100-fold, in the 30 years since it was designated as an SEZ. A third person may think about places like Dubai or Singapore, whose ports serve as the basis for wide range of trade- and logistics-oriented activities. In this book, the author use SEZ as a generic expression to describe the broad range of modern economic zones discussed in this book. But we are most concerned with two specific forms of those zones: (1) the export processing zones (EPZs) or free zones, which focus on manufacturing for export; and (2) the large-scale SEZs, which usually combine residential and multiuse commercial and industrial activity. The former represents a traditional model used widely throughout the developing world for almost four decades. The latter represents a more recent form of economic zone, originating in the 1980s in China and gaining in popularity in recent years. Although these models need not be mutually exclusive (many SEZs include EPZ industrial parks within them), they are sufficiently different in their objectives, investment requirements, and approach to require a distinction in this book.

Newborn bloodspot screening (NBS) began in the early 1960s based on the work of Dr. Robert “Bob” Guthrie in Buffalo, NY, USA. His development of a screening test for phenylketonuria on blood absorbed onto a special filter paper and transported to a remote testing laboratory began it all. Expansion of NBS to large numbers of asymptomatic congenital conditions flourishes in many settings while it has not yet been realized in others. The need for NBS as an efficient and effective public health prevention strategy that contributes to lowered morbidity and mortality wherever it is sustained is well known in the medical field but not necessarily by political policy makers. Acknowledging the value of national NBS reports published in 2007, the authors collaborated to create a worldwide NBS update in 2015. In a continuing attempt to review the progress of NBS globally, and to move towards a more harmonized and equitable screening system, we have updated our 2015 report with information available at the beginning of 2024. Reports on sub-Saharan Africa and the Caribbean, missing in 2015, have been included. Tables popular in the previous report have been updated with an eye towards harmonized comparisons. To emphasize areas needing attention globally, we have used regional tables containing similar listings of conditions screened, numbers of screening laboratories, and time at which specimen collection is recommended. Discussions are limited to bloodspot screening.

The sustainable development goals (SDGs) were established by the United Nations as an international call to eradicate poverty, safeguard the environment, and guarantee that everyone lives in peace and prosperity by 2030. The SDGs aim to balance growth and sustainability in three dimensions: social, economic and environmental. However, in the post-pandemic era, when resources for public development policies are scarce, nations face the problem of prioritizing which SDGs to pursue. A lack of agreement is one of the determinants of low performance levels of the SDGs, and multicriteria decision analysis tools can help in this task, which is especially relevant in developing countries that are falling behind in achieving the SDGs. To test the feasibility and appropriateness of one of these tools, the Fuzzy Logarithm Methodology of Additive Weights, we apply it to prioritize the SDGs in the Dominican Republic, to see if the priorities established are consistent. Seventeen experts were surveyed, and the main result was that Decent work and economic growth was the most important goal for the country. Our findings, consistent with the literature, show the path to similar applications in other developing countries to enhance performance levels in the achievement of the SDGs.

Background The geographical accessibility of health services is an important issue especially in developing countries and even more for those sharing a border as for Haiti and the Dominican Republic. During the last 2 decades, numerous studies have explored the potential spatial access to health services within a whole country or metropolitan area. However, the impacts of the border on the access to health resources between two countries have been less explored. The aim of this paper is to measure the impact of the border on the accessibility to health services for Haitian people living close to the Haitian-Dominican border. Methods To do this, the widely employed enhanced two-step floating catchment area (E2SFCA) method is applied. Four scenarios simulate different levels of openness of the border. Statistical analysis are conducted to assess the differences and variation in the E2SFCA results. A linear regression model is also used to predict the accessibility to health care services according to the mentioned scenarios. Results The results show that the health professional-to-population accessibility ratio is higher for the Haitian side when the border is open than when it is closed, suggesting an important border impact on Haitians’ access to health care resources. On the other hand, when the border is closed, the potential accessibility for health services is higher for the Dominicans. Conclusion The openness of the border has a great impact on the spatial accessibility to health care for the population living next to the border and those living nearby a road network in good conditions. Those findings therefore point to the need for effective and efficient trans-border cooperation between health authorities and health facilities. Future research is necessary to explore the determinants of cross-border health care and offers an insight on the spatial revealed access which could lead to a better understanding of the patients’ behavior.

Background: Processes and best practices for initiating and growing university global health programs in high-income countries (HICs) synchronously and symbiotically with partners in low- and middle-income countries (LMICs) are not abundantly described in the medical literature. In particular, programs that do not have university partners in LMICs may struggle to develop sustainable, ethical, and anticolonial community and governmental partnerships. Methods: This article reviews existing literature and describes the challenges in the contemporaneous development of university global health programs and community/governmental partners. The paper goes on to describe the creation of the Office of Global Health at Rush University in conjunction with the inception and development of its partner non-governmental organization (NGO), Community Empowerment in the Dominican Republic. The success and opportunities in the evolution of this ongoing relationship are described. Guiding principles for others attempting similar work are provided. Results: Creating these entities simultaneously promotes the establishment of relationships with equal power and authority from the inception, facilitates the creation of customized programs that capitalize on the strengths of the university and infrastructure of the partner country/community, and allows both entities to grow together in scope and impact. Challenges include identifying and nurturing like-minded university, NGO, and community/government partners; securing bilateral sustainable funding; ensuring quality of clinical services and educational/scholarly activities; and consistently promoting anticolonial practices. Conclusion: Developing university global health programs in HICs simultaneously with a partner NGO can result in mutual and commensurate growth and outcomes as well as strong and equitable relationships. This paper describes the author’s own experience at Rush University building connections with community partners and colleagues in the Dominican Republic and outlines strategies to achieve these results.

Most individuals show immunity to SARS-CoV-2 from vaccination or infection, or both. We aimed to determine the safety and immunogenicity of an omicron-containing COVID-19 vaccine (mRNA-1273.222) in vaccine-naive adolescents who were SARS-CoV-2 positive. Part 3 of the phase 2/3 TeenCOVE trial was a phase 3, open-label, single-arm part done in the USA and the Dominican Republic that enrolled healthy, vaccine-naive adolescents (aged 12–17 years) to receive two 50 μg doses of mRNA-1273.222 (ancestral strain Wuhan-Hu-1 and omicron subvariants BA.4 and BA.5), 6 months apart. Primary reactogenicity and safety outcomes included assessment of solicited local or systemic adverse reactions 7 days after vaccination, and unsolicited and prespecified adverse events throughout study participation. Inferred effectiveness (primary immunogenicity outcome) was established by comparing neutralising antibody responses 28 days after dose 1 of mRNA-1273.222 in SARS-CoV-2-positive adolescents with responses 28 days after dose 2 of mRNA-1273 100 μg primary series in SARS-CoV-2-negative young adults (aged 18–25 years) from the COVE trial. This study is registered with ClinicalTrials.gov (NCT04649151). Between Dec 21, 2022, and June 5, 2023, 379 adolescents (378 of whom were SARS-CoV-2 positive) received at least one mRNA-1273.222 dose and were included in the safety analysis set. The reactogenicity profile was favourable compared with the mRNA-1273 primary series, with no new safety concerns identified. Unsolicited adverse events were reported in 49 (13%) of 379 participants; no deaths or adverse events leading to study discontinuation were reported. The immunogenicity set included 245 adolescents from the per-protocol immunogenicity subset who were SARS-CoV-2 positive at baseline and 296 young adults who were SARS-CoV-2 negative. Compared with the mRNA-1273 primary series in SARS-CoV-2-negative young adults, a single dose of mRNA-1273.222 induced superior (geometric mean ratio [GMR] 95% CI lower bound >1) neutralising antibody responses against omicron BA.4 and BA.5 (GMR 48·95 [95% CI 44·21–54·21]) and non-inferior (GMR 95% CI lower bound >0·667) neutralising antibody responses against ancestral SARS-CoV-2 (GMR 4·25 [95% CI 3·69–4·88]) in SARS-CoV-2-positive adolescents. In vaccine-naive, SARS-CoV-2-positive adolescents, single-dose mRNA-1273.222 was effective against COVID-19 based on successful immunobridging to the two-dose mRNA-1273 primary series in young adults. The findings support a simplified single-dose vaccination schedule with variant-containing mRNA vaccines, regardless of previous vaccination status. Moderna.

Background A growing number of studies have explored how features of the neighbourhood environment can be related to cognitive health in later life. Yet few have focused on low- and middle-income countries and compared the results across different settings. The aim of this study is to investigate the cross-sectional associations between neighbourhood amenities and dementia in older people from high-, middle- and low-income countries. Methods This study was based on two population-based cohort studies of people aged≥65: the Cognitive Function and Ageing Study II (CFAS II) in UK ( N  = 4955) and a subset of the 10/66 study in China, Dominican Republic and Mexico ( N  = 3386). In both cohorts, dementia was assessed using the Geriatric Mental State−Automated Geriatric Examination for Computer Assisted Taxonomy (GMS-AGECAT) algorithm. The 10/66 dementia diagnostic algorithm was also used as an additional criterion in the 10/66 study. Publicly accessible databases, Google Maps and Open Street Map, were used to obtain geographic information system data on distance to neighbourhood amenities, including lifestyle (cafés, libraries, movie theatres, parks), daily life (post offices, convenience stores), healthcare (hospitals, pharmacies) and percentages of local green and blue spaces within 400 and 800 m of participants’ residences. Multilevel logistic regression was used to investigate the associations between these environmental features and dementia adjusting for sociodemographic factors and self-rated health. Results Living far from daily life amenities was associated with higher odds of dementia in both CFAS II (1.47; 95% CI: 0.96, 2.24) and the 10/66 study (1.53; 95% CI: 1.15, 2.04), while living far from lifestyle (1.50; 95% CI: 1.13, 1.99) and healthcare amenities (1.32; 95% CI: 0.93, 1.87) was associated with higher odds of dementia only in the 10/66 study. A high availability of local green and blue spaces was not associated with dementia in either cohort yet living far from public parks was associated with lower odds of dementia in CFAS II (0.64; 95% CI: 0.41, 1.00). Conclusions The different relationships across cohorts may indicate a varying role for local amenities in diverse settings. Future research may investigate mechanisms related to these differences and social, cultural and historical influences on the interaction between neighbourhood amenities and older people.