Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Health Reform Requires Policy Capacity265266301210.15171/ijhpm.2015.85ENPierre-GerlierForestInstitute for Health and Social Policy, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, MD, USAJean-LouisDenisEcole nationale
d’administration publique, Montreal, QC, CanadaLawrence D.BrownDepartment of Health Policy
and Management, Mailman School of Public Health, Columbia University, New
York City, NY, USADavidHelmsDepartment of Health Policy and Management, Bloomberg
School of Public Health, Johns Hopkins University, Baltimore, MD, USAJournal Article20150309Among the many reasons that may limit the adoption of promising reform ideas, policy capacity is the least recognized. The concept itself is not widely understood. Although policy capacity is concerned with the gathering of information and the formulation of options for public action in the initial phases of policy consultation and development, it also touches on all stages of the policy process, from the strategic identification of a problem to the actual development of the policy, its formal adoption, its implementation, and even further, its evaluation and continuation or modification. Expertise in the form of policy advice is already widely available in and to public administrations, to well-established professional organizations like medical societies and, of course, to large private-sector organizations with commercial or financial interests in the health sector. We need more health actors to join the fray and move from their traditional position of advocacy to a fuller commitment to the development of policy capacity, with all that it entails in terms of leadership and social responsibilityhttps://www.ijhpm.com/article_3012_691405b1882a813c18c5886e710b6b26.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Who Killed the English National Health Service?267269299910.15171/ijhpm.2015.72ENMartinPowellHealth Services Management Centre, School of Social Policy, University of Birmingham, Birmingham, UKJournal Article20150225The death of the English National Health Service (NHS) has been pronounced many times over the years, but the time and cause of death and the murder weapon remains to be fully established. This article reviews some of these claims, and asks for clearer criteria and evidence to be presented.https://www.ijhpm.com/article_2999_af5e0887fd78a4b0f3bd6a6b1d1fe9d9.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Inadequate Control of Diabetes and Metabolic Indices among Diabetic Patients: A Population Based Study from the Kerman Coronary Artery Disease Risk Study (KERCADRS)271277293410.15171/ijhpm.2015.06ENGholamrezaYousefzadehPhysiology Research Center, Institute of Neuropharmacology, Kerman
University of Medical Sciences, Kerman, IranMostafaShokoohiResearch Center for Modeling
in Health, Institute for Futures Studies in Health, Kerman University of Medical
Sciences, Kerman, IranHamidNajafipourPhysiology Research Center, Institute of Neuropharmacology, Kerman
University of Medical Sciences, Kerman, IranJournal Article20140907Background <br />The goal of diabetes control should be feasible in order to minimize the risk of its adverse events and to reduce its burden and cost on patients. The current study aimed to assess the status of glycemic control in male and female patients with Type 2 Diabetes Mellitus (T2DM) in Kerman, Iran. <br /> <br />Methods <br />In the present study, 500 T2DM (300 women and 200 men) from the Kerman Coronary Artery Disease Risk Study (KERCADRS), a population-based study from 2009 to 2011, were selected. Patients were >18 years old, had Fasting Blood Sugar (FBS) higher than 126 mg/dl, and had been through treatment for their diagnosed disease. All participants underwent Glycosylated Hemoglobin (HbA1c) analysis. HbA1c less than 7% was considered as good glucose control. Other metabolic indices based on American Diabetes Association (ADA) target recommendations were considered. <br /> <br />Results <br />The mean level of HbA1c in total subjects was 8.56 ± 4.72% that only 31.66% of men and 26.00% of women had controlled level of HbA1c. Total cholesterol less than 200 mg/dl was reported in 64.50% of men and 44.00% of women, High Density Lipoprotein (HDL) more than 40 mg/dl was revealed in 20.50% of men and 34.67% of women, and Low Density Lipoprotein (LDL) less than 100 mg/dl was reported in 41.50% of men and 25.33% of women. In multivariate logistic regression model, longer duration of disease and higher Waist Circumference (WC) were positively associated with uncontrolled diabetes status. <br /> <br />Conclusion <br />The findings of the present study revealed that diabetes control in T2DM was inadequate. Changing the policy of treatment in individual patient and establishing better diabetes clinic to decrease the frequency of uncontrolled T2DM are crucial. Paying attention to other affecting metabolic components such as WC in the process of T2DM management is important.https://www.ijhpm.com/article_2934_149aa07dcb83cba263850e539a7947e1.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Perceived Barriers to Utilizing Maternal and Neonatal Health Services in Contracted-Out Versus Government-Managed Health Facilities in the Rural Districts of Pakistan279284298110.15171/ijhpm.2015.50ENAtifRiazDepartment of Community Health Sciences, Aga Khan University, Karachi,
PakistanShehlaZaidiDepartment of Community Health Sciences, Aga Khan University, Karachi,
PakistanWomen and Child Health Division, Aga Khan University, Karachi,
PakistanAsif RazaKhowajaWomen and Child Health Division, Aga Khan University, Karachi,
PakistanJournal Article20141122Background <br />A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users’ perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). <br /> <br />Methods <br />A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. <br /> <br />Results <br />Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. <br /> <br />Conclusion <br />Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong communitybased behavior change strategies.https://www.ijhpm.com/article_2981_97862c28a19c8a32504d10a8d17667dd.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Evidence for Informing Health Policy Development in Low- Income Countries (LICS): Perspectives of Policy Actors in Uganda285293298410.15171/ijhpm.2015.52ENJulietNabyonga-OremWHO Regional Office for Africa, Brazzaville, CongoRhonaMijumbiRegional East African
Community Health (REACH) Policy Initiative, Kampala, UgandaCollege of Health
Sciences, Makerere University Medical School, Kampala, UgandaJournal Article20140724Background <br />Although there is a general agreement on the benefits of evidence informed health policy development given resource constraints especially in Low-Income Countries (LICs), the definition of what evidence is, and what evidence is suitable to guide decision-making is still unclear. Our study is contributing to filling this knowledge gap. We aimed to explore health policy actors’ views regarding what evidence they deemed appropriate to guide health policy development. <br /> <br />Methods <br />Using exploratory qualitative methods, we conducted interviews with 51 key informants using an indepth interview guide. We interviewed a diverse group of stakeholders in health policy development and knowledge translation in the Uganda health sector. Data were analyzed using inductive content analysis techniques. <br /> <br />Results <br />Different stakeholders lay emphasis on different kinds of evidence. While donors preferred international evidence and Ministry of Health (MoH) officials looked to local evidence, district health managers preferred local evidence, evidence from routine monitoring and evaluation, and reports from service providers. Service providers on the other hand preferred local evidence and routine monitoring and evaluation reports whilst researchers preferred systematic reviews and clinical trials. Stakeholders preferred evidence covering several aspects impacting on decision-making highlighting the fact that although policy actors look for factual information, they also require evidence on context and implementation feasibility of a policy decision. <br /> <br />Conclusion <br />What LICslike Uganda categorize as evidence suitable for informing policy encompasses several types with no consensus on what is deemed as most appropriate. Evidence must be of high quality, applicable, acceptable to the users, and informing different aspects of decision-making.https://www.ijhpm.com/article_2984_27bc595fee8bdb9c7c67f2258ecc305e.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Pharmacovigilance in India, Uganda and South Africa with Reference to WHO’s Minimum Requirements295305298510.15171/ijhpm.2015.55ENKarenMaigetterDepartment of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, SwitzerlandUniversity of Basel, Basel, Switzerland0000-0003-0498-0803Allyson M.PollockQueen Mary University of London, Global Public Health Unit, London, UKAbhayKadamThe Foundation for Research in Community Health, Pune, IndiaKimWardSchool
of Pharmacy, University of the Western Cape, Bellville, South AfricaMitchellWeissSwiss
Tropical and Public Health Institute, Basel, SwitzerlandUniversity of Basel, Basel, SwitzerlandJournal Article20141107Background <br />Pharmacovigilance (PV) data are crucial for ensuring safety and effectiveness of medicines after drugs have been granted marketing approval. This paper describes the PV systems of India, Uganda and South Africa based on literature and Key Informant (KI) interviews and compares them with the World Health Organization’s (WHO’s) minimum PV requirements for a Functional National PV System. <br /> <br />Methods <br />A documentary analysis of academic literature and policy reports was undertaken to assess the medicines regulatory systems and policies in the three countries. A gap analysis from the document review indicated a need for further research in PV. KI interviews covered topics on PV: structure and practices of the system; current regulatory policy; capacity limitations, staffing, funding and training; availability and reporting of data; and awareness and usage of the systems. Twenty interviews were conducted in India, 8 in Uganda and 11 in South Africa with government officials from the ministries of health, national regulatory authorities, pharmaceutical producers, Non-Governmental Organizations (NGOs), members of professional associations and academia. The findings from the literature and KI interviews were compared with WHO’s minimum requirements. <br /> <br />Results <br />All three countries were confronted with similar barriers: lack of sufficient funding, limited number of trained staff, inadequate training programs, unclear roles and poor coordination of activities. Although KI interviews represented viewpoints of the respondents, the findings confirmed the documentary analysis of the literature. Although South Africa has a legal requirement for PV, we found that the three countries uniformly lacked adequate capacity to monitor medicines and evaluate risks according to the minimum standards of the WHO. <br /> <br />Conclusion <br />A strong PV system is an important part of the overall medicine regulatory system and reflects on the stringency and competence of the regulatory bodies in regulating the market ensuring the safety and effectiveness of medications. National PV systems in the study countries needed strengthening. Greater attention to funding is needed to coordinate and sustain PV activities. Our study highlights a need for developing more systematic approaches to regularly monitoring and evaluating PV policy and practices.https://www.ijhpm.com/article_2985_b9e92f98bb5e8e7d59d17613ebd2c6ef.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Thinking Shift on Health Systems: From Blueprint Health Programmes towards Resilience of Health Systems; Comment on “Constraints to Applying Systems Thinking Concepts in Health Systems: A Regional Perspective from Surveying Stakeholders in Eastern Mediterranean Countries”307309297510.15171/ijhpm.2015.49ENKarlBlanchetClinical Research Department, London School of Hygiene and Tropical Medicine, London, UKJournal Article20150120International health is still highly dominated by equilibrium approaches. The emergence of systems thinking in international health provides a great avenue to develop innovative health interventions adapted to changing contexts. The public health community, nevertheless, has the responsibility to translate concepts related to systems thinking and complexity into concrete research methods and interventions. One possibility is to consider the properties of systems such as resilience and adaptability as entry points to better understand how health systems react to shocks.https://www.ijhpm.com/article_2975_b7d505804d29f7c616a6c7c7104c8c21.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501The Politics of Researching Global Health Politics; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”311314297710.15171/ijhpm.2015.47ENSimonRushtonDepartment of Politics, University of Sheffield, Sheffield, UKJournal Article20150201In this comment, I build on Shiffman’s call for the global health community to more deeply investigate structural and productive power. I highlight two challenges we must grapple with as social scientists carrying out the types of investigation that Shiffman proposes: the politics of challenging the powerful; and the need to investigate types of expertise that have traditionally been thought of as ‘outside’ global health. In doing so, I argue that moving forward with the agenda Shiffman sets out requires social scientists interested in the global politics of health to be reflexive about our own exercise of structural and productive power and the fact that researching global health politics is itself a political undertaking.https://www.ijhpm.com/article_2977_4c4517fe51917792ae4c13b1723a3bab.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Power in Global Health Agenda-Setting: The Role of Private Funding; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”315317297610.15171/ijhpm.2015.51ENRuth E.LevineGlobal Development and Population Program, The William and Flora Hewlett Foundation, Menlo Park, CA, USAJournal Article20150213The editorial by Jeremy Shiffman, “Knowledge, moral claims and the exercise of power in global health”, highlights the influence on global health priority-setting of individuals and organizations that do not have a formal political mandate. This sheds light on the way key functions in global health depend on private funding, particularly from the Bill & Melinda Gates Foundation.https://www.ijhpm.com/article_2976_8f5a604c4453e9113e401b0ec383248a.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Heterogeneity of European DRG Systems and Potentials for a Common Eurodrg System; Comment on “Cholecystectomy and Diagnosis-Related Groups (DRGs): Patient Classification and Hospital Reimbursement in 11 European Countries”319320297910.15171/ijhpm.2015.53ENAlexanderGeisslerDepartment of Health Care Management, Berlin University of Technology, Berlin, GermanyWilmQuentinDepartment of Health Care Management, Berlin University of Technology, Berlin, GermanyReinhardBusseDepartment of Health Care Management, Berlin University of Technology, Berlin, GermanyJournal Article20150129Diagnosis-Related Group (DRG) systems across Europe are very heterogeneous, in particular because of different classification variables and algorithms as well as costing methodologies. But, given the challenge of increasing patient mobility within Europe, health systems are forced to incorporate a common patient classification language in order to compare and identify similar patients e.g. for reimbursement purposes. Beside the national adoption of DRGs for a wide range of purposes (measuring hospital activity vs. paying hospitals), a common DRG system can serve as an international communication basis among health administrators and can reduce the national development efforts as it is demonstrated by the NordDRG consortium.https://www.ijhpm.com/article_2979_1fd0f5235e26a5d3c14700f010345b28.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Power and Priorities: The Growing Pains of Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”321322298010.15171/ijhpm.2015.48ENKaren AnnGrépinRobert F. Wagner Graduate School of Public Service, New York University, New York City, NY, USAJournal Article20150216Shiffman has argued that some actors have a great deal of power in global health, and that more reflection is needed on whether such forms of power are legitimate. Global health is a new and evolving field that builds upon the historical fields of public and international health, but is more multi-disciplinary and inter-disciplinary in nature. This article argues that the distribution of power in some global health institutions may be limiting the contributions of all researchers in the fieldhttps://www.ijhpm.com/article_2980_89d2315e38b3d026dd2920090171e7c1.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150307International Patients on Operation Vacation: Medical Refuge and Health System Crisis; Comment on “International Patients on Operation Vacation – Perspectives of Patients Travelling to Hungary for Orthopaedic Treatments”323325298210.15171/ijhpm.2015.56ENNeilLuntDepartment of Social Policy and Social Work, University of York, Heslington, York, UKJournal Article20150208An understanding of patient mobility, international patients and medical tourism includes supply and demand side considerations. As well as micro-level reports of motivation and satisfaction we must acknowledge broader system-level dynamics. Exploring these may unearth more complex geographies of patient travel.https://www.ijhpm.com/article_2982_c35a4b2361d5592669d6b139c17d82f8.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Addressing the Shortage of Health Professionals in Rural China: Issues and Progress; Comment on “Have Health Human Resources Become More Equal between Rural and Urban Areas after the New Reform?”327328298310.15171/ijhpm.2015.57ENJianlinHouInstitute of Medical Education, Peking University, Beijing, ChinaYangKePeking University Health Science Centre (PUHSC), Beijing, ChinaJournal Article20150214Maldistribution of health professionals between urban and rural areas has been a serious problem in China. Urban hospitals attract most of the health professionals with serious shortages in rural areas. To address this issue, a number of policies have been implemented by the government, such as free medical education in exchange for obligatory rural service.https://www.ijhpm.com/article_2983_0d56288aa570078b145f48629798a45f.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501A Response to the Commentary Entitled: “Addressing the Shortage of Health Professionals in Rural China: Issues and Progress”329330301010.15171/ijhpm.2015.83ENQianYangCenter for Health Policy Studies, Department of Social Medicine, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, ChinaHengjinDongCenter for Health Policy Studies, Department of Social Medicine, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, ChinaJournal Article20150329https://www.ijhpm.com/article_3010_16ca321d44bdce386b176d9da8095383.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394520150501Introducing the Urban Community Health Center (UCHC) as a Nascent Local Model: Will it be a Linchpin in the Health Sector Reform in Iran?331332300210.15171/ijhpm.2015.74ENMohammad HadiImaniehDepartment of Pediatrics,
Shiraz University of Medical Sciences, Shiraz, IranAhmadKalateh SadatiHealth Policy Research Center, Shiraz University of Medical Sciences, Shiraz,
IranMohsenMoghadamiDepartment of Internal Medicine, Shiraz University of Medical Sciences,
Shiraz, IranAbdulrasoolHemmatiResource Management Unit of Health System, Shiraz University of Medical Sciences, Shiraz, IranJournal Article20150121https://www.ijhpm.com/article_3002_676cf1c910b5aef58a940e5172be4b2d.pdf