2024-03-28T14:37:23Z
https://www.ijhpm.com/?_action=export&rf=summon&issue=662
International Journal of Health Policy and Management
IJHPM
2018
7
7
Exploring 70 Years of the British National Health Service through Anniversary Documents
Martin
Powell
The British National Health Service (NHS) celebrates its 70th birthday on July 5, 2018. This article examines this anniversary through the lens of previous anniversaries. It examines seven documents close to each anniversary over a period of some 60 years, drawing on interpretive content analysis, based on the narrative dimensions of context (structure and finance); success or achievements; problems; and solutions or recommendations. It finds that the anniversary documents tend to show change rather than consistency. For example, the Guillebaud Report tended to dismiss the problem of ageing populations, for it to reappear in 1979 and 1989, to fade in 2009, and reappear once more in 2017. Despite being downplayed or ignored in some years, the problems identified by most of the documents such as demography and technology are unlikely to disappear. Some solutions such as market-based reform have flowed and ebbed over the years, and the ‘solution’ of structural reorganisation in one year has become the ‘problem’ in a future year. While predicting the future is always hazardous, it can be said with some confidence that future anniversaries are likely to see discussion of similar themes.
National Health Service
UK
70th Anniversary
Documents
Content Analysis
2018
07
01
574
580
https://www.ijhpm.com/article_3473_e64b9cef9547ae38494b7333f323c675.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
Addressing Health Equity Through Action on the Social Determinants of Health: A Global Review of Policy Outcome Evaluation Methods
Janice
Lee
Ashley
Schram
Emily
Riley
Patrick
Harris
Fran
Baum
Matt
Fisher
Toby
Freeman
Sharon
Friel
Background Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research. Methods We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated. Results We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated. Conclusion Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequities
Policy Evaluation
Methodology
Health Inequities
Social Determinants of Health
Review
2018
07
01
581
592
https://www.ijhpm.com/article_3459_a0dd788951dff189523154479133fc77.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
“Three Nooses on Our Head”: The Influence of District Health Reforms on Maternal Health Service Delivery in Vietnam
Nguyen
Thi Hoai Thu
Fiona
McDonald
Sophie
Witter
Andrew
Wilson
Background The impact of reorganisation on health services delivery is a recurring issue in every healthcare system. In 2005 Vietnam reorganised the delivery of health services at the district level by splitting preventive, curative, and administrative roles. This qualitative study explored how these reforms impacted on the organisation of maternal health service delivery at district and commune levels. Methods Forty-three semi-structured interviews were conducted with health staff and managers involved in the provision of maternal health services from the commune to the central level within five districts of two Northern provinces in Vietnam. The data were analysed thematically. Results The results showed that 10 years after the reforms created three district-level entities, participants reported difficulties in management of health services at the district and commune levels in Vietnam. The reforms were largely perceived to negatively affect the efficient and effective use of clinical and other resources. At the commune level, the reforms are said to have affected the quality of supervision of the communes and their staff and increased the workload in community health centres. Conclusion The findings from this study suggest that the current organisation of district health services in Vietnam may have had unintended negative consequences. It also indicates that countries which decide to reform their systems in a manner similar to Vietnam need to pay attention to coordination between a multiplicity of agencies at the district level.
District Health Reforms
Health System Governance
Health Policy
Fragmentation of Services
Maternal Health
Vietnam
2018
07
01
593
602
https://www.ijhpm.com/article_3439_c676536f3d3399cd835958f46cf2b54c.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
Examining the Implementation of the Free Maternity Services Policy in Kenya: A Mixed Methods Process Evaluation
Eric
Tama
Sassy
Molyneux
Evelyn
Waweru
Benjamin
Tsofa
Jane
Chuma
Edwine
Barasa
Background Kenya introduced a free maternity policy in 2013 to address the cost barrier associated with accessing maternal health services. We carried out a mixed methods process evaluation of the policy to examine the extent to which the policy had been implemented according to design, and positive experiences and challenges encountered during implementation. Methods We conducted a mixed methods study in 3 purposely selected counties in Kenya. Data were collected through in-depth interviews (IDIs) with policy-makers at the national level, health managers at the county level, and frontline staff at the health facility level (n = 60), focus group discussions (FGDs) with community representatives (n = 10), facility records, and document reviews. We analysed the data using a framework approach. Results Rapid implementation led to inadequate stakeholder engagement and confusion about the policy. While the policy was meant to cover antenatal visits, deliveries, and post-natal visits, in practice the policy only covered deliveries. While the policy led to a rapid increase in facility deliveries, this was not matched by an increase in health facility capacity and hence compromised quality of care. The policy led to an improvement in the level of revenues for facilities. However, in all three counties, reimbursements were not made on time. The policy did not have a system of verifying health facility reports on utilization of services. Conclusion The Kenyan Ministry of Health (MoH) should develop a formal policy on the free maternity services, and provide clear guidelines on its content and implementation arrangements, engage with and effectively communicate the policy to stakeholders, ensure timeliness of payment disbursement to healthcare facilities, and introduce a mechanism for verifying utilization reports prepared by healthcare providers. User fee removal policies such as free maternity programmes should be accompanied by supply side capacity strengthening
User Fee Removal
Free Maternity Care
Policy Fidelity
Policy Implementation
Kenya
2018
07
01
603
613
https://www.ijhpm.com/article_3440_cca2ad9a33d3c4744010470311ecee2d.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
Psychosocial Workplace Factors and Healthcare Utilization: A Study of Two Employers
Jessica Allia
Williams
Orfeu
Buxton
Jesse
Hinde
Jeremy
Bray
Lisa
Berkman
Background While a large literature links psychosocial workplace factors with health and health behaviors, there is very little work connecting psychosocial workplace factors to healthcare utilization. Methods Survey data were collected from two different employers using computer-assisted telephone interviewing as a part of the Work-Family Health Network (2008-2013): one in the information technology (IT) service industry and one that is responsible for a network of long-term care (LTC) facilities. Participants were surveyed four times at six month intervals. Responses in each wave were used to predict utilization in the following wave. Four utilization measures were outcomes: having at least one emergency room (ER)/Urgent care, having at least one other healthcare visit, number of ER/urgent care visits, and number of other healthcare visits. Population-averaged models using all four waves controlled for health and other factors associated with utilization. Results Having above median job demands was positively related to the odds of at least one healthcare visit, odds ratio [OR] 1.37 (P < .01), and the number of healthcare visits, incidence rate ratio (IRR) 1.36 (P < .05), in the LTC sample. Work-to-family conflict was positively associated with the odds of at least one ER/urgent care visit in the LTC sample, OR 1.15 (P < .05), at least one healthcare visit in the IT sample, OR 1.35 (P < .01), and with more visits in the IT sample, IRR 1.35 (P < .01). Greater schedule control was associated with reductions in the number of ER/urgent care visits, IRR 0.71 (P < .05), in the IT sample. Conclusion Controlling for other factors, some psychosocial workplace factors were associated with future healthcare utilization. Additional research is needed.
Healthcare Utilization
Psychosocial Workplace Factors
Work-Family Conflict
ER Visits
2018
07
01
614
622
https://www.ijhpm.com/article_3442_686f4284104a57209b94c93964395fbb.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
Validation of Instruments for Assessing Drug Safety Management During the Conduction of Clinical Trials
Yaimarelis
Saumell
Olga
Torres
Maritza
Batista
Lizet
Sánchez
Background The management of drug safety with the collection of reliable safety data during the conduction of clinical trials conduct is essential for the registry and marketing of products. The systematic evaluation of this process, based on objective measures, requires the application of quality instruments. This study was aimed to design and validate eight instruments through the components of quality (structure, process, and results), for characterizing and assessing the process of drug safety management, during the conduction of clinical trials. Methods The eight instruments were designed according to the international recommendations for Good Clinical Practice (GCP) and comprise a knowledge survey for professionals at the investigational sites, a satisfaction scale of internal and external clients and a satisfaction survey for patients with the treatment of the adverse events. The instruments also include a checklist to evaluate the safety management infrastructure (human, material and organizational resources) in the sponsoring center, a checklist to evaluate the same criterion at the investigational sites and three checklists that evaluate adherence to regulatory requirements of essential documents (investigator’s brochure, protocol, and informed consent form). The content validity was evaluated by Delphi method and the reliability was determined by Cronbach α test. Results All the items were valued as very adequate after the second round of the expert panel. The instruments were deemed as appropriate and understandable in the pre-test performed. All responders agreed with the options given and the accessibility of the application. Only 10% of professionals at the research sites suggested that the knowledge survey was too long. Cronbach α values between .66 and .93 were obtained. Conclusion The structure, process, and outcome framework allowed for the characterization of drug safety management during clinical trials, providing a useful approach for the promoter to systematically measure and evaluate the process. The eight instruments were deemed as reliable, feasible and easy to be used for examining drug safety management while carrying out clinical trials.
Validation Studies
Drug
Safety Management
Clinical Trial
Cuba
2018
07
01
623
629
https://www.ijhpm.com/article_3446_28af62624ae370356485b1b0c1b3ec7f.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
Performance-Based Financing Empowers Health Workers Delivering Prevention of Vertical Transmission of HIV Services and Decreases Desire to Leave in Mozambique
Roseanne C.
Schuster
Octávio
de Sousa
Anne-Kathe
Reme
Carolyn
Vopelak
David L.
Pelletier
Lynn M.
Johnson
Mduduzi
Mbuya
Delphine
Pinault
Sera L.
Young
Background Despite increased access to treatment and reduced incidence, vertical transmission of HIV continues to pose a risk to maternal and child health in sub-Saharan Africa. Performance-based financing (PBF) directed at healthcare providers has shown potential to improve quantity and quality of maternal and child health services. However, the ways in which these PBF initiatives lead to improved service delivery are still under investigation. Methods Therefore, we implemented a longitudinal-controlled proof-of-concept PBF intervention at health facilities and with community-based associations focused on preventing vertical transmission of HIV (PVT) in rural Mozambique. We hypothesized that PBF would increase worker motivation and other aspects of the workplace environment in order to achieve service delivery goals. In this paper, we present two objectives from the PBF intervention with public health facilities (n = 6): first, we describe the implementation of the PBF intervention and second, we assess the impact of the PBF on health worker motivation, key factors in the workplace environment, health worker satisfaction, and thoughts of leaving. Implementation (objective 1) was evaluated through quantitative service delivery data and multiple forms of qualitative data (eg, quarterly meetings, participant observation (n = 120), exit interviews (n = 11)). The impact of PBF on intermediary constructs (objective 2) was evaluated using these qualitative data and quantitative surveys of health workers (n = 83) at intervention baseline, midline, and endline. Results We found that implementation was challenged by administrative barriers, delayed disbursement of incentives, and poor timing of evaluation relative to incentive disbursement (objective 1). Although we did not find an impact on the motivation constructs measured, PBF increased collegial support and worker empowerment, and, in a time of transitioning implementing partners, decreased against desire to leave (objective 2). Conclusion Areas for future research include incentivizing meaningful quality- and process-based performance indicators and evaluating how PBF affects the pathway to service delivery, including interactions between motivation and workplace environment factors.
Performance-Based Incentives
PMTCT
Motivation
Health Worker Attrition
Mozambique
2018
07
01
630
644
https://www.ijhpm.com/article_3448_da8efb1b25bfeb792c8b113a70782a3e.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
Contribution of Nepal’s Free Delivery Care Policies in Improving Utilisation of Maternal Health Services
Hema
Bhatt
Suresh
Tiwari
Tim
Ensor
Dhruba Raj
Ghimire
Tania
Gavidia
Background Nepal has made remarkable improvements in maternal health outcomes. The implementation of demand and supply side strategies have often been attributed with the observed increase in utilization of maternal healthcare services. In 2005, Free Delivery Care (FDC) policy was implemented under the name of Maternity Incentive Scheme (MIS), with the intention of reducing transport costs associated with giving birth in a health facility. In 2009, MIS was expanded to include free delivery services. The new expanded programme was named “Aama” programme, and further provided a cash incentive for attending four or more antenatal visits. This article analysed the influence of FDC policies, individual and community level factors in the utilisation of four antenatal care (4 ANC) visits and institutional deliveries in Nepal. Methods Demographic and health survey data from 1996, 2001, 2006 and 2011 were used and a multi-level analysis was employed to determine the effect of FDC policy intervention, individual and community level factors in utilisation of 4 ANC visits and institutional delivery services. Results Multivariate analysis suggests that FDC policy had the largest effect in the utilisation of 4 ANC visits and institutional delivery compared to individual and community factors. After the implementation of MIS in 2005, women were three times (adjusted odds ratio [AOR] = 3.020, P < .001) more likely to attend 4 ANC visits than when there was no FDC policy. After the implementation of Aama programme in 2009, the likelihood of attending 4 ANC visits increased six-folds (AOR = 6.006, P < .001) compared prior to the implementation of FDC policy. Similarly, institutional deliveries increased two times after the implementation of the MIS (AOR = 2.117, P < .001) than when there was no FDC policy. The institutional deliveries increased five-folds (AOR = 5.116, P < .001) after the implementation of Aama compared to no FDC policy. Conclusion Results from this study suggest that MIS and Aama policies have had a strong positive influence on the utilisation of 4 ANC visits and institutional deliveries in Nepal. Nevertheless, results also show that FDC policies may not be sufficient in raising demand for maternal health services without adequately considering the individual and community level factors
Free Delivery Policies
Institutional Delivery
ANC Visits
2018
07
01
645
655
https://www.ijhpm.com/article_3452_47b0576223eaf49c225233d77ee02958.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
From Mid-Level Policy Analysis to Macro-Level Political Economy; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”
Ronald
Labonté
This latest contribution by the evaluation research team at Flinders University/Southgate Institute on their multiyear study of South Australia’s Health in All Policies (HiAP) initiative is simultaneously frustrating, exemplary, and partial. It is frustrating because it does not yet reveal the extent to which the initiative achieved its stated outcomes; that awaits further papers. It is exemplary in describing an evaluation research design in which the research team has excelled over the years, and in adding to it an element of theory testing and re-testing. It is partial, in that the political and economic context considered important in examining both process and outcome of the HiAP initiative stops at the Australian state’s borders as if the macro-level national and global political economy (and its power relations) have little or no bearing on the sustainability of the policy learning that the initiative may have engendered. To ask that of an otherwise elegant study design that effectively engages policy actors in its implementation may be demanding too much; but it may now be time that more critical political economy theories join with those that elaborate well the more routine praxis of public policy-making.
Health in All Policies
Evaluation Research
Program Theory
Political Economy
2018
07
01
656
658
https://www.ijhpm.com/article_3461_e9de6815a1a7fadc620ba96bbdf3a774.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
It Ain’t What You Do (But the Way That You Do It): Will Safety II Transform the Way We Do Patient Safety; Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”
Rebecca
Lawton
Mannion and Braithwaite outline a new paradigm for studying and improving patient safety – Safety II. In this response, I argue that Safety I should not be dismissed simply because the safety management strategies that are developed and enacted in the name of Safety I are not always true to the original philosophy of ‘systems thinking.’
Patient Safety
Systems Thinking
Safety I
Safety II
Resilience
2018
07
01
659
661
https://www.ijhpm.com/article_3469_579b79636c738c9fffe264ea91ed43d3.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
A Safety-II Perspective on Organisational Learning in Healthcare Organisations; Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”
Mark
Sujan
In their recent editorial Mannion and Braithwaite provide an insightful critique of traditional patient safety improvement efforts, and offer a powerful alternative vision based on Safety-II thinking that has the potential to radically transform the way we approach patient safety. In this commentary, I explore how the Safety-II perspective points to new directions for organisational learning in healthcare organisations. Current approaches to organisational learning adopted by healthcare organisations have had limited success in improving patient safety. I argue that these approaches learn about the wrong things, and in the wrong way. I conclude that organisational learning in healthcare organisations should provide deeper understanding of the adaptations healthcare workers make in their everyday clinical work, and that learning and improvement approaches should be more democratic by promoting participation and ownership among a broader range of stakeholders as well as patients.
Safety-II
Resilience Engineering
Patient Safety
Work-As-Done
Organisational Learning
2018
07
01
662
666
https://www.ijhpm.com/article_3468_cbeb5eeb6f785ea56825eed2e6b487b0.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
The Rise of Patient Safety-II: Should We Give Up Hope on Safety-I and Extracting Value From Patient Safety Incidents?; Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”
Andrew
Carson-Stevens
Liam
Donaldson
Aziz
Sheikh
Who could disagree with the seemingly common-sense reasoning that: “We must learn from the things that go wrong.”? Despite major investments to improve patient safety, relatively few evaluations demonstrate convincing reductions in risk, harm, serious error or death. This disappointing trajectory of improvement from learning from errors or Safety-I as it is sometimes known has led some researchers to argue that there is more to be gained by learning from the majority of healthcare episodes: the things that go right. Based on this premise, socalled Safety-II has emerged as a new paradigm. In this commentary, we consider the ongoing value of Safety-I based approaches and explore whether now is the time to abandon learning from “the bad” and re-energise data collection and analysis by focusing on “the good.”
Adverse Events
Preventable Harm
2018
07
01
667
670
https://www.ijhpm.com/article_3475_ab1d6a9cc95f2c88910541d52e36a997.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
Safety I to Safety II: A Paradigm Shift or More Work as Imagined?; Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”
Kelly M.
Smith
Annette L.
Valenta
In their editorial, Mannion and Braithwaite contend that the approach to solving the problem of unsafe care, Safety I, is flawed and requires a shift in thinking to what they are calling Safety II. We have reservations as to whether by itself the shift from Safety I to Safety II is sufficient. Perhaps our failure to improve outcomes in the field of patient safety and quality lies less in our approach – Safety I vs. Safety II – and more in the lack of an agreed upon, commonly understood set of core competencies (knowledge, skills, and attitudes) needed in its workforce. The authors explore in this commentary the need to establish core competencies as part of the pathway to professionalism for the discipline of patient safety and quality.
Patient Safety
Quality Improvement
Professionalism
Education
2018
07
01
671
673
https://www.ijhpm.com/article_3476_c80897cfdabd78bb3595f2a3dae94cf2.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
Tapping the Power of Soda Taxes: A Call for Multidisciplinary Research and Broad-Based Advocacy Coalitions – A Response to the Recent Commentaries
Sarah A.
Roache
Lawrence O.
Gostin
Global Health Law
Public Health Law
Soda Taxes
Sugar-Sweetened Beverage Taxes
Diet-Related Diseases
2018
07
01
674
676
https://www.ijhpm.com/article_3484_40acdf0ff659535645b3a1378b2ba63b.pdf
International Journal of Health Policy and Management
IJHPM
2018
7
7
Human Rights and the Tobacco Industry: An Unsuitable Alliance
Brigit
Toebes
Tobacco Industry
Human Rights
Responsibility to Respect
Right to Health
Right to Life
2018
07
01
677
677
https://www.ijhpm.com/article_3455_979acde2eefdb28e358b713de7bbaa86.pdf