Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
4
2014
09
01
Inequities in the Freedom to Lead a Flourishing and Healthy Life: Issues for Healthy Public Policy
161
163
EN
Sharon
Friel
0000-0002-8345-5435
Menzies Centre for Health Policy, The Australian National University, Canberra, Australia
sharon.friel@anu.edu.au
10.15171/ijhpm.2014.82
There are many reasons for the health inequities that we see around the world today. Public policy and the way society organises its affairs affects the economic, social and physical factors that influence the conditions in which people are born, grow, live, work and age - the social determinants of health. Tackling health inequities is a political issue that requires leadership, political courage, progressive public policy, social struggle and action, and a sound evidence base.
Health Inequalities,Social Determinants,Public Policy
https://www.ijhpm.com/article_2881.html
https://www.ijhpm.com/article_2881_56899843d417c5ad1216e3c3c0ee8e4c.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
4
2014
09
01
Fetus, Fasting, and Festival: The Persistent Effects of In Utero Social Shocks
165
169
EN
Xi
Chen
0000-0002-2058-0351
Faculty of Arts and Sciences, Yale University, New Haven, CT, USA
xi.chen@yale.edu
10.15171/ijhpm.2014.92
<span>The Fetal Origins Hypothesis (FOH), put forward in the epidemiological literature and later flourished in the economics literature, suggests that the time </span><span>in utero </span><span>is a critical period for human development. However, much attention has been paid to the consequences of fetal exposures to more extreme natural shocks, while less is known about fetal exposures to milder but more commonly experienced social shocks. Using two examples of under-nutrition due to mild social shocks, i.e. Ramadan fasting and festival overspending, this paper summarizes our current knowledge, especially the contribution from economics, and key challenges in exploring fetal exposures to milder social shocks. I also discuss the salient added value of identifying milder versus more extreme fetal shocks. Finally, implications are drawn on individual decisions and public policy to improve children’s well-being before they are born or even before their mothers realize that they are pregnant.</span>
In Utero,Maternal Fasting,Ramadan,Gift,Ceremonies,Early Childhood Development
https://www.ijhpm.com/article_2889.html
https://www.ijhpm.com/article_2889_f39193dd3f6fb1cf8fb00f5f426f0497.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
4
2014
09
01
Preventing Injuries in Workers: The Role of Management Practices in Decreasing Injuries Reporting
171
177
EN
Fariba
Kiani
Young Researchers and Elite Club, Shahrekord Branch, Islamic Azad
University, Shahrekord, Iran
fariba.kiani64@yahoo.com
Mohammad Reza
Khodabakhsh
Young Researchers and Elite Club, Mashhad
Branch, Islamic Azad University, Mashhad, Iran
khodabakhsh@ut.ac.ir
10.15171/ijhpm.2014.83
Background<br />Researchers have found that management safety practices may predict occupational injuries and psychological distresses in the workplace. The present study examined the perception of management safety practices related to injuries reporting and its dimensions among workers of Isfahan Steel Company (ESCO). <br /> <br />Methods <br />A self-administered anonymous survey was distributed to 189 workers. The survey included demographic factors, management safety perception, injuries reporting and its components (physical symptoms, psychological symptoms, and injuries). The data were analyzed by Multivariate and correlation techniques. <br /> <br />Results <br />The results showed that: 1) there were significant correlations between management safety perception with injuries reporting and its two dimensions namely physical and psychological symptoms; 2) there was no significant relationship between management safety perception and injury; 3) in Multivariate analysis, management safety perception significantly predicted about 26%, 19%, and 28% of the variances of variables of injuries reporting, physical symptoms, and psychological symptoms respectively (P< 0.01). <br /> <br />Conclusion <br />Improving employees’ perception of management safety practices can be important to prevent the development of job injuries and to promote workers’ safety and well-being.
Management Safety Perception,Injuries Reporting,Physical Symptoms,Psychological Symptoms,Injuries,Workers
https://www.ijhpm.com/article_2882.html
https://www.ijhpm.com/article_2882_4b7b061090f47056b5359cd1e2bd7ae7.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
4
2014
09
01
Assessing Performance of Botswana’s Public Hospital System: The Use of the World Health Organization Health System Performance Assessment Framework
179
189
EN
Onalenna
Seitio-Kgokgwe
Ministry of Health, Gaborone, Botswana
oseitio@gmail.com
Robin
Gauld
0000-0001-5401-1192
Department of Preventive and Social Medicine, School of Medicine, University of Otago, Dunedin, New Zealand
robin.gauld@otago.ac.nz
Philip
Hill
Department of Preventive and Social Medicine, School of Medicine, University of Otago, Dunedin, New Zealand
phill@otago.ac.nz
Pauline
Barnett
School of Health Sciences at Canterbury, Christchurch, New Zealand
pauline.barnett@canterbury.ac.nz
10.15171/ijhpm.2014.85
Background <br />Very few studies have assessed performance of Botswana public hospitals. We draw from a large research study assessing performance of the Botswana Ministry of Health (MoH) to evaluate the performance of public hospital system using the World Health Organization Health Systems Performance Assessment Framework (WHO HSPAF). We aimed to evaluate performance of Botswana public hospital system; relate findings of the assessment to the potential for improvements in hospital performance; and determine the usefulness of the WHO HSPAF in assessing performance of hospital systems in a developing country. <br /> <br />Methods <br />This article is based on data collected from document analysis, 54 key informants comprising senior managers and staff of the MoH (N= 40) and senior officers from stakeholder organizations (N= 14), and surveys of 42 hospital managers and 389 health workers. Data from documents and transcripts were analyzed using content and thematic analysis while data analysis for surveys was descriptive determining proportions and percentages. <br /> <br />Results <br />The organizational structure of the Botswana’s public hospital system, authority and decision-making are highly centralized. Overall physical access to health services is high. However, challenges in the distribution of facilities and inpatient beds create inequities and inefficiencies. Capacity of the hospitals to deliver services is limited by inadequate resources. There are significant challenges with the quality of care. <br /> <br />Conclusion <br />While Botswana invested considerably in building hospitals around the country resulting in high physical access to services, the organization and governance of the hospital system, and inadequate resources limit service delivery. The ongoing efforts to decentralize management of hospitals to district level entities should be expedited. The WHO HSPAF enabled us to conduct a comprehensive assessment of the public hospital system. Though relatively new, this approach proved useful in this study.
Botswana,Public Hospitals,Service Delivery,World Health Organization Health System Performance Assessment Framework (WHO HSPSF)
https://www.ijhpm.com/article_2883.html
https://www.ijhpm.com/article_2883_aae6e3f0977f17b29b507f7fd4fbed3b.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
4
2014
09
01
Potential Benefits and Downsides of External Healthcare Performance Evaluation Systems: Real-Life Perspectives on Iranian Hospital Evaluation and Accreditation Program
191
198
EN
Ebrahim
Jaafaripooyan
http://orcid.org.000
Department of Health Services Management, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
jaafaripooyan@tums.ac.ir
10.15171/ijhpm.2014.84
Background <br />Performance evaluation is essential to quality improvement in healthcare. The current study has identified the potential pros and cons of external healthcare evaluation programs, utilizing them subsequently to look into the merits of a similar case in a developing country. <br /> <br />Methods <br />A mixed method study employing both qualitative and quantitative data collection and analysis techniques was adopted to achieve the study end. Subject Matter Experts (SMEs) and professionals were approached for two-stage process of data collection. <br /> <br />Results <br />Potential advantages included greater attractiveness of high accreditation rank healthcare organizations to their customers/purchasers and boosted morale of their personnel. Downsides, as such, comprised the programs’ over-reliance on value judgment of surveyors, routinization and incurring undue cost on the organizations. In addition, the improved, standardized care processes as well as the judgmental nature of program survey were associated, as pros and cons, to the program investigated by the professionals. <br /> <br />Conclusion <br />Besides rendering a tentative assessment of Iranian hospital evaluation program, the study provides those running external performance evaluations with a lens to scrutinize the virtues of their own evaluation systems through identifying the potential advantages and drawbacks of such programs. Moreover, the approach followed could be utilized for performance assessment of similar evaluation programs.
Benefits and Downsides,Health care,Performance Evaluation Program,Iran
https://www.ijhpm.com/article_2884.html
https://www.ijhpm.com/article_2884_3f28010e9140b1a5cba3159505ca6b98.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
4
2014
09
01
Social Determinants of Equity in Access to Healthcare for Tuberculosis Patients in Republic of Macedonia – Results from a Case-Control Study
199
205
EN
Dance
Gudeva Nikovska
Department of Social Medicine, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, Macedonia
dgnikovska@gmail.com
Fimka
Tozija
National Institute of Public Health, Department of Social Medicine, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, Macedonia
ftozija@mt.net.mk
10.15171/ijhpm.2014.89
Background <br />Health is a complex phenomenon and equity as a basic human right an integral part of constitutions in almost all countries in the world. In Republic of Macedonia (RM), Tuberculosis (TB) is clustered regionally and in certain ethnic groups. The main objective of this study was to analyze Social Determinants of Health (SDH) and equity in access to healthcare services for TB patients in RM, aimed at complex analysis of factors that cause inequities. <br /> <br />Methods <br />Case-control study was conducted in the period March–December, 2013; “cases” are households of TB patients registered in the period July, 2012–June, 2013 and controls are households with no TB patients in their immediate vicinity. World Health Organization (WHO) World Health Survey questionnaire was used to <br />collect data. <br /> <br />Results <br />Analysis of SDH of TB patients shows that patients are mostly males, of lower socio-economic status, are less educated, unemployed and TB is clustered in certain ethnic groups. Analysis of access has identified these determinants as important barriers in access to health services. <br /> <br />Conclusion <br />The study has documented the basic SDH of TB patients in RM, as well as barriers in access to healthcare, providing useful baseline information to facilitate determination where to concentrate future efforts.
Equity,Social Determinants of Health (SDH),Tuberculosis (TB) Patients,Macedonia
https://www.ijhpm.com/article_2891.html
https://www.ijhpm.com/article_2891_50ef3a379f5c4bfd50bc99a1616a4d7d.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
4
2014
09
01
Local Stakeholders’ Perceptions about the Introduction of Performance-Based Financing in Benin: A Case Study in Two Health Districts
207
214
EN
Elisabeth
Paul
0000-0002-3928-4093
Universite de Liègeand Research Group on the Implementation of the Agenda for Aid Effectiveness in the Health Sector (GRAP-PA Sante), Liège, Belgium
elisabeth.paul@ulb.ac.be
Nadine
Sossouhounto
Universite d’Abomey-Calavi, LADYD, Cotonou, Benin
nadinesossouhounto@yahoo.fr
Dieudonné
Sèdjro
Eclou
Universite d’Abomey-Calavi, LADYD, Cotonou, Benin
eclousedjro@gmail.com
10.15171/ijhpm.2014.93
Background <br />Performance-Based Financing (PBF) has been advanced as a solution to contribute to improving the performance of health systems in developing countries. This is the case in Benin. This study aims to analyse how two PBF approaches, piloted in Benin, behave during implementation and what effects they produce, through investigating how local stakeholders perceive the introduction of PBF, how they adapt the different approaches during implementation, and the behavioural interactions induced by PBF. <br /> <br />Methods <br />The research rests on a socio-anthropological approach and qualitative methods. The design is a case study in two health districts selected on purpose. The selection of health facilities was also done on purpose, until we reached saturation of information. Information was collected through observation and semi-directive interviews supported by an interview guide. Data was analysed through contents and discourse analysis. <br /> <br />Results <br />The Ministry of Health (MoH) strongly supports PBF, but it is not well integrated with other ongoing reforms and processes. Field actors welcome PBF but still do not have a sense of ownership about it. The two PBF approaches differ notably as for the organs in charge of verification. Performance premiums are granted according to a limited number of quantitative indicators plus an extensive qualitative checklist. PBF matrices and verification missions come in addition to routine monitoring. Local stakeholders accommodate theoretical approaches. Globally, staff is satisfied with PBF and welcomes additional supervision and training. Health providers reckon that PBF forces them to depart from routine, to be more professional and to respect national norms. A major issue is the perceived unfairness in premium distribution. Even if health staff often refer to financial premiums, actually the latter are probably too weak—and ‘blurred’—to have a lasting inciting effect. It rather seems that PBF motivates health workers through other elements of its ‘package’, especially formative supervisions. <br /> <br />Conclusion <br />If the global picture is quite positive, several issues could jeopardise the success of PBF. It appears crucial to reduce the perceived unfairness in the system, notably through enhancing all facilities’ capacities to ensure they are in line with national norms, as well as to ensure financial and institutional sustainability of the system.
Performance-Based Financing (PBF),Benin,Qualitative Study,Stakeholders,Case Study,Health District
https://www.ijhpm.com/article_2892.html
https://www.ijhpm.com/article_2892_a88278ee1c8d2b0fd8e8d82f458dcd4c.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
4
2014
09
01
A Single Competency-Based Education and Training and Competency-Based Career Framework for the Australian Health Workforce: Discussing the Potential Value Add
215
221
EN
Sharon
Brownie
Griffith Health, Griffith University, Queensland, Australia
s.brownie@griffith.edu.au
Janelle
Thomas
Department of Medical Imaging, Royal Brisbane and Women’s Hospital, Queensland, Australia
janelle_thomas@health.qld.gov.au
10.15171/ijhpm.2014.88
This brief discusses the policy implications of a research study commissioned by Health Workforce Australia (HWA) within its health workforce innovation and reform work program. The project explored conceptually complex and operationally problematic concepts related to developing a whole-of-workforce competency-based education and training and competency-based career framework for the Australian health workforce and culminated with the production of three reports published by HWA. The project raised important queries as to whether such a concept is desirable, feasible or implementable – in short what is the potential value add and is it achievable? In setting the scene for discussion, the foundation of the project’s genesis and focus of the study are highlighted. A summary of key definitions related to competency-based education and training frameworks and competency-based career frameworks are provided to further readers’ commonality of understanding. The nature of the problem to be solved is explored and the potential value-add for the Australian health workforce and its key constituents proposed. The paper concludes by discussing relevance and feasibility issues within Australia’s current and changing healthcare context along with the essential steps and implementation realities that would need to be considered and actioned if whole-of-workforce frameworks were to be developed and implemented.
Competency-Based Education,Career Ladders,Health Workforce,Career Mobility,Innovation,Healthcare Reform,Public Policy Implementation
https://www.ijhpm.com/article_2888.html
https://www.ijhpm.com/article_2888_e33f5b86c095f17b0c46d594882fa753.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
3
4
2014
09
01
Inequities in the Freedom to Lead a Flourishing and Healthy Life: Time for a Progressive Social Protections Framework; Comment on “Inequities in the Freedom to Lead a Flourishing and Healthy Life: Issues for Healthy Public Policy”
223
225
EN
Gemma
Carey
0000-0001-7698-9044
National Centre for Epidemiology and Population Health, School of Population Health, College of Medicine, Biology and Environment, The Australian National
University, Canberra, Australia
gemma.carey@unsw.edu.au
10.15171/ijhpm.2014.90
Evidence now shows that the key drivers of poor health are social factors, such as education, employment, <br />housing and urban environments. Variations in these social factors—or the conditions in which we live our <br />lives—have lead to a growth in health inequalities within and between countries. One of the key challenges <br />facing those concerned with health equity is how to effect change across the broad policy areas that impact <br />these social conditions, and create a robust ‘social protections framework’ to address and prevent health <br />inequalities.
Healthy Public Policy,Health Equity,Social Protections Policies
https://www.ijhpm.com/article_2887.html
https://www.ijhpm.com/article_2887_0d93506a3cea6735ad72ea739bc70625.pdf