Johanna Hanefeld

London School of Hygiene and Tropical Medicine | LSHTM · Faculty of Public Health and Policy

Digital technologies can help support the health of migrants and refugees and facilitate research on their health issues. However, ethical concerns include security and confidentiality of information; informed consent; how to engage migrants in designing, implementing and researching digital tools; inequitable access to mobile devices and the inter...

Introduction Incentive-linked prescribing, which is when healthcare providers accept incentives from pharmaceutical companies for prescribing promoted medicines, is a form of bribery that harms patients and health systems globally. We developed a novel method using data collectors posing as pharmaceutical company sales representatives to evaluate p...

Digital technologies can help support the health of migrants and refugees and facilitate research on their health issues. However, ethical concerns include security and confidentiality of information; informed consent; how to engage migrants in designing, implementing and researching digital tools; inequitable access to mobile devices and the inter...

Background Community engagement is essential for the successful implementation of infection control activities during epidemics and pandemics. Recent reviews of community engagement lack evidence of engagement during the COVID-19 pandemic, while previous reviews have largely focused on concepts and models of community engagement. To address this ga...

Introduction: The surge of public health emergencies over the past decade has disproportionately affected sub-Saharan Africa. These include outbreaks of infectious diseases such as Ebola, Monkeypox and COVID-19. Experience has shown that community participation is key to the successful implementation of infection control activities. Despite the pi...

The bilateral agreements signed between South Africa and countries in Southern and Eastern Africa are a rare example of efforts to regulate health-related issues in a world region. As far as we know, there are no comparable bilateral health governance mechanisms in regions elsewhere. Furthermore, the rapidly growing literature on global health gove...

Introduction Four years after the devastating Ebola outbreak, governments in West Africa were quick to implement non-pharmaceutical interventions (NPIs) in response to the rapid spread of SARS-CoV-2. The NPIs implemented included physical distancing, closure of schools and businesses, restrictions on public gatherings and mandating the use of face...

Background An improved estimation of the clinical sequelae of SARS-CoV-2 infection is crucial in African countries, where the subject has received little attention despite more than 12 million reported cases and evidence that many more people were infected. We reviewed the evidence on prevalence, associated risk factors for long COVID, and systemic...

Background Timely strategic information is essential for decision makers to mount an effective public health response to infectious disease outbreaks, and public health actors must find an effective way to supply it. The Centre for International Health Protection at the Robert Koch Institute (Germany’s national public health institute) developed a...

For over a decade, the global health community has advanced policy engagement with migration and health, as reflected in multiple global-led initiatives. These initiatives have called on governments to provide universal health coverage to all people, regardless of their migratory and/or legal status. South Africa is a middle-income country that exp...

Assumptions surrounding the origins of Covid-19, the relationship between human mobility and the spread of the virus, and the pressure that the pandemic has placed on communities, have exacerbated xenophobic tensions globally, including in South Africa, a country long-associated with xenophobia. Previous research exploring how the South African med...

Background There has been insufficient attention to a fundamental force shaping healthcare policies—conflicts of interest (COI). We investigated COI, which results in the professional judgement of a policymaker or healthcare provider being compromised by a secondary interest, in relation to antimicrobial use, thereby illuminating challenges to the...

Background Reflecting global norms, South Africa is associated with high levels of cross-border and internal population mobility, yet migration-aware health system responses are lacking. Existing literature highlights three methodological challenges limiting the development of evidence-informed responses to migration and health: (1) lack of engagem...

Globally, the use of mobile phones for improving access to healthcare and conducting health research has gained traction in recent years as rates of ownership increase, particularly in low- and middle-income countries (LMICs). Mobile instant messaging applications, including WhatsApp Messenger, provide new and affordable opportunities for health re...

Global health, as a field of study, research, and practice, has grown in prominence over the past two decades. This chapter sets out what “global health” is and outlines key principles and core concepts of relevance for the field. It goes on to take a historical look at the origins of global health in the fields of public health, international heal...

The COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions can...

Background: Reflecting global norms, South Africa is associated with high levels of cross-border and internal population mobility, yet migration-aware health system responses are lacking. Existing literature highlights four methodological challenges limiting the development of evidence-informed responses to migration and health: (1) lack of engagem...

Despite political commitment to address antimicrobial resistance (AMR), countries are facing challenges to implementing policies to reduce inappropriate use of antibiotics. Critical factors to the success of policy implementation in low- and middle-income countries (LMIC), such as capacity for enforcement, contestation by influential stakeholders a...

Background: Healthcare providers' (HCPs) professionalism refers to their commitment and ability to respond to the health needs of the communities they serve and to act in the best interest of patients. Despite attention to increasing the number of HCPs in low- and middle-income countries (LMIC), the quality of professional education delivered to H...

Background Global attention to antimicrobial resistance has increased interest in tackling the widespread inappropriate dispensing of antibiotics by informal, for-profit healthcare providers (HCPs). We provide new evidence on an understudied group of informal HCPs: invisible medicine sellers (IMS) who operate without any marked facility. We investi...

Antimicrobial resistance (AMR) has recently emerged as a salient global issue, and policy formulation to address AMR has become a contested space, with various actors sharing competing-and sometimes contradictory-explanations of the problem and the range of possible solutions. To facilitate national policy setting and implementation around AMR, mor...

Migrants’ access to healthcare has attracted attention from policy makers in Thailand for many years. The most relevant policies have been (i) the Health Insurance Card Scheme (HICS) and (ii) the One Stop Service (OSS) registration measure, targeting undocumented migrants from neighbouring countries. This study sought to examine gaps and dissonance...

Introduction The global health field has witnessed the rise, short-term persistence and fall of several movements. One Health, which addresses links between human, animal and environmental health, is currently experiencing a surge in political and financial attention, but there are well-documented barriers to collaboration between stakeholders from...

While antimicrobial resistance (AMR) has rapidly ascended the political agenda in numerous high-income countries, developing effective and sustainable policy responses in low- and middle-income countries (LMIC) is far from straightforward, as AMR could be described as a classic ‘wicked problem’. Effective policy responses to combat AMR in LMIC will...

Summary of findings: • Regional cooperation for health in Asia has emerged in part due to a spirit of solidarity and a sense of shared vulnerability to common health threats, which has encouraged the development of regional public health networks and programmes. • Despite substantial achievements in strengthening regional governance for health, dif...

Agricultural input subsidies, a form of social protection, are often considered an important means of improving agricultural productivity in low- and middle-income countries. However, their effectiveness and efficiency remains contentious with respect to productivity, economic and consumer welfare measures, as well as food and nutrition security. T...

Background: The resolution adopted in 2006 by the World Health Organization on international trade and health urges Member States to understand the implications of international trade and trade agreements for health and to address any challenges arising through policies and regulations. The government of Maldives is an importer of health services...

Background: In resource-constrained health systems medical travel is a common alternative to seeking unavailable health services. This paper was motivated by the need to understand better the impact of such travel on households and health systems. Methods: We used primary data from 344 subsidized and 471 non-subsidized inbound medical travellers...

Many low- and middle-income countries facing high levels of antimicrobial resistance, and the associated morbidity from ineffective treatment, also have a high burden of tuberculosis. Over recent decades many countries have developed effective laboratory and information systems for tuberculosis control. In this paper we describe how existing tuberc...

South Africa’s public healthcare system responses seldom engage with migration. Our exploratory study investigates migration proles and experiences of primary healthcare (PHC) users. A cross-sectional survey involving non-probability sampling was conducted with 229 PHC users at six purposively selected PHC clinics in three districts of SA. The su...

Background Universal health coverage (UHC) is difficult to achieve in settings short of medicines, health workers and health facilities. These characteristics define the majority of the small island developing states (SIDS), where population size negates the benefits of economies of scale. One option to alleviate this constraint is to import health...

The recent outbreak of Ebola Virus Disease (EVD) in West Africa has drawn attention to the role and responsiveness of health systems in the face of shock. It brought into sharp focus the idea that health systems need not only to be stronger but also more 'resilient'. In this article, we argue that responding to shocks is an important aspect of resi...

RLabonté et al entitle their paper in this issue of the International Journal of Health Policy and Management "The Trans-Pacific Partnership: Is It Everything We Feared for Health?" Tantalisingly, they do not directly answer the question they pose, and in this commentary, we suggest that it is the wrong question; we should not ‘fear’ the Trans-Paci...

The scoping review focuses on medical tourism, whereby consumers elect to travel across borders or to overseas destinations to receive their treatment. Such treatments include: cosmetic and dental surgery; cardio, orthopaedic and bariatric surgery; IVF; and organ and tissue transplantation. The review assesses the emerging focus of research evidenc...

The past 10 to 15 years has seen a substantial rise in the number (or at least the perception) of patients traveling for medical treatment, often to exotic or long-haul destinations; it is this latter element that has lent popular press especially to use the somewhat pejorative term medical tourism. A rapid increase in research focused on the issue...

Health and economics have a symbiotic relationship. Although this is often examined at the individual level, it is less often examined at the more macro-level. Yet, the health sector itself is a major economic sector, in terms of employment for instance. It is linked to other sectors of the economy, in terms of the consumption of intermediate goods...

In his perspective "Navigating between stealth advocacy and unconscious dogmatism: the challenge of researching the norms, politics and power of global health," Ooms argues that actions taken in the field of global health are dependent not only on available resources, but on the normative premise that guides how these resources are spent. This comm...

Objective: To investigate the magnitude and characteristics of medical tourism in Thailand and the impact of such tourism on the Thai health system and economy. Methods: In 2010, we checked the records of all visits to five private hospitals that are estimated to cover 63% of all foreign patients. We reviewed hospital records of foreign patients...

The impact of global increases in human mobility on health systems is a little understood but highly political issue in recipient countries.[1] South Africa (SA) is the greatest recipient of migrants from the Southern African Development Community (SADC), a region with high levels of migration, a high communicable disease burden and struggling publ...

The growth of international travel for purposes of medical treatment has been accompanied by increased academic research and analysis. This Handbook explores the emergence of medical travel and patient mobility and the implications for patients and health systems. Bringing together leading scholars and analysts from across the globe, this unprecede...

Shiffman rightly raises questions about who exercises power in global health, suggesting power is a complex concept, and the way it is exercised is often opaque. Power that is not based on financial strength but on knowledge or experience, is difficult to estimate, and yet it may provide the legitimacy to make moral claims on what is, or ought to b...

This article examines why and how a national health insurance (NHI) proposal targeting universal health coverage (UHC) in Nigeria developed over time. The study involved document reviews, in-depth interviews, a further review of preliminary analysis by relevant actors and use of a stakeholder analysis approach. The need for strategies to improve he...

The aim of this article is to contribute towards greater theoretical and empirical understanding about medical tourism developments globally. This evidence leads us to examine some widely-held assumptions regarding the size and shape of global medical travel. Our paper examines three central issues: (1) Do published figures and projections 'add-up'...

Background Medical tourism is a growing phenomenon. This review of the literature maps current knowledge and discusses findings with reference to the UK National Health Service (NHS).Methods Databases were systematically searched between September 2011 and March 2012 and 100 papers were selected for review.ResultsThe literature shows specific types...

Evidence on medical tourism, including patient motivation, is increasing. Existing studies have focused on identifying push and pull factors across different types of treatment, for example cosmetic or bariatric surgery, or on groups, such as diaspora patients returning 'home' for treatment. Less attention has been on why individuals travel to spec...

Despite a huge amount of speculation and expectation surrounding medical tourism, hard empirical evidence is only now beginning to emerge. This paper widens the focus of discussion by contrasting two country experiences (UK and Korea) which on the surface illustrate the diversity of medical tourism and little else. However, considered more comparat...

Despite being central to achieving improved population health outcomes, primary health centres in low- and middle-income settings continue to underperform. Little research exists to adequately explain how and why this is the case. This study aimed to test the relevance and usefulness of an adapted conceptual framework for improving our understandin...

Background Travel for medical treatment is an aspect of globalization and health that is comparatively less understood. Little is known about volume, characteristic and motivation of medical tourists, limiting understanding of effects on health systems and patients. Thailand is amongst a handful of countries that have positioned themselves as medic...

Many public health systems in high- and middle-income countries are under increasing financial pressures as a result of ageing populations, a rise in chronic and non-communicable diseases and shrinking public resources. At the same time the rise in patient mobility and concomitant market in medical tourism provides opportunities for additional inco...

As we enter the fourth decade of HIV and AIDS, sustainability of treatment and prevention programmes is a growing concern in an environment of shrinking resources. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) will be critical to maintaining current trajectories of scale-up and ultimately, ensuring access to HIV treatment and prev...

The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund or GFATM) is a private public partnership aimed at leveraging and providing funding for the three focal diseases outlined in its title. Set up in 2002, the fund was part of a new 'breed' of players in the field of global health, combining skills from bilateral and multilateral...

The study examined the implications of inward and outward flows of private patients for the NHS across a range of specialties and services. Objectives To generate a comprehensive documentary review; to better understand information, marketing and advertising practices; examine the magnitude and economic and health-related consequences of travel; u...

Increasing attention is being paid to the potential of anti-retroviral treatment (ART) for HIV prevention. The possibility of eliminating HIV from a population through a universal test and treat intervention, where all people within a population are tested for HIV and all positive people immediately initiated on ART, as part of a wider prevention i...

Despite increasing reference to medical tourism by politicians and reports in popular media, there remains little understanding of actual size, scope, and effect of inbound and outbound UK patients. Although evidence suggests that a growing number of patients travel to access (and pay for) medical treatment, including UK residents and, equally, tha...

'Medical Tourism' - the phenomenon of people travelling abroad to access medical treatment - has received increasing attention in academic and popular media. This paper reports findings from a study examining effect of inbound and outbound medical tourism on the UK NHS, by estimating volume of medical tourism and associated costs and benefits. A mi...

http://www.hhrjournal.org/2013/07/18/the-global-funds-new-funding-model-missed-opportunities-for-human-rights/

We have recently completed the most comprehensive research project to date examining the effects of UK medical tourism on the NHS. Research findings currently under review may have some bearing on the debate about the effects of expanding the NHS abroad for UK patients.1 2 Our analysis, which …

The key arguments of this chapter are as follows: Medical tourism has become increasingly prominent during the last decade and this is in large part a consequence of the way it is marketed through the Internet. Concerns regarding the quality of health information that exists on the Internet have been held for some time. Given that most medical tour...

Background: While sustainability of health programmes has been the subject of empirical studies, there is little evidence specifically on the sustainability of Community Based Organisations (CBOs) for HIV/AIDS. Debates around optimal approaches in community health have centred on utilitarian versus empowerment approaches. This paper, using the Wor...

Global initiatives and recent G8 commitments to health systems strengthening have brought increased attention to factors affecting health system performance. While equity concerns and human rights language appear often in the global health discourse, their inclusion in health systems efforts beyond rhetorical pronouncements is limited. Building on...

Global Health Initiatives (GHIs), such as the President's Emergency Plan For AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, TB and Malaria (the GFATM), have emerged as new mechanisms for development assistance in health. By 2008, GHIs were providing two-thirds of all external funding for HIV/AIDS globally. In Zambia and South Africa over t...

Allegations of the reckless or intentional transmission of HIV raise challenging questions about how states can best address a disease which is transmitted primarily through behaviours that both states and community “police” in different ways. This paper argues that in the rare cases in which someone engages in specific behaviour with the intent to...

Since the beginning of the 21st century, development assistance for HIV/AIDS has increasingly been provided through Global Health Initiatives, specifically the United States Presidential Emergency Plan for AIDS Relief, the Global Fund to Fight HIV, TB and Malaria and the World Bank Multi-country AIDS Programme. Zambia, like many of the countries he...

This review examines the impact of Global Health Initiatives (GHIs) on health equity, focusing on low- and middle-income countries. It is a summary of a literature review commissioned by the WHO Commission on the Social Determinants of Health. GHIs have emerged during the past decade as a mechanism in development assistance for health. The review f...

Feminist Review (2002) 72, 84–92. doi:10.1057/palgrave.fr.9400057

Global HIV/AIDS Initiatives (GHIs), such as US PEPFAR and the Global Fund to Fight AIDS, TB and Malaria, have emerged as new mechanisms for development assistance in health. By 2008, GHIs were providing two-thirds of all external funding for HIV/AIDS globally. In Zambia and South Africa over the past five years, US PEPFAR and the Global Fund have p...