Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Equitable and Effective Distribution of the COVID-19 Vaccines – A Scientific and Moral Obligation100102403810.34172/ijhpm.2021.49ENAgnesBinagwahoVice Chancellor’s Office, University of Global Health Equity, Kigali, Rwanda0000-0002-6779-3151KedestMathewosVice Chancellor’s Office, University of Global Health Equity, Kigali, Rwanda0000-0001-6525-3517SheilaDavisPartners in Health, Boston, MA, USA0000-0002-8601-5603Journal Article20210205<span class="fontstyle0">The rapid development of coronavirus disease 2019 (COVID-19) vaccines has not been met with the assurance of an effective and equitable global distribution mechanism. Low-income countries are especially at-risk, with the price of the vaccines and supply shortages limiting their ability to procure and distribute the vaccines. While the COVAX initiative is one of the solutions to these challenges, vaccine nationalism has resulted in the hoarding of vaccines and the signing of parallel bilateral deals, undermining this formerly promising initiative. Moreover, inequity in local distribution also remains a problem, with clear discrimination of minorities and lack of logistical preparation in some countries. As we continue to distribute the COVID-19 vaccines, pharmaceutical companies should share their technology to increase supply and reduce prices, governments should prioritize equitable distribution to the most at- risk in all nations and low-income countries should bolster their logistical capacity in preparation for mass vaccination campaigns.</span>https://www.ijhpm.com/article_4038_bb872822ecb60173405cbcc926ee2c8f.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Defining Delayed Discharges of Inpatients and Their Impact in Acute Hospital Care: A Scoping Review103111384410.34172/ijhpm.2020.94ENAlexanderMicallefDepartment of Health Services Management, Faculty of Health Sciences,
University of Malta, Msida, Malta0000-0001-9823-1947SandraButtigiegDepartment of Health Services Management, Faculty of Health Sciences,
University of Malta, Msida, Malta0000-0002-0572-2462GianpaoloTomaselliDepartment of Health Services Management, Faculty of Health Sciences,
University of Malta, Msida, Malta0000-0002-9064-8315LalitGargDepartment of Computer Information
Systems, Faculty of ICT, University of Malta, Msida, Malta0000-0002-3868-0481Journal Article20190630<span class="fontstyle0">Background</span><br /><span class="fontstyle2">With the ever-increasing demand on acute healthcare, the hospital discharge process and delayed discharges are considered relevant in achieving optimal performance in clinical settings. The purpose of this paper is to review the literature to identify conceptual and operational definitions of delayed discharges, identify causes and effects of delayed discharges, and also to explore the literature for interventions aimed at decreasing the impact (in terms of reducing the number/rate of delays) of delayed discharges in acute healthcare settings.<br /></span><br /><span class="fontstyle0">Methods</span><br /><span class="fontstyle2">An extensive literature search yielded a total of 26 248 records. Sixty-four research articles were included in the scoping review after considering inclusion/exclusion criteria and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) search strategy. The following databases were utilized: Cochrane, EBSCO, PubMed, PubMed Central, Medline, and Web of Science. The search was carried out between January 2017 and March 2020 and covered literature ranging from 1990 to 2019. Results were reviewed by authors for duplicates and filtered using the inclusion/exclusion criteria. Tables were created to classify the chosen articles (n = 64), allowing us to organise findings and results.<br /></span><br /><span class="fontstyle0">Results</span><br /><span class="fontstyle2">Conceptual and operational definitions were analysed. In turn, causes and effects of delayed discharges were extracted and represented in diagrammatic format, together with specific interventions used in acute healthcare settings to lessen the effect of delayed discharges. Operational definitions of delayed discharges were found to be more difficult to establish, particularly in the light of the vast number of different scenarios and workplace interventions uncovered in the literature. The main causes of delayed discharges were faulty organisational management, inadequate discharge planning, transfer of care problems, and age. The main effects were bed-blocking, A&E (Accident & Emergency) overcrowding, and financial implications. The main interventions included ‘discharge before noon’ initiative, ‘discharge facilitation tools,’ ‘discharge delay tracking’ mechanisms, and the role of general practitioners and social care staff.<br /></span><br /><span class="fontstyle0">Conclusion</span><br /><span class="fontstyle2">This paper fills a gap in the fragmented literature on delayed inpatient discharges by providing a research-based perspective on conceptual and operational definitions, causes and effects, as well as interventions to minimize their impact. The findings and definitions are intended as points of reference for future research.</span>https://www.ijhpm.com/article_3844_df28ede79c2e8edf0f1b4cefb8bd05ef.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Experiences of Using Cochrane Systematic Reviews by Local HTA Units112117387510.34172/ijhpm.2020.133ENThomas G.PoderDepartment of Management, Evaluation and Health Policy, School of Public
Health, University of Montreal, Montréal, QC, CanadaCentre de Recherche
de l’Institut Universitaire en Santé Mentale de Montréal, CIUSSS de l’Est de l’Île
de Montréal, Montréal, QC, Canada0000-0001-7017-096XMarcRhaindsHTA Unit, CHU de Québec – Université
Laval, Québec, QC, Canada0000-0002-0333-6146Christian A.BellemareDepartment of Multidisciplinary Services, Clinical
Quality Division, CIUSSS de l’Estrie-CHUS, Sherbrooke, QC, Canada0000-0002-4209-8152SimonDebloisHTA
Unit, CHUM, Montréal, QC, Canada0000-0002-0374-2486ImaneHammanaHTA
Unit, CHUM, Montréal, QC, Canada0000-0002-7944-9868CatherineSafianykHTA Unit, CIUSSS de la Capitale-
Nationale, Québec, QC, Canada0000-0001-6935-8746SylvieSt-JacquesHTA Unit, CIUSSS de la Capitale-
Nationale, Québec, QC, Canada0000-0002-9215-3375PierreDagenaisHTA Unit, CIUSSS de l’Estrie – CHUS,
Sherbrooke, QC, CanadaDepartment of Medicine, Faculty of Medicine and
Health Science, University of Sherbrooke, Sherbrooke, QC, Canada000-0001-5058-6941Journal Article20191127<span class="fontstyle0">This study evaluated the use of Cochrane systematic reviews (CSRs) by Quebec’s local health technology assessment (HTA) units to promote efficiency in hospital decision-making. An online survey was conducted to examine: Characteristics of the HTA units; Knowledge about works and services from the Cochrane Collaboration; Level of satisfaction about the use of CSRs; Facilitating factors and barriers to the implementation of CSRs evidence in a local context; Suggestions to improve the use of CSRs. Data accuracy was checked by 2 independent evaluators. Ten HTA units participated. From their implementation a total of 321 HTA reports were published (49.8% included a SR). Works and services provided by the Cochrane collaboration were very well-known and HTA units were highly satisfied with CSRs (80%-100%). As regards to applicability in HTA and use of CSRs, major strengths were as follow: Useful as resource for search terms and background material; May reduce the workload (eg, brief review instead of full SR); Use to update a current review. Major weaknesses were: Limited use since no CSRs were available for many HTA projects; Difficulty to apply findings to local context; Focused only on efficacy and innocuity; Cannot be used as a substitute to a full HTA report. This study provided a unique context of assessment with a familiar group of producers, users and disseminators of CSRs in hospital setting. Since they generally used other articles from the literature or produce an original SR in complement with CSRs, this led to suggestions to improve their use of CSRs. However, the main limit for the use of CRS in local HTA will remain its lack of contextualisation. As such, this study reinforces the need to consider the notion of complementarity of experimental data informing us about causality and contextual data, allowing decision-making adapted to local issues.</span>https://www.ijhpm.com/article_3875_628fb16e260c166b03bf52025f3921a5.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201The Dutch Citizen Forum on Public Reimbursement of Healthcare: A Qualitative Analysis of Opinion Change118127382910.34172/ijhpm.2020.81ENMaartenJansenDepartment for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The NetherlandsRobBaltussenDepartment for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands0000-0002-8364-2847LeonBijlmakersDepartment for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands0000-0003-2252-0579MarciaTummersDepartment for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands0000-0001-5913-4554Journal Article20190731<span class="fontstyle0">Background</span><br /><span class="fontstyle2">A deliberative Citizen Forum ‘Choices in healthcare’ was held in the Netherlands to obtain insight into the criteria informed citizens would propose for the public reimbursement of healthcare. During 3 weekends, 24 citizens participated in evidence-informed deliberation on the basis of 8 case studies. The aim of this study was to assess how the opinions of 8 participants in the deliberative Citizens Forum changed and if so, why participants themselves believe their opinions have changed, whether participation influenced their perceived reasonableness of other participants in the forum and whether it influenced their opinions about involvement of citizens in decision-making.<br /></span><br /><span class="fontstyle0">Methods</span><br /><span class="fontstyle2">Semi-structured interviews were held with 8 participants before and after their participation in the Citizen Forum. Using the method of reconstructing interpretive frames opinions about the public reimbursement of healthcare were reconstructed.<br /></span><br /><span class="fontstyle0">Results</span><br /><span class="fontstyle2">Participants’ opinions changed over time; they became more aware of the complexity of decision-making and came to accept that there are limits to the available resources and accept cost as a criterion for reimbursement decisionmaking. Participants report that exchanging arguments and personal experiences with other participants made them change their initial opinions. Participants ascribed increases in the perceived reasonableness of other participants’ opinions to feelings of group-bonding and becoming more familiar with each other’s personal circumstances. Participants further believe that citizens represent an additional opinion to that of other stakeholders and believe their opinions should be considered in relation to those of other stakeholders, given they are provided with opportunities for critical discussion.</span><br /> <br /><span class="fontstyle0">Conclusion</span><br /><span class="fontstyle2">Organized deliberation should allow for the exchange of arguments and the sharing of personal experiences which is linked to learning. On the one hand this is reflected in the uptake of new arguments and on the other hand in the revision, specification or expansion of personal argumentation. Providing opportunities for critical deliberation is key to prevent citizens from adhering to initial emotional reactions that remain unchallenged and which may no longer be supported after deliberation.</span>https://www.ijhpm.com/article_3829_41127af355b5c85a3d10088c4a227dac.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201A Process for Evaluating Quality Decision-Making Practices During the Development, Review and Reimbursement of Medicines128137383210.34172/ijhpm.2020.86ENMagdalenaBujarDepartment of Clinical and Pharmaceutical Sciences, School of Life & Medical
Sciences, University of Hertfordshire, Hatfield, UKCentre for Innovation in
Regulatory Science (CIRS), London, UK0000-0001-8579-2163NeilMcAuslaneDepartment of Clinical and Pharmaceutical Sciences, School of Life & Medical
Sciences, University of Hertfordshire, Hatfield, UKStuartWalkerDepartment of Clinical and Pharmaceutical Sciences, School of Life & Medical
Sciences, University of Hertfordshire, Hatfield, UKCentre for Innovation in
Regulatory Science (CIRS), London, UKSamSalekCentre for Innovation in
Regulatory Science (CIRS), London, UKJournal Article20200102<span class="fontstyle0">Background</span><br /><span class="fontstyle2">The development of a medicine is not only underpinned by good science but also by Quality DecisionMaking Practices (QDMPs). Indeed, it is important to ensure that all organisations involved in the lifecycle of medicines are aligning their practices in decision-making to the QDMPs to ensure quality, transparent and consistent decisionmaking processes.<br /></span><br /><span class="fontstyle0">Methods</span><br /><span class="fontstyle2">The aim of this study was to evaluate the practicality of QoDoS (Quality of Decision-Making Orientation Scheme) in assessing the incorporation of ten QDMPs during the development, review and reimbursement of medicines, illustrated by case studies with a pharmaceutical company, a regulatory authority and a health technology assessment (HTA) agency. Individuals from each organisation completed the 47-item QoDoS questionnaire.<br /></span><br /><span class="fontstyle0">Results</span><br /><span class="fontstyle2">The results demonstrate the applicability of QoDoS in identifying favourable and unfavourable practices and in assessing the consistency and transparency of the QDMPs within each organisation, as well as across the different stakeholders. Furthermore, the study established the value of the methodology in raising awareness of the biases and best practices in decision-making, as well as having a basis for discussion for differences within and across stakeholders to promote consistency and alignment in decision-making. Finally, the QoDoS demonstrated the need for improvement across a number of decision-making practices for the 3 organisations such as the evaluation of alternatives and of the decision impact.<br /></span><br /><span class="fontstyle0">Conclusion</span><br /><span class="fontstyle2">The QoDoS can be used to benchmark organisations’ decision-making practices to provide a basis for discussion to ultimately encourage a level of trust across and within organisations and helping to identify areas for improvement.</span>https://www.ijhpm.com/article_3832_df04017cfbe6c51c03f94f048ae45406.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Hospital Expenditure at the End-of-Life: A Time-to-Death Approach138144383110.34172/ijhpm.2020.88ENVahidAlipourHealth Management and Economics Research Center, Iran University of
Medical Sciences, Tehran, Iran0000-0003-1010-9571AbolghasemPourrezaDepartment of Health Education and Promotion,
School of Public Health, Tehran University of Medical Sciences, Tehran, Iran0000-0002-6957-6660MajidKosheshiDepartment of Demography, Social Science Faculty, Tehran University,
Tehran, Iran0000-0003-4829-2762HassanHeydariDepartment of Economic Sciences, School of Management and
Economics, Tarbiat Modares University, Tehran, Iran0000-0001-8915-6076SaraEmamgholipour SefiddashtiDepartment of Health
Management and Economics, School of Public Health, Tehran University of
Medical Sciences, Tehran, Iran0000-0001-8654-6554Journal Article20190805<span class="fontstyle0">Background</span><br /><span class="fontstyle2">In recent years the use of time to death (TTD) variables in the modeling of individual health expenditures has been of interest to health economics researchers. The aim of this study was to investigate the effect of age and TTD on hospital inpatient expenditure (HIE).<br /></span> <br /><span class="fontstyle0">Methods</span><br /><span class="fontstyle2">We used a claims database from Iran Health Insurance Organization of Tehran city that includes considerable proportion of Tehran residents and contains information on insured individuals’ HIE. We included HIE of all insured decedents (30 to 90 years old) who died during March 2013 and March 2014 (n = 1018). No sampling was required. According to the decedents’ date of death, we extracted their last 24 months HIE. The period of time March 30, 2011 until March 30, 2014 (3 years) was used to guarantee a full 24 months of observations for decedents. A two-part econometric model was employed to investigate the effect of age, TTD, and some demographic variables on probability and conditional amount of individuals’ hospital expenditure. Stata software (version 16.0) was used for data processing and analysis.<br /></span> <br /><span class="fontstyle0">Results</span><br /><span class="fontstyle2">Our results demonstrated that the month-based TTDs especially near months before death of decedents (TTD1 to TTD10) significantly affected both probability and conditional amount of HIE. One month before death incurred more HIE than the rest of the months. A further interesting finding is that after including TTD, age variable as a conditional driver of HIE loses its direct effect on decedents’ HIE, but age TTD interaction effect on HIE is still positive and statistically significant.<br /></span><br /><span class="fontstyle0">Conclusion</span><br /><span class="fontstyle2">The results confirm that TTD as a proxy of mortality indicator has a considerable effect on decedents’ HIE. The age variable has not directly affected decedents’ HIE but indirectly and through its interaction with TTD has a statistically significant effect on HIE. In addition to age, policy-makers should consider TTD to make better predictions of future HIE.</span>https://www.ijhpm.com/article_3831_e552c9edd4e1d93f55f3bacef98be135.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201An Exploration of the Unintended Consequences of Performance-Based Financing in 6 Primary Healthcare Facilities in Burkina Faso145159383610.34172/ijhpm.2020.83ENAnne-MarieTurcotte-TremblayÉcole de santé publique de l’Université de Montréal, Montreal, QC,
Canada0000-0002-6138-9908Idriss AliGali GaliAssociation Action Gouvernance Intégration Renforcement
(AGIR), Ouagadougou, Burkina FasoValéryRiddeIRD (French Institute for Research on
Sustainable Development), CEPED, Université de Paris, Paris, France0000-0001-9299-8266Journal Article20190902<span class="fontstyle0">Background</span><br /><span class="fontstyle2">Performance-based financing (PBF) is promoted to improve the quality and quantity of healthcare services in low-income countries. Despite the complexity of the intervention, little attention has been given to studying its unintended consequences. Our objective is to increase evidence on the unintended consequences of PBF in Burkina Faso.<br /></span> <br /><span class="fontstyle0">Methods</span><br /><span class="fontstyle2">Using the diffusion of innovations theory, we conducted a multiple case study. The cases were 6 healthcare facilities in two districts. Between April 2015 and 2016, we collected data through 101 semi-structured interviews, discussions, observations, and documents. We conducted thematic analysis using a hybrid deductive-inductive approach. Secondary data was used to illustrate the evolution of reported services. We conducted a cross-case synthesis to identify the results arising independently from more than 1 case.<br /></span><br /><span class="fontstyle0">Results</span><br /><span class="fontstyle2">A desirable unintended consequence of PBF was that 3 facilities limited the sale of non-prescribed medication to encourage patients to consult. Undesirable unintended consequences were found in the majority of facilities including fixation on measures rather than on underlying objectives, the pursuit of narrow and less relevant performance indicators, gaming, and teaching trainees improper practices. Providers in all facilities deliberately manipulated medical registers and documents, such that the reported quantity and quality of care differed from what was actually delivered. While most participants indicated that PBF was more advantageous than previous practices, the long payment delays were a source of dissatisfaction and demotivation across all facilities. Dissatisfaction also emerged in relation to the distribution of subsidies and the non-attribution of quality points for services delivered by certain staff considered “unqualified” in guidelines. Results in many facilities revealed suboptimal planning, a perception of the intervention as “budgetivorous,” as well as tensions related to the principle of managerial autonomy.<br /></span><br /><span class="fontstyle0">Conclusion</span><br /><span class="fontstyle2">PBF led to numerous unintended consequences that could undermine the intervention’s effectiveness. The findings contribute to a more comprehensive picture of the consequences of implementing PBF. Policy-makers can use the results of this study to devise effective strategies before, during and after the implementation of the intervention to minimize undesirable unintended consequences and promote desirable ones.</span>https://www.ijhpm.com/article_3836_9eefeaa969e8d8004e4a45f2998e1aba.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Using Open Public Meetings and Elections to Promote Inward Transparency and Accountability: Lessons From Zambia160172383710.34172/ijhpm.2020.84ENTarynVianSchool of Nursing and Health Professions, University of San Francisco, San
Francisco, CA, USA0000-0002-6968-7002Rachel M.FongDepartment of Global Health, Boston University School
of Public Health, Boston, MA, USA0000-0003-0296-2521Jeanette L.KaiserDepartment of Global Health, Boston University School
of Public Health, Boston, MA, USA0000-0001-6008-5219MisheckBwalyaDepartment of Research, Right to Care
Zambia, Lusaka, ZambiaViviane I.R.SakangaDepartment of Programs, Amref Health Africa,
Lusaka, ZambiaThandiweNgomaDepartment of Research, Right to Care
Zambia, Lusaka, Zambia0000-0003-2643-5021Nancy A.ScottDepartment of Global Health, Boston University School
of Public Health, Boston, MA, USA0000-0002-4713-4642Journal Article20190812<span class="fontstyle0">Background</span><br /><span class="fontstyle2">Community-led governance can ensure that leaders are accountable to the populations they serve and strengthen health systems for maternal care. A key aspect of democratic accountability is electing respective governance bodies, in this case community boards, and holding public meetings to inform community members about actions taken on their behalf. After helping build and open 10 maternity waiting homes (MWHs) in rural Zambia as part of a randomized controlled trial, we assisted community governance committees to plan and execute annual meetings to present performance results and, where needed, to elect new board members.<br /></span><br /><span class="fontstyle0">Methods</span><br /><span class="fontstyle2">We applied a principally qualitative design using observation and analysis of written documentation of public meetings to answer our research question: how do governance committees enact inward transparency and demonstrate accountability to their communities. The analysis measured participation and stakeholder representation at public meetings, the types and purposes of accountability sought by community members as evidenced by questions asked of the governance committee, and responsiveness of the governance committee to issues raised at public meetings.<br /></span><br /><span class="fontstyle0">Results</span><br /><span class="fontstyle2">Public meetings were attended by 6 out of 7 possible stakeholder groups, and reports were generally transparent. Stakeholders asked probing questions focused mainly on financial performance. Governance committee members were responsive to questions raised by participants, with 59% of answers rated as fully or mostly responsive (showing understanding of and answering the question). Six of the 10 sites held elections to re-elect or replace governance committee members. Only 2 sites reached the target set by local stakeholder committees of 50% female membership, down from 3 at formation. To further improve transparency and accountability, community governance committees need to engage in advance preparation of reports, and should consult with stakeholders on broader measures for performance assessment. Despite receiving training, community-level governance committees lacked understanding of the strategic purpose of open public meetings and elections, and how these relate to democratic accountability. They were therefore not motivated to engage in tactics to manage stakeholders effectively.</span><br /> <br /><span class="fontstyle0">Conclusion</span><br /><span class="fontstyle2">While open meetings and elections have potential to enhance good governance at the community level, continuous training and mentoring are needed to build capacity and enhance sustainability.</span>https://www.ijhpm.com/article_3837_757d051e23b32ffc861151ad14e3b615.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201A Board Level Intervention to Develop Organisation-Wide Quality Improvement Strategies: Cost-Consequences Analysis in 15 Healthcare Organisations173182384210.34172/ijhpm.2020.91ENEstela CapelasBarbosaDepartment of Applied Health Research, University College London, London,
UK0000-0002-7621-7957LoreleiJonesUniversity of Bangor, Bangor, UK0000-0002-7737-5981LindaPomeroyDepartment of Applied Health Research, University College London, London,
UKGlennRobertNational Nursing Research Unit,
Florence Nightingale School of Nursing and Midwifery, King’s College London,
London, UKSusanBurnettCentre for Patient Safety and Service Quality, Faculty of Medicine,
Imperial College London, London, UKJanet E.AndersonFlorence Nightingale School of Nursing
and Midwifery, King’s College London, London, UK0000-0002-1452-8370SteveMorrisDepartment of Public
Health and Primary Care, University of Cambridge, Cambridge, UKNaomiFulopDepartment of Applied Health Research, University College London, London,
UK0000-0001-5306-6140Journal Article20190802<span class="fontstyle0">Background</span><br /><span class="fontstyle2">Hospital boards have statutory responsibility for upholding the quality of care in their organisations. International research on quality in hospitals resulted in a research-based guide to help senior hospital leaders develop and implement quality improvement (QI) strategies, the QUASER Guide. Previous research has established a link between board practices and quality of care; however, to our knowledge, no board-level intervention has been evaluated in relation to its costs and consequences. The aim of this research was to evaluate these impacts when the QUASER Guide was implemented in an organisational development intervention (iQUASER).<br /></span><br /><span class="fontstyle0">Methods</span><br /><span class="fontstyle2">We conducted a ‘before and after’ cost-consequences analysis (CCA), as part of a mixed methods evaluation. The analysis combined qualitative data collected from 66 interviews, 60 hours of board meeting observations and documents from 15 healthcare organisations, of which 6 took part on iQUASER, and included direct and opportunity costs associated with the intervention. The consequences focused on the development of an organisation-wide QI strategy, progress on addressing 8 dimensions of QI (the QUASER challenges), how organisations compared to benchmarks, engagement with the intervention and progress in the implementation of a QI project.<br /></span><br /><span class="fontstyle0">Results</span><br /><span class="fontstyle2">We found that participating organisations made greater progress in developing an organisation-wide QI strategy and became more similar to the high-performing benchmark than the comparators. However, progress in addressing all 8 QUASER challenges was only observed in one organisation. Stronger engagement with the intervention was associated with the implementation of a QI project. On average, iQUASER costed £23 496 per participating organisation, of which approximately 44% were staff time costs. Organisations that engaged less with the intervention had lower than average costs (£21 267 per organisation), but also failed to implement an organisation-wide QI project.<br /></span><br /><span class="fontstyle0">Conclusion</span><br /><span class="fontstyle2">We found a positive association between level of engagement with the intervention, development of an organisation-wide QI strategy and the implementation of an organisation-wide QI project. Support from the board, particularly the chair and chief executive, for participation in the intervention, is important for organisations to accrue most benefit. A board-level intervention for QI, such as iQUASER, is relatively inexpensive as a proportion of an organisation’s budget.</span>https://www.ijhpm.com/article_3842_5d9d90daa47f0ac30136ff8f12d1b4b7.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Perceived Burden Due to Registrations for Quality Monitoring and Improvement in Hospitals: A Mixed Methods Study183196384610.34172/ijhpm.2020.96ENMariekeZegersDepartment of Intensive Care, Radboud Institute for Health Sciences, Radboud
University Medical Center, Nijmegen, The NetherlandsScientific Center
for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud
University Medical Center, Nijmegen, The Netherlands0000-0002-7472-6184Gepke L.VeenstraCentre of Expertise
on Quality and Safety, University Medical Centre Groningen, Groningen, The
Netherlands0000-0002-9464-0943GerardGerritsenDepartment of Quality and Safety, Rijnstate Hospital, Arnhem,
The NetherlandsRutgerVerhageDepartment of Intensive Care, Radboud Institute for Health
Sciences, Radboud University Medical Center, Nijmegen, The NetherlandsHans (J.G.)Van Der HoevenDepartment of Intensive Care, Radboud Institute for Health
Sciences, Radboud University Medical Center, Nijmegen, The NetherlandsGera A.WelkerCentre of Expertise
on Quality and Safety, University Medical Centre Groningen, Groningen, The
NetherlandsJournal Article20190912Background<br />Quality indicators are registered to monitor and improve the quality of care. However, the number and effectiveness of quality indicators is under debate, and may influence the joy in work of physicians and nurses. Empirical data on the nature and consequences of the registration burden are lacking. The aim of this study was to identify and explore healthcare professionals’ perceived burden due to quality registrations in hospitals, and the effect of this burden on their joy in work.<br /> <br />Methods<br />A mixed methods observational study, including participative observations, a survey and semi-structured interviews in two academic hospitals and one teaching hospital in the Netherlands. Study participants were 371 healthcare professionals from an intensive care unit (ICU), a haematology department and others involved in the care of elderly patients and patients with prostate or gastrointestinal cancer.<br /> <br />Results<br />On average, healthcare professionals spend 52.3 minutes per working day on quality registrations. The average number of quality measures per department is 91, with 1380 underlying variables. Overall, 57% are primarily registered for accountability purposes, 19% for institutional governance and 25% for quality improvement objectives. Only 36% were perceived as useful for improving quality in everyday practice. Eight types of registration burden were identified, such as an excessive number of quality registrations, and the lack of usefulness for improving quality and inefficiencies in the registration process. The time healthcare professionals spent on quality registrations was not correlated with any measure of joy in work. Perceived unreasonable registrations were negatively associated with healthcare professionals’ joy in work (intrinsic motivation and autonomy). Healthcare professionals experienced quality registrations as diverting time from patient care and from actually improving quality.<br /> <br />Conclusion<br />Registering fewer quality indicators, but more of what really matters to healthcare professionals, is key to increasing the effectiveness of registrations for quality improvement and governance. Also the efficiency of quality registrations should be increased through staffing and information and communications technology solutions to reduce the registration burden experienced by nurses and physicians.https://www.ijhpm.com/article_3846_dd320f19a3d3f769ac32298686978206.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201CHAT SA: Modification of a Public Engagement Tool for Priority Setting for a South African Rural Context197209385210.34172/ijhpm.2020.110ENAvivaTugendhaftSAMRC/Wits Centre for Health Economics and Decision Science -
PRICELESS, School of Public Health, Faculty of Health Sciences, University of
Witwatersrand, Johannesburg, South Africa0000-0003-4104-4299MarionDanisDepartment of Bioethics, National
Institutes of Health, Bethesda, MD, USA0000-0002-4749-4568NicolaChristofidesSchool of Public Health, Faculty
of Health Sciences, University of the Witwatersrand, Johannesburg, South
Africa0000-0002-3559-6401KathleenKahnMRC/Wits Rural Public Health and Health Transitions Research Unit -
Agincourt, School of Public Health, Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, South Africa0000-0003-3339-3931AgnesErzseSAMRC/Wits Centre for Health Economics and Decision Science -
PRICELESS, School of Public Health, Faculty of Health Sciences, University of
Witwatersrand, Johannesburg, South AfricaMartheGoldNew York Academy of Medicine,
New York City, NY, USARhianTwineMRC/Wits Rural Public Health and Health Transitions Research Unit -
Agincourt, School of Public Health, Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, South Africa0000-0002-0766-6556AudreyKhosaMRC/Wits Rural Public Health and Health Transitions Research Unit -
Agincourt, School of Public Health, Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg, South AfricaKarenHofmanSAMRC/Wits Centre for Health Economics and Decision Science -
PRICELESS, School of Public Health, Faculty of Health Sciences, University of
Witwatersrand, Johannesburg, South Africa0000-0001-9512-7220Journal Article20191111Background<br />Globally, as countries move towards universal health coverage (UHC), public participation in decision-making is particularly valuable to inform difficult decisions about priority setting and resource allocation. In South Africa (SA), which is moving towards UHC, public participation in decision-making is entrenched in policy documents yet practical applications are lacking. Engagement methods that are deliberative could be useful in ensuring the public participates in the priority setting process that is evidence-based, ethical, legitimate, sustainable and inclusive. Methods modified for the country context may be more relevant and effective. To prepare for such a deliberative process in SA, we aimed to modify a specific deliberative engagement tool – the CHAT (Choosing All Together) tool for use in a rural setting.<br /> <br />Methods<br />Desktop review of published literature and policy documents, as well as 3 focus groups and modified Delphi method were conducted to identify health topics/issues and related interventions appropriate for a rural setting in SA. Our approach involved a high degree of community and policy-maker/expert participation. Qualitative data were analysed thematically. Cost information was drawn from various national sources and an existing actuarial model used in previous CHAT exercises was employed to create the board.<br /> <br />Results<br />Based on the outcomes, 7 health topics/issues and related interventions specific for a rural context were identified and costed for inclusion. These include maternal, new-born and reproductive health; child health; woman and child abuse; HIV/AIDS and tuberculosis (TB); lifestyle diseases; access; and malaria. There were variations in priorities between the 3 stakeholder groups, with community-based groups emphasizing issues of access. Violence against women and children and malaria were considered important in the rural context.<br /> <br />Conclusion<br />The CHAT SA board reflects health topics/issues specific for a rural setting in SA and demonstrates some of the context-specific coverage decisions that will need to be made. Methodologies that include participatory principles are useful for the modification of engagement tools like CHAT and can be applied in different country contexts in order to ensure these tools are relevant and acceptable. This could in turn impact the success of the implementation, ultimately ensuring more effective priority setting approaches.https://www.ijhpm.com/article_3852_e58ad36a34a3ebf12a15b17e824dd18a.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Prediction of Cardiovascular Disease Mortality in a Middle Eastern Country: Performance of the Globorisk and Score Functions in Four Population-Based Cohort Studies of Iran210217385910.34172/ijhpm.2020.103ENNoushinFahimfarDepartment of Epidemiology and Biostatistics, School of Public Health, Tehran
University of Medical Sciences, Tehran, IranOsteoporosis Research Center,
Endocrinology and Metabolism Clinical Sciences Institute, Tehran University
of Medical Sciences, Tehran, Iran0000-0001-6205-9794AkbarFotouhiDepartment of Epidemiology and Biostatistics, School of Public Health, Tehran
University of Medical Sciences, Tehran, Iran0000-0002-6438-6833Mohammad AliMansourniaDepartment of Epidemiology and Biostatistics, School of Public Health, Tehran
University of Medical Sciences, Tehran, Iran0000-0003-3343-2718RezaMalekzadehDigestive Diseases Research Center,
Digestive Diseases Research Institute, Tehran University of Medical Sciences,
Tehran, Iran0000-0003-1043-3814NizalSarrafzadeganIsfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, IranSchool of Population and Public Health, Faculty of Medicine, University of
British Columbia, Vancouver, BC, Canada0000-0002-8352-0540FereidounAziziEndocrine Research Center,
Research Institute for Endocrine Sciences, Shahid Beheshti University of
Medical Sciences, Tehran, Iran0000-0002-6470-2517MarjanMansourianIsfahan Cardiovascular Research Center,
Isfahan Cardiovascular Research Institute, Isfahan University of Medical
Sciences, Isfahan, Iran0000-0002-7217-0282Sadaf G.SepanlouDigestive Diseases Research Center,
Digestive Diseases Research Institute, Tehran University of Medical Sciences,
Tehran, Iran0000-0002-3669-5129Mohammad HassanEmamianOphthalmic Epidemiology Research Center, Shahroud
University of Medical Sciences, Shahroud, Iran0000-0002-1994-1105FarzadHadaeghEndocrine Research Center,
Research Institute for Endocrine Sciences, Shahid Beheshti University of
Medical Sciences, Tehran, Iran0000-0002-8935-2744HamidrezaRoohafzaCardiac Rehabilitation
Research Center, Cardiovascular Research Institute, Isfahan University of
Medical Sciences, Isfahan, Iran0000-0003-3582-0431HassanHashemiNoor Ophthalmology Research Center, Noor
Eye Hospital, Tehran, IranHosseinPoustchiDigestive Diseases Research Center,
Digestive Diseases Research Institute, Tehran University of Medical Sciences,
Tehran, Iran0000-0003-4566-3628AkramPourshamsDigestive Diseases Research Center,
Digestive Diseases Research Institute, Tehran University of Medical Sciences,
Tehran, Iran0000-0002-7950-3983TaherehSamavatOffice for Prevention & Control of Heart Diseases,
Center for Non-communicable Diseases Control, Ministry of Health, Tehran,
IranMaryamSharafkhahDepartment of Epidemiology and Biostatistics, School of Public Health, Tehran
University of Medical Sciences, Tehran, IranDigestive Diseases Research Center,
Digestive Diseases Research Institute, Tehran University of Medical Sciences,
Tehran, IranMohammadTalaeiIsfahan Cardiovascular Research Center, Cardiovascular
Research Institute, Isfahan University of Medical Sciences, Isfahan, IranInstitute of Population Health Sciences, Barts and The London School
of Medicine and Dentistry, Queen Mary University of London, London, UK0000-0002-6901-3665DavidVan KlaverenDepartment of Public Health, Erasmus University Medical Center, Rotterdam,
The NetherlandsEwout W.SteyerbergDepartment of Public Health, Erasmus University Medical Center, Rotterdam,
The NetherlandsDepartment of Biomedical Data Sciences, Sections Medical
Statistics and Medical Decision Making, Leiden University Medical Centre,
Leiden, The Netherlands0000-0002-7787-0122DavoodKhaliliPrevention of Metabolic Disorders Research Center,
Research Institute for Endocrine Sciences, Shahid Beheshti University of
Medical Sciences, Tehran, IranDepartment of Biostatistics and Epidemiology,
Research Institute for Endocrine Sciences, Shahid Beheshti University of
Medical Sciences, Tehran, Iran0000-0003-4956-1039Journal Article20191207<span class="fontstyle0">Background</span><br /><span class="fontstyle2">Considering the importance of cardiovascular disease (CVD) risk prediction for healthcare systems and the limited information available in the Middle East, we evaluated the SCORE and Globorisk models to predict CVD death in a country of this region.<br /></span><br /><span class="fontstyle0">Methods</span><br /><span class="fontstyle2">We included 24 427 participants (11 187 men) aged 40-80 years from four population-based cohorts in Iran. Updating approaches were used to recalibrate the baseline survival and the overall effect of the predictors of the models. We assessed the models’ discrimination using C-index and then compared the observed with the predicted risk of death using calibration plots. The sensitivity and specificity of the models were estimated at the risk thresholds of 3%, 5%, 7%, and 10%. An agreement between models was assessed using the intra-class correlation coefficient (ICC). We applied decision analysis to provide perception into the consequences of using the models in general practice; for this reason, the clinical usefulness of the models was assessed using the net benefit (NB) and decision curve analysis. The NB is a sensitivity penalized by a weighted false positive (FP) rate in population level.<br /></span><br /><span class="fontstyle0">Results</span><br /><span class="fontstyle2">After 154 522 person-years of follow-up, 437 cardiovascular deaths (280 men) occurred. The 10-year observed risks were 4.2% (95% CI: 3.7%-4.8%) in men and 2.1% (1.8-2%.5%) in women. The c-index for SCORE function was 0.784 (0.756-0.812) in men and 0.780 (0.744-0.815) in women. Corresponding values for Globorisk were 0.793 (0.766-0.820) and 0.793 (0.757-0.829). The deviation of the calibration slopes from one reflected a need for recalibration; after which, the predicted-to-observed ratio for both models was 1.02 in men and 0.95 in women. Models showed good agreement (ICC 0.93 in men, and 0.89 in women). Decision curve showed that using both models results in the same clinical usefulness at the risk threshold of 5%, in both men and women; however, at the risk threshold of 10%, Globorisk had better clinical usefulness in women (Difference: 8%, 95% CI: 4%-13%).<br /></span><br /><span class="fontstyle0">Conclusion</span><br /><span class="fontstyle2">Original Globorisk and SCORE models overestimate the CVD risk in Iranian populations resulting in a high number of people who need intervention. Recalibration could adopt these models to precisely predict CVD mortality. Globorisk showed better performance clinically, only among high-risk women.</span>https://www.ijhpm.com/article_3859_ab76e8e6e80735328695e978e4dd3afe.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Influence of Government Price Regulation on the Price, Volume and Spending of Antibiotics in China: A Controlled Interrupted Time Series Study218223386310.34172/ijhpm.2020.113ENHaishaerjiangWushouerCenter for Strategic Studies, Chinese Academy of Engineering, Beijing, ChinaSchool of Medicine, Tsinghua University, Beijing, ChinaInternational
Research Center for Medicinal Administration (IRCMA), Peking University,
Beijing, China0000-0003-1466-9840ZhenhuanLuoDepartment of Pharmacy Administration and Clinical Pharmacy,
School of Pharmaceutical Sciences, Peking University, Beijing, China0000-0002-3259-4005XiaodongGuanInternational
Research Center for Medicinal Administration (IRCMA), Peking University,
Beijing, ChinaDepartment of Pharmacy Administration and Clinical Pharmacy,
School of Pharmaceutical Sciences, Peking University, Beijing, China0000-0002-1290-3827LuwenShiInternational
Research Center for Medicinal Administration (IRCMA), Peking University,
Beijing, ChinaDepartment of Pharmacy Administration and Clinical Pharmacy,
School of Pharmaceutical Sciences, Peking University, Beijing, China0000-0003-2683-6685Journal Article20191212<span class="fontstyle0">Background</span><br /><span class="fontstyle2">Chinese government established maximum retail prices for antibiotics listed in China’s National Reimbursement List in February 2013. This study aimed to analyze the impact of pharmaceutical price regulation on the price, volume and spending of antibiotics in China.<br /></span><br /><span class="fontstyle0">Methods</span><br /><span class="fontstyle2">An interrupted time series design with comparison series was used to examine impacts of the policy changes on average daily cost, monthly hospital purchase volume and spending of the 11 price-regulated antibiotics and 40 priceunregulated antibiotics in 699 hospitals. One intervention point was applied to assess the impact of policy.<br /></span> <br /><span class="fontstyle0">Results</span><br /><span class="fontstyle2">After government price regulation, compared to price-unregulated antibiotics, the average daily cost of the price-regulated group declined rapidly (β = -5.68, </span><span class="fontstyle3">P </span><span class="fontstyle2">< .001). The average hospital monthly purchase spending of priceregulated antibiotics also decreased rapidly (β = -0.49, </span><span class="fontstyle3">P </span><span class="fontstyle2">< .010) and a positive trend change (β = 0.04, </span><span class="fontstyle3">P </span><span class="fontstyle2">< .001) in average hospital spending of price-unregulated antibiotics was found.<br /></span> <br /><span class="fontstyle0">Conclusion</span><br /><span class="fontstyle2">Government regulation can reduce the prices and spending of price-regulated antibiotics. To control increasing expenditure, besides price caps regulation, factors determining drug utilization also need to be considered in policy designing.</span>https://www.ijhpm.com/article_3863_097b144c9dd33cdc82fe2e01e4b068dd.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Preventing and Managing Conflict of Interest in Nutrition Policy: Lessons for Alcohol Control; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool”224227389310.34172/ijhpm.2020.161ENKatherineSeveriInstitute of Alcohol Studies (IAS), London, UK0000-0002-4282-0272Journal Article20200720Ralston et al present an analysis of policy actor responses to a draft World Health Organization (WHO) tool to prevent and manage conflicts of interest (COI) in nutrition policy. While the Ralston et al study is focussed explicitly on food and nutrition, the issues and concepts addressed are relevant also to alcohol policy debates and present an important opportunity for shared learning across unhealthy commodity industries in order to protect and improve population health. This commentary addresses the importance of understanding how alcohol policy actors – especially decision-makers – perceive COI in relation to alcohol industry engagement in policy. A better understanding of such perceptions may help to inform the development of guidelines to identify, manage and protect against risks associated with COI in alcohol policy.https://www.ijhpm.com/article_3893_599772660cc6776e3ee632946bbb4595.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201The World Health Organization, Corporate Power, and the Prevention and Management of Conflicts of Interest in Nutrition Policy; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool”228232389810.34172/ijhpm.2020.156ENGary JonasFooksDepartment of Sociology and Policy, Aston University, Birmingham, UK0000-0003-0080-4802CharlotteGodziewskiDepartment of Sociology and Policy, Aston University, Birmingham, UK0000-0002-7036-2387Journal Article20200702The World Health Organization’s (WHO’s) draft Decision-Making Process and Tool to assist governments in preventing and managing conflicts of interest in nutrition policy marks a step-change in WHO thinking on large corporations and nutrition policy. If followed closely it stands to revolutionise business-government relations in nutrition policy. Ralston and colleagues outline how the food and beverage industry have argued against the decision-making tool. This commentary expands on their study by setting industry framing within a broader analysis of corporate power and explores the challenges in managing industry influence in nutrition policy. The commentary examines how the food and beverage industry’s collaboration and partnership agenda seeks to shape how policy problems and solutions are interpreted and acted on and explores how this agenda and their efforts to define conflicts of interest effectively represent non-policy programmes. More generally, we point to the difficulties that member states will face in adopting the tool and highlight the importance of considering the central role of transnational food and beverage companies in contemporary economies to managing their influence in nutrition policy.https://www.ijhpm.com/article_3898_25baf8e8c348eee616066d7e41497feb.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Star Trek Offers Insights That Illuminate Actor Engagement in Global Nutrition Governance; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool”233238389910.34172/ijhpm.2020.158ENVivica I.KraakDepartment of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University,
Blacksburg, VA, USA0000-0002-9303-5530Journal Article20200702<span class="fontstyle0">This commentary describes insights from Star Trek’s fictional television series to understand how state and nonstate actors address conflicts of interest (COIs) through global nutrition governance. I examine the findings of Ralston and colleagues for 44 state and non-state actors who responded to the World Health Organization’s (WHO’s) consultation for a COI risk-assessment tool, developed for member states to engage effectively with non-state actors to address malnutrition in all forms. Star Trek reveals that actor engagement is inevitable in a shared universe. The Prime Directive is a non interference principle reflecting a moral commitment to reduce harm, respect autonomy and protect rights. Engagement principles are relevant to all actors who influence nutrition policies and programs, and must be held accountable when their actions undermine healthy and sustainable food systems. Certain actors use COI to justify non-engagement with commercial actors yet competing interests, biases, corruption and regulatory capture are distinct challenges to manage. Finally, Star Trek’s characters serve as allegories to understand actors’ motives and actions to promote healthy and sustainable food systems. Unlike non-state actors, states are legally required to achieve their commitments and targets in the United Nations’ (UN) Decade of Action on Nutrition (2016-2025) and Sustainable Development Goals (SDGs) 2030 Agenda.</span>https://www.ijhpm.com/article_3899_6b0d85db5aa3f09f134e41f72c360a6b.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201“Conflicted” Conceptions of Conflict of Interest: How the Commercial Sector Responses to the WHO Tool on Conflict of Interest in Nutrition Policy Are Part of Their Standard Playbook to Undermine Public Health; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool”239242390110.34172/ijhpm.2020.164ENA. RobMoodieMelbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia0000-0002-8425-7975Journal Article20200713<span class="fontstyle0">Managing conflict of interest (CoI) among the interested stake-holders in nutrition policy is a vexed and controversial issue. This commentary builds on Ralston and colleagues’ highly informative analysis of the 44 submissions to the World Health Organization (WHO) draft tool on preventing and managing CoI in national nutrition programs. The commentary proposes that the commercial sector actors are, by definition, too conflicted to objectively respond to the draft tool. The responses of the commercial sectors are predictable, as they mimic their positions during the prior negotiation for the development of the Framework for Engagement of Non-State Actors (FENSA). Their overall approach, and specific responses, are typical of the now standard methods of the ultra-processed food and beverage industry’s ‘corporate playbook.’ In addition, Ralston et al’s analysis raises a number of other issues, such as: why these corporations are so keen to be included in the world of multi-stakeholder partnerships, why so few member states responded to the draft tool, and problems with the term ‘private sector.’ The commentary ends with a suggestion for WHO to seek broader involvement from the 160+ member states who have yet to participate in the consultations regarding the draft tool.</span>https://www.ijhpm.com/article_3901_7fa943bd58e8a3b89915f2d218c7ada8.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Purveyors of the Commercial Determinants of Health Have No Place at Any Policy Table; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool”243245390710.34172/ijhpm.2020.171ENRonaldLabontéSchool of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada0000-0002-0615-740XJournal Article20200805With public health attention on the commercial determinants of health showing little sign of abatement, how to manage conflicts of interest (COI) in regulatory policy discussions with corporate actors responsible for these determinants is gaining critical traction. The contribution by Ralston et al explores how COI management has itself become a terrain of contestation in their analysis of submissions on a draft World Health Organization (WHO) tool to manage COI conflicts in development of nutrition policy. The authors identify two camps in conflict with one another: a corporate side emphasizing their individual good intents and contributions, and an non-governmental organization (NGO) side maintaining inherent structural conflicts that require careful proscribing. The study concludes that the draft tool does a reasonable job in ensuring COI are avoided and policy development sheltered from corporate self-interests, introducing novel improvements in global governance for health. At the same time, the tool appears to adhere to a belief that private economic (corporate) and public good (citizen) conflicts can indeed be managed. I question this assumption and posit that public health needs to be much bolder in its critique of the nature of power, influence, and self-interests that pervade and risk dominating our stakeholder models of global governance.https://www.ijhpm.com/article_3907_42b9a8654c7cb887b79646c43bcc75f9.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Tackling NCDs: The Need to Address Alcohol Industry Interference and Policy Incoherence Across Sectors; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool”246249390810.34172/ijhpm.2020.172ENBelindaTownsendMenzies Centre for Health Governance, School of Regulation and Global
Governance, Australian National University, Canberra, ACT, Australia0000-0002-2480-2820MiaMillerCentre
for Alcohol Policy Research, School of Psychology & Public Health, La Trobe
University, Melbourne, VIC, AustraliaDeborahGleesonSchool of Psychology and Public Health,
La Trobe University, Melbourne, VIC, AustraliaJournal Article20200804Ralston et al highlight the ways that different actors in global nutrition governance conceptualise and frame the role of non-state actors in governance arrangements, including the potential for conflict of interest (COI) to undermine global health efforts. The authors argue that the World Health Organization (WHO) draft tool on managing COI in nutrition policy is an important innovation in global health, but that further research and refinement is needed for operationalising the management of COI with diverse actors in diverse contexts. In this commentary, reflecting on strategic framing and industry interference in policy-making, we argue for the urgent need for states and intergovernmental organisations to prevent alcohol industry interference in the development of national and global alcohol policy. We argue that policy incoherence remains a key barrier, where governments pursue health goals in the health sector while pursuing exports and market liberalisation of health harmful commodities in the trade sector.https://www.ijhpm.com/article_3908_5dfb20205f70919a43d7bb83997497d9.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593911220220201Papering Over the Cracks in the NHS250251390010.34172/ijhpm.2020.160ENShujhatKhanDepartment of Medicine, Imperial College London, London, UK0000-0001-7125-4815AreebMianDepartment of Medicine, Imperial College London, London, UK0000-0002-4035-4052Journal Article20200515https://www.ijhpm.com/article_3900_aa9e6f0ba8b9660c88ab7dea8b3393dd.pdf