Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Agency, Structure and the Power of Global Health Networks879884352010.15171/ijhpm.2018.71ENJeremyShiffmanJohns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USAPaul H. Nitze School of Advanced International Studies,
Washington, DC, USA0000-0002-1693-4671Journal Article20180501Global health networks—webs of individuals and organizations linked by a shared concern for a particular condition—have proliferated over the past quarter century. In a recent editorial in this journal, I presented evidence that their effectiveness in addressing four challenges—problem definition, positioning, coalitionbuilding and governance—shapes their ability to influence policy. The editorial prompted five thoughtful commentaries that reflected on these and other challenges. In this follow-up editorial, I build on the commentaries to suggest ways of advancing research on global health networks. I argue that investigators would do well to consider three social theory-influenced global governance debates pertaining to agency—the capacity of individuals and organizations to act autonomously amidst structural constraints. The three debates concern the relationship between agency and structure, the power of ideas vis-à-vis interests and material capabilities, and the level of influence of non-state actors in a global governance system that most scholars identify as state-dominated. Drawing on these debates, I argue that rather than presume global health network influence, we need to find more robust ways to investigate their effects. I argue also that rather than juxtapose agency and structure, ideas and interests and non-state and state power, it would be more productive to consider the ways in which these elements are intertwined.https://www.ijhpm.com/article_3520_6c0958d82a830a02c0718147b1b565c1.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Challenges and Prospects for Integrating the Assessment of Health Impacts in the Licensing Process of Large Capital Project in Brazil885888351110.15171/ijhpm.2018.58ENSandraDe Souza HaconEscola Nacional de Saúde Pública Sérgio Arouca (Ensp), Fundação Oswaldo
Cruz (Fiocruz), Rio de Janeiro, BrazilAndré Reynaldo SantosPérisséEscola Nacional de Saúde Pública Sérgio Arouca (Ensp), Fundação Oswaldo
Cruz (Fiocruz), Rio de Janeiro, BrazilJeanSimosInstitute of Global Health, University
of Geneva, Genève, Switzerland0000-0003-1340-5739Nicola LucaCantoreggiInstitute of Global Health, University
of Geneva, Genève, Switzerland0000-0001-6430-1070Mirko SeverinWinklerSwiss Tropical and Public Health Institute,
Basel, SwitzerlandUniversity of Basel, Basel, SwitzerlandJournal Article20180226Brazil was one of the first countries in Latin America to institutionalize a National Environmental Policy in 1981, including the environmental impact assessment (EIA) process of economic activities with anticipated impacts on the environment. Today, EIA practice in Brazil comes with a number of limitations: it is constrained by its environmental advocacy role; application is strongly oriented towards large capital projects; and social responsibility considerations are only partially included. Consequently, EIA studies mainly address issues connected to localised and direct environmental impacts, largely ignoring any socio-economic and health impacts. This perspective paper highlights limitations of current EIA practice in Brazil with a focus on health considerations in impact assessment. While recognizing the positive impact to municipalities where large capital projects are being developed and operated, adverse impacts on health are a reality with measurable evidence in Brazil. Therefore, we argue that specificities on how to systematically assess and monitor potential health impacts cannot remain invisible in the Brazilian legislation, as currently seen in the reformulation of the licensing process in the country. The process of better integrating the assessment of health impacts in the licensing process of large capital project in Brazil must, however, not be based on the imposition of an external model but should be promoted by internal stakeholders from the environmental and health sector, incorporating the experiences gained in various case studies from all over the countryhttps://www.ijhpm.com/article_3511_9a85c12a21b76392747906fc7b2aff92.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review889903349910.15171/ijhpm.2018.43ENVadimDukhaninDepartment of Health Policy and Management, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, USA0000-0002-8685-0027RachelTopazianNational Journal, Washington,
DC, USAJohns Hopkins Berman Institute of Bioethics, Baltimore, MD, USAMatthewDeCampJohns Hopkins Berman Institute of Bioethics, Baltimore, MD, USADivision of General Internal Medicine, Department of Medicine, Johns Hopkins
School of Medicine, Baltimore, MD, USA0000-0002-9371-8729Journal Article20171004Background Patient, public, consumer, and community (P2C2) engagement in organization-, community-, and systemlevel healthcare decision-making is increasing globally, but its formal evaluation remains challenging. To define a taxonomy of possible P2C2 engagement metrics and compare existing evaluation tools against this taxonomy, we conducted a systematic review. Methods A broad search strategy was developed for English language publications available from January 1962 through April 2015 in PubMed, Embase, Sociological Abstracts, PsycINFO, EconLit, and the gray literature. A publication was excluded if: (1) the setting was not healthcare delivery (ie, we excluded non-health sectors, such as urban planning; research settings; and public health settings not involving clinical care delivery); (2) the P2C2 engagement was episodic; or (3) the concept of evaluation or possible evaluation metrics were absent. To be included as an evaluation tool, publications had to contain an evaluative instrument that could be employed with minimal modification by a healthcare organization. Results A total of 199 out of 3953 publications met exclusion and inclusion criteria. These were qualitatively analyzed using inductive content analysis to create a comprehensive taxonomy of 116 possible metrics for evaluating P2C2 engagement. 44 outcome metrics were grouped into three domains (internal, external, and aggregate outcomes) that included six subdomains: impact on engagement participants, impact on services provided by the healthcare organization, impact on the organization itself, influence on the broader public, influence on population health, and engagement cost-effectiveness. The 72 process metrics formed four domains (direct process metrics; surrogate process metrics; aggregate process metrics; and preconditions for engagement) that comprised sixteen subdomains. We identified 23 potential tools for evaluating P2C2 engagement. The identified tools were published between 1973-2015 and varied in their coverage of the taxonomy, methodology used (qualitative, quantitative, or mixed), and intended evaluators (organizational leaders, P2C2 participants, external evaluators, or some combination). Parts of the metric taxonomy were absent from all tools. Conclusions By comprehensively mapping potential outcome and process metrics as well as existing P2C2 engagement tools, this review supports high-quality P2C2 engagement globally by informing the selection of existing evaluation tools and identifying gaps where new tools are needed. Systematic Review Registration PROSPERO registration number CRD42015020317https://www.ijhpm.com/article_3499_3ea2db50e62ceefceaf70a9d9a56a6f4.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001The Economic Burden of Stroke Based on South Korea’s National Health Insurance Claims Database904909349710.15171/ijhpm.2018.42ENYu-JinChaDepartment of Occupational Therapy, Semyung University, Jecheon, Republic of Korea0000-0003-2257-020XJournal Article20171028Background This study was conducted to determine the scale and the nature of the economic burden caused by strokes and to use the results as an evidential source for determining the allocation of South Korea stroke cases in 2015. Methods For research subjects, the study analyzed demographic characteristics and economic burden based on data from national health insurance (NHI) claims for inpatient and outpatient cases of ischemic stroke and hemorrhagic stroke in 2015 through the Health Insurance Review and Assessment Service (HIRA) and statistical data regarding cause of death from the Korea National Statistical Office (KNSO). This study, in order to estimate economic burden due to stroke, deduced the direct and indirect costs of illness caused by stroke, using cost-of-illness (COI) methods. The economic burden is divided into direct and indirect costs, and indirect cost is estimated by summing lost productivity measured in opportunity cost lost by medical disposition due to a specific disease and lost productivity due to premature death. Results The total economic burden in Korea due to stroke was US$6.855 billion, that due to ischemic stroke was US$3.658 billion, and that due to hemorrhagic stroke was US$3.197 billion. The average economic burden per stroke case was about US$7247. Conclusion The results of estimating the annual economic burden in all of Korea due to stroke will be used as an evidential source for preparing medical insurance policies, priorities, and plans for arranging medical resources for stroke as well as for determining effective prevention of the disease and related priorities in national health care policies.https://www.ijhpm.com/article_3497_7535bbb91c8fde347ad861f293126633.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Contracting Out Non-State Providers to Provide Primary Healthcare Services in Tanzania: Perceptions of Stakeholders910918350110.15171/ijhpm.2018.46ENStephenMalukaInstitute of Development Studies, University of Dar es Salaam, Dar es Salaam, TanzaniaJournal Article20170830Background In the attempt to move towards universal health coverage (UHC), many low- and middle-income countries (LMICs) are actively seeking to contract-out non-state providers (NSPs) to deliver health services to a specified population. Research on contracting-out has focused more on the impact of contracting-out than on the actual processes underlying the intervention and contextual factors that influence its performance. This paper reports on perceptions of stakeholders on contracting-out faith-based hospitals through service agreements (SAs) to provide primary healthcare services in Tanzania. Methods We adopted a qualitative descriptive case study design. Qualitative research tools included document review and in-depth interviews with key informants, and data were analysed using a thematic approach. Results Stakeholders reported mixed perceptions on the SA. The government considered the SA as an important mechanism for improving access to primary healthcare services where there were no public hospitals. The faith-based hospitals viewed the SA as a means of overcoming serious budget and human resource constraints as a result of the tightening funding environment. However, constant delays in disbursement of funds, mistrust among partners, and ineffective contract enforcement mechanisms resulted into negative perceptions of the SA. Conclusion SAs between local governments and faith-based hospitals were perceived to be important by both parties. However, in order to implement SAs effectively, the districts should diversify the sources of financing the contracts. In addition, the government and the faith-based organizations should continually engage in dialogue so as to build more trust between the partners involved in the SA. Furthermore, the central government needs to play a greater role in building the capacity of district and regional level actors in monitoring the implementation of the SA.https://www.ijhpm.com/article_3501_d494020ff8ec181ef98ed97ac3f25453.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Stakeholder’s Assessment of the Awareness and Effectiveness of Smoke-free Law in Thailand919922350310.15171/ijhpm.2018.47ENNipapunKungskulnitiFaculty of Public Health, Mahidol University, Bangkok, ThailandCenter
of Excellence on Environmental Health and Toxicology, Bangkok, ThailandSiriwanPitayarangsaritTobacco Control Research and Knowledge Management Center, Mahidol
University, Bangkok, ThailandInternational Health Policy Programme,
Bangkok, ThailandStephenHamannTobacco Control Research and Knowledge Management Center, Mahidol
University, Bangkok, ThailandJournal Article20171029BackgroundThis study reports stakeholders’ ratings, and perceived gaps in World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) Article 8 implementation in Thailand viewed against WHO’s Guidelines for Article 8 and to inform action in preparing the 2017 Tobacco Product Control Act. MethodsStakeholder ratings of Guideline provisions of Article 8 on a three-tiered scale of implementation from understanding to effectiveness and efficiency were used to identify gaps in enforcement and compliance important to success in meeting Article 8 goals. This stakeholder assessment occurred through a stakeholder meeting of 55 stakeholders in Bangkok, Thailand in June 2016. ResultsThe average of all assessment ratings by stakeholders on an ascending 0-3 scale had a mean score of 1.67, which means the level of implementation for Article 8 in Thailand was rated less than effective for enforcement. The assessment shows that the public understanding of smoke-free principles is also poor at a mean of 1.28, that there is incomplete effectiveness of smoke-free measures with a mean of 1.75, and only a general effectiveness that smoke-free protections are adequately covering most places with a mean of 1.98. More needs to be done to make all places compliant through enforcement efforts rated with a mean of only 1, and that more is necessary for protection from tobacco-smoke exposure in other public places and in private vehicles with mean ratings of 1.71 and 1.14. ConclusionThis stakeholder approach using a three-tiered rating scale found that the implementation of Article 8 in Thailand is still lacking. With this approach, stakeholders identified critical issues needing improvement and informed changes in the then-proposed Tobacco Product Control Act which later was adopted in 2017.https://www.ijhpm.com/article_3503_87f7ee4fdb57bdfd52179947211b7ebb.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001A Partnership Model for Improving Service Delivery in Remote Papua New Guinea: A Mixed Methods Evaluation923933350510.15171/ijhpm.2018.50ENEmmaFieldGlobal and Tropical Health, Menzies School of Health Research, Brisbane,
QLD, AustraliaAbt Associates, Brisbane, AustraliaSchool of Public Health
and Community Medicine, University of New South Wales, Sydney, NSW,
AustraliaDominicaAboAbt Associates, Port Moresby, Papua New GuineaLouisSamiakUniversity of
Papua New Guinea, Port Moresby, Papua New GuineaMafuVilaAbt Associates, Port Moresby, Papua New GuineaGeorginaDoveAbt Associates, Brisbane, AustraliaAlexRosewellSchool of Public Health
and Community Medicine, University of New South Wales, Sydney, NSW,
Australia0000-0002-5437-9920SallyNathanSchool of Public Health
and Community Medicine, University of New South Wales, Sydney, NSW,
Australia0000-0002-1960-1063Journal Article20170710Background The Community Mine Continuation Agreement Middle (CMCA) and South Fly Health Program (the Health Program) is a partnership for improving health service delivery in remote Papua New Guinea (PNG). The Health Program is delivered by a private contractor working in partnership with existing health service providers to improve service delivery using existing government systems, where possible, and aligns with national policies, plans and strategies. A midline evaluation was conducted to determine changes in health service delivery since commencement of the Health Program. Methods A mixed methods evaluation was undertaken mid-way through implementation of the Health Program, including a pre/post analysis of health service delivery indicators, semi-structured interviews with health workers and assessment of health facility equipment and infrastructure. Results Improvements in many of the long-term expected outcomes of the Health Program were observed when compared to the pre-program period. The number of outpatient visits per person per year and number of outreach clinics per 1000 children under 5 years increased by 15% and 189% respectively (P < .001). Increases in vaccination coverage for infants aged P < .001) and 75% for 1st dose Sabin (P < .001), 30% for 3rd dose pentavalent (P < .001) and 26% for measles vaccination (P < .001). Family planning coverage remained at similar levels (increasing 5%, P = .095) and antenatal care coverage increased by 26% (P < .001). Supervised deliveries coverage declined by 32% (P < .001), a continuation of the pre-Program trend. The proportion of facilities with standard equipment items, transport and lighting increased. Health worker training, in particular obstetric training, was most commonly cited by health workers as leading to improved services. Conclusion Following implementation, substantial improvements in health service delivery indicators were observed in the Health Program area as compared with pre-program period and the stagnating or declining national performance. This model could be considered for similar contexts where existing health service providers require external assistance to provide basic health services to the community.https://www.ijhpm.com/article_3505_2a3d6d6cc4b5e77238c1fc1bb6cdd681.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Conditional Cash Transfers for Maternal Health Interventions: Factors Influencing Uptake in North-Central Nigeria934942350810.15171/ijhpm.2018.56ENFatimaBaba-AriDepartment of Primary Healthcare Systems Development, National Primary
Health Care Development Agency, Abuja, NigeriaPresidential Initiative for
the North East (PINE), Abuja, NigeriaEjemai AmaizeEboreimeDepartment of Planning, Research and
Statistics, National Primary Health Care Development Agency, Abuja, NigeriaCentre for Health Policy, Wits School of Public Health, University of the
Witwatersrand, Johannesburg, South Africa0000-0001-8277-2570MazedaHossainDepartment of Global Health and
Development, London School of Hygiene and Tropical Medicine, London, UKJournal Article20171022Background Nigeria accounts for a significant proportion of global maternal mortality figures with little progress made in curbing poor health indices. In a bid to reverse this trend, the Government of Nigeria initiated a conditional cash transfer (CCT) programme to encourage pregnant women utilize services at designated health facilities. This study aims to understand experiences of women who register for CCT services and explore reasons behind non-uptake of those women who do not register. Methods We conducted this study in a rural community in North Central Nigeria. Having identified programme beneficiaries by randomly sampling contact details obtained from the programme database, using snowball sampling method we sourced non-beneficiaries list based on recommendations from beneficiaries and other community members. Thereafter we undertook semi-structured interviews on both beneficiaries and non-beneficiaries and analysed data obtained thematically. Results Our findings revealed that, while beneficiaries of the programme were influenced by the cash transfers, cash may not be sufficient incentive for uptake by non-beneficiaries of CCT in Nigeria. Factors such as community and spousal influence, availability of free drugs, proximity to health facility are critical factors that affect uptake in our study context. On the other hand, poor programme administration, mistrust for government initiatives as well as poor quality of services could significantly constrain service utilization despite cash transfers. Conclusion Considering that a number of barriers to uptake of the CCT programme are similar to barriers to maternal health services, it is essential that maternal health services are available, accessible and of acceptable quality to target recipients for CCT programmes to reach their full implementation potential.https://www.ijhpm.com/article_3508_7d2be41b1bde6ff8fe45150c37488ebb.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Community Health Worker Programs to Improve Healthcare Access and Equity: Are They Only Relevant to Low- and Middle-Income Countries?943954351210.15171/ijhpm.2018.53ENSaraJavanparastSouthgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia0000-0002-0388-5524AliceWindleSouthgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, AustraliaTobyFreemanSouthgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia0000-0002-2787-8580FranBaumSouthgate Institute for Health Society and Equity, Flinders University, Adelaide, SA, Australia0000-0002-2294-1368Journal Article20171003BackgroundCommunity Health Workers (CHWs) are proven to be highly effective in low- and middle-income countries with many examples of successful large-scale programs. There is growing interest in deploying CHW programs in high-income countries to address inequity in healthcare access and outcomes amongst population groups facing disadvantage. This study is the first that examines the scope and potential value of CHW programs in Australia and the challenges involved in integrating CHWs into the health system. The potential for CHWs to improve health equity is explored. MethodsAcademic and grey literature was searched to examine existing CHW roles in the Australian primary healthcare system. Semi-structured telephone interviews were conducted with a purposive sample of 11 people including policymakers, program managers and practitioners, to develop an understanding of policy and practice. ResultsLiterature on CHWs in Australia is sparse, yet combined with interview data indicates CHWs conduct a broad range of roles, including education, advocacy and basic clinical services, and work with a variety of communities experiencing disadvantage. Many, and to some extent inconsistent, terms are used for CHWs, reflecting the various strategies employed by CHWs, the characteristics of the communities they serve, and the health issues they address. The role of aboriginal health workers (AHWs) is comparatively well recognised, understood and documented in Australia with evidence on their contribution to overcoming cultural barriers and improving access to health services. Ethnic health workers assist with language barriers and increase the cultural appropriateness of services. CHWs are widely seen to be well accepted and valuable, facilitating access to health services as a trusted ‘bridge’ to communities. They work best where ‘health’ is conceived to include action on social determinants and service models are less hierarchical. Short term funding models and the lack of professional qualifications and recognition are challenges CHWs encounter. ConclusionCHWs serve a range of functions in various contexts in Australian primary healthcare (PHC) with a common, valued purpose of facilitating access to services and information for marginalised communities. CHWs offer a promising opportunity to enhance equity of access to PHC for communities facing disadvantage, especially in the face of rising chronic disease.https://www.ijhpm.com/article_3512_0dbb3fb9a5cd1d5f8a9075b5bb8070aa.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Care Integration – From “One Size Fits All” to Person Centred Care; Comment on “Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight for the Future?”955957350710.15171/ijhpm.2018.51ENAxelKaehneEvidence-Based Practice Research Centre, Edge Hill University, Ormskirk, UK0000-0002-7978-2214Journal Article20180307Integrating services is a hot topic amongst health system policy-makers and healthcare managers. There is some evidence that integrated services deliver efficiencies and reduce service utilisation rates for some patient populations. In their article on Achieving Integrated Care for Older People, Gillian Harvey and her colleagues formulate some critical insights from practice and research around integrated care. However, the real challenge is to reconcile service integration with patient experiences. This paper argues that unless we think service integration from the patient’s perspective we will continue to fail to produce the evidence we need to support integrated care solutions to the current health system challenges.https://www.ijhpm.com/article_3507_0e7c7d6c41c76b9ee6445ae01cc0181d.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001On Fundamental Premises for Addressing “Context” and “Contextual Factors” Influencing Value Decisions in Healthcare; Comment on “Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis”958960351010.15171/ijhpm.2018.62ENKristineBærøeDepartment of Global Public Health and Primary Care, University of Bergen, Bergen, Norway0000-0002-4626-7232Journal Article20180530In this commentary on Williams and colleagues’ paper, I will address some essential issues related to research on contextual factors that influence value decision-making in healthcare. Based on the presumption that scientific work requires coherence in its ontological, epistemological and methodological approaches, I identify some challenges in their text and reflect on how those challenges might be addressed. I recommend that more normative work be done to make this a comprehensive area of research and suggest that the fundamental premises structuring investigations in this field be explicitly clarified.https://www.ijhpm.com/article_3510_15e122e839dfdaa7ce969536f94aecf6.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Healthcare Priority-Setting: Chat-Ting Is Not Enough; Comment on “Swiss-CHAT: Citizens Discuss Priorities for Swiss Health Insurance Coverage”961963351710.15171/ijhpm.2018.66ENLeonard M.FleckCenter for Ethics, College of Human Medicine, Michigan State University, East Lansing, MI, USAJournal Article20180530CHAT has its limits. It is a three-hour exercise. However, the real world problems of healthcare rationing and priority-setting are too complex for a three-hour exercise. What is needed, as a supplement, are sustained processes of rational democratic deliberation that can address the challenges to healthcare justice posed by costly emerging medical technologies, such as these targeted cancer therapies.https://www.ijhpm.com/article_3517_b5b0db7f3a77ca4fcf9eca57aa7181ca.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Understanding the Promotion of Health Equity at the Local Level Requires Far More than Quantitative Analyses of Yes-No Survey Data; Comment on “Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups”964967351810.15171/ijhpm.2018.70ENDennisRaphaelSchool of Health Policy and Management, York University, Toronto, ON, Canada0000-0002-0724-3174Journal Article20180603Health promotion is a complex activity that requires analytic methods that recognize the contested nature of it definition, the barriers and supports for such activities, and its embeddedness within the politics of distribution. In this commentary I critique a recent study of municipalities’ implementation of the Norwegian Public Health Act that employed analysis of “yes” or “no” responses from a large survey. I suggest the complexity of health promotion activities can be best captured through qualitative methods employing open-ended questions and thematic analysis of responses. To illustrate the limitations of the study, I provide details of how these methods were employed to study local public health unit (PHU) activity promoting health equity in Ontario, Canada.https://www.ijhpm.com/article_3518_5401acfe633e6817b508b84d23686743.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Challenging Institutional Norms to Improve Local-Level Policy for Health and Health Equity; Comment on “Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups”968970352110.15171/ijhpm.2018.67ENMatthewFisherSouthgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia0000-0003-3756-1146Journal Article20180522The article by Susanne Hagen and colleagues on Health Promotion at Local Level in Norway discusses actions by municipal governments to assess and address heath inequities within their respective regions, as required under the Norwegian Public Health Act (PHA). Although the broad intent of the Norwegian government is to encourage action on social determinants of health (SDH), Hagen et al find that many of the initiatives undertaken by municipalities ‘tend to cash out as single, targeted initiatives,’ and focus on individual behaviours. In this commentary, I use the concept of place-based policy and ideas from policy theory on the institutional behaviours of public policy agencies and services, to discuss reasons behind this narrowing of perspective and policy action. I argue in favour of an alternative approach involving public agencies and services supporting processes of community-led action and social change.https://www.ijhpm.com/article_3521_98afdcc1ebd85daa0f1749c5e56b9d8c.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971020181001Are We Asking All the Right Questions About Quality of Care in Low- and Middle-Income Countries?971972350210.15171/ijhpm.2018.48ENStephanie M.ToppCollege of Public Health, Medical and Veterinary Sciences, James Cook
University, Townsville, QLD, AustraliaPublic Health Foundation of India,
New Delhi, India0000-0002-3448-7983KabirSheikhNossal Institute for Global Health, University of Melbourne,
Melbourne, VIC, AustraliaPublic Health Foundation of India,
New Delhi, India0000-0003-4755-2075Journal Article20180219Are We Asking All the Right Questions About Quality of Care in Low- and Middle-Income Countries?https://www.ijhpm.com/article_3502_d2350a54d774001d6078e326b4488878.pdf