ORIGINAL_ARTICLE
We Need to Talk About Corruption in Health Systems
The health sector consistently appears prominently in surveys of perceived corruption, with considerable evidence that this has serious adverse consequences for patients. Yet this issue is far from prominent in the international health policy discourse. We identify five reasons why the health policy community has been reluctant to talk about it. These are the problem of defining corruption, the fact that some corrupt practices are actually ways of making dysfunctional systems work, the serious challenges to researching corruption, concerns that a focus on corruption is a form of victim blaming that ignores larger issues, and a lack of evidence about what works to tackle it. We propose three things that can be done to address this situation. First, seek consensus on the scale and nature of corruption. Second, decide on priorities, taking account the importance of the particular problem and the feasibility of doing something about it. Third, take a holistic view, drawing on a wide range of disciplines.
https://www.ijhpm.com/article_3578_72fb5e614a6761eb1da854bca2ecda61.pdf
2019-04-01
191
194
10.15171/ijhpm.2018.123
Corruption
Governance
Bribery
Absenteeism
Procurement
Eleanor
Hutchinson
eleanor.hutchinson@lshtm.ac.uk
1
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
AUTHOR
Dina
Balabanova
dina.balabanova@lshtm.ac.uk
2
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
AUTHOR
Martin
McKee
martin.mckee@lshtm.ac.uk
3
Department of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
LEAD_AUTHOR
Jagsi R. Sexual Harassment in Medicine - #MeToo. N Engl J Med. 2018;378(3):209-211. doi:10.1056/NEJMp1715962
1
Jain A, Nundy S, Abbasi K. Corruption: medicine’s dirty open secret. BMJ. 2014;348:g4184. doi:10.1136/bmj.g4184
2
Transparency International. Global corruption barometer 2013 report. 2013; https://www.transparency.org/gcb2013. Accessed October 31, 2018.
3
Vian T. Review of corruption in the health sector: theory, methods and interventions. Health policy planning. 2008;23(2):83-94.
4
Petkov M, Cohen D. Diagnosing corruption in health care. 2016; https://www.transparency.org.uk/wp-content/plugins/download-attachments/includes/download.php?id=5804. Accessed October 31, 2018.
5
Berger D. Corruption ruins the doctor-patient relationship in India. BMJ. 2014;348:g3169.
6
Hanf M, Van-Melle A, Fraisse F, Roger A, Carme B, Nacher M. Corruption kills: estimating the global impact of corruption on children deaths. PLoS One. 2011;6(11):e26990. doi:10.1371/journal.pone.0026990
7
Mackey TK, Vian T, Kohler J. The sustainable development goals as a framework to combat health-sector corruption. Bull World Health Organ. 2018;96(9):634-643. doi:10.2471/blt.18.209502
8
United Nations. Convention against Corruption. New York: United Nations; 2003.
9
Gaitonde R, Oxman AD, Okebukola PO, Rada G. Interventions to reduce corruption in the health sector. Cochrane Database Syst Rev. 2016(8):Cd008856. doi:10.1002/14651858.CD008856.pub2
10
Vian T, Nordberg C. Corruption and the health sector. Bergen: Anti-Corruption Resource Centre, CHR Michelsen Institute; 2002.
11
Fadlallah R, Alkhaled L, Brax H, et al. Extent of physician-pharmaceutical industry interactions in low- and middle-income countries: a systematic review. Eur J Public Health. 2018;28(2):224-230. doi:10.1093/eurpub/ckx204
12
Fickweiler F, Fickweiler W, Urbach E. Interactions between physicians and the pharmaceutical industry generally and sales representatives specifically and their association with physicians' attitudes and prescribing habits: a systematic review. BMJ Open. 2017;7(9):e016408. doi:10.1136/bmjopen-2017-016408
13
Balabanova D, McKee M. Understanding informal payments for health care: the example of Bulgaria. Health Policy. 2002;62(3):243-273.
14
Gaal P, Belli PC, McKee M, Szocska M. Informal payments for health care: definitions, distinctions, and dilemmas. J Health Polit Policy Law. 2006;31(2):251-293. doi:10.1215/03616878-31-2-251
15
Lewis M. Informal payments and the financing of health care in developing and transition countries. Health Aff (Millwood). 2007;26(4):984-997. doi:10.1377/hlthaff.26.4.984
16
Lindelow M, Serneels P. The performance of health workers in Ethiopia: results from qualitative research. Soc Sci Med. 2006;62(9):2225-2235. doi:10.1016/j.socscimed.2005.10.015
17
Garcia-Prado A, Chawla M. The impact of hospital management reforms on absenteeism in Costa Rica. Health Policy Plan. 2006;21(2):91-100. doi:10.1093/heapol/czj015
18
Randall D, Anderson A, Taylor J. Protecting children in research: Safer ways to research with children who may be experiencing violence or abuse. J Child Health Care. 2016;20(3):344-353. doi:10.1177/1367493515587060
19
Bedirhanoğlu P. The neoliberal discourse on corruption as a means of consent building: reflections from post-crisis Turkey. Third World Quarterly. 2007;28(7):1239-1254.
20
Khan MH. Introduction: Political Settlements and the Analysis of Institutions. Afr Aff (Lond). 2017:1-20.
21
Kingdon JW, Thurber JA. Agendas, alternatives, and public policies. Boston: Little, Brown 1984.
22
Zyglidopoulos S, Hirsch P, Martin de Holan P, Phillips N. Expanding Research on Corporate Corruption, Management, and Organizations. Los Angeles, CA: SAGE Publications; 2017.
23
Anand V, Ashforth BE, Joshi M. Business as usual: The acceptance and perpetuation of corruption in organizations. Acad Manag Perspect. 2004;18(2):39-53.
24
Anechiarico F, Jacobs JB, Jacobs JB. The pursuit of absolute integrity: How corruption control makes government ineffective. Chicago, IL: University of Chicago Press; 1996.
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Wedeman A. Looters, rent-scrapers, and dividend-collectors: Corruption and growth in Zaire, South Korea, and the Philippines. J Dev Areas. 1997;31(4):457-478.
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Hirsch PM, Milner D. When scandals yield “it’s about time!” Rather than “We’re shocked and surprised!.” Journal of Management Inquiry. 2016;25(4):447-449.
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Hlatshwayo S, Oeking A, Ghazanchyan MM, Corvino D, Shukla A, Leigh MLY. The Measurement and Macro-Relevance of Corruption: A Big Data Approach. Washington DC: International Monetary Fund; 2018.
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Diviák T, Dijkstra JK, Snijders TA. Structure, multiplexity, and centrality in a corruption network: the Czech Rath affair. Trends Organ Crime. 2018. doi:10.1007/s12117-018-9334-y
29
Colladon AF, Remondi E. Using social network analysis to prevent money laundering. Expert Syst Appl. 2017;67:49-58.
30
ORIGINAL_ARTICLE
Implementing Federalism in the Health System of Nepal: Opportunities and Challenges
Nepal moved from unitary system with a three-level federal system of government. As federalism accelerates, the national health system can also speed up its own decentralization process, reduce disparities in access, and improve health outcomes. The turn towards federalism creates several potential opportunities for the national healthcare system. This is because decision making has been devolved to the federal, provincial and local governments, and so they can make decisions that are more representative of their localised health needs. The major challenge during the transition phase is to ensure that there are uninterrupted supplies of medical commodities and services. This requires scaling up the ability of local bodies to manage drug procurement and general logistics and adequate human resource in local healthcare centres. This article documents the efforts made so far in context of health sector federalization and synthesizes the progress and challenges to date and potential ways forward. This paper is written at a time while it is critical to review the federalism initiatives and develop way forward. As Nepal progress towards the federalized health system, we propose that the challenges inherent with the transition are critically analysed and mitigated while unfolding the potential of federal health system.
https://www.ijhpm.com/article_3579_efbd5a429ffb7cc9b002da8fd85fb0e7.pdf
2019-04-01
195
198
10.15171/ijhpm.2018.121
Challenges and Opportunities
Decentralization
Federalism
Health Reform
Health Sector
Nepal
Rajshree
Thapa
raazshree.thapa@gmail.com
1
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal
LEAD_AUTHOR
Kiran
Bam
bam.kiran@gmail.com
2
FHI 360 Nepal, LINKAGES Nepal Project, Kathmandu, Nepal
AUTHOR
Pravin
Tiwari
ppravin.tiwari@gmail.com
3
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal
AUTHOR
Tirtha Kumar
Sinha
tirthasinha70@gmail.com
4
Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Kathmandu, Nepal
AUTHOR
Sagar
Dahal
sagardhl@gmail.com
5
Province Health Directorate, Ministry of Social Development, Dhankuta, Nepal
AUTHOR
Regmi K, Upadhyay M, Tarin E, et al. Need of the Ministry of Health in Federal Democratic Republic of Nepal. JNMA J Nepal Med Assoc. 2017; 56(206): 281-87.
1
Government of Nepal. Constitution of Nepal. http://www.easynepalityping.com/nepali-sanvidhana. Accessed January 25, 2018. Published 2015.
2
Ministry of Health and Population (MoHP) [Nepal], New ERA, and ICF International Inc.. Nepal Demographic and Health Survey 2011. Kathmandu, Nepal: Ministry of Health and Population, New ERA, and ICF International, Calverton, Maryland; 2012.
3
Ministry of Health of Nepal, New ERA, ICF International Inc. Nepal Demographic and Health Survey 2016. https://dhsprogram.com/pubs/pdf/FR336/FR336.pdf. Accessed February 9, 2018. Published November 2017.
4
Ministry of Health and Population, Government of Nepal. Nepal Health Sector Strategy, 2015-2020. Government of Nepal: Saugat Printing and Publication; 2015. http://nhsp.org.np/nepal-health-sector-strategy-2015-2020/. Accessed March 25, 2018.
5
Ministry of Health. National Health Policy. http://nnfsp.gov.np/PublicationFiles/a93626f6-5e96-4cf6-b96e-c282addd4832.pdf. Published 2014.
6
World Health Organization, Regional Office for South-East Asia. Health financing profile 2017: Nepal. http://www.who.int/iris/handle/10665/259643. Published 2017.
7
Ministry of Health. Nepal Health sector programme (2004-2009). http://dohs.gov.np/wp-content/uploads/2014/04/NHSP_IP.pdf. Published October 2014.
8
Government of Nepal, Ministry of Health and Population. Nepal Health Sector programme II (2010-2014). Ministry of Health and Population. http://nhsp.org.np/wp-content/uploads/2014/11/NHSP-II-Final.pdf. Published 2010.
9
Office of Prime Minister and Council of Minister, Government of Nepal. Functional analysis assignment. http://www.nepalvotes.com/. Accessed May 04, 2018. Published 2016.
10
Government of Nepal. Local Government Operation Act 2017. http://www.chainpurmun.gov.np/en/content/local-government-operation-act-2074-0. Published 2017.
11
Rubio DJ.The impact of decentralization of health services on health outcomes: evidence from Canada. Appl Econ 2011;43(26)3907-3917. doi:10.1080/00036841003742579
12
Glenngard AH, Maina TM. Reversing the trend of weak policy implementation in the Kenyan health sector?--a study of budget allocation and spending of health resources versus set priorities. Health Res Policy Syst. 2007;5:3. doi:10.1186/1478-4505-5-3
13
Mills A, Vaughan JP, Smith DL, Tabibzadeh I; World Health Organization. Health system decentralization: concepts, issues and country experiences. http://apps.who.int/iris/handle/10665/39053. Accessed February 9, 2018. Published 1990.
14
Bossert TJ, Beauvais JC. Decentralization of health systems in Ghana, Zambia, Uganda and the Philippines: a comparative analysis of decision space. Health Policy Plan. 2002;17(1):14-31.
15
Laxminarayan R. Decentralization and its Implications for Reproductive Health: The Philippines Experience. Reprod Health Matters. 2003;11(21):96-107. doi:10.1016/S0968-8080(03)02168-2
16
Bossert TJ, Mitchell AD, Janjua MA. Improving health system performance in a decentralized health system: capacity building in Pakistan. Health Systems & Reform. 2015;1(4):276-284. doi:10.1080/23288604.2015.1056330
17
Yilmaz S, Beris Y, Serrano-Berthet R. Local government discretion and accountability: a diagnostic framework for local governance (Local governance and accountability series paper no. 113). Washington, DC: World Bank; 2008
18
Schwefel D. Federalism and Health system in Nepal. Kathmandu, Nepal: Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH; 2011. http://detlef-schwefel.de/267-Schwefel-federalism.pdf. Accessed March 25, 2018.
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World Health Organization. Measuring overall health system performance for 191 countries. http://www.who.int/healthinfo/paper30.pdf. Accessed March 25, 2018. Published 2000.
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Ministry of Health and Population. Progress for the health sector. Report for the joint annual review, 2018. http://www.nhssp.org.np/JAR-Reports.html.
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Ministry of Finance, Government of Nepal. Budget speech of fiscal year 2018/918. http://www.mof.gov.np/en/archive-documents/budget-speech-17.html. Accessed June 30, 2018. Published November 2017.
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Government of Nepal, Ministry of Finance (2075/76). Inter-ministerial fiscal transfer Province and local level http://mof.gov.np/uploads/document/file/Local%20Final%20Redbook_20180529121743.pdf.
23
Akin O, Hutchinson P, Stumpf K. Decentralization and government provision of public goods: The public health sector in Uganda. J Dev Stud. 2007;41:8:1417-1443. doi:10.1080/00220380500187075
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Crivelli L, Salari P. The impact of federalism on the healthcare system in terms of efficiency, equity, and cost containment: the case of Switzerland. Dev Health Econ Public Policy. 2014;12:155-278
25
Schwefel D. Health care organization and financing in eleven federal countries. http://detlef-schwefel.de/253-Schwefel-Nepal-federalism.pdf. Accessed February 9, 2018. Published 2011.
26
Mills A, Vaughan JP, Smith DL, Tabibzadeh I. (1990). Health system decentralization: concepts, issues and country experience. Geneva: World Health Organization; 1990.
27
Ministry of Health. Strategic Plan for human resource for health. http://apps.who.int/medicinedocs/documents/s18827en/s18827en.pdf. Accessed November 20, 2018. Published 2003.
28
Department of Health Services (DoHS). Annual Report 2074/75. http://dohs.gov.np/wp-content/uploads/2018/04/Annual_Report_2073-74.pdf.
29
Baral B, Prajapati R, Karki KB, Bhandari K. Distribution and Skill Mix of Health Workforce in Nepal. Nepal: Nepal Health Research council; 2013.
30
Ministry of Health and Population. http://www.mohp.gov.np/downloads/organogram.pdf.
31
Ministry of Federal Affairs and General Administration. Organization and management Survey. http://kathmandupost.ekantipur.com/news/2018-04-01/local-units-need-16080-more-staff. Accessed May 1, 2018. Published 2018.
32
Chiappinelli O. Decentralization and Public Procurement Performance: New Evidence from Italy. Berlin: DIW Berlin, German Institute for Economic Research; 2014.
33
Palcek M. The effects of decentralization on efficiency in public procurement: Empirical evidence for the Czech Republic. Lex locals: Journal of Local Self-government. 2017;15(1):67-92.
34
Adhikari B. Framework for transition to federalism in Nepal: Lesson from comparative experiences. http://bipinadhikari.com.np/Archives/Journals/Framework%20for%20Transition%20to%20Federalism.pdf.
35
Government of Nepal. Civil Servant Adjustment Act. http://www.lawcommission.gov.np/np/. Accessed August 20, 2018.
36
ORIGINAL_ARTICLE
Assessment of Public Hospital Governance in Romania: Lessons From 10 Case Studies
Background The Government of Romania commissioned international technical assistance to help unpacking the causes of arrears in selected public hospitals. Emphases were placed on the governance-related determinants of the hospital performance in the context of the Romanian health system. Methods The assessment was structured around a public hospital governance framework examining 4 dimensions: institutional arrangements, financing arrangements, accountability arrangements and correspondence between responsibility and decision-making capacity. The framework was operationalized using a 2-pronged approach: (i) a policy review of broader health system governance arrangements influencing hospital performance; and (ii) a series of 10 case-studies of public hospitals experiencing financial hardship. Data were collected during 2016-2017 through key informant interviews with central authorities and hospital management teams, exhaustive semi-structured questionnaires filled in by hospitals, as well as the review of documentary sources where feasible. Results Overall, the governance landscape of Romanian public hospitals includes a large number of seemingly modern legislative provisions and management instruments. Over the past 30 years substantial efforts have been made to put in place standardised hospital classification, hospital governance structures, management and service purchasing contracts with key performance indicators, modern reimbursement mechanisms based on diagnosis-related groups (DRGs), and regulatory requirements for accountability, including internal and external audit. Nevertheless, their application appears to have been challenging for a range of reasons, pointing to the misalignment between the responsibility and decision-making capacity given to hospitals in a questionably conducive context. Incoherent policy design, outdated and often disjointed regulatory frameworks, and cumbersome administrative procedures limit managerial autonomy and obstruct efficiency gains. In a context of chronic insufficient funding, misaligned incentives, and overly rigid service procurement processes, hospitals seem to struggle to adjust service baskets to the population’s health needs or to overcoming financial hardship. External challenges, combined with the limited strategic, operational, and financial management capacity within hospitals, make it difficult to exhibit good financial and general performance. Conclusion Existing governance arrangements for Romanian public hospitals appear conducive to poor financial performance. The suggested framework for hospital governance assessment has proved a powerful tool for identifying system and hospital-specific challenges contributing to sub-optimal hospital performance.
https://www.ijhpm.com/article_3581_faf72d8013261a35d7f652454a15e0fa.pdf
2019-04-01
199
210
10.15171/ijhpm.2018.120
Hospital Performance Assessment
Governance Framework
Romania
Antonio
Duran
aduran@alldmh.com
1
ALLDMHEALTH, Seville, Spain
AUTHOR
Tata
Chanturidze
tata.chanturidze@opml.co.uk
2
Oxford Policy Management, Oxford, UK
LEAD_AUTHOR
Adrian
Gheorghe
adrian.gheorghe@opml.co.uk
3
Oxford Policy Management, Oxford, UK
AUTHOR
Antonio
Moreno
amoreno@alldmh.com
4
ALLDMHEALTH, Seville, Spain
AUTHOR
OECD. Health at a Glance 2017: OECD Indicators. Paris: OECD; 2017. doi:10.1787/health_glance-2017-en
1
OECD.Stat. Health expenditure and financing. https://stats.oecd.org/index.aspx?DataSetCode=SHA. Published 2017.
2
Ministry of Health (MoH). Kenya National Health Accounts 2012/13. Nairobi: MoH; 2015.
3
Ministry of Health and Social Welfare. Tanzania National Health Accounts Year 2010 with Sub-Accounts for HIV and AIDS, Malaria, Reproductive, and Child Health. Dar es Salaam; 2012.
4
Racelis R, Dy-Liacco F, David L, Nievera L. Health Accounts Estimates of the Philippines for CY 2012 Based on the 2011 System of Health Accounts. Philipp J Dev. 2016;41-42(1-2):188-210.
5
National Health Systems Resource Centre. National Health Accounts Estimates for India (2013-14). New Delhi; 2016.
6
James C, Berchet C, Muir T. Addressing operational waste by better targeting the use of hospital care. In: Tackling Wasteful Spending on Health. Paris: OECD Publishing; 2017:193-225. doi:10.1787/9789264266414-en
7
Tracking Universal Health Coverage: 2017 Global Monitoring Report (Joint WHO/World Bank Group report). WHO website. https://www.who.int/healthinfo/universal_health_coverage/report/2017/en/. Published December 2017.
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National Institute of Statistics. Health Sector Activity Statistics 2017. Bucharest; 2018.
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National Health Insurance House. Annual Evolution of the National Health Insurance Fund 1999-2018. Bucharest; 2018.
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Vladescu C, Scintee S, Olsavsky V, Hernandez-Quevedo C, Sagan A. Romania Health System Review. Health Syst Transit. 2016;18(4):1-170.
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Presidential Commission for the analysis and elaboration of public health policies in Romania. A Health System Centered on Citizens’ Needs. Published 2008.
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European Commission. Country Report Romania 2015 Including an In-Depth Review on the Prevention and Correction of Macroeconomic Imbalance. European Commission; 2015.
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European Commission. Balance of Payments Assistance Programme, Romania 2013-2015. Luxembourg; 2015.
14
Duran A. A framework for assessing hospital governance. In: Saltman R, Duran A, Dubois HFW, eds. Governing Public Hospitals. Reform Strategies and the Movement towards Institutional Autonomy. Who; 2011.
15
Arah OA, Westert GP, Hurst J, Klazinga NS. A conceptual framework for the OECD Health Care Quality Indicators Project. Int J Qual Heal Care. 2006;18(suppl_1):5-13. doi:10.1093/intqhc/mzl024
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Groene O, Botje D, Suñol R, Lopez MA, Wagner C. A systematic review of instruments that assess the implementation of hospital quality management systems. Int J Qual Health Care. 2013;25(5):525-541. doi:10.1093/intqhc/mzt058
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Veillard J, Champagne F, Klazinga N, Kazandjian V, Arah OA, Guisset A-L. A performance assessment framework for hospitals: the WHO regional office for Europe PATH project. Int J Qual Heal Care. 2005;17(6):487-496. doi:10.1093/intqhc/mzi072.
18
The International Federation of Accountants (IFAC). International Standard on Assurance Engagements (ISAE) 3000 “Assurance Audits Engagements Other Than Audits or Reviews of Historical Financial Information.” IFAC; 2013.
19
Ruiz F, Lopert R, Chalkidou K. Technical Assistance in Reviewing the Content and Listing Processes for the Romanian Basic Package of Health Services and Technologies: Final Report. NICE International; 2012.
20
Chiriac N, Musat S, Shah J, Vladescu C. Romania – experience and new steps in the context of the international patient classification system. BMC Health Serv Res. 2011;11(Suppl 1):A12. doi:10.1186/1472-6963-11-S1-A12
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WHO Europe. Evaluation of Structure and Provision of Primary Care in Romania - a Survey-Based Project. Who; 2012.
22
Radu C-P, Pana BC, Furtunescu FL. Drug Policy in Romania. Value Heal Reg Issues. 2018;16:28-32. doi:10.1016/j.vhri.2017.11.003
23
Barasa EW, Molyneux S, English M, Cleary S. Hospitals as complex adaptive systems: A case study of factors influencing priority setting practices at the hospital level in Kenya. Soc Sci Med. 2017;174:104-112. doi:10.1016/j.socscimed.2016.12.026
24
De Geyndt W. Does autonomy for public hospitals in developing countries increase performance? Evidence-based case studies. Soc Sci Med. 2017;179:74-80. doi:10.1016/j.socscimed.2017.02.038
25
ORIGINAL_ARTICLE
The Impact of Conflict on Immunisation Coverage in 16 Countries
Background Military conflict has been an ongoing determinant of inequitable immunisation coverage in many low- and middle-income countries, yet the impact of conflict on the attainment of global health goals has not been fully addressed. This review will describe and analyse the association between conflict, immunisation coverage and vaccine-preventable disease (VPD) outbreaks, along with country specific strategies to mitigate the impact in 16 countries. Methods We cross-matched immunisation coverage and VPD data in 2014 for displaced and refugee populations. Data on refugee or displaced persons was sourced from the United Nations High Commissioner for Refugees (UNHCR) database, and immunisation coverage and disease incidence data from World Health Organization (WHO) databases. Demographic and Health Survey (DHS) databases provided additional data on national and sub-national coverage. The 16 countries were selected because they had the largest numbers of registered UNHCR “persons of interest” and received new vaccine support from Global Alliance for Vaccine and Immunisation (GAVI), the Vaccine Alliance. We used national planning and reporting documentation including immunisation multiyear plans, health system strengthening strategies and GAVI annual progress reports (APRs) to assess the impact of conflict on immunisation access and coverage rates, and reviewed strategies developed to address immunisation program shortfalls in conflict settings. We also searched the peer-reviewed literature for evidence that linked immunisation coverage and VPD outbreaks with evidence of conflict. Results We found that these 16 countries, representing just 12% of the global population, were responsible for 67% of global polio cases and 39% of global measles cases between 2010 and 2015. Fourteen out of the 16 countries were below the global average of 85% coverage for diphtheria, pertussis, and tetanus (DPT3) in 2014. We present data from countries where the onset of conflict has been associated with sudden drops in national and sub-national immunisation coverage. Tense security conditions, along with damaged health infrastructure and depleted human resources have contributed to infrequent outreach services, and delays in new vaccine introductions and immunisation campaigns. These factors have in turn contributed to pockets of low coverage and disease outbreaks in sub-national areas affected by conflict. Despite these impacts, there was limited reference to the health needs of conflict affected populations in immunisation planning and reporting documents in all 16 countries. Development partner investments were heavily skewed towards vaccine provision and working with partner governments, with comparatively low levels of health systems support or civil partnerships. Conclusion Global and national policy and planning focus is required on the service delivery needs of conflict affected populations, with increased investment in health system support and civil partnerships, if persistent immunisation inequities in conflict affected areas are to be addressed.
https://www.ijhpm.com/article_3585_fce5b025343313d658c90318c24e887d.pdf
2019-04-01
211
221
10.15171/ijhpm.2018.127
Immunisation
Conflict
Displaced Populations
Refugees
Equity
GAVI
John
Grundy
john.grundy@jcu.edu.au
1
College of Public Health, Medical and Veterinary Services, Cairns Campus, James Cook University, Douglas, QLD, Australia
AUTHOR
Beverley-Ann
Biggs
babiggs@unimelb.edu.au
2
Department of Medicine, Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
LEAD_AUTHOR
United States Agency for International Development (USAID). 2017 Demographic and Health Surveys. Demographic Health Surveys website. https://www.dhsprogram.com. Accessed January 24, 2017.
1
Hussain SF, Boyle P, Patel P, Sullivan R. Eradicating polio in Pakistan: an analysis of the challenges and solutions to this security and health issue. Global Health. 2016;12(1):63. doi:10.1186/s12992-016-0195-3
2
Mashal T, Nakamura K, Kizuki M, et al. Impact of conflict on infant immunisation coverage in Afghanistan: a countrywide study 2000–2003. Int J Health Geographics. 2007;6:23.
3
Bagcchi S. Inadequate vaccine coverage fuels polio outbreak in Ukraine. Lancet Infect Dis. 2015;15(11):1268-1269. doi:10.1016/S1473-3099(15)00367-9
4
World Health Organization (WHO). 2017 Vaccine Preventable Disease Data base; WHO/United Nations Children’s Fund (UNICEF) Estimates. WHO website. http://www.who.int/immunisation/monitoring_surveillance/data/en/. Accessed January 24, 2017.
5
World Health Organization (WHO). Disease Incidence Data, 2017. WHO website. http://apps.who.int/immunisation_monitoring/globalsummary/timeseries/tsincidencediphtheria.html. Accessed January 24, 2017.
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Global Alliance for Vaccine and Immunisation (GAVI). 2017 Country Hub. Global Alliance for Vaccine and Immunisation website. https://www.gavi.org/country/. Accessed January 24, 2017.
7
National Institutes for Health. PubMed database. https://www.ncbi.nlm.nih.gov/pubmed. Accessed September 9, 2018.
8
Nnadi C, Etsano A, Uba B, et al. Approaches to vaccination among populations in areas of conflict. J Infect Dis. 2017; 216(Suppl 1):S368–S372.
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Shuaibu FM, Birukila G, Usman S, et al. Mass immunization with inactivated polio vaccine in conflict zones--Experience from Borno and Yobe States, North-Eastern Nigeria. J Public Health Policy. 2016;37(1):36-50. doi:10.1057/jphp.2015.34
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Senessie C, Gage GN, von Elm E. Delays in childhood immunization in a conflict area: a study from Sierra Leone during civil war. Confl Health. 2007;1:14.
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Peyraud N, Quéré M, Duc G1, et al. A post-conflict vaccination campaign, Central African Republic. Bull World Health Organ. 2018;96(8):540-547. doi:10.2471/BLT.17.204321
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de Lima Pereira A, Southgate R, Ahmed H, O’Connor P, Cramond V, Lenglet A. Infectious disease risk and vaccination in northern Syria after 5 years of civil war: the MSF experience. PLoS Curr. 2018. doi:10.1371/currents.dis.bb5f22928e631dff9a80377309381feb
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ORIGINAL_ARTICLE
Awareness and Attitude Towards Opioid and Stimulant Use and Lifetime Prevalence of the Drugs: A Study in 5 Large Cities of Iran
Background Providing population-based data on awareness, attitude and practice of drug and stimulant use has policy implications. A national study was conducted among Iranian general population to explore life time prevalence, awareness and attitudes toward opioids and stimulant use. Methods We recruited subjects from 5 provinces with heterogenic pattern of drug use. Participants were selected using stratified multistage cluster sampling. Data were collected using a validated self-administered questionnaire. Logistic regression model was applied to identify the variables that are associated with drug and stimulant use. Results In total 2065 respondents including 1155 men (33.96 ± 10.40 years old) and 910 women (35.45 ± 12.21 years old) were recruited. Two-third of respondents had good awareness about adverse effects of opioid use. Corresponding figure in terms of stimulants was 81.4%. Almost 95% of participants reported a negative attitude towards either opioid or stimulant use. The lifetime prevalence of opioid use and stimulant use were 12.9% (men: 21.5%, women: 4.0%) and 7.3% (men: 9.6%, women: 4.9%), respectively. Gender (adjusted odds ratio [AOR]M/W = 6.92; 95% CI: 2.92, 16.42), education (AORundergraduate/diploma or less = 0.49; 95% CI: 0.26, 0.90), and marital status (AORothers/single = 2.13; 95% CI: 1.36, 3.33) were significantly related with opioid use. With respect to stimulant use, age was negatively associated with the outcome (AOR60+/20-29 years = 0.08: 95% CI; 0.01, 0.98) and men were 2 times more likely than women to use stimulants (ORM/W=2.15: 95% CI: 0.83, 5.56). In addition, marital status (AOROthers/singles = 3.45; 95% CI: 1.09, 10.93), and awareness (AORWeak and moderate/good = 0.40; 95% CI: 0.25, 0.61) were independently correlated with stimulants use. Conclusion While the attitude of Iranian adults toward opioid and stimulant use was negative, their awareness was not that adequate to prevent the drug use. Men and those with lower socio-economic status (SES) should be the focus of health promotion programs regarding opioid use. However, regarding stimulants use, promotion programs should target younger age groups and those with higher SES status.
https://www.ijhpm.com/article_3586_f141e57d347c7d12a2466871ad06eae1.pdf
2019-04-01
222
232
10.15171/ijhpm.2018.128
Cognition
Attitude
Prevalence
Opioid Related Disorders
Amphetamines
Elham
Mohebbi
mohebi.el@gmail.com
1
HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
Ali Akbar
Haghdoost
ahaghdoost@gmail.com
2
Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
Alireza
Noroozi
a_r_noroozi@yahoo.com
3
School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences (TUMS), Tehran, Iran
AUTHOR
Hossein
Molavi Vardanjani
hosseinmolavi.vardanjani@gmail.com
4
MPH Department, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran
AUTHOR
Ahmad
Hajebi
hajebi.ahmad@gmail.com
5
Research Center for Addiction & Risky Behavior (ReCARB), Psychiatric Department, Iran University of Medical Sciences, Tehran, Iran
AUTHOR
Roya
Nikbakht
roya_nikbakht2000@yahoo.com
6
Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
Maryam
Mehrabi
mary.mehrabi@yahoo.com
7
Department of Sociology, Faculty of Social Sciences and Economics, Alzahra University, Tehran, Iran
AUTHOR
Akram
Jabbarinejad Kermani
a.jabbarinejad@gmail.com
8
Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
Mahshid
Salemianpour
msalemiyanpoor@gmail.com
9
Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
AUTHOR
Mohammad Reza
Baneshi
rbaneshi2@gmail.com
10
Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
LEAD_AUTHOR
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Alam-mehrjerdi Z, Mokri A, Dolan K. Methamphetamine use and treatment in Iran: A systematic review from the most populated Persian Gulf country. Asian J Psychiatr. 2015;16:17-25. doi:10.1016/j.ajp.2015.05.036
47
Zolala F, Mahdavian M, Haghdoost AA, Karamouzian M. Pathways to Addiction: A Gender-Based Study on Drug Use in a Triangular Clinic and Drop-in Center, Kerman, Iran. Int J High Risk Behav Addict. 2016;5(2):e22320. doi:10.5812/ijhrba.22320
48
Nemati S, Rafei A, Freedman ND, Fotouhi A, Asgary F, Zendehdel K. Cigarette and Water-Pipe Use in Iran: Geographical Distribution and Time Trends among the Adult Population; A Pooled Analysis of National STEPS Surveys, 2006-2009. Arch Iran Med. 2017;20(5):295-301.
49
Pinkham S, Malinowska-Sempruch K. Women, harm reduction and HIV. Reprod Health Matters. 2008;16(31):168-181. doi:10.1016/s0968-8080(08)31345-7
50
Meysamie A, Sedaghat M, Mahmoodi M, Ghodsi SM, Eftekhar B. Opium use in a rural area of the Islamic Republic of Iran. East Mediterr Health J. 2009;15(2):425-431.
51
Brady KT, Sinha R. Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress. Am J Psychiatry. 2005;162(8):1483-1493. doi:10.1176/appi.ajp.162.8.1483
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53
Safizadeh M, Nakhaee N. Causes of increasing trend of divorce in Iranian community: what do the experts think? J Fam Med. 2016;3(4):1064.
54
Haghdoost AA, Baneshi MR, Eybpoosh S, Khajehkazemi R. Comparison of three interview methods on response pattern to sensitive and non-sensitive questions. Iran Red Crescent Med J. 2013;15(6):500-506. doi:10.5812/ircmj.7673
55
Nasirian M, Hosseini Hooshyar S, Haghdoost AA, Karamouzian M. How and Where Do We Ask Sensitive Questions: Self-reporting of STI-associated Symptoms Among the Iranian General Population. Int J Health Policy Manag. 2018;7(8):738-745. doi:10.15171/ijhpm.2018.18
56
ORIGINAL_ARTICLE
Perspectives on Rebuilding Health System Governance in Opposition-Controlled Syria: A Qualitative Study
BackgroundOngoing conflict and systematic targeting of health facilities and personnel by the Syrian regime in opposition-controlled areas have contributed to health system and governance mechanisms collapse. Health directorates (HDs) were established in opposition-held areas in 2014 by the interim (opposition) Ministry of Health (MoH), to meet emerging needs. As the local health authorities responsible for health system governance in opposition-controlled areas in Syria, they face many challenges. This study explores ongoing health system governance efforts in 5 opposition-controlled areas in Syria. MethodsA qualitative study design was selected, using in-depth key informant interviews with 20 participants purposely sampled from HDs, non-governmental organisations (NGOs), donors, and service-users. Data were analysed thematically. ResultsHealth system governance elements (ie, strategic vision, participation, transparency, responsiveness, equity, effectiveness, accountability, information) were considered important, but not interpreted or addressed equally in opposition-controlled areas. Participants identified HDs as primarily responsible for health system governance in opposition-controlled areas. Main health system governance challenges identified were security (eg, targeting of health facilities and personnel), funding, and capacity. Suggested solutions included supporting HDs, addressing health-worker loss, and improving coordination. ConclusionRebuilding health system governance in opposition-controlled areas in Syria is already progressing, despite ongoing conflict. Local health authorities need support to overcome identified challenges and build sustainable health system governance mechanisms.
https://www.ijhpm.com/article_3588_0c56fa17714f1dfbb05132d0868484f4.pdf
2019-04-01
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10.15171/ijhpm.2018.132
Health System Governance
Health System Strengthening
Conflict
Resilience
Syria
Yazan
Douedari
dr.yazan.douedari@gmail.com
1
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
AUTHOR
Natasha
Howard
natasha.howard@lshtm.ac.uk
2
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
LEAD_AUTHOR
Ziadeh R. Revolution in Syria. Turkish Review. 2014;4(2):186.
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72
ORIGINAL_ARTICLE
Reflections on Health Workforce Development; 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”
This commentary addresses the statement that “the authors believe that the HRH [Human Resources for Health] Program can serve as a model for other initiatives that seek to address the shortage of qualified health professionals in low-income countries and strengthen the long-term capacity of local academic institutions.” I adopt the position of the devil’s advocate and ask whether a country, with a profile comparable to Rwanda’s, should adopt this twinning model. I suggest that the alignment with population and other capacity development needs should be the main criteria of decision.
https://www.ijhpm.com/article_3583_7da6ecc8de0a80d94adb6be927487bc0.pdf
2019-04-01
245
246
10.15171/ijhpm.2018.129
Capacity Development
Health Workforce
Academic Partnerships
Gilles
Dussault
gillesdussault@ihmt.unl.pt
1
Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
LEAD_AUTHOR
Cancedda C, Cotton P, Shema J, et al. Health professional training and capacity strengthening through international academic partnerships: the first 5 years of the Human Resources for Health Program in Rwanda. Int J Health Policy Manag. 2018;7(11):1024–1039. doi:10.15171/ijhpm.2018.61
1
World Health Organization, UNICEF. Declaration of Alma-Ata, International Conference on Primary Health Care, Alma-Ata, USSR, September 6-12, 1978. http://www.who.int/publications/almaata_declaration_en.pdf
2
World Health Organization. A Vision for Primary Health Care in the 21st Century: Toward Universal Coverage and the Sustainable Development Goals: Draft. Geneva: World Health Organization; 2018.
3
Cometto G et al, Health policy and system support to optimise community health worker programmes: an abridged WHO guideline. Lancet Glob Health. 2018;6(12):e1397-e1404. doi:10.1016/S2214-109X(18)30482-0
4
Cailhol J, Craveiro I, Madede T, et al.Analysis of HRH strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities. Global Health. 2013;9:52. doi:10.1186/1744-8603-9-52
5
World Health Organization. Global strategy on human resources for health: Workforce 2030. Geneva: WHO; 2016; http://www.who.int/hrh/resources/pub_globstrathrh-2030/en/
6
ORIGINAL_ARTICLE
Delving Into the Details of Evaluating Public Engagement Initiatives; Comment on “Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review”
Initiatives to engage the public in health policy decisions have been widely endorsed and used, yet agreed upon methods for systematically evaluating the effectiveness of these initiatives remain to be developed. Dukhanin, Topazian, and DeCamp have thus developed a useful taxonomy of evaluation criteria derived from a systematic review of published evaluation tools that might serve as the basis for systematic evaluation. In considering the application of such a taxonomy, it is important to appreciate the political space in which health policy decisions occur. In this context, public engagement initiatives are likely to have a modest and unpredictable impact on policy decisions. Other goals, aside from influencing policy decisions, such as informing the public about issues, identifying the public’s values, enhancing public support for decisions, and promoting public discourse, are likely to be more feasible. While Dukanan and colleagues did not aim to do so, future efforts to align guidance for planning public engagement initiatives with evaluation tools would be useful to promote the success of public engagement initiatives.
https://www.ijhpm.com/article_3587_713bb3d89488638fc926dba72ced7c8b.pdf
2019-04-01
247
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10.15171/ijhpm.2018.126
Public Participation
Evaluation Studies
Healthcare System
Organizational Policy
Marion
Danis
mdanis@nih.gov
1
National Institutes of Health, Bethesda, MD, USA
LEAD_AUTHOR
WHO Declaration of Alma-Ata. WHO Chronicle. 1978;32:428-430.
1
Dukhanin V, Topazian R, DeCamp M. Metrics and evaluation tools for patient engagement in healthcare organization—and system-level decision-making: a systematic review. Int J Health Policy Manag. 2018;7(10):889–903. doi:10.15171/ijhpm.2018.43
2
Institute for Local Government. Public Engagement and Why I Should Do It. http://www.ca-ilg.org/sites/main/files/file-attachments/ilg_what_is_public_engagement_and_why_should_i_do_it_8.31.16.pdf. Accessed July 18, 2018. Published 2016.
3
Thurston WE, MacKean G, Vollman A, et al. Public participation in regional health policy: a theoretical framework. Health Policy. 2004;73:237-252.
4
Sabik L and Lie R. Priority setting in health care: Lessons from the experiences of eight countries. Int J Equity Health. 2008;7:4. doi:10.1186/1475-9276-7-4
5
Bolsewicz Alderman K, Hipgrave D, Jimenez-Soto E. Public engagement in health priority setting in low- and middle income countries: current trends and considerations for policy. PLoS Med. 2013;10(8):e1001495. doi:10.1371/journal.pmed.1001495
6
Abelson J, Forest P-G, Eyles J, Smith P, Martin E, Gauvin FP. Deliberations about public deliberative methods: issues in the design and evaluation of public participation processes. Soc Sci Med. 2003;57(2):239-251.
7
Health Quality Ontario. Choosing Methods for Patient and Caregiver Engagement: A Guide for Health Care Organizations. http://www.hqontario.ca/Portals/0/Documents/qi/choosing-methods-pce.pdf. Accessed July 27, 2018.
8
ORIGINAL_ARTICLE
The Value of Engaging the Public in CHATing About Healthcare Priorities: A Response to Recent Commentaries
https://www.ijhpm.com/article_3573_251ec7be28917601792893dc62fb9a05.pdf
2019-04-01
250
252
10.15171/ijhpm.2018.113
Resource Allocation
Priority Setting
Public Participation
Universal Insurance System
Marion
Danis
mdanis@nih.gov
1
Department of Bioethics, National Institutes of Health, Bethesda, MD, USA
AUTHOR
Susan D.
Goold
sgoold@med.umich.edu
2
Department of General Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
AUTHOR
Melinee
Schindler
melinee.schindler@unige.ch
3
Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland
AUTHOR
Samia A.
Hurst
samia.hurst@unige.ch
4
Institute for Ethics, History, and the Humanities, Geneva University Medical School, Geneva, Switzerland
LEAD_AUTHOR
Fleck LM. Healthcare priority-setting: CHAT-ting is not enough: Comment on "Swiss-CHAT: citizens discuss priorities for Swiss Health Insurance Coverage." Int J Health Policy Manag. 2018;7(10):961-963. doi:10.15171/ijhpm.2018.66
1
Mongoven A. Tradeoff negotiation: the importance of getting in the game: Comment on "Swiss-CHAT: citizens discuss priorities for Swiss health insurance coverage." Int J Health Policy Manag. 2018;7(12):1148-1150. doi:10.15171/ijhpm.2018.86
2
Hurst SA, Schindler M, Goold SD, Danis M. Swiss-CHAT: citizens discuss priorities for swiss health insurance coverage. Int J Health Policy Manag. 2018;7(8):746-754. doi:10.15171/ijhpm.2018.15
3
Goold SD, Myers CD, Szymecko L, et al. Priorities for patient-centered outcomes research: the views of minority and underserved communities. Health Serv Res. 2017;52(2):599-615. doi:10.1111/1475-6773.12505
4
Goold SD, Myers CD, Danis M, et al. Members of Minority and Underserved Communities Set Priorities for Health Research. Milbank Q. 2018; Forthcoming.
5
Danis M, Ginsburg M, Goold S. Experience in the United States with public deliberation about health insurance benefits using the small group decision exercise, CHAT. J Ambul Care Manage. 2010;33(3):205-214. doi:10.1097/JAC.0b013e3181e56340
6
Dror DM, Koren R, Ost A, Binnendijk E, Vellakkal S, Danis M. Health insurance benefit packages prioritized by low-income clients in India: three criteria to estimate effectiveness of choice. Soc Sci Med. 2007;64(4):884-896. doi:10.1016/j.socscimed.2006.10.032
7
Schindler M, Danis M, Goold SD, Hurst SA. Solidarity and cost management: Swiss citizens' reasons for priorities regarding health insurance coverage. Health Expect. 2018;21(5):858-869. doi:10.1111/hex.12680
8
ORIGINAL_ARTICLE
Health Promotion at Local Level in Norway – Who, What, When, and How: A Response to Recent Commentaries
https://www.ijhpm.com/article_3591_dee4d0ffe2133cfda7f4b16a77d38107.pdf
2019-04-01
253
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10.15171/ijhpm.2019.01
Equity
HIAP
Norway
Health Promotion
Commentary
Susanne
Hagen
susanne.hagen@usn.no
1
Department of Health, Social, and Welfare Studies, University of South-Eastern Norway, Borre, Norway
LEAD_AUTHOR
Kjell
Ivar Øvergård
koe@usn.no
2
Department of Health, Social, and Welfare Studies, University of South-Eastern Norway, Borre, Norway
AUTHOR
Marit Kristine
Helgesen
marit.k.helgesen@hiof.no
3
Faculty of Health and Welfare, Østfold University College, Halden, Norway
AUTHOR
Elisabeth
Fosse
elisabeth.fosse@uib.no
4
Department of Health Promotion and Development, University of Bergen, Bergen, Norway
AUTHOR
Steffen
Torp
steffen.torp@usn.no
5
Department of Health, Social, and Welfare Studies, University of South-Eastern Norway, Borre, Norway
AUTHOR
Bekken W. Public health coordinator - how to promote focus on social inequality at a local level, and how should it be included in public health policies? Comment on "Health promotion at local level in Norway: the use of public health coordinators and health overviews to promote fair distribution among social groups." Int J Health Policy Manag. 2018;7(11):1061-1063. doi:10.15171/ijhpm.2018.74
1
Fisher M. Challenging institutional norms to improve local-level policy for health and health equity: Comment on "Health promotion at local level in Norway: the use of public health coordinators and health overviews to promote fair distribution among social groups." Int J Health Policy Manag. 2018;7(10):968-970. doi:10.15171/ijhpm.2018.67
2
Holt DH. Rethinking the theory of change for health in all policies: Comment on "Health promotion at local level in Norway: the use of public health coordinators and health overviews to promote fair distribution among social groups." Int J Health Policy Manag. 2018;7(12):1161-1164. doi:10.15171/ijhpm.2018.96
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