Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398920190901How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention514520364610.15171/ijhpm.2019.56ENRaphaelLencuchaSchool of Physical and Occupational Therapy, Faculty of Medicine, McGill
University, Montreal, QC, Canada0000-0002-9273-2027Anne MarieThowMenzies Centre for Health Policy, Sydney
School of Public Health, University of Sydney, Sydney, NSW, Australia0000-0002-6460-5864Journal Article20190505Alcohol, tobacco, and unhealthy foods contribute greatly to the global burden of non-communicable disease (NCD). Member states of the World Health Organization (WHO) have recognized the critical need to address these three key risk factors through global action plans and policy recommendations. The 2013-2020 WHO action plan identifies the need to engage economic, agricultural and other relevant sectors to establish comprehensive and coherent policy. To date one of the biggest barriers to action is not so much identifying affective policies, but rather how a comprehensive policy approach to NCD prevention can be established across sectors. Much of the research on policy incoherence across sectors has focused on exposing the strategies used by commercial interests to shape public policy in their favor. Although the influence of commercial interests on government decisions remains an important issue for policy coherence, we argue, that the dominant neoliberal policy paradigm continues to enable the ability of these interests to influence public policy. In this paper, we examine how this dominant paradigm and the way it has been enshrined in institutional mechanisms has given rise to existing systems of governance of product environments, and how these systems create structural barriers to the introduction of meaningful policy action to prevent NCDs by fostering healthy product environments. Work to establish policy coherence across sectors, particularly to ensure a healthy product environment, will require systematic engagement with the assumptions that continue to structure institutions that perpetuate unhealthy product environments.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398920190901Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries521537363310.15171/ijhpm.2019.43ENKatherine R.IversonProgram in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USAGeneral Surgery Department, University of California
Davis Medical Center, Sacramento, CA, USA0000-0002-5261-8027EmmaSvenssonProgram in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USALund University, Lund,
SwedenKristinSondermanProgram in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USABrigham and Women’s Hospital, Boston, MA, USAErnest J.BarthélemyProgram in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USAIcahn School of
Medicine at Mount Sinai, New York City, NY, USAIsabelleCitronProgram in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USA0000-0003-4702-4926Kerry A.VaughanProgram in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USAUniversity of Pennsylvania,
Philadelphia, PA, USABrittany L.PowellProgram in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USAStanford University School of Medicine, Stanford, CA,
USAJohn G.MearaProgram in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USADepartment of Plastic and Oral Surgery, Boston Children’s Hospital,
Boston, MA, USAMark G.ShrimeProgram in Global Surgery and Social Change, Harvard Medical School,
Boston, MA, USAMassachusetts Eye and Ear Infirmary, Boston, MA, USAJournal Article20180519Background<br />While recommendations for the optimal distribution of surgical services in high-income countries (HICs) exist, it is unclear how these translate to resource-limited settings. Given the significant shortage and maldistribution of surgical workforce and infrastructure in many low- and middle-income countries (LMICs), the optimal role of decentralization versus regionalization (centralization) of surgical care is unknown. The aim of this study is to review evidence around interventions aimed at redistributing surgical services in LMICs, to guide recommendations for the ideal organization of surgical services.<br /> <br />Methods<br />A narrative-based literature review was conducted to answer this question. Studies published in English between 1997 and 2017 in PubMed, describing interventions to decentralize or regionalize a surgical procedure in a LMIC, were included. Procedures were selected using the Disease Control Priorities’ (DCP3) Essential Surgery Package list. Intervention themes and outcomes were analyzed using a narrative, thematic synthesis approach. Primary outcomes included mortality, complications, and patient satisfaction. Secondary outcomes included input measures: workforce and infrastructure, and process measures: facility-based care, surgical volume, and referral rates.<br /> <br />Results<br />Thirty-five studies were included. Nine (33%) of the 27 studies describing decentralization showed an improvement in primary outcomes. The procedures associated with improved outcomes after decentralization included most obstetric, gynecological, and family planning services as well as some minor general surgery procedures. Out of 8 studies on regionalization (centralization), improved outcomes were shown for trauma care in one study and cataract extraction in one study.<br /> <br />Conclusion<br />Interventions aimed at decentralizing obstetric care to the district hospital and health center levels have resulted in mortality benefits in several countries. However, more evidence is needed to link service distribution to patient outcomes in order to provide recommendations for the optimal organization of other surgical procedures in LMICs. Considerations for the optimal distribution of surgical procedures should include the acuity of the condition for which the procedure is indicated, anticipated case volume, and required level of technical skills, resources, and infrastructure. These attributes should be considered within the context of each country.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398920190901“Because Even the Person Living With HIV/AIDS Might Need to Make Babies” – Perspectives on the Drivers of Feasibility and Acceptability of an Integrated Community Health Worker Model in Iringa, Tanzania538549363110.15171/ijhpm.2019.38ENKatharine D.ShelleyDepartment of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA0000-0001-6550-5446GastoFrumenceDepartment of Development Studies,
School of Public Health and Social Sciences, Muhimbili University of Health and
Allied Sciences, Dar es Salaam, Tanzania0000-0003-4605-9457RoseMpembeniDepartment of Epidemiology and
Biostatistics, School of Public Health and Social Sciences, Muhimbili University
of Health and Allied Sciences, Dar es Salaam, Tanzania0000-0002-3916-2790GeorgeMwinnyaaDepartment of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USAJulianaJoachimDepartment of Epidemiology and
Biostatistics, School of Public Health and Social Sciences, Muhimbili University
of Health and Allied Sciences, Dar es Salaam, TanzaniaHawaKadria KisusiChristian Social
Services Commission, Dar es Salaam, TanzaniaJaphetKillewoDepartment of Epidemiology and
Biostatistics, School of Public Health and Social Sciences, Muhimbili University
of Health and Allied Sciences, Dar es Salaam, Tanzania0000-0001-6998-6750Abdullah H.BaquiDepartment of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USADavid H.PetersDepartment of International Health, Johns Hopkins Bloomberg School of
Public Health, Baltimore, MD, USA0000-0001-8377-3444Asha S.GeorgeSchool of Public Health,
University of the Western Cape, Cape Town, South Africa0000-0002-5968-1424Journal Article20181004Background<br />Countries with health workforce shortages are increasingly turning to multipurpose community health workers (CHWs) to extend integrated services to the community-level. However, there may be tradeoffs with the number of tasks a CHW can effectively perform before quality and/or productivity decline. This qualitative study was conducted within an existing program in Iringa, Tanzania where HIV-focused CHWs working as volunteers received additional training on maternal, newborn, and child health (MNCH) promotion, thereby establishing a dual role CHW model.<br /> <br />Methods<br />To evaluate the feasibility and acceptability of the combined HIV/MNCH CHW model, qualitative in-depth interviews (IDIs) with 36 CHWs, 21 supervisors, and 10 program managers were conducted following integration of HIV and MNCH responsibilities (n = 67). Thematic analysis explored perspectives on task planning, prioritization and integration, workload, and the feasibility and acceptability of the dual role model. Interview data and field observations were also used to describe implementation differences between HIV and MNCH roles as a basis for further contextualizing the qualitative findings.<br /> <br />Results<br />Perspectives from a diverse set of stakeholders suggested provision of both HIV and MNCH health promotion by CHWs was feasible. Most CHWs attempted to balance HIV/MNCH responsibilities, although some prioritized MNCH tasks. An increased workload from MNCH did not appear to interfere with HIV responsibilities but drew time away from other income-generating activities on which volunteer CHWs rely. Satisfaction with the dual role model hinged on increased community respect, gaining new knowledge/skills, and improving community health, while the remuneration-level caused dissatisfaction, a complaint that could challenge sustainability.<br /> <br />Conclusions<br />Despite extensive literature on integration, little research at the community level exists. This study demonstrated CHWs can feasibly balance HIV and MNCH roles, but not without some challenges related to the heavier workload. Further research is necessary to determine the quality of health promotion in both HIV and MNCH domains, and whether the dual role model can be maintained over time among these volunteers.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398920190901Health Equity in National Cancer Control Plans: An Analysis of the Ontario Cancer Plan550556363210.15171/ijhpm.2019.40ENAmbreenSayaniSchool of Health Policy and Management, Faculty of Health, York University, Toronto, ON, CanadaMAP Centre for Urban Health Solutions, Li
Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada0000-0001-5391-7769Journal Article20180825<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">National cancer control plans (NCCPs) are important documents that guide strategic priorities in cancer care and plan for the appropriate allocation of resources based on the social, geographic and economic needs of a population. Despite the emphasis on health equity by the World Health Organization (WHO), few NCCPs have a focus on health equity. The Ontario Cancer Plan (OCP) IV, (2015 to 2019) is an example of an NCCP with clearly defined health equity goals and objectives.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">This paper presents a directed-content analysis of the OCP IV health equity goals and objectives, in light of the synergies of oppression analytical framework.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">The OCP IV confines equity to an issue of access-to-care. As a result, it calls for training, funding, and social support services to increase accessibility for high-risk population groups. However, equity has a broader definition. And as such, it also implies that systematic differences in health outcomes between social groups should be minimal. This is particularly significant given that socially disadvantaged cancer patients in Ontario have distinctly poorer cancer-related health outcomes.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Health systems are seeking ways to reduce the health equity gap. However, to reduce health inequities which are socially-based will require a recognition of the living and working conditions of patients which influence risk, mortality and survival. NCCPs represent a way to politically advocate for the determinants of health which profoundly influence cancer risk, outcomes and mortality.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398920190901Bridging the Gap Between Research and Policy and Practice; Comment on “CIHR Health System Impact Fellows: Reflections on ‘Driving Change’ Within the Health System”557559363410.15171/ijhpm.2019.46ENMartinMcKeeDepartment of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK0000-0002-0121-9683Journal Article20190430<span class="fontstyle0">Far too often, there is a gap between research and policy and practice. Too much research is undertaken with little relevance to real life problems or its reported in ways that are obscure and impenetrable. At the same time, many policies are developed and implemented but are untouched by, or even contrary to evidence. An accompanying paper describes an innovative programme in Canada to help bridge this gap. This commentary notes the growing acceptance of such initiatives but highlights the challenges of sustaining their benefits.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398920190901Some Things Are Rarely Discussed in Public – on the Discourse of Corruption in Healthcare; Comment on “We Need to Talk About Corruption in Health Systems”560562363610.15171/ijhpm.2019.51ENPeterStiernstedtSchool of Law and Criminology, University of West London, London, UK0000-0003-0824-8396Journal Article20190430In an editorial titled “We Need to Talk About Corruption in Health Systems” the authors Hutchinson, Balabanova, and McKee hope to encourage a wider conversation about corruption in the health sector. Such conversations are difficult to hold for at least five reasons; it is hard to define corruption; corruption may allow some fragile health systems to subsist, shifting blame – are those involved in anti-corruption research colluding with corrupt officials; the legitimacy of studying corruption; and, that far too little is known about how to tackle corruption. This commentary explores those reasons and concludes that the authors make a strong case for a more open and directed discussion about corruption.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398920190901I Know It When I See It: The Challenges of Addressing Corruption in Health Systems; Comment on “We Need to Talk About Corruption in Health Systems”563566364310.15171/ijhpm.2019.48ENJillian ClareKohlerWHO Collaborating Center for Governance, Accountability and Transparency in the Pharmaceutical Sector and Leslie Dan Faculty of
Pharmacy, University of Toronto, Toronto, ON, Canada0000-0003-1290-9484Journal Article20190425<span class="fontstyle0">In this commentary, I argue that corruption in health systems is a critical and legitimate area for research in order to strengthen health policy goals. This rationale is based partly on citizen demand for more accountable and transparent health systems, along with the fact that the poor and vulnerable suffer the most from the presence of corruption in health systems. What is more, there is a growing body of literature on the impact of corruption in the health system and best practices in terms of anti-corruption, transparency and accountability (ACTA) strategies and tactics within the health system. Still, we need to support ACTA integration into the health system by having a common definition of corruption that is meaningful for health systems and ensure that ACTA strategies and tactics are transparent themselves. The 2019 Consultation on a proposed Global Network on ACTA in Health Systems is promising for these efforts.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398920190901Innovation, Demand, and Responsibility: Some Fundamental Questions About Health Systems; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”567569364210.15171/ijhpm.2019.47ENHarroVan LenteFaculty of Arts and Social Sciences, Maastricht University, Maastricht, The Netherlands0000-0002-4719-360XJournal Article20190307<span class="fontstyle0">In this commentary on the exercise of Lehoux et al (this volume) I argue that in discussions on the current challenges of health systems, a better diagnosis of the health system is required. The cause of responsible innovation in health (RIH) requires a better understanding of the dynamics of health systems, in particular how innovation, demand, and responsibility are manifested. Innovation brings its own dynamic to the health system; demands are linked to historical and social developments; responsibility brings contestations about what counts as good healthcare. Any attempt of RIH should include such reflections.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398920190901Innovation Strategies and Health System Guiding Principles to Address Equity and Sustainability in Responsible Innovation in Health; Comment on “What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review”570572364010.15171/ijhpm.2019.50ENSandra C.ButtigiegDepartment of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, MaltaHealth Services Management
Centre, School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, UK0000-0002-0572-2462Journal Article20190422The insights from an international scoping review provided by Lehoux et al challenge health policy-makers, entrepreneurs/innovators and users of healthcare, worldwide, to be aware of equity and sustainability challenges at system-level when appraising responsible innovation in health (RIH) – purposefully designed to better support health systems.The authors manage to extract no less than 1391 health system challenges with those mostly cited pertaining to service delivery, human resources, leadership and governance. Countries were classified according to the Human Development Index (HDI), while the authors decided not to classify according to the types of health systems justifying this on the basis that the articles reviewed studied a specific setting within a broader national or regional health system. The article presents highly powerful and discerning viewpoints, indeed providing numerous standpoints, yet in a comprehensive manner, thereby putting structure to a somewhat highly complex and multidimensional subject. This commentary brings forth several considerations that are perceived on reading this article. First, although innovation strategies are important for the dynamicity of health systems, one should discuss whether or not RIH can adequately address equity and sustainability on a global scale. Secondly, RIH across countries should also be debated in the context of the principles garnered by the type of health system, thereby identifying whether or not the prevailing political goals support equity and sustainability, and whether or not policy-makers are adequately supported to translate system-level demand signals into innovation development opportunities. As key messages, the commentary reiterates the emphasis made by the authors of the need for international policy-oriented fora as learning vehicles on RIH that also address system-level challenges, albeit the need to acknowledge cultural differences. In addition, the public has not only the right for transparency on how equity and sustainability challenges are addressed in innovation decisions, but also the responsibilities to contribute to overcome these challenges.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59398920190901The Why, Who, What, How, and When of Patient Engagement in Healthcare Organizations: A Response to Recent Commentaries573574362910.15171/ijhpm.2019.42ENVadimDukhaninDepartment of Health Policy and Management, Johns Hopkins Bloomberg
School of Public Health, Baltimore, MD, USA0000-0002-8685-0027MatthewDeCampJohns Hopkins Berman Institute
of Bioethics, Baltimore, MD, USACenter for Bioethics and Humanities and
Division of General Internal Medicine, University of Colorado, Denver, CO, USA0000-0002-9371-8729Journal Article20190516