Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 COP27 Climate Change Conference: Urgent Action Needed for Africa and the World 1983 1985 4330 10.34172/ijhpm.2022.7752 EN Lukoye Atwoli Editor in Chief, East African Medical Journal, Nairobi, Kenya Gregory E. Erhabor Editor in Chief, West African Journal of Medicine, Lagos, Nigeria Aiah A. Gbakima Editor in Chief, Sierra Leone Journal of Biomedical Research, Freetown, Sierra Leone Abraham Haileamlak Editor in Chief, Ethiopian Journal of Health Sciences, Jimma, Ethiopia Jean-Marie Kayembe Ntumba Editor in Chief, Annales Africaines de Medecine, Kinshasa, Democratic Republic of Congo James Kigera Editor in Chief, Annals of African Surgery, Nairobi, Kenya Laurie Laybourn-Langton University of Exeter, Exeter, UK Robert Mash Editor in Chief, African Journal of Primary Health Care & Family Medicine, Stellenbosch, South Africa Joy Muhia London School of Medicine and Tropical Hygiene, London, UK Fhumulani Mavis Malaudzi Editor in Chief, Curationis, Pretoria, South Africa David Ofori-Adjei Editor in Chief, Ghana Medical Journal, Accra, Ghana Fricay Okonofua Editor in Chief, African Journal of Reproductive Health, Ondo City, Nigeria Arash Rashidian Executive Editor, Eastern Mediterranean Health Journal, Cairo, Egypt Maha El-Adawy Director of Health Promotion, Eastern Mediterranean Health Journal, Cairo, Egypt Siaka Sidibé Director of Publication, Mali Médical, Bamako, Mali Abdelmadjid Snouber Managing Editor, Journal de la Faculté de Médecine d’Oran, Oran, Algeria James Tumwine Editor in Chief, African Health Sciences, Kabale, Uganda Mohammad Sahar Yassien Editor in Chief, Evidence-Based Nursing Research, Cairo, Egypt Paul Yonga Editor in Chief, East African Medical Journal, Eldoret, Kenya Lilia Zakhama Editor in Chief, Tunisie Medicale, Tunis, Tunisia Chris Zielinski University of Winchester, Winchester, UK Journal Article 2022 10 09

https://www.ijhpm.com/article_4330_10d0f9d33a8de45cce0181727725bc6b.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 How Can Reasoned Transparency Enhance Co-Creation in Health Care and Remedy the Pitfalls of Digitization in Doctor-Patient Relationships? 1986 1990 3996 10.34172/ijhpm.2020.263 EN Vincent Mabillard Solvay Brussels School of Economics and Management, Université libre de Bruxelles (ULB), Brussels, Belgium Nicolas Demartines Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland Gaëtan-Romain Joliat Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland Journal Article 2020 07 07 This article addresses transparency in the current era of digital co-creation between healthcare professionals and patients. The concept of reasoned transparency is presented as a potential tool to guide the development of digital co-creation that is rapidly growing. The aim was to reflect on how doctors can apply transparency in their daily practice, following the shift from paternalistic to more collaborative relationships. On the one hand, our contribution indicates ways to take advantage of the existing digital tools to improve efficiency and increase patient trust, including the latest trend of artificial intelligence. On the other hand, this article identifies pitfalls of digitization and proposes reasoned transparency as remedy for the challenges rose by artificial intelligence. As a result, this perspective article tackles the issue of maintaining trustful and high-quality relationships between doctors and patients, increasingly challenged by the dissemination of online information and the pressures on healthcare professionals’ accountability towards patients and the general public.

https://www.ijhpm.com/article_3996_b985ece0a92b9d6675719dfdac18b608.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Attributes Underlying Patient Choice for Telerehabilitation Treatment: A mixed-Methods Systematic Review to Support a Discrete Choice Experiment Study Design 1991 2002 4158 10.34172/ijhpm.2021.150 EN Lucien P. Coulibaly Université de Sherbrooke, Sherbrooke, QC, Canada Centre de Recherche sur le Vieillissement, Sherbrooke, QC, Canada Thomas G. Poder Département de Gestion, Évaluation et Politique de Santé, École de santé publique de l'Université de Montréal, Montréal, QC, Canada Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada Michel Tousignant Université de Sherbrooke, Sherbrooke, QC, Canada Centre de Recherche sur le Vieillissement, Sherbrooke, QC, Canada Journal Article 2021 01 03 Background Across most healthcare systems, patients are the primary focus. Patient involvements enhance their adherence to treatment, which in return, influences their health. The objective of this study was to determine the characteristics (ie, attributes) and associated levels (ie, values of the characteristics) that are the most important for patients regarding telerehabilitation (TR) healthcare to support a future discrete choice experiment (DCE) study design. Methods A mixed-methods systematic review was conducted from January 2005 to the end of July 2020 and the search strategy was applied to five different databases. The initial selection of articles that met the eligibility criteria was independently made by one researcher, two researchers verified the accuracy of the extracted data, and all researchers discussed about relevant variables to include. Reporting of this systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the study. A qualitative synthesis was used to summarize findings. Results From a total of 928 articles, 11 (qualitative [n = 5], quantitative [n = 3] and mixed-methods [n = 3] design) were included, and 25 attributes were identified and grouped into 13 categories: Accessibility, Distance, Interaction, Technology experience, Treatment mode, Treatment location, Physician contact mode, Physician contact frequency, Cost, Confidence, Ease of use, Feeling safer, and Training session. The attributes levels varied from two to five. The DCE studies identified showed the main stages to undertake these types of studies. Conclusion This study could guide the development of interview grid for individual interviews and focus groups to support a DCE study design in the TR field. By understanding the characteristics that enhance patients’ preferences, healthcare providers can create or improve TR programs that provide high-quality and accessible care. Future research via a DCE is needed to determine the relative importance of the attributes.

https://www.ijhpm.com/article_4158_6972089d9fa99fe263de46dc7182156a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Epidemics, Lockdown Measures and Vulnerable Populations: A Mixed-Methods Systematic Review of the Evidence of Impacts on Mother and Child Health in Low- and Lower-Middle-Income Countries 2003 2021 4163 10.34172/ijhpm.2021.155 EN Giuliano Russo Wolfson Institute of Population Health, Queen Mary University of London, London, UK Tiago Silva Jesus Global Health & Tropical Medicine, Instituto de Higiene e Medicina Tropical, Nova University of Lisbon, Lisbon, Portugal Kevin Deane Faculty of Arts & Social Sciences, School of Social Sciences & Global Studies, Open University, Milton Keynes, UK 0000-0001-5421-9815 Abdinasir Yusuf Osman Royal Veterinary College, University of London, London, UK David McCoy Wolfson Institute of Population Health, Queen Mary University of London, London, UK Journal Article 2021 02 20 Background The aim of this research was to synthetise the existing evidence on the impact of epidemic-related lockdown measures on women and children’s health in low- and lower-middle-income countries (LLMICs). Methods A mixed-methods systematic review was conducted of qualitative, quantitative and mixed-methods evidence. Between 1st and 10th of November 2021, seven scientific databases were searched. The inclusion criteria were that the paper provided evidence on the impact of lockdown and related measures, focused on LLMICs, addressed impacts on women and child’s health, addressed epidemics from 2000-2020, was peer-reviewed, provided original evidence, and was published in English. The Joanne Briggs Institute’s critical appraisal tools were used to assess the quality of the studies, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting. The evidence from the papers was grouped by type of lockdown measure and categories of impact, using a narrative databased convergent synthesis design. Results The review process identified 46 papers meeting the inclusion criteria from 17 countries that focussed on the coronavirus disease 2019 (COVID-19) and Ebola epidemics. The evidence on the decrease of utilisation of health services showed plummeting immunisation rates and faltering use of maternal and perinatal services, which was linked to a growth of premature deaths. Impacts on the mental health of children and women were convincingly established, with lockdowns associated with surges in depression, anxiety and low life satisfaction. Vulnerability may be compounded by lockdowns, as livelihoods were disrupted, and poverty levels increased. Conclusion Limitations included that searches were conducted in late-2020 as new research was being published, and that some evidence not published in English may have been excluded. Epidemic-related lockdown measures carry consequences for the health of women and children in lower-income settings. Governments will need to weigh the tradeoffs of introducing such measures and consider policies to mitigate their impacts on the most vulnerable.

https://www.ijhpm.com/article_4163_9f605858ccb0e122407b560401523576.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Strategies to Facilitate Improved Recruitment, Development, and Retention of the Rural and Remote Medical Workforce: A Scoping Review 2022 2037 4168 10.34172/ijhpm.2021.160 EN Farah Noya Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia Sandra Carr Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia Kirsty Freeman Duke National University Singapore Medical School, Singapore, Singapore Division of Health Professions Education, School of Allied Health, University of Western Australia, Perth, WA, Australia Sandra Thompson Western Australian Centre for Rural Health, The University of Western Australia, Perth, WA, Australia Rhonda Clifford School of Allied Health, University of Western Australia, Perth, WA, Australia Denese Playford The Rural Clinical School of WA, School of Medicine, The University of Western Australia, Perth, WA, Australia Journal Article 2021 02 09 Background Medical workforce shortages in rural and remote areas are a global issue. Highincome countries (HICs) and low- and middle-income countries (LMICs) seek to implement strategies to address this problem, regardless of local challenges and contexts. This study distilled strategies with positive outcomes and success from international peer-reviewed literature regarding recruitment, retention, and rural and remote medical workforce development in HICs and LMICs. Methods The Arksey and O’Malley scoping review framework was utilised. Articles were retrieved from electronic databases Medline, Embase, Global Health, CINAHL Plus, and PubMed from 2010-2020. PRISMA-P guideline was used to ensure rigour in reporting the methodology in the interim, and PRISMA extension for scoping review (PRISMA-ScR) was used as a guide to report the findings. The success of strategies was examined against the following outcomes: for recruitment - rural and remote practice location; for development - personal and professional development; and for retention - continuity in rural and remote practice and low turnover rates. Results Sixty-one studies were included according to the restriction criteria. Most studies (n=53; 87%) were undertaken in high-income countries, with only eight studies from low and middle-income countries. This scoping review found implementation strategies classified as Educational, Financial, and Multidimensional were successful for recruitment, retention, and development of the rural and remote medical workforce. Conclusion This scoping review shows that effective strategies to recruit and retain rural and remote medical workforce are feasible worldwide despite differences in socio-economic factors. While adjustment and adaptation to match the strategies to the local context are required, the country's commitment to act to improve the rural medical workforce shortage is most critical.<br style="font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px;" />

https://www.ijhpm.com/article_4168_592e60d986e3d5a1a6a9d631747c3463.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 The Impact of Drug Trials With Financial Conflict of Interests on the Meta-analyses: A Meta-epidemiological Study 2038 2045 4170 10.34172/ijhpm.2021.162 EN Na Zhang Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China Peijing Yan Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China Haitong Zhao Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China Lufang Feng Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China Xiajing Chu Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China Jingwen Li Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China Nan Chen Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China Kehu Yang Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China Health Technology Assessment Center of Lanzhou University, School of Public Health, Lanzhou University, Lanzhou, China Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China Xingrong Liu Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China Journal Article 2021 04 23 Background To assess the impact of trials with potential financial conflict of interests (FCOIs) on evidence synthesis in meta-analyses (MAs). Methods A total of 96 MAs from the Cochrane Library about drug trials were investigated. The primary outcomes examined the proportion of conclusions that would change with the exclusion of trials with potential FCOIs. If the proportion of changed conclusions was below the non-inferiority margin of 10%, we considered that it was not inferior to include the trials with potential FCOIs in the MAs. Results Only 54.17% of MAs reported the funding sources of each included trial, and in 21.88% of MAs, the authorindustry- related financial ties of each included trial were reported. When trials with FCOIs were excluded, the changed conclusions of effectiveness and major adverse events were 13.16% and 11.11%, respectively, and the I2 decreased by 13.56% and 10.09%, respectively. For serious adverse events, the exclusion of FCOIs trials did not lead to any change in conclusions; however, the I2 decreased by 24.24%. The impact of trials without reported FCOIs was also examined on evidence synthesis, and the results showed that the changed conclusions of effectiveness and major adverse events were 5.26% and 6.25%, respectively, indicating non-inferiority. However, the I2 increased by 13.60% and 12.37%, respectively. Conclusion In this meta-epidemiological study, we demonstrated that trials with FCOIs may not only influence the final outcome of MAs but may also increase the heterogeneity of results. It is suggested that all MAs fully report the FCOIs involved in evidence-based research and explore the impact of its FCOIs to better provide a more valuable reference for patients, clinicians, and policy-makers.

https://www.ijhpm.com/article_4170_36e36518bd2589e1e4140ee802265a86.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Donations Made and Received: A Study of Disclosure Practices of Pharmaceutical Companies and Patient Groups in Canada 2046 2053 4180 10.34172/ijhpm.2021.172 EN Joel Lexchin School of Health Policy and Management, York University, Toronto, ON, Canada University Health Network, Toronto, ON, Canada Faculty of Medicine, University of Toronto, Toronto, ON, Canada Journal Article 2021 05 31 Given the increasing role of patient groups in pharmaceutical policy-making in Canada, this observational study was undertaken to determine whether companies that are members of Innovative Medicines Canada (IMC) list, on their publicly available websites, the names of patient groups that they make donations to and reciprocally, whether patient groups publicly list the names of the companies that they receive donations from. Websites of IMC members were searched for the names of the patient groups receiving donations, value of the donations and year the donations were made. The website of each patient group that was listed as receiving a donation was then searched for information about the name of companies making donations along with the value of the donations, year the donations were made and percent of the patient groups’ income represented by the donation. For donations over $50 000, an attempt was made to match donations that companies made to donations that patient groups received. Eleven of 44 IMC members reported making 165 donations to 114 different patient groups. Seventy-nine of these 114 groups reported receiving 373 donations from IMC members. Information about the value of donations, the year that they were given and received and the percent of patient groups’ income that they represented was limited. Donations made and received could not be matched because of the absence of information about the donations. Reporting on websites about donations by both companies and patient groups in Canada is haphazard, inconsistent and incomplete. Reforms are need to both the way that companies and patient groups report donations.

https://www.ijhpm.com/article_4180_084e07fda250303f989474c15de51f6b.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Financial Assistance for Health Security: Effects of International Financial Assistance on Capacities for Preventing, Detecting, and Responding to Public Health Emergencies 2054 2061 4115 10.34172/ijhpm.2021.120 EN Matthew R. Boyce Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA Mark J. Meyer Department of Mathematics and Statistics, Georgetown University, Washington, DC, USA John D. Kraemer Department of Health Systems Administration, Georgetown University, Washington, DC, USA Rebecca Katz Center for Global Health Science & Security, Georgetown University Medical Center, Georgetown University, Washington, DC, USA Journal Article 2020 07 28 Background Health security funding is intended to improve capacities for preventing, detecting, and responding to public health emergencies. Recent years have witnessed substantial increases in the amounts of donor financial assistance to health security from countries, philanthropies, and other development partners. To date, no work has examined the effects of assistance on health security capacity development over time. This paper presents an analysis of the timelagged effects of assistance for health security (AHS) on levels of capacity. Methods We collected publicly available health security assessment scores published between 2010 and 2019 and data relating to financial AHS. Using validated methods, we rescaled assessment scores on analogous scales to enable comparison and binned them in quartiles. We then used a distributed lag model (DLM) in a Bayesian ordinal regression framework to assess the effects of AHS on capacity development over time. Results Strong evidence exists for associations between financial assistance and select capacities on a variety of lagged time intervals. Financial assistance had positive effects on zoonotic disease capacities in the year it was disbursed, and positive effects on legislation, laboratory, workforce, and risk communication capacities one year after disbursal. Financial assistance had negative effects on laboratory and emergency response capacities two years after it was disbursed. Financial assistance did not have measurable effects on coordination, antimicrobial resistance (AMR), food safety, biosafety, surveillance, or response preparedness capacities over the timeframe considered. Conclusion Financial AHS is associated with positive effects for several core health security capacities. However, for the majority of capacities, levels of funding were not significantly associated with capacity level, though we cannot fully exclude endogeneity. Future work should continue to investigate these relationships in different contexts and examine other factors that may contribute to capacity development.

https://www.ijhpm.com/article_4115_540f1e514a7001d54940e206b72a0eda.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Individual and Contextual Factors Associated With Maternal and Child Health Essential Health Services Indicators: A Multilevel Analysis of Universal Health Coverage in 58 Low- and Middle-Income Countries 2062 2071 4116 10.34172/ijhpm.2021.121 EN Seun S. Anjorin Warwick-Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK Abimbola A. Ayorinde Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK Oyinlola Oyebode Warwick-Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK Olalekan A. Uthman Warwick-Centre for Global Health, Division of Health Sciences, Warwick Medical School, University of Warwick, Warwick, UK Journal Article 2020 09 11 Background Universal health coverage (UHC) is part of the global health agenda to tackle the lack of access to essential health services (EHS). This study developed and tested models to examine the individual, neighbourhood and countrylevel determinants associated with access to coverage of EHS under the UHC agenda in low- and middle-income countries (LMICs). Methods We used datasets from the Demographic and Health Surveys (DHSs) of 58 LMICs. Suboptimal and optimal access to EHS were computed using nine indicators. Descriptive and multilevel multinomial regression analyses were performed using R and STATA. Results The prevalence of suboptimal and optimal access to EHS varies across the countries, the former ranging from 5.55% to 100%, and the latter ranging from 0% to 90.36% both in Honduras and Colombia, respectively. In the fully adjusted model, children of mothers with lower educational attainment (relative risk ratio [RRR] 2.11, 95% credible interval [CrI] 1.92 to 2.32) and those from poor households (RRR 1.79, 95% CrI 1.61 to 2.00) were more likely to have suboptimal access to EHS. Also, those with health insurance (RRR 0.72, 95% CrI 0.59 to 0.85) and access to media (RRR 0.59, 95% CrI 0.51 to 0.67) were at lesser risk of having suboptimal EHS. Similar trends, although in the opposite direction, were observed in the analysis involving optimal access. The intra-neighbourhood and intra-country correlation coefficients were estimated using the intercept component variance; 57.50%% and 27.70% of variances in suboptimal access to EHS are attributable to the neighbourhood and country-level factors. Conclusion Neighbourhood-level poverty, illiteracy, and rurality modify access to EHS coverage in LMICs. Interventions aimed at achieving the 2030 UHC goals should consider integrating socioeconomic and living conditions of people.

https://www.ijhpm.com/article_4116_c37f1d8630038469749fb214ecf7d424.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 UK Healthcare Workers’ Experiences of Major System Change in Elective Surgery During the COVID-19 Pandemic: Reflections on Rapid Service Adaptation 2072 2082 4118 10.34172/ijhpm.2021.101 EN Georgina Singleton Department of Targeted Intervention, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK Anna Dowrick Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK Louisa Manby Institute of Epidemiology and Healthcare, University College London, London, UK Harrison Fillmore Department of Anthropology, University College London, London, UK Aron Syverson Institute of Epidemiology and Healthcare, University College London, London, UK Sasha Lewis-Jackson Department of Targeted Intervention, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK Inayah Uddin Department of Targeted Intervention, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK Kirsi Sumray Institute of Epidemiology and Healthcare, University College London, London, UK Elysse Bautista-González Institute of Epidemiology and Healthcare, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK Ginger Johnson Department of Targeted Intervention, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK 0000-0002-4728-3744 Cecilia Vindrola-Padros Department of Targeted Intervention, University College London, London, UK Rapid Research Evaluation and Appraisal Lab (RREAL), University College London, London, UK Journal Article 2021 04 14 Background The coronavirus disease 2019 (COVID-19) pandemic disrupted the delivery of elective surgery in the United Kingdom. The majority of planned surgery was cancelled or postponed in March 2020 for the duration of the first wave of the pandemic. We investigated the experiences of staff responsible for delivering rapid changes to surgical services during the first wave of the pandemic in the United Kingdom, with the aim of developing lessons for future major systems change (MSC). Methods Using a rapid qualitative study design, we conducted 25 interviews with frontline surgical staff during the first wave of the pandemic. Framework analysis was used to organise and interpret findings. Results Staff discussed positive and negative experiences of rapid service organisation. Clinician-led decision-making, the flexibility of individual staff and teams, and the opportunity to innovate service design were all seen as positive contributors to success in service adaptation. The negative aspects of rapid change were inconsistent guidance from national government and medical bodies, top-down decisions about when to cancel and restart surgery, the challenges of delivering emergency surgical care safely and the complexity of prioritising surgical cases when services re-started. Conclusion Success in the rapid reorganisation of elective surgical services can be attributed to the flexibility and adaptability of staff. However, there was an absence of involvement of staff in wider system-level pandemic decisionmaking and competing guidance from national bodies. Involving staff in decisions about the organisation and delivery of MSC is essential for the sustainability of change processes.

https://www.ijhpm.com/article_4118_bfdf453018420ba308511829875aaf61.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Impact of COVID-19 on Timing of Hip-Fracture Surgeries: An Interrupted Time-Series Analysis of the Pre/Post-Quarantine Period in Northern Italy 2083 2089 4120 10.34172/ijhpm.2021.103 EN Jacopo Lenzi Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – Università di Bologna, Bologna, Italy Stefano Rousset Department of Public Health Sciences and Paediatrics, Università di Torino, Torino, Italy Maria Pia Fantini Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum – Università di Bologna, Bologna, Italy Maria Michela Gianino Department of Public Health Sciences and Paediatrics, Università di Torino, Torino, Italy Journal Article 2021 02 02 Background To assess whether the imposition of the coronavirus disease 2019 (COVID-19) national quarantine (March 10, 2020) resulted in a shift in the proportion of patients operated for hip fracture on the day of admission, the following day and two days after admission in the region of Piedmont, northern Italy. Methods Interrupted time-series analysis (ITSA) comparing hospitalization rate and timing of hip-fracture surgeries between pre- and post-quarantine period. The same data observed in Piedmont the year before were included as a control time series with no “intervention” (quarantine) in the middle of the observation period. Results We found that 70.3% and 69.4% of hip-fracture patients received surgery within 2 days of hospital admission in the 16 weeks before and after the national quarantine, respectively. One-day surgery went from 46.0% to 46.5%, and same- day surgery from 13.3% to 12.4%. Unchanged trends were confirmed by ITSA after controlling for the 32-week time- series observed the year before. In the second week of March 2020, there was a borderline significant decrease in weekly hospital admissions for hip fractures as compared with that of the same week of March 2019 (–1.95 per 100 000, 95% CI = –4.10 to 0.21, P value = .075), followed by a weekly significant increase in the hospitalization rate (+0.14 per 100 000, 95% CI = 0.01 to 0.27, P value = .039), although the difference-in-differences of slopes failed to achieve statistical significance (0.19 per 100 000, 95% CI = –0.03 to 0.41, P value = .090). Conclusion Our study shows that the timing of hip-fracture surgery was unchanged during the lockdown period. This suggests that the healthcare systems can be resilient and able to guarantee a high-quality and safe healthcare to hipfracture patients, even in the most challenging working conditions.

https://www.ijhpm.com/article_4120_21f0aab9fe1c1bce66879d1ce0db28e9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Effect of Health Shocks on Poverty Status in South Korea: Exploring the Mechanism of Medical Impoverishment 2090 2102 4122 10.34172/ijhpm.2021.97 EN Chang-O Kim Visiting Doctors Program of Medical Home, Seoul, Republic of Korea Institute of Social Welfare, SungKongHoe University, Seoul, Republic of Korea Journal Article 2020 05 30 Background South Korea has the highest out-of-pocket burden for medical expenses among the Organisation for Economic Co- operation and Development (OECD) member countries and has no formal sickness benefit system, along with United States and Switzerland, greatly increasing the risk of poverty due to a sudden illness. Methods We identify the causal effect of health shocks on poverty status and explore the mechanisms of medical impoverishment by analyzing longitudinal data from 13 670 households that participated in the representative Korean Welfare Panel Study (KOWEPS) from 2007 to 2016. In this study, we define a health shock as a case in which no household members were hospitalized in the previous year, but together they had more than 30 days of hospitalization in this year. The propensity score matching method was combined with a mediation analysis in this work. Results The proportion of households in absolute poverty increased by 4.6–8.0 percentage points among households that experienced a health shock compared with matched controls. The selection effects due to health shock were estimated to be 5.6–8.2 percentage points. On average, a sudden hospitalization reduces annual non-medical expenditures and equivalized disposable income by just over 3.2 million KRW (2500 USD) and 1.2 million KRW (1000 USD), respectively. Health shock induces impoverishment after one year through both the medical expense and work capacity pathways, which explain 12.8% and 12.8% of the total effect, respectively. However, when we decompose the mediation effect of a health shock on poverty status after two years, we find that a health shock leads to poverty mainly through labor force nonparticipation (9.9%). Conclusion Income stabilizing scheme to protect households that experience a health shock should be introduced as a policy alternative to confront the issue of medical impoverishment.

https://www.ijhpm.com/article_4122_cbc2b99370a6d6a531e9a2eccf09c967.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Evaluating Cancer Care Networks; A Case Study of a Lung Cancer Care Network 2103 2114 4123 10.34172/ijhpm.2021.98 EN Anke Wind Rijnstate, Arnhem, The Netherlands Alliantie Regionale Topzorg (A.R.T.Z.), Arnhem, The Netherlands René Limbeek Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands Henrike Bretveld Netherlands Cancer Registration, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands Robert Van Schijndel Alliantie Regionale Topzorg (A.R.T.Z.), Arnhem, The Netherlands Daan Smits Slingeland Hospital, Doetinchem, The Netherlands Wouter De Jong Ziekenhuis Gelderse Vallei, Ede, The Netherlands Hans Smit Rijnstate, Arnhem, The Netherlands Journal Article 2020 07 01 Background Networks are promoted as an organizational form that enables integrated care as well as enhanced patient outcomes. However, implementing networks is complex. It is therefore important to evaluate the quality and effectiveness of networks to ensure it is worth developing and maintaining them. This article describes the development of an evaluation tool for cancer care networks and the results of a pilot study with a regional lung cancer care network. Methods This study used a combination of qualitative and quantitative evaluation methods. The qualitative evaluation was based on a framework with 10 standards for the organization of an oncological (tumor-specific) care network. Data for the quantitative evaluation were obtained from the Dutch Cancer Registry. The evaluation was performed at a network of three hospitals collaborating in the field of lung oncology. Results The qualitative evaluation framework consisted of 10 standards/questions which were divided into 38 subquestions. The evaluation showed that in general patients are satisfied with the collaboration in the network. However, some improvement points were found such as the need for more attention for the implementation and periodic evaluation of a regional care pathway. The start of a regional multidisciplinary meeting has been a major step for improving the collaboration. Conclusion An evaluation tool for (lung) cancer care networks was successfully developed and piloted within a cancer care network. The tool has proven to be a useful method for evaluating collaboration within an oncological network. It helped network partners to understand what they see as important and allowed them to learn about their program’s dynamics. Improvement opportunities were successfully identified. To keep the tool up to date continuous improvement is needed, following the Plan Do Check Act (PDCA) cycle.

https://www.ijhpm.com/article_4123_0101a44cdd10054d13ccfb1ea7679952.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Cost-Effectiveness of Hepatitis B Mass Screening and Management in High-Prevalent Rural China: A Model Study From 2020 to 2049 2115 2123 4128 10.34172/ijhpm.2021.126 EN Xiaolan Xu State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Chensi Wu State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China 0000-0002-7541-5361 Lushun Jiang State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Chunting Peng State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Liya Pan State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Xue Zhang State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Wei Shen State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Lin Chen State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Zhuoqi Lou State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Kaijin Xu State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Lanjuan Li State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Yin Dong People’s Hospital Medical Community of Yuhuan County, Taizhou, China Bing Ruan State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China Journal Article 2021 03 29 Background Chronic hepatitis B (CHB) is highly prevalent among adults in rural China and better management of those populations is of vital importance for viral hepatitis elimination. Adult immunization has been the subject of much controversy in previous studies. This study estimates the cost-effectiveness of population-based hepatitis B screening, treatment, and immunization strategy (comprehensive strategy) in rural areas with high prevalence under the national policy of sharp- drop drug prices. Methods We constructed a Markov model comparing 4 strategies in a 30-year horizon from the healthcare payer perspective: (1) the conventional pattern; (2) screening and treating infected (treatment); (3) screening and immunizing susceptible individuals (immunization); and (4) the comprehensive strategy. Screening intensity ranged from 50% to 100%. Outcomes were measured by costs, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and clinical outcomes. Results The costs for the conventional pattern, treatment strategy, immunization strategy, and comprehensive strategy were US$ 341, 351, 318, and 323, respectively. In addition, effects were 17.45, 17.57, 17.46, and 17.58 QALYs, respectively. The ICER of the comprehensive strategy was US$ 35/QALY gained at 50% screening intensity and 420 US$/QALY gained at 100%. The net monetary benefit increased with increasing screening intensity and declined after 90%, with the highest value of US$40 693. All new infections and 52.5% mortality could be avoided from 2020 to 2049 if all patients were properly treated and all susceptible individuals were immunized. The results were stable within a wide range of parameters. Conclusion It was cost-effective to implement the mass hepatitis B screening, treatment, and immunization strategy in areas of rural China with high prevalence, and the strategy gained the most net monetary benefit at a screening intensity of 90%. Although it was impractical to fulfill 100% coverage, efforts should be made to obtain more people screened.

https://www.ijhpm.com/article_4128_f94189131a191fab1f7815430fb65ad9.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Designed to Fail? Revisiting Uganda’s Maternal Health Policies to Understand Policy Design Issues Underpinning Missed Targets for Reduction of Maternal Mortality Ratio (MMR): 2000-2015 2124 2134 4129 10.34172/ijhpm.2021.127 EN Moses Mukuru Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda Jonathan Gorry School of Social Sciences, Nottingham Trent University, Nottingham, UK Suzanne N. Kiwanuka Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda Linda Gibson School of Social Sciences, Nottingham Trent University, Nottingham, UK David Musoke Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda Freddie Ssengooba Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda Journal Article 2020 12 01 Background Despite Uganda and other sub-Saharan African countries missing their maternal mortality ratio (MMR) targets for Millennium Development Goal (MDG) 5, limited attention has been paid to policy design in the literature examining the persistence of preventable maternal mortality. This study examined the specific policy interventions designed to reduce maternal deaths in Uganda and identified particular policy design issues that underpinned MDG 5 performance. We suggest a novel prescriptive and analytical (re)conceptualization of policy in terms of its fidelity to ‘3Cs’ (coherence of design, comprehensiveness of coverage and consistency in application) that could have implications for future healthcare programming. Methods We conducted a retrospective study. Sixteen Ugandan maternal health policy documents and 21 national programme performance reports were examined, and six key informant interviews conducted with national stakeholders managing maternal health programmes during the reference period 2000-2015. We applied the analytical framework of the ‘three delay model’ combined with a broader literature on ‘policy mixing.’ Results Despite introducing fourteen separate policy instruments over 15 years with the goal of reducing maternal mortality, by the end of the MDG period in 2015, only 87.5% of the interventions for the three delays were covered with a notable lack of coherence and consistency evident among the instruments. The three delays persisted at the frontline with 70% of deaths by 2014 attributed to failures in referral policies while 67% of maternal deaths were due to inadequacies in healthcare facilities and trained personnel in the same period. By 2015, 37.3% of deaths were due to transportation issues. Conclusion The piecemeal introduction of additional policy instruments frequently distorted existing synergies among policies resulting in persistence of the three delays and missed MDG 5 target. Future policy reforms should address the ‘three delays’ but also ensure fidelity of policy design to coherence, comprehensiveness and consistency.

https://www.ijhpm.com/article_4129_7078a6a36f67a96656f9869bfcab3097.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Local Dynamics of Collaboration for Maternal, Newborn and Child Health: A Social Network Analysis of Healthcare Providers and Their Managers in Gert Sibande District, South Africa 2135 2145 4130 10.34172/ijhpm.2021.106 EN Fidele Kanyimbu Mukinda School of Public Health, University of the Western Cape, Cape Town, South Africa Sara Van Belle Institute of Tropical Medicine, Antwerp, Belgium Helen Schneider School of Public Health, University of the Western Cape, Cape Town, South Africa South African Medical Research Council Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa Journal Article 2020 12 20 Background Accountability for maternal, newborn and child health (MNCH) is a collaborative endeavour and documenting collaboration dynamics may be key to understanding variations in the performance of MNCH services. This study explored the dynamics of collaboration among frontline health professionals participating in two MNCH coordination structures in a rural South African district. It examined the role and position of actors, the nature of their relationships, and the overall structure of the collaborative network in two sub-districts. Methods Cross-sectional survey using a social network analysis (SNA) methodology of 42 district and sub district actors involved in MNCH coordination structures. Different domains of collaboration (eg, communication, professional support, innovation) were surveyed at key interfaces (district-sub-district, across service delivery levels, and within teams). Results The overall network structure reflected a predominantly hierarchical mode of clustering of organisational relationships around hospitals and their referring primary healthcare (PHC) facilities. Clusters were linked through (and dependent on) a combination of district MNCH programme and line managers, identified as central connectors or boundary spanners. Overall network density remained low suggesting potential for strengthening collaborative relationships. Within cluster collaborative patterns (inter-professional and across levels) varied, highlighting the significance of small units in district functioning. Conclusion SNA provides a mechanism to uncover the nature of relationships and key actors in collaborative dynamics which could point to system strengths and weaknesses. It offers insights on the level of fragmentation within and across small units, and the need to strengthen cohesion and improve collaborative relationships, and ultimately, the delivery of health services.

https://www.ijhpm.com/article_4130_383b90b970d695b866bf0cbcb889d69c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Prohibit, Protect, or Adapt? The Changing Role of Volunteers in Palliative and Hospice Care Services During the COVID-19 Pandemic. A Multinational Survey (Covpall) 2146 2154 4132 10.34172/ijhpm.2021.128 EN Catherine Walshe International Observatory on End of Life Care, Lancaster University, Lancaster, UK Ian Garner International Observatory on End of Life Care, Lancaster University, Lancaster, UK Lesley Dunleavy International Observatory on End of Life Care, Lancaster University, Lancaster, UK Nancy Preston International Observatory on End of Life Care, Lancaster University, Lancaster, UK Andy Bradshaw Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK Rachel L. Cripps Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK Sabrina Bajwah Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK Katherine E. Sleeman Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK Mevhibe Hocaoglu Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK Matthew Maddocks Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK Fliss EM Murtagh Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK Adejoke O. Oluyase Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK Lorna K. Fraser The Martin House Research Centre, Department of Health Sciences, University of York, York, UK Irene J. Higginson Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK Journal Article 2021 04 12 Background Volunteers are common within palliative care services, and provide support that enhances care quality. The support they provided, and any role changes, during the coronavirus disease 2019 (COVID-19) pandemic are unknown. The aim of this study is to understand volunteer deployment and activities within palliative care services, and to identify what may affect any changes in volunteer service provision, during the COVID-19 pandemic. Methods Multi-national online survey disseminated via key stakeholders to specialist palliative care services, completed by lead clinicians. Data collected on volunteer roles, deployment, and changes in volunteer engagement. Analysis included descriptive statistics, a multivariable logistic regression, and analysis of free-text comments using a content analysis approach. Results 458 respondents: 277 UK, 85 rest of Europe, and 95 rest of the world. 68.5% indicated volunteer use preCOVID-19 across a number of roles (from 458): direct patient facing support (58.7%), indirect support (52.0%), back office (48.5%) and fundraising (45.6%). 11% had volunteers with COVID-19. Of those responding to a question on change in volunteer deployment (328 of 458) most (256/328, 78%) indicated less or much less use of volunteers. Less use of volunteers was associated with being an in-patient hospice, (odds ratio [OR] = 0.15, 95% CI = 0.07-0.3, P < .001). This reduction in volunteers was felt to protect potentially vulnerable volunteers, with policy changes preventing volunteer support. However, adapting was also seen where new roles were created, or existing roles pivoted to provide virtual support. Conclusion Volunteers were mostly prevented from supporting many forms of palliative care which may have quality and safety implications given their previously central roles. Volunteer re-deployment plans are needed that take a more considered approach, using volunteers more flexibly to enhance care while ensuring safe working practices. Consideration needs to be given to widening the volunteer base away from those who may be considered to be most vulnerable to COVID-19.

https://www.ijhpm.com/article_4132_328cf40c4fd650dc1e758e7e5b0214da.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic 2155 2165 4133 10.34172/ijhpm.2021.130 EN Michael Hodgins University of New South Wales, Sydney, NSW, Australia Dee Van Leeuwen Sydney Children’s Hospitals Network, Sydney, NSW, Australia Jeffrey Braithwaite Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia Johanna Hanefeld Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK Ingrid Wolfe Institute for Women and Children’s Health, King’s College London, London, UK 0000-0002-4717-7634 Christine Lau Integrated Care Project, Sydney Children’s Hospitals Network, Sydney, NSW, Australia Emma Dickins Integrated Care Project, Sydney Children’s Hospitals Network, Sydney, NSW, Australia Joeanne McSweeney Integrated Care Project, Sydney Children’s Hospitals Network, Sydney, NSW, Australia Mary McCaskill Integrated Care Project, Sydney Children’s Hospitals Network, Sydney, NSW, Australia Raghu Lingam University of New South Wales, Sydney, NSW, Australia Journal Article 2021 04 01 Background Coronavirus disease 2019 (COVID-19) has resulted in over 2 million deaths globally. The experience in Australia presents an opportunity to study contrasting responses to the COVID-19 health system shock. We adapted the Hanefeld et al framework for health systems shocks to create the COVID-19 System Shock Framework (CSSF). This framework enabled us to assess innovations and changes created through COVID-19 at the Sydney Children’s Hospitals Network (SCHN), the largest provider of children’s health services in the Southern hemisphere. Methods We used ethnographic methods, guided by the CSSF, to map innovations and initiatives implemented across SCHN during the pandemic. An embedded field researcher shadowed members of the emergency operations centre (EOC) for nine months. We also reviewed clinic and policy documents pertinent to SCHN’s response to COVID-19 and conducted interviews and focus groups with stakeholders, including clinical directors, project managers, frontline clinicians, and other personnel involved in implementing innovations across SCHN. Results The CSSF captured SCHN’s complex response to the pandemic. Responses included a COVID-19 assessment clinic, inpatient and infectious disease management services, redeploying and managing a workforce working from home, cohesive communication initiatives, and remote delivery of care, all enabled by a dedicated COVID-19 fund. The health system values that shaped SCHN’s response to the pandemic included principles of equity of healthcare delivery, holistic and integrated models of care, and supporting workforce wellbeing. SCHN’s resilience was enabled by innovation fostered through a non-hierarchical governance structure and responsiveness to emerging challenges balanced with a singular vision. Conclusion Using the CSSF, we found that SCHN’s ability to innovate was key to ensuring its resilience during the pandemic.

https://www.ijhpm.com/article_4133_a3e746e4b21f3aa5826c1ecb925860ff.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 The Effect of Governmental Health Measures on Public Behaviour During the COVID-19 Pandemic Outbreak 2166 2174 4135 10.34172/ijhpm.2021.131 EN Guoyan Wang School of Communication, Soochow University, Suzhou, China Li Li Health Inspection Institute, Health Commission of Suzhou, Suzhou, China Lingfei Wang School of Communication, Soochow University, Suzhou, China Zhi Xu Jiangsu Key Laboratory of Culture and Tourism for Digital Twin Perception Technology in Museums, Suzhou, China Journal Article 2021 04 20 Background The coronavirus disease 2019 (COVID-19) pandemic resulted in radical changes in many aspects of life. To deal with this, each country has implemented continuous health measures from the beginning of the outbreak. Discovering how governmental actions impacted public behaviour during the outbreak stage is the purpose of this study. Methods This study uses a hybrid large-scale data visualisation method to analyse public behaviour (epidemic concerns, self- protection, and mobility trends), using the data provided by multiple authorities. Meanwhile, a content analysis method is used to qualitatively code the health measures of three countries with severe early epidemic outbreaks from different continents, namely China, Italy, and the United States. Eight dimensions are coded to rate the mobility restrictions implemented in the above countries. Results (1) Governmental measures did not immediately persuade the public to change their behaviours during the COVID-19 epidemic. Instead, the public behaviour proceeded in a three-phase rule, which is typically witnessed in an epidemic outbreak, namely the wait-and-see phase, the surge phase and the slow-release phase. (2) The strictness of the mobility restrictions of the three countries can be ranked as follows: Hubei Province in China (with an average score of 8.5 out of 10), Lombardy in Italy (7.125), and New York State in the United States (5.375). Strict mobility restrictions are more likely to cause a surge of population outflow from the epidemic area in the short term, whereas the effect of mobility restrictions is positively related to the stringency of policies in the long term. Conclusion The public showed generally lawful behaviour during regional epidemic outbreaks and blockades. Meanwhile public behaviour was deeply affected by the actions of local governments, rather than the global pandemic situation. The contextual differences between the various countries are important factors that influence the effects of the different governments’ health measures.

https://www.ijhpm.com/article_4135_a36724c184755e34a865385ead04bdbb.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Designing a Healthy Food-Store Intervention; A Co-Creative Process Between Interventionists and Supermarket Actors 2175 2188 4137 10.34172/ijhpm.2021.110 EN Cédric N.H. Middel Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Tjerk Jan Schuitmaker-Warnaar Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands 0000-0001-5158-581X Joreintje D. Mackenbach Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Upstream Team, Amsterdam University Medical Centers, Amsterdam, The Netherlands Jacqueline E.W. Broerse Athena Institute, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands 0000-0002-8478-3422 Journal Article 2021 01 04 Background Without consideration for the food system in which healthy food-store interventions (HFIs) are implemented, their effects are likely to be unsustainable. Co-creation of HFIs by interventionists and food-store actors may improve contextual fit and therefore the effectiveness and sustainability of interventions, but there are few case studies on the topic. This study aims to provide insights into the integration of knowledge from contextual actors into HFI designs, through a co-creative process, to illustrate potential challenges, advantages, and outcomes. Methods We describe the co-creative design of an HFI in a Dutch supermarket chain, conducted through three increasingly in-depth design phases. Each phase consisted of a cycle of theorizing (gather insights from literature, feedback, and pilot studies), building (develop intervention designs), and evaluating (interviews or workshops with supermarket actors, to explore barriers and facilitators for sustainable implementation), feeding back into the next phase (drafting adapted intervention designs, based on feedback, and research input). Interview transcripts underwent a qualitative content analysis. Results We co-creatively designed four types of interventions to promote healthier food choices in supermarkets: (1) price strategies, (2) product presentation and positioning, (3) signage, and (4) interactive messaging. Interventions were aligned with the culture, structures and practices of the supermarket chain, while simultaneously challenging these system characteristics. For example, the idea of price promotions on healthy foods was well-received and encountered only practical barriers, which were easily resolved. However, the specification of tax-like price increases on unhealthy foods led to substantial resistance on cultural and commercial grounds, which were resolved through support from a key supermarket actor. Conclusion Our results illustrate the potential benefits of co-creation approaches in HFI design. We reflect on the value of more easily accepted interventions to develop collaborative momentum and more radical interventions to drive more substantial changes.

https://www.ijhpm.com/article_4137_10f211fdcbcf49075a341f05b0628b04.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Bio-Politics and Calculative Technologies in COVID-19 Governance: Reflections From England 2189 2197 4140 10.34172/ijhpm.2021.134 EN Kelum Jayasinghe Faculty of Social Sciences, University of Essex, Colchester, UK Tarosha Jayasinghe Norwich Medical School, University of East Anglia, Norwich, UK Chaminda Wijethilake Faculty of Social Sciences, University of Essex, Colchester, UK Pawan Adhikari Faculty of Social Sciences, University of Essex, Colchester, UK Journal Article 2021 03 04 Background Through the extensive use of public media, the government of England was heavily involved in encouraging and instructing people on how to manage their life during coronavirus disease 2019 (COVID-19). This model of health emergency governance replicates the practice of ‘calculative technologies’ and ‘bio-politics’ embedded in population management. Previous research on COVID-19 governance both in the United Kingdom and beyond provides varied revelations on broader ‘technologies of government’ and bio-politics by numerous governments. However, rarely have any studies explicitly and distinctively highlighted the unique ‘calculative technologies’ mobilised by governments within their bio-politically designed “technologies of government” to compel the populations to manage their lives under their COVID-19 guidance. The paper therefor examines how the UK government deployed “calculative technologies,” as part of its strategies of health governance and governmentality during the first wave of COVID-19 in England. Methods This study uses document analysis as its data collection method. Its review includes documents, press releases, social media disclosures and health guidance issued by the UK government from March to December, 2020. The data are analysed employing the Foucault’s governmentality and bio-political scholarship. Results The paper’s findings reveal the UK government’s use of integrated calculative technologies of self-governance in the form of risk calculations and metrices/statistics (eg, death tolls, infection rates), performance management (eg, two metre social distancing, and hand washing for twenty seconds) and discipline and control (eg, fourteen days selfisolation), in addition to a more conventional top-down, managerial decision-making process adopted in the past. By these newly initiated “calculative technologies,” the government has “bio-politically” governed the behaviours and lifestyles of vulnerable community members, health workers and general public at a distance, inculcating selfmanagement and individualisation of responsibility. Conclusion The newly adopted calculative technologies used by the UK government created a multi-faceted discourse of obligations, entitlements and scale of engagement, and facilitated directions about what people should do to protect themselves and others from the spread of the virus. Overall, the overtly and idiosyncratically used calculative technologies resemble a unique ‘art of government’ and produce a set of ‘bio-political’ interventions enforcing the populations to manage their own wellbeing and governing them at a distance during COVID-19.

https://www.ijhpm.com/article_4140_b6712d72d784dd88d5ac659db2e0ac50.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 The Effects of Cost Containment and Price Policies on Pharmaceutical Expenditure in South Korea 2198 2207 4142 10.34172/ijhpm.2021.135 EN Woohyeon Kim Korea Institute of Public Finance, Sejong, South Korea Heejo Koo College of Pharmacy, Yonsei Institute of Pharmaceutical Research, Yonsei University, Seoul, South Korea Hye-Jae Lee College of Pharmacy, Woosuk University, Wanju, South Korea Euna Han College of Pharmacy, Yonsei Institute of Pharmaceutical Research, Yonsei University, Seoul, South Korea Journal Article 2020 09 08 Background Policy-makers have proposed and implemented various cost-containment policies for drug prices and quantities to regulate rising pharmaceutical spending. Our study focused on a major change in pricing policy and several incentive schemes for curbing pharmaceutical expenditure growth during the 2010s in Korea. Methods We constructed the longitudinal dataset from 2008-2017 for 12 904 clinics to track the prescriber behavior before and after the implemented policies. Applying an interrupted time series model, we analyzed changes in trends in overall monthly drug expenditure and antibiotic drug expenditure per prescription for outpatient claims diagnosed with three major diseases before and after the policies’ implementation. Results Significant price reductions and incentives for more efficient drug prescriptions resulted in an immediate decrease in monthly drug expenditures in clinics. However, we found attenuated effects over the long run. The topspending clinics showed the highest rate of increase in drug costs. Conclusion Future policy interventions can maximize their effects by targeting high-spending providers.

https://www.ijhpm.com/article_4142_ca677e9dd8f4d072466652c34252441e.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Usefulness of Home Screening for Promoting Awareness of Impaired Glycemic Status and Utilization of Primary Care in a Low Socio-Economic Setting: A Follow-Up Study in Reunion Island 2208 2218 4146 10.34172/ijhpm.2021.114 EN Adrian Fianu INSERM CIC1410, CHU Réunion, Saint-Pierre, France CERPOP, Université de Toulouse, Inserm, UPS, Toulouse, France Éric Doussiet INSERM CIC1410, CHU Réunion, Saint-Pierre, France Nadège Naty INSERM CIC1410, CHU Réunion, Saint-Pierre, France Sylvaine Porcherat INSERM CIC1410, CHU Réunion, Saint-Pierre, France Corinne Mussard INSERM CIC1410, CHU Réunion, Saint-Pierre, France Karim Boussaïd INSERM CIC1410, CHU Réunion, Saint-Pierre, France Muriel Cogne Service de Diabétologie - Site Sud, CHU de la Réunion, Saint-Pierre, France Patrick Gérardin INSERM CIC1410, CHU Réunion, Saint-Pierre, France François Favier ADERC, Saint-Pierre, France Journal Article 2020 07 02 Background Low socio-economic settings are characterized by high prevalence of diabetes and difficulty in accessing healthcare. In these contexts, proximity health services could improve healthcare access for diabetes prevention. Our primary objective was to evaluate the usefulness of home screening for promoting awareness of impaired glycemic status and utilization of primary care among adults aged 18-79 in a low socio-economic setting. Methods This follow-up study was conducted in 2015-2016 in Reunion Island, a French overseas department in the Indian Ocean. Enrollment and screening occurred on the same day at the home of participants (N = 907). Impaired glycemic status was defined as [glycated hemoglobin (HbA1c) ≥5.7%] OR [fasting capillary blood glucose (FCBG) ≥1.10 g/L] OR [HbA1c = 5.5-5.6% and FCBG = 1.00-1.09 g/L]. Medical, socio-cultural, and socio-economic characteristics were collected via a face- to-face questionnaire. A one-month telephone follow-up survey was conducted to determine whether participants had consulted a general practitioner (GP) for confirmation of screening results. A multinomial polytomous logistic regression model was used to identify factors independently associated with non-use of GP consultation for confirmation of screening results and nonresponse to the telephone follow-up survey. Results Prevalence of glycemic abnormalities was 46.0% (95% CI = 42.7-49.2%). Among participants with impaired glycemic status (N = 417), 77.7% (95% CI = 73.7-81.7%) consulted a GP for confirmation of screening results, 12.5% (95% CI = 9.3-15.6%) did not, and 9.8% failed to respond to the follow-up survey. Factors independently associated with nonuse of GP consultation for confirmation of screening results were self-reported unwillingness to consult a GP (adjusted odds ratio [OR]: 4.86, 95% CI = 1.70-13.84), usual GP consultation frequency of less than once a year (adjusted OR: 4.13, 95% CI = 1.56-10.97), and age 18-39 years (adjusted OR: 3.09, 95% CI = 1.46-6.57). Conclusion Home screening for glycemic abnormalities is a useful proximity health service for diabetes prevention in low socio- economic settings. Further efforts, including health literacy interventions, are needed to increase utilization of primary care.

https://www.ijhpm.com/article_4146_509e040d00febe7ff8755a13050456b8.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Management of Conflicts of Interest in WHO’s Consultative Processes on Global Alcohol Policy 2219 2227 4148 10.34172/ijhpm.2021.139 EN June YY Leung SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand Sally Casswell SHORE & Whariki Research Centre, College of Health, Massey University, Auckland, New Zealand Journal Article 2021 05 06 Background The World Health Organization (WHO) has engaged in consultations with the alcohol industry in global alcohol policy development, including currently a draft action plan to strengthen implementation of the Global strategy to reduce the harmful use of alcohol. WHO’s Framework for Engagement with Non-State Actors (FENSA) is an organization-wide policy that aims to manage potential conflicts of interest in WHO’s interactions with private sector entities, non-governmental institutions, philanthropic foundations and academic institutions. Methods We analysed the alignment of WHO’s consultative processes with non-state actors on “the way forward” for alcohol policy and a global alcohol action plan with FENSA. We referred to publicly accessible WHO documents, including the Alcohol, Drugs and Addictive Behaviours Unit website, records of relevant meetings, and other documents relevant to FENSA. We documented submissions to two web-based consultations held in 2019 and 2020 by type of organization and links to the alcohol industry. Results WHO’s processes to conduct due diligence, risk assessment and risk management as required by FENSA appeared to be inadequate. Limited information was published on non-state actors, primarily the alcohol industry, that participated in the consultations, including their potential conflicts of interest. No minutes were published for WHO’s virtual meeting with the alcohol industry, suggesting a lack of transparency. Organizations with known links to the tobacco industry participated in both web-based consultations, despite FENSA’s principle of non-engagement with tobacco industry actors. Conclusion WHO’s consultative processes have not been adequate to address conflicts of interest in relation to the alcohol industry, violating the principles of FENSA. Member states must ensure that WHO has the resources to implement and is held accountable for appropriate and consistent safeguards against industry interference in the development of global alcohol policy.

https://www.ijhpm.com/article_4148_59d422eed25f77613fc6cded7a437861.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 A Review of the User Fees Policy for Primary Healthcare Consultations in Botswana: Problems With Effective Planning, Implementation and Evaluation 2228 2235 4149 10.34172/ijhpm.2021.141 EN Vincent Pagiwa Okavango Research Institute, University of Botswana, Maun, Botswana Alan Shiell School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia Simon Barraclough School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia Onalenna Seitio-Kgokgwe Institute of Development Management, Gaborone, Botswana Journal Article 2020 05 11 Background The Government of Botswana introduced user-fees for primary healthcare consultations in 1975. The policy has remained in place since then, although the fee has remained largely unaltered despite rising inflation. Early reviews of the policy pointed to problems in its implementation, but there has been no evaluation in the past 20 years. The aim of this study was to review the policy to assess whether documented issues with its implementation have been addressed. Methods This qualitative study involved interviews with 32 key informants: 18 policy-makers and 14 front-line revenue collectors. Data were analysed thematically using a template approach with constructs from an established organizational capacity assessment framework used as predetermined categories to guide data collection and analysis. Results Limited administrative and management capacity has been a major hindrance to effective implementation of the policy. The lack of infrastructure for effective revenue collection led to misappropriation of funds. Lack of clear guidelines for health facilities on how to implement the policy generated interdepartmental conflicts. Study participants believed the current policy was unlikely to be cost-effective since the cost of collecting fees probably exceeded the revenue it generated. Conclusion If the Botswana Government persists with the policy then it needs to improve organizational capacity to collect and manage revenues efficiently. However, policy thinking since the turn of the century has turned away from user-charges in healthcare as they impede the move towards universal access. It is timely therefore to consider alternative financing approaches that are more effective and a more equitable means of paying for healthcare.

https://www.ijhpm.com/article_4149_3a250698663171a84f4fb26d001d1eaf.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Developing Framework and Strategies for Capacity Building to Apply Evidence-Informed Health Policy-Making in Iran: Mixed Methods Study of SAHSHA Project 2236 2247 4150 10.34172/ijhpm.2021.142 EN Mahdi Mahdavi The Bernard Lown Scholar in Cardiovascular Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran Javad Sajjadi Khasraghi School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Haniye Sadat Sajadi Knowledge Utilization Research Center, University Research and Development Center, Tehran University of Medical Sciences, Tehran, Iran 0000-0003-0897-4080 Bahareh Yazdizadeh Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran Sima Nikooee Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran Elham Ehsani-Chimeh National Institute for Health Research, Tehran University of Medical Sciences, Tehran, Iran Hossein Dargahi School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Leila Doshmangir Tabriz Health Services Management Research Center, Department of Health Policy & Management, Tabriz University of Medical Sciences, Tabriz, Iran Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran Shahram Ghaffari Iranian Social Security Organization, Tehran, Iran Reza Toyserkanmanesh Social Security Research Institute, Tehran, Iran Reza Majdzadeh Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran Journal Article 2020 08 04 Background SASHA, which stands for “evidence-informed health policy-making (EIHP)” in Persian, is a national project to draw a roadmap for strengthening EIHP in Iran. As a part of SASHA, this research aimed to develop evidencebased and context-aware policy options for increasing the capacity of decision-makers to apply EIHP in Iran. Methods This was a qualitative study, which was informed by a literature review of pull efforts’ capacity building programs. Based on the review, we developed policy options and validated them through an expert panel that involved twelve experts. Data were analyzed using a content analysis method. Results We extracted data from 11 articles. The objectives of capacity building programs were: single-skill development, personal/professional development, and organizational development. According to these objectives, the contents and training methods of the programs vary. Capacity building programs have shown positive impacts on individual knowledge/attitudes to use EIHP. However, the impacts of programs at the organizational or the health system level remain under-researched. We followed several threads from the literature review through to the expert panel that included training the management team, instead of training managers, training for problem-solving skills, and designing tailored programs. Barriers of capacity building for EIHP regard the context of the health system (weak accountability and the widespread conflict of interest) and healthcare organizational structures (decision support systems, knowledge management infrastructures, and lack of management team). Experts suggested interventions on the barriers, particularly on resolving the conflict of interests before launching new programs. A proposed framework to increase the capacity of health policy-makers incorporates strategies at three levels: capacity building program, organizational structure, and health system context. Conclusion To prepare the context of Iranian healthcare organizations for capacity building programs, the conflict of interests needs to be resolved, decision-makers should be made more accountable, and healthcare organizations need to provide more knowledge management infrastructures and decision support systems.

https://www.ijhpm.com/article_4150_130bbe5d84ed33e38879a5bf883695eb.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 How to Realize the Benefits of Point-of-Care Testing at the General Practice: A Comparison of Four High-Income Countries 2248 2260 4151 10.34172/ijhpm.2021.143 EN Deon Lingervelder Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands 0000-0002-6529-2564 Hendrik Koffijberg Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia Jon D. Emery Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, VIC, Australia Paul Fennessy Department of Health & Human Services, State Government of Victoria, Melbourne, VIC, Australia Christopher P. Price Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK Harm Van Marwijk Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Falmer, UK Torunn B. Eide Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway Sverre Sandberg The Norwegian Organisation for Quality Improvement of Laboratory Examinations (NOKLUS), Haraldsplass Deaconess Hospital, Bergen, Norway Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Norwegian Porphyria Centre, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway Jochen W.L. Cals Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Joke T.M. Derksen Sector Zorg, Zorginstituut Nederland, Diemen, The Netherlands Ron Kusters Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands Maarten J. IJzermanx Health Technology and Services Research Department, Technical Medical Centre, University of Twente, Enschede, The Netherlands Cancer Health Services Research, School of Population and Global Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia 0000-0001-5788-5805 Journal Article 2021 03 08 Background In some countries, such as the Netherlands and Norway, point-of-care testing (POCT) is more widely implemented in general practice compared to countries such as England and Australia. To comprehend what is necessary to realize the benefits of POCT, regarding its integration in primary care, it would be beneficial to have an overview of the structure of healthcare operations and the transactions between stakeholders (also referred to as value networks). The aim of this paper is to identify the current value networks in place applying to POCT implementation at general practices in England, Australia, Norway and the Netherlands and to compare these networks in terms of seven previously published factors that support the successful implementation, sustainability and scale-up of innovations. Methods The value networks were described based on formal guidelines and standards published by the respective governments, organizational bodies and affiliates. The value network of each country was validated by at least two relevant stakeholders from the respective country. Results The analysis revealed that the biggest challenge for countries with low POCT uptake was the lack of effective communication between the several organizations involved with POCT as well as the high workload for general practitioners (GPs) aiming to implement POCT. It is observed that countries with a single national authority responsible for POCT have a better uptake as they can govern the task of POCT roll-out and management and reduce the workload for GPs by assisting with set-up, quality control, training and support. Conclusion Setting up a single national authority may be an effective step towards realizing the full benefits of POCT. Although it is possible for day-to-day operations to fall under the responsibility of the GP, this is only feasible if support and guidance are readily available to ensure that the workload associated with POCT is limited and as low as possible.

https://www.ijhpm.com/article_4151_fbc06fb015c32c6cc31f6a3d6118019d.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 What Managers Find Important for Implementation of Innovations in the Healthcare Sector – Practice Through Six Management Perspectives 2261 2271 4154 10.34172/ijhpm.2021.146 EN Klas Palm Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden Ulrika Persson Fischier Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden Journal Article 2020 09 02 Background There is a growing expectation that many health organisations will implement innovations. One obstacle for innovative ideas to have an impact on the healthcare system in practice seems to be difficulties in the implementation phase. There is a lack of concretization of theoretical perspectives related to implementation of innovations. The research question answered by this article is: Which enabling factors can facilitate the specific step of moving from idea generation to implementation in a healthcare context? Methods The research was carried out with a qualitative action research methodology where the researchers took part in the innovation implementation project. The authors of this article were part of a collaborative innovation implementation project involving approximately 54 practitioners. The project was run by five stakeholders: (1) the Division of Assistive Technology in the Dalarna County Council Regional Healthcare Administration, (2) the Habilitation Division, (3) the Division for Home Care and Social Services in the municipality of Leksand, (4) Dalarna University, and (5) Uppsala University. Through a ‘Pearl growing’ technique six implementation management perspectives were, as a framework, identified and presented for the practitioners. The practitioners worked further to concretize these six perspectives. Data was collected through five workshops and collaborations between the researchers and the practitioners. Data was clustered regarding what the managers want to achieve within these six perspectives (ideal situation) and the main means for reaching this situation. Results The study underlying this article generated 35 concrete enabling factors for successful innovation implementation, distributed over the initially presented six theoretical perspectives. Conclusion Concretizing management principles into enabling factors shows, on the one hand, that the theoretical principles have practical value, but on the other that they must be adopted to the specific circumstances of each organization, and that too abstract principles can hardly be operationalized.

https://www.ijhpm.com/article_4154_31be846d276e258bbd008f13707e148b.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 The Economic Value of Non-professional Care: A Europe-Wide Analysis 2272 2286 4157 10.34172/ijhpm.2021.149 EN Luz María Peña-Longobardo Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain Juan Oliva-Moreno Faculty of Law and Social Sciences, University of Castilla-La Mancha, Toledo, Spain Journal Article 2020 09 16 Background This paper had two aims. Firstly, to provide a broader view of the profile of non-professional caregivers in Europe, and secondly, to estimate the economic value of the non-professional caregiving. Methods The European Quality of Life Survey 2016/2017, carried out by Eurofound, was used. The target population of the survey was adults who care for a relative or friend in a total of 33 European countries. The opportunity cost method was used to estimate the economic value of caregiving, in which two of the activities forgone were analysed: paid activities (restricted to caregivers who were employed), for which the average gross wage of each country was used; and unpaid activities, for which the minimum gross wage of each country was used. Results There were more than 76 million non-professional caregivers in Europe that provide care for a relative or friend. This figure represents 12.7% of the population in Europe. The estimated time devoted to non-professional care in Europe reached 72 301.5 million hours in 2016. Sharp differences were found among countries. The economic value of that time is estimated at 576 000 million of euros, which represented about 3.63% of Europe’s gross domestic product (GDP). Conclusion This study shows the very important number of resources dedicated to the non-professional care of dependent people and their economic valuation. These results may be helpful in prospective analyses estimating future needs on professional and non-professional and for designing of long-term care (LTC) policies in Europe.

https://www.ijhpm.com/article_4157_1ee1206e961401dd3189eac3835989e0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Social Media as a Tool for Consumer Engagement in Hospital Quality Improvement and Service Design: Barriers and Enablers for Implementation 2287 2298 4160 10.34172/ijhpm.2021.151 EN Louisa Walsh Centre for Health Communication and Participation, La Trobe University, Bundoora, VIC, Australia Nerida Hyett La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia 0000-0003-0554-1773 Jayne Howley Independent Researcher, Melbourne, VIC, Australia Nicole Juniper Orygen, Parkville, VIC, Australia Chi Li Albury Woonga Health, Wodonga, VIC, Australia Belinda MacLeod-Smith Safer Care Victoria, Melbourne, VIC, Australia Sophie Rodier Northern Health, Bundoora, Australia Sophie Hill Centre for Health Communication and Participation, La Trobe University, Bundoora, VIC, Australia Journal Article 2021 04 09 Background Social media can be used to engage consumers in hospital service design and quality improvement (QI) activities, however its uptake may be limited by a lack of guidance to support implementation. This article presents the perceived barriers and enablers in using social media for consumer engagement derived from an interview study with public hospital stakeholders. Methods Semi-structured interviews with 26 Australian hospital service providers and consumer representatives. Data were analysed using a deductive content analysis method. Results Data were collected between October 2019 and April 2020. Facebook was the platform most commonly used for consumer engagement activities. Barriers and enablers to social media-based consumer engagement were identified. The barrier themes were (1) fears and concerns; (2) lack of skills and resources for social media engagement; (3) lack of organisational processes and support; and (4) problems with social media platforms and the changing social media landscape. The enabler themes were: (1) hospitals facilitating access and use; (2) making discussions safe; (3) cultivating a social media community; and (4) building on success. Conclusion Using social media to facilitate consumer engagement in hospital service design and QI activities is feasible and acceptable to service providers and consumers. Hospitals and their executives can create a supportive environment for social media-based engagement activities through developing clear governance systems and providing training and support to all users. Consumers need to be involved in co-designing social media-based activities and determining which forms of engagement are accessible and acceptable. For some consumers and service providers, barriers such as a lack of resources and distrust of social media companies might mean that social media-based engagement will be less acceptable for them. Because of this it is important that hospitals provide complementary methods of engagement (eg, face-to-face) alongside social media-based methods.

https://www.ijhpm.com/article_4160_f61c6f3eda41c237d438c19a88e0e40f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Measuring the Protective Effect of Health Insurance Coverage on Out-of-Pocket Expenditures During the COVID-19 Pandemic in the Peruvian Population 2299 2307 4162 10.34172/ijhpm.2021.154 EN Akram Hernández-Vásquez Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru Carlos Rojas-Roque Universidad de Buenos Aires, Buenos Aires, Argentina Antonio Barrenechea-Pulache Universidad Científica del Sur, Lima, Peru Guido Bendezu-Quispe Centro de Investigación Epidemiológica en Salud Global, Universidad Privada Norbert Wiener, Lima, Peru Journal Article 2021 06 30 Background Health insurance coverage is expected to protect individuals from out-of-pocket (OOP) expenditures, potentially preventing them from falling into poverty. However, to date, the effect of health insurance on OOP spending during the coronavirus disease 2019 (COVID-19) pandemic has not been fully explored. This study aimed to estimate differences in the proportion and the amount of OOP expenditures among Peruvians during the pre- and post- mandatory lockdown response to COVID-19 in 2020 according to the health insurance coverage status. Methods This study utilized repeated cross-sectional data from the National Household Survey on Living and Poverty Conditions (ENAHO) from the first quarter of 2017 until the fourth quarter of 2020. The outcomes were (i) the proportion of individuals who incurred OOP expenditures and (ii) the monetary value of OOP expenditures. An interrupted time series analysis (ITS) and a quasi-experimental difference-in-difference (DID) analysis were performed to examine the outcomes among the control (individuals without health insurance) and treatment groups (individuals with health insurance) after the COVID-19 pandemic. Results ITS analysis showed that the proportion of individuals reporting OOP expenditures after implementation of mandatory lockdown due to COVID-19 in Peru decreased in both groups, but no difference in the slope trend was found (P = .916). The average quarterly amount of OOP spending increased in both groups, but no difference in the slope trend was found (P = .073). Lastly, the DID analysis showed that the mandatory lockdown was associated with a higher amount of OOP, but there was no evidence to indicate that the higher amount was different between the control and treatment groups. Conclusion The mandatory lockdown in response to the COVID-19 was associated with a higher amount of OOP expenditures and a lower likelihood of incurring OOP expenditures. However, our findings suggest that health insurance coverage does not lower OOP expenditures or reduce the likelihood of incurring OOP expenditures.

https://www.ijhpm.com/article_4162_9246a2dfb42bd410b1120004d1145622.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Implementing Universal and Targeted Policies for Health Equity: Lessons From Australia 2308 2318 4164 10.34172/ijhpm.2021.157 EN Matthew Fisher Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia Patrick Harris Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia Toby Freeman Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia Tamara Mackean College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia The George Institute for Global Health, Sydney, NSW, Australia Emma George School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia Sharon Friel RegNet School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia Fran Baum Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, SA, Australia Journal Article 2021 05 28 Background Debate continues in public health on the roles of universal or targeted policies in providing equity of access to health- related goods or services, and thereby contributing to health equity. Research examining policy implementation can provide fresh insights on these issues. Methods We synthesised findings across case studies of policy implementation in four policy areas of primary healthcare (PHC), telecommunications, Indigenous health and land use policy, which incorporated a variety of universal and targeted policy structures. We analysed findings according to three criteria of equity in access – availability, affordability and acceptability – and definitions of universal, proportionate-universal, targeted and residual policies, and devolved governance structures. Results Our analysis showed that existing universal, proportionate-universal and targeted policies in an Australian context displayed strengths and weaknesses in addressing availability, affordability and acceptability dimensions of equity in access. Conclusion While residualist policies are unfavourable to equity of access, other forms of targeting as well as universal and proportionate-universal structure have the potential to be combined in context-specific ways favourable to equity of access to health-related goods and services. To optimise benefits, policies should address equity of access in the three dimensions of availability, affordability and acceptability. Devolved governance structures have the potential to augment equity benefits of either universal or targeted policies.

https://www.ijhpm.com/article_4164_7fb89e8ede56e0ea8e41b1ce64521865.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Evidence-Informed Deliberative Processes for Legitimate Health Benefit Package Design − Part I: Conceptual Framework 2319 2326 4165 10.34172/ijhpm.2021.158 EN Rob Baltussen Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Maarten Jansen Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Wija Oortwijn Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Journal Article 2021 04 09 Background Countries around the world are increasingly rethinking the design of their health benefit packages to achieve universal health coverage (UHC). Health technology assessment (HTA) bodies support governments in these decisions, but employ value frameworks that do not sufficiently account for the intrinsically complex and value-laden political reality of benefit package design. Methods Several years ago, evidence-informed deliberative processes (EDPs) were developed to address this issue. An EDP is a practical and stepwise approach for HTA bodies to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, and to interpret available evidence on these values. We further developed the conceptual framework and initial 2019 guidance based on academic knowledge exchange, analysing practices of HTA bodies, surveying HTA bodies and experts around the globe, and implementation of EDPs in several countries around the world. Results EDPs stem from the general concept of legitimacy, which is translated into four elements – stakeholder involvement ideally operationalised through stakeholder participation with deliberation; evidence-informed evaluation; transparency; and appeal. The 2021 practical guidance distinguishes six practical steps of a HTA process and provides recommendations on how these elements can be implemented in each of these steps. Conclusion There is an increased attention for legitimacy, deliberative processes for HTA and health benefit package design, but the development of theories and methods for such processes remain behind. The added value of EDPs lies in the operationalisation of the general concept of legitimacy into practical guidance for HTA bodies.

https://www.ijhpm.com/article_4165_c19f7d194876169f8659e79b4a8e94c1.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide 2327 2336 4166 10.34172/ijhpm.2021.159 EN Wija Oortwijn Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Maarten Jansen Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Rob Baltussen Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands Journal Article 2021 04 09 Background Countries around the world are using health technology assessment (HTA) for health benefit package design. Evidence-informed deliberative processes (EDPs) are a practical and stepwise approach to enhance legitimate health benefit package design based on deliberation between stakeholders to identify, reflect and learn about the meaning and importance of values, informed by evidence on these values. This paper reports on the development of practical guidance on EDPs, while the conceptual framework of EDPs is described in a companion paper. Methods The first guide on EDPs (2019) is further developed based on academic knowledge exchange, surveying 27 HTA bodies and 66 experts around the globe, and the implementation of EDPs in several countries. We present the revised steps of EDPs and how selected HTA bodies (in Australia, Brazil, Canada, France, Germany, Scotland, Thailand and the United Kingdom) organize key issues of legitimacy in their processes. This is based on a review of literature via PubMed and HTA bodies’ websites. Results HTA bodies around the globe vary considerable in how they address legitimacy (stakeholder involvement ideally through participation with deliberation; evidence-informed evaluation; transparency; and appeal) in their processes. While there is increased attention for improving legitimacy in decision-making processes, we found that the selected HTA bodies are still lacking or just starting to develop activities in this area. We provide recommendations on how HTA bodies can improve on this. Conclusion The design and implementation of EDPs is in its infancy. We call for a systematic analysis of experiences of a variety of countries, from which general principles on EDPs might subsequently be inferred.<br style="font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px;" />

https://www.ijhpm.com/article_4166_079925c67897a931add5b8bd457d79af.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Systems Science and Evidence-Informed Deliberation to Mitigate Dilemmas in Situations of Dual Agency at the Hospital Level; Comment on “Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations” 2337 2339 4220 10.34172/ijhpm.2022.6940 EN Leon Bijlmakers Department for Health Evidence (HEV), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands Journal Article 2021 11 14 The article by Waitzberg et al on dual agency in hospitals reports on three strategies to mitigate dilemmas arising from conflicting clinical and economic considerations. This could be further explored by using systems science methods that allow in-depth analyses of (health) system dynamics, networks, and agent-based modelling, and that take into account local context, incentives and how institutions work. Future studies may also draw on the literature of multi-criteria decision-making and evidence-informed deliberative processes (EDPs) that are increasingly being used to optimise legitimate health benefit package design. Toolkits to assist hospital professionals in improving their decision-making need to be practical, with ample attention for the process of decision-making, including transparency, use of evidence, and opportunities for health professionals (and possibly others stakeholders) to contest or formally appeal against certain decisions.

https://www.ijhpm.com/article_4220_387dd4e691e127c1450f28d2b00f1184.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 In Need of Renewal Rather Than Reconciliation: Why We Cannot Be Satisfied With Hospital Management’s Status Quo; Comment on “Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?” 2340 2342 4222 10.34172/ijhpm.2022.6859 EN Benjamin Ewert Department of Health Sciences, Fulda University of Applied Sciences, Fulda, Germany Journal Article 2021 10 14 Activity-based payment systems enforce Israeli and German hospital professionals to continuously balance clinical and economic considerations. As argued this status quo is unsatisfactory due to two reasons. First, professional hybridity in hospital management is restricted to the physician versus manager dichotomy rather than a multifaceted-identity framework. Second, by depending mostly on serendipity rather than hospital professionals’ organizational leeway applied reconciliation strategies seem extremely temporarily and brittle. As concluded, alternative models of hospital funding and organization such as global budgets are urgently needed. In addition, hospital professionals have to be empowered to make effectively us from their hybrid identities.

https://www.ijhpm.com/article_4222_faab5b17d0ab40bddce582e52fee7107.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Hospital Professionals as Dual Agents: A Superordinate Identity to Solve Interprofessional Conflicts in Hospitals?; Comment on “Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?” 2343 2345 4224 10.34172/ijhpm.2022.6928 EN Rosalía Cascón-Pereira Business Management Department, University Rovira i Virgili, Reus, Spain Journal Article 2021 11 09 The inherent conflict between economic and clinical considerations, between professionalism and managerialism, and between being a manager or being a clinician is widely acknowledged in the sociology of professions. The original article by Waitzberg and colleagues focused on how hospital professionals reconcile these conflicting demands. In this commentary, we argue that their assumption that the considered hospital professionals (managers, chief financial officers [CFOs], chief physicians and practising physicians) are dual agents moves on from the unproductive debates of inherent conflicts to envisage possibilities of reconciling economic and clinical considerations. We conclude that the instrumental use of the term dual agent to include “the other” (the manager or the clinician) in a superlative and inclusive category can be considered a reframing strategy to solve inherent interprofessional conflicts and to implement more collaborative models in healthcare.

https://www.ijhpm.com/article_4224_bd775c37e65a23acaa498d06963d8232.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 If It Is Complex, Let It Be Complex – Dealing With Institutional Complexity in Hospitals; Comment on “Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?” 2346 2348 4228 10.34172/ijhpm.2022.6922 EN Thomas Andersson School of Business, University of Skövde, Skövde, Sweden Faculty of Theology, Diaconal & Leadership, VID Specialized University, Oslo, Norway 0000-0002-1989-2745 Journal Article 2021 11 08 Waitzberg and colleagues identified strategies that managers and physicians in hospitals apply to reconcile dilemmas between clinical and economic considerations. Contributions that actually acknowledge the institutional complexity of hospitals and describe how to deal with it are rare. This comment explains the reason behind the institutional complexity in healthcare organizations and argues that institutional complexity is a good foundation for a wellfunctioning and sustainable healthcare, as long as we are able to deal with this complexity. This point underscores the importance of their contribution. However, even if the identified strategies on how to reconcile and balance different, competing demands are important, they are not easy to apply in practice. First, the strategies require frequent and high-quality interaction between different actors adhering to different institutional logics. Second, even when the strategies are applied successfully, it is difficult to make them sustainable since they rest on a fragile balance between competing logics. However, these are important avenues for future research for researchers who want to follow the route of Waitzberg and colleagues.

https://www.ijhpm.com/article_4228_af960a686b743756d9c85a2210940aac.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Moral Lacunae in the Management of Dual Agency Dilemmas; Comment on “Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?” 2349 2351 4234 10.34172/ijhpm.2022.6779 EN Wendy Lipworth Department of Philosophy, Macquarie University, Sydney, NSW, Australia Journal Article 2021 09 14 Waitzberg and colleagues’ participants articulate a wide range of strategies to manage tensions between clinical and economic obligations. There are, however, three notable absences in the data. First, all strategies described by participants are underpinned by the assumption that clinical (and associated administrative) practices need to either align with economic considerations or be made more compatible with them. Second, the dual agency dilemma was framed exclusively as existing at the level of the health care institution, with little attention paid to obligations to broader health systems. Third, there was no evidence of critical questioning of the priorities of the hospitals in which participants work. These absences do not render the strategies used by Weitzberg and colleagues’ participants morally “wrong,” but they do suggest that people who are deeply embedded in a system might fail to recognise the full range of moral concerns and moral possibilities.

https://www.ijhpm.com/article_4234_1514eec98819c6f618f8d328e859af8f.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Dual Goals, Dual Agency: The Perils of Measurement and Control; Comment on “Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?” 2352 2354 4244 10.34172/ijhpm.2022.6764 EN Henrich R. Greve INSEAD, Singapore, Singapore Journal Article 2021 09 07 This commentary to Waitzberg et al draws on the research stream on organizational goals in management to examine the findings they report, point out the correspondence of their findings and interpretation with existing theory, including development beyond it. Their work discusses these considerations very well. It also suggests paths to further theoretical development and proposes how their work demonstrate the potential for further research on multiple goals in hospitals. Such research will be important both for health policy and management and for management theory and practice generally.

https://www.ijhpm.com/article_4244_eb1e4cea0b1a2ecedc045e4b7720ef59.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Navigating Dichotomies and Dilemmas; Comment on “Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?” 2355 2357 4263 10.34172/ijhpm.2022.6965 EN Stephen Sirris VID Specialized University, Oslo, Norway Journal Article 2021 11 27 The complexity within healthcare typically surfaces in tensions between organizational efficiency and professional values when hospital managers and professionals face dilemmas between economic and clinical considerations. Waitzberg et al, based on interviews with managers and physicians working in Israeli and German hospitals, explore strategies to cope with such dilemmas to safeguard both financial sustainability and patient quality. This short commentary provides some follow-up questions in two ways. First, I highlight the importance of nuancing and hybridizing the dichotomies that lead to dilemmas in the hospital context. Second, I discuss how such dilemmas can be highlighted in systematic group reflection which in turn can inform decision-making.

https://www.ijhpm.com/article_4263_8f6b783904f138bd6ce341afa6d879c6.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 The Dilemmas of Leading Health Organizations in Complex Settings; Comment on “Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?” 2358 2360 4298 10.34172/ijhpm.2022.7252 EN Ian Greener University of Strathclyde, Glasgow, UK Journal Article 2022 03 16 Waitzberg and colleagues’ research explores hospital managers, chief physicians and other physicians in German and Israeli hospitals, making use of thematic analysis to explore what they call ‘dilemmas’ between the commitments to clinical needs, and their hospitals’ financial sustainability. This commentary will provide a summary of the paper, into which I will embed some items I will follow-up on in my second half. The second half will then explore these items in greater depth, considering the strengths and weaknesses of the article. I then make some suggestions for future work based around the findings the authors present in terms of managerial and clinical identity, how compromises are reached in hospital settings, and how we compare different health systems.<br style="font-style: normal; font-variant: normal; font-weight: normal; letter-spacing: normal; line-height: normal; orphans: 2; text-align: -webkit-auto; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-size-adjust: auto; -webkit-text-stroke-width: 0px;" />

https://www.ijhpm.com/article_4298_f10bdd0a46fc0ecb142a16fd4e331aa0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Improving District Hospital Surgical Capacity in Resource Limited Settings: Challenges and Lessons From South Africa; Comment on “Improving Access to Surgery through Surgical Team Mentoring – Policy Lessons From Group Model Building with Local Stakeholders in Malawi” 2361 2364 4202 10.34172/ijhpm.2022.6937 EN Lynn Bust Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa Kathryn Chu Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa Department of Surgery, University of Botswana, Gaborone, Botswana Journal Article 2021 11 12 Strengthening surgical capacity of district hospitals (DHs) in low- and middle-income countries (LMICs) has been recognised globally as key to improving equitable access to surgical care. This commentary considers the benefits and challenges of surgical mentoring in South Africa and applies the lessons learned to other low-resource settings. Surgical team mentoring programmes require consideration of all stakeholders involved, with strong relationships between mentors and mentees, and the possible establishment of roaming district surgical teams. Other components of a surgical ecosystem must also be strengthened including defining a DH surgical package of care, ensuring strong referral systems through a hub and spoke model, and routine monitoring and evaluation. These recommendations have the potential to strengthen surgical capacity in DHs in low-resource settings which is critical to achieving health for all.

https://www.ijhpm.com/article_4202_dfd1bad1ce1d23fbd400397936eaaa9c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Optimising the Conceptualisation of Context; Comment on “Stakeholder Perspectives of Attributes and Features of Context Relevant to Knowledge Translation in Health Settings: A Multi-country Analysis” 2365 2367 4307 10.34172/ijhpm.2022.6900 EN Jo Rycroft-Malone Faculty of Health & Medicine, Lancaster University, Lancaster, UK Lisa Rogers University College Dublin Centre for Interdisciplinary Research, Education, and Innovation in Health Systems (UCD IRIS), University College Dublin, Dublin 4, Ireland Health Sciences Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin 4, Ireland Christopher R. Burton School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK Journal Article 2021 10 29 Context matters. Therefore, efforts to develop greater conceptual clarity are important for science and practice. In this commentary, we outline some key issues that were prompted by Squires and colleagues’ contribution. Specifically, we reinforce context as an interactive concept and therefore something that is hard to ‘pin down,’ the problematic nature of conceptualising context in implementation and de-implementation, and a requirement for the development of culturally sensitive understandings. Finally, we suggest it is vital that continued investment into providing a more comprehensive list of determinants needs to be accompanied by an equal effort in developing practical methods and tools to support use and application.

https://www.ijhpm.com/article_4307_56262b0bc98379320a0f8b063db173e0.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 11 10 2022 10 01 Telehealth, COVID-19 and Refugees and Migrants in Australia: Policy and Related Barriers and Opportunities for More Inclusive Health and Technology Systems 2368 2372 4027 10.34172/ijhpm.2021.31 EN Ben O’Mara Department of Media and Communication, Faculty of Health, Arts and Design, Swinburne University, Melbourne, VIC, Australia Devaki Monani School of Social Work, College of Health and Human Sciences, Charles Darwin University, Casuarina, NT, Australia Gemma Carey Centre for Social Impact, University of New South Wales, Sydney, NSW, Australia Journal Article 2021 02 02

https://www.ijhpm.com/article_4027_ac57cdfa4a81853683cf724db1d6a297.pdf