Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Beyond the Science: Advancing the “Art and Craft” of Implementation in the Training and Practice of Global Health 252 256 3857 10.34172/ijhpm.2020.131 EN Ejemai Amaize Eboreime Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada Department of Planning, Research and Statistics, National Primary Health Care Development Agency, Abuja, Nigeria 0000-0001-8277-2570 Aduragbemi Banke-Thomas Department of Health Policy, London School of Economics and Political Science, London, UK 0000-0002-4449-0131 Journal Article 2020 04 25 Interesting debates are ongoing on how to develop practical implementation science competencies that can bridge the “know-do” gap in global health. We advance these debates by arguing that apprenticeship and mentorship models drawn from “art and craft” used in industry is the missing piece of the puzzle that will bridge the persisting gap between academics and real-world practitioners. We propose examples of such models and how they can be applied to improve existing capacity building programs, as well as implementation in practice.

https://www.ijhpm.com/article_3857_f269cb7796c3319c9aa4d146b52139e6.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 The Long and Winding Road: A Systematic Literature Review Conceptualising Pathways for Hypertension Care and Control in Low- and Middle-Income Countries 257 268 3862 10.34172/ijhpm.2020.105 EN Rachel Brathwaite Brown School, Washington University in St Louis, St Louis, MO, USA 0000-0002-9363-3581 Eleanor Hutchinson Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 0000-0002-9718-2407 Martin McKee Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 0000-0002-0121-9683 Benjamin Palafox Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 0000-0003-3775-4415 Dina Balabanova Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 0000-0001-7163-3428 Journal Article 2019 11 25 Background Hypertension control is poor everywhere, especially in low- and middle-income countries (LMICs). An effective response requires understanding factors acting at each stage on the patients’ pathway through the health system from entry or first contact with the health system, through to treatment initiation and follow up. This systematic review aimed to identify barriers to and facilitators of hypertension control along this pathway and, respectively, ways to overcome or strengthen them. Methods MEDLINE, EMBASE, Global Health, CINAHL Plus, and Africa-Wide Information (1980-April 2019) were searched for studies of hypertensive adults in LMICs reporting details of at least 2 adequately described health system contacts. Data were extracted and analysed by 2 reviewers. Themes were developed using NVivo in patient-related (sociodemographic, knowledge and health beliefs, health status and co-morbidities, trade-offs), social (social relationships and traditions) and health system domains (resources and processes). Results are reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results From 2584 identified records, 30 were included in the narrative synthesis. At entry, ‘health systems resources and processes’ and ‘knowledge and beliefs about hypertension’ dominated while ‘social relations and traditions’ and ‘comorbidities’ assume greater importance subsequently, with patients making ‘trade-offs’ with family priorities during follow up. Socio-demographic factors play a role, but to a lesser extent than other factors. Context matters. Conclusion Understanding the changing barriers to hypertension control along the patient journey is necessary to develop a comprehensive and efficient response to this persisting problem.

https://www.ijhpm.com/article_3862_533fa796b43291fc61a9e812a50c3fb6.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Engaging Knowledge Users with Mental Health Experience in a Mixed-Methods Systematic Review of Post-secondary Students with Psychosis: Reflections and Lessons Learned from a Master’s Thesis 269 276 3877 10.34172/ijhpm.2020.138 EN Victoria Sanderson School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada 0000-0003-1310-3052 Amanda Vandyk School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada 0000-0002-2356-7136 Jean Daniel Jacob School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada 0000-0002-4032-2229 Ian D. Graham School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada 0000-0002-3669-1216 Journal Article 2020 01 28 Engaging knowledge users (KUs) as research team members throughout the research process helps generate relevant knowledge and may improve uptake of research results. The purpose of this article is to describe how an integrated knowledge translation (iKT) approach was embedded within a master’s thesis project comprising a mixed-methods systematic review. KUs were engaged in four distinct phases of the systematic review process, including (1) proposal development; (2) development of the research question and approach; (3) creation of an advisory panel; and (4) an end of study meeting to interpret findings and plan dissemination of findings. The extent of each KU’s engagement on the research team fluctuated during the study. Challenges included maintaining the same KUs throughout the project and maintaining the scope of the project to align with a master’s thesis. Our suggestions for optimizing graduate student iKT projects include having regular team meetings and periodically checking in with team members to encourage reflection on overall engagement and progress of the project. Overall, KUs helped create a research project designed to address their needs and provided input on how results might translate into implications for clinical practice, education, academic policy, and future research within their respective contexts.

https://www.ijhpm.com/article_3877_8d9a6e908ed2b731fb96151d9bb94d49.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Medical Service Utilization and Direct Medical Cost of Stroke in Urban China 277 286 3865 10.34172/ijhpm.2020.111 EN Dawei Zhu China Center for Health Development Studies, Peking University, Beijing, China 0000-0003-0167-6603 Shi Xuefeng School of Management, Beijing University of Chinese Medicine, Beijing, China National Institute of Chinese Medicine Development and Strategy, Beijing University of Chinese Medicine, Beijing, China 0000-0001-7056-2912 Stephen Nicholas School of Economics and School of Management, Tianjin Normal University, Tianjin, China Australian National Institute of Management and Commerce, Sydney, NSW, Australia Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia 0000-0001-6770-7105 Siyuan Chen School of Public Health, Peking University, Beijing, China China Center for Health Development Studies, Peking University, Beijing, China Ruoxi Ding Institute of Population Research, Peking University, Beijing, China Lieyu Huang School of Management, Beijing University of Chinese Medicine, Beijing, China National Institute of Chinese Medicine Development and Strategy, Beijing University of Chinese Medicine, Beijing, China Yong Ma China Health Insurance Research Association, Beijing, China Ping He China Center for Health Development Studies, Peking University, Beijing, China 0000-0001-5040-5012 Journal Article 2019 12 24 Background Understanding the treatment costs of stroke can guide health policies and interventions. However, few studies have analyzed the treatment costs of stroke in China. The aim of this study is to assess stroke-related medical service utilization, direct costs of stroke and associated stroke predictors, and, second, to understand the structure of medical resource use. Methods This study used a 5% random sample of claim data from China’s Urban Basic Medical Insurance between January 2013 to December 2016. The sampling design assigned a sample weight to each beneficiary. Weighted descriptive analyses, Poisson regression and generalized linear model were used to analyze the medical service utilization, costs and their associations with patient characteristics. Results In urban China, the annual prevalence of stroke was 730.43 (95% CI = 730.10-730.76) cases per 100 000 people, and nearly 2% of total health expenditures of urban residents was spent on stroke-related medical costs. Weighted average annual total medical cost of stroke was RMB10 637 [95% CI = 10 435-10 840] (US$1682, 95% CI = 1650-1714), with annual out-of-pocket (OOP) cost of RMB3093 [95% CI = 3026-3161] (US$489, 95% CI = 478-500). The average yearly number of stroke-related outpatient visit was 1.67 [SD = 3.39] and inpatient admission was 0.79 [SD = 0.83], with an average cost of RMB440 [SD = 739] (US$70, SD = 117) for outpatients and RMB12 702 [SD = 21 424] (US$2008, SD = 3387) for inpatients. Inpatient costs accounted for 94% (RMB10 034 or US$ 1586) of medical costs, and tertiary hospitals were the main provider of stroke care. Stroke-related medical care utilization and direct costs were associated with gender, age, pathological stroke types and insurance status. Medication costs contributed to 50.6% (RMB5382 or US$ 851) of the average stroke-related medical costs. Conclusion China’s health system bares a large economic burden from stroke. Specific policies are needed to strengthen the capacity of secondary hospitals, alter the structure of medical resource allocation, and target specific sections of the stroke population.

https://www.ijhpm.com/article_3865_866d90e0921ac7b024b47d672445a086.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Access of Migrant Youths in Sweden to Sexual and Reproductive Healthcare: A Cross-sectional Survey 287 298 3868 10.34172/ijhpm.2020.123 EN Mazen Baroudi Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden 0000-0002-0609-8745 Faustine Nkulu-Kalengayi Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden Isabel Goicolea Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden Robert Jonzon The Public Health Agency of Sweden, Solna, Sweden Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden Miguel San Sebastian Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden 0000-0001-7234-3510 Anna-Karin Hurtig Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden 0000-0001-7087-1467 Journal Article 2019 12 05 Background This study aims to assess migrant youths’ access to sexual and reproductive healthcare (SRHC) in Sweden, to examine the socioeconomic differences in their access, and to explore the reasons behind not seeking SRHC. Methods A cross-sectional survey was conducted for 1739 migrant youths 16 to 29 years-old during 2018. The survey was self-administered through: ordinary post, web survey and visits to schools and other venues. We measured access as a 4-stage process including: healthcare needs, perception of needs, utilisation of services and met needs. Results Migrant youths faced difficulties in accessing SRHC services. Around 30% of the participants needed SRHC last year, but only one-third of them fulfilled their needs. Men and women had the same need (27.4% of men [95% CI: 24.2, 30.7] vs. 32.7% of women [95% CI: 28.2, 37.1]), but men faced more difficulties in access. Those who did not categorise themselves as men or women (50.9% [95% CI: 34.0, 67.9]), born in South Asia (SA) (39% [95% CI: 31.7, 46.4]), were waiting for residence permit (45.1% [95% CI: 36.2, 54.0]) or experienced economic stress (34.5% [95% CI: 30.7, 38.3]) had a greater need and found more difficulties in access. The main difficulties were in the step between the perception of needs and utilisation of services. The most commonly reported reasons for refraining from seeking SRHC were the lack of knowledge about the Swedish health system and available SRHC services (23%), long waiting times (7.8%), language difficulties (7.4%) and unable to afford the costs (6.4%). Conclusion There is an urgent need to improve migrant youths’ access to SRHC in Sweden. Interventions could include: increasing migrant youths’ knowledge about their rights and the available SRHC services; improving the acceptability and cultural responsiveness of available services, especially youth clinics; and improving the quality of language assistance services.

https://www.ijhpm.com/article_3868_70162fe655ec381ac6312ebf026aac54.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Understanding the Costs of Surgery: A Bottom-Up Cost Analysis of Both a Hybrid Operating Room and Conventional Operating Room 299 307 3870 10.34172/ijhpm.2020.119 EN Sejal Patel Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands 0000-0002-5858-5166 Melanie Lindenberg Division of Psychosocial Research and Epidemiology, The Netherlands Cancer InstituteAntoni van Leeuwenhoek, Amsterdam, The Netherlands Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands 0000-0001-7522-1009 Maroeska M. Rovers Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands 0000-0002-3095-170X Wim H. Van Harten Division of Psychosocial Research and Epidemiology, The Netherlands Cancer InstituteAntoni van Leeuwenhoek, Amsterdam, The Netherlands Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands Theo J.M. Ruers Department of Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands Lieke Poot Department of Medical Technology, Isala Hospital, Zwolle, The Netherlands Valesca P. Retel Division of Psychosocial Research and Epidemiology, The Netherlands Cancer InstituteAntoni van Leeuwenhoek, Amsterdam, The Netherlands Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands Janneke P.C. Grutters Department of Operating Rooms, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands 0000-0002-2579-1561 Journal Article 2020 01 06 Background Over the past decade, many hospitals have adopted hybrid operating rooms (ORs). As resources are limited, these ORs have to prove themselves in adding value. Current estimations on standard OR costs show great variety, while cost analyses of hybrid ORs are lacking. Therefore, this study aims to identify the cost drivers of a conventional and hybrid OR and take a first step in evaluating the added value of the hybrid OR. Methods A comprehensive bottom-up cost analysis was conducted in five Dutch hospitals taking into account: construction, inventory, personnel and overhead costs by means of interviews and hospital specific data. The costs per minute for both ORs were calculated using the utilization rates of the ORs. Cost drivers were identified by sensitivity analyses. Results The costs per minute for the conventional OR and the hybrid OR were €9.45 (€8.60-€10.23) and €19.88 (€16.10-€23.07), respectively. Total personnel and total inventory costs had most impact on the conventional OR costs. For the hybrid OR the costs were mostly driven by utilization rate, total inventory and construction costs. The results were incorporated in an open access calculation model to enable adjustment of the input parameters to a specific hospital or country setting. Conclusion This study estimated a cost of €9.45 (€8.60-€10.23) and €19.88 (€16.10-€23.07) for the conventional and hybrid OR, respectively. The main factors influencing the OR costs are: total inventory costs, total construction costs, utilization rate, and total personnel costs. Our analysis can be used as a basis for future research focusing on evaluating value for money of this promising innovative OR. Furthermore, our results can inform surgeons, and decision and policy-makers in hospitals on the adoption and optimal utilization of new (hybrid) ORs.

https://www.ijhpm.com/article_3870_c255c05246a081654a0267cbb725f5a7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Can Combining Performance-Based Financing With Equity Measures Result in Greater Equity in Utilization of Maternal Care Services? Evidence From Burkina Faso 308 322 3873 10.34172/ijhpm.2020.121 EN Takondwa Mwase Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany 0000-0002-3067-3981 Julia Lohmann Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK 0000-0003-4136-9296 Saidou Hamadou The World Bank, Yaoundé, Cameroon 0000-0002-0650-7473 Stephan Brenner Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany 0000-0001-5397-7008 Serge M.A. Somda Centre MURAZ, Bobo-Dioulasso, Burkina Faso UFR/ST, Université Nazi Boni, Bobo-Dioulasso, Burkina Faso 0000-0001-9855-9395 Hervé Hien Centre MURAZ, Bobo-Dioulasso, Burkina Faso 0000-0003-2578-7535 Michael Hillebrecht Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany 0000-0003-1799-952X Manuela De Allegri Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany 0000-0002-8677-1337 Journal Article 2019 09 12 Background As countries reform health financing systems towards universal health coverage, increasing concerns emerge on the need to ensure inclusion of the most vulnerable segments of society, working to counteract existing inequities in service coverage. To this end, selected countries in sub-Saharan Africa have decided to couple performance-based financing (PBF) with demand-side equity measures. Still, evidence on the equity impacts of these more complex PBF models is largely lacking. We aimed at filling this gap in knowledge by assessing the equity impact of PBF combined with equity measures on utilization of maternal health services in Burkina Faso. Methods Our study took place in 24 districts in rural Burkina Faso. We implemented an experimental design (cluster-randomized trial) nested within a quasi-experimental one (pre- and post-test design with independent controls). Our analysis relied on self-reported data on pregnancy history from 9999 (baseline) and 11 010 (endline) women of reproductive age (15-49 years) on use of maternal healthcare and reproductive health services, and estimated effects using a difference-in-differences (DID) approach, purposely focused on identifying program effects among the poorest wealth quintile. Results PBF improved the utilization of few selected maternal health services compared to status quo service provision. These benefits, however, were not accrued by the poorest 20%, but rather by the other quintiles. PBF combined with equity measures did not produce better or more equitable results than standard PBF, with specific differences only on selected outcomes. Conclusion Our findings challenge the notion that implementing equity measures alongside PBF is sufficient to produce an equitable distribution in program benefits and point at the need to identify more innovative and context-sensitive measures to ensure adequate access to care for the poorest. Our findings also highlight the importance of considering changing policy environments and the need to assess interferences across policies.

https://www.ijhpm.com/article_3873_db346ccb62d491029b590bbbf0f5c412.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 “Not Just a Journal Club – It’s Where the Magic Happens”: Knowledge Mobilization through Co-Production for Health System Development in the Western Cape Province, South Africa 323 333 3874 10.34172/ijhpm.2020.128 EN The Western Cape HPSR Journal Club Team A list of The Western Cape HPSR Journal Club Team is provided in the Acknowledgments. Journal Article 2020 01 24 Background The field of Health Policy and Systems Research (HPSR) views researchers as active participants in processes of knowledge mobilization, learning and action. Yet few studies examine how such processes are institutionalized or consider their health system or wider impacts. This paper aims to contribute insights by presenting a South African experience: the Western Cape (WC) HPSR Journal Club (JC). Methods The paper draws on collective reflection by its authorial team, who are managerial and academic JC participants; reflective discussions with a wider range of people; and external evaluation reports. The analysis has been validated through rounds of collective engagement among authors, and through comparison with the wider sets of data, documentation and international literature. It considers impacts using a framework drawn from the co-production literature. Results Since 2012, the JC has brought together provincial and local government health system managers and academics to discuss complex systems’ and social science perspectives on health system development. The JC impacts encompass the trusting relationships (group micro-level) that have not only strengthened personal confidence and leadership skills (individual micro level), but also led to organizational impacts (meso level), such as practice and policy changes (practitioner organizations) and strengthened research and post-graduate teaching programs (academic organizations). Macro-societal impacts are, finally, judged likely to have resulted from new health system practices and policies and from academic post-graduate training activities. This set of impacts has been enabled by: the context of the JC; aspects of the JC design that underpin trusting relationships and mutual learning; the sustained participation of senior health system managers and academic managers who are able to translate new ideas into practice in their own organizational environments; and our individual and collective motivations – including the shared goal of health system development for social justice. Our challenges include risks and costs to ourselves, and the potential exclusion of challenging voices. Conclusion The principles and practice of the JC approach, rather than the JC as a model, offer ideas for others wishing to mobilize knowledge for health system development through embedded and co production processes. It demonstrates the potential for productive human interactions to seed long lasting systemic change.

https://www.ijhpm.com/article_3874_2ed80f6311c1825feb854d78fa969d34.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Estimating COVID-19-Related Infections, Deaths, and Hospitalizations in Iran Under Different Physical Distancing and Isolation Scenarios 334 343 3876 10.34172/ijhpm.2020.134 EN 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 Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran 0000-0002-9008-7618 Yunes Jahani Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran 0000-0002-6808-7101 Ali Mirzazadeh Department of Epidemiology and Biostatistics, Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA 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 0000-0002-0478-3220 Milad Ahmadi Gohari Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 0000-0003-1998-9157 Mehran Nakhaeizadeh Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Department of Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran 0000-0001-8441-6975 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 Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada 0000-0002-3810-752X Sana Eybpoosh Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran 0000-0002-2304-8352 Hamid Reza Tohidinik 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 Biostatistics and Epidemiology, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran Ehsan Mostafavi Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran 0000-0002-1997-517X Davood Khalili Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0003-4956-1039 Seyed Saeed Hashemi Nazari Prevention of Cardiovascular Disease Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran 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 0000-0002-5631-4469 Ali Akbar Haghdoost Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran 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 0000-0003-4628-4849 Journal Article 2020 05 07 Background Iran is one of the first few countries that was hit hard with the coronavirus disease 2019 (COVID-19) pandemic. We aimed to estimate the total number of COVID-19 related infections, deaths, and hospitalizations in Iran under different physical distancing and isolation scenarios. Methods We developed a susceptible-exposed-infected/infectious-recovered/removed (SEIR) model, parameterized to the COVID-19 pandemic in Iran. We used the model to quantify the magnitude of the outbreak in Iran and assess the effectiveness of isolation and physical distancing under five different scenarios (A: 0% isolation, through E: 40% isolation of all infected cases). We used Monte-Carlo simulation to calculate the 95% uncertainty intervals (UIs). Results Under scenario A, we estimated 5 196 000 (UI 1 753 000-10 220 000) infections to happen till mid-June with 966 000 (UI 467 800-1 702 000) hospitalizations and 111 000 (UI 53 400-200 000) deaths. Successful implantation of scenario E would reduce the number of infections by 90% (ie, 550 000) and change the epidemic peak from 66 000 on June 9, to 9400 on March 1, 2020. Scenario E also reduces the hospitalizations by 92% (ie, 74 500), and deaths by 93% (ie, 7800). Conclusion With no approved vaccination or therapy available, we found physical distancing and isolation that include public awareness and case-finding and isolation of 40% of infected people could reduce the burden of COVID-19 in Iran by 90% by mid-June.

https://www.ijhpm.com/article_3876_834a3bd235bca0caa53141f2ebc30438.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Views on Workplace Policies and its Impact on Health-Related Quality of Life During Coronavirus Disease (COVID-19) Pandemic: Cross-Sectional Survey of Employees 344 353 3879 10.34172/ijhpm.2020.127 EN Eliza Lai-Yi Wong JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 0000-0001-9983-6219 Kai-Fai Ho JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 0000-0001-7464-3437 Samuel Yeung-Shan Wong JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 0000-0003-0934-6385 Annie Wai-Ling Cheung JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 0000-0001-6968-6221 Peter Sen-Yung Yau JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China Dong Dong JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 0000-0001-9784-6472 Eng-Kiong Yeoh JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China 0000-0002-1721-9450 Journal Article 2020 05 18 Background This study explored the degree of views towards supportive workplace policies among employees during coronavirus disease 2019 (COVID-19) pandemic and its association with health-related quality of life (HRQoL) in Hong Kong. Methods A cross-sectional study was conducted in 1049 employees using online self-administered questionnaire. Views on workplace policies were measured in term of agreement on its comprehensiveness, timeliness and transparency whereas HRQoL was measured using EQ-5D-5L Hong Kong version. Univariate estimates on the impact of HRQoL from views of measures in workplace was done. Qualitative comments on the suggestions to strengthen workplace measures were collected and presented descriptively. Results Of 1048 respondents, 16% reported that no workplace measures nor guidelines were existed in their company related to the COVID-19 pandemics. Those who reported having workplace policy were not satisfied with the arrangement in term of comprehensiveness (36%), timeliness (38%), and transparency (63%). Regarding to the policy measure, only 68% respondents reported that their workplace supplied face masks to them. The health index was 0897, which was lower than the norm of 0.924. 64% of respondents reported having a health problem in at least 1 of 5 dimension of EQ-5D-5L with the highest proportion of having problem in anxiety/depression (55%). In addition, the workplace policy and measure had a direct effect of 0.131 on health outcome. Perception of infection risk had a direct effect of 0.218 on health outcome and partly mediated the relationship between workplace policy and measure and health outcome (0.066). Conclusion The study highlighted the workplace policy and measure is an important mean to minimize infection risk at workplace so as to reduce tremendous stress and health outcome caused by a COVID-19 pandemic. Workplace measures related to COVID-19 pandemic should be further strengthen to mitigate the risk of infection and protect employee’s health.

https://www.ijhpm.com/article_3879_cc58f7abf0b0cf2d5ac95ab60e4f14e9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Why Do They Leave? Challenges to Retention of Surgical Clinical Officers in District Hospitals in Malawi 354 361 3882 10.34172/ijhpm.2020.142 EN Jakub Gajewski Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin 2, Ireland 0000-0003-0440-6051 Marisa Wallace Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands Chiara Pittalis Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland 0000-0003-3465-9850 Gerald Mwapasa Department of Surgery, College of Medicine Malawi, Blantyre, Malawi Eric Borgstein Department of Surgery, College of Medicine Malawi, Blantyre, Malawi Leon Bijlmakers Radboud University Medical Centre, Nijmegen, The Netherlands 0000-0003-2252-0579 Ruairi Brugha Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland 0000-0003-0729-0197 Journal Article 2020 02 04 Background Low- and middle-income countries (LMICs) are the worst affected by a lack of safe and affordable access to safe surgery. The significant unmet surgical need can be in part attributed to surgical workforce shortages that disproportionately affect rural areas of these countries. To combat this, Malawi has introduced a cadre of non-physician clinicians (NPCs) called clinical officers (COs), trained to the level of a Bachelor of Science (BSc) in Surgery. This study explored the barriers and enablers to their retention in rural district hospitals (DHs), as perceived by the first cohort of COs trained to BSc in Surgery level in Malawi. Methods A longitudinal qualitative research approach was used based on interviews with 16 COs, practicing at DHs, during their BSc training (2015); and again with 15 of them after their graduation (2019). Data from both time points were analysed and compared using a top-down thematic analysis approach. Results Of the 16 COs interviewed in 2015, 11 intended to take up a post at a DH following graduation; however, only 6 subsequently did so. The major barriers to remaining in a DH post as perceived by these COs were lack of promotion, a more attractive salary elsewhere; and unclear, stagnant career progression within surgery. For those who remained working in DH posts, the main enablers are a willingness to accept a low salary, to generate greater opportunities to engage in additional earning opportunities; the hope of promotional opportunities within the government system; and greater responsibility and recognition of their surgical knowledge and skills as a BSc-holder at the district level. Conclusion The sustainability of surgically trained NPCs in Malawi is not assured and further work is required to develop and implement successful retention strategies, which will require a multi-sector approach. This paper provides insights into barriers and enablers to retention of this newly-introduced cadre and has important lessons for policy-makers in Malawi and other countries employing NPCs to deliver essential surgery.

https://www.ijhpm.com/article_3882_df42e2244c97a0d80d565ae8176d3351.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Measuring Governance: Developing a Novel Metric for Assessing Whether Policy Environments are Conducive for the Development and Implementation of Nutrition Interventions in Nepal 362 373 3883 10.34172/ijhpm.2020.135 EN Grace Namirembe Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA 0000-0002-8017-4144 Robin Shrestha Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA 0000-0001-9729-2123 Patrick Webb Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA 0000-0002-9857-3354 Robert Houser Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA 0000-0002-8645-5561 Dale Davis Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur, Nepal Kedar Baral Helen Keller International, Patan, Nepal 0000-0002-3689-2763 Julieta Mezzano Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA 0000-0001-6029-5785 Shibani Ghosh Friedman School of Nutrition Science and Policy, Tufts University, Boston MA, USA 0000-0001-5893-6774 Journal Article 2019 11 13 Background The Nutrition Governance Index (NGI) defines a first standardized approach to quantifying the ‘quality of governance’ in relation to national plans of action to accelerate improvements in nutrition. It was created in response to growing demand for evidence-based measures that reveal opportunities and challenges as nutrition-related policies on paper are translated into outcomes on the ground. Numerous past efforts to measure ‘governance,’ most notably World Health Organization’s (WHO’s) NGI and the separate Hunger and Nutrition Commitment Index (HANCI), both of which lack granularity below the national level and each of which fails to capture pinch points related to necessary crosssectoral actions. This paper addresses such caveats by introducing an innovative metric to assess self-reported practices of, and perceptions held by, administration officials tasked with implementing government policy at the sub-national level. The paper discusses the development of this metric, its methodology, and explores its application in the context of Nepal. Methods Conducted as part of a nationally representative longitudinal survey across 21 of Nepal’s 75 districts, the substudy on which this paper is based used data from 520 government and non government officials at different geographic and administrative tiers of authority. Using robust statistical techniques, structured questionnaire data were condensed into a score using a scale from 0 to 100. Results Six domains were identified through the analysis: Understanding Nutrition and related responsibilities; Collaboration; Financial Resources; Nutrition Leadership, Capacity, and Support. About half of all health sector representatives achieved a high score (>3 on 5-point scale) compared to representatives in other sectors of government activity (such as agriculture or education) (χ2= 12.99, P < .003). The health sector also showed the most improvement in mean NGI score over a two-year follow-up period. Conclusion This paper shows that self-reported perceptions and behaviors of those responsible for policy implementation can be usefully quantified. The NGI can be used to assess countries’ readiness for the application of nutrition policies.

https://www.ijhpm.com/article_3883_51f3eb940fd73a19119534c063967bff.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Ethical and Social Values for Paediatric Health Technology Assessment and Drug Policy 374 382 3889 10.34172/ijhpm.2020.144 EN Avram E. Denburg Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada 0000-0003-0039-0742 Mita Giacomini Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada Wendy Ungar Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada Julia Abelson Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada 0000-0002-2907-2783 Journal Article 2020 03 23 Background Public policy approaches to funding paediatric medicines in advanced health systems remain understudied. In particular, the ethical and social values dimensions of health technology assessment (HTA) and drug coverage decisions for children have received almost no attention in research or policy. Methods To elicit and understand the social values that influence decision-making for public funding of paediatric drugs, we undertook a series of in-depth, semi-structured interviews with a stratified purposive sample (n = 22) of stakeholders involved with or affected by drug funding decisions for children at the provincial (Ontario) and national levels in Canada. Constructivist grounded theory methodology guided data collection and thematic analysis. Results Our study provides empirical evidence about the unique ethical and social values dimensions of HTA for children, and describes a novel social values typology for paediatric drug policy decision-making. Three principal categories of values emerged from stakeholder reflections on HTA and drug policy-making for children: procedural values, structural values, and sociocultural values. Key findings include the importance of attention to the procedural legitimacy of HTA for children, with emphasis on the inclusion of child health voices in processes of technology appraisal and policy uptake; a role for HTA institutions to consider the equity impacts of technologies, both in setting review priorities and in assessing the value of technologies for public coverage; and the potential benefits of a distinct national framework to guide drug policy for children. Conclusion Current approaches to HTA are not well designed for the realities of child health and illness, nor the societal priorities regarding children that our study identified. This research generates new knowledge to inform decision-making on paediatric drugs by HTA institutions and government payers in Canada and other publicly-funded health systems, through insights into the relevant social values for child drug funding decisions from varied stakeholder groups.

https://www.ijhpm.com/article_3889_86098ef82c97fa789a47a8d2e8800794.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Should Public Health and Policy Communities Interact With the Food Industry? It Depends on Context; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool” 383 385 3913 10.34172/ijhpm.2020.176 EN Katherine Cullerton School of Public Health, University of Queensland, Herston, QLD, Australia 0000-0001-9517-6380 Jean Adams MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK 0000-0002-5733-7830 Martin White MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, UK 0000-0002-1861-6757 Journal Article 2020 08 17 The issue of public health and policy communities engaging with food sector companies has long caused tension and debate. Ralston and colleagues’ article ‘Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool’ further examines this issue. They found widespread food industry opposition, not just to the details of the World Health Organization (WHO) tool, but to the very idea of it. In this commentary we reflect on this finding and the arguments for and against interacting with the food industry during different stages of the policy process. While involving the food industry in certain aspects of the policy process without favouring their business goals may seem like an intractable problem, we believe there are opportunities for progress that do not compromise our values as public health professionals. We suggest three key steps to making progress.

https://www.ijhpm.com/article_3913_b085c4fa543afe32970749f5e2bcdc6a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 WHO’s Attempt to Navigate Commercial Influence and Conflicts of Interest in Nutrition Programs While Engaging With Non-State Actors: Reflections on WHO Guidance for Nation States; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool” 386 390 3914 10.34172/ijhpm.2020.162 EN Marc A. Rodwin Law School, Suffolk University, Boston, MA, USA 0000-0002-0415-7131 Journal Article 2020 08 03 This commentary situates the comments submitted in response to the World Health Organization (WHO) draft guidance on conflicts of interest in national nutrition programs in light of: (1) WHO policies to protect WHO integrity; (2) the Framework of Engagement with Non-State Actors (FENSA); (3) WHO’s attempt to seek funds due to cuts in member contributions; and (4) attempts — often by corporate entities — to redefine conflicts of interest to avoid oversight of conflicts of interest and increase corporate influence. The WHO guidance defines conflicts of interest in ways that deviate from standard legal usage which confuses its analysis and facilitates the creation of conflicted public-private partnerships. The guidance suggests that nations can allow engagement with non-state actors when the benefits are greater than risks without separate check due to conflicts of interest. Instead, the WHO should have recommended that nations seek alternative ways to achieve their goals when non-state actors have significant institutional conflicts of interest.

https://www.ijhpm.com/article_3914_b85d65c39e12a5515c19fd72b6f48199.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Conflict of Interest in Nutrition: Where’s the Power?; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool” 391 393 3919 10.34172/ijhpm.2020.177 EN Jody Harris Institute of Development Studies, University of Sussex, Brighton, UK World Vegetable Center, Bangkok, Thailand 0000-0002-3369-1253 Nicholas Nisbett Institute of Development Studies, University of Sussex, Brighton, UK Stuart Gillespie International Food Policy Research Institute, Washington, DC, USA 0000-0002-8501-5943 Journal Article 2020 07 31 Actual or perceived conflict of interests (COIs) among public and private actors in the field of nutrition must be managed. Ralston et al expose sharply contrasting views on the new World Health Organization (WHO) COI management tool, highlighting the contested nature of global debates. Both the WHO COI tool and the Ralston et al paper are largely quiet on aspects of power among different actors, however, which we argue is integral to these conflicts. We suggest that power needs to be acknowledged as a factor in COI; that it needs to be systematically assessed in COI tools using approaches we outline here; and that it needs to be explicitly addressed through COI mechanisms. We would recommend that all actors in the nutrition space (not only private companies) are held to the same COI standards, and we would welcome further studies such as Ralston et al to further build accountability.

https://www.ijhpm.com/article_3919_5fc7c9bd1fcb12799f02da8adfa4954f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 It Is Not Enough to Assess Conflicts of Interest When We Bring the Commercial Sector to the Policy Table; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool” 394 397 4156 10.34172/ijhpm.2021.148 EN Elisa Chilet-Rosell Department of Public Health, Universidad Miguel Hernández, Alicante, Spain 0000-0002-9091-7255 Ildefonso Hernandez-Aguado Department of Public Health, Universidad Miguel Hernández, Alicante, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain 0000-0003-1911-5759 Journal Article 2021 08 31 Ralston et al offer us an interesting analysis of the consultation process of World Health Organization’s (WHO’s) “Draft approach on the prevention and management of conflicts of interests in the policy development and implementation of nutrition programs at country level,” in which it shows us how the industry tries to frame the discussion in individual conflicts of interest, avoiding structural conflicts of interest. We must not forget other issues of importance in policymaking, such as the imbalance of power between different actors and the strategies of undue influence used by food and beverage corporations. It is essential to develop regulatory-based tools and procedures that embody ethics and good governance and that can be applied systematically and routinely to prevent corporate influence in health policymaking. A global observatory of corporate practices would also be needed to recommend to governments efficient actions to avoid corporate capture of their policies.

https://www.ijhpm.com/article_4156_bba6bca05fecde04c682328e44b974b7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Is It Possible to Solve the Conflicts Over Conflict of Interest?; Comment on “Towards Preventing and Managing Conflict of Interest in Nutrition Policy? An Analysis of Submissions to a Consultation on a Draft WHO Tool” 398 400 4185 10.34172/ijhpm.2021.178 EN Stella Aguinaga Bialous Department of Social and Behavioural Sciences, School of Nursing, University of California San Francisco, San Francisco, CA, USA 0000-0002-6471-5457 Journal Article 2021 07 20 Addressing conflicts of interest (COIs) when developing and implementing policies to address commercial determinants of health is pivotal to ensure that these policies are free from commercial and other vested interests of unhealthy commodities industry. As a concept, this is well accepted within the tobacco control community, and supported by the existence of an international treaty, the WHO Framework Convention on Tobacco Control (FCTC). But in nutrition policy the engagement of the food industry appears to remain controversial, as efforts to create partnerships are still underway. There is a need to undertake evaluation of existing COI policies to assess their implementation and outcomes, creating best practice models that can be replicated, and understanding how to change norms within governments. Additionally, a review of existing norms, codes of conduct, and ethics to determine their impact on preventing COI would guide future implementation of these measures. Finally, governments, academics, and advocates should consider how existing tools, guidelines or other instruments could help frame the COI discussion to ensure its political feasibility. There is a need for a discussion on whether the current approach of separate policies for distinct industries is preferable than a broader COI policy that would be applicable to a wide range of unhealthy commodities and across governmental sectors.

https://www.ijhpm.com/article_4185_b207f5c56605a9d1a22e1e134fe95ba9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 Advice for Food Systems Governance Actors to Decide Whether and How to Engage With the Agri-Food and Beverage Industry to Address Malnutrition Within the Context of Healthy and Sustainable Food Systems; Comment on “Challenges to Establish Effective Public-Private Partnerships to Address Malnutrition in All Its Forms” 401 406 4074 10.34172/ijhpm.2021.70 EN Vivica I. Kraak Department of Human Nutrition, Foods, and Exercise, College of Agriculture and Life Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA 0000-0002-9303-5530 Journal Article 2021 04 18 The effectiveness of public-private partnerships (PPPs) to address malnutrition will depend on the issue, engagement purpose, policy context and actors’ interactions. This commentary offers advice for governments, United Nations (UN) and civil society organizations to decide whether and how to engage with industry actors to improve diets for populations. First, food systems governance actors must acknowledge and reconcile competing visions, harmonize numerous corporate-engagement principles, and support a shared narrative to motivate collective actions toward healthy sustainable diets. Second, food systems governance actors have tools to guide engagement through many alliances, networks, coalitions and multi-stakeholder platforms with different levels of risk and trust. Third, food systems governance actors must prioritize accountability by setting corporate-performance threshold scores to justify private-sector engagement; evaluating engagement processes, outcomes and consequences; using incentives, financial penalties and social media advocacy to accelerate time-bound changes; and revoking UN consultative status for corporate actors who undermine healthy people and planet.

https://www.ijhpm.com/article_4074_0f9cafd014db7a619ddb4276af0d692c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 3 2022 03 01 How to Face COVID-19 Outbreak: Reconfiguration of a Private Radiological Clinic 407 408 3903 10.34172/ijhpm.2020.165 EN Michaela Cellina Department of Radiology, ASST Fatebenefratelli Sacco, Milan, Italy 0000-0002-7401-1971 Filippo Pesapane University of Milan, Milan, Italy 0000-0002-0374-5054 Laura Bracchi Cerba Healthcare Italia, Milan, Italy Gianfranco Bracchi Cerba Healthcare Italia, Milan, Italy Anna Maria Ierardi Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy Carlo Martinenghi Cerba Healthcare Italia, Milan, Italy Gianpaolo Carrafiello Radiology Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy Journal Article 2020 05 12

https://www.ijhpm.com/article_3903_9d949c3d8baa0f9df6f22c4661946a61.pdf