Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59399720200701Diversity, Inclusive Leadership, and Health Outcomes266268374710.15171/ijhpm.2020.12ENElizabeth H.BradleyVassar College, Poughkeepsie, NY, USA0000-0003-2592-2741Journal Article20191024<span class="fontstyle0">In this time of polarization and divisiveness across increasingly diverse communities, health policy and management research offers an important insight: engaging diversity meaningfully through inclusive leadership—that embraces staff across hierarchies and engages difference perspectives so that all healthcare workers of all kinds feel they can speak up and participate—can save lives. In multiple studies of quality in cardiovascular care, top performing hospitals have been shown to exhibit the capacity to embrace staff across hierarchies and engage differences so that healthcare workers of all kinds feel they can speak up and participate meaningfully in improvement efforts. Most recently, in the two-year, longitudinal Leadership Saves Lives study of 10 hospitals, the ability to adopt a culture of improvement rather than blaming was linked to significant reductions in risk-standardized mortality rates. Moreover, the guiding coalitions (ie, quality improvement teams) in six of the 10 hospitals that were most successful were distinguished in three ways that give insight about effective modes of engaging differences: (1) including staff from difference disciplines and levels in the organizational hierarchy, (2) encouraging authentic participation by the members, and (3) using constructive patterns of managing conflict (ie, having clear role definitions, working to surface minority viewpoints, and collectively revisiting the shared goal of saving lives). Based on this literature, adequately engaging a wide range of diverse viewpoints and staff roles can have a marked impact on health outcomes. Although the studies reviewed do not examine racial/ethnic diversity per se, they do lend insight into effectively navigating environments with extensive diversity of perspectives, professional identities, and experiences. Future research may assess whether these insights have application to other forms of diversity as well. In this time of extreme polarization and division globally and locally, health policy and management research has an opportunity to share evidence that could help navigate an increasingly diverse environment, at least within the field of healthcare, towards a more inclusive, humane, and life-giving approach to our collective future.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59399720200701Handing the Microphone to Women: Changes in Gender Representation in Editorial Contributions Across Medical and Health Journals 2008-2018269273374310.15171/ijhpm.2020.06ENAngela Y.ChangInstitute for Health Metrics and Evaluation, University of Washington, Seattle,
WA, USA0000-0003-3947-3588NinaCesareBoston University School of Public Health, Boston, MA, USAJournal Article20191026<span class="fontstyle0">The editorial materials in top medical and public health journals are opportunities for experts to offer thoughts that might influence the trajectory of the field. To date, while some studies have examined gender bias in the publication of editorial materials in medical journals, none have studied public health journals. In this perspective, we studied the gender ratio of the editorial materials published in the top health and medical sciences journals between 2008 and early 2018 to test whether gender bias exists. We studied a total of 59 top journals in health and medical sciences. Overall, while there is a trend of increasing proportion of female first authors, there is still a greater proportion of male than female first authors. The average male-to-female first author ratio during the study period across all journals was 2.08. Ensuring equal access and exposure through journal editorials is a critical step, albeit only one step of a longer journey, towards gender balance in health and medical sciences research. Editors of top journals have a key role to play in pushing the fields towards more balanced gender equality, and we strongly urge editors to rethink the strategies for inviting authors for editorial materials.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59399720200701Realist Synthesis of the International Theory and Evidence on Strategies to Improve Childhood Vaccination in Low- and Middle-Income Countries: Developing Strategies for the Nigerian Healthcare System274285372410.15171/ijhpm.2019.120ENOluwadamilola SolabiOmoniyiHealth Services Management Centre, University of Birmingham, Birmingham, UK0000000242651800IestynWilliamsHealth Services Management Centre, University of Birmingham, Birmingham, UK0000-0002-9462-9488Journal Article20190403<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Childhood vaccination coverage rates in low- and middle-income countries (LMICs) vary significantly, with some countries achieving higher rates than others. Several attempts have been made in Nigeria to achieve universal vaccination coverage but with limited success. This study aimed to analyse strategies used to improve childhood vaccine access and uptake in LMICs in order to inform strategy development for the Nigerian healthcare system.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">A realist synthesis approach was adopted in order to elucidate the contexts and mechanisms wherewith these strategies achieved their aim (or not). Nine databases were searched for relevant articles and 27 articles were included in the study. Programme theories were generated from the included articles, and data extraction was carried out paying particular attention to context, mechanism and outcomes configurations.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Interventions used in LMICs to improve vaccination coverage were categorised as follows: communication/ educational, reminder-type, incentives, social mobilisation, provider-directed strategies, health service integration and multi-pronged strategies. The strategies that appeared most likely to be effective in the health contexts of contemporary Nigeria include communication and educational interventions; employing informal change agents, and; monitoring and evaluation to strengthen communication. The programme theories for the use of reminders, social mobilisation, staff training and supportive supervision were observed in practice, and these strategies were generally successful within some contexts. By contrast, the use of monetary incentives in Nigeria is not supported by the evidence, although further research and evaluation is required. The integration of other interventions with routine immunisation (RI) to improve uptake was more effective when the perceived value of the other program was high. Adoption of multipronged interventions for hard to reach communities was beneficial. However, caution should be exercised because of varying levels of published evidence in respect of each intervention type and a relative lack of the rich description required to conduct a full realist analysis.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">This paper adds to the evidence base on the adaption of strategies to improve vaccine access and uptake to the context of LMICs.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59399720200701Where Do We Start? Building Consensus on Drivers of Health Sector Corruption in Nigeria and Ways to Address It286296372310.15171/ijhpm.2019.128ENObinnaOnwujekweHealth Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, NigeriaDepartment of Health Administration and
Management, College of Medicine, University of Nigeria Enugu Campus, Enugu,
Nigeria0000-0002-1214-4285Charles T.OrjiakorHealth Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, NigeriaDepartment of Psychology, University of Nigeria, Nsukka, Nigeria0000-0001-5379-8915EleanorHutchinsonLondon School of Hygiene and Tropical Medicine, London, UK0000-0002-9718-2407MartinMcKeeLondon School of Hygiene and Tropical Medicine, London, UK0000-0002-0121-9683PrinceAgwuHealth Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, NigeriaDepartment of
Social Work, University of Nigeria, Nsukka, Nigeria0000-0001-9224-7622ChinyereMbachuHealth Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, NigeriaDepartment of Community
Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu,
Nigeria0000-0003-3936-6184PamelaOgbozorHealth Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria0000-0003-1343-1822UcheObiHealth Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, NigeriaDepartment of Community
Medicine, College of Medicine, University of Nigeria Enugu Campus, Enugu,
Nigeria0000-0003-0684-2455AloysiusOdiiHealth Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, NigeriaDepartment of Sociology and Anthropology, University of Nigeria,
Nsukka, Nigeria0000-0002-2222-0835HyacinthIchokuHealth Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, NigeriaDepartment of Economics, University of Nigeria, Nsukka,
NigeriaVeritas Universit, Abuja, NigeriaDinaBalabanovaLondon School of Hygiene and Tropical Medicine, London, UK0000-0001-7163-3428Journal Article20190718<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Corruption is widespread in Nigeria’s health sector but the reasons why it exists and persists are poorly understood and it is often seen as intractable. We describe a consensus building exercise in which we asked health workers and policy-makers to identify and prioritise feasible responses to corruption in the Nigerian health sector.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">We employed three sequential activities. First, a narrative literature review identified which types of corruption are reported in the Nigerian health system. Second, we asked 21 frontline health workers to add to what was found in the review (based on their own experiences) and prioritise them, based on their significance and the feasibility of assessing them, by means of a consensus building exercise using a Nominal Group Technique (NGT). Third, we presented their assessments in a meeting of 25 policy-makers to offer their views on the practicality of implementing appropriate<br />measures.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Participants identified 49 corrupt practices from the literature review and their own experience as most important in the Nigerian health system. The NGT prioritised: absenteeism, procurement-related corruption, underthe-counter payments, health financing-related corruption, and employment-related corruption. This largely reflected findings from the literature review, except for the greater emphasis on employment-related corruption from the NGT. Absenteeism, Informal payments and employment-related corruption were seen as most feasible to tackle. Frontline workers and policy-makers agreed that tackling corrupt practices requires a range of approaches.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Corruption is recognized in Nigeria as widespread but often seems insurmountable. We show how a structured approach can achieve consensus among multiple stakeholders, a crucial first step in mobilizing action to address corruption.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59399720200701Monitoring Sustainable Development Goals 3: Assessing the Readiness of Low- and Middle-Income Countries297308372510.15171/ijhpm.2019.134ENJoy BelindaNabukaluHealthNet Consult, Kampala, UgandaJames AvokaAsamaniWorld Health Organization (WHO),
Inter-Country Support Team for Eastern & Southern Africa, Harare, Zimbabwe0000-0003-0620-6010JulietNabyonga-OremWorld Health Organization (WHO),
Inter-Country Support Team for Eastern & Southern Africa, Harare, Zimbabwe0000-0002-1061-8678Journal Article20190604<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">The Millennium Development Goals (MDGs) availed opportunities for scaling up service coverage but called for stringent monitoring and evaluation (M&E) focusing mainly on MDG related programs. The Sustainable Development Goals 3 (SDGs) and the universal health coverage (UHC) agenda present a broader scope and require more sophisticated M&E systems. We assessed the readiness of low- and middle-income countries to monitor SDG 3.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Employing mixed methods, we reviewed health sector M&E plans of 6 countries in the World Health Organization (WHO) Africa Region to assess the challenges to M&E, the indicator selection pattern and the extent of multisectoral collaboration. Qualitative data were analysed using content thematic analysis while quantitative data were analysed using Excel.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Challenges to monitoring SDG 3 include weak institutional capacity; fragmentation of M&E functions; inadequate domestic financing; inadequate data availability, dissemination and utilization of M&E products. The total number of indictors in the reviewed plans varied from 38 for Zimbabwe to 235 for Zanzibar. Sixty-nine percent of indicators for the Gambia and 89% for Zanzibar were not classified in any domain in the M&E results chain. Countries lay greater M&E emphasis on service delivery, health systems, maternal and child health as well as communicable diseases with a seeming neglect of the non-communicable diseases (NCDs). Inclusion of SDG 3 indicators only ranged from 48% for Zanzibar to 67% for Kenya. Although monitoring SDG 3 calls for multisectoral collaboration, consideration of the role of other sectors in the M&E plans was either absent or limited to the statistical departments.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">There are common challenges confronting M&E at county-level. Countries have omitted key indicators for monitoring components of the SDG 3 targets especially those on NCDs and injuries. The role of other sectors in monitoring SDG 3 targets is not adequately reflected. These could be bottlenecks to tracking progress towards SDG 3 if not addressed. Beyond providing compendium of indicators to guide countries, we advocate for a more binding minimum set of indicators for all countries to which they may add depending on their context. Ministries of Health (MoHs) should prioritise M&E as an important pillar for health service planning and implementation and not as an add-on activity.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59399720200701Transforming Disciplinary Traditions; Comment on “Problems and Promises of Health Technologies: The Role of Early Health Economic Modeling”309311371110.15171/ijhpm.2019.130ENPascaleLehouxDepartment of Health Management, Evaluation and Policy, Institute of Public
Health Research, University of Montreal, Montreal, QC, Canada0000-0001-9482-1800HudsonSilvaInstitute of
Public Health Research, University of Montreal, Montreal, QC, Canada0000-0001-7507-0917Journal Article20191024<span class="fontstyle0">Grutters et al show that economic assessments can inform the development of new health technologies at an early stage. This is an important contribution to health services and policy research, which implies a “shift away” from the more traditional forms of academic health economic modeling. Because transforming established disciplinary traditions is both valuable and demanding, we invite scholars to further the discussion on how the value of health innovations should be appraised in view of today’s societal challenges.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59399720200701Next Steps for Elevating Health on Trade and Investment Policy Agendas; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”312314371210.15171/ijhpm.2019.126ENBelindaTownsendSchool of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia0000-0002-2480-2820Journal Article20190926<span class="fontstyle0">Despite intergovernmental calls for greater policy coherence to tackle rising non-communicable diseases (NCDs), there has been a striking lack of coherence internationally and nationally between trade and health sectors. In this commentary, I explore the arguments by Lenucha and Thow in relation to barriers for greater coherence for NCDs, apply them to regional trade agreements, and point to next steps in research and advocacy for greater attention to health and NCD prevention in government trade agendas.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59399720200701Understanding Structure and Agency as Commercial Determinants of Health; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”315318371310.15171/ijhpm.2019.127ENKelleyLeeFaculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada0000-0002-3625-1915EricCrosbieSchool of Community Health Sciences, University of Nevada, Reno, NV, USA0000-0002-6219-298XJournal Article20191016<span class="fontstyle0">The limited success to date, by the public health community, to address the dramatic rise in non-communicable diseases (NCDs) has prompted growing attention to the commercial determinants of health. This has led to a much needed shift in attention, from metabolic and behavioural risk factors, to the production and consumption of health-harming products by the commercial sector. Building on Lencucha and Thow’s analysis of neoliberalism, in shaping the underlying policy environment favouring commercial interests, we argue for fuller engagement with structure and agency interaction when conceptualising, assessing, and identifying public health measures to address the commercial determinants of health.</span>