Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Relevance and Effectiveness of the WHO Global Code Practice on the International Recruitment of Health Personnel – Ethical and Systems Perspectives333336302710.15171/ijhpm.2015.103ENRuairiBrughaDivision of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland0000-0003-0729-0197SophieCroweDivision of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, IrelandJournal Article20150417The relevance and effectiveness of the World Health Organization’s (WHO’s) Global Code of Practice on the International Recruitment of Health Personnel is being reviewed in 2015. The Code, which is a set of ethical norms and principles adopted by the World Health Assembly (WHA) in 2010, urges members states to train and retain the health personnel they need, thereby limiting demand for international migration, especially from the under-staffed health systems in low- and middle-income countries. Most countries failed to submit a first report in 2012 on implementation of the Code, including those source countries whose health systems are most under threat from the recruitment of their doctors and nurses, often to work in 4 major destination countries: the United States, United Kingdom, Canada and Australia. Political commitment by source country Ministers of Health needs to have been achieved at the May 2015 WHA to ensure better reporting by these countries on Code implementation for it to be effective. This paper uses ethics and health systems perspectives to analyse some of the drivers of international recruitment. The balance of competing ethics principles, which are contained in the Code’s articles, reflects a tension that was evident during the drafting of the Code between 2007 and 2010. In 2007-2008, the right of health personnel to migrate was seen as a preeminent principle by US representatives on the Global Council which co-drafted the Code. Consensus on how to balance competing ethical principles – giving due recognition on the one hand to the obligations of health workers to the countries that trained them and the need for distributive justice given the global inequities of health workforce distribution in relation to need, and the right to migrate on the other hand – was only possible after President Obama took office in January 2009. It is in the interests of all countries to implement the Global Code and not just those that are losing their health personnel through international recruitment, given that it calls on all member states “to educate, retain and sustain a health workforce that is appropriate for their (need) …” (Article 5.4), to ensure health systems’ sustainability. However, in some wealthy destination countries, this means tackling national inequities and poorly designed health workforce strategies that result in foreign-trained doctors being recruited to work among disadvantaged populations and in primary care settings, allowing domestically trained doctors work in more attractive hospital settings.https://www.ijhpm.com/article_3027_b922ede9c9eb9eabec1c1fecbdecb45d.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Global Health Diplomacy, National Integration, and Regional Development through the Monitoring and Evaluation of HIV/AIDS Programs in Papua New Guinea, Vanuatu, and Samoa337341301810.15171/ijhpm.2015.89ENSebastianKevanyUniversity of California, San Francisco, CA, USAAmyGildeaKPMG Health Advisory Services, Port Moresby, Papua New GuineaCalebGaraeMinistry of Health, Port Vila,
VanuatuSerafiMoaMinistry of Health, Apia, SamoaAvaiaLautusiMinistry of Health, Apia, SamoaJournal Article20150313The South Pacific countries of Vanuatu, Samoa, and Papua New Guinea have ascended rapidly up the development spectrum in recent years, refining an independent and post-colonial economic and political identity that enhances their recognition on the world stage. All three countries have overcome economic, political and public health challenges in order to stake their claim to sovereignty. In this regard, the contributions of national and international programs for the diagnosis, treatment and prevention of HIV/AIDS, with specific reference to their monitoring and evaluation (M&E) aspects, have contributed not just to public health, but also to broader political and diplomatic goals such as ‘nation-building’. This perspective describes the specific contributions of global health programs to the pursuit of national integration, development, and regional international relations, in Vanuatu, Samoa and Papua New Guinea, respectively, based on in-country M&E activities on behalf of the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria and the Australian Department of Foreign Affairs and Trade (DFAT) during 2014 and 2015. Key findings include: (1) that global health programs contribute to non-health goals; (2) that HIV/AIDS programs promote international relations, decentralized development, and internal unity; (3) that arguments in favour of the maintenance and augmentation of global health funding may be enhanced on this basis; and (4) that “smart” global health approaches have been successful in South Pacific countries.https://www.ijhpm.com/article_3018_9a96a2c73c0d477ff2a6da3bf538f4f4.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Oral Hygiene Status in a General Population of Iran, 2011: A Key Lifestyle Marker in Relation to Common Risk Factors of Non-Communicable Diseases343352294610.15171/ijhpm.2015.18ENFereshtehAsgariCenter for Disease Control and Prevention, Deputy for Health, Ministry
of Health and Medical Education, Tehran, IranAzamMajidiCancer Research Center,
Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, IranJalilKoohpayehzadehDepartment of Community Medicine, Iran University of Medical Sciences,
Tehran, IranKooroshEtemadDepartment of Epidemiology, School of Public Health, ShahidBeheshti University of Medical Sciences, Tehran, IranAliRafeiNational Program for
Disease Registries and Health Outcomes, Deputy for Research, Ministry of
Health and Medical Education, Tehran, IranJournal Article20140930Background <br />To estimate Oral Hygiene (OH) status in the Iranian population in 2011, and to determine the influence of socio-economic characteristics on OH, and its interrelation with common risk factors of Non-Communicable Diseases (NCDs). <br /> <br />Methods <br />Data including a total of 12,105 individuals aged 6-70 years were obtained from the sixth round of the surveys of NCDs risk factors in Iran. OH was recorded through a structured questionnaire measuring daily frequencies of tooth brushing and dental flossing. Descriptive analyses were performed on demographic characteristics in the complex sample survey setting. We also employed weighted binary logistic regression to compute Odds Ratio (OR) as a measure of association between the response and explanatory factors. Furthermore, to construct an asset index, we utilized Principal Component Analysis (PCA). <br /> <br />Results <br />The percentage with minimum recommended daily OH practices was 3.7% among men and 7.7% among women (OR= 2.3; P< 0.001). Urban citizens were more likely to have their teeth cleaned compared to rural people (OR= 2.8; P< 0.001). For both genders, a relatively better condition was observed in the 25–34 age group (male: 5.6%; female: 10.3%). In addition, OH status improved significantly by increase in both level of education (P< 0.001) and economic status (P< 0.001). There were also apparent associations between self-care practices and specific behavioral risk factors, though the correlation with dietary habits and tobacco use could be largely explained by socio-economic factors. <br /> <br />Conclusion <br />OH situation in Iran calls for urgent need to assign proper interventions and strategies toward raising public awareness and reducing disparities in access to health facilities.https://www.ijhpm.com/article_2946_c9efe5f26cd17ba6216bbe2a7d26d490.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Implementation of a Health Management Mentoring Program: Year-1 Evaluation of Its Impact on Health System Strengthening in Zambézia Province, Mozambique353361299110.15171/ijhpm.2015.58ENLaura J.EdwardsVanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN,
USAAbúMoisésFriends in Global Health, Maputo, MozambiqueMathiasNzarambaFriends in Global Health, Maputo, MozambiqueAboobacarCassimoFriends in Global Health, Maputo, MozambiqueLauraSilvaFriends in Global Health, Maputo, MozambiqueJoaquimMauricioFriends in Global Health, Maputo, MozambiqueC. WilliamWesterVanderbilt Institute
for Global Health, Department of Medicine, Division of Infectious Diseases,
Vanderbilt University, Nashville, TN, USASten H.VermundVanderbilt Institute for Global Health,
Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University,
Nashville, TN, USATroy D.MoonVanderbilt Institute for Global Health,
Department of Pediatrics, Division of Infectious Diseases, Vanderbilt University,
Nashville, TN, USA0000-0002-1637-829XJournal Article20140815Background <br />Avante Zambéziais an initiative of a Non-Governmental Organization (NGO), Friends in Global Health, LLC (FGH) and the Vanderbilt Institute for Global Health (VIGH) to provide technical assistance to the Mozambican Ministry of Health (MoH) in rural Zambézia Province. Avante Zambézia developed a district level Health Management Mentorship (HMM) program to strengthen health systems in ten of Zambézia’s 17 districts. Our objective was to preliminarily analyze changes in four domains of health system capacity after the HMM’s first year: accounting, Human Resources (HRs), Monitoring and Evaluation (M&E), and transportation management. <br /> <br />Methods <br />Quantitative metrics were developed in each domain. During district visits for weeklong, on-site mentoring, the health management mentoring teams documented each indicator as a success ratio percentage. We analyzed data using linear regressions of each indicator’s mean success ratio across all districts submitting a report over time. <br /> <br />Results <br />Of the four domains, district performance in the accounting domain was the strongest and most sustained. Linear regressions of mean monthly compliance for HR objectives indicated improvement in three of six mean success ratios. The M&E capacity domain showed the least overall improvement. The one indicator analyzed for transportation management suggested progress. <br /> <br />Conclusion <br />Our outcome evaluation demonstrates improvement in health system performance during a HMM initiative. Evaluating which elements of our mentoring program are succeeding in strengthening district level health systems is vital in preparing to transition fiscal and managerial responsibility to local authorities.https://www.ijhpm.com/article_2991_c5c1cb0bebd56ae38817b251ad72bedb.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Regional Incentives and Patient Cross-Border Mobility: Evidence from the Italian Experience363372299810.15171/ijhpm.2015.65ENElenkaBrennaDepartment of Economics and Finance, Università Cattolica del S. Cuore,
Milano, ItalyFedericoSpandonaroDepartment of Economics, Law and Institutions, Università Tor
Vergata, Roma, ItalyJournal Article20141128Background <br />In recent years, accreditation of private hospitals followed by decentralisation of the Italian National Health Service (NHS) into 21 regional health systems has provided a good empirical ground for investigating the Tiebout principle of “voting with their feet”. We examine the infra-regional trade-off between greater patient choice (due to an increase in hospital services supply) and financial equilibrium, and we relate it to the significant phenomenon of Cross-Border Mobility (CBM) between Italian regions. Focusing on the rules supervising the financial agreements between regional authorities and providers of hospital care, we find incentives for private accredited providers in attracting patient inflows. <br /> <br />Methods <br />The analysis is undertaken from an institutional, regulatory and empirical perspective. We select a sample of five regions with higher positive CBM balance and we examine regional regulations governing the contractual agreements between purchasers and providers of hospital care. According to this sample, we provide a statistical analysis of CBM and apply a Regional Attraction Ability Index (RAAI), aimed at testing patient preferences for private/public accredited providers. <br /> <br />Results <br />We find that this index is systematically higher for private providers, both in the case of distance/boundary patients and of excellence/general hospitals. <br /> <br />Conclusion <br />Conclusions address both financial issues regarding the coverage of regional healthcare systems and equity issues on patient healthcare access. They also raise concerns on the new European Union (EU) directive inherent to patient mobility across Europe.https://www.ijhpm.com/article_2998_71887f62f073a78511cbac56f8cab53f.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Examining the Potential Role of a Supervised Injection Facility in Saskatoon, Saskatchewan, to Avert HIV among People Who Inject Drugs373379300110.15171/ijhpm.2015.73ENEhsanJozaghiSchool of Criminology, Simon Fraser University, Burnaby, BC, CanadaAshekaJacksonSchool of Criminology, Simon Fraser University, Burnaby, BC, CanadaJournal Article20141117Background <br />Research predicting the public health and fiscal impact of Supervised Injection Facilities (SIFs), across different cities in Canada, has reported positive results on the reduction of HIV cases among People Who Inject Drugs (PWID). Most of the existing studies have focused on the outcomes of Insite, located in the Vancouver Downtown Eastside (DTES). Previous attention has not been afforded to other affected areas of Canada. The current study seeks to address this deficiency by assessing the cost-effectiveness of opening a SIF in Saskatoon, Saskatchewan. <br /> <br />Methods <br />We used two different mathematical models commonly used in the literature, including sensitivity analyses, to estimate the number of HIV infections averted due to the establishment of a SIF in the city of Saskatoon, Saskatchewan. <br /> <br />Results <br />Based on cumulative cost-effectiveness results, SIF establishment is cost-effective. The benefit to cost ratio was conservatively estimated to be 1.35 for the first two potential facilities. The study relied on 34% and 14% needle sharing rates for sensitivity analyses. The result for both sensitivity analyses and the base line estimates indicated positive prospects for the establishment of a SIF in Saskatoon. <br /> <br />Conclusion <br />The opening of a SIF in Saskatoon, Saskatchewan is financially prudent in the reduction of tax payers’ expenses and averting HIV infection rates among PWID.https://www.ijhpm.com/article_3001_908c9a564a86426585b29f5335b619bc.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Strengthening Core Public Health Capacity Based on the Implementation of the International Health Regulations (IHR) (2005): Chinese Lessons381386301310.15171/ijhpm.2015.84ENBinLiuSchool of Medicine and Health Management, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, ChinaYanSunThe Bureau for Health
Inspection and Supervision of Haidian District, Beijing, ChinaQianDongDepartment of
International Cooperation, National Health and Family Planning Commission
of the People’s Republic of China, Beijing, ChinaZongjiuZhangOffice of Health Emergency
(Center for Public Health Emergency), National Health and Family Planning
Commission of the People’s Republic of China, Beijing, ChinaLiangZhangSchool of Medicine and Health Management, Tongji Medical College, Huazhong
University of Science and Technology, Wuhan, ChinaJournal Article20141226As an international legal instrument, the International Health Regulations (IHR) is internationally binding in 196 countries, especially in all the member states of the World Health Organization (WHO). The IHR aims to prevent, protect against, control, and respond to the international spread of disease and aims to cut out unnecessary interruptions to traffic and trade. To meet IHR requirements, countries need to improve capacity construction by developing, strengthening, and maintaining core response capacities for public health risk and Public Health Emergency of International Concern (PHEIC). In addition, all the related core capacity requirements should be met before June 15, 2012. If not, then the deadline can be extended until 2016 upon request by countries. China has promoted the implementation of the IHR comprehensively, continuingly strengthening the core public health capacity and advancing in core public health emergency capacity building, points of entry capacity building, as well as risk prevention and control of biological events (infectious diseases, zoonotic diseases, and food safety), radiological, nuclear, and chemical events, and other catastrophic events. With significant progress in core capacity building, China has dealt with many public health emergencies successfully, ensuring that its core public health capacity has met the IHR requirements, which was reported to WHO in June 2014. This article describes the steps, measures, and related experiences in the implementation of IHR in China.https://www.ijhpm.com/article_3013_4110a1994471c595f7583ef1b74ba4cb.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Diffusion of Innovation in Mental Health Policy Adoption: What Should We Ask about the Quality of Policy and the Role of Stakeholders in this Process?; Comment on “Cross-National Diffusion of Mental Health Policy”387389298610.15171/ijhpm.2015.59ENLucyLeeCentre for Global Mental Health, London School of Hygiene & Tropical Medicine, London, UKJournal Article20150123In his recent study, Gordon Shen analyses a pertinent question facing the global mental health research and practice community today; that of how and why mental health policy is or is not adopted by national governments. This study identifies becoming a World Health Organization (WHO) member nation, and being in regional proximity to countries which have adopted a mental health policy as supportive of mental health policy adoption, but no support for its hypothesis that country recipients of higher levels of aid would have adopted a mental health policy due to conditionalities imposed on aid recipients by donors. Asking further questions of each may help to understand more not only about how and why mental health policies may be adopted, but also about the relevance and quality of implementation of these policies and the role of specific actors in achieving adoption and implementation of high quality mental health policies.https://www.ijhpm.com/article_2986_769675d7c11f336ae6573e7e533570ec.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Health Policy and Management: In Praise of Political Science; Comment on “On Health Policy and Management (HPAM): Mind the Theory-Policy Practice Gap”391394298910.15171/ijhpm.2015.62ENDavid JHunterCentre for Public Policy and Health, School of Medicine, Pharmacy and Health, Durham University, Durham, UK0000-0002-7085-8729Journal Article20150205Health systems have entered a third era embracing whole systems thinking and posing complex policy and management challenges. Understanding how such systems work and agreeing what needs to be put in place to enable them to undergo effective and sustainable change are more pressing issues than ever for policy-makers. The theory-policy-practice-gap and its four dimensions, as articulated by Chinitz and Rodwin, is acknowledged. It is suggested that insights derived from political science can both enrich our understanding of the gap and suggest what changes are needed to tackle the complex challenges facing health systems.https://www.ijhpm.com/article_2989_5848ad959570f87753a60ce8be1567f3.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Your Call Could not be Completed as Dialled: Why Truth Does not Speak to Power In Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”395397299010.15171/ijhpm.2015.63ENJesse BBumpDepartment of International Health, Georgetown University, Washington, DC, USA0000-0003-1014-0456Journal Article20150216This article contends that legitimacy in the exercise of power comes from the consent of those subject to it. In global health, this implies that the participation of poor country citizens is required for the legitimacy of major actors and institutions. But a review of institutions and processes suggests that this participation is limited or absent. Particularly because of the complex political economy of non-communicable diseases, this participation is essential to the future advancement of global health and the legitimacy of its institutions. More analysis of power and legitimacy provides one entry point for fostering progress.https://www.ijhpm.com/article_2990_f6b5f8c32c65fee991049a55dc97d1ce.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Morality and Values in Support of Universal Healthcare Must be Enshrined in Law; Comment on “Morality and Markets in the NHS”399402298710.15171/ijhpm.2015.61ENAllyson MPollockQueen Mary University of London, London, UKJournal Article20150216This is a commentary on Gilbert and colleagues’ (1) paper on morality and markets in the National Health Service (NHS). Morality and values are not ephemeral qualities and universal healthcare is not simply an aspiration; it has to be enshrined in law. The creation of the UK NHS in 1948 was underpinned by core legal duties which required a system of public funding and delivery to follow. The moral values of the citizens in support of social solidarity were thus transformed into a political and legal contract for citizens. The NHS still survives in Scotland, Wales and Northern Ireland but the coalition government abolished it in England in 2012, reducing the NHS to a funding stream, a logo and a set of market regulators. This paper describes and explains the Health and Social Care (HSC) Act 2012 in England and how the NHS is withering away and health services are being remodeled along US Health Maintenance Organization (HMO) lines. There was nothing moral about this extraordinary act of savagery and violence against the public in England, and against common values and widely held beliefs in public ownership funding and provision of universal healthcare. The public health consequences will be catastrophic which is why after the election on May seventh a new Bill is required to Reinstate the NHS and the Secretary of State’s legal duty to provide listed health services throughout England.https://www.ijhpm.com/article_2987_ae1d2c2d957a01dcb3f3b39685cdb4fa.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Untimely Applause Was a Distraction; Comment on “Shanghai Rising: Health Improvements as Measured by Avoidable Mortality since 2000”403405299210.15171/ijhpm.2015.64ENYanFeiDepartment of Social Medicine, School of Public Health, Fudan University,
Shanghai, ChinaJianZhangJiann-Ping Hsu College of Public Health, Georgia Southern
University, Statesboro, GA, USAJournal Article20150228The paper published in the January 2015 issue of this journal by Gusmano and colleagues entitled “<em>Shanghai rising: health improvements as measured by avoidable mortality since 2000</em>” has spurred this commentary. We discuss controversial issues surrounding the concept of avoidable mortality in health service research in general and Gusmano’s study in particular. The impact of overall social development on mortality may be underappreciated in Gusmano’s report; the innovative efforts of healthcare professionals to use cutting-edge technology and evidenceapproved preventive strategies to reduce healthcare cost and improve the life quality of community members may not necessarily come to fruition in death reduction, and might be undervalued, too. More critically, the shape and magnitude of emerging health issues in Shanghai, such as accidents and injuries, pollution-related cancers, may be camouflaged in Gusmano’s report. We conclude this commentary by suggesting the most urgent questions to be addressed in the future studies.https://www.ijhpm.com/article_2992_24b43fb034a10d78bec71274033b4096.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601NHS Values, Compassion and Quality Indicators for Relationship Based Person-Centred Healthcare; Comment on “Morality and Markets in the NHS”407408299410.15171/ijhpm.2015.70ENJohnCoxKeele University, Keele, UKJournal Article20150228The paper by Gilbert <em>et al.</em> should be on the table of every politician and National Health Service (NHS) manager in the run up to the general election, when the NHS is at the hustings. They have raised profound moral dilemmas of the internal and external market in their present form, such as the practicalities of distributive justice and the enhancement of autonomy – to which are added the preservation of personhood, the values of listening, the maintenance of altruism and the origins of compassion. It is asserted that the quality of healthcare is dependent on the quality of the caring relationship between healthcare staff members, and between staff and patients. The nature of Compassionate Resilience is outlined with respect to Health Visitor training – and the contribution of faith communities to public health is also considered. The four Quality Indicators of an enabling environment first proposed by Cox and Gray are summarised, and the need for increased conceptual clarity of these key values recognised.https://www.ijhpm.com/article_2994_ec47a5de1ebd60f559fee4afd739d59b.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394620150601Morality not Markets: A Manifesto for the NHS; Response to Pollock, Frith, and Cox409410300410.15171/ijhpm.2015.78ENEmmaClarkeGreen Templeton College, University of Oxford, Oxford, UKLaurenceLeaverGreen Templeton College, University of Oxford, Oxford, UKBarnabas JGilbertHarvard
University, Cambridge, MA, USAJournal Article20150320https://www.ijhpm.com/article_3004_20479c788fb27378c2c99eadcf207e7f.pdf