Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396420170401Four Challenges That Global Health Networks Face183189332010.15171/ijhpm.2017.14ENJeremyShiffmanDepartment of Public Administration and Policy, School of Public Affairs, American University, Washington, DC, USA0000-0002-1693-4671Journal Article20161031Global health networks, webs of individuals and organizations with a shared concern for a particular condition, have proliferated over the past quarter century. They differ in their effectiveness, a factor that may help explain why resource allocations vary across health conditions and do not correspond closely with disease burden. Drawing on findings from recently concluded studies of eight global health networks—addressing alcohol harm, early childhood development (ECD), maternal mortality, neonatal mortality, pneumonia, surgically-treatable conditions, tobacco use, and tuberculosis—I identify four challenges that networks face in generating attention and resources for the conditions that concern them. The first is<em> problem definition</em>: generating consensus on what the problem is and how it should be addressed. The second is <em>positioning</em>: portraying the issue in ways that inspire external audiences to act. The third is <em>coalition-building</em>: forging alliances with these external actors, particularly ones outside the health sector. The fourth is governance: establishing institutions to facilitate collective action. Research indicates that global health networks that effectively tackle these challenges are more likely to garner support to address the conditions that concern them. In addition to the effectiveness of networks, I also consider their legitimacy, identifying reasons both to affirm and to question their right to exert power.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396420170401Diplomacy and Health: The End of the Utilitarian Era191194330610.15171/ijhpm.2016.155ENSebastianKevanyUniversity of California, San Francisco, CA, USAhttps://orcid.org/00MarcusMatthewsAmur Consultancy, Dublin,
IrelandJournal Article20160529Cost-effectiveness analysis (CEA), as a system of allocative efficiency for global health programs, is an influential criterion for resource allocation in the context of diplomacy and inherent foreign policy decisions therein. This is because such programs have diplomatic benefits and costs that can be uploaded from the recipient and affect the broader foreign policy interests of the donor and the diplomacy landscape between both parties. These diplomatic implications are vital to the long-term success of both the immediate program and any subsequent programs; hence it is important to articulate them alongside program performance, in terms of how well their interrelated interventions were perceived by the communities served. Consequently, the exclusive focus of cost-effectiveness on medical outcomes ignores (1) the potential non-health benefits of less cost-effective interventions and (2) the potential of these collateral gains to form compelling cases across the interdisciplinary spectrum to increase the overall resource envelope for global health. The assessment utilizes the Kevany Riposte’s “K-Scores” methodology, which has been previously applied as a replicable evaluation tool<sup>1</sup> and assesses the trade-offs of highly costeffective but potentially “undiplomatic” global health interventions. Ultimately, we apply this approach to selected HIV/AIDS interventions to determine their wider benefits and demonstrate the value alternative evaluation and decision-making methodologies. Interventions with high “K-Scores” should be seriously considered for resource allocation independent of their cost-effectiveness. “Oregon Plan” thresholds<sup>2</sup> are neither appropriate nor enforceable in this regard while “K-Score” results provide contextual information to policy-makers who may have, to date, considered only cost-effectiveness data. While CEA is a valuable tool for resource allocation, its use as a utilitarian focus should be approached with caution. Policy-makers and global health program managers should take into account a wide range of outcomes before agreeing upon selection and implementation.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396420170401Sustainability of Long-term Care: Puzzling Tasks Ahead for Policy-Makers195205325410.15171/ijhpm.2016.109ENIlariaMoscaDivision of Health Systems and Public Health, World Health Organization
Regional Office for Europe, Copenhagen, DenmarkEcorys Netherlands B.V.,
Rotterdam, The NetherlandsPhilip J.Van Der WeesRadboud University Medical Center, Nijmegen,
The NetherlandsRadboud Institute for Health Sciences, Nijmegen, The
NetherlandsCelsus Academy for Sustainable Healthcare, and Scientific
Institute for Quality of Healthcare, Nijmegen, The NetherlandsEsther S.MotCPB Netherlands
Bureau for Economic Policy Analysis, The Hague, The NetherlandsJoost J.G.WammesRadboud University Medical Center, Nijmegen,
The NetherlandsRadboud Institute for Health Sciences, Nijmegen, The
NetherlandsCelsus Academy for Sustainable Healthcare, and Scientific
Institute for Quality of Healthcare, Nijmegen, The NetherlandsPatrick P.T.JeurissenRadboud University Medical Center, Nijmegen,
The NetherlandsRadboud Institute for Health Sciences, Nijmegen, The
NetherlandsCelsus Academy for Sustainable Healthcare, and Scientific
Institute for Quality of Healthcare, Nijmegen, The Netherlands0000-0002-4198-2448Journal Article20150921Background <br />The sustainability of long-term care (LTC) is a prominent policy priority in many Western countries. LTC is one of the most pressing fiscal issues for the growing population of elderly people in the European Union (EU) Member States. Country recommendations regarding LTC are prominent under the EU’s European Semester. <br /> <br />Methods <br />This paper examines challenges related to the financial- and organizational sustainability of LTC systems in the EU. We combined a targeted literature review and a descriptive selected country analysis of: (1) public- and private funding; (2) informal care and externalities; and (3) the possible role of technology in increasing productivity. Countries were selected via purposive sampling to establish a cohort of country cases covering the spectrum of differences in LTC systems: public spending, private funding, informal care use, informal care support, and cash benefits. <br /> <br />Results <br />The aging of the population, the increasing gap between availability of informal care and demand for LTC, substantial market failures of private funding for LTC, and fiscal imbalances in some countries, have led to structural reforms and enduring pressures for LTC policy-makers across the EU. Our exploration of national policies illustrates different solutions that attempt to promote fairness while stimulating efficient delivery of services. Important steps must be taken to address the sustainability of LTC. First, countries should look deeper into the possibilities of complementing public- and private funding, as well as at addressing market failures of private funding. Second, informal care externalities with spill-over into neighboring policy areas, the labor force, and formal LTC workers, should be properly addressed. Thirdly, innovations in LTC services should be stimulated to increase productivity through technology and process innovations, and to reduce costs. <br /> <br />Conclusion <br />The analysis shows why it is difficult for EU Member State governments to meet all their goals for sustainable LTC, given the demographic- and fiscal circumstances, and the complexities of LTC systems. It also shows the usefulness to learn from policy design and implementation of LTC policy in other countries, within and outside the EU. Researchers can contribute by studying conditions, under which the strategies explored might deliver solutions for policy-makersKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396420170401Barriers to the Implementation of the Health and Rehabilitation Articles of the United Nations Convention on the Rights of Persons with Disabilities in South Africa207218326610.15171/ijhpm.2016.117ENMeghanHusseyCentre for Global Health, Trinity College Dublin, Dublin 2, IrelandMalcolmMacLachlanSchool of
Psychology, Trinity College Dublin, Dublin 2, IrelandGubelaMjiCentre for Rehabilitation
Studies, Department of Interdisciplinary Health Sciences, School of Medicine
and Health Sciences, Stellenbosch University, Cape Town, South AfricaJournal Article20151204Background <br />The United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) is a milestone in the recognition of the human rights of persons with disabilities, including the right to health and rehabilitation. South Africa has signed and ratified the CRPD but still has a long way to go in reforming policies and systems in order to be in compliance with the convention. This paper seeks to fill a gap in the literature by exploring what the barriers to the implementation of the health and rehabilitation articles of the CRPD are, as identified by representatives of the disability community. <br /> <br />Methods <br />This investigation used a qualitative, exploratory methodology. 10 semi-structured interviews of a purposive sample of representatives of disabled persons organizations (DPOs), non-governmental organizations (NGOs), and service providers in South Africa were conducted. Participants were drawn from urban, peri-urban, and rural settings in order to reflect diverse perspectives within South Africa. Data was analysed using a multi-stage coding process to establish the main categories and relationships between them. <br /> <br />Results <br />Six main categories of barriers to the implementation of the health and rehabilitation articles of the CRPD were identified. Attitude barriers including stigma and negative assumptions about persons with disabilities were seen as an underlying cause and influence on all of the other categories; which included political, financial, health systems, physical, and communication barriers. <br /> <br />Conclusion <br />The findings of this study have important implications for strategies and actions to implement the CRPD. Given the centrality of attitudinal barriers, greater sensitization around the area of disability is needed. Furthermore, disability should be better integrated and mainstreamed into more general initiatives to develop the health system and improve the lives of persons living in poverty in South Africa.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396420170401Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis219228327510.15171/ijhpm.2016.127ENMostafaAmini RaraniDepartment of Health Management and Economics, School of Public Health,
Tehran University of Medical Sciences, Tehran, IranHealth Management and
Economics Research Center, Isfahan University of Medical Sciences, Isfahan,
Iran0000-0002-4809-2237ArashRashidianDepartment of Health Management and Economics, School of Public Health,
Tehran University of Medical Sciences, Tehran, Iran0000-0002-4005-5183ArdeshirKhosraviDeputy of Public Health, Ministry of Health and Medical Education,
Tehran, IranMohammadArabDepartment of Health Management and Economics, School of Public Health,
Tehran University of Medical Sciences, Tehran, Iran0000-0002-5637-287XEzatollahAbbasianDepartment of Economics, Bu-Ali Sina University, Hamadan, IranEsmaeilKhedmati MorasaeDepartment of Public Health, Qom University of Medical Sciences, Qom, IranCentre for System Studies (CSS), Hull University Business School (HUBS),
Hull York Medical School (HYMS), University of Hull, Hull, UKJournal Article20160314Background <br />Exploring changes in health inequality and its determinants over time is of policy interest. Accordingly, this study aimed to decompose inequality in neonatal mortality into its contributing factors and then explore changes from 1995-2000 to 2005-2010 in Iran. <br /> <br />Methods <br />Required data were drawn from two Iran’s demographic and health survey (DHS) conducted in 2000 and 2010. Normalized concentration index (CI) was used to measure the magnitude of inequality in neonatal mortality. The contribution of various determinants to inequality was estimated by decomposing concentration indices in 1995-2000 and 2005-2010. Finally, changes in inequality were investigated using Oaxaca-type decomposition technique. <br /> <br />Results <br />Pro-rich inequality in neonatal mortality was declined by 16%, ie, the normalized CI dropped from -0.1490 in 1995-2000 to -0.1254 in 2005-2010. The largest contribution to inequality was attributable to mother’s education (32%) and household’s economic status (49%) in 1995-2000 and 2005-2010, respectively. Changes in mother’s educational level (121%), use of skilled birth attendants (79%), mother’s age at the delivery time (25-34 years old) (54%) and using modern contraceptive (29%) were mainly accountable for the decrease in inequality in neonatal mortality. <br /> <br />Conclusion <br />Policy actions on improving households’ economic status and maternal education, especially in rural areas, may have led to the reduction in neonatal mortality inequality in Iran.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396420170401Universal Health Coverage and Primary Healthcare: Lessons From Japan; Comment on “Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries”229231326510.15171/ijhpm.2016.120ENGeraldBloomInstitute of Development Studies, University of Sussex, Brighton, UKJournal Article20160804A recent editorial by Naoki Ikegami has proposed three key lessons from Japan’s experience of achieving virtually universal coverage with primary healthcare services: the need to integrate the existing providers of primary healthcare services into the organised health system; the need to limit government commitments to finance hospital services and the need to empower providers of primary healthcare to influence decisions that influence their livelihoods. Although the context of low- and middle-income countries (LMICs) differs in many ways from Japan in the late 19th and early 20th centuries, the lesson that short-term initiatives to achieve universal coverage need to be complemented by an understanding of the factors influencing long-term change management remains highly relevant.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396420170401Health Technology Assessment: Global Advocacy and Local Realities; Comment on “Priority Setting for Universal Health Coverage: We Need Evidence-Informed Deliberative Processes, Not Just More Evidence on Cost-Effectiveness”233236326710.15171/ijhpm.2016.118ENKalipsoChalkidouInstitute of Global Health Innovation, Imperial College London, London, UKRyanLiInstitute of Global Health Innovation, Imperial College London, London, UKAnthony J.CulyerDepartment of Economics & Related Studies and Centre for Health Economics,
University of York, York, UK0000-0002-8896-8491AmandaGlassmanCenter for Global Development, Washington,
DC, USAKaren J.HofmanSchool of Public Health, Faculty of Health Sciences, University
of the Witwatersrand, Johannesburg, South Africa0000-0001-9512-7220YotTeerawattananonHealth Intervention and
Technology Assessment Program (HITAP), Nonthaburi, ThailandJournal Article20160723Cost-effectiveness analysis (CEA) can help countries attain and sustain universal health coverage (UHC), as long as it is context-specific and considered within deliberative processes at the country level. Institutionalising robust deliberative processes requires significant time and resources, however, and countries often begin by demanding evidence (including local CEA evidence as well as evidence about local values), whilst striving to strengthen the governance structures and technical capacities with which to generate, consider and act on such evidence. In low- and middle-income countries (LMICs), such capacities could be developed initially around a small technical unit in the health ministry or health insurer. The role of networks, development partners, and global norm setting organisations is crucial in supporting the necessary capacities.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396420170401History, Structure and Agency in Global Health Governance; Comment on “Global Health Governance Challenges 2016 – Are We Ready?”237241326810.15171/ijhpm.2016.119ENStephenGillDepartment of Political Science, York University, Toronto, ON, CanadaSolomon R.BenatarUniversity of Cape Town, Cape Town, South AfricaDalla Lana School of
Public Health, University of Toronto, Toronto, ON, CanadaJournal Article20160729Ilona Kickbusch’s thought provoking editorial is criticized in this commentary, partly because she fails to refer to previous critical work on the global conditions and policies that sustain inequality, poverty, poor health and damage to the biosphere and, as a result, she misreads global power and elides consideration of the fundamental historical structures of political and material power that shape agency in global health governance. We also doubt that global health can be improved through structures and processes of multilateralism that are premised on the continued reproduction of the ecologically myopic and socially unsustainable market civilization model of capitalist development that currently prevails in the world economy. This model drives net financial flows from poor to rich countries and from the poor to the affluent and super wealthy individuals. By contrast, we suggest that significant progress in global health requires a profound and socially just restructuring of global power, greater global solidarity and the “development of sustainability.”Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396420170401Trade Policy and Health: Adding Retrospective Studies to the Research Agenda; Comment on “The Trans-Pacific Partnership: Is It Everything We Feared for Health?”243244327210.15171/ijhpm.2016.123ENChantalBlouinCentre for Interdisciplinary Studies on International Trade and Investment, Institute for Advanced International Studies (HEI), Université Laval,
Quebec City, QC, CanadaJournal Article20160731Prospective studies of the potential health consequences of trade and investment treaties, such as the Trans-Pacific Partnership, are critical. These studies can make visible to trade policy-makers the potential negative impacts associated to such treaties and can influence the outcomes of such negotiations. However, few researchers have examined retrospectively the consequences of trade agreements. With more than 400 trade agreements and more than 2000 investment treaties currently in force, researchers have a large corpus of agreements to analyse in order to assess not only their potential impacts on health system and population health, but also their actual impacts. This comment suggests some research questions that would benefit from retrospective inquiry.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396420170401The TPP Is Dead, Long Live the TPP? A Response to Recent Commentaries245247331510.15171/ijhpm.2017.12ENRonaldLabontéCanada Research Chair, Globalization and Health Equity, Faculty of Medicine, School of Epidemiology, Public Health and Preventive Medicine, University of
Ottawa, Ottawa, ON, Canada0000-0002-0615-740XAshleySchramSchool of Regulation and Global Governance,
Australian National University, Canberra, AustraliaArneRuckertFaculty of Medicine, School
of Epidemiology, Public Health and Preventive Medicine, University of Ottawa,
Ottawa, ON, CanadaJournal Article20170107