Governance Roles and Capacities of Ministries of Health: A Multidimensional Framework
Kabir
Sheikh
Alliance for Health Policy and Systems Research, World Health Organization,
Geneva, Switzerland
author
Veena
Sriram
University of Chicago, Chicago, IL, USA
author
Benjamin
Rouffy
World
Health Organization, Geneva, Switzerland
author
Benjamin
Lane
World
Health Organization, Geneva, Switzerland
author
Agnes
Soucat
World
Health Organization, Geneva, Switzerland
author
Maryam
Bigdeli
World
Health Organization, Geneva, Switzerland
author
text
article
2021
eng
The lack of capacity for governance of Ministries of Health (MoHs) is frequently advanced as an explanation for health systems failures in low- and middle-income countries (LMICs). But do we understand what governance capacities MoHs should have? Existing frameworks have not fully captured the dynamic and contextually determined role of MoHs, and there are few frameworks that specifically define capacities for governance. We propose a multidimensional framework of capacities for governance by MoHs that encompasses both the “hard” (de jure, explicit and functional) and “soft” (de facto, tacit, and relational) dimensions of governance, and reflects the diversification of their mandates in the context of the Sustainable Development Goals (SDGs). Four case studies illustrate different aspects of the framework. We hope that the framework will have multiple potential benefits including benchmarking MoH governance capacities, identifying and helping analyze capacity gaps, and guiding strategies to strengthen capacity.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
237
243
https://www.ijhpm.com/article_3779_c045c8db5bce01f279a3b6dd374821b0.pdf
dx.doi.org/10.34172/ijhpm.2020.39
Effects of Activity-Based Hospital Payments in Israel: A Qualitative Evaluation Focusing on the Perspectives of Hospital Managers and Physicians
Ruth
Waitzberg
The Smokler Center for Health Policy Research, Myers-JDC-Brookdale
Institute, Jerusalem, Israel
author
Wilm
Quentin
Department of Health Care Management,
Faculty of Economics & Management, Technical University Berlin, Berlin,
Germany
author
Elad
Daniels
The Smokler Center for Health Policy Research, Myers-JDC-Brookdale
Institute, Jerusalem, Israel
author
Yael
Paldi
Maccabi Healthcare Services, Tel Aviv-Yafo, Israel
author
Reinhard
Busse
Department of Health Care Management,
Faculty of Economics & Management, Technical University Berlin, Berlin,
Germany
author
Dan
Greenberg
Department of Health Systems Management,
School of Public Health, Faculty of Health Sciences, Ben-Gurion University
of the Negev, Beer-Sheva, Israel
author
text
article
2021
eng
Background Since 2010, Israel has expanded the adoption of procedure-related group (PRG) based payments for hospitals. While there is a rich quantitative literature that assesses the effects of payment reforms on efficiency or quality of care, very few qualitative studies have focused on the impacts of diagnosis-related group (DRG)-like payments on hospitals from the perspective of hospital workers as change agents. Methods We used a qualitative, thematic analysis based on 33 semi-structured in-depth interviews with chief executive officers (CEOs), chief financial officers (CFOs), ward directors and physicians conducted in five public hospitals in Israel, sampled by maximum variation according to hospital characteristics. Results Interviewees reported that the payment reform led to organizational changes such as increased transparency and enhanced supervision. Interviewees also reported several actions in response to the economic incentives of PRGbased payment. These included (1) shifting activities to afterhours and using operating rooms (ORs) more efficiently to enable increased surgical volumes; (2) reducing costs by shortening lengths of stay and increasing cost-consciousness in procurement; and (3) increasing revenues by improving coding and selecting procedures. Moderating factors reduced the effects of the reform. For example, organizational factors such as the public nature of hospitals or the (un)availability of healthcare resources did not always allow hospitals to increase the number of cases treated. Also, conflicting incentives such as multiple payment mechanisms or underpricing of procedures blurred the incentives of the reform. Finally, managers and physicians have many other considerations that outweigh the economic ones. Conclusion PRG payments affected the organizational dynamics of hospitals and changed decision-making about admission and treatment policies. However, such effects were moderated by many other factors that should be considered when shaping and analyzing hospital payment reforms.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
244
254
https://www.ijhpm.com/article_3791_b4b9d8e097fc8cd4966f538e4056458f.pdf
dx.doi.org/10.34172/ijhpm.2020.51
Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool
Rob
Ralston
Global Health Policy Unit, Social Policy, School of Social and Political Science,
University of Edinburgh, Edinburgh, UK
author
Sarah E.
Hill
Global Health Policy Unit, Social Policy, School of Social and Political Science,
University of Edinburgh, Edinburgh, UK
author
Fabio da Silva
Gomes
Department of Noncommunicable Diseases and Mental Health, Pan-American
Health Organization/World Health Organization, Washington, DC, USA
author
Jeff
Collin
Global Health Policy Unit, Social Policy, School of Social and Political Science,
University of Edinburgh, Edinburgh, UK
author
text
article
2021
eng
BackgroundWith multi-stakeholder approaches central to efforts to address global health challenges, debates around conflict of interest (COI) are increasingly prominent. The World Health Organization (WHO) recently developed a proposed tool to support member states in preventing and managing COI in nutrition policy. We analysed responses to an online consultation to explore how actors from across sectors understand COI and the ways in which they use this concept to frame the terms of commercial sector engagement in health governance. MethodsSubmissions from 44 Member States, international organisations, non-governmental organizations (NGOs), academic institutions and commercial sector actors were coded using a thematic framework informed by framing theory. Respondents’ orientation to the tool aligned with two broad frames, ie, a ‘collaboration and partnership’ frame that endorsed multi-stakeholder approaches and a ‘restricted engagement’ frame that highlighted core tensions between public health and food industry actors. ResultsResponses to the WHO tool reflected contrasting conceptualisations of COI and implications for health governance. While most Member States, NGOs, and academic institutions strongly supported the tool, commercial sector organisations depicted it as inappropriate, unworkable and incompatible with the Sustainable Development Goals (SGDs). Commercial sector respondents advanced a narrow, individual-level understanding of COI, seen as adequately addressed by existing mechanisms for disclosure, and viewed the WHO tool as unduly restricting scope for private sector engagement in nutrition policy. In contrast, health-focused NGOs and several Member States drew on a more expansive understanding of COI that recognised scope for wider tensions between public health goals and commercial interests and associated governance challenges. These submissions mostly welcomed the tool as an innovative approach to preventing and managing such conflicts, although some NGOs sought broader exclusion of corporate actors from policy engagement. ConclusionSubmissions on the WHO tool illustrate how contrasting positions on COI are central to understanding broader debates in nutrition policy and across global health governance. Effective health governance requires greater understanding of how COI can be conceptualised and managed amid high levels of contestation on policy engagement with commercial sector actors. This requires both ongoing innovation in governance tools and more extensive conceptual and empirical research.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
255
265
https://www.ijhpm.com/article_3793_f709da473aef3c77acff6810ba79c2a5.pdf
dx.doi.org/10.34172/ijhpm.2020.52
A Cross-sectional Analysis of Facebook Comments to Study Public Perception of the Mass Drug Administration Program in the Philippines
Ryan V.
Labana
Department of Biology, College of Science, Polytechnic University of the
Philippines, Sta. Mesa, Philippines
author
Veeranoot
Nissapatorn
School of Allied Health Sciences (Southeast
Asia Water Team), Walailak University, Nakhon Si Thammarat, Thailand
author
Kristel Joy S.
Cada
Biology Department,
College of Arts and Sciences, New Era University, Quezon City, Philipppines
author
Khristine L.
Sandoval
College of Arts and Sciences, National University-Laguna, Calamba Laguna,
Philippines
author
text
article
2021
eng
Mass Drug Administration (MDA) of albendazole is being implemented in the Philippines to eliminate soil-transmitted helminthiasis (STH) among school-age children (SAC). The first round of MDA for the school year 2019-2020 was suspended in the province of Surigao del Norte due to a reported death of a student after deworming. It was broadcasted on a national television and the story was then posted on Facebook. We used structured and simple nature of social media research to study public perception of the MDA program after the controversial issue in the Philippines. The news story was assessed, and the Facebook comments were analyzed. A large portion of the Facebook comments expressed a declining trust of the Filipinos toward MDA. The negative impact could be attributed to the public-initiated discussion and sharing of comments with no solid evidence in Facebook. This study showed a possible threat to the successful implementation of the program if not properly managed. The Department of Health (DOH) should be able to cope with the developing landscape of public perception during the era of social media.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
266
272
https://www.ijhpm.com/article_3794_9196aec000df097f33191adbfcdab60d.pdf
dx.doi.org/10.34172/ijhpm.2020.55
Improve the Design and Implementation of Metrics From the Perspective of Complexity Science; Comment on “Gaming New Zealand’s Emergency Department Target: How and Why Did It Vary Over Time and Between Organisations?”
Junqiao
Chen
The CareVoice, Shanghai, China
author
text
article
2021
eng
From the perspective of complexity science, this commentary addresses Tenbensel and colleagues’ study, which reveals varied gaming behaviours to meet the New Zealand Emergency Department (ED) metric. Seven complexity-informed principles previously published in this Journal are applied to formulate recommendations to improve the design and implementation of metrics. (1) Acknowledge unpredictability. When designing a metric, policy-makers need to leave room for flexibility to account for unforeseen situations. When implementing a metric, they need to promote sense-making of relevant stakeholders. (2) Sense-making shall be encouraged because it is a social process to understand a metric, align values and develop a coherent strategy. Sense-making is important to (3) cope with self-organised gaming behaviours and to (4) facilitate interdependencies between ED and other departments as well as organisations. (5) We also need to attend to the relationship between senior management and frontline staff. Additionally, to address one of the methodological weaknesses in Tenbensel and colleagues’ study, (6) adaptive research approach is needed to better answer emerging questions. (7) Conflict should be harnessed productively. I hope these recommendations could limit gaming in future metrics and encourage stakeholders to view inevitable gaming as an improvement opportunity.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
273
276
https://www.ijhpm.com/article_3784_ade26c848dcc295198906d9fa232ede6.pdf
dx.doi.org/10.34172/ijhpm.2020.47
Without Systems and Complexity Thinking There Is no Progress - or Why Bureaucracy Needs to Become Curious; Comment on “What Can Policy-Makers Get out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”
Joachim P.
Sturmberg
School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
author
text
article
2021
eng
The bureaucracy’s goal is to maintain uniformity and control within discrete areas of activity and relies on hierarchical processes and procedural correctness as means to suppress autonomous decision making. That worldview, however, is unsuited for problem solving of real world VUCA (Volatility, uncertainty, complexity and ambiguity) problems. Solving wicked problems in the VUCA world requires curiosity, creativity and collaboration, and a willingness to deeply engage and an ability to painstakingly work through their seemingly contradictory and chaotic pathways. In addition, it necessitates leadership. Leaders require a deep – indeed academic – understanding of the nature of the problems and the veracity of various problem-solving approaches. Leadership after all means “[facilitating] the necessary adaptive work that needs to be done by the people connected to the problem.” That are the people at the coalface who understand and have to manage the complexities relating to problems unique to their local environment for which of the shelf solutions never work. Systems and complexity thinking is more than a tool, it is – in a sense – a way of being, namely deeply interested in understanding the highly interconnected and interdependent nature of the issues affecting our life and work. Hence, system and complexity thinking is, contrary to what Haynes and colleagues state in their “summation for the public reader,” neither “overwhelming and hard [nor difficult] to use practically.” Such a view is as much misleading as self-defeating.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
277
280
https://www.ijhpm.com/article_3783_2b251ec4e0f0344558dc2705dc310b2b.pdf
dx.doi.org/10.34172/ijhpm.2020.45
Overcoming Barriers to Applying Systems Thinking Mental Models in Policy-Making; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”
Sobia
Khan
The Center for Implementation, Toronto, ON, Canada
author
text
article
2021
eng
Systems thinking provides the health system with important theories, models and approaches to understanding and assessing complexity. However, the utility and application of systems thinking for solution-generation and decision-making is uncertain at best, particularly amongst health policy-makers. This commentary aims to elaborate on key themes discussed by Haynes and colleagues in their study exploring policy-makers’ perceptions of an Australian researcher-policy-maker partnership focused on applications of systems thinking. Findings suggest that policy-makers perceive systems thinking as too theoretical and not actionable, and that the value of systems thinking can be gleaned from greater involvement of policy-makers in research (ie, through co-production). This commentary focuses on the idea that systems thinking is a mental model that, contrary to researchers’ beliefs, may be closely aligned with policy-makers’ existing worldviews, which can enhance adoption of this mental model. However, wider application of systems thinking beyond research requires addressing multiple barriers faced by policy-makers related to their capability, opportunity and motivation to action their systems thinking mental models. To make systems thinking applicable to the policy sphere, multiple approaches are required that focus on capacity building, and a shift in shared mental models (or the ideas and institutions that govern policy-making).
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
281
283
https://www.ijhpm.com/article_3787_7136b0cf80561fdf020f300de2871386.pdf
dx.doi.org/10.34172/ijhpm.2020.50
Can Systems Thinking Become “The Way We Do Things?”; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”
Bev J.
Holmes
Michael Smith Foundation for Health Research, Vancouver, BC, Canada
author
text
article
2021
eng
In “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health,” Haynes et al glean two important insights from the policy-makers they interview. First: active promotion of systems thinking may work against its champions. Haynes and colleagues’ findings support a backgrounding of systems thinking; more important for policy-makers than understanding the finer details of systems thinking is working in situations of mutual learning and shared expertise. Second: coproduction may be getting short shrift in prevention research. Most participant comments were not about systems thinking, but about the benefits of working across sectors. Operationalizing the ‘co’ in co-production is not easy, but it may be where the pay-off will be for prevention researchers, who must understand the critical success factors of co-production and its potential pitfalls, to capitalize on its significant opportunities.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
284
286
https://www.ijhpm.com/article_3808_627b0c41956f6357ac3313c76f05efde.pdf
dx.doi.org/10.34172/ijhpm.2020.70
But Does It Work? Evidence, Policy-Making and Systems Thinking; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”
Tara
Lamont
Wessex Institute, University of Southampton, Southampton, UK
author
text
article
2021
eng
Systems thinking provides new ways of seeing the world, focusing attention on the relationship between elements in complex systems and the spaces inbetween. Haynes study shows that many policy-makers valued systems thinking as a new way to approach old problems. But they also wanted greater focus on useful policy solutions. This raises interesting questions about the tensions between complexity and simple, action-oriented solutions and how evidence is used in decision-making. Backstage understanding of the complexity of policy problems is matched with the frontstage need to focus on what works. This reflects trends in recent public policy for evidence centres providing decision-makers with toolkits and dashboards of ‘proven’ interventions. There are good examples of evaluations using systems thinking allowing for complexity while addressing policy-maker needs to be accountable for public investment and decisions. Strategic communication skills are needed to provide compelling stories which embrace systems thinking without losing clarity and impact.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
287
289
https://www.ijhpm.com/article_3813_93ad1df8269c0f300dea178a1a8a41e9.pdf
dx.doi.org/10.34172/ijhpm.2020.71
The Challenges of Putting Systems Thinking into Practice; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”
John
Boswell
Politics and International Relations, University of Southampton, Southampton,
UK
author
Janis
Baird
Human Development and Health, University of Southampton, Southampton,
UK
author
Ravita
Taheem
Human Development and Health, University of Southampton, Southampton,
UK
author
text
article
2021
eng
In theory, ‘systems thinking’ offers a remarkably attractive solution to the persistent challenges of preventive public health. Haynes and colleagues’ recent analysis of the Prevention Centre in Australia offers reason for optimism that it might be possible to translate this promise into action on the ground. In this commentary, we critically assess the claims from this promising case study and their broader applicability to the cause of preventive health. We argue that, in many other contexts, persistent obstacles remain, such as a lack of buy-in from senior policy actors, and a lack of tangible or concrete action following through on an abstract commitment to systems thinking.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
290
292
https://www.ijhpm.com/article_3827_15973b1e6421775ac4a943ef987bce8f.pdf
dx.doi.org/10.34172/ijhpm.2020.92
Unresolved Issues in Implementing Integrated Management of Childhood Illness (IMCI) Approach
Masahiro J.
Morikawa
Department of Family Medicine, University of Virginia, Charlottesville, VA, USA
author
text
article
2021
eng
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
10
v.
5
no.
2021
293
294
https://www.ijhpm.com/article_3823_b1ed8d054278a11dd558c4f3d099639a.pdf
dx.doi.org/10.34172/ijhpm.2020.89