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Health Policy and Planning

Matthew M Kavanagh, Vuyiseka Dubula-Majola
Efforts to improve the effectiveness of global health aid rarely take full account of the micro-politics of policy change and implementation. South Africa's HIV/AIDS epidemic is a case in point, where the US President's Emergency Plan for AIDS Relief (PEPFAR) has provided essential support to the national AIDS response. With changing political context, PEPFAR has shifted focus several times-most recently reversing the policy of 'transition' out of direct aid to a policy of re-investing in front-line services in priority districts to improve aid effectiveness...
January 9, 2019: Health Policy and Planning
Sanjana J Ravi, Michael R Snyder, Caitlin Rivers
The 2014-16 West Africa Ebola epidemic was a watershed moment for global health. The outbreak galvanized global action around strengthening infectious disease prevention, detection and response capabilities. We examined the nascent landscape of international programmes, initiatives and institutions established in the aftermath of the 2014-16 Ebola outbreak with the aim of assessing their progress to date to illustrate the current state of the world's global health security architecture. We also compare these efforts with shortcomings in epidemic management documented during the epidemic, and underscore remaining gaps in regional and global epidemic response capabilities that might benefit from additional programmatic and financial support...
January 8, 2019: Health Policy and Planning
Charles P Larson, Tracey Perez Koehlmoos, David A Sack
No abstract text is available yet for this article.
January 3, 2019: Health Policy and Planning
Katharine D Shelley, Gasto Frumence, Rose Mpembeni, Asha S George, Elizabeth A Stuart, Japhet Killewo, Abdullah H Baqui, David H Peters
Community health workers (CHWs) play a critical role in health promotion, but their workload is often oriented around a single disease. Renewed interest in expansion of multipurpose CHWs to cover an integrated package of services must contend with the debate over how effectively CHWs can perform an increased range of tasks. In this study, we examine whether an existing cadre of HIV-focused paid volunteer CHWs in Iringa, Tanzania, can take on new maternal, newborn and child health (MNCH) promotion tasks without adversely affecting their HIV role...
December 26, 2018: Health Policy and Planning
Mirkuzie Woldie, Garumma Tolu Feyissa, Bitiya Admasu, Kalkidan Hassen, Kirstin Mitchell, Susannah Mayhew, Martin McKee, Dina Balabanova
A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies are narrowly focused on a single condition. As this cadre grows in importance, there is a need to examine the evidence on whether and how CHVs can improve access to and use of essential health services in low- and middle-income countries (LMICs)...
December 24, 2018: Health Policy and Planning
Joseph F Naimoli, Sweta Saxena
The burgeoning literature on resilient health systems in low- and middle-income countries (LMICs) provides limited insights into the practice of resilience-building. To address this operational shortcoming, we explore the potential of health ministries to become 'learning organizations' to help foster resilience. We adopted a multi-stage, iterative methodology comprising multiple purposive literature searches, the selection and application of a conceptual framework from the 'learning organizations' literature, and expert opinion to expand on the framework with illustrative examples from LMICs...
December 14, 2018: Health Policy and Planning
Hamid Ravaghi, Zeynab Foroughi, Ali Nemati, Victoria D Bélorgeot
The excessive use of resources, inefficiency and poor service quality in public hospitals has led developing countries to create reforms in public hospital governance, including autonomization. Hospital autonomy refers to the delegation of administrative rights to the hospital management team. The purpose of the present research is to review different aspects of hospital autonomy reforms in developing countries, such as incentives, preparations, obstacles and facilitators to change prior to implementation, impacts on achieving Universal Health Coverage (UHC) goals, challenges, outcomes and implications for implementation...
December 13, 2018: Health Policy and Planning
Svetlana V Doubova, Sebastián García-Saisó, Ricardo Pérez-Cuevas, Odet Sarabia-González, Paulina Pacheco-Estrello, Hannah H Leslie, Carmen Santamaría, Laura Del Pilar Torres-Arreola, Claudia Infante-Castañeda
This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated...
December 12, 2018: Health Policy and Planning
Sara A Morgan, Mohamed M Ali
Estimation of maternal mortality ratio (MMR) in humanitarian settings ('settings of conflict, displacement and natural disaster') is challenging, particularly where communities have dissolved and geographical areas are inaccessible. During humanitarian events, the reproduction of maternal mortality figures by the media is common, and are often based on inaccurate reports. In light of such uncertainties and challenges, the aim of this article was to review and appraise the methodology and data collection tools used to measure MMR in humanitarian settings...
December 10, 2018: Health Policy and Planning
Abolfazl Abouie, Reza Majdzadeh, Roghayeh Khabiri, Soudabeh Hamedi-Shahraki, Seyed Hasan Emami Razavi, Mir Saeed Yekaninejad
Health equity has become a progressively popular research topic in recent years. Therefore, this study was made to identify the contributions made by socioeconomic determinants in order to quantify their roles to healthcare utilization inequity and to show their status especially after the recent reform in Iran, i.e. Health Transformation Plan, which one of its main goals is providing access to healthcare for all people. This study is a cross-sectional study conducted on a national level in Iran in 2015. For the sampling frame, three-stage cluster sampling was used...
December 7, 2018: Health Policy and Planning
Johanna Hanefeld, Susannah Mayhew, Helena Legido-Quigley, Frederick Martineau, Marina Karanikolos, Karl Blanchet, Marco Liverani, Esther Yei Mokuwa, Gillian McKay, Dina Balabanova
No abstract text is available yet for this article.
December 4, 2018: Health Policy and Planning
Leon Bijlmakers, Dennis Cornelissen, Mweene Cheelo, Mzaza Nthele, John Kachimba, Henk Broekhuizen, Jakub Gajewski, Ruairí Brugha
The lack of access to quality-assured surgery in rural parts of sub-Saharan Africa, where the numbers of trained health workers are often insufficient, presents challenges for national governments. The case for investing in scaling up surgical systems in low-resource settings is 3-fold: the potential beneficial impact on a large proportion of the global burden of disease; better access for rural populations who have the greatest unmet need; and the economic case. The economic losses from untreated surgical conditions far exceed any expenditure that would be required to scale up surgical care...
November 6, 2018: Health Policy and Planning
Ruiz Fernando, Avila-Burgos Leticia, Trujillo Antonio J
This paper studies the effect on hospital service prices of a health system reform that allows managed selective contracting and regulation as a means for efficiency and price competition. Cross-sectional data about prices and market structure were analysed from a pool of 20 markets which includes 15 million Colombians. A multilevel regression method comparing three different market settings was performed. The analysis evaluates the effects of insurer choice, hospital quality and market characteristics using a nationwide health services transactional database...
November 1, 2018: Health Policy and Planning
Peter Binyaruka, Bjarne Robberstad, Gaute Torsvik, Josephine Borghi
The impact of payment-for-performance (P4P) schemes in the health sector has been documented, but there has been little attention to the distributional effects of P4P across health facilities. We examined the distribution of P4P payouts over time and assessed whether increased service coverage due to P4P differed across facilities in Tanzania. We used two service outcomes that improved due to P4P [facility-based deliveries and provision of antimalarials during antenatal care (ANC)], to also assess whether incentive design matters for performance inequalities...
November 1, 2018: Health Policy and Planning
Pablo Villalobos Dintrans
Similar to many other countries, Chile is facing the challenges of rapid ageing and the increase in long-term care (LTC) needs for this population. Implementation of LTC systems has been the response to these challenges in other countries, however, Chile still lacks a strategy for addressing LTC needs. This article advocates for the implementation of a LTC system in Chile, demonstrating that this could be an effective and efficient response to cope with the current and future challenges faced by the country...
November 1, 2018: Health Policy and Planning
Sachiko Ozawa, Manuela Villar-Uribe, Daniel R Evans, Vivek Kulkarni, Por Ir
Unnecessary injections increase the risk of blood-borne infections as well as pose an avoidable financial burden on patients. Perceptions in rural Cambodia that medical drug injections provide the best quality medical care have resulted in a large proportion of the population seeking injections across medical conditions. As private providers have a higher propensity to offer injections, patients pursue more expensive care contributing to a greater financial burden. This study aimed to use an educational intervention to improve participant knowledge about injections and health insurance in order to build informed trust in safer injection practices and health insurance...
November 1, 2018: Health Policy and Planning
Isabella Epiu, Godfrey Alia, John Mukisa, Paula Tavrow, Mohammed Lamorde, Andreas Kuznik
In Africa, about 33 000 cases of obstetric fistula occur each year. Women with fistula experience debilitating incontinence of urine and/or faeces and are often socially ostracized. Worldwide, Uganda ranks third among countries with the highest burden of obstetric fistula. Obstetric fistula repair competes for scarce resources with other healthcare interventions in resource-limited settings, even though it is surgically efficacious. There is limited documentation of its cost-effectiveness in the most affected settings...
November 1, 2018: Health Policy and Planning
K Scott, N Jessani, M Qiu, S Bennett
Health policy and systems research (HPSR) is vital to guiding global institutions, funders, policymakers, activists and implementers in developing and enacting strategies to achieve the Sustainable Development Goals. We undertook a multi-stage participatory process to identify priority research questions relevant to improving accountability within health systems. We conducted interviews (n = 54) and focus group discussions (n = 2) with policymakers from international and national bodies (ministries of health, other government agencies and technical support institutions) across the WHO regions...
November 1, 2018: Health Policy and Planning
Maryse C Kok, Frédérique Vallières, Olivia Tulloch, Meghan B Kumar, Aschenaki Z Kea, Robinson Karuga, Sozinho D Ndima, Kingsley Chikaphupha, Sally Theobald, Miriam Taegtmeyer
Supportive supervision is an important element of community health worker (CHW) programmes and is believed to improve CHW motivation and performance. A group supervision intervention, which included training and mentorship of supervisors, was implemented in Ethiopia, Kenya, Malawi and Mozambique. In three of the countries, this was combined with individual and/or peer supervision. A mixed-methods implementation study was conducted to assess the effect of the supervision intervention on CHWs' perceptions of supervision and CHW motivation-related outcomes...
November 1, 2018: Health Policy and Planning
Rebecca Dodd, Anna Palagyi, Laura Guild, Vivekanand Jha, Stephen Jan
Chronic kidney disease (CKD) is a significant and growing driver of the global non-communicable diseases (NCD) burden, responsible for 1.2 million deaths in 2016. While previous research has estimated the out-of-pocket costs of CKD treatment and resulting levels of catastrophic health expenditures, less is known about the impact of such costs on access to, and maintenance of, care. Our study seeks to fill this gap by synthesizing available evidence on cost as a determinant of CKD treatment discontinuation. We searched for studies which considered the financial burden of treatment and medication for CKD patients and the extent to which this burden was associated with patients forgoing or discontinuing treatment...
November 1, 2018: Health Policy and Planning
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