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Health Policy and Planning

Andrea Sprockett
Measuring and tracking the quality of healthcare is a critical part of improving service delivery, clinic efficiency and health outcomes. However, no standardized or widely accepted tool exists to assess the quality of clinic-based family planning services in low- and middle-income countries. The objective of this literature review was to identify widely used public domain quality assessment tools with existing or potential application in clinic-based family planning programmes. Using PubMed, PopLine, Google Scholar and Google, key terms such as 'quality assessment tool', 'quality assessment method', 'quality measurement', 'LMIC', 'developing country', 'family planning' and 'reproductive health' were searched for articles, identifying 20 relevant tools...
October 13, 2016: Health Policy and Planning
Thandeka T T Dlamini-Simelane, Eileen Moyer
Through various campaigns and strategies, more women are being tested for HIV in countries with a high prevalence of the virus. Despite the ready availability of treatment at government clinics in sub-Saharan African countries like Swaziland, women consistently report difficulty in maintaining access to treatment. Drawing on two individual case studies selected from a larger study of the so-called leaky cascade in Swaziland, we illustrate the protracted journeys married women undertake to initiate treatment...
October 13, 2016: Health Policy and Planning
Péter Elek, Eszter Takács, Gergő Merész, Zoltán Kaló
External price referencing (EPR) is applied more and more frequently worldwide by payers to control pharmaceutical prices. Together with the parallel trade of pharmaceuticals, EPR may result in lower pharmaceutical prices in higher-income countries and higher prices in lower-income countries, which implies that pharmaceutical expenditure grows more rapidly in the latter than in the former group. Our objective was to assess this hypothesis. We used hierarchical linear models on country-level panel data to show that-after controlling for compounding factors such as GDP, the proportion of the old-age population or life expectancy-the annual growth rate of pharmaceutical expenditure was 2...
October 3, 2016: Health Policy and Planning
Harry E Cross, Omarzaman Sayedi, Laili Irani, Lauren C Archer, Kathleen Sears, Suneeta Sharma
BACKGROUND: Since 2003, Afghanistan's largely unregulated for-profit private health sector has grown at a rapid pace. In 2008, the Ministry of Public Health (MoPH) launched a long-term stewardship initiative to oversee and regulate private providers and align the sector with national health goals. AIM: We examine the progress the MoPH has made towards more effective stewardship, consider the challenges and assess the early impacts on for-profit performance. METHODS: We reviewed publicly available documents, publications and the grey literature to analyse the development, adoption and implementation of strategies, policies and regulations...
September 28, 2016: Health Policy and Planning
Edwine W Barasa, Susan Cleary, Sassy Molyneux, Mike English
This paper describes and evaluates the budgeting and planning processes in public hospitals in Kenya. We used a qualitative case study approach to examine these processes in two hospitals in Kenya. We collected data by in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), a review of documents, and non-participant observations within the hospitals over a 7 month period. We applied an evaluative framework that considers both consequentialist and proceduralist conditions as important to the quality of priority-setting processes...
September 26, 2016: Health Policy and Planning
Hibret Tilahun, Binyam Fekadu, Habtamu Abdisa, Maureen Canavan, Erika Linnander, Elizabeth H Bradley, Peter Berman
Ethiopia implemented an innovative community-based health program, called the health extension program, to enhance access to basic health promotion, disease prevention and selected curative services by establishing health posts in every village, also called kebeles, with average of 5000 people, staffed with two health extension workers (HEWs). This time and motion study was done to estimate the amount of time that HEWs spend on various work duties and to explore differences in urban compared with rural settings and among regions...
September 21, 2016: Health Policy and Planning
Chetna Malhotra, Young Kyung Do
Improvement in overall responsiveness to people's expectations is an important goal for any health system; socioeconomic equity in responsiveness is equally important. However, it is not known if socioeconomic disparities in responsiveness can be reduced through greater public health expenditures. This article assesses the relationship of the proportion of public health expenditure over total health expenditure (PPHE) with responsiveness for poorest individuals and the difference in responsiveness between the richest and poorest individuals...
September 20, 2016: Health Policy and Planning
Sinead Cook, Bregje de Kok, Maria Lisa Odland
Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions are an important contributor to Malawi's maternal mortality and morbidity, where abortion is illegal except to save the woman's life. Postabortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference...
September 10, 2016: Health Policy and Planning
Anna Helova, Eliud Akama, Elizabeth A Bukusi, Pamela Musoke, Wafula Z Nalwa, Thomas A Odeny, Maricianah Onono, Sydney A Spangler, Janet M Turan, Iris Wanga, Lisa L Abuogi
Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014...
September 10, 2016: Health Policy and Planning
Michele R Decker, Amanda Kalamar, Özge Tunçalp, Michelle J Hindin
OBJECTIVE: Reducing unwanted adolescent childbearing is a global priority. Little is known about how national-level economic and human development indicators relate to early adolescent childbearing. This ecological study evaluates associations of Gross Domestic Product (GDP), GINI index, Human Development Index (HDI) and Gender-related Development Index (GDI; i.e. the HDI adjusted for gender disparities) with early adolescent childbearing in 27 low- and middle-income countries (LMICs) across three time periods...
September 10, 2016: Health Policy and Planning
Elizabeth Pisani, Maarten Olivier Kok, Kharisma Nugroho
In 2013 Indonesia, the world's fourth most populous country, declared that it would provide affordable health care for all its citizens within seven years. This crystallised an ambition first enshrined in law over five decades earlier, but never previously realised. This paper explores Indonesia's journey towards universal health coverage (UHC) from independence to the launch of a comprehensive health insurance scheme in January 2014. We find that Indonesia's path has been determined largely by domestic political concerns - different groups obtained access to healthcare as their socio-political importance grew...
September 6, 2016: Health Policy and Planning
Sarah D Rominski, Jody Lori, Emmanuel Nakua, Veronica Dzomeku, Cheryl A Moyer
Despite global attention, high levels of maternal mortality continue to plague many low- and middle-income settings. One important way to improve the care of women in labour is to increase the proportion of women who deliver in a health facility. However, due to poor quality of care, including being disrespected and abused, women are reluctant to come to facilities for delivery care. The current study sought to examine disrespectful and abusive treatment towards labouring women from the perspective of midwifery students who were within months of graduation...
September 4, 2016: Health Policy and Planning
Yao Liu, Omar Galárraga
BACKGROUND: The efficacy of low- and middle-income countries' (LMIC) national drug policies in managing antiretroviral (ARV) pharmaceutical prices is not well understood. Though ARV drug prices have been declining in LMIC over the past decade, little research has been done on the role of their national drug policies. This study aims to (i) analyse global ARV prices from 2004 to 2013 and (ii) examine the relationship of national drug policies to ARV prices. METHODS: Analysis of ARV drug prices utilized data from the Global Price Reporting Mechanism from the World Health Organization (WHO)...
September 1, 2016: Health Policy and Planning
Ebiowei Samuel F Orubu, Chinyere Okwelogu, Olabisi Opanuga, Tony Nunn, Catherine Tuleu
Policies to improve access to medicines for children in Nigeria do not include compounding as a source of medicines. Compounding is often applied as a last resort in health institutions to provide age-appropriate formulations usually for oral use in young children; but it bears some risk. Some countries have adopted policies aimed at reducing the risk based on available data. There is not much data for Nigeria. This retrospective study examined compounding records from January to December 2011 in a sample of seven hospitals to describe what medicines for oral use were commonly compounded in Nigeria...
September 1, 2016: Health Policy and Planning
Soter Ameh, Kerstin Klipstein-Grobusch, Lucia D'ambruoso, Kathleen Kahn, Stephen M Tollman, Francesc Xavier Gómez-Olivé
The integrated chronic disease management (ICDM) model was introduced as a response to the dual burden of HIV/AIDS and non-communicable diseases (NCDs) in South Africa, one of the first of such efforts by an African Ministry of Health. The aim of the ICDM model is to leverage HIV programme innovations to improve the quality of chronic disease care. There is a dearth of literature on the perspectives of healthcare providers and users on the quality of care in the novel ICDM model. This paper describes the viewpoints of operational managers and patients regarding quality of care in the ICDM model...
September 1, 2016: Health Policy and Planning
Sophie Witter, Patrick G Ilboudo, Nadia Cunden, Chakib Boukhalfa, Patrick Makoutode, Zoumana Daou
Many countries, especially in Africa, have in recent years introduced fee exemptions or subsidies targeting deliveries and emergency obstetric care. A number of aspects of these policies have been studied but there are few studies which look at how staff have been affected and how they have responded. This article focuses on this question, comparing data from Benin, Burkina Faso, Mali and Morocco. It is nested in wider evaluation of the policies. The article analyses responses to a health worker survey, carried out in 2012 on 683 health staff (doctors, nurses, midwives and others such as auxiliaries) across the four countries...
August 30, 2016: Health Policy and Planning
Alison B Comfort, Paul J Krezanoski
There is an on-going debate about whether health products, such as insecticide-treated bednets (ITNs) for protection against malaria, should be distributed for free or at a positive price to maximize ownership and use. One argument in favour of free distribution is related to positive externalities. Like vaccines, individual use of ITNs provides a community-wide protective effect against malaria even for non-users. In addition, price may act as a barrier to ownership particularly among those most at-risk who are frequently poor...
August 23, 2016: Health Policy and Planning
Ajay Bhaskarabhatla, Chirantan Chatterjee, Priyatam Anurag, Enrico Pennings
The use of drug price controls is a contentious issue globally. Low- and middle-income countries use direct price controls to improve access to essential drugs. But such price controls have little meaning if they are not designed and implemented well, and the extent to which firms coordinate in these countries to weaken price controls has been largely overlooked. In mid-2013, India adopted partial price-cap regulation for some, but not all, formulations of several essential medicines. Using data on sales and prices of the out-of-patent oral antidiabetic drug Metformin-considered essential by WHO since 1998-and employing the differences-in-differences methodology, we examine the impact of the regulation on curbing prices...
August 18, 2016: Health Policy and Planning
Alyssa Sharkey, Aisha Yansaneh, Peter Soulaiman Bangura, Augustin Kabano, Eoghan Brady, Fatu Yumkella, Theresa Diaz
Despite recent progress, Sierra Leone's lifetime risk of maternal death remains high (1 in 21), as does neonatal mortality (35 per 1000 live births). We present findings on maternal and neonatal care practices from a mixed methods study conducted in four districts during July-August 2012. We conducted a household cluster survey with data on maternal and newborn care practices collected from women ages 15-49 years who had ever given birth. We also conducted focus group discussions and in-depth interviews in two communities in each of the four districts...
August 14, 2016: Health Policy and Planning
Sukumar Vellakkal, Adyya Gupta, Zaky Khan, David Stuckler, Aaron Reeves, Shah Ebrahim, Ann Bowling, Pat Doyle
BACKGROUND: In 2005, India launched the National Rural Health Mission (NRHM) to strengthen the primary healthcare system. NRHM also aims to encourage pregnant women, particularly of low socioeconomic backgrounds, to use institutional maternal healthcare. We evaluated the impacts of NRHM on socioeconomic inequities in the uptake of institutional delivery and antenatal care (ANC) across high-focus (deprived) Indian states. METHODS: Data from District Level Household and Facility Surveys (DLHS) Rounds 1 (1995-99) and 2 (2000-04) from the pre-NRHM period, and Round 3 (2007-08), Round 4 and Annual Health Survey (2011-12) from post-NRHM period were used...
August 10, 2016: Health Policy and Planning
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