Blog posts

Innovative children’s hospice opens in Italy with support from IGHI

“Arca sull’albero”, a new children’s hospice in Bologna, Italy, was inaugurated last week, marking a significant milestone in children’s palliative care. The hospice, funded by Fondazione Hospice Maria Teresa Chiantore Seràgnoli, is a testament to innovative, user-centred design and care. Researchers and designers from the Institute of Global Health Innovation (IGHI) and its Helix Centre played a pivotal role in its development, ensuring the incorporation of lessons from international best practices and of user-centred innovation.

Aerial view of "Arca sull’albero" children’s hospice in Italy. Credits: Enrico Cano
Aerial view of “Arca sull’albero” children’s hospice in Italy. Credits: Enrico Cano

Access to children’s palliative care is a human right. According to the United Nations Committee on the Rights of the Child, “children are entitled to quality health services, including prevention, promotion, treatment, rehabilitation and palliative care services.’’ However, 8 million children around the world need specialist palliative care, but only 10% of them actually receive it. Even in otherwise developed health systems like Italy’s, provision of paediatric palliative care is limited.

The new children’s hospice

“Arca sull’albero” is one of the first and most innovative children’s hospices in Italy. It stands out as unique in several key ways. Its architecture, designed by Renzo Piano Building Workshop, merges functionality with a serene, home-like atmosphere, providing a comforting sanctuary with natural light and open spaces.

"Arca sull’albero" children’s hospice in Italy. Credits: Enrico Cano
“Arca sull’albero” children’s hospice in Italy. Credits: Enrico Cano

The hospice’s care protocols align with global best practices, ensuring the highest standard and continuity of care. Focus on user experience is paramount, with every detail meticulously designed to make the stay comfortable and stress-free for children and their families. Additionally, the hospice’s governance and management processes aim to maximise effectiveness and openness to innovation.

Isabella Seràgnoli, from the Fondazione Hospice Maria Teresa Chiantore Seràgnoli, said:

“The children’s hospice represents concretely the concept of care. Palliative care is not only about treating physical pain, but also psychological pain, and requires attention to the situation of the person and their family. For this reason the hospice is an open and permeable place, a home where social relations and affection are possible and in which to experience beauty.’’

Collaboration with IGHI

The IGHI team has been involved from the project’s inception. Leveraging its extensive expertise and research, IGHI informed the hospice’s strategy and its approach to innovation, ensuring that “Arca sull’albero” not only meets but exceeds global standards in children’s palliative care.

Designers from the Helix Centre engaged with children and their families, including siblings, to understand their needs and put them at the centre of IGHI’s research efforts in this area. They also designed prototypes of innovative solutions that informed the plans of Fondazione Hospice Maria Teresa Chiantore Seràgnoli  for the new hospice.

Gianluca Fontana, Deputy Director of IGHI, said:

“It is rare to be able to play an active role in the creation of a new healthcare provider. I am proud of the work of many IGHI team members in researching and designing solutions in children palliative care. I am extremely grateful to Fondazione Seràgnoli for the trust they put in us and for their support of our activities in this space.”

A team from IGHI’s Centre for Health Policy led the development of the report, “The children’s palliative care provider of the future: A blueprint to spark, scale and share innovation”. The report emphasises the importance of innovation in children’s palliative care, advocating for adopting new technologies, interdisciplinary collaboration, and a patient-centred approach. Through interviews with 51 experts in 27 countries, the project identified 9 key features of innovative paediatric palliative care providers:

      • People
      • Culture
      • Leadership
      • Vision
      • Organisation
      • Partnerships
      • Services
      • Technology
      • Place

“Arca sull’albero” exemplifies these characteristics, setting a new standard for children’s hospices in Italy and beyond. The report also revealed the opportunity for dedicated advancement of excellence and innovation in paediatric palliative care worldwide. With the support of the partnership between Fondazione Hospice Maria Teresa Chiantore Seràgnoli and the Institute of Global Health Innovation, Global Treehouse Foundation was established and is now working in partnership with innovators, funders, providers and entrepreneurs to address the global lack of access to children’s palliative care.

Laura Dale-Harris, Founder Director of Global Treehouse Foundation, added :

“Arca sull’albero is a model of where the global children’s palliative care field can grow – deep local roots with families, children, and communities – partnered with innovators and expertise like IGHI. We are excited to welcome Arca sull’albero to the community of entrepreneurial children’s palliative care providers around the world.”

The opening event

At the inauguration last week, Gianluca Fontana from IGHI took part in an event alongside Renzo Piano, the building’s renowned architect, paediatric palliative care experts Professor Julia Downing, CEO of the International Children’s Palliative Care Network, and Dr Renee McCulloch from Great Ormond Street Hospital and University College London. The speakers presented the latest development in paediatric palliative care globally to an audience of paediatricians and nurses from the Emilia Romagna region.

Gianluca Fontana speaking at the inauguration event. Credits: Jonty Roland
Gianluca Fontana speaking at the inauguration event. Credits: Jonty Roland

Renzo Piano described his vision for the architectural project, an “ark on the trees where children and families can find relief surrounded by the magic and natural beauty of the woods”. Professor Downing presented a global overview of the development of paediatric palliative care services. Dr McCulloch shared her experience working in research and clinical practice in the sector. Gianluca Fontana spoke about the key features of the paediatric palliative care provider of the future.

Renzo Piano speaking at the inauguration event. Credits: IGHI
Renzo Piano speaking at the inauguration event. Credits: IGHI

The future

IGHI is committed to improvement and innovation in paediatric palliative care and in the health of children more broadly. Beside the continued collaboration with Arca sull’albero and Global Treehouse Foundation, researchers at IGHI and Helix have a number of early stage projects working with children and young people, particularly around mental health and rare diseases, for which they are interested in exploring opportunities for further collaboration and funding.

Impact of the cost-of-living crisis on patient preferences towards virtual consultations

Since 2021, the world has faced a cost-of-living crisis that has adversely affected population health. With rising living costs, many people have been forced to make significant cuts in their daily expenses and adjust their lifestyles accordingly. But has this crisis influenced how people prefer to access health services? In this blog, we share the results of our international cross-sectional study involving 6,391 participants from the United Kingdom, Germany, Sweden, and Italy.

The COVID-19 pandemic, followed by military destabilisation in Europe, has contributed to a major cost-of-living crisis characterised by significant price and tax rises, drastic cuts to social security, as well as rises in rent and energy bills. Many people are opting for less expensive supermarkets, reducing recreational overseas travel, and cutting back on spending for clothes and leisure activities.

“More people started using public transport instead of driving a car and eliminated non-essential journeys due to substantial increases in fuel prices. We believe that, in light of these forced adjustments, people’s decisions regarding healthcare might have also changed”.

Dr Tetiana Lunova, Research Associate

Since the start of the COVID-19 pandemic, virtual consultations have become widely used and remain popular even after the pandemic. Virtual consultations have proven to be a convenient alternative for many service users as they allow people to avoid travel and parking expenses, taking time off work, or securing childcare.

We hypothesise that this could have influenced patients’ decisions when choosing the modality of consultation in the cost-of-living crisis times. However, no actual research has been done in this matter so far.

Virtual consultations are getting popular but not among all population groups

We conducted a cross-sectional study using an online questionnaire survey of 6,391 participants from the UK, 1459 (23.0%), Germany, 1597 (25.0%), Italy, 1723 (27.0%) and Sweden, 1612 (25.0%). In this survey, we asked people about their preferences for the modality of care (face-to-face or virtual) before and after the onset of the cost-of-living crisis.

Overall, there has been a tangible increase in public preference for virtual care compared to pre-crisis times in all four included countries. At the same time, face-to-face appointments remain the most preferred mode of healthcare delivery.

Before the onset of the crisis, those who preferred virtual care were mainly younger and from urban backgrounds. Approximately 17% of study participants changed their preference for the modality of care after the onset of the cost-of-living crisis. Among them, younger people were more likely to switch to virtual care, while change to face-to-face was associated with younger age and lower income. Older adults were less likely to change their preference for either of the modalities.

Policy implications and lessons for future

Our findings show a growing demand for virtual consultations, particularly among younger people. However, this trend is not reflected among those who consume the most healthcare resources (i.e. older people and those from lower-income groups).

“Scaling up digital healthcare will, therefore, prove a challenging equilibrium to strike to ensure that the wants and needs of the younger population are met while not alienating the older population and those more deprived of their healthcare providers.”

Dr Ana Luisa Neves, Senior Clinical Lecturer in Digital Health

Policymakers should consider strategies to ensure equitable access to virtual care at all stages of its conception and implementation. Such strategies could include digital health literacy training, creating comprehensible guidance materials, and community support initiatives. Our results also indicate that participants from rural communities preferred face-to-face appointments rather than virtual consultations.

While our study did not explore the rationale for this, future work may have implications for the industry to ensure equitable coverage of internet networks and digital health hubs to improve access to virtual services for rural communities. But, most importantly, the rationale behind patients’ preferences should be investigated to ensure all patients can access care in their preferred modality.

Children’s mental health must be prioritised at the first Children’s Dialogue at the UN Climate Negotiations

This blog post is written by Dr Alessandro Massazza, United for Global Mental Health, and Dr Omnia El Omrani, Climate Cares Centre, Imperial College London.

Girls study by edge of water
Credit: Moniruzzaman Sazal/ Climate Visuals

No country is sufficiently protecting children and young people’s health, their environment and their futures. Young people under 24 make up 41% of all people alive today. Among them, 89% live in low- and middle-income countries that are particularly vulnerable to the impacts of climate change. According to Save the Children, a child born in 2020 will be exposed to seven times the number of heatwaves as their grandparents, even if the emission reduction targets set by the 2015 Paris Agreement are met.

As a result, children’s physical and mental health is being disproportionately affected by climate change. The 2022 IPCC report indicated there is very high confidence that climate change has already negatively impacted mental health globally, with children and young people identified as populations at higher risk.

Extreme weather events can negatively impact children’s mental health by exposing them to potentially traumatic events such as the death of loved ones and serious injury, as well as by negatively impacting determinants of mental health such as increasing levels of food insecurity, causing family separation during crises, increasing the risk of violence against children, or leading to school closures. In Australia, a recent UNICEF report highlighted that more than 1.4 million Australian children and young people experience at least one climate disaster or extreme weather event every year. That is equivalent to one in six children, and that number is on the rise. 

Increasing global temperatures and extreme heat are also impacting children’s mental health as more and more children are being exposed to extreme temperatures. Extreme heat exposes children to chronic levels of stress, disrupting sleep and increasing domestic violence. The perinatal period is particularly affected by extreme heat resulting in obstetric complications, and potentially impacting children’s emotional and cognitive development. For example, In recent months, multiple countries from South Sudan to the Philippines were forced to impose school closures due to extreme temperatures, with potential negative consequences on the mental health of children.

Finally, children’s mental health and wellbeing are being negatively affected as young generations grapple with the perception of climate change as an existential threat. Children around the world have been found to be experiencing a range of uncomfortable emotions concerning climate change variously described as climate anxiety, climate distress, or eco-anxiety. One study of 10,000 children and young people across 10 countries found that 59% of participants were very or extremely worried about climate change and 45% of participants reported that their feelings about climate change negatively affected their daily life and functioning. Although these reactions may be experienced as distressing and may act as a stressor that can worsen mental health, it’s important to highlight that in most cases they are adaptive responses to climate change and should not in themselves be pathologized.

Children sit around a table
Credit: Abir Abdullah / Climate Visuals Countdown

Given the growing evidence on the impacts of climate change on children’s mental health, it is paramount that mental health is prioritised in discussions on children and climate change. For the first time, the Subsidiary Body for Implementation (SBI) of the United Nations Framework Convention on Climate Change (UNFCCC) has been tasked with holding an expert dialogue on the disproportionate impacts of climate change on children to identify appropriate child-responsive policy solutions. 

The Climate Cares Centre at Imperial College London has joined forces with United for Global Mental Health with support from partners of the Global Mental Health Action Network from Brazil and Azerbaijan, to call for children’s mental health to be central in this dialogue. 

You can find the full submission linked on this page. 

Recommendations

As part of this submission, we make a specific set of recommendations across three areas including mental health support for children in the context of climate adaptation, integration of mental health into the ​​Glasgow Work Programme on Action for Climate Empowerment (ACE), and ensuring the meaningful participation of children in the expert dialogue.

  • First, we are calling for mental health support for children to be provided in the context of climate adaptation efforts. According to the 2022 IPCC AR6 report, improving access to mental healthcare is considered a form of effective adaptation (see C.3.7). It is imperative that special consideration is given to children given the foundational nature of this period for mental health across the life course. Discussing access and scale-up of frameworks and  finance to build the climate resilience of child-responsive mental health services in adaptation planning and disaster preparedness interventions is critical to effectively protect children from immediate distress and anxiety while mitigating the long-term mental health consequences resulting from exposure to extreme climate events. 
  • Secondly, we are calling for mental health considerations to be integrated within the Glasgow work programme on Action for Climate Empowerment (ACE). The overarching goal of ACE is to empower all members of society to engage in climate action, through climate change education and public awareness, training, public participation, public access to information, and international cooperation on these issues. It is fundamental for mental health to be considered when conducting this work with children, to ensure they feel equipped to engage in climate action as appropriate and their mental health is protected and safeguarded. 
  • Thirdly, we call for meaningful participation within the expert dialogue of children, particularly children with lived experience of mental health challenges in the context of climate change. Young people should be given the space to self-advocate for their mental health and drive the change they want to see in mental health at the national and global levels. It is of utmost importance to support and advance the work led by the official youth and children constituency of the UNFCCC (YOUNGO) and engage the COP29 Presidency Youth Climate Champion, Ms Leyla Hasanova, within the expert dialogue, given the potential of this role to mobilise support for ACE implementation, especially for children. 

The expert dialogue on children and climate change taking part at the SB60 climate meeting in Bonn represents a key opportunity to advocate for children’s mental health to be at the heart of discussions on climate change. We call on the UNFCCC to hold a follow-up expert dialogue on children and climate change to provide a timely stocktake on progress and to convene Parties, experts, civil society, people with lived experience, and other stakeholders to strengthen child-responsive actions and initiatives, to ensure that children’s mental health and wellbeing remain at the forefront of our collective efforts. 

We hope this will represent the first important step towards ensuring that children’s mental health is integrated as a cross-cutting consideration across policies and actions to respond to climate change. 

The healthy psychological development of children represents the foundation of future societies and must be safeguarded at all costs in the face of climate change. 

Read Submission by The Climate Cares Centre and United for Global Mental Health to the Expert Dialogue on Children and Climate Change

Student Wellbeing in IGHI Postgraduate Education and Mental Health Awareness Week:

The Institute of Global Health Innovation (IGHI) is proud to support the Mental Health Foundation this Mental Health Awareness Week – 13 to 19 May. Student Mental Health and Wellbeing (MH&W) has always been an area of focus of the Institute of Global Health Innovation’s Education department. Across its postgraduate courses, the majority of which are delivered online, the IGHI aims to train and develop future leaders in the healthcare sector. We currently host over 400 students studying on a range of post-graduate programmes within the Institute.

In early 2023, a team of Teaching Fellows within IGHI formed a working group to review and identify areas of development within our approach to supporting student mental health and wellbeing. This group grew into the Student Wellbeing in IGHI Postgraduate Education (SWIPE) team. SWIPE undertook a data collection project involving both external colleagues from other universities within the UK who were involved in the delivery of online post-graduate taught (PGT) courses and IGHI students.

Cover page of Interim Report into a Proposed Student Mental Health & Wellbeing Strategy’

We are very excited to share the resulting ‘Interim Report into a Proposed Student Mental Health & Wellbeing Strategy’ to coincide with Mental Health Awareness Week. The report summarises the key findings of the data collection project and includes a list of key areas where changes in practice could lead to improved outcomes, as well as a list of both practical recommendations and broader improvements. The report will be of interest to academics and other professionals involved in the delivery of online PGT programmes.

Read the report

Another important finding of the report was the worryingly small size of the evidence base related to the mental health and wellbeing of online PGT students – it is no surprise that there is also a shocking lack of guidance and examples of best practice on how to best support the mental wellbeing of these students.

The existing evidence base has already shown that there are particular challenges to being an online PGT student. Some of these overlap with the general experience of being an online student in any setting, such as isolation and fewer opportunities to interact with teaching and support staff. Other issues, however, are more likely to affect PGT online students. For example, these students are more likely to be undertaking their studies alongside working a full-time job and/or juggling caring and familial responsibilities. As the online PGT offering expands, and the number of online PGT students grows, there is an urgent need to explore issues related to the mental health and wellbeing of current and future students on these online PGT programmes.

Students informally chatting in a classroom
IGHI postgraduate students at a workshop

Creating a network

Alongside the report, one of the key planned outcomes of the work undertaken by SWIPE to date is the creation and development of a collaborative research network to bring together colleagues who work on – or are interested in – PGT online education. This network will serve as both a space where best practice can be shared but will also allow access to larger samples of students, which will help drive the production of high-quality evidence on how best to support the mental health and wellbeing of this student population.

Two people face each other to chat

The SWIPE team are currently building on existing internal and external collaborations to launch a network of professionals in Higher Education across the UK with an interest in the student experience of online postgraduates, the CROPS (Collaborative Research for Online Postgraduate Students) network. While the focus will initially be on mental health and wellbeing, it is hoped that the work of the network will extend to other aspects of the delivery of online PGT offerings.

Please follow IGHI on X or LinkedIn for more news related to the CROPS network! A launch event is being planned for the summer of 2024.

 

If you are interested in connecting with the SWIPE team, either in relation to CROPS or SWIPE’s work in general, you can reach us at SWIPE@ic.ac.uk.

To find out more about other events organised by Imperial College in the scope of Mental Health Awareness week, visit the Mental Health Awareness Week 2024 page of the Imperial website.

Find out more about our postgraduate programmes: Healthcare and Design; Health Policy; Digital Health Leadership

Making connections for climate change and mental health

Connecting Climate Minds Global Event recap

The Connecting Climate Minds (CCM) Global Event in Barbados involved 70 in-person participants and more than 600 virtual participants. Together, we celebrated the initiative’s first year of work led by seven regional communities, youth, Indigenous Nations and Peoples, and small farmers and fisher peoples.

At the Global Event:

  • The Connecting Climate Minds Hub was launched – an innovative digital platform designed as a collaborative space for researchers, policymakers, educators, and community groups to share their knowledge, resources, and experiences on the climate-mental health nexus including the CCM outputs. 
  • The global event featured keynote sessions delivered by prominent experts in climate change and mental health, along with the marketplace, regional spotlight sessions, and breakout sessions to discuss the Global Research and Action Agenda.
  • “Need for measurement and data” on climate-related mental health impacts, “community” and “co-creation” were the key recurring themes highlighted by participants. 
  • The first Global Research and Action Agenda on climate change and mental health was discussed and will be finalised for launch in July.
  • The global event also launched the key CCM outputs, including ten regional and community research and action agendas, lived experiences, case studies and toolkits. The CCM community discussed opportunities to support the capacity of the Regional Communities of Practice to fulfil the imperative agendas created through the project.

(more…)

Inaugural IGHI Education Community event a success!

The first IGHI Education Community event took place on the evening of Thursday, 11 April 2024. Organised by the Student Wellbeing in IGHI Postgraduate Education (SWIPE) team, in collaboration with St John International, the event welcomed guests in the surrounds of the Museum of the Order of St John’s historic Chapter Hall.
IGHI Education Community Event – The role of the third sector in health systems: focus on the order of St John

IGHI students and staff, alongside guests from the Order of St John, had the privilege of hearing an engaging and eye-opening series of talks from esteemed speakers from both the International Order of St John and St John Ambulance England.

The evening began with a short presentation by Susan le Jeune d’Allegeershecque, Secretary-General of St John International, which provided a whistlestop tour of the history of the Order and its operations in the present day.
Susan le Jeune d’Allegeershecque
She was followed by James Radford, Chief of Staff at St John Ambulance England, who discussed St John Ambulance’s position and role within the UK health system and its interactions with the NHS. Mr Radford stressed the importance of relationship building and the benefits for an organisation of creating a clear identity and staying true to it.
James Radford
Mr Richard Lee, Chief Operation Officer of St John Ambulance England, delivered the final talk of the evening. Mr Lee’s presentation focused on the role St John Ambulance played during the COVID pandemic and provided an enlightening explanation of how the organisation mobilised, trained, and deployed close to 30,000 volunteers to deliver COVID vaccinations within an 8-week timeframe.
The presentations were rounded off by a panel discussion, facilitated by Joe Kerr, during which the speakers shared their thoughts on lessons learned from the pandemic, the impact of changes in the political landscape on third-sector planning, and the experience and lessons learned by transitioning from a 36-year career within the Foreign Office to a senior leadership role within a third-sector organisation.
Panel discussion, facilitated by Joe Kerr
Drinks and a networking session followed, providing guests with the chance to partake in refreshments, chat, and enjoy the splendid atmosphere of the Chapter Hall.
The SWIPE team wish to thank St John International, St John Ambulance England, and the Museum of the Order of St John, for their help in organising this event. Future IGHI Education Community Events are in the process of being planned, so keep your ears to the ground and make sure to join us for the next event!

Julia Anderson Careers Event 2024: Inspiring sixth formers with career insights and opportunities to transform global health

In February we hosted the Julia Anderson Training Programme (JATP) Careers Event 2024 at Institute of Global Health Innovation (IGHI), a fantastic evening for sixth form students to learn more about our Julia Anderson programme and the IGHI, and get inspired for their future careers. 

JATP trainees with IGHI staff
Credit: Rolando Charles

Sixth formers from different London state-funded schools travelled to The Invention Rooms, at Imperial College London’s White City Campus, to participate in the event. They got the chance to learn more about the opportunities at IGHI, hear some of our staff members’ career journeys, as well as interact with some of the fantastic workstreams we work on to improve people’s health.

About the Julia Anderson Programme and next cohort recruitment 

The evening started with Sophie Pieters, IGHI Operations Officer and JATP Programme Lead, welcoming the attendees and introducing the JATP programme, including the eligibility criteria and the new trainee roles available in the summer. 

The Julia Anderson Training Programme gives people with limited or no work experience the opportunity to join an impactful stream of work at IGHI, Imperial College London’s. The paid programme gives trainees the opportunity to grow their network, boost their CV and develop applicable workplace skills and knowledge.  

Sophie announced the three upcoming roles for the next cohort in July, specifically Analytics and Events Trainee, Public Involvement Trainee and Educational Research Trainee (the first two are open to those with no university). On 14 March, a webinar will be held to provide people with more information on the programme, the training positions on offer and useful advice for the application. Students were highly encouraged to sign up for the webinar. 

Career talks from IGHI staff and trainees 

Next, some of the IGHI staff and current trainees delivered individual presentations highlighting their career journey, challenges, and other valuable insights from their experience. 

“I found the job I loved although didn’t know it existed. It’s okay if you don’t know what you want to do.’’, said Eleni Daniels, Patient Safety Research Centre (PSTRC) Manager at IGHI, who has a background in biomedical sciences and worked in advertising before finding her dream job in a patient safety field. 

Image: Eleni Daniels giving a presentation about her career journey. Credits: Rolando Charles
Image: Eleni Daniels giving a presentation about her career journey. Credits: Rolando Charles

Amish Acharya, Scientific Advisor to Professor Ara Darzi at IGHI, talked about his ‘unconventional’ career path from medicine, followed by PhD in Behavioural Science, to his current role, where he is contributing to creating research projects and supporting the progress of scientific work. Amish advised: 

“Exams don’t represent who you are and what you can do. It’s never too late to change your path, don’t be afraid to try different things – this can often make you more adaptable and rounded as a person.’’ 

One of our current Julia Anderson Trainees, Tania Domun, a graduate of Population Health and Medical Sciences with a Master’s degree in Public Health, shared her experience so far as a JATP trainee in Behavioural Science and the benefits of joining the programme: 

Tania Domun sharing her experience as a current JATP trainee. Credits: Rolando Charles
Tania Domun sharing her experience as
a current JATP trainee. Credits: Rolando Charles

“JATP allows you to develop your skills and support you with the next steps in your career. It’s challenging when you don’t have a mentor or people to help you navigate your professional path. The programme does exactly that, by focusing on you as an individual. It’s a lot about your passions and not your previous work experience. This makes it a unique programme.’’ 

She also talked about the Imposter syndrome: ‘’I’ve realised many people, including me, deal with this syndrome – don’t let these feelings stop you from applying for the programme. This is the best time to explore possibilities and build new skills.’’ 

Lastly, Clarissa Gardner, Senior Design Researcher at TPXimpact and Honorary Research Fellow, spoke about her career journey as a ‘learning process’ and how she came about setting the JATP programme, after doing a MSc in Health and Design at IGHI: 

‘‘Your job title doesn’t matter as much as your ability to help others and inspire positive change. I recognised the diversity of people at IGHI, so I proposed this programme to create work experiences for people.’’  

Interactive activities showcasing IGHI Centres’ work 

After these inspiring talks, we organised interactive activities led by each of the IGHI Centres. During these sessions, attendees had the opportunity to engage with the different workstreams at IGHI in small groups and interact with IGHI staff members.  

The Hamlyn centre hosted a ‘create your own surgical robot’ activity. Sixth formers were challenged to conceptualise the design of a robot, then turn their drawings into 3D images using specialised software. Hamlyn centre representatives also explained the benefits of surgeons using surgical robots compared to traditional surgery methods, highlighting how they enhance precision during procedures. The participating team included Brandon Davies, Learning Technologist, Nazia Bharde, Project Officer, Robert Merrifield, Medical Design Associate and Salzitsa Anastasova-Ivanova, Facilities Manager.

Brandon Davies briefing students on how to design a surgical robot. Credits: Rolando Charles
Brandon Davies briefing students on how to design a surgical robot. Credits: Rolando Charles

At one of the Helix Centre stands led by Jodie Chan, Patient and Public Involvement and Engagement Officer, and Clare McCrudden, Policy Fellow from the Change Lab, students had the opportunity to discover how the public can influence research priorities, methodologies, and dissemination for healthcare improvement. They were encouraged to brainstorm alternative names for ‘antimicrobial resistance’ and open the ‘can of worms’ around healthcare data through an interactive activity, sparking further discussions on its benefits and risks. 

Image: Clare McCrudden talking about antimicrobial resistance with sixth formers. Credits: Rolando Charles
Image: Clare McCrudden talking about antimicrobial
resistance with sixth formers. Credits: Rolando Charles

They also learned about one of the upcoming JATP roles – Public Involvement Trainee – who will help to involve local youth groups and schools in a project aimed at better understanding the mental health needs of children across the UK and identifying how services can better support them. 

The second Helix Centre stand was led by Matthew Harrison, Senior Design Associate, Alex Dallman-Porter, Designer Healthcare Products, and current JATP trainee, Andrew Watt. People were invited to participate in a grip strength assessment activity, during which they were asked to squeeze a ball-shaped dynamometer (‘squegg’) in their hand to measure their frailty levels and compare with their peers. Additionally, the stand showcased a sleeping mat used for measuring heart rate and respiratory rate, along with other environmental sensors designed for individuals with dementia. 

Jessica Newberry Le Vay, Climate Change and Health Policy Fellow at the Climate Cares Centre, hosted an interactive session about exploring climate emotions and imagining what future they want to see. The students were challenged to think about the following questions: ‘’How does climate change make you feel?, What stories do you hear about the future?, What would you want the future to look like?’’  

People were able to discuss their responses to these questions and see what other people have put. They explored actions that can improve both mental health and the climate, building hopeful and constructive narratives around climate change.  

Eleni Daniels from PSRC also had a stand on patient journey. She encouraged students to reflect on healthcare experiences of themselves, their family members, or friends, and to consider how these experiences could be further improved. People shared their thoughts and experiences, engaging in a dialogue that allowed them to open up and explore patient journeys from the GP to hospital settings. 

Feedback from sixth formers 

We were impressed by the amount of positive feedback we received from the sixth formers. Some examples below: 

“I’ve discovered that you don’t need to know exactly what you want to do at this age. It’s more important to be open to learning and taking on new opportunities and experiences.” 

“Many internships and training programmes require individuals to meet specific minimum requirements. It’s fantastic to discover that the JATP program doesn’t have such requirements, giving people the chance to gain those skills and build experience.”

Sophie Pieters, JATP Lead, and Holly Merton, JATP trainee, chatting with the sixth formers. Credits: Rolando Charles
Sophie Pieters, JATP Lead, and Holly Merton, JATP trainee, chatting with the sixth formers. Credits: Rolando Charles

“I found the event very engaging and fun. It made me think about my future career, the steps I want to take next and the sort of support I should be seeking. I am keen to apply for this programme!’’ 

On the day feedback indicated that, among our participants, 90% were inspired for their career after attending the event. According to our post-event online survey, 92% of our participants expressed their willingness to recommend JATP to a friend, while 83% of respondents indicated their intention to apply for JATP in the future. 

We are looking forward to seeing people applying for the JATP programme and taking advantage of the tremendous opportunities at IGHI to advance in their careers. The event was made possible by the EDI Seed Fund and we are very grateful for their support. 

Celebrating women at IGHI for International Women’s Day

We’re featuring some of the amazing women at the Institute of Global Health Innovation, to celebrate their achievements during Women at Imperial Week 2024.

Imperial President Prof Hugh Brady with some of the women at IGHI
Imperial President Prof Hugh Brady with some of the women at IGHI

Meet some of our women at IGHI

From our teaching team…

Christa Hansen, Teaching Fellow, DHL Programmes, IGHI

Christa HansenI work as a Teaching Fellow on the Digital Health Leadership programmes, and across IGHI more broadly. I completed my PhD in Health Economics here at the Business School. Since graduating I have enjoyed coming over to the ‘health’ side, supporting GMPH and BSc students at the School of Public Health, and now NHS clinicians on the DHL programme. I love working in a multi-disciplinary setting, and am proud to be a member of the IGHI team. Personally, I have a 9-year-old daughter who plans to be a ‘discovery scientist’. Any future PhD ‘discovery’ ideas welcome.

 

Toni Page, Senior Teaching Fellow, DHL Programmes, IGHI

I have the privilege to be working on the Digital Health Leadership programmes supporting health and social care professionals in their journey of developing as digital leaders. I enjoy being part of a multidisciplinary team enthused about health and education. My PhD focused on developing a model offering undergraduate nursing students the opportunity to help service users and carers in learning about and using digital health. Embedding digital health into the curricular for health and social care professionals is a topic I am truly passionate about, and I am always keen to work collaboratively with others to achieve this.

 

Working with the Helix Centre…

Anna Lawrence-Jones, Public Involvement Lead, IGHI

I support staff to meaningfully involve patients, carers and public members in their work. I’m passionate about ensuring people from under-represented groups are heard in research. I lead the public involvement strategy across our Patient Safety Research Collaboration (PSRC) and lead the Public Involvement and Equity Diversity and Inclusion Networks for SafetyNet (a collaboration between the 6 national PSRCs). Working at IGHI has led to me meet and learn from so many talented colleagues, patient representatives and external partners, from diverse backgrounds.

I’ve been at IGHI for 8 years. Each year, there is always new exciting work to get involved in. Currently, I’m working with the charity Mental Health Innovations to set up their first Service User Voice Group, who will help to improve Shout, the 24 hour crisis text line. I’m also working with our amazing data analysts to safely analyse anonymous data from Shout. Service users will shape this work, which we hope will lead to changes in policy and practice and improve mental health care.

 

Fiona O’Driscoll, Policy Fellow at the Helix Centre, IGHI

As part of the Helix Centre, I work on a range of projects that aim to improve health and healthcare for all with design. I mainly work on projects with our local NHS Trust – Imperial College Healthcare NHS Trust – which is also where we’re based at St Mary’s Hospital.

I enjoy working with such an amazing and creative team at Helix Centre and across IGHI. Working on real-life issues and challenges within the NHS is really rewarding, as we hope to make a tangible impact to patient and staff experience.

I worked as a doctor and management consultant before joining the Helix Centre, so have taken a more unconventional route to IGHI! During COVID I also started a part-time Masters in Public Health. It’s been challenging to do in my spare time, but really interesting to apply what I’ve learnt to my projects. My team have also been really supportive in helping me to fit in time to study and take exams, as I’m planning to complete it this year!

 

Kate Grailey, Centre for Health Policy and Helix Centre Academic Research Lead

I provide academic support to both the Centre for Health Policy and the Helix Centre at IGHI, which gives me the amazing opportunity to collaborate with a huge range of inspiring people – including policy makers, designers, data analysts and researchers.

I also work as a research fellow in behavioural science as part of the Fleming Initiative and in a team called the Change Lab. I really enjoy exploring the determinants of behaviours and co-designing solutions to a range of problems including antimicrobial resistance and patient safety.

Before my time at IGHI I worked clinically as an Anaesthetist and completed a PhD in Psychological Safety.

Clare McCrudden, Policy Fellow, Helix Centre, Institute of Global Health Innovation

I am a Policy Fellow based at the Helix Centre at IGHI. I apply behavioural economics and user-centred design methods to improve healthcare. I work on projects for our NHS partners, as well as within our Health Tech products through stakeholder engagement and involving patients throughout.

It is brilliant to work with such talented and creative colleagues and learn from all the variety of disciplines that make up IGHI! I also enjoy that our work is both hyper local to Northwest London as well as on an international scale, enabling us to collaborate across the globe.

I am a Qualified Social Worker, experienced in both community and hospital settings which is helpful for understanding how our health systems work. I then moved abroad and completed a Master of Science in Global Health where I spent some time in Maastricht, Netherlands and working in public health in Bogotá, Colombia. Once I moved to London, I worked cross cuttingly with the NHS and charity sector in the public involvement space in cancer care, before joining IGHI in 2021!

Dr Leila Shepherd, Managing Director, Helix Centre

Here at IGHI, I have the privilege of leading the Helix Centre and championing the impact of design in healthcare.

What I enjoy most about my role are the inspiring people I get to work with at Helix and IGHI, and also frontline staff and public members. As a parent, I find IGHI to be a great place to flexibly balance professional and personal growth.

An engineer by background, my mission is to use tech for good. As my career has evolved though, I’ve learnt that tech that isn’t designed with users can do more harm than good, and also that tech is not always the answer! This is what makes the design methods we use at Helix to put people and their needs first so important.

From our Big Data and Analytical Unit (BDAU)…

Davina Tijani, Data Operations Manager, Big Data Analytical Unit, IGHI

I am Data Operations Manager for the Big Data Analytical Unit, my main responsibilities are onboarding users to the BDAU Server, dealing with user enquires and supporting data management which includes data transfers and completing data applications. Previously, I completed my undergraduate in Actuarial Sciences at University of East Anglia and my masters in Smart Cities and Urban Analytics at University College London. I love working with and supporting researchers in their clinical research across a variety of disciplines and subjects such as Patient Safety, Mental Health and Cancer to name a few.

 

Mahsa Mazidi, Big Data and Analytical Unit, IGHI

I lead the Big Data and Analytical Unit (BDAU) at IGHI, where our primary focus is on providing data services and analytical support to researchers engaged in the analysis of sensitive patient data. My role involves overseeing the BDAU Secure Environment (SE), a research space that is ISO 27001 certified and compliant with the NHS Data Security and Protection Toolkit. This ensures that researchers can do their work with the highest level of security and data protection. I have a master’s degree in computer science and have been part of the Imperial community for over 9 years. What I find most rewarding is the chance to collaborate with colleagues from across the College and support their incredible research projects.

 

From Climate Cares…

Daniella Watson, Research Associate, Climate Cares Centre, IGHI

I am a Research Associate and Health Psychologist working on climate change and mental research projects. I love working with an ambitious team of women at the Climate Cares Centre. With my behavioural science hat on, I am also a Co-convenor and Trainer of ‘Healthy Conversation Skills’ training. Previously I was working on maternal and child health projects in South Africa. Turning points in my career were working with two fabulous psychologists during my undergraduate years, who later became my PhD supervisors, mentors and friends, and also working on voluntary projects in the Caribbean and India.

 

And Communications…

Victoria Murphy, Stakeholder Engagement and Communications Manager

I communicate the amazing work that our colleagues do – engaging the public, influencing policy, and research with global impact. I love that I get to hear the details of what we’re doing at IGHI, and working with different colleagues across all our programmes of work and in various of parts of Imperial.

My career started in a very different way – working in mining in remote parts of Australia. It had its moments – good and bad! I’ve really grown my career since changing my focus to communications and research. I find my colleagues here so supportive and interesting, and I have a lot of respect for their talents. It’s one of the reasons I’ve been at Imperial for over 6 years!

 

Dr Laura-Maria Horga, Communications and Events Office

I am delivering the communications and engagements across IGHI, to promote the fantastic research and achievements of the Institute. I started in this role over two months ago, and I’m thrilled to contribute to a range of impactful projects aimed at addressing some of the biggest global health challenges of our time.

Everyone I met at IGHI is genuinely friendly, supportive, and passionate about their work. I’m particularly drawn to the creative environment and the opportunities for innovation that it offers. I’m passionate about amplifying researchers’ profiles, highlighting their achievements, and making science more accessible to the public.

Prior to this, I worked in communications at The Institute of Cancer Research for two years. My background is in biotechnology, and my PhD project at University College London focused on investigating the impact of marathon running on orthopaedics using imaging technologies.

 

Ukraine: Better care for children with complex long-term health needs

Our third blog post for the two-year anniversary of the invasion of Ukraine addresses the importance of prioritising better care for children with complex long-term health needs.

This is part of a series of blog posts sharing insights from our Ukraine Health Summit, hosted in partnership with the British Red Cross to further efforts in supporting the delivery and restoration of health services in Ukraine. This piece is written by Alexandra Shaw, Institute of Global Health Innovation, Imperial College London, with colleagues.

[Ukraine Health Summit: attendees chatting]
Ukraine Health Summit: attendees chatting

In Ukraine, many children continue to be cared for in institutions. Estimates vary widely and suggest that between 90,000-200,000 children reside in these institutions, and approximately 20,000-50,000 of them have disabilities.1 2

Children have a range of disabilities including congenital abnormalities of the nervous and cardiovascular systems, foetal alcohol spectrum disorders, genetic disorders and chromosomal abnormalities, visual impairments, cerebral palsy and epilepsy.3  Factors impacting institutionalisation include poor infrastructure for children with disabilities, including education and community-based therapy services. There is a lack of crucial services, including rehabilitation and palliative care, and support in the community, making caring for a child with complex health needs even more challenging. Social challenges also drive institutionalisation including poverty, social stigma and the lack of support means families are left isolated.3 An estimated 90% of children placed in institutions have parents or family but are placed in institutions because of the challenges of caring for them in the community. Other factors include the inability of parents to care for their children, neglect or substance abuse.2   

Impact of institutionalisation 

In 2019, the 74th UN General Assembly adopted the resolution on ‘Rights of the child’ which urges that family and community-based care should be promoted over placement in institutions, and that children with disabilities should enjoy all human rights and fundamental freedoms on an equal basis with other children, including access to a family life.4 Children living in institutional environments can suffer significant harm including the impact on their quality of life, their ability to adapt to society, mental health and overall development.5 Facilities often fail to meet basic needs, address individual requirements and provide emotional and social stimulation.

Institutionalisation can lead to poor physical and mental health outcomes, stunting and a lack of development from inadequate nutrition, and infectious disease. Children who have been institutionalised can be left with difficulties processing and integrating sensory information, poor language development, damaging behaviours and significantly shortened life expectancy.6 Staff to child ratios are often inadequate, leading to inappropriate methods of restraint, and a lack of supervision means children are not provided with adequate sanitary care, or assistance with feeding.2

Reform and impact of war

Before the war, the government had adopted the National Strategy on Reform of the Institutional Care System (2017-2026), however there have been delays in implementation and children with disabilities have been excluded included in these reforms.7 The war has made the situation for children with complex long-term health needs even more desperate. Whilst children with more mild disabilities are being evacuated, many children have been moved from facilities in the east of Ukraine to inadequate facilities in the west. This had led to overcrowding, further reduced staff ratios, and a lack of medical records leaving staff looking after children with no background information about their condition and care needs.8

In some cases, children have been returned to their families without support or guidance to ensure the child’s health needs are adequately met.1 The European Commission has provided 230 million in humanitarian aid to the Ukrainian government which brings an opportunity to ensure disabled children benefit from the assistance provided to Ukraine.9

[Ukraine Health Summit: Dr Ulana Suprun]
Ukraine Health Summit: Dr Ulana Suprun

Moving forward 

There is still progress to be made to improve care for children with complex health needs in Ukraine. A unified approach is required which clearly defines the responsibilities and powers of government authorities and local organisations to apply standards to protect children’s rights and care. Key recommendations include:

     1. Reform for the provision of community based care 

  • Change of policy and legislation, alongside political commitment, to prevent future institutionalisation and protect the rights of children, particularly those with disabilities.   
  • Implement programmes to develop long-term family-based environments for children currently living in institutions. 
  • Develop services to support children and families in the community including early intervention, social care support systems, family-based care, rehabilitation services, social services and paediatric palliative care. 
  • Enable a holistic approach to care for children with complex health needs, including the role of education, sport, family and culture. 

     2. Paradigm and cultural change campaign 

  • Launch a comprehensive and sustained campaign to enable a shift in attitudes and paradigms across all professions and the workforce. 
  • Implement policy and a public campaign to encourage a societal shift in the way children with complex long-term health needs are viewed. 
  • Enable the empowerment of families to advocate for their own children and specialist needs. 

      3. Development of health and social care workforce  

  • Implement educational programmes to increase the size of the workforce in the areas of medical rehabilitation services, paediatric palliative care and social services. 
  • Upskill professionals and expand access to continuing development for staff working across paediatric health and social care. 
  • Develop capability in the community for family members, carers, social workers, rehabilitation staff, and other allied professionals such as speech and language therapists to support children in the community. 

     4. Strategic allocation of reconstruction funding 

  • Develop a strategic plan to guide the allocation of reconstruction and support funding for children to be cared for outside of institutions.  
  • Enable collaboration across different ministries which oversee education, social care and health to bring a more unified effort towards reducing the number of children living in institutions. 
  • Prevent the reconstruction and rebuilding of institutions and instead invest in foster care, family and community-based services. 

 

References 

  1. Ukraine war response: Children with disabilities. UNICEF; 2022 (https://www.unicef.org/emergencies/ukraine-war-response-children-disabilities, accessed 18 February 2024).
  2. No Way Home: The exploitation and abuse of children in Ukraine’s orphanages. Disability Rights International; 2015.  (https://www.driadvocacy.org/reports/no-way-home-exploitation-and-abuse-children-ukraines-orphanages, accessed 18 February 2024).
  3. Behind the mask of care: A report based on the results of the situation analysis of baby homes in Ukraine. Hope and Homes for Children, USAID, UK Aid; 2020.  (https://www.hopeandhomes.org/publications/a-report-based-on-the-results-of-the-situation-analysis-of-baby-homes-in-ukraine/, accessed 18 February 2024).
  4. Rights of the child: resolution adopted by the General Assembly. 74th UN General Assembly; 2019: United Nations.
  5. Slozanska H, Horishna N. Functioning of boarding schools negative impact on pupils. Social work and education. 2021;8:18-41.
  6. Huseynli A. Implementation of deinstitutionalization of child care institutions in post-soviet countries: The case of Azerbaijan. Child Abuse Negl. 2018;76:160-72.
  7. Rosenthal E, Kurylo H, Ciric Milovanovic D, Ahern L, Rodriguez P. Protection and safety of children and disabilities in the residential institutions of war-torn Ukraine: The UN Guidelines on Deinstitutionalization and the role of International Donors. International Journal of Disability and Social Justice. 2022;2(2).
  8. In Ukraine, children with disabilities live in horrific conditions. Handicap International; 2022 (https://www.hi.org/en/in-ukraine–children-with-disabilities-live-in-horrific-conditions#:~:text=The%20situation%20of%20disabled%20children,risk%20of, accessed 18 February 2024).
  9. The forgotten victims of the war against Ukraine: European Network on Independent Living; 2022 (https://enil.eu/the-forgotten-victims-of-the-war-against-ukraine/, accessed 19 February 2024).

 

Health in Ukraine: Prioritise health care reform across the Ukraine health system for recovery and stable peace

Two years on from the invasion of Ukraine, we share a series of blog posts highlighting insights from our Ukraine Health Summit last year, hosted in partnership with the British Red Cross to reflect on and support the delivery and restoration of health services in Ukraine.

The second blog post focuses on the prioritisation of health care reform across the Ukraine health system for recovery and stable peace, and is written by Niki O’Brien, Institute of Global Health Innovation, Imperial College London, with colleagues.

Ukrainian flag colours. Credits: Tina Hartung/Unsplash
[Ukrainian flag colours. Credits: Tina Hartung/Unsplash]

The war in Ukraine has caused substantial disruption to a health system that was already having to manage complex transitions.1

In 2014 the Ministry of Health of Ukraine initiated a national strategy to improve quality and access to care and sought to address longstanding challenges in strengthening primary health care (PHC), among other reforms.2 Since then, a guaranteed benefit package to reduce out-of-pocket payments was set up and enrolment with contracted PHC providers expanded to cover over 70% of the population as of 2020.

Since 2014, initial armed conflicts in the Donetsk and Luhansk regions have had implications on regional health services. However, the ongoing Russian invasion in 2022 has led to widespread disruption and destruction of infrastructure and resources across the country. Nationwide attacks on civilian infrastructure also target healthcare facilities, with over 1,500 damaged or destroyed as of 15 June 2023.3 The occupied territories have been hit particularly hard and face a severe shortage of health care workers (HCWs), medications, and supplies. For example, in the municipality of Melitopol, half of the doctors were forced to leave in the first months of the war.4 National and regional progress towards health policy ambitions has been drastically curtailed as resources have been reallocated to the immediate needs of the emergency response including frontline medical care.

Armed conflicts cause both direct and indirect morbidity and mortality with the latter occurring from both communicable and non-communicable diseases (NCDs). As expected, a rapid increase in infections has been reported, and the destruction of the Kakhovka Dam may further affect many thousands of local inhabitants while increasing the risk of the waterborne diseases.5 Moreover, cancers, oncology, and stroke in particularly can occur as a result of or be exacerbated by stress-mediated pathways.6 In Ukraine, cancer mortality was already high, however, recent research suggests that war-related delay in care of four months for five of the most prevalent cancers could lead to an excess of over 3,600 cancer deaths in the coming years.4

The war has also interrupted reform at the patient, health delivery and policy levels which had been initiated through disease-specific lenses in secondary and tertiary care pre-2022. For example, a significant proportion of Ukraine’s radiotherapy is based on Cobalt-60, rather than modern linear accelerators (LINACs) reflecting a wider need not just to increase basic modern technologies (CT, MR scanners etc) but also to upgrade existing hospital infrastructure.7 Volunteer and humanitarian help are essential but currently fulfil only some of the gaps, challenged further by lack of a nationwide coordination to address the needs of healthcare institutions.

Ukraine Health Summit woman in the audience speaking
[Ukraine Health Summit: woman in the audience speaking]

Measures to support Ukraine’s health system both now and in the early recovery period will need to focus on investment in HCWs and working with patient groups. For HCWs, examining and addressing the various push-pull factors, at a policy and systems level are required to support return. Pull factors for return include security and the potential to resume professional advancement and renumeration by re-establishing links between health service delivery and continuing education. Subject to budgetary constraints, the Ministry of Health could consider capitation-based payments and non-financial benefits to encourage relocation to resource-limited geographic areas or specialties.

Research in post-conflict settings highlights the value of indirect financial incentives (e.g., subsidised meals, childcare facilities, support for continuing education) and non-financial incentives (e.g., career development, improved healthcare facility resources and infrastructure).8 Digital learning platforms can further offer HCWs the opportunity to develop their knowledge by undertaking education and training remotely. There is also a need to invest in the PHC workforce (both physician and non-physician) together with substantial investment support and treat patients in the post-war period.

Ukraine is fortunate to have strong physician and patient organizations who can advocate for the needs of patients and communities. Advocating across disease areas and advising on where treatment can be sought, these organizations connect to patients and communities through social media while also working with high-level policymakers to drive change. When ProZorro, an electronic procurement system was launched in 2020 as part of reforms, 100% Life, one of the largest patient organizations in Ukraine used data from the system to fight corruption, with tangible benefits for the Ukrainian health system.9

After one year of war, in 2023 the organisation had collected $968,000 USD for humanitarian aid and provided 4,773,296 packages of medical goods.10 In 2024, the organisation and its partners has continued to support health service delivery by facilitating training and purchasing medical equipment.11 12Importantly, all individuals, organizations, and groups involved in delivering and receiving health care in Ukraine must come together to through a ground-up, community-led approach to realise a people-centred health system and drive people-centred reforms.

To be successful, efforts must be driven by patient, community, and population needs, led by government, and supported by providers and other stakeholders across the public and private sectors. As further atrocities are reported daily as the war in Ukraine rages on, there may be a reluctance to prioritise the planning of future health services. However, health, and therefore health care, is a prerequisite for recovery and stable peace.

References

1. Roborgh S, Coutts AP, Chellew P, Novykov V, Sullivan R. Conflict in Ukraine undermines an already challenged health system. Lancet. 2022 Apr 9;399(10333):1365-1367. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)00485-8/

2. WHO. Health financing reform in Ukraine: progress and future directions. World Health

Organization, 2022. Geneva, Switzerland. Available at: https://www.who.int/ukraine/publications/i/item/WHO-EURO-2022-5639-45404-64974

3. Міністерство охорони здоров’я України. За понад 15 місяців повномасштабної війни росія пошкодила або зруйнувала 1 554 об’єкти медзакладів. Міністерство охорони здоров’я України, 2023. Kyiv, Ukraine. Available at: https://moz.gov.ua/article/news/za-ponad-15-misjaciv-povnomasshtabnoi-vijni-rosija-poshkodila-abo-zrujnuvala-1-554-ob’ekti-medzakladiv-

4. Khanyk N, Hromovyk B, Levytska O, Agh T, Wettermark B, Kardas P. The impact of the

war on maintenance of long-term therapies in Ukraine. Front Pharmacol. 2022;13:1024046. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9731218/

5. Pavlenko D, Pavlenko M, Pavlenko R. Advantages and limitations of teleophthalmology during the war in Ukraine. Graefes Arch Clin Exp Ophthalmol. 2023 Jun;261(6):1761-1763. Available at: https://link.springer.com/article/10.1007/s00417-022-05967-1

6. Jawad M, Hone T, Vamos EP, et al. Estimating indirect mortality impacts of armed conflict in civilian populations: panel regression analyses of 193 countries, 1990–2017. BMC Med, 2020; 18, 266. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487992/

7. Price P, Sullivan R, Zubarev M, Zelinskyi R. Radiotherapy in conflict: lessons from Ukraine. Lancet Oncol. 2022 Jul;23(7):845-847. Available at: https://www.sciencedirect.com/science/article/pii/S1470204522002984?via%3Dihub

8. Witter S, Tulloch O, Martineau T. Health workers’ incentives in post-conflict settings – a review of the literature and framework for research. ReBUILD RPC, 2012. London, United Kingdom. Available at: https://assets.publishing.service.gov.uk/media/57a08a7be5274a31e0000614/rebuild_hwi_lit_review.pdf

9. Hrytsenko, Y. Fight for life: how Ukraine is fixing medical procurement and serving patients better. Open Contracting Partnership, 2021. Available at: https://www.open-contracting.org/2021/02/22/fight-for-life-how-ukraine-is-fixing-medical-procurement-and-serving-patients-better/

10. 100% Life. 100% LIFE, A Year Of Courage. 100% Life, 2023. Available at: https://network.org.ua/en/100-life-a-year-of-courage/

11. 100% Life. With the USAID support, 100% Life covered all primary care physicians in Lviv the training. Available at: https://network.org.ua/en/with-the-usaid-support-100-life-covered-all-primary-care-physicians-in-lviv-the-training/

12. 100% Life. Japanese Ministry of Foreign Affairs funds purchase of equipment for Ukrainian hospitals. Available at: https://network.org.ua/en/japanese-ministry-of-foreign-affairs-funds-purchase-of-equipment-for-ukrainian-hospitals/