NURS 6050 Week 11 Assignment: Global Healthcare Comparison Matrix and Narrative Statement
- NURS 6050 Week 11 Assignment
Global Healthcare Comparison Matrix and Narrative Statement
Student name
Walden University
NURS 6050
Professor Name
Submission Date
Global Health Comparison Grid Template
Use this document to complete the Module 6 Assessment Global Healthcare Comparison Matrix and Narrative Statement.
| Global Healthcare Issue | Tuberculosis (TB) | |
| Description | WHO (2023) explains T.B. to be one of the many infectious diseases that is caused by the bacteria Mycobacterium tuberculosis, which primarily attacks the lungs. It mostly spreads through the lungs; however, other parts of the body, including the intestines, brain, etc, can be attacked by T.B. if the infected person coughs, sneezes, or spits on another person. T.B. can affect everyone of all ages, genders, and ethnicities. The good news is that T.B. is preventable and can be cured with treatment that rapidly decreases and removes the organism’s pathogenicity.About one-fourth of the world is estimated to be infected with T.B. However, a minority of those infected (5-10) later turn into disease carriers and start to show the symptoms. It is important to note that those infected or who have been infected in the past and are disease-free are non-infectious. Untreated T.B. is a disease that could later be life-threatening and may require treatment with antibiotics if a person has not undergone treatment yet. In several countries, all infants and some children under the age of 5, at present, are given the BCG vaccination against Tuberculosis. Although the vaccination may interfere with and reduce the severity of T.B. disease and other non-pulmonary forms of T.B., it still has a limited effect on the prevention of pulmonary T.B.In 2022, Tuberculosis is estimated to have caused 1.3 million deaths. Another 167,000 deaths were of people who were co-infected with Tuberculosis and HIV.According to the WHO (2023), TB is the second deadliest communicable disease, after COVID-19, even more so than HIV/AIDS. In 2022, there were approximately 10.6 million new TB cases, consisting of 5.8 million men, 3.5 million women, and 1.3 million children.Although there have been new advancements in fields such as science and technology, the emergence of multidrug-resistant TB (MDR-TB) has been a huge global concern, as it has in the past. In 2022, it is estimated that only 40% of people who had MDR-TB were receiving treatment. The WHO (2023), however, states that new innovations in global health have attained impressive results (over 75 million lives saved) as of the year 2022.To ensure TB is prevented and in order that there is early and proper diagnosis, treatment, and care, the ‘TB Response’ was created to meet the Global End-TB target set at the 2018 UN General Assembly on TB, which advocates a yearly investment of US$13 billion (WHO, 2022). With the existence of TB as an endemic and a public health concern, it is one of the priority health issues for the UN SDGs, which will be an urgent economic, social, and health interest to resolve.This paper’s aim is to raise awareness of the key issues of TB, as well as its treatment and prevention. In particular, it is to help critical thinkers understand the roles of TB workers, as well as the WHO and related NGOs, in prevention, treatment, and the fight against the TB epidemic. | |
| Country | United States | Brazil |
| Describe the policy in each country related to the identified healthcare issue. | The Centers for Disease Control and Prevention (CDC) established policies in its Tuberculosis Elimination Division (DTBE) and Public Health Law Program (PHLP), which have helped to develop and shape Tuberculosis (T.B.) control and containment policies (CDC, 2020). The U.S. Government has designed and implemented policies and has taken substantial action to control T.B. and has become one of the primary funding and implementing agencies for this disease (Kaiser Family Foundation, 2019). The U.S. Government has allocated as much as $406 Million for its global programs for Fiscal Year 2023 (Kaiser Family Foundation, 2019). The U.S. Government has targeted approximately 50 countries, and has focused its efforts on the prevention, detection, and treatment of T.B., including Multi Drug-Resistant Tuberculosis (MDR-T.B.), as well as for the control of the global burden of T.B. health and health systems. The U.S. Government’s national policies and strategies for essential health services, such as those of the CDC (2021), advocate for early case detection and reporting, protective measures for close contacts, intentional measures to control the disease, enhanced prevention efforts, and reduction of the burden and risk of T.B. The use and implementation of infection control measures and strategies are also advocated. The 2019 Recommendations regarding Tuberculosis screening in the U.S. health care personnel (HCP) outline screening and testing baseline requirements, as well as post-exposure testing, screening, and serial testing as part of precautionary measures and identification steps among HCPs with no LTBI (Sosa et al., 2019). The U.S.A. does not rely solely on its resources and controlling T.B. within its frontiers; rather, it finances the health care of 24 high-burden T.B. countries through the USAID program. The U.S. supports the World Health Organization’s efforts to reach every T.B. patient, provide treatment, and stop the transmission. They provide tailored assistance to maximize the Government’s investment in the Global Fund. Alongside T.B. treatment and prevention guidelines, CDC (2021) conducts continuous training and education courses aimed at the general public and health care personnel.The Strategic Plan 2022-2026 by the National Center of HIV, Viral Hepatitis, STI, and TB Prevention (CDC, 2022) states its vision, mission, values, principles, strategies, and key objectives, and is intended to deliver the following outcomes by 2026:Goal: Reduce HIV, Viral Hepatitis, STIs, and TB.1. Reduced morbidity and mortality due to these diseases.2. Reduce and leverage inequalities and promote health equity.3. Attain organizational excellence | Humanized ResultDescribed as rapid diagnosis with fast testing, the Brazilian national policies rely on limited physical contact prevention and management of medicines using quality-assured regulatory policies (StopTB, 2020). With a 50% uptake, Brazil is classified based on the uptake of the key policies recommended internationally. Brazil, along with the WHO, has established the Inter-ministerial Committee on the Elimination of Tuberculosis and Other Socially Determined Diseases (CIEDS), which is in line with the WHO recommendations of undertaking multi-sectoral approaches to end the T.B. epidemic and other naturally occurring social-determined diseases in Brazil by the year 2030 (Sanjeet Bagcchi, 2023).From a funding and costing perspective, individuals with T.B. in Brazil experience economic difficulties in accessing the means necessary to obtain a TB diagnosis and TB care. In order to facilitate the monitoring and evaluation of the financial woes of T.B., the WHO has made available a number of standard survey methodologies that are meant to assess the T.B. disease burden (WHO, 2021).Largely financed by the Global T.B. Program, a survey carried out by the Brazilian National T.B. Program (NTP) between 2019 and 2021, reported that nearly 48% of the T.B.-burdened families surveyed suffered a tremendous financial burden, with this burden averaging a financial threshold of greater than USD 1,573 (WHO, 2021). Stemming from the above, in order to implement the Brazilian policy to combat T.B., the approach is made to be incremental and places a disproportionate financial burden on the patient(s). Consequently, this policy causes the patient(s) to have a fear of seeking the diagnosis and treatment of the disease.As described by Oliveira Cortez et al. (2021), Brazil has only embraced the Directly Observed Treatment, Short Course (DOTS), recommended by the WHO as an effective measure for the treatment of T.B.It has also undertaken and extended several campaigns of creating awareness, education, and training of the population in order to improve knowledge on T.B. and its vectors, prevention, and treatment. Such campaigns will reduce the stigma associated with the early detection of the ailment and will encourage prompt diagnosis and treatment (Baumgarten et al., 2019).All in all, the policy on T.B. in the Brazilian health system aims to ensure health equity and access, in addition to affordability, in a bid to favor the prevention and control of the disease through education. |
| What are the strengths of this policy? | Comprehensive and Extensive Approach: The United States has developed an all-encompassing set of measures across prevention, diagnosis, and treatment, as well as the public health framework, to manage and ultimately eradicate Tuberculosis (TB). The goal of these policies and measures is to sustain the progress of TB control and prevention.Enhancing Public Health FrameworksThe United States employs its all-encompassing public health framework, consisting of the federal Centers for Disease Control and Prevention (CDC) and the local health departments, to design, implement, and manage TB control programs and to further provide training to Health Care Personnel (HCP) while engaging in TB control programs’ educational activities in the community. Evidence-based guidelines: In comparison to the more conventional methods and theoretical frameworks, almost all TB control programs in the U.S. employ evidence-informed design and implementation for program operations. Networks, including the CDC, evaluate the quality and uniformity of practice to improve patient outcomes.The U.S. has made significant financial and institutional commitments to tuberculosis research, particularly in the areas of new tuberculosis diagnostic and therapeutic development and improving control strategies. The investment in research and innovation has been a central argument for the successes of the U.S. commitment to global tuberculosis control. | Multisector and Interdisciplinary Approach: CDDS is a project launched by the Brazilian government to eliminate tuberculosis infections by the year 2030. It employs a multi-faceted and comprehensive approach that incorporates different elements and combines the public and private sectors to bolster the efforts made by the government to alleviate the disease burden. (Sanjeet Bagcchi, 2023).With respect to its tuberculosis elimination strategies and recommendations, the CIEDS initiative is also very important for the World Health Organization. The WHO also acknowledges the active role of Brazilian authorities in this important project. Economic Impact: With the second-largest GDP in the Americas after the United States, Brazil’s intention to use its growing and expanding economy to fight and ultimately eradicate the tuberculosis epidemic is justified. (Jarovsky, 2019). |
| What are the weaknesses of this policy? | The barriers restricting access to services provided by the national programs are a big part of the weaknesses of any country’s policy, including the US. In the US, people without health insurance, undocumented and unregistered immigrants, and the homeless, among other populations, face hurdles even after federally funded and provided TB diagnosis and treatment were made available. There have also been some successful partnership efforts to control TB in the US, as in other countries, but TB continues to be a stigmatized disease, and still, awareness and education to eliminate TB and give it no second thought to control the stigmatization should be of the utmost priority (Datiko et al, 2020).The most concerning negative aspect of this policy is probably drug resistance. Extensively Drug-Resistant TB is a huge burden as it carries treatment and testing cost burdens which are even more and greater than those of normal TB, and the same is true for the burden of control and management (Dheda et al, 2024). | Integrated Health System (SUS) offers diagnosis and treatment services free of charge. However, in Brazil, access to healthcare in areas outside of large cities is extremely limited. This, in turn, leads to late diagnosis and treatment of patients, resulting in the continued transmission of TB. Socioeconomic factors, which, among other things, include poverty, poor housing conditions, and undernutrition, are ignored in Brazilian TB policy. All of these factors are intertwined with TB, and these factors, in addition to the treatment and control of TB, have a greater impact on the burden of the disease. Brazil is also struggling with the control of drug-resistant TB because of the unavailability of second-line drugs and the poor infrastructure to conduct drug susceptibility tests, leading to poor treatment and the continued spread of drug-resistant TB. To make matters worse, TB is highly stigmatized, which leads to even greater treatment barriers. TB-related stigmatisation is so strong to the extent that people make a conscious effort to avoid seeking diagnosis and treatment, resulting in TB being under-reported and delayed illness-seeking services. |
| Explain how the social determinants of health may impact the specified global health issue. (Be specific and provide examples) | Tuberculosis (TB cases in the United States cannot be understood without examining the social determinants of health. These determinants speak to the built environment, exposure, and even homelessness, as well as other factors like poverty and race/ethnicity (Abrams and Szefler, 2020). The social determinants of TB show a clear case of the intersection of the homeless population and the impoverished urban TB-endemic population. The role of homelessness and inadequate housing is significant in the TB situation and further complicates TB control and management. TB-affected immigrants arriving from high TB-endemic countries face delays in treatment exacerbated by TB stigma, the fear of TB, and delays and fears associated with the language barrier. Most of these affected TB patients, who are mainly from racial and ethnic minority groups and who are also deprived of cultural and social resources, do not have access to TB care. This situation further develops TB into a more complicated case. The combination of structural racism and inequities in the healthcare system causes the highest burden of TB in ethnic minority groups ailing from TB, particularly Native Americans and Black people. TB stigma delays the TB-affected population from seeking care. The United States requires a thorough, integrated, and complicated TB control and care approach. | Social determinants of TB are found in Brazil. TB has a higher prevalence in people of lower socioeconomic status. Examples of lower status TB populations are people in poverty. They live in extreme overcrowding, are malnourished, and are medically neglected. This is even more concentrated in urban slums and in rural areas with limited infrastructure. Homeless people in these areas also have a higher prevalence of TB. They also have difficulty with the healthcare system, and leave care prematurely. Another determinant of TB is immigrant status. This is especially the case in low-TB country migrants. Low-country immigrants, especially, are challenged due to language barriers and limited understanding of the healthcare system. This results in delays in healthcare seeking and TB treatment. Marginalized groups, such as the indigenous groups and Afro-Brazilians, as well as TB-related stigma and discrimination, directly affect TB healthcare seeking and treatment adherence. This ultimately results in continued TB transmission. Combining multiple strategies directed towards the different social and healthcare system determinants of TB for Brazil, with an emphasis on poverty and housing approaches, is the most effective way to minimize TB-related stigma and discrimination. This will also improve TB prevention, treatment, and care for diverse populations (Zille et al., 2019). |
| How has each country’s government addressed cost, quality, and access to the selected global health issue? | The United States has tried to balance the challenges of cost versus quality and the availability of services for global health issues with Medicaid and Children’s Health Insurance Program (CHIP) expansions to include vulnerable populations (Readhead et al., 2021; Goodman-Bacon, 2021). The Affordable Care Act (ACA) has increased health insurance access to affordable health insurance in the U.S. The Hospital Value-Based Purchasing Program is one of the foremost examples of the marriage of healthcare and customer service. It incentivizes hospitals to improve the patient experience and ultimately the patient outcomes. Value-based model programs center the flow of investments and time taken to develop innovative treatment and strengthen the application of the evidence-based practice. The system doesn’t place cost containment in a vacuum. It integrates improvements of medication affordability, the price negotiations of medication administered through the Medicare system, and a pushing of prescription compliance for generics. All strategies aim to establish and sustain the healthcare system as a cost-efficient, value-enhanced system tailored to improve accessibility the most during the global health crisis the US is experiencing (Campbell & Shore-Sheppard, 2020). | The Brazilian government has initiated several measures in response to service criticisms concerning cost, quality, and access. The Brazilian Unified Health System (SUS) provides all tuberculosis (TB) services at absolutely no charge. To promote quality, the decentering of TB care (i.e., more urban and rural TB care availability) has begun. This process includes the construction of TB care facilities, the hiring of TB care and treatment staff, and the integration of TB care provision services. TB care services collaborated and partnered with community health staff and utilized mobile clinics directed toward TB care in rural and disadvantaged/yielding areas, with a focus on indigenous people. Using this quality TB care approach is anticipated to enhance TB services and improve TB control in Brazil (Pellison et al., 2020). |
| How has the identified health policy impacted the health of the global population? (Be specific and provide examples) | US policy on tuberculosis (TB) has many global effects. There are initiatives and partnerships to support this. The CDC has capacity and offers funding for TB work in the low and middle-income countries. The US supports TB work through PEPFAR and The Global Fund to Fight AIDS, particularly to improve TB surveillance systems, TB testing, TB treatments, and TB services across sub-Saharan Africa and Southeast Asia. Based on research and innovation that the US has done, we now have TB tests, treatments, and vaccines. The TB research and partnerships with the WHO and other governments improve TB control and capacity for other countries. Improving TB health outcomes and lowering the TB burden can be attributed to US TB policies. The CDC, for example, offers training and technical support to health workers in TB-burden countries.Centers of Excellence for Training, Education, and Medical Consultation for TB (hereafter, “Centers of Excellence”) train healthcare workers in TB control, diagnosis, and treatment across the globe. TB control in foreign governments, through funds in over 140 countries, is managed in the U.S. Government by the Global Fund to Fight AIDS, Tuberculosis, and Malaria. As such, the goal of the Fund is to terminate TB, improve access to TB services and care for millions, and enhance TB services across the world. U.S. Government innovations in TB treatment, diagnostics, and the GeneXpert TB (Brown et al., 2021) and other TB tests in developing countries have increased access to TB services and care for millions. The U.S. Government works in partnership with the WHO and other governments and non-governmental organizations to control TB on a national and international level. The Stop TB Partnership supports the sharing of TB control experiences and TB control resources among countries to assist them in reaching their shared TB control objectives. | Brazil’s system for assessing health access and rights has positively influenced healthcare on a global scale. Integrating free TB diagnosis and treatment into the health system is a crucial step for Brazil and other countries. Positioning treatment services closer to where clients are, coupled with the development and improvement of TB treatment services for health professionals, has enhanced TB treatment services. Other countries in the region and beyond have also benefited from these services. Providing TB treatment services to the indigenous and border populations of Brazil has contributed to the global TB and treatment adherence crisis. Brazil’s health policy on TB has favored the global health community through the provision of TB services that are accessible, affordable, and of good quality, and has contributed to alleviating the global TB burden. |
| Describe the potential impact of the identified health policy on the role of nurses in each country. | Health policies concerning tuberculosis (TB) in the U.S. will have multiple impacts on nurses, the first line responders in TB prevention, TB screening, and TB treatment in almost every range of the health care system, e.g., hospitals, clinics, and community health care centers. Aiming to reduce the incidence of TB and improve treatment outcomes will add additional burdens on nurses to perform TB screening, teach TB prevention to patients and the community, and motivate them to adhere to TB treatment. In addition, nurses will play the first-line role in contact tracing to determine exposed TB cases and help them to undergo evaluation and testing. Because nurses are advocates of patient-centered care, they should be able to tackle the social determinants of health that propagate TB, including the lack of housing and health care. Overall, this TB health policy defines the critical role of the nursing profession in TB care and control, aimed at highlighting that nurses are essential for the sustained health of the community and the reduction of TB in the U.S. (Putra & Toonsiri, 2019). | Nursing practices in Brazil may expand due to policies pertaining to the screening, diagnosing, and treating of TB, along with the education of TB patients. TB Control and Prevention policies in Brazil are likely to promote higher engagement by nurses to meet the goals of outreach services. Through these policies, nurses are likely to attain TB Control and Prevention goals while remaining active in multiple TB services. |
| Explain how global health issues impact local healthcare organizations and policies in both countries. (Be specific and provide examples) | Global mass health scenarios provide a basis for strengthening the health systems, health policies, and models of health services in the country, and the prioritization of community health in the USA. Local healthcare systems, for example, have improved their infection control systems and created coordination protocols for integration between the healthcare and public health systems. The two outbreaks, Zika and Ebola, are among global mass health situations that have prompted local healthcare systems to enhance their infection control systems. In addition, local healthcare systems have addressed the challenge of rising levels of AMR through control of antibiotics and the implementation of Antimicrobial Stewardship Programs (ASP). The emerging global mass health issues have changed local health systems’ public health policies, especially the COVID-19 pandemic, to prioritize public health and health equity and health system access by increasing the availability of telehealth and vaccination services. The COVID-19 pandemic has necessitated the kind of responsive public health policies and innovative and adaptive local healthcare systems that the USA health care system requires. (Gostin et a). | Health issues on a global scale have compelled Brazil to revise its health system and health policy frameworks. Brazil’s response to the international crisis of TB was the establishment of TB-specialized clinics and TB services at health posts and the integration of TB services into the primary health care system. Brazil has also had to respond to international health initiatives for the treatment and care of HIV/AIDS and malaria, among others. Consequently, the Brazilian government was mandated to provide HIV/AIDS antiretroviral and malaria treatment and preventive services at publicly funded health services. Brazil has also responded to international health initiatives by changing the frameworks of its health care system and policies for the prevention and control of several health challenges. This includes the provision of COVID-19 vaccines and other health services aimed at controlling pandemics. Brazil has a considerable TB public health challenge. This has necessitated Brazil to establish special TB clinics and TB care services within the primary health centers, with policy priorities on the free provision of anti-TB drugs within the Unified Health System (SUS) and the provision of free TB diagnostic services. International collaboration to mitigate HIV/AIDS ushered in new adaptations to Brazil’s policies regarding antiretroviral therapy (ART) and other related preventative measures. Local delivery units for HIV service encompass health institutions involved in the diagnosis and treatment of HIV infection. Control measures for malaria involve the distribution of bed nets and other vector control interventions and the establishment of rapid diagnosis and treatment services, especially in the Amazon basin. COVID-19 necessitated rapid policy responses to develop and establish vaccination and testing quarantine, along with the formation of different health partnerships to provide a coordinated response to the infection. All of these aforementioned instances demonstrate that the challenges of health that occur at the international level are translated into the challenges of health at the local level and the health needs of the community, in this context, Brazil (Rocha et al, 2021). |
| General Notes/Comments | ||
Planning and Implementing Social Change: Integrating Local Nursing Practices with Global Perspectives
Introduction
The global and public health challenges faced by many communities are of great concern to me as a leader in my profession. I am well-placed to analyze global health policies within the context of my field of practice and articulate local health imbalances fostered by inequities. This informs my practice as I advocate for social change.
Advocating Global Perspective
I intend to educate myself and my team on the details and policies of the global health initiatives. I will participate in global health trainings, workshops, and conferences, which I will share with my team, and I will employ the materials. I will utilize my existing networks to develop collaborations with global health organizations and educational Institutes, as well as with Health skill professionals. I will partner with organizations to focus on specific health issues and challenges that are global in nature, to integrate the diverse and specific health resources and creative approaches of my collaborators.
I will promote the integration of global health into local health care systems by advocating for partnerships with stakeholders, as well as by participating in policy discussions and debates, and by advocating at my Institution and in the Community. I will work with the various stakeholders and communities within my surroundings to enhance global health literacy and develop health care systems that are responsive to the varied needs of specific communities and are culturally appropriate. Some of these are health awareness workshops in the community and discussions on global health. I will also organize community health fairs.
Impacts on Local Nursing Practice
I will meet the needs of patients in my diverse community by delivering services that are culturally informed. My understanding of the interconnected social, cultural, and economic factors impacting health will help me meet the culturally specific needs of the patients in my community. By focusing on global health disparities, I learned to identify the disparities in my community and develop the best approaches to respond.
Ensuring that health services are available and distributed in an equitable manner can eliminate health inequity and fulfill the right to health. Local health challenges will differ across the board, but global health initiatives and programs will offer guidance and teach us what we need to know. The health of our patients and our community will improve through the world’s best practices.
Contributing to Social Change
Integrating a global perspective in local nursing practices acts as a catalyst for social change by raising awareness in the community regarding specific global health issues and the potential ways to address them. By recognizing the diverse dreadful realities of global health problems and the inequities associated with them, nurses advocate for social justice and health equity by employing different methods and frameworks. An example of such advocacy is if nurses engage community members to work on the health impacts of negative environmental change and on the difficulties of managing a declining health situation.
That community would be empowered to undertake health-protective advocacy and motivate policymakers. Moreover, nurses can also respond inventively to the complex health issues through partnerships and collaboration of local and global peers and community members to make the best use of their resources and assistive skills. To conclude, the international nature of local nursing practices will foster a sense of moral responsibility and ownership towards global health and well-being of the community and a compassionate world.
Conclusion
Nursing practices should be flexible and encompass the values pertaining to changes in society. Due to global interdependence and shared responsibility for global health, the nursing profession can collectively advance healthcare for individuals and populations globally.
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