ORIGINAL_ARTICLE
Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness
Priority setting of health interventions is generally considered as a valuable approach to support low- and middle-income countries (LMICs) in their strive for universal health coverage (UHC). However, present initiatives on priority setting are mainly geared towards the development of more cost-effectiveness information, and this evidence does not sufficiently support countries to make optimal choices. The reason is that priority setting is in reality a value-laden political process in which multiple criteria beyond cost-effectiveness are important, and stakeholders often justifiably disagree about the relative importance of these criteria. Here, we propose the use of ‘evidence-informed deliberative processes’ as an approach that does explicitly recognise priority setting as a political process and an intrinsically complex task. In these processes, deliberation between stakeholders is crucial to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. Such processes then result in the use of a broader range of explicit criteria that can be seen as the product of both international learning (‘core’ criteria, which include eg, cost-effectiveness, priority to the worse off, and financial protection) and learning among local stakeholders (‘contextual’ criteria). We believe that, with these evidence-informed deliberative processes in place, priority setting can provide a more meaningful contribution to achieving UHC.
https://www.ijhpm.com/article_3231_0b8154abfa743a669765193093e58f9c.pdf
2016-11-01
615
618
10.15171/ijhpm.2016.83
Universal Health Coverage (UHC)
Priority Setting
Cost-Effectiveness Analysis
Evidence-Informed Deliberative Processes
Decision-Making
Legitimacy
Rob
Baltussen
rob.baltussen@radboudumc.nl
1
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
LEAD_AUTHOR
Maarten P.
Jansen
jansenm@who.int
2
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
AUTHOR
Evelinn
Mikkelsen
evelinn.mikkelsen@radboudumc.nl
3
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
AUTHOR
Noor
Tromp
noor.tromp@radboudumc.nl
4
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
AUTHOR
Jan
Hontelez
jan.hontelez@gmail.com
5
Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
AUTHOR
Leon
Bijlmakers
leon.bijlmakers@radboudumc.nl
6
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
AUTHOR
Gert Jan
Van der Wilt
gertjan.vanderwilt@radboudumc.nl
7
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
AUTHOR
Teerawattananon Y, Luz A, Kanchanachitra C, Tantivess S, Prince Mahidol Award Conference s. Role of priority setting in implementing universal health coverage. BMJ. 2016;532:i244. doi:10.1136/bmj.i244
1
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20
Tromp N, Prawiranegara R, Subhan Riparev H, Siregar A, Sunjaya D, Baltussen R. Priority setting in HIV/AIDS control in West Java Indonesia: an evaluation based on the accountability for reasonableness framework. Health Policy Plan. 2015;30(3):345-355. doi:10.1093/heapol/czu020
21
Tromp N, Prawiranegara R, Siregar A, Jansen MP, Baltussen R. Time to recognise countries' preferences in HIV control. Lancet. 2016:1053-1054. doi:10.1016/S0140-6736(16)00659-0
22
Tromp N, Prawiranega, R, Siregar A, Jansen M, Baltussen R. Towards participatory and evidence-based resource allocation decisions for AIDS funding in Indonesia. Nijmegen; 2016.
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Ottersen T, Norheim OF. Making fair choices on the path to universal health coverage. Bull World Health Organ. 2014;92(6):389. doi:10.2471/BLT.14.139139
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Zorginstituut Nederland (Netherlands Health Care Institute). Kosteneffectiviteit in de praktijk (Cost-effectiveness analysis in practice). Diemen; 2015.
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Youngkong S, Baltussen R, Tantivess S, Mohara A, Teerawattananon Y. Multicriteria decision analysis for including health interventions in the universal health coverage benefit package in Thailand. Value Health. 2012;15(6):961-970. doi:10.1016/j.jval.2012.06.006
27
Thokala P, Devlin N, Marsh K, et al. Multiple Criteria Decision Analysis for Health Care Decision Making-An Introduction: Report 1 of the ISPOR MCDA Emerging Good Practices Task Force. Value Health. 2016;19(1):1-13. doi:10.1016/j.jval.2015.12.003
28
Mitton C, Peacock S, Donaldson C, Bate A. Using PBMA in health care priority setting: description, challenges and experience. Appl Health Econ Health Policy. 2003;2(3):121-127.
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Byskov J, Marchal B, Maluka S, et al. The accountability for reasonableness approach to guide priority setting in health systems within limited resources--findings from action research at district level in Kenya, Tanzania, and Zambia. Health Res Policy Syst. 2014;12:49. doi:10.1186/1478-4505-12-49
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Norheim OF. Ethical priority setting for universal health coverage: challenges in deciding upon fair distribution of health services. BMC Med. 2016;14(1):75.
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38
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39
Jansen MPM, Helderman JK, Boer B, Baltussen R. Fair processes for priority setting: putting theory into practice. Int J Health Policy Manag. 2016; forthcoming.
40
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41
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42
ORIGINAL_ARTICLE
Medicalisation and Overdiagnosis: What Society Does to Medicine
The concept of overdiagnosis is a dominant topic in medical literature and discussions. In research that targets overdiagnosis, medicalisation is often presented as the societal and individual burden of unnecessary medical expansion. In this way, the focus lies on the influence of medicine on society, neglecting the possible influence of society on medicine. In this perspective, we aim to provide a novel insight into the influence of society and the societal context on medicine, in particularly with regard to medicalisation and overdiagnosis.
https://www.ijhpm.com/article_3269_e100f2351e57ebd7069f76847dda3de5.pdf
2016-11-01
619
622
10.15171/ijhpm.2016.121
Medicalisation
Overdiagnosis
Society
Wieteke
van Dijk
wieteke.vandijk@radboudumc.nl
1
Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
LEAD_AUTHOR
Marjan J.
Faber
marjan.faber@radboudumc.nl
2
Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
AUTHOR
Marit A.C.
Tanke
marit.tanke@radboudumc.nl
3
Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
AUTHOR
Patrick P.T.
Jeurissen
patrick.jeurissen@radboudumc.nl
4
Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
AUTHOR
Gert P.
Westert
gert.westert@radboudumc.nl
5
Celsus Academy for Sustainable Healthcare, and Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
AUTHOR
Hofmann B. Medicalization and overdiagnosis: different but alike. Med Health Care Philos. 2016. doi:10.1007/s11019-016-9693-6
1
Welsh H, Schwartz L, Woloshin S. Overdiagnosed: Making People Sick in the Pursuit of Health. Boston: Beacon Press; 2011.
2
Conrad P. The shifting engines of medicalization. J Health Soc Behav. 2005;46:3-14. doi:10.1177/002214650504600102
3
Earp BD, Sandberg A, Savulescu J. The medicalization of love. Camb Q Healthc Ethics. 2015;24(3):323-336. doi:10.1017/S0963180114000206
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Carter SM, Rogers W, Heath I, Degeling C, Doust J, Barratt A. The challenge of overdiagnosis begins with its definition. BMJ.2015;350:h869. doi:10.1136/bmj.h869
5
Morrison M. Overdiagnosis, medicalisation and social justice: commentary on Carter et al (2016) ‘A definition and ethical evaluation of overdiagnosis.’ J Med Ethics. 2016. doi:10.1136/medethics-2015-102928
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Rose N. Beyond medicalisation. Lancet. 2007;369:700-701. doi:10.1016/S0140-6736(07)60319-5
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Conrad P. Medicalization: changing contours, characteristics, and contexts. In: Cockerham W, ed. Medical Sociology on the Move. Dordrecht: Springer Science + Business Media; 2013.
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Hofmann B. Diagnosing overdiagnosis: conceptual challenges and suggested solutions. Eur J Epidemiol. 2014;29(9):599-604. doi:10.1007/s10654-014-9920-5
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Freidson E. Profession of Medicine. A Study of the Sociology of Applied Knowledge.New York: Dodd, Mead & Company; 1971.
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Conrad P, Barker KK. The social construction of illness: key insights and policy implications. Journal of Health and Social Behavior. 2010;51 Suppl:S67-79. doi:10.1177/0022146510383495
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Brunet M. Targets for dementia diagnoses will lead to overdiagnosis. BMJ. 2014;348:g2224. doi:10.1136/bmj.g2224
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Welch H, Schwartz LM, Woloshin S. Overdiagnosed. Making people sick in the pursuit of health. Boston: Beacon Press; 2011.
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40
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41
ORIGINAL_ARTICLE
Values in Health Policy – A Concept Analysis
Background Despite the significant role “values” play in decision-making no definition or attributes regarding the concept have been provided in health policy-making. This study aimed to clarify the defining attributes of a concept of value and its irrelevant structures in health policy-making. We anticipate our findings will help reduce the semantic ambiguities associated with the use of “values” and other concepts such as principles, criteria, attitudes, and beliefs. Methods An extensive search of literature was carried out using electronic data base and library. The overall search strategy yielded about 1540 articles and 450 additional records. Based on traditional qualitative research, studies were purposefully selected and the coding of articles continued until data saturation was reached. Accordingly, 31 articles, 2 books, and 5 other documents were selected for the review. We applied Walker and Avant’s method of concept analysis in studying the phenomenon. Definitions, applications, attributes, antecedents, and consequences of the concept of “value in health policy-making” were extracted. We also identified similarities and differences that exist between and within them. Results We identified eight major attributes of “value in health policy-making”: ideological origin, affect one’s choices, more resistant to change over time, source of motivation, ability to sacrifice one’s interest, goal-oriented nature for community, trans-situational and subjectivity. Other features pinpointed include alternatives, antecedents, and consequences. Alternative, antecedents and consequences case may have more or fewer attributes or may lack one of these attributes and at the same time have other distinctive ones. Conclusion Despite the use of the value framework, ambiguities still persist in providing definition of the concept value in health policy-making. Understanding the concept of value in health policy-making may provide extra theoretical support to decision-makers in their policy-making process, to help avoid poor policy formulation and wastage of limited resources.
https://www.ijhpm.com/article_3261_f0d5821c502e473c02447e53d7aac01b.pdf
2016-11-01
623
630
10.15171/ijhpm.2016.102
Values
Health
Policy-Making
Ideology
Principle
Belie
Lida
Shams
shams_lida@yahoo.com
1
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Ali
Akbari Sari
akbarisari@tums.ac.ir
2
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
AUTHOR
Shahram
Yazdani
shahram.yazdani@yahoo.com
3
Department of Medical Education, School of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
LEAD_AUTHOR
Strydom WF, Funke N, Nienaber S, Nortje K, Steyn M. Evidencebased policymaking: a review. S Afr J Sci. 2010;106(5-6):17-24. doi:10.4102/sajs.v106i5/6.249
1
Canadian Health Services Research Foundation. Health Services Research and Evidence-Based Decision-Making. http://www.cfhi-fcass.ca/migrated/pdf/mythbusters/EBDM_e.pdf. Published 2000.
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Wood Bridge K, Fulford KW. Whose Values? A Workbook for Values-Based Practice in Mental Health Care.London, UK: The Sainsbury Centre for Mental Health; 2004.
3
Kehoe SM, Ponting JR. Value importance and value congruence as determinants of trust in health policy actors. Soc Sci Med. 2003;57(6):1065-1075. doi:10.1016/S0277-9536(02)00485-9
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Kjervik DK. A values orientation to health care policy. J Prof Nurs. 1996;12(2):67. doi: 10.1016/S8755-7223(96)80049-4
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Stewart J. Public Policy Values. University of New South Wales, Australia: Australian Defence Force Academy; 2009.
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Giacomini M, Hurley J, Gold I, Smith P, Abelson J. The policy analysis of ‘values talk’: lessons from Canadian health reform. Health Policy. 2004;67(1):15-24. doi:10.1016/S0168-8510(03)00100-3
7
Segal E. Social Welfare Policy and Social Programs: A Values Perspective. Boston: Cengage Learning; 2009.
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Nvail S. Canadians’ values and attitudes on Canada’s health care system: a synthesis of survey results. A Conference Board of Canada report from the Economic Forecasting Group; 2001.
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McLaughlin B. Values in behavioral science. J Relig Health. 1965;4(3):258-279. doi:10.1007/BF01532334
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William R MJ. Concept of Value In International Encyclopedia of the Social Sciences. 12th ed. D. L. Sills Glencoe, Ill: Free Press; 1968.
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Fulford KW. The value of evidence and evidence of values: bringing together values-based and evidence-based practice in policy and service development in mental health. J Eval Clin Pract. 2011;17(5):976-987. doi:10.1111/j.1365-2753.2011.01732.x
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Roberts M, Hsiao W, Berman P, Reich M. Getting health reform right:a guide to improving performance and equity. Oxford University Press; 2008.
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Hoedemaekers R, Dekkers W. Justice and solidarity in priority setting in health care. Health Care Anal. 2003;11(4):325-343. doi:10.1023/B:HCAN.0000010061.71961.87
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57
ORIGINAL_ARTICLE
Private Practitioners’ Perspectives on Their Involvement With the Tuberculosis Control Programme in a Southern Indian State
Background Public and private health sectors both play a crucial role in the health systems of low- and middleincome countries (LMICs). The tuberculosis (TB) control strategy in India encourages the public sector to actively partner with private practitioners (PPs) to improve the quality of front line service delivery. However, ensuring effective and sustainable involvement of PPs constitutes a major challenge. This paper reports the findings from an empirical study focusing on the perspectives and experiences of PPs towards their involvement in TB control programme in India. Methods The study was carried out between November 2010 and December 2011 in a district of a Southern Indian State and utilised qualitative methodologies, combining observations and in-depth interviews with 21 PPs from different medical systems. The collected data was coded and analysed using thematic analysis. Results PPs perceived themselves to be crucial healthcare providers, with different roles within the public-private mix (PPM) TB policy. Despite this, PPs felt neglected and undervalued in the actual process of implementation of the PPM-TB policy. The entire process was considered to be government driven and their professional skills and knowledge of different medical systems remained unrecognised at the policy level, and weakened their relationship and bond with the policy and with the programme. PPs had contrasting perceptions about the different components of the TB programme that demonstrated the public sector’s dominance in the overall implementation of the DOTS strategy. Although PPs felt responsible for their TB patients, they found it difficult to perceive themselves as ‘partners with the TB programme.’ Conclusion Public-private partnerships (PPPs) are increasingly utilized as a public health strategy to strengthen health systems. These policies will fail if the concerns of the PPs are neglected. To ensure their long-term involvement in the programme the abilities of PPs and the important perspectives from other Indian medical systems need to be recognised and supported.
https://www.ijhpm.com/article_3197_befe3b0663f3a52d0b2d1e09dc891d8c.pdf
2016-11-01
631
642
10.15171/ijhpm.2016.52
Public Sector
Private Sector
Private Practitioners (PPs)
Public-Private Mix (PPM)
Tuberculosis
(TB)
India
Solomon
Salve
solomon.salve@gmail.com
1
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
LEAD_AUTHOR
Kabir
Sheikh
kabir.sheikh@gmail.com
2
Public Health Foundation of India, New Delhi, India
AUTHOR
John DH
Porter
john.porter@lshtm.ac.uk
3
Departments of Clinical Research and Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
AUTHOR
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90
ORIGINAL_ARTICLE
Bed Utilisation in an Irish Regional Paediatric Unit – A Cross-Sectional Study Using the Paediatric Appropriateness Evaluation Protocol (PAEP)
Background Increasing demand for limited healthcare resources raises questions about appropriate use of inpatient beds. In the first paediatric bed utilisation study at a regional university centre in Ireland, we conducted a cross-sectional study to audit the utilisation of inpatient beds at the Regional Paediatric Unit (RPU) in University Hospital Limerick (UHL), Limerick, Ireland and also examined hospital activity data, to make recommendations for optimal use of inpatient resources. Methods We used a questionnaire based on the paediatric appropriateness evaluation protocol (PAEP), modified and validated for use in the United Kingdom, to prospectively gather data regarding reasons for admission and for ongoing care after 2 days, from case records for all inpatients during 11 days in February (winter) and 7 days in May–June (summer). We conducted bivariate and multivariate analysis to explore associations between failure to meet PAEP criteria and patient attributes including age, gender, admission outside of office hours, arrival by ambulance, and private health insurance. Inpatient bed occupancy and day ward activity were also scrutinised. Results Mean bed occupancy was 84.1%. In all, 12/355 (3.4%, 95% CI: 1.5%–5.3%) of children failed to meet PAEP admission criteria, and 27/189 (14.3%, 95% CI: 9.3%–19.3%) who were still inpatients after 2 days failed to meet criteria for ongoing care. 35/355 (9.9%, 95% CI: 6.8%–13.0%) of admissions fulfilled only the PAEP criterion for intravenous medications or fluid replacement. A logistic regression model constructed by forward selection identified a significant association between failure to meet PAEP criteria for ongoing care 2 days after admission and admission during office hours (08.00–17.59) (P = .020), and a marginally significant association between this outcome and arrival by ambulance (P = .054). Conclusion At a mean bed occupancy of 84.1%, an Irish RPU can achieve 96.6% appropriate admissions. Although almost all inpatients met PAEP criteria, improvements could be made regarding emergency access to social services, management of parental anxiety, and optimisation of access to community-based services. Potential ways to provide nasogastric or intravenous fluid therapy on an ambulatory basis, and outpatient antimicrobial therapy (OPAT) should be explored. Elective surgical admissions should adhere to day-of-surgery admissions (DOSA) policy.
https://www.ijhpm.com/article_3199_c2a6896cef8df1838624785bcfe9ed21.pdf
2016-11-01
643
652
10.15171/ijhpm.2016.53
Bed Utilisation
Bed Occupancy
Hospitalisation
Paediatrics
Quality Of Healthcare
Social Work
Clinical
Audit
Coilín
ÓhAiseadha
coilin.ohaiseadha@hse.ie
1
Department of Public Health, Health Service Executive, Dublin, Ireland
AUTHOR
Mai
Mannix
mai.mannix@hse.ie
2
Department of Public Health, Health Service Executive, Dublin, Ireland
AUTHOR
Jean
Saunders
jean.saunders@ul.ie
3
Statistical Consulting Unit, University of Limerick, Limerick, Ireland
AUTHOR
Roy K.
Philip
roy.philip@hse.ie
4
Regional Paediatric Unit (Children’s Ark), University Hospital Limerick (UHL), Limerick, Ireland
LEAD_AUTHOR
Fieldston ES, Hall M, Sills MR, et al. Children's hospitals do not acutely respond to high occupancy. Pediatrics. 2010;125(5):974-981. doi:10.1542/peds.2009-1627
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Hillier DF, Parry GJ, Shannon MW, Stack AM. The effect of hospital bed occupancy on throughput in the pediatric emergency department. Ann Emerg Med. 2009;53(6):767-776. e3. doi:10.1016/j.annemergmed.2008.11.024
16
Morrison AK, Myrvik MP, Brousseau DC, Hoffmann RG, Stanley RM. The relationship between parent health literacy and pediatric emergency department utilization: a systematic review. Acad Pediatr. 2013;13(5):421-429. doi:10.1016/j.acap.2013.03.001
17
Citizens' Information Board. Charges for hospital services. http://www.citizensinformation.ie/en/health/hospital_services/hospital_charges.html. published 2014.
18
Turner B. Unwinding the State subsidisation of private health insurance in Ireland. Health Policy. 2015;119(10):1349-1357. doi:10.1016/j.healthpol.2015.08.008
19
Layte R. Equity in the utilisation of hospital inpatient services in Ireland? An improved approach to the measurement of health need. Econ Soc Rev. 2007;38(2):191.
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Organization for Economic Cooperation and Development (OECD) Staff. Health at a Glance 2013 OECD Indicators. OECD;2013.
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PA Consulting Group. Acute Hospital Bed Review: Health Service Executive;2007.
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Doré-Bergeron MJ, Gauthier M, Chevalier I, McManus B, Tapiero B, Lebrun S. Urinary tract infections in 1- to 3-month-old infants: ambulatory treatment with intravenous antibiotics. Pediatrics. 2009;124(1):16-22.
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Meates M. Ambulatory paediatrics—making a difference. Arch Dis Child. 1997;76(5):468-476. doi:10.1136/adc.76.5.468
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Beverley DW, Ball RJ, Smith RA, et al. Planning for the future: the experience of implementing a children’s day assessment unit in a district general hospital. Arch Dis Child. 1997;77(4):287-293. doi:10.1136/adc.77.4.287
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MacFaul R. Planning for the future: the experience of implementing a children's day assessment unit in a district general hospital-Commentary. Arch Dis Child. 1997;77:287-293. doi:10.1136/adc.77.4.287
26
Aitken P, Birch S, Cogman G, Glasper EA, Wiltshire M. Quadrennial review of a paediatric emergency assessment unit. Br J Nurs. 2003;12(4):234-241. doi:10.12968/bjon.2003.12.4.11163
27
ORIGINAL_ARTICLE
Key Ethical Issues Discussed at CDC-Sponsored International, Regional Meetings to Explore Cultural Perspectives and Contexts on Pandemic Influenza Preparedness and Response
Background Recognizing the importance of having a broad exploration of how cultural perspectives may shape thinking about ethical considerations, the Centers for Disease Control and Prevention (CDC) funded four regional meetings in Africa, Asia, Latin America, and the Eastern Mediterranean to explore these perspectives relevant to pandemic influenza preparedness and response. The meetings were attended by 168 health professionals, scientists, academics, ethicists, religious leaders, and other community members representing 40 countries in these regions. Methods We reviewed the meeting reports, notes and stories and mapped outcomes to the key ethical challenges for pandemic influenza response described in the World Health Organization’s (WHO’s) guidance, Ethical Considerations in Developing a Public Health Response to Pandemic Influenza: transparency and public engagement, allocation of resources, social distancing, obligations to and of healthcare workers, and international collaboration. Results The important role of transparency and public engagement were widely accepted among participants. However, there was general agreement that no “one size fits all” approach to allocating resources can address the variety of economic, cultural and other contextual factors that must be taken into account. The importance of social distancing as a tool to limit disease transmission was also recognized, but the difficulties associated with this measure were acknowledged. There was agreement that healthcare workers often have competing obligations and that government has a responsibility to assist healthcare workers in doing their job by providing appropriate training and equipment. Finally, there was agreement about the importance of international collaboration for combating global health threats. Conclusion Although some cultural differences in the values that frame pandemic preparedness and response efforts were observed, participants generally agreed on the key ethical principles discussed in the WHO’s guidance. Most significantly the input gathered from these regional meetings pointed to the important role that procedural ethics can play in bringing people and countries together to respond to the shared health threat posed by a pandemic influenza despite the existence of cultural differences.
https://www.ijhpm.com/article_3206_193a5ab3c5d46c96a8914bd9fcb6c6e5.pdf
2016-11-01
653
662
10.15171/ijhpm.2016.55
Public Health Ethics
Culture
Influenza
Pandemic Preparedness
Global Health
Emergency Response
Aun
Lor
aal8@cdc.gov
1
Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
LEAD_AUTHOR
James C.
Thomas
jim.thomas@unc.edu
2
Gilllings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
AUTHOR
Drue H.
Barrett
dhb1@cdc.gov
3
Office of Science Integrity, Office of the Associate Director for Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
AUTHOR
Leonard W.
Ortmann
hsq3@cdc.gov
4
Office of Science Integrity, Office of the Associate Director for Science, Centers for Disease Control and Prevention, Atlanta, GA, USA
AUTHOR
Dionisio J.
Herrera Guibert
dherrera@tephinet.org
5
Training Programs in Epidemiology and Public Health Interventions Network, Task Force for Global Health Inc., Atlanta, GA, USA
AUTHOR
Pandemic Flu History. Department of Health and Human Services (Flu.gov) website. http://www.flu.gov/pandemic/history/index.html. Accessed October 23, 2015.
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Ethical Considerations for Decision-making Regarding Allocation of Mechanical Ventilators during a Severe Influenza Pandemic or Other Public Health Emergency. Prepared by the Ventilator Document Workgroup, Ethics Subcommittee of the Advisory Committee to the Director. Centers for Disease Control and Prevention website. http://www.cdc.gov/about/advisory/pdf/VentDocument_Release.pdf. Accessed October 23, 2015.
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Ethical considerations in developing a public health response to pandemic influenza. World Health Organization website. http://www.who.int/csr/resources/publications/WHO_CDS_EPR_GIP_2007_2c.pdf. Accessed October 23, 2015. Published 2007.
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Kinlaw K, Levine R. Ethical guidelines in pandemic influenza. Centers for Disease Control and Prevention website. http://www.cdc.gov/od/science/integrity/phethics/panFlu_Ethic_Guidelines.pdf. Accessed October 23, 2015. Published 2007.
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Kinlaw K, Barrett DH, Levine RJ. Ethical guidelines in pandemic influenza: Recommendations of the Ethics Subcommittee of the Advisory Committee of the Director, Centers for Disease Control and Prevention. Disaster Med Public Health Prep. 2009;3(suppl 2):S185-S192. doi:10.1097/dmp.0b013e3181ac194f
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Bennett B, Carney T. Law, Ethics and Pandemic Preparedness: The Importance of Cross-jurisdictional and Cross-Cultural Perspectives. Aust N Z J Public Health. 2010;34(2):106-112. doi:10.1111/j.1753-6405.2010.00492.x
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Gostin LO. Influenza pandemic preparedness: legal and ethical dimensions. Hastings Cent Rep. 2004;34(5):10-11. doi:10.2307/3527583
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Gostin LO. Pandemic Influenza: public health preparedness for the next global health emergency. J Law Med Ethics. 2004;32(4):565-573. doi:10.1111/j.1748-720X.2004.tb01962.x
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Kayman H, Ablorh-Odjidja A. Revisiting public health preparedness: incorporating social justice principles into pandemic preparedness planning for influenza. J Public Health Manag Pract. 2006; 12(4):373-80. doi:10.1097/00124784-200607000-00011
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Ruderman C, Tracy CS, Bensimon CM, et al. On pandemics and the duty to care: Whose duty? Who cares? BMC Med Ethics. 2006;7:E5.
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Tilburt JC, Mueller PS, Ottenberg AL, Poland GA, Koenig BA. Facing the challenges of influenza in healthcare settings: the ethical rationale for mandatory seasonal influenza vaccination and its implications for future pandemics. Vaccine. 2008; 26(suppl 4):D27-30. doi:10.1016/j.vaccine.2008.07.068
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Tuohey JF. A matrix for ethical decision-making in a pandemic. the Oregon tool for emergency preparedness. Health Prog. 2007;88(6):20-25.
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Thompson AK, Faith K, Gibson JL, Upshur RE. Pandemic influenza preparedness: an ethical framework to guide decision-making. BMC Med Ethics. 2006;7:E12.
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Khan N. Why China’s SARS Legacy May Give It an Edge Against Ebola. http://www.bloomberg.com/news/articles/2014-10-29/why-china-s-sars-legacy-may-give-it-an-edge-against-ebola. Accessed October 23, 2015. Published 2014.
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Shiffman J. Global health as a field of power relations: a response to recent commentaries. International Journal of Health Policy and Management. 2015;4(7):497-499. doi:10.15171/ijhpm.2015.104
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45
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46
ORIGINAL_ARTICLE
Low Decision Space Means No Decentralization in Fiji; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”
Mohammed, North, and Ashton find that decentralization in Fiji shifted health-sector workloads from tertiary hospitals to peripheral health centres, but with little transfer of administrative authority from the centre. Decisionmaking in five functional areas analysed remains highly centralized. They surmise that the benefits of decentralization in terms of services and outcomes will be limited. This paper invokes Faguet’s (2012) model of local government responsiveness and accountability to explain why this is so – not only for Fiji, but in any country that decentralizes workloads but not the decision space of local governments. A competitive dynamic between economic and civic actors that interact to generate an open, competitive politics, which in turn produces accountable, responsive government can only occur where real power and resources have been devolved to local governments. Where local decision space is lacking, by contrast, decentralization is bound to fail because it has not really happened in the first place.
https://www.ijhpm.com/article_3229_2327af22894c19b20cb69636e79e79dc.pdf
2016-11-01
663
665
10.15171/ijhpm.2016.82
Decentralization
Democracy
Local Government
Good Governance
Civil Society
Fiji
Jean-Paul
Faguet
j.p.faguet@lse.ac.uk
1
Department of International Development & STICERD, London School of Economics, London, UK
LEAD_AUTHOR
Bossert T. Analyzing the decentralization of health in developing countries: decision space, innovation and performance. Soc Sci Med 1998;47:1513-1527. doi:10.1016/S0277-9536(98)00234-2
1
Bossert T. Empirical Studies of an Approach to Decentralization: "Decision Space" in Decentralized Health Systems. In: Faguet JP, Pöschl C, eds. Is Decentralization Good for Development? Perspectives from Academics and Policy Makers. Oxford: Oxford University Press; 2015.
2
Faguet JP. Decentralization and Popular Democracy: Governance from Below in Bolivia. Ann Arbor: University of Michigan Press; 2012.
3
Mohammed J, North N, Ashton T. Decentralisation of health services in Fiji: a decision space analysis. Int J Health Policy Manag. 2015;5(3):173-181. doi:10.15171/ijhpm.2015.199.
4
Faguet JP, Pöschl C, eds. Is Decentralization Good for Development? Perspectives from Academics and Policy Makers. Oxford: Oxford University Press; 2015.
5
Channa A, Faguet JP. 2016. Decentralization of Health and Education in Developing Countries: A Quality-Adjusted Review of the Empirical Literature.” World Bank Research Observer. 2016. doi: 10.1093/wbro/lkw001
6
Faguet JP. Transformation from Below in Bangladesh: Decentralization, Local Governance, and Systemic Change. Modern Asian Studies. Forthcoming.
7
Faguet JP. Building Democracy in Quicksand: Altruism, Empire and the United States. Challenge: The Magazine of Economic Affairs. 2004;47:73-93.
8
ORIGINAL_ARTICLE
Consumers or Citizens? Whose Voice Will Healthwatch Represent and Will It Matter?; Comment on “Challenges Facing Healthwatch, a New Consumer Champion in England”
Efforts to achieve effective and meaningful patient and public involvement (PPI) in healthcare have existed for nearly a century, albeit with limited success. This brief commentary discusses a recent paper by Carter and Martin exploring the “Challenges Facing Healthwatch, a New Consumer Champion in England,” and places these challenges in the context of the broader struggle to give a voice to healthcare consumers and citizens. With an overview of what can go right and—perhaps more importantly—what can go wrong, the question remains: will Healthwatch—and other PPI efforts in healthcare—represent the voice of consumers or citizens and will it matter?
https://www.ijhpm.com/article_3230_00e838396ee9e8504b7feccfca5380c7.pdf
2016-11-01
667
669
10.15171/ijhpm.2016.84
Patient and Public Involvement (PPI)
Consumer Involvement
Governance
Representation
Healthwatch
England
Brad
Wright
brad_wright@med.unc.edu
1
Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
LEAD_AUTHOR
Contandriopoulos D. A sociological perspective on public participation in health care. Soc Sci Med. 2004;58(2):321-330.
1
Cross M. Should consumers be present on an HMO's board of directors? Manag Care. 2002;11(11):22-28.
2
Pickard S, Marshall M, Rogers A, et al. User involvement in clinical governance. Health Expect. 2002;5(3):187-198.
3
Robins AJ, Blackburn C. Governing boards in mental health: Roles and training needs. Adm Policy Ment Health. 1974;2(1):37-45.
4
Schwartz JL. Participation of Consumers in Prepaid Health Plans. J Health Hum Behav. 1964;5(2/3):74-84.
5
Vladeck BC. Interest-group representation and the HSAs: health planning and political theory. Am J Pub Health. 1977;67(1):23-29.
6
Stewart EA, Greer SL, Wilson I, Donnelly PD. Power to the people? An international review of the democratizing effects of direct elections to healthcare organizations. Int J Health plan Manag. 2015;31(2):e69-e85. doi:10.1002/hpm.2282.
7
Stewart E. What is the point of citizen participation in health care? J Health Serv Res Policy. 2013;18(2):124-126.
8
Crawford MJ, Rutter D, Manley C, et al. Systematic review of involving patients in the planning and development of health care. BMJ. 2002;325(7375):1263.
9
Chesney JD. Strategies for building representative HSAs: The impact of legal structure. J Health Polit Policy Law. 1982;7(1):96-110.
10
Morone JA, Kilbreth EH. Power to the people? Restoring citizen participation. J Health Polit Policy Law. 2003;28(2-3):271-288.
11
Carter P, Martin G. Challenges facing Healthwatch, a new consumer champion in England. Int J Health Policy Manag. 2016;5(4):259-263. doi: 10.15171/ijhpm.2016.07
12
Local Government Association. Delivering effective local Healthwatch: Key success features. 2013; http://www.local.gov.uk/documents/10180/11463/Delivering+effective+local+Healthwatch+-+key+success+factors/0aa41576-d5f1-40e9-9b7c-fa2d9716618e. Accessed May 25, 2016.
13
Pitkin H. The Concept of Representation. Berkeley: The University of California Press; 1967.
14
Martin GP. Citizens, publics, others and their role in participatory processes: A commentary on Lehoux, Daudelin and Abelson. Social Sci Med. 2012;74(12):1851-1853.
15
Windle C, Bass RD, Taube CA. PR aside: Initial results from NIMH's service program evaluation studies. Am J Community Psychol. 1974;2(3):311-327.
16
Wright B. Do patients have a voice? The social stratification of health center governing boards. Health Expect. 2015;18(3):430-437.
17
Berger J, Cohen BP, Zelditch Jr M. Status characteristics and social interaction. American Sociological Review. 1972;37(3):241-255.
18
Webster M Jr, Driskell Jr JE. Status generalization: A review and some new data. Am Sociol Rev. 1978;43(2):220-236.
19
Dovi S. In Praise of Exclusion. J Polit. 2009;71(3):1172-1186.
20
Greer SL, Stewart EA, Wilson I, Donnelly PD. Victory for volunteerism? Scottish health board elections and participation in the welfare state. Social Sci Med. 2014;106:221-228.
21
Litva A, Canvin K, Shepherd M, Jacoby A, Gabbay M. Lay perceptions of the desired role and type of user involvement in clinical governance. Health Expect. 2009;12(1):81-91. doi:10.1111/j.1369-7625.2008.00530.x
22
Wright B. Who Governs Federally Qualified Health Centers? J Health Polit Policy Law. 2013;38(1):27-55.
23
Learmonth M, Martin GP, Warwick P. Ordinary and effective: the Catch‐22 in managing the public voice in health care? Health Expect. 2009;12(1):106-115.
24
Gaventa J. Poverty, participation and social exclusion in North and South. IDS Bull. 1998;29(1):50-57.
25
Dudley JR. Citizens'boards for Philadelphia community mental health centers. Community Ment Health J. 1975;11(4):410-417.
26
Grant J. The Participation of Mental Health Service Users in Ontario, Canada: A Canadian Application of the Consumer Participation Questionnaire. Int J Soc Psychiatry. 2007;53(2):148-158.
27
Scherl DJ, English JT. Community mental health and comprehensive health service programs for the poor. Am J Psychiatry. 1969;125(12):1666-1674.
28
Thomson R. The whys and why nots of consumer participation. Community Ment Health J. 1973;9(2):143-150.
29
Ives J, Damery S, Redwod S. PPI, paradoxes and Plato: who's sailing the ship? J Med Ethics. 2013;39(3):181-185.
30
Staley K. There is no paradox with PPI in research. J Med Ethics. 2013;39(3):186-187.
31
Brindle D. Anna Bradley, chair of Healthwatch England: standing up for patients. The Guardian. April 9, 2013; http://www.theguardian.com/society/2013/apr/09/anna-bradley-healthwatch-england-chair. Accessed May 25, 2016.
32
Healthwatch. Healthwatch England Strategy 2014-16. http://www.healthwatch.co.uk/sites/healthwatch.co.uk/files/healthwatch-england-strategy_2014-2016.pdf. Updated July 21, 2014. Accessed May 25, 2016.
33
ORIGINAL_ARTICLE
Have Non-physician Clinicians Come to Stay?; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”
A decade ago, sub-Saharan Africa accounted for 24% of the global disease burden but was served by only 4% of the global health workforce. The chronic shortage of medical doctors has led other health professionals especially nurses to perform the role of healthcare providers. These health workers have been variously named clinical officers, health officers, physician assistants, nurse practitioners, physician associates and non-physician clinicians (NPCs) defined as “health workers who have fewer clinical skills than physicians but more than nurses.” Although born out of exigencies, NPCs, like previous initiatives, seem to have come to stay and many more medical doctors are being trained to care for the sick and to supervise other health team members. Physicians also have to assume new roles in the healthcare system with consequent changes in medical education.
https://www.ijhpm.com/article_3232_ea67174387c06ea256634b4f7fce090c.pdf
2016-11-01
671
672
10.15171/ijhpm.2016.86
Non-physician Clinician (NPC)
Physician
Tradi-Practitioner
Health Worker
Healthcare
Workforce
Medical Education
Gottlieb Lobe
Monekosso
globalhealth2202@yahoo.fr
1
Regional Office for Africa, World Health Organization (WHO), Republic of Congo, Africa
LEAD_AUTHOR
Eyal N, Cancedda C, Kyamanywa P, Hurst SA. Non-physician clinicians in sub-Saharan Africa and the evolving role of physicians. Int J Health Policy Manag. 2015;5(3):149-153. doi:10.15171/ijhpm.2015.215
1
McNeur R, ed. The changing roles and education of healthcare personnel worldwide in view of the increase of basic health services. Philadelphia, USA: Society for Health and Human Values; 1978.
2
Monekosso GL. The changing profile of the doctor. Med Educ. 1994;28(Suppl 1):32-35.
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Monekosso GL. The teaching of Medicine at the University Centre for Health Sciences Yaounde - concordance with the Edinburgh Declaration on Medical Education. Med Educ. 1993;27:304-320.
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Elie Claude Njitoyap Ndam. De l’aide de santé... au médecin : réflexion sur la genèse, l’évolution et les perspectives de la formation médicale au Cameroun. Yaoundé: Cameroon University Press; 2003.
5
Monekosso GL. The Evolution of Professional Education and Health Systems in Sub-Saharan Africa. In Omaswa F, Crisp N, ed. African Health Leaders: Making Change and Claiming the Future. Oxford University Press; 2014:205-217
6
Monekosso GL. Essential medical studies. Medical Teacher 1998;20(6):536-543. doi:10.1080/01421599880247
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World Healthn Organization (WHO). Towards a Global Consensus on Quality Medical Education: Serving the Needs of Populations and Individuals. Geneva: WHO; 1994.
8
Hamilton J. Training for skills. Med Educ. 1995;29(Suppl 1):83-87.
9
ORIGINAL_ARTICLE
From Almost Empty to Half Full? A Response to Recent Commentaries
https://www.ijhpm.com/article_3242_33c65861df7dd4a413be37ab7360b0d9.pdf
2016-11-01
673
674
10.15171/ijhpm.2016.94
Right to Health
Global Health Policy
Sustainable Development Goals (SDGs)
Lisa
Forman
lisa.forman@utoronto.ca
1
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
LEAD_AUTHOR
Gorik
Ooms
gorik.ooms@lshtm.ac.uk
2
Institute of Public Health, Heidelberg University Hospital, Heidelberg, Germany
AUTHOR
Claire E.
Brolan
c.brolan@sph.uq.edu.au
3
School of Public Health, University of Queensland, Brisbane, QLD, Australia
AUTHOR
Jose Saramago J. Death with Interruptions. Harcourt Publishers; 2005.
1
Forman L, Ooms G, Brolan CE. Rights language in the sustainable development agenda: has right to health discourse and norms shaped health goals? Int J Health Policy Manag. 2015;4(12):799-804. doi:10.15171/ijhpm.2015.171
2
Rushton S. Health rights and realization: Comment on ‘Rights language in the sustainable development agenda: has right to health discourse and norms shaped health goals? Int J Health Policy Manag. 2016;5(5):341-344. doi:10.15171/ijhpm.2016.26
3
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