Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398620190601A Crisis of Humanitarianism: Refugees at the Gates of Europe321324361110.15171/ijhpm.2019.22ENMariannaFotakiWarwick Business School, University of Warwick, Coventry, UK0000-0002-2130-6936Journal Article20181113<span class="fontstyle0">Having initially welcomed more than a million refugees and forced migrants into Europe between 2015 and 2016, the European Union’s (EU’s) policy has shifted toward externalising migration control to Turkey and Northern Africa. This goes against the spirit of international conventions aiming to protect vulnerable populations, yet there is widespread indifference toward those who remain stranded in Italy, Greece and bordering Mediterranean countries. Yet there are tens of thousands living in overcrowded reception facilities that have, in effect, turned into long-term detention centres with poor health and safety for those awaiting resettlement or asylum decisions. Disregard for humanitarian principles is predicated on radical inequality between lives that are worth living and protecting, and unworthy deaths that are unseen and unmarked by grieving. However, migration is on the rise due to natural and man-made disasters, and is becoming a global issue that concerns us all. We must therefore deal with it through collective political action that recognises refugees’ and forced migrants’ right to protection and ensures access to the health services they require.</span>https://www.ijhpm.com/article_3611_7002684312988eeff8539306a35f1017.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398620190601CIHR Health System Impact Fellows: Reflections on “Driving Change” Within the Health System325328358410.15171/ijhpm.2018.124ENS MeaghanSimHealthy Populations Institute, Dalhousie University, Halifax, NS, CanadaNova
Scotia Health Authority, Halifax, NS, Canada0000-0003-4477-3833JonathanLaiMcGill University, Montreal, QC,
CanadaCentre for Innovation in Autism and Intellectual Disabilities, Montreal,
QC, Canada0000-0002-3060-1232KatieAubrechtMount Saint Vincent University, Halifax, NS, CanadaContinuing-Care Research, Nova Scotia Health Authority, Halifax, NS, CanadaIvyChengInstitute of
Health Policy and Management, University of Toronto, Toronto, ON, CanadaSunnybrook Health Sciences Centre, Toronto, ON, CanadaMarkEmbrettDeGroote School
of Business, McMaster University, Hamilton, ON, CanadaNova Scotia Health
Research Foundation, Halifax, NS, Canada0000-0002-3969-0219El KebirGhandourInstitut National D'excellence en Santé et en Services Sociaux (INESSS), Québec City, QC, CanadaCentre Intégré en Santé et Services Sociaux de Chaudière-Appalaches, Ste-Marie, QC, CanadaDépartement de Médecine Familiale et Médecine D'urgence, Université Laval, Quebec City, QC, CanadaMeganHighetSchool
of Public Health, University of Alberta, Edmonton, AB, CanadaPrimary and
Community Health, Health Service Delivery, Alberta Health, Edmonton, AB,
CanadaRebeccaLiuDepartment of Human Kinetics, University of Ottawa, Ottawa, ON,
CanadaChristiane PMCasteliUniversity Health and Social Services Centre (IUHSSC) of Capitale-Nationale (CN), Faculty of Nursing Sciences, Université Laval, Québec City,
QC, CanadaMargaretSaariSchool of Public Health and Health Systems, University of
Waterloo, Waterloo, ON, CanadaSE Health, Markham, ON, CanadaSamiratouOuédraogoDepartment of Epidemiology Epidemiology, Biostatistics and Occupational
Health, McGill University, Montréal, QC, CanadaInstitut National de Santé
Publique du Québec (INSPQ), Montréal, QC, CanadaHazelWilliams-RobertsSaskatchewan Health
Authority, Saskatoon, SK, CanadaUniversity of Saskatchewan, Saskatoon,
SK, CanadaJournal Article20180924Learning health systems necessitate interdependence between health and academic sectors and are critical to address the present and future needs of our health systems. This concept is being supported through the new Canadian Institutes of Health Research (CIHR) Health System Impact (HSI) Fellowship, through which postdoctoral fellows are situated within a health system-related organization to help propel evidence-informed organizational transformation and change. A voluntary working group of fellows from the inaugural cohort representing diversity in geography, host setting and personal background, collectively organized a panel at the 2018 Canadian Association for Health Services and Policy Research Conference with the purpose of describing this shared scholarship experience. Here, we present a summary of this panel reflecting on our experiential learning in a practice environment and its ability for impact.https://www.ijhpm.com/article_3584_e3e8befb2f4522ba7bed5993193e2e25.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398620190601The Challenge of Additionality: The Impact of Central Grants for Primary Healthcare on State-Level Spending on Primary Healthcare in India329336359610.15171/ijhpm.2019.06ENDiana M.BowserThe Heller School for Social Policy and Management, Brandeis University,
Waltham, MA, USA0000-0001-9582-7761RajeshJhaIndependent Consultant, Delhi, IndiaManjiriBhawalkarHealth Financing
Team, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva,
SwitzerlandPeterBermanDepartment of Global Health and Population, International Health
Systems Program, Harvard School of Public Health, Boston, MA, USAJournal Article20180725Background<br />In planning for universal health coverage, many countries have been examining their fiscal decentralization policies with the goal of increasing efficiency and equity via “additionalities.” The concept of “additionality,” when the government of a lower administrative level increases the funding allocated to a particular issue when extra funds are present, is often used in these contexts. Although the definition of “additionality” can be used more broadly, for the purposes of this paper we focus narrowly on the additional allocation of primary healthcare expenditures. This paper explores this idea by examining the impact of central level primary healthcare expenditure, on individual state level contributions to primary healthcare expenditure within 16 Indian states between 2005 and 2013.<br /> <br />Methods<br />In examining 5 main variables, we compared differences between government expenditures, contributions, and revenues for Empowered Action Group (EAG) states, and non-EAG states. EAG states are normally larger states that have weaker public health infrastructure and hence qualify for additional funding. Finally, using a model that captured the quantity of central level primary healthcare expenditure distributions to these states, we measured its impact on each state’s own contributions to primary healthcare spending.<br /> <br />Results<br />Our results show that, at the state level, growth in per capita central level primary healthcare expenditure has increased by 110% from 2005-2013, while state’s own contributions to primary healthcare expenditure per capita increased by 32%. Further analyses show that a 1% change disbursement from the central level leads to a -0.132%, although not significant, change by states in their own expenditure. The effect for wealthier states is -0.151% and significant and for poorer states the effect is smaller at -0.096% and not significant.<br /> <br />Conclusion<br />This analysis suggests that increases in central level primary healthcare expenditure to states have an inverse relationship with primary healthcare expenditures by the state level. Furthermore, this effect is more pronounced in wealthier Indian states. This finding has policy implications on India’s decision to increase block grants to states in place of targeted program expenditures.https://www.ijhpm.com/article_3596_07c36cfd3d1cfa9f762ced7c99df017c.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398620190601Some Multidimensional Unintended Consequences of Telehealth Utilization: A Multi-Project Evaluation Synthesis337352360310.15171/ijhpm.2019.12ENHassaneAlamiInstitute of Health and Social Services in Primary Care, Research Center
on Healthcare and Services in Primary Care, Laval University, Quebec City,
QC, CanadaResearch Center of Quebec City University Hospital Center,
St-François d’Assise Hospital, Quebec City, QC, Canada0000-0002-5461-7693Marie-PierreGagnonInstitute of Health and Social Services in Primary Care, Research Center
on Healthcare and Services in Primary Care, Laval University, Quebec City,
QC, CanadaResearch Center of Quebec City University Hospital Center,
St-François d’Assise Hospital, Quebec City, QC, CanadaFaculty of Nursing
Science, Laval University, Quebec City, QC, Canada0000000207825457Jean-PaulFortinInstitute of Health and Social Services in Primary Care, Research Center
on Healthcare and Services in Primary Care, Laval University, Quebec City,
QC, CanadaResearch Center of Quebec City University Hospital Center,
St-François d’Assise Hospital, Quebec City, QC, CanadaDepartment of Social
and Preventive Medicine, Faculty of Medicine, Laval University, Quebec City,
QC, Canada0000-0002-4107-9937Journal Article20180226Background<br /> Telehealth initiatives have bloomed around the globe, but their integration and diffusion remain challenging because of the complex issues they raise. Available evidence around telehealth usually deals with its expected effects and benefits, but its unintended consequences (UCs) and influencing factors are little documented. This study aims to explore, describe and analyze multidimensional UCs that have been associated with the use of telehealth.<br /> <br /> Methods<br /> We performed a secondary analysis of the evaluations of 10 telehealth projects conducted over a 22-year period in the province of Quebec (Canada). All material was subjected to a qualitative thematic-pragmatic content analysis with triangulation of methodologies and data sources. We used the conceptual model of the UCs of health information technologies proposed by Bloomrosen et al to structure our analysis.<br /> <br /> Results<br /> Four major findings emerged from our analysis. First, telehealth utilization requires many adjustments, changes and negotiations often underestimated in the planning and initial phases of the projects. Second, telehealth may result in the emergence of new services corridors that disturb existing ones and involve several adjustments for organizations, such as additional investments and resources, but also the risk of fragmentation of services and the need to balance between standardization of practices and local innovation. Third, telehealth may accentuate power relations between stakeholders. Fourth, it may lead to significant changes in the responsibilities of each actor in the supply chain of services. Finally, current legislative and regulatory frameworks appear ill-adapted to many of the new realities brought by telehealth.<br /> <br /> Conclusion<br /> This study provides a first attempt for an overview of the UCs associated with the use of telehealth. Future research-evaluation studies should be more sensitive to the multidimensional and interdependent factors that influence telehealth implementation and utilization as well as its impacts, intended or unintended, at all levels. Thus, a consideration of potential UCs should inform telehealth projects, from their planning until their scaling-up.https://www.ijhpm.com/article_3603_0b661dcb4e35e53641ad5a80af47ab40.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398620190601Relevance of a Toll-Free Call Service Using an Interactive Voice Server to Strengthen Health System Governance and Responsiveness in Burkina Faso353364360510.15171/ijhpm.2019.13ENLucieLechatUMI Resiliences, IRD (French Institute For Research on sustainable
Development), Bondy, France0000-0003-1163-4247EmmanuelBonnetUMI Resiliences, IRD (French Institute For Research on sustainable
Development), Bondy, France0000-0001-6735-5330LudovicQueuillePan American Health Organization, Portau-Prince, HaitiZoumanaTraoréCEO Africasys, Paris, FrancePaul-AndréSoméNGO Action-GovernanceIntegration-Strengthening, Health and Development Working Group (AGIRSD), Ouagadougou, Burkina-Faso0000-0002-0065-8852ValéryRiddeIRD (French Institute For Research
on sustainable Development), CEPED (IRD-Université Paris Descartes),
Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France0000-0001-9299-8266Journal Article20180122Background<br /> In Africa, health systems are poorly accessible, inequitable, and unresponsive. People rarely have either the confidence or the opportunity to express their opinions. In Burkina Faso, there is a political will to improve governance and responsiveness to create a more relevant and equitable health system. Given their development in Africa, information and communication technologies (ICTs) offer opportunities in this area.<br /> <br /> Methods<br /> This article presents the results of an evaluation of a toll-free call service coupled with an interactive voice server (TF-IVS) tested in Ouagadougou, Burkina Faso, to assess its relevance for improving health systems governance. The approach consisted of a 2-phased action research project to test 2 technologies: recorded messages and touch keypad. Using a concurrent mixed approach, we assessed the technological, social, and instrumental relevance of the service.<br /> <br /> Results<br /> The call service is available everywhere, 24 hours per day, seven days per week. The equipment and its physical location were not adequately protected against technological hazards. Of the 278 days of operation, 49 were non-functional. In 8 months, there were 13 877 calls, which demonstrated the popularity of ICTs and the ease of access to telephone networks and mobile technologies. The TF-IVS was free, anonymous, and multilingual, which fostered the expression of public opinion. However, cultural context (religion, ethnic culture) and fear of reprisals may have had a negative influence. In the end, questions remained regarding people’s capacity to use this innovative service. In the first trial, 49% of callers recorded their message and in the second, 48%. Touch key technology appeared more relevant for automated and real-time data collection and analysis, but there was no comprehensive strategy for translating the information collected into a response from healthcare actors or the government.<br /> <br /> Conclusion<br /> This study showed the relevance and feasibility of implementing a TF-IVS to strengthen health system responsiveness in one of the world’s poorest countries. Public opinion expressed through data collected in real-time is helpful for improving system responsiveness to meet care needs and enhance equity. However, the strategy for developing this tool must take into account the implementation context and the activities needed to influence the mechanisms of social responsibility (eg, information provision, citizen action, and state response).https://www.ijhpm.com/article_3605_49829981d3b367b704c8a0cfe455a438.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398620190601Political Ideology and Stigmatizing Attitudes Toward Depression: The Swedish Case365374360610.15171/ijhpm.2019.15ENJesperLöveDepartment of Public Health and Community Medicine at Institute of Medicine,
University of Gothenburg, Gothenburg, Sweden0000-0003-3184-6730MonicaBertilssonDepartment of Public Health and Community Medicine at Institute of Medicine,
University of Gothenburg, Gothenburg, Sweden0000-0003-2365-2522JohanMartinssonDepartment of Political
Science, University of Gothenburg, Gothenburg, SwedenLenaWängnerudDepartment of Political
Science, University of Gothenburg, Gothenburg, SwedenGunnelHensingDepartment of Public Health and Community Medicine at Institute of Medicine,
University of Gothenburg, Gothenburg, SwedenJournal Article20180629Background<br />Stigmatizing attitudes toward persons with mental disorders is a well-established and global phenomenon often leading to discrimination and social exclusion. Although previous research in the United States showed that conservative ideology has been related to stigmatizing attitudes toward mental disorders, there is reason to believe that this mechanism plays a different role in the context of a universal welfare state with a multi-party system such as Sweden. Furthermore, “mental disorders” may signify severe psychotic disorders, which may evoke more negative attitudes. This suggests the importance of specific studies focusing on the more common phenomenon of depression. This paper investigates the relationship between political ideology and stigmatizing attitudes toward depression in Sweden.<br /> <br />Methods<br />This study is part of the New Ways research program. Data were collected by the Laboratory of Opinion Research (LORE) at the University of Gothenburg in 2014 (N = 3246). Independent variables were political ideology and party affiliation. The dependent variable was the Depression Stigma Scale (DSS). Data were analyzed with linear regression analyses and analyses of variance.<br /> <br />Results<br />More conservative ideology (B = 0.68, standard error [SE] = 0.04, P < .001) and more conservative party affiliation (F(8 2920) = 38.45, P < .001) showed more stigmatizing attitudes toward depression. Item-level analyses revealed a difference where the supporters of the conservative party differed (P < .05) from supporters of the liberal party, with a higher proportion agreeing that “people could snap out of” depression if they wanted to; the populist right-wing party differed from the conservative party with a higher proportion agreeing on items displaying people with depression as “dangerous” and “unpredictable.” Even self-stigma was highest among the populist right-wing party with 22.3% agreeing that “if I had depression I wouldn’t tell….”<br /> <br />Conclusion<br />Political ideology was associated with stigmatizing attitudes toward depression in Sweden. The results also confirm the need to distinguish between different forms of conservatism by observing social distance as being a more important driver among voters for the populist right-wing party compared with personal agency and responsibility among voters for the more traditional conservative party.https://www.ijhpm.com/article_3606_d3aef6c1983256e0f9b82460a5bfe4b6.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398620190601Reflections on Norheim (2018), Disease Control Priorities Third Edition Is Published; Comment on “Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy”375377359910.15171/ijhpm.2019.09ENRachelNugentRTI International, Seattle, WA, USA0000-0001-6421-9077Journal Article20181209<span class="fontstyle0">The publication of </span><em><span class="fontstyle0">Disease Control Priorities</span></em><span class="fontstyle0">, 3rd edition (DCP3) is a major milestone in the global health world. DCP3 reviews and summarizes high quality health intervention effectiveness and cost-effectiveness evidence relevant to low- and middle-income countries and is freely available to users. This Commentary summarizes Norheim’s (2018) assessment of DCP3’s role in country health priority-setting and offers reflections on what DCP3 can continue to offer countries seeking to improve their purchasing of health.</span>https://www.ijhpm.com/article_3599_0bf7678a9bde7842ecc3c10183f63b12.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398620190601Patient Engagement and its Evaluation Tools – Current Challenges and Future Directions; Comment on “Metrics and Evaluation Tools for Patient Engagement in Healthcare Organization- and System-Level Decision-Making: A Systematic Review”378380360410.15171/ijhpm.2019.16ENSamiraAbbasgholizadeh RahimiDepartment of Family Medicine, Faculty of Medicine, McGill University,
Montreal, QC, Canada0000-0003-3781-1360Hervé Tchala VignonZomahounHealth and Social Services Systems, Knowledge
Translation and Implementation Component of the Quebec SPOR-SUPPORT
Unit, Université Laval, Quebec, QC, CanadaUniversité Laval Primary Care
Research Centre (CERSSPL-UL), Université Laval, Quebec, QC, CanadaFranceLégaréDepartment of Family Medicine and Emergency Medicine, Faculty of Medicine,
Université Laval, Quebec, QC, CanadaCanada Research Chair in Shared
Decision Making and Knowledge Translation, Quebec, QC, CanadaJournal Article20181116Considering the growing recognition of the importance of patient engagement in healthcare decisions, research and delivery systems, it is important to ensure high quality and efficient patient engagement evaluation tools. In this commentary, we will first highlight the definition and importance of patient engagement. Then we discuss the psychometric properties of the patient engagement evaluation tools identified in a recent review on patient engagement in healthcare organization- and system-level decision-making. Lastly, we suggest future directions for patient engagement and its evaluation tools.https://www.ijhpm.com/article_3604_d999a2db6074bd48ab4d5362ad93b7fc.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398620190601Global Surgery Priorities: A Response to Recent Commentaries381383359810.15171/ijhpm.2019.10ENJakubGajewskiInstitute of Global Surgery, Royal College of Surgeons in Dublin, Dublin,
Ireland0000-0003-0440-6051RuairiBrughaDepartment of Epidemiology and Public Health Medicine, Royal
College of Surgeons in Ireland, Dublin 2, Ireland0000-0003-0729-0197LeonBijlmakersRadboud University Medical
Centre, Nijmegen, The Netherlands0000-0003-2252-0579Journal Article20190207https://www.ijhpm.com/article_3598_11a77e7403605895d77066b2c116aa68.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398620190601Health Financing Consequences of Implementing Health Transformation Plan in Iran: Achievements and Challenges384386360810.15171/ijhpm.2019.18ENLeilaDoshmangirTabriz Health Services Management Research Center, Iranian Center of
Excellence in Health Management, Tabriz University of Medical Sciences,
Tabriz, IranSocial Determinants of Health Research Center, Health
Management and Safety Promotion Research Institute, Tabriz University of
Medical Sciences, Tabriz, IranDepartment of Health Services Management,
School of Management and Medical Informatics, Tabriz University of Medical
Sciences, Tabriz, IranMohammadBazyarDepartment of Public Health, Faculty of Health,
Ilam University of Medical Sciences, Ilam, Iran0000-0003-2543-1862BehzadNajafiTabriz Health Services
Management Research Center, Tabriz University of Medical Sciences, Tabriz,
IranDepartment of Health Economics, School of Management and Medical
Informatics, Tabriz University of Medical Sciences, Tabriz, Iran0000-0001-9479-3774HassanHaghparast-BidgoliInstitute for
Global Heath, University College London, London, UKJournal Article20181229https://www.ijhpm.com/article_3608_7985c2fbdfa47dcb4a0d057a79e6618b.pdf