Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Stakeholder Participation for Legitimate Priority Setting: A Checklist973976351410.15171/ijhpm.2018.57ENMaarten P.M.JansenDepartment for Health Evidence, Radboud Institute for Health Sciences,
Radboud University Medical Center, Nijmegen, The NetherlandsRobBaltussenDepartment for Health Evidence, Radboud Institute for Health Sciences,
Radboud University Medical Center, Nijmegen, The Netherlands0000-0002-8364-2847KristineBærøeDepartment
of Global Public Health and Primary Care, University of Bergen, Bergen,
Norway0000-0002-4626-7232Journal Article20180315<span class="fontstyle0">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 <em>(</em></span><em><span class="fontstyle0">i</span></em><span class="fontstyle0"><em>)</em> proactively identifying potentially adversely affected stakeholders; <em>(</em></span><em><span class="fontstyle0">ii</span></em><span class="fontstyle0"><em>)</em> comprehensively including them in the decision-making process; <em>(</em></span><em><span class="fontstyle0">iii</span></em><span class="fontstyle0"><em>)</em> ensuring meaningful participation; <em>(</em></span><em><span class="fontstyle0">iv</span></em><span class="fontstyle0"><em>)</em> communication of recommendations or decisions; and <em>(</em></span><em><span class="fontstyle0">v</span></em><span class="fontstyle0"><em>)</em> 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.</span>https://www.ijhpm.com/article_3514_3ad2240d1138a5a9b4f979e3e003a4ee.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101“You Travel Faster Alone, but Further Together”: Learning From a Cross Country Research Collaboration From a British Council Newton Fund Grant977981352910.15171/ijhpm.2018.73ENPriscillaReddyHuman Sciences Research Council, Population Health, Health Systems
and Innovation, Cape Town, South AfricaFaculty of Community and Health
Science, University of the Western Cape, Cape Town, South AfricaRachanaDesaiHuman Sciences Research Council, Population Health, Health Systems
and Innovation, Cape Town, South Africa0000-0001-8754-1093SibusisoSifundaHuman
Sciences Research Council, HIV/AIDS, STI’s and TB, Pretoria, South AfricaKalipsoChalkidouCentre for Global Development, London, UKSchool of Public Health, Imperial
College London, London, UKCharlesHongoroDepartment of Surgery and Cancer, Centre for
Global Development, London, UKWilliamMachariaFaculty of Health Sciences, Department of
Paediatrics and Child Health, Aga Khan University, Nairobi, KenyaHelenRobertsFaculty of
Population Health Sciences, UCL Great Ormond Street Institute of Child Health,
London, UKJournal Article20180131Providing 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.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Intersectoral Planning for Public Health: Dilemmas and Challenges982992351310.15171/ijhpm.2018.59ENEllenStrøm SynnevågFaculty of Social Sciences and History, Volda University College, Volda,
NorwayDepartment of Health Promotion and Development, University of
Bergen, Bergen, NorwayRoarAmdamFaculty of Social Sciences and History, Volda University College, Volda,
NorwayElisabethFosseDepartment of Health Promotion and Development, University of
Bergen, Bergen, Norway0000-0002-6038-5059Journal Article20171004<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">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.</span> <br /><br />https://www.ijhpm.com/article_3513_ea0c29af96e329e4be1845df6e6758e7.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101The Making of a New Medical Specialty: A Policy Analysis of the Development of Emergency Medicine in India9931006351510.15171/ijhpm.2018.55ENVeenaSriramCenter for Health and the Social Sciences, University of Chicago, Chicago,
IL, USAAdnan A.HyderHealth Systems Program, Department of International Health
and International Injury Research Unit, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USASaraBennettHealth Systems Program, Department
of International Health, Johns Hopkins Bloomberg School of Public Health,
Baltimore, MD, USAJournal Article20170914<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">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.</span>https://www.ijhpm.com/article_3515_8de14935204a90250f0e29c511e721f7.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Condom Use and its Associated Factors Among Iranian Youth: Results From a Population-Based Study10071014351910.15171/ijhpm.2018.65ENSamiraHosseini HooshyarHIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, IranThe Kirby Institute, UNSW Sydney,
Sydney, NSW, Australiahttps://orcid.org/00MohammadKaramouzianHIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, IranSchool of Population and Public Health, Faculty of
Medicine, University of British Columbia, Vancouver, BC, Canada0000-0002-5631-4469AliMirzazadehHIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, IranDepartment
of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA0000-0002-0478-3220Ali AkbarHaghdoostHIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran0000-0003-4628-4849HamidSharifiHIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran0000-0002-9008-7618MostafaShokoohiHIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, IranDepartment of Epidemiology & Biostatistics, Schulich
School of Medicine & Dentistry, The University of Western Ontario, London,
ON, Canada0000-0002-3810-752XJournal Article20170704<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">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.</span>https://www.ijhpm.com/article_3519_ce9cfb400d1c759d661a6a22ddce62f3.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Predictors of Enrolment in the National Health Insurance Scheme Among Women of Reproductive Age in Nigeria10151023352310.15171/ijhpm.2018.68ENBolaji SamsonAregbesholaDepartment of Community Health & Primary Care, College of Medicine,
University of Lagos, Lagos, Nigeria0000-0001-9944-2543Samina MohsinKhanDepartment of Public Health Sciences,
Karolinska Institutet, Stockholm, SwedenJournal Article20180307Background<br /> 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.<br /> <br /> Methods<br /> 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.<br /> <br /> Results<br /> 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. <br /> <br /> Conclusion<br /> 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.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Health Professional Training and Capacity Strengthening Through International Academic Partnerships: The First Five Years of the Human Resources for Health Program in Rwanda10241039352410.15171/ijhpm.2018.61ENCorradoCanceddaCenter for Global Health, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, USAPhilipCottonOffice of the Vice-Chancellor, University
of Rwanda, Kigali, RwandaJosephShemaRwanda Human Resources for Health Program
Team, Ministry of Health, Kigali, RwandaStephenRulisaOffice of the Dean, School of
Medicine and Pharmacy, College of Medicine and Health Sciences, University
of Rwanda, Kigali, RwandaRobertRivielloCenter for Surgery and Public Health, Brigham
and Women’s Hospital, Boston, MA, USADepartment of Global Health and
Social Medicine, Harvard Medical School, Boston, MA, USALisa V.AdamsCenter for
Health Equity, Geisel School of Medicine, Dartmouth College, Hanover, NH,
USADepartment of Medicine, Geisel School of Medicine, Dartmouth College,
Hanover, NH, USAPaul E.FarmerDepartment of Global Health and
Social Medicine, Harvard Medical School, Boston, MA, USADivision of Global Health Equity, Department of Medicine,
Brigham and Women’s Hospital, Boston, MA, USAJeanne N.KagwizaOffice of the Principal,
College of Medicine and Health Sciences, University of Rwanda, Kigali,
RwandaPatrickKyamanywaDepartment of Surgery, Faculty of Clinical Medicine and Dentistry,
Kampala International University - Western Campus, Ishaka, UgandaDonatillaMukamanaSchool
of Nursing and Midwifery, College of Medicine and Health Sciences, University
of Rwanda, Kigali, RwandaChrispinusMumenaOffice 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,
RwandaDavid K.TumusiimeSchool of Health Sciences, College of Medicine and Health Sciences,
University of Rwanda, Kigali, RwandaLydieMukashyakaRwanda Human Resources for Health Program
Team, Ministry of Health, Kigali, RwandaEsperanceNdengaRwanda Human Resources for Health Program
Team, Ministry of Health, Kigali, RwandaTheogeneTwagirumugabeDepartment of Anesthesiology, School
of Medicine and Pharmacy, College of Medicine and Health Sciences, University
of Rwanda, Kigali, RwandaKaitesi B.MukaraDepartment of Ear, Nose, and Throat, School of
Medicine and Pharmacy, College of Medicine and Health Sciences, University
of Rwanda, Kigali, RwandaVincentDusabejamboDepartment of Internal Medicine, School of
Medicine and Pharmacy, College of Medicine and Health Sciences, University
of Rwanda, Kigali, RwandaTimothy D.WalkerDepartment of Internal Medicine, School of
Medicine and Pharmacy, College of Medicine and Health Sciences, University
of Rwanda, Kigali, RwandaSchool of Medicine and Public Health, Faculty
of Health and Medicine, University of Newcastle, Newcastle, NSW, AustraliaDepartment of General Medicine, Calvary Mater Hospital, Newcastle, NSW,
AustraliaEmmyNkusiDepartment of Neurosurgery, School of Medicine and Pharmacy,
College of Medicine and Health Sciences, University of Rwanda, Kigali,
RwandaLisaBazzett-MatabeleDepartment of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USAAlexButeraDepartment of Orthopedic
Surgery, Rwanda Military Hospital, Kigali, RwandaBelsonRugwizangogaDepartment of Pathology,
School of Medicine and Pharmacy, College of Medicine and Health Sciences,
University of Rwanda, Kigali, RwandaJean ClaudeKabayizaDepartment of Pediatrics, School of
Medicine and Pharmacy, College of Medicine and Health Sciences, University
of Rwanda, Kigali, RwandaSimonKanyandekweDepartment of Mental Health, School of Medicine
and Pharmacy, College of Medicine and Health Sciences, University of
Rwanda, Kigali, RwandaLouiseKalisaDepartment of Radiology, School of Medicine and
Pharmacy, College of Medicine and Health Sciences, University of Rwanda,
Kigali, RwandaFaustinNtirenganyaDepartment of Surgery, School of Medicine and Pharmacy,
College of Medicine and Health Sciences, University of Rwanda, Kigali,
RwandaJeffreyDixsonYale School of Medicine, New Haven, CT, USATanyaRogoDepartment of
Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, NY, USADepartment of Pediatrics, BronxCare Health System, Bronx, NY, USANatalieMcCallDepartment of Pediatrics, Yale School of Medicine, New Haven, CT, USAMarkCordenDivision of Hospital Medicine, Department of Pediatrics, Children’s Hospital
Los Angeles, Los Angeles, CA, USADepartment of Pediatrics, Keck School
of Medicine, University of Southern California, Los Angeles, CA, USARexWongGlobal
Health Leadership Institute, Yale School of Public Health, New Haven, CT,
USAMadeleineMukeshimanaSchool
of Nursing and Midwifery, College of Medicine and Health Sciences, University
of Rwanda, Kigali, RwandaAgnesGatarayihaOffice 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,
RwandaDepartment of Preventive and Community Dentistry, School of Dentistry,
College of Medicine and Health Sciences, University of Rwanda, Kigali, RwandaEgide KayongaNtagungiraSchool of Health Sciences, College of Medicine and Health Sciences,
University of Rwanda, Kigali, RwandaAttilaYamanDivision of Global Health Equity, Department of Medicine,
Brigham and Women’s Hospital, Boston, MA, USAJulietMusabeyezuUniversity of Global Health Equity, Kigali, RwandaAnneSlineyClinton Health Access
Initiative, Boston, MA, USATejNuthulagantiClinton Health Access
Initiative, Boston, MA, USAMeredithKiernanClinton Health Access
Initiative, Boston, MA, USAPeterOkwiClinton Health Access Initiative, Kigali, RwandaJosephRhatiganDepartment of Global Health and
Social Medicine, Harvard Medical School, Boston, MA, USADivision of Global Health Equity, Department of Medicine,
Brigham and Women’s Hospital, Boston, MA, USAJaneBarrowOffice of Global and Community Health, Harvard School of Dental Medicine,
Boston, MA, USADepartment of Oral Health Policy and Epidemiology,
Harvard School of Dental Medicine, Boston, MA, USAKimWilsonDepartment of General
Pediatrics, Boston Children’s Hospital, Boston, MA, USADepartment of Global Health and
Social Medicine, Harvard Medical School, Boston, MA, USAAdam C.LevineDepartment of
Emergency Medicine, Warren Alpert Medical School of Brown University,
Providence, RI, USARebeccaReeceDepartment of Medicine, Warren Alpert Medical School
of Brown University, Providence, RI, USAMichaelKosterDepartment of Pediatrics, Warren
Alpert Medical School of Brown University, Providence, RI, USARachel T.MoreskysidHARTe Program,
Heilbrunn Department of Population and Family Health, Mailman School of
Public Health, Columbia University, New York City, NY, USADepartment of
Emergency Medicine, Columbia University College of Physicians and Surgeons,
New York City, NY, USAJennifer E.O’FlahertyDepartment of Anesthesiology, Geisel School of
Medicine, Dartmouth College, Hanover, NH, USADartmouth-Hitchcock
Medical Center, Lebanon, NH, USAPaul E.PalumboDepartment of Medicine, Geisel School of Medicine, Dartmouth College,
Hanover, NH, USADartmouth-Hitchcock
Medical Center, Lebanon, NH, USADepartment of Pediatrics, Geisel School
of Medicine, Dartmouth College, Hanover, NH, USARashnaGinwallaDartmouth-Hitchcock
Medical Center, Lebanon, NH, USADepartment of Surgery,
Geisel School of Medicine, Dartmouth College, Hanover, NH, USACynthia A.BinanayDuke
Hubert-Yeargan Center for Global Health, Durham, NC, USANathanThielmanDepartment
of Medicine, Duke University School of Medicine, Durham, NC, USADuke
Global Health Institute, Durham, NC, USADuke University Medical Center,
Durham, NC, USAMichaelRelfDuke
Global Health Institute, Durham, NC, USADuke University School of Nursing, Durham, NC, USARodneyWrightDepartment of Obstetrics & Gynecology and Women’s Health, Albert Einstein
College of Medicine, New York City, NY, USAObstetrics & Gynecology and
Women’s Health, Montefiore Medical Center, New York City, NY, USAMaryHillDivision
of Nursing, Howard University College of Nursing and Allied Health Sciences,
Washington, DC, USADeborahChyunUniversity of Connecticut School of Nursing, Storrs,
CT, USARobin T.KlarNew York University Rory Meyers College of Nursing, New York City,
NY, USALinda L.McCrearyUniversity of Illinois at Chicago College of Nursing, Chicago, IL, USATonda L.HughesColumbia University School of Nursing, New York City, NY, USAMarikMoenDepartment
of Family & Community Health, University of Maryland School of Nursing,
Baltimore, MD, USAGlobal Education and Mentorship, Office of Global Health,
University of Maryland School of Nursing, Baltimore, MD, USAValliMeeksDepartment of
Oncology & Diagnostic Sciences, University of Maryland School of Dentistry,
Baltimore, MD, USABethBarrowsOffice of Global Health, University of Maryland School
of Nursing, Baltimore, MD, USAPartnerships, Professional Education, and
Practice, University of Maryland School of Nursing, Baltimore, MD, USAMarcel E.DurieuxDepartment of Anesthesiology, University of Virginia School of Medicine,
Charlottesville, VA, USACraig D.McClainDepartment of Global Health and
Social Medicine, Harvard Medical School, Boston, MA, USADepartment of Anesthesiology Perioperative and
Pain Medicine, Boston Children’s Hospital, Boston, MA, USAAmyBuntsDepartment of
Surgery, University of Virginia School of Medicine, Charlottesville, VA, USAForrest J.CallandDepartment of
Surgery, University of Virginia School of Medicine, Charlottesville, VA, USABethanyHedt-GauthierDepartment of Global Health and
Social Medicine, Harvard Medical School, Boston, MA, USADannyMilnerCenter for Global Health, American Society for Clinical Pathology, Chicago, IL,
USADepartment of Immunology and Infectious Diseases, Harvard T. H. Chan
School of Public Health, Boston, MA, USAGiuseppeRaviolaDepartment of Global Health and
Social Medicine, Harvard Medical School, Boston, MA, USADepartment of Psychiatry, Boston
Children’s Hospital, Boston, MA, USAStacy E.SmithDepartment of Radiology, Brigham and
Women’s Hospital, Boston, MA, USAMeenuTutejaGlobal Health and Research Programs,
Biomedical Research Institute, Brigham and Women’s Hospital, Boston MA,
USAUraniaMagriplesDepartment of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USAAsgharRastegarDepartment of Internal Medicine, Yale School of Medicine, New Haven,
CT, USALindaArnoldDepartment of Pediatrics, Yale School of Medicine, New Haven, CT, USAIraMagazinerClinton Health Access
Initiative, Boston, MA, USAAgnesBinagwahoDepartment of Global Health and
Social Medicine, Harvard Medical School, Boston, MA, USADepartment of Pediatrics, Geisel School
of Medicine, Dartmouth College, Hanover, NH, USAInstitute for Health Policy and Clinical Practice, Dartmouth College,
Hanover, NH, USAOffice of the Vice-Chancellor, University of Global Health
Equity, Kigali, Rwanda0000-0002-6779-3151Journal Article20180124Background<br />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.<br /><br /> <br />Methods<br />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.<br /><br /> <br />Results<br />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.<br /><br /> <br />Conclusion<br />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.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Forecast of Healthcare Facilities and Health Workforce Requirements for the Public Sector in Ghana, 2016–202610401052352510.15171/ijhpm.2018.64ENJames AvokaAsamaniHuman Resources Division, Ghana Health Service, Accra, GhanaMargaret M.ChebereHuman Resources Division, Ghana Health Service, Accra, GhanaPelham M.BartonHealth
Economics Unit, University of Birmingham, Birmingham, UKSelassi AmahD’AlmeidaWorld Health
Organization (WHO), Accra, GhanaEmmanuel AnkrahOdameMinistry of Health, Accra, GhanaRaymondOppongHealth
Economics Unit, University of Birmingham, Birmingham, UKJournal Article20171023<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">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).<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">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.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">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.</span> <br /><br />https://www.ijhpm.com/article_3525_159a0c6579d2360722f094153f068406.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Ownership 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”10531055352210.15171/ijhpm.2018.72ENMelisaMartinez-AlvarezMRC Unit The Gambia, London School of Hygiene and Tropical Medicine, London, UK0000-0003-4020-7527Journal Article20180615A 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.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Progress in Global Surgery; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa”10561057352710.15171/ijhpm.2018.69ENHaile T.DebasInstitute for Global Health Sciences, University of California, San Francisco, CA, USAJournal Article20180628<span class="fontstyle0">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.</span> <br /><br />https://www.ijhpm.com/article_3527_2f004bd7a29dd2bee82ce715e77f1c0e.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Local Research Catalyzes National Surgical Planning; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa”10581060352610.15171/ijhpm.2018.78ENMicah G.KatzCenter for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA0000-0001-8315-0909Raymond R.PriceCenter for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USAJade M.NunezCenter for Global Surgery, University of Utah School of Medicine, Salt Lake City, UT, USAJournal Article20180703<span class="fontstyle0">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.</span>https://www.ijhpm.com/article_3526_d24eeb50d980a96873c7e8d1b9daf962.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Public 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”10611063353210.15171/ijhpm.2018.74ENWencheBekkenDepartment of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Oslo, NorwayJournal Article20180615The Norwegian Public Health Act of 2012 (PHA)<sup>1</sup> 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 al<sup>2</sup> 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 al<sup>2</sup> 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.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Global Surgery – Redirecting Strategies for a Global Research Agenda; Comment on “Global Surgery – Informing National Strategies for Scaling Up Surgery in Sub-Saharan Africa”10641066353010.15171/ijhpm.2018.79ENJaymie A.HenryDepartment of Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA0000-0003-3331-8704Journal Article20180702More 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.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Decisions of Value: Going Backstage; Comment on “Contextual Factors Influencing Cost and Quality Decisions in Health and Care: A Structured Evidence Review and Narrative Synthesis”10671069353310.15171/ijhpm.2018.81ENMichaelCalnanSocial Policy, Sociology and Social Research (SSPSSR), University of Kent, Canterbury, UK0000-0002-7239-6898Journal Article20180327This 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.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-593971120181101Trump’s Zero-tolerance Policy: Would a Political Response to a Humanitarian Crisis Work?10701072353110.15171/ijhpm.2018.80ENMohammadKaramouzianSchool of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, CanadaHIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran0000-0002-5631-4469Journal Article20180703https://www.ijhpm.com/article_3531_40871e863533678ec424a021ad61b4c1.pdf