Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
4
2019
04
01
We Need to Talk About Corruption in Health Systems
191
194
EN
Eleanor
Hutchinson
0000-0002-9718-2407
Department of Global Health and Development, London School of Hygiene and
Tropical Medicine, London, UK
eleanor.hutchinson@lshtm.ac.uk
Dina
Balabanova
0000-0001-7163-3428
Department of Global Health and Development, London School of Hygiene and
Tropical Medicine, London, UK
dina.balabanova@lshtm.ac.uk
Martin
McKee
0000-0002-0121-9683
Department of Public Health & Policy, London
School of Hygiene and Tropical Medicine, London, UK
martin.mckee@lshtm.ac.uk
10.15171/ijhpm.2018.123
The health sector consistently appears prominently in surveys of perceived corruption, with considerable evidence that this has serious adverse consequences for patients. Yet this issue is far from prominent in the international health policy discourse. We identify five reasons why the health policy community has been reluctant to talk about it. These are the problem of defining corruption, the fact that some corrupt practices are actually ways of making dysfunctional systems work, the serious challenges to researching corruption, concerns that a focus on corruption is a form of victim blaming that ignores larger issues, and a lack of evidence about what works to tackle it. We propose three things that can be done to address this situation. First, seek consensus on the scale and nature of corruption. Second, decide on priorities, taking account the importance of the particular problem and the feasibility of doing something about it. Third, take a holistic view, drawing on a wide range of disciplines.
Corruption,Governance,Bribery,Absenteeism,Procurement
https://www.ijhpm.com/article_3578.html
https://www.ijhpm.com/article_3578_72fb5e614a6761eb1da854bca2ecda61.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
4
2019
04
01
Implementing Federalism in the Health System of Nepal: Opportunities and Challenges
195
198
EN
Rajshree
Thapa
0000-0003-1442-793X
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH,
Kathmandu, Nepal
raazshree.thapa@gmail.com
Kiran
Bam
0000-0002-1696-781X
FHI 360 Nepal, LINKAGES Nepal Project, Kathmandu,
Nepal
bam.kiran@gmail.com
Pravin
Tiwari
0000-0002-7824-9442
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH,
Kathmandu, Nepal
ppravin.tiwari@gmail.com
Tirtha Kumar
Sinha
0000-0002-8026-4836
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH,
Kathmandu, Nepal
tirthasinha70@gmail.com
Sagar
Dahal
0000-0001-7188-4665
Province Health Directorate, Ministry of Social Development, Dhankuta,
Nepal
sagardhl@gmail.com
10.15171/ijhpm.2018.121
Nepal moved from unitary system with a three-level federal system of government. As federalism accelerates, the national health system can also speed up its own decentralization process, reduce disparities in access, and improve health outcomes. The turn towards federalism creates several potential opportunities for the national healthcare system. This is because decision making has been devolved to the federal, provincial and local governments, and so they can make decisions that are more representative of their localised health needs. The major challenge during the transition phase is to ensure that there are uninterrupted supplies of medical commodities and services. This requires scaling up the ability of local bodies to manage drug procurement and general logistics and adequate human resource in local healthcare centres. This article documents the efforts made so far in context of health sector federalization and synthesizes the progress and challenges to date and potential ways forward. This paper is written at a time while it is critical to review the federalism initiatives and develop way forward. As Nepal progress towards the federalized health system, we propose that the challenges inherent with the transition are critically analysed and mitigated while unfolding the potential of federal health system.
Challenges and Opportunities,Decentralization,Federalism,Health Reform,Health Sector,Nepal
https://www.ijhpm.com/article_3579.html
https://www.ijhpm.com/article_3579_efbd5a429ffb7cc9b002da8fd85fb0e7.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
4
2019
04
01
Assessment of Public Hospital Governance in Romania: Lessons From 10 Case Studies
199
210
EN
Antonio
Duran
0000-0002-8765-1468
ALLDMHEALTH, Seville, Spain
aduran@alldmh.com
Tata
Chanturidze
Oxford Policy Management, Oxford, UK
tata.chanturidze@opml.co.uk
Adrian
Gheorghe
Oxford Policy Management, Oxford, UK
adrian.gheorghe@opml.co.uk
Antonio
Moreno
ALLDMHEALTH, Seville, Spain
amoreno@alldmh.com
10.15171/ijhpm.2018.120
Background<br /> The Government of Romania commissioned international technical assistance to help unpacking the causes of arrears in selected public hospitals. Emphases were placed on the governance-related determinants of the hospital performance in the context of the Romanian health system.<br /> <br /> Methods<br /> The assessment was structured around a public hospital governance framework examining 4 dimensions: institutional arrangements, financing arrangements, accountability arrangements and correspondence between responsibility and decision-making capacity. The framework was operationalized using a 2-pronged approach: (i) a policy review of broader health system governance arrangements influencing hospital performance; and (ii) a series of 10 case-studies of public hospitals experiencing financial hardship. Data were collected during 2016-2017 through key informant interviews with central authorities and hospital management teams, exhaustive semi-structured questionnaires filled in by hospitals, as well as the review of documentary sources where feasible.<br /> <br /> Results<br /> Overall, the governance landscape of Romanian public hospitals includes a large number of seemingly modern legislative provisions and management instruments. Over the past 30 years substantial efforts have been made to put in place standardised hospital classification, hospital governance structures, management and service purchasing contracts with key performance indicators, modern reimbursement mechanisms based on diagnosis-related groups (DRGs), and regulatory requirements for accountability, including internal and external audit. Nevertheless, their application appears to have been challenging for a range of reasons, pointing to the misalignment between the responsibility and decision-making capacity given to hospitals in a questionably conducive context. Incoherent policy design, outdated and often disjointed regulatory frameworks, and cumbersome administrative procedures limit managerial autonomy and obstruct efficiency gains. In a context of chronic insufficient funding, misaligned incentives, and overly rigid service procurement processes, hospitals seem to struggle to adjust service baskets to the population’s health needs or to overcoming financial hardship. External challenges, combined with the limited strategic, operational, and financial management capacity within hospitals, make it difficult to exhibit good financial and general performance.<br /> <br /> Conclusion<br /> Existing governance arrangements for Romanian public hospitals appear conducive to poor financial performance. The suggested framework for hospital governance assessment has proved a powerful tool for identifying system and hospital-specific challenges contributing to sub-optimal hospital performance.
Hospital Performance Assessment,Governance Framework,Romania
https://www.ijhpm.com/article_3581.html
https://www.ijhpm.com/article_3581_faf72d8013261a35d7f652454a15e0fa.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
4
2019
04
01
The Impact of Conflict on Immunisation Coverage in 16 Countries
211
221
EN
John
Grundy
0000-0002-4713-9443
College of Public Health, Medical and Veterinary Services, Cairns Campus, James Cook University, Douglas, QLD, Australia
john.grundy@jcu.edu.au
Beverley-Ann
Biggs
0000-0002-2961-9793
Department of Medicine,
Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
babiggs@unimelb.edu.au
10.15171/ijhpm.2018.127
Background<br /> Military conflict has been an ongoing determinant of inequitable immunisation coverage in many low- and middle-income countries, yet the impact of conflict on the attainment of global health goals has not been fully addressed. This review will describe and analyse the association between conflict, immunisation coverage and vaccine-preventable disease (VPD) outbreaks, along with country specific strategies to mitigate the impact in 16 countries.<br /> <br /> Methods<br /> We cross-matched immunisation coverage and VPD data in 2014 for displaced and refugee populations. Data on refugee or displaced persons was sourced from the United Nations High Commissioner for Refugees (UNHCR) database, and immunisation coverage and disease incidence data from World Health Organization (WHO) databases. Demographic and Health Survey (DHS) databases provided additional data on national and sub-national coverage. The 16 countries were selected because they had the largest numbers of registered UNHCR “persons of interest” and received new vaccine support from Global Alliance for Vaccine and Immunisation (GAVI), the Vaccine Alliance. We used national planning and reporting documentation including immunisation multiyear plans, health system strengthening strategies and GAVI annual progress reports (APRs) to assess the impact of conflict on immunisation access and coverage rates, and reviewed strategies developed to address immunisation program shortfalls in conflict settings. We also searched the peer-reviewed literature for evidence that linked immunisation coverage and VPD outbreaks with evidence of conflict.<br /> <br /> Results<br /> We found that these 16 countries, representing just 12% of the global population, were responsible for 67% of global polio cases and 39% of global measles cases between 2010 and 2015. Fourteen out of the 16 countries were below the global average of 85% coverage for diphtheria, pertussis, and tetanus (DPT3) in 2014. We present data from countries where the onset of conflict has been associated with sudden drops in national and sub-national immunisation coverage. Tense security conditions, along with damaged health infrastructure and depleted human resources have contributed to infrequent outreach services, and delays in new vaccine introductions and immunisation campaigns. These factors have in turn contributed to pockets of low coverage and disease outbreaks in sub-national areas affected by conflict. Despite these impacts, there was limited reference to the health needs of conflict affected populations in immunisation planning and reporting documents in all 16 countries. Development partner investments were heavily skewed towards vaccine provision and working with partner governments, with comparatively low levels of health systems support or civil partnerships.<br /> <br /> Conclusion<br /> Global and national policy and planning focus is required on the service delivery needs of conflict affected populations, with increased investment in health system support and civil partnerships, if persistent immunisation inequities in conflict affected areas are to be addressed.
Immunisation,Conflict,Displaced Populations,Refugees,Equity,GAVI
https://www.ijhpm.com/article_3585.html
https://www.ijhpm.com/article_3585_fce5b025343313d658c90318c24e887d.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
4
2019
04
01
Awareness and Attitude Towards Opioid and Stimulant Use and Lifetime Prevalence of the Drugs: A Study in 5 Large Cities of Iran
222
232
EN
Elham
Mohebbi
0000-0003-0868-4067
HIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran
mohebi.el@gmail.com
Ali Akbar
Haghdoost
0000-0003-4628-4849
Modeling in Health Research Center,
Institute for Futures Studies in Health, Kerman University of Medical Sciences,
Kerman, Iran
ahaghdoost@gmail.com
Alireza
Noroozi
0000-0002-5838-4348
School of Advanced Technologies in Medicine (SATiM), Tehran
University of Medical Sciences (TUMS), Tehran, Iran
a_r_noroozi@yahoo.com
Hossein
Molavi Vardanjani
MPH Department, Medical School, Shiraz University of Medical
Sciences, Shiraz, Iran
hosseinmolavi.vardanjani@gmail.com
Ahmad
Hajebi
0000-0001-8435-0398
Research Center for Addiction & Risky Behavior
(ReCARB), Psychiatric Department, Iran University of Medical Sciences,
Tehran, Iran
hajebi.ahmad@gmail.com
Roya
Nikbakht
Modeling in Health Research Center,
Institute for Futures Studies in Health, Kerman University of Medical Sciences,
Kerman, Iran
roya_nikbakht2000@yahoo.com
Maryam
Mehrabi
Department of Sociology, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
mary.mehrabi@yahoo.com
Akram
Jabbarinejad Kermani
Social
Determinants of Health Research Center, Institute for Futures Studies in Health,
Kerman University of Medical Sciences, Kerman, Iran
a.jabbarinejad@gmail.com
Mahshid
Salemianpour
Modeling in Health Research Center,
Institute for Futures Studies in Health, Kerman University of Medical Sciences,
Kerman, Iran
msalemiyanpoor@gmail.com
Mohammad Reza
Baneshi
0000-0002-6405-8688
Modeling in Health Research Center,
Institute for Futures Studies in Health, Kerman University of Medical Sciences,
Kerman, Iran
rbaneshi2@gmail.com
10.15171/ijhpm.2018.128
Background<br /> Providing population-based data on awareness, attitude and practice of drug and stimulant use has policy implications. A national study was conducted among Iranian general population to explore life time prevalence, awareness and attitudes toward opioids and stimulant use.<br /> <br /> Methods<br /> We recruited subjects from 5 provinces with heterogenic pattern of drug use. Participants were selected using stratified multistage cluster sampling. Data were collected using a validated self-administered questionnaire. Logistic regression model was applied to identify the variables that are associated with drug and stimulant use.<br /> <br /> Results<br /> In total 2065 respondents including 1155 men (33.96 ± 10.40 years old) and 910 women (35.45 ± 12.21 years old) were recruited. Two-third of respondents had good awareness about adverse effects of opioid use. Corresponding figure in terms of stimulants was 81.4%. Almost 95% of participants reported a negative attitude towards either opioid or stimulant use. The lifetime prevalence of opioid use and stimulant use were 12.9% (men: 21.5%, women: 4.0%) and 7.3% (men: 9.6%, women: 4.9%), respectively. Gender (adjusted odds ratio [AOR]M/W = 6.92; 95% CI: 2.92, 16.42), education (AORundergraduate/diploma or less = 0.49; 95% CI: 0.26, 0.90), and marital status (AORothers/single = 2.13; 95% CI: 1.36, 3.33) were significantly related with opioid use. With respect to stimulant use, age was negatively associated with the outcome (AOR60+/20-29 years = 0.08: 95% CI; 0.01, 0.98) and men were 2 times more likely than women to use stimulants (ORM/W=2.15: 95% CI: 0.83, 5.56). In addition, marital status (AOROthers/singles = 3.45; 95% CI: 1.09, 10.93), and awareness (AORWeak and moderate/good = 0.40; 95% CI: 0.25, 0.61) were independently correlated with stimulants use.<br /> <br /> Conclusion<br /> While the attitude of Iranian adults toward opioid and stimulant use was negative, their awareness was not that adequate to prevent the drug use. Men and those with lower socio-economic status (SES) should be the focus of health promotion programs regarding opioid use. However, regarding stimulants use, promotion programs should target younger age groups and those with higher SES status.
Cognition,Attitude,Prevalence,Opioid Related Disorders,Amphetamines
https://www.ijhpm.com/article_3586.html
https://www.ijhpm.com/article_3586_f141e57d347c7d12a2466871ad06eae1.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
4
2019
04
01
Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study
233
244
EN
Yazan
Douedari
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
dr.yazan.douedari@gmail.com
Natasha
Howard
0000-0003-4174-7349
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
natasha.howard@lshtm.ac.uk
10.15171/ijhpm.2018.132
Background<br />Ongoing conflict and systematic targeting of health facilities and personnel by the Syrian regime in opposition-controlled areas have contributed to health system and governance mechanisms collapse. Health directorates (HDs) were established in opposition-held areas in 2014 by the interim (opposition) Ministry of Health (MoH), to meet emerging needs. As the local health authorities responsible for health system governance in opposition-controlled areas in Syria, they face many challenges. This study explores ongoing health system governance efforts in 5 opposition-controlled areas in Syria.<br /> <br />Methods<br />A qualitative study design was selected, using in-depth key informant interviews with 20 participants purposely sampled from HDs, non-governmental organisations (NGOs), donors, and service-users. Data were analysed thematically.<br /> <br />Results<br />Health system governance elements (ie, strategic vision, participation, transparency, responsiveness, equity, effectiveness, accountability, information) were considered important, but not interpreted or addressed equally in opposition-controlled areas. Participants identified HDs as primarily responsible for health system governance in opposition-controlled areas. Main health system governance challenges identified were security (eg, targeting of health facilities and personnel), funding, and capacity. Suggested solutions included supporting HDs, addressing health-worker loss, and improving coordination.<br /> <br />Conclusion<br />Rebuilding health system governance in opposition-controlled areas in Syria is already progressing, despite ongoing conflict. Local health authorities need support to overcome identified challenges and build sustainable health system governance mechanisms.
Health System Governance,Health System Strengthening,Conflict,Resilience,Syria
https://www.ijhpm.com/article_3588.html
https://www.ijhpm.com/article_3588_0c56fa17714f1dfbb05132d0868484f4.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
4
2019
04
01
Reflections on Health Workforce Development; Comment on “Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda”
245
246
EN
Gilles
Dussault
0000-0002-5976-3454
Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
gillesdussault@ihmt.unl.pt
10.15171/ijhpm.2018.129
This commentary addresses the statement that “the authors believe that the HRH [Human Resources for Health] Program can serve as a model for other initiatives that seek to address the shortage of qualified health professionals in low-income countries and strengthen the long-term capacity of local academic institutions.” I adopt the position of the devil’s advocate and ask whether a country, with a profile comparable to Rwanda’s, should adopt this twinning model. I suggest that the alignment with population and other capacity development needs should be the main criteria of decision.
Capacity Development,Health Workforce,Academic Partnerships
https://www.ijhpm.com/article_3583.html
https://www.ijhpm.com/article_3583_7da6ecc8de0a80d94adb6be927487bc0.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
4
2019
04
01
Delving Into the Details of Evaluating Public Engagement Initiatives; Comment on “Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review”
247
249
EN
Marion
Danis
0000-0002-4749-4568
National Institutes of Health, Bethesda, MD, USA
mdanis@nih.gov
10.15171/ijhpm.2018.126
Initiatives to engage the public in health policy decisions have been widely endorsed and used, yet agreed upon methods for systematically evaluating the effectiveness of these initiatives remain to be developed. Dukhanin, Topazian, and DeCamp have thus developed a useful taxonomy of evaluation criteria derived from a systematic review of published evaluation tools that might serve as the basis for systematic evaluation. In considering the application of such a taxonomy, it is important to appreciate the political space in which health policy decisions occur. In this context, public engagement initiatives are likely to have a modest and unpredictable impact on policy decisions. Other goals, aside from influencing policy decisions, such as informing the public about issues, identifying the public’s values, enhancing public support for decisions, and promoting public discourse, are likely to be more feasible. While Dukanan and colleagues did not aim to do so, future efforts to align guidance for planning public engagement initiatives with evaluation tools would be useful to promote the success of public engagement initiatives.
Public Participation,Evaluation Studies,Healthcare System,Organizational Policy
https://www.ijhpm.com/article_3587.html
https://www.ijhpm.com/article_3587_713bb3d89488638fc926dba72ced7c8b.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
4
2019
04
01
The Value of Engaging the Public in CHATing About Healthcare Priorities: A Response to Recent Commentaries
250
252
EN
Marion
Danis
0000-0002-4749-4568
Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
mdanis@nih.gov
Susan D.
Goold
Department of General Internal Medicine, University of Michigan Medical
Center, Ann Arbor, MI, USA
sgoold@med.umich.edu
Melinee
Schindler
Institute for Ethics, History, and the Humanities,
Geneva University Medical School, Geneva, Switzerland
melinee.schindler@unige.ch
Samia A.
Hurst
0000-0002-1980-5226
Institute for Ethics, History, and the Humanities,
Geneva University Medical School, Geneva, Switzerland
samia.hurst@unige.ch
10.15171/ijhpm.2018.113
Resource Allocation,Priority Setting,Public Participation,Universal Insurance System
https://www.ijhpm.com/article_3573.html
https://www.ijhpm.com/article_3573_251ec7be28917601792893dc62fb9a05.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
4
2019
04
01
Health Promotion at Local Level in Norway – Who, What, When, and How: A Response to Recent Commentaries
253
255
EN
Susanne
Hagen
0000-0003-3392-160X
Department of Health, Social, and Welfare Studies, University of South-Eastern
Norway, Borre, Norway
susanne.hagen@usn.no
Kjell
Ivar Øvergård
Department of Health, Social, and Welfare Studies, University of South-Eastern
Norway, Borre, Norway
koe@usn.no
Marit Kristine
Helgesen
Faculty of Health and Welfare, Østfold University
College, Halden, Norway
marit.k.helgesen@hiof.no
Elisabeth
Fosse
0000-0002-6038-5059
Department of Health Promotion and Development,
University of Bergen, Bergen, Norway
elisabeth.fosse@uib.no
Steffen
Torp
Department of Health, Social, and Welfare Studies, University of South-Eastern
Norway, Borre, Norway
steffen.torp@usn.no
10.15171/ijhpm.2019.01
Equity,HIAP,Norway,Health Promotion,Commentary
https://www.ijhpm.com/article_3591.html
https://www.ijhpm.com/article_3591_dee4d0ffe2133cfda7f4b16a77d38107.pdf