Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Corporations and Health: The Need to Combine Forces to Improve Population Health 871 873 4260 10.34172/ijhpm.2022.6687 EN Mélissa Mialon Trinity College Dublin, Dublin 2, Ireland 0000-0002-9883-6441 Gary Fooks Aston University, Birmingham, UK Katherine Cullerton University of Queensland, Brisbane, QLD, Australia Clara Gómez-Donoso University of Navarra, Pamplona, Spain Hernando Salcedo Fidalgo FIAN Colombia, Bogota, Colombia Rima Nakkash Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon Global and Community Health Department, College of Health and Human Services, George Mason University, Fairfax, VA, USA Jennifer Lacy-Nichols University of Melbourne, Melbourne, VIC, Australia Journal Article 2021 08 06 <span class="fontstyle0">The recent concerns raised about commercial determinants of health (CDoH) are not new. Numerous organizations around the world are working on these issues. These groups have emerged in response to specific issues and contexts and bring with them a diversity of interests, worldviews and strategies for change. In creating the ‘Governance, Ethics and Conflicts of Interest in Public Health’ network in 2018, our hope was to broaden our engagement with other actors advocating for change and strengthen our collective efforts. For academics, this requires moving further beyond the collective comfort zone of peer-reviewed publications, working with the media and those with political expertise, and learning from and supporting other stakeholders with a common vision.</span> https://www.ijhpm.com/article_4260_c7dd7185a673aa88c841417033575a76.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 The Implementation of Improvement Interventions for “Low Performing” and “High Performing” Organisations in Health, Education and Local Government: A Phased Literature Review 874 882 3943 10.34172/ijhpm.2020.197 EN Cecilia Vindrola-Padros Department of Applied Health Research, University College London, London, UK Jean Ledger Department of Applied Health Research, University College London, London, UK Estela Capelas Barbosa Bristol Medical School, University of Bristol, Bristol, UK Naomi J. Fulop Department of Applied Health Research, University College London, London, UK Journal Article 2020 04 10 Background<br />There is limited understanding about whether and how improvement interventions are effective in supporting failing healthcare organisations and improving the quality of care in high-performing organisations. The aim of this review was to examine the underlying concepts guiding the design of interventions aimed at low and high performing healthcare organisations, processes of implementation, unintended consequences, and their impact on costs and quality of care. The review includes articles in the healthcare sector and other sectors such as education and local government.<br /> <br />Methods<br />We carried out a phased rapid systematic review of the literature. Phase one was used to develop a theoretical framework of organisational failure and turnaround, and the types of interventions implemented to improve quality. The framework was used to inform phase 2, which was targeted and focused on organisational failure and turnaround in healthcare, education and local government settings. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to guide the reporting of the methods and findings and the Mixed Methods Appraisal Tool (MMAT) as a quality assessment tool. The review protocol was registered with PROSPERO (CRD: 42019131024).<br /> <br />Results<br />Failure is frequently defined as the inability of organisations to meet pre-established performance standards and turnaround as a linear process. Improvement interventions are designed accordingly and are focused on the organisation, with limited system-level thinking. Successful interventions included restructuring senior leadership teams, inspections, and organisational restructuring by external organisations. Limited attention was paid to the potential negative consequences of the interventions and their costs.<br /> <br />Conclusion<br />Dominant definitions of success/failure and turnaround have led to the reduced scope of improvement interventions, the linear perception of turnaround, and lack of consideration of organisations within the wider system in which they operate. Future areas of research include an analysis of the costs of delivering these interventions in relation to their impact on quality of care. https://www.ijhpm.com/article_3943_e679fcea687a0772c5a1aaa1bd9b57d1.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Mapping the Qualitative Evidence Base on the Use of Research Evidence in Health Policy-Making: A Systematic Review 883 898 3946 10.34172/ijhpm.2020.201 EN Ben Verboom Centre for Evidence-Based Intervention, University of Oxford, Oxford, UK Aron Baumann Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland Journal Article 2020 05 08 Background<br />The use of research evidence in health policy-making is a popular line of inquiry for scholars of public health and policy studies, with qualitative methods constituting the dominant strategy in this area. Research on this subject has been criticized for, among other things, disproportionately focusing on high-income countries; overemphasizing ‘barriers and facilitators’ related to evidence use to the neglect of other, less descriptive concerns; relying on descriptive, rather than in-depth explanatory designs; and failing to draw on insights from political/policy studies theories and concepts. We aimed to comprehensively map the global, peer-reviewed qualitative literature on the use of research evidence in health policy-making and to provide a descriptive overview of the geographic, temporal, methodological, and theoretical characteristics of this body of literature.<br /> <br />Methods<br />We conducted a systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We searched nine electronic databases, hand-searched 11 health- and policy-related journals, and systematically scanned the reference lists of included sudies and previous reviews. No language, date or geographic limitations were imposed.<br /> <br />Results<br />The review identified 319 qualitative studies on a diverse array of topics related to the use of evidence in health policy-making, spanning 72 countries and published over a nearly 40 year period. A majority of these studies were conducted in high-income countries, but a growing proportion of the research output in this area is now coming from low- and middle-income countries, especially from sub-Saharan Africa. While over half of all studies did not use an identifiable theory or framework, and only one fifth of studies used a theory or conceptual framework drawn from policy studies or political science, we found some evidence that theory-driven and explanatory (eg, comparative case study) designs are becoming more common in this literature. Investigations of the barriers and facilitators related to evidence use constitute a large proportion but by no means a majority of the work in this area.<br /> <br />Conclusion<br />This review provides a bird’s eye mapping of the peer reviewed qualitative research on evidence-to-policy processes, and has identified key features of – and gaps within – this body of literature that will hopefully inform, and improve, research in this area moving forward. https://www.ijhpm.com/article_3946_1d7a3a6e400c9d63a5da67d58000c897.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Enhancing the Understanding of Resilience in Health Systems of Low- and Middle-income Countries: A Qualitative Evidence Synthesis 899 911 3999 10.34172/ijhpm.2020.261 EN Pauline Yongeun Grimm Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland Sandy Oliver Social Science Research Unit, University College London, London, UK Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa Sonja Merten Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland Wai Wai Han Department of Medical Research, Ministry of Health and Sports, Yangon, Myanmar Kaspar Wyss Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland Journal Article 2020 05 27 Background<br />A country’s health system faces pressure when hit by an unexpected shock, such as what we observe in the midst of the coronavirus disease 2019 (COVID-19) pandemic. The concept of resilience is highly relevant in this context and is a prerequisite for a health system capable of withstanding future shocks. By exploring how the key dimensions of the resilient health system framework are applied, the present systematic review synthesizes the vital features of resilient health systems in low- and middle-income countries. The aim of this review is to ascertain the relevance of health system resilience in the context of a major shock, through better understanding its dimensions, uses and implications.<br /> <br />Methods<br />The review uses the best-fit framework synthesis approach. An <em>a priori</em> conceptual framework was selected and a coding framework created. A systematic search identified 4284 unique citations from electronic databases and reports by non-governmental organisations, 12 of which met the inclusion criteria. Data were extracted and coded against the pre-existing themes. Themes outside of the a priori framework were collated to form a refined list of themes. Then, all twelve studies were revisited using the new list of themes in the context of each study.<br /> <br />Results<br />Ten themes were generated from the analysis. Five confirmed the <em>a priori</em> conceptual framework that capture the dynamic attributes of a resilient system. Five new themes were identified as foundational for achieving resilience: realigned relationships, foresight and motivation as drivers, and emergency preparedness and change management as organisational mechanisms.<br /> <br />Conclusion<br />The refined conceptual model shows how the themes inter-connect. The foundations of resilience appear to be critical especially in resource-constrained settings to unlock the dynamic attributes of resilience. This review prompts countries to consider building the foundations of resilience described here as a priority to better prepare for future shocks. https://www.ijhpm.com/article_3999_688a065646f4ff03479cb5b26ef6b19e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Measuring Organizational Readiness for Implementing Change in Primary Care Facilities in Rural Bushbuckridge, South Africa 912 918 3960 10.34172/ijhpm.2020.223 EN Hannah H. Leslie Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA Rebecca West Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA Boston University School of Public Health, Boston, MA, USA Rhian Twine MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Nkosinathi Masilela MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Wayne T. Steward Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA Kathleen Kahn MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Sheri A. Lippman Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Journal Article 2020 03 09 Meaningful gains in health outcomes require successful implementation of evidence-based interventions. Organizations such as health facilities must be ready to implement efficacious interventions, but tools to measure organizational readiness have rarely been validated outside of high-income settings. We conducted a pilot study of the organizational readiness to implement change (ORIC) measure in public primary care facilities serving Bushbuckridge Municipality in South Africa in early 2019. We administered the 10-item ORIC to 54 nurses and lay counsellors in 9 facilities to gauge readiness to implement the national Central Chronic Medicine Dispensing and Distribution (CCMDD) programme intended to declutter busy health facilities. We used exploratory factor analysis (EFA) to identify factor structure. We used Cronbach alpha and intraclass correlation (ICC) to assess reliability at the individual and facility levels. To assess validity, we drew on existing data from routine clinic monitoring and a 2018 quality assessment to test the correlation of ORIC with facility resources, value of CCMDD programme, and better programme uptake and service quality. Six items from the ORIC loaded onto a single factor with Cronbach’s alpha of 0.82 and ICC of 0.23. While facility ORIC score was not correlated with implementation of CCMDD, higher scores were correlated with facility resources, perceived value of the CCMDD program, patient satisfaction with wait time, and greater linkage to care following positive HIV testing. The study is limited by measuring ORIC after programme implementation. The findings support the relevance of ORIC, but identify a need for greater adaptation and validation of the measure. https://www.ijhpm.com/article_3960_f89bf10948ac0c565b428b95223d8e7c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Partnering to Build Human Resources for Health Capacity in Africa: A Descriptive Review of the Global Health Service Partnership’s Innovative Model for Health Professional Education and Training From 2013-2018 919 927 3973 10.34172/ijhpm.2020.228 EN Vanessa B. Kerry Seed Global Health, Boston, MA, USA Massachusetts General Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA 0000-0001-9363-6830 Bonaventure Ahaisibwe Seed Global Health, Kampala, Uganda Bridget Malewezi Seed Global Health, Lilongwe, Malawi Deo Ngoma ASCEND Program/Crown Agents, Dar es Salaam, Tanzania Patricia Daoust Center for Global Health, Massachusetts General Hospital, Boston, MA, USA Eileen Stuart-Shor University of Massachusetts Boston, Boston, MA, USA Beth Israel Deaconess Medical Center, Boston, MA, USA Clelia Anna Mannino Seed Global Health, Boston, MA, USA Dick Day Catholic Medical Mission Board, New York City, NY, USA Laura Foradori Former US Peace Corps, Washington, DC, USA Sadath A. Sayeed Seed Global Health, Boston, MA, USA Harvard Medical School, Boston, MA, USA Boston Children’s Hospital, Boston, MA, USA Journal Article 2020 06 08 Several Sustainable Development Goals (SDGs) (3, 16, 17) point to the need to systematically address massive shortages of human resources for health (HRH), build capacity and leverage partnerships to reduce the burden of global illness. Addressing these complex needs remain challenging, as simple increases in absolute numbers of healthcare providers trained is insufficient; substantial investment into long-term high-quality training programs is needed, as are incentives to retain qualified professionals within local systems of care delivery. We describe a novel HRH initiative, the Global Health Service Partnership (GHSP), involving collaboration between the US government (President’s Emergency Plan for AIDS Relief [PEPFAR], Peace Corps), 5 African countries, and a US-based non-profit, Seed Global Health. GHSP was formed to enlist US health professionals to assist in strengthening teaching and training capacity and focused on pre-and in-service medical and nursing education in Malawi, Tanzania, Uganda, Eswatini and Liberia. From 2013-2018, GHSP sent 186 US health professionals to 27 institutions in 5 countries, helping to train 16 280 unique trainees of all levels. Qualitative impacts included cultivating a supportive classroom learning environment, providing a pedagogical bridge to clinical service, and fostering a supportive clinical learning and practice environment through role modeling, mentorship and personalized learning at the bedside. GHSP represented a novel, multilateral, public-private collaboration to help address HRH needs in Africa. It offers a plausible, structured template for engagement and partnership in the field. https://www.ijhpm.com/article_3973_2aa447f8741afa7225c16b65d4beb646.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Examining Governing Board Functions and Health Center Performances During Health System Reform: A Cross-sectional Study in 4 Regional States of Ethiopia 928 936 3974 10.34172/ijhpm.2020.235 EN Mesele Damte Argaw USAID Transform: Primary Health Care, JSI Research & Training Institute Inc., Addis Ababa, Ethiopia Binyam Fekadu Desta USAID Transform: Primary Health Care, JSI Research & Training Institute Inc., Addis Ababa, Ethiopia Journal Article 2020 05 05 Background<br />Since 1995, the Ethiopian health system has been managed through decentralizing functions, resources, and authorities to local levels. As a result, health centers are led and managed by governing boards. In addition, the national health system strives to transform the performance of health centers through the implementation of reforms. Therefore, this study aims to examine the relationship between governing board functions and health center performances within a health reform context in 4 agrarian regions of Ethiopia.<br /> <br />Methods<br />A cross-sectional survey was conducted from August 28, 2018 to September 30, 2018. Primary data were collected from governing board chairpersons or their designees using interviewer-administered structured questionnaires. The performance of each health center was rated out of 100 percentage points against the Ethiopian Health Center Reform Guideline (EHCRIG) standards. Secondary data were abstracted from a routine health information database using customized tools to capture achievements on 69 EHCRIG standards and its 174 validation criteria. Since the data violate the assumptions of the parametric test, the Spearman’s rank (rho) correlation test, (a non-parametric test) was employed to see if any correlation exists among 4 parameters; namely: structure, roles and responsibilities, training and development of governing boards, and performance of health centers against EHCRIGs standards. A statistically significant relationship was claimed at P < .050.<br /> <br />Results<br />All 83 health center governing boards or designees who were approached for this study, participated. The mean health center governing board function score with standard deviation was 56.0% (SD ± 14.5%). The overall performance of health centers against EHCRIGs was 70.4% (SD ± 15.0%). There was a statistically significant and strong correlation (Spearman rho correlation coefficient) between health center performance scores measured against reform standards with governing board scores of (rho = 0.866, P < .001) and overall governance scores (rho = 0.828, P < .001).<br /> <br />Conclusion<br />Based on the results of this study, we can conclude that well-functioning health center governing boards can improve the performance of health centers against clinical, and management reform standards. Therefore, continuous strengthening of the capacity of governing boards, focusing on improving implementation of their roles and responsibilities, and continuing training on business management is recommended. https://www.ijhpm.com/article_3974_66d357037d9206d30872e5b8a9c44138.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Did an Intervention Programme Aimed at Strengthening the Maternal and Child Health Services in Nigeria Improve the Completeness of Routine Health Data Within the Health Management Information System? 937 946 3976 10.34172/ijhpm.2020.226 EN Benjamin Uzochukwu Department of Community Medicine, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria 0000-0002-0794-0455 Tolib Mirzoev Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK Chinyere Okeke Department of Community Medicine, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria Joseph Hicks Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK Enyi Etiaba Department of Health Administration and Management, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria Uche Obi Department of Community Medicine, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria Tim Ensor Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK Adaora Uzochukwu Department of Management, University of Nigeria (Enugu Campus), Nsukka, Nigeria Obinna Onwujekwe Department of Health Administration and Management, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria Journal Article 2020 03 09 Background<br />During 2012-2015, the Federal Government of Nigeria launched the Subsidy Reinvestment and Empowerment Programme, a health system strengthening (HSS) programme with a Maternal and Child Health component (Subsidy Reinvestment and Empowerment Programme [SURE-P]/MCH), which was monitored using the Health Management Information Systems (HMIS) data reporting tools. Good quality data is essential for health policy and planning decisions yet, little is known on whether and how broad health systems strengthening programmes affect quality of data. This paper explores the effects of the SURE-P/MCH on completeness of MCH data in the National HMIS.<br /> <br />Methods<br />This mixed-methods study was undertaken in Anambra state, southeast Nigeria. A standardized proforma was used to collect facility-level data from the facility registers on MCH services to assess the completeness of data from 2 interventions and one control clusters. The facility data was collected to cover before, during, and after the SURE-P intervention activities. Qualitative in-depth interviews were conducted with purposefully-identified health facility workers to identify their views and experiences of changes in data quality throughout the above 3 periods.<br /> <br />Results<br />Quantitative analysis of the facility data showed that data completeness improved substantially, starting before SURE-P and continuing during SURE-P but across all clusters (ie, including the control). Also health workers felt data completeness were improved during the SURE-P, but declined with the cessation of the programme. We also found that challenges to data completeness are dependent on many variables including a high burden on providers for data collection, many variables to be filled in the data collection tools, and lack of health worker incentives.<br /> <br />Conclusion<br />Quantitative analysis showed improved data completeness and health workers believed the SURE-P/MCH had contributed to the improvement. The functioning of national HMIS are inevitably linked with other health systems components. While health systems strengthening programmes have a great potential for improved overall systems performance, a more granular understanding of their implications on the specific components such as the resultant quality of HMIS data, is needed. https://www.ijhpm.com/article_3976_9c55d4d1f33ace9232e501cfce2fcba2.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Creating Political Will for Action on Health Equity: Practical Lessons for Public Health Policy Actors 947 960 3978 10.34172/ijhpm.2020.233 EN Fran Baum Southgate Institute for Health, Society & Equity, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia Belinda Townsend Menzies Centre for Health Governance, School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia 0000-0002-2480-2820 Matthew Fisher Southgate Institute for Health, Society & Equity, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia Kathryn Browne-Yung Deceased March 19, 2020 Toby Freeman Southgate Institute for Health, Society & Equity, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia Anna Ziersch Southgate Institute for Health, Society & Equity, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia Patrick Harris Menzies Centre for Health Policy, School of Public Health, The University of Sydney, Sydney, NSW, Australia Sharon Friel Menzies Centre for Health Governance, School of Regulation and Global Governance, College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia Journal Article 2020 04 28 Background<br />Despite growing evidence on the social determinants of health and health equity, political action has not been commensurate. Little is known about how political will operates to enact pro-equity policies or not. This paper examines how political will for pro-health equity policies is created through analysis of public policy in multiple sectors.<br /> <br />Methods<br />Eight case studies were undertaken of Australian policies where action was either taken or proposed on health equity or where the policy seemed contrary to such action. Telephone or face-to-face interviews were conducted with 192 state and non-state participants. Analysis of the cases was done through thematic analysis and triangulated with document analysis.<br /> <br />Results<br />Our case studies covered: trade agreements, primary healthcare (PHC), work conditions, digital access, urban planning, social welfare and Indigenous health. The extent of political will for pro-equity policies depended on the strength of path dependency, electoral concerns, political philosophy, the strength of economic and biomedical framings, whether elite interests were threatened and the success or otherwise of civil society lobbying.<br /> <br />Conclusion<br />Public health policy actors may create political will through: determining how path dependency that exacerbates health inequities can be broken, working with sympathetic political forces committed to fairness; framing policy options in a way that makes them more likely to be adopted, outlining factors to consider in challenging the interests of elites, and considering the extent to which civil society will work in favour of equitable policies. A shift in norms is required to stress equity and the right to health. https://www.ijhpm.com/article_3978_bbbb77712d1f439af164c06ceb1194f0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Are We Asking Too Much of the Health Sector? Exploring the Readiness of Brazilian Primary Healthcare to Respond to Domestic Violence Against Women 961 972 3980 10.34172/ijhpm.2020.237 EN Ana Flávia Pires Lucas D’Oliveira Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil Stephanie Pereira Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil Loraine J. Bacchus London School of Hygiene & Tropical Medicine, London, UK Gene Feder Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK Lilia Blima Schraiber Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil 0000-0002-3326-0824 Janaina Marques De Aguiar Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil 0000-0001-5974-1194 Renata Granusso Bonin Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil Cecilia Guida Vieira Graglia Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil Manuela Colombini London School of Hygiene & Tropical Medicine, London, UK Journal Article 2020 05 01 Background<br />There is growing recognition of the health sector’s potential role in addressing domestic violence (DV) against women. Although Brazil has a comprehensive policy framework on violence against women (VAW), implementation has been slow and incomplete in primary healthcare (PHC), and little is known about the implementation challenges. This paper aims to assess the readiness of two PHC clinics in urban Brazil to integrate an intervention to strengthen their DV response.<br /> <br />Methods<br />We conducted 20 semi-structured interviews with health managers and health providers; a document analysis of VAW and DV policies from São Paulo and Brazil; and 2 structured facility observations. Data were analysed using thematic analysis.<br /> <br />Results<br />Findings from our readiness assessment revealed gaps in both current policy and practice needing to be addressed, particularly with regards to governance and leadership, health service organisation and health workforce. DV received less political recognition, being perceived as a lower priority compared to other health issues. Lack of clear guidance from the central and municipal levels emerged as a crucial factor that weakened DV policy implementation both by providers and managers. Furthermore, responses to DV lost visibility, as they were diluted within generic violence responses. The organizational structure of the PHC system in São Paulo, which prioritised the number of consultations and household visits as the main performance indicators, was an additional difficulty in legitimising healthcare providers’ time to address DV. Individual-level challenges reported by providers included lack of time and knowledge of how to respond, as well as fears of dealing with DV.<br /> <br />Conclusion<br />Assessing readiness is critical because it helps to evaluate what services and infrastructure are already in place, also identifying obstacles that may hinder adaptation and integration of an intervention to strengthen the response to DV before implementation. https://www.ijhpm.com/article_3980_1914eb7cc514a163bff690f3eb8df544.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 District-Level Health Management and Health System Performance: The Ethiopia Primary Healthcare Transformation Initiative 973 980 3981 10.34172/ijhpm.2020.236 EN Lingrui Liu Global Health Leadership Initiative, Yale University, New Haven, CT, USA Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA Mayur M. Desai Global Health Leadership Initiative, Yale University, New Haven, CT, USA Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA Netsanet Fetene Global Health Leadership Initiative, Yale University, New Haven, CT, USA 0000-0002-3208-0055 Temsgen Ayehu Federal Ministry of Health, Government of Ethiopia, Addis Ababa, Ethiopia Kidest Nadew Global Health Leadership Initiative, Yale University, New Haven, CT, USA Erika Linnander Global Health Leadership Initiative, Yale University, New Haven, CT, USA Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA Journal Article 2020 04 14 Background<br />Despite a wide range of interventions to improve district health management capacity in low-income settings, evidence of the impact of these investments on system-wide management capacity and primary healthcare systems performance is limited. To address this gap, we conducted a longitudinal study of the 36 rural districts (woredas), including 229 health centers, participating in the Primary Healthcare Transformation Initiative (PTI) in Ethiopia.<br /> <br />Methods<br />Between 2015 and 2017, we collected quantitative measures of management capacity at the district and health center levels and a primary healthcare key performance indicator (KPI) summary score based on antenatal care (ANC) coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. We conducted repeated measures analysis of variance (ANOVA) to assess (1) changes in management capacities at the district health office level and health center level, (2) changes in health systems performance, and (3) the differential effects of more vs less intensive intervention models.<br /> <br />Results<br />Adherence to management standards at both district and health center levels improved during the intervention, and the most prominent improvement was achieved during district managers’ exposure to intensive mentorship and education. We did not observe similar patterns of change in KPI summary score.<br /> <br />Conclusion<br />The district health office is a valuable entry point for primary healthcare reform, and district- and facility-level management capacity can be measured and improved in a relatively short period of time. A combination of intensive mentorship and structured team-based education can serve as boh an accelerator for change and a mechanism to inform broader reform efforts. https://www.ijhpm.com/article_3981_b326db646dc6680b01d47114c6a03b0e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Using Group Model Building to Capture the Complex Dynamics of Scaling Up District-Level Surgery in Arusha Region, Tanzania 981 989 3982 10.34172/ijhpm.2020.249 EN Henk Broekhuizen Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands Monic Lansu Department of Business Administration, Institute for Management Research, Radboud University, Nijmegen, The Netherlands Jakub Gajewski Institute of Global Surgery, Royal College of Surgeons Ireland, Dublin 2, Ireland 0000-0003-0440-6051 Chiara Pittalis Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland Martilord Ifeanyichi Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands Adinan Juma East Central and Southern Africa Health Community, Arusha, Tanzania Paul Marealle Tanzania Surgical Association, Dar Es Salaam, Tanzania Edward Kataika East Central and Southern Africa Health Community, Arusha, Tanzania Kondo Chilonga Kilimanjaro Christian Medical Centre, Moshi, Tanzania Etiënne Rouwette Department of Business Administration, Institute for Management Research, Radboud University, Nijmegen, The Netherlands Ruairi Brugha Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland Leon Bijlmakers Department of Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands Journal Article 2020 02 15 Background<br />Scaling up surgery at district hospitals (DHs) is the critical challenge if the Tanzanian national Surgical, Obstetric, and Anesthesia Plan (NSOAP) objectives are to be achieved. Our study aims to address this challenge by taking a dynamic view of surgical scale-up at the district level using a participatory research approach.<br /> <br />Methods<br />A group model building (GMB) workshop was held with 18 professionals from three hospitals in the Arusha region. They built a graphical representation of the local system of surgical services delivery through a facilitated discussion that employed the nominal group technique. This resulted in a causal loop diagram (CLD) from which the participants identified the requirements for scaling-up surgery and the stakeholders who could satisfy these. After the GMB sessions, we identified clusters of related variables using inductive thematic analysis and the main feedback loops driving the model.<br /> <br />Results<br />The CLD consists of 57 variables. These include the 48 variables that were obtained through the nominal group technique and those that participants added later. We identified 6 themes: patient benefits, financing of surgery, cost sharing, staff motivation, communication, and effects on referral hospital. There are 5 self-reinforcing feedback loops: training, learning, meeting demand, revenues, and willingness to work in a good hospital. There are four self-correcting feedback loops or ‘resistors to change:’ recurrent costs, income lost, staff stress, and brain drain.<br /> <br />Conclusion<br />This study provides a systems view on the scaling up of surgery from a district level perspective. Its results enable a critical appraisal of the feasibility of implementing the NSOAP. Our results suggest that policy-makers should be wary of ‘quick fixes’ that have short term gains only. Long term policy that considers the complex dynamics of surgical systems and that allows for periodic evaluation and adaption is needed to scale up surgery in a sustainable manner. https://www.ijhpm.com/article_3982_e88973359e0620fb1a2a8e0bc39d7ff7.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Evaluation of Pharmacovigilance System in Iran 990 1000 3984 10.34172/ijhpm.2020.243 EN Malahat Khalili HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Hamid Sharifi HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Bita Mesgarpour National Institute for Medical Research Development, Tehran, Iran Mehrnaz Kheirandish Department for Assessment and Control of Prescribing and Use of Medicines and Health Products, Food and Drug Administration, Tehran, Iran Sten Olsson International Society of Pharmacovigilance, London, UK Pharmacovigilance Consulting, Uppsala, Sweden Naghmeh Javidnikou Deceased August 14, 2020 Ali Akbar Haghdoost HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran Journal Article 2020 06 06 Background<br />Evaluating a pharmacovigilance system helps identify its deficiencies and could facilitate measures to remedy and improve the quantity and quality of adverse drug reaction (ADR) reports and other opportunities for pharmacovigilance systems strengthening. This study aimed to evaluate the status of pharmacovigilance in Iran using the World Health Organization (WHO) pharmacovigilance indicators with the prospect of identifying the gaps and areas for improvement.<br /> <br />Methods<br />This study was conducted in 2 parts. The first part included a secondary analysis of the national data obtained from the Iranian National Pharmacovigilance Center (PVC) using a structured data collection form based on WHO core pharmacovigilance indicators. In the second part, a 3-month prospective study was carried out to investigate 2 outcome indicators, ie, length of stay and costs of medicine-related hospitalization in all patients of 2 main referral hospitals in the southeast and north of Iran.<br /> <br />Results<br />Iran has a PVC with national policy, trained staff, and a statutory budget. In 2017, the number of ADR reports was 15.0 per 100 000 population, and 262 signals were detected during the preceding 5 years. The average length of stay and costs of medicine-related hospitalization were 5 days and US$817.2 in Afzalipour hospital and 6.6 days and US$306.7 in Razi hospital, respectively. The status of pharmacovigilance in the Iranian public health programs (PHPs) is unknown, and most of the indicators could not be assessed.<br /> <br />Conclusion<br />A robust pharmacovigilance system is a pivotal part of the overall medicines regulatory system. The Iranian pharmacovigilance system has relatively the proper structural condition. Though the underreporting of ADRs, especially medicine-related deaths, is an important issue, and some indicators’ status was unclear. The Iranian pharmacovigilance program requires a higher prioritization, particularly in the PHPs, a greater allocation of resources, and cross-sectoral cooperation to bolster and achieve the pharmacovigilance objectives. https://www.ijhpm.com/article_3984_996488f1aaa4fcb334e6ea40204420e0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Occupational Therapists, Physiotherapists and Orthopaedic Surgeons Agree on the Decision for Carpal Tunnel Surgery 1001 1008 3987 10.34172/ijhpm.2020.227 EN Karina J. Lewis Occupational Therapy Department, Gold Coast University Hospital, Southport, QLD, Australia Michel W. Coppieters Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, QLD, Australia Amsterdam Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands 0000-0002-3958-4408 Bill Vicenzino School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Brisbane, QLD, Australia Ian Hughes Office of Research Governance and Development, Gold Coast University Hospital, Southport, QLD, Australia Leo Ross Division of Allied Health, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia Annina B. Schmid Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK Journal Article 2020 06 03 Background<br />Therapist-led pathways have been proposed as waitlist management strategies prior to surgery for conditions such as carpal tunnel syndrome (CTS) in public hospitals. These models of care typically shift the initial care of patients and decision-making from surgeons to therapists and, have been shown to reduce the number of patients requiring surgery and improve wait-times. This occurs despite limited evidence of surgeon-therapist agreement on key decisions, such as the need for surgery. The purpose of this was study was to assess the agreement between therapists and orthopaedic surgeons regarding the need for surgery for patients who have CTS.<br /> <br />Methods<br />This blinded inter-rated agreement study was embedded in a multicentre randomised parallel groups trial of 105 patients with CTS referred to four orthopaedic departments and waitlisted for an appointment. The trial evaluated the effect of a therapist-led care pathway on the need for surgery and outcomes related to symptoms and function. Patients were randomised to either remain on the orthopaedic waitlist or receive group education, a splint and home exercises. The decision on the need for surgery at 6 months was made by a member of the orthopaedic consultant team or by one of the 14 participating therapists. The therapists and surgeons were blinded to each other’s decision. Agreement was determined using percentage agreement, kappa coefficients (k), prevalence-adjusted and bias-adjusted kappa (PABAK), and Gwet’s first-order agreement coefficient (AC1).<br /> <br />Results<br />Substantial agreement was seen between therapists and surgeons regarding the need for surgery (PABAK = 0.74 (0.60-0.88)). Agreement was significantly associated with experience (P = .02). Therapists with advanced experience and scope of practice demonstrated perfect agreement with surgeons (PABAK = 1.00 (95% CI: 1.00-1.00)). Mid-career therapists demonstrated substantial agreement (PABAK = 0.67 (95% CI: 0.42-0.91)) and early-career therapists demonstrated fair agreement (PABAK = 0.43 (95% CI: -0.04-0.90)).<br /> <br />Conclusion<br />Therapists with advanced scope of practice make decisions that are consistent with orthopaedic surgeons. https://www.ijhpm.com/article_3987_362c858b7009a8182343450d5e28565f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Can the Use of Health Insurance Claim Data Benefit the Risk-Based Supervision of General Practitioner Practices? An Exploratory Study in the Netherlands 1009 1016 3988 10.34172/ijhpm.2020.242 EN Rudolf Bertijn Kool Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands Reinier Peter Akkermans Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands Radboud University Medical Centre, Department of Primary and Community Care, Nijmegen, The Netherlands Ine Borghans Dutch Health and Youth Care Inspectorate, Utrecht, The Netherlands Corline Brouwers Department of Public and Occupational Health, Amsterdam Public Health Research Institute Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Sander Ranke Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands Journal Article 2020 05 09 Background<br />The Dutch Health and Youth Care Inspectorate has organized a study investigating whether there are benefits to using claim data in the risk-based supervision of general practitioner (GP) practices.<br /> <br />Methods<br />We identified and selected signals of risks based on interviews with experts. Next, we selected 3 indicators that could be measured in the claim database. These were: the expected and actual costs of the GP practice; the percentage of reserve antibiotics prescribed; and the percentage of patients undergoing an emergency admission during the weekend. We corrected the scores of the GP practices based on their casemix and identified practices with the most unfavorable scores, ‘red flags,’ in 2015, or the trend between 2013-2015. Finally, we analysed the data of GP practices already identified as delivering substandard care by the Health and Youth Care Inspectorate and calculated the sensitivity and specificity of using the indicators to identify poor performing GP practices.<br /> <br />Results<br />By combining the 3 indicators, we identified 1 GP practice with 3 red flags and 24 GP practices with 2 red flags. The a priori chance of identifying a GP practice that shows substandard care is 0.3%. Using the indicators, this improved to 1.0%. The sensitivity was 26.7%, the specificity was 92.8%.<br /> <br />Conclusion<br />The Dutch Health and Youth Care Inspectorate might use claim data to calculate indicators on costs, the prescribing of reserve antibiotics and emergency admissions during the weekend, when setting priorities for its visits to GP practices. Visiting more GP practices by the Health and Youth Care Inspectorate, and identifying substandard care, is necessary to validate the use of these indicators. https://www.ijhpm.com/article_3988_628d8ee34492f572d5a20837e77b9e62.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Functional Dependency in Mexico: Measurement Issues and Policy Challenges 1017 1023 3989 10.34172/ijhpm.2020.248 EN Pablo Villalobos Dintrans Programa Centro Salud Pública, Facultad de Ciencias Médicas, Universidad de Santiago, Santiago, Chile Emmanuel González Bautista National Institute of Geriatrics, Mexico City, Mexico Journal Article 2020 05 19 Background<br />Different definitions have been used to measure functional dependency (FD) in Mexico. This study aims to explore if different definitions of FD lead to low consistency between the estimations of its prevalence. Accurate estimations of FD are useful to estimate the potential demand for long-term care (LTC) services in the country.<br /> <br />Methods<br />A literature review including documents with estimations on the number or prevalence of dependents in Mexico with national representativeness between 2000 and 2019 was performed as well as estimations of different definitions of FD, using the National Study on Health and Aging in Mexico (ENASEM).<br /> <br />Results<br />There is a lack of consensus on the definition of FD. Among the most frequently used terms to define FD are “disability” and “dependency.” The heterogeneity of definitions results in a wide range of estimations of the demand for LTC. Methodological choices can lead to important differences in FD prevalence estimations. Results from ENASEM 2001 show that FD prevalence could range from 13% to 35% in people 60+; sex prevalences also vary when using different ways to measure FD.<br /> <br />Conclusion<br />Besides the highlighted issues in calculating FD in the population, Mexico should consider broadening the assessment of FD, including people with dementia and younger populations. Although the literature search is not systematic, it helps exemplifying the current issues when measuring FD in Mexico. A consensual definition of dependency is required to have a more accurate estimated demand for LTC. Having good data sources is not enough when dissimilar estimations of an indicator like dependency result from the same study. Wide heterogeneity in estimations of dependency could be an obstacle to inform public policies during the construction of a care system in Mexico. https://www.ijhpm.com/article_3989_4988551a879288bb319846de94f0b626.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 “There’s Not Enough Bodies to Do the Demand:” An Exploration of Key Stakeholder Views on the Role of Health Service Capacity in Shaping Cancer Outcomes in 7 International Cancer Benchmarking Partnership Countries 1024 1034 3990 10.34172/ijhpm.2020.254 EN Maureen Seguin Department of Health Services Research & Policy, London School of Hygiene & Topical Medicine, London, UK Melanie Morris Department of Health Services Research & Policy, London School of Hygiene & Topical Medicine, London, UK Martin McKee Department of Health Services Research & Policy, London School of Hygiene & Topical Medicine, London, UK Ellen Nolte Department of Health Services Research & Policy, London School of Hygiene & Topical Medicine, London, UK Journal Article 2020 10 12 Background<br />Differences in cancer survival are shaped by differences in health system capacity in workforce and infrastructure. Part of the International Cancer Benchmarking Partnership (ICBP), this study explored stakeholders’ perceptions of the role of health system capacity necessary for cancer care in influencing cancer survival in 7 high-income countries.<br /> <br />Methods<br />We conducted semi-structured interviews with 79 key informants from national, regional, and local tiers of health systems, professional bodies, patient associations, and academic experts in Australia, Canada, Denmark, Ireland, New Zealand, Norway, and the United Kingdom. Data collection was guided by a conceptual model linking characteristics of health systems and cancer survival along the cancer patient journey, from recognition of symptoms at pre-diagnostic stages through to survivorship or death. Data were analysed using a thematic approach.<br /> <br />Results<br />We identified 3 themes as important in shaping cancer outcomes: primary care and access to diagnostic evaluation, specialist care and access to treatment, and workforce pertaining to diagnostic and treatment phases. Improved infrastructure for diagnosis and treatment had improved cancer outcomes in all jurisdictions. However, this was seen as insufficient if staffing was inadequate. Consolidation of services and greater surgical specialisation was important in some jurisdictions if accompanied by a reconfiguration of services, in particular the creation of specialist multidisciplinary teams, along with supporting capacity in the wider health system. Staff shortages were commonly cited as reasons why some jurisdictions lagged behind others.<br /> <br />Conclusion<br />Continued improvement in cancer outcomes will require sustained investment in plans to deliver and maintain the workforce engaged in cancer care and in the infrastructure on which they depend. However, strategic plans must recognise that systems for cancer care do not work in isolation from the rest of the health system and a whole systems approach is essential if we are to improve outcomes for an ageing, increasingly multimorbid population. https://www.ijhpm.com/article_3990_886d48695a3f8cb77a904bcfa1fa5046.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Measuring the Overall Burden of Early Childhood Malnutrition in Ghana: A Comparison of Estimates from Multiple Data Sources 1035 1046 3992 10.34172/ijhpm.2020.253 EN John Paul Kuwornu Research Department, Saskatchewan Health Authority, Regina, SK, Canada Jonathan Amoyaw Department of Sociology, University of Saskatchewan, Saskatoon, SK, Canada Taru Manyanga School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada Elizabeth J. Cooper Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK, Canada Elvis Donkoh Department of Mathematics and Statistics, University of Energy and Natural Resources, Sunyani, Ghana Amos Nkrumah Department of Sociology & Anthropology, Mount Saint Vincent University, Halifax, NS, Canada Journal Article 2020 04 03 Background<br />Childhood malnutrition contributes to nearly half (45%) of all deaths among children under 5 globally. The United Nations’ Sustainable Development Goals (SDGs) aims to end all forms of malnutrition by 2030; however, measuring progress towards these goals is challenging, particularly in countries with emerging economies where nationally-representative data are limited. The primary objective of this study was to estimate the overall burden of childhood malnutrition in Ghana at national and regional levels using 3 data sources.<br /> <br />Methods<br />Using data from the long-standing Ghana Demographic and Health Surveys (GDHS), Ghana Multiple Indicator Cluster Survey (GMICS), and the emerging Ghana Socioeconomic Panel Survey (GSPS), we compared the prevalence of malnutrition using the extended composite index of anthropometric failure (eCIAF) for the period 2008-2011. This study included data for children aged 6-59 months and calculated all anthropometric z-scores based on the World Health Organization (WHO) Growth Standards. We tested for differences in malnutrition subtypes using two-group configural frequency analysis (CFA).<br /> <br />Results<br />Of the 10 281 children (6532 from GMICS, 2141 from GDHS and 1608 from GSPS) included in the study, the only demographic difference observed was the children included in the GSPS were slightly older than those included in the GDHS and GMICS (median age of 36 vs 30 vs 33 months, P < .001). Based on the eCIAF, the overall prevalence of malnutrition at the national level was higher among children in the GSPS (57.3%, 95% CI: 53.9%–60.6%), followed by the GDHS (39.7%, 95% CI: 37.0%–42.5%), and then those in the GMICS (31.2%, 95% CI: 29.3%–33.1%). The two-group CFA showed that the 3 data sources also estimated different prevalence rates for most of the malnutrition subtypes included in the eCIAF.<br /> <br />Conclusion<br />Depending on the data source adopted, our estimates of eCIAF showed that between one-third and half of all Ghanaian children aged 6-59 months had at least one form of malnutrition over the period 2008-2011. These eCIAF estimates should complement the commonly reported measures such as stunting and wasting when interpreting the severity of malnutrition in the country to inform policy decisions. https://www.ijhpm.com/article_3992_01405682612c8096fd1b8a31dc822b6f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Barriers to Equitable Public Participation in Health-System Priority Setting Within the Context of Decentralization: The Case of Vulnerable Women in a Ugandan District 1047 1057 3991 10.34172/ijhpm.2020.256 EN S. Donya Razavi Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada Lydia Kapiriri Department of Health, Aging and Society, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada Julia Abelson Department of Health Research Methods, Evidence, and Impact (HEI), Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada Michael Wilson Department of Health Research Methods, Evidence, and Impact (HEI), McMaster Health Forum, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada Journal Article 2020 01 31 Background<br />Decentralization of healthcare decision-making in Uganda led to the promotion of public participation. To facilitate this, participatory structures have been developed at sub-national levels. However, the degree to which the participation structures have contributed to improving the participation of vulnerable populations, specifically vulnerable women, remains unclear. We aim to understand whether and how vulnerable women participate in health-system priority setting; identify any barriers to vulnerable women’s participation; and to establish how the barriers to vulnerable women’s participation can be addressed.<br /> <br />Methods<br />We used a qualitative description study design involving interviews with district decision-makers (n = 12), subcounty leaders (n = 10), and vulnerable women (n = 35) living in Tororo District, Uganda. Data was collected between May and June 2017. The analysis was conducting using an editing analysis style.<br /> <br />Results<br />The vulnerable women expressed interest in participating in priority setting, believing they would make valuable contributions. However, both decision-makers and vulnerable women reported that vulnerable women did not consistently participate in decision-making, despite participatory structures that were instituted through decentralization. There are financial (transportation and lack of incentives), biomedical (illness/disability and menstruation), knowledge-based (lack of knowledge and/or information about participation), motivational (perceived disinterest, lack of feedback, and competing needs), socio-cultural (lack of decision-making power), and structural (hunger and poverty) barriers which hamper vulnerable women’s participation.<br /> <br />Conclusion<br />The identified barriers hinder vulnerable women’s participation in health- system priority setting. Some of the barriers could be addressed through the existing decentralization participatory structures. Respondents made both short-term, feasible recommendations and more systemic, ideational recommendations to improve vulnerable women’s participation. Integrating the vulnerable women’s creative and feasible ideas to enhance their participation in health-system decision-making should be prioritized. https://www.ijhpm.com/article_3991_902ba98bcb33a12ae19f52e5d764c583.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Towards Core Competencies for Health Policy and Systems Research (HPSR) Training: Results From a Global Mapping and Consensus-Building Process 1058 1068 3994 10.34172/ijhpm.2020.258 EN Meike J. Schleiff Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Avanti Rangnekar University of Tennessee, Knoxville, TN, USA Francisco Oviedo Gomez Ministry of Health, San José, Costa Rica School of Public Health, University of Costa Rica, San José, Costa Rica Gina Teddy Center for Health Systems and Policy Research at GIMPA, Accra, Ghana David H. Peters Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 0000-0001-8377-3444 Dina Balabanova London School of Hygiene and Tropical Medicine, London, UK Journal Article 2020 07 09 Background<br />As the field of health policy and systems research (HPSR) continues to grow, there is a recognition of the need for training in HPSR. This aspiration has translated into a multitude of teaching programmes of variable scope and quality, reflecting a lack of consensus on the skills and practices required for rigorous HPSR. The purpose of this paper is to identify an agreed set of core competencies for HPSR researchers, building on the previous work by the Health Systems Global (HSG) Thematic Working Group on Teaching & Learning.<br /> <br />Methods<br />Our methods involved an iterative approach of four phases including a literature review, key informant interviews and group discussions with HPSR educators, and webinars with pre-post surveys capturing views among the global HPSR community. The phased discussions and consensus-building contributed to the evolution of the HPSR competency domains and competencies framework.<br /> <br />Results<br />Emerging domains included understanding health systems complexity, assessing policies and programs, appraising data and evidence, ethical reasoning and practice, leading and mentoring, building partnerships, and translating and utilizing knowledge and HPSR evidence. The development of competencies and their application were often seen as a continuous process spanning evidence generation, partnering, communicating and helping to identify new critical health systems questions.<br /> <br />Conclusion<br />The HPSR competency set can be seen as a useful reference point in the teaching and practice of high-quality HPSR and can be adapted based on national priorities, the particularities of local contexts, and the needs of stakeholders (HPSR researchers and educators), as well as practitioners and policy-makers. Further research is needed in using the core competency set to design national training programmes, develop locally relevant benchmarks and assessment methods, ad evaluate their use in different settings. https://www.ijhpm.com/article_3994_82d49d8299751494187eed845084da56.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 A Report on Statistics of an Online Self-screening Platform for COVID-19 and Its Effectiveness in Iran 1069 1077 4000 10.34172/ijhpm.2020.252 EN Sina Azadnajafabad Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Sahar Saeedi Moghaddam Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Negar Rezaei Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran 0000-0001-7047-7638 Erfan Ghasemi Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran 0000-0001-7047-7638 Shohreh Naderimagham Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Mehrdad Azmin Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Esmaeil Mohammadi Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Kosar Jamshidi Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Nima Fattahi Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Hossein Zokaei Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Ashkan Mehregan Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Bahman Damerchilu Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Pouya Fathi Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Hossein Erfani Center for Communicable Diseases Control, Ministry of Health & Medical Education, Tehran, Iran Abbas Norouzinejad Center for Communicable Diseases Control, Ministry of Health & Medical Education, Tehran, Iran Mohammad Mehdi Gooya Center for Communicable Diseases Control, Ministry of Health & Medical Education, Tehran, Iran Hamidreza Jamshidi School of Medicine, Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran Reza Malekzadeh Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran Bagher Larijani Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Farshad Farzadfar Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Journal Article 2020 06 10 Background<br />The most recent emerging infectious disease, coronavirus disease 2019 (COVID-19), is pandemic now. Iran is a country with community transmission of the disease. Telehealth tools have been proved to be useful in controlling public health disasters. We developed an online self-screening platform to offer a population-wide strategy to control the massive influx to medical centers.<br /> <br />Methods<br />We developed a platform operating based on given history by participants, including sex, age, weight, height, location, primary symptoms and signs, and high risk past medical histories. Based on a decision-making algorithm, participants were categorized into four levels of suspected cases, requiring diagnostic tests, supportive care, not suspected cases. We made comparisons with Iran STEPs (STEPwise approach to Surveillance) 2016 study and data from the Statistical Centre of Iran to assess population representativeness of data. Also, we made a comparison with officially confirmed cases to investigate the effectiveness of the platform. A multilevel mixed-effects Poisson regression was used to check the association of visiting platform and deaths caused by COVID-19.<br /> <br />Results<br />About 310 000 individuals participated in the online self-screening platform in 33 days. The majority of participants were in younger age groups, and males involved more. A significant number of participants were screened not to be suspected or needing supportive care, and only 10.4% of males and 12.0% of females had suspected results of COVID-19. The penetration of the platform was assessed to be acceptable. A correlation coefficient of 0.51 was calculated between suspected results and confirmed cases of the disease, expressing the platform’s effectiveness.<br /> <br />Conclusion<br />Implementation of a proper online self-screening tool can mitigate population panic during wide-spread epidemics and relieve massive influx to medical centers. Also, an evidence-based education platform can help fighting infodemic. Noticeable utilization and verified effectiveness of such platform validate the potency of telehealth tools in controlling epidemics and pandemics. https://www.ijhpm.com/article_4000_305141fbf744cfb642ca7aefb5c4ccbb.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases 1078 1089 4001 10.34172/ijhpm.2020.257 EN Mao Suzuki Department of Political Science and International Relations, University of Southern California, Los Angeles, CA, USA HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA 0000-0002-5848-2730 Douglas Webb HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA Roy Small HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA Journal Article 2020 06 13 Background<br />Non-communicable diseases (NCDs) are increasingly recognized as a significant threat to health and development globally, and United Nations (UN) Member States adopted the Political Declaration of the Third High-level Meeting (HLM) on the prevention and control of NCDs in 2018. The negotiation process for the Declaration included consultations with Member States, intergovernmental organizations (IGOs), and non-state actors such as non-governmental organizations (NGOs) and the private sector. With NCD responses facing charges of inadequacy, it is important to scrutinize the governance process behind relevant high-level global decisions and commitments.<br /> <br />Methods<br />Through a review of 159 documents submitted by stakeholders during the negotiation process, we outline a typology of policy positions advocated by various stakeholders in the development of the Declaration. We document changes in text from the draft to the final version of the Declaration to analyse the extent to which various positions and their proponents were influential.<br /> <br />Results<br />NGOs and low- and middle-income countries (LMICs) generally pursued ‘stricter’ governance of NCD risk factors including stronger regulation of unhealthy products and improved management of conflicts of interest that arise when health-harming industries are involved in health policy-making. The private sector and high-income countries generally opposed greater restrictions on commercial factors. The pattern of changes between the draft and final Declaration indicate that advocated positions tended to be included in the Declaration if there was no clear opponent, whereas opposed positions were either not included or included with ambiguous language.<br /> <br />Conclusion<br />Many cost-effective policy options to address NCDs, such as taxation of health-harming products, were opposed by high-income countries and the private sector and not well-represented in the Declaration. To ensure robust political commitments and action on NCDs, multi-stakeholder governance for NCDs must consider imbalances in power and influence amongst constituents as well as biases and conflicts in positioning. https://www.ijhpm.com/article_4001_65577e3e9ca83f21248bec38a0cd1a78.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Understanding the Prevalence and Associated Factors of Behavioral Intention of COVID-19 Vaccination Under Specific Scenarios Combining Effectiveness, Safety, and Cost in the Hong Kong Chinese General Population 1090 1101 4003 10.34172/ijhpm.2021.02 EN Yanqiu Yu Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China Joseph T.F. Lau Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China Mason M.C. Lau Centre for Health Behaviours Research, School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China Martin C.S. Wong School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China Paul K.S. Chan Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China Journal Article 2020 10 20 Background<br />The prevalence of coronavirus disease 2019 (COVID-19) vaccination is very critical in controlling COVID-19. This study mainly aimed to (1) investigate behavioral intentions of COVID-19 vaccination under various specific scenarios, and (2) associated factors of the afore-mentioned vaccination intentions.<br /> <br />Methods<br />A random anonymous telephone survey interviewed 450 Chinese adults from September 16-30, 2020 in Hong Kong, China. Nine scenarios of behavioral intentions of COVID-19 vaccinations were measured combining effectiveness (80% versus 50%), safety (rare versus common mild side effect), and cost (free versus HK$ 500).<br /> <br />Results<br />The prevalence of behavioral intentions of COVID-19 vaccination under the 9 specific scenarios was very low and varied greatly (4.2% to 38.0%). The prospective countries of manufacture also influenced vaccination intention (eg, Japan: 55.8% vs China: 31.1%). Only 13.1% intended to take up COVID-19 vaccination at the soonest upon its availability. The attributes of effectiveness and side effect influenced vaccination intention most. Positively associated factors of behavioral intentions of COVID-19 vaccination included trust/satisfaction toward the government, exposure to positive social media information about COVID-19 vaccines, descriptive norms, perceived impact on the pandemic, perceived duration of protectiveness, and life satisfaction.<br /> <br />Conclusion<br />Intention of COVID-19 vaccination was low in the Hong Kong general population, especially among younger people, females, and single people. Health promotion is warranted to enhance the intention. The significant factors identified in this study may be considered when designing such health promotion. Future research is required to confirm the findings in other countries. Such studies should pay attention to the specific context of cost, safety, and effectiveness, which would lead to different responses in the level of behavioral intention of COVID-19 vaccination (BICV). https://www.ijhpm.com/article_4003_ef0946ee7e841b9cac9255cf2ab8c570.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Feasibility of Good Governance at Health Facilities: A Proposed Framework and its Application Using Empirical Insights From Kenya 1102 1111 4005 10.34172/ijhpm.2021.01 EN Thidar Pyone Department of Global Public Health, Public Health England, London, UK Tolib Mirzoev Leeds Institute of Health Sciences, University of Leeds, UK Journal Article 2020 07 14 Background<br />Governance is a social phenomenon which permeates throughout systemic, organisational and individual levels. Studies of health systems governance traditionally assessed performance of systems or organisations against principles of good governance. However, understanding key pre-conditions to embed good governance required for healthcare organisations is limited. We explore the feasibility of embedding good governance at healthcare facilities in Kenya.<br /> <br />Methods<br />Our conceptualisation of organisational readiness for embedding good governance stems from a theory of institutional analysis and frameworks for understanding organisational readiness for change. Four inter-related constructs underpin to embed good governance: (i) individual motivations, determined by (ii) mechanisms for encouraging adherence to good governance through (iii) organisation’s institutional arrangements, all within (iv) a wider context. We propose a framework, validated through qualitative methods and collected through 39 semi-structured interviews with healthcare providers, county and national-level policy-makers in Kenya. Data was analysed using framework approach, guided by the four constructs of the theoretical framework. We explored each construct in relation to three key principles of good governance: accountability, participation and transparency of information.<br /> <br />Results<br />Embedding good governance in healthcare organisations in Kenya is influenced by political and socio-cultural contexts. Individual motivations were a critical element of self-enforcement to embed principles of good governance by healthcare providers within their facilities. Healthcare providers possess strong moral incentives to self-enforce accountability to local populations, but their participation in decision-making was limited. Health facilities lacked effective mechanisms for enforcing good governance such as combating corruption, which led to a proliferation of informal institutional arrangements.<br /> <br />Conclusion<br />Organisational readiness for good governance is context-specific so future work should recognise different interpretations of acceptable degrees of transparency, accountability and participation. While good governance involves collective social action, organisational readiness relies on individual choices and decisions within the context of organisational rules and cultural and historical environments. https://www.ijhpm.com/article_4005_2e4bd31f56adabc676a8cea6939b1b12.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Major Thalassemia, Screening or Treatment: An Economic Evaluation Study in Iran 1112 1119 4008 10.34172/ijhpm.2021.04 EN Firooz Esmaeilzadeh Department of Public Health, School of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran Batoul Ahmadi Department of Health Management & Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Sajad Vahedi Department of Healthcare Administration, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Saeed Barzegari Department of Health Information Technology, Amol Faculty of Paramedical Sciences, Mazandaran University of Medical Sciences, Sari, Iran Abdolhalim Rajabi Department of Health Management and Social Development Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran Department of Environmental Health Research Center, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran Journal Article 2019 10 13 Background<br />Beta-thalassemia minor and thalassemia major are an autosomal recessive disease with hypochromic, microcytic anemia, and morbidities, Today, therapeutic advances have significantly improved the life expectancy of thalassemia major patients, but at the cost of financial toxicity. The present study aimed to investigate the possibility of increasing the funding for thalassemia screening programs and comparing the cost-effectiveness of screening for thalassemia in the treatment of the patients.<br /> <br />Methods<br />In this study, screening for thalassemia minor was compared with the treatment of thalassemia major patients. A decision tree model was used for analysis. A hospital database, supplemented with a review of published literature, was used to derive input parameters for the model. A lifetime study horizon was used and future costs and consequences were discounted at 3%. The approach of purchases of services was used to evaluate the screening test costs for patients with thalassemia major. Also, a bottom-up method was applied to estimate other screening and treatment costs. All the costs were calculated over one year. The number of gained quality-adjusted life years (QALYs) was calculated using the EQ-5D questionnaire in the evaluated patients.<br /> <br />Results<br />In this study, 26.97 births of patients with thalassemia major were prevented by screening techniques. On the other hand, total screening costs for patients with thalassemia major were estimated equal to US$ 879 879, while the costs of preventing the birth of each thalassaemia major patient was US$ 32 624 by screening techniques. In comparison, the cost of managing a patient with thalassemia major is about US$ 136 532 per year. The life time QALYs for this is 11.8 QALYs. Results are presented using a societal perspective. Incremental cost per QALY gained with screening as compared with managing thalassaemia major was US$ 11 571.<br /> <br />Conclusion<br />Screening is a long-term value for money intervention that is highly cost effective and its long-term clinical and economic benefits outweigh those of managing thalassaemia major patients. https://www.ijhpm.com/article_4008_9455b9f75398c3a4ed7f0832856458c2.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Economic Costs of Providing District- and Regional-Level Surgeries in Tanzania 1120 1131 4014 10.34172/ijhpm.2021.09 EN Martilord Ifeanyichi Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands Henk Broekhuizen Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands Adinan Juma East, Central and Southern Africa Health Community, Arusha, Tanzania Kondo Chilonga Department of Surgery, Kilimanjaro Christian Medical Centre, Moshi, Tanzania Edward Kataika East, Central and Southern Africa Health Community, Arusha, Tanzania Jakub Gajewski Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland 0000-0003-0440-6051 Ruairi Brugha Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland Leon Bijlmakers Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands Journal Article 2020 06 05 <span class="fontstyle0">Background </span><br /><span class="fontstyle2">Access to surgical care is poor in Tanzania. The country is at the implementation stage of its first National Surgical, Obstetric, and Anesthesia Plan (NSOAP; 2018-2025) aiming to scale up surgery. This study aimed to calculate the costs of providing surgical care at the district and regional hospitals.<br /></span><br /><span class="fontstyle0">Methods </span><br /><span class="fontstyle2"><span class="fontstyle0">Two district hospitals (DHs) and the regional referral hospital (RH) in Arusha region were selected. All the staff, buildings, equipment, and medical and non-medical supplies deployed in running the hospitals over a 12 month period were identified and quantified from interviews and hospital records. Using a combination of step-down costing (SDC) and activity-based costing (ABC), all costs attributed to surgeries were established and then distributed over the individual types of surgeries. These costs were delineated into pre-operative, intra-operative, and post-operative components.</span> </span><br /> <span class="fontstyle2"><br /></span><span class="fontstyle0">Results</span><br /><span class="fontstyle2">The total annual costs of running the clinical cost centres ranged from $567k at Oltrumet DH to $3453k at Mt Meru RH. The total costs of surgeries ranged from $79k to $813k; amounting to 12%-22% of the total costs of running the hospitals. At least 70% of the costs were salaries. Unit costs and relative shares of capital costs were generally higher at the DHs. Two-thirds of all the procedures incurred at least 60% of their costs in the theatre. Open reduction and internal fixation (ORIF) performed at the regional hospital was cheaper ($618) than surgical debridement (plus conservative treatment) due to prolonged post-operative inpatient care associated with the latter ($1177), but was performed infrequently due mostly to unavailability of implants.</span><br /><span class="fontstyle2"><br /></span><span class="fontstyle0">Conclusion </span><br /><span class="fontstyle2">Lower unit costs and shares of capital costs at the RH reflect an advantage of economies of scale and scope at the RH, and a possible underutilization of capacity at the DHs. Greater efficiencies make a case for concentration and scale-up of surgical services at the RHs, but there is a stronger case for scaling up district-level surgeries, not only for equitable access to services, but also to drive down unit costs there, and free up RH resources for more complex cases such as ORIF.</span> https://www.ijhpm.com/article_4014_a31101173fe78c9f3d79aff5a93d9daa.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Density of Patient-Sharing Networks: Impact on the Value of Parkinson Care 1132 1139 4015 10.34172/ijhpm.2021.15 EN Floris P. Vlaanderen Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands Yvonne De Man Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands Marit A.C. Tanke Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands Marten Munneke Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands Department of Neurology, Radboud Institute for Health Sciences, Nijmegen, The Netherlands Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands Femke Atsma Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands 0000-0002-5944-2431 Marjan J. Meinders Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands 0000-0001-6491-7035 Patrick P.T. Jeurissen Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands Bastiaan R. Bloem Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands Department of Neurology, Radboud Institute for Health Sciences, Nijmegen, The Netherlands Center of Expertise for Parkinson & Movement Disorders, Nijmegen, The Netherlands Jesse H. Krijthe Department of Intelligent Systems, Delft University of Technology, Delft, The Netherlands Stef Groenewoud Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Nijmegen, The Netherlands Journal Article 2020 08 10 <span class="fontstyle0">Background  </span><br /><span class="fontstyle2">Optimal care for Parkinson’s disease (PD) requires coordination and collaboration between providers within a complex care network. Individual patients have personalised networks of their own providers, creating a unique informal network of providers who treat (‘share’) the same patient. These ‘patient-sharing networks’ differ in density, ie, the number of identical patients they share. Denser patient-sharing networks might reflect better care provision, since providers who share many patients might have made efforts to improve their mutual care delivery. We evaluated whether the density of these patient-sharing networks affects patient outcomes and costs.</span><br /> <span class="fontstyle2"><br /></span><span class="fontstyle0">Methods  </span><br /><span class="fontstyle2"><span class="fontstyle0">We analysed medical claims data from all PD patients in the Netherlands between 2012 and 2016. We focused on seven professional disciplines that are commonly involved in Parkinson care. We calculated for each patient the density score: the average number of patients that each patient’s providers shared. Density scores could range from 1.00 (which might reflect poor collaboration) to 83.00 (which might reflect better collaboration). This score was also calculated at the hospital level by averaging the scores for all patients belonging to a specific hospital. Using logistic and linear regression analyses we estimated the relationship between density scores and health outcomes, healthcare utilization, and healthcare costs.</span> </span><br /> <span class="fontstyle2"><br /></span><span class="fontstyle0">Results  </span><br /><span class="fontstyle2">The average density score varied considerably (average 6.7, SD 8.2). Adjusted for confounders, higher density scores were associated with a lower risk of PD-related complications (odds ratio [OR]: 0.901; </span><span class="fontstyle3">P </span><span class="fontstyle2">< .001) and with lower healthcare costs (coefficients: -0.018, </span><span class="fontstyle3">P </span><span class="fontstyle2">= .005). Higher density scores were associated with more frequent involvement of neurologists (coefficient 0.068), physiotherapists (coefficient 0.052) and occupational therapists (coefficient 0.048) (</span><span class="fontstyle3">P </span><span class="fontstyle2">values all <.001).</span><br /> <span class="fontstyle2"><br /></span><span class="fontstyle0">Conclusion  </span><br /><span class="fontstyle2">Patient sharing networks showed large variations in density, which appears unwanted as denser networks are associated with better outcomes and lower costs.</span> https://www.ijhpm.com/article_4015_f584b904a708313c87ddac84b68f7636.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 The Evolution of Trust Within a Global Health Partnership With the Private Sector: An Inductive Framework 1140 1147 4017 10.34172/ijhpm.2021.14 EN Sarah Christie Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA Teresa Chahine Yale School of Management, New Haven, CT, USA Leslie A. Curry Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA Emily Cherlin Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA Erika L. Linnander Global Health Leadership Initiative, Yale School of Public Health, New Haven, CT, USA Journal Article 2020 06 24 <span class="fontstyle0">Background  </span><br /><span class="fontstyle2">Public-private partnerships (PPPs) in global health are increasingly common to support sustainable development and strengthen health systems in low- and middle-income countries. Since the release of the Sustainable Development Goals (SDGs) in 2015 culminating in a discrete goal “to revitalize the global partnership for sustainable development,” public health scholars have sought to understand what makes PPPs successful in different contexts. While trust has long been identified as a key component of successful strategic alliances in the private sector, less is known about how trust emerges between public- and private- sector partners, particularly in global health. Therefore, we investigated how trust between partners evolved in the context of Project Last Mile (PLM), a global health partnership that translates the business acumen of The Coca-Cola Company to strengthen public health systems across Africa. </span><br /> <br /><span class="fontstyle0">Methods  </span><br /><span class="fontstyle2">This study draws upon secondary analysis of qualitative data generated as part of the longitudinal, mixedmethods evaluation of PLM across country settings. Seventy-seven interviews with a purposeful sample of key stakeholders were conducted in Mozambique, South Africa and eSwatini between August 2016 and July 2018. Trained qualitative interviewers followed a standard discussion guide, and audio-recorded interviews with participants’ consent. In this secondary analysis, we analyzed qualitative data to understand how trust between partners was cultivated across settings. </span><br /> <br /><span class="fontstyle0">Results  </span><br /><span class="fontstyle2">We drew upon stakeholder experiences to inform an inductive framework for how trust develops over time. Our analysis revealed five domains that were foundational to building trust: (1) reputational context, (2) team composition, (3) tangible outputs, (4) shared values, and (5) effective communication.  </span><br /> <br /><span class="fontstyle0">Conclusion  </span><br /><span class="fontstyle2">The framework may be useful for private and public sector entities seeking to establish and sustain trust within their global health partnerships.</span> https://www.ijhpm.com/article_4017_3b6be0f7816f46d6254f3b0d1348f731.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Clinical Priority Setting and Decision-Making in Sweden: A Cross-sectional Survey Among Physicians 1148 1157 4020 10.34172/ijhpm.2021.16 EN Catharina Drees Division of Biomedical Ethics, Institute of Experimental Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany Barbro Krevers Department of Health, Medicine and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden National Centre for Priorities in Health, Linköping University, Linköping, Sweden Niklas Ekerstad Department of Health, Medicine and Caring Sciences, Unit of Health Care Analysis, Linköping University, Linköping, Sweden National Centre for Priorities in Health, Linköping University, Linköping, Sweden NU Hospital Group, The Research and Development Unit, Trollhättan, Sweden Annette Rogge Division of Biomedical Ethics, Institute of Experimental Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany Christoph Borzikowsky Institute of Medical Informatics and Statistics, University Hospital Schleswig-Holstein, Kiel, Germany Stuart McLennan Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany Institute for Biomedical Ethics, University of Basel, Basel, Switzerland Alena M. Buyx Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany Journal Article 2020 06 25 <span class="fontstyle0">Background  </span><br /><span class="fontstyle2">Priority setting in healthcare that aims to achieve a fair and efficient allocation of limited resources is a worldwide challenge. Sweden has developed a sophisticated approach. Still, there is a need for a more detailed insight on how measures permeate clinical life. This study aimed to assess physicians’ views regarding (1) impact of scarce resources on patient care, (2) clinical decision-making, and (3) the ethical platform and national guidelines for healthcare by the National Board of Health and Welfare (NBHW).</span><br /> <br /><span class="fontstyle0">Methods  </span><br /><span class="fontstyle2">An online cross-sectional questionnaire was sent to two groups in Sweden, 2016 and 2017. Group 1 represented 331 physicians from different departments at one University hospital and group 2 consisted of 923 members of the Society of Cardiology.</span><br /> <br /><span class="fontstyle0">Results  </span><br /><span class="fontstyle2">Overall, a 26% (328/1254) response rate was achieved, 49% in group 1 (162/331), 18% in group 2 (166/923). Scarcity of resources was perceived by 59% more often than ‘at least once per month,’ whilst 60% felt less than ‘wellprepared’ to address this issue. Guidelines in general had a lot of influence and 19% perceived them as limiting decisionmaking. 86% professed to be mostly independent in decision-making. 36% knew the ethical platform ‘well’ and ‘very well’ and 64% NBHW’s national guidelines. 57% expressed a wish for further knowledge and training regarding the ethical platform and 51% for support in applying NBHW’s national guidelines.</span><br /> <br /><span class="fontstyle0">Conclusion  </span><br /><span class="fontstyle2">There was a need for more support to deal with scarcity of resources and for increased knowledge about the ethical platform and NBHW’s national guidelines. Independence in clinical decision-making was perceived as high and guidelines in general as important. Priority setting as one potential pathway to fair and transparent decision-making should be highlighted more in Swedish clinical settings, with special emphasis on the ethical platform.</span> https://www.ijhpm.com/article_4020_7b6b1ca51c1b4d86b1afd6e058da1272.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Health in Food Systems Policies in India: A Document Review 1158 1171 4021 10.34172/ijhpm.2021.18 EN Adithya Pradyumna Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland Azim Premji University, Bengaluru, India Arima Mishra Azim Premji University, Bengaluru, India Jürg Utzinger Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland Mirko S Winkler Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland 0000-0001-7387-3863 Journal Article 2020 06 01 <span class="fontstyle0">Background  </span><br /><span class="fontstyle2">Food systems affect nutritional and other health outcomes. Recent literature from India has described policy aspects addressing nutritional implications of specific foods (eg, fruits, vegetables, and trans-fats), and identified opportunities to tackle the double burden of malnutrition. This paper attempts to deepen the understanding on how health concerns and the role of the health sector are addressed across food systems policies in India. </span><br /> <br /><span class="fontstyle0">Methods  </span><br /><span class="fontstyle2">This qualitative study used two approaches; namely (i) the framework method and (ii) manifest content analysis, to investigate national-level policy documents from relevant sectors (ie, food security, agriculture, biodiversity, food processing, trade, and waste management, besides health and nutrition). The documents were selected purposively. The textual data were coded and compared, from which themes were identified, described, and interpreted. Additionally, mentions of various health concerns and of the health ministry in the included documents were recorded and collated.</span><br /> <span class="fontstyle2"><br /></span><span class="fontstyle0">Results  </span><br /><span class="fontstyle2">A total of 35 policy documents were included in the analysis. A variety of health concerns spanning nutritional, communicable and non-communicable diseases (NCDs) were mentioned. Undernutrition received specific attention even beyond nutrition policies. Only few policies mentioned NCDs, infectious diseases, and injuries. Governing and advisory bodies were instituted by 17 of the analysed policies (eg, food safety, agriculture, and food processing), and often included representation from the health ministry (9 of the 17 identified inter-ministerial bodies).</span><br /> <span class="fontstyle2"><br /></span><span class="fontstyle0">Conclusion  </span><br /><span class="fontstyle2">We found some evidence of concern for health, and inclusion of health ministry in food policy documents in India. The ongoing and planned intersectoral coordination to tackle undernutrition could inform actions to address other relevant but currently underappreciated concerns such as NCDs. Our study demonstrated a method for analysis of health consideration and intersectoral coordination in food policy documents, which could be applied to studies in other settings and policy domains.</span> https://www.ijhpm.com/article_4021_6fd189afb981d8b5a271925c60f98b9a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 “Apples and Oranges”: Examining Different Social Groups’ Compliance With Government Health Instructions During the COVID-19 Pandemic 1172 1186 4026 10.34172/ijhpm.2021.21 EN Talia Goren Division of Public Administration and Policy, School of Political Sciences, University of Haifa, Haifa, Israel Dana R. Vashdi Division of Public Administration and Policy, School of Political Sciences, University of Haifa, Haifa, Israel Itai Beeri Division of Public Administration and Policy, School of Political Sciences, University of Haifa, Haifa, Israel Journal Article 2020 10 06 <span class="fontstyle0">Background  </span><br /><span class="fontstyle2">The coronavirus outbreak has demonstrated the crucial effect of the public’s compliance with the government’s health instructions on the population’s health. However, evidence shows that some communities are less likely to comply with such instructions than others. This study highlights the factors related to intentions to comply with newly issued health directives during an ongoing extreme crisis, such as the current pandemic. In addition, it compares the impact of these factors on different minority groups and the general population in Israel.</span><br /> <br /><span class="fontstyle0">Methods  </span><br /><span class="fontstyle2">Using an online survey (N = 1005), we examined the impact of compliance-related factors on compliance intentions with newly issued health directives in two minority groups in Israel: the ultra-Orthodox Jewish community (N = 323) and the Arab community (N = 361), as well as in the general population (N = 321), during the first outbreak of coronavirus disease 2019 (COVID-19). Participants were presented with a new made-up COVID-19-related instruction simulated to be issued by the Israeli Ministry of Health. Compliance intentions and compliance-related factors were measured.</span><br /> <span class="fontstyle2"><br /></span><span class="fontstyle0">Results  </span><br /><span class="fontstyle2">The Arab minority expressed greater intentions of complying with the instructions than the other groups. Perceptions on risk and the effectiveness of the instruction were the only two significantly associated factors with compliance intentions in all of the social groups. Additional factors affected different groups to different extents. Trust in government was related to compliance intentions only in the Arab minority. </span><br /> <br /><span class="fontstyle0">Conclusion  </span><br /><span class="fontstyle2">Intentions to comply with health instructions during a crisis differ in various minority groups and in comparison to the general population, both in their levels and in the factors related to them. Policy-makers and health authorities should consider providing information about the risks and negative outcomes of the crisis as well as the expected effectiveness of the recommended behaviors. Future research should examine other minority groups and other types of instructions in different stages of a crisis.</span> https://www.ijhpm.com/article_4026_e8a94913324681f42576655d2367aef3.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Policy Implementation Challenges and Barriers to Access Sexual and Reproductive Health Services Faced By People With Disabilities: An Intersectional Analysis of Policy Actors’ Perspectives in Post-Conflict Northern Uganda 1187 1196 4028 10.34172/ijhpm.2021.28 EN Muriel Mac-Seing Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada Emmanuel Ochola Public Health Department, St-Mary’s Hospital, Lacor, Uganda Martin Ogwang Institutional Direction Department, St-Mary’s Hospital, Lacor, Uganda Kate Zinszer Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada Christina Zarowsky Social and Preventive Medicine Department, School of Public Health, Université de Montréal, Montreal, QC, Canada Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sudde-l’Île-de-Montréal, Montreal, QC, Canada School of Public Health, University of Western Cape, Bellville, South Africa Journal Article 2020 08 19 <span class="fontstyle0">Background </span><br /><span class="fontstyle2">Emerging from a 20-year armed conflict, Uganda adopted several laws and policies to protect the rights of people with disabilities, including their sexual and reproductive health (SRH) rights. However, the SRH rights of people with disabilities continue to be infringed in Uganda. We explored policy actors’ perceptions of existing prodisability legislation and policy implementation, their perceptions of potential barriers experienced by people with disabilities in accessing and using SRH services in post-conflict Northern Uganda, and their recommendations on how to redress these inequities.</span><br /> <br /><span class="fontstyle0">Methods  </span><br /><span class="fontstyle2">Through an intersectionality-informed approach, we conducted and thematically analysed 13 in-depth semi-structured interviews with macro level policy actors (national policy-makers and international and national organisations); seven focus groups (FGs) at meso level with 68 health service providers and representatives of disabled people’s organisations (DPOs); and a two-day participatory workshop on disability-sensitive health service provision for 34 healthcare providers. </span><br /> <br /><span class="fontstyle0">Results </span><br /><span class="fontstyle2">We identified four main themes: (1) legislation and policy implementation was fraught with numerous technical and financial challenges, coupled with lack of prioritisation of disability issues; (2) people with disabilities experienced multiple physical, attitudinal, communication, and structural barriers to access and use SRH services; (3) the conflict was perceived to have persisting impacts on the access to services; and (4) policy actors recommended concrete solutions to reduce health inequities faced by people with disabilities. </span><br /> <br /><span class="fontstyle0">Conclusion  </span><br /><span class="fontstyle2">This study provides substantial evidence of the multilayered disadvantages people with disabilities face when using SRH services and the difficulty of implementing disability-focused policy in Uganda. Informed by an intersectionality approach, policy actors were able to identify concrete solutions and recommendations beyond the identification of problems. These recommendations can be acted upon in a practical road map to remove different types of barriers in the access to SRH services by people with disabilities, irrespective of their geographic location in Uganda.</span> https://www.ijhpm.com/article_4028_6de4c7f88b69cf341ed628f6f986b80a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Community Health Center Efficiency. The Impact of Organization Design and Local Context: The Case of Indonesia 1197 1207 4029 10.34172/ijhpm.2021.19 EN Suwatin Miharti Department of Competency Development and Evaluation for Policy Analyst, Center of Policy Analyst Reinforcement, The National Institute of Public Administration, Jakarta, Indonesia Rafael Wittek Department of Sociology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands Bart Los Department of Global Economics & Management, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands Liesbet Heyse Department of Sociology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands Journal Article 2020 05 19 <span class="fontstyle0">Background  </span><br /><span class="fontstyle2">The decentralization of the Indonesian healthcare system, launched in the year 2000, allowed the authorities of local community health centers (CHCs) to tailor their services to the needs of their clients. Many observers see this as an opportunity to increase CHC efficiency. Building on the Context Design Performance Framework, this paper assesses the extent to which efficiency variations between CHCs can be explained by the degree of fit between their organizational design characteristics and aspects of the communities in which they are embedded.  </span><br /> <br /><span class="fontstyle0">Methods  </span><br /><span class="fontstyle2">Data envelopment analysis (DEA) was applied to construct a measure of CHC efficiency for a sample of 598 CHCs in 2011, drawn from a publicly available Ministry of Health (MoH) dataset. Tobit regression analysis was applied to assess the impact of organization design and community characteristics and their interplay on efficiency.</span><br /> <br /><span class="fontstyle0">Results </span><br /><span class="fontstyle2">Large variations in CHC efficiency were discovered, suggesting that not all CHCs are equally capable of finding the optimal design to operate most efficiently. A significant inverted U-shape relationship was found for the organization design-efficiency link: efficiency is highest for CHCs with 1-2 horizontal units and decreases for CHCs exceeding or not reaching this number. No significant association was found between community characteristics (proportion of poor people, remote location of CHC) and CHC efficiency. </span><br /> <br /><span class="fontstyle0">Conclusion  </span><br /><span class="fontstyle2">Organizational design matters for CHC efficiency, but no evidence was found for the hypothesis that a better fit between community characteristics and CHC design increases efficiency. A potential reason for this might be that CHC management’s main design challenge is how to cope with the scarce availability of well-trained health personnel.</span> https://www.ijhpm.com/article_4029_e5ecb46eecae937451a4b826d00fb05a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Thinking Politically About UN Political Declarations: A Recipe for Healthier Commitments—Free of Commercial Interests; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases” 1208 1211 4094 10.34172/ijhpm.2021.92 EN Kent Buse Healthier Societies Program, The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia Mélissa Mialon Trinity Business School, Trinity College Dublin, Dublin, Ireland 0000-0002-9883-6441 Alexandra Jones The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia Journal Article 2021 06 14 <span class="fontstyle0">As evidence mounts that corporate actor engagement in United Nations (UN) policy- making processes leads to weaker and shallower public health commitments, greater attention is being paid to how to minimise undue interference and manage conflicts of interest (CoI). While we welcome efforts to develop normative guidance on managing such conflicts, we argue that there is the need to go further. In particular, we propose that an index be developed that would assess the health impacts of individual corporate actors, and those actors who fail to achieve a set benchmark would not have engagement privileges. We further propose the establishment of an independent panel of experts to advise on corporate actor engagement as well as on ambiguous and potentially health- harming commitments in text under negotiation in the UN. Recognising that the implementation of such measures will be contested, we recommend a number of practical steps to make their implementation more politically palatable.</span> https://www.ijhpm.com/article_4094_3870e533a7310701be1482f34b425c54.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Public-Private Partnerships With Unhealthy Commodity Industries: Are They Undermining Real Progress in NonCommunicable Disease Prevention?; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases” 1212 1214 4112 10.34172/ijhpm.2021.118 EN Chiara Rinaldi Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK Journal Article 2021 06 11 <span class="fontstyle0">Public-private partnerships (PPPs) and whole-of-society approaches are increasingly common in public health promotion and non-communicable disease prevention, despite a lack of evidence in favour of their effectiveness in improving health outcomes. While PPPs may have advantages, they also give industry actors more influence over the design and implementation of public health strategies and interventions. Partnering with unhealthy commodity industries in particular – including the alcohol and ultra-processed food and beverages industries – can pose significant risks to public health due to these industries’ deep-rooted conflicts of interest. In this commentary, I reiterate Suzuki et al.’s message about the importance of assessing and managing conflicts of interest before engaging with non-state actors through PPPs or other forms of engagement.</span> https://www.ijhpm.com/article_4112_d6c7ead835894e0733edc6262f776029.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Lacking Clarity or Strategic Ambiguity?; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-Communicable Diseases” 1215 1218 4117 10.34172/ijhpm.2021.113 EN Angela Carriedo World Public Health Nutrition Association, London, UK Kathrin Lauber Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK Margaret M. Miller School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia Rob Ralston Global Health Policy Unit, Social Policy, School of Social and Political Science, University of Edinburgh, Edinburgh, UK Journal Article 2021 06 18 <span class="fontstyle0">This commentary engages with Suzuki and colleagues’ analysis about the ambiguity of multi-stakeholder discourses in the United Nations (UN) Political Declaration of the 3rd High-Level Meeting of the General Assembly on the Prevention and Control of Non-Communicable Diseases (HLM-NCDs), suggesting that blurring between public and private sector in this declaration reflects broader debates about multi-stakeholder partnerships (MSPs) and publicprivate partnerships (PPPs) in health governance. We argue that the ambiguity between the roles and responsibilities of public and private actors involved may downplay the role (and regulation) of conflicts of interest (COI) between unhealthy commodity industries and public health. We argue that this ambiguity is not simply an artefact of the Political Declaration process, but a feature of multi-stakeholderism, which assumes that commercial actors´ interests can be aligned with the public interest. To safeguard global health governance, we recommend further empirical and conceptual research on COI and how it can be managed.</span> https://www.ijhpm.com/article_4117_c11b8da0cbcdfcef03e4700ab1fe6da2.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Commercial Influence on Political Declarations: The Crucial Distinction Between Consultation and Negotiation and the Need for Transparency in Lobbying; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-Communicable Diseases” 1219 1221 4136 10.34172/ijhpm.2021.132 EN Astrid Berner-Rodoreda Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany Albrecht Jahn Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany Journal Article 2021 08 02 <span class="fontstyle0">Suzuki and colleagues’ rare and elaborate analysis of the political processes behind the 2018 United Nations (UN) non- communicable diseases (NCD) Declaration discloses various pathways towards influencing global public health policies. Their study should be a wake-up call for further scientific political scrutiny and analysis, including clearly distinguishing between consultations such as UN multi-stakeholder hearings preceding high-level meetings and the actual negotiating and decision making process. While stakeholder positions at interactive hearings are documented and published and thus made transparent, the negotiating process among member states is not publicly known. The extent to which intergovernmental negotiations are influenced at country or regional levels by commercial interests through direct and indirect lobbying outside of public consultations should be given more attention. Lobby registers should be implemented more stringently and legislative footprints required and applied not only to legally binding but also to internationally important documents such as political declarations.</span> https://www.ijhpm.com/article_4136_d98687a97b50707ce50ac8ad76000626.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Powerful Allies and Weak Consensus: Towards a Deeper Understanding of how Health-Harming Industries Seek to Influence Global Health Governance; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-Communicable Diseases” 1222 1224 4143 10.34172/ijhpm.2021.136 EN Marco Zenone Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK Benjamin Hawkins MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK Journal Article 2021 07 17 <span class="fontstyle0">Suzuki et al have identified commonalities in the policy positions adopted at a global forum by commercial sector actors and high-income countries (HICs), on the one hand, and non-governmental organizations (NGOs) and lowand middle-income countries (LMICs), on the other, in ways that may allow commercial sector actors to block or delay evidence-based policies through the creation of political controversy. The ability of industry actors to draw on the support of the most politically and economically powerful countries for their favoured policy agenda is an important contribution to understanding the dynamics of global health governance in the area of non-communicable diseases (NCDs) and beyond. Here we assess the relevance of this paper for the field of corporate actors’ research and the potential avenues this opens up for further study. More specifically we emphasize the need for comparative, cross disciplinary research to examine the power of heath-harming industries and the relevance of these findings for decolonizing global health.</span> https://www.ijhpm.com/article_4143_d5e5b60c001dd66731efe40bd71bc401.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 “A Promise Unfulfilled”: Stakeholder Influence and the 2018 UN High-Level Meeting on NCDs; Comment on “Competing Frames in Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases” 1225 1227 4147 10.34172/ijhpm.2021.140 EN Johanna Ralston World Obesity Federation, London, UK Journal Article 2021 07 22 <span class="fontstyle0">In recognition of the global burden of non-communicable diseases (NCDs), the past decade has seen three United Nations High-Level Meetings (UN HLMs) on NCDs. Yet progress in terms of political or financial commitments has been very slow. At the 2018 meeting, a political declaration was approved but featured language that had been watered down in terms of commitments. In “Competing Frames of Global Health Governance: An Analysis of Stakeholder Influence on the Political Declaration on Non-communicable Diseases,” Suzuki et al analyze the documents that were submitted by Member States, non-governmental organizations and the private sector during the consultation period and conclude that the private sector and several high-income countries (HICs) appeared to oppose regulatory frameworks for products associated with NCDs, that wealthier countries resisted financing commitments, and that general power asymmetries affected the final document. This comment supports their findings and provides additional considerations for why the NCD response has yet to produce significant commitments.</span> https://www.ijhpm.com/article_4147_7a6cc853bdae631b124d88ed18db1bde.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Bridging the Gap Between Public Health and Political Science to Study the Populist Radical Right in its Multiple Manifestations: A Response to Recent Commentaries 1228 1230 4070 10.34172/ijhpm.2021.65 EN Chiara Rinaldi Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK Marleen PM Bekker Health and Society Group, Wageningen University & Research, Wageningen, The Netherlands Journal Article 2021 05 21 https://www.ijhpm.com/article_4070_a8d6fa58f60b1784b88bd103925a9662.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Consucrats and Pathocrats: The Prequel, Quel, and Sequel; A Response to the Recent Commentaries 1231 1232 4126 10.34172/ijhpm.2021.124 EN Evelyne De Leeuw Centre for Health Equity Training, Research and Evaluation (CHETRE), University of New South Wales, Sydney, NSW, Australia South Western Sydney Local Health District Population Health, Liverpool, NSW, Australia Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia Journal Article 2021 08 24 https://www.ijhpm.com/article_4126_398120f237da2bf756d586314dc65388.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Competing Values in Global Health: Is Inclusive Governance Valued Higher Than the Right to Health? A Response to the Recent Commentaries 1233 1235 4232 10.34172/ijhpm.2022.7209 EN Mao Suzuki Yale-NUS College, Singapore, Singapore 0000-0002-5848-2730 Roy Small HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA Douglas Webb HIV, Health and Development Group, Bureau for Policy and Programme Support, United Nations Development Programme, New York City, NY, USA Journal Article 2022 02 28 https://www.ijhpm.com/article_4232_502cd21a1408ce9ffeb1751366d6ca9c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Time to See Quality Measurement Differently: Focus on Reflection, Learning and Improvement; A Response to the Recent Commentaries 1236 1237 4236 10.34172/ijhpm.2022.7228 EN Marieke Zegers Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Intensive Care, Nijmegen, The Netherlands 0000-0002-7472-6184 Gijs Hesselink Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Intensive Care, Nijmegen, The Netherlands Hans (J.G.) Van Der Hoeven Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Intensive Care, Nijmegen, The Netherlands Journal Article 2022 02 25 https://www.ijhpm.com/article_4236_7e16d1850b058dd97057a1300e260e0b.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 Mobilising Knowledge in (and About) Academic Health Science Centres: Boundary Spanning, Inter-organisational Governance and Systems Thinking 1238 1240 4252 10.34172/ijhpm.2022.7314 EN Alexandra Edelman College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia Robyn Clay-Williams Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia 0000-0002-6107-7445 Michael Fischer Melbourne Business School, University of Melbourne, Melbourne, VIC, Australia Roman Kislov Manchester Metropolitan University, Manchester, UK The University of Manchester, Manchester, UK Alison Kitson College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia 0000-0003-3053-8381 Ian McLoughlin Formerly Monash Business School, Monash University, Melbourne, VIC, Australia Helen Skouteris Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia 0000-0001-9959-5750 Gillian Harvey Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, SA, Australia Journal Article 2022 04 06 https://www.ijhpm.com/article_4252_ecbcf8461b339085473832d8eb0b8400.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 7 2022 07 01 “When My Information Changes, I Alter My Conclusions.” What Can We Learn From the Failures to Adaptively Respond to the SARS-CoV-2 Pandemic and the Under Preparedness of Health Systems to Manage COVID-19? 1241 1245 3972 10.34172/ijhpm.2020.240 EN Elisabeth Paul School of Public Health, Université libre de Bruxelles, Brussels, Belgium Garrett W. Brown Global Health Theme, University of Leeds, Leeds, UK Andreas Kalk Deutsche Gesellschaft für Internationale Zusammenarbeit, Kinshasa Country Office, Kinshasa, Democratic Republic of the Congo Wim Van Damme Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium Valéry Ridde CEPED, Institute for Research on Sustainable Development (IRD), IRD-Université de Paris, Paris, France Joachim Sturmberg School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan NSW, Australia Journal Article 2020 10 05 https://www.ijhpm.com/article_3972_d4ab927d7b1996a8924c7905e4c96b81.pdf