2015 4 2 2 0

Fee-for-Service Payment – An Evil Practice that Must be Stamped Out? 2 2 Co-opting physicians to regulate Fee-for-Service (FFS) payment is more feasible and simpler to administer than capitation, Diagnosis-Related Groups (DRGs) and pay-for-performance. The key lies in designing and revising the fee schedule, which not only defines and sets the fee for each item, but also the conditions of billing. Adherence to these regulations must be strictly audited in order to control volume and costs, and to assure quality. The fee schedule requires periodic revisions on an item-by-item basis in order to maintain balance among the providers, to list new drugs, devices and equipment, and to reflect the lower market prices of existing ones. Implementing the fee schedule will facilitate the control of balance billing and extra billing, and the introduction of more sophisticated methods of payment in the future. 1 - 57 59 - - Naoki Ikegami Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan Department of Health Policy and Management, Iran nikegami@a5.keio.jp Fee-for-Service (FFS) Regulations Professional ethics World Health Organization (WHO). Health System Financing. Geneva: WHO; 2010. p. 72-5. ##Marmor TR, Gordon RW. Commercial pressures on professionalism in American medical care: From Medicare to the Affordable Care Act. J Law Med Ethics 2014; 42: 412-20. doi: 10.1111/jlme.12164 ##Chinitz D, Rodwin VG. What passes and fails as health policy and management. J Health Polit Policy Law 2014; 39: 1113-26. doi: 10.1215/03616878-2813719 ##Field RI. Health Care Regulations in America. New York: Oxford University Press; 2007. ##Gosden T, Forland F, Kristiansen I, Sutton M, Leese B, Giuffrida A, et al. Capitation, salary, fee-for-service and mixed systems of payment: effects on the behaviour of primary care physicians. Cochrane Database Syst Rev 2000; (3): CD002215. doi: 10.1002/14651858.CD002215 ##O’Reilly J, Busse R, Hakkinen U, Or Z, Street A, Wiley M. Paying for hospital care: the experience with implementing activity-based funding in five European countries. Health Econ Policy Law 2012; 7: 73-101. doi: 10.1017/S1744133111000314 ##Glickman SW, Schulman KA, Peterson ED, Hocker MB, Cairns CB. Evidence-based perspectives on pay for performance and quality of patient care and outcomes in emergency medicine. Ann Emerg Med 2008; 51: 622-31. doi: 10.1016/j.annemergmed.2008.01.010 ##Greene J. An examination of pay-for-performance in general practice in Australia. Health Serv Res 2013; 48: 1415-32. ##Harzband P, Groopman J. How medical care is being corrupted. New York Times [serial on the Internet]. Nov 19, 2014. Available from: http://www.nytimes.com/2014/11/19/opinion/           how-medical-care-is-being-corrupted.html?_r=0 ##Ikegami N. Games policy makers and providers play: Introducing case-mix-based payment to hospital chronic care units in Japan. J Health Polit Policy Law 2009; 34: 361-80. doi: 10.1215/03616878-2009-003 ##Ikegami N. Universal Health Coverage for Inclusive and Sustainable Development Lessons from Japan [internet]. 2014; http://documents.worldbank.org/curated/en/2014/09/20278271/      universal-health-coverage-inclusive-sustainable-development-lessons-japan ##

Quaternary Prevention, an Answer of Family Doctors to Overmedicalization 2 2 In response to the questioning of Health Policy and Management (HPAM) by colleagues on the role of rank and file family physicians in the same journal, the author, a family physician in Belgium, is trying to highlight the complexity and depth of the work of his colleagues and their contribution to the understanding of the organization and economy of healthcare. It addresses, in particular, the management of health elements throughout the ongoing relationship of the family doctor with his/her patients. It shows how the three dimensions of prevention, clearly included in the daily work, are complemented with the fourth dimension, quaternary prevention or prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare. 1 - 61 64 - - Marc Jamoulle Espace Temps, Maison de Santé, Charleroi, Belgium, and Department of General Practice, University of Liege, Liège, Belgium Espace Temps, Maison de Santé, Charleroi, Iran marc.jamoulle@doct.ulg.ac.be Physicians, Family Preventive Medicine Physician’s Role Medicalization Ethics, Clinical Chinitz DP, Rodwin VG. On Health Policy and Management (HPAM): mind the theory-policy-practice gap. Int J Health Policy Manag 2014; 3: 3613. doi: 10.15171/ijhpm.2014.122 ##Harrison C, Britt H, Miller G, Henderson J. Prevalence of chronic conditions in Australia. PLoS One  2013; 8: e67494. doi: 10.1371/journal.pone.0067494 ##Gijsen R, Poos R. Using registries in general practice to estimate countrywide morbidity in the Netherlands. Public Health 2006; 120: 923-36. doi: 10.1016/j.puhe.2006.06.005 ##Lykkegaard J, Larsen PV, Paulsen MS, Søndergaard J. General practitioners’ home visit tendency and readmission-free survival after COPD hospitalisation: a Danish nationwide cohort study. NPJ Prim care Respir Med 2014; 24: 14100. doi: 10.1038/npjpcrm.2014.100 ##Laux G, Kuehlein T, Rosemann T, Szecsenyi J. Co- and multimorbidity patterns in primary care based on episodes of care: results from the German CONTENT project. BMC Health Serv Res 2008; 8: 14. doi: 10.1186/1472-6963-8-14 ##Lamberts H, Meads S, Wood M. Classification of reasons why persons seek primary care: pilot study of a new system. Public Heal Rep 1984; 99: 597-605. ##Soler JK, Okkes I, Wood M, Lamberts H. The coming of age of ICPC: celebrating the 21st birthday of the International Classification of Primary Care. Fam Pract. 2008; 25: 312-7. doi: 10.1093/fampra/cmn028 ##Leavell H, Clark E. Preventive Medicine for the Doctor in His Community an Epidemiologic Approach. McGraw-Hill; 1958.  ##Jamoulle M. Information et informatisation en médecine générale [Computer and computerisation in general practice]. Dans: Les informa-g-iciens. Namur, Belgium: Press Univ Namur; 1986. p. 193–209. Available from: http://hdl.handle.net/2268/170822 ##Jamoulle M, Roland M. Quaternary prevention. WICC annual workshop: Hongkong, Wonca congress proceedings; 1995.  Available from:  http://hdl.handle.net/2268/173994 ##Jamoulle M. The four duties of family doctors: quaternary prevention - first, do no harm. Hong Kong Pract 2014; 36: 72-7. ##Bentzen N. Wonca Dictionary of General/Family Practice. Maanedsskr: Copenhagen; 2003.  ##Norman AH, Tesser CD. [Quaternary prevention in primary care: a necessity for the Brazilian Unified National Health System]. Cad Saude Publica 2009; 25: 2012-20.  doi: 10.1590/S0102-311X2009000900015 ##De Vito EL. Prevención cuaternaria, un término aún no incluido entre los MESH. Med (Buenos Aires). Fundación Revista Medicina (Buenos Aires) 2013; 73: 187-90. ##Silva AL, Mangin D, Pizzanelli M, Jamoulle M, Wagner HL, Silva DH, et al. Manifesto de Curitiba: pela Prevenção Quaternária e por uma Medicina sem conflitos de interesse. Rev Bras Med Família e Comunidade 2014; 9: 371–4.  [in Portuguese] ##Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoulle M. Quaternary prevention: a task of the general practitioner. Prim Care [Internet]. 2010. Available from: http://www.primary-care.ch/docs/primarycare/archiv/de/2010/                                   2010-18/2010-18-368_ELPS_engl.pdf ##Jamoulle M, Tsoi G, Heath I, Mangin D, Pezeshki M, Pizzanelli Báez M.  Quaternary prevention,   addressing the limits of medical practice. Wonca world conference Prague; 2013.  Available from:  http://www.ph3c.org/PH3C/docs/27/000322/0000469.pdf ##Martin C, Heleno B, Hestbech M, Brodersen J. Screening Evidence And Wishful Thinking – A Europrev Workshop About Quaternary Prevention In General Practice. WONCA Europe Conference 2014, Lisbon, Portugal; 2014. Available from:     http://www.woncaeurope.org/content/ws407-screening-evidence-and-wishful-thinking-%E2%80%93-europrev-workshop-about-quaternary ##Jamoulle M, Roland M.  Quaternary prevention. From Wonca world Hong Kong 1995 to Wonca world Prague 2013. In Wonca world conference Prague 2013 [Poster]. Available also in Chinese, Thai, Vietnamese, French, Spanish and Portuguese on www.ph3c.org/P4 ##Tsoi G. Quaternary prevention. Hong Kong Pract 2014; 36: 49-50. ##Alonso-Coello P, García-Franco AL, Guyatt G, Moynihan R. Drugs for pre-osteoporosis: prevention or disease mongering? BMJ 2008; 336: 126 -9. doi: 10.1136/bmj.39435.656250.AD ##Conrad P, Bergey MR. The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder. Soc Sci Med 2014; 122: 31-43. doi: 10.1016/j.socscimed.2014.10.019 ##Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering. BMJ 2002; 324: 886-91. doi: 10.1136/bmj.324.7342.886 ##Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane database Syst Rev 2009; 4: CD001877. doi: 10.1002/14651858.CD001877.pub3 ##Tomljenovic L, Shaw CA. Human papillomavirus (HPV) vaccine policy and evidence-based medicine: are they at odds? Ann Med 2013; 45: 182-93. doi: 10.3109/07853890.2011.645353 ##Wolinsky H. Disease mongering and drug marketing. Does the pharmaceutical industry manufacture diseases as well as drugs? EMBO Rep 2005; 6P: 612–4. doi: 10.1038/sj.embor.7400476 ##Mariño Maria A. Incidentaloma. Rev Bras Med Família e Comunidade 2015; forthcoming. ##Welch HG. Overdiagnosed: Making People Sick in the Pursuit of Health. Boston, MA : Beacon Press; 2012. ##Heath I. Combating Disease Mongering: Daunting but Nonetheless Essential. PLoS Med 2006; 3: e146. doi: 10.1371/journal.pmed.0030146 ##Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoulle M. Quaternary prevention: a task of the general practitioner. Prim Care [internet]. 2010. Available from: http://www.primary-care.ch/pdf_f/2010/2010-18/2010-18-368_ELPS_engl.pdf ##Light DW, Lexchin J, Darrow JJ. Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs. J Law Med Ethics 2013; 14: 590-600. ##Rodwin MA. Institutional Corruption & Pharmaceutical Policy. J Law Med Ethics 2013; 41: 544-52. ##Gotzsche PG. Deadly Medicines and Organised Crime: How Big Pharma Has Corrupted Healthcare. London: Radcliffe Publishing Ltd; 2013.  ##Mangin D, Heath I, Jamoulle M. Beyond diagnosis: rising to the multimorbidity challenge. Br Med J 2012; 344: e3526. doi: 10.1136/bmj.e3526 ##Giguere A, Labrecque M, Haynes R, Grad R, Pluye P, Légaré F, et al. Evidence summaries (decision boxes) to prepare clinicians for shared decision-making with patients: a mixed methods implementation study. Implement Sci 2014; 9: 144. doi: 10.1186/s13012-014-0144-6 ##Feldman AM. Understanding Health Care Reform: Bridging the Gap Between Myth and Reality. New York, NY: CRC Press; 2011. ##Lancaster T, Stead L, Silagy C, Sowden A. Effectiveness of interventions to help people stop smoking: findings from the Cochrane Library. BMJ 2000; 321: 355-8. ##Welch HG, Passow HJ. Quantifying the benefits and harms of screening mammography. JAMA Intern Med  2014; 174: 448–54. doi: 10.1001/jamainternmed.2013.13635 ##Lipska KJ, Ross JS, Miao Y, Shah ND, Lee SJ, Steinman MA. Potential Overtreatment of Diabetes Mellitus in Older Adults With Tight Glycemic Control. JAMA Intern Med 2015.  doi: 10.1001/jamainternmed.2014.7345    ##Al-Nabhani K, Kakaria A, Syed R. Computed tomography in management of patients with non-localizing headache. Oman Med J 2014; 29: 28-31. doi: 10.5001/omj.2014.07 ##Légaré F, Ratté S, Stacey D, Kryworuchko J, Gravel K, Graham ID, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane database Syst Rev 2010; (5): CD006732. doi: 10.1002/14651858.CD006732.pub2 ##Widmer D, Herzig L, Jamoulle M. [Quaternary prevention: is acting always justified in family medicine?]. Rev Med Suisse 2014; 10: 1052-6. [in French] ##Heath I. The art of doing nothing. Eur J Gen Pract 2012; 18: 242-6. doi: 10.3109/13814788.2012.733691 ##Báez EM. Princípios Éticos e Prevenção Quaternária: é possível não proteger o exercício do princípio da autonomia? [Ethical Principles and Quaternary Prevention: is it possible not to protect the exercise of the principle of autonomy?] Rev Bras Med Família e Comunidade 2013; 9: 169-73. [in Portuguese] ##Sharpe VA. Why “Do No Harm”? The Influence of Edmund D. Pellegrino’s Philosophy of Medicine. Theor Med 1997; 18: 197-215. doi: 10.1007/978-94-017-3364-9 ##

Factors Associated with Pediatrician Attitudes over the Use of Complementary and Traditional Medicine on Children in Muscat, Oman 2 2 This study aimed to evaluate the attitude of pediatricians toward the use of complementary and Traditional Medicine (TM) on children in Muscat, Oman. A cross-sectional survey was performed using a self-completed questionnaire during the year 2012. A total of 67 pediatricians, comprising of 30 males (44.8%) and 37 females (55.2%) participated in the study. The majority of the studied group (83.5%) was of the opinion that most types of complementary and TM are not safe for children, except spiritual healing, to which 53.7% considered as safe. About one third (29.9%) of the participants reported that they might recommend complementary and TM for sick children in the future. Almost half the participants (52.2%) acknowledged personal use of complementary and TM in the past and 67.2% reported that their family members used these medicines. Herbal therapy was found to be the most commonly used method (38.9%) followed by spiritual (33.9%), cautery (20.2%) and Curucoma (15.7%). Other methods, which include; acupuncture, bone healing and Chinese healing were also found to be in use but in rare manner. Knowledge level of TM and complementary medicine of most of the doctors was found to be low but one third of them acknowledged that they may recommend these treatments to their patients in future. Therefore, training pediatricians on the types, benefits and side effects of complementary and TM is recommended. 1 - 65 68 - - Muna Al Saadoon Department of Child Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman Department of Child Health, College of Medicine Iran munasa@squ.edu.om - - Mohammed Al Jafari Ministry of Health, Muscat, Oman Ministry of Health, Muscat, Oman Iran amskyat@gmail.com - - Bader Al Dhouyani Ministry of Health, Muscat, Oman Ministry of Health, Muscat, Oman Iran bader69914@gmail.com - - Syed Rizvi Family Medicine and Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman Family Medicine and Public Health, College Iran rizvi@squ.edu.om Complementary Medicine Traditional Medicine (TM) Attitude Pediatrician Children Oman World Health Organization (WHO). WHO traditional medicine strategy [internet]. 2012. Available from:  http://www.who.int/medicines/publications/traditionalpolicy/en/index.html ##World Health Organization (WHO). Traditional medicine [WWW Document]. 2012. Available from:  http://www.who.int/mediacentre/factsheets/fs134/en/ ##Gooneratne NS. Complementary and alternative medicine for sleep disturbances in older adults. Clin Geriatr Med 2008; 24: 121-8. doi: 10.1016/j.cger.2007.08.002 ##World Health Organization (WHO). Traditional medications: global situation, issues and challenges. Geneva: WHO; 2011. ##Johnson PJ, Ward A, Knutson L, Sendelbach S. Personal use of complementary and alternative medicine (CAM) by U.S. health care workers. Health Serv Res 2012; 47: 211-27. doi: 10.1111/j.1475-6773.2011.01304.x ##Adib-Hajbagherya M, Hoseinian M. Knowledge, attitude and practice toward complementary and traditional medicine among Kashan health care staff. Complement Ther Med 2014; 22: 126-32. doi: 10.1016/j.ctim.2013.11.009 ##Gruber M, Ben-Arye E, Kerem N, Cohen-Kerem R. Use of complementary alternative medicine in pediatric otolaryngology patients: A survey. Int J Pediatr Otorhinolaryngol 2014; 78: 248-52. doi: 10.1016/j.ijporl.2013.11.016 ##Birdee GS, Phillips RS, Davis RB, Gardiner P. Factors associated with pediatric use of complementary and alternative medicine. Pediatrics 2010; 125: 249-56. doi: 10.1542/peds.2009-1406 ##Farag TH, Kotloff KL, Levine MM, Onwuchekwa U, Van Eijk AM, Doh S, et al. Seeking care for pediatric diarrheal illness from traditional healers in Bamako, Mali. Am J Trop Med Hyg 2013; 89: 21-8. doi: 10.4269/ajtmh.12-0753 ##Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Rep 2008; 12: 1-23. doi: 10.1037/e623942009-001 ##Abolhassani H, Naseri M, Mahmoudzadeh S. A Survey of Complementary and Alternative Medicine in Iran. Chin J Integr Med 2012; 18: 409-16. doi: 10.1007/s11655-012-1124-9 ##Ito A, Munakata K, Imazu Y, Watanabe K. First nationwide attitude survey of Japanese physicians on the use of traditional Japanese medicine (Kampo) in cancer treatment. Evid Based Complement Alternat Med 2012; 2012: 957082. doi: 10.1155/2012/957082 ##Ghazanfar SA, Al-Sabahi MA. Medicinal plants of northern and central Oman. Econ Bot 1993; 47: 89-98. doi: 10.1007/bf02862209 ##Al Saadoon M, Al-jashemi RM, Al-Farsi AM, Al-Suleimani SH, Al-Khayari HY. Medical student attitude toward traditional, complementary and alternative medicine: cross-sectional study. The Journal of Ethnobiology and Traditional Medicine 2014; 122: 900-5. ##Mbutho NP, Gqaleni N, Korporaal CM. Traditional complementary and alternative medicine: knowledge, attitudes and practices of health care workers in HIV and AIDS clinics in Durban hospitals. Afr J Tradit Complement Altern Med 2012; 9: 64-72. doi: 10.4314/ajtcam.v9i3s.8 ##

Hospitals’ Readiness to Implement Clinical Governance 2 2 Background Quality of health services is one of the most important factors for delivery of these services. Regarding the importance and vital role of quality in the health sector, a concept known as “Clinical Governance” (CG) has been introduced into the health area which aims to enhance quality of health services. Thus, this study aimed to assess private and public hospitals’ readiness to implement CG in Iran.   Methods This descriptive and cross-sectional study was carried out in 2012. Four hundred thirty participants including doctors, nurses, diagnostic departments personnel, and support staff were chosen randomly from four hospitals (equally divided into private and public hospitals). Clinical Governance Climate Questionnaire (CGCQ) was used for data collection. Finally, data were entered into the SPSS 18 and were analyzed using statistical methods.   Results Among the CG dimensions, “organizational learning” and “planned and integrated quality improvement program” scored the highest and the lowest respectively for both types of hospitals. Hospitals demonstrated the worst condition with regard to the latter dimension. Furthermore, both types of hospitals had positive picture regarding “training and development opportunities”. Private hospitals scored better than public ones in all dimensions but there was only a significant difference in “proactive risk management” dimension between both types of hospitals (P< 0.05).   Conclusion Hospitals’ readiness for CG implementation was “average or weak”. In order to implement CG successfully, it is essential to have a quality-centered culture, a culture specified by less paperwork, more selfsufficiency, and flexibility in hospitals’ affairs as well as centring on shared vision and goals with an emphasis on continuous improvement and innovation. 1 - 69 74 - - Farbod Ebadi Fardazar Hospital Management Research Center, Iran University of Medical Sciences, Tehran, Iran Hospital Management Research Center, Iran Iran dr_febadi@yahoo.com - - Hossein Safari Department of Health Management and Economics, Health School, Tehran University of Medical Sciences, Tehran, Iran Department of Health Management and Iran hossein_comely1367@yahoo.com - - Farhad Habibi Department of Health Management and Economics, Health School, Tehran University of Medical Sciences, Tehran, Iran Department of Health Management and Iran farhad.habibi@rocketmail.com - - Feyzollah Akbari Haghighi Department of Health Management and Economics, Health School, Tehran University of Medical Sciences, Tehran, Iran Department of Health Management and Iran feyzollah.akbari@gmail.com - - Aziz Rezapour Department of Health Economics, School of Health Management and Information Science, Iran University of Medical Sciences, Tehran, Iran | Health Management and Economics Research Center, Iran University of Medical Sciences, Department of Health Economics, School Iran rezapoor_a5@yahoo.com Clinical Governance (CG) Hospital Health Services Quality Improvement Silimperi DR, Franco LM, van Zanten TV, Macaulay C. A framework for institutionalizing quality assurance. Int J Qual Health Care 2002; 14: 67-73.  doi: 10.1093/intqhc/14.suppl_1.67 ##Power M. The audit society—Second thoughts. International Journal of Auditing 2000; 4: 111-9. doi: 10.1111/1099-1123.00306 ##Hood C, James O, Scott C. Regulation of government: has it increased, is it increasing, should it be diminished? Public Adm 2000; 78: 283-304.  doi: 10.1111/1467-9299.00206 ##O'neill O. A question of trust: The BBC Reith Lectures 2002. Cambridge: Cambridge University Press; 2002. ##Mojtaba S. Designing and implementing clinical governance in pilot hospitals. Tehran university of medical sciences; 2006. [In Persian] ##Scally G, Donaldson LJ. Clinical governance and the drive for quality improvement in the new NHS in England. BMJ 1998; 317: 61-5. doi: 10.1136/bmj.317.7150.61 ##Donaldson LJ, Gray J. Clinical governance: a quality duty for health organisations. Qual Health Care 1998; 7: S37-44.  ##Kassirer JP. The quality of care and the quality of measuring it. N Engl J Med 1993; 329: 1263.  doi: 10.1056/nejm199310213291710 ##Karassavidou E, Glaveli N, Zafiropoulos K. Assessing hospitals' readiness for clinical governance quality initiatives through organisational climate. J Health Organ Manag 2011; 25: 214-40.  ##Bahrami MA, Sabahi AA, Montazeralfaraj R, Shamsi F, Entezarian S. Hospitals’ Readiness for Clinical Governance Implementation in Educational Hospitals of Yazd, Iran. Electronic Physician 2014; 6: 794-800.  ##Konteh FH, Mannion R, Davies HT. Clinical governance views on culture and quality improvement. Clinical Governance: An International Journal 2008; 13: 200-7.  doi: 10.1108/14777270810892610 ##Ekvall G. Climate, structure and innovativeness of organizations: A theoretical framework and an experiment. Stockholm: FArådet, the Swedish Council for Management and Organizational Behaviour; 1983. ##Morgan PI, Ogbonna E. Subcultural dynamics in transformation: a multi-perspective study of healthcare professionals. Hum Relat 2008; 61: 39-65.  doi: 10.1177/0018726707085945 ##Haslock I. Introducing clinical governance in an acute trust. Hosp Med 1999; 60: 744-7. doi: 10.12968/hosp.1999.60.10.1220  ##Freeman T. Measuring progress in clinical governance: assessing the reliability and validity of the Clinical Governance Climate Questionnaire. Health Serv Manag Res 2003; 16: 234-50.  doi: 10.1258/095148403322488937 ##Nicholls S, Cullen R, O’Neill S, Halligan A. Clinical governance: its origins and its foundations. British Journal of Clinical Governance 2000; 5: 172-8.  doi: 10.1108/14777270010734055 ##Rose RC, Uli J, Abdul M, Ng KL. Hospital service quality: a managerial challenge. Int J Health Care Qual Assur 2004; 17: 146-59.  ##Halligan A. Clinical governance: assuring the sacred duty of trust to patients. Clinical Governance: An International Journal 2006; 11: 5-7.  doi: 10.1108/14777270610646967 ##Peak M, Burke R, Ryan S, Wratten K, Turnock R, Vellenoweth C. Clinical governance–the turn of continuous improvement? Clinical Governance: An International Journal 2005; 10: 98-105. doi: 10.1108/14777270510594272 ##Preker AS, Harding A. Innovations in health service delivery: the corporatization of public hospitals.  Washington, DC: World Bank Publications; 2003. ##van Zwanenberg T. Clinical governance in primary care: from blind-eye to no-blame culture in one short leap? British Journal of Clinical Governance 2001; 6: 83-6.  doi: 10.1108/14664100110815414 ##Mehrdad R. Health system in Iran. JMAJ 2009; 52: 69-73.  ##National Health Service (NHS). A review of integrated clinical governance in the context of medical revalidation. Britain Revalidation support team; 2011. ##Freeman T, Walshe K. Achieving progress through clinical governance? A national study of health care managers’ perceptions in the NHS in England. Qual Saf Health Care 2004; 13: 335-43.  doi: 10.1136/qhc.13.5.335 ##Som CV. Clinical governance: a fresh look at its definition. Clinical Governance: An International Journal 2004; 9: 87-90.  doi: 10.1108/14777270410536358 ##Warwick C. The new NHS: modern dependable. British Journal of Midwifery 1998; 6: 265.   doi: 10.12968/bjom.1998.6.4.265 ##Moran R. “There’s no time to learn”… like the present. Clinical Governance: An International Journal 2003; 8: 46-56.  doi: 10.1108/14777270310460010 ##Luthans KW, Lebsack SA, Lebsack RR. Positivity in healthcare: relation of optimism to performance. J Health Organ Manag 2008; 22: 178-88. doi: 10.1108/14777260810876330 ##McSherry R, Pearce P. Clinical governance. Chichester: John Wiley & Sons; 2010. ##McSherry R. Factors influencing collaborative working. In: McSherry R, Warr J, editors. 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Understanding Perception and Factors Influencing Private Voluntary Health Insurance Policy Subscription in the Lucknow Region 2 2 Background Health insurance has been acknowledged by researchers as a valuable tool in health financing. In spite of its significance, a subscription paralysis has been observed in India for this product. People who can afford health insurance are also found to be either ignorant or aversive towards it. This study is designed to investigate into the socio-economic factors, individuals’ health insurance product perception and individuals’ personality traits for unbundling the paradox which inhibits people from subscribing to health insurance plans.   Methods This survey was conducted in the region of Lucknow. An online questionnaire was sent to sampled respondents. Response evinced by 263 respondents was formed as a part of study for the further data analysis. For assessing the relationships between variables T-test and F-test were applied as a part of quantitative measuring tool. Finally, logistic regression technique was used to estimate the factors that influence respondents’ decision to purchase health insurance.   Results Age, dependent family members, medical expenditure, health status and individual’s product perception were found to be significantly associated with health insurance subscription in the region. Personality traits have also showed a positive relationship with respondent’s insurance status.   Conclusion We found in our study that socio-economic factors, individuals’ product perception and personality traits induces health insurance policy subscription in the region. 1 - 75 83 - - Tanuj Mathur Department of Humanities and Social Sciences, National Institute of Technology, Silchar, Assam, India Department of Humanities and Social Sciences, Iran tanujmathur10@gmail.com - - Ujjwal Paul Department of Humanities and Social Sciences, National Institute of Technology, Silchar, Assam, India Department of Humanities and Social Sciences, Iran ujjwal.paul@gmail.com - - Himanshu Prasad Department of Humanities and Social Sciences, National Institute of Technology, Silchar, Assam, India Department of Humanities and Social Sciences, Iran hnprasad78@gmail.com - - Subodh Das Department of Humanities and Social Sciences, National Institute of Technology, Silchar, Assam, India Department of Humanities and Social Sciences, Iran dssubodh30@gmail.com Health Insurance Perception Mediclaim Policy Personality Traits Private Voluntary Health Insurance (PVHI) Reddy KS, Selvaraj S, Rao KD, Chokshi M, Kumar P, Arora V, et al. A Critical Assesment of the Existing Health Insurance Models in India. Public Health Foundation of India; 2011. ##La Forgia G, Nagpal S. Government Sponsored Health Insurance in India: Are you covered? Washington, DC:The World Bank Publications; 2011. doi: 10.1596/978-0-8213-9618-6 ##World Health Organization (WHO). Global Health Observatory Data Repository [internet]. 2014 [updated  June 2014; cited 2014 October 16]. Available from: http://apps.who.int/gho/data/node.country.country-IND ##Dinodia Capital Advisors New Delhi. Indian Healthcare Industry 2012. [cited 2014 Nov 3]. Available from: http://www.dinodiacapital.com/admin/upload/Indian-Healthcare-Industry-November-2012.pdf ##Rajeev A, Narang A. Emerging Trends in Health Insurance for Low-Income Groups. Econ Polit Wkly 2005; 40: 17-23. ##Sapelli C, Torche A. The Mandatory Health Insurance System in Chile: Explaining the Choice between Public and Private Insurance. 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Econ Polit Wkly 2002; 37: 2795-02. ##Mcdonald EM, Shannon F, Edsall Kromm  E, Ma X, Pike M, Holtgrave D. Improvements in health behaviors and health status among newly insured members of an innovative health access plan. J Community Health 2012; 345: 1106-12. doi: 10.1007/s10900-012-9615-3 ##Rosenman R, Wang HH. Perceived need and actual demand for health insurance among rural chinese residents. China Economic Review 2006; 18: 373-88. doi: 10.1016/j.chieco.2006.11.002 ##Saver, Barry G and Doescher, Mark P. To buy, or not to buy, factors associated with the purchase of nongroup, private health insurance. Med Care 2000; 38: 141-51. doi: 10.1097/00005650-200002000-00004 ##Lave J, Keane CR, Lin CJ, Ricci EM, Amersbach G, LaVallee CP. The impact of a children's health insurance program by age. Pediatrics 1999; 104: 1051-8. doi: 10.1542/peds.104.5.1051 ##Monheit AC,  Vistnes JP. Health insurance enrollment decisions: preferences for coverage, worker sorting and insurance take-up. 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Employee Engagement within the NHS: A Cross-Sectional Study 2 2 Background Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital.   Methods We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual.   Results We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001  for both). The score for absorption was significantly higher than comparison group (P< 0.0001). However, total score is not significantly different.   Conclusion The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience. 1 - 85 90 - - Yadava Jeve University Hospitals of Leicester, Leicester, UK University Hospitals of Leicester, Leicester, Iran drybjeve@gmail.com - - Christna Oppenhemier University Hospitals of Leicester, Leicester, UK University Hospitals of Leicester, Leicester, Iran christna.oppnhemier@uhl-tr.nhs.uk - - Justin Konje University Hospitals of Leicester, Leicester, UK University Hospitals of Leicester, Leicester, Iran jck@le.ac.uk Employee Engagement Patient Safety Vigor Dedication Absorption Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annu Rev Psychol 2001; 52: 397.  ##Maslach C, Schaufeli WB. Historical and conceptual development of burnout. In: Schaufeli WB, C Maslach, T Marek, editors. Professional burnout: Recent developments in theory and research. 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Available from:http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/leadership-for-engagement-improvement-nhs-final-review2012.pdf ##Juniper B. Engagement versus wellbeing. Occupational Health 2012; 64: 26.  ##O'Reilly N. Boorman urges NHS OH staff to work with HR to improve health. Occupational Health 2010; 62: 8.  ##Palmer E. Mid Staffordshire Report: Change Needed at NHS ‘on Every Level’ [internet]. 2013. Available from: http://www.ibtimes.co.uk/mid-staffordshire-hospital-report-nhs-failing-change-432151 ##Adyasha R. A Motivated Employee: A Qualitative Study on various Motivational Practices used in Organizations. Aweshkar Research Journal 2013; 15: 98-103.  ##Handa M, Gulati A. Employee Engagement. Journal of Management Research 2014; 14: 57-67.  ##Catlette B, Hadden R. Discretionary Effort. Sales and Service Excellence 2008; 8: 8.  ##Harrison AG. 5 steps to employee engagement: Improving your goals for organizational success. 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“Hearing from All Sides” How Legislative Testimony Influences State Level Policy-Makers in the United States 2 2 Background This paper investigates whether state legislators find testimony influential, to what extent testimony influences policy-makers’ decisions, and defines the features of testimony important in affecting policy-makers’ decisions.   Methods We used a mixed method approach to analyze responses from 862 state-level legislators in the United States (U.S.). Data were collected via a phone survey from January-October, 2012. Qualitative data were analyzed using a general inductive approach and codes were designed to capture the most prevalent themes. Descriptive statistics and cross tabulations were also completed on thematic and demographic data to identify additional themes.   Results: Most legislators, regardless of political party and other common demographics, find testimony influential, albeit with various definitions of influence. While legislators reported that testimony influenced their awareness or encouraged them to take action like conducting additional research, only 6% reported that testimony changes their vote. Among those legislators who found testimony influential, characteristics of the presenter (e.g., credibility, knowledge of the subject) were the most important aspects of testimony. Legislators also noted several characteristics of testimony content as important, including use of credible, unbiased information and data.   Conclusion Findings from this study can be used by health advocates, researchers, and individuals to fine tune the delivery of materials and messages to influence policy-makers during legislative testimony. Increasing the likelihood that information from scholars will be used by policy-makers may lead to the adoption of more health policies that are informed by scientific and practice-based evidence. 1 - 91 98 - - Sarah Moreland-Russell Center for Public Health Systems Science, Brown School, Washington University, St. Louis, MO, USA Center for Public Health Systems Science, Iran smoreland-russell@wustl.edu - - Colleen Barbero Center for Public Health Systems Science, Brown School, Washington University, St. Louis, MO, USA Center for Public Health Systems Science, Iran cbarbero@wustl.edu - - Stephanie Andersen Center for Public Health Systems Science, Brown School, Washington University, St. Louis, MO, USA Center for Public Health Systems Science, Iran sandersen@wustl.edu - - Nora Geary Prevention Research Center, Brown School, Washington University, St. Louis, MO, USA Prevention Research Center, Brown School, Iran ngeary@gmail.com - - Elizabeth Dodson Prevention Research Center, Brown School, Washington University, St. Louis, MO, USA Prevention Research Center, Brown School, Iran edodson@wustl.edu - - Ross Brownson Prevention Research Center, Brown School, Washington University, St. Louis, MO, USA | Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University, St. Louis, MO, USA Prevention Research Center, Brown School, Iran rbrownson@wustl.edu Testimony Policy-making Legislators Weiss C. The many meanings of research utilization. Public Adm Rev 1979; 39: 426-31.  ##Kingdon J. Agendas, Alternatives, and Public Policies. New York: Longman; 2003. ##Mays N, Pope C, Popay J. Systematically reviewing qualitative and quantitative evidence to inform management and policy-making in the health field. J Health Serv Res Policy 2005; 10: 6-20. doi: 10.1258/1355819054308576 ##van Kammen J, de Savigny D, Sewankambo N. Using knowledge brokering to promote evidence-based policy-making: the need for support structures. Bull World Health Org Suppl 2006; 84: 608-12. doi: 10.1590/S0042-96862006000800011 ##Sanderson I. Evaluation, policy learning and evidence‐based policy making. Public Adm 2002; 80: 1-22. doi: 10.1111/1467-9299.00292 ##Cohen M, March J, Olsen J. 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Legislative Studies Quarterly 1995; 20: 89-139.  ##Bogenschneider K, Corbett T. Evidence-Based Policymaking. New York: Routledge; 2010. ##Albert M, Fretheim A, Maïga D. Factors influencing the utilization of research findings by health policy-makers in a developing country: the selection of Mali's essential medicines. Health Res Policy Syst 2007; 5. doi: 10.1186/1478-4505-5-2 ##Innvær S, Vist G, Trommald M, Oxman A. Health policy-makers' perceptions of their use of evidence: a systematic review. J Health Serv Res Policy 2002; 7: 239-44. doi: 10.1258/135581902320432778 ##Edwards H, Bryant D, Bent-Goodley T. Participation and influence in federal child welfare policymaking. J Public Child Welf 2011; 5: 145-66. doi: 10.1080/15548732.2011.566750 ##Larsen J, Vrangbæk K, Traulsen J. Advocacy coalitions and pharmacy policy in Denmark: solid cores with fuzzy edges. Soc Sci Med 2006; 63: 212-24. doi: 10.1016/j.socscimed.2005.11.045 ##Sorian R, Baugh T. 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Emergency Referral Transport for Maternal Complication: Lessons from the Community Based Maternal Death Audits in Unnao District, Uttar Pradesh, India 2 2 Background An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP).   Methods A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths.   Results It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours.   Conclusion The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major contributing factor for maternal deaths in Unnao district, UP. The UP Government, besides strengthening Emergency Obstetric and Newborn Care (EmONC) and Basic Emergency Obstetric and Newborn Care (BEmONC) services in the district and state as a whole, also needs to focus on developing a functional and effective referral system on a priority basis to reduce the maternal deaths in Unnao district. 1 - 99 106 - - Sunil Raj HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India HIV/AIDS Partnership for Impact through Iran sunil.sraj@phfi.org - - Suneedh Manthri HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India HIV/AIDS Partnership for Impact through Iran suneedh@phfi.org - - Pratap Sahoo Health Promotion Division, Public Health Foundation of India, New Delhi, India Health Promotion Division, Public Health Iran pratap.kumar@phfi.org Referral Transport Maternal Deaths Facility Review Maternal Death Review (MDR) 1. 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An American Plague: Pro-Market Believers in Health Policy; Comment on “On Health Policy and Management (HPAM): Mind the Theory-Policypractice Gap” 2 2 Although American health policy debates address similar problems to other developed nations, it has factual and ideological specificities. I agree with Chinitz and Rodwin on the dominance of micro-economics thinking. However, I am not certain that learning from management theory or modifying medical education will be powerful enough to change the system. The vested interests of the stakeholders are too powerful, the more so when they are supported by economists who ideologically reinforce them and by neglecting the fact that the basic premises of market ideology are false when applied to medical care. There is enough empirical evidence to support that but, apparently, these facts do not dent these beliefs. 1 - 107 109 - - Jean de Kervasdoué Conservatoire National des Arts et Métiers, Paris, France Conservatoire National des Arts et Métiers, Iran jean.de_kerguiziau_de_kervasdoue@cnam.fr Market Ideology Medical Care Microeconomic Concepts Health Policy Chinitz DP, Rodwin VG. On Health Policy and Management (HPAM): mind the theory-policy-practice gap. Int J Health Policy Manag 2014; 3: 361–3. doi: 10.15171/ijhpm.2014.122 ##Jost T. Health Care at Risk: A Critique of the Consumer-Driven Movement. Durham: Duke University Press; 2007. ##Marmor T,  Klein R. Politics, Health, and Health Care: Selected Essays. New Haven: Yale University Press;  2012 ##Rose R, Mackenzie WJ. Comparing forms of comparative analysis.  Polit Stud (Oxf) 1991; 39: 446-62. doi: 10.1111/j.1467-9248.1991.tb01622.x ##Sicotte C, Champagne F, Contandriopoulos AP, Barnsley J, Béland F, Leggat SG, et al. A conceptual framework for the analysis of health care organizations’ performance. Health Serv Manage Res 1998; 11: 24-41. ##Guisset AL, Sicotte C, Leclercq P, D’hoore W. [Définition de la performance hospitalière: une enquête auprès des divers acteurs stratégiques au sein des hôpitaux]. Sciences Sociales et Santé 2002; 20: 65-104. ##Porter M, Tiesberg E. Why Health Care is Stuck – and How to Fix It [internet]. HBR Blog Network, Harvard Business Review. September 17, 2013. Available from: https://hbr.org/2013/09/why-health-care-is-stuck-and-how-to-fix-it ##Organization for Economic Co-operation and Development (OECD). Health at a Glance, 2013.  http://www.oecd.org/els/health-systems/Health-at-a-Glance-2013.pdf ##de Kervasdoué J. Power, efficiency and innovations in formal organizations [PhD dissertation]. ILR School, Cornell University; 1973. ##Marmor TR, Gordon RW. Commercial pressures on professionalism in american medical care: from medicare to the affordable care act. J Law Med Ethics 2014; 42: 412-9. doi: 10.1111/jlme.12164 ##Tuohy C. Accidental Logics The Dynamics of Change in the Health Care Arena in the United States, Britain, and Canada. USA: OUP; 1999. ##Pierson P. Dismantling the Welfare State? Reagan, Thatcher and the Politics of Retrancement (Cambridge Studies in Comparative Politics). Cambridge: Cambridge University Press; 1995. ##

Knowledge, Politics and Power in Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health” 2 2 This article agrees with recent arguments suggesting that normative and epistemic power is rife within global health policy and provides further examples of such. However, in doing so, it is argued that it is equally important to recognize that global health is, and always will be, deeply political and that some form of power is not only necessary for the system to advance, but also to try and control the ways in which power within that system operates. In this regard, a better focus on health politics can both expose illegitimate sources of power, but also provide better recommendations to facilitate deliberations that can, although imperfectly, help legitimate sources of influence and power. 1 - 111 113 - - Garrett Wallace Brown Department of Politics, University of Sheffield, Sheffield, UK Department of Politics, University of Sheffield, Iran g.w.brown@sheffield.ac.uk Global Health Power Politics of Health Bacon F. Meditationes Sacrae. Whitefish: Kessinger Publications; 1996. p. 67. ##Hobbes T. Leviathan. Indianapolis: Hackett Classics; 1994. Ch. 10. ##Emerson R. Society and Solitude. Boston: The Riverside Press; 1892. p. 303. ##Nietzsche F. The Will to Power: In Science, Nature, Society and Art. New York:  Random House; 1968. ##Shiffman J. Knowledge, moral claims and the exercise of power in global health. Int J Health Policy Manag 2014; 3: 297-9. Doi: 10.15171/ijhpm.2014.120 ##Barnes A, Brown GW, Harman S. The Global Politics of Health Reform in Africa: Performance, Participation and Policy. London: Palgrave; 2015. ##Brown GW, Barnes A, Harman S, Gruia M, Papamichail A. Discussion Paper 98: Annotated literature review: Africa actors, global health governance and performance based funding. Equinet Africa. [cited Jan 19, 2015]. Available from: http://www.equinetafrica.org/bibl/docs/Diss98PBFLitRevJune2013.pdf ##Barnes A, Brown GW. The Global Fund to Fight AIDS, Tuberculosis and Malaria: Expertise, accountability and the depoliticisation of global health. In:  Rushton S, Williams O, editors. Partnerships and Foundations in Global Health Governance. Basingstoke: Palgrave; 2011. p. 53-75. ##Ooms G. From international health to global health: How to foster a better dialogue between empirical and normative disciplines. BMC Int Health Hum Rights 2014; 14: 36. Doi: 10.1186/s12914-014-0036-5 ##Barnes A, Parkhurst J. Can global health policy be depoliticized? A critique of global calls for evidence-based policy. In: Brown GW, Yamey G, Wamala S, editors. Global Health Policy. London: Willey-Blackwell; 2014. ##Marten R, Hanefeld J, Smith R. Power: The nexus of global health diplomacy Journal of Health Diplomacy 2014, 1 (2). [cited Jan. 29, 2015]. Available from: http://www.ghd-net.org/sites/default/files/martenhanefeldsmith_power (1).pdf ##Habermas J. Between Facts and Norms. Cambridge: Polity Press; 1996. ##Bruen C, Brugha R. A ghost in the machine? Politics in global health policy. International Journal of Health Policy and Management 2014, 3 (1): 1-4. Doi: 10.15171/ijhpm.2014.59 ##McCoy D., & Singh G., A Spanner in the works?: Anti-politics in global health policy. Int J Health Policy Manag 2014, 3: 151-3. Doi: 10.15171/ijhpm.2014.77 ##Hammer A. Democracy – The real ‘ghost’ in the machine of global health policy. Int J Health Policy Manag 2014; 3: 149-50. Doi: 10.15171/ijhpm.2014.75 ##Kickbusch I, Lister G, Told M, Drager N. Global Health Diplomacy: Concepts, Issues, Actors, Instruments, Fora and Cases. London: Springer; 2013. ##

Powerful Concepts in Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health” 2 2 In this paper we emphasize the importance of questioning the global validity of significant concepts underpinning global health policy. This implies questioning the concept of global health as such and accepting that there is no global definition of the global. Further, we draw attention to ‘quality’ and ‘empowerment’ as examples of world-forming concepts. These concepts are exemplary for the gentle and quiet forms of power that underpin our reasoning within global health. 1 - 115 117 - - Eivind Engebretsen Faculty of Medicine, University of Oslo, Oslo, Norway Faculty of Medicine, University of Oslo, Iran eivind.engebretsen@medisin.uio.no - - Kristin Heggen Faculty of Medicine, University of Oslo, Oslo, Norway Faculty of Medicine, University of Oslo, Iran k.m.heggen@medisin.uio.no Global Health Governance Power Language Global Health Shiffman, J. Knowledge, moral claims and the exercise of power in global health. Int J Health Policy Manag 2014; 3: 297-9. Doi: 10.15171/ijhpm.2014.120 ##Engebretsen E, Heggen K.   Global Governance for Health: what about liberal power? Lancet 2014; 384: s664. doi: 10.1016/S0140-6736(14)61390-8 ##Nancy JL. La création du monde ou la mondialisation. Paris: Galilée; 2002 ##Engebretsen E, Heggen K. Makt på nye måter (New Forms of Power). Oslo: University Press; 2012. ##Engebretsen E, Heggen K. Conversations with the Norwegian Minister of Health Jonas Gahr Støre about insuring the quality of health care [internet]. Available from: http://morgenbladet.no/ideer/2012/kjaere_jonas_gahr_store#.VJ3GvCcA ##Juritzen TI,  Engebretsen E,  Heggen, K. Subject to empowerment: The constitution of power in an educational programme for health professionals.  2012; 16:  443-55. doi: 10.1007/s11019-012-9412-x ##World Health Organization (WHO). 7th Global Conference on Health Promotion: Track 1: Community Empowerment [internet]. http://www.who.int/healthpromotion/conferences/7gchp/track1/en/ ##

Knowledge and Networks – Key Sources of Power in Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health” 2 2 Shiffman rightly raises questions about who exercises power in global health, suggesting power is a complex concept, and the way it is exercised is often opaque. Power that is not based on financial strength but on knowledge or experience, is difficult to estimate, and yet it may provide the legitimacy to make moral claims on what is, or ought to be, on global health agendas. Twenty years ago power was exercised in a much less complex health environment. The World Health Organization (WHO) was able to exert its authority as world health leader. The landscape today is very different. Financial resources for global health are being competed for by diverse organisations, and power is diffused and somewhat hidden in such a climate, where each organization has to establish and make its own moral claims loudly and publicly. We observe two ways which allow actors to capture moral authority in global health. One, through power based on scientific knowledge and two, through procedures in the policy process, most commonly associated with the notion of broad consultation and participation. We discuss these drawing on one particular framework provided by Bourdieu, who analyses the source of actor power by focusing on different sorts of capital. Different approaches or theories to understanding power will go some way to answering the challenge Shiffman throws to health policy analysts. We need to explore much more fully where power lies in global health, and how it is exercised in order to understand underlying health agendas and claims to legitimacy made by global health actors today. 1 - 119 121 - - Johanna Hanefeld London School of Hygiene and Tropical Medicine, London, UK London School of Hygiene and Tropical Medicine, Iran johanna.hanefeld@lshtm.ac.uk - - Gill Walt London School of Hygiene and Tropical Medicine, London, UK London School of Hygiene and Tropical Medicine, Iran gill.walt@lshtm.ac.uk Power Global Health Bourdieu Participation Evidence-Based Policy-Making Shiffman, J. Knowledge, moral claims and the exercise of power in global health. Int J Health Policy Manag 2014; 3: 297-9. doi: 10.15171/ijhpm.2014.120 ##Vaughan JP, Modedal S, Kruse SE, Lee K, Walt G, de Wilde K. Financing the World Health Organization: global importance of extrabudgetary funds. Health Policy 1996; 35; 229-45. doi: 10.1016/0168-8510(95)00786-5 ##Sridhar D, Gostin L. Reforming the World Health Organization.  JAMA 2011; 303: 15; 1585-6. doi: 10.1001/jama.2011.418 ##Frenk J, Moon S. Governance challenges in global health. N Engl J Med 2013; 368: 936-42. doi: 10.1056/NEJMra1109339 ##Bruen C, Brugha R. A ghost in the machine? politics in global health policy. Int J Health Policy Manag 2014; 3: 1–4. doi: 10.15171/ijhpm.2014.59 ##Bourdieu P. Outline of a theory of practice. Cambridge: University of Cambridge Press; 1977. ##Bourdieu P. The forms of capital. In: Richardson J, editor. Handbook of Theory and Research for the Sociology of Education. New York: Greenwood; 1984. P. 241-58. ##Greenhalgh T, Wieringa S. Is it time to drop the ‘knowledge translation’ metaphor? A critical literature review. J R Soc Med 2011; 104: 501-9. doi: 10.1258/jrsm.2011.110285 ##Barnes A, Parkhurst J. Can Global Health Policy be Depoliticized? A Critique of Global Calls for Evidence‐Based Policy. In: Brown G, Yamey G and Wamala S, editors. Handbook of Global Health Policy. UK: John Wiley & Sons, Ltd; 2014. ##Buse K, Mays N, Walt G. Making Health Policy. Berkshire: Open University Press-McGraw Hill; 2012. ##McCoy D, Kembhavi G, Patel J, Luintel A. The Bill and Melinda Gates Foundation’s grant-making programme for global health. Lancet 2009; 373: 1645-53. doi: 10.1016/s0140-6736(09)60571-7 ##Walt G. WHO under stress: implications for health policy. Health Policy 1993; 24; 125-44. doi: 10.1016/0168-8510(93)90030-s ##