What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review
Pascale
Lehoux
Department of Health Management, Evaluation and Policy, School of Public
Health, University of Montreal, Montreal, QC, Canada
author
Federico
Roncarolo
Institute of Public Health
Research of University of Montreal (IRSPUM), University of Montreal, Montreal,
QC, Canada
author
Hudson Pacifico
Silva
Institute of Public Health
Research of University of Montreal (IRSPUM), University of Montreal, Montreal,
QC, Canada
author
Antoine
Boivin
Department of Family Medicine, University of Montreal, Montreal,
QC, Canada
author
Jean-Louis
Denis
Department of Health Management, Evaluation and Policy, School of Public
Health, University of Montreal, Montreal, QC, Canada
author
Réjean
Hébert
School of Public Health, University of Montreal,
Montreal, QC, Canada
author
text
article
2019
eng
Background While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems’ demand for innovations. Methods We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed. Results Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored. Conclusion Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
2
no.
2019
63
75
https://www.ijhpm.com/article_3572_28e333dd03b56823ee0c7ab76916ceae.pdf
dx.doi.org/10.15171/ijhpm.2018.110
Smog, Cognition and Real-World Decision-Making
Xi
Chen
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
author
text
article
2019
eng
Cognitive functioning is critical as in our daily life a host of real-world complex decisions in high-stakes markets have to be made. The decision-making process can be vulnerable to environmental stressors. Summarizing the growing economic and epidemiologic evidence linking air pollution, cognition performance and real-world decision-making, we first illustrate key physiological and psychological pathways between air pollution and cognition. We then document the main patterns of air pollution affecting cognitive test performance by type of cognitive tests, gender, window of exposure, age profile, and educational attainment. We further extend to a review of real-world decision-making that has been found to be affected by air pollution and the resulting cognitive impairments. Finally, rich implications on environmental health policies are drawn based on existing evaluations of social costs of air pollution.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
2
no.
2019
76
80
https://www.ijhpm.com/article_3558_68e1c1d9b92a653df070d0e3733efd96.pdf
dx.doi.org/10.15171/ijhpm.2018.105
Content Analysis of Media Coverage of Childhood Obesity Topics in UAE Newspapers and Popular Social Media Platforms, 2014-2017
Niyi
Awofeso
School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, UAE
author
Sara
Al Imam
School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, UAE
author
Arwa
Ahmed
School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, UAE
author
text
article
2019
eng
The 2017 prevalence of obesity among children (age 5–17 years) in the United Arab Emirates (UAE) is 13.68%. Childhood obesity is one of the 10 top health priorities in the UAE. This study examines the quality, frequency, sources, scope and framing of childhood obesity in popular social media and three leading UAE newspapers from 2014 to 2017. During the review period, 152 newspaper articles from three leading national newspapers – Gulf News, The National and Al Ittihad – met the eligibility criteria for this study. There were 57 Facebook posts, 50 Twitter posts, 14 posted YouTube videos, and 13 Media releases on related to childhood obesity between 2014 and 2017. Childhood obesity was consistently problematized, primarily in health terms, but was not strongly linked to socio-economic and geographical factors. Childhood obesity was framed as being predominantly influenced by individual and parental behaviours more frequently (n = 76) compared with structural or environmental factors such as the roles of the food and beverage industry (n = 22). Unlike findings from studies with adult obesity, articles advocating individual behavior changes to address childhood obesity were relatively few (n = 29). Social media may be an effective way to help children overcome obesity, in part through online interaction with health care providers and health conscious obese peers. Areas for improvement in social media use to reduce childhood obesity prevalence in UAE include enhancing public engagement with social media posts on childhood obesity, as reflected in the numbers of Likes and Retweets or Shares.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
2
no.
2019
81
89
https://www.ijhpm.com/article_3565_03813794338ab0cde34bea5ce1b187fc.pdf
dx.doi.org/10.15171/ijhpm.2018.100
Decentralisation and Health Services Delivery in 4 Districts in Tanzania: How and Why Does the Use of Decision Space Vary Across Districts?
Ramadhani
Kigume
Department of History, Political Science & Development Studies, Dar es
Salaam University College of Education, Dar es Salaam, Tanzania
author
Stephen
Maluka
Institute of
Development Studies, University of Dar es Salaam, Dar es Salaam, Tanzania
author
text
article
2019
eng
Background Decentralisation in the health sector has been promoted in low- and middle-income countries (LMICs) for many years. Inherently, decentralisation grants decision-making space to local level authorities over different functions such as: finance, human resources, service organization, and governance. However, there is paucity of studies which have assessed the actual use of decision-making space by local government officials within the decentralised health system. The objective of this study was to analyse the exercise of decision space across four districts in Tanzania and explore why variations exist amongst them. Methods The study was guided by the decision space framework and relied on interviews and documentary reviews. Interviews were conducted with the national, regional and district level officials; and data were analysed using thematic approach. Results Decentralisation has provided moderate decision space on the Community Health Fund (CHF), accounting for supplies of medicine, motivation of health workers, additional management techniques and rewarding the formally established health committees as a more effective means of community participation and management. While some districts innovated within a moderate range of choice, others were unaware of the range of choices they could utilise. Leadership skills of key district health managers and local government officials as well as horizontal relationships at the district and local levels were the key factors that accounted for the variations in the use of the decision space across districts. Conclusion This study concludes that more horizontal sharing of innovations among districts may contribute to more effective service delivery in the districts that did not have active leadership. Additionally, the innovations applied by the best performing districts should be incorporated in the national guidelines. Furthermore, targeted capacity building activities for the district health managers may improve decision-making abilities and in turn improve health system performance.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
2
no.
2019
90
100
https://www.ijhpm.com/article_3552_244889c08298710b372b80942116136a.pdf
dx.doi.org/10.15171/ijhpm.2018.97
Coming Full Circle: How Health Worker Motivation and Performance in Results-Based Financing Arrangements Hinges on Strong and Adaptive Health Systems
Sumit
Kane
KIT Royal Tropical Institute, Amsterdam, The Netherlands
author
Crecentia
Gandidzanwa
Independent Consultant
author
Ronald
Mutasa
World Bank
Group, Washington, DC, USA
author
Irene
Moyo
Independent Consultant
author
Chenjerai
Sismayi
World Bank
Group, Washington, DC, USA
author
Patron
Mafaune
Ministry of Health and Child Care, Government
of Zimbabwe, Harare, Zimbabwe
author
Marjolein
Dieleman
KIT Royal Tropical Institute, Amsterdam, The Netherlands
author
text
article
2019
eng
Background This paper presents findings from a study which sought to understand why health workers working under the results-based financing (RBF) arrangements in Zimbabwe reported being satisfied with the improvements in working conditions and compensation, but paradoxically reported lower motivation levels compared to those not working under RBF arrangements. Methods A qualitative study was conducted amongst health workers and managers working in health facilities that were implementing the RBF arrangements and those that were not. Through purposeful sampling, four facilities in RBF implementing districts that reported poor motivation and satisfaction, were included as study sites. Four facilities located in non-RBF districts which reported high motivation and satisfaction were also included. Data was collected through in-depth interviews and analyzed using the framework approach. Results Results based financing arrangements introduce a wide range of new institutional arrangements, roles, tasks, and ways of doing things, for facility staff, facility managers and, district and provincial health management teams. Findings reveal that insufficient preparedness of people and processes for this change, constrained managers and workers performance. Results based financing arrangements introduce explicit and tacit changes, including but not limited to, incentive logics, in the system. Findings show that unless systematic efforts are made to enable the absorption of these changes in the system: eg, through reconfiguring the decision space available at various levels, through clarification of accountability relationships, through building personnel and process capacities, before instituting changes, the full potential of the RBF arrangements cannot be realised. Conclusion Our study demonstrates the importance of analysing existing institutional, management and governance arrangements and capabilities and taking these into account when designing and implementing RBF interventions. Introducing RBF arrangements cannot alone overcome chronic systemic weaknesses. For a system wide change, as RBF arguably is, to be effected, explicit organisational change management processes need to be put in place, across the system. Carefully designed processes, which take into account the interest and willingness of various actors to change, and which are cognizant of and constructively engage with potential bottlenecks and points of resistance, should accompany any health system change initiative.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
2
no.
2019
101
111
https://www.ijhpm.com/article_3557_7e12aa69c0db0b42249563540800973f.pdf
dx.doi.org/10.15171/ijhpm.2018.98
Improving Care for the Frail in Nova Scotia: An Implementation Evaluation of a Frailty Portal in Primary Care Practice
Beverley
Lawson
Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
author
Tara
Sampalli
Research and Innovation, Nova Scotia Health Authority, Primary Health Care
& Chronic Disease Management, Halifax, NS, Canada
author
Grace
Warner
School of Occupational Therapy, Dalhousie University,
Halifax, NS, Canada
author
Fred
Burge
Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
author
Paige
Moorhouse
Division
of Geriatric Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
author
Rick
Gibson
Department of Family Practice, Nova Scotia Health Authority, Halifax,
NS, Canada
author
Stephanie
Wood
Primary Health Care, Nova Scotia Health Authority, Halifax,
NS, Canada
author
Ashley
Harnish
Primary Health Care, Nova Scotia Health Authority, Halifax,
NS, Canada
author
Lisa G.
Bedford
Primary Health Care, Nova Scotia Health Authority, Halifax,
NS, Canada
author
Lynn
Edwards
Primary Heath Care, Family Practice and Chronic Disease
and Wellness, Nova Scotia Health Authority, Halifax, NS, Canada
author
Shannon
Ryan-Carson
Chronic
Disease and Wellness, Nova Scotia Health Authority, Halifax, NS, Canada
author
text
article
2019
eng
Background Understanding and addressing the needs of frail patients has been identified as an important strategy by the Nova Scotia Health Authority (NSHA). Primary care (PC) providers are in a key position to aid in the identification of, and response to frailty as part of routine care. Unlike singular chronic conditions such as diabetes and hypertension which garner a disease-based approach and identification as part of standard practice, frailty is only just emerging as a concept for PC. The web-based Frailty Portal was developed to aid in the identification of, assessment and care planning for frail patients in PC practice. In this study we assess the implementation feasibility and impact of the Frailty Portal by: (1) identifying factors influencing the Frailty Portal’s use in community PC practice, and (2) examination of the immediate impact of the ‘Frailty Portal’ on frail patients, their caregivers and PC providers. Methods A convergent mixed method approach was implemented among PC providers in community-based practice in the NSHA, Central Zone. Quantitative and qualitative data were collected concurrently over a 9-month period. A sample of patients who underwent assessment and/or their caregiver were approached for survey participation. Results Fourteen community PC providers (10 family physicians, 4 nurse practitioners) completed 48 patient assessments and completed or begun 41 care plans; semi-structured interviews were conducted among 9 providers. Nine patients and 5 caregivers participated in the survey. PC providers viewed frailty as an important concept but implementation challenges were met, primarily with respect to the time required for use and lack of fit with traditional practice routines. Additional barriers included tool usability and accessibility, training and care planning steps, and privacy. Impacts of the tools use with respect to confidence and knowledge showed early promise. Conclusion This feasibility study highlights the need for added health system supports, resources and financial incentives for successful implementation of the Frailty Portal in community PC practice. We suggest future implementation integrate the Frailty Portal to practice electronic medical records (EMRs) and target providers with largely geriatric practice populations and those practicing within interdisciplinary, collaborative primary healthcare (PHC) teams.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
2
no.
2019
112
123
https://www.ijhpm.com/article_3561_2ac81993d928143e39a981b3d1d2f45a.pdf
dx.doi.org/10.15171/ijhpm.2018.102
From Craft to Reflective Art and Science; Comment on “Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review”
Antoine
Boivin
Center of Excellence on Partnership with Patients and the Public, University of Montreal Hospital Research Center (CRCHUM), Montreal, QC, Canada
author
text
article
2019
eng
Patient engagement practices are increasingly incorporated in health research, governance, and care. More recently, a large number of evaluation tools and metrics have been developed to support engagement evaluation. This growing interest in evaluation reflects a maturation of the patient engagement field, moving from a “craft” to a reflective “art and science,” with more explicit expected benefits and risks, better understood conditions for success and failure, and increasingly rigorous evaluation instruments to improve engagement theories and interventions. It also supports a more critical view of engagement science, moving beyond reductionist views of engagement as a “black box technology” to a more subtle view of this broad category of complex interventions. Structured evaluation can advance patient engagement by supporting more reflective partnerships between patients, clinicians, health system leaders and citizens. This can help clarify mutual (and potentially contradictory) expectations toward engagement, provide a reality check toward claims of benefits and harms, and increase health systems’ capacity to implement effective engagement practices over time. To do so, closer collaborations are required between engagement scientists and practitioners to align the theories, practice and evaluation of patient and community engagement.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
2
no.
2019
124
127
https://www.ijhpm.com/article_3563_63e7d2d38f63f6e4304ac5b315b3cda9.pdf
dx.doi.org/10.15171/ijhpm.2018.108
The Human Resources for Health Program in Rwanda – Reflections on Achievements and Challenges; Comment on “Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda”
Hélène
Delisle
Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
author
text
article
2019
eng
This commentary is a further discussion of a paper published in this journal on the health professional training initiative led by the Government of Rwanda since 2012 and presented as a case study. According to the authors, the partnership program with international academic institutions may serve as model for other countries to address the shortage of health professionals and to strengthen institutional capacity, based on the competency-based and innovative training programs, the numbers of graduates, the improved quality of health services and institution strengthening. However, the conditions may not be as optimal elsewhere. A supportive government policy, massive funding and an academic consortium comprised of 19 United States academic institutions have contributed to the success of the program. We also noted that the trained professionals were clinicians almost exclusively, at the expense of public health specialists and other health professionals who can better address emerging issues such as non-communicable diseases (NCDs) particularly for their prevention, which is now compelling. Among others, the training of more nutritionists as members of the health team is needed.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
2
no.
2019
128
131
https://www.ijhpm.com/article_3567_206ec9889b8da570fc2bd770ad48b21b.pdf
dx.doi.org/10.15171/ijhpm.2018.114
Disease Control Priorities Third Edition: Time to Put a Theory of Change Into Practice; Comment on “Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy”
Wanrudee
Isaranuwatchai
Health Intervention and Technology Assessment Program, Ministry of Public
Health, Nonthaburi, Thailand
author
Ryan
Li
School of Public Health, Imperial College London, London, UK
author
Amanda
Glassman
Center for
Global Development, London, UK
author
Yot
Teerawattananon
Health Intervention and Technology Assessment Program, Ministry of Public
Health, Nonthaburi, Thailand
author
Anthony J.
Culyer
Department of Economics and Related
Studies and Centre for Health Economics, University of York, York, UK
author
Kalipso
Chalkidou
School of Public Health, Imperial College London, London, UK
author
text
article
2019
eng
The Disease Control Priorities program (DCP) has pioneered the use of economic evidence in health. The theory of change (ToC) put forward by Norheim is a further welcome and necessary step towards translating DCP evidence into better priority setting in low- and middle-income countries (LMICs). We also agree that institutionalising evidence for informed priority-setting processes is crucial. Unfortunately, there have been missed opportunities for the DCP program to challenge ill-judged global norms about opportunity costs and too little respect has been shown for the wider set of local circumstances that may enable, or disable, the productive application of the DCP evidence base. We suggest that the best way forward for the global health community is a new platform that integrates the many existing development initiatives and that is driven by countries’ asks.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
2
no.
2019
132
135
https://www.ijhpm.com/article_3571_4c17afc45eec469d4f01376ebc51706a.pdf
dx.doi.org/10.15171/ijhpm.2018.115
Where is Patient Safety Research and Practice Heading? A Response to Recent Commentaries
Russell
Mannion
Health Services Management Centre, University of Birmingham, Birmingham,
UK
author
Jeffrey
Braithwaite
Australian Institute of Health Innovation, Macquarie University, Sydney,
NSW, Australia
author
text
article
2019
eng
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
8
v.
2
no.
2019
136
137
https://www.ijhpm.com/article_3568_d809fa8ce428821679ec20adbdea6af3.pdf
dx.doi.org/10.15171/ijhpm.2018.112