Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
Rhetoric or Reform? Changing Health and Social Care in Wales
295
298
EN
Alan
Willson
0000-0001-8810-1479
College of Human and Health Science, Swansea University, Swansea, UK
a.r.willson@swansea.ac.uk
Andrew
Davies
Swansea Bay University Health Board, Swansea, UK (retired)
d.andrew.davies@googlemail.com
10.34172/ijhpm.2020.53
<span class="fontstyle0">Throughout the United Kingdom, the National Health Service (NHS) struggles to meet demand and achieve performance targets. Services need to work with individuals and communities to reduce avoidable disease and dependence. All four UK nations have separately realised the need for change but 20 years’ experience suggests that vision and rhetoric are not enough. Success requires reformed systems and changed leadership behaviour to enable frontline staff to break the status quo. Top down, target driven behaviour must be replaced with a real focus on improvement, championing those who have the knowledge to deliver it.</span>
Healthcare,Policy,Reforms,Improvement,Wales
https://www.ijhpm.com/article_3790.html
https://www.ijhpm.com/article_3790_3ec454d08f77e8f2fdb3dcde0fe135ec.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle
299
309
EN
Ruairi
Brugha
0000-0003-0729-0197
RCSI Division of Population Health Sciences, Royal College of Surgeons in
Ireland, Dublin, Ireland
rbrugha@rcsi.ie
Nicholas
Clarke
0000-0001-8666-5449
School of Psychology, Dublin City University, Dublin,
Ireland
clanick@gmail.com
Louise
Hendrick
0000-0001-7722-6276
National Doctors Training and Planning, Health Service Executive,
Dublin 8, Ireland
louise.hendrick@hse.ie
James
Sweeney
0000-0002-5649-3233
Department of Mathematics & Statistics, University of
Limerick, Limerick, Ireland
jsweeney@rcsi.ie
10.34172/ijhpm.2020.54
<span class="fontstyle0">Background</span><br /><span class="fontstyle2">The failure of some high-income countries to retain their medical graduates is one driver of doctor immigration from low- and middle-income countries. Ireland, which attracts many international medical graduates, implemented a doctor retention strategy from early 2015. This study measures junior doctors’ migration intentions, the reasons they leave and likelihood of them returning. The aim is to identify the characteristics and patterns of doctors who plan to emigrate to inform targeted measures to retain these doctors.<br /></span><br /> <br /><span class="fontstyle0">Methods</span><br /><span class="fontstyle2">A national sample of 1148 junior hospital doctors completed an online survey in early 2018, eliciting their experiences of training and working conditions. Respondents were asked to choose between the following career options: remain in Ireland, go and return, go and stay away, or quit medicine. Bivariate analyses and a two-stage multivariable analysis were used to model the factors associated with these outcomes.<br /></span><br /> <br /><span class="fontstyle0">Results</span><br /><span class="fontstyle2">45% of respondents planned to remain in Ireland, 35% leave but return later, 17% leave and not return; and 3% to </span><span class="fontstyle2">quit medicine. An intention to go abroad versus remain in Ireland was independently associated (</span><span class="fontstyle3">P </span><span class="fontstyle2">< .05) with the doctor </span><span class="fontstyle2">being under 30 years (odds ratio [OR] = 1.09 per year under 30), a non-European Union (EU) national (OR = 1.54), a </span><span class="fontstyle2">trainee (OR = 1.50), and with hospital specialization, especially in Anesthesiology (OR = 5.09). Respondents were more </span><span class="fontstyle2">likely to remain if they had experienced improvements in supervision and training costs. Intention to go abroad and not </span><span class="fontstyle2">return versus go and return was independently associated (</span><span class="fontstyle3">P </span><span class="fontstyle2">< .05) with: age over 30 years (OR = 1.16 per year over 30); </span><span class="fontstyle2">being a non-EU (OR = 9.85) or non-Irish EU (OR = 3.42) national; having trained through a graduate entry pathway </span><span class="fontstyle2">(OR = 2.17), specializing in Psychiatry (OR = 4.76) and reporting that mentoring had become worse (OR = 5.85).</span><br /> <br /><br /><span class="fontstyle0">Conclusion</span><br /><span class="fontstyle2">Ireland’s doctor retention strategy has not addressed the root causes of poor training and working </span><span class="fontstyle2">experiences in Irish hospitals. It needs a more diversified retention strategy that addresses under-staffing, facilitates </span><span class="fontstyle2">circular migration by younger trainees who choose to train abroad, identifies and addresses specialty-specific factors, </span><span class="fontstyle2">and builds mentoring linkages between trainees and senior specialists.</span>
Workforce,Doctor Retention,Migration,WHO Global Code,Ireland
https://www.ijhpm.com/article_3795.html
https://www.ijhpm.com/article_3795_d6dd529c4265b7537068c2b87bd4f63d.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
Transnational Networks’ Contribution to Health Policy Diffusion: A Mixed Method Study of the Performance-Based Financing Community of Practice in Africa
310
323
EN
Lara
Gautier
0000-0002-9515-295X
Department of Social and Preventive Medicine, University of Montreal,
Montreal, QC, Canada
lara.gautier@umontreal.ca
Manuela
De Allegri
0000-0002-8677-1337
Heidelberg Institute of Global Health, Medical Faculty
and University Hospital, Heidelberg University, Heidelberg, Germany
manuela.deallegri@uni-heidelberg.de
Valéry
Ridde
0000-0001-9299-8266
CEPED
(IRD-Université de Paris), Université de Paris, ERL INSERM SAGESUD, Paris,
France
valery.ridde@ird.fr
10.34172/ijhpm.2020.57
<span class="fontstyle0">Background</span><br /> <span class="fontstyle2">Transnational networks such as Communities of Practice (CoPs) are flourishing, yet their role in diffusing health systems reforms has been seldom investigated. Over the past decade, performance-based financing (PBF) has rapidly spread in Africa. This study explores how, through the PBF Community of Practice’s attributes, structure, and strategies, PBF diffusion was fostered in sub-Saharan Africa (SSA).<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle2">Informed by the diffusion entrepreneurs’ (DEs) framework dimensions, we used a mixed methods convergent design to investigate how the attributes, structure, and strategies of this community fostered the diffusion of PBF. The quantitative strand of work included firstly a semantic discourse analysis of textual data extracted from CoP’s online discussion forum (n = 1346 posts). Secondly, the relational data extracted from these 1346 forum posts was examined using social network analysis (SNA). We confronted these quantitative results with a thematic analysis of qualitative interviews (n = 40) and data extracted from the CoP’s key documentation (n = 17).<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle2">CoP members’ attributes included: representation systems anchored in clinical and economic sciences, strong expectations that the CoP would boost professional visibility and career, and significant health systems knowledge and social resources. The CoP’s core group, dominated by high-income country (HIC) members, critically matched PBF principles to major health systems issues in Africa. The broad consensus in online PBF thematic discussions created a strong sense of community, a breeding ground for emulation among CoP members. The CoP also sought to produce and promote experiential knowledge exchanges about PBF amongst African practitioners. Findings from network analyses showed that the promoted Africa-driven community was led by HIC members, although their prominence tended to decrease with time.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle2">This empirical research highlighted some of the constituting features, structure, and strategies of policy networks in influencing health policy diffusion. Despite good intentions to disrupt the established governance landscape, influential actors coming from HICs continued to drive the framing, and shaped health systems policy experimentation, emulation, and learning in African countries. Beyond mere knowledge exchange platforms, CoP can act as meaningful transnational policy networks pursuing the diffusion of health systems reforms, such as PBF.</span>
Transnational Policy Networks,Communities of Practice,Social Network Analysis,Semantic Analysis,Performance-Based Financing,Sub-Saharan Africa
https://www.ijhpm.com/article_3796.html
https://www.ijhpm.com/article_3796_f575e09adaea4e59ea452b1f24489da9.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
A Systematic Review of Tobacco Industry Tactics in Southeast Asia: Lessons for Other Low- And MiddleIncome Regions
324
337
EN
Gianna Gayle Herrera
Amul
0000-0002-4197-9601
Lee Kuan Yew School of Public Policy, National University of Singapore,
Singapore, Singapore
giannagayle@nus.edu.sg
Grace Ping Ping
Tan
0000-0002-6211-7461
Saw Swee Hock School of Public Health, National
University of Singapore, Singapore, Singapore
grace.tan@nus.edu.sg
Yvette
van der Eijk
0000-0002-8095-1214
Saw Swee Hock School of Public Health, National
University of Singapore, Singapore, Singapore
yvette.eijk@nus.edu.sg
10.34172/ijhpm.2020.97
<span class="fontstyle0">Background</span><br /> <span class="fontstyle2">Transnational tobacco companies (TTCs) have a well-established presence in Southeast Asia and are now targeting other low- and middle-income countries (LMICs), especially Africa. While the tobacco industry’s tactics in Southeast Asia are well documented, no study has systematically reviewed these tactics to inform tobacco control policies and movements in Africa, where the tobacco epidemic is spreading.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle2">We conducted a systematic literature review of articles that describe tobacco industry tactics in Southeast Asia, which includes Singapore, Indonesia, Malaysia, the Philippines, Myanmar, East Timor, Thailand, Cambodia, Vietnam, Laos, and Brunei. After screening 512 articles, we gathered and analysed data from 134 articles which met our final inclusion criteria.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle2">Tobacco transnationals gained dominance in Southeast Asian markets by positioning themselves as good corporate citizens with corporate social responsibility (CSR) initiatives, promoting the industry as a pillar of, and partner for, economic growth. Tobacco transnationals also formed strategic sectoral alliances and reinforced their political ties to delay the implementation of regulations and lobby for weaker tobacco control. Where governments resisted the transnationals’ attempts to enter a market, they used litigation and deceptive tactics including smuggling to pressure governments to open markets, and tarnished the reputation of public health organizations. The tobacco industry undermined tobacco advertising, promotion and sponsorship (TAPS) regulations through a broad range of direct and indirect marketing tactics.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle2">The experience of Southeast Asia with tobacco transnationals show that, beyond highlighting the public health benefits, underscoring the economic benefits of tobacco control might be a more compelling argument for governments in LMICs to prioritise tobacco control. Given the tobacco industry’s widespread use of litigation, LMICs need more legal support and resources to counter industry litigations. LMICs should also prioritize measures to protect health policy from the vested interests of the tobacco industry, and to close regulatory loopholes in tobacco marketing restrictions.</span>
Tobacco Industry Tactics,Transnational Tobacco,Southeast Asia,Tobacco Control,LMICs
https://www.ijhpm.com/article_3834.html
https://www.ijhpm.com/article_3834_cff48f40438283de4933c520832d296b.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
Sense-Making, Mutual Learning and Cognitive Shifts When Applying Systems Thinking in Public Health – Examples From Sweden; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”
338
342
EN
Monica E.
Nyström
0000-0003-2281-4622
Department of Learning, Informatics, Management and Ethics (LIME), Medical
Management Centre, SOLIID, Karolinska Institutet, Stockholm, Sweden
monica.nystrom@ki.se
Sara
Tolf
Department of Learning, Informatics, Management and Ethics (LIME), Medical
Management Centre, SOLIID, Karolinska Institutet, Stockholm, Sweden
sara.tolf@ki.se
Helena
Strehlenert
0000-0002-4399-5592
Department of Learning, Informatics, Management and Ethics (LIME), Medical
Management Centre, SOLIID, Karolinska Institutet, Stockholm, Sweden
helena.strehlenert@ki.se
10.34172/ijhpm.2020.106
It is widely acknowledged that systems thinking (ST) should be implemented in the area of public health, but how this should be done is less clear. In this commentary we focus on sense-making and double-loop learning processes when using ST and soft systems methodology in research collaborations with policy-makers. In their study of policy-makers’ experiences of ST, Haynes et al emphasize the importance of knowledge processes and mutual learning between researchers and policy-makers, processes which can change how policy-makers think and thus have impact on real-world policy concerns. We provide some additional examples from Sweden on how ST has been applied to create learning and shared mental models among stakeholders and researchers in national and regional healthcare development initiatives. We conclude that investigating and describing such processes on micro-level can aid the knowledge on how to implement ST in public health.
Systems Thinking,Soft Systems Methodology,Healthcare Development,Double-Loop Learning,Policy-makers,Sweden
https://www.ijhpm.com/article_3848.html
https://www.ijhpm.com/article_3848_6e0330c6ea3b2d93f746a821816b0fde.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
Applying a Systems Perspective to Preventive Health: How Can It Be Useful?; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”
343
346
EN
Matt
Egan
0000-0002-4040-200X
Department of Public Health, Environments and Society, Faculty of Public
Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
matt.egan@lshtm.ac.uk
Elizabeth
McGill
0000-0002-3841-8467
Department of Health Services Research and Policy, Faculty of Public Health
and Policy, London School of Hygiene & Tropical Medicine, London, UK
elizabeth.mcgill@lshtm.ac.uk
10.34172/ijhpm.2020.120
Advocates suggest that a paradigm shift in preventive health towards systems thinking is desirable and may be underway. In a recent study of policy-makers’ opinions, Haynes and colleagues found a mixed response to an Australian initiative that sought to apply systems theories and associated methods to preventive health. Some were enthusiastic about systems, but others were concerned or unconvinced about its usefulness. This commentary responds to such concerns. We argue that a systems perspective can help provide policy-makers with timely evidence to inform decisions about intervention planning and delivery. We also suggest that research applying a systems perspective could provide policy-makers with evidence to support planning and incremental decision-making; make recommendations to support intervention adaptability; consider potential barriers due to incoherent systems, and consider the political consequences of interventions.
Preventive Health,Systems Thinking,Complexity Science,Evidence-Informed Policy
https://www.ijhpm.com/article_3855.html
https://www.ijhpm.com/article_3855_c46caf75e1780e4c9efd7a4fa09e6a13.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
Reflections on Methodological Congruence in Systems and Complexity-Informed Research; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”
347
350
EN
Ana
Teixeira de Melo
0000-0001-7816-3836
Centre for Social Studies, University of Coimbra, Coimbra, Portugal
anamelopsi@gmail.com
10.34172/ijhpm.2020.231
In this paper we argue, for an increased congruence between the conceptual frameworks and the research methodology in studies focused on the theory or practice of systems and complexity-informed thinking (SCT). In doing so, we believe we can build more complex forms of knowledge with clearer and more impactful implications for practice. There is scope for both methodological innovations and the adaptation of traditional research methods to enact properties congruent with the systemic complexity of our targeted realities. We organise our reflection around the paper of Haynes et al. We provide examples of how a research methodology more deeply embedded in systems and complexity-thinking may add depth and meaning to the research results and their interpretation. We explore the creative adaptation of the interview techniques to integrate systemic forms of questioning (eg, circular and reflexive questioning) to map the patterns of interaction contributing to the outcomes of interventions.
Systems Thinking,Complexity Thinking,Methodological Congruence,Methodologies
https://www.ijhpm.com/article_3971.html
https://www.ijhpm.com/article_3971_159d334d839fee4cb1cc993aeadcadf4.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
Can We Build an Evidence Base on the Impact of Systems Thinking for Wicked Problems?; Comment on “What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health”
351
353
EN
Diane T.
Finegood
0000-0002-0568-0522
Morris J. Wosk Centre for Dialogue, Simon Fraser University, Vancouver, BC, Canada
finegood@sfu.ca
10.34172/ijhpm.2020.194
The published literature on the application of systems thinking to influence policies and programs has grown in recent years. The original article by Haynes et al and the subsequent commentaries have focused on the upstream connection between capacity building for systems thinking and systems informed decision-making. This commentary explores the downstream connection between systems-informed decision-making and broader impacts on the health system, the health of the population and other economic and social benefits. Storytelling, systems-based syntheses and systems intervention principles are explored as approaches to strengthen the evidence base. For systems thinking to gain broader acceptance and application to complex health-related challenges, we need more of an evidence base demonstrating impact.
Systems Thinking,Complex Adaptive Systems,Evidence Base,Decision-Making,Research Impact
https://www.ijhpm.com/article_3927.html
https://www.ijhpm.com/article_3927_486c52ae20ded96c57434ccf96cb4a71.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
If Gaming is the Problem, Is “Complexity Thinking” the Answer? A Response to the Recent Commentaries
354
355
EN
Tim
Tenbensel
0000-0001-7832-3318
School of Population Health, University of Auckland, Auckland, New Zealand
t.tenbensel@auckland.ac.nz
Peter
Jones
0000-0003-1560-1186
Auckland District Health Board, University of Auckland, Auckland, New
Zealand
peterj@adhb.govt.nz
Linda
Chalmers
Wintec, Hamilton, New Zealand
l.chalmers@inspire.net.nz
Shanthi
Ameratunga
0000-0001-8042-2251
School of Population Health, University of Auckland, Auckland, New Zealand
s.ameratunga@auckland.ac.nz
Peter
Carswell
0000-0002-8416-9561
School of Population Health, University of Auckland, Auckland, New Zealand
p.carswell@auckland.ac.nz
10.34172/ijhpm.2020.95
Gaming,Performance Management,Complexity,New Zealand,Emergency Department,Targets
https://www.ijhpm.com/article_3830.html
https://www.ijhpm.com/article_3830_c711e20592d888a9819c4a9352a0070e.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
Universal Pharmacare – Redressing Social Inequities in the Canadian Health System: A Response to Recent Commentaries
356
357
EN
Mohammad
Hajizadeh
0000-0002-4591-8531
School of Health Administration, Dalhousie University, Halifax, NS, Canada
m.hajizadeh@dal.ca
Sterling
Edmonds
Schulich School of Law, Dalhousie University, Halifax, NS, Canada
sterling.edmonds@dal.ca
10.34172/ijhpm.2020.129
Universal Pharmacare,Health Policy,Equity,Canada
https://www.ijhpm.com/article_3861.html
https://www.ijhpm.com/article_3861_962d93e855dedcf7571c6f0bb321f781.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
10
6
2021
06
01
Improving the Rural-Urban Balance in Cambodia’s Health Services
358
359
EN
Yurie
Kobashi
0000-0002-3442-3779
Department of General Internal Medicine, Sunrise Japan Hospital Phnom
Penh, Phnom Penh, Cambodia
tenten.yurie@gmail.com
Kimhab
Chou
Department of
Medicine, University of Puthisastra, Phnom Penh, Cambodia
choukimhabchou@gmail.com
Novy
Slaiman
Department of General Internal Medicine, Sunrise Japan Hospital Phnom
Penh, Phnom Penh, Cambodia
novya555@gmail.com
Phannoch
Neun
Department of General Internal Medicine, Sunrise Japan Hospital Phnom
Penh, Phnom Penh, Cambodia
phannochs.n@gmail.com
Yoshifumi
Hayashi
Department of
Neurosurgery, Sunrise Japan Hospital Phnom Penh, Phnom Penh, Cambodia
yhayashi0911@gmail.com
Masaharu
Tsubokura
0000-0001-8027-202X
Department of Public Health, Fukushima
Medical University School of Medicine, Fukushima, Japan
tsubokura_tky@me.com
Manabu
Okawada
Department of Pediatrics, Sunrise Japan Hospital Phnom Penh, Phnom Penh,
Cambodia
okawada.manabu@sunrise-hs.com
10.34172/ijhpm.2020.136
Regional Disparity,Global Health,Workforce
https://www.ijhpm.com/article_3871.html
https://www.ijhpm.com/article_3871_06016c7673f02d7c281b234f42062c49.pdf