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Translating Evidence into Healthcare Policy and Practice: Single Versus Multi-Faceted Implementation Strategies – Is There a Simple Answer to a Complex Question? 2 2 How best to achieve the translation of research evidence into routine policy and practice remains an enduring challenge in health systems across the world. The complexities associated with changing behaviour at an individual, team, organizational and system level have led many academics to conclude that tailored, multifaceted strategies provide the most effective approach to knowledge translation. However, a recent overview of systematic reviews questions this position and sheds doubt as to whether multi-faceted strategies are any better than single ones. In this paper, we argue that this either-or distinction is too simplistic and fails to recognize the complexity that is inherent in knowledge translation. Drawing on organizational theory relating to boundaries and boundary management, we illustrate the need for translational strategies that take account of the type of knowledge to be implemented, the context of implementation and the people and processes involved. 1 - 123 126 - - Gill Harvey School of Nursing, University of Adelaide, Adelaide, Australia | Manchester Business School, University of Manchester, Manchester School of Nursing, University of Adelaide, Iran gillian.harvey@adelaide.edu.au - - Alison Kitson School of Nursing, University of Adelaide, Adelaide, Australia | Central Adelaide Local Health Network (CALHN), Adelaide, Australia School of Nursing, University of Adelaide, Iran alison.kitson@adelaide.edu.au Knowledge Translation Boundaries Boundary Management Evidence-Based Healthcare 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 ##Davies H, Nutley S, Walter I. Why 'knowledge transfer' is misconceived for applied social research. J Health Serv Res Policy 2008; 13: 188-90.  doi: 10.1258/jhsrp.2008.008055 ##Dopson S, Fitzgerald L. Knowledge to Action? Evidence-Based Health Care in Action. New York: Oxford University Press; 2005. ##Ferlie E, Dopson S, Fitzgerald L, Locock L. Renewing policy to support evidence-based health care. Public Administration 2009; 87: 837-52.  doi: 10.1111/j.1467-9299.2009.01796.x ##Wensing M, Oxman A, Baker R, Godycki-Cwirko M, Flottorp S, Szecsenyi J, et al. Tailored implementation for chronic diseases (TICD): A project protocol. Implement Sci 2011; 6: 103.  ##Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. The Cochrane Effective Practice and Organization of Care Review Group. British Medical Journal 1998; 317: 465-8.  ##Squires J, Sullivan K, Eccles M, Worswick J, Grimshaw J. Are multifaceted interventions more effective than single-component interventions in changing health-care professionals' behaviours? An overview of systematic reviews. Implement Sci 2014; 9: 152.  ##Kitson A, Harvey G, McCormack B. Enabling the implementation of evidence based practice: a conceptual framework. Quality Health Care 1998; 7: 149-59.  ##Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, et al. Ingredients for change: revisiting a conceptual framework. Qual Saf Health Care 2002; 11: 174-80.  ##Kitson A, Rycroft-Malone J, Harvey G, McCormack B, Seers K, Titchen A. Evaluating the successful implementation of evidence into practice using the PARIHS framework: theoretical and practical challenges. Implement Sci 2008; 3: 1.  ##Rycroft-Malone J, Seers K, Titchen A, Harvey G, Kitson A, McCormack B. What counts as evidence in evidence-based practice? J Adv Nurs 2004; 47: 81-90.  ##McCormack B, Kitson A, Harvey G, Rycroft-Malone J, Titchen A, Seers K. Getting evidence into practice: the meaning of 'context'. J Adv Nurs 2002; 38: 94-104.  ##Harvey G, Loftus-Hills A, Rycroft-Malone J, Titchen A, Kitson A, McCormack B, et al. Getting evidence into practice: the role and function of facilitation. J Adv Nurs 2002; 37: 577-88.  ##Weiner B. A theory of organizational readiness for change. Implement Sci 2009; 4: 67.  ##Harvey G, Jas P, Walshe K. Analysing organisational context: case studies on the contribution of absorptive capacity theory to understanding inter-organisational variation in performance improvement. BMJ Qual Saf 2014.  doi: 10.1136/bmjqs-2014-002928 ##Bate P. Context is everything.  Perspectives on Context: A selection of essays considering the role of context in successful quality improvement. London: The Health Foundation; 2014. ##Seers K, Cox K, Crichton N, Edwards R, Eldh A, Estabrooks C, et al. FIRE (facilitating implementation of research evidence): a study protocol. Implement Sci 2012; 7: 25.  ##Carlile PR. A Pragmatic View of Knowledge and Boundaries: Boundary Objects in New Product Development. Organ Sci 2002; 13: 442-55.  doi: 10.1287/orsc.13.4.442.2953 ##Carlile PR. Transferring, Translating, and transforming: an integrative framework for managing knowledge across boundaries. Organ Sci 2004; 15: 555-68.  doi: 10.1287/orsc.1040.0094 ##Grol R, Bosch M, Hulscher M, Eccles M, Wensing M. Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q 2007; 85: 93-138.  ##Burton CR, Rycroft-Malone J. Resource based view of the firm as a theoretical lens on the organisational consequences of quality improvement. Int J Health Policy Manag 2014; 3: 113-5.  doi: 10.15171/ijhpm.2014.74 ##Ferlie E. Resource based view: a promising new theory for healthcare organizations: Comment on "Resource based view of the firm as a theoretical lens on the organisational consequences of quality improvement". Int J Health Policy Manag 2014; 3: 347-8.  doi: 10.15171/ijhpm.2014.107 ##Michie S, van Stralen M, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci 2011; 6: 42.  ##Tabak RG, Khoong EC, Chambers DA, Brownson RC. Bridging Research and Practice. American Journal of Preventive Medicine 2012; 43: 337-50.  doi: 10.1016/j.amepre.2012.05.024 ##Rycroft-Malone J, Bucknall T. Models and frameworks for implementing evidence-based practice: linking evidence to action. Chichester, England: Wiley-Blackwell; 2010. ##Kislov R. Boundary discontinuity in a constellation of interconnected practices. Public Adm 2014; 92: 307-23.  doi: 10.1111/padm.12065 ##Currie G, El Enany N, Lockett A. Intra-professional dynamics in translational health research: The perspective of social scientists. Soc Sci Med 2014; 114: 81-8.  doi: 10.1016/j.socscimed.2014.05.045 ##Rycroft-Malone J, Wilkinson J, Burton CR, Harvey G, McCormack B, Graham I, et al. Collaborative action around implementation in Collaborations for Leadership in Applied Health Research and Care: towards a programme theory. J Health Serv Res Policy 2013; 18: 13-26.  doi: 10.1177/1355819613498859 ##Greenhalgh T, Humphrey C, Hughes J, Macfarlane F, Butler C, Pawson R. How do you modernize a health service? A realist evaluation of whole-scale transformation in london. Milbank Q 2009; 87: 391-416.  doi: 10.1111/j.1468-0009.2009.00562.x ##Pawson R. The Science of Evaluation: A Realist Manifesto. London: Sage; 2013. ##

Knowledge Mobilization in Healthcare Organizations: A View from the Resource-Based View of the Firm 2 2 This short literature review argues that the Resource-Based View (RBV) school of strategic management has recently become of increased interest to scholars of healthcare organizations. RBV links well to the broader interest in more effective Knowledge Mobilization (KM) in healthcare. The paper outlines and discusses key concepts, texts and authors from the RBV tradition and gives recent examples of how RBV concepts have been applied fruitfully to healthcare settings. It concludes by setting out a future research agenda. 1 - 127 130 - - Ewan Ferlie Department of Management, King’s College London, London, UK Department of Management, King’s College Iran ewan.ferlie@kcl.ac.uk - - Tessa Crilly Crystal Blue Consulting Ltd., London, UK Crystal Blue Consulting Ltd., London, UK Iran tessa@crystalblueconsulting.com - - Ashok Jashapara School of Management, Royal Holloway University of London, Egham, Surrey, UK School of Management, Royal Holloway Iran ashok.jashapara@rhul.ac.uk - - Susan Trenholm Department of Management and Marketing, University of Melbourne, Melbourne, Australia Department of Management and Marketing, Iran susan.trenholm@unimelb.edu.ac - - Anna Peckham Independent Librarian, Kent, UK Independent Librarian, Kent, UK Iran amgpeckham@gmail.com - - Graeme Currie Warwick Business School, University of Warwick, Coventry, UK Warwick Business School, University of Iran graeme.currie@wbs.ac.uk Resource-Based View (RBV) Knowledge Mobilization (KM) Healthcare Organizations Burton CR, Rycroft-Malone J. Resource based view of the firm as a theoretical lens on the organisational consequences of quality improvement. Int J Health Policy Manag 2014; 3: 113-5. doi: 10.15171/ijhpm.2014.74 ##Rosenberg Hansen J,  Ferlie E. Applying strategic management theories in public sector organizations: Developing a Typology. Public Management Review 2014 Sep. 17. doi: 10.1080/14719037.2014.957339 ##Cooksey Report. A Review of UK Health Research Funding. HM Treasury, London: HMSO: 2006. ##Department of Health. Innovation, Health and Wealth. London: HMSO; 2011. ##Sung NS, Crowley WF Jr, Genel M, Salber P, Sandy L, Sherwood LM, et al. Central challenges facing the national clinical research enterprise. JAMA 2003; 289: 1278-87. ##Lenfant C. Clinical Research to Clinical Practice — Lost in Translation? N Engl J Med 2003; 349: 868-74. ##Quality Enhancement Research Initiative (QUERI) [home page on the internet]. [cited 14 Jan. 2015]. Available from: http://www.queri.research.va.gov/about/default.cfm ##Graham ID, Tetroe J. Learning from the U.S. Department of Veterans Affairs Quality Enhancement Research Initiative: QUERI Series. Implement Sci 2009; 4: 13. doi: 10.1186/1748-5908-4-13 ##Institute for Healthcare Improvement [home page on the internet]. [cited 14 Jan. 2015]. Available from: http://www.ihi.org/about/Pages/IHIVisionandValues.aspx ##Berwick DM. Disseminating innovations in health care. JAMA 2003; 289: 1969-75. ##Canadian Health Services Research Foundation. The Theory and Practice of Knowledge brokering in Canada’s Health System. Ottawa, ON: Canadian Health Services Research Foundation; 2003. Available from: http://www.cfhi-fcass.ca/migrated/pdf/Theory_and_Practice_e.pdf ##Ward V, House A, Hamer S. Knowledge Brokering: The missing link in the evidence to action chain? Evid Policy 2009; 5: 267-79. doi: 10.1332/174426409X463811 ##Lomas J. Using Linkage And Exchange To Move Research Into Policy At A Canadian Foundation. Health Aff (Millwood) 2000; 19: 236-40. ##Canadian Institutes of Health Research (CIHR). home page on the internet]. [cited 14 Jan. 2015]. Available from: http://www.cihr-irsc.gc.ca/e/13733.html ##Graham ID, Tetroe JM. Getting evidence into policy and practice: perspective of a health research funder. J Can Acad Child Adolesc Psychiatry 2009; 18: 46-50. ##Wehrens R, Bekker M, Bal R. Dutch Academic Collaborative Centres for Public Health: development through time–issues, dilemmas and coping strategies. Evid Policy 2012; 8: 149-70. ##Straus S, Tetroe J, Graham I. Knowledge Translation in Health Care: Moving From Evidence to Practice. 2nd edition. Chichester: Wiley Blackwell, BMJ Books: 2013. ##Crilly, Tessa, Ashok Jashapara, Susan Trenholm, Anna Peckham, Graeme Currie, and Ewan Ferlie . “Research Utilization and Knowledge Mobilization By Health Care managers: Synthesising Evidence and Theory Using Perspectives of Organizational Form, Resource based View and Critical Theory.” Final report. NIHR Service Delivery and Organisation programme; 2012. http://www.nets.nihr.ac.uk/__data/assets/pdf_file/0003/85107/FR-09-1002-13.pdf ##Penrose E. The Theory of the Growth of The Firm. New York: John Wiley; 1959 ##Wernerfelt B. A resource‐based view of the firm. Strategic Management Journal 1984; 5: 171-80. ##Spender J, Grant R. Knowledge and the Firm: Overview. Strategic Management Journal 1996; 17: 5-9. ##Grant R. Towards a Knowledge based Theory of the Firm.Strategic Management Journal 1996; 17: 199-221. ##Prahalad C, Hamel G. The Core Competence of the Corporation.Harv Bus Rev 1990; 68: 79-91. ##Barney J, Clark D. Resource Based Theory: Creating and Sustaining Competitive Advantage. Oxford: Oxford University Press; 2007 ##Bryson J, Ackermann F, Eden C. Putting The Resource Based View of Strategy and Distinctive Competencies To Work in Public Organizations. Public Adm Rev 2007; 67: 702-17. ##Teece D, Pisano G, Shuen A. Dynamic Capabilities and Strategic Management. Strategic Management Journal 1997; 18: 509-33. ##Eisenhardt K, Martin J. Dynamic capabilities: What are they? Strategic Management Journal 2000; 21: 1105-21. ##Casebeer A, Reay T, Deward J, Pablo A. Knowing Through Doing: Unleashing Latent Capabilities in the Public Sector. In: Walshe K, Harvey G, Jas P, editors. Connecting Knowledge and Performance in Public Services. Cambridge: Cambridge University Press; 2010. p. 251-75. ##Cohen WM, Levinthal DA. Absorptive capacity: a new perspective on learning and innovation. Adm Sci Q 1990; 35: 128-52. ##Bierly PE, Damanpour F, Santoro MD. The application of external knowledge: organizational conditions for exploration and exploitation. Journal of Management Studies 2009; 46: 481-509. ##Harvey G, Jas P, Walshe K, Skelcher C. Absorptive Capacity: How Organizations Assimilate and Apply Knowledge to Improve Performance. In: Walshe K, Harvey G, Jas P, editors. Connecting Knowledge and Performance in Public Services. Cambridge: Cambridge University Press; 2010. p. 226-50. ##Raisch S, Birkinshaw J. Organizational ambidexterity: Antecedents, outcomes, and moderators. J Manage 2008; 34: 375-409. ##Fischer MD, Ferlie E, French C, Fulop N, Wolfe C. The Creation and Survival of an Academic Health Science Organization: Counter-Colonization Through A New Organizational Form? University of Oxford-Said Business School Working Paper; 2013. ##

Situation of Linkage between Sexual and Reproductive Health and HIV-Related Policies in Islamic Republic of Iran – A Rapid Assessment in 2011–2 2 2 The number of sexual transmission of HIV is increasing globally. Sexual and Reproductive Health (SRH) issues and HIV/AIDS related problems are rooted in common grounds such as poverty, gender inequality, and social exclusion. As a result, international health organizations have suggested the integration of SRH services with HIV/AIDS services as a strategy to control HIV and to improve people’s access to SRH services. The aim of this study was to evaluate the relationship between reproductive health and HIV/AIDS services at policy-making level in Islamic Republic of Iran (IRI). This study was conducted in 2011–2 and was a rapid assessment based on guidelines provided by the World Health Organization (WHO), United Nations Programme on HIV/AIDS (UNAIDS), Family Health International Association, and some other international organizations. In this rapid assessment we used different methods such as a review of literature and documents, visiting and interviewing professionals and experts in family health and HIV/AIDS programs, and experts working in some NonGovernmental Organizations (NGOs). Overall, based on the results obtained in this study, in most cases there was not much linkage between HIV/AIDS policies and SRH policies in Iran. Since integration of HIV/AIDS services and SRH services is recommended as a model and an appropriate response to HIV epidemics worldwide, likewise to control the HIV/AIDS epidemic in Iran it is required to integrate HIV/AIDS and SRH services at all levels, particularly at the policy-making level. 1 - 131 136 - - Ghobad Moradi Kurdistan Research Center for Social Determinants of Health (KRCSDH), Kurdistan University of Medical Sciences, Sanandaj, Iran | Department of Epidemiology and Biostatistics, School of Medicine, Kurdistan University of Kurdistan Research Center for Social Iran moradi_gh@yahoo.com - - Sahar Khoshravesh Kurdistan Research Center for Social Determinants of Health (KRCSDH), Kurdistan University of Medical Sciences, Sanandaj, Iran Kurdistan Research Center for Social Iran khoshraveshsahar@yahoo.com - - Mozhgan Hosseiny Faculty of Management and Medical Informatics, Tabriz University of Medical Science, Tabriz, Iran Faculty of Management and Medical Informatics, Iran saharkhoshravesh@gmail.com HIV/AIDS Reproductive Health Rapid Assessment Iran Singler J, Farmer P. Treating HIV in resource-poor setting. JAMA 2002; 288: 1652-3.  doi: 10.1001/jama.288.13.1652-JMS1002-6-1 ##Joint United Nations Program on HIV/AIDS (UNAIDS). Report on the Global AIDS Epidemic [internet]. 2012. [cited 2014 Oct 10]. Available from: http://www.unaids.org/sites/default/files/media_asset/                20121120_UNAIDS_Global_Report_2012_with_annexes_en_1.pdf ##Report of HIV /AIDS in Iran AIDS and STI Office, CCDC, Ministry of health [internet].  2013. [ Cited 2014 Oct 8]. Available from: http://asibha.mcls.gov.ir/fa/filepool/download/                2f1adb2fd2344e27800644aa7b74964f?redirectpage=/fa/statistics/amarekeshvari ##World Health Organization (WHO). Global strategy for the prevention and control of sexually transmitted infections: 2006-2015. Breaking the chain of transmission [internet]. 2007. [Cited 2014 Oct 10]. Available from: http://www.who.int/reproductivehealth/publications/ rtis/9789241563475/en/index.html ##Myer L, Rabkin M, Abrams EJ, Rosenfield A, El-Sadr WM. Focus on women: linking HIV care and treatment with reproductive health services in the MTCT-Plus Initiative. Reprod Health Matters 2005; 13: 136-46.  ##Gogna ML, Pecheny MM, Ibarlucia I, Manzelli H, Lopez SB. The reproductive needs and rights of people living with HIV in Argentina: health service users' and providers' perspectives. Soc Sci Med 2009; 69: 813-20.  doi: 10.1016/j.socscimed.2009.06.002 ##Moradi G, Mohraz M, Gouya MM, Dejman M, Seyedalinaghi  SA, Khoshravesh S, et al. Health needs of people living with HIV/AIDS: from the perspective of policy makers, physicians and consultants, and people living with HIV/AIDS. Iranian J Publ Health 2014; 43: 1424-35. doi: 10.1016/S0968-8080(05)25185-6 ##Moradi G, Esmaeilnasab N, Moshiri E, Nowrozinejad A, Hojatzadeh A, Hajizadeh S, et al. Rapid Assessment Tool for Sexual & Reproductive Health and HIV Linkages, a Generic Guide. Family Planning Association/IRI; 2011.  ##Makwiza I, Nyirenda L, Bongololo G, Banda T, Chimzizi R, Theobad S. Who has access to counseling and testing and anti-retroviral therapy in Malawi - an equity analysis. Int J Equity Health 2009; 10: 8-13.  doi: 10.1186/1475-9276-8-13 ##World Health Organization (WHO). Linking sexual and reproductive health and HIV in countries of Eastern Europe and Central Asia: Examining the future of integrated services [internet].  2011. [Cited 2014 Oct 13]. Available from: http://www.euro.who.int/en/health-topics/communicable-diseases/   sexually-transmitted-infections/news/news/2012/11/              linking-sexual-and-reproductive-health-and-hiv-in-countries-of                -eastern-europe-and-central-asia-examining-the-future-of-integrated-services ##Karamouzian M, Nasirian M, Sedaghat A, Haghdoost AA. HIV in Iran. Lancet 2013; 382: 1958.  doi: 10.1016/s0140-6736(13)62645-8 ##Patel SK. Integration of HIV and other health programmes: Implications and challenges. Int J Med Sci Public Health 2014; 3: 643-8.  doi: 10.5455/ijmsph.2014.010420141 ##Lusti-Narasimhan M, Say L, Mbizvo MT. Linking HIV and sexual and reproductive health services to enhance program outcomes. Int J Gynaecol Obstet 2010; 110: 57-9.  doi: 10.1016/j.ijgo.2010.04.002 ##Kashi A, Yadyad M, Hajiabdolbaghi M, Jafari S. Utilization of the Health Ministry recommended services by Iranian HIV/AIDS patients. TUMJ 2008; 66: 670-6.  ##Nasirian M, Doroudi F, Gooya MM, Sedaghat A, Haghdoost AA. Modeling of human immunodeficiency virus modes of transmission in iran. J Res Health Sci 2012; 12: 81-7.  ##Shahbazi M, Farnia M, Rahmani K, Moradi G. Trend of HIV/AIDS Prevalence and Related Interventions Administered in Prisons of Iran -13 Years’ Experience. Iran J Publ Health 2014; 43: 471-9.  ##17.   Khajehkazemi R, Osooli M, Sajadi L, Karamouzian M, Sedaghat A, Fahimfar N, et al. HIV prevalence and risk behaviours among people who inject drugs in Iran: the 2010 National Surveillance Survey. Sex Transm Infect 2013; 89 Suppl 3: iii29-32. doi: 10.1136/sextrans-2013-051204 ##Lotfi R, Ramezani Tehrani F, Yaghmaei F, Hajizadeh E. Socio-environmental barriers of condom use among women at risk for HIV/AIDS: a qualitative Study. Payesh 2012; 11: 669-78.  ##Karamouzian M, Akbari M, Haghdoost AA, Hamidreza S, Farzaneh Z. “I Am Dead to Them”: HIV-related Stigma Experienced by People Living With HIV in Kerman, Iran. J Assoc Nurses AIDS Care 2014; In Press. doi: 10.1016/j.jana.2014.04.005 ##Kennedy CE, Spaulding AB, Brickley DB, Almers L, Mirjahangir J, Packel L. Linking sexual and reproductive health and HIV interventions: a systematic review. J Int AIDS Soc 2010; 13: 26.  doi: 10.1186/1758-2652-13-26 ##United Nations Population Fund (UNFPA). Rapid Assessment Tool for Sexual & Reproductive Health and HIV Linkages [internet].  2009. [Cited 2014 Oct 10]. Available from: http://www.unfpa.org/publications/rapid-assessment-tool-             sexual-reproductive-health-and-hiv-linkages ##

Study of Patients Absconding Behavior in a General Hospital at Southern Region of Iran 2 2 Background Patients’ escape from hospital imposes a significant cost to patients as well as the health system. Besides, for these patients, exposure to adverse events (such as suicide, self-harm, violence and harm to hospital reputation) are more likely to occur compared to others. The present study aimed to determine the characteristics of the absconding patients in a general hospital through a case-control design in Shiraz, Iran.   Methods This case-control study was conducted on 413 absconded patients as case and 413 patients as control in a large general hospital in Shiraz, southern Iran. In this study, data on the case and control patients was collected from the medical records using a standard checklist in the period of 2011–3. Then, the data were analyzed using descriptive and analytical statistics, through SPSS 16.   Results The finding showed that 413 patients absconded (0.50%) and mean of age in case group was 40.98 ± 16.31 years. In univariate analysis, variables of gender [Odds Ratio (OR)= 2], ward (OR= 1.22), insurance status (OR= 0.41), job status (OR= 0.34) and residence expenditure were significant. However, in multivariate analysis significant variables were age (ORadj= 0.13), gender (ORadj= 2.15), self-employment/unemployed (ORadj= 0.47), emergency/admission (ORadj= 2.14), internal/admission (ORadj= 3.16), insurance status (ORadj= 4.49) and residence expenditure (ORadj= 1.15).   Conclusion Characteristics such as middle age, male gender, no insurance coverage, inability to afford hospital expenditures and admission in emergency department make patients more likely abscond from the hospital. Therefore, it may be necessary to focus efforts on high-risk groups and increase insurance coverage in the country to prevent absconding from hospital. 1 - 137 141 - - Mohammad Khammarnia Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran Health Promotion Research Center, Zahedan Iran m_khammar1985@yahoo.com - - Aziz Kassani Prevention of Psychosocial Injuries Research Centre, Ilam University of Medical Sciences, Ilam, Iran Prevention of Psychosocial Injuries Research Iran azizkassani@yahoo.com - - Mohammad Reza Amiresmaili Research Center for Health Services Management, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Research Center for Health Services Iran mohammadreza.amiresmaili@gmail.com - - Ahmad Sadeghi Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Student Research Committee, Shiraz University Iran ahmadsadeghi1363@gmail.com - - Zahra Karimi Jaberi Research Center for Health Services Management, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran | Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran Research Center for Health Services Iran zkarimijaberi@gmail.com - - Zahra Kavosi Department of Health Services Management, School of Management and Medical Information, Shiraz University of Medical Sciences, Shiraz, Iran Department of Health Services Management, Iran zhr.kavosi@gmail.com Absconding General Hospital Emergency Ward Antebi R. Some characteristics of mental hospital absconders. Br J Psychiatry 1967; 113: 1087-90.  doi: 10.1192/bjp.113.503.1087 ##Bowers L, Simpson A, Alexander J. Real world application of an intervention to reduce absconding. J Psychiatr Ment Health Nurs 2005; 12: 598-602. doi: 10.1111/j.1365-2850.2005.00879.x ##Bowers L, Jarrett M, Clark N, Kiyimba F, McFarlane L. Determinants of absconding by patients on acute psychiatric wards. J Adv Nurs 2000; 32: 644-9.  doi: 10.1046/j.1365-2648.2000.01523.x ##Stewart D, Bowers L. Absconding and locking ward doors: evidence from the literature. J Psychiatr Ment Health Nurs 2011; 18: 89-93.  doi: 10.1111/j.1365-2850.2010.01622.x ##Sheikhmoonesi F, Kabirzadeh A, Yahyavi ST, Mohseni B. A prospective study of patients absconding from a psychiatric hospital in Iran. Med Glas 2012; 9: 345-9.  doi: 10.1016/s0924-9338(13)75790-0 ##Yasini M, Sedaghat M, Ghasemi Esfe A, Tehranidoost M. Epidemiology of absconding from an Iranian psychiatric centre. J Psychiatr Ment Health Nurs 2009; 16: 153-7.  doi: 10.1111/j.1365-2850.2008.01350.x ##Muir‐Cochrane E, Mosel KA. Absconding: A review of the literature 1996–2008. Int J Ment Health Nurs 2008; 17: 370-8.  doi: 10.1111/j.1447-0349.2008.00562.x ##Cheng S, Chung C, Leung Y, Lai K. Patient absconding behaviour in a public general hospital: retrospective study. Hong Kong Med J 2002; 8: 87-91.  ##Davis B, Bowers L, Jarrett M, Clark N, Kiyimba F, Mcfarlane L. Absconding: why patients leave. J Psychiatr Ment Health Nurs 1999; 6: 199-205.  doi: 10.1046/j.1365-2850.1999.630199.x ##Bowers L, Jarrett M, Clark N. Absconding: a literature review. J Psychiatr Ment Health Nurs 1998; 5: 343-54.  doi: 10.1046/j.1365-2850.1998.00149.x ##Izquierdo JL, Martínez A, Guzmán E, de Lucas P, Rodríguez JM. Lack of association of ischemic heart disease with COPD when taking into account classical cardiovascular risk factors. Int J Chron Obstruct Pulmon Dis 2010; 5: 387. doi: 10.1111/j.1365-2850.2008.01350.x ##Molnar G, Pinchoff DM. Factors in patient elopements from an urban state hospital and strategies for prevention. Psychiatr Serv 1993; 44: 791-2.  ##Hunt IM, Windfuhr K, Swinson N, Shaw J, Appleby L, Kapur N. Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey. BMC Psychiatr 2010; 10: 14.  doi: 10.1186/1471-244x-10-14 ##Mosel KA, Gerace A, Muir‐Cochrane E. Retrospective analysis of absconding behaviour by acute care consumers in one psychiatric hospital campus in Australia. Int J Ment Health Nurs 2010; 19: 177-85. doi: 10.1111/j.1447-0349.2009.00660.x   ##Khisty N, Raval N, Dhadphale M, Kale K, Javadekar A. A prospective study of patients absconding from a general hospital psychiatry unit in a developing country. J Psychiatr Ment Health Nurs 2008; 15: 458-64.  doi: 10.1111/j.1365-2850.2008.01249.x ##Meehan T, Morrison P, McDougall S. Absconding behaviour: an exploratory investigation in an acute inpatient unit. Aust N Z J Psychiatry 1999; 33: 533-7.  doi: 10.1080/j.1440-1614.1999.00603.x ##Lang UE, Hartmann S, Schulz-Hartmann S, Gudlowski Y, Ricken R, Munk I, et al. Do locked doors in psychiatric hospitals prevent patients from absconding? The European Journal of Psychiatry 2010; 24: 199-204.  doi: 10.4321/s0213-61632010000400001 ##Muir‐Cochrane E, Oster C, Grotto J, Gerace A, Jones J. The inpatient psychiatric unit as both a safe and unsafe place: Implications for absconding. Int J Ment Health Nurs 2013; 22: 304-12. doi: 10.1111/j.1447-0349.2012.00873.x ##Gordon JT. Emergency department junior medical staff’s knowledge, skills and confidence with psychiatric patients: a survey. Psychiatrist 2012; 36: 186-8.  doi: 10.1192/pb.bp.111.035188 ##

Long and Short Integrated Management of Childhood Illness (IMCI) Training Courses in Afghanistan: A Cross-sectional Cohort Comparison of Post-Course Knowledge and Performance 2 2 Background In 2003 the Afghan Ministry of Public Health (MoPH) adopted the Integrated Management of Childhood Illness (IMCI) for delivering child health services in primary care facilities. Key problems were subsequently identified: high cost of training, frequent health worker turnover and poor quality of IMCI implementation by those trained – specifically in the use of job aids and protocols for assessment, classification, treatment and counselling. The high financial, human resources and opportunity costs of implementing IMCI spurred the MoPH to prioritize developing a shortened IMCI course of comparable quality to the 11-Day training.   Methods This cross-sectional evaluation compared knowledge before and after training, and health worker performance in assessment, classification and treatment of sick children in two similar cohorts, eight months post-training.   Results The mean increase in knowledge scores of the thirty 7-Day course trainees was 29 [95% Confidence Interval (CI): 24, 34] compared to 23 (95% CI: 18, 28) in the 31 trained in the 11-Day course. During assessment visits, mean scores in the 7-Day course trainees and the 11-Day course trainees were 93% (95% CI: 91, 95) versus 94% (95% CI: 91, 96) in assessment; 95% (95% CI: 89, 100) versus 96% (95% CI: 91, 100) in classification; 95% (95% CI: 92, 100) versus 97% (95% CI: 95, 100) in treatment; and 81% (95% CI: 76, 86) versus 80% (95% CI: 75, 85) in counselling. The 7-Day course was 36% less expensive than the 11-Day course. For each course opportunity costs, measured as numbers of children who potentially received poorer care than usual during trainee absence, were 3,160 for the 11-Day course and 2,016 for the 7-Day course. This measure was chosen because trainee absence commonly resulted in higher patient volumes per remaining provider or complete closure of a health facility with one single health worker.   Conclusion Given similar performance and knowledge of health workers trained in both courses, potential cost savings, the possibility of training more health workers and the relative ease with which health workers in remote settings might participate in a shorter course, it seems prudent to standardize the 7-Day course in Afghanistan where child mortality rates remain unacceptably high. 1 - 143 152 - - Maureen Mayhew School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada School of Population and Public Health, Iran maureen.mayhew@ubc.ca - - Paul Ickx BASICS/Afghanistan and Centre for Health Services, Management Sciences for Health, Medford, MA, USA BASICS/Afghanistan and Centre for Health Iran pickx@msh.org - - William Newbrander BASICS/Afghanistan and Centre for Health Services, Management Sciences for Health, Medford, MA, USA BASICS/Afghanistan and Centre for Health Iran wnewbrander@msh.org - - Hedayatullah Stanekzai BASICS/Afghanistan, Ministry of Public Health, Great Massoud Circle, Kabul, Afghanistan BASICS/Afghanistan, Ministry of Public Health, Iran h_stanekzai@yahoo.com - - Sayed Alawi Child and Adolescent Health Department, Ministry of Public Health, Kabul, Afghanistan Child and Adolescent Health Department, Ministry Iran alawi_dr@yahoo.com Child Health Integrated Management of Childhood Illness (IMCI) In-Service Training Afghanistan Salama P. Status of the health and nutrition sector in Afghanistan: progress and challenges 2001-2003. Kabul: UNICEF; 2003. Unpublished presentation by the Chief Health and Nutrition Officer of UNICEF. ##The United Nations Children's Fund (UNICEF). Best Estimates of Social Indicators for Children in Afghanistan. New York City: UNICEF; 2005. ##Gove S. Integrated management of childhood illness by outpatient health workers: technical basis and overview. The WHO Working Group on Guidelines for Integrated Management of the Sick Child. Bull World Health Organ 1997; 75 Suppl 1: 7-24.  ##Afghan Ministry of Public Health (MoPH). Basic Package of Health Services. Kabul: Afghan Ministry of Public Health; 2005. ##Goga AE, Muhe LM. Global challenges with scale-up of the integrated management of childhood illness strategy: results of a multi-country survey. BMC Public Health 2011; 11: 503.  doi: 10.1186/1471-2458-11-503 ##Goga AE, Muhe LM, Forsyth K, Chopra M, Aboubaker S, Martines J, et al. Results of a multi-country exploratory survey of approaches and methods for IMCI case management training. Health Res Policy Syst 2009; 7: 18.  doi: 10.1186/1478-4505-7-18 ##Nguyen DT, Leung KK, McIntyre L, Ghali WA, Sauve R. Does integrated management of childhood illness (IMCI) training improve the skills of health workers? A systematic review and meta-analysis. PLoS One 2013; 8: e66030.  doi: 10.1371/journal.pone.0066030 ##World Health Organization (WHO). Report of technical consultation on IMCI training approaches and pre-service IMCI: 19-23 November, 2007. Geneva: WHO; 2008. ##Hansen PM, Peters DH, Niayesh H, Singh LP, Dwivedi V, Burnham G. Measuring and managing progress in the establishment of basic health services: the Afghanistan health sector balanced scorecard. Int J Health Plann Manage 2008; 23: 107-17.  doi: 10.1002/hpm.931 ##Edward A, Kumar B, Niayesh H, Naeem AJ, Burnham G, Peters DH. The association of health workforce capacity and quality of pediatric care in Afghanistan. Int J Qual Health Care 2012; 24: 578-86.  doi: 10.1093/intqhc/mzs058 ##Chopra M, Patel S, Cloete K, Sanders D, Peterson S. Effect of an IMCI intervention on quality of care across four districts in Cape Town, South Africa. Arch Dis Child 2005; 90: 397-401.  doi: 10.1136/adc.2004.059147 ##Bryce J, Victora CG, Habicht JP, Vaughan JP, Black RE. The multi-country evaluation of the integrated management of childhood illness strategy: lessons for the evaluation of public health interventions. Am J Public Health 2004; 94: 406-15.  ##Rowe AK, Rowe SY, Holloway KA, Ivanovska V, Muhe L, Lambrechts T. Does shortening the training on Integrated Management of Childhood Illness guidelines reduce its effectiveness? A systematic review. Health Policy Plan 2012; 27: 179-93.  doi: 10.1093/heapol/czr033 ##Bishai D, Mirchandani G, Pariyo G, Burnham G, Black R. The cost of quality improvements due to integrated management of childhood illness (IMCI) in Uganda. Health Econ 2008; 17: 5-19.  doi: 10.1002/hec.1231 ##Rowe AK, Osterholt DM, Kouame J, Piercefield E, Herman KM, Onikpo F, et al. Trends in health worker performance after implementing the Integrated Management of Childhood Illness strategy in Benin. Trop Med Int Health 2012; 17: 438-46.  doi: 10.1111/j.1365-3156.2012.02976.x ##Tavrow P, Kekitiinwa Rukyalekere A, Maganda A, Ndeezi G, Sebina-Zziwa A, Knebel E. A comparison of computer-based and standard training in the Integrated Management of Childhood Illness in Uganda. Bethesda, Maryland: United States Agency for International Development (USAID) through the Quality Assurance Project; 2002. ##Afghan Ministry of Public Health (MoPH). Mid-Term Review of Facility-based Integrated Management of Childhood Illness Implementation in Afghanistan. Kabul: MoPH Afghanistan/USAID; 2008. ##Afghan Ministry of Public Health (MoPH). Integrated Management of Childhood Illness Situational Analysis. Kabul: BASICS/USAID; 2008. ##Lind A, Edward A, Bonhoure P, Mustafa L, Hansen P, Burnham G, et al. Quality of outpatient hospital care for children under 5 years in Afghanistan. Int J Qual Health Care 2011; 23: 108-16.  doi: 10.1093/intqhc/mzq081 ##Edward A, Dwivedi V, Mustafa L, Hansen PM, Peters DH, Burnham G. Trends in the quality of health care for children aged less than 5 years in Afghanistan, 2004-2006. Bull World Health Organ 2009; 87: 940-9.  doi: 10.2471/BLT.08.054858 ##Peters DH, Noor AA, Singh LP, Kakar FK, Hansen PM, Burnham G. A balanced scorecard for health services in Afghanistan. Bull World Health Organ 2007; 85: 146-51.  ##Huicho L, Scherpbier RW, Nkowane AM, Victora CG. How much does quality of child care vary between health workers with differing durations of training? An observational multicountry study. Lancet 2008; 372: 910-6.  doi: 10.1016/S0140-6736(08)61401-4 ##Mitchell M, Hedt-Gauthier BL, Msellemu D, Nkaka M, Lesh N. Using electronic technology to improve clinical care - results from a before-after cluster trial to evaluate assessment and classification of sick children according to Integrated Management of Childhood Illness (IMCI) protocol in Tanzania. BMC Med Inform Decis Mak 2013; 13: 95.  doi: 10.1186/1472-6947-13-95 ##Mitchell M, Getchell M, Nkaka M, Msellemu D, Van Esch J, Hedt-Gauthier B. Perceived improvement in integrated management of childhood illness implementation through use of mobile technology: qualitative evidence from a pilot study in Tanzania. J Health Commun 2012; 17 Suppl 1: 118-27.  doi: 10.1080/10810730.2011.649105 ##World Health Organization (WHO). Integrated Management of Childhood Illness - Self-study modules. Geneva: WHO; 2014. ##Lehmann U, Dieleman M, Martineau T. Staffing remote rural areas in middle- and low-income countries: a literature review of attraction and retention. BMC Health Serv Res 2008; 8: 19.  doi: 10.1186/1472-6963-8-19 ##Quality Assurance Project. Evaluation of an IMCI Computer-based Training Course in Kenya. Bethesda, Maryland, USA: Published for the U.S. Agency for International Development (USAID) by the Quality Assurance Project; 2006. ##Afghan Ministry of Public Health (MoPH). Afghanistan Health Sector Balanced Scorecard 2008. Kabul: MOPH; 2008. ##

Course of Health Care Costs before and after Psychiatric Inpatient Treatment: Patient-Reported vs. Administrative Records 2 2 Background There is limited evidence on the course of health service costs before and after psychiatric inpatient treatment, which might also be affected by source of cost data. Thus, this study examines: i) differences in health care costs before and after psychiatric inpatient treatment, ii) whether these differences vary by source of cost-data (self-report vs. administrative), and iii) predictors of cost differences over time.   Methods Sixty-one psychiatric inpatients gave informed consent to their statutory health insurance company to provide insurance records and completed assessments at admission and 6-month follow-up. These were compared to the self‐reported treatment costs derived from the “Client Socio-demographic and Service Use Inventory” (CSSRI‐EU) for two 6‐month observation periods before and after admission to inpatient treatment to a large psychiatric hospital in rural Bavaria. Costs were divided into subtypes including costs for inpatient and outpatient treatment as well as for medication.   Results Sixty-one participants completed both assessments. Over one year, the average patient‐reported total monthly treatment costs increased from € 276.91 to € 517.88 (paired Wilcoxon Z = ‐2.27; P = 0.023). Also all subtypes of treatment costs increased according to both data sources. Predictors of changes in costs were duration of the index admission and marital status.   Conclusion Self-reported costs of people with severe mental illness adequately reflect actual service use as recorded in administrative data. The increase in health service use after inpatient treatment can be seen as positive, while the pre-inpatient level of care is a potential problem, raising the question whether more or better outpatient care might have prevented hospital admission. Findings may serve as a basis for future studies aiming at furthering the understanding of what to expect regarding appropriate levels of posthospital care, and what factors may help or inhibit post-discharge treatment engagement. Future research is also needed to examine long-term effects of inpatient psychiatric treatment on outcome and costs. 1 - 153 160 - - Nadja Zentner Department of Psychiatry II, Ulm University, Ulm, Germany Department of Psychiatry II, Ulm University, Iran nadja.zentner@uni-ulm.de - - Ildiko Baumgartner Department of Psychiatry II, Ulm University, Ulm, Germany Department of Psychiatry II, Ulm University, Iran ildiko.baumgartner@bkh-guenzburg.de - - Thomas Becker Department of Psychiatry II, Ulm University, Ulm, Germany Department of Psychiatry II, Ulm University, Iran t.becker@bkh-guenzburg.de - - Bernd Puschner Department of Psychiatry II, Ulm University, Ulm, Germany Department of Psychiatry II, Ulm University, Iran bernd.puschner@bkh-guenzburg.de Health Service Costs Administrative Data Self-Report Mental Health Services 1. Leslie DL, Rosenheck R. Shifting to outpatient care? Mental health care use and cost under private insurance. Am J Psychiatry 1999; 156: 1250-7. ##2. 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Implementation of a Health Policy Advisory Committee as a Knowledge Translation Platform: The Nigeria Experience 2 2 Background In recent times, there has been a growing demand internationally for health policies to be based on reliable research evidence. Consequently, there is a need to strengthen institutions and mechanisms that can promote interactions among researchers, policy-makers and other stakeholders who can influence the uptake of research findings. The Health Policy Advisory Committee (HPAC) is one of such mechanisms that can serve as an excellent forum for the interaction of policy-makers and researchers. Therefore, the need to have a long term mechanism that allows for periodic interactions between researchers and policy-makers within the existing government system necessitated our implementation of a newly established HPAC in Ebonyi State Nigeria, as a Knowledge Translation (KT) platform. The key study objective was to enhance the capacity of the HPAC and equip its members with the skills/competence required for the committee to effectively promote evidence informed policy-making and function as a KT platform.   Methods A series of capacity building programmes and KT activities were undertaken including: i) Capacity building of the HPAC using Evidence-to-Policy Network (EVIPNet) SUPPORT tools; ii) Capacity enhancement mentorship programme of the HPAC through a three-month executive training programme on health policy/health systems and KT in Ebonyi State University Abakaliki; iii) Production of a policy brief on strategies to improve the performance of the Government’s Free Maternal and Child Health Care Programme in Ebonyi State Nigeria; and iv) Hosting of a multi-stakeholders policy dialogue based on the produced policy brief on the Government’s Free Maternal and Child Health Care Programme.   Results The study findings indicated a noteworthy improvement in knowledge of evidence-to-policy link among the HPAC members; the elimination of mutual mistrust between policy-makers and researchers; and an increase in the awareness of importance of HPAC in the Ministry of Health (MoH).   Conclusion Findings from this study suggest that a HPAC can function as a KT platform and can introduce a new dimension towards facilitating evidence-to-policy link into the operation of the MoH, and can serve as an excellent platform to bridge the gap between research and policy. 1 - 161 168 - - Chigozie Uneke Department of Medical Microbiology/Parasitology, Faculty of Clinical Medicine, Ebonyi State University, Abakaliki, Nigeria | Health Policy & Systems Research Project (Knowledge Translation Platform), Ebonyi State University, Abakaliki, Department of Medical Microbiology/Parasitology, Iran unekecj@yahoo.com - - Chinwendu Ndukwe National Agency for the Control of AIDS, Abuja, Nigeria National Agency for the Control of AIDS, Iran nducd2@gmail.com - - Abel Ezeoha Department of Banking & Finance, Ebonyi State University, Abakaliki, Nigeria Department of Banking & Finance, Ebonyi Iran aezeoha@yahoo.co.uk - - Henry Uro-Chukwu National Obstetrics Fistula Centre, Abakaliki, Nigeria National Obstetrics Fistula Centre, Abakaliki, Iran henryuchukwu@yahoo.co.uk - - Chinonyelum Ezeonu Department of Paediatrics, Ebonyi State University, Abakaliki, Nigeria Department of Paediatrics, Ebonyi State Iran ctezeonu@gmail.com Health Policy Advisory Committee Knowledge Translation (KT) Uneke CJ, Ezeoha AE, Ndukwe CD, Oyibo PG, Onwe F. Promotion of evidence-informed health policy-making in Nigeria: bridging the gap between researchers and policy-makers. Glob Public Health 2012; 7: 750-65. doi: 10.1080/17441692.2012.666255 ##Uneke CJ, Ezeoha AE, Ndukwe CD, Oyibo PG, Onwe F. Development of health policy and systems research in Nigeria: lessons for developing countries’ evidence-based health policy making process and practice. Healthc Policy 2010; 6: 48-65. doi: 10.12927/hcpol.2013.22749 ##Campbell DM, Redman S, Jorm L, Cooke M, Zwi AB, Rychetnik L. Increasing the use of evidence in health policy: practice and views of policy makers and researchers. Aust New Zealand Health Policy2009;6: 21. doi: 10.1186/1743-8462-6-21 ##Dobrow MJ, Goel V, Upshur RE. Evidence-based health policy: context and utilisation. Soc Sci Med 2004; 58: 207-17. doi: 10.1016/s0277-9536(03)00166-7 ##Hanney SR, Gonzalez-Block MA, Buxton MJ, Kogan M. The Utilization of Health Research in Policy-Making: Concepts, Examples and Methods of Assessment. 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Addressing Health Workforce Distribution Concerns: A Discrete Choice Experiment to Develop Rural Retention Strategies in Cameroon 2 2 Background Nearly every nation in the world faces shortages of health workers in remote areas. Cameroon is no exception to this. The Ministry of Public Health (MoPH) is currently considering several rural retention strategies to motivate qualified health personnel to practice in remote rural areas.   Methods To better calibrate these mechanisms and to develop evidence-based retention strategies that are attractive and motivating to health workers, a Discrete Choice Experiment (DCE) was conducted to examine what job attributes are most attractive and important to health workers when considering postings in remote areas. The study was carried out between July and August 2012 among 351 medical students, nursing students and health workers in Cameroon. Mixed logit models were used to analyze the data.   Results Among medical and nursing students a rural retention bonus of 75% of base salary (aOR= 8.27, 95% CI: 5.28-12.96, P< 0.001) and improved health facility infrastructure (aOR= 3.54, 95% CI: 2.73-4.58) respectively were the attributes with the largest effect sizes. Among medical doctors and nurse aides, a rural retention bonus of 75% of base salary was the attribute with the largest effect size (medical doctors aOR= 5.60, 95% CI: 4.12-7.61, P< 0.001; nurse aides aOR= 4.29, 95% CI: 3.11-5.93, P< 0.001). On the other hand, improved health facility infrastructure (aOR= 3.56, 95% CI: 2.75-4.60, P< 0.001), was the attribute with the largest effect size among the state registered nurses surveyed. Willingness-to-Pay (WTP) estimates were generated for each health worker cadre for all the attributes. Preference impact measurements were also estimated to identify combination of incentives that health workers would find most attractive.   Conclusion Based on these findings, the study recommends the introduction of a system of substantial monetary bonuses for rural service along with ensuring adequate and functional equipment and uninterrupted supplies. By focusing on the analysis of locally relevant, actionable incentives, generated through the involvement of policymakers at the design stage, this study provides an example of research directly linked to policy action to address a vitally important issue in global health. 1 - 169 180 - - Paul Robyn The World Bank, Cameroon Country Office, Yaoundé, Cameroon The World Bank, Cameroon Country Office, Iran probyn@worldbank.org - - Zubin Shroff World Health Organization, Geneva, Switzerland World Health Organization, Geneva, Switzerland Iran zcs885@mail.harvard.edu - - Omer Zang The World Bank, Cameroon Country Office, Yaoundé, Cameroon The World Bank, Cameroon Country Office, Iran rzang@worldbank.org - - Samuel Kingue Ministry of Public Health, Yaoundé, Cameroon Ministry of Public Health, Yaoundé, Cameroon Iran samuel_kingue@yahoo.fr - - Sebastien Djienouassi Institute for Survey and Statistical Analysis, Yaoundé, Cameroon Institute for Survey and Statistical Analysis, Iran djienouassi@yahoo.fr - - Christian Kouontchou Institute for Survey and Statistical Analysis, Yaoundé, Cameroon Institute for Survey and Statistical Analysis, Iran koumijech@yahoo.fr - - Gaston Sorgho The World Bank, Cameroon Country Office, Yaoundé, Cameroon The World Bank, Cameroon Country Office, Iran gsorgho@worldbank.org Cameroon Human Resources for Health Discrete Choice Experiment (DCE) Rural Retention Strategies Travis P, Bennett S, Haines A, Pang T, Bhutta Z, Hyder A, et al. Overcoming health-systems constraints to achieve the Millennium Development Goals. Lancet 2004; 364: 900-6. ##Miller C, Holly L. Health workers and universal health coverage. Lancet 2012; 380: 1643. doi: 10.1016/S0140-6736(12)61939-4 ##Jimba M, Cometto G, Yamamoto T, Shiao L, Huicho L, Sheikh M. Health workforce: the critical pathway to universal health coverage. In: World Health Organization, editor. First Global Symposium on Health Systems Research. Montreux, Switzerland: WHO; 2010. ##Anand S, Bärnighausen T. Human resources and health outcomes: cross-country econometric study. Lancet 2004; 364: 1603-9. ##Anand S, Bärnighausen T. Health workers and vaccination coverage in developing countries: an econometric analysis. Lancet 2007; 369: 1277-85. doi: 10.1016/S0140-6736(07)60599-6 ##Rao K, Shroff Z, Ramani S, Khandpur N, Murthy S, Hazarika I, et al. How to Attract Health Workers to Rural Areas? Findings from A Discrete Choice Experiment From India. Washington, DC: The World Bank; 2012. ##Vujicic M, Alfano M, Shengelia B, Witter S. Attracting Doctors and Medical Students to Rural Vietnam: Insights from a Discrete Choice Experiment. Washington, DC: The World Bank; 2010. ##Bärnighausen T, Bloom DE. Financial incentives for return of service in underserved areas: a systematic review. BMC Health Serv Res 2009; 9: 86. doi: 10.1186/1472-6963-9-86 ##Lehmann U, Dieleman M, Martineau T. Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention. BMC Health Serv Res 2008; 8: 19. doi: 10.1186/1472-6963-8-19 ##Franco L, Bennett S, Kanfer R. Health sector reform and public health worker motivation: a conceptual framework. Soc Sci Med 2002; 54: 1255-66. ##Blaauw D, Erasmus E, Pagaiya N, Tangcharoensathein V, Mullei K, Mudhune S, et al. Policy interventions that attract nurses to rural areas: a multicountry discrete choice experiment. 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Pharmacoeconomics 2008; 26: 661-77. ##Mangham LJ, Hanson K, McPake B. How to do (or not to do) ... Designing a discrete choice experiment for application in a low-income country. Health Policy Plan 2009; 24: 151-8. doi: 10.1093/heapol/czn047 ##Kolstad J. How to make rural jobs more attractive to health workers. Findings from a discrete choice experiment in Tanzania. Health Econ 2011; 20: 196-211. doi: 10.1002/hec.1581 ##Mangham LJ, Hanson K. Employment preferences of public sector nurses in Malawi: results from a discrete choice experiment. Trop Med Int Health 2008; 13: 1433-41. doi: 10.1111/j.1365-3156.2008.02167.x ##Kruk ME, Johnson JC, Gyakobo M, Agyei-Baffour P, Asabir K, Kotha SR, et al. Rural practice preferences among medical students in Ghana: a discrete choice experiment. Bull World Health Organ 2010; 88: 333-41. doi: 10.2471/BLT.09.072892 ##Rockers PC, Jaskiewicz W, Wurts L, Kruk ME, Mgomella GS, Ntalazi F, et al. 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The Use (or rather the non-Use) of Cost-Effectiveness Data in Priority Setting Decisions – Are We Underestimating the Barriers to Using Health Economics in Real World Priority Setting Decisions?; Comment on “Use of Cost-Effectiveness Data in Priority Setting Decisions: Experiences from the National Guidelines for Heart Diseases in Sweden” 2 2 After having practicing and researching health economics for nearly 15 years now, it has become clear to me that the use of cost-effectiveness data in priority setting decisions is rather a rare than a common practice. The Eckard et al.article though, describes a wonderful exception to this rule and a very good example of how it can be used when the conditions are right. However, do we fully understand what these conditions are? In this commentary article I will address some of the institutional and cultural conditions that need to be fulfilled in order for cost-effectiveness data to actually be used in priority setting decisions. 1 - 181 183 - - Sandra Erntoft LEO Pharma A/S, Copenhagen, Denmark LEO Pharma A/S, Copenhagen, Denmark Iran sandra.erntoft@leo-pharma.com Health Policy Cost-Effectiveness Priority Setting Coyle D.  Increasing the Impact of Economic Evaluations in Health-Care Decision Making. Discussion paper 108. Centre for Health Economics, University of York, Health Economics Consortium; 1993. ##Drummond M, Cooke J, Walley T. Economic Evaluation in Health Care Decision Making: Evidence from the UK. Discussion paper 148. Centre for Health Economics, University of York, Health Economics Consortium; 1996. ##Späth HM, Charavel M, Morelle M, Carrere MO. A qualitative approach to the use of economic data in the selection of medicines for hospital formularies: a French survey. Pharm World Science 2003 25: 269-75. doi: 10.1023/b:phar.0000006523.22131.69 ##McDonald R.  Using Health Economics in Health Services. Rationing Rationally? Buckingham: Open University Press; 2002 ##Suh DC, Okpara IR, Agnese WB, Toscani M. Application of Pharmacoeconomics to Formulary Decision Making in Managed Care Organizations. Am J Manag Care 2002; 8: 161-9. ##Van Velden ME, Severens JL, Novak A. Economic Evaluations of Healthcare Programmes and Decision Making. Pharmacoeconomics  2005; 23: 1075-82. doi: 10.2165/00019053-200523110-00002 ##Walkom E, Robertson J, Newby D, Pillay T. The role of pharmacoeconomics in formulary decision-making. Considerations for hospital and managed care pharmacy and therapeutics committees. Formulary 2006 41: 374-86. ##Williams I, Bryan S, McIver S. The use of health economic evaluations in NHS decision-making. A review and empirical investigation. Health Technology Assessment  2008; 12(7). Available from: http://www.journalslibrary.nihr.ac.uk/hta/volume-12/issue-7# ##Eddama O, Coast J. A systematic review of the use of economic evaluation in local decision-making. Health Policy2008; 86: 129-41.  doi: 10.1016/j.healthpol.2007.11.010 ##Vourenkoski L, Toivaninen H, Hemminki E. Decision-making in priority setting for medicines – A review of empirical studies. Health Policy 2008; 86: 1-9. doi: 10.1016/j.healthpol.2007.09.007 ##Anell A. Priority setting for pharmaceuticals. The use of health economic evidence by reimbursement and clinical guidance committees. Eur J Health Econ 2004; 5: 28-35. doi: 10.1007/s10198-003-0195-0 ##Eckard N, Janzon M, Levin LÅ. Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden. Int J Health Policy Manag 2014; 3: 323-32. doi: 10.15171/ijhpm.2014.105 ##13.   Erntoft S. The use of health economic evaluations in pharmaceutical priority setting. The case of Sweden [Doctoral dissertation]. Lund Business Press, Lund Institute of Economic Research, Lund University; 2010. ##Daniels N, Sabin J. Limits to Health Care: Fair Procedures, Democratic Deliberation, and the Legitimacy Problem for Insurers. Philos Public Aff 1997; 26: 302-50. doi: 10.1111/j.1088-4963.1997.tb00082.x ##DiMaggio P, Powell WW. The iron cage revisited: Institutional Isomorphism and Collective Rationality in Organizational Fields. Am Soc Rev 1983; 48: 147-60. doi: 10.2307/2095101 ##16.   Williams I. Cost-effectiveness analysis and technology coverage decision making: the case of the English NHS [Doctoral dissertation]. HealthServices Management Centre, School of Social Policy, University ofBirmingham; 2009. ##

Lonely at the Top and Stuck in the Middle? The Ongoing Challenge of Using Cost-Effectiveness Information in Priority Setting; Comment on “Use of Cost-Effectiveness Data in Priority Setting Decisions: Experiences from the National Guidelines for Heart Diseases in Sweden” 2 2 The topic of how cost-effectiveness information informs priority setting in healthcare remains important to both policy and practice. This commentary considers the study carried out by Eckard and colleagues in Sweden. In it we distinguish between the conditions at national and local levels and put forward some recommendations for research into local priority setting in particular. 1 - 185 187 - - Iestyn Williams Health Services Management Centre, University of Birmingham, Birmingham, UK Health Services Management Centre, University Iran i.p.williams@bham.ac.uk - - Stirling Bryan Centre for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver General Hospital Research Pavilion, Vancouver, British Columbia, Canada Centre for Clinical Epidemiology and Iran stirling.bryan@ubc.ca Priority Setting Economic Evaluation Decision-Making Healthcare Technology Coverage Eckard N, Janzon M, Levin L. Use of cost-effectiveness data in priority setting decisions: experiences from the national guidelines for heart diseases in Sweden. Int J Health Policy Manag 2015; 3: 323-332. doi: 10.15171/ijhpm.2014.105 ##Williams I, McIver S, Moore D, Bryan S. The use of economic evaluations in NHS decision making: a review and empirical investigation. Health Technology Assessment 2008; 12: 1-193. doi: 10.3310/hta12070 ##Erntoft S. Pharmaceutical priority setting and the use of economic evaluation: a systematic literature review. Value Health 2011; 14: 587-99.  doi: 10.1016/j.jval.2010.10.036 ##Silva ML, Spath HM, Perrier L, Moumjid N. The use of economic evaluation in health decision making at the macro level: a literature review. Journal de Gestion et D’Economie Medicales 2013; 31: 72. doi: 10.3917/jgem.131.0031 ##Checkland K, Harrison S, Marshall M. Is the metaphor of ‘barriers to change’ useful in understanding implementation? Evidence from general medical practice. J Health Serv Res Policy 2007; 12: 95-100. doi: 10.1258/135581907780279657 ##Bryan S, Williams I. Adoption of New Technologies, Using Economic Evaluation. Encyclopedia of Health Economics; 2014. p. 26-31. ##Williams I, Bryan S. Understanding the limited impact of economic evaluation in health care resource allocation: a conceptual framework. Health Policy 2007; 80: 135-43. doi: 10.1016/j.healthpol.2006.03.006 ##Klein R. Dimensions of rationing: who should do what? BMJ 1993; 307: 309-11. doi: 10.1136/bmj.307.6899.309 ##Williams, I. Institutions and health care rationing: the example of health care coverage in the English National Health Service. Policy Polit 2013; 41: 223-9. doi: 10.1332/030557312X655477 ##Brouselle A, Lessard C. Economic evaluation to inform health care decision making: promise, pitfalls and a proposal for an alternative path. Soc Sci Med 2011; 72: 832-9. doi: 10.1016/j.socscimed.2011.01.008 ##Rousseau DM. In there such a thing as evidence-based management? Acad Manage J 2006; 31: 256-69. doi: 10.5465/amr.2006.20208679 ##

Health Improvements for a Healthy Shanghai Rising; Comment on “Shanghai Rising: Health Improvements as Measured by Avoidable Mortality since 2000” 2 2 The commentator suggests that it is necessary to extend the classical connotation of  global city which focuses much on the functions of controlling global capital and production. Global city should also include the dimensions of the leading role and capacity on health improvements and well-being promotion. The commentator agrees with authors’ assessments about Shanghai’s substantial progress on health services and health system reform, however, we should pay much attention to the significant inequality of health services between central city and outskirt, and between local residents and non-hukoumigrants. The commentator also suggests that future researches could study the successful experiences of Avoidable Mortality (AM) decline and also disease specific AM decline in main global cities, in order to make more effective policy implications and social schemes recommendations for health improvements in Shanghai and in other cities. 1 - 189 190 - - Yuan Ren School of Social Development and Public Policy, Fudan University, Shanghai, China School of Social Development and Public Policy, Iran yren@fudan.edu.cn Healthy Rising Health Improvement Inequality Non-hukou Migrant Gusmano MK, Rodwin VG, Wang C, Weisz D, Luo L, Hua F. Shanghai rising: health improvements as measured by avoidable mortality since 2000. Int J Health Policy Manag 2014; 4: 7-12. doi: 10.15171/ijhpm.2015.07 ##Sassen S. The global city. Princeton, NJ: Princeton University Press: 1991. ##Ren Y.  Spatial access to health services in Shanghai [internet]. November 2011. Available from: http://lsecities.net/media/objects/articles/           spatial-access-to-health       -services-in-shanghai/en-gb/ ##New York City, Department of Design and Construction (DDC), Health and Mental Hygiene, Transportation (DOT) and City Planning. Active Design Guidelines: Promoting Physical Activity and Health in Design. 2010. Available from: http://centerforactivedesign.org/dl/guidelines.pdf ##

“Wood Already Touched by Fire is not Hard to Set Alight”; Comment on “Constraints to Applying Systems Thinking Concepts in Health Systems: A Regional Perspective from Surveying Stakeholders in Eastern Mediterranean Countries” 2 2 A major constraint to the application of any form of knowledge and principles is the awareness, understanding and acceptance of the knowledge and principles. Systems Thinking (ST) is a way of understanding and thinking about the nature of  health systems and how to make and implement decisions within health systems to maximize desired and minimize undesired effects. A major constraint to applying ST within health systems in Low- and Middle-Income Countries (LMICs) would appear to be an awareness and understanding of ST and how to apply it. This is a fundamental constraint and in the increasing desire to enable the application of ST concepts in health systems in LMIC and understand and evaluate the effects; an essential first step is going to be enabling of a wide spread as well as deeper understanding of ST and how to apply this understanding. 1 - 191 193 - - Irene Agyepong Health Policy, Planning and Management Department, School of Public Health, University of Ghana, Accra, Ghana; Julius Global Health, University Medical Center Utrecht, Utrecht, The Netherlands Health Policy, Planning and Management Department, Iran iagyepong@hotmail.com Health Systems Systems Thinking (ST) Decision-Making Low- and Middle-Income Countries (LMIC) Paina L, Peters DH. Understanding pathways for scaling up health services through the lens of complex adaptive systems. Health Policy Plan 2012; 27: 365-73. ##Senge P. The Fifth Discipline. The Art and Practice of the Learning Organization. New York: Crown Publishing Group; 1990. ##Agyepong IA, Kodua A, Adjei S, Adam T. When ‘solutions of yesterday become problems of today’: crisis-ridden decision making in a complex adaptive system (CAS)—the Additional Duty Hours Allowance in Ghana. Health Policy Plan 2012; 27 Suppl 4: iv20-31. doi: 10.1093/heapol/czs083 ##Adam T. Editorial Advancing the application of systems thinking in health. Health Res Policy Syst 2014; 12: 50. doi: 10.1186/1478-4505-12-50 ##Alliance for Health Policy and Systems Research, World Health Organization. Systems Thinking for Health Systems Strengthening. Geneva, Switzerland: WHO: 2009 ##El-Jardali F, Adam T, Ataya N, Jamal D, Jaafer M. Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries. Int J Health Policy Manag 2014; 3: 399-407. doi: 10.15171/ijhpm.2014.124 ##Yehezkel Dror. Public Policy-making re-examined. New York: Leonard Hil Books; 1968 ##Charles E. Lindblom and David Braybrooke: A Strategy of Decision. New York: The Free Press; 1970 ##Herbert A. Simon: Administrative Behavior: As study of Decision making processes in Administrative Organization. 3rd edition. New York: The Free Press; 1976. ##Appiah P. Appiah KA, Agyeman-Duah I. Bu me Bε. Proverbs of the Akans. Oxfordshire, UK: Ayebia Clarke Ltd; 2007. ##

The Chinese Healthcare Challenge; Comment on “Shanghai Rising: Avoidable Mortality as Measured by Avoidable Mortality since 2000” 2 2 Investments in the extension of health insurance coverage, the strengthening of public health services, as well as primary care and better hospitals, highlights the emerging role of healthcare as part of China’s new growth regime, based on an expansion of services, and redistributive policies. Such investments, apart from their central role in terms of relief for low-income people, serve to rebalance the Chinese economy away from export-led growth toward the domestic market, particularly in megacity-regions as Shanghai and the Pearl River Delta, which confront the challenge of integrating migrant workers. Based on the paper by Gusmano and colleagues, one would expect improvements in population health for permanent residents of China’s cities. The challenge ahead, however, is how to address the growth of inequalities in income, wealth and the social wage. 1 - 195 197 - - Guilhem Fabre University of Le Havre, Le Havre, France University of Le Havre, Le Havre, France Iran guilhem.fabre@univ-lehavre.fr Healthcare Challenges China Inequalities Universal Health Coverage Gusmano MK, Rodwin VG, Wang C, Weisz D, Luo L, Hua F. Shanghai rising: health improvements as measured by avoidable mortality since 2000. Int J Health Policy Manag 2015; 4: 7-12. doi: 10.15171/ijhpm.2015.07 ##Study of IHS Global Insight. Financial Times, March 13, 2011. ##Yongding Y. China’s Policy Responses to the Global Financial Crisis. Melbourne, Australia: Productivity Commission; 2009. ##Rutkowski R. Service Sector Reform in China. Peterson Institute of International Economics; 2015. Available from: http://www.piie.com/publications/interstitial.cfm?ResearchID=2746 ##Lewis A. Economic growth with unlimited supply of labor, Manchester school of economic and social studies, 1954, Vol.22. ##Xianjin X. [Studies on the problem of migrant labor shortage and the migrant social protection]. Nongye Jingji 2007; 90: 44-6. [in Chinese]  ##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        ##United Nations. World Population Prospects: The 2010 Revision. New York: United Nations; 2011. Available from:   http://esa.un.org/wpp/documentation/                pdf/WPP2010_Volume-I_Comprehensive-Tables.pdf   ##Li H, Li L, Wu B, Xiong Y. The End of Cheap Chinese Labor. J Econ Perspect 2012; 26: 59-60. ##General research report on the question of Chinese rural migrants; 2006. Available from: http://www.usc.cuhk.edu.hk/Eng/Default.aspx ##Xinhua News Agency. [updated April 27, 2012]. ##Fabre G. The lion’s share: What is behind China’s economic slowdown? [internet]. FMSH Working Paper; October 2013.  Available from: http://wpfmsh.hypotheses.org/399 ##China Perspectives. Special Issue 2011/2: The Changing World of Chinese Labour, CEFC, Hongkong. ##Glassman J. Is America Suffering an Innovation Gap? 2010. Available from: http://www.itif.org/media/america-suffering-innovation-gap ##Fabre G. Urbanisation, Economic Policy and Housing Policy in China, 1949-2000. PhD  in socio-economy of development, direction: Ignacy Sachs, EHESS, Paris, February 1992; The ambiguities of privatisation during transition: the Case of Housing in China, Revue de l’Institut de Recherches Economiques et Sociales, (IRES), 1992. p.139-168. ##Chan KW. Achieving comprehensive Hukou reform in China [internet]. 2014. Available from: http://www.paulsoninstitute.org/think-tank/paulson-policy-memoranda/       2014/achieving-comprehensive-hukou-reform-in-china/ ##China’s Transition: The Third Plenum One Year On [internet]. Available from: http://www.bloombergbriefs.com/content/                uploads/sites/2/2014/10/China-Plenum-opt.pdf ##URBACHINA program [home page on the internet]. Paris: European Commission. Available from: http://urbachina.hypotheses.org/ ##