A Crisis of Humanitarianism: Refugees at the Gates of Europe
Marianna
Fotaki
Warwick Business School, University of Warwick, Coventry, UK
author
text
article
2019
eng
Having initially welcomed more than a million refugees and forced migrants into Europe between 2015 and 2016, the European Union’s (EU’s) policy has shifted toward externalising migration control to Turkey and Northern Africa. This goes against the spirit of international conventions aiming to protect vulnerable populations, yet there is widespread indifference toward those who remain stranded in Italy, Greece and bordering Mediterranean countries. Yet there are tens of thousands living in overcrowded reception facilities that have, in effect, turned into long-term detention centres with poor health and safety for those awaiting resettlement or asylum decisions. Disregard for humanitarian principles is predicated on radical inequality between lives that are worth living and protecting, and unworthy deaths that are unseen and unmarked by grieving. However, migration is on the rise due to natural and man-made disasters, and is becoming a global issue that concerns us all. We must therefore deal with it through collective political action that recognises refugees’ and forced migrants’ right to protection and ensures access to the health services they require.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
6
no.
2019
321
324
https://www.ijhpm.com/article_3611_7002684312988eeff8539306a35f1017.pdf
dx.doi.org/10.15171/ijhpm.2019.22
CIHR Health System Impact Fellows: Reflections on “Driving Change” Within the Health System
S Meaghan
Sim
Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
author
Jonathan
Lai
McGill University, Montreal, QC,
Canada
author
Katie
Aubrecht
Mount Saint Vincent University, Halifax, NS, Canada
author
Ivy
Cheng
Institute of
Health Policy and Management, University of Toronto, Toronto, ON, Canada
author
Mark
Embrett
DeGroote School
of Business, McMaster University, Hamilton, ON, Canada
author
El Kebir
Ghandour
Institut National D'excellence en Santé et en Services Sociaux (INESSS), Québec City, QC, Canada
author
Megan
Highet
School
of Public Health, University of Alberta, Edmonton, AB, Canada
author
Rebecca
Liu
Department of Human Kinetics, University of Ottawa, Ottawa, ON,
Canada
author
Christiane PM
Casteli
University Health and Social Services Centre (IUHSSC) of Capitale-Nationale (CN), Faculty of Nursing Sciences, Université Laval, Québec City,
QC, Canada
author
Margaret
Saari
School of Public Health and Health Systems, University of
Waterloo, Waterloo, ON, Canada
author
Samiratou
Ouédraogo
Department of Epidemiology Epidemiology, Biostatistics and Occupational
Health, McGill University, Montréal, QC, Canada
author
Hazel
Williams-Roberts
Saskatchewan Health
Authority, Saskatoon, SK, Canada
author
text
article
2019
eng
Learning health systems necessitate interdependence between health and academic sectors and are critical to address the present and future needs of our health systems. This concept is being supported through the new Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship, through which postdoctoral fellows are situated within a health system-related organization to help propel evidence-informed organizational transformation and change. A voluntary working group of fellows from the inaugural cohort representing diversity in geography, host setting and personal background, collectively organized a panel at the 2018 Canadian Association for Health Services and Policy Research Conference with the purpose of describing this shared scholarship experience. Here, we present a summary of this panel reflecting on our experiential learning in a practice environment and its ability for impact.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
6
no.
2019
325
328
https://www.ijhpm.com/article_3584_e3e8befb2f4522ba7bed5993193e2e25.pdf
dx.doi.org/10.15171/ijhpm.2018.124
The Challenge of Additionality: The Impact of Central Grants for Primary Healthcare on State-Level Spending on Primary Healthcare in India
Diana M.
Bowser
The Heller School for Social Policy and Management, Brandeis University,
Waltham, MA, USA
author
Rajesh
Jha
Independent Consultant, Delhi, India
author
Manjiri
Bhawalkar
Health Financing
Team, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva,
Switzerland
author
Peter
Berman
Department of Global Health and Population, International Health
Systems Program, Harvard School of Public Health, Boston, MA, USA
author
text
article
2019
eng
BackgroundIn planning for universal health coverage, many countries have been examining their fiscal decentralization policies with the goal of increasing efficiency and equity via “additionalities.” The concept of “additionality,” when the government of a lower administrative level increases the funding allocated to a particular issue when extra funds are present, is often used in these contexts. Although the definition of “additionality” can be used more broadly, for the purposes of this paper we focus narrowly on the additional allocation of primary healthcare expenditures. This paper explores this idea by examining the impact of central level primary healthcare expenditure, on individual state level contributions to primary healthcare expenditure within 16 Indian states between 2005 and 2013. MethodsIn examining 5 main variables, we compared differences between government expenditures, contributions, and revenues for Empowered Action Group (EAG) states, and non-EAG states. EAG states are normally larger states that have weaker public health infrastructure and hence qualify for additional funding. Finally, using a model that captured the quantity of central level primary healthcare expenditure distributions to these states, we measured its impact on each state’s own contributions to primary healthcare spending. ResultsOur results show that, at the state level, growth in per capita central level primary healthcare expenditure has increased by 110% from 2005-2013, while state’s own contributions to primary healthcare expenditure per capita increased by 32%. Further analyses show that a 1% change disbursement from the central level leads to a -0.132%, although not significant, change by states in their own expenditure. The effect for wealthier states is -0.151% and significant and for poorer states the effect is smaller at -0.096% and not significant. ConclusionThis analysis suggests that increases in central level primary healthcare expenditure to states have an inverse relationship with primary healthcare expenditures by the state level. Furthermore, this effect is more pronounced in wealthier Indian states. This finding has policy implications on India’s decision to increase block grants to states in place of targeted program expenditures.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
6
no.
2019
329
336
https://www.ijhpm.com/article_3596_07c36cfd3d1cfa9f762ced7c99df017c.pdf
dx.doi.org/10.15171/ijhpm.2019.06
Some Multidimensional Unintended Consequences of Telehealth Utilization: A Multi-Project Evaluation Synthesis
Hassane
Alami
Institute of Health and Social Services in Primary Care, Research Center
on Healthcare and Services in Primary Care, Laval University, Quebec City,
QC, Canada
author
Marie-Pierre
Gagnon
Institute of Health and Social Services in Primary Care, Research Center
on Healthcare and Services in Primary Care, Laval University, Quebec City,
QC, Canada
author
Jean-Paul
Fortin
Institute of Health and Social Services in Primary Care, Research Center
on Healthcare and Services in Primary Care, Laval University, Quebec City,
QC, Canada
author
text
article
2019
eng
Background Telehealth initiatives have bloomed around the globe, but their integration and diffusion remain challenging because of the complex issues they raise. Available evidence around telehealth usually deals with its expected effects and benefits, but its unintended consequences (UCs) and influencing factors are little documented. This study aims to explore, describe and analyze multidimensional UCs that have been associated with the use of telehealth. Methods We performed a secondary analysis of the evaluations of 10 telehealth projects conducted over a 22-year period in the province of Quebec (Canada). All material was subjected to a qualitative thematic-pragmatic content analysis with triangulation of methodologies and data sources. We used the conceptual model of the UCs of health information technologies proposed by Bloomrosen et al to structure our analysis. Results Four major findings emerged from our analysis. First, telehealth utilization requires many adjustments, changes and negotiations often underestimated in the planning and initial phases of the projects. Second, telehealth may result in the emergence of new services corridors that disturb existing ones and involve several adjustments for organizations, such as additional investments and resources, but also the risk of fragmentation of services and the need to balance between standardization of practices and local innovation. Third, telehealth may accentuate power relations between stakeholders. Fourth, it may lead to significant changes in the responsibilities of each actor in the supply chain of services. Finally, current legislative and regulatory frameworks appear ill-adapted to many of the new realities brought by telehealth. Conclusion This study provides a first attempt for an overview of the UCs associated with the use of telehealth. Future research-evaluation studies should be more sensitive to the multidimensional and interdependent factors that influence telehealth implementation and utilization as well as its impacts, intended or unintended, at all levels. Thus, a consideration of potential UCs should inform telehealth projects, from their planning until their scaling-up.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
6
no.
2019
337
352
https://www.ijhpm.com/article_3603_0b661dcb4e35e53641ad5a80af47ab40.pdf
dx.doi.org/10.15171/ijhpm.2019.12
Relevance of a Toll-Free Call Service Using an Interactive Voice Server to Strengthen Health System Governance and Responsiveness in Burkina Faso
Lucie
Lechat
UMI Resiliences, IRD (French Institute For Research on sustainable
Development), Bondy, France
author
Emmanuel
Bonnet
UMI Resiliences, IRD (French Institute For Research on sustainable
Development), Bondy, France
author
Ludovic
Queuille
Pan American Health Organization, Portau-Prince, Haiti
author
Zoumana
Traoré
CEO Africasys, Paris, France
author
Paul-André
Somé
NGO Action-GovernanceIntegration-Strengthening, Health and Development Working Group (AGIRSD), Ouagadougou, Burkina-Faso
author
Valéry
Ridde
IRD (French Institute For Research
on sustainable Development), CEPED (IRD-Université Paris Descartes),
Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
author
text
article
2019
eng
Background In Africa, health systems are poorly accessible, inequitable, and unresponsive. People rarely have either the confidence or the opportunity to express their opinions. In Burkina Faso, there is a political will to improve governance and responsiveness to create a more relevant and equitable health system. Given their development in Africa, information and communication technologies (ICTs) offer opportunities in this area. Methods This article presents the results of an evaluation of a toll-free call service coupled with an interactive voice server (TF-IVS) tested in Ouagadougou, Burkina Faso, to assess its relevance for improving health systems governance. The approach consisted of a 2-phased action research project to test 2 technologies: recorded messages and touch keypad. Using a concurrent mixed approach, we assessed the technological, social, and instrumental relevance of the service. Results The call service is available everywhere, 24 hours per day, seven days per week. The equipment and its physical location were not adequately protected against technological hazards. Of the 278 days of operation, 49 were non-functional. In 8 months, there were 13 877 calls, which demonstrated the popularity of ICTs and the ease of access to telephone networks and mobile technologies. The TF-IVS was free, anonymous, and multilingual, which fostered the expression of public opinion. However, cultural context (religion, ethnic culture) and fear of reprisals may have had a negative influence. In the end, questions remained regarding people’s capacity to use this innovative service. In the first trial, 49% of callers recorded their message and in the second, 48%. Touch key technology appeared more relevant for automated and real-time data collection and analysis, but there was no comprehensive strategy for translating the information collected into a response from healthcare actors or the government. Conclusion This study showed the relevance and feasibility of implementing a TF-IVS to strengthen health system responsiveness in one of the world’s poorest countries. Public opinion expressed through data collected in real-time is helpful for improving system responsiveness to meet care needs and enhance equity. However, the strategy for developing this tool must take into account the implementation context and the activities needed to influence the mechanisms of social responsibility (eg, information provision, citizen action, and state response).
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
6
no.
2019
353
364
https://www.ijhpm.com/article_3605_49829981d3b367b704c8a0cfe455a438.pdf
dx.doi.org/10.15171/ijhpm.2019.13
Political Ideology and Stigmatizing Attitudes Toward Depression: The Swedish Case
Jesper
Löve
Department of Public Health and Community Medicine at Institute of Medicine,
University of Gothenburg, Gothenburg, Sweden
author
Monica
Bertilsson
Department of Public Health and Community Medicine at Institute of Medicine,
University of Gothenburg, Gothenburg, Sweden
author
Johan
Martinsson
Department of Political
Science, University of Gothenburg, Gothenburg, Sweden
author
Lena
Wängnerud
Department of Political
Science, University of Gothenburg, Gothenburg, Sweden
author
Gunnel
Hensing
Department of Public Health and Community Medicine at Institute of Medicine,
University of Gothenburg, Gothenburg, Sweden
author
text
article
2019
eng
BackgroundStigmatizing attitudes toward persons with mental disorders is a well-established and global phenomenon often leading to discrimination and social exclusion. Although previous research in the United States showed that conservative ideology has been related to stigmatizing attitudes toward mental disorders, there is reason to believe that this mechanism plays a different role in the context of a universal welfare state with a multi-party system such as Sweden. Furthermore, “mental disorders” may signify severe psychotic disorders, which may evoke more negative attitudes. This suggests the importance of specific studies focusing on the more common phenomenon of depression. This paper investigates the relationship between political ideology and stigmatizing attitudes toward depression in Sweden. MethodsThis study is part of the New Ways research program. Data were collected by the Laboratory of Opinion Research (LORE) at the University of Gothenburg in 2014 (N = 3246). Independent variables were political ideology and party affiliation. The dependent variable was the Depression Stigma Scale (DSS). Data were analyzed with linear regression analyses and analyses of variance. ResultsMore conservative ideology (B = 0.68, standard error [SE] = 0.04, P < .001) and more conservative party affiliation (F(8 2920) = 38.45, P < .001) showed more stigmatizing attitudes toward depression. Item-level analyses revealed a difference where the supporters of the conservative party differed (P < .05) from supporters of the liberal party, with a higher proportion agreeing that “people could snap out of” depression if they wanted to; the populist right-wing party differed from the conservative party with a higher proportion agreeing on items displaying people with depression as “dangerous” and “unpredictable.” Even self-stigma was highest among the populist right-wing party with 22.3% agreeing that “if I had depression I wouldn’t tell….” ConclusionPolitical ideology was associated with stigmatizing attitudes toward depression in Sweden. The results also confirm the need to distinguish between different forms of conservatism by observing social distance as being a more important driver among voters for the populist right-wing party compared with personal agency and responsibility among voters for the more traditional conservative party.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
6
no.
2019
365
374
https://www.ijhpm.com/article_3606_d3aef6c1983256e0f9b82460a5bfe4b6.pdf
dx.doi.org/10.15171/ijhpm.2019.15
Reflections on Norheim (2018), Disease Control Priorities Third Edition Is Published; Comment on “Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy”
Rachel
Nugent
RTI International, Seattle, WA, USA
author
text
article
2019
eng
The publication of Disease Control Priorities, 3rd edition (DCP3) is a major milestone in the global health world. DCP3 reviews and summarizes high quality health intervention effectiveness and cost-effectiveness evidence relevant to low- and middle-income countries and is freely available to users. This Commentary summarizes Norheim’s (2018) assessment of DCP3’s role in country health priority-setting and offers reflections on what DCP3 can continue to offer countries seeking to improve their purchasing of health.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
6
no.
2019
375
377
https://www.ijhpm.com/article_3599_0bf7678a9bde7842ecc3c10183f63b12.pdf
dx.doi.org/10.15171/ijhpm.2019.09
Patient Engagement and its Evaluation Tools – Current Challenges and Future Directions; Comment on “Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review”
Samira
Abbasgholizadeh Rahimi
Department of Family Medicine, Faculty of Medicine, McGill University,
Montreal, QC, Canada
author
Hervé Tchala Vignon
Zomahoun
Health and Social Services Systems, Knowledge
Translation and Implementation Component of the Quebec SPOR-SUPPORT
Unit, Université Laval, Quebec, QC, Canada
author
France
Légaré
Department of Family Medicine and Emergency Medicine, Faculty of Medicine,
Université Laval, Quebec, QC, Canada
author
text
article
2019
eng
Considering the growing recognition of the importance of patient engagement in healthcare decisions, research and delivery systems, it is important to ensure high quality and efficient patient engagement evaluation tools. In this commentary, we will first highlight the definition and importance of patient engagement. Then we discuss the psychometric properties of the patient engagement evaluation tools identified in a recent review on patient engagement in healthcare organization- and system-level decision-making. Lastly, we suggest future directions for patient engagement and its evaluation tools.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
6
no.
2019
378
380
https://www.ijhpm.com/article_3604_d999a2db6074bd48ab4d5362ad93b7fc.pdf
dx.doi.org/10.15171/ijhpm.2019.16
Global Surgery Priorities: A Response to Recent Commentaries
Jakub
Gajewski
Institute of Global Surgery, Royal College of Surgeons in Dublin, Dublin,
Ireland
author
Ruairi
Brugha
Department of Epidemiology and Public Health Medicine, Royal
College of Surgeons in Ireland, Dublin 2, Ireland
author
Leon
Bijlmakers
Radboud University Medical
Centre, Nijmegen, The Netherlands
author
text
article
2019
eng
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
6
no.
2019
381
383
https://www.ijhpm.com/article_3598_11a77e7403605895d77066b2c116aa68.pdf
dx.doi.org/10.15171/ijhpm.2019.10
Health Financing Consequences of Implementing Health Transformation Plan in Iran: Achievements and Challenges
Leila
Doshmangir
Tabriz Health Services Management Research Center, Iranian Center of
Excellence in Health Management, Tabriz University of Medical Sciences,
Tabriz, Iran
author
Mohammad
Bazyar
Department of Public Health, Faculty of Health,
Ilam University of Medical Sciences, Ilam, Iran
author
Behzad
Najafi
Tabriz Health Services
Management Research Center, Tabriz University of Medical Sciences, Tabriz,
Iran
author
Hassan
Haghparast-Bidgoli
Institute for
Global Heath, University College London, London, UK
author
text
article
2019
eng
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
6
no.
2019
384
386
https://www.ijhpm.com/article_3608_7985c2fbdfa47dcb4a0d057a79e6618b.pdf
dx.doi.org/10.15171/ijhpm.2019.18