Improving the Quality and Quantity of HIV Data in the Middle East and North Africa: Key Challenges and Ways Forward
Mohammad
Karamouzian
HIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran
author
Navid
Madani
Department of
Cancer Immunology and Virology, Dana-Farber Cancer Institute, Department
of Global Health and Social Medicine, Harvard Medical School, Boston, MA,
USA
author
Fardad
Doroudi
UNAIDS – The Joint United Nations Programme on HIV/AIDS (UNAIDS),
Tehran, Iran
author
Ali Akbar
Haghdoost
HIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran
author
text
article
2017
eng
Although the HIV pandemic is witnessing a decline in the number of new infections in most regions of the world, the Middle East and North Africa (MENA) has a rapidly growing HIV problem. While generating HIV data has been consistently increasing since 2005, MENA’s contribution to the global HIV literature is just over 1% and the existing evidence often falls behind the academic standards. Several factors could be at play that contribute to the limited quantity and quality of HIV data in MENA. This editorial tries to explore and explain the barriers to collecting high-quality HIV data and generating precise estimates in MENA. These barriers include a number of logistic and socio-political challenges faced by researchers, public health officials, and policy-makers. Looking at successful regional HIV programs, we explore examples were policies have shifted and lessons could be learned in developing appropriate responses to HIV across the region.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
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2
no.
2017
65
69
https://www.ijhpm.com/article_3264_c3e62949ffce8224a4b18035866161e9.pdf
dx.doi.org/10.15171/ijhpm.2016.112
The Development of Public Policies to Address Non-communicable Diseases in the Caribbean Country of Barbados: The Importance of Problem Framing and Policy Entrepreneurs
Nigel
Unwin
Chronic Disease Research Centre, University of the West Indies, Bridgetown, Barbados
author
T. Alafia
Samuels
Chronic Disease Research Centre, University of the West Indies, Bridgetown, Barbados
author
Trevor
Hassell
Healthy Caribbean Coalition, Bridgetown, Barbados
author
Ross C.
Brownson
Prevention
Research Center in St. Louis, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
author
Cornelia
Guell
MRC
Epidemiology Unit and UKCRC Centre for Diet and Activity Research, University
of Cambridge, Cambridge, UK
author
text
article
2017
eng
Background Government policy measures have a key role to play in the prevention and control of noncommunicable diseases (NCDs). The Caribbean, a middle-income region, has the highest per capita burden of NCDs in the Americas. Our aim was to examine policy development and implementation between the years 2000 and 2013 on NCD prevention and control in Barbados, and to investigate factors promoting, and hindering, success. Methods A qualitative case study design was used involving a structured policy document review and semistructured interviews with key informants, identified through stakeholder analysis and ‘cascading.’ Documents were abstracted into a standard form. Interviews were recorded, transcribed verbatim and underwent framework analysis, guided by the multiple streams framework (MSF). There were 25 key informants, from the Ministry of Health (MoH), other government Ministries, civil society organisations, and the private sector. Results A significant policy window opened between 2005 and 2007 in which new posts to address NCDs were created in the MoH, and a government supported multi-sectoral national NCD commission was established. Factors contributing to this government commitment and funding included a high level of awareness, throughout society, of the NCD burden, including media coverage of local research findings; the availability of policy recommendations by international bodies that could be adopted locally, notably the framework convention on tobacco control (FCTC); and the activities of local highly respected policy entrepreneurs with access to senior politicians, who were able to bring together political concern for the problem with potential policy solutions. However, factors were also identified that hindered multi-sectoral policy development in several areas, including around nutrition, physical activity, and alcohol. These included a lack of consensus (valence) on the nature of the problem, often framed as being predominantly one of individuals needing to take responsibility for their health rather than requiring government-led environmental changes; lack of appropriate detailed policy guidance for local adaptation; conflicts with other political priorities, such as production and export of alcohol, and political reluctance to use legislative and fiscal measures. Conclusion The study’s findings indicate mechanisms to promote and support NCD policy development in the Caribbean and similar settings.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
6
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2
no.
2017
71
82
https://www.ijhpm.com/article_3222_75340d3b996529e187033bfeca39f3ab.pdf
dx.doi.org/10.15171/ijhpm.2016.74
District Health Officer Perceptions of PEPFAR’s Influence on the Health System in Uganda, 2005-2011
Nathaniel
Lohman
Department of Global Health, University of Washington, Seattle, WA, USA
author
Amy
Hagopian
Department of Global Health, University of Washington, Seattle, WA, USA
author
Samuel Abimerech
Luboga
Faculty of Health Sciences, Makerere University, Kampala, Uganda
author
Bert
Stover
Department of Health Services, University of Washington, Seattle, WA, USA
author
Travis
Lim
Division of Global HIV and Tuberculosis, Atlanta, GA, USA
author
Frederick
Makumbi
Faculty of Health Sciences, Makerere University, Kampala, Uganda
author
Noah
Kiwanuka
Faculty of Health Sciences, Makerere University, Kampala, Uganda
author
Flavia
Lubega
Faculty of Health Sciences, Makerere University, Kampala, Uganda
author
Assay
Ndizihiwe
Division of Global HIV and Tuberculosis, Atlanta, GA, USA
author
Eddie
Mukooyo
Resource Center for the
Uganda Ministry of Health, Uganda Ministry of Health, Nakasero, Uganda
author
Scott
Barnhart
Department of Global Health, University of Washington, Seattle, WA, USA
author
James
Pfeiffer
Department of Global Health, University of Washington, Seattle, WA, USA
author
text
article
2017
eng
Background Vertically oriented global health initiatives (GHIs) addressing the HIV/AIDS epidemic, including the President’s Emergency Plan for AIDS Relief (PEPFAR), have successfully contributed to reducing HIV/AIDS related morbidity and mortality. However, there is still debate about whether these disease-specific programs have improved or harmed health systems overall, especially with respect to non-HIV health needs. Methods As part of a larger evaluation of PEPFAR’s effects on the health system between 2005-2011, we collected qualitative and quantitative data through semi-structured interviews with District Health Officers (DHOs) from all 112 districts in Uganda. We asked DHOs to share their perceptions about the ways in which HIV programs (largely PEPFAR in the Ugandan context) had helped and harmed the health system. We then identified key themes among their responses using qualitative content analysis. Results Ugandan DHOs said PEPFAR had generally helped the health system by improving training, integrating HIV and non-HIV care, and directly providing resources. To a lesser extent, DHOs said PEPFAR caused the health system to focus too narrowly on HIV/AIDS, increased workload for already overburdened staff, and encouraged doctors to leave public sector jobs for higher-paid positions with HIV/AIDS programs. Conclusion Health system leaders in Uganda at the district level were appreciative of resources aimed at HIV they could often apply for broader purposes. As HIV infection becomes a chronic disease requiring strong health systems to manage sustained patient care over time, Uganda’s weak health systems will require broad infrastructure improvements inconsistent with narrow vertical health programming.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
6
v.
2
no.
2017
83
95
https://www.ijhpm.com/article_3246_dc356e1bf0c5fd0775a151e98fb03077.pdf
dx.doi.org/10.15171/ijhpm.2016.98
The Frequency of Alcohol Use in Iranian Urban Population: The Results of a National Network Scale Up Survey
Ali
Nikfarjam
Emergency Medical Center, Ministry of Health and Medical Education, Tehran,
Iran
author
Saiedeh
Hajimaghsoudi
HIV/STI Surveillance Research Center, and WHO Collaborating Center
for HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran
author
Azam
Rastegari
HIV/STI Surveillance Research Center, and WHO Collaborating Center
for HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran
author
Ali Akbar
Haghdoost
HIV/STI Surveillance Research Center, and WHO Collaborating Center
for HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran
author
Abbas Ali
Nasehi
Iran Helal Institute of Applied-Science and
Technology, Tehran, Iran
author
Nadereh
Memaryan
Faculty of Behavioral Sciences and Mental Health,
Iran University of Medical Sciences, Tehran, Iran
author
Terme
Tarjoman
Department of Community
Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
author
Mohammad Reza
Baneshi
Modeling in Health Research Center, Institute for Futures Studies in Health,
Kerman University of Medical Sciences, Kerman, Iran
author
text
article
2017
eng
Background In Islamic countries alcohol consumption is considered as against religious values. Therefore, estimation of frequency of alcohol consumptions using direct methods is prone to different biases. In this study, we indirectly estimated the frequency of alcohol use in Iran, in network of a representative sample using network scale up (NSU) method. Methods In a national survey, about 400 participants aged above 18 at each province, around 12 000 in total, were recruited. In a gender-match face to face interview, respondents were asked about the number of those who used alcohol (even one episode) in previous year in their active social network, classified by age and gender. The results were corrected for the level of visibility of alcohol consumption. Results The relative frequency of alcohol use at least once in previous year, among general population aged above 15, was estimated at 2.31% (95% CI: 2.12%, 2.53%). The relative frequency among males was about 8 times higher than females (4.13% versus 0.56%). The relative frequency among those aged 18 to 30 was 3 times higher than those aged above 30 (3.97% versus 1.36%). The relative frequency among male aged 18 to 30 was about 7%. Conclusion It seems that the NSU is a feasible method to monitor the relative frequency of alcohol use in Iran, and possibly in countries with similar culture. Alcohol use was lower than non-Muslim countries, however, its relative frequency, in particular in young males, was noticeable.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
6
v.
2
no.
2017
97
102
https://www.ijhpm.com/article_3257_b655c984e7cb3a3ae91fb0fea754cbb7.pdf
dx.doi.org/10.15171/ijhpm.2016.103
Mitigating Evidentiary Bias in Planning and Policy-Making; Comment on “Reflective Practice: How the World Bank Explored Its Own Biases?”
Justin
Parkhurst
London School of Hygiene and Tropical Medicine, London, UK
author
text
article
2017
eng
The field of cognitive psychology has increasingly provided scientific insights to explore how humans are subject to unconscious sources of evidentiary bias, leading to errors that can affect judgement and decision-making. Increasingly these insights are being applied outside the realm of individual decision-making to the collective arena of policy-making as well. A recent editorial in this journal has particularly lauded the work of the World Bank for undertaking an open and critical reflection on sources of unconscious bias in its own expert staff that could undermine achievement of its key goals. The World Bank case indeed serves as a remarkable case of a global policy-making agency making its own critical reflections transparent for all to see. Yet the recognition that humans are prone to cognitive errors has been known for centuries, and the scientific exploration of such biases provided by cognitive psychology is now well-established. What still remains to be developed, however, is a widespread body of work that can inform efforts to institutionalise strategies to mitigate the multiple sources and forms of evidentiary bias arising within administrative and policy-making environments. Addressing this gap will require a programme of conceptual and empirical work that supports robust development and evaluation of institutional bias mitigation strategies. The cognitive sciences provides a scientific basis on which to proceed, but a critical priority will now be the application of that science to improve policy-making within those agencies taking responsibility for social welfare and development programmes.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
6
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2
no.
2017
103
105
https://www.ijhpm.com/article_3245_b67b5f7770e8e85b91a8e51cd2c6dde0.pdf
dx.doi.org/10.15171/ijhpm.2016.96
Policy Choices for Progressive Realization of Universal Health Coverage; Comment on “Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage”
Viroj
Tangcharoensathien
International Health Policy Program, Ministry of Public Health, Nonthaburi,
Thailand
author
Walaiporn
Patcharanarumol
International Health Policy Program, Ministry of Public Health, Nonthaburi,
Thailand
author
Warisa
Panichkriangkrai
International Health Policy Program, Ministry of Public Health, Nonthaburi,
Thailand
author
Angkana
Sommanustweechai
International Health Policy Program, Ministry of Public Health, Nonthaburi,
Thailand
author
text
article
2017
eng
In responses to Norheim’s editorial, this commentary offers reflections from Thailand, how the five unacceptable trade-offs were applied to the universal health coverage (UHC) reforms between 1975 and 2002 when the whole 64 million people were covered by one of the three public health insurance systems. This commentary aims to generate global discussions on how best UHC can be gradually achieved. Not only the proposed five discrete tradeoffs within each dimension, there are also trade-offs between the three dimensions of UHC such as population coverage, service coverage and cost coverage. Findings from Thai UHC show that equity is applied for the population coverage extension, when the low income households and the informal sector were the priority population groups for coverage extension by different prepayment schemes in 1975 and 1984, respectively. With an exception of public sector employees who were historically covered as part of fringe benefits were covered well before the poor. The private sector employees were covered last in 1990. Historically, Thailand applied a comprehensive benefit package where a few items are excluded using the negative list; until there was improved capacities on technology assessment that cost-effectiveness are used for the inclusion of new interventions into the benefit package. Not only costeffectiveness, but long term budget impact, equity and ethical considerations are taken into account. Cost coverage is mostly determined by the fiscal capacities. Close ended budget with mix of provider payment methods are used as a tool for trade-off service coverage and financial risk protection. Introducing copayment in the context of feefor-service can be harmful to beneficiaries due to supplier induced demands, inefficiency and unpredictable out of pocket payment by households. UHC achieves favorable outcomes as it was implemented when there was a full geographical coverage of primary healthcare coverage in all districts and sub-districts after three decade of health infrastructure investment and health workforce development since 1980s. The legacy of targeting population group by different prepayment mechanisms, leading to fragmentation, discrepancies and inequity across schemes, can be rectified by harmonization at the early phase when these schemes were introduced. Robust public accountability and participation mechanisms are recommended when deciding the UHC strategy.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
6
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2
no.
2017
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110
https://www.ijhpm.com/article_3247_e1c97e7d155335e0c680a4dcbc41ea3f.pdf
dx.doi.org/10.15171/ijhpm.2016.99
Defining Sub-Saharan Africa’s Health Workforce Needs: Going Forwards Quickly Into the Past; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”
E. Oluwabunmi
Olapade-Olaopa
College of Medicine, University of Ibadan, Ibadan, Nigeria
author
Nelson K.
Sewankambo
College of Health
Sciences, Makarere University, Kampala, Uganda
author
Jehu E.
Iputo
Department of Medical
Education, Walter Sisulu University, Mthatha, South Africa
author
text
article
2017
eng
Recent proposals for re-defining the roles Africa’s health workforce are a continuation of the discussions that have been held since colonial times. The proposals have centred on basing the continent’s healthcare delivery on non-physician clinicians (NPCs) who can be quickly trained and widely distributed to treat majority of the common diseases. Whilst seemingly logical, the success of these proposals will depend on the development of clearly defined professional duties for each cadre of healthcare workers (HCW) taking the peculiarities of each country into consideration. As such the continent-wide efforts aimed at health-professional curriculum reforms, more effective utilisation of task-shifting as well as the intra – and inter-disciplinary collaborations must be encouraged. Since physicians play a major role in the training mentoring and supervision of physician and nonphysician health-workers alike, the maintenance of the standards of university medical education is central to the success of all health system models. It must also be recognized that, efforts at improving Africa’s health systems can only succeed if the necessary socio-economic, educational, and technological infrastructure are in place.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
6
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2
no.
2017
111
113
https://www.ijhpm.com/article_3251_5495988b6d40d9eb44cedbf07c0f9aa4.pdf
dx.doi.org/10.15171/ijhpm.2016.100
The Need for Global Application of the Accountability for Reasonableness Approach to Support Sustainable Outcomes; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”
Jens
Byskov
Department of Public Health, University of Zambia, Lusaka, Zambia
author
Stephen Oswald
Maluka
Institute of Development Studies, University of Dar Es Salaam,
Dar Es Salaam, Tanzania
author
Bruno
Marchal
Department of Public Health, Institute of Tropical
Medicine, Antwerpen, Belgium
author
Elizabeth H.
Shayo
National Institute of Medical Research (NIMR),
Dar Es Salaam, Tanzania
author
Salome
Bukachi
Institute of Anthropology, Gender and African
Studies, University of Nairobi, Nairobi, Kenya
author
Joseph M.
Zulu
Department of Public Health,
School of Medicine, University of Zambia, Lusaka, Zambia
author
Erik
Blas
International Public
Health Consultant, Copenhagen, Denmark
author
Charles
Michelo
Department of Public Health,
School of Medicine, University of Zambia, Lusaka, Zambia
author
Benedict
Ndawi
Primary Health Care Institute
(PHCI), Iringa, Tanzania
author
Anna-Karin
Hurtig
Umeå International School of Public Health, Umeå
University, Umeå, Sweden
author
text
article
2017
eng
The accountability for reasonableness (AFR) concept has been developed and discussed for over two decades. Its interpretation has been studied in several ways partly guided by the specific settings and the researchers involved. This has again influenced the development of the concept, but not led to universal application. The potential use in health technology assessments (HTAs) has recently been identified by Daniels et al as yet another excellent justification for AFR-based process guidance that refers to both qualitative and a broader participatory input for HTA, but it has raised concerns from those who primarily support the consistency and objectivity of more quantitative and reproducible evidence. With reference to studies of AFR-based interventions and the through these repeatedly documented motivation for their consolidation, we argue that it can even be unethical not to take AFR conditions beyond their still mainly formative stage and test their application within routine health systems management for their expected support to more sustainable health improvements. The ever increasing evidence and technical expertise are necessary but at times contradictory and do not in isolation lead to optimally accountable, fair and sustainable solutions. Technical experts, politicians, managers, service providers, community members, and beneficiaries each have their own values, expertise and preferences, to be considered for necessary buy in and sustainability. Legitimacy, accountability and fairness do not come about without an inclusive and agreed process guidance that can reconcile differences of opinion and indeed differences in evidence to arrive at a by all understood, accepted, but not necessarily agreed compromise in a current context - until major premises for the decision change. AFR should be widely adopted in projects and services under close monitoring and frequent reviews.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
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2
no.
2017
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https://www.ijhpm.com/article_3252_b9f2e625d1caa0d401124df4b2536c9a.pdf
dx.doi.org/10.15171/ijhpm.2016.106
Non-physician Clinicians – A Gain for Physicians’ Working in Sub-Saharan Africa; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”
Delanyo
Dovlo
World Health Organization (WHO) Africa Region Office, Brazzaville, Congo
author
Ibiso Ivy
King-Harry
SUN Business Network, Global Alliance
for Improved Nutrition, Abuja, Nigeria
author
Kevin
Ousman
Department of Health System Policies
and Operations, World Health Organization Regional Office for Africa (AFRO)
Brazzaville, Congo
author
text
article
2017
eng
The changing demands on the health sectors in low- and middle-income countries especially sub-Saharan African countries continue to challenge efforts to address critical shortages of the health workforce. Addressing these challenges have led to the evolution of “non-physician clinicians” (NPCs), that assume some physician roles and thus mitigate the continuing shortage of doctors in these countries. While it is agreed that changes are needed in physicians’ roles and their training as part of the new continuum of care that includes NPCs, we disagree that such training should be geared solely at ensuring physicians dominated health systems. Discussions on the workforce models to suit low-income countries must avoid an endorsement of a culture of physician focused health systems as the only model for sub-Saharan Africa (SSA). It is also essential that training for NPCs be harmonized with that of physicians to clarify the technical roles of both.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
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2017
119
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https://www.ijhpm.com/article_3253_57d19477a929c4a1f979dbcbcbcfe2a4.pdf
dx.doi.org/10.15171/ijhpm.2016.110
Coordinating Between Medical Professions’ Tasks to Optimize Sub-Saharan Health Systems: A Response to Recent Commentaries
Nir
Eyal
Department of Global Health and Population, Harvard TH Chan School of
Public Health, Boston, MA, USA
author
Corrado
Cancedda
Division of Global Health Equity, Brigham
and Women’s Hospital, and Department of Global Health and Social Medicine,
Harvard Medical School, Boston, MA, USA
author
Samia A.
Hurst
Institute for Ethics, History, and
the Humanities, Faculty of Medicine, Geneva University, Geneva, Switzerland
author
Patrick
Kyamanywa
School of Health Sciences, Kampala International University, Kampala,
Uganda
author
text
article
2017
eng
International Journal of Health Policy and Management
Kerman University of Medical Sciences
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https://www.ijhpm.com/article_3290_eeef1dc194c1d9b099ffc8dc1eedd2e4.pdf
dx.doi.org/10.15171/ijhpm.2016.142