Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
9
2019
09
01
How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention
514
520
EN
Raphael
Lencucha
0000-0002-9273-2027
School of Physical and Occupational Therapy, Faculty of Medicine, McGill
University, Montreal, QC, Canada
raphael.lencucha@mcgill.ca
Anne Marie
Thow
0000-0002-6460-5864
Menzies Centre for Health Policy, Sydney
School of Public Health, University of Sydney, Sydney, NSW, Australia
annemarie.thow@sydney.edu.au
10.15171/ijhpm.2019.56
Alcohol, tobacco, and unhealthy foods contribute greatly to the global burden of non-communicable disease (NCD). Member states of the World Health Organization (WHO) have recognized the critical need to address these three key risk factors through global action plans and policy recommendations. The 2013-2020 WHO action plan identifies the need to engage economic, agricultural and other relevant sectors to establish comprehensive and coherent policy. To date one of the biggest barriers to action is not so much identifying affective policies, but rather how a comprehensive policy approach to NCD prevention can be established across sectors. Much of the research on policy incoherence across sectors has focused on exposing the strategies used by commercial interests to shape public policy in their favor. Although the influence of commercial interests on government decisions remains an important issue for policy coherence, we argue, that the dominant neoliberal policy paradigm continues to enable the ability of these interests to influence public policy. In this paper, we examine how this dominant paradigm and the way it has been enshrined in institutional mechanisms has given rise to existing systems of governance of product environments, and how these systems create structural barriers to the introduction of meaningful policy action to prevent NCDs by fostering healthy product environments. Work to establish policy coherence across sectors, particularly to ensure a healthy product environment, will require systematic engagement with the assumptions that continue to structure institutions that perpetuate unhealthy product environments.
Policy Coherence,Tobacco,Food,Neoliberalism,Governance
https://www.ijhpm.com/article_3646.html
https://www.ijhpm.com/article_3646_de9739f79e93e90e9a2ac71993c2e48d.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
9
2019
09
01
Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries
521
537
EN
Katherine R.
Iverson
0000-0002-5261-8027
Program in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USA
katie.r.iverson@gmail.com
Emma
Svensson
Program in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USA
emma.ca.svensson@gmail.com
Kristin
Sonderman
Program in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USA
ksonderman@bwh.harvard.edu
Ernest J.
Barthélemy
Program in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USA
cheminmedical@gmail.com
Isabelle
Citron
0000-0003-4702-4926
Program in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USA
isabelle.citron@gmail.com
Kerry A.
Vaughan
Program in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USA
kavaugha@gmail.com
Brittany L.
Powell
Program in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USA
brittanylpowell@gmail.com
John G.
Meara
Program in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USA
john.meara@childrens.harvard.edu
Mark G.
Shrime
Program in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USA
shrime@mail.harvard.edu
10.15171/ijhpm.2019.43
Background<br />While recommendations for the optimal distribution of surgical services in high-income countries (HICs) exist, it is unclear how these translate to resource-limited settings. Given the significant shortage and maldistribution of surgical workforce and infrastructure in many low- and middle-income countries (LMICs), the optimal role of decentralization versus regionalization (centralization) of surgical care is unknown. The aim of this study is to review evidence around interventions aimed at redistributing surgical services in LMICs, to guide recommendations for the ideal organization of surgical services.<br /> <br />Methods<br />A narrative-based literature review was conducted to answer this question. Studies published in English between 1997 and 2017 in PubMed, describing interventions to decentralize or regionalize a surgical procedure in a LMIC, were included. Procedures were selected using the Disease Control Priorities’ (DCP3) Essential Surgery Package list. Intervention themes and outcomes were analyzed using a narrative, thematic synthesis approach. Primary outcomes included mortality, complications, and patient satisfaction. Secondary outcomes included input measures: workforce and infrastructure, and process measures: facility-based care, surgical volume, and referral rates.<br /> <br />Results<br />Thirty-five studies were included. Nine (33%) of the 27 studies describing decentralization showed an improvement in primary outcomes. The procedures associated with improved outcomes after decentralization included most obstetric, gynecological, and family planning services as well as some minor general surgery procedures. Out of 8 studies on regionalization (centralization), improved outcomes were shown for trauma care in one study and cataract extraction in one study.<br /> <br />Conclusion<br />Interventions aimed at decentralizing obstetric care to the district hospital and health center levels have resulted in mortality benefits in several countries. However, more evidence is needed to link service distribution to patient outcomes in order to provide recommendations for the optimal organization of other surgical procedures in LMICs. Considerations for the optimal distribution of surgical procedures should include the acuity of the condition for which the procedure is indicated, anticipated case volume, and required level of technical skills, resources, and infrastructure. These attributes should be considered within the context of each country.
Global Surgery,Service Delivery,Regionalization,Decentralization,Centralization,Low- and Middle-Income Countries (LMICs)
https://www.ijhpm.com/article_3633.html
https://www.ijhpm.com/article_3633_266df227ca16783afcc7b297ece288bd.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
9
2019
09
01
“Because Even the Person Living With HIV/AIDS Might Need to Make Babies” – Perspectives on the Drivers of Feasibility and Acceptability of an Integrated Community Health Worker Model in Iringa, Tanzania
538
549
EN
Katharine D.
Shelley
0000-0001-6550-5446
Department of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
kath.shelley@gmail.com
Gasto
Frumence
0000-0003-4605-9457
Department of Development Studies,
School of Public Health and Social Sciences, Muhimbili University of Health and
Allied Sciences, Dar es Salaam, Tanzania
gfrumence@muhas.ac.tz
Rose
Mpembeni
0000-0002-3916-2790
Department of Epidemiology and
Biostatistics, School of Public Health and Social Sciences, Muhimbili University
of Health and Allied Sciences, Dar es Salaam, Tanzania
rcmpembeni@gmail.com
George
Mwinnyaa
Department of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
georgemwinnyaa@gmail.com
Juliana
Joachim
Department of Epidemiology and
Biostatistics, School of Public Health and Social Sciences, Muhimbili University
of Health and Allied Sciences, Dar es Salaam, Tanzania
julianajoachim@gmail.com
Hawa
Kadria Kisusi
Christian Social
Services Commission, Dar es Salaam, Tanzania
hawakadria@yahoo.com
Japhet
Killewo
0000-0001-6998-6750
Department of Epidemiology and
Biostatistics, School of Public Health and Social Sciences, Muhimbili University
of Health and Allied Sciences, Dar es Salaam, Tanzania
jkillewo@yahoo.co.uk
Abdullah H.
Baqui
Department of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
abaqui@jhu.edu
David H.
Peters
0000-0001-8377-3444
Department of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA
dhpeters@yorku.ca
Asha S.
George
0000-0002-5968-1424
School of Public Health,
University of the Western Cape, Cape Town, South Africa
asgeorge@uwc.ac.za
10.15171/ijhpm.2019.38
Background<br />Countries with health workforce shortages are increasingly turning to multipurpose community health workers (CHWs) to extend integrated services to the community-level. However, there may be tradeoffs with the number of tasks a CHW can effectively perform before quality and/or productivity decline. This qualitative study was conducted within an existing program in Iringa, Tanzania where HIV-focused CHWs working as volunteers received additional training on maternal, newborn, and child health (MNCH) promotion, thereby establishing a dual role CHW model.<br /> <br />Methods<br />To evaluate the feasibility and acceptability of the combined HIV/MNCH CHW model, qualitative in-depth interviews (IDIs) with 36 CHWs, 21 supervisors, and 10 program managers were conducted following integration of HIV and MNCH responsibilities (n = 67). Thematic analysis explored perspectives on task planning, prioritization and integration, workload, and the feasibility and acceptability of the dual role model. Interview data and field observations were also used to describe implementation differences between HIV and MNCH roles as a basis for further contextualizing the qualitative findings.<br /> <br />Results<br />Perspectives from a diverse set of stakeholders suggested provision of both HIV and MNCH health promotion by CHWs was feasible. Most CHWs attempted to balance HIV/MNCH responsibilities, although some prioritized MNCH tasks. An increased workload from MNCH did not appear to interfere with HIV responsibilities but drew time away from other income-generating activities on which volunteer CHWs rely. Satisfaction with the dual role model hinged on increased community respect, gaining new knowledge/skills, and improving community health, while the remuneration-level caused dissatisfaction, a complaint that could challenge sustainability.<br /> <br />Conclusions<br />Despite extensive literature on integration, little research at the community level exists. This study demonstrated CHWs can feasibly balance HIV and MNCH roles, but not without some challenges related to the heavier workload. Further research is necessary to determine the quality of health promotion in both HIV and MNCH domains, and whether the dual role model can be maintained over time among these volunteers.
Community Health Workers,Implementation Research,Integration,Tanzania,Workload
https://www.ijhpm.com/article_3631.html
https://www.ijhpm.com/article_3631_6966e75de4f0744bde4d3f28128b6a4a.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
9
2019
09
01
Health Equity in National Cancer Control Plans: An Analysis of the Ontario Cancer Plan
550
556
EN
Ambreen
Sayani
0000-0001-5391-7769
School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
ambreen.sayani@wchospital.ca
10.15171/ijhpm.2019.40
<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">National cancer control plans (NCCPs) are important documents that guide strategic priorities in cancer care and plan for the appropriate allocation of resources based on the social, geographic and economic needs of a population. Despite the emphasis on health equity by the World Health Organization (WHO), few NCCPs have a focus on health equity. The Ontario Cancer Plan (OCP) IV, (2015 to 2019) is an example of an NCCP with clearly defined health equity goals and objectives.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">This paper presents a directed-content analysis of the OCP IV health equity goals and objectives, in light of the synergies of oppression analytical framework.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">The OCP IV confines equity to an issue of access-to-care. As a result, it calls for training, funding, and social support services to increase accessibility for high-risk population groups. However, equity has a broader definition. And as such, it also implies that systematic differences in health outcomes between social groups should be minimal. This is particularly significant given that socially disadvantaged cancer patients in Ontario have distinctly poorer cancer-related health outcomes.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Health systems are seeking ways to reduce the health equity gap. However, to reduce health inequities which are socially-based will require a recognition of the living and working conditions of patients which influence risk, mortality and survival. NCCPs represent a way to politically advocate for the determinants of health which profoundly influence cancer risk, outcomes and mortality.</span>
Cancer Control Plan,Health Equity,Ontario
https://www.ijhpm.com/article_3632.html
https://www.ijhpm.com/article_3632_b64cbbbae7bd002b29ed2eb2e9ac4414.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
9
2019
09
01
Bridging the Gap Between Research and Policy and Practice; Comment on “CIHR Health System Impact Fellows: Reflections on ‘Driving Change’ Within the Health System”
557
559
EN
Martin
McKee
0000-0002-0121-9683
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
martin.mckee@lshtm.ac.uk
10.15171/ijhpm.2019.46
<span class="fontstyle0">Far too often, there is a gap between research and policy and practice. Too much research is undertaken with little relevance to real life problems or its reported in ways that are obscure and impenetrable. At the same time, many policies are developed and implemented but are untouched by, or even contrary to evidence. An accompanying paper describes an innovative programme in Canada to help bridge this gap. This commentary notes the growing acceptance of such initiatives but highlights the challenges of sustaining their benefits.</span>
Impact,Evidence,Policy,Knowledge Translation,Knowledge Brokering
https://www.ijhpm.com/article_3634.html
https://www.ijhpm.com/article_3634_e9d712df147f7c076e33d875bdaf1ee8.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
9
2019
09
01
Some Things Are Rarely Discussed in Public – on the Discourse of Corruption in Healthcare; Comment on “We Need to Talk About Corruption in Health Systems”
560
562
EN
Peter
Stiernstedt
0000-0003-0824-8396
School of Law and Criminology, University of West London, London, UK
peter.stiernstedt@uwl.ac.uk
10.15171/ijhpm.2019.51
In an editorial titled “We Need to Talk About Corruption in Health Systems” the authors Hutchinson, Balabanova, and McKee hope to encourage a wider conversation about corruption in the health sector. Such conversations are difficult to hold for at least five reasons; it is hard to define corruption; corruption may allow some fragile health systems to subsist, shifting blame – are those involved in anti-corruption research colluding with corrupt officials; the legitimacy of studying corruption; and, that far too little is known about how to tackle corruption. This commentary explores those reasons and concludes that the authors make a strong case for a more open and directed discussion about corruption.
Corruption,Anti-corruption,Governance,Healthcare
https://www.ijhpm.com/article_3636.html
https://www.ijhpm.com/article_3636_db3cae16b8c7600e2edac59d8b005e96.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
9
2019
09
01
I Know It When I See It: The Challenges of Addressing Corruption in Health Systems; Comment on “We Need to Talk About Corruption in Health Systems”
563
566
EN
Jillian Clare
Kohler
0000-0003-1290-9484
WHO Collaborating Center for Governance, Accountability and Transparency in the Pharmaceutical Sector and Leslie Dan Faculty of
Pharmacy, University of Toronto, Toronto, ON, Canada
jillian.kohler@utoronto.ca
10.15171/ijhpm.2019.48
<span class="fontstyle0">In this commentary, I argue that corruption in health systems is a critical and legitimate area for research in order to strengthen health policy goals. This rationale is based partly on citizen demand for more accountable and transparent health systems, along with the fact that the poor and vulnerable suffer the most from the presence of corruption in health systems. What is more, there is a growing body of literature on the impact of corruption in the health system and best practices in terms of anti-corruption, transparency and accountability (ACTA) strategies and tactics within the health system. Still, we need to support ACTA integration into the health system by having a common definition of corruption that is meaningful for health systems and ensure that ACTA strategies and tactics are transparent themselves. The 2019 Consultation on a proposed Global Network on ACTA in Health Systems is promising for these efforts.</span>
Corruption and Health Systems,Health Policy,Health System Governance
https://www.ijhpm.com/article_3643.html
https://www.ijhpm.com/article_3643_b990f405cca89ba767be6d067a03b7d2.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
9
2019
09
01
Innovation, Demand, and Responsibility: Some Fundamental Questions About Health Systems; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”
567
569
EN
Harro
van Lente
0000-0002-4719-360X
Faculty of Arts and Social Sciences, Maastricht University, Maastricht, The Netherlands
h.vanlente@maastrichtuniversity.nl
10.15171/ijhpm.2019.47
<span class="fontstyle0">In this commentary on the exercise of Lehoux et al (this volume) I argue that in discussions on the current challenges of health systems, a better diagnosis of the health system is required. The cause of responsible innovation in health (RIH) requires a better understanding of the dynamics of health systems, in particular how innovation, demand, and responsibility are manifested. Innovation brings its own dynamic to the health system; demands are linked to historical and social developments; responsibility brings contestations about what counts as good healthcare. Any attempt of RIH should include such reflections.</span>
Health System,Innovation,Demand,Responsible Innovation
https://www.ijhpm.com/article_3642.html
https://www.ijhpm.com/article_3642_ab3bf7f5f1f2bfc48241da7aee4151ea.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
9
2019
09
01
Innovation Strategies and Health System Guiding Principles to Address Equity and Sustainability in Responsible Innovation in Health; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”
570
572
EN
Sandra C.
Buttigieg
0000-0002-0572-2462
Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta
sandra.buttigieg@um.edu.mt
10.15171/ijhpm.2019.50
The insights from an international scoping review provided by Lehoux et al challenge health policy-makers, entrepreneurs/innovators and users of healthcare, worldwide, to be aware of equity and sustainability challenges at system-level when appraising responsible innovation in health (RIH) – purposefully designed to better support health systems.The authors manage to extract no less than 1391 health system challenges with those mostly cited pertaining to service delivery, human resources, leadership and governance. Countries were classified according to the Human Development Index (HDI), while the authors decided not to classify according to the types of health systems justifying this on the basis that the articles reviewed studied a specific setting within a broader national or regional health system. The article presents highly powerful and discerning viewpoints, indeed providing numerous standpoints, yet in a comprehensive manner, thereby putting structure to a somewhat highly complex and multidimensional subject. This commentary brings forth several considerations that are perceived on reading this article. First, although innovation strategies are important for the dynamicity of health systems, one should discuss whether or not RIH can adequately address equity and sustainability on a global scale. Secondly, RIH across countries should also be debated in the context of the principles garnered by the type of health system, thereby identifying whether or not the prevailing political goals support equity and sustainability, and whether or not policy-makers are adequately supported to translate system-level demand signals into innovation development opportunities. As key messages, the commentary reiterates the emphasis made by the authors of the need for international policy-oriented fora as learning vehicles on RIH that also address system-level challenges, albeit the need to acknowledge cultural differences. In addition, the public has not only the right for transparency on how equity and sustainability challenges are addressed in innovation decisions, but also the responsibilities to contribute to overcome these challenges.
Equity,Health System Principles,Innovation Strategies,Political Systems,Sustainability
https://www.ijhpm.com/article_3640.html
https://www.ijhpm.com/article_3640_a0167648cdda545d8fe87dd18fac1826.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
8
9
2019
09
01
The Why, Who, What, How, and When of Patient Engagement in Healthcare Organizations: A Response to Recent Commentaries
573
574
EN
Vadim
Dukhanin
0000-0002-8685-0027
Department of Health Policy and Management, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, USA
vdukhan1@jhu.edu
Matthew
DeCamp
0000-0002-9371-8729
Johns Hopkins Berman Institute
of Bioethics, Baltimore, MD, USA
matthew.decamp@ucdenver.edu
10.15171/ijhpm.2019.42
Patient Engagement,Patient and Public Involvement,Patient Participation,Health Systems,Health Planning,Organizational Decision Making
https://www.ijhpm.com/article_3629.html
https://www.ijhpm.com/article_3629_4771728372ae115d6153c6dcc56f7f25.pdf