Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59395920160901Strategic Faults in Implementation of Hospital Accreditation Programs in Developing Countries: Reflections on the Iranian Experience515517321210.15171/ijhpm.2016.70ENAidinAryankhesalDepartment of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences,
Tehran, IranHealth Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran0000-0002-6695-227XJournal Article20160418Establishment of hospital accreditation programs is increasingly growing across numerous developing nations. Such initiatives aim to improve quality of care. However, such establishments, mainly incentivized by successful and famous accreditation plans in developed countries, usually suffer from lack of necessary arrangements which, in turn, result in undesired consequences. Indeed, the first priority for such nations, including Iran, is not establishment of accreditation programs, yet strict licensing plans.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59395920160901UK and Twenty Comparable Countries GDP-Expenditure-on-Health 1980-2013: The Historic and Continued Low Priority of UK Health-Related Expenditure519523324110.15171/ijhpm.2016.93ENAndrew J.E.HardingFaculty of Health & Social Sciences, Bournemouth University, Dorset, UKColinPritchardFaculty of Health & Social Sciences, Bournemouth University, Dorset, UKJournal Article20151124It is well-established that for a considerable period the United Kingdom has spent proportionally less of its gross domestic product (GDP) on health-related services than almost any other comparable country. Average European spending on health (as a % of GDP) in the period 1980 to 2013 has been 19% higher than the United Kingdom, indicating that comparable countries give far greater fiscal priority to its health services, irrespective of its actual fiscal value or configuration. While the UK National Health Service (NHS) is a comparatively lean healthcare system, it is often regarded to be at a ‘crisis’ point on account of low levels of funding. Indeed, many state that currently the NHS has a sizeable funding gap, in part due to its recently reduced GDP devoted to health but mainly the challenges around increases in longevity, expectation and new medical costs. The right level of health funding is a political value judgement. As the data in this paper outline, if the UK ‘afforded’ the same proportional level of funding as the mean averageEuropean country, total expenditure would currently increase by one-fifth.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59395920160901Operationalization of the Ghanaian Patients’ Charter in a Peri-urban Public Hospital: Voices of Healthcare Workers and Patients525533318810.15171/ijhpm.2016.42ENLilyYarneyDepartment of Public Administration and Health Services Management, Business School, University of Ghana, Accra, GhanaThomasBuabengDepartment of Public Administration and Health Services Management, Business School, University of Ghana, Accra, GhanaDianaBaidooDepartment of Public Administration and Health Services Management, Business School, University of Ghana, Accra, GhanaJustice NyigmahBawoleDepartment of Public Administration and Health Services Management, Business School, University of Ghana, Accra, GhanaJournal Article20150914Background <br />Health is a basic human right necessary for the exercise of other human rights. Every human being is, therefore, entitled to the highest possible standard of health necessary to living a life of dignity. Establishment of patients’ Charter is a step towards protecting the rights and responsibilities of patients, but violation of patients’ rights is common in healthcare institutions, especially in the developing world. This study which was conducted between May 2013 and May 2014, assessed the operationalization of Ghana’s Patients Charter in a peri-urban public hospital. <br /> <br />Methods <br />Qualitative data collection methods were used to collect data from 25 healthcare workers and patients who were purposively selected. The interview data were analyzed manually, using the principles of systematic text condensation. <br /> <br />Results <br />The findings indicate that the healthcare staff of the Polyclinic are aware of the existence of the patients’ Charter and also know some of its contents. Patients have no knowledge of the existence or the contents of the Charter. Availability of the Charter, community sensitization, monitoring and orientation of staff are factors that promote the operationalization of the Charter, while institutional implementation procedures such as lack of complaint procedures and low knowledge among patients militate against operationalization of the Charter. <br /> <br />Conclusion <br />Public health facilities should ensure that their patients are well-informed about their rights and responsibilities to facilitate effective implementation of the Charter. Also, patients’ rights and responsibilities can be dramatized and broadcasted on television and radio in major Ghanaian languages to enhance awareness of Ghanaians on the Charter.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59395920160901Correcting India’s Chronic Shortage of Drug Inspectors to Ensure the Production and Distribution of Safe, High-Quality Medicines535542319010.15171/ijhpm.2016.44ENAbhay B.KadamThe Foundation for Research in Community Health (FRCH), Pune, IndiaKarenMaigetterDepartment of Epidemiology and Public Health, Swiss Tropical and Public
Health Institute (Swiss TPH), Basel, SwitzerlandUniversity of Basel, Basel,
Switzerland0000-0003-0498-0803RogerJefferyCentre for South Asian Studies, School of Social and Political
Science, University of Edinburgh, Edinburgh, UKNerges F.MistryThe Foundation for Research in Community Health (FRCH), Pune, IndiaMitchell G.WeissDepartment of Epidemiology and Public Health, Swiss Tropical and Public
Health Institute (Swiss TPH), Basel, SwitzerlandUniversity of Basel, Basel,
SwitzerlandAllyson M.PollockGlobal Public Health Unit,
Queen Mary University of London, London, UKJournal Article20150920Background <br />Good drug regulation requires an effective system for monitoring and inspection of manufacturing and sales units. In India, despite widespread agreement on this principle, ongoing shortages of drug inspectors have been identified by national committees since 1975. The growth of India’s pharmaceutical industry and its large export market makes the problem more acute. <br /> <br />Methods <br />The focus of this study is a case study of Maharashtra, which has 29% of India’s manufacturing units and 38% of its medicines exports. India’s regulations were reviewed, comparing international, national and state inspection norms with the actual number of inspectors and inspections. Twenty-six key informant interviews were conducted to ascertain the causes of the shortfall. <br /> <br />Results <br />In 2009-2010, 55% of the sanctioned posts of drug inspectors in Maharashtra were vacant. This resulted in a shortfall of 83%, based on the Mashelkar Committee’s recommendations. Less than a quarter of the required inspections of manufacturing and sales units were undertaken. The Indian Drugs and Cosmetics Act and its Rules and Regulations make no provisions for drug inspectors and workforce planning norms, despite the growth and increasing complexity of India’s pharmaceutical industry. <br /> <br />Conclusion <br />The Maharashtra Food and Drug Administration (FDA) falls short of the Mashelkar Committee’s recommended workforce planning norms. Legislation and political and operational support are required to produce needed changes.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59395920160901The Politico-Economic Challenges of Ghana’s National Health Insurance Scheme Implementation543552319110.15171/ijhpm.2016.47ENAdamFusheiniCentre for Health Policy/MRC Health Policy Research Group, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand,
Johannesburg, South AfricaDepartment of Health Policy, Planning and Management, School of Public Health, University of Health and Allied
Sciences, Ho, Ghana0000-0001-7896-3841Journal Article20150728Background <br />National/social health insurance schemes have increasingly been seen in many low- and middle-income countries (LMICs) as a vehicle to universal health coverage (UHC) and a viable alternative funding mechanism for the health sector. Several countries, including Ghana, have thus introduced and implemented mandatory national health insurance schemes (NHIS) as part of reform efforts towards increasing access to health services. Ghana passed mandatory national health insurance (NHI) legislation (ACT 650) in 2003 and commenced nationwide implementation in 2004. Several peer review studies and other research reports have since assessed the performance of the scheme with positive rating while challenges also noted. This paper contributes to the literature on economic and political implementation challenges based on empirical evidence from the perspectives of the different category of actors and institutions involved in the process. <br /> <br /> <br />Methods <br />Qualitative in-depth interviews were held with 33 different category of participants in four selected district mutual health insurance schemes in Southern (two) and Northern (two) Ghana. This was to ascertain their views regarding the main challenges in the implementation process. The participants were selected through purposeful sampling, stakeholder mapping, and snowballing. Data was analysed using thematic grouping procedure. <br /> <br /> <br />Results <br />Participants identified political issues of over politicisation and political interference as main challenges. The main economic issues participants identified included low premiums or contributions; broad exemptions, poor gatekeeper enforcement system; and culture of curative and hospital-centric care. <br /> <br /> <br />Conclusion <br />The study establishes that political and economic factors have influenced the implementation process and the degree to which the policy has been implemented as intended. Thus, we conclude that there is a synergy between implementation and politics; and achieving UHC under the NHIS requires political stewardship. Political leadership has the responsibility to build trust and confidence in the system by providing the necessary resources and backing with minimal interference in the operations. For sustainability of the scheme, authorities need to review the exemption policy, rate of contributions, especially, from informal sector employees and recruitment criteria of scheme workers, explore additional sources of funding and re-examine training needs of employees to strengthen their competences among others.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59395920160901Governance: Blending Bureaucratic Rules with Day to Day Operational Realities; Comment on “Governance, Government, and the Search for New Provider Models”553555321110.15171/ijhpm.2016.69ENDavid PChinitzSchool of Public Health, Hebrew University-Hadassah, Jerusalem, IsraelJournal Article20160330Richard Saltman and Antonio Duran take up the challenging issue of governance in their article “Governance, Government and the Search for New Provider Models,” and use two case studies of health policy changes in Sweden and Spain to shed light on the subject. In this commentary, I seek to link their conceptualization of governance, especially its interrelated roles at the macro, meso, and micro levels of health systems, with the case studies on which they report. While the case studies focus on the shifts in governance between the macro and meso levels and their impacts on achievement of desired policy outcomes, they also highlight the need to better integrate the dynamics of day to day operations within micro organizations into the overall governance picture.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59395920160901Universal Health Coverage – The Critical Importance of Global Solidarity and Good Governance; Comment on “Ethical Perspective: Five Unacceptable Trade-offs on the Path to Universal Health Coverage”557559321610.15171/ijhpm.2016.61ENAndreas A.ReisGlobal Health Ethics Unit, Health Systems and Innovation Cluster, World Health Organization (WHO), Geneva, SwitzerlandJournal Article20160322This article provides a commentary to Ole Norheim’ s editorial entitled “Ethical perspective: Five unacceptable trade-offs on the path to universal health coverage.” It reinforces its message that an inclusive, participatory process is essential for ethical decision-making and underlines the crucial importance of good governance in setting fair priorities in healthcare. Solidarity on both national and international levels is needed to make progress towards the goal of universal health coverage (UHC).Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59395920160901U-Form vs. M-Form: How to Understand Decision Autonomy Under Healthcare Decentralization?; Comment on “Decentralisation of Health Services in Fiji: A Decision Space Analysis”561563321810.15171/ijhpm.2016.73ENArturo VargasBustamanteDepartment of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USAJournal Article20160420For more than three decades healthcare decentralization has been promoted in developing countries as a way of improving the financing and delivery of public healthcare. Decision autonomy under healthcare decentralization would determine the role and scope of responsibility of local authorities. Jalal Mohammed, Nicola North, and Toni Ashton analyze decision autonomy within decentralized services in Fiji. They conclude that the narrow decision space allowed to local entities might have limited the benefits of decentralization on users and providers. To discuss the costs and benefits of healthcare decentralization this paper uses the U-form and M-form typology to further illustrate the role of decision autonomy under healthcare decentralization. This paper argues that when evaluating healthcare decentralization, it is important to determine whether the benefits from decentralization are greater than its costs. The U-form and M-form framework is proposed as a useful typology to evaluate different types of institutional arrangements under healthcare decentralization. Under this model, the more decentralized organizational form (M-form) is superior if the benefits from flexibility exceed the costs of duplication and the more centralized organizational form (U-form) is superior if the savings from economies of scale outweigh the costly decision-making process from the center to the regions. Budgetary and financial autonomy and effective mechanisms to maintain local governments accountable for their spending behavior are key decision autonomy variables that could sway the cost-benefit analysis of healthcare decentralization.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59395920160901Expanded HTA, Legitimacy and Independence; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”565567322010.15171/ijhpm.2016.75ENKeithSyrettCardiff School of Law and Politics, Cardiff University, Wales, UKJournal Article20160416This brief commentary seeks to develop the analysis of Daniels, Porteny and Urrutia of the implications of expansion of the scope of health technology assessment (HTA) beyond issues of safety, efficacy, and cost-effectiveness. Drawing in particular on experience in the United Kingdom, it suggests that such expansion can be understood not only as a response to the problem of insufficiency of evidence, but also to that of legitimacy. However, as expansion of HTA also renders it more visibly political in character, it is plausible that its legitimacy may be undermined, rather than enhanced by, independence from the policy process.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59395920160901Re-Conceptualising Public Health Interventions in Government: A Response to Recent Commentaries569570323810.15171/ijhpm.2016.91ENGemmaCareyBusiness School, University of New South Wales, Canberra, ACT, Australia0000-0001-7698-9044Journal Article20160620