Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Stakeholder Participation for Legitimate Priority Setting: A Checklist 973 976 3514 10.15171/ijhpm.2018.57 EN Maarten P.M. Jansen Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Rob Baltussen Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Kristine Bærøe Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Journal Article 2018 03 15 Accountable decision-makers are required to legitimize their priority setting decisions in health to members of society. In this perspective we stress the point that fair, legitimate processes should reflect efforts of authorities to treat all stakeholders as moral equals in terms of providing all people with well-justified, reasonable reasons to endorse the decisions. We argue there is a special moral concern for being accountable to those who are potentially adversely affected by decisions. Health authorities need to operationalize this requirement into real world action. In this perspective, we operationalize five key steps in doing so, in terms of (i) proactively identifying potentially adversely affected stakeholders; (ii) comprehensively including them in the decision-making process; (iii) ensuring meaningful participation; (iv) communication of recommendations or decisions; and (v) the organization of evaluation and appeal mechanisms. Health authorities are advised to use a checklist in the form of 29 reflective questions, aligned with these five key steps, to assist them in the practical organization of legitimate priority setting in healthcare.

https://www.ijhpm.com/article_3514_3ad2240d1138a5a9b4f979e3e003a4ee.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 “You Travel Faster Alone, but Further Together”: Learning From a Cross Country Research Collaboration From a British Council Newton Fund Grant 977 981 3529 10.15171/ijhpm.2018.73 EN Priscilla Reddy Human Sciences Research Council, Population Health, Health Systems and Innovation, Cape Town, South Africa Faculty of Community and Health Science, University of the Western Cape, Cape Town, South Africa Rachana Desai Human Sciences Research Council, Population Health, Health Systems and Innovation, Cape Town, South Africa Sibusiso Sifunda Human Sciences Research Council, HIV/AIDS, STI’s and TB, Pretoria, South Africa Kalipso Chalkidou Centre for Global Development, London, UK School of Public Health, Imperial College London, London, UK Charles Hongoro Department of Surgery and Cancer, Centre for Global Development, London, UK William Macharia Faculty of Health Sciences, Department of Paediatrics and Child Health, Aga Khan University, Nairobi, Kenya Helen Roberts Faculty of Population Health Sciences, UCL Great Ormond Street Institute of Child Health, London, UK Journal Article 2018 01 31 Providing universal health coverage (UHC) through better maternal, neonatal, child and adolescent health (MNCAH) can benefit both parties through North–South research collaborations. This paper describes lessons learned from bringing together early career researchers, tutors, consultants and mentors from the United Kingdom, Kenya, and South Africa to work in multi-disciplinary teams in a capacity-building workshop in Johannesburg, co-ordinated by senior researchers from the three partner countries. We recruited early career researchers and research users from a range of sectors and institutions in the participating countries and offered networking sessions, plenary lectures, group activities and discussions. To encourage bonding and accommodate cross-cultural and cross-disciplinary partners, we asked participants to respond to questions relating to research priorities and interventions in order to allocate them into multidisciplinary and cross-country teams. A follow up meeting took place in London six months later. Over the five day initial workshop, discussions informed the development of four draft research proposals. Intellectual collaboration, friendship and respect were engendered to sustain future collaborations, and we were able to identify factors which might assist capacity-building funders and organizers in future. This was a modestly funded brief intervention, with a follow-up made possible through the careful stewardship of resources and volunteerism. Having low and middle-income countries in the driving seat was a major benefit but not without logistic and financial challenges. Lessons learned and follow-up are described along with recommendations for future funding of partnerships schemes.

https://www.ijhpm.com/article_3529_2e31e332871d34046f31f2a75588eb49.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Intersectoral Planning for Public Health: Dilemmas and Challenges 982 992 3513 10.15171/ijhpm.2018.59 EN Ellen Strøm Synnevåg Faculty of Social Sciences and History, Volda University College, Volda, Norway Department of Health Promotion and Development, University of Bergen, Bergen, Norway Roar Amdam Faculty of Social Sciences and History, Volda University College, Volda, Norway Elisabeth Fosse Department of Health Promotion and Development, University of Bergen, Bergen, Norway 0000-0002-6038-5059 Journal Article 2017 10 04 Background Intersectoral action is often presented as essential in the promotion of population health and health equity. In Norway, national public health policies are based on the Health in All Policies (HiAP) approach that promotes whole-of-government responsibility. As part of the promotion of this intersectoral responsibility, planning is presented as a tool that every Norwegian municipality should use to integrate public health policies into their planning and management systems. Although research on implementing the HiAP approach is increasing, few studies apply a planning perspective. To address this gap in the literature, our study investigates how three Norwegian municipalities experience the use of planning as a tool when implementing the HiAP approach. Methods To investigate planning practices in three Norwegian municipalities, we used a qualitative multiple case study design based on face-to-face interviews. When analysing and discussing the results, we used the dichotomy of instrumental and communicative planning approaches, in addition to a collaborative planning approach, as the theoretical framework. Results The municipalities encounter several dilemmas when using planning as a tool for implementing the HiAP approach. Balancing the use of qualitative and quantitative knowledge and balancing the use of structural and processual procedures are two such dilemmas. Other dilemmas include balancing the use of power and balancing action and understanding in different municipal contexts. They are also faced with the dilemma of whether to place public health issues at the forefront or to present these issues in more general terms. Conclusion We argue that the dilemmas experienced by the municipalities might be explained by the difficult task of combining instrumental and communicative planning approaches because the balance between them is seldom fixed.

https://www.ijhpm.com/article_3513_ea0c29af96e329e4be1845df6e6758e7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 The Making of a New Medical Specialty: A Policy Analysis of the Development of Emergency Medicine in India 993 1006 3515 10.15171/ijhpm.2018.55 EN Veena Sriram Center for Health and the Social Sciences, University of Chicago, Chicago, IL, USA Adnan A. Hyder Health Systems Program, Department of International Health and International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Sara Bennett Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Journal Article 2017 09 14 Background Medical specialization is an understudied, yet growing aspect of health systems in low- and middleincome countries (LMICs). In India, medical specialization is incrementally, yet significantly, modifying service delivery, workforce distribution, and financing. However, scarce evidence exists in India and other LMICs regarding how medical specialties evolve and are regulated, and how these processes might impact the health system. The trajectory of emergency medicine appears to encapsulate broader trends in medical specialization in India – international exchange and engagement, the formation of professional associations, and a lengthy regulatory process with the Medical Council of India. Using an analysis of political priority setting, our objective was to explore the emergence and recognition of emergency medicine as a medical specialty in India, from the early 1990s to 2015. Methods We used a qualitative case study methodology, drawing on the Shiffman and Smith framework. We conducted 87 in-depth interviews, reviewing 122 documents, and observing six meetings and conferences. We used a modified version of the ‘Framework’ approach in our analysis. Results Momentum around emergency medicine as a viable solution to weak systems of emergency care in India gained traction in the 1990s. Public and private sector stakeholders, often working through transnational professional medical associations, actively pursued recognition from Medical Council of India. Despite fragmentation within the network, stakeholders shared similar beliefs regarding the need for specialty recognition, and were ultimately achieved this objective. However, fragmentation in the network made coalescing around a broader policy agenda for emergency medicine challenging, eventually contributing to an uncertain long-term pathway. Finally, due to the complexities of the regulatory system, stakeholders promoted multiple forms of training programs, expanding the workforce of emergency physicians, but with limited coordination and standardization. Conclusion The ideational centrality of postgraduate medical education, a challenging national governance system, and fragmentation within the transnational stakeholder network characterized the development of emergency medicine in India. As medical specialization continues to shape and influence health systems globally, research on the evolution of new medical specialties in LMICs can enhance our understanding of the connections between specialization, health systems, and equity.

https://www.ijhpm.com/article_3515_8de14935204a90250f0e29c511e721f7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Condom Use and its Associated Factors Among Iranian Youth: Results From a Population-Based Study 1007 1014 3519 10.15171/ijhpm.2018.65 EN Samira Hosseini Hooshyar HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia Mohammad Karamouzian HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada Ali Mirzazadeh HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA 0000-0002-0478-3220 Ali Akbar Haghdoost HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Hamid Sharifi HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Mostafa Shokoohi HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada Journal Article 2017 07 04 Background Given the young structure of Iran’s population and the fact that extramarital sexual relationships are both prohibited by legislation and shunned by society and religion, examining condom use practices among Iranian youth is highly important. The aim of this study was to explore condom use and its correlates among Iranian young adults. Methods In a sample of 3,045 individuals aged 19-29 who were recruited from a nation-wide study, we analyzed data from 633 participants who reported a history of extramarital sex. Subjects were asked about their condom use practices during their last penetrative sex. Data were collected through a self-administered questionnaire where the respondents completed the survey on their own and passed it to trained gender-matched interviewers. Multivariable regression models were constructed to report adjusted odds ratios (AOR) along with 95% CI. Results Of the 633 participants, 222 (35.1%) reported condom use at last sex. Men reported significantly higher condom use than women (38.5% vs. 25.7%). Having a stable job (AOR = 1.86, 95% CI: 1.01, 3.43), higher knowledge of condom use (AOR = 1.57, 95% CI: 1.03, 2.37) and sexual transmission of HIV (AOR = 1.83, 95% CI: 1.18, 2.85) were positively associated with condom use at last sex. Conversely, experience of sex under the influence of substances (AOR = 0.66, 95% CI: 0.45, 0.94) was significantly associated with reduced odds of condom use at last sex. Conclusion This study shows that only one out of every three young adults reported using condoms at last sex. While educational programs are helpful, multi-sectoral approaches (eg, individual-, community-, and structural-level interventions) are required to change sexual behaviours towards safe sex practices and reinforce negotiating condom use among youth.

https://www.ijhpm.com/article_3519_ce9cfb400d1c759d661a6a22ddce62f3.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Predictors of Enrolment in the National Health Insurance Scheme Among Women of Reproductive Age in Nigeria 1015 1023 3523 10.15171/ijhpm.2018.68 EN Bolaji Samson Aregbeshola Department of Community Health & Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria Samina Mohsin Khan Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Journal Article 2018 03 07 Background Despite the implementation of the National Health Insurance Scheme (NHIS) since 2005 in Nigeria, the level of health insurance coverage remains low. The study aims to examine the predictors of enrolment in the NHIS among women of reproductive age in Nigeria. Methods Secondary data from the 2013 Nigeria Demographic and Health Survey (NDHS) were utilized to examine factors influencing enrolment in the NHIS among women of reproductive age (n = 38 948) in Nigeria. Demographic and socio-economic characteristics of women were determined using univariate, bivariate and multivariate analyses. Data analysis was performed using STATA version 12 software. Results We found that 97.9% of women were not covered by health insurance. Multivariate analysis indicated that factors such as age, education, geo-political zone, socio-economic status (SES), and employment status were significant predictors of enrolment in the NHIS among women of reproductive age. Conclusion This study concludes that health insurance coverage among women of reproductive age in Nigeria is very low. Additionally, demographic and socio-economic factors were associated with enrolment in the NHIS among women. Therefore, policy-makers need to establish a tax-based health financing mechanism targeted at women who are young, uneducated, from poorest households, unemployed and working in the informal sector of the economy. Extending health insurance coverage to women from poor households and those who work in the informal sector through a tax-financed non-contributory health insurance scheme would accelerate progress towards universal health coverage (UHC).

https://www.ijhpm.com/article_3523_9f718b470b1b46fdf9a1ee30ba73a42c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda 1024 1039 3524 10.15171/ijhpm.2018.61 EN Corrado Cancedda Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Philip Cotton Office of the Vice-Chancellor, University of Rwanda, Kigali, Rwanda Joseph Shema Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda Stephen Rulisa Office of the Dean, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Robert Riviello Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, MA, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Lisa V. Adams Center for Health Equity, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA Paul E. Farmer Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA Jeanne N. Kagwiza Office of the Principal, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Patrick Kyamanywa Department of Surgery, Faculty of Clinical Medicine and Dentistry, Kampala International University - Western Campus, Ishaka, Uganda Donatilla Mukamana School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Chrispinus Mumena Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda David K. Tumusiime School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Lydie Mukashyaka Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda Esperance Ndenga Rwanda Human Resources for Health Program Team, Ministry of Health, Kigali, Rwanda Theogene Twagirumugabe Department of Anesthesiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Kaitesi B. Mukara Department of Ear, Nose, and Throat, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Vincent Dusabejambo Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Timothy D. Walker Department of Internal Medicine, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia Department of General Medicine, Calvary Mater Hospital, Newcastle, NSW, Australia Emmy Nkusi Department of Neurosurgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Lisa Bazzett-Matabele Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA Alex Butera Department of Orthopedic Surgery, Rwanda Military Hospital, Kigali, Rwanda Belson Rugwizangoga Department of Pathology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Jean Claude Kabayiza Department of Pediatrics, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Simon Kanyandekwe Department of Mental Health, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Louise Kalisa Department of Radiology, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Faustin Ntirenganya Department of Surgery, School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Jeffrey Dixson Yale School of Medicine, New Haven, CT, USA Tanya Rogo Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USA Department of Pediatrics, BronxCare Health System, Bronx, NY, USA Natalie McCall Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA Mark Corden Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital Los Angeles, Los Angeles, CA, USA Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Rex Wong Global Health Leadership Institute, Yale School of Public Health, New Haven, CT, USA Madeleine Mukeshimana School of Nursing and Midwifery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Agnes Gatarayiha Office of the Dean and Department of Oral and Maxillofacial Surgery, Oral Pathology and Oral Medicine, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Department of Preventive and Community Dentistry, School of Dentistry, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Egide Kayonga Ntagungira School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda Attila Yaman Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA Juliet Musabeyezu University of Global Health Equity, Kigali, Rwanda Anne Sliney Clinton Health Access Initiative, Boston, MA, USA Tej Nuthulaganti Clinton Health Access Initiative, Boston, MA, USA Meredith Kiernan Clinton Health Access Initiative, Boston, MA, USA Peter Okwi Clinton Health Access Initiative, Kigali, Rwanda Joseph Rhatigan Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Division of Global Health Equity, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA Jane Barrow Office of Global and Community Health, Harvard School of Dental Medicine, Boston, MA, USA Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA Kim Wilson Department of General Pediatrics, Boston Children’s Hospital, Boston, MA, USA Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Adam C. Levine Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA Rebecca Reece Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA Michael Koster Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, USA Rachel T. Moresky sidHARTe Program, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, NY, USA Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York City, NY, USA Jennifer E. O’Flaherty Department of Anesthesiology, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA Paul E. Palumbo Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA Rashna Ginwalla Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA Department of Surgery, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA Cynthia A. Binanay Duke Hubert-Yeargan Center for Global Health, Durham, NC, USA Nathan Thielman Department of Medicine, Duke University School of Medicine, Durham, NC, USA Duke Global Health Institute, Durham, NC, USA Duke University Medical Center, Durham, NC, USA Michael Relf Duke Global Health Institute, Durham, NC, USA Duke University School of Nursing, Durham, NC, USA Rodney Wright Department of Obstetrics & Gynecology and Women’s Health, Albert Einstein College of Medicine, New York City, NY, USA Obstetrics & Gynecology and Women’s Health, Montefiore Medical Center, New York City, NY, USA Mary Hill Division of Nursing, Howard University College of Nursing and Allied Health Sciences, Washington, DC, USA Deborah Chyun University of Connecticut School of Nursing, Storrs, CT, USA Robin T. Klar New York University Rory Meyers College of Nursing, New York City, NY, USA Linda L. McCreary University of Illinois at Chicago College of Nursing, Chicago, IL, USA Tonda L. Hughes Columbia University School of Nursing, New York City, NY, USA Marik Moen Department of Family & Community Health, University of Maryland School of Nursing, Baltimore, MD, USA Global Education and Mentorship, Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA Valli Meeks Department of Oncology & Diagnostic Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA Beth Barrows Office of Global Health, University of Maryland School of Nursing, Baltimore, MD, USA Partnerships, Professional Education, and Practice, University of Maryland School of Nursing, Baltimore, MD, USA Marcel E. Durieux Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA Craig D. McClain Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Department of Anesthesiology Perioperative and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA Amy Bunts Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA Forrest J. Calland Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA Bethany Hedt-Gauthier Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Danny Milner Center for Global Health, American Society for Clinical Pathology, Chicago, IL, USA Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA Giuseppe Raviola Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Department of Psychiatry, Boston Children’s Hospital, Boston, MA, USA Stacy E. Smith Department of Radiology, Brigham and Women’s Hospital, Boston, MA, USA Meenu Tuteja Global Health and Research Programs, Biomedical Research Institute, Brigham and Women’s Hospital, Boston MA, USA Urania Magriples Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA Asghar Rastegar Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA Linda Arnold Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA Ira Magaziner Clinton Health Access Initiative, Boston, MA, USA Agnes Binagwaho Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA Office of the Vice-Chancellor, University of Global Health Equity, Kigali, Rwanda Journal Article 2018 01 24 Background The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. Methods The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. Results In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. Conclusion The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.

https://www.ijhpm.com/article_3524_b08db13b92d2d6b9fa79bfc301b98fd5.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Forecast of Healthcare Facilities and Health Workforce Requirements for the Public Sector in Ghana, 2016–2026 1040 1052 3525 10.15171/ijhpm.2018.64 EN James Avoka Asamani Human Resources Division, Ghana Health Service, Accra, Ghana Margaret M. Chebere Human Resources Division, Ghana Health Service, Accra, Ghana Pelham M. Barton Health Economics Unit, University of Birmingham, Birmingham, UK Selassi Amah D’Almeida World Health Organization (WHO), Accra, Ghana Emmanuel Ankrah Odame Ministry of Health, Accra, Ghana Raymond Oppong Health Economics Unit, University of Birmingham, Birmingham, UK Journal Article 2017 10 23 Background Ghana is implementing activities towards universal health coverage (UHC) as well as the attainment of the health-related Sustainable Development Goals (SDGs) by the health sector by the year 2030. Aside lack of empirical forecast of the required healthcare facilities to achieve these mandates, health workforce deficits are also a major threat. We therefore modelled the needed healthcare facilities in Ghana and translated it into year-by-year staffing requirements based on established staffing standards. Methods Two levels of modelling were used. First, a predictive model based on Markov processes was used to estimate the future healthcare facilities needed in Ghana. Second, the projected healthcare facilities were translated into aggregate staffing requirements using staffing standards developed by Ghana’s Ministry of Health (MoH). Results The forecast shows a need to expand the number/capacity of healthcare facilities in order to attain UHC. All things being equal, the requisite healthcare infrastructure for UHC would be attainable from 2023. The forecast also shows wide variations in staffing-need-availability rate, ranging from 15% to 94% (average being 68%) across the various staff types. Thus, there are serious shortages of staff which are worse amongst specialists. Conclusion Ghana needs to expand and/or increase the number of healthcare facilities to facilitate the attainment of UHC. Also, only about 68% of the health workforce (HWF) requirements are employed and available for service delivery, leaving serious shortages of the essential health professionals. Immediate recruitment of unemployed but qualified health workers is therefore imperative. Also, addressing health worker productivity, equitable distribution of existing workers, and attrition may be the immediate steps to take whilst a long-term commitment to comprehensively address HWF challenges, including recruitments, expansion and streamlining of HWF training, is pursued.

https://www.ijhpm.com/article_3525_159a0c6579d2360722f094153f068406.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Ownership in Name, But not Necessarily in Action; Comment on “It’s About the Idea Hitting the Bull’s Eye”: How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations” 1053 1055 3522 10.15171/ijhpm.2018.72 EN Melisa Martinez-Alvarez MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, London, UK Journal Article 2018 06 15 A recently-published paper by Wickremasinghe et al assesses the scalability of pilot projects in three countries using the aid effectiveness agenda as an analytical framework. The authors report uneven progress and recommend applying aid effectiveness principles to improve the scalability of projects. This commentary focuses on one key principle of aid effectiveness – country ownership; it describes difficulties in defining and achieving it, and provides practical steps donors and recipient governments can take to move forward towards country ownership.

https://www.ijhpm.com/article_3522_7dc2135840b70bb92f48bb6f8a766a6e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Progress in Global Surgery; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa” 1056 1057 3527 10.15171/ijhpm.2018.69 EN Haile T. Debas Institute for Global Health Sciences, University of California, San Francisco, CA, USA Journal Article 2018 06 28 Impressive progress has been made in global surgery in the past 10 years, and now serious and evidence-based national strategies are being developed for scaling-up surgical services in sub-Saharan Africa. Key to achieving this goal requires developing a realistic country-based estimate of burden of surgical disease, developing an accurate estimate of existing need, developing methods, rigorously planning and implementing the plan, and scaling-up essential surgical services at the national level.

https://www.ijhpm.com/article_3527_2f004bd7a29dd2bee82ce715e77f1c0e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Local Research Catalyzes National Surgical Planning; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa” 1058 1060 3526 10.15171/ijhpm.2018.78 EN Micah G. Katz Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA Raymond R. Price Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA Jade M. Nunez Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA Journal Article 2018 07 03 In 2015 the Lancet Commission on Global Surgery (LCoGS) argued that surgical care is important to national health systems along with the economic viability of countries. Gajewski and colleagues outlined how the Commission’s blueprint has been implemented in sub-Saharan Africa, including two funded research projects that were integrated into national surgical plans. Here, we outline how the five processes proposed by Gajewski and colleagues are critical to integrate research, policy, and on-the-ground implementation. We also propose that, moving forward, the most pressing adjunct in many low- and middle-income countries (LMICs) may be a better characterization of rural surgical practices through rigorous research along with models that enable lessons to inform national policy.

https://www.ijhpm.com/article_3526_d24eeb50d980a96873c7e8d1b9daf962.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Public Health Coordinator – How to Promote Focus on Social Inequality at a Local Level, and How Should It Be Included in Public Health Policies?; 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” 1061 1063 3532 10.15171/ijhpm.2018.74 EN Wenche Bekken Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, Norway Journal Article 2018 06 15 The Norwegian Public Health Act of 2012 (PHA)1 states that the social causes of inequality in health have not been devoted sufficient attention in Norwegian health policy. Different means have been implemented to pay more attention to health inequalities at a local level, one is the use of a designated public health coordinator (PHC). Hagen et al2 reveals in a new study, however, that the presence of PHCs’ does not add to the priority of reducing inequality as a health objective. This negative association is, by the authors, explained by a widespread use of coordinators before the Act, and as such, not really a new measure. Another factor emphasized is that the PHC position is not empowered by bureaucratic backing. I agree with these explanations. However, the study by Hagen et al2 lacks a critical discussion of how the role of the PHC is situated in an administrative intersection between national health policy based on universal initiatives and social policy in the municipalities historically driven by a focus on poverty and specific target groups. This commentary reflects upon how social inequalities in health at a local level and the responsibilities imposed on the municipalities contest the principals of universalism. The tension between universalism and selectivity needs to be more prominent in the debate on how health inequalities should be abated at the local level, if universalism shall prevail as the overarching principle in Norwegian health policies. The commentary concludes by asking for a more nuanced discussion on how work with health related social problems can support universalistic initiatives. It is also suggested as a task for the PHC to make sure that public health initiatives are systematically evaluated. Documentation of effects will provide knowledge needed about how initiatives affects the social gradient over time.

https://www.ijhpm.com/article_3532_85795d3dfdfec96622e03645573f14cb.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Global Surgery – Redirecting Strategies for a Global Research Agenda; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa” 1064 1066 3530 10.15171/ijhpm.2018.79 EN Jaymie A. Henry Department of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA Journal Article 2018 07 02 More than three years have passed since the publication of the Lancet Commission on Global Surgery and its recommendations on scaling up surgery in sub-Saharan Africa (SSA). An important gap, the voice of the districts as well as lack of contextualized research, has been noted in its support of national surgical plans that run the risk of being at best, aspirational. Moreover, a ‘one-size-fits-all approach’ may not adequately address country-specific challenges on the ground. There is a need to redirect attention, effort, and funding in creating a global mechanism to gather baseline country information documenting every single district level government health facility’s ability and readiness to provide safe surgical, obstetric, trauma, and anesthesia care using the World Health Organization (WHO) Service Availability and Readiness Assessment (SARA) tool to aid in directing country-specific efforts in surgical systems strengthening and ensuring that a basic package of essential surgical and anesthesia services is made available to each citizen with adequate financial protection by 2030. This global mechanism will enable benchmarking, accountability, and streamlining of the work of the global surgical community to achieve true progress in scaling up surgery not only in SSA, but for the rest of the developing world.

https://www.ijhpm.com/article_3530_5e63168acac3e259706c877f8e8fa6a8.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Decisions of Value: Going Backstage; Comment on “Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis” 1067 1069 3533 10.15171/ijhpm.2018.81 EN Michael Calnan Social Policy, Sociology and Social Research (SSPSSR), University of Kent, Canterbury, UK 0000-0002-7239-6898 Journal Article 2018 03 27 This commentary expands on two of the key themes briefly raised in the paper involving analysis of the evidence about key contextual influences on decisions of value. The first theme focuses on the need to explore in more detail what is called backstage decision-making looking at how actual decisions are made drawing on evidence from ethnographies about decision-making. These studies point to less of an emphasis on instrumental and calculative forms of decision-making with more of an emphasis on more pragmatic rationality. The second related theme picks up on the issue of sources of information as a contextual influence particularly highlighting the salience of uncertainty or information deficits. It is argued that there are a range of different types of uncertainties, not only associated with information deficits, which are found particularly in allocative types of decisions of value. This means that the decision-making process although attempting to be linear and rational, tends to be characterised by a form of navigation where the decision-makers navigate their way through the uncertainties inherent and overtly manifested in the decision-making process.

https://www.ijhpm.com/article_3533_57389a9f9b91b937855267d77fd63cb6.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 7 11 2018 11 01 Trump’s Zero-tolerance Policy: Would a Political Response to a Humanitarian Crisis Work? 1070 1072 3531 10.15171/ijhpm.2018.80 EN Mohammad Karamouzian School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Journal Article 2018 07 03

https://www.ijhpm.com/article_3531_40871e863533678ec424a021ad61b4c1.pdf