A Call for a Backward Design to Knowledge Translation 2 2 Despite several calls to support evidence-informed policy-making, variations in uptake of evidence into policy persist. This editorial brings together and builds on previous Knowledge Translation (KT) frameworks and theories to present a simple, yet, holistic approach for promoting evidence-informed policies. The proposed conceptual framework is characterized by its impact-oriented approach and its view of KT as a continuum from the evidence synthesis stage to uptake and evaluation, while highlighting capacity and resource requirement at every step. A practical example is given to guide readers through the different steps of the framework. With a growing interest in strengthening evidence-informed policy-making, there is a need to continuously develop theories to understand and improve the science of KT and its implementation within the field of policy-making. 1 - 1 5 - - Fadi El-Jardali Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon | Knowledge to Policy (K2P) Center, American University of Beirut, Beirut, Lebanon | Center for Systematic Department of Health Management and Iran fe08@aub.edu.lb - - Racha Fadlallah Center for Systematic Reviews in Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon Center for Systematic Reviews in Health Iran rf52@aub.edu.lb Evidence-Informed Policy Knowledge Translation (KT) Research Utilization Lebanon Lavis JN, Oxman AD, Lewin S, Fretheim A. SUPPORT Tools for evidence-informed health Policymaking (STP) 3: Setting priorities for supporting evidence-informed policymaking. 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Knowledge translation framework for ageing and health [internet]. 2012. Available from: http://www.who.int/ageing/publications/knowledge_translation/en/ ##Murthy L, Shepperd S, Clarke MJ, Garner SE, Lavis JN, Perrier L, et al. Interventions to improve the use of systematic reviews in decision-making by health system managers, policy makers and clinicians. Cochrane Database Syst Rev 2012; 9: CD009401. doi: 10.1002/14651858.CD009401.pub2 ##Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging research and practice: models for dissemination and implementation research. Am J Prev Med 2012; 43: 337-50. ##Bangpan M, Stansfield C, Vigurs C, Oliver S. Systematic reviewing in low and middle income countries: a rapid appraisal of capacity. 2013. EPPI-Centre, SSRU, Institute of Education, University of London. Available from: http://www.cochrane.org/sites/default/files/uploads/CCSGagendaandopenaccessbackgroundpapers-Quebec2013.pdf ##El-Jardali F, Lavis J, Moat K, Pantoja T, Ataya N. Capturing lessons learned from evidence-to-policy initiatives through structured reflection. Health Res Policy Syst 2014; 12: 2. doi: 10.1186/1478-4505-12-2 ##Lavis JN, Lomas J, Hamid M, Sewankambo NK. Assessing country-level efforts to link research to action. Bull World Health Organ 2006; 84: 620-8. doi: 10.2471/blt.06.030312 ##Lavis JN. How can we support the use of systematic reviews in policymaking? PLoS Med 2009; 6: e1000141. doi: 10.1371/journal.pmed.1000141 ##Lavis JN, Catallo C. Bridging the worlds of research and policy in European health systems. Copenhagen, Denmark: WHO Regional Office for Europe; 2013. ##Armstrong R, Waters E, Roberts H, Oliver S, Popay J. The role and theoretical evolution of knowledge translation and exchange in public health. J Public Health 2006; 28: 384-9. doi: 10.1093/pubmed/fdl072 ##Young J. Research, policy and practice: why developing countries are different. 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Strategies to promote the impact of systematic reviews on healthcare policy: A systematic review of the literature. Evid Policy 2011; 7: 403-28. doi: 10.1332/174426411x603434 ##Mitton C, Adair CE, McKenzie E, Patten SB, Wayne Perry B. Knowledge transfer and exchange: Review and synthesis of the literature. Milbank Q 2007; 85: 729-68. doi: 10.1111/j.1468-0009.2007.00506.x ##Brehaut JC, Eva KW. Building theories of knowledge translation interventions: use the entire menu of constructs. Implement Sci 2012; 7: 114. doi: 10.1111/j.1468-0009.2007.00506.x ##

Shanghai Rising: Health Improvements as Measured by Avoidable Mortality since 2000 2 2 Over the past two decades, Shanghai, the largest megacity in China, has been coping with unprecedented growth of its economy and population while overcoming previous underinvestment in the health system by the central and local governments. We study the evolution of Shanghai’s healthcare system by analyzing “Avoidable Mortality” (AM) – deaths amenable to public health and healthcare interventions, as previously defined in the literature. Based on analysis of mortality data, by cause of death, from the Shanghai Municipal Center for Disease Control and Prevention, we analyze trends over the period 2000–10 and compare Shanghai’s experience to other mega-city regions – New York, London and Paris. Population health status attributable to public health and healthcare interventions improved dramatically for Shanghai’s population with permanent residency status. The age-adjusted rate of AM, per 1,000 population, dropped from 0.72 to 0.50. The rate of decrease in age-adjusted AM in Shanghai (30%) was comparable to New York City (30%) and Paris (25%), but lower than London (42%). Shanghai’s establishment of the Municipal Center for Disease Control and Prevention and its upgrading of public health and health services are likely to have contributed to the large decrease in the number and rate of avoidable deaths, which suggests that investments in public health infrastructure and increasing access to health services in megacities – both in China and worldwide – can produce significant mortality declines. Future analysis in Shanghai should investigate inequalities in avoidable deaths and the extent to which these gains have benefitted the significant population of urban migrants who do not have permanent residency status. 1 - 7 12 - - Michael Gusmano The Hasting Center, Garrison, New York, USA The Hasting Center, Garrison, New York, Iran gusmanom@thehastingscenter.org - - Victor Rodwin Robert Wagner School of Public Service, New York, USA Robert Wagner School of Public Service, Iran victor.rodwin@nyu.edu - - Chunfang Wang Vital Statistics Division, Shanghai Municipal Center for Disease Prevention and Control, Shanghai, China Vital Statistics Division, Shanghai Municipal Iran cfwang@scdc.sh.cn - - Daniel Weisz The International Longevity Center, Columbia University, New York, USA The International Longevity Center, Columbia Iran dw2493@columbia.edu - - Li Luo School of Public Health, Shanghai, China School of Public Health, Shanghai, China Iran iluo@fudan.edu.cn - - Fu Hua School of Public Health, Shanghai, China School of Public Health, Shanghai, China Iran hfusph@hotmail.com Shanghai Urban Health Amenable Mortality Gusmano MK, Rodwin VG, Weisz D. Health Care in World Cities: New York, Paris, and London.Baltimore: Johns Hopkins University Press; 2010. ##Fainstein S. Inequality in global city-regions. In: Scott AJ, editor. Global City-Regions: Trends, Theory, Policy. New York: Oxford University Press; 2002. ##Rodwin VG, Gusmano MK. Growing Older in World Cities: New York, London, Paris and Tokyo. Nashville: Vanderbilt University Press; 2006. ##Chen X. Shanghai Rising: State Power and Local Transformations in a Global Megacity. Minneapolis, MN: University of Minnesota Press; 2009. ##Krämer A, Khan MH, Kraas F. Health in Megacities and Urban Areas. New York: Springer Publishing; 2007. ##Fabre G, Rodwin VG. Public health and medical care for the world's factory: China's Pearl River Delta Region. BMC Med 2011; 9: 110. doi: 10.1186/1741-7015-9-110 ##Khanna P. When cities rule the world. McKinsey & Company; 2011 [updated February 2011; cited 2014 Dec 12]. 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Washington, DC: World Bank; 2004. ##Li Z, Jiale H, Lin L, Shenglan T, Jin M. On residents’ satisfaction with community health services after health care system reform in Shanghai, China. BMC Public Health 2012; 12: S9. doi: 10.1186/1471-2458-12-s1-s9 ##Shanghai Municipal Health Bureau. On improving the city's community health services: research report; 2010. ##Preston SH, Ho J. Low life expectancy in the United States: Is the health care system at fault? PSC Working Paper Series; 2009. ##Schroeder S. We can do better: Improving health for the American people. N Engl J Med 2007; 357: 1221-8. doi: 10.1056/nejmsa073350 ##Rosenfield A, Maine D. Maternal mortality – a neglected tragedy: Where is the M in MCH? Lancet1985; 326: 83-5. doi: 10.1016/s0140-6736(85)90188-6 ##Peto J, Gilham C, Fletcher O, Matthews FE. The cervical cancer epidemic that screening has prevented in the UK. Lancet 2004; 364: 249-56. doi: 10.1016/s0140-6736(04)16674-9 ##Rutstein DD, Berenberg W, Chalmers TC, Child CG, Fishman AP, Perrin EB. Measuring the quality of health care. N Engl J Med 1976; 294: 582-8. ##Holland W. European Community Atlas of Avoidable Death. Oxford: Oxford University Press; 1993. p. 1985-9. ##Gay J, Paris V, Devaux M, de Looper M. Mortality amenable to health care in 31 OECD countries: Estimates and methodological issues. OECD Health Working Papers, OECD Publishing, No. 55; 2011. doi: 10.1787/5kgj35f9f8s2-en ##Nolte E, McKee M. Does health care save lives? Avoidable mortality revisited. London: Nuffield Provincial Hospitals Trust; 2004. ##Nolte E, McKee M. Measuring the health status of nations: updating an earlier analysis. Health Aff (Millwood) 2008; 27: 58-71. doi: 10.1377/hlthaff.27.1.58 ##Niti M, Ng TP. Temporal trends and ethnic variations in amenable mortality in Singapore 1965-1974: The impact of health care in transition. 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Adherence to Informed Consent Standards in Shiraz Hospitals: Matrons Perspective 2 2 Background Informed consent is an important part of the patients’ rights and hospitals are assigned to obtain informed consent before any diagnostic or therapeutic procedures. Obtaining an informed consent enables patients to accept or reject their care or treatments and prevent future contentions among patients and medical staff. Methods This survey was carried out during 2011-2. We assessed adherence of 33 Shiraz hospitals (governmental and non-governmental) to informed consent standards defined by Joint Commission International (JCI) Accreditation, USA. The questionnaire was designed using the Delphi method and then filled out by hospital matrons. We calculated valid percent frequency for each part of the questionnaire and compared these frequencies in governmental and nongovernmental hospitals using analytical statistics. Results Considering 63% of the hospitals that filled out the questionnaire, no statistically significant difference was observed between the governmental and non-governmental hospitals in adherence to informed consent standards. Conclusion This study shows a relatively acceptable adherence to standards about informed consent in Shiraz hospitals but the implementation seems not to be as satisfactory. 1 - 13 18 - - Alireza Mohsenian Sisakht Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Student Research Committee, Shiraz University Iran alirezamohseniansisakht@gmail.com - - Najme Karamzade Ziarati Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Student Research Committee, Shiraz University Iran n.karamzade@gmail.com - - Farideh Kouchak Department of Community Medicine, Golestan University of Medical Sciences, Gorgan, Iran Department of Community Medicine, Golestan Iran kkfdehe@gmail.com - - Mehrdad Askarian Department of Community Medicine, Shiraz Nephrourology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Department of Community Medicine, Shiraz Iran askariam@sums.ac.ir Informed Consent Shiraz Hospitals Standards Bottrell MM, Alpert H, Fischbach RL, Emanuel LL. Hospital Informed Consent for Procedures Forms. Arch Surg 2000; 135; 26-33. ##Guide for writing a Research Protocol for research involving human participation [Internet]. Available: http://www.who.int/rpc/research_ethics/guide_rp/en/index.html ##Hall JK, Boswell MV. Ethics, Law, and Pain Management as a Patient Right. Pain Physician 2009; 12; 499-506. ##Iranian Center for Research of Medical Ethics and History [homepage on the Internet]. Iranian Patient Rights 2004. Available From: http://mehr.tums.ac.ir/Default.aspx?lang=en ##Joint Commission International (JCI). Joint Commission International Accreditation Standards for Hospitals. 3rd edition. Oak Brook: JCI; 2008. p. 71-93. ##Khodayari R, Tourani S, Qaderi A, Salehi M, Jafari H. [Capabilities assessing of teaching hospitals in Iran University of medical sciences in attracting medical tourists according to JCI patient-oriented standards]. Journal of Hospital 2011; 9: 51-6. [In Persian] ##Ahmadi M, Khoshgam M, Mohammadpoor A. [Comparative study of the Ministry of Health standards for hospitals with Joint Commission International hospital accreditation standards]. Hakim Research Journal 2007; 10: 45-52. [In Persian] ##Jukic M, Kvolik S, Kardum G, Kozina S, TomicJuraga A. Knowledge and practices of obtaining informed consent for medical procedures among specialist physicians: questionnaire study in 6 Croatian hospitals. Croat Med J 2009; 50: 567-74. ##Mirbagher Ajorpaz N, Heidari S, Ranjbar N, Afshar M. Assessment Rate of Being Conscious and Quality of Informed Consent Process in inpatients Undergoing Surgery in Selected Hospitals of Isfahan in 2009. Qom University of Medical Sciences Journal 2011; 3: 53-60. [In Persian] ##Skulmoski GJ, Hartman FT, Krahn J. The Delphi Method for Graduate Research. Journal of Information Technology Education 2007; 6: 1-21. ##Amini M, Moosavi S, Mohammadnejad S. The informatory of the inpatients’ informed consent: a survey in selected hospitals. Iranian Journal of Medical Ethics and History of Medicine 2009; 2: 61-70. ##Sheikhtaheri A, Farzandipour M. [Quality of Informed Consent Process and Factors Affecting it among Patients Undergoing Surgery, an Empirical Study in Hospitals of Kashan, Iran]. Hakim Research Journal 2009; 10: 33-41. [In Persian] ##Ogundrin TO, Adebamowo CA. Surgeons’ opinions and practice of informed consent in Nigeria. J Med Ethics 2010; 36: 741-5. doi: 10.1136/jme.2010.037440 ##Taylor KM, Kelner M. Informed consent: the physicians’ perspective. Soc Sci Med 1987; 24: 135-43. doi: 10.1016/0277-9536(87)90246-2 ##

Planning and Developing Services for Diabetic Retinopathy in Sub-Saharan Africa 2 2 Background Over the past few decades diabetes has emerged as an important non-communicable disease in SubSaharan Africa (SSA). Sight loss from Diabetic Retinopathy (DR) can be prevented with screening and early treatment. The objective of this paper is to outline the required actions and considerations in the planning and development of DR screening services. Methods A multiple-case study approach was used to analyse five DR screening services in Botswana, Ghana, Tanzania and Zambia. Cases included: two regional screening programmes, two hospital-based screening services and one nationwide screening service. Data was collected using qualitative methodologies including: document analysis, indepth interviews and observation. The World Health Organization (WHO) Health Systems Framework was adopted as the conceptual framework for analysis. Results Planning for a sustainable and integrated DR screening programme demanded a health systems approach. Collaboration with representatives from a variety of ministerial departments and professional bodies was required. Evolution of DR screening services may occur in a variety of ways including: increasing geographical coverage, integration into the general healthcare system, and stepwise progression from a passive, opportunistic service to one that systematically and proactively seeks to prevent DR. Lessons learned from the implementation of cervical cancer prevention programmes in resource-poor settings may assist the development of DR programmes in similar settings. Conclusion To promote good planning of DR screening services and ensure limited resources are used effectively, there is a need to learn from screening programmes in other medical specialities and a need to share experiences between newly-developing DR programmes in resource-poor countries. The WHO Health Systems Framework presents an invaluable tool to ensure a systematic approach to planning DR screening services. 1 - 19 28 - - Sophie Poore Royal Sussex County Hospital, Brighton, UK Royal Sussex County Hospital, Brighton, Iran sophiepoore@doctors.org.uk - - Allen Foster International Centre for Eye Health, International Centre for Evidence in Disability (ICED), London School of Hygiene and Tropical Medicine, London, UK International Centre for Eye Health, Internatio Iran allen.foster@lshtm.ac.uk - - Marcia Zondervan VISION 2020 LINKS Programme, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK VISION 2020 LINKS Programme, International Iran marcia.zondervan@lshtm.ac.uk - - Karl Blanchet International Centre for Eye Health, International Centre for Evidence in Disability (ICED), London School of Hygiene and Tropical Medicine, London, UK International Centre for Eye Health, Internatio Iran karl.blanchet@lshtm.ac.uk Diabetic Retinopathy (DR) Health Systems Service Planning Screening Programme Sub-Saharan Africa (SSA) Zheng Y, He M, Congdon N. The worldwide epidemic of diabetic retinopathy. Indian J Ophthalmol 2012; 60: 428-31. doi: 10.4103/0301-4738.100542 ##Burgess PI, Msukwa G, Beare N. Diabetic retinopathy in sub-Saharan Africa : meeting the challenges of an emerging epidemic. BMC Med 2013; 11: 157. doi: 10.1186/1741-7015-11-157 ##International Council of Ophthalmology (ICO). ICO Guidelines for Diabetic Eye Care [internet]. 2014. Available from: http://www.icoph.org/resources/309/ICO-Guidelines-for-Diabetic-Eye-Care.html ##Beran D, Yudkin JS. Diabetes care in sub-Saharan Africa. Lancet 2006; 368: 1689-95. doi: 10.1016/s0140-6736(06)69704-3 ##Alliance for Cervical Cancer Prevention (ACCp). Planning and Implementing Cervical Cancer Prevention and Control Programs. Geneva: WHO; 2004. ##World Health Organization (WHO). Everybody’s Buisness. Strenthening Health Systems to Improve Health Outcomes. WHO's Framework For Action. Geneva: WHO; 2007. ##Blanchet K, Patel D. Applying principles of health system strengthening to eye care. Indian J Ophthalmol 2012; 60: 470-4. doi: 10.4103/0301-4738.100553 ##Pope C, Mays N. Using case studies in health services and policy research. In: Keen J, Packwood T, editors. Qualitative Research in Health Care. London: BMJ Books; 2000. ##Baxter P, Jack S. Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers. The Qualitative Report 2008; 13: 544-59. ##Health Knowledge. Section 5: Data Collection Methods [Internet]. 2011 [cited 2014 Nov 30]. Available from: http://www.healthknowledge.org.uk/public-health-textbook/research-methods/1d-qualitative-methods/section5-data-collection-methods ##Boyce C, Neale P. Conducting In-Depth Interviews: A Guide for Designing and Conducting In-Depth Interviews. Pathfinder International; 2006. ##Nkomazana O. A national survey of visual impairment in Botswana. Community Eye Heal J 2007; 20: 2020. ##Jones S, Edwards RT. Diabetic retinopathy screening: a systematic review of the economic evidence. Diabet Med 2010; 27: 249-56. doi: 10.1111/j.1464-5491.2009.02870.x ##Goldie SJ, Gaffikin L, Goldhaber-fiebert JD, Gordillo-tobar A, Levin C, Wright TC. Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries. N Engl J Med 2005; 353: 2158-68. doi: 10.1056/nejmsa044278 ##Goldie SJ, Kuhn L, Denny L, Mmed O, Pollack A, Wright TC. Policy Analysis of Cervical Cancer Screening Strategies in Low-Resource Settings. JAMA 2001; 285: 3107-16. doi: 10.1001/jama.285.24.3107 ##Raffle A, Gray M. Screening: Evidence and Practice. Oxford: Oxford University Press; 2007. ##Atun RA, Bennett S, Duran A. When do vertical (stand-alone) programmes have a place in health systems? Copenhagen: WHO Regional Office for Europe; 2008. ##World Health Organization (WHO). Integrated health services – what and why ? Technical Brief No.1. Geneva: WHO; 2008. ##UK National Screening Committee. Essential Elements in Developing a Diabetic Retinopathy Screening Programme; 2009. p. 1-75. ##Ministry of Health and Social Welfare. United Republic of Tanzania. National Eye Care Strategic Plan 2011-2016. ##Potter A, Debrah O, Ashun J, Blanchet K. Eye Health Systems Assessment (EHSA): Ghana Country Report, Ghana Health Service, International Centre for Eye Health, Sightsavers. 2013. ##Melkus GD, Kurth AE, Newlin Lew K, Amoah AG, Ogedegbe G. Development and Implementation of a Diabetes Electronic Health Record in Ghana. 42nd Biennial Convention 2013 Theme: Give Back to Move Forward. Indianapolis, Indiana, USA; 2013. ##Scanlon P. Diabetic Retinopathy Screening: Progress or Lack of Progress. In: Tombran-Tink J, Barnstable CJ, Gardner TW, editors. Ophthalmology Research: Visual Dysfunction in Diabetes. New York: Springer; 2012. p. 17-29. ##Wormald R, Lindfield R. Screening in Ophthalmology. In: Johnson GJ, Minassian D, Weale R, West S, editors. The Epidemiology of Eye Disease. 3rd edition. London: Imperial College Press; 2012. p. 147-68. ##Mumba M, Hall A, Lewallen S. Compliance with eye screening examinations among diabetic patients at a Tanzanian referral hospital. Ophthalmic Epidemiol 2007; 14: 306-10. doi: 10.1080/09286580701272079 ##Levy J, Jotkowitz AB. European Journal of Internal Medicine Diabetes in Africa: Screening for diabetic retinopathy. Eur J Intern Med 2010; 21: 145-6. doi: 10.1016/j.ejim.2010.02.010 ##Mbanya JCN, Motala A, Sobngwi E, Assah FK, Enoru ST. Diabetes in sub-Saharan Africa. Lancet 2010; 375: 2254-66. doi: 10.1016/s0140-6736(10)60550-8 ##

Inequity in Hospitalization Care: A Study on Utilization of Healthcare Services in West Bengal, India 2 2 Background Out of eight commonly agreed Millennium Development Goals (MDG), six are related to the attainment of Universal Health Coverage (UHC) throughout the globe. This universalization of health status suggests policies to narrow the gap in access and benefit sharing between different socially and economically underprivileged classes with that of the better placed ones and a consequent expansion of subsidized healthcare appears to be a common feature for most of the developing nations. The National Health Policy in India (2002) suggests expansion of market-based care for the affording class and subsidized care for the deserving class of the society. So, the benefit distribution of this limited public support in health sector is important to examine to study the welfare consequences of the policy. This paper examines the nature of utilizationto inpatient care by different socio-economic groups across regions and gender in West Bengal (WB), India. The benefit incidence of public subsidies across these socio-economic groups has also been verified for different types of services like medicines, diagnostics and professional care etc. Methods National Sample Survey Organization (NSSO) has collected information on all hospitalized cases (60th round, 2004) with a recall period of 365 days from the sampled households through stratified random sampling technique. The data has been used to assess utilization of healthcare services during hospitalization and the distribution of public subsidies among the patients of different socio-economic background; a Benefit Incidence Analysis (BIA) has also been carried out. Results Analysis shows that though the rate of utilization of public hospitals is quite high, other complementary services like medicine, doctor and diagnostic tests are mostly purchased from private market. This leads to high Out-of-Pocket (OOP) expenditure. Moreover, BIA reveals that the public subsidies are mostly enjoyed by the relatively better placed patients, both socially and economically. The worse situation is observed for gender related inequality in access and benefit from public subsidies in the state. Conclusion Focused policies are required to ensure proper distribution of public subsidies to arrest high OOP expenditure. Drastic change in policy targeting is needed to secure equity without compromising efficiency. 1 - 29 38 - - Montu Bose Public Health Foundation of India, New Delhi, India Public Health Foundation of India, New Delhi, Iran monbose@gmail.com - - Arijita Dutta Department of Economics, University of Calcutta, Kolkata, West Bengal, India Department of Economics, University of Calcutta, Iran dutta.arijita@gmail.com Access to Hospitalization Care Universal Health Coverage (UHC) Inequity Utilization of Healthcare Services Benefit Incidence Analysis (BIA) Planning Commission of India. High Level Expert Group Report on Universal Health Coverage for India; 2011. ##Harris B, Goudge J, Ataguba JE, McIntyre D, Nxumalo N, Jikwana S, et al. Inequities in access to health care in South Africa. J Public Health Policy 2011; 32 Suppl 1: S102-23. doi: 10.1057/jphp.2011.35 ##Garcia-Subirats I, Vargas I, Mogollón-Pérez AS, De Paepe P, da Silva MR, Unger JP, et al. Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil. Int J Equity Health 2014; 13: 10. doi: 10.1186/1475-9276-13-10 ##National Health policy of India. Ministry of Health and Family Welfare; 2002. ##O’Donnell O, Doorslaer EV, Wagstaff A, Lindelow M. Analyzing Health Equity Using Household Survey Data: A Guide to techniques & their Implementation. Washington DC: The World Bank; 2008. ##Sen A. Why Health Equity? In: Anand S, Peter F, Sen A, editors. Public Health, Ethics and Equity. Oxford: Oxford University Press; 2006. ##World Health Organization (WHO). World Health Statistics 2014 [internet]. 2014. Available from: http://www.who.int/mediacentre/news/releases/2014/world-health-statistics-2014/en/ ##The Indian Census. Sample Registration System [internet]. 2013. Available from: http://www.censusindia.gov.in/2011-common/Sample_Registration_System.html ##West Bengal State Drug Policy [internet]. 2004. Available from: http://www.wbhealth.gov.in/download/state%20drug%20policy,%20west%20bengal%20-%202004.pdf ##Census of India [internet]. 2011. Available from: http://censusindia.gov.in/Tables_Published/SCST/dh_st_westbengal.pdf ##National Sample Survey Organization (NSSO) [internet]. Available from: http://mospi.nic.in/Mospi_New/Admin/publication.aspx ##Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res 1974; 9: 208-20. ##Kirby JB, Kaneda T. Neighborhood Socioeconomic Disadvantage and Access to Health Care. J Health Soc Behav 2005; 46: 15-31. doi: 10.1177/002214650504600103 ##Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care 1981; 19: 127-40. doi: 10.1097/00005650-198102000-00001 ##Davis K. Inequality and Access to Health Care. Milbank Q 1991; 69: 253-73. doi: 10.2307/3350204 ##Dilip TR. Extent of Inequality in Access to Health Care Services in India. CEHAT; 2005. ##Lingam L. Emergent Issues beyond Equitable Access. Presentation made at Forum 11, Beijing, China, 2007. ##Sen G, Iyer A. Who gains, who loses and how: leveraging gender and class intersections to secure health entitlements. Soc Sci Med 2012; 74: 1802-11. doi: 10.1016/j.socscimed.2011.05.035 ##Oliver A, Mossialos E. Equity of access to health care: outlining the foundations for action. J Epidemiol Community Health 2005; 58: 655-8. doi: 10.1136/jech.2003.017731 ##Palmer N. Access and Equity: Evidence on the Extent to Which Health Services Address the Needs of the Poor. In: Bennett S, Gilson L, Mills A, editors. Health, Economic Development and Household Poverty. London: Routledge; 2008. p. 61-74. ##The MIT Dictionary of Modern Economics. 3rd edition. Cambridge: MIT Press; 1986 ##McIntyre D, Ataguba JE. How to do (or not to do) ... a benefit incidence analysis. Health Policy plan 2011; 26: 174-82. doi: 10.1093/heapol/czq031 ##Bose M. Access to In-Patient Healthcare in West Bengal: A Benefit Incidence Analysis. International Institute for Population Sciences; 2014. ##Wagstaff A. Benefit-incidence analysis: are government health expenditures more pro-rich than we think? Health Econ 2012; 21: 351-66. doi: 10.1002/hec.1727 ##Halasa Y, Nassar H, Zaky H. Benefit-incidence analysis of government spending on Ministry of Health outpatient services in Jordan. East Mediterr Health J 2010; 16: 467-73. ##Demery L, Gaddias I. Social Spending, Poverty and Gender Equity in Kenya: A Benefit Incidence Analysis. Kenya: Support to Public Finance Management Reforms; 2009. ##Glick P, Razakamanantsoa M. The Distribution of Social Service in Madagascar – 1993-99. Strategies and Analysis for Growth and Access. Working Paper; 2002. ##Castro-Leal F, Dayton J, Demery L, Mehra K. Public Social Spending in Africa: Do the Poor Benefit? World Bank Res Obs 1999; 14: 49-72. doi: 10.1093/wbro/14.1.49 ##Selden TM, Wasylenko MJ. Benefit Incidence Analysis in Developing Countries, No 1015, Policy Research Working Paper Serie. The World Bank; 1992. ##Mahal A, Yazbeck AS, Peters DH, Ramanan GN. The Poor and Health Service Use in India. Health, Nutrition and Population (HNP), Discussion Paper; 2001. ##Chakraborty L, Singh Y, Jacob JF. Public Expenditure Benefit Incidence on Health: Selective Evidence from India. New Delhi:National Institute of Public Finance and Policy; 2011. ##Acharya D, Vaidyanathan G, Muraleedharan V, Dheenadayalan D, Dash U. Do the Poor Benefit from Public Spending on Healthcare in India? Results from Benefit (Utilization) Incidence Analysis in Tamil Nadu and Orissa. CREHS; 2011. ##Thorat S, & Dubey A. Has Growth been Socially Inclusive during 1993-94 – 2009-10? Economic & Political Weekly [Serial on the internet]. [updated March 2012]. Available from: http://www.epw.in/special-articles/has-growth-been-socially-inclusive-during-1993-94-2009-10.html ##World Bank. World Development Report: Investing in Health. New York: Oxford University Press; 1993. ##Bose M, Dutta A. Access to Non-hospitalization Care in West Bengal: A Demand-side Assessment Based on NSS Data. Indian Journal of Human Development 2014: forthcoming. ##Prinja S, Kanavos P, Kumar R. Health care inequities in north India: role of public sector in universalizing health care. Indian J Med Res 2012; 136: 421-31. ##Lanjouw P, Ravallion M. Benefit incidence, public spending reforms, and the timing of program capture. World Bank Econ Rev 1999: 13: 257-73. ##Younger SD. Benefits on the Margin: Observations on Marginal Benefit Incidence. World Bank Econ Rev 2003: 17: 89-106. ##Shahrawat R, Rao KD. Insured yet Vulnerable: Out-of-Pocket Payments and India’s Poor. Health Policy Plan 2012; 27: 213-21. doi: 10.1093/heapol/czr029 ##

Addressing Geriatric Oral Health Concerns through National Oral Health Policy in India 2 2 There is an escalating demand for geriatric oral healthcare in all developed and developing countries including India. Two-thirds of the world’s elderly live in developing countries. This is a huge population that must receive attention from policy-makers who will be challenged by the changing demands for social and health services including oral health services. Resources are limited thus rather than being aspirational in wanting to provide all treatment needed for everybody, this critique presents a road map of how we might answer the present and future geriatric oral health concerns in a most efficient manner in a developing country. Viewing the recent Indian demographic profile and the trends in oral health, pertinent policy subjects have been discussed concerning the oral health needs of the elderly and also the associated challenges which include strategies to improve quality of life, strategies to train and educate the dental workforce and above all the role of healthcare systems towards realization of better aged society in India and other developing countries 1 - 39 42 - - Abhinav Singh Department of Dentistry, All India Institute of Medical Sciences (AIIMS), Bhopal Ministry of Health and Family Welfare, Government of India, Bhopal, India Department of Dentistry, All India Institute Iran drabhinav.singh@gmail.com - - Bharathi Purohit People’s College of Dental Sciences & Research Centre, Bhopal, India People’s College of Dental Sciences & Research Iran bharathipurohit@gmail.com Developing Country Geriatric Dental Education Health Services Oral Health Policy United Nations. Population Ageing and Development [internet]. Datasheet, United Nations, Department of Economic and Social Affairs, Population Division, 2012. [cited 2013 June]. Available from: http://www.un.org/esa/population/publications/2012PopAgeingDev_Chart/2012AgeingWallchart.html ##World Health Organization (WHO). Active Ageing: a Policy Framework. Geneva: WHO; 2002. ##United Nations. Department of Economic & Social affairs. World population ageing, 2009. [cited 2013 June]. Available from: http://www.un.org/esa/population/publications/WPA2009/WorkingPaper.pdf ##Ingle GK, Nath A. Geriatric Health in India: Concerns and Solutions. Indian J Community Med 2008; 33: 214-8. doi: 10.4103/0970-0218.43225 ##Panchbhai AS. Oral Health Care Needs in the Dependant Elderly in India. Indian J Palliat Care 2012; 18: 19-26. doi: 10.4103/0973-1075.97344 ##Shah N. Oral health care system for elderly in India. Geriatr Gerontol Int 2004; 4: 162-4. doi: 10.1111/j.1447-0594.2004.00187.x ##Gambhir RS, Bbrar P, Singh G, Sofat A, Kakar H. Utlilization of dental care: An Indian outlook. J Nat Sci Biol Med 2013; 4: 292-7. doi: 10.4103/0976-9668.116972 ##United Nations Population Fund. India’s elderly population: some fundamentals [internet]. 2013. [cited 2013 June 10]. Available from: http://www.gktoday.in/indias-elderly-population-some-fundamentals ##Singh A, Purohit B. Addressing oral health disparities, inequity in access and workforce issues in a developing country. Int Dent J 2013; 63: 225-9. doi: 10.1111/idj.12035 ##Doifode VV, Ambadekar NN, Lanewar AG. Assessment of oral health status and its with some epidemiological factors in population of Nagpur, India. Indian J of Med Sci 2000; 54: 261-9. ##Dental Council of India (DCI). National oral health survey and ﬂuoride mapping 2002–2003 India. Dental Council of India in collaboration with Ministry of Health & Family Welfare. Government of India, 2003-2004. ##Thukral G, Shah N, Prakash H. Oral health status & treatment needs of institutionalised elderly in India [internet]. [cited 2013 September]. Available from: https://iadr.confex.com/iadr/2002SanDiego ##Goel P, Singh K, Kaur A, Verma M. Oral health care for elderly: Identifying needs and feasible strategies for service provision. Indian J Dent Res 2006; 17: 11-21. doi: 10.4103/0970-9290.29897 ##Shah N, Pandey RM, Duggal R, Mathur VP, Parkash H, Sundaram KR. Oral Health in India. A report of Multi-centric study. Director General of Health Services, Ministry of Health and Family Welfare, Government of India and WHO collaborative programme; 2007. ##Patro BK, Ravi Kumar B, Goswami A, Mathur VP, Nongkynrih B. Prevalence of dental caries among adults and elderly in an urban resettlement colony of New Delhi. Indian J Dent Res 2008; 19: 95-8. doi: 10.4103/0970-9290.40460 ##Shrivastav A, Bhambal A, Reddy V, Jain M. Dental prosthetic status and needs of the residents of geriatric homes in Madhya Pradesh, India. J Int Oral Health 2011; 4: 9-14. ##Shenoy RP, Hegde V. Dental Prosthetic Status and Prosthetic Need of the Institutionalized Elderly Living in Geriatric Homes in Mangalore: A Pilot Study. International Scholarly Research Notices 2011; 1: 1- 3. doi: 10.5402/2011/987126 ##Bijjargi S, Chowdhary R. Geriatric dentistry: is rethinking still required? A community-based survey in Indian population. Gerodontology 2013; 30: 247-53. doi: 10.1111/j.1741-2358.2012.00667.x ##Besdine R, Boult C, Brangman S, Coleman EA, Fried LP, Gerety M, et al. Caring for Older Americans: The Future of Geriatric Medicine. J Am Geriatr Soc 2005; 53: S245-56. doi: 10.1111/j.1532-5415.2005.53350.x ##Mohammad AR, Preshaw PM, Ettinger RL. Current status of predoctoral geriatric education in U.S. dental schools. J Dent Educ 2003; 67: 509-14. ##Shah N. 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Responsibilising Managers and Clinicians, Neglecting System Health? What Kind of Healthcare Leadership Development Do We Want?; Comment on “Leadership and Leadership Development in Healthcare Settings - A Simplistic Solution to Complex Problems?” 2 2 Responding to Ruth McDonald’s editorial on the rise of leadership and leadership development programmes in healthcare, this paper offers three arguments. Firstly, care is needed in evaluating impact of leadership development, since achievement of organisational goals is not necessarily an appropriate measure of good leadership. Secondly, the proliferation of styles of leadership might be understood in part as a means of retaining control over public services while distributing responsibility for their success and failure. Thirdly, it makes a plea for the continued utility of good administrative skills for clinicians and managers, which are likely to become all-the-more important given recent developments in healthcare policy and governance. 1 - 43 44 - - Graham P. Martin Department of Health Sciences, University of Leicester, Leicester, UK Department of Health Sciences, University Iran graham.martin@leicester.ac.uk Leadership Healthcare Evaluation Training Quality Patient Safety McDonald R. Leadership and leadership development in healthcare settings – a simplistic solution to complex problems? Int J Health Policy Manag 2014; 3: 227-9. doi: 10.15171/ijhpm.2014.101 ##Martin GP, Currie G, Finn R. Leadership, service reform, and public-service networks: the case of cancer-genetics pilots in the English NHS. J Public Adm Res Theory 2009; 19: 769-94. doi: 10.1093/jopart/mun016 ##Hartley J, Martin J, Benington J. Leadership in healthcare. Coventry: Institute of Governance and Public Management; 2008. ##Trastek VF, Hamilton NW, Niles EE. Leadership models in health care—a case for servant leadership. Mayo Clin Proc 2014; 89: 374-81. doi: 10.1016/j.mayocp.2013.10.012 ##Macrae C. Early warnings, weak signals and learning from healthcare disasters. BMJ Qual Saf 2014; 23: 440-5. doi: 10.1136/bmjqs-2013-002685 ##Jones A, Kelly D. Deafening silence? Time to reconsider whether organizations are silent or deaf when things go wrong. BMJ Qual Saf 2014; 23: 709-13. doi: 10.1136/bmjqs-2013-002718 ##Evetts J. New professionalism and new public management: changes, continuities and consequences. Comp Sociol 2009; 8: 247-66. doi: 10.1163/156913309x421655 ##Martin GP, Learmonth M. A critical account of the rise and spread of “leadership”: the case of UK healthcare. Soc Sci Med 2012; 74: 281-8. doi: 10.1016/j.socscimed.2010.12.002 ##Williams Z. The entire schools inspection culture is the problem. The Guardian [Internet]. [cited 2014 Oct 19]; Available from: http://www.theguardian.com/commentisfree/2014/oct/19/schools-inspection-ofsted-rachel-de-souza ##Boyne GA, Meier KJ. Burdened by bureaucracy? Determinants of administrative intensity in public organisations. Int Public Manag J 2013; 16: 307-27. doi: 10.1080/10967494.2013.817261 ##Woolhandler S, Campbell T, Himmelstein DU. Costs of health care administration in the United States and Canada. N Engl J Med 2003; 349: 768-75. doi: 10.1056/nejmsa022033 ##

Who Doesn’t Want to be a Leader? Leaders Are Such Wonderful People; Comment on “Leadership and Leadership Development in Healthcare Settings - A Simplistic Solution to Complex Problems?” 2 2 Leadership, as McDonald (1)argues, is a phenomenon which many people involved in healthcare around the globe put great emphasis on today; some even see the improvement of leadership as a panacea for all the ills of their healthcare system. This brief commentary on her work seeks to supplement the points she makes by emphasising the personalattractions leadership enjoys, at least in the eyes of many of those who exercise power in healthcare. It also endeavours to highlight some of the ironies and absurdities which arise as a result of the conflicts about what terms we should use to describe the “leaders” (or, alternatively perhaps, those who seek to enjoy supremacy) within healthcare. 1 - 45 47 - - Mark Learmonth Durham University, Durham, UK Durham University, Durham, UK Iran mark.learmonth@durham.ac.uk Leadership Irony Contestation Language McDonald R. Leadership and leadership development in healthcare settings – a simplistic solution to complex problems? Int J Health Policy Manag 2014; 3: 227–9. doi: 10.15171/ijhpm.2014.101 ##What is Leadership? [internet]. [cited 2014 November 17]. Available from: http://www.mindtools.com/pages/article/newLDR_41.htm ##http://www.leadershipacademy.nhs.uk/. [cited 2014 November 17]. ##Calás MB, Smircich L. Voicing Seduction to Silence Leadership. Organization Studies 1991; 12: 567-602. doi: 10.1177/017084069101200406 ##Harding N, Lee H, Ford J, Learmonth M. Leadership and charisma: a desire that cannot speak its name? Hum Relat 2011; 64: 927-49. doi: 10.1177/0018726710393367 ##Learmonth M. Doing things with words: the case of ‘management’ and ‘administration’. Public Adm 2005; 83: 617-37. doi: 10.1111/j.0033-3298.2005.00465.x ##Currie G, Brown AD. A Narratological Approach to Understanding Processes of Organizing in a UK Hospital. Hum Relat 2003; 56: 563-86. doi: 10.1177/0018726703056005003 ##O’Reilly D, Reed M. The Grit in the Oyster: Professionalism, Managerialism and Leaderism as Discourses of UK Public Services Modernization. Organization Studies 2011; 32: 1011-79. doi: 10.1177/0170840611416742 ##Parker M. Structure, Culture and Anarchy: Ordering the NHS. In Learmonth M, Harding N, editors. Unmasking Health Management: A Critical Text. New York: Nova Science; 2004. p. 171-85. ##

Will Universal Health Coverage (UHC) Lead to the Freedom to Lead Flourishing and Healthy Lives?; Comment on “Inequities in the Freedom to Lead a Flourishing and Healthy Life: Issues for Healthy Public Policy” 2 2 The focus on public policy and health equity is discussed in reference to the current global health policy discussion on Universal Health Coverage (UHC). This initiative has strong commitment from the leadership of the international organizations involved, but a lack of policy clarity outside of the health financing component may limit the initiative’s impact on health inequity. In order to address health inequities there needs to be greater focus on the most vulnerable communities, subnational health systems, and attention paid to how communities, civil society and the private sector engage and participate in health systems. 1 - 49 51 - - Don Matheson Centre for Public Health Research, Massey University, Palmerston North, New Zealand Centre for Public Health Research, Massey Iran d.p.matheson@massey.ac.nz Health Equity Universal Health Coverage (UHC) Complexity Participatory Action Research Healthy Public Policy 1. Friel S. Inequities in the freedom to lead a flourishing and healthy life: issues for healthy public policy. Int J Health Policy Manag 2014; 3: 161-3. doi: 10.15171/ijhpm.2014.82 ##2. Open Working Group proposal for Sustainable Development Goals [internet]. Available from: http://sustainabledevelopment.un.org/focussdgs.html ##3. World Health Organization (WHO). What is Universal Health Coverage [internet]. 2014. 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