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Sample records for achieving health sector

  1. Colombian public policies contributing to the achievement of Millennium Development Goals in the health sector, 2006

    Lina M. Grisales

    2008-02-01

    Full Text Available During the General Assembly of the United Nations, in September 2000,189 countries (including Colombia committed to eight objectives leading to a more human and fairer world. Such objectives are called the Millennium Development Goals (mdg and to achieve them it is crucial to incorporate them in the action agendas of each country. The purpose of this monograph is to recognize current public policies in Colombia and Antioquia leading the achievement of the Millennium Development Goals, specifically those related to the reduction of mortality among children less than 5 years of age, improvement of maternal health and fighting against hiv/aids, malaria and dengue.In Colombia, Conpes 91 of 2005 is the only guideline given by the Government establishing goals and strategies to achieve the Millennium Development Goals in 2015. Nevertheless, other policies, programs and projects before and even after the Millennium Statement (but without explicit purpose contribute to achieving such goals. Revision of those policies is an effort for the research project “Degree of contribution of public policies to the achievement of the Millennium Development Goals related to the health sector, Antioquia, 2006”, which will evaluate the impact these guidelines have had in the achievement of the development goals in that particular sector.

  2. Achieving universal health care coverage: Current debates in Ghana on covering those outside the formal sector

    Abiiro Gilbert

    2012-10-01

    Full Text Available Abstract Background Globally, extending financial protection and equitable access to health services to those outside the formal sector employment is a major challenge for achieving universal coverage. While some favour contributory schemes, others have embraced tax-funded health service cover for those outside the formal sector. This paper critically examines the issue of how to cover those outside the formal sector through the lens of stakeholder views on the proposed one-time premium payment (OTPP policy in Ghana. Discussion Ghana in 2004 implemented a National Health Insurance Scheme, based on a contributory model where service benefits are restricted to those who contribute (with some groups exempted from contributing, as the policy direction for moving towards universal coverage. In 2008, the OTPP system was proposed as an alternative way of ensuring coverage for those outside formal sector employment. There are divergent stakeholder views with regard to the meaning of the one-time premium and how it will be financed and sustained. Our stakeholder interviews indicate that the underlying issue being debated is whether the current contributory NHIS model for those outside the formal employment sector should be maintained or whether services for this group should be tax funded. However, the advantages and disadvantages of these alternatives are not being explored in an explicit or systematic way and are obscured by the considerable confusion about the likely design of the OTPP policy. We attempt to contribute to the broader debate about how best to fund coverage for those outside the formal sector by unpacking some of these issues and pointing to the empirical evidence needed to shed even further light on appropriate funding mechanisms for universal health systems. Summary The Ghanaian debate on OTPP is related to one of the most important challenges facing low- and middle-income countries seeking to achieve a universal health care system. It

  3. Challenges in Achieving Health for All in the Boarding Home Sector.

    Babiski, Laura; And Others

    1996-01-01

    The Boarding Home Support Program for adults with mental health problems uses health promotion mechanisms of self-care, mutual aid, and healthy environments. The program is challenged by increased numbers of persons served, substandard homes, and conflicts between tenant and operator needs and between individual and group tenant needs. (SK)

  4. An international comparative public health analysis of sex trafficking of women and girls in eight cities: achieving a more effective health sector response.

    Macias Konstantopoulos, Wendy; Ahn, Roy; Alpert, Elaine J; Cafferty, Elizabeth; McGahan, Anita; Williams, Timothy P; Castor, Judith Palmer; Wolferstan, Nadya; Purcell, Genevieve; Burke, Thomas F

    2013-12-01

    Sex trafficking, trafficking for the purpose of forced sexual exploitation, is a widespread form of human trafficking that occurs in all regions of the world, affects mostly women and girls, and has far-reaching health implications. Studies suggest that up to 50 % of sex trafficking victims in the USA seek medical attention while in their trafficking situation, yet it is unclear how the healthcare system responds to the needs of victims of sex trafficking. To understand the intersection of sex trafficking and public health, we performed in-depth qualitative interviews among 277 antitrafficking stakeholders across eight metropolitan areas in five countries to examine the local context of sex trafficking. We sought to gain a new perspective on this form of gender-based violence from those who have a unique vantage point and intimate knowledge of push-and-pull factors, victim health needs, current available resources and practices in the health system, and barriers to care. Through comparative analysis across these contexts, we found that multiple sociocultural and economic factors facilitate sex trafficking, including child sexual abuse, the objectification of women and girls, and lack of income. Although there are numerous physical and psychological health problems associated with sex trafficking, health services for victims are patchy and poorly coordinated, particularly in the realm of mental health. Various factors function as barriers to a greater health response, including low awareness of sex trafficking and attitudinal biases among health workers. A more comprehensive and coordinated health system response to sex trafficking may help alleviate its devastating effects on vulnerable women and girls. There are numerous opportunities for local health systems to engage in antitrafficking efforts while partnering across sectors with relevant stakeholders.

  5. Responsible leader behavior in health sectors.

    Longest, Beaufort

    2017-02-06

    Purpose The purpose of this paper is to expand attention to responsible leader behavior in the world's health sectors by explaining how this concept applies to health sectors, considering why health sector leaders should behave responsibly, reviewing how they can do so, and asserting potential impact through an applied example. Design/methodology/approach This paper is a viewpoint, reflecting conceptualizations rooted in leadership literature which are then specifically applied to health sectors. A definition of responsible leader behavior is affirmed and applied specifically in health sectors. Conceptualizations and viewpoints about practice of responsible leader behavior in health sectors and potential consequences are then discussed and asserted. Findings Leadership failures and debacles found in health, but more so in other sectors, have led leadership researchers to offer insights, many of them empirical, into the challenges of leadership especially by more clearly delineating responsible leader behavior. Practical implications Much of what has been learned in the research about responsible leader behavior offers pathways for health sector leaders to more fully practice responsible leadership. Social implications This paper asserts and provides a supporting example that greater levels of responsible leader behavior in health sectors hold potentially important societal benefits. Originality/value This paper is the first to apply emerging conceptualizations and early empirical findings about responsible leader behavior specifically to leaders in health sectors.

  6. Gender Issues in Health Sector

    Prakash Prabhakarrao Doke

    2015-04-01

    Full Text Available Gender wise analysis of data brings out biological, behavioural and social variables which indicate inequality in the health parameters in male and female sex. There is discrimination against women. Right to birth is denied by sex selective elimination, right to survival is denied by the neglect of girl child resulting in declining trend of child sex ratio which has reached an alarming low level of 914 in 2011 in spite of the fact that the female sex is biologically stronger. The mortality and morbidity indicators are unfavourable to the females. Maternal mortality in developing countries including India is unacceptably high. There is a failure of achievement of Millennium Development Goals in relation to maternal mortality and gender equality and empowerment of women. Crime against women is increasing. Violence is domestic or at workplace or occurring in public places. Social factors like male dominance and subordinate status of women make them vulnerable to unfair treatment, discrimination, denial of basic human rights to survival, education, health, inheritance, etc. The preventive measures in the form of education of masses for effective change in behaviour against gender discrimination, provision of facilities for achieving gender equality, and legislative measures for controlling violence against women at domestic and public level need intensification to achieve social justice of gender equality.

  7. Occupational health scenario of Indian informal sector.

    Nag, Anjali; Vyas, Heer; Nag, Pranab

    2016-08-05

    Workers in the Indian informal sector are engaged with different occupations. These occupations involve varied work related hazards. These occupational hazards are a consequent risk to health. The study aimed to determine occupational health scenario in the Indian Informal sector. One thousand eleven hundred twenty two workers from five different occupations namely weaving (handloom and power loom), construction, transportation, tobacco processing and fish processing were assessed by interviewer administered health questionnaire. Workers suffered from musculo-skeletal complaints, respiratory health hazards, eye problems and skin related complaints. There was a high prevalence of self-reported occupational health problems in the selected sectors. The study finds that workers have occupational exposures to multiple hazards. The absence of protective guards aggrevate their health condition. The study attempts to draws an immediate attention on the existing health scenario of the Indian Informal sector.

  8. Appropriate reserves in the health care sector

    Feenstra, D.W.; Helden, G.J. van

    1999-01-01

    Organizations in the health care sector are increasingly managed and judged on the basis of economic criteria. At the same time they are faced with growing risks which necessitate ‘appropriate’ reserves. Various major risks are mentioned in this paper. Health care organizations are allowed to form p

  9. Implementing TQM in the health care sector.

    Motwani, J; Sower, V E; Brashier, L W

    1996-01-01

    This article examines the issue of implementing TQM/CQI programs in the health care industry by grouping the prescriptive literature into four research streams. Based on the literature, a strategic programming model for implementing TQM/CQI in the health care industry is suggested. Finally, issues relating to TQM in the health care sector, which need to be addressed within each research stream in the future, are provided.

  10. Decentralising the health sector: issues in Brazil.

    Collins, C; Araujo, J; Barbosa, J

    2000-06-01

    The health sector in Brazil has undergone important changes, particularly with the development of the Unified Health System (SUS). Decentralisation is an important principle of SUS and advances have been made in transferring responsibilities and resources to the local government units, known as municipios. This article describes the changes introduced, focusing on the system of municipio classification and the funding mechanisms introduced through the basic operating rule (BOR) of 1996. The paper then moves on to analysing three key issues of decentralisation in Brazil that are related to the policy process, the system of decentralisation and the output of decentralisation. Firstly, the formal process by which decisions on health sector reform are made is discussed with particular attention being paid to the negotiated and relatively open policy space. Secondly, the role of the states is discussed within the decentralised system. Thirdly, the impact of decentralisation on equity is discussed with particular reference to the resourcing of the Municipal Health Funds. The article concludes by emphasising the political nature of health sector decentralisation and the need to develop the conditions for effectiveness in decentralisation programmes.

  11. THE ROLE OF THE ICT SECTOR IN ACHIEVING SUSTAINABLE DEVELOPMENT

    TEODORESCU ANA MARIA

    2015-06-01

    Full Text Available Sustainable development requires the merge of objectives for economic growth, quality of life and environmental protection. If in the 70’s the need to shift towards sustainable development has been made on the basis of environmental concerns, with the Brundtland Report the concept gains economic and social dimensions. Challenges such as technology, globalization, competition, efficiency, competitiveness, determine the businesses need to adapt to the new economy. Support information to doing business in these conditions is given by IT. The transition to the information society is considered a step to achieve sustainable development. Information, which became resource both in the business and in everyday environment, is the challenge that economic and social pillars of sustainable development must potency. Based on the review of interest for the concept "information society" in Europe, this article discusses the impact of the ICT sector on economic and social pillars of sustainable development. Information and Communication Technology, identified as the fifth wave of technological innovation, is the support of information society. It is playing a supporting role for the activities of all areas with a significant impact on the economy and quality of life. Quantification of any process can be achieved through indicators, created to reflect the progression or regression of the proposed targets. Indicators are tools for measuring any process, so their importance is essential for making decision. Using the scheme of interactions between the pillars of sustainable development proposed by the Organisation for Economic Cooperation and Development, I have emphasized the role of the ICT sector on the social and economic pillar. Based on the relations established, I analyzed the results of the information society indicators at european level. Although in Europe plans and strategies on the transition to a knowledge economy were developed in the last 15

  12. Student Health and Academic Achievement

    ... youth is strongly linked with their health. Healthy Students Are Better Learners Health-related factors such as ... well-being within the educational environment for all students. 8-11 Resources Health and Academics Data and ...

  13. Africa's health: could the private sector accelerate the progress towards health MDGs?

    2011-01-01

    Background Out of 1.484 billion disability-adjusted life years lost globally in 2008, 369.1 million (25%) were lost in the WHO African Region. Despite the heavy disease burden, the majority of countries in the Region are not on track to achieve Millennium Development Goals (MDG) 4 (reducing child mortality), 5 (improving maternal health), and 6 (combating HIV/AIDS, malaria and other diseases). This article provides an overview of the state of public health, summarizes 2010-2015 WHO priorities, and explores the role that private sector could play to accelerate efforts towards health MDGs in the African Region. Discussion Of the 752 total resolutions adopted by the WHO Regional Committee for Africa (RC) between years 1951 and 2010, 45 mention the role of the private sector. We argue that despite the rather limited role implied in RC resolutions, the private sector has a pivotal role in supporting the achievement of health MDGs, and articulating efforts with 2010-2015 priorities for WHO in the African Region: provision of normative and policy guidance as well as strengthening partnerships and harmonization; supporting the strengthening of health systems based on the Primary Health Care approach; putting the health of mothers and children first; accelerating actions on HIV/AIDS, malaria and tuberculosis; intensifying the prevention and control of communicable and noncommunicable diseases; and accelerating response to the determinants of health. Conclusion The very high maternal and children mortality, very high burden of communicable and non-communicable diseases, health systems challenges, and inter-sectoral issues related to key determinants of health are too heavy for the public sector to address alone. Therefore, there is clear need for the private sector, given its breadth, scope and size, to play a more significant role in supporting governments, communities and partners to develop and implement national health policies and strategic plans; strengthen health

  14. Are lessons from the education sector applicable to health care reforms? The case of Uganda.

    Okuonzi, S A; Birungi, H

    2000-01-01

    The decision by donors to use external aid for poverty alleviation in very low-income countries and the redefinition of development to include human aspects of society have renewed interest in education and health services. The debate about accountability, priorities and value-for-money of social services has intensified. Uganda's universal primary education programme (UPE) has within 2 years of inception achieved 90% enrollment. The programme has been acclaimed as successful. But the health sector that has been implementing primary health care and reforms for two decades is viewed as having failed in its objectives. The paper argues that the education sector has advantages over the health sector in that its programme is simple in concept, and was internally designed involving few actors. The sector received strong political support, already has an extensive infrastructure, receives much more funding and has a straightforward objective. Nevertheless, the health sector has made some achievements in AIDS control, in the prevention and control of epidemics, and in behavioural change. But these achievements will not be noticed if only access and health-status are used to assess the health sector. However, UPE demonstrates that a universal basic health care is possible, given the same level of resources and political commitment. The lesson for the health sector is to implement a priority universal health care programme based on national values and to assess its performance using the objectives of the UPE.

  15. Health sector reform and public sector health worker motivation: a conceptual framework.

    Franco, Lynne Miller; Bennett, Sara; Kanfer, Ruth

    2002-04-01

    Motivation in the work context can be defined as an individual's degree of willingness to exert and maintain an effort towards organizational goals. Health sector performance is critically dependent on worker motivation, with service quality, efficiency, and equity, all directly mediated by workers' willingness to apply themselves to their tasks. Resource availability and worker competence are essential but not sufficient to ensure desired worker performance. While financial incentives may be important determinants of worker motivation, they alone cannot and have not resolved all worker motivation problems. Worker motivation is a complex process and crosses many disciplinary boundaries, including economics, psychology, organizational development, human resource management, and sociology. This paper discusses the many layers of influences upon health worker motivation: the internal individual-level determinants, determinants that operate at organizational (work context) level, and determinants stemming from interactions with the broader societal culture. Worker motivation will be affected by health sector reforms which potentially affect organizational culture, reporting structures, human resource management, channels of accountability, types of interactions with clients and communities, etc. The conceptual model described in this paper clarifies ways in which worker motivation is influenced and how health sector reform can positively affect worker motivation. Among others, health sector policy makers can better facilitate goal congruence (between workers and the organizations they work for) and improved worker motivation by considering the following in their design and implementation of health sector reforms: addressing multiple channels for worker motivation, recognizing the importance of communication and leadership for reforms, identifying organizational and cultural values that might facilitate or impede implementation of reforms, and understanding that reforms

  16. [Cost effectiveness and health sector reform].

    Musgrove, P

    1995-01-01

    The cost-effectiveness of a health intervention is an estimate of the relation between what it costs to be provided, and the improvement in health which results from such intervention. Health may improve because the incidence of illness or injury is reduced, because death is avoided or delayed, or because the duration or severity of disability is limited. The calculation of this health benefit combines objective factors, such as the age at incidence and whether or not the outcome is death, with subjective factors such as the severity of disability, the judgement as to the value of life lived at different ages, and the rate at which the future is discounted. The construction and interpretation of the estimate are explained. Also, the paper examines whether the concept of cost-effectiveness is consistent with ethical norms such as equity, and concludes that they are not in conflict. Finally, it addresses the question of how to incorporate cost-effectiveness into a health sector reform, and possible ways to implement it.

  17. Health and Nutrition: Preconditions for Educational Achievement.

    Negussie, Birgit

    This paper discusses the importance of maternal and infant health for children's educational achievement. Education, health, and nutrition are so closely related that changes in one causes changes in the others. Improvement of maternal and preschooler health and nutrition is a precondition for improved educational achievement. Although parental…

  18. Pesticide Vendors in the Informal Sector: Trading Health for Income.

    Rother, Hanna-Andrea

    2016-08-01

    South African low-income communities face many challenges (e.g., insufficient housing, poor service delivery, and abject poverty); additionally, a silent challenge of pest infestation plagues these areas resulting in disease risks, nuisances, and stigma. Consequently, an enterprising urban informal sector business has emerged providing residents with highly toxic, effective, cheap, and illegal "street pesticides." These pesticides pose acute and chronic health risks for vendors and residents. The economic opportunity provided by the high demand for effective and cheap pest control results in the high risk of health effects being traded for income. Current measures to control and "regulate" the massive street pesticide sales result in toxic stockpiles and government's "turning a blind eye." Solutions will only be achieved through open dialog identifying and developing non-toxic pest control strategies while ensuring vendors' income; and relevant stakeholder recognition that pest infestation is a social and environmental health determinant needing acknowledgement in different government policies.

  19. Working in the health sector: implementation of workplace health promotion

    Eliana Castro S

    2011-11-01

    Full Text Available Objective: to discuss issues that are relevant to the implementation of workplace health promotion (whp in organization processes of the health sector as a strategic tool to manage health and safety at the workplace. Methods: after a conceptual review of whp in 2009, a qualitative case study on the development of this strategy in third level hospitals of Bogotá was carried out. This descriptive and cross-sectional study was approved by the Ethics Committee of the Faculty of Nursing at the National University of Colombia. Results: although there are occupational health programs that convey the spirit of whp in their content, its level of development is not consistently linked to it. The following criteria were analyzed: strategy and commitment, human resources and organization, social responsibility, planning, and development and results, all of which were not well valued by workers. Final considerations: the traditional approach to occupational health and the poor integration of the WHP principles into organizational processes are reflected in the actions taken and the expectations regarding the subject. Therefore, actions should be taken in terms of public policies to strengthen the institutional capacity to ensure the feasibility of whp in the health sector.

  20. Has the Swap Influenced Aid Flows in the Health Sector?

    Sweeney, Rohan; Mortimer, Duncan

    2016-05-01

    The sector wide approach (SWAp) emerged during the 1990s as a mechanism for managing aid from the multiplicity of development partners that operate in the recipient country's health, education or agricultural sectors. Health SWAps aim to give increased control to recipient governments, allowing greater domestic influence over how health aid is allocated and facilitating allocative efficiency gains. This paper assesses whether health SWAps have increased recipient control of health aid via increased general sector-support and have facilitated (re)allocations of health aid across disease areas. Using a uniquely compiled panel data set of countries receiving development assistance for health over the period 1990-2010, we employ fixed effects and dynamic panel models to assess the impact of introducing a health SWAp on levels of general sector-support for health and allocations of health-sector aid across key funding silos (including HIV, 'maternal and child health' and 'sector-support'). Our results suggest that health SWAps have influenced health-sector aid flows in a manner consistent with increased recipient control and improvements in allocative efficiency.

  1. Clustering economic sectors in China on a life cycle basis to achieve environmental sustainability

    Sai LIANG; Tianzhu ZHANG; Xiaoping JIA

    2013-01-01

    To improve material efficiency, industrial structure optimization becomes a focal point in Chinese industrial and environmental policies. It is crucial to cluster economic sectors and determine their priority for industrial and environmental policy implementation. Integrating a set of criteria, a hybrid input-output model and the hierarchical cluster analysis, this study clusters China's economic sectors and determines their priority on a life cycle basis. China's economic sectors are clustered into three clusters. Industrial structure changes (industrial policy) should encourage the development of sectors in cluster 1 and limit the development of sectors in cluster 2. Technology development and materials recycling (two environmental policies) should mainly focus on sectors in clusters 1 and 2. Future industrial policies in China should limit the development of two sectors named Manufacture of metal products and Extraction of petroleum and natural gas. Instead of limiting some industries by command-and- control, the best policy option is to remedy environmental standards and law enforcement. Enterprises belonging to the identified key sectors from the viewpoint of direct production impacts should be concerned to achieve enterprise sustainability. To achieve sustainable production chains, the identified key sectors from the viewpoint of accumulative production impacts should be concerned. For sustainable consumption, the identified key sectors from the viewpoint of consumption impacts should be concerned to transform consumption styles. Most of environmental pressure can be alleviated not only by technical improvements and material recycling, but also by the development of economic sectors in cluster 1.

  2. The Korean economic crisis and coping strategies in the health sector: pro-welfarism or neoliberalism?

    Kim, Chang-Yup

    2005-01-01

    In South Korea, there have been debates on the welfare policies of the Kim Dae-jung government after the economic crisis beginning in late 1997, but it is unquestionable that health and health care policies have followed the trend of neoliberal economic and social polices. Public health measures and overall performance of the public sector have weakened, and the private health sector has further strengthened its dominance. These changes have adversely affected the population's health status and access to health care. However, the anti-neoliberal coalition is preventing the government's drive from achieving a full success.

  3. Facilitating health and education sector collaboration in support of comprehensive school health.

    2010-01-01

    Comprehensive school health (CSH) is embraced internationally as the most effective way of promoting the health of students and the school community. It is a framework for supporting improvements in students' educational outcomes while addressing their well-being in a planned, holistic way. While many successful CSH initiatives are brought about by passionate individuals at the grassroots level, these initiatives benefit greatly from effective cross-sector collaborations within and among governments to coordinate policy and funding from the health and education sectors. Governments represent just one group of professionals within the myriad of players involved in implementing CSH in Canada. To be effective contributors to the model, all levels of government need to work together to reduce duplication while at the same time minimizing gaps in the policies and practices that support school health promotion. Collaboration between the health and education sectors within and across governmental boundaries is proving to be an effective mechanism for achieving this. In its first five-year mandate, the Pan Canadian Joint Consortium for School Health has broken new ground in horizontal integration and, as a result, has identified a set of key factors necessary for successful cross-sector collaboration.

  4. Roundtable discussion: what is the future role of the private sector in health?

    2014-01-01

    Background The role for the private sector in health remains subject to much debate, especially within the context of achieving universal health coverage. This roundtable discussion offers diverse perspectives from a range of stakeholders – a health funder, a representative from an implementing organization, a national-level policy-maker, and an expert working in a large multi-national company – on what the future may hold for the private sector in health. Discussion The first perspective comes from a health funder, who argues that the discussion about the future role of the private sector has been bogged down in language. He argues for a ‘both/and’ approach rather than an ‘either/or’ when it comes to talking about health service provision in low- and middle-income countries. The second perspective is offered by an implementer of health insurance in sub-Saharan Africa. The piece examines the comparative roles of public sector actors, private sector actors and funding agencies, suggesting that they must work together to mobilize domestic resources to fund and deliver health services in the longer term. Thirdly, a special advisor working in the federal government of Nigeria considers the situation in that country. He notes that the private sector plays a significant role in funding and delivering health services there, and that the government must engage the private sector or forever be left behind. Finally, a representative from a multi-national pharmaceutical corporation gives an overview of global shifts that are creating opportunities for the private sector in health markets. Summary Overall, the roundtable discussants agree that the private sector will play an important role in future health systems. But we must agree a common language, work together, and identify key issues and gaps that might be more effectively filled by the private sector. PMID:24961806

  5. A special report on India's biotech scenario: advancement in biopharmaceutical and health care sectors.

    Chakraborty, Chiranjib; Agoramoorthy, Govindasamy

    2010-01-01

    India's biotechnology industry has been growing towards new heights in conjunction with the recent economic outburst. The country has the potential to revolutionize biopharmaceutical and healthcare sectors. In this review, we have highlighted the achievements of India's biotechnology industry, especially biopharmaceutical and healthcare sectors that include therapeutics, diagnostics, stem cell research, human healthcare related bioinformatics and animal health care. We have also described regulatory mechanisms involved in India's health care biotech including manpower development.

  6. Using climate information in the health sector

    T. A. Ghebreyesus

    2010-09-01

    Full Text Available Many infectious and chronic diseases are either directly or indirectly sensitive to the climate. Managing this climate sensitivity more effectively requires new working relationships between the health sector and the providers of climate data and information. In Africa, where communities are particularly vulnerable, Ministries of Health and National Meteorological Services need to collaborate to reduce the burden of climate related ill health. The Ministry of Health and the National Meteorological Agency of Ethiopia have made significant progress towards the development of a climate-informed early warning and response system for diseases such as malaria and other climate-sensitive diseases. An important enabling mechanism is a Climate and Health Working Group, which is a multi-sectoral partnership created to spearhead the use of climate information for health interventions. While this is a work in progress, the key ingredients necessary to sustain such a joint venture are described to encourage similar activities in other countries faced with a growing climate-sensitive disease burden, to facilitate networking and to increase the return from the investment.De nombreuses infections et maladies chroniques sont sensibles, directement ou indirectement, au climat. Une gestion plus efficace de cette sensibilité au climat passe par l’instauration d’une coopération entre le secteur de la santé et les fournisseurs de données et d’informations sur le climat. En Afrique, où les communautés sont particulièrement vulnérables, le ministère de la Santé et les Services de météorologie nationale doivent collaborer pour réduire le fardeau des maladies liées au climat.Le ministère de la Santé et l’Agence de météorologie nationale d’Ethiopie ont fait des progrès considérables dans le développement d’un système d’alerte et de réponse précoces basé sur les informations climatiques pour des maladies comme le paludisme et d

  7. Health sector reforms for 21 st century healthcare

    Darshan Shankar

    2015-01-01

    Full Text Available The form of the public health system in India is a three tiered pyramid-like structure consisting primary, secondary, and tertiary healthcare services. The content of India′s health system is mono-cultural and based on western bio-medicine. Authors discuss need for health sector reforms in the wake of the fact that despite huge investment, the public health system is not delivering. Today, 70% of the population pays out of pocket for even primary healthcare. Innovation is the need of the hour. The Indian government has recognized eight systems of healthcare viz., Allopathy, Ayurveda, Siddha, Swa-rigpa, Unani, Naturopathy, Homeopathy, and Yoga. Allopathy receives 97% of the national health budget, and 3% is divided amongst the remaining seven systems. At present, skewed funding and poor integration denies the public of advantage of synergy and innovations arising out of the richness of India′s Medical Heritage. Health seeking behavior studies reveal that 40-70% of the population exercise pluralistic choices and seek health services for different needs, from different systems. For emergency and surgery, Allopathy is the first choice but for chronic and common ailments and for prevention and wellness help from the other seven systems is sought. Integrative healthcare appears to be the future framework for healthcare in the 21 st century. A long-term strategy involving radical changes in medical education, research, clinical practice, public health and the legal and regulatory framework is needed, to innovate India′s public health system and make it both integrative and participatory. India can be a world leader in the new emerging field of "integrative healthcare" because we have over the last century or so assimilated and achieved a reasonable degree of competence in bio-medical and life sciences and we possess an incredibly rich and varied medical heritage of our own.

  8. A participação popular em Ipatinga (MG, Brasil: conquistas e desafios do setor de saúde Popular participation in Ipatinga (MG, Brazil: achievements and challenges of the health sector

    Elizabeth da Costa Batista

    2011-01-01

    referential the Communicative Action Theory of Habermas and, from this theory, a model of democracy which is understood as the institutionalization of the discursive processes of opinion and will formation. The results obtained indicate that there is an important democratic history in the city, but with indications, however, of retrocessions in the participative practices of the health sector, as the reproduction of traditional practices of government is verified

  9. Health care financing in Nigeria: Implications for achieving universal health coverage.

    Uzochukwu, B S C; Ughasoro, M D; Etiaba, E; Okwuosa, C; Envuladu, E; Onwujekwe, O E

    2015-01-01

    The way a country finances its health care system is a critical determinant for reaching universal health coverage (UHC). This is so because it determines whether the health services that are available are affordable to those that need them. In Nigeria, the health sector is financed through different sources and mechanisms. The difference in the proportionate contribution from these stated sources determine the extent to which such health sector will go in achieving successful health care financing system. Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. This review draws on relevant literature to provide an overview and the state of health care financing in Nigeria, including policies in place to enhance healthcare financing. We searched PubMed, Medline, The Cochrane Library, Popline, Science Direct and WHO Library Database with search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies. Further publications were identified from references cited in relevant articles and reports. We reviewed only papers published in English. No date restrictions were placed on searches. It notes that health care in Nigeria is financed through different sources including but not limited to tax revenue, out-of-pocket payments (OOPs), donor funding, and health insurance (social and community). In the face of achieving UHC, achieving successful health care financing system continues to be a challenge in Nigeria and concludes that to achieve universal coverage using health financing as the strategy, there is a dire need to review the system of financing health and ensure that resources are used more efficiently while at the same time removing financial barriers to access by shifting focus from OOPs to other hidden resources. There is also need to give presidential assent to the national health bill and its prompt implementation when signed into law.

  10. Creating the Business Case for Achieving Health Equity.

    Chin, Marshall H

    2016-07-01

    Health care organizations have increasingly acknowledged the presence of health care disparities across race/ethnicity and socioeconomic status, but significantly fewer have made health equity for diverse patients a true priority. Lack of financial incentives is a major barrier to achieving health equity. To create a business case for equity, governmental and private payors can: 1) Require health care organizations to report clinical performance data stratified by race, ethnicity, and socioeconomic status. 2) Incentivize preventive care and primary care. Implement more aggressive shared savings plans, update physician relative value unit fee schedules, and encourage partnerships across clinical and non-clinical sectors. 3) Incentivize the reduction of health disparities with equity accountability measures in payment programs. 4) Align equity accountability measures across public and private payors. 5) Assist safety-net organizations. Provide adequate Medicaid reimbursement, risk-adjust clinical performance scores for sociodemographic characteristics of patients, provide support for quality improvement efforts, and calibrate cuts to Disproportionate Share Hospital (DSH) payments to the pace of health insurance expansion. 6) Conduct demonstration projects to test payment and delivery system reform interventions to reduce disparities. Commitment to social justice is essential to achieve health equity, but insufficient without a strong business case that makes interventions financially feasible.

  11. The Role of Branding in the Health Sector

    Shahriar Shafiee

    2010-05-01

    Full Text Available A services brand is essentially a promise about the nature of a future experience with an organization or individual service provider. A strong services brand is built and sustained primarily by customers' interactions with the provider. From the inter relationships among the presented brand, external communications, and customers' experiences emerge brand awareness, meaning, and, ultimately, equity. Customers' experience-based perceptions prevail if external information and personal experience are conflicting. Great services brands are built on excellent customer experiences. Building a strong identity in the health care category comes with a unique set of branding challenges. Consider that a successful branding strategy must address how to:"n•Re-shape the consumers' perceptions of the health care organization by signaling a new future-focused strategy"n•Consolidate and coordinate existing identities"n•Preserve the equity residing with keystone health care identities and lever those equities to build trust and equity in the new identity"n•Incorporate the values of the organization to reinforce "living the brand""nBrand building in health services insures the patients (clients with the quality of treatment they receive via creating, extending, and protecting value under the name of powerful brands. This cannot be achieved without an unwavering commitment to the customers' well-being. Today's health care environment requires a branding process that goes beyond the traditional, corporate identity process. It is a process that focuses on building brand equity with health care consumers. Managers in the healthcare sector may benefit from branding through:"n•Enrichment of organizational values"n•Manifesting the brand core values in each and every effective contact point"n•Amplifying patients' word-of-mouth (turning customers into marketers

  12. COMMENTARY: GLOBALIZATION, HEALTH SECTOR REFORM, AND THE HUMAN RIGHT TO HEALTH: IMPLICATIONS FOR FUTURE HEALTH POLICY.

    Schuftan, Claudio

    2015-01-01

    The author here distills his long-time personal experience with the deleterious effects of globalization on health and on the health sector reforms embarked on in many of the more than 50 countries where he has worked in the last 25 years. He highlights the role that the "human right to health" framework can and should play in countering globalization's negative effects on health and in shaping future health policy. This is a testimonial article.

  13. Designing New Financial Management System in Health Sector of Islamic Republic of Iran

    R Hafezi

    2009-03-01

    Full Text Available "nBackground: In health system of any country, securing financial resources and management of the same is one of the most vital apprehensions in regards policy makers. This article expresses a part of the obstacles and threats present in the man­agement of the government financial resources of health sector and in assimilating this, the requirement for amendments in the financial system and designing new financial management system of health sector in Iran."nMethods: The authors conducted a case study based on interviews with government, and academic participants. Two meth­ods of data collection were used: retrospective analysis of official documents and in-depth interview."nResults: The root of the obstacles relevant to the management of financial resources in health sector in four intricate and fundamental modes of executing cash accounts in contrary to accrual accounts, where there is an intense weakness in the internal controls due to the lack of periodic reports, so as to define the source of deviations, the lack of a mechanized system and ultimately, the absence of a comprehensive monetary plan in the Country. Based on these obstacles, the new financial management system of health sector in Iran was designed including mission, objectives, structure, human resources and duties, processes and procedures, external environment."nConclusion: Designing new financial system in health sector of country is a way to effective and efficient management of financial resources and aid health system to achieve ultimate goals.

  14. Stakeholder learning for health sector reform in Lao PDR.

    Phillips, Simone; Pholsena, Soulivanh; Gao, Jun; Oliveira Cruz, Valeria

    2016-09-01

    Development organizations and academic institutions have expressed the need for increased research to guide the development and implementation of policies to strengthen health systems in low- and middle-income countries. The extent to which evidence-based policies alone can produce changes in health systems remains a point of debate; other factors, such as a country's political climate and the level of actor engagement, have been identified as influential variables in effective policy development and implementation. In response to this debate, this article contends that the success of health sector reform depends largely on policy learning-the degree to which research recommendations saturate a given political environment in order to successfully inform the ideas, opinions and perceived interests of relevant actors. Using a stakeholder analysis approach to analyze the case of health sector reform in Lao PDR, we examine the ways that actors' understanding and interests affect the success of reform-and how attitudes towards reform can be shaped by exposure to policy research and international health policy priorities. The stakeholder analysis was conducted by the WHO during the early stages of health sector reform in Lao PDR, with the purpose of providing the Ministry of Health with concrete recommendations for increasing actor involvement and strengthening stakeholder support. We found that dissemination of research findings to a broad array of actors and the inclusion of diverse stakeholder groups in policy design and implementation increases the probability of a sustainable and successful health sector reform.

  15. Organizing the health sector for response to disasters

    Kimberley Shoaf

    2014-09-01

    Full Text Available Each year millions of people around the world are affected by natural and manmade disasters. The consequences of natural disasters in terms of health are complex. Disasters directly impact the health of the population resulting in physical trauma, acute disease, and emotional trauma. Furthermore, disasters may increase the morbidity and mortality associated with chronic and infectious diseases due to the impact on the health system. The health sector must be organized for adequate preparedness, mitigation, response and recuperation from a plethora of potential disasters. This paper examines the various potential impacts of disasters on health, the components of the health sector and their roles in emergency medical care and disaster situations, as well as the coordination and organization necessary within the system to best meet the health needs of a population in the aftermath of a disaster.

  16. Exploring corruption in the South African health sector.

    Rispel, Laetitia C; de Jager, Pieter; Fonn, Sharon

    2016-03-01

    Recent scholarly attention has focused on weak governance and the negative effects of corruption on the provision of health services. Employing agency theory, this article discusses corruption in the South African health sector. We used a combination of research methods and triangulated data from three sources: Auditor-General of South Africa reports for each province covering a 9-year period; 13 semi-structured interviews with health sector key informants and a content analysis of print media reports covering a 3-year period. Findings from the Auditor-General reports showed a worsening trend in audit outcomes with marked variation across the nine provinces. Key-informants indicated that corruption has a negative effect on patient care and the morale of healthcare workers. The majority of the print media reports on corruption concerned the public health sector (63%) and involved provincial health departments (45%). Characteristics and complexity of the public health sector may increase its vulnerability to corruption, but the private-public binary constitutes a false dichotomy as corruption often involves agents from both sectors. Notwithstanding the lack of global validated indicators to measure corruption, our findings suggest that corruption is a problem in the South African healthcare sector. Corruption is influenced by adverse agent selection, lack of mechanisms to detect corruption and a failure to sanction those involved in corrupt activities. We conclude that appropriate legislation is a necessary, but not sufficient intervention to reduce corruption. We propose that mechanisms to reduce corruption must include the political will to run corruption-free health services, effective government to enforce laws, appropriate systems, and citizen involvement and advocacy to hold public officials accountable. Importantly, the institutionalization of a functional bureaucracy and public servants with the right skills, competencies, ethics and value systems and whose

  17. Ideologies in the Swedish health sector today

    Diderichsen, Finn

    1982-01-01

    Sweden has a long tradition of social democracy and corporate cooperation. Social problems are treated as technological questions that always should be solved through rational and neutral means. Today Sweden faces a crisis of economy as well as a crisis of medicine. In the spirit of consensus......, the state has proposed a new health reform emphasizing the responsibility of the public health service to prevent disease and provide equal access to care. It is claimed that improved health planning, based on epidemiological knowledge on inequalities, can solve the crisis in medicine within an improved...... system of primary care and prevention. However, in the context of the current economic crisis, the struggle against health hazards and cuts in public spending has intensified and the gap between the ideology of technological rationalism and reality has widened....

  18. Health sector employment growth calls for improvements in labor productivity.

    Hofmarcher, Maria M; Festl, Eva; Bishop-Tarver, Leslie

    2016-08-01

    While rising costs of healthcare have put increased fiscal pressure on public finance, job growth in the health sector has had a stabilizing force on overall employment levels - not least in times of economic crises. In 2014 EU-15 countries employed 21 million people in the health and social care sector. Between 2000 and 2014 the share of employed persons in this sector rose from 9.5% to 12.5% of the total labor force in EU-15 countries. Over time labor input growth has shifted towards residential care activities and social work while labor in human health activities including hospitals and ambulatory care still comprises the major share. About half of the human health labor force works in hospital. Variation of health and social care employment is large even in countries with generally comparable institutional structures. While standard measures of productivity in health and social care are not yet comparable across countries, we argue that labor productivity of a growing health work force needs more attention. The long-term stability of the health system will require care delivery models that better utilize a growing health work force in concert with smart investments in digital infrastructure to support this transition. In light of this, more research is needed to explain variations in health and social care labor endowments, to identify effective policy measures of labor productivity enhancement including enhanced efforts to develop comparable productivity indicators in these areas.

  19. Performance of private sector health care: implications for universal health coverage.

    Morgan, Rosemary; Ensor, Tim; Waters, Hugh

    2016-08-06

    Although the private sector is an important health-care provider in many low-income and middle-income countries, its role in progress towards universal health coverage varies. Studies of the performance of the private sector have focused on three main dimensions: quality, equity of access, and efficiency. The characteristics of patients, the structures of both the public and private sectors, and the regulation of the sector influence the types of health services delivered, and outcomes. Combined with characteristics of private providers-including their size, objectives, and technical competence-the interaction of these factors affects how the sector performs in different contexts. Changing the performance of the private sector will require interventions that target the sector as a whole, rather than individual providers alone. In particular, the performance of the private sector seems to be intrinsically linked to the structure and performance of the public sector, which suggests that deriving population benefit from the private health-care sector requires a regulatory response focused on the health-care sector as a whole.

  20. Diagnostic evaluation of dementia in the secondary health care sector

    Phung, Thien Kieu Thi; Andersen, Birgitte Bo; Kessing, Lars Vedel;

    2009-01-01

    to clinical guidelines concerning dementia work-up is inadequate in the secondary health care sector. Our findings call for improvement in the organization of clinical dementia care, for education of specialists and for changes in attitude towards making a diagnosis of dementia.......BACKGROUND: We conducted a nationwide registry-based study of the quality of diagnostic evaluation for dementia in the secondary health care sector. METHOD: Two hundred patients were randomly selected from the patient population (4,682 patients) registered for the first time with a dementia...

  1. Population health improvement: a community health business model that engages partners in all sectors.

    Kindig, David A; Isham, George

    2014-01-01

    Because population health improvement requires action on multiple determinants--including medical care, health behaviors, and the social and physical environments--no single entity can be held accountable for achieving improved outcomes. Medical organizations, government, schools, businesses, and community organizations all need to make substantial changes in how they approach health and how they allocate resources. To this end, we suggest the development of multisectoral community health business partnership models. Such collaborative efforts are needed by sectors and actors not accustomed to working together. Healthcare executives can play important leadership roles in fostering or supporting such partnerships in local and national arenas where they have influence. In this article, we develop the following components of this argument: defining a community health business model; defining population health and the Triple Aim concept; reaching beyond core mission to help create the model; discussing the shift for care delivery beyond healthcare organizations to other community sectors; examining who should lead in developing the community business model; discussing where the resources for a community business model might come from; identifying that better evidence is needed to inform where to make cost-effective investments; and proposing some next steps. The approach we have outlined is a departure from much current policy and management practice. But new models are needed as a road map to drive action--not just thinking--to address the enormous challenge of improving population health. While we applaud continuing calls to improve health and reduce disparities, progress will require more robust incentives, strategies, and action than have been in practice to date. Our hope is that ideas presented here will help to catalyze a collective, multisectoral response to this critical social and economic challenge.

  2. Adaptation to climate change in the Ontario public health sector

    Paterson Jaclyn A

    2012-06-01

    Full Text Available Abstract Background Climate change is among the major challenges for health this century, and adaptation to manage adverse health outcomes will be unavoidable. The risks in Ontario – Canada’s most populous province – include increasing temperatures, more frequent and intense extreme weather events, and alterations to precipitation regimes. Socio-economic-demographic patterns could magnify the implications climate change has for Ontario, including the presence of rapidly growing vulnerable populations, exacerbation of warming trends by heat-islands in large urban areas, and connectedness to global transportation networks. This study examines climate change adaptation in the public health sector in Ontario using information from interviews with government officials. Methods Fifty-three semi-structured interviews were conducted, four with provincial and federal health officials and 49 with actors in public health and health relevant sectors at the municipal level. We identify adaptation efforts, barriers and opportunities for current and future intervention. Results Results indicate recognition that climate change will affect the health of Ontarians. Health officials are concerned about how a changing climate could exacerbate existing health issues or create new health burdens, specifically extreme heat (71%, severe weather (68% and poor air-quality (57%. Adaptation is currently taking the form of mainstreaming climate change into existing public health programs. While adaptive progress has relied on local leadership, federal support, political will, and inter-agency efforts, a lack of resources constrains the sustainability of long-term adaptation programs and the acquisition of data necessary to support effective policies. Conclusions This study provides a snapshot of climate change adaptation and needs in the public health sector in Ontario. Public health departments will need to capitalize on opportunities to integrate climate change into

  3. Building health research systems to achieve better health.

    Hanney, Stephen R; González Block, Miguel A

    2006-01-01

    Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS) provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics related to the above

  4. Building health research systems to achieve better health

    González Block Miguel

    2006-11-01

    Full Text Available Abstract Health research systems can link knowledge generation with practical concerns to improve health and health equity. Interest in health research, and in how health research systems should best be organised, is moving up the agenda of bodies such as the World Health Organisation. Pioneering health research systems, for example those in Canada and the UK, show that progress is possible. However, radical steps are required to achieve this. Such steps should be based on evidence not anecdotes. Health Research Policy and Systems (HARPS provides a vehicle for the publication of research, and informed opinion, on a range of topics related to the organisation of health research systems and the enormous benefits that can be achieved. Following the Mexico ministerial summit on health research, WHO has been identifying ways in which it could itself improve the use of research evidence. The results from this activity are soon to be published as a series of articles in HARPS. This editorial provides an account of some of these recent key developments in health research systems but places them in the context of a distinguished tradition of debate about the role of science in society. It also identifies some of the main issues on which 'research on health research' has already been conducted and published, in some cases in HARPS. Finding and retaining adequate financial and human resources to conduct health research is a major problem, especially in low and middle income countries where the need is often greatest. Research ethics and agenda-setting that responds to the demands of the public are issues of growing concern. Innovative and collaborative ways are being found to organise the conduct and utilisation of research so as to inform policy, and improve health and health equity. This is crucial, not least to achieve the health-related Millennium Development Goals. But much more progress is needed. The editorial ends by listing a wide range of topics

  5. Private Sector An Important But Not Dominant Provider Of Key Health Services In Low- And Middle-Income Countries.

    Grépin, Karen A

    2016-07-01

    There is debate about the role of the private sector in providing services in the health systems of low- and middle-income countries and about how the private sector could help achieve the goal of universal health coverage. Yet the role that the private sector plays in the delivery of health services is poorly understood. Using data for the period 1990-2013 from 205 Demographic and Health Surveys in seventy low- and middle-income countries, I analyzed the use of the private sector for the treatment of diarrhea and of fever or cough in children, for antenatal care, for institutional deliveries, and as a source of modern contraception for women. I found that private providers were the dominant source of treatment for childhood illnesses but not for the other services. I also found no evidence of increased use of the private sector over time. There is tremendous variation in use of the private sector across countries and health services. Urban and wealthier women disproportionately use the private sector, compared to rural and poorer women. The private sector plays an important role in providing coverage, but strategies to further engage the sector, if they are to be effective, will need to take into consideration the variation in its use.

  6. Promoting Occupational Safety and Health for Cambodian Entertainment Sector Workers.

    Hsu, Lee-Nah; Howard, Richard; Torriente, Anna Maria; Por, Chuong

    2016-08-01

    Cambodia has developed booming textile, garment, tourism, and entertainment service industries since the mid-1990s. The 2007 global financial crisis pushed many garment workers, who lost their jobs, into the entertainment sector. Entertainment workers are typically engaged informally by their employers and are subjected to long working hours, sexual harassment, and violence. Many who sell beverages are forced into excessive alcohol consumption as part of their work. Many are also expected by their employers and clients to provide sexual services. To address unsafe and unhealthy working conditions for these workers, an innovative occupational safety and health regulation was adopted in 2014. This first-of-its-kind occupational safety and health regulation was developed jointly by the Cambodian Ministry of Labour and Vocational Training and employers' and workers' organizations in the entertainment sector. The implementation of this regulation can also be a viable contribution of occupational safety and health to HIV interventions for these workers.

  7. Guidelines for Analysis of Health Sector Financing in Developing Countries. Volume 8: Health Sector Financing in Developing Countries. International Health Planning Methods Series.

    Robertson, Robert L.; And Others

    Intended to assist Agency for International Development officers, advisors, and health officials in incorporating health planning into national plans for economic development, this eighth of ten manuals in the International Health Planning Methods series provides a methodology for conducting a study of health sector financing. It presents an…

  8. Organization and Finance of China’s Health Sector

    Hui Li PhD

    2016-01-01

    Full Text Available China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP. Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China’s shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China’s evolution, adding another layer of

  9. Health sector reform in Brazil: a case study of inequity.

    Almeida, C; Travassos, C; Porto, S; Labra, M E

    2000-01-01

    Health sector reform in Brazil built the Unified Health System according to a dense body of administrative instruments for organizing decentralized service networks and institutionalizing a complex decision-making arena. This article focuses on the equity in health care services. Equity is defined as a principle governing distributive functions designed to reduce or offset socially unjust inequalities, and it is applied to evaluate the distribution of financial resources and the use of health services. Even though in the Constitution the term "equity" refers to equal opportunity of access for equal needs, the implemented policies have not guaranteed these rights. Underfunding, fiscal stress, and lack of priorities for the sector have contributed to a progressive deterioration of health care services, with continuing regressive tax collection and unequal distribution of financial resources among regions. The data suggest that despite regulatory measures to increase efficiency and reduce inequalities, delivery of health care services remains extremely unequal across the country. People in lower income groups experience more difficulties in getting access to health services. Utilization rates vary greatly by type of service among income groups, positions in the labor market, and levels of education.

  10. Health resources in a 200,000 urban Indian population argues the need for a policy on private sector health services

    Kheya Melo Furtado

    2014-01-01

    Full Text Available Background: There are limited primary data on the number of urban health care providers in private practice in developing countries like India. These data are needed to construct and test models that measure the efficacy of public stewardship of private sector health services. Objective: This study reports the number and characteristics of health resources in a 200 000 urban population in Pune. Materials and Methods: Data on health providers were collected by walking through the 15.46 sq km study area. Enumerated data were compared with existing data sources. Mapping was carried out using a Global Positioning System device. Metrics and characteristics of health resources were analyzed using ArcGIS 10.0 and Statistical Package for the Social Sciences, Version 16.0 software. Results: Private sector health facilities constituted the majority (424/426, 99.5% of health care services. Official data sources were only 39% complete. Doctor to population ratios were 2.8 and 0.03 per 1000 persons respectively in the private and public sector, and the nurse to doctor ratio was 0.24 and 0.71, respectively. There was an uneven distribution of private sector health services across the area (2-118 clinics per square kilometre. Bed strength was forty-fold higher in the private sector. Conclusions: Mandatory registration of private sector health services needs to be implemented which will provide an opportunity for public health planners to utilize these health resources to achieve urban health goals.

  11. Health Resources in a 200,000 Urban Indian Population Argues the Need for a Policy on Private Sector Health Services

    Furtado, Kheya Melo; Kar, Anita

    2014-01-01

    Background: There are limited primary data on the number of urban health care providers in private practice in developing countries like India. These data are needed to construct and test models that measure the efficacy of public stewardship of private sector health services. Objective: This study reports the number and characteristics of health resources in a 200 000 urban population in Pune. Materials and Methods: Data on health providers were collected by walking through the 15.46 sq km study area. Enumerated data were compared with existing data sources. Mapping was carried out using a Global Positioning System device. Metrics and characteristics of health resources were analyzed using ArcGIS 10.0 and Statistical Package for the Social Sciences, Version 16.0 software. Results: Private sector health facilities constituted the majority (424/426, 99.5%) of health care services. Official data sources were only 39% complete. Doctor to population ratios were 2.8 and 0.03 per 1000 persons respectively in the private and public sector, and the nurse to doctor ratio was 0.24 and 0.71, respectively. There was an uneven distribution of private sector health services across the area (2-118 clinics per square kilometre). Bed strength was forty-fold higher in the private sector. Conclusions: Mandatory registration of private sector health services needs to be implemented which will provide an opportunity for public health planners to utilize these health resources to achieve urban health goals. PMID:24963226

  12. Co-operative bidding of SMEs in health care sector.

    Mezgár, István; Kovács, György; Bonfatti, Fabio

    2002-01-01

    Tendering become an important process for customers in the health care sector to select products and services from the market for the lowest price, with the highest quality and with the shortest delivery time. The number of SMEs (Small and Medium-sized Enterprises) delivering products or services for the health care sector is increasing, but they have usually limited capital and expertise to participate in tenders. The paper introduces a possible solution for this problem, when SMEs form special groups, so called Smart Bidding Organisations (SBO), to prepare a bid for the tender jointly. The SBO appears for the customer (tender issuer) as a single enterprise and the bidding procedure will be faster and less expensive in this way.

  13. Mental health policy and development in Egypt - integrating mental health into health sector reforms 2001-9

    Siekkonen Inkeri

    2010-06-01

    Full Text Available Abstract Background Following a situation appraisal in 2001, a six year mental health reform programme (Egymen 2002-7 was initiated by an Egyptian-Finnish bilateral aid project at the request of a former Egyptian minister of health, and the work was incorporated directly into the Ministry of Health and Population from 2007 onwards. This paper describes the aims, methodology and implementation of the mental health reforms and mental health policy in Egypt 2002-2009. Methods A multi-faceted and comprehensive programme which combined situation appraisal to inform planning; establishment of a health sector system for coordination, supervision and training of each level (national, governorate, district and primary care; development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at each level; integration of mental health into health management systems; and dedicated efforts to improve forensic services, rehabilitation services, and child psychiatry services. Results The project has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, mental health masterplan (policy guidelines to accompany the general health policy, updated Egyptian mental health legislation, Code of Practice, adaptation of the WHO primary care guidelines, primary care training, construction of a quality system of roles and responsibilities, availability of medicines at primary care level, public education about mental health, and a research programme to inform future developments. Intersectoral liaison with education, social welfare, police and prisons at national level is underway, but has not yet been established for governorate and district levels, nor mental health training for police, prison staff and teachers. Conclusions The bilateral collaboration programme

  14. Service planning in the Victorian community health sector.

    Roussy, Véronique; Livingstone, Charles

    2015-01-01

    Until now, comprehensive service planning has been uncommon in the Victorian community health sector. Where it has occurred, it has primarily been undertaken by community health services embedded within larger, hospital-based health services. Reflections on the utility and efficacy of community health service planning are largely absent from the Australian peer-reviewed literature. Using a case study focussed on a specific centre in Melbourne's outer suburbs, this paper explores how community health service planning is shaped by the current policy context, the legal status of registered community health services, and the data and methodologies available to inform planning. It argues that regular and systematic service planning could support registered community health centres to better understand their unique position within the primary health-care landscape, having regard to their inherent opportunities and vulnerabilities. Furthermore, consistent and effective service planning is proposed to benefit agencies in establishing themselves as critical players in promoting local population health initiatives and driving improved health outcomes.

  15. Understanding human resource management practices in Botswana's public health sector.

    Seitio-Kgokgwe, Onalenna Stannie; Gauld, Robin; Hill, Philip C; Barnett, Pauline

    2016-11-21

    Purpose The purpose of this paper is to assess the management of the public sector health workforce in Botswana. Using institutional frameworks it aims to document and analyse human resource management (HRM) practices, and make recommendations to improve employee and health system outcomes. Design/methodology/approach The paper draws from a large study that used a mixed methods approach to assess performance of Botswana's Ministry of Health (MOH). It uses data collected through document analysis and in-depth interviews of 54 key informants comprising policy makers, senior staff of the MOH and its stakeholder organizations. Findings Public health sector HRM in Botswana has experienced inadequate planning, poor deployment and underutilization of staff. Lack of comprehensive retention strategies and poor working conditions contributed to the failure to attract and retain skilled personnel. Relationships with both formal and informal environments affected HRM performance. Research limitations/implications While document review was a major source of data for this paper, the weaknesses in the human resource information system limited availability of data. Practical implications This paper presents an argument for the need for consideration of formal and informal environments in developing effective HRM strategies. Originality/value This research provides a rare system-wide approach to health HRM in a Sub-Saharan African country. It contributes to the literature and evidence needed to guide HRM policy decisions and practices.

  16. Climate cure 2020 measures and instruments to achieve Norwegian climate goals by 2020. Chapter 10 - the transport sector analysis

    2010-11-15

    This document is a translation of Chapter 10, Sector analysis of transport, in the Norwegian report Climate Cure 2020, Measures and Instruments for Achieving Norwegian Climate Goals by 2020. The sector analysis has been prepared by an inter agency working group, conducted by the Norwegian Public Road Administration. (Author)

  17. Improving child health promotion practices in multiple sectors – outcomes of the Swedish Salut Programme

    Edvardsson Kristina

    2012-10-01

    Full Text Available Abstract Background To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme on professionals’ self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation. Methods A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points. Results Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1 an increase in the extent to which midwives in antenatal care raised issues related to men’s violence against women, 2 an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3 an increased use of motivational interviewing (MI and separate ‘fathers visits’ in child health care 4 improvements in the supply of healthy snacks and beverages in open pre-schools and 5 increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff. Conclusion This multisectoral programme for health promotion, based on sector

  18. Data Hemorrhages in the Health-Care Sector

    Johnson, M. Eric

    Confidential data hemorrhaging from health-care providers pose financial risks to firms and medical risks to patients. We examine the consequences of data hemorrhages including privacy violations, medical fraud, financial identity theft, and medical identity theft. We also examine the types and sources of data hemorrhages, focusing on inadvertent disclosures. Through an analysis of leaked files, we examine data hemorrhages stemming from inadvertent disclosures on internet-based file sharing networks. We characterize the security risk for a group of health-care organizations using a direct analysis of leaked files. These files contained highly sensitive medical and personal information that could be maliciously exploited by criminals seeking to commit medical and financial identity theft. We also present evidence of the threat by examining user-issued searches. Our analysis demonstrates both the substantial threat and vulnerability for the health-care sector and the unique complexity exhibited by the US health-care system.

  19. What is the Meaning of Public Sector Health?

    Waldorff, Susanne Boch

    2013-01-01

    This study explores the dynamics involved in establishing discourses necessary for constructing organizational change within the public sector. Drawing upon critical discourse analysis, the study identifies two competing discourses – a ‘patient’ and a ‘healthy citizen’ discourse, which exist...... as strategic resources in health care. The case study focuses on a municipality in Denmark and the way the organizational actors translated meaning into the development of a new healthcare centre. The analysis contributes to our understandings of translation by focusing on discursive legitimizing strategies...... in the context of public sector change. First, the study shows that discourses not only provide different senses of meaning and warrant particular social actors a louder voice than others, but that these actors also develop discursive legitimizing strategies and translate particular meanings...

  20. Beyond trade: taking globalization to the health sector.

    Daulaire, Nils

    2003-01-01

    The pace of globalization has brought the world to the brink of a new era in international relations. While the world has outgrown traditional mechanisms for addressing global issues, it has not yet developed new forms of effective governance. This temporary void poses threats and enormous opportunities. The public health sector will play a crucial "formal" role--that is, carried out by existing bodies such as WHO and the UN. But WHO does not necessarily represent the full spectrum of views and its members necessarily work, to some degree, for separate national interests. The formal dimension must be supplemented. Globalization is not synonymous with lack of regulation. Many responsible businesses would welcome a transparent and universally applied regulatory regime to prevent a race to the lowest standards. The economic benefits of globalization may hit a glass ceiling if societies outside the global economy become progressively poorer and less healthy. The business community is recognizing that good health is essential for economic growth and social stability. Globalization may cause millions to migrate for economic opportunity. The private sector's forward-thinkers recognize the health threats of migration and are beginning to view global health promotion as a means to ensure optimal market access.

  1. [Gender equity in health sector reform policies in Latin America and the Caribbean].

    Gómez, Elsa Gómez

    2002-01-01

    Gender equity is increasingly being acknowledged as an essential aspect of sustainable development and more specifically, of health development. The Pan American Health Organization's Program for Women, Health, and Development has been piloting for a year now a project known as Equidad de género en las políticas de reforma del sector de salud, whose objective is to promote gender equity in the health sector reform efforts in the Region. The first stage of the project is being conducted in Chile and Peru, along with some activities throughout the Region. The core of the project is the production and use of information as a tool for introducing changes geared toward achieving greater gender equity in health, particularly in connection with malefemale disparities that are unnecessary, avoidable, and unfair in health status, access to health care, and participation in decision-making within the health system. We expect that in three years the project will have brought about changes in the production of information and knowledge, advocacy, and information dissemination, as well as in the development, appropriation, and identification of intersectoral mechanisms that will make it possible for key figures in government and civil society to work together in setting and surveying policy on gender equity in health.

  2. Health sector operational planning and budgeting processes in Kenya-"never the twain shall meet".

    Tsofa, Benjamin; Molyneux, Sassy; Goodman, Catherine

    2016-07-01

    Operational planning is considered an important tool for translating government policies and strategic objectives into day-to-day management activities. However, developing countries suffer from persistent misalignment between policy, planning and budgeting. The Medium Term Expenditure Framework (MTEF) was introduced to address this misalignment. Kenya adopted the MTEF in the early 2000s, and in 2005, the Ministry of Health adopted the Annual Operational Plan process to adapt the MTEF to the health sector. This study assessed the degree to which the health sector Annual Operational Plan process in Kenya has achieved alignment between planning and budgeting at the national level, using document reviews, participant observation and key informant interviews. We found that the Kenyan health sector was far from achieving planning and budgeting alignment. Several factors contributed to this problem including weak Ministry of Health stewardship and institutionalized separation between planning and budgeting processes; a rapidly changing planning and budgeting environment; lack of reliable data to inform target setting and poor participation by key stakeholders in the process including a top-down approach to target setting. We conclude that alignment is unlikely to be achieved without consideration of the specific institutional contexts and the power relationships between stakeholders. In particular, there is a need for institutional integration of the planning and budgeting processes into a common cycle and framework with common reporting lines and for improved data and local-level input to inform appropriate and realistic target setting. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.

  3. Increased fairness in priority setting processes within the health sector

    Zulu, Joseph M.; Michelo, Charles; Msoni, Carol

    2014-01-01

    to enhance legitimate and fair PS was introduced by researchers and decision makers within the health sector in the EU funded research project entitled 'Response to Accountable priority setting for Trust in health systems' (REACT). The project aimed to strengthen fairness and accountability in the PS...... by the present project with its emphasis on fairness and enhanced participation. A responsive leadership that was increasingly accountable to its operational staff and communities emerged as one of the key elements in driving the processes forward....... processes of health systems at district level in Zambia, Tanzania and Kenya. This paper focuses on local perceptions and practices of fair PS (baseline study) as well as at the evolution of such perceptions and practices in PS following an AFR based intervention (evaluation study), carried out at district...

  4. Just How Big is the Schism Between the Health Sector and the Water and Sanitation Sector in Developing Countries?

    A. A. Cronin

    2008-01-01

    Full Text Available Water, sanitation and hygiene are all key aspects to a healthy environment but often they suffer from a lack of coherence within the sector itself and also a lack of synergy with the health sector. This is not acceptable given one quarter of all child deaths are directly attributable to water-borne disease. This lack of synergy is evident at many different layers including planning, resource allocation and donor commitment. Developing countries must, in consultation with their communities, examine their biggest health risks and allocate resources accordingly. Sustained dialogue and increased in-depth analysis are needed to find consensus and an improved synergy across these vital sectors.

  5. One Health in NSW: coordination of human and animal health sector management of zoonoses of public health significance.

    Adamson, Sheena; Marich, Andrew; Roth, Ian

    2011-07-01

    Zoonoses of public health significance may occur in wildlife, livestock or companion animals, and may be detected by the human or animal health sectors. Of particular public health interest are foodborne, arboviral and emerging zoonoses (known/unknown, endemic/exotic). A coordinated One Health approach to the management of zoonoses in NSW uses measures including: mutually agreed intersectoral procedures for detection and response; surveillance and notification systems for defined endemic and exotic diseases; joint meetings and exercises to ensure currency of response plans; and intersectoral communication during a response. This One Health approach is effective and ensures the interests of both the human health and animal health sectors are addressed.

  6. Climate change and eHealth: a promising strategy for health sector mitigation and adaptation.

    Holmner, Asa; Rocklöv, Joacim; Ng, Nawi; Nilsson, Maria

    2012-01-01

    Climate change is one of today's most pressing global issues. Policies to guide mitigation and adaptation are needed to avoid the devastating impacts of climate change. The health sector is a significant contributor to greenhouse gas emissions in developed countries, and its climate impact in low-income countries is growing steadily. This paper reviews and discusses the literature regarding health sector mitigation potential, known and hypothetical co-benefits, and the potential of health information technology, such as eHealth, in climate change mitigation and adaptation. The promising role of eHealth as an adaptation strategy to reduce societal vulnerability to climate change, and the link's between mitigation and adaptation, are also discussed. The topic of environmental eHealth has gained little attention to date, despite its potential to contribute to more sustainable and green health care. A growing number of local and global initiatives on 'green information and communication technology (ICT)' are now mentioning eHealth as a promising technology with the potential to reduce emission rates from ICT use. However, the embracing of eHealth is slow because of limitations in technological infrastructure, capacity and political will. Further research on potential emissions reductions and co-benefits with green ICT, in terms of health outcomes and economic effectiveness, would be valuable to guide development and implementation of eHealth in health sector mitigation and adaptation policies.

  7. Interventions to reduce corruption in the health sector

    Gaitonde, Rakhal; Oxman, Andrew D; Okebukola, Peter O; Rada, Gabriel

    2016-01-01

    Background Corruption is the abuse or complicity in abuse, of public or private position, power or authority to benefit oneself, a group, an organisation or others close to oneself; where the benefits may be financial, material or non-material. It is wide-spread in the health sector and represents a major problem. Objectives Our primary objective was to systematically summarise empirical evidence of the effects of strategies to reduce corruption in the health sector. Our secondary objective was to describe the range of strategies that have been tried and to guide future evaluations of promising strategies for which there is insufficient evidence. Search methods We searched 14 electronic databases up to January 2014, including: CENTRAL; MEDLINE; EMBASE; sociological, economic, political and other health databases; Human Resources Abstracts up to November 2010; Euroethics up to August 2015; and PubMed alerts from January 2014 to June 2016. We searched another 23 websites and online databases for grey literature up to August 2015, including the World Bank, the International Monetary Fund, the U4 Anti-Corruption Resource Centre, Transparency International, healthcare anti-fraud association websites and trial registries. We conducted citation searches in Science Citation Index and Google Scholar, and searched PubMed for related articles up to August 2015. We contacted corruption researchers in December 2015, and screened reference lists of articles up to May 2016. Selection criteria For the primary analysis, we included randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies that evaluated the effects of an intervention to reduce corruption in the health sector. For the secondary analysis, we included case studies that clearly described an intervention to reduce corruption in the health sector, addressed either our primary or secondary objective, and stated the methods that the study authors used to collect and

  8. Health Information Management System for Elderly Health Sector: A Qualitative Study in Iran

    Sadoughi, Farahnaz; Shahi, Mehraban; Ahmadi, Maryam; Davaridolatabadi, Nasrin

    2016-01-01

    Background: There are increasing change and development of information in healthcare systems. Given the increase in aging population, managers are in need of true and timely information when making decision. Objectives: The aim of this study was to investigate the current status of the health information management system for the elderly health sector in Iran. Materials and Methods: This qualitative study was conducted in two steps. In the first step, required documents for administrative managers were collected using the data gathering form and observed and reviewed by the researcher. In the second step, using an interview guide, the required information was gathered through interviewing experts and faculty members. The convenience, purposeful and snowball sampling methods were applied to select interviewees and the sampling continued until reaching the data saturation point. Finally, notes and interviews were transcribed and content analysis was used to analyze them. Results: The results of the study showed that there was a health information management system for the elderly health sector in Iran. However, in all primary health care centers the documentation of data was done manually; the data flow was not automated; and the analysis and reporting of data are also manually. Eventually, decision makers are provided with delayed information. Conclusions: It is suggested that the steward of health in Iran, the ministry of health, develops an appropriate infrastructure and finally puts a high priority on the implementation of the health information management system for elderly health sector in Iran. PMID:27186383

  9. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns.

    Moradi-Lakeh, Maziar; Vosoogh-Moghaddam, Abbas

    2015-08-31

    In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP), was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016). It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME) affiliated hospitals, reduce out-of-pocket (OOP) payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs) of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers' concerns (as powerful and influential stakeholders) potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes) should be addressed through proper revision(s) while nontechnical concerns (which are derived from conflicting interests) must be responded through clarification and providing transparent information. The requirements of

  10. Health Sector Evolution Plan in Iran; Equity and Sustainability Concerns

    Maziar Moradi-Lakeh

    2015-10-01

    Full Text Available In 2014, a series of reforms, called as the Health Sector Evolution Plan (HSEP, was launched in the health system of Iran in a stepwise process. HSEP was mainly based on the fifth 5-year health development national strategies (2011-2016. It included different interventions to: increase population coverage of basic health insurance, increase quality of care in the Ministry of Health and Medical Education (MoHME affiliated hospitals, reduce out-of-pocket (OOP payments for inpatient services, increase quality of primary healthcare, launch updated relative value units (RVUs of clinical services, and update tariffs to more realistic values. The reforms resulted in extensive social reaction and different professional feedback. The official monitoring program shows general public satisfaction. However, there are some concerns for sustainability of the programs and equity of financing. Securing financial sources and fairness of the financial contribution to the new programs are the main concerns of policy-makers. Healthcare providers’ concerns (as powerful and influential stakeholders potentially threat the sustainability and efficiency of HSEP. Previous experiences on extending health insurance coverage show that they can lead to a regressive healthcare financing and threat financial equity. To secure financial sources and to increase fairness, the contributions of people to new interventions should be progressive by their income and wealth. A specific progressive tax would be the best source, however, since it is not immediately feasible, a stepwise increase in the progressivity of financing must be followed. Technical concerns of healthcare providers (such as nonplausible RVUs for specific procedures or nonefficient insurance-provider processes should be addressed through proper revision(s while nontechnical concerns (which are derived from conflicting interests must be responded through clarification and providing transparent information. The

  11. Public sector reform and demand for human resources for health (HRH

    Lethbridge Jane

    2004-11-01

    Full Text Available Abstract This article considers some of the effects of health sector reform on human resources for health (HRH in developing countries and countries in transition by examining the effect of fiscal reform and the introduction of decentralisation and market mechanisms to the health sector. Fiscal reform results in pressure to measure the staff outputs of the health sector. Financial decentralisation often leads to hospitals becoming "corporatised" institutions, operating with business principles but remaining in the public sector. The introduction of market mechanisms often involves the formation of an internal market within the health sector and market testing of different functions with the private sector. This has immediate implications for the employment of health workers in the public sector, because the public sector may reduce its workforce if services are purchased from other sectors or may introduce more short-term and temporary employment contracts. Decentralisation of budgets and administrative functions can affect the health sector, often in negative ways, by reducing resources available and confusing lines of accountability for health workers. Governance and regulation of health care, when delivered by both public and private providers, require new systems of regulation. The increase in private sector provision has led health workers to move to the private sector. For those remaining in the public sector, there are often worsening working conditions, a lack of employment security and dismantling of collective bargaining agreements. Human resource development is gradually being recognised as crucial to future reforms and the formulation of health policy. New information systems at local and regional level will be needed to collect data on human resources. New employment arrangements, strengthening organisational culture, training and continuing education will also be needed.

  12. Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges.

    Gresenz, Carole Roan; Hoch, Emily; Eibner, Christine; Rudin, Robert S; Mattke, Soeren

    2016-05-09

    Overhauling the individual health insurance market-including through the creation of health insurance exchanges-was a key component of the Patient Protection and Affordable Care Act's multidimensional approach to addressing the long-standing problem of the uninsured in the United States. Despite succeeding in enrolling millions of Americans, the exchanges still face several challenges, including poor consumer experience, high operational and development costs, and incomplete market penetration. In light of these challenges, analysts considered a different model for the exchanges-privately facilitated exchanges-which could address these challenges and deepen the Affordable Care Act's impact. In this model, the government retains control over sovereign exchange functions but allows the private sector to assume responsibility for more-peripheral exchange functions, such as developing and sustaining exchange websites. Although private-sector entities have already undertaken exchange-related functions on a limited basis, privately facilitated exchanges could conceivably relieve the government of its responsibility for front-end website operations and consumer decision-support functions entirely. A shift to privately facilitated exchanges could improve the consumer experience, increase enrollment, and lower costs for state and federal governments. A move to such a model requires, nonetheless, managing its risks, such as reduced consumer protection, increased consumer confusion, and the possible lack of a viable revenue base for privately facilitated exchanges, especially in less populous states. On net, the benefits are large enough and the risks sufficiently manageable to seriously consider such a shift. This paper provides background information and more detail on the analysts' assessment.

  13. Right Place of Human Resource Management in the Reform of Health Sector

    Seyed Abas Hassani

    2013-01-01

    Full Text Available Background: In this paper the real role and place of human resource (HR in health system reform will be discussed and determined within the whole system through the comprehensive Human Resource Management (HRM model. Method: Delphi survey and a questionnaire were used to 1 collect HR manager ideas and comments and 2 identify the main challenges of HRM. Then the results were discussed in an expert panel after being analyzed by content analysis method. Also, a deep focus study of recorded documents related to Health Human Resource Management was done. Then based on all achieved results, a rich picture was drawn to illustrate the right place of HRM in health sector. Finally, the authors revitalize the missed function of HRM within the health sector by drawing a holistic conceptual model.Result: The most percentage of frequency about HR belongs to "Lack of reliable HR information system" (91% and the least percentage of frequency belongs to "Low responsibility of HR" (28%. The most percentage of frequency about HR manager belongs to "Inattention to HR managers as key managers and consider them in background" (80% and the least percentage of frequency belongs to "Lack of coordination between universities' policies" (30%. According to the conceptual framework, human resources employed in health system are viewed from two comprehensive approaches: instrumental approach and institutional.Conclusion: Unlike the common belief that looks HRM through the supportive approach, it is discussed that HRM not only has an instrumental role, but also do have a driver role.

  14. Chiropractic practice in the Danish public health care sector

    Myburgh, Corrie

    2009-01-01

    This commentary offers preliminary considerations around a phenomenological investigation of chiropractic services in a Danish public sector setting. In this narrative description, the main venue for chiropractic public (secondary) sector practice in the Danish context is briefly described...

  15. Pesticide Health and Safety Challenges Facing Informal Sector Workers: A Case of Small-scale Agricultural Workers in Tanzania.

    Ngowi, Aiwerasia; Mrema, Ezra; Kishinhi, Stephen

    2016-08-01

    The Tanzania informal sector is growing fast, with precarious working conditions and particular hazards for women and children in agriculture. Hazardous agricultural chemicals including pesticides are mostly imported and have been used for many years. Despite the role played by pesticides in food security and vector control, these chemicals are responsible for acute and chronic illnesses among communities. The availability of obsolete persistent organic pesticides on the open market indicates existence of an inadequate regulatory system. People who get injured or ill in the agriculture sector in Tanzania receive health services in primary health care facilities where professionals have little or no knowledge of pesticides. We are presenting the pesticide health and safety challenges faced by small-scale farmers who fall in the informal sector. Achievements that have been made by the government and other players to reduce and prevent pesticide exposures and poisoning are also outlined.

  16. Health sector reform and sexual and reproductive health services in Mongolia.

    Hill, Peter S; Dodd, Rebecca; Dashdorj, Khurelmaa

    2006-05-01

    Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.

  17. A decision Enhancement Service for Stakeholder Analysis to Achieve Transformations in the Public Sector

    Knol, Arjan; Janssen, Marijn; Sol, H G

    2015-01-01

    Sourcing has become a popular practice for public sector managers aiming for transformations to save costs and improve service delivery. Nevertheless, public sector sourcing often fails due to stakeholder resistance and power struggles, stressing the need for stakeholder analysis. This paper present

  18. School Sector Differences in Student Achievement in Australian Primary and Secondary Schools: A Longitudinal Analysis

    Marks, Gary N.

    2015-01-01

    This article examines school sector differences in student performance Years 3, 5, and 7 in numeracy, reading, writing, spelling and grammar using data from the Longitudinal Study of Australian Children and the national testing program (NAPLAN). At each of the 3 Year levels, there are sizable school sector differences with students from…

  19. Creating conditions for greater private sector participation in achieving contraceptive security.

    Sharma, Suneeta; Dayaratna, Varuni

    2005-03-01

    The growing gap between donor/government funding and the expected need for contraceptives is an issue of great concern for most developing countries. Addressing this resource shortfall, and meeting the goals of contraceptive security requires that countries mobilize the full and active participation of the private sector in the contraceptive market. Private sector involvement will not only increase the resource base available for contraceptives, it can also free up scarce donor and government resources to serve those who have the greatest need for public subsidies. This paper provides an overview of policy processes, strategies, and tools that can be used in developing countries to create an enabling environment for greater private sector participation, foster complementary public-private sector roles, and enhance the contribution of the private sector to contraceptive security.

  20. Improving Cross-Sector Comparisons: Going Beyond the Health-Related QALY.

    Brazier, John; Tsuchiya, Aki

    2015-12-01

    The quality-adjusted life-year (QALY) has become a widely used measure of health outcomes for use in informing decision making in health technology assessment. However, there is growing recognition of outcomes beyond health within the health sector and in related sectors such as social care and public health. This paper presents the advantages and disadvantages of ten possible approaches covering extending the health-related QALY and using well-being and monetary-based methods, in order to address the problem of using multiple outcome measures to inform resource allocation within and between sectors.

  1. Is the Black-White Achievement Gap a Public Sector Effect? An Examination of Student Achievement in the Third Grade

    Simms, Kathryn

    2012-01-01

    Prior research has suggested private school education in middle school and high school as a solution for the Black-White achievement gap. However, more recent research calls this solution into question. Additionally, research increasingly implicates third grade as being of preeminent importance in driving students' subsequent academic achievement.…

  2. [Shifting of emphasis in the world health sector strategy; from political concerns to economic ones].

    Yuasa, Motoyuki; Tateno, Seiki; Wakai, Susumu

    2003-11-01

    Primary Health Care, proclaimed by WHO in 1978, is a health strategy that aims to achieve the ultimate objective "Health For All", with underlying political concerns for ideals such as social justice, equity and human rights. Meanwhile, "globalization", urged by the U.S.A., other developed countries and multinational corporations, has since promoted liberalization of trade, capital and finance, which has in the past few decades been sweeping all over the world. With this "new economic liberalism", values that put much emphasis on economic efficiency are now at the forefront. The World Bank, which supports the tendency along with the International Monetary Fund and the World Trade Organization, has become an influential actor in helping developing countries to prosper economically. The World Bank, whose basic idea is that investment in health is basic for economic growth, has in the 1990s also exerted considerable influence on the international health sector with its overwhelming provision of financial assistance. Instead of political concerns like equity and human rights, 'economic concerns' such as fairer budget allocation, cost-effectiveness, cost reduction and efficiency have now become main points for discussion in the international health field. This shift in emphasis poses fundamental questions for the core goal of the World Health Organization; "Health For All".

  3. Applying the brand community concept in the nonprofit sector : the case of junior achievement Ireland

    Thorsteinsson, Tomas Gunnar; Casalini, Giulia

    2015-01-01

    In this paper, we aim to investigate the benefits of the application of a brand community strategy into a nonprofit organization (NPO), as well as the strategies that the NPO could adopt in order to facilitate the creation of such a community. We review the challenges and opportunities of using marketing strategies in the nonprofit sector. With increased competition in the “third” sector, it has become ever more important for nonprofit organizations to engage in branding and ma...

  4. Climate change and adaptation of the health sector: The case of infectious diseases.

    Confalonieri, Ulisses E C; Menezes, Júlia Alves; Margonari de Souza, Carina

    2015-01-01

    Infectious diseases form a group of health problems highly susceptible to the influences of climate. Adaptation to protect human population health from the changes in infectious disease epidemiology expected to occur as a consequence of climate change involve actions in the health systems as well as in other non-health sectors. In the health sector strategies such as enhanced and targeted epidemiological and entomological surveillance and the development of epidemic early warning systems informed by climate scenarios are needed. Measures in other sectors such as meteorology, civil defense and environmental sanitation will also contribute to a reduction in the risk of infection under climate change.

  5. THE EXPECTANCIES OF THE HEALTH SECTOR FROM ACCOUNTING EDUCATION AND THE IMPLEMENTATION OF ANKARA PUBLIC HOSPITALS

    Seyhan ÇİL KOÇYİĞİT

    2016-01-01

    Full Text Available Health sector requires qualified accounting personnel and demands qualified accounting personnel who knows the sector and who has the vocational knowledge and the ability. Education and training activities designed to meet the expectencies and the requirements of the sector are very important. These requirements can be met by the good quality of accounting education designed by the demands of the health sector. In this research, a survey has been administered to the managers of Ankara public hospitals in order to reveal the expectencies of the health sector from accounting education. The results of the survey show the follwings; accounting education should include practical information, The Uniform Chart Of Accounts should be developed in order to meet the expectencies of the health sector, there should be an internship opportunity at the health sector for accounting students, the content of the accounting courses should be determined by a cooperation between the sector and the academia and the demands of the health sector should be taken into consideration more.

  6. Health behaviour and safety in the construction sector.

    Meliá, José L; Becerril, Marta

    2009-08-01

    Workers' health behaviour includes habits or actions related to physical exercise, nutrition, smoking, and drug or alcohol consumption. Unhealthy behaviour, and especially alcohol consumption, has been considered a source of accidents and injuries among construction workers. However, unhealthy behaviour can also be seen as a result of the safety and risk conditions of these jobs. The purpose of this paper is to contrast the role of unhealthy behaviour as a source or as an outcome of safety and risk in the construction sector. Data was collected from 180 workers belonging to a Spanish construction company. Two path models representing these two hypotheses were tested. The model in which unhealthy behaviour is an antecedent of injuries did not fit the data (Chi square=73.798, df=3, p<0.001). Results support the hypothesis of unhealthy behaviour as a result of safety and risk factors through the mediating effect of the experience of tension (Chi-square=4.507, df=2, p=.212). This model not only corroborates the stressful nature of exposure to risk and the absence of supervisors' safety response, but it also makes it possible to consider injuries as a cause of tension that, in turn, affects the employees' unhealthy behaviour.

  7. Catastrophic Health Expenditure After the Implementation of Health Sector Evolution Plan: A Case Study in the West of Iran

    Bakhtiar Piroozi

    2016-07-01

    Full Text Available Background: One of the main objectives of health systems is the financial protection against out-of-pocket (OOP health expenditures. OOP health expenditures can lead to catastrophic payments, impoverishment or poverty among households. In Iran, health sector evolution plan (HSEP has been implemented since 2014 in order to achieve universal health coverage and reduce the OOP health expenditures as a percentage of total health expenditures. This study aimed to explore the percentage of households facing catastrophic health expenditures (CHE after the implementation of HSEP and the factors that determine CHE. Methods: A total of 663 households were selected through a cluster sampling based on the census framework of Sanandaj Health Center in July 2015. Data were gathered using face-to-face interviews based on the household section of the World Health Survey questionnaire. In this study, according to the World Health Organization (WHO definition, if household health expenditures were equal to or more than 40% of the household capacity to pay, household was considered to be facing CHE. The determinants of CHE were analyzed using logistic regression model. Results: The rates of households facing CHE were 4.8%. The key determinants of CHE were household economic status, presence of elderly or disabled members in the household and utilization of inpatient or rehabilitation services. Conclusion: The comparison of our findings and those of other studies carried out using a methodology comparable with ours in different parts of Iran before the implementation of HSEP suggests that the implementation of recent reforms has reduced CHE at the household level. Utilization of inpatient and rehabilitation services, the presence of elderly or disabled members in the household and the low economic status of the household would increase the likelihood of facing CHE. These variables should be considered by health policy-makers in order to review and revise content of

  8. The challenge of effective workplace change in the health sector.

    Kerr, Michael S; Mustard, Cam

    2007-01-01

    There is significant personal injury risk associated with the provision of high-quality healthcare. The magnitude of this risk, combined with the possibility that it can often go underappreciated by caregivers and the organizations they work for, might help explain why the health sector has largely missed out on the benefits of an overall declining trend in injury rates. Despite covering two very different topics in their lead papers, Shamian and El-Jardali and Clements, Dault and Priest present a surprising degree of overlap in relation to what might help enable effective workplace change. Leadership, role clarity, trust, respect, values and workplace culture are all viewed as key enablers of effective teamwork by Clements, Dault and Priest. They could also be considered required ingredients of successful workplace health initiatives, as discussed by Shamian and El-Jardali. A lot of background and positional work regarding teamwork and healthy workplaces exists, but this has not necessarily translated into front-line change. These authors have done an excellent job of pointing out the potential benefits of workplace changes. What is needed now is for someone to take the lead in developing, implementing and evaluating these changes. The adult human form is an awkward burden to lift or carry. Weighing up to 200 pounds or more, it has no handles, it is not rigid, and it is susceptible to severe damage if mishandled or dropped. When lying in bed, a patient is placed inconveniently for lifting and the weight and placement of such a load would be tolerated by few industrial workers.

  9. The roles of the health sector and health workers before, during and after violent conflict

    Buhmann, Caecilie; Barbara, Joanna Santa; Arya, Neil

    2010-01-01

    Starting with a view of war as a significant population health problem, this article explores the roles of health workers in relation to violent conflict. Four different roles are identified, defined by goals and values--military, development, humanitarian and peace. In addition, four dimensions...... of health work are seen as cross-cutting factors influencing health work in violent conflict-- whether the health worker is an insider or outsider to the conflict, whether they are oriented to primary, secondary or tertiary prevention of the mortality and morbidity of war, whether they take an individual...... clinical or a population health approach, and whether they are oriented to policy and whole-sector change or not. This article explores the nature of these roles, the influence of these cross-cutting dimensions, the challenges of each role and finally commonalities and possibilities for cooperation between...

  10. Strengthening Intersectoral Collaboration for Primary Health Care in Developing Countries: Can the Health Sector Play Broader Roles?

    Omokhoa Adedayo Adeleye

    2010-01-01

    Full Text Available Many strategic challenges impeding the success of primary health care are rooted in weak strategic inputs, including intersectoral collaboration. Some encouraging evidence from programmes, projects, and studies suggests that intersectoral collaboration is feasible and useful. The strategy has the potential to fast-track the attainment of Millenium Development Goals. However, the strategy is not commonly utilised in developing countries. The health sector expects inputs from other sectors which may not necessarily subscribe to a shared responsibility for health improvement, whereas the public expects ‘‘health’’ from the health sector. Yet, the health sector rarely takes on initiatives in that direction. The sector is challenged to mobilise all stakeholders for intersectoral collaboration through advocacy and programming. Pilot projects are advised in order to allow for cumulative experience, incremental lessons and more supportive evidence.

  11. Contracting private sector providers for public sector health services in Jalisco, Mexico: perspectives of system actors

    González Luz

    2009-10-01

    Full Text Available Abstract Introduction Contracting out health services is a strategy that many health systems in the developing world are following, despite the lack of decisive evidence that this is the best way to improve quality, increase efficiency and expand coverage. A large body of literature has appeared in recent years focusing on the results of several contracting strategies, but very few papers have addressed aspects of the managerial process and how this can affect results. Case description This paper describes and analyses the perceptions and opinions of managers and workers about the benefits and challenges of the contracting model that has been in place for almost 10 years in the State of Jalisco, Mexico. Both qualitative and quantitative information was collected. An open-ended questionnaire was used to obtain information from a group of managers, while information provided by a self-selected group of workers was collected via a closed-ended questionnaire. The analysis contrasted the information obtained from each source. Discussion and Evaluation Findings show that perceptions of managers and workers vary for most of the items studied. For managers the model has been a success, as it has allowed for expansion of coverage based on a cost-effective strategy, while for workers the model also possesses positive elements but fails to provide fair labour relationships, which negatively affects their performance. Conclusion Perspectives of the two main groups of actors in Jalisco's contracting model are important in the design and adjustment of an adequate contracting model that includes managerial elements to give incentives to worker performance, a key element necessary to achieve the model's ultimate objectives. Lessons learnt from this study could be relevant for the experience of contracting models in other developing countries.

  12. The Bangladesh paradox: exceptional health achievement despite economic poverty.

    Chowdhury, A Mushtaque R; Bhuiya, Abbas; Chowdhury, Mahbub Elahi; Rasheed, Sabrina; Hussain, Zakir; Chen, Lincoln C

    2013-11-23

    Bangladesh, the eighth most populous country in the world with about 153 million people, has recently been applauded as an exceptional health performer. In the first paper in this Series, we present evidence to show that Bangladesh has achieved substantial health advances, but the country's success cannot be captured simplistically because health in Bangladesh has the paradox of steep and sustained reductions in birth rate and mortality alongside continued burdens of morbidity. Exceptional performance might be attributed to a pluralistic health system that has many stakeholders pursuing women-centred, gender-equity-oriented, highly focused health programmes in family planning, immunisation, oral rehydration therapy, maternal and child health, tuberculosis, vitamin A supplementation, and other activities, through the work of widely deployed community health workers reaching all households. Government and non-governmental organisations have pioneered many innovations that have been scaled up nationally. However, these remarkable achievements in equity and coverage are counterbalanced by the persistence of child and maternal malnutrition and the low use of maternity-related services. The Bangladesh paradox shows the net outcome of successful direct health action in both positive and negative social determinants of health--ie, positives such as women's empowerment, widespread education, and mitigation of the effect of natural disasters; and negatives such as low gross domestic product, pervasive poverty, and the persistence of income inequality. Bangladesh offers lessons such as how gender equity can improve health outcomes, how health innovations can be scaled up, and how direct health interventions can partly overcome socioeconomic constraints.

  13. Private sector participation and health system performance in sub-saharan Africa.

    Joanne Yoong

    Full Text Available BACKGROUND: The role of the private health sector in developing countries remains a much-debated and contentious issue. Critics argue that the high prices charged in the private sector limits the use of health care among the poorest, consequently reducing access and equity in the use of health care. Supporters argue that increased private sector participation might improve access and equity by bringing in much needed resources for health care and by allowing governments to increase focus on underserved populations. However, little empirical exists for or against either side of this debate. METHODOLOGY/PRINCIPAL FINDINGS: We examine the association between private sector participation and self-reported measures of utilization and equity in deliveries and treatment of childhood respiratory disease using regression analysis, across a sample of nationally-representative Demographic and Health Surveys from 34 SSA economies. We also examine the correlation between private sector participation and key background factors (socioeconomic development, business environment and governance and use multivariate regression to control for potential confounders. Private sector participation is positively associated with greater overall access and reduced disparities between rich and poor as well as urban and rural populations. The positive association between private sector participation and improved health system performance is robust to controlling for confounders including per capita income and maternal education. Private sector participation is positively correlated with measures of socio-economic development and favorable business environment. CONCLUSIONS/SIGNIFICANCE: Greater participation is associated with favorable intermediate outcomes in terms of access and equity. While these results do not establish a causal link between private sector participation and health system performance, they suggest that there is no deleterious link between private sector

  14. Human resources: the Cinderella of health sector reform in Latin America

    Ugalde Antonio

    2005-01-01

    Full Text Available Abstract Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside.

  15. A Cost-Benefit Analysis of the Legalization of an Informal Health Sector

    Roger Lee Mendoza

    2010-01-01

    Full Text Available Problem statement: The Philippines--a developing Southeast Asian country--exemplifies the co-existence of Western-oriented, medical science and indigenous, non-allopathic practices collectively known as Complementary and Alternative Medicine (CAM. The purpose of this study is to determine why and how the economics and politics of CAM’s integration with biomedical science could impede the achievement of health care redistribution in developing countries like the Philippines. Approach: Representative case studies of CAM methods and content analysis of related legislation and policy initiatives were undertaken. Results: The study shed light on the problems, challenges and opportunities in addressing the misdistribution of primary and secondary health care in the Philippines. It found that subjective considerations underlie CAM’s legitimacy. These become critical when scientific validity is at issue, information exchanged is asymmetric and political consensus is not readily available. How these considerations were valued from a cost-benefit perspective shaped actual policy outcomes. Conclusion: The study suggested that proper timing, phasing and collaborative strategies are critical to CAM's institutionalization in light of confining economic conditions and political conflicts over health policy. Both objective and subjective costs and benefits of CAM methods and products should be considered in integrating the formal (biomedical and informal (CAM health sectors, particularly in developing countries where health care is largely dependent on individual or household resource-based access and competitive prowess.

  16. Ten great public health achievements--worldwide, 2001-2010.

    2011-06-24

    Worldwide, a child born in 1955 had an average life expectancy at birth of only 48 years. By 2000, the average life expectancy at birth had increased to 66 years and, if past trends continue, is projected to rise to 73 years by 2025. These improvements in longevity have resulted from improved living conditions overall, advances in medical science, and a number of population-level interventions. However, major disparities persist. During the past decade, in low-income countries, average life expectancy at birth increased from 55 to 57 years (3.6%), while increasing from 78 to 80 years (2.6%) in high-income countries. Analogous to the recent MMWR report highlighting 10 public health achievements that occurred in the United States over the first 10 years of the new century, this report describes global public health achievements during the same period. Experts in global public health were asked to nominate noteworthy public health achievements that occurred outside of the United States during 2001-2010. From them, 10 have been summarized in this report. As with the previous report, the 10 global public health achievements are not ranked in any order. Additional information regarding these achievements is available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6019a5_addinfo.htm.

  17. Assessment of the Technical Potential for Achieving Net Zero-Energy Buildings in the Commercial Sector

    Griffith, B.; Long, N.; Torcellini, P.; Judkoff, R.; Crawley, D.; Ryan, J.

    2007-12-01

    This report summarizes the findings from research conducted at NREL to assess the technical potential for zero-energy building technologies and practices to reduce the impact of commercial buildings on the U.S. energy system. Commercial buildings currently account for 18% of annual U.S. energy consumption, and energy use is growing along with overall floor area. Reducing the energy use of this sector will require aggressive research goals and rapid implementation of the research results.

  18. The creation of the health consumer: challenges on health sector regulation after managed care era

    Merhy Emerson E

    2011-02-01

    Full Text Available Abstract Background We utilized our previous studies analyzing the reforms affecting the health sector developed in the 1990s by financial groups to frame the strategies implemented by the pharmaceutical industry to regain market positions and to understand the challenges that regulatory agencies are confronting. Methods We followed an analytical approach for analyzing the process generated by the disputes between the financial groups and the pharmaceutical corporations and the challenges created to governmental regulation. We analyzed primary and secondary sources using situational and discourse analyses. We introduced the concepts of biomedicalization and biopedagogy, which allowed us to analyze how medicalization was radicalized. Results In the 1990s, structural adjustment policies facilitated health reforms that allowed the entrance of multinational financial capital into publicly-financed and employer-based insurance. This model operated in contraposition to the interests of the medical industrial complex, which since the middle of the 1990s had developed silent reforms to regain authority in defining the health-ill-care model. These silent reforms radicalized the medicalization. Some reforms took place through deregulatory processes, such as allowing direct-to-consumer advertisements of prescription drugs in the United States. In other countries different strategies were facilitated by the lack of regulation of other media such as the internet. The pharmaceutical industry also has had a role in changing disease definitions, rebranding others, creating new ones, and pressuring for approval of treatments to be paid by public, employer, and private plans. In recent years in Brazil there has been a substantial increase in the number of judicial claims demanding that public administrations pay for new treatments. Conclusions We found that the dispute for the hegemony of the health sector between financial and pharmaceutical companies has deeply

  19. A Development of an ISG Framework for Mosul’s Health Sector

    Mohammad Salim

    2012-06-01

    Full Text Available The world has started to appreciate more and more the value ofinformation and its impact on the community. This paper sharesthe findings of a study done on information securityimplementation at Mosul’s health sector. The study wasconducted via a self-administrated questionnaire and interview.The respondents are the IT managers and personnel withfunctions related to IT in selected hospitals in the city of Mosul.The findings reveal an ISG status that is in dire need forimprovement to maintain suitable level of security ofinformation which can be achieved through having goodgovernance practices in place. However there are variousdegrees of implementation by the hospitals. It is recommendedthat these findings be used as basis for developing a secureinformation-based system for the respective hospitals.

  20. Using sustainability as a collaboration magnet to encourage multi-sector collaborations for health.

    Khayatzadeh-Mahani, Akram; Labonté, Ronald; Ruckert, Arne; de Leeuw, Evelyne

    2017-03-01

    The World Health Organization Commission on Social Determinants of Health (SDH) places great emphasis on the role of multi-sector collaboration in addressing SDH. Despite this emphasis on this need, there is surprisingly little evidence for this to advance health equity goals. One way to encourage more successful multi-sector collaborations is anchoring SDH discourse around 'sustainability', subordinating within it the ethical and empirical importance of 'levelling up'. Sustainability, in contrast to health equity, has recently proved to be an effective collaboration magnet. The recent adoption of the Sustainable Development Goals (SDGs) provides an opportunity for novel ways of ideationally re-framing SDH discussions through the notion of sustainability. The 2030 Agenda for the SDGs calls for greater policy coherence across sectors to advance on the goals and targets. The expectation is that diverse sectors are more likely and willing to collaborate with each other around the SDGs, the core idea of which is 'sustainability'.

  1. Towards the ‘Right’ Reforms: The impact of health sector reforms on sexual and reproductive health

    Helen de Pinho

    2005-01-01

    Helen de Pinho focuses on the tension between market-driven health sector reform processes post-1990 and those reforms necessary to ensure sexual and reproductive health as mediated through health systems that are rights based and equitable. She argues that sexual and reproductive health services depend on progressive realization of the right to sexual and reproductive health through fundamental and systemic changes to the health system, with a focus on shifting power dynamics to ensure peopl...

  2. Development of health biotechnology in developing countries: can private-sector players be the prime movers?

    Abuduxike, Gulifeiya; Aljunid, Syed Mohamed

    2012-01-01

    Health biotechnology has rapidly become vital in helping healthcare systems meet the needs of the poor in developing countries. This key industry also generates revenue and creates employment opportunities in these countries. To successfully develop biotechnology industries in developing nations, it is critical to understand and improve the system of health innovation, as well as the role of each innovative sector and the linkages between the sectors. Countries' science and technology capacities can be strengthened only if there are non-linear linkages and strong interrelations among players throughout the innovation process; these relationships generate and transfer knowledge related to commercialization of the innovative health products. The private sector is one of the main actors in healthcare innovation, contributing significantly to the development of health biotechnology via knowledge, expertise, resources and relationships to translate basic research and development into new commercial products and innovative processes. The role of the private sector has been increasingly recognized and emphasized by governments, agencies and international organizations. Many partnerships between the public and private sector have been established to leverage the potential of the private sector to produce more affordable healthcare products. Several developing countries that have been actively involved in health biotechnology are becoming the main players in this industry. The aim of this paper is to discuss the role of the private sector in health biotechnology development and to study its impact on health and economic growth through case studies in South Korea, India and Brazil. The paper also discussed the approaches by which the private sector can improve the health and economic status of the poor.

  3. Cross-sectoral cancer care: views from patients and health care professionals regarding a personal electronic health record.

    Baudendistel, I; Winkler, E C; Kamradt, M; Brophy, S; Längst, G; Eckrich, F; Heinze, O; Bergh, B; Szecsenyi, J; Ose, D

    2017-03-01

    Cross-sectoral cancer care is complex and involves collaboration from health care professionals (HCPs) across multiple sectors. However, when health information exchange (HIE) is not adequate, it results in impeded coordination and continuity of care. A web-based personal electronic health record (PEPA) under patients' control, providing access to personal health data across sectors, is being developed. Aim of this study was to explore perceived benefits and concerns. Using a qualitative approach, 10 focus groups were performed collecting views of three prospective user groups: patients with colorectal cancer (n = 12), physicians (n = 17) and other HCPs (n = 16). Representatives from different health sectors across the Rhine-Neckar region (Germany) participated. Data were audio- and videotaped, transcribed verbatim and thematically analysed. Our study shows that patients and HCPs expected a PEPA to enhance cross-sectoral availability of information, cross-sectoral cooperation and facilitate data management. Quality of cancer care was expected to be improved. Concerns were expressed in terms of data protection and data security. Concepts like a PEPA offer the chance to support HIE and avoid gaps of information in cross-sectoral cancer care. This may lead to improvements in coordination and continuity of care. Issues concerning data security and protection have to be addressed.

  4. Health 2020 – Achieving Health and Development in Today’s Europe

    Zsuzsanna Jakab

    2014-09-01

    CONCLUSION: This article presents the development process of Health 2020 and its main strategic goals, objectives and content. Further, it describes what is needed to successfully implement Health 2020 in countries and how WHO can provide technical assistance to countries that embark on developing health policy aligned with the Health 2020 policy framework. The development and implementation of Health 2020 is a powerful vehicle for concerted inter-sectoral action across the WHO European Region for improving health and well-being of present and future generations. Successful implementation of Health 2020 needs providing technical assistance by WHO to the countries to embark on developing health policy aligned with the Health 2020 policy framework.

  5. Health systems in developing countries: public sector managers and the management of contradictions and change.

    Green, Andrew; Collins, Charles

    2003-01-01

    Health sector reform in the past decade has tended to focus on remodelling institutional relations and changing methods of health system financing. Little attention has been paid to human resources. This paper focuses on one category of health sector staff, health managers and planners, and the tensions they face in carrying out their roles. An understanding of these tensions has been neglected in the policy-making process. The paper is divided into two parts. Firstly, it will set out the nature of three tensions that public sector health managers and planners face: changes in the health care system; the contradictions between public interest and private gain; and changes in the forms of accountability. Secondly, it will suggest ways forward in relation to these problems, paying particular attention to the role of international agencies.

  6. The Longitudinal Link between Student Health and Math Achievement Scores

    Garcy, Anthony M.

    2009-01-01

    This study investigated the relationship between health conditions suffered over time and student scores on the Stanford Achievement Test 9 in Yuma County, Arizona, public grade schools. The majority of children in Yuma County were of Hispanic origin. The poverty and low income status of most of these children placed them at greater risk for…

  7. How to achieve care coordination inside health care organizations

    Prætorius, Thim; Becker, Markus

    2015-01-01

    Understanding how health care organizations can achieve care coordination internally is essential because it is difficult to achieve, but essential for high quality and efficient health care delivery. This article offers an answer by providing a synthesis of knowledge about coordination from...... organization theory, where coordination is a central research topic. The article focuses on intra-organizational coordination, which is challenging especially across boundaries such as departments or professions. It provides an overview of the classic coordination mechanisms, e.g., standardization of work...... processes, but also of recent insights that have identified the conditions that are required to achieve coordination, and how these conditions can be provided by formal mechanisms such as standardization, but also informally by drawing on features of the emerging situation. Such research highlights...

  8. Creating an integrated public sector? Labour's plans for the modernisation of the English health care system

    Nick Goodwin

    2002-03-01

    Full Text Available The current Labour Government has embarked on radical public sector reform in England. A so-called ‘Modernisation Agenda’ has been developed that is encapsulated in the NHS Plan—a document that details a long-term vision for health care. This plan involves a five-fold strategy: investment through greater public funding; quality assurance; improving access; service integration and inter-professional working; and providing a public health focus. The principles of Labour's vision have been broadly supported. However, achieving its aims appears reliant on two key factors. First, appropriate resources are required to create capacity, particularly management capacity, to enable new functions to develop. Second, promoting access and service integration requires the development of significant co-ordination, collaboration and networking between agencies and individuals. This is particularly important for health and social care professionals. Their historically separate professions suggest that a significant period of change management is required to allow new roles and partnerships to evolve. In an attempt to secure delivery of its goals, however, the Government has placed the emphasis on further organisational restructuring. In doing so, the Government may have missed the key challenges faced in delivering its NHS Plan. As this paper argues, cultural and behavioural change is probably a far more appropriate and important requirement for success than a centrally directed approach that emphasises the rearrangement of structural furniture.

  9. The role of retiree health insurance in the early retirement of public sector employees.

    Shoven, John B; Slavov, Sita Nataraj

    2014-12-01

    Most government employees have access to retiree health coverage, which provides them with group health coverage even if they retire before Medicare eligibility. We study the impact of retiree health coverage on the labor supply of public sector workers between the ages of 55 and 64. We find that retiree health coverage raises the probability of stopping full time work by 4.3 percentage points (around 38 percent) over two years among public sector workers aged 55-59, and by 6.7 percentage points (around 26 percent) over two years among public sector workers aged 60-64. In the younger age group, retiree health insurance mostly seems to facilitate transitions to part-time work rather than full retirement. However, in the older age group, it increases the probability of stopping work entirely by 4.3 percentage points (around 22 percent).

  10. FUNCTIONAL ANALYSIS OF THE HEALTH SECTOR IN ROMANIA

    Bogdan Tatiana

    2015-07-01

    Full Text Available This paper comprises an assessment of the Romanian health financing policy and a detailed analysis of income and expenditure trends over the past seven years. The current situation of the health system is evaluated by reviewing the existing health legislation and documents on public health policies from Romania and from abroad, by analyzing the official statistics (the Romanian Yearbook of Health Statistics, Who database and by performing a healthcare system financial analysis. Although the financial efforts of the Romanian state to support the health system have increased, almost all the incomes and expenditures of the health care system having recorded significant increases, the population perception on health services worsened. Financing the health system continues to be inadequate and used in an ineffective way. Health is an essential component of well-being with major socio-economic implications. The organization and functioning of the health system depends on ensuring adequate funding. Romania must develop its health strategy in the context of European Union policies. These policies are based on values and principles such as promoting universal protection against financial risk, promoting a more equitable distribution of the financing burden, promoting equitable provision and use of services relative to need, improving the transparency and accountability of the system to the public, promoting quality and efficiency in service delivery, improving administrative efficiency, while ensuring the financial sustainability of the health system. In this context, in order to support a financially sustainable and high performing health system, the paper includes recommendations for increasing the public incomes in the health insurance system and options to streamline the healthcare services and expenses in the future.

  11. Expanding Medicare and employer plans to achieve universal health insurance.

    Davis, K

    1991-05-15

    This article presents a proposal for expanding Medicare and employer-based health insurance plans to achieve universal health insurance. Under this proposed health care financing system, employees would provide basic health insurance coverage to workers and dependents, or pay a payroll tax contribution toward the cost of their coverage under Medicare. States would have the option of buying all Medicaid beneficiaries and other poor individuals into Medicare by paying the Medicare premiums and cost sharing. Other uninsured individuals would be automatically covered by Medicare. Employer plans would incorporate Medicare's provider payment methods. This proposal would result in incremental federal governmental outlays on the order of $25 billion annually. These new federal budgetary costs would be met through a combination of premiums, employer payroll tax, income tax, and general tax revenues. The principal advantage of this plan is that it draws on the strengths of the current system while simplifying the benefit and provider payment structure and instituting innovations to promote efficiency.

  12. Exploration of priority actions for strengthening the role of nurses in achieving universal health coverage

    Maaitah, Rowaida Al; AbuAlRub, Raeda Fawzi

    2017-01-01

    ABSTRACT Objective: to explore priority actions for strengthening the role of Advanced Practice Nurses (APNs) towards the achievement of Universal Health Converge (UHC) as perceived by health key informants in Jordan. Methods: an exploratory qualitative design, using a semi-structured survey, was utilized. A purposive sample of seventeen key informants from various nursing and health care sectors was recruited for the purpose of the study. Content analysis utilizing the five-stage framework approach was used for data analysis. Results: the findings revealed that policy and regulation, nursing education, research, and workforce were identified as the main elements that influence the role of APNs in contributing to the achievement of UHC. Priority actions were identified by the participants for the main four elements. Conclusion: study findings confirm the need to strengthen the role of APNs to achieve UHC through a major transformation in nursing education, practice, research, leadership, and regulatory system. Nurses should unite to come up with solid nursing competencies related to APNs, PHC, UHC, leadership and policy making to strengthen their position as main actors in influencing the health care system and evidence creation. PMID:28146176

  13. Cross-sector cooperation in health-enhancing physical activity policymaking

    Hämäläinen, Riitta-Maija; Aro, Arja R; Lau, Cathrine Juel;

    2016-01-01

    BACKGROUND: The cooperation of actors across policy fields and the need for cross-sector cooperation as well as recommendations on how to implement cross-sector cooperation have been addressed in many national and international policies that seek to solve complex issues within societies. For such......BACKGROUND: The cooperation of actors across policy fields and the need for cross-sector cooperation as well as recommendations on how to implement cross-sector cooperation have been addressed in many national and international policies that seek to solve complex issues within societies...... in health-enhancing physical activity (HEPA) policies in six European Union (EU) member states. METHODS: Qualitative content analysis of HEPA policies and semi-structured interviews with key policymakers in six European countries. RESULTS: Cross-sector cooperation varied between EU member states within HEPA...

  14. Health sector reforms in Central and Eastern Europe

    2004-04-01

    Full Text Available The political and economic transition of the 1990s in the countries of central and eastern Europe has been accompanied by wide ranging health care reform. The initial Soviet model has given way to a variety of forms of health insurance. Yet, as this paper argues, reform has too often been preoccupied with ideological imperatives, such as provider autonomy and the creation of funds separate from government, and has given much less thought to the contribution that health care can make to population health. The paper begins by examining the changing nature of health care. It recalls how the Soviet model was able to provide basic care to dispersed populations at low cost but notes how this is no longer sufficient in the face of an increasingly complex health care environment. This complexity reflects several factors, such as the growth in chronic disease, the emergence of new forms of infectious disease, and the introduction of new treatments requiring integrated delivery systems. It reviews evidence on how the former communist countries failed to keep up with developments in the west from the 1970s onwards, at a time when the complexity of health care was becoming apparent. It continues by setting out a framework for the organisation of health care based on the goal of health gain. This involves a series of activities that can be summarised as active purchasing, and which include assessment of health needs, designing effective packages of care, and monitoring outcomes. It concludes by arguing that a new relationship is needed between the state and the organisations involved in funding and delivering health care, to design a system that will tackle the considerable health needs of the people who live in this region.

  15. Cross-sector Service Provision in Health and Social Care: An Umbrella Review

    Shannon Winters

    2016-04-01

    Full Text Available Introduction: Meeting the complex health needs of people often requires interaction among numerous different sectors. No one service can adequately respond to the diverse care needs of consumers. Providers working more effectively together is frequently touted as the solution. Cross-sector service provision is defined as independent, yet interconnected sectors working together to better meet the needs of consumers and improve the quality and effectiveness of service provision. Cross-sector service provision is expected, yet much remains unknown about how it is conceptualised or its impact on health status. This umbrella review aims to clarify the critical attributes that shape cross-sector service provision by presenting the current state of the literature and building on the findings of the 2004 review by Sloper. Methods: Literature related to cross-sector service provision is immense, which poses a challenge for decision makers wishing to make evidence-informed decisions. An umbrella review was conducted to articulate the overall state of cross-sector service provision literature and examine the evidence to allow for the discovery of consistencies and discrepancies across the published knowledge base. Findings: Sixteen reviews met the inclusion criteria. Seven themes emerged: Focusing on the consumer, developing a shared vision of care, leadership involvement, service provision across the boundaries, adequately resourcing the arrangement, developing novel arrangements or aligning with existing relationships, and strengthening connections between sectors. Future research from a cross-organisational, rather than individual provider, perspective is needed to better understand what shapes cross-sector service provision at the boundaries. Conclusion: Findings aligned closely with the work done by Sloper and raise red flags related to reinventing what is already known. Future researchers should look to explore novel areas rather than looking into

  16. Private sector, human resources and health franchising in Africa.

    Prata, Ndola; Montagu, Dominic; Jefferys, Emma

    2005-04-01

    In much of the developing world, private health care providers and pharmacies are the most important sources of medicine and medical care and yet these providers are frequently not considered in planning for public health. This paper presents the available evidence, by socioeconomic status, on which strata of society benefit from publicly provided care and which strata use private health care. Using data from The World Bank's Health Nutrition and Population Poverty Thematic Reports on 22 countries in Africa, an assessment was made of the use of public and private health services, by asset quintile groups, for treatment of diarrhoea and acute respiratory infections, proxies for publicly subsidized services. The evidence and theory on using franchise networks to supplement government programmes in the delivery of public health services was assessed. Examples from health franchises in Africa and Asia are provided to illustrate the potential for franchise systems to leverage private providers and so increase delivery-point availability for public-benefit services. We argue that based on the established demand for private medical services in Africa, these providers should be included in future planning on human resources for public health. Having explored the range of systems that have been tested for working with private providers, from contracting to vouchers to behavioural change and provider education, we conclude that franchising has the greatest potential for integration into large-scale programmes in Africa to address critical illnesses of public health importance.

  17. Informal payments in the health sector: a case study from Turkey.

    Tatar, Mehtap; Ozgen, Hacer; Sahin, Bayram; Belli, Paolo; Berman, Peter

    2007-01-01

    The practice of making informal payments in the health sector is common in a number of countries. It has become an important policy issue around the world. These payments can jeopardize governments' attempts to improve equity and access to care and policies targeted to the poor. It is widely believed that a considerable amount of out-of-pocket payment in the health sector in Turkey is informal. To examine this issue, we used a questionnaire adopted from a wider international study. We concluded that informal payments in Turkey are significant and have important implications for health care reform.

  18. Evaluating digital libraries in the health sector. Part 1: measuring inputs and outputs.

    Cullen, Rowena

    2003-12-01

    This is the first part of a two-part paper which explores methods that can be used to evaluate digital libraries in the health sector. In this first part, some approaches to evaluation that have been proposed for mainstream digital information services are examined for their suitability to provide models for the health sector. The paper summarizes some major national and collaborative initiatives to develop measures for digital libraries, and analyses these approaches in terms of their relationship to traditional measures of library performance, which are focused on inputs and outputs, and their relevance to current debates among health information specialists. The second part* looks more specifically at evaluative models based on outcomes, and models being developed in the health sector.

  19. Prohibit, constrain, encourage, or purchase: how should we engage with the private health-care sector?

    Montagu, Dominic; Goodman, Catherine

    2016-08-06

    The private for-profit sector's prominence in health-care delivery, and concern about its failures to deliver social benefit, has driven a search for interventions to improve the sector's functioning. We review evidence for the effectiveness and limitations of such private sector interventions in low-income and middle-income countries. Few robust assessments are available, but some conclusions are possible. Prohibiting the private sector is very unlikely to succeed, and regulatory approaches face persistent challenges in many low-income and middle-income countries. Attention is therefore turning to interventions that encourage private providers to improve quality and coverage (while advancing their financial interests) such as social marketing, social franchising, vouchers, and contracting. However, evidence about the effect on clinical quality, coverage, equity, and cost-effectiveness is inadequate. Other challenges concern scalability and scope, indicating the limitations of such interventions as a basis for universal health coverage, though interventions can address focused problems on a restricted scale.

  20. Simulation modelling for resource allocation and planning in the health sector.

    Lehaney, B; Hlupic, V

    1995-12-01

    This paper provides a review of the use of simulation for resource planning in the health sector. Case examples of simulation in health are provided, and the modelling problems are explored. The successes and failures of simulation modelling in this context are examined, and an approach for improving the processes, and outcomes, by the use of soft systems methodology, is suggested.

  1. The Brain Drain Potential of Students in the African Health and Nonhealth Sectors

    Jonathan Crush

    2012-01-01

    Full Text Available The departure of health professionals to Europe and North America is placing an intolerable burden on public health systems in many African countries. Various retention, recall, and replacement policies to ameliorate the impact of this brain drain have been suggested, none of which have been particularly successful to date. The key question for the future is whether the brain drain of health sector skills is likely to continue and whether the investment of African countries in training health professionals will continue to be lost through emigration. This paper examines the emigration intentions of trainee health professionals in six Southern African countries. The data was collected by the Southern African Migration Program (SAMP in a survey of final-year students across the region which included 651 students training for the health professions. The data also allows for the comparison of health sector with other students. The analysis presented in this paper shows very high emigration potential amongst all final-year students. Health sector students do show a slightly higher inclination to leave than those training to work in other sectors. These findings present a considerable challenge for policy makers seeking to encourage students to stay at home and work after graduation.

  2. Integrating Health and Sustainability: The Higher Education Sector as a Timely Catalyst

    Orme, J.; Dooris, M.

    2010-01-01

    Higher education is an influential sector with enormous potential to impact positively on health and sustainability. The purpose of this paper was to explore its emergent role as a key setting for promoting health and sustainability and for addressing their challenges in an integrated and coherent way. Acknowledging both the relative narrowness of…

  3. The "aid contract" and its compensation scheme: a case study of the performance of the Ugandan health sector.

    Oliveira Cruz, Valeria; McPake, Barbara

    2010-10-01

    Current literature on aid effectiveness describes increasing use of a more contractual approach to the relationship between donor and recipient government in which a system of rewards and penalties for good and bad performance operates. The purpose of this case study of the Ugandan health sector was to understand the extent to which this approach is influencing processes and effectiveness. This qualitative study used a conceptual framework based on agency theory and 'realistic evaluation'. Our results showed that the main official mechanism to assess and reward performance established through the Sector Wide Approach lacked objective criteria and was based on an unstructured system of discussions and agreements among donors. The achievement of a satisfactory performance rating was facilitated by the agreeing to undertakings that were under-demanding, vaguely formulated and lacking quantitative benchmarks against which progress could be measured. However, even when poor performance was readily observable, penalties failed to be applied by donors. This was always the case in relation to health sector performance and mostly so in relation to general governance and accountability. Funds continued to be disbursed despite the lack of progress made in achieving targets and undertakings and other evident performance problems (e.g. in the area of governance). A series of explanations of the failure to penalise were put forward by donor representatives in relation to this behaviour including the need to maintain long-term relationships based on trust and not to undermine health sector performance by withdrawing aid. Thus there are likely to be incentives to disburse funds and report success, irrespective of the realities of aid programmes in the context of large foreign aid volumes associated with increased political visibility of aid in donor countries.

  4. Consensus and contention in the priority setting process: examining the health sector in Uganda.

    Colenbrander, Sarah; Birungi, Charles; Mbonye, Anthony K

    2015-06-01

    Health priority setting is a critical and contentious issue in low-income countries because of the high burden of disease relative to the limited resource envelope. Many sophisticated quantitative tools and policy frameworks have been developed to promote transparent priority setting processes and allocative efficiency. However, low-income countries frequently lack effective governance systems or implementation capacity, so high-level priorities are not determined through evidence-based decision-making processes. This study uses qualitative research methods to explore how key actors' priorities differ in low-income countries, using Uganda as a case study. Human resources for health, disease prevention and family planning emerge as the common priorities among actors in the health sector (although the last of these is particularly emphasized by international agencies) because of their contribution to the long-term sustainability of health-care provision. Financing health-care services is the most disputed issue. Participants from the Ugandan Ministry of Health preferentially sought to increase net health expenditure and government ownership of the health sector, while non-state actors prioritized improving the efficiency of resource use. Ultimately it is apparent that the power to influence national health outcomes lies with only a handful of decision-makers within key institutions in the health sector, such as the Ministries of Health, the largest bilateral donors and the multilateral development agencies. These power relations reinforce the need for ongoing research into the paradigms and strategic interests of these actors.

  5. Accreditation and Participatory Design in the Health-Care Sector

    Simonsen, Jesper; Scheuer, John Damm; Hertzum, Morten

    2015-01-01

    We reconsider the role of participatory design approaches emphasizing the current context of the accreditation regime imposed on the Danish healthcare sector. We describe effects-driven IT development as an instrument supporting sustained participatory design. Effects-driven IT development includes...... specifying, realizing, and measuring effects from using an information technology. This approach aligns with much of the logic inherent in accreditation and it supports challenging parts of the accreditation process. Effects-driven IT development furthermore might support effects related to clinical evidence......-based thinking. We describe and compare effects- driven IT development with accreditation and discuss the prospects and challenges for this approach to participatory design within the healthcare domain....

  6. Independent sector mental health care: a 1-day census of private and voluntary sector placements in seven Strategic Health Authority areas in England.

    Hatfield, Barbara; Ryan, Tony; Simpson, Victoria; Sharma, Indhu

    2007-09-01

    The aims of this study were (i) to map the extent of all mental health placements in the independent sector, for adults of working age, and elderly people (excluding those with a diagnosis of dementia placed in Local Authority care homes), on a census date, across the areas in which the study was commissioned; (ii) to identify the characteristics of the population in placements; (iii) to explore some of the characteristics of the placements and the patterns of use within the private and voluntary sectors; and (iv) to identify the funding source of placements, and cost differences between the private and voluntary sector. The study took place in seven Strategic Health Authority areas, and information was sought from all Primary Care Trust and Social Services commissioners of mental health services, including regional secure commissioning teams, within those areas. A cross-sectional sample was used. Information was requested in relation to every individual meeting the inclusion criteria, placed in independent (private or voluntary) psychiatric hospitals, registered mental nursing homes and care homes on a specified study 'census date' of 28 June 2004 in six of the Strategic Health Authority areas, and 7 October 2004 in the seventh. Information was recorded on a standard questionnaire specifically designed for the study. Information was obtained on 3535 adults and 1623 elderly people in private or voluntary facilities. The largest groups of adults and elderly people had diagnoses of severe mental illnesses (42.1% and 30.5%, respectively), and placements were described as 'continuing care' or rehabilitation, with a 'niche' in specialist forensic care. Around four-fifths of units were in the private sector, which for adults was significantly more expensive than the voluntary sector. A large proportion of units (47.2% of adult placements and 59.3% of placements for elderly people) had only single placements from particular commissioning authorities, whilst others had

  7. Medicare and Medicaid Trends in Health Care Sectors

    U.S. Department of Health & Human Services — The Centers for Medicare and Medicaid Services (CMS) provides monthly and fiscal-year-to-date income and expenditure trends for Medicare Hospital Insurance (HI) and...

  8. Local communities and health disaster management in the mining sector

    Freek Cronjé

    2013-01-01

    Full Text Available Mining activities throughout the Southern African Development Community (SADC have impacted on the health and safety of mining communities for many decades. Despite the economic contribution of mining to surrounding communities, a huge amount of social and environmental harm is associated with the industry. In this regard, mining companies have, on the one hand, contributed toward improved social development by providing jobs, paying taxes and earning foreign exchange. On the other hand, they have been linked publicly to poor labour conditions, corruption, pollution incidents, health and safety failings, as well as disrespect of human rights. The objectives of this study are to give an overview of social and natural factors relating to health disasters in selected communities in the mining environment. Regarding the findings, this paper focuses on the social and natural factors involved in the creation of health disasters. The social factors include poverty, unemployment, poor housing and infrastructure, prostitution and a high influx of unaccompanied migrant labour. Major health issues in this regard, which will be highlighted, are the extraordinary high incidence rate of HIV and STIs (sexually transmitted infections, addiction and mental illness. The environmental (natural threats to health that will be discussed in the study are harmful particles in the air and water, excessive noise and overcrowded and unhygienic living conditions. In conclusion, the paper also finds that communities need to be ‘fenced in’ in terms of health disaster management instead of being excluded. Specific recommendations to mining companies to reduce health and safety disasters will be made to conclude the paper.

  9. Health transformation plan: Goals achievement in Nemazee hospital

    Ali Akbar Ahmadi

    2016-01-01

    Full Text Available Introduction: The main purpose of this study was to assess fulfillment of goals about “Health Transformation Plan (HTP of Ministry of Health, Treatment and Medical Education” from the perspective of managers, which is as one of the most important management challenges in the Health System Reform Plan. These goals included six packages determined by the Ministry of Health, Treatment and Medical Education, the fulfillment of each of which one was evaluated separately as sub-goals in the current study. Finally, the rank of each package in comparison to other packages was determined and presented, using means rank test (Friedman test. Method: This study was conducted using a questionnaire in which comments of the senior and middle managers of Nemazee hospital were collected as the research data. Due to the fact that about one year has passed since the beginning of implementation of HTP and since there were no documented methods or questionnaires, the researcher designed a self-made questionnaire. The basis of designing the questionnaire was the set of guidelines developed for Health System Reform Plan. These guidelines include goals that a hospital should achieve during implementation of Health System Reform Plan. After sharing these goals with senior and middle managers of Nemazee hospital (as the place of research, they were converted to a questionnaire including 20 questions. The questionnaire included the goals that must be achieved in Nemazee hospital of Shiraz during the implementation of the plan. After designing the questionnaire, a preliminary test was taken to assess the reliability. Results: Cronbach’s alpha coefficient (0.88 showed a high rate of reliability in the above questionnaire. After the final data collection, the questionnaire was tested in a sample of 100 senior and middle managers; the results showed that about six packages were specified by the Ministry of Health, Treatment and Medical Education. The majority of

  10. [Neoliberal health sector reforms in Latin America: unprepared managers and unhappy workers].

    Ugalde, Antonio; Homedes, Nuria

    2005-03-01

    This work analyzes the neoliberal health sector reforms that have taken place in Latin America, the preparation of health care workers for the reforms, the reforms' impacts on the workers, and the consequences that the reforms have had on efficiency and quality in the health sector. The piece also looks at the process of formulating and implementing the reforms. The piece utilizes secondary sources and in-depth interviews with health sector managers in Bolivia, Colombia, Costa Rica, the Dominican Republic, Ecuador, El Salvador, and Mexico. Neoliberal reforms have not solved the human resources problems that health sector evaluations and academic studies had identified as the leading causes of health system inefficiency and low-quality services that existed before the reforms. The reforms worsened the situation by putting new pressures on health personnel, in terms of both the lack of necessary training to face the challenges that came with the reforms and efforts to take away from workers the rights and benefits that they had gained during years of struggles by unions, and to replace them with temporary contracts, reduced job security, and lower benefits. The secrecy with which the reforms were developed and applied made workers even more unified. In response, unions opposed the reforms, and in some countries they were able to delay the reforms. The neoliberal reforms have not improved the efficiency or quality of health systems in Latin America despite the resources that have been invested. Nor have the neoliberal reforms supported specific changes that have been applied in the public sector and that have demonstrated their ability to solve important health problems. These specific changes have produced better results than the neoliberal reforms, and at a lower cost.

  11. Corporate governance of public health services: lessons from New Zealand for the state sector.

    Perkins, R; Barnett, P; Powell, M

    2000-01-01

    New Zealand public hospitals and related services were grouped into 23 Crown Health Enterprises and registered as companies in 1993. Integral to this change was the introduction of corporate governance. New directors, largely from the business sector, were appointed to govern these organisations as efficient and effective businesses. This article presents the results of a survey of directors of New Zealand publicly-owned health provider organisations. Although directors thought they performed well in business systems development, they acknowledged their shortcomings in meeting government expectations in respect to financial performance and social responsibility. Changes in public health sector provider performance indicators have resulted in a mixed report card for the sector six years after corporate governance was instituted.

  12. Lumbar spinal fusion patients' demands to the primary health sector: evaluation of three rehabilitation protocols

    Soegaard, Rikke; Christensen, Finn B; Lauerberg, Ida

    2006-01-01

    Very few studies have investigated the effects or costs of rehabilitation regimens following lumbar spinal fusion. The effectiveness of in-hospital rehabilitation regimens has substantial impact on patients' demands in the primary health care sector. The aim of this study was to investigate patient......-articulated demands to the primary health care sector following lumbar spinal fusion and three different in-hospital rehabilitation regimens in a prospective, randomized study with a 2-year follow-up. Ninety patients were randomized 3 months post lumbar spinal fusion to either a 'video' group (one-time oral...... service utilization in the primary health care sector as compared to the usual regimen and a training exercise regimen. The results stress the importance of a cognitive element of coping in a rehabilitation program....

  13. The use of geographical information system in health sector.

    Mechili, Aggelos; Zimeras, Stelios; Al-Fantel, Konstantina; Diomidous, Marianna

    2014-01-01

    The provision of health care has undergone radical changes during the last years. Geography plays an important role in understanding the dynamics of health, as well as the reasons why a disease is spreading. In general, a Geographic Information System (GIS) is based on the same principals with a traditional relational database. The main idea behind this study is the methodological approach as far as the implementation of a real- time electronic healthcare record is concerned, for the descriptive statistical analysis that uses geographical information to identify spatial data related to accidents. The purpose of developing such a health care record is to record the patients who were injured in accidents. The database that will be used for the development of the EHR is based on Microsoft Office 2007, which is considered to be one of the best tools for developing databases. The main table of the database includes the fields with demographics, ie name, surname, age, sex, address and place of birth. The primary key of the table Demographics is Patient_ID. The demographics from the table are connected to the table Admission with a relationship type one- to- many. The combination of these features in a graphic representation can be used to display the health problems on the map, so that the proper health policies can be applied. The results of the monitoring could be used as pilot instructions for spatial epidemiological analysis.

  14. Developing and testing an instrument for identifying performance incentives in the Greek health care sector

    Paleologou Victoria

    2006-09-01

    Full Text Available Abstract Background In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity. Methods A methodological exploratory design was employed in three phases: a content development and assessment, which resulted in a 28-item instrument, b pilot testing (N = 74 and c field testing (N = 353. Internal consistency reliability was tested via Cronbach's alpha coefficient and factor analysis was used to identify the underlying constructs. Tests of scaling assumptions, according to the Multitrait-Multimethod Matrix, were used to confirm the hypothesized component structure. Results Four components, referring to intrinsic individual needs and external job-related aspects, were revealed and explain 59.61% of the variability. They were subsequently labeled: job attributes, remuneration, co-workers and achievement. Nine items not meeting item-scale criteria were removed, resulting in a 19-item instrument. Scale reliability ranged from 0.782 to 0.901 and internal item consistency and discriminant validity criteria were satisfied. Conclusion Overall, the instrument appears to be a promising tool for hospital administrations in their attempt to identify job-related factors, which motivate their employees. The psychometric properties were good and warrant administration to a larger

  15. Forging partnerships to solve the global health workforce crisis and achieve the health MDGs.

    Cometto, Giorgio; Sheikh, Mubashar

    2010-01-01

    The health workforce is in many countries the weakest link in the effective and equitable delivery of quality health services, and the largest impediment to the achievement of health Millennium Development Goals. The Kampala Declaration and Agenda for Global Action, championed by the Global Health Workforce Alliance, provide an effective overarching framework for the bold, concerted and sustained action which is required at the international, national and local level.

  16. The Impact of Electricity Sector Privatization on Public Health

    Gonzalez-Eiras, Martin; Rossi, Martín

    2008-01-01

    We use province-level data for Argentina to test for the causal relation between electricity distribution and health. We are interested in the impact of privatization on two output measures, incidence of low birth weight and child mortality rates caused by food poisoning. Privatization improves s...

  17. Chile's health sector reform: lessons from four reform periods.

    de la Jara, J J; Bossert, T

    1995-01-01

    This paper applies an interdisciplinary approach to analyze the process of health reform in four significant periods in Chilean history: (1) the consolidation of state responsibility for public health in the 1920s, (2) the creation of the state-run National Health Service in the 1950s, (3) the decentralization of primary care and privatization of health insurance in the 1980s, and (4) the strengthening of the mixed public-private market in the 1990s. Building on the authors' separate disciplines, the paper examines the epidemiological, political and economic contexts of these reforms to test simple hypotheses about how these factors shape reform adoption and implementation. The analysis underlines: (1) the importance of epidemiological data as an impetus to public policy; (2) the inhibiting role of economic recession in adoption and implementation of reforms: and (3) the importance of the congruence of reforms with underlying political ideology in civil society. The paper also tests several hypotheses about the reform processes themselves, exploring the role of antecedents, interest groups, and consensus-building in the policy process. It found that incremental processes building on antecedent trends characterize most reform efforts. However, interest group politics and consensus building were found to be complex processes that are not easily captured by the simple hypotheses that were tested. The interdisciplinary approach is found to be a promising form of analysis and suggests further theoretical and empirical issues to be explored.

  18. The Impact of Electricity Sector Privatization on Public Health

    Gonzalez-Eiras, Martin; Rossi, Martín

    2008-01-01

    We use province-level data for Argentina to test for the causal relation between electricity distribution and health. We are interested in the impact of privatization on two output measures, incidence of low birth weight and child mortality rates caused by food poisoning. Privatization improves...

  19. Analysis of Developing Public Health Service Sector with Private Finance Initiative in Guangxi

    王宇

    2006-01-01

    In Guangxi Public Health Service Sector (GPHSS), because lack of budget, it has caused a number of problems, such as weakened public health service in rural areas, poor professional quality of medical personnel in public health units at village and township levels, current urban public health service could not meet the health demand for urban residents. This paper is a secondary research. Through analysis of the financial problem and both of the advantages and disadvantages of using the Private Finance Initiative (PFI), it intend to demonstrate that using the PFI could be considered as a good way for the Guangxi government.

  20. The Effect of Managers Genders on Workers Mental and Physical Health: An Application in Banking Sector

    Mahmut Özdevecioğlu

    2013-09-01

    Full Text Available In this research it is evaluated the workers physical and mental health differences in which their managers gender is man or woman. To find out the differences a research is handled in banking sector. According to the results of the research, workers in which working with the male manager; there are difference between male and female workers according to physical health and there are not difference between male and female workers according to mental health. There are differences between male and female workers in which working with woman manager according to physical and mental health. The physical and mental health of woman workers, working with woman managers, looks like worse.

  1. Trends in Health Care Spending by the Private Sector

    1997-04-01

    trends in employment-based premiums. One such study by Jon Gabel and colleagues compared results from the Peat Marwick/Wayne State University 1993 survey...shift from indemnity to managed care plans during that period. 18. Jon Gabel and others, "The Health Insurance Picture in 1993: Some Rare Good News...Jonathan M. Gruber , Does Public Insurance Crowd Out Private Insurance? Working Paper No. 5082 (Cambridge, Mass.: National Bureau of Economic Research

  2. Implementation Status of Accrual Accounting System in Health Sector

    Mehrolhassani, Mohammad Hossien; Khayatzadeh-Mahani, Akram; Emami, Mozhgan

    2014-01-01

    Introduction: Management of financial resources in health systems is one of the major issues of concern for policy makers globally. As a sub-set of financial management, accounting system is of paramount importance. In this paper, which presents part of the results of a wider research project on transition process from a cash accounting system to an accrual accounting system, we look at the impact of components of change on implementation of the new system. Implementing changes is fraught wit...

  3. Extending social health insurance to the informal sector in Kenya. An assessment of factors affecting demand.

    Mathauer, Inke; Schmidt, Jean-Olivier; Wenyaa, Maurice

    2008-01-01

    This paper contributes to analysing and understanding the demand for (social) health insurance of informal sector workers in Kenya by assessing their perceptions and knowledge of and concerns regarding health insurance and the Kenyan National Hospital Insurance Fund (NHIF). It serves to explore how informal sector workers could be integrated into the NHIF. To collect data, focus group discussions were held with organized groups of informal sector workers of different types across the country, backed up by a self-administered questionnaire completed by heads of NHIF area branch offices. It was found that the most critical barrier to NHIF enrollment is the lack of knowledge of informal sector workers about the NHIF, its enrollment option and procedures for informal sector workers. Inability to pay is a critical factor for some, but people were, in principle, interested in health insurance, and thus willing to pay for it. In sum, the mix of demand-side determinants for enrolling in the NHIF is not as complex as expected. This is good news, as these demand-side determinants can be addressed with a well-designed strategy, focusing on awareness raising and information, improvement of insurance design features and setting differentiated and affordable contribution rates.

  4. The World Health Organization's mechanisms for increasing the health sector budget: The South African context.

    Venter, Fouche Hendrik Johannes; Wolfaardt, Jaqueline Elizabeth

    2016-07-04

    South Africa (SA) has limited scope for raising income taxes, and the proposed National Health Insurance (NHI) scheme will necessitate growth in the health sector budget. The NHI White Paper suggests five funding scenarios to meet the expected shortfall. These scenarios are a mixture of a surcharge on taxable income, an increase in value-added tax and a payroll tax. Five alternative options, suggested by the World Health Organization, are interrogated as ways to decrease the general taxation proposed in the White Paper. The five mechanisms (corporate tax, financial transaction levy, and taxes on tobacco, alcohol and unhealthy foods) were chosen based on their fund-raising potential and their mandatory element. A literature review provides the information for a discussion of the potential costs of each mechanism. Within specific assumptions, potential budgetary contribution is compared with the requirement. First, raising corporate tax rates could raise enough funds, but the losses due to capital flight might be too much for the local economy to bear. Second, a levy on currency transactions is unlikely to raise the required resources, even without a probable decrease in the number of transactions. Third, the increase in the tax on tobacco and alcohol would need to be very large, even assuming that consumption patterns would remain unchanged. Lastly, a tax on unhealthy food products is a new idea and could be explored as an option - especially as the SA Treasury has announced its future implementation. Implementing only one of the mechanisms is unlikely to increase available funding sufficiently, but if they are implemented together the welfare-maximising tax rate for each mechanism may be high enough to fulfil the NHI scheme's budgetary requirement, moderating the increases in the tax burden of the SA population.

  5. Increased fairness in priority setting processes within the health sector

    Zulu, Joseph M.; Michelo, Charles; Msoni, Carol;

    2014-01-01

    level in Kapiri-Mposhi District in Zambia. METHODS: Data was collected using in depth interviews (IDIs), focus group discussions (FGDs) and review of documents from national to district level. The study population for this paper consisted of health related stakeholders employed in the district...... devolution of PS and decision making procedures. However, important gaps were identified in terms of experiences of stakeholder involvement and fairness in PS processes in practice. The evaluation study revealed that a transformation of the views and methods regarding fairness in PS processes was ongoing...

  6. TECHNOLOGY MANAGEMENT IN THE PUBLIC HEALTH SECTOR: PROFESSIONAL VIEW FROM EQUIPMENT MAINTENANCE EXPERTS

    M.O. Kachieng’a

    2012-01-01

    Full Text Available South Africa has tried various strategies to improve access, quality and cost-efficiency in the health care delivery systems. However it is clear that the optimal approach has yet to be found. It has been recognised that health technology is an important element of this transformation, and will continue to play a vital role.
    It is almost evident that the way health technology is managed in health care institutions directly affects the quality of treatment patients receive. Although strategic importance of technology in health care has been documented widely in scientific literature; technology planning, procurement and management have not received the attention they deserve in the transformation of health care services in the country.
    The survey discussed in this paper investigated health care equipment maintenance problems and associated technological constraints from point of view of health technology managers, biomedical and clinical engineers. It also provides recommendations for competitive utilisation of technology in the public health sector.

  7. Use of communities of practice in business and health care sectors: A systematic review

    Coyte Peter C

    2009-05-01

    Full Text Available Abstract Background Since being identified as a concept for understanding knowledge sharing, management, and creation, communities of practice (CoPs have become increasingly popular within the health sector. The CoP concept has been used in the business sector for over 20 years, but the use of CoPs in the health sector has been limited in comparison. Objectives First, we examined how CoPs were defined and used in these two sectors. Second, we evaluated the evidence of effectiveness on the health sector CoPs for improving the uptake of best practices and mentoring new practitioners. Methods We conducted a search of electronic databases in the business, health, and education sectors, and a hand search of key journals for primary studies on CoP groups. Our research synthesis for the first objective focused on three areas: the authors' interpretations of the CoP concept, the key characteristics of CoP groups, and the common elements of CoP groups. To examine the evidence on the effectiveness of CoPs in the health sector, we identified articles that evaluated CoPs for improving health professional performance, health care organizational performance, professional mentoring, and/or patient outcome; and used experimental, quasi-experimental, or observational designs. Results The structure of CoP groups varied greatly, ranging from voluntary informal networks to work-supported formal education sessions, and from apprentice training to multidisciplinary, multi-site project teams. Four characteristics were identified from CoP groups: social interaction among members, knowledge sharing, knowledge creation, and identity building; however, these were not consistently present in all CoPs. There was also a lack of clarity in the responsibilities of CoP facilitators and how power dynamics should be handled within a CoP group. We did not find any paper in the health sector that met the eligibility criteria for the quantitative analysis, and so the effectiveness

  8. The challenges of good governance in the aquatic animal health sector.

    Kahn, S; Mylrea, G; Yaacov, K Bar

    2012-08-01

    Animal health is fundamental to efficient animal production and, therefore, to food security and human health. This holds true for both terrestrial and aquatic animals. Although partnership between producers and governmental services is vital for effective animal health programmes, many key activities are directly carried out by governmental services. Noting the need to improve the governance of such services in many developing countries, the World Organisation for Animal Health (OIE), using the OIE Tool for the Evaluation of Performance of Veterinary Services, conducts assessments of Veterinary Services and Aquatic Animal Health Services (AAHS) to help strengthen governance and support more effective delivery of animal health programmes. While good governance and the tools to improve governance in the aquatic animal sector are largely based on the same principles as those that apply in the terrestrial animal sector, there are some specific challenges in the aquatic sector that have a bearing on the governance of services in this area. For example, the aquaculture industry has experienced rapid growth and the use of novel species is increasing; there are important gaps in scientific knowledge on diseases of aquatic animals; there is a need for more information on sustainable production; the level of participation of the veterinary profession in aquatic animal health is low; and there is a lack of standardisation in the training of aquatic animal health professionals. Aquaculture development can be a means of alleviating poverty and hunger in developing countries. However, animal diseases, adverse environmental impacts and food safety risks threaten to limit this development. Strengthening AAHS governance and, in consequence, aquatic animal health programmes, is the best way to ensure a dynamic and sustainable aquaculture sector in future. This paper discusses the specific challenges to AAHS governance and some OIE initiatives to help Member Countries to address

  9. Improving mental health outcomes: achieving equity through quality improvement

    Poots, Alan J.; Green, Stuart A.; Honeybourne, Emmi; Green, John; Woodcock, Thomas; Barnes, Ruth; Bell, Derek

    2014-01-01

    Objective To investigate equity of patient outcomes in a psychological therapy service, following increased access achieved by a quality improvement (QI) initiative. Design Retrospective service evaluation of health outcomes; data analysed by ANOVA, chi-squared and Statistical Process Control. Setting A psychological therapy service in Westminster, London, UK. Participants People living in the Borough of Westminster, London, attending the service (from either healthcare professional or self-referral) between February 2009 and May 2012. Intervention(s) Social marketing interventions were used to increase referrals, including the promotion of the service through local media and through existing social networks. Main Outcome Measure(s) (i) Severity of depression on entry using Patient Health Questionnaire-9 (PHQ9). (ii) Changes to severity of depression following treatment (ΔPHQ9). (iii) Changes in attainment of a meaningful improvement in condition assessed by a key performance indicator. Results Patients from areas of high deprivation entered the service with more severe depression (M = 15.47, SD = 6.75), compared with patients from areas of low (M = 13.20, SD = 6.75) and medium (M = 14.44, SD = 6.64) deprivation. Patients in low, medium and high deprivation areas attained similar changes in depression score (ΔPHQ9: M = −6.60, SD = 6.41). Similar proportions of patients achieved the key performance indicator across initiative phase and deprivation categories. Conclusions QI methods improved access to mental health services; this paper finds no evidence for differences in clinical outcomes in patients, regardless of level of deprivation, interpreted as no evidence of inequity in the service with respect to this outcome. PMID:24521701

  10. Review of corruption in the health sector: theory, methods and interventions.

    Vian, Taryn

    2008-03-01

    There is increasing interest among health policymakers, planners and donors in how corruption affects health care access and outcomes, and what can be done to combat corruption in the health sector. Efforts to explain the risk of abuse of entrusted power for private gain have examined the links between corruption and various aspects of management, financing and governance. Behavioural scientists and anthropologists also point to individual and social characteristics which influence the behaviour of government agents and clients. This article presents a comprehensive framework and a set of methodologies for describing and measuring how opportunities, pressures and rationalizations influence corruption in the health sector. The article discusses implications for intervention, and presents examples of how theory has been applied in research and practice. Challenges of tailoring anti-corruption strategies to particular contexts, and future directions for research, are addressed.

  11. Analysis of health sector gender equality and social inclusion strategy 2009 of Nepal.

    Mahara, G B; Dhital, S R

    2014-01-01

    The policy on gender equality and social inclusion (GESI) in health sector of Nepal is formulated in 2009 targeting toward poor, vulnerable, marginalized social and ethnic groups. Gender inequality and social discrimination are a social problem that affect on individual health finally. The main objective of this paper is to critically analysis and evaluates the Government's strategy on health sector gender equality and social inclusion in Nepal. We collected published and unpublished information assessing the public health, policy analysis and research needs from different sources. A different policy approaches for the analysis and evaluation of GESI strategies is applied in this paper. Universal education, community participation, individual, group and mass communication approaches, and social capital are the key aspects of effective implementation of policy at target levels.

  12. A participatory approach to health promotion for informal sector workers in Thailand

    Jittra Rukijkanpanich

    2010-07-01

    Full Text Available BACKGROUND: This study aims to promote occupational health in the informal sector in Thailand by using a participatory approach. The success of the intervention is based on an evaluation of the informal sector workers' a knowledge, attitudes, and behaviors in occupational health and safety, b work practice improvement, and c working condition improvement. METHODS: This study applies the Participatory Action Research (PAR method. The participants of the study consisted of four local occupations in different regions of Thailand, including a ceramic making group in the North, a plastic weaving group in the Central region, a blanket making group in the Northeast, and a pandanus weaving group in the South. Data was collected using both qualitative and quantitative methods through questionnaires, industrial hygiene instruments, and group discussions. RESULTS: The results showed that the working conditions of the informal sector were improved to meet necessary standards after completing the participatory process. Also, the post-test average scores on 1 the occupational health and safety knowledge, attitudes and behaviors measures and 2 the work practice improvement measures were significantly higher than the pre-test average scores (p=sig. CONCLUSIONS: The results demonstrate that the participatory approach is an effective tool to use when promoting the health safety of the informal sector and when encouraging the workers to voluntarily improve the quality of their own lives.

  13. Reforming the health sector in Thailand: the role of policy actors on the policy stage.

    Green, A

    2000-01-01

    This paper reports on exploratory research carried out into the processes of policy-making, and in particular health sector reform, in the health sector of Thailand. It is one of a set of studies examining health sector reform processes in a number of countries. Though in the period under study (1970-1996) there had been no single health sector reform package in Thailand, there was interest in a number of quarters in the development of such an initiative. It is clear, however, that despite recognition of the need for reform such a policy was far from being formulated, let alone implemented. The research, based on both documentary analysis and interviews, explores the reasons underpinning the failure of the policy process to respond to such a perceived need. The research findings suggest that the policy formation process in Thailand successfully occurs when there is a critical mass of support from strategic interest groups. The relative power of these interest groups is constantly changing. In particular the last two decades has seen a decline in the power of the bureaucratic élites (military and civilian) and a related rise in the power of the economic élites either directly or through their influence on political parties and government. Other critical groups include the media, NGOs and the professions. Informal policy groups are also significant. A number of implications for policy makers operating under such circumstances are drawn.

  14. Three methods of interfacing with the private sector by mental health agencies.

    McRae, J A

    1989-01-01

    This article outlines three methods of mental health marketing--formal, intermediary, and interactive. It discusses advantages and disadvantages of each method. These approaches are particularly good for public, non-profit agencies and individuals in contacting the private sector. The need for flexibility and marketing mix is emphasized.

  15. Foreign direct investment in the health care sector and most-favoured locations in developing countries.

    Outreville, J François

    2007-12-01

    Given the growing importance of the health care sector and the significant development of trade in health services, foreign direct investment (FDI) in this sector has gathered momentum with the General Agreement on Trade in Services. Despite extensive case based research and publications in recent years on health care markets and the rise of private sectors, it is surprisingly difficult to find evidence on the relative importance of the largest multinational corporations (MNCs) operating in the health care sector. The objective of the paper is to identify some of the determinants of foreign investment of the largest MNCs operating in this industry. The list of the largest MNCs has been compiled using company websites and data is available for 41 developing economies for which at least two MNCs have an office (branch and/or affiliate). The results of this study have some important implications. They indicate that location-specific advantages of host countries, including good governance, do provide an explication of the internationalization of firms in some developing countries rather than others.

  16. Resistance and renewal: health sector reform and Cambodia's national tuberculosis programme.

    Hill, Peter S; Tan Eang, Mao

    2007-08-01

    Following the destruction of Cambodia's health infrastructure during the Khmer Rouge period (1975-1979) and the subsequent decade of United Nations sanctions, international development assistance has focused on reconstructing the country's health system. The recognition of Cambodia's heavy burden of tuberculosis (TB) and the lapse of TB control strategies during the transition to democracy prompted the national tuberculosis programme's relaunch in the mid-1990s as WHO-backed health sector reforms were introduced. This paper examines the conflicts that arose between health reforms and TB control programmes due to their different operating paradigms. It also discusses how these tensions were resolved during introduction of the DOTS strategy for TB treatment.

  17. Achieving and Sustaining Universal Health Coverage: Fiscal Reform of the National Health Insurance in Taiwan.

    Lan, Jesse Yu-Chen

    2016-10-25

    The paper discusses the expansion of the universal health coverage (UHC) in Taiwan through the establishment of National Health Insurance (NHI), and the fiscal crisis it caused. Two key questions are addressed: How did the NHI gradually achieve universal coverage, and yet cause Taiwanese health spending to escalate to fiscal crisis? What measures have been taken to reform the NHI finance and achieve moderate success to date? The main argument of this paper is that the Taiwanese Government did try to implement various reforms to save costs and had moderate success, but the path-dependent process of reform does not allow increasing contribution rates significantly and thereby makes sustainability challenging.

  18. Lighting in the health care sector; Verlichting in de zorg

    Visser, R. [Grontmij, Amersfoort (Netherlands)

    2009-02-15

    The importance of light for people's health and welfare attracts frequent attention, not only the professional press but also in countless articles in newspapers and news magazines. Insufficient illumination can upset the biological clock and may even cause depression. In principle this applies to anyone who has to stay indoors all day or nearly all day; in the case of care homes it affects residents who have no regular opportunity to sit at a window, for example those who are bedridden. Research indicates that we need a minimum daily portion of daylight or of artificial light with similar qualities as daylight. This is also of great importance to night workers. [Dutch] Niet alleen in de vakpers, maar ook in tal van dag- en weekbladen, wordt regelmatig het belang van licht voor het welzijn en de gezondheid van de mens aan de orde gesteld. Gebrek aan voldoende licht kan het bioritme verstoren en zelfs leiden tot depressie. Dat geldt in principe voor alle mensen die om wat voor redenen dan ook de hele dag of nagenoeg de hele dag binnen moeten blijven. In zorginstellingen is dit vooral van toepassing voor degenen die zich niet regelmatig direct achter het ream kunnen bevinden, zoals mensen die bedlegering zijn. Want door onderzoek is gebleken dat we elke dag een voldoende portie daglicht nodig hebben of licht met overeenkomstige kwaliteiten als daglicht. Voor mensen die 's nachts moeten werken is het laatstgenoemde ook van groot belang.

  19. Psychosocial safety climate: a multilevel theory of work stress in the health and community service sector.

    Dollard, M F; McTernan, W

    2011-12-01

    Work stress is widely thought to be a significant problem in the health and community services sector. We reviewed evidence from a range of different data sources that confirms this belief. High levels of psychosocial risk factors, psychological health problems and workers compensation claims for stress are found in the sector. We propose a multilevel theoretical model of work stress to account for the results. Psychosocial safety climate (PSC) refers to a climate for psychological health and safety. It reflects the balance of concern by management about psychological health v. productivity. By extending the health erosion and motivational paths of the Job Demands-Resources model we propose that PSC within work organisations predicts work conditions and in turn psychological health and engagement. Over and above this, however, we expect that the external environment of the sector particularly government policies, driven by economic rationalist ideology, is increasing work pressure and exhaustion. These conditions are likely to lead to a reduced quality of service, errors and mistakes.

  20. Health sector planning led by management of recurrent expenditure: an agenda for action-research.

    Segall, M

    1991-01-01

    Health services in developing countries face a crisis of recurrent costs. Far from being able to fund primary health care (PHC) developments, governments now have difficulty in keeping existing health services in operation. This article proposes an approach to the problem based on the proactive planning and management of recurrent health expenditure. The system addresses existing services as well as future plans and allows explicit trade-offs to be made in resource allocation. This may be termed 'recurrent-expenditureled planning'. The article describes a diagnostic health sector review, which incorporates a recurrent expenditure profile in four planes: by type of provider, source of finance, level of care and recipient population group. A fifth dimension of time trends for certain expenditure categories can be added. The steps of a strategic planning cycle for health services resources are then described, which allows health service strategies to be tested for broad economic feasibility. It also results in the establishment of resource targets that can act as benchmarks against which actual levels of funding can be compared. The targets help to maintain sectoral priorities in resource allocation even in times of economic constraint and to channel funds preferentially to localities and facilities in greatest need. The system calls for innovations in the methods of health planning and financial management in the health sector. Implementation will require health systems action-research at the country level. The essential purpose is to promote PHC policy-led resource allocation and use. No amount of planning can substitute for political action to realize 'health for all', but this system provides technical support to the political forces in favour of distributive PHC policies.

  1. Role of GIS in social sector planning: can developing countries benefit from the examples of primary health care (PHC) planning in Britain?

    Ishfaq, Mohammad; Lodhi, Bilal Khan

    2012-04-01

    Social sector planning requires rational approaches where community needs are identified by referring to relative deprivation among localities and resources are allocated to address inequalities. Geographical information system (GIS) has been widely argued and used as a base for rational planning for equal resource allocation in social sectors around the globe. Devolution of primary health care is global strategy that needs pains taking efforts to implement it. GIS is one of the most important tools used around the world in decentralization process of primary health care. This paper examines the scope of GIS in social sector planning by concentration on primary health care delivery system in Pakistan. The work is based on example of the UK's decentralization process and further evidence from US. This paper argues that to achieve benefits of well informed decision making to meet the communities' needs GIS is an essential tool to support social sector planning and can be used without any difficulty in any environment. There is increasing trend in the use of Health Management Information System (HMIS) in Pakistan with ample internet connectivity which provides well established infrastructure in Pakistan to implement GIS for health care, however there is need for change in attitude towards empowering localities especially with reference to decentralization of decision making. This paper provides GIS as a tool for primary health care planning in Pakistan as a starting point in defining localities and preparing locality profiles for need identification that could help developing countries in implementing the change.

  2. Good governance and corruption in the health sector: lessons from the Karnataka experience.

    Huss, R; Green, A; Sudarshan, H; Karpagam, Ss; Ramani, Kv; Tomson, G; Gerein, N

    2011-11-01

    Strengthening good governance and preventing corruption in health care are universal challenges. The Karnataka Lokayukta (KLA), a public complaints agency in Karnataka state (India), was created in 1986 but played a prominent role controlling systemic corruption only after a change of leadership in 2001 with a new Lokayukta (ombudsman) and Vigilance Director for Health (VDH). This case study of the KLA (2001-06) analysed the:Scope and level of poor governance in the health sector; KLA objectives and its strategy; Factors which affected public health sector governance and the operation of the KLA. We used a participatory and opportunistic evaluation design, examined documents about KLA activities, conducted three site visits, two key informant and 44 semi-structured interviews and used a force field model to analyse the governance findings. The Lokayukta and his VDH were both proactive and economically independent with an extended social network, technical expertise in both jurisdiction and health care, and were widely perceived to be acting for the common good. They mobilized media and the public about governance issues which were affected by factors at the individual, organizational and societal levels. Their investigations revealed systemic corruption within the public health sector at all levels as well as in public/private collaborations and the political and justice systems. However, wider contextual issues limited their effectiveness in intervening. The departure of the Lokayukta, upon completing his term, was due to a lack of continued political support for controlling corruption. Governance in the health sector is affected by positive and negative forces. A key positive factor was the combined social, cultural and symbolic capital of the two leaders which empowered them to challenge corrupt behaviour and promote good governance. Although change was possible, it was precarious and requires continuous political support to be sustained.

  3. Great expectations for the World Health Organization: a Framework Convention on Global Health to achieve universal health coverage.

    Ooms, G; Marten, R; Waris, A; Hammonds, R; Mulumba, M; Friedman, E A

    2014-02-01

    Establishing a reform agenda for the World Health Organization (WHO) requires understanding its role within the wider global health system and the purposes of that wider global health system. In this paper, the focus is on one particular purpose: achieving universal health coverage (UHC). The intention is to describe why achieving UHC requires something like a Framework Convention on Global Health (FCGH) that have been proposed elsewhere,(1) why WHO is in a unique position to usher in an FCGH, and what specific reforms would help enable WHO to assume this role.

  4. Resource allocation in Pakistan's health sector: a critical appraisal and a path toward the Millennium Development Goals.

    Shaikh, Babar Tasneem; Ejaz, Irum; Mazhar, Arslan; Hafeez, Assad

    2013-01-01

    Pakistan is trying hard to sustain its progress toward the Millennium Development Goals. However, because of a lack of political commitment to innovative solutions to improve its financing mechanism, the health system is unable to provide even essential and basic services to the people. The country, with more than 70% of the population living on less than two US dollars a day, largely depends on direct taxes for its revenue. Because of inadequate financing, the quality of government services is inexcusably poor; therefore, a majority of people seek healthcare in the private sector. This has led to a horde of issues pertaining to equity, accessibility and fairness. High out-of-pocket expenses on health jeopardize a family's livelihood, pushing it into a vicious circle of poverty. In the wake of recent devolution, this paper presents options for future health financing that enables the provinces to exert their autonomy to safeguard the health of the most vulnerable in the country. Our recommendations follow the vision of the World Health Organization and the Commission on Macroeconomics and Health, to achieve universal health coverage and social protection for the poor.

  5. Evaluating digital libraries in the health sector. Part 2: measuring impacts and outcomes.

    Cullen, Rowena

    2004-03-01

    This is the second part of a two-part paper which explores methods that can be used to evaluate digital libraries in the health sector. Part 1 focuses on approaches to evaluation that have been proposed for mainstream digital information services. This paper investigates evaluative models developed for some innovative digital library projects, and some major national and international electronic health information projects. The value of ethnographic methods to provide qualitative data to explore outcomes, adding to quantitative approaches based on inputs and outputs is discussed. The paper concludes that new 'post-positivist' models of evaluation are needed to cover all the dimensions of the digital library in the health sector, and some ways of doing this are outlined.

  6. The building blocks of health reform: achieving universal coverage and health system savings.

    Davis, Karen; Schoen, Cathy; Collins, Sara R

    2008-05-01

    The presidential election has focused public attention on the need for health system reform--to ensure health insurance for all, to make health care more accessible and responsive to patients, and to slow the growth in health care cost. This issue brief sets forth a framework for expanding health coverage that offers Americans a choice of a product modeled on Medicare to those under age 65, made available through a national insurance connector. Coupled with reforms to Medicare provider payment, expansion of preventive health care, and improved information, such a strategy has the potential to achieve near-universal coverage and improve quality and access, while generating health system savings of $1.6 trillion over 10 years.

  7. A participatory model for improving occupational health and safety: improving informal sector working conditions in Thailand.

    Manothum, Aniruth; Rukijkanpanich, Jittra; Thawesaengskulthai, Damrong; Thampitakkul, Boonwa; Chaikittiporn, Chalermchai; Arphorn, Sara

    2009-01-01

    The purpose of this study was to evaluate the implementation of an Occupational Health and Safety Management Model for informal sector workers in Thailand. The studied model was characterized by participatory approaches to preliminary assessment, observation of informal business practices, group discussion and participation, and the use of environmental measurements and samples. This model consisted of four processes: capacity building, risk analysis, problem solving, and monitoring and control. The participants consisted of four local labor groups from different regions, including wood carving, hand-weaving, artificial flower making, and batik processing workers. The results demonstrated that, as a result of applying the model, the working conditions of the informal sector workers had improved to meet necessary standards. This model encouraged the use of local networks, which led to cooperation within the groups to create appropriate technologies to solve their problems. The authors suggest that this model could effectively be applied elsewhere to improve informal sector working conditions on a broader scale.

  8. Health workforce attrition in the public sector in Kenya: a look at the reasons

    Muchiri Stephen

    2009-07-01

    Full Text Available Abstract Background Kenya, like many other countries in sub-Saharan Africa, has been affected by shortages of health workers in the public sector. Data on the rates and leading reasons for health workers attrition in the public sector are key in developing effective, evidence-based planning and policy on human resources for health. Methods This study analysed data from a human resources health facility survey conducted in 2005 in 52 health centres and 22 public hospitals (including all provincial hospitals across all eight provinces in Kenya. The study looked into the status of attrition rates and the proportion of attrition due to retirement, resignation or death among doctors, clinical officers, nurses and laboratory and pharmacy specialists in surveyed facilities. Results Overall health workers attrition rates from 2004 to 2005 were similar across type of health facility: provincial hospitals lost on average 4% of their health workers, compared to 3% for district hospitals and 5% for health centres. However, there are differences in the patterns of attrition rates by cadre. Attrition among doctors and registered nurses was much higher at the provincial hospitals than at district hospitals or health centres, whereas the opposite pattern was observed for laboratory and pharmacy staff (lost at a higher rate in lower-level facilities. In provincial hospitals, doctors had higher attrition rates than clinical officers, and registered nurses had higher attrition rates than enrolled nurses. In contrast, attrition of enrolled and registered nurses in district hospitals and health centres was similar. The main reason for health worker attrition (all cadres combined at each level of facility was retirement, followed by resignation and death. However, resignation drives attrition among doctors and clinical officers; retirement accounts for the main share of attrition among nurses and pharmacy staff; and death is the primary reason for attrition among

  9. Informal sector providers in Bangladesh: how equipped are they to provide rational health care?

    Ahmed, Syed Masud; Hossain, Md Awlad; Chowdhury, Mushtaque Raja

    2009-11-01

    In Bangladesh, there is a lack of knowledge about the large body of informal sector practitioners, who are the major providers of health care to the poor, especially in rural areas, knowledge which is essential for designing a need-based, pro-poor health system. This paper addresses this gap by presenting descriptive data on their professional background including knowledge and practices on common illnesses and conditions from a nationwide, population-based health-care provider survey undertaken in 2007. The traditional healers (43%), traditional birth attendants (TBAs, 22%), and unqualified allopathic providers (village doctors and drug sellers, 16%) emerged as major providers in the health care scenario of Bangladesh. Community health workers (CHWs) comprised about 7% of the providers. The TBAs/traditional healers had sector, instead of ignoring, recognize the importance of the informal providers for the health care of the poor. Consequently, their capacity should be developed through training, supportive supervision and regulatory measures so as to accommodate them in the mainstream health system until constraints on the supply of qualified and motivated health care providers into the system can be alleviated.

  10. The relationship between the growth in the health sector and inbound health tourism: the case of Turkey.

    Uçak, Harun

    2016-01-01

    One of the consequences of globalisation for Turkey, as well as in other emerging countries, has been an increasing trend in health tourism. Households have been considered choice the best option in terms of price and alternative possibilities while they have been solved their health problems. Previous studies have argued that the main drivers of the growth of inbound health tourism to developing countries are lower costs, shorter waiting periods, and better quality of care. This study aimed to test the effect of health and social service sector growth on the flow of inbound health tourism between 2004:Q1 and 2015:Q4 by employing Granger causality and Johansen cointegration approaches. Our findings suggested that there is a long-run Granger causality from domestic health and social work expenditures to health tourism income whereas this is non-existence in the opposite direction.

  11. Public-private sector interactions and the demand for supplementary health insurance in the United Kingdom.

    Bíró, Anikó; Hellowell, Mark

    2016-07-01

    We examine the demand for private health insurance (PHI) in the United Kingdom and relate this to changes in the supply of public and private healthcare. Using a novel collection of administrative, private sector and survey data, we re-assess the relationships between the quality and availability of public and private sector inpatient care, and the demand for PHI. We find that PHI coverage in the United Kingdom is positively related to the median of the region- and year-specific public sector waiting times. We find that PHI prevalence ceteris paribus increases with being self-employed and employed, while it decreases with having financial difficulties. In addition, we highlight the complexities of inter-sectoral relations and their impact on PHI demand. Within a region, we find that an increase in private healthcare supply is associated with a decrease in public sector waiting times, implying lower PHI demand. This may be explained by the usage of private facilities by NHS commissioners. These results have important implications for policymakers interested in the role of private healthcare supply in enhancing the availability of and equitable access to acute inpatient care.

  12. Access to safe legal abortion in Malaysia: women's insights and health sector response.

    Low, Wah-Yun; Tong, Wen-Ting; Wong, Yut-Lin; Jegasothy, Ravindran; Choong, Sim-Poey

    2015-01-01

    Malaysia has an abortion law, which permits termination of pregnancy to save a woman's life and to preserve her physical and mental health (Penal Code Section 312, amended in 1989). However, lack of clear interpretation and understanding of the law results in women facing difficulties in accessing abortion information and services. Some health care providers were unaware of the legalities of abortion in Malaysia and influenced by their personal beliefs with regard to provision of abortion services. Accessibility to safer abortion techniques is also an issue. The development of the 2012 Guidelines on Termination of Pregnancy and Guidelines for Management of Sexual and Reproductive Health among Adolescents in Health Clinics by the Ministry of Health, Malaysia, is a step forward toward increasing women's accessibility to safe abortion services in Malaysia. This article provides an account of women's accessibility to abortion in Malaysia and the health sector response in addressing the barriers.

  13. Strengthening institutional and organizational capacity for social health protection of the informal sector in lesser-developed countries: a study of policy barriers and opportunities in Cambodia.

    Annear, Peter Leslie; Ahmed, Shakil; Ros, Chhun Eang; Ir, Por

    2013-11-01

    Reaching out to the poor and the informal sector is a major challenge for achieving universal coverage in lesser-developed countries. In Cambodia, extensive coverage by health equity funds for the poor has created the opportunity to consolidate various non-government health financing schemes under the government's proposed social health protection structure. This paper identifies the main policy and operational challenges to strengthening existing arrangements for the poor and the informal sector, and considers policy options to address these barriers. Conducted in conjunction with the Cambodian Ministry of Health in 2011-12, the study reviewed policy documents and collected qualitative data through 18 semi-structured key informant interviews with government, non-government and donor officials. Data were analysed using the Organizational Assessment for Improving and Strengthening Health Financing conceptual framework. We found that a significant shortfall related to institutional, organisational and health financing issues resulted in fragmentation and constrained the implementation of social health protection schemes, including health equity funds, community-based health insurance, vouchers and others. Key documents proposed the establishment of a national structure for the unification of the informal-sector schemes but left unresolved issues related to structure, institutional capacity and the third-party status of the national agency. This study adds to the evidence base on appropriate and effective institutional and organizational arrangements for social health protection in the informal sector in developing countries. Among the key lessons are: the need to expand the fiscal space for health care; a commitment to equity; specific measures to protect the poor; building national capacity for administration of universal coverage; and working within the specific national context.

  14. Developing a composite index of spatial accessibility across different health care sectors: A German example.

    Siegel, Martin; Koller, Daniela; Vogt, Verena; Sundmacher, Leonie

    2016-02-01

    The evolving lack of ambulatory care providers especially in rural areas increasingly challenges the strict separation between ambulatory and inpatient care in Germany. Some consider allowing hospitals to treat ambulatory patients to tackle potential shortages of ambulatory care in underserved areas. In this paper, we develop an integrated index of spatial accessibility covering multiple dimensions of health care. This index may contribute to the empirical evidence concerning potential risks and benefits of integrating the currently separated health care sectors. Accessibility is measured separately for each type of care based on official data at the district level. Applying an Improved Gravity Model allows us to factor in potential cross-border utilization. We combine the accessibilities for each type of care into a univariate index by adapting the concept of regional multiple deprivation measurement to allow for a limited substitutability between health care sectors. The results suggest that better health care accessibility in urban areas persists when taking a holistic view. We believe that this new index may provide an empirical basis for an inter-sectoral capacity planning.

  15. Lessons from the business sector for successful knowledge management in health care: A systematic review

    Sibbald Shannon

    2011-07-01

    Full Text Available Abstract Background The concept of knowledge management has been prevalent in the business sector for decades. Only recently has knowledge management been receiving attention by the health care sector, in part due to the ever growing amount of information that health care practitioners must handle. It has become essential to develop a way to manage the information coming in to and going out of a health care organization. The purpose of this paper was to summarize previous studies from the business literature that explored specific knowledge management tools, with the aim of extracting lessons that could be applied in the health domain. Methods We searched seven databases using keywords such as "knowledge management", "organizational knowledge", and "business performance". We included articles published between 2000-2009; we excluded non-English articles. Results 83 articles were reviewed and data were extracted to: (1 uncover reasons for initiating knowledge management strategies, (2 identify potential knowledge management strategies/solutions, and (3 describe facilitators and barriers to knowledge management. Conclusions KM strategies include such things as training sessions, communication technologies, process mapping and communities of practice. Common facilitators and barriers to implementing these strategies are discussed in the business literature, but rigorous studies about the effectiveness of such initiatives are lacking. The health care sector is at a pinnacle place, with incredible opportunities to design, implement (and evaluate knowledge management systems. While more research needs to be done on how best to do this in healthcare, the lessons learned from the business sector can provide a foundation on which to build.

  16. Organization and Finance of China's Health Sector: Historical Antecedents for Macroeconomic Structural Adjustment.

    Li, Hui; Hilsenrath, Peter

    2016-01-01

    China has exploded onto the world economy over the past few decades and is undergoing rapid transformation toward relatively more services. The health sector is an important part of this transition. This article provides a historical account of the development of health care in China since 1949. It also focuses on health insurance and macroeconomic structural adjustment to less saving and more consumption. In particular, the question of how health insurance impacts precautionary savings is considered. Multivariate analysis using data from 1990 to 2012 is employed. The household savings rate is the dependent variable in 3 models segmented for rural and urban populations. Independent variables include out-of-pocket health expenditures, health insurance payouts, housing expenditure, education expenditure, and consumption as a share of gross domestic product (GDP). Out-of-pocket health expenditures were positively correlated with household savings rates. But health insurance remains weak, and increased payouts by health insurers have not been associated with lower levels of household savings so far. Housing was positively correlated, whereas education had a negative association with savings rates. This latter finding was unexpected. Perhaps education is perceived as investment and a substitute for savings. China's shift toward a more service-oriented economy includes growing dependence on the health sector. Better health insurance is an important part of this evolution. The organization and finance of health care is integrally linked with macroeconomic policy in an environment constrained by prevailing institutional convention. Problems of agency relationships, professional hegemony, and special interest politics feature prominently, as they do elsewhere. China also has a dual approach to medicine relying heavily on providers of traditional Chinese medicine. Both of these segments will take part in China's evolution, adding another layer of complexity to policy.

  17. Is the Water Sector Lagging behind Education and Health on Aid Effectiveness? Lessons from Bangladesh, Ethiopia and Uganda

    Katharina Welle

    2009-10-01

    Full Text Available A study in three countries (Bangladesh, Ethiopia and Uganda assessed progress against the Paris Principles for Aid Effectiveness (AE in three sectors – water, health and education – to test the assumption that the water sector is lagging behind. The findings show that it is too simplistic to say that the water sector is lagging, although this may well be the case in some countries. The study found that wider governance issues are more important for AE than having in place sector-specific mechanics such as Sector-Wide Approaches alone. National political leadership and governance are central drivers of sector AE, while national financial and procurement systems and the behaviour of actors who have not signed up to the Paris Principles – at both national and global levels – have implications for progress that cut across sectors. Sectors and sub-sectors do nonetheless have distinct features that must be considered in attempting to improve sector-level AE. In light of these findings, using political economy approaches to better understand and address governance and strengthening sector-level monitoring is recommended as part of efforts to improve AE and development results in the water sector.

  18. Implementation and quality monitoring of e-communication across health care sectors

    Nicolaisen, Anne; Qvist, Peter

    Background: There has been an increased focus on how to improve the quality of care for patients that receives services from more than one sector in the health care system. Continuity in and coordination of patient pathways in the health care system are included in accreditation standards both...... and municipalities. The Sam:Bo agreement comprises guidelines for clinical pathways that involves more than one of the participating stakeholders and specified quality standards for the content and timeliness of information exchange across sectors. Part of the Sam:Bo agreement is the implementation of quality...... monitoring of specified quality standards. Objective: To monitor the implementation and quality of the Sam:Bo e-communication Method: An explicit audit performed in all local municipalities and at selected hospital departments from all hospital units in the Region of Southern Denmark. The audit was conducted...

  19. A realistic theory of health sector management. The case for critical realism.

    Connelly, J

    2000-01-01

    To date the practice of health sector management has not been sufficiently theorised. An adequate theory should be able to answer the pre-eminent critique of managerial rationality and ethics mounted by Alasdair MacIntyre in After Virtue and should also offer robust analytical and ethical resources to identify and engage with the social, political, economic and moral issues underlying health sector management. Critical realism with its ontology of generative mechanisms, agency-structure relationships, valorisation of activity and ideology critique offers such resources in an empirically orientated but adequately theorised realist framework. Rather than negate MacIntyre, critical realism incorporates and transcends his key arguments regarding the rationality and ethics of management. This article introduces the main elements of critical realism and clears a conceptual space for the cumulation of critical realist case-studies and managerial craft knowledge.

  20. Community awareness and perceptions of health sector preparedness and response to Cyclone Nargis.

    Myint, N W; Kaewkungwal, J; Singhasivanon, P; Chaisiri, K; Ponpet, P; Siriwan, P; Mallik, A K; Thet, K W

    2011-07-01

    Community awareness, preparedness and response to public health emergencies are essential for a successful response to public health emergencies. This study was carried out to determine community awareness and perceptions regarding health sector preparedness and response to Cyclone Nargis in Myanmar. Six focus group discussions were carried out in 3 villages severely affected by Cyclone Nargis. Thematic content analysis was carried out to determine community perceptions. Focus group participants, consisting of community members, community leaders and government personnel, were aware of the cyclone, but were unaware of its intensity and where it would make landfall. There was inadequate knowledge on how to prepare for a cyclone. There was some training on cyclone preparation but coverage was not wide enough. Participants received service and relief from health sector; they had a positive attitude toward health services provided to them. However, 5 out of 6 focus groups stated most villagers were not interested in health education. Only a few participants had some knowledge on how to prepare for a cyclone. Based on these results, there are evident weaknesses on how to prepare for cyclones. Community preparedness is essential to prevent disasters with cyclones, such as with Cyclone Nargis.

  1. Community mental health in two sectors: County Caroni and St. George East--an evaluation.

    James, V

    1986-01-01

    An evaluation of the community mental health program in Trinidad in two sectors with differing sociological backgrounds is made. Results showed that both sectors had regular outpatient clinics, outpatient group psychotherapy, and mental health officers partly community based. County Caroni had a low admission rate to St. Ann's Hospital, an ongoing education programme, an outpatient club, and an Extended Care Centre with Day Care Centre. The predominant illnesses seen in County Caroni were Alcoholism in the males and Depression and Anxiety States in the females. In St. George East, there was a higher admission rate to St. Ann's Hospital. The education program was irregular. There was an Extended Care Centre in Tacarigua half of which was allocated to psychiatric patients and a Day Care Centre at the Tumpuna Rehabilitation Centre. The most frequent illnesses in St. George East were Schizophrenia and Alcoholism in the males, and Schizophrenia and Depression with equal frequency in the females. The results indicated that the specific needs of each sector were different--hence the need for different approaches. The difficulties of implementing the Community Mental Health programme are discussed.

  2. Partnerships between the faith-based and medical sectors: Implications for preventive medicine and public health.

    Levin, Jeff

    2016-12-01

    Interconnections between the faith-based and medical sectors are multifaceted and have existed for centuries, including partnerships that have evolved over the past several decades in the U.S. This paper outlines ten points of intersection that have engaged medical and healthcare professionals and institutions across specialties, focusing especially on primary care, global health, and community-based outreach to underserved populations. In a time of healthcare resource scarcity, such partnerships-involving religious congregations, denominations, and communal and philanthropic agencies-are useful complements to the work of private-sector medical care providers and of federal, state, and local public health institutions in their efforts to protect and maintain the health of the population. At the same time, challenges and obstacles remain, mostly related to negotiating the complex and contentious relations between these two sectors. This paper identifies pressing legal/constitutional, political/policy, professional/jurisdictional, ethical, and research and evaluation issues that need to be better addressed before this work can realize its full potential.

  3. Partnerships between the faith-based and medical sectors: Implications for preventive medicine and public health

    Jeff Levin

    2016-12-01

    Full Text Available Interconnections between the faith-based and medical sectors are multifaceted and have existed for centuries, including partnerships that have evolved over the past several decades in the U.S. This paper outlines ten points of intersection that have engaged medical and healthcare professionals and institutions across specialties, focusing especially on primary care, global health, and community-based outreach to underserved populations. In a time of healthcare resource scarcity, such partnerships—involving religious congregations, denominations, and communal and philanthropic agencies—are useful complements to the work of private-sector medical care providers and of federal, state, and local public health institutions in their efforts to protect and maintain the health of the population. At the same time, challenges and obstacles remain, mostly related to negotiating the complex and contentious relations between these two sectors. This paper identifies pressing legal/constitutional, political/policy, professional/jurisdictional, ethical, and research and evaluation issues that need to be better addressed before this work can realize its full potential.

  4. Diabetes, HIV and other health determinants associated with absenteeism among formal sector workers in Namibia

    Guariguata Leonor

    2012-01-01

    Full Text Available Abstract Background As countries in sub-Saharan Africa develop their economies, it is important to understand the health of employees and its impact on productivity and absenteeism. While previous studies have assessed the impact of single conditions on absenteeism, the current study evaluates multiple health factors associated with absenteeism in a large worker population across several sectors in Namibia. Methods From March 2009 to June 2010, PharmAccess Namibia conducted a series of cross-sectional surveys of 7,666 employees in 7 sectors of industry in Namibia. These included a self-reported health questionnaire and biomedical screenings for certain infectious diseases and non-communicable disease (NCD risk factors. Data were collected on demographics, absenteeism over a 90-day period, smoking behavior, alcohol use, hemoglobin, blood pressure, blood glucose, cholesterol, waist circumference, body mass index (BMI, HIV status, and presence of hepatitis B antigens and syphilis antibodies. The associations of these factors to absenteeism were ascertained using negative binomial regression. Results Controlling for demographic and job-related factors, high blood glucose and diabetes had the largest effect on absenteeism (IRR: 3.67, 95%CI: 2.06-6.55. This was followed by anemia (IRR: 1.59, 95%CI: 1.17-2.18 and being HIV positive (IRR: 1.47; 95%CI: 1.12-1.95. In addition, working in the fishing or services sectors was associated with an increased incidence of sick days (IRR: 1.53, 95%CI: 1.23-1.90; and IRR: 1.70, 95%CI: 1.32-2.20 respectively. The highest prevalence of diabetes was in the services sector (3.6%, 95%CI:-2.5-4.7. The highest prevalence of HIV was found in the fishing sector (14.3%, 95%CI: 10.1-18.5. Conclusion Both NCD risk factors and infectious diseases are associated with increased rates of short-term absenteeism of formal sector employees in Namibia. Programs to manage these conditions could help employers avoid costs associated

  5. Latin America and the Caribbean: Assessment of the Advances in Public Health for the Achievement of the Millennium Development Goals

    Amal K. Mitra

    2010-05-01

    Full Text Available To improve health and economy of the world population, the United Nations has set up eight international goals, known as Millennium Development Goals (MDGs, that 192 United Nations member states and at least 23 international organizations have agreed to achieve by the year 2015. The goals include: (1 eradicating extreme poverty and hunger; (2 achieving universal primary education; (3 promoting gender equality; (4 reducing child mortality; (5 improving maternal health; (6 combating HIV/AIDS, malaria and other diseases; (7 ensuring environmental sustainability; and (8 developing a global partnership for development. Having been in the midway from the 2015 deadline, the UN Secretary-General urges countries to engage constructively to review progress towards the MDGs. This paper aims to evaluate advances in public health, with special reference to gender inequalities in health, health sector reform, global burden of disease, neglected tropical diseases, vaccination, antibiotic use, sanitation and safe water, nutrition, tobacco and alcohol use, indicators of health, and disease prevention in Latin America and the Caribbean region (LAC. The paper also identifies areas of deficits for the achievement of MDGs in LAC.

  6. Health Care Exceptionalism? Performance and Allocation in the US Health Care Sector

    Chandra, Amitabh; Finkelstein, Amy; Sacarny, Adam; Syverson, Chad

    2016-01-01

    The conventional wisdom for the healthcare sector is that idiosyncratic features leave little scope for market forces to allocate consumers to higher performance producers. However, we find robust evidence - across several different conditions and performance measures - that higher quality hospitals have higher market shares and grow more over time. The relationship between performance and allocation is stronger among patients who have greater scope for hospital choice, suggesting that patient demand plays an important role in allocation. Our findings suggest that healthcare may have more in common with “traditional” sectors subject to market forces than often assumed. PMID:27784907

  7. Pro-social preferences and self-selection into the public health sector: evidence from an economic experiment.

    Kolstad, Julie Riise; Lindkvist, Ida

    2013-05-01

    Motivational crowding-out theory establishes that the effectiveness of financial incentive schemes, like pay-for-performance, crucially depends on the underlying social preferences of health workers. In this paper we study the extent to which heterogeneity in the strength and structure of social preferences is related to career choices by testing whether preferences vary systematically between Tanzanian health worker students who prefer to work in the private for-profit health sector and those who prefer to work in the public health sector. Despite its important policy implications, this issue has received little attention to date. By combining data from a questionnaire and an economic experiment, we find that students who prefer to work in the public health sector have stronger pro-social preferences than those who prefer to work in the private for-profit sector.

  8. Healthy firms: constraints to growth among private health sector facilities in Ghana and Kenya.

    Nicholas E Burger

    Full Text Available BACKGROUND: Health outcomes in developing countries continue to lag the developed world, and many countries are not on target to meet the Millennium Development Goals. The private health sector provides much of the care in many developing countries (e.g., approximately 50 percent in Sub-Saharan Africa, but private providers are often poorly integrated into the health system. Efforts to improve health systems performance will need to include the private sector and increase its contributions to national health goals. However, the literature on constraints private health care providers face is limited. METHODOLOGY/PRINCIPAL FINDINGS: We analyze data from a survey of private health facilities in Kenya and Ghana to evaluate growth constraints facing private providers. A significant portion of facilities (Ghana: 62 percent; Kenya: 40 percent report limited access to finance as the most significant barrier they face; only a small minority of facilities report using formal credit institutions to finance day to day operations (Ghana: 6 percent; Kenya: 11 percent. Other important barriers include corruption, crime, limited demand for goods and services, and poor public infrastructure. Most facilities have paper-based rather than electronic systems for patient records (Ghana: 30 percent; Kenya: 22 percent, accounting (Ghana: 45 percent; Kenya: 27 percent, and inventory control (Ghana: 41 percent; Kenya: 24 percent. A majority of clinics in both countries report undertaking activities to improve provider skills and to monitor the level and quality of care they provide. However, only a minority of pharmacies report undertaking such activities. CONCLUSIONS/SIGNIFICANCE: The results suggest that improved access to finance and improving business processes especially among pharmacies would support improved contributions by private health facilities. These strategies might be complementary if providers are more able to take advantage of increased access to

  9. The Gateway Paper--stewardship and governance in the health sector in Pakistan.

    Nishtar, Sania

    2006-12-01

    As an opening for a dialogue on health reforms in the country, the Gateway Paper places emphasis on strengthening the stewardship function of mandated State agencies in Pakistan with particular attention to two key areas. Firstly, greater emphasis on a stewardship role for the Ministry and departments of health in the context of inter-sectoral scope of health and secondly, a stronger role for the State agencies as regulators of healthcare within the country. The Gateway Paper envisages that the role of State agencies will become more critical as new models of financing health and delivering services are structured given that these entail regulation of private sector providers, providing oversight for ensuring a system for ongoing education and implementation of frameworks for public-private partnerships. The Gateway Paper refers to stewardship with reference to analysis and overview of health policies within the country, their relationship with evidence, their follow-up into planning and finally their implementation. The Paper also provides an insight into policies from a process-related as well as content and program related perspectives. In doing so a number of questions relating to the evidence and policy disconnect; issues at strategic and operational levels of planning, and governance-related impediments to program implementation have been discussed and a viewpoint articulated on an approach to addressing these challenges.

  10. Assessing the impact of a new health sector pay system upon NHS staff in England

    Buchan James

    2008-06-01

    Full Text Available Abstract Background Pay and pay systems are a critical element in any health sector human resource strategy. Changing a pay system can be one strategy to achieve or sustain organizational change. This paper reports on the design and implementation of a completely new pay system in the National Health Service (NHS in England. 'Agenda for Change' constituted the largest-ever attempt to introduce a new pay system in the UK public services, covering more than one million staff. Its objectives were to improve the delivery of patient care as well as enhance staff recruitment, retention and motivation, and to facilitate new ways of working. Methods This study was the first independent assessment of the impact of Agenda for Change at a local and national level. The methods used in the research were a literature review; review of 'grey' unpublished documentation provided by key stakeholders in the process; analysis of available data; interviews with key national informants (representing government, employers and trade unions, and case studies conducted with senior human resource managers in ten NHS hospitals in England Results Most of the NHS trust managers interviewed were in favour of Agenda for Change, believing it would assist in delivering improvements in patient care and staff experience. The main benefits highlighted were: 'fairness', moving different staff groups on to harmonized conditions; equal pay claim 'protection'; and scope to introduce new roles and working practices. Conclusion Agenda for Change took several years to design, and has only recently been implemented. Its very scale and central importance to NHS costs and delivery of care argues for a full assessment at an early stage so that lessons can be learned and any necessary changes made. This paper highlights weaknesses in evaluation and limitations in progress. The absence of systematically derived and applied impact indicators makes it difficult to assess impact and impact

  11. Financial Health of the Higher Education Sector: Financial Results and TRAC Outcomes 2013-14. Issues Paper 2015/07

    Higher Education Funding Council for England, 2015

    2015-01-01

    This report provides an overview of the financial health of the Higher Education Funding Council for England (HEFCE)-funded higher education sector in England. The analysis covers financial results for the academic year 2013-14, as submitted to HEFCE in December 2014, as well as the outcomes from the sector's Transparent Approach to Costing (TRAC)…

  12. Violencia contra las mujeres: el papel del sector salud en la legislación internacional Violence against women: the role of the health sector in international legislation

    Gaby Ortiz-Barreda

    2012-10-01

    Full Text Available Objetivos: Identificar y describir las responsabilidades que se atribuyen a las administraciones sanitarias en materia de prevención y atención de la violencia contra las mujeres en la legislación internacional sobre este tema. Métodos: Análisis de contenido de las leyes de violencia contra las mujeres recopiladas en The Annual Review of Law of Harvard University, UN Secretary-General's database on Violence against Women, International Digest of Health Legislation y Stop Violence against Women. Se identificaron y seleccionaron las leyes que hacían mención explícita a la participación del sector salud en intervenciones de violencia contra las mujeres. Se clasificaron las intervenciones según los niveles de prevención primaria, secundaria y terciaria definidos por la Organización Mundial de la Salud en su Informe Mundial sobre Violencia y Salud (2002. Resultados: De 115 países analizados, 55 disponen de leyes sobre la violencia contra las mujeres que contemplan la participación del sector salud en sus intervenciones. En la mayoría, esta participación se centra en la denuncia de casos detectados y la atención de casos derivados de servicios policiales. Se identificaron 24 leyes que hacían mención a intervenciones específicamente desarrolladas por el sector salud, sobre todo de prevención terciaria. Las leyes de México, Colombia, Argentina, El Salvador, España y Filipinas integran intervenciones relacionadas con los tres niveles de prevención. Conclusiones: Una cuarta parte de las leyes sobre la violencia contra las mujeres estudiadas incorporan intervenciones específicas del sector salud. Esto sugiere que todavía es incipiente el abordaje integral del problema. Se requiere un mayor aprovechamiento de las potencialidades de este sector en intervenciones previas a las consecuencias de la violencia contra las mujeres.Objectives: To identify and describe the responsibilities attributed to health administrations in preventing

  13. Policy process for health sector reforms: a case study of Punjab Province (Pakistan).

    Tarin, Ehsanullah; Green, Andrew; Omar, Maye; Shaw, Jane

    2009-01-01

    The health sector in the Punjab (Pakistan) faces many problems, and, the government introduced reforms during 1993-2000. This paper explores the policy process for the reforms. A case study method was used and, to assist this, a conceptual framework was developed. Analysis of four initiatives indicated that there were deviations from the government guidelines and that the policy processes used were weak. The progress of different reforms was affected by a variety of factors: the immaturity of the political process and civil society, which together with innate conservatism and resistance to change on the part of the bureaucracy resulted in weak strategic sectoral leadership and a lack of clear purpose underpinning the reforms. It also resulted in weaknesses in preparation of the detail of reforms leading to poor implementation. The study suggests a need for broadening the stakeholders' base, building the capacity of policy-makers in policy analysis and strengthening the institutional basis of policymaking bodies.

  14. EXAMINING THE DIMENSIONALITY OF COLQUITT'S ORGANIZATIONAL JUSTICE SCALE IN A PUBLIC HEALTH SECTOR CONTEXT.

    Enoksen, Elisabeth

    2015-06-01

    In 2001, Colquitt developed an Organizational Justice Scale that intended to measure procedural, distributive, interpersonal, and informational justice. The dimensionality of the scale has been tested in subsequent studies with diverging results. Given the fact that contextual differences may account for more variation across research sites than individual differences, the deviating research findings may be due to context. This study examined the dimensionality of Colquitt's Organizational Justice Scale in a new context: the public health sector. The procedural and informational justice dimensions were highly correlated, but confirmatory factor analysis showed that a four-factor solution provided a better fit than a three-factor solution. All fit indices for the four-factor model were consistent with a good model. There was, however, evidence of a potential omitted factor, procedural-voice justice, which has also been found in a previous examination of the measure in the public sector.

  15. Job satisfaction and motivation of health workers in public and private sectors: cross-sectional analysis from two Indian states

    Mahapatra Prasanta

    2010-11-01

    Full Text Available Abstract Background Ensuring health worker job satisfaction and motivation are important if health workers are to be retained and effectively deliver health services in many developing countries, whether they work in the public or private sector. The objectives of the paper are to identify important aspects of health worker satisfaction and motivation in two Indian states working in public and private sectors. Methods Cross-sectional surveys of 1916 public and private sector health workers in Andhra Pradesh and Uttar Pradesh, India, were conducted using a standardized instrument to identify health workers' satisfaction with key work factors related to motivation. Ratings were compared with how important health workers consider these factors. Results There was high variability in the ratings for areas of satisfaction and motivation across the different practice settings, but there were also commonalities. Four groups of factors were identified, with those relating to job content and work environment viewed as the most important characteristics of the ideal job, and rated higher than a good income. In both states, public sector health workers rated "good employment benefits" as significantly more important than private sector workers, as well as a "superior who recognizes work". There were large differences in whether these factors were considered present on the job, particularly between public and private sector health workers in Uttar Pradesh, where the public sector fared consistently lower (P P Conclusion There are common areas of health worker motivation that should be considered by managers and policy makers, particularly the importance of non-financial motivators such as working environment and skill development opportunities. But managers also need to focus on the importance of locally assessing conditions and managing incentives to ensure health workers are motivated in their work.

  16. Health worker (internal customer) satisfaction and motivation in the public sector in Ghana.

    Agyepong, Irene Akua; Anafi, Patricia; Asiamah, Ebenezer; Ansah, Evelyn K; Ashon, Daniel A; Narh-Dometey, Christiana

    2004-01-01

    This paper describes factors affecting health worker motivation and satisfaction in the public sector in Ghana. The data are from a survey of public sector health care providers carried out in January 2002 and repeated in August 2003 using an interviewer administered structured questionnaire. It is part of a continuous quality improvement (CQI) effort in the health sector in the Greater Accra region of Ghana. Workplace obstacles identified that caused dissatisfaction and de-motivated staff in order of the most frequently mentioned were low salaries such that obtaining basic necessities of daily living becomes a problem; lack of essential equipment, tools and supplies to work with; delayed promotions; difficulties and inconveniences with transportation to work; staff shortages; housing, additional duty allowances and in-service (continuous) training. Others included children's education, vehicles to work with such as ambulances and pickups, staff transfer procedures, staff pre-service education inadequate for job requirements, and the effect of the job on family and other social factors. There were some differences in the percentages of staff selecting a given workplace obstacle between the purely rural districts, the highly urbanized Accra metropolis and the districts that were a mixture of urbanized and rural. It is unlikely that the Ghana Health Service can provide high quality of care to its end users (external customers) if workplace obstacles that de-motivate staff (internal customers) and negatively influence their performance are not properly recognized and addressed as a complex of inter-related problems producing a common result--dissatisfied poorly motivated staff and resulting poor quality services.

  17. The voluntary sector and health policy: the role of national level health consumer and patients' organisations in the UK.

    Baggott, Rob; Jones, Kathryn

    2014-12-01

    This article explores the policy role of health consumer and patients' organisations (HCPOs), an important subset of the UK voluntary health sector. Based on research findings from two surveys, the article examines the activities, resources and contacts of HCPOs. It also assesses their impact on health policy and reform. There is some evidence that HCPOs can influence policy and reform. However, much depends on the alliances they build with other policy actors (including other HCPOs), their resources and leadership. HCPOs seem to have more impact on the detail of policy than on the direction of travel. In addition, there are potentially adverse consequences for HCPOs that do engage with the policy process, which may partly explain why some are wary of such involvement. For example, it is possible that HCPOs can be manipulated by government and other powerful policy actors such as health professionals and the drugs industry.

  18. Advantages of Coordinated School Health Portfolios: Documenting and Showcasing Achievements

    Shipley, Meagan; Lohrmann, David; Barnes, Priscilla; O'Neill, Jim

    2013-01-01

    Background: Thirteen school district teams from Michigan and Indiana participated in the Michiana Coordinated School Health Leadership Institute with the intent of Coordinated School Health Program (CSHP) implementation. The purpose of this study was to determine if portfolios served as an effective approach for documenting teams'…

  19. Advantages of Coordinated School Health Portfolios: Documenting and Showcasing Achievements

    Shipley, Meagan; Lohrmann, David; Barnes, Priscilla; O'Neill, Jim

    2013-01-01

    Background: Thirteen school district teams from Michigan and Indiana participated in the Michiana Coordinated School Health Leadership Institute with the intent of Coordinated School Health Program (CSHP) implementation. The purpose of this study was to determine if portfolios served as an effective approach for documenting teams' accomplishments…

  20. Treatment and prevention of malaria in pregnancy in the private health sector in Uganda

    Mbonye, Anthony K; Buregyeya, Esther; Rutebemberwa, Elizeus;

    2016-01-01

    and prevention practices for malaria among pregnant women. The main study outcome was the proportion of private health facilities who prescribe treatment of fever among pregnant women as recommended in the guidelines. RESULTS: A total of 241 private health facilities were surveyed; 70.5 % were registered drug...... clinics and pharmacies for prevention of malaria in pregnancy. Few facilities had malaria treatment guidelines; (44.1 % of private clinics, 17.9 % of drug shops, and 41.7 % at pharmacies. Knowledge of people at risk of malaria, P = 0.02 and availability of malaria treatment guidelines, P = 0.03 were......BACKGROUND: Malaria in pregnancy is a major public health problem in Uganda; and it is the leading cause of anaemia among pregnant women and low birth weight in infants. Previous studies have noted poor quality of care in the private sector. Thus there is need to explore ways of improving quality...

  1. Health and Academic Achievement: Cumulative Effects of Health Assets on Standardized Test Scores among Urban Youth in the United States

    Ickovics, Jeannette R.; Carroll-Scott, Amy; Peters, Susan M.; Schwartz, Marlene; Gilstad-Hayden, Kathryn; McCaslin, Catherine

    2014-01-01

    Background: The Institute of Medicine (2012) concluded that we must "strengthen schools as the heart of health." To intervene for better outcomes in both health and academic achievement, identifying factors that impact children is essential. Study objectives are to (1) document associations between health assets and academic achievement,…

  2. Achievements and challenges of innovation co-production support initiatives in the Australian and Dutch dairy sectors: A comparative study

    Klerkx, L.W.A.; Nettle, R.

    2013-01-01

    Policymakers and innovation scholars share an increasing interest in how to operationalize innovation support given the increasing number and range of stakeholders engaged in co-producing innovation. Using comparative case study analysis, this article examines support initiatives for dairy sector in

  3. The promotion of children's health and wellbeing: the contributions of England's charity sector

    Persaud Albert

    2010-07-01

    Full Text Available Abstract Background Sports and arts based services for children have positive impacts on their mental and physical health. The charity sector provides such services, often set up in response to local communities expressing a need. The present study maps resilience promoting services provided by children's charities in England. Specifically, the prominence of sports and arts activities, and types of mental health provisions including telephone help-lines, are investigated. Findings The study was a cross-sectional web-based survey of chief executives, senior mangers, directors and chairs of charities providing services for children under the age of 16. The aims, objectives and activities of participating children's charities and those providing mental health services were described overall. In total 167 chief executives, senior managers, directors and chairs of charities in England agreed to complete the survey. From our sample of charities, arts activities were the most frequently provided services (58/167, 35%, followed by counselling (55/167, 33% and sports activities (36/167, 22%. Only 13% (22/167 of charities expected their work to contribute to the health legacy of the 2012 London Olympics. Telephone help lines were provided by 16% of the charities that promote mental health. Conclusions Counselling and arts activities were relatively common. Sports activities were limited despite the evidence base that sport and physical activity are effective interventions for well-being and health gain. Few of the charities we surveyed expected a health legacy from the 2012 London Olympics.

  4. Health Status of the Female Workers in the Garment Sector of Bangladesh

    Shaheen AHMED

    2014-06-01

    Full Text Available Readymade Garment (RMG Sector in Bangladesh has been playing a vital role in creating employment opportunity for the rural marginal people for the last two decades. At present 5,100 garment factories are operating in this country and 3.6 million workers are working there in which more than 80 percent of them are female. From the beginning it is largely apparent that the health status of the female garment workers is not well enough to do their work properly. Keeping this in mind, the study was conducted to find out the health status of the female workers. In this study, 200 female workers of Bangladesh were interviewed to identify the major diseases they experienced. The study reveals that the majority of the female workers in the garment sector suffer from the diseases like problems in bones, abortion complexity, dermatitis, back pain, eye stain, pruritus, malnutrition, respiratory problems, hepatitis (Jandice, gastric pain, fatigue, fever, abdomen pain, common cold, and helminthiasis. The policy makers and other concern bodies should take necessary measures to ensure good health of the garment workers. It will help female workers to be more productive and their contribution to the country will be enhanced.

  5. [The evaluation of efficacy and efficiency in the health care sector: separate or integrated moments?].

    Braga, M; Cislaghi, C

    2002-01-01

    Studies on efficacy (clinical trials) and efficiency (Cost Benefit) in health care are frequently disjoint and carried on by researchers with different background in distinct moments. The origin of this division can be found in the profound conviction existing in the healthcare researchers that efficiency and efficacy are distinct and distant concepts, the former pertaining to the economist, the latter to the clinician. Many are the factors at the basis of this separation which consequently lead to the divergence between the two sector of analysis; among those, probably the most relevant factor is the distinction, in the healthcare sector, between the consumer (the patient) and the purchaser (private and/or public insurance). In reality, the organizational evolution of the health care systems, the consciousness of the interdependency between health and economic benefits, and the progressive shortage of economic resources for the growing healthcare needs, require a major integration of analyses concerning efficacy and efficiency. On this line of thought is moving the operational research where models such as the Data Envelope Analysis and the Semi-Markov Decisional Models have been developed.

  6. Multi-sectoral action for addressing social determinants of noncommunicable diseases and mainstreaming health promotion in national health programmes in India.

    Arora, Monika; Chauhan, Kavita; John, Shoba; Mukhopadhyay, Alok

    2011-12-01

    Major noncommunicable diseases (NCDs) share common behavioral risk factors and deep-rooted social determinants. India needs to address its growing NCD burden through health promoting partnerships, policies, and programs. High-level political commitment, inter-sectoral coordination, and community mobilization are important in developing a successful, national, multi-sectoral program for the prevention and control of NCDs. The World Health Organization's "Action Plan for a Global Strategy for Prevention and Control of NCDs" calls for a comprehensive plan involving a whole-of-Government approach. Inter-sectoral coordination will need to start at the planning stage and continue to the implementation, evaluation of interventions, and enactment of public policies. An efficient multi-sectoral mechanism is also crucial at the stage of monitoring, evaluating enforcement of policies, and analyzing impact of multi-sectoral initiatives on reducing NCD burden in the country. This paper presents a critical appraisal of social determinants influencing NCDs, in the Indian context, and how multi-sectoral action can effectively address such challenges through mainstreaming health promotion into national health and development programs. India, with its wide socio-cultural, economic, and geographical diversities, poses several unique challenges in addressing NCDs. On the other hand, the jurisdiction States have over health, presents multiple opportunities to address health from the local perspective, while working on the national framework around multi-sectoral aspects of NCDs.

  7. Worksite health and wellness programs: Canadian achievements & prospects.

    Després, Jean-Pierre; Alméras, Natalie; Gauvin, Lise

    2014-01-01

    Canada has experienced a substantial reduction in mortality related to cardiovascular disease (CVD). There is a general consensus that more effective and widespread health promotion interventions may lead to further reductions in CVD risk factors and actual disease states. In this paper, we briefly outline the prevalence of selected risk factors for CVD in Canada, describe characteristics of the Canadian labor market and workforce, and depict what is known about health and wellness program delivery systems in Canadian workplaces. Our review indicates that there have been numerous and diverse relevant legislative and policy initiatives to create a context conducive to improve the healthfulness of Canadian workplaces. However, there is still a dearth of evidence on the effectiveness of the delivery system and the actual impact of workplace health and wellness programs in reducing CVD risk in Canada. Thus, while a promising model, more research is needed in this area.

  8. Priority-setting for achieving universal health coverage.

    Chalkidou, Kalipso; Glassman, Amanda; Marten, Robert; Vega, Jeanette; Teerawattananon, Yot; Tritasavit, Nattha; Gyansa-Lutterodt, Martha; Seiter, Andreas; Kieny, Marie Paule; Hofman, Karen; Culyer, Anthony J

    2016-06-01

    Governments in low- and middle-income countries are legitimizing the implementation of universal health coverage (UHC), following a United Nation's resolution on UHC in 2012 and its reinforcement in the sustainable development goals set in 2015. UHC will differ in each country depending on country contexts and needs, as well as demand and supply in health care. Therefore, fundamental issues such as objectives, users and cost-effectiveness of UHC have been raised by policy-makers and stakeholders. While priority-setting is done on a daily basis by health authorities - implicitly or explicitly - it has not been made clear how priority-setting for UHC should be conducted. We provide justification for explicit health priority-setting and guidance to countries on how to set priorities for UHC.

  9. Politics, class actors, and health sector reform in Brazil and Venezuela.

    Mahmood, Qamar; Muntaner, Carles

    2013-03-01

    Universal access to healthcare has assumed renewed importance in global health discourse, along with a focus on strengthening health systems. These developments are taking place in the backdrop of concerted efforts to advocate moving away from vertical, disease-based approaches to tackling health problems. While this approach to addressing public health problems is a step in the right direction, there is still insufficient emphasis on understanding the socio-political context of health systems. Reforms to strengthen health systems and achieve universal access to healthcare should be cognizant of the importance of the socio-political context, especially state-society relations. That context determines the nature and trajectory of reforms promoting universality or any pro-equity change. Brazil and Venezuela in recent years have made progress in developing healthcare systems that aim to achieve universal access. These achievements are noteworthy given that, historically, both countries had a long tradition of healthcare systems which were highly privatized and geared towards access to healthcare for a small segment of the population while the majority was excluded. These achievements are also remarkable since they took place in an era of neoliberalism when many states, even those with universally-based healthcare systems, were moving in the opposite direction. We analyze the socio-political context in each of these countries and look specifically at how the changing state-society relations resulted in health being constitutionally recognized as a social right. We describe the challenges that each faced in developing and implementing healthcare systems embracing universality. Our contention is that achieving the principle of universality in healthcare systems is less of a technical matter and more a political project. It involves opposition from the socially conservative elements in the society. Navigation to achieve this goal requires a political strategy that

  10. Utilisation and costs of nursing agencies in the South African public health sector, 2005–2010

    Laetitia C. Rispel

    2014-12-01

    Full Text Available Background: Globally, insufficient information exists on the costs of nursing agencies, which are temporary employment service providers that supply nurses to health establishments and/or private individuals. Objective: The aim of the study was to determine the utilisation and direct costs of nursing agencies in the South African public health sector. Design: A survey of all nine provincial health departments was conducted to determine utilisation and management of nursing agencies. The costs of nursing agencies were assumed to be equivalent to expenditure. Provincial health expenditure was obtained for five financial years (2005/6–2009/10 from the national Basic Accounting System database, and analysed using Microsoft Excel. Each of the 166,466 expenditure line items was coded. The total personnel and nursing agency expenditure was calculated for each financial year and for each province. Nursing agency expenditure as a percentage of the total personnel expenditure was then calculated. The nursing agency expenditure for South Africa is the total of all provincial expenditure. The 2009/10 annual government salary scales for different categories of nurses were used to calculate the number of permanent nurses who could have been employed in lieu of agency expenditure. All expenditure is expressed in South African rands (R; US$1 ∼ R7, 2010 prices. Results: Only five provinces reported utilisation of nursing agencies, but all provinces showed agency expenditure. In the 2009/10 financial year, R1.49 billion (US$212.64 million was spent on nursing agencies in the public health sector. In the same year, agency expenditure ranged from a low of R36.45 million (US$5.20 million in Mpumalanga Province (mixed urban-rural to a high of R356.43 million (US$50.92 million in the Eastern Cape Province (mixed urban-rural. Agency expenditure as a percentage of personnel expenditure ranged from 0.96% in KwaZulu-Natal Province (mixed urban-rural to 11.96% in the

  11. The Challenges and Issues Regarding E-Health and Health Information Technology Trends in the Healthcare Sector

    Esmaeilzadeh, Pouyan; Sambasivan, Murali; Kumar, Naresh

    Like other industries, the utilization of the internet and Information Technology (IT) has increased in the health sector. Different applications attributed to the internet and IT in healthcare practice. It includes a range of services that intersect the edge of medicine, computer and information science. The presence of the internet helps healthcare practice with the use of electronic processes and communication. Also, health IT (HIT) deals with the devices, clinical guidelines and methods required to improve the management of information in healthcare. Although the internet and HIT has been considered as an influential means to enhance health care delivery, it is completely naive to imagine all new tools and mechanisms supported by the internet and HIT systems are simply adopted and used by all organizational members. As healthcare professionals play an important role in the healthcare sector, there is no doubt that mechanism of newly introduced HIT and new application of the internet in medical practice should be coupled with healthcare professionals' acceptance. Therefore, with great resistance by healthcare professionals new mechanism and tools supported by IT and the internet cannot be used properly and subsequently may not improve the quality of medical care services. However, factors affecting the healthcare professionals' adoption behavior concerning new e-health and HIT mechanism are still not conclusively identified. This research (as a theoretical study) tries to propose the source of resistance in order to handle the challenges over new e-technology in the health industry. This study uses the involved concepts and develops a conceptual framework to improve overall acceptance of e-health and HIT by healthcare professionals.

  12. Re-thinking global health sector efforts for HIV and tuberculosis epidemic control: promoting integration of programme activities within a strengthened health system

    Maher Dermot

    2010-07-01

    Full Text Available Abstract Background The global financial crisis threatens global health, particularly exacerbating diseases of inequality, e.g. HIV/AIDS, and diseases of poverty, e.g. tuberculosis. The aim of this paper is to reconsider established practices and policies for HIV and tuberculosis epidemic control, aiming at delivering better results and value for money. This may be achieved by promoting greater integration of HIV and tuberculosis control programme activities within a strengthened health system. Discussion HIV and tuberculosis share many similarities in terms of their disease burden and the recommended stratagems for their control. HIV and tuberculosis programmes implement similar sorts of control activities, e.g. case finding and treatment, which depend for success on generic health system issues, including vital registration, drug procurement and supply, laboratory network, human resources, and financing. However, the current health system approach to HIV and tuberculosis control often involves separate specialised services. Despite some recent progress, collaboration between the programmes remains inadequate, progress in obtaining synergies has been slow, and results remain far below those needed to achieve universal access to key interventions. A fundamental re-think of the current strategic approach involves promoting integrated delivery of HIV and tuberculosis programme activities as part of strengthened general health services: epidemiological surveillance, programme monitoring and evaluation, community awareness of health-seeking behavior, risk behaviour modification, infection control, treatment scale-up (first-line treatment regimens, drug-resistance surveillance, containing and countering drug-resistance (second-line treatment regimens, research and development, global advocacy and global partnership. Health agencies should review policies and progress in HIV and tuberculosis epidemic control, learn mutual lessons for policy

  13. Achievements in mental health outcome measurement in Australia: Reflections on progress made by the Australian Mental Health Outcomes and Classification Network (AMHOCN

    Burgess Philip

    2012-05-01

    Full Text Available Abstract Background Australia’s National Mental Health Strategy has emphasised the quality, effectiveness and efficiency of services, and has promoted the collection of outcomes and casemix data as a means of monitoring these. All public sector mental health services across Australia now routinely report outcomes and casemix data. Since late-2003, the Australian Mental Health Outcomes and Classification Network (AMHOCN has received, processed, analysed and reported on outcome data at a national level, and played a training and service development role. This paper documents the history of AMHOCN’s activities and achievements, with a view to providing lessons for others embarking on similar exercises. Method We conducted a desktop review of relevant documents to summarise the history of AMHOCN. Results AMHOCN has operated within a framework that has provided an overarching structure to guide its activities but has been flexible enough to allow it to respond to changing priorities. With no precedents to draw upon, it has undertaken activities in an iterative fashion with an element of ‘trial and error’. It has taken a multi-pronged approach to ensuring that data are of high quality: developing innovative technical solutions; fostering ‘information literacy’; maximising the clinical utility of data at a local level; and producing reports that are meaningful to a range of audiences. Conclusion AMHOCN’s efforts have contributed to routine outcome measurement gaining a firm foothold in Australia’s public sector mental health services.

  14. Assistive technologies along supply chains in health care and in the social services sector.

    Mayer, Peter; Hauer, Katharina; Schloffer, Evelyn; Leyrer, Barbara

    2015-01-01

    Health care systems in Austria and Slovenia are currently facing challenges due to scarce resources and demographic change which can be seen especially along the supply chains. The main objective of this paper is to present an option to improve the use of assistive technologies. An extensive literature research for the theoretic part as well as a qualitative survey for the empiric part focusing on short-term care were carried out. Results show that there is a lack of information and training on assistive technologies. As a consequence, their full potential cannot be exploited. Therefore a guideline for nursing consultations was developed. To conclude, both the literature research and the qualitative survey show that assistive technologies have high potentials to improve the supply chains in the health care and social services sector, but there is a lot of information and training on them needed.

  15. Health co-benefits of climate change mitigation policies in the transport sector

    Shaw, Caroline; Hales, Simon; Howden-Chapman, Philippa; Edwards, Richard

    2014-06-01

    Theory, common sense and modelling studies suggest that some interventions to mitigate carbon emissions in the transport sector can also have substantial short-term benefits for population health. Policies that encourage active modes of transportation such as cycling may, for example, increase population physical activity and decrease air pollution, thus reducing the burden of conditions such as some cancers, diabetes, heart disease and dementia. In this Perspective we systematically review the evidence from 'real life' transport policies and their impacts on health and CO2 emissions. We identified a few studies that mostly involved personalized travel planning and showed modest increases in active transport such as walking, and reductions in vehicle use and CO2 emissions. Given the poor quality of the studies identified, urgent action is needed to provide more robust evidence for policies.

  16. A Survey of Job Satisfaction among Health Sector Staff of Tabriz Taleghani Educational Hospital

    Leila Rastgar-Farajzadeh

    2016-03-01

    Full Text Available Background and Objectives : Job satisfaction is one of the most important variables in organizational behavior and the key variable in organizational researches and theories as well. The aim of present investigation was to determine the level of job satisfaction among health sector staff of Tabriz Taleghani Educational Hospital. Material and Methods : This cross-sectional study was performed in 2014. Health sector staffs of Taleghani Educational Hospital were studied through census method. Data collection tool was a questionnaire based on previous studies and consisted of 3 parts: demographic information (7 items, job satisfaction (21 questions and factors related to employee dissatisfaction (10 items. After collecting and entering data into IBM SPSS software, independent t tests, chi-square and ANOVA were applied. Results : The highest level of job satisfaction was in the field of relationship with colleagues and lowest level of job satisfaction was related to salary and benefits. The most common cause of employee dissatisfaction was pressure and stressful working environment and the least cause was the improper distribution of employees based on workload . Conclusion : According to the findings, the majority of job satisfaction among staff was at low and medium-level. Since job satisfaction is an important factor in the performance and quality of services provided by the hospital staff, it is recommended that managers and officials pay attention to defects and shortcomings and remove barriers.

  17. Do we have the right models for scaling up health services to achieve the Millennium Development Goals?

    Subramanian Savitha

    2011-12-01

    Full Text Available Abstract Background There is widespread agreement on the need for scaling up in the health sector to achieve the Millennium Development Goals (MDGs. But many countries are not on track to reach the MDG targets. The dominant approach used by global health initiatives promotes uniform interventions and targets, assuming that specific technical interventions tested in one country can be replicated across countries to rapidly expand coverage. Yet countries scale up health services and progress against the MDGs at very different rates. Global health initiatives need to take advantage of what has been learned about scaling up. Methods A systematic literature review was conducted to identify conceptual models for scaling up health in developing countries, with the articles assessed according to the practical concerns of how to scale up, including the planning, monitoring and implementation approaches. Results We identified six conceptual models for scaling up in health based on experience with expanding pilot projects and diffusion of innovations. They place importance on paying attention to enhancing organizational, functional, and political capabilities through experimentation and adaptation of strategies in addition to increasing the coverage and range of health services. These scaling up approaches focus on fostering sustainable institutions and the constructive engagement between end users and the provider and financing organizations. Conclusions The current approaches to scaling up health services to reach the MDGs are overly simplistic and not working adequately. Rather than relying on blueprint planning and raising funds, an approach characteristic of current global health efforts, experience with alternative models suggests that more promising pathways involve "learning by doing" in ways that engage key stakeholders, uses data to address constraints, and incorporates results from pilot projects. Such approaches should be applied to current

  18. [Decentralization of the health sector in Mexico. Scope and limitations of local health systems].

    González-Block, M A

    1992-01-01

    This paper is a product of the reflection on the decentralization and sectorization experiences in Mexico since 1917 with particular emphasis on the 1980s. The historical analysis included the creation of an analytical model designed to identify the relationship between the distinct sanitary policies implemented in Mexico and the tendencies towards decentralization and integration. This analysis is combined with a critical review of the recent decentralization experiences undertaken in the states of Guerrero, Oaxaca and Nuevo León. While comparing Guerrero and Oaxaca, restitution and deconcentration under similar socio-economic conditions were discussed. The comparison between Guerrero and Nuevo Leon allowed the discussion of the benefits and limits of restitution under different socio-economic conditions. In addition, with this model the author discusses a few generalizations regarding the possible future of decentralization.

  19. Health sector solidarity: a core European value but with broadly varying content.

    Saltman, Richard B

    2015-01-01

    Although the concept of solidarity sits at the center of many European health sector debates, the specific groups eligible for coverage, the financing arrangements, and the range of services and benefits that, together, compose the operational content of solidarity have all changed considerably over time. In prior economic periods, solidarity covered considerably fewer services or groups of the population than it does today. As economic and political circumstances changed, the content of solidarity changed with them. Recent examples of these shifts are illustrated through a discussion of health reforms in Netherlands, Germany and also Israel (although not in Europe, the Israeli health system is similar in structure to European social health insurance systems). This article suggests that changed economic circumstances in Europe since the onset of the 2008 financial crisis may lead to re-configuring the scope and content of services covered by solidarity in many European health systems. A key issue for policymakers will be protecting vulnerable populations as this re-design occurs.

  20. Achieving 60% CO{sub 2} reductions within the UK energy system-Implications for the electricity generation sector

    Odenberger, M. [Energy Conversion, Department of Energy and Environment, Chalmers University of Technology, SE 412 96 Goeteborg (Sweden); Johnsson, F. [Energy Conversion, Department of Energy and Environment, Chalmers University of Technology, SE 412 96 Goeteborg (Sweden)]. E-mail: filip.johnsson@me.chalmers.se

    2007-04-15

    This paper explores how investment in the UK electricity generation sector can contribute to the UK goal of reducing CO{sub 2} emissions with 60% by the year 2050 relative to the 1990 emissions. Considering likely development of the transportation sector and industry over the period, i.e. a continued demand growth and dependency on fossil fuels and electricity, the analysis shows that this implies CO{sub 2} emission reductions of up to 90% by 2050 for the electricity sector. Emphasis is put on limitations imposed by the present system, described by a detailed database of existing power plants, together with meeting targets on renewable electricity generation (RES) including assumptions on gas acting as backup technology for intermittent RES. In particular, it is investigated to what extent new fossil fuelled and nuclear power is required to meet the year 2050 demand as specified by the Royal Commission on Environmental Pollution (RCEP). In addition, the number of sites required for centralized electricity generation (large power plants) is compared with the present number of sites. A simulation model was developed for the analysis. The model applies the UK national targets on RES, taken from Renewable Obligation (RO) for 2010 and 2020 and potentials given by RCEP for 2050, and assumed technical lifetimes of the power plants of the existing system and thus, links this system with targets for the years 2010, 2020 and 2050. The results illustrate the problem with lock-in effects due to long capital stock turnover times, which can either lead to political difficulty meeting targets in established policy or costly early retirement of power plants (stranded assets) to comply with emission goals prescribed in Kyoto targets or the 60% emission reduction goal. Assuming typical technical lifetimes of the power plants it can be concluded that the present electricity generation system continues to play a significant role for several decades generating about 50% of projected

  1. Achieving 60% CO{sub 2} reductions within the UK energy system - implications for the electricity generation sector

    Odenberger, M.; Johnsson, F. [Chalmers University of Technology, Goeteborg (Sweden). Dept. of Energy and Environment

    2007-04-15

    This paper explores how investment in the UK electricity generation sector can contribute to the UK goal of reducing CO{sub 2} emissions with 60% by the year 2050 relative to the 1990 emissions. Considering likely development of the transportation sector and industry over the period, i.e. a continued demand growth and dependency on fossil fuels and electricity, the analysis shows that this implies CO{sub 2} emission reductions of up to 90% by 2050 for the electricity sector. Emphasis is put on limitations imposed by the present system, described by a detailed database of existing power plants, together with meeting targets on renewable electricity generation (RES) including assumptions on gas acting as backup technology for intermittent RES. In particular, it is investigated to what extent new fossil fuelled and nuclear power is required to meet the year 2050 demand as specified by the Royal Commission on Environmental Pollution (RCEP). In addition, the number of sites required for centralized electricity generation (large power plants) is compared with the present number of sites. A simulation model was developed for the analysis. The model applies the UK national targets on RES, taken from Renewable Obligation (RO) for 2010 and 2020 and potentials given by RCEP for 2050, and assumed technical lifetimes of the power plants of the existing system and thus, links this system with targets for the years 2010, 2020 and 2050. The results illustrate the problem with lock-in effects due to long capital stock turnover times, which can either lead to political difficulty meeting targets in established policy or costly early retirement of power plants (stranded assets) to comply with emission goals prescribed in Kyoto targets or the 60% emission reduction goal. Assuming typical technical lifetimes of the power plants it can be concluded that the present electricity generation system continues to play a significant role for several decades generating about 50% of projected

  2. The comparative advantage of NGO (non-governmental organizations) in the health sector--a look at the evidence.

    Matthias, A R; Green, A T

    1994-01-01

    Attention being given to the development of an appropriate public/private mix in health-care delivery should not exclude the role of non-governmental organizations (NGOs). There is a widely accepted thesis of NGO comparative advantage over government, but evidence to support this thesis is generally more anecdotal than analytical. This paper considers evidence available in the literature and from field research in southern Africa, especially with regard to efficiency, innovation and reaching grass-roots communities. The paper concludes that the comparative advantage of the NGO sector needs to be analysed in relation to both the private for-profit sector and the public sector.

  3. STRATEGIC MANAGEMENT OF BIOCHEMICAL AND BIOPHYSICAL CONTROL STRUCTURES AND SUSTAINABILITY HEALTH ACHIEVEMENT

    Ioana-Andreea, MARINESCU

    2014-11-01

    Full Text Available Scientific Investigation of sustainability sanitary herein, matters to a define the structure of the health sector; b knowing the contents of the local health systems, c to obtain information about the properties and characteristics associated with health in Romania; d obtaining views on the mission, objectives, goals and targets pursued by health services; e scheduling results, effects and positive consequences among human communities to ensure sustainable health in the framework of sustainable development of the country and, last but not least; f it is intended to measure people's participation and the rule management process, based on biochemical and biophysical control structures. Mainly, it is considered that the sustainability and health have depicted conceptual content that must be secured effectively recovered, concrete operational activities of health systems in laboratories and hospitals.

  4. Health technology assessment and its role in the future development of the Indian healthcare sector.

    Hass, Bastian; Pooley, Jayne; Feuring, Martin; Suvarna, Viraj; Harrington, Adrian E

    2012-04-01

    Public expenditure on healthcare in India is low by international comparison, and access to essential treatment pushes many uninsured citizens below the poverty line. In many countries, policymakers utilize health technology assessment (HTA) methodologies to direct investments in healthcare, to obtain the maximum benefit for the population as a whole. With rising incomes and a commitment from the Government of India to increase the proportion of gross domestic product spent on health, this is an opportune moment to consider how HTA might help to allocate healthcare spending in India, in an equitable and efficient manner. Despite the predominance of out-of-pocket payments in the Indian healthcare sector, payers of all types are increasingly demanding value for money from expenditure on healthcare. In this review we demonstrate how HTA can be used to inform several aspects of healthcare provision. Areas in which HTA could be applied in the Indian context include, drug pricing, development of clinical practice guidelines, and prioritizing interventions that represent the greatest value within a limited budget. To illustrate the potential benefits of using the HTA approach, we present an example from a mature HTA market (Canada) that demonstrates how a new treatment for patients with atrial fibrillation - although more expensive than the current standard of care - improves clinical outcomes and represents a cost-effective use of public health resources. If aligned with the prevailing cultural and ethical considerations, and with the necessary investment in expert staff and resources, HTA promises to be a valuable tool for development of the Indian healthcare sector.

  5. Health technology assessment and its role in the future development of the Indian healthcare sector

    Bastian Hass

    2012-01-01

    Full Text Available Public expenditure on healthcare in India is low by international comparison, and access to essential treatment pushes many uninsured citizens below the poverty line. In many countries, policymakers utilize health technology assessment (HTA methodologies to direct investments in healthcare, to obtain the maximum benefit for the population as a whole. With rising incomes and a commitment from the Government of India to increase the proportion of gross domestic product spent on health, this is an opportune moment to consider how HTA might help to allocate healthcare spending in India, in an equitable and efficient manner. Despite the predominance of out-of-pocket payments in the Indian healthcare sector, payers of all types are increasingly demanding value for money from expenditure on healthcare. In this review we demonstrate how HTA can be used to inform several aspects of healthcare provision. Areas in which HTA could be applied in the Indian context include, drug pricing, development of clinical practice guidelines, and prioritizing interventions that represent the greatest value within a limited budget. To illustrate the potential benefits of using the HTA approach, we present an example from a mature HTA market (Canada that demonstrates how a new treatment for patients with atrial fibrillation - although more expensive than the current standard of care - improves clinical outcomes and represents a cost-effective use of public health resources. If aligned with the prevailing cultural and ethical considerations, and with the necessary investment in expert staff and resources, HTA promises to be a valuable tool for development of the Indian healthcare sector.

  6. Encouraging Health Insurance for the Informal Sector: A Cluster Randomized Experiment in Vietnam.

    Wagstaff, Adam; Nguyen, Ha Thi Hong; Dao, Huyen; Bales, Sarah

    2016-06-01

    Subsidized voluntary enrollment in government-run health insurance schemes is often proposed as a way of increasing coverage among informal sector workers and their families. We report the results of a cluster randomized experiment, in which 3000 households in 20 communes in Vietnam were randomly assigned at baseline to a control group or one of three treatments: an information leaflet about Vietnam's government-run scheme and the benefits of health insurance, a voucher entitling eligible household members to 25% off their annual premium, and both. At baseline, the four groups had similar enrollment rates (4%) and were balanced on plausible enrollment determinants. The interventions all had small and insignificant effects (around 1 percentage point or ppt). Among those reporting sickness in the 12 months prior to the baseline survey the subsidy-only intervention raised enrollment by 3.5 ppts (p = 0.08) while the combined intervention raised enrollment by 4.5 ppts (p = 0.02); however, the differences in the effect sizes between the sick and non-sick were just shy of being significant. Our results suggest that information campaigns and subsidies may have limited effects on voluntary health insurance enrollment in Vietnam and that such interventions might exacerbate adverse selection. Copyright © The World Bank Health Economics © 2015 John Wiley & Sons, Ltd.

  7. [Telematics in the public health sector. Where is the protection of health data?].

    Voßhoff, Andrea; Raum, Bertram; Ernestus, Walter

    2015-10-01

    There is a long history of telematics in the German health system. Apart from the growing technical possibilities in the field, it is important to concentrate on the protection of health data in telematics applications. Health data in the hands of service providers or other third parties entails certain risks for the patient's personality rights, because these institutions may not be bound by the practice of medical confidentiality. In addition, big data processing risks make the individual lives of patients and insured persons totally transparent. Measures to reduce these risks have to be taken by the providers as well as by the users of telematics infrastructure; they are the ones who should explicitly address the relevant risks and dangers in a data protection and IT-security concept and develop adequate strategies to cope with these dangers. Additionally, the German legislator remains obliged to create a regulatory framework for the protection of patients' rights.

  8. An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up

    Colombini Manuela

    2012-07-01

    Full Text Available Abstract Background Malaysia has been at the forefront of the development and scale up of One-Stop Crisis Centres (OSCC - an integrated health sector model that provides comprehensive care to women and children experiencing physical, emotional and sexual abuse. This study explored the strengths and challenges faced during the scaling up of the OSCC model to two States in Malaysia in order to identify lessons for supporting successful scale-up. Methods In-depth interviews were conducted with health care providers, policy makers and key informants in 7 hospital facilities. This was complemented by a document analysis of hospital records and protocols. Data were coded and analysed using NVivo 7. Results The implementation of the OSCC model differed between hospital settings, with practise being influenced by organisational systems and constraints. Health providers generally tried to offer care to abused women, but they are not fully supported within their facility due to lack of training, time constraints, limited allocated budget, or lack of referral system to external support services. Non-specialised hospitals in both States struggled with a scarcity of specialised staff and limited referral options for abused women. Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling. Conclusions The national implementation of OSCC provides a potentially important source of support for women experiencing violence. Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place – in other words a supportive health system. Furthermore, the successful replication of the OSCC model in other similar settings requires that the

  9. Community-based organizations in the health sector: A scoping review

    Wilson Michael G

    2012-11-01

    Full Text Available Abstract Community-based organizations are important health system stakeholders as they provide numerous, often highly valued programs and services to the members of their community. However, community-based organizations are described using diverse terminology and concepts from across a range of disciplines. To better understand the literature related to community-based organizations in the health sector (i.e., those working in health systems or more broadly to address population or public health issues, we conducted a scoping review by using an iterative process to identify existing literature, conceptually map it, and identify gaps and areas for future inquiry. We searched 18 databases and conducted citation searches using 15 articles to identify relevant literature. All search results were reviewed in duplicate and were included if they addressed the key characteristics of community-based organizations or networks of community-based organizations. We then coded all included articles based on the country focus, type of literature, source of literature, academic discipline, disease sector, terminology used to describe organizations and topics discussed. We identified 186 articles addressing topics related to the key characteristics of community-based organizations and/or networks of community-based organizations. The literature is largely focused on high-income countries and on mental health and addictions, HIV/AIDS or general/unspecified populations. A large number of different terms have been used in the literature to describe community-based organizations and the literature addresses a range of topics about them (mandate, structure, revenue sources and type and skills or skill mix of staff, the involvement of community members in organizations, how organizations contribute to community organizing and development and how they function in networks with each other and with government (e.g., in policy networks. Given the range of terms used to

  10. The health sector and nursing work El sector salud y el trabajo en enfermería

    MORALES CORREA ESPERANZA

    2007-12-01

    Full Text Available AEn el sector de la salud y la seguridad social, la aplicación de las políticas del actual gobierno, encaminadas a la privatización y a su adecuación a las reglas del Acuerdo General de Comercialización de Servicios de la Organización Mundial del Comercio (OMC, se viene impulsando con especial empeño y rapidez, lo que se ha traducido en la adopción de reformas que han dado lugar a la liquidación, privatización o transformación de las entidades estatales de la seguridad social, con énfasis en aquellas que prestan servicios de salud y las que administran los distintos regímenes de pensiones, lo que ha incidido gravemente sobre la estabilidad y los derechos laborales de los trabajadores y profesionales vinculados a esta rama de los servicios y, naturalmente, ha significado un deterioro de la calidad y reducción de cobertura en la prestación de los servicios de la salud. Hoy el mundo del trabajo para el conjunto de los trabajadores del sector comporta los elementos de un modelo de salud que se opuso diametralmente al fundamento del sistema de salud que operaba en Colombia desde la década de los setenta, y antes de la Ley 100 de 1993; como se evidencia en la actualidad, este modelo alejó la salud como un derecho social, e incorporó la competencia entre lo público y lo privado, el concepto de mercado de servicios, la selección adversa e intermediación en el sistema de salud, la calificación de enfermedades como ruinosas catastróficas costosas, la flexibilización laboral y la polivalencia de los trabajadores: "Hacer más y de todo por un menor costo".

  11. Conceptual framework of public health surveillance and action and its application in health sector reform

    Alemu Wondi

    2002-01-01

    Full Text Available Abstract Background Because both public health surveillance and action are crucial, the authors initiated meetings at regional and national levels to assess and reform surveillance and action systems. These meetings emphasized improved epidemic preparedness, epidemic response, and highlighted standardized assessment and reform. Methods To standardize assessments, the authors designed a conceptual framework for surveillance and action that categorized the framework into eight core and four support activities, measured with indicators. Results In application, country-level reformers measure both the presence and performance of the six core activities comprising public health surveillance (detection, registration, reporting, confirmation, analyses, and feedback and acute (epidemic-type and planned (management-type responses composing the two core activities of public health action. Four support activities – communications, supervision, training, and resource provision – enable these eight core processes. National, multiple systems can then be concurrently assessed at each level for effectiveness, technical efficiency, and cost. Conclusions This approach permits a cost analysis, highlights areas amenable to integration, and provides focused intervention. The final public health model becomes a district-focused, action-oriented integration of core and support activities with enhanced effectiveness, technical efficiency, and cost savings. This reform approach leads to sustained capacity development by an empowerment strategy defined as facilitated, process-oriented action steps transforming staff and the system.

  12. Cross-sector cooperation in health-enhancing physical activity policymaking

    Hämäläinen, Riitta-Maija; Aro, Arja R.; Juel Lau, Cathrine

    2016-01-01

    and private actors for HEPA policymaking. Successful cross-sector cooperation required joint planning and evaluation, financial frameworks, mandates based on laws or agreed methods of work, communication lines, and valued processes of cross-sector cooperation. CONCLUSIONS: Cross-sector cooperation required......BACKGROUND: The cooperation of actors across policy fields and the need for cross-sector cooperation as well as recommendations on how to implement cross-sector cooperation have been addressed in many national and international policies that seek to solve complex issues within societies....... For such a purpose, the relevant governance structure between policy sectors is cross-sector cooperation. Therefore, cross-sector cooperation and its structures need to be better understood for improved implementation. This article reports on the governance structures and processes of cross-sector cooperation...

  13. Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India

    Gupta, Aditi; Verma, Ramesh; Bahuguna, Pankaj; Kumar, Dinesh; Kaur, Manmeet; Kumar, Rajesh

    2016-01-01

    Background With the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc. Methods We undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology. Results The overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630–10,294,065) and INR 26.9 million (95% CI: 22,225,159.3–32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6–208.3) and INR162.1 (95% CI: 112–219

  14. Bridging the gaps in the Health Management Information System in the context of a changing health sector

    Nyamtema Angelo S

    2010-06-01

    Full Text Available Abstract Background The Health Management Information System (HMIS is crucial for evidence-based policy-making, informed decision-making during planning, implementation and evaluation of health programs; and for appropriate use of resources at all levels of the health system. This study explored the gaps and factors influencing HMIS in the context of a changing health sector in Tanzania. Methods A cross sectional descriptive study was conducted in 11 heath facilities in Kilombero district between January and February 2008. A semi-structured questionnaire was used to interview 43 health workers on their knowledge, attitude, practice and factors for change on HMIS and HMIS booklets from these facilities were reviewed for completeness. Results Of all respondents, 81% had never been trained on HMIS, 65% did not properly define this system, 54% didn't know who is supposed to use the information collected and 42% did not use the collected data for planning, budgeting and evaluation of services provision. Although the attitude towards the system was positive among 91%, the reviewed HMIS booklets were never completed in 25% - 55% of the facilities. There were no significant differences in knowledge, attitude and practice on HMIS between clinicians and nurses. The most common type of HMIS booklets which were never filled were those for deliveries (55%. The gaps in the current HMIS were linked to lack of training, inactive supervision, staff workload pressure and the lengthy and laborious nature of the system. Conclusions This research has revealed a state of poor health data collection, lack of informed decision-making at the facility level and the factors for change in the country's HMIS. It suggests need for new innovations including incorporation of HMIS in the ongoing reviews of the curricula for all cadres of health care providers, development of more user-friendly system and use of evidence-based John Kotter's eight-step process for implementing

  15. Bridging the gaps in the Health Management Information System in the context of a changing health sector

    2010-01-01

    Background The Health Management Information System (HMIS) is crucial for evidence-based policy-making, informed decision-making during planning, implementation and evaluation of health programs; and for appropriate use of resources at all levels of the health system. This study explored the gaps and factors influencing HMIS in the context of a changing health sector in Tanzania. Methods A cross sectional descriptive study was conducted in 11 heath facilities in Kilombero district between January and February 2008. A semi-structured questionnaire was used to interview 43 health workers on their knowledge, attitude, practice and factors for change on HMIS and HMIS booklets from these facilities were reviewed for completeness. Results Of all respondents, 81% had never been trained on HMIS, 65% did not properly define this system, 54% didn't know who is supposed to use the information collected and 42% did not use the collected data for planning, budgeting and evaluation of services provision. Although the attitude towards the system was positive among 91%, the reviewed HMIS booklets were never completed in 25% - 55% of the facilities. There were no significant differences in knowledge, attitude and practice on HMIS between clinicians and nurses. The most common type of HMIS booklets which were never filled were those for deliveries (55%). The gaps in the current HMIS were linked to lack of training, inactive supervision, staff workload pressure and the lengthy and laborious nature of the system. Conclusions This research has revealed a state of poor health data collection, lack of informed decision-making at the facility level and the factors for change in the country's HMIS. It suggests need for new innovations including incorporation of HMIS in the ongoing reviews of the curricula for all cadres of health care providers, development of more user-friendly system and use of evidence-based John Kotter's eight-step process for implementing successful changes in this

  16. Evaluation of health workforce competence in maternal and neonatal issues in public health sector of Pakistan: an Assessment of their training needs

    Jafarey Sadiqua N

    2010-11-01

    Full Text Available Abstract Background More than 450 newborns die every hour worldwide, before they reach the age of four weeks (neonatal period and over 500,000 women die from complications related to childbirth. The major direct causes of neonatal death are infections (36%, Prematurity (28% and Asphyxia (23%. Pakistan has one of the highest perinatal and neonatal mortality rates in the region and contributes significantly to global neonatal mortality. The high mortality rates are partially attributable to scarcity of trained skilled birth attendants and paucity of resources. Empowerment of health care providers with adequate knowledge and skills can serve as instrument of change. Methods We carried out training needs assessment analysis in the public health sector of Pakistan to recognize gaps in the processes and quality of MNCH care provided. An assessment of Knowledge, Attitude, and Practices of Health Care Providers on key aspects was evaluated through a standardized pragmatic approach. Meticulously designed tools were tested on three tiers of health care personnel providing MNCH in the community and across the public health care system. The Lady Health Workers (LHWs form the first tier of trained cadre that provides MNCH at primary care level (BHU and in the community. The Lady Health Visitor (LHVs, Nurses, midwives cadre follow next and provide facility based MNCH care at secondary and tertiary level (RHCs, Taluka/Tehsil, and DHQ Hospitals. The physician/doctor is the specialized cadre that forms the third tier of health care providers positioned in secondary and tertiary care hospitals (Taluka/Tehsil and DHQ Hospitals. The evaluation tools were designed to provide quantitative estimates across various domains of knowledge and skills. A priori thresholds were established for performance rating. Results The performance of LHWs in knowledge of MNCH was good with 30% scoring more than 70%. The Medical officers (MOs, in comparison, performed poorly in their

  17. Developing a decision aid to guide public sector health policy decisions: A study protocol

    Brouwers Melissa

    2011-05-01

    Full Text Available Abstract Background Decision aids have been developed in a number of health disciplines to support evidence-informed decision making, including patient decision aids and clinical practice guidelines. However, policy contexts differ from clinical contexts in terms of complexity and uncertainty, requiring different approaches for identifying, interpreting, and applying many different types of evidence to support decisions. With few studies in the literature offering decision guidance specifically to health policymakers, the present study aims to facilitate the structured and systematic incorporation of research evidence and, where there is currently very little guidance, values and other non-research-based evidence, into the policy making process. The resulting decision aid is intended to help public sector health policy decision makers who are tasked with making evidence-informed decisions on behalf of populations. The intent is not to develop a decision aid that will yield uniform recommendations across jurisdictions, but rather to facilitate more transparent policy decisions that reflect a balanced consideration of all relevant factors. Methods/design The study comprises three phases: a modified meta-narrative review, the use of focus groups, and the application of a Delphi method. The modified meta-narrative review will inform the initial development of the decision aid by identifying as many policy decision factors as possible and other features of methodological guidance deemed to be desirable in the literatures of all relevant disciplines. The first of two focus groups will then seek to marry these findings with focus group members' own experience and expertise in public sector population-based health policy making and screening decisions. The second focus group will examine issues surrounding the application of the decision aid and act as a sounding board for initial feedback and refinement of the draft decision aid. Finally, the Delphi

  18. Teachers' experiences of English-language-taught degree programs within health care sector of Finnish polytechnics.

    Pitkajarvi, Marianne; Eriksson, Elina; Kekki, Pertti

    2011-08-01

    The purpose of this study was to research teachers' experiences of the English-Language-Taught Degree Programs in the health care sector of Finnish polytechnics. More specifically, the focus was on teachers' experiences of teaching methods and clinical practice. The data were collected from eighteen teachers in six polytechnics through focus group interviews. Content analysis was used to analyse the data. The results suggested that despite the positive interaction between students and teachers, choosing appropriate teaching methods provided a challenge for teachers, due to cultural diversity of students as well as to the use of a foreign language in tuition. Due to students' language-related difficulties, clinical practice was found to be the biggest challenge in the educational process. Staffs' attitudes were perceived to be significant for students' clinical experience. Further research using stronger designs is needed.

  19. Ethics in public health research: masters of marketing: bringing private sector skills to public health partnerships.

    Curtis, Valerie A; Garbrah-Aidoo, Nana; Scott, Beth

    2007-04-01

    Skill in marketing is a scarce resource in public health, especially in developing countries. The Global Public-Private Partnership for Handwashing with Soap set out to tap the consumer marketing skills of industry for national handwashing programs. Lessons learned from commercial marketers included how to (1) understand consumer motivation, (2) employ 1 single unifying idea, (3) plan for effective reach, and (4) ensure effectiveness before national launch. After the first marketing program, 71% of Ghanaian mothers knew the television ad and the reported rates of handwashing with soap increased. Conditions for the expansion of such partnerships include a wider appreciation of what consumer marketing is, what it can do for public health, and the potential benefits to industry. Although there are practical and philosophical difficulties, there are many opportunities for such partnerships.

  20. Achieving Excellence in Palliative Care: Perspectives of Health Care Professionals

    Margaret I Fitch

    2016-01-01

    Full Text Available Caring for individuals at the end of life in the hospital environment is a challenging proposition. Understanding the challenges to provide quality end of life care is an important first step in order to develop appropriate approaches to support and educate staff members and facilitate their capacity remaining "caring." Four studies were undertaken at our facility to increase our understanding about the challenges health professionals experience in caring for patients at end of life and how staff members could be supported in providing care to patients and families: (1 In-depth interviews were used with cancer nurses (n = 30 to explore the challenges talking about death and dying with patients and families; (2 Surveys were used with nurses (n = 27 and radiation therapists (n = 30 to measure quality of work life; (3 and interprofessional focus groups were used to explore what it means "to care" (five groups held; and (4 interprofessional focus groups were held to understand what "support strategies for staff" ought to look like (six groups held. In all cases, staff members confirmed that interactions concerning death and dying are challenging. Lack of preparation (knowledge and skill in palliative care and lack of support from managers and colleagues are significant barriers. Key strategies staff members thought would be helpful included: (1 Ensuring all team members were communicating and following the same plan of care, (2 providing skill-based education on palliative care, and (3 facilitating "debriefing" opportunities (either one-on-one or in a group. For staff to be able to continue caring for patients at the end of life with compassion and sensitivity, they need to be adequately prepared and supported appropriately.

  1. Measuring and managing progress in the establishment of basic health services: the Afghanistan health sector balanced scorecard.

    Hansen, Peter M; Peters, David H; Niayesh, Haseebullah; Singh, Lakhwinder P; Dwivedi, Vikas; Burnham, Gilbert

    2008-01-01

    The Ministry of Public Health (MOPH) of Afghanistan has adopted the Balanced Scorecard (BSC) as a tool to measure and manage performance in delivery of a Basic Package of Health Services. Based on results from the 2004 baseline round, the MOPH identified eight of the 29 indicators on the BSC as priority areas for improvement. Like the 2004 round, the 2005 and 2006 BSCs involved a random selection of more than 600 health facilities, 1700 health workers and 5800 patient-provider interactions. The 2005 and 2006 BSCs demonstrated substantial improvements in all eight of the priority areas compared to 2004 baseline levels, with increases in median provincial scores for presence of active village health councils, availability of essential drugs, functional laboratories, provider knowledge, health worker training, use of clinical guidelines, monitoring of tuberculosis treatment, and provision of delivery care. For three of the priority indicators-drug availability, health worker training and provider knowledge-scores remained unchanged or decreased between 2005 and 2006. This highlights the need to ensure that early gains achieved in establishment of health services in Afghanistan are maintained over time. The use of a coherent and balanced monitoring framework to identify priority areas for improvement and measure performance over time reflects an objectives-based approach to management of health services that is proving to be effective in a difficult environment.

  2. Applications of the balanced scorecard for strategic management and performance measurement in the health sector.

    Behrouzi, Farshad; Shaharoun, Awaluddin Mohamed; Ma'aram, Azanizawati

    2014-05-01

    In order to attain a useful balanced scorecard (BSC), appropriate performance perspectives and indicators are crucial to reflect all strategies of the organisation. The objectives of this survey were to give an insight regarding the situation of the BSC in the health sector over the past decade, and to afford a generic approach of the BSC development for health settings with specific focus on performance perspectives, performance indicators and BSC generation. After an extensive search based on publication date and research content, 29 articles published since 2002 were identified, categorised and analysed. Four critical attributes of each article were analysed, including BSC generation, performance perspectives, performance indicators and auxiliary tools. The results showed that 'internal business process' was the most notable BSC perspective as it was included in all reviewed articles. After investigating the literature, it was concluded that its comprehensiveness is the reason for the importance and high usage of this perspective. The findings showed that 12 cases out of 29 reviewed articles (41%) exceeded the maximum number of key performance indicators (KPI) suggested in a previous study. It was found that all 12 cases were large organisations with numerous departments (e.g. national health organisations). Such organisations require numerous KPI to cover all of their strategic objectives. It was recommended to utilise the cascaded BSC within such organisations to avoid complexity and difficulty in gathering, analysing and interpreting performance data. Meanwhile it requires more medical staff to contribute in BSC development, which will result in greater reliability of the BSC.

  3. A strategy for the management of HIV/ AIDS in the health sector of the city of Johannesburg

    A. Barnard

    2004-09-01

    Full Text Available The HIV/AIDS pandemic is posing major challenges to all sectors in South Africa, including the health sector of the city of Johannesburg. The health sector of the city of Johannesburg, as a result of the pandemic, is faced with increasing demands on its scarce resources at a time of major reform at local government level including transformation of the health sector. The overall objective of the study is to explore and describe a strategy for the management of HIV/AIDS by the health sector of the city of Johannesburg. An exploratory, descriptive and quantitative research design was utilized and the UNAIDS “Guide to the strategic planning process for a national response to HIV/AIDS” (1998, was employed to formulate the strategy. The content validity of the strategy was determined according to the process originally described by Lynn (1986 and adopted by Muller (in Booyens, 1998:607-609. The research was conducted in two phases. The first phase, the developmental phase, involved the exploration and description of the theoretical framework and the response to the pandemic, and formulation of a draft strategy. The second phase, the quantification phase, involved the assertion of the content of the strategy by a group of experts and determination of the content validity index (CV1. The final strategy focused on the following: to lead and facilitate intersectoral collaboration; to strengthen primary health care services to provide comprehensive community-based care; prevention of new infections; community mobilization towards prevention, non-discrimination and non stigmatization and empowerment of the health sector to deal with the AIDS .pandemic. The CVI results showed that the average content validity index determined during this study was adequate: full score (1.0 for acceptability and technical soundness, and 0.89 for feasibility and perceived affordability. The strategy formulated for the management of HI V/A1DS by the health sector of the

  4. A strategy for the management of HIV/ AIDS in the health sector of the city of Johannesburg.

    Barnard, A; Muller, M

    2004-11-01

    The HIV/AIDS pandemic is posing major challenges to all sectors in South Africa, including the health sector of the city of Johannesburg. The health sector of the city of Johannesburg, as a result of the pandemic, is faced with increasing demands on its scarce resources at a time of major reform at local government level including transformation of the health sector. The overall objective of the study is to explore and describe a strategy for the management of HIV/AIDS by the health sector of the city of Johannesburg. An exploratory, descriptive and quantitative research design was utilized and the UNAIDS "Guide to the strategic planning process for a national response to HIV/AIDS" (1998), was employed to formulate the strategy. The content validity of the strategy was determined according to the process originally described by Lynn (1986) and adopted by Muller (in Booyens, 1998:607-609). The research was conducted in two phases. The first phase, the developmental phase, involved the exploration and description of the theoretical framework and the response to the pandemic, and formulation of a draft strategy. The second phase, the quantification phase, involved the assertion of the content of the strategy by a group of experts and determination of the content validity index (CVI). The final strategy focused on the following: to lead and facilitate intersectoral collaboration; to strengthen primary health care services to provide comprehensive community-based care; prevention of new infections; community mobilization towards prevention, non discrimination and non stigmatization and empowerment of the health sector to deal with the AIDS.pandemic. The CVI results showed that the average content validity index determined during this study was adequate: full score (1.0) for acceptability and technical soundness, and 0.89 for feasibility and perceived affordability. The strategy formulated for the management of HIV/AIDS by the health sector of the city of Johannesburg is

  5. ICTs and the health sector towards smarter health and wellness models

    2013-01-01

    The future sustainability of health systems will depend on how well governments are able to anticipate and respond to efficiency and quality of care challenges. Bold action is required, as well as willingness to test innovative care delivery approaches. The greatest promise for transformational change is in applications that encourage new, ubiquitous, participatory preventive and personalised smart models of care. A whole new world of possibilities in using mobiles and the Internet to address healthcare challenges has opened up. The potential of mobile devices, services and applications to sup

  6. Occupational and Environmental Health Risks Associated with Informal Sector Activities-Selected Case Studies from West Africa.

    Basu, Niladri; Ayelo, Paul Ahoumènou; Djogbénou, Luc S; Kedoté, Marius; Lawin, Herve; Tohon, Honesty; Oloruntoba, Elizabeth O; Adebisi, Nurudeen A; Cazabon, Danielle; Fobil, Julius; Robins, Thomas; Fayomi, Benjamin

    2016-08-01

    Most in the Economic Community of West African States region are employed in the informal sector. While the informal sector plays a significant role in the region's economy, policymakers and the scientific community have long neglected it. To better understand informal-sector work conditions, the goal here is to bring together researchers to exchange findings and catalyze dialogue. The article showcases research studies on several economic systems, namely agriculture, resource extraction, transportation, and trade/commerce. Site-specific cases are provided concerning occupational health risks within artisanal and small-scale gold mining, aggregate mining, gasoline trade, farming and pesticide applications, and electronic waste recycling. These cases emphasize the vastness of the informal sector and that the majority of work activities across the region remain poorly documented, and thus no data or knowledge is available to help improve conditions and formulate policies and programs to promote and ensure decent work conditions.

  7. Digital technology for health sector governance in low and middle income countries: a scoping review

    Holeman, Isaac; Cookson, Tara Patricia; Pagliari, Claudia

    2016-01-01

    Background Poor governance impedes the provision of equitable and cost–effective health care in many low– and middle–income countries (LMICs). Although systemic problems such as corruption and inefficiency have been characterized as intractable, “good governance” interventions that promote transparency, accountability and public participation have yielded encouraging results. Mobile phones and other Information and Communication Technologies (ICTs) are beginning to play a role in these interventions, but little is known about their use and effects in the context of LMIC health care. Methods Multi–stage scoping review: Research questions and scope were refined through a landscape scan of relevant implementation activities and by analyzing related concepts in the literature. Relevant studies were identified through iterative Internet searches (Google, Google Scholar), a systematic search of academic databases (PubMed, Web of Science), social media crowdsourcing (targeted LinkedIn and Twitter appeals) and reading reference lists and websites of relevant organizations. Parallel expert interviews helped to verify concepts and emerging findings and identified additional studies for inclusion. Results were charted, analyzed thematically and summarized. Results We identified 34 articles from a wide range of disciplines and sectors, including 17 published research articles and 17 grey literature reports. Analysis of these articles revealed 15 distinct ways of using ICTs for good governance activities in LMIC health care. These use cases clustered into four conceptual categories: 1) gathering and verifying information on services to improve transparency and auditability 2) aggregating and visualizing data to aid communication and decision making 3) mobilizing citizens in reporting poor practices to improve accountability and quality and 4) automating and auditing processes to prevent fraud. Despite a considerable amount of implementation activity, we identified

  8. Can working with the private for-profit sector improve utilization of quality health services by the poor? A systematic review of the literature

    Hanson Kara G

    2007-11-01

    Full Text Available Abstract Background There has been a growing interest in the role of the private for-profit sector in health service provision in low- and middle-income countries. The private sector represents an important source of care for all socioeconomic groups, including the poorest and substantial concerns have been raised about the quality of care it provides. Interventions have been developed to address these technical failures and simultaneously take advantage of the potential for involving private providers to achieve public health goals. Limited information is available on the extent to which these interventions have successfully expanded access to quality health services for poor and disadvantaged populations. This paper addresses this knowledge gap by presenting the results of a systematic literature review on the effectiveness of working with private for-profit providers to reach the poor. Methods The search topic of the systematic literature review was the effectiveness of interventions working with the private for-profit sector to improve utilization of quality health services by the poor. Interventions included social marketing, use of vouchers, pre-packaging of drugs, franchising, training, regulation, accreditation and contracting-out. The search for published literature used a series of electronic databases including PubMed, Popline, HMIC and CabHealth Global Health. The search for grey and unpublished literature used documents available on the World Wide Web. We focused on studies which evaluated the impact of interventions on utilization and/or quality of services and which provided information on the socioeconomic status of the beneficiary populations. Results A total of 2483 references were retrieved, of which 52 qualified as impact evaluations. Data were available on the average socioeconomic status of recipient communities for 5 interventions, and on the distribution of benefits across socioeconomic groups for 5 interventions

  9. Translating school health research to policy. School outcomes related to the health environment and changes in mathematics achievement.

    Snelling, Anastasia M; Belson, Sarah Irvine; Watts, Erin; George, Stephanie; Van Dyke, Hugo; Malloy, Elizabeth; Kalicki, Michelle

    2015-10-01

    This paper describes an exploration of the relationship between mathematic achievement and the school health environment relative to policy-driven changes in the school setting, specifically with regard to physical education/physical activity. Using school-level data, the authors seek to understand the relationship between mathematics achievement and the school health environment and physical education minutes. This work provides a description of the aspects of the school health environment, an exploration of the interrelationships between school health and student achievement, and an assessment of the effects of the school health policy and practice on student performance and health status. Based on these findings, we identify additional research necessary to describe the relationship between obesity and learning in children.

  10. Public and Private Sector in the Health Care System of the Federation Bosnia and Herzegovina: Policy and Strategy

    Slipicevic, Osman; Malicbegovic, Adisa

    2012-01-01

    In Bosnia and Herzegovina citizens receive health care from both public and private providers. The current situation calls for a clear government policy and strategy to ensure better position and services from both parts. This article examines how health care services are delivered, particularly with respect to relationship between public and private providers. The paper notes that the public sector is plagued by a number of weaknesses in terms of inefficiency of services provision, poorly motivated staff, prevalent dual practice of public employees, poor working conditions and geographical imbalances. Private sector is not developing in ways that address the weaknesses of the public sector. Poorly regulated, it operates as an isolated entity, strongly profit-driven. The increasing burdens on public health care system calls for government to abandon its passive role and take action to direct growth and use potential of private sector. The paper proposes a number of mechanisms that can be used to influence private as well as public sector, since actions directed toward one part of the system will inevitable influence the other. PMID:23678309

  11. Impatience versus achievement strivings in the Type A pattern: Differential effects on students' health and academic achievement

    Spence, Janet T.; Helmreich, Robert L.; Pred, Robert S.

    1987-01-01

    Psychometric analyses of college students' responses to the Jenkins Activity Survey, a self-report measure of the Type A behavior pattern, revealed the presence of two relatively independent factors. Based on these analyses, two scales, labeled Achievement Strivings (AS) and Impatience and Irritability (II), were developed. In two samples of male and female college students, scores on AS but not on II were found to be significantly correlated with grade point average. Responses to a health survey, on the other hand, indicated that frequency of physical complaints was significantly correlated with II but not with AS. These results suggest that there are two relatively independent factors in the Type A pattern that have differential effects on performance and health. Future research on the personality factors related to coronary heart disease and other disorders might more profitably focus on the syndrome reflected in the II scale than on the Type A pattern.

  12. Assessing Private Sector Involvement in Health Care and Universal Health Coverage in Light of the Right to Health

    Hallo de Wolf, Antenor; Toebes, Brigit

    2016-01-01

    e goal of universal health coverage is to “ensure that all people obtain the health services they need without su ering nancial hardship when paying for them.” There are many connections between this goal and the state’s legal obligation to realize the human right to health. In the context of this g

  13. Social security health insurance for the informal sector in Nicaragua: a randomized evaluation.

    Thornton, Rebecca L; Hatt, Laurel E; Field, Erica M; Islam, Mursaleena; Diaz, Freddy Solís; González, Martha Azucena

    2010-09-01

    This article presents the results from an experimental evaluation of a voluntary health insurance program for informal sector workers in Nicaragua. Costs of the premiums as well as enrollment location were randomly allocated. Overall, take-up of the program was low, with only 20% enrollment. Program costs and streamlined bureaucratic procedures were important determinants of enrollment. Participation of local microfinance institutions had a slight negative effect on enrollment. One year later, those who received insurance substituted toward services at covered facilities and total out-of-pocket expenditures fell. However, total expenditures fell by less than the insurance premiums. We find no evidence of an increase in health-care utilization among the newly insured. We also find very low retention rates after the expiration of the subsidy, with less than 10% of enrollees still enrolled after one year. To shed light on the findings from the experimental results, we present qualitative evidence of institutional and contextual factors that limited the success of this program.

  14. Human health-related externalities in energy system modelling the case of the Danish heat and power sector

    Zvingilaite, Erika

    2011-01-01

    and power sector verifies that it is cheaper for the society to include externalities in the planning of an energy system than to pay for the resulting damages later. Total health costs decrease by around 18% and total system costs decrease by nearly 4% when health externalities are included...... in the optimisation. Furthermore, including localisation aspects can reduce health costs of the heat and power sector in Denmark by additional 7%.......This paper discusses methodology of energy system modelling when reduction of local externalities, such as damage to the human health from energy production-related air pollution, is in focus. Ideally, the local energy externalities should be analysed by adopting the impact pathway approach...

  15. District decision-making for health in low-income settings: a case study of the potential of public and private sector data in India and Ethiopia.

    Bhattacharyya, Sanghita; Berhanu, Della; Taddesse, Nolawi; Srivastava, Aradhana; Wickremasinghe, Deepthi; Schellenberg, Joanna; Iqbal Avan, Bilal

    2016-09-01

    Many low- and middle-income countries have pluralistic health systems where private for-profit and not-for-profit sectors complement the public sector: data shared across sectors can provide information for local decision-making. The third article in a series of four on district decision-making for health in low-income settings, this study shows the untapped potential of existing data through documenting the nature and type of data collected by the public and private health systems, data flow and sharing, use and inter-sectoral linkages in India and Ethiopia. In two districts in each country, semi-structured interviews were conducted with administrators and data managers to understand the type of data maintained and linkages with other sectors in terms of data sharing, flow and use. We created a database of all data elements maintained at district level, categorized by form and according to the six World Health Organization health system blocks. We used content analysis to capture the type of data available for different health system levels. Data flow in the public health sectors of both counties is sequential, formal and systematic. Although multiple sources of data exist outside the public health system, there is little formal sharing of data between sectors. Though not fully operational, Ethiopia has better developed formal structures for data sharing than India. In the private and public sectors, health data in both countries are collected in all six health system categories, with greatest focus on service delivery data and limited focus on supplies, health workforce, governance and contextual information. In the Indian private sector, there is a better balance than in the public sector of data across the six categories. In both India and Ethiopia the majority of data collected relate to maternal and child health. Both countries have huge potential for increased use of health data to guide district decision-making.

  16. Regulación, innovación y mejora de las prestaciones sanitarias: El sector del medicamento Regulation, innovation, and improvement of health care: The pharmaceutical sector

    Guillem López-Casasnovas

    2008-02-01

    Full Text Available Se exponen unas reflexiones acerca de lo que son hoy y pueden ser en el futuro los marcos regulatorios para el sector del medicamento. Éste es un sector que se mueve en las coordenadas del esfuerzo innovador a largo plazo y de la limitación del gasto en el corto. Lejos de contar con un marco estable, el farmacéutico ha devenido un ámbito poliédrico y controvertido como el que más. Desde el análisis económico y la mirada subjetiva de la experiencia «tal como lo veo», se perfilan algunas oportunidades a partir del gran reto que implica la descentralización y se derivan algunas prescripciones de política sanitaria. Aunque no hay futuros ciertos, la idea fundamental es que la descentralización sanitaria territorial y de proveedores puede ser parte de la solución y no el problema en sí para nuestro sistema de salud, tal como ha funcionado hasta ahora.The paper comments on present and future scenarios for the pharmaceutical sector in Spain, framed a highly regulated system. So far the drug industry has evolved under the short term public financial constraints for additional health care spending and the long term efforts to innovate. This has not proved to offer a stable setting for the relationship between the industry and Health Authorities. The author offers from the economic analysis and a subjective appraisal from his experience some recommendations for regulatory changes in order to better align the incentives of the parts for improving the health system as a whole. The basic point is that 'consumption levels' (quantities and not «prices» (unit costs are the main challenge to tackle today in our Public Health Care system, and for this the decentralisation of financial responsibility is not in itself "the" problem but it may well be a part of the solution.

  17. Making governance work in the health care sector: evidence from a 'natural experiment' in Italy.

    Nuti, Sabina; Vola, Federico; Bonini, Anna; Vainieri, Milena

    2016-01-01

    The Italian Health care System provides universal coverage for comprehensive health services and is mainly financed through general taxation. Since the early 1990s, a strong decentralization policy has been adopted in Italy and the state has gradually ceded its jurisdiction to regional governments, of which there are twenty. These regions now have political, administrative, fiscal and organizational responsibility for the provision of health care. This paper examines the different governance models that the regions have adopted and investigates the performance evaluation systems (PESs) associated with them, focusing on the experience of a network of ten regional governments that share the same PES. The article draws on the wide range of governance models and PESs in order to design a natural experiment. Through an analysis of 14 indicators measured in 2007 and in 2012 for all the regions, the study examines how different performance evaluation models are associated with different health care performances and whether the network-shared PES has made any difference to the results achieved by the regions involved. The initial results support the idea that systematic benchmarking and public disclosure of data are powerful tools to guarantee the balanced and sustained improvement of the health care systems, but only if they are integrated with the regional governance mechanisms.

  18. Physician distribution and attrition in the public health sector of Ethiopia

    Assefa T

    2016-12-01

    Full Text Available Tsion Assefa,1 Damen Haile Mariam,1 Wubegzier Mekonnen,1 Miliard Derbew,2 Wendimagegn Enbiale3 1School of Public Health, 2School of Medicine, Addis Ababa University, Addis Ababa, 3College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia Background: Shortages and imbalances in physician workforce distribution between urban and rural and among the different regions in Ethiopia are enormous. However, with the recent rapid expansion in medical education training, it is expected that the country can make progress in physician workforce supply. Therefore, the aim of this study was to examine the distribution of physician workforce in Ethiopia and assess the role of retention mechanisms in the reduction of physician migration from the public health sector of Ethiopia. Methods: This organizational survey examined physician workforce data from 119 hospitals from 5 regions (Amhara, Oromia, Southern Nations Nationalities and Peoples Region [SNNPR], Tigray, and Harari and 2 city administrations (Addis Ababa and Dire Dawa City. Training opportunity, distribution, and turnover between September 2009 and July 2015 were analyzed descriptively. Poisson regression model was used to find the association of different covariates with physician turnover. Results: There were 2,300 medical doctors in 5 regions and 2 city administrations in ~6 years of observations. Of these, 553 (24.04% medical doctors moved out of their duty stations and the remaining 1,747 (75.96% were working actively. Of the actively working, the majority of the medical doctors, 1,407 (80.5%, were males, in which 889 (50.9% were born after the year 1985, 997 (57% had work experience of <3 years, and most, 1,471 (84.2%, were general practitioners. Within the observation period, physician turnover among specialists ranged from 21.4% in Dire Dawa to 43.3% in Amhara region. The capital, Addis Ababa, was the place of destination for 32 (82% of the physicians who moved out to

  19. Willingness to pay for social health insurance among informal sector workers in Wuhan, China: a contingent valuation study

    Zhang Xinping

    2007-07-01

    Full Text Available Abstract Background Most of the about 140 million informal sector workers in urban China do not have health insurance. A 1998 central government policy leaves it to the discretion of municipal governments to offer informal sector workers in cities voluntary participation in a social health insurance for formal sector workers, the so-called 'basic health insurance' (BHI. Methods We used the contingent valuation method to assess the maximum willingness to pay (WTP for BHI among informal sector workers, including unregistered rural-to-urban migrants, in Wuhan City, China. We selected respondents in a two-stage self-weighted cluster sampling scheme. Results On average, informal sector workers were willing to pay substantial amounts for BHI (30 Renminbi (RMB, 95% confidence interval (CI 27-33 as well as substantial proportions of their incomes (4.6%, 95% CI 4.1-5.1%. Average WTP increased significantly when any one of the copayments of the BHI was removed in the valuation: to 51 RMB (95% CI 46-56 without reimbursement ceiling; to 43 RMB (95% CI 37-49 without deductible; and to 47 RMB (95% CI 40-54 without coinsurance. WTP was higher than estimates of the cost of BHI based on past health expenditure or on premium contributions of formal sector workers. Predicted coverage with BHI declined steeply with the premium contribution at low contribution levels. When we applied equity weighting in the aggregation of individual WTP values in order to adjust for inequity in the distribution of income, mean WTP for BHI increased with inequality aversion over a plausible range of the aversion parameter. Holding other factors constant in multiple regression analysis, for a 1% increase in income WTP for BHI with different copayments increased by 0.434-0.499% (all p Conclusion Our results suggest that Chinese municipal governments should allow informal sector workers to participate in the BHI. From a normative perspective, BHI for informal sector workers is likely to

  20. Linking the Organizational Health of Middle Grades Schools to Student Achievement

    Roney, Kathleen; Coleman, Howard; Schlichting, Kathleen A.

    2007-01-01

    The purpose of this study was to examine the relationship between student reading achievement and the organizational health of five middle grades schools in North Carolina. The theoretical framework was based upon Hoy and Feldman's definition of organizational health, which links healthy school climates to improved learning environments and…

  1. The present and future roles of Traditional Health Practitioners within the formal healthcare sector of South Africa, as guided by the Traditional Health Practitioners Act No 22 (2007

    Gabriel Louw

    2016-12-01

    Full Text Available Background The promulgation of the Traditional Health Practitioners Act No 22 (2007 was seen as the long awaited start-up of the traditional healing profession in South Africa. Act No 22 (2007 was strongly politically driven from the late 1960s onward. Many of these political motivators were based upon outdated cultural ideas, customs and traditions, rooted outside the modern day healthcare needs and demands of the particular population that traditional healing intends to serve. An in-depth needs and skills analysis, to test the viability and sustainability of the South African traditional healers as well as their positions and roles as health practitioners inside the formal healthcare sector, as guided and stipulated by the Traditional Health Practitioners Act No 22 (2007, was lacking in this early development and start-up process. This resulted in the traditional healers’ present and future roles as specific healthcare practitioners being both undefined and insufficiently formulated. In addition their existing education, training, skills and abilities to compete in the formal healthcare sector were ignored. Therefore, since the promulgation of the Act in 2007, there was limited professional-development for traditional healers, to improve their immediate professionalism and thus to promote effective role-playing and management in the formal healthcare sector. The South African traditional healing professional model is still in the foundational stage of its professional development; a stage which the other registered/regulated healthcare practitioners of the country surpassed long ago, making them well-equipped for role-playing and management as health professionals in the formal healthcare sector. The whole venture of the statutory recognition of the traditional health practitioners in 2007 as new healthcare professionals with the promulgation of the Traditional Health Practitioners Act No 22 (2007 seems to increasingly be a failure. There is

  2. Level of Educational Objectives Achievement in Health and Community Medicine Internship Course; Interns Viewpoint

    2016-01-01

    Aims: Nowadays, the community oriented medicine education model has been mainly noticed. The aim of this study was to survey the interns about achievement to the educational goals confirmed by Health Ministry in health internship and community medicine courses.    Instrument & Methods: In the descriptive cross-sectional study, 56 health internship and community medicine students of one of the military universities of medical sciences in Tehran were studied in 2014 and 2015....

  3. The sociology of space as a catalyst for innovation in the health sector.

    Saidi, Trust; de Villiers, Katusha; Douglas, Tania S

    2017-03-09

    This paper reviews the role of space in facilitating innovation. It draws on the sociology of space in exploring the social practices, institutional forces and material complexity of how people and spaces interact. We assess how space influences the development of innovative solutions to challenges in the health sector. Our aim is to advance an understanding of the social production of space for healthcare innovation. We draw empirical examples from the Innovation Hub at Groote Schuur Hospital in Cape Town to illustrate that innovation does not take place in an institutional vacuum, but requires space that facilitates interaction of different players. This paper demonstrates that space matters in promoting innovation, particularly through its influence on social relationships and networks. An attractive and novel space, which is different from the usual workplace, stimulates innovation, mainly through being a base for the creation of an ecosystem for the productive interaction of different players. The interaction is important in inspiring new ideas, facilitating creative thought processes, maintaining the flow of information and bringing innovation to life.

  4. Reforma del sector salud y la política farmacéutica en Perú Health sector reform and pharmaceutical policy in Peru

    Carmen Phang Romero

    2002-08-01

    Full Text Available Este artículo analiza el Programa de Administración Compartida de Farmacias (PACFARM y su articulación con la Política Farmacéutica en Perú, en el contexto de la reforma del sector salud. La ejecución de los diversos Programas de Medicamentos Esenciales precedentes muestra el permanente esfuerzo por mejorar la cobertura con medicamentos esenciales a la población, no obstante, el marco jurídico en esta área presenta normas dispersas y desarticuladas, que dificultan la construcción de una Política Nacional de Medicamentos. El PACFARM es un sistema descentralizado de abastecimiento de medicamentos esenciales para el primer nivel de atención, auto-sustentado a través de fondos rotatorios. Mientras la ampliación de cobertura y la disminución de las barreras económicas de acceso a medicamentos esenciales fundamentaban lineamientos de una política farmacéutica, en tanto trazos de eficiencia gerencial en el suministro acompasaban la modernización de la gestión como parte de la reforma, otros aspectos dificultaron su implantación y limitaron sus efectos, tales como: la desregulación y los propios procesos de cambio en el sector. El abordaje metodológico incluyó técnicas cuali y cuantitativas, privilegiando el análisis de implantación del Programa.This article analyzes the Shared Pharmaceutical Management Program (PACFARM and its relationship to pharmaceutical policy in Peru within the scope of health sector reform. Implementation of various programs for essential medicines has involved an on-going effort towards improving the supply of essential drugs to the community. However, the corresponding legal framework includes random and disconnected regulations which hinder the feasibility of a consistent national drug policy. PACFARM is a decentralized system for the provision of essential medicines on a care-level basis, self-supported by revolving funds. While expanded coverage and decreased economic barriers to access to

  5. Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses.

    Knaul, Felicia Marie; Bhadelia, Afsan; Atun, Rifat; Frenk, Julio

    2015-09-01

    Health systems in low- and middle-income countries were designed to provide episodic care for acute conditions. However, the burden of disease has shifted to be overwhelmingly dominated by chronic conditions and illnesses that require health systems to function in an integrated manner across a spectrum of disease stages from prevention to palliation. Low- and middle-income countries are also aiming to ensure health care access for all through universal health coverage. This article proposes a framework of effective universal health coverage intended to meet the challenge of chronic illnesses. It outlines strategies to strengthen health systems through a "diagonal approach." We argue that the core challenge to health systems is chronicity of illness that requires ongoing and long-term health care. The example of breast cancer within the broader context of health system reform in Mexico is presented to illustrate effective universal health coverage along the chronic disease continuum and across health systems functions. The article concludes with recommendations to strengthen health systems in order to achieve effective universal health coverage.

  6. A REFLECTION ON THE WAVE OF AMALGAMATIONS IN THE ROMANIAN HEALTH SECTOR

    Ina MITU

    2014-12-01

    Full Text Available In the context of New Public Management (NPM and good governance, in the last decade the Romanian public health system has undergone a reform process. One of its consequences is the wave of public hospitals amalgamations that have occurred especially since the adoption of the new health law. Thus, in 2011 the Ministry of Health has made public a list of proposed amalgamations of hospitals (around 25% from total hospitals with beds that existed in that period. The aim of this research is to examine the wave of hospital mergers that occurred in Romania between 2011 and 2012. In particular, the study focuses on the drivers, social impact, typology and purpose of the analysed amalgamations. The study uses primary resources documents and it is based on a content analysis of 25 Government Decisions and Substantiation Notes from 2011 to 2012. An important generalization of the paper is that all the amalgamations from the analysed period are involuntary and are selected on territorial criteria and depending on the distance, the specific health services for the purpose of efficient use of human and material resources in order to enhance public health services. Additionally, the expected social impact of these events is materialized mainly in improving the quality of medical services provided to the population and providing unconditional access to medical services for policyholders. The expected changes include: reduction of staff costs; efficient use of public services; classifying the amalgamated hospitals in a higher category; reduction of management positions; optimizing medical activity in terms of economic efficiency; and achieving a management capable of the best use of existing financial resources.

  7. Assessing the use of an essential health package in a sector wide approach in Malawi

    Mwase Takondwa

    2011-01-01

    Full Text Available Abstract Background The sector wide approach (SWAp used in many developing countries is difficult to assess. One way is to consider the essential health package (EHP which is commonly the vehicle for a SWAp's policies and plans. It is not possible to measure the impact of an EHP by measuring health outcomes in countries such as Malawi. But it is possible to assess the choice of interventions and their delivery in terms of coverage. This paper describes an attempt to assess the Malawi SWAp through its EHP using these available measures of technical efficiency. Methods A burden of disease model was used to identify the priority diseases and their estimated incidence. Data from the health management information system (HMIS were used to measure the coverage of these interventions. A review of the cost-effectiveness of the chosen and potential interventions was undertaken to assess the appropriateness of each intervention used in the EHP. Expenditure data were used to assess the level of funding of the EHP. Results 33 of the 55 EHP interventions were found to be potentially cost-effective ($150/DALY and cost-effective estimates were not available for ten. 15 potential interventions, which were cost-effective and tackling one of the top 20 ranked diseases, were identified. Provision had increased in nearly all EHP services over the period of the SWAp. The rates of out patient attendances and inpatient days per 1000 population had both increased from 929 attendances in 2002/3 to 1135 in 2007/08 and from 124 inpatient days in 2002/03 to 179 in 2007/08. However, by 2007/08 the mean gap between what was required and what was provided was 0.68 of the estimated need. Two services involving the treatment of malaria were overprovided, but the majority were underprovided, with some such as maternity care providing less than half of what was required. The EHP was under-funded throughout the period covering on average 57% of necessary costs. By 2007/08 the

  8. The Utrecht Healthy School Project: Connecting adolescent health behavior, academic achievement and Health Promoting Schools

    Busch, V.

    2014-01-01

    Unhealthy behaviors contribute to the development of diseases such as diabetes, cardiovascular disease and psychiatric disorders. Most often these behaviors develop in the teenage years. This thesis addresses the following topics: (1) How do health-related behaviors cluster and affect health in adol

  9. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

    Bryant-Lukosius, Denise; Valaitis, Ruta; Martin-Misener, Ruth; Donald, Faith; Peña, Laura Morán; Brousseau, Linda

    2017-01-01

    ABSTRACT Objective: to examine advanced practice nursing (APN) roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries. PMID:28146177

  10. Advanced Practice Nursing: A Strategy for Achieving Universal Health Coverage and Universal Access to Health

    Denise Bryant-Lukosius

    Full Text Available ABSTRACT Objective: to examine advanced practice nursing (APN roles internationally to inform role development in Latin America and the Caribbean to support universal health coverage and universal access to health. Method: we examined literature related to APN roles, their global deployment, and APN effectiveness in relation to universal health coverage and access to health. Results: given evidence of their effectiveness in many countries, APN roles are ideally suited as part of a primary health care workforce strategy in Latin America to enhance universal health coverage and access to health. Brazil, Chile, Colombia, and Mexico are well positioned to build this workforce. Role implementation barriers include lack of role clarity, legislation/regulation, education, funding, and physician resistance. Strong nursing leadership to align APN roles with policy priorities, and to work in partnership with primary care providers and policy makers is needed for successful role implementation. Conclusions: given the diversity of contexts across nations, it is important to systematically assess country and population health needs to introduce the most appropriate complement and mix of APN roles and inform implementation. Successful APN role introduction in Latin America and the Caribbean could provide a roadmap for similar roles in other low/middle income countries.

  11. The roles of veterinary, medical and environmental professionals to achieve ONE HEALTH

    Mahendra Pal

    2014-12-01

    Full Text Available According to the WHO- “Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity”. The good health is the fundamental right of all the people on earth. The concept of ‘One Medicine’ coined by Calvin W. Schwabe evolves towards ’One Health’ which comprises collaborative efforts of multiple disciplines to achieve perfect health of people, animals, and our environment. ‘One Health’ deals with the challenges at the intersection of animal, human and environment health including the infectious diseases, the global food crises, and climate change due to global warming. The cordial and active association of various disciplines such as medicine, veterinary, public health, environment, wildlife, ecology, and food hygiene is highly emphasized in order to achieve the goal of ‘One Health’. This mini-review describes brief history of ‘one health’, the roles of veterinary, medical and environmental professionals, and developing collaboration with various concern professionals to achieve ‘one health’. In addition, the selected achievements of ‘one health’ in the past 10 years have been described along with the challenges ahead for the successful implementation of such concept.

  12. 卫生部门治理:战略与机制%Health sector governance:Strategies and mechanisms

    刘丽杭

    2014-01-01

    在将健康作为一个要素融入所有政府部门与社会团体政策制定中的大健康整合战略下,政府各部门及社会团体在共识基础上形成广泛性治理目标,由政府主导卫生系统的运行,通过加强政府各部门间及与社会组织的协调与合作,统筹卫生系统的服务及管理功能,建立社会参与的绩效问责机制,实现提升卫生部门治理水平,改善社会健康结果的目标。%Under the health integration strategies of public policy to health in all policies of all sectors and so-cial areas, government departments and social organizations form a broad consensus on the basis of the goals of gov-ernance, led by government health system operations, through the strengthening of coordination and cooperation a-mong government departments and social organizations as well as overall planning of the service functions of the health system, and the establishment of community participation in the performance accountability mechanism, in order to enhance the level of health sector governance and improve community health outcomes.

  13. The precariousness of the franchise state: Voluntary sector health services and international NGOs in Tanzania, 1960s - mid-1980s.

    Jennings, Michael

    2015-09-01

    This paper challenges conventional narratives on the role of international non-governmental organisations (INGOs) in the delivery of health services in Tanzania. Adopting an historical gaze which focuses on the 1960s to mid-1980s the paper argues that the 'franchise state' in the Tanzanian health system was not created by collusion between international donors and INGOs, underpinned by a set of health sector reforms that advocated the use of non-state actors; but was rather the legacy of the colonial health system bequeathed to the post-independence state. It was a system in which voluntary non-state actors (but, importantly, not INGOs) were already entrenched as key providers; and in which many of the features of the franchise state - fragmentation, structural weaknesses, lack of accountability to users - were already long established. But if INGOs did not create these features, as their critics attest, they did contribute to the maintenance and extension of these features. The short-term perspectives of NGOs, their small-scale piecemeal engagement, and the extra demands they placed upon their voluntary actor partners, left little scope for the development of sustainable, national and accountable solutions to the health needs of the country. In exploring these ideas, the paper contributes to a more nuanced understanding of the path dependency that created Tanzania's health system. The analysis also contributes to a deepening of the understanding of the make-up of the voluntary sector beyond a narrow gaze on the institution of the INGO.

  14. Private sector participation in delivering tertiary health care: a dichotomy of access and affordability across two Indian states

    Katyal, Anuradha; Singh, Prabal Vikram; Bergkvist, Sofi; Samarth, Amit; Rao, Mala

    2015-01-01

    Poor quality care in public sector hospitals coupled with the costs of care in the private sector have trapped India's poor in a vicious cycle of poverty, ill health and debt for many decades. To address this, the governments of Andhra Pradesh (AP) and Maharashtra (MH), India, have attempted to improve people’s access to hospital care by partnering with the private sector. A number of government-sponsored schemes with differing specifications have been launched to facilitate this strategy. Aims This article aims to compare changes in access to, and affordability and efficiency of private and public hospital inpatient (IP) treatments between MH and AP from 2004 to 2012 and to assess whether the health financing innovations in one state resulted in larger or smaller benefits compared with the other. Methods We used data from household surveys conducted in 2004 and 2012 in the two states and undertook a difference-in-difference (DID) analysis. The results focus on hospitalization, out-of-pocket expenditure and length of stay. Results The average IP expenditure for private hospital care has increased in both states, but more so in MH. There was also an observable increase in both utilization of and expenditure on nephrology treatment in private hospitals in AP. The duration of stay recorded in days for private hospitals has increased slightly in MH and declined in AP with a significant DID. The utilization of public hospitals has reduced in AP and increased in MH. Conclusion The state of AP appears to have benefited more than MH in terms of improved access to care by involving the private sector. The Aarogyasri scheme is likely to have contributed to these impacts in AP at least in part. Our study needs to be followed up with repeated evaluations to ascertain the long-term impacts of involving the private sector in providing hospital care. PMID:25759452

  15. Review of the President’s Fiscal Year 2009 Budget Request for the Defense Health Program’s Private Sector Care Budget Activity Group

    2008-05-28

    2009 budget request for the Defense Health Program’s Private Sector Care BAG. To do this, we reviewed (1) DOD’s justification for the request for the... Private Sector Care BAG, including the underlying estimates and the extent to which DOD considered historical information; and (2) changes between this...develop the budget requests for the Private Sector Care BAG in fiscal years 2008 and 2009. We also interviewed officials and analyzed documents from

  16. Scientific and technological capabilities in health-related areas: opportunities, challenges, and interactions with the industrial sector.

    Vargas, Marco Antonio; Britto, Jorge

    2016-11-03

    Characterization of the scientific and technological infrastructure in health and its interactions with the industrial sector provides key elements for understanding the dynamics of innovation in health. This study conducts an exploratory analysis of the potentialities and limitations associated with scientific and technological capabilities in the health area in Brazil and the different links between the scientific and industrial sectors in health. The analysis points to important growth in internationally indexed research output, especially in certain areas such as pharmaceutics, public health, genetics, morphology, physiology, and microbiology. There has also been important growth in research groups that interact with the industrial sector in selected areas of health. The study highlights the importance of building more solid and permanent bridges between companies, research institutions, and the health system, linking the knowledge developed in research institutions to the dynamics of the industrial sector in health. Resumo: A caracterização da infraestrutura científica e tecnológica na área da saúde e das suas formas de articulação com a base produtiva representam elementos centrais na compreensão da dinâmica de inovação em saúde. Este estudo faz uma análise exploratória sobre as potencialidades e limitações associadas às capacitações científicas e tecnológicas na área da saúde no Brasil e as formas de articulação entre a base científica e a base produtiva em saúde. A análise aponta para o crescimento expressivo da produção bibliográfica com circulação internacional no campo da saúde, particularmente em determinadas áreas como farmácia, saúde coletiva, genética, morfologia, fisiologia e microbiologia. Além disso, observa-se um crescimento expressivo dos grupos de pesquisa com relacionamentos com o setor produtivo em áreas selecionadas da saúde. Destaca-se a importância da construção de pontes mais sólidas e

  17. A comparative study of internal customer management practices within service sector firms and the National Health Service.

    Chaston, I

    1994-02-01

    In responding to the UK government's market forces model, some National Health Service (NHS) managers have introduced private sector concepts such as 'customer care' and 'total quality management' (TQM). Private sector firms find that success of these techniques is dependent upon creating an internal marketing orientation across the entire organization. To determine how internal marketing is being applied, a comparative survey of UK service sector firms and NHS units was undertaken using a modified version of Parasuraman's SERVQUAL model. All respondents indicated existence of type 1, 2, 3 and 4 gaps in the internal customer management process within their organizations. Major influencers of service gaps include departments placing internal efficiency ahead of internal customers and insufficient understanding of internal customer requirements. The survey indicated that, in certain areas of managing service quality, the NHS is performing better than its private sector counterparts. Nevertheless, opportunity for enhancing service quality in the NHS is possible through improving the flow of information between departments, stronger orientation towards meeting customer needs, upgrading provision systems and changing intradepartmental culture. The constraint facing the NHS manager is the limited availability of resources. One solution is to allocate resources in relation to service priorities. A directional planning matrix is presented as a tool for developing an optimum internal customer management strategy within an NHS unit.

  18. What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries.

    Mackintosh, Maureen; Channon, Amos; Karan, Anup; Selvaraj, Sakthivel; Cavagnero, Eleonora; Zhao, Hongwen

    2016-08-06

    Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners-both unlicensed and licensed-to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector's structure and behaviour, and vice versa.

  19. Advancing Efforts to Achieve Health Equity: Equity Metrics for Health Impact Assessment Practice

    Jonathan Heller

    2014-10-01

    Full Text Available Equity is a core value of Health Impact Assessment (HIA. Many compelling moral, economic, and health arguments exist for prioritizing and incorporating equity considerations in HIA practice. Decision-makers, stakeholders, and HIA practitioners see the value of HIAs in uncovering the impacts of policy and planning decisions on various population subgroups, developing and prioritizing specific actions that promote or protect health equity, and using the process to empower marginalized communities. There have been several HIA frameworks developed to guide the inclusion of equity considerations. However, the field lacks clear indicators for measuring whether an HIA advanced equity. This article describes the development of a set of equity metrics that aim to guide and evaluate progress toward equity in HIA practice. These metrics also intend to further push the field to deepen its practice and commitment to equity in each phase of an HIA. Over the course of a year, the Society of Practitioners of Health Impact Assessment (SOPHIA Equity Working Group took part in a consensus process to develop these process and outcome metrics. The metrics were piloted, reviewed, and refined based on feedback from reviewers. The Equity Metrics are comprised of 23 measures of equity organized into four outcomes: (1 the HIA process and products focused on equity; (2 the HIA process built the capacity and ability of communities facing health inequities to engage in future HIAs and in decision-making more generally; (3 the HIA resulted in a shift in power benefiting communities facing inequities; and (4 the HIA contributed to changes that reduced health inequities and inequities in the social and environmental determinants of health. The metrics are comprised of a measurement scale, examples of high scoring activities, potential data sources, and example interview questions to gather data and guide evaluators on scoring each metric.

  20. On the Path to SunShot. The Environmental and Public Health Benefits of Achieving High Solar Penetrations in the United States

    Wiser, Ryan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Mai, Trieu [National Renewable Energy Lab. (NREL), Golden, CO (United States); Millstein, Dev [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Macknick, Jordan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Carpenter, Alberta [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cohen, Stuart [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cole, Wesley [National Renewable Energy Lab. (NREL), Golden, CO (United States); Frew, Bethany [National Renewable Energy Lab. (NREL), Golden, CO (United States); Heath, Garvin [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-05-01

    Compared with fossil fuel generators, photovoltaics (PV) and concentrating solar power (CSP) produce far lower lifecycle levels of greenhouse gas (GHG) emissions and harmful pollutants including fine particular matter (PM2.5), sulfur dioxide (SO2), and nitrogen oxides (NOx). In this report, we monetize the emission reductions from achieving the U.S. Department of Energy's SunShot deployment goals: 14% of U.S. electricity demand met by solar in 2030 and 27% in 2050. We estimate that achieving these goals could reduce cumulative power-sector GHG emissions by 10% between 2015 and 2050, resulting in savings of $238-$252 billion. This is equivalent to 2.0-2.2 cents per kilowatt-hour of solar installed (cents/kWh-solar). Similarly, realizing these levels of solar deployment could reduce cumulative power-sector emissions of PM2.5 by 8%, SO2 by 9%, and NOx by 11% between 2015 and 2050. This could produce $167 billion in savings from lower future health and environmental damages, or 1.4 cents/kWh-solar--while also preventing 25,000-59,000 premature deaths. To put this in perspective, this estimated combined benefit of 3.5 cents/kWh-solar due to SunShot-level solar deployment is approximately equal to the additional levelized cost of electricity reduction needed to make unsubsidized utility-scale solar competitive with conventional generators today. In addition, the analysis shows that achieving the SunShot goals could save 4% of total power-sector water withdrawals and 9% of total power-sector water consumption over the 2015-2050 period--a particularly important consideration for arid states where substantial solar will be deployed. These results have potential implications for policy innovation and the economic competitiveness of solar and other generation technologies.

  1. School Environmental Health Programs and the Challenges of Achieving the Millennium Development Goals

    Ana, Godson R. E. E.; Shendell, Derek G.

    2011-01-01

    The United Nations (UN) mandate of achieving healthful living for all by the year 2015 through the Millennium Development Goals (MDGs) is facing several challenges. In the school environment, and particularly in less developed countries (LDCs), the situation is further strained by both relatively weak infrastructure and competing governmental…

  2. Costs of lifestyle interventions within health care and the amount of weight loss achieved

    Bogers RP; Vijgen SMC; Bemelmans WJE; PZO

    2006-01-01

    Lifestyle counselling in health care with respect to diet and physical activity can reduce body weight at reasonable costs. A weight loss of 5% after one year can be achieved at a cost of around 150 euro per patient (with an uncertainty range up to 300-400 euro). Each extra investment of 100 euro re

  3. Formative Assessment and Academic Achievement in Pre-Graduate Students of Health Sciences

    Carrillo-de-la-Pena, Maria T.; Bailles, Eva; Caseras, Xavier; Martinez, Alvar; Ortet, Generos; Perez, Jorge

    2009-01-01

    Although educational experts recommend the use of formative assessment, there is a dearth of empirical studies on its impact on academic achievement. In this research the authors analyse to what extent participation and performance in formative assessment are associated with positive academic outcomes of pre-graduate students of health sciences. A…

  4. A public health achievement under adversity: the eradication of poliomyelitis from Peru, 1991.

    Sobti, Deepak; Cueto, Marcos; He, Yuan

    2014-12-01

    The fight to achieve global eradication of poliomyelitis continues. Although native transmission of poliovirus was halted in the Western Hemisphere by the early 1990s, and only a few cases have been imported in the past few years, much of Latin America's story remains to be told. Peru conducted a successful flexible, or flattened, vertical campaign in 1991. The initial disease-oriented programs began to collaborate with community-oriented primary health care systems, thus strengthening public-private partnerships and enabling the common goal of poliomyelitis eradication to prevail despite rampant terrorism, economic instability, and political turmoil. Committed leaders in Peru's Ministry of Health, the Pan American Health Organization, and Rotary International, as well as dedicated health workers who acted with missionary zeal, facilitated acquisition of adequate technologies, coordinated work at the local level, and increased community engagement, despite sometimes being unable to institutionalize public health improvements.

  5. Strategic planning as a tool for achieving alignment in academic health centers.

    Higginbotham, Eve J; Church, Kathryn C

    2012-01-01

    After the passage of the Patient Protection and Affordable Care Act in March 2010, there is an urgent need for medical schools, teaching hospitals, and practice plans to work together seamlessly across a common mission. Although there is agreement that there should be greater coordination of initiatives and resources, there is little guidance in the literature to address the method to achieve the necessary transformation. Traditional approaches to strategic planning often engage a few leaders and produce a set of immeasurable initiatives. A nontraditional approach, consisting of a Whole-Scale (Dannemiller Tyson Associates, Ann Arbor, MI) engagement, appreciative inquiry, and a balanced scorecard can, more rapidly transform an academic health center. Using this nontraditional approach to strategic planning, increased organizational awareness was achieved in a single academic health center. Strategic planning can be an effective tool to achieve alignment, enhance accountability, and a first step in meeting the demands of the new landscape of healthcare.

  6. Authentic leadership as a source of optimism, trust in the organisation and work engagement in the public health care sector

    Frederick W. Stander

    2015-03-01

    Full Text Available Orientation: The orientation of this study is towards authentic leadership (AL and its influence on optimism, trust in the organisation and work engagement of employees in the public health care sector.Research purpose: The objectives of this study were to determine whether the leadership style of AL could predict optimism, trust in the organisation and work engagement amongst a large sample of employees from various functions in public hospitals and clinics in Gauteng and to establish whether optimism and trust in the organisation could mediate the relationship between AL and work engagement.Research approach, design and method: A convenience sample of 633 public health employees from various functions within 27 public hospitals and clinics in the province was used in this research. A cross-sectional research design was implemented. Structural equation modelling was utilised to investigate the Authentic Leadership Inventory (ALI, and the validity and fit of the measurement model, to position AL as a job resource within the nomological net and to test its mediating effects.Main findings: The statistical analysis revealed that AL was a significant predictor of optimism and trust in the organisation and that optimism and trust in the organisation mediated the relationship between AL and work engagement.Practical/managerial implications: The research results suggested that organisations in the public health care sector should encourage their managers to adopt a more authentic leadership style. This will lead to higher levels of optimism, trust in the organisation and eventually work engagement. This will greatly assist employees in the domain of public health care to manage their demanding working environment.Contribution: This study provides evidence that the ALI can be used reliably within the South African context and specifically within the public health care sector. It further substantiates for the implementation of AL as a leadership style in

  7. The quest for universal health coverage: achieving social protection for all in Mexico.

    Knaul, Felicia Marie; González-Pier, Eduardo; Gómez-Dantés, Octavio; García-Junco, David; Arreola-Ornelas, Héctor; Barraza-Lloréns, Mariana; Sandoval, Rosa; Caballero, Francisco; Hernández-Avila, Mauricio; Juan, Mercedes; Kershenobich, David; Nigenda, Gustavo; Ruelas, Enrique; Sepúlveda, Jaime; Tapia, Roberto; Soberón, Guillermo; Chertorivski, Salomón; Frenk, Julio

    2012-10-06

    Mexico is reaching universal health coverage in 2012. A national health insurance programme called Seguro Popular, introduced in 2003, is providing access to a package of comprehensive health services with financial protection for more than 50 million Mexicans previously excluded from insurance. Universal coverage in Mexico is synonymous with social protection of health. This report analyses the road to universal coverage along three dimensions of protection: against health risks, for patients through quality assurance of health care, and against the financial consequences of disease and injury. We present a conceptual discussion of the transition from labour-based social security to social protection of health, which implies access to effective health care as a universal right based on citizenship, the ethical basis of the Mexican reform. We discuss the conditions that prompted the reform, as well as its design and inception, and we describe the 9-year, evidence-driven implementation process, including updates and improvements to the original programme. The core of the report concentrates on the effects and impacts of the reform, based on analysis of all published and publically available scientific literature and new data. Evidence indicates that Seguro Popular is improving access to health services and reducing the prevalence of catastrophic and impoverishing health expenditures, especially for the poor. Recent studies also show improvement in effective coverage. This research then addresses persistent challenges, including the need to translate financial resources into more effective, equitable and responsive health services. A next generation of reforms will be required and these include systemic measures to complete the reorganisation of the health system by functions. The paper concludes with a discussion of the implications of the Mexican quest to achieve universal health coverage and its relevance for other low-income and middle-income countries.

  8. Sources of satisfaction and dissatisfaction among specialists within the public and private health sectors

    Ashton, Toni; Brown, Paul M.; Sopina, Elizaveta (Liza)

    2013-01-01

    and professional development, key sources of dissatisfaction are workload pressures, mentally demanding work and managerial interference. In the private sector specialists value the opportunity to work independently and apply their own ideas in the workplace. Conclusion Sources of job satisfaction......Aim As in many countries, medical and surgical specialists in New Zealand have the opportunity of working in the public sector, the private sector or both. This study aimed to explore the level and sources of satisfaction and dissatisfaction of specialists in New Zealand with working in the two...... of satisfaction and 9 sources of dissatisfaction according to a 5-point Likert scale. Means and standard deviations were calculated for the total sample, and for procedural and non-procedural specialties. Differences between the means of each source of satisfaction and dissatisfaction were also calculated...

  9. Achieving large ends with limited means: grand strategy in global health.

    Curry, Leslie A; Luong, Minh A; Krumholz, Harlan M; Gaddis, John; Kennedy, Paul; Rulisa, Stephen; Taylor, Lauren; Bradley, Elizabeth H

    2010-06-01

    Unprecedented attention is focused on global health, with a four-fold increase in development assistance in the last 15 years and the scope of global health expanding beyond infectious disease to include chronic disease and health systems strengthening. As the global impact of health is more widely understood, it has become a crucial element of international relations, economic development, and foreign affairs. At this potential leverage point in the global health movement, the application of grand strategy is of critical importance. Grand strategy, i.e., the development and implementation of comprehensive plans of action to achieve large ends with limited means, has been refined through centuries of international relations and the management of states but has been inadequately applied to global health policy and implementation. We review key principles of grand strategy and demonstrate their applicability to a central global health issue: maternal mortality. The principles include: start with the end in mind, take an ecological approach, recognize that tactics matter, use positive deviance to characterize practical solutions and foster scale-up, and integrate timely intelligence and data into health interventions and improvement efforts. We advocate for the greater use of grand strategy in global health.

  10. Achieving universal health coverage in France: policy reforms and the challenge of inequalities.

    Nay, Olivier; Béjean, Sophie; Benamouzig, Daniel; Bergeron, Henri; Castel, Patrick; Ventelou, Bruno

    2016-05-28

    Since 1945, the provision of health care in France has been grounded in a social conception promoting universalism and equality. The French health-care system is based on compulsory social insurance funded by social contributions, co-administered by workers' and employers' organisations under State control and driven by highly redistributive financial transfers. This system is described frequently as the French model. In this paper, the first in The Lancet's Series on France, we challenge conventional wisdom about health care in France. First, we focus on policy and institutional transformations that have affected deeply the governance of health care over past decades. We argue that the health system rests on a diversity of institutions, policy mechanisms, and health actors, while its governance has been marked by the reinforcement of national regulation under the aegis of the State. Second, we suggest the redistributive mechanisms of the health insurance system are impeded by social inequalities in health, which remain major hindrances to achieving objectives of justice and solidarity associated with the conception of health care in France.

  11. Challenges facing minority women in achieving good health: voices of Arab women in Israel.

    Daoud, Nihaya

    2008-01-01

    Arab women citizens of Israel bear a heavier burden of health problems compared with Jewish women. These inequalities were examined by conducting 6 focus groups that explored obstacles to achieving good health and strategies for maintaining good health as articulated by 86 Arab-Moslem women from the Triangle area in central Israel. Perceived obstacles ranged from personal to socio-political: unhealthy lifestyles, obedience to patriarchal norms, rapid lifestyle transitions, the political situation, poverty and lower socioeconomic status, and limited access to specific health care services. These multi-layered obstacles appeared to operate synergistically to limit women's access to social support and health care systems, intensify feelings of powerlessness, and further promote unhealthy behaviors. Moreover, these perceptions differed by the socioeconomic status of the group. The relatively more advantaged groups did not address issues related to poverty or access to health care services. Most health maintenance strategies discussed were personal and conservative, and considerate of traditional Arab cultural norms. The findings provide a basis for developing more culturally competent and adequate health care services for Arab women in Israel and for further research concerning Arab women's health in the region.

  12. The relevance of a coproductive capacity framework to climate change adaptation: investigating the health and water sectors in Cambodia

    Kathryn J. Bowen

    2015-03-01

    Full Text Available Multiple active partnerships in the health and water sectors in Cambodia exist to address climate change adaptation, operating beyond typical sectoral and organizational divides. Decisions around national adaptation policy are made predominantly by the relevant lead ministry, contrasting with where funding originates from (i.e., major donors, multilaterals, United Nation agencies. Adaptation policy is thus the result of a process of coproduction by state and nonstate actors. The research we present sought to understand the relationships that exist between knowledge- and decision-makers with respect to climate change adaptation in the health and water sectors in Cambodia, and the factors that enabled or constrained these relationships. Forty-four interviews were conducted with representatives of 32 organizations. We found that coproductive relationships were most effective when there were clearly defined roles and responsibilities, coordination of technical and financial resources, and trust. The two key factors of coproductive capacity that enabled and supported these partnerships were scientific resources and governance capability. Ultimately, the roles and responsibilities given to various actors requires commensurate funding and greater consideration of existing relationships and power dynamics. The reliance on international scientific expertise also needs to be challenged so that local research capabilities can be developed and locally relevant, problem-specific information can be provided. The ongoing funding, codevelopment, and sharing of such knowledge would significantly enhance trust and cooperation.

  13. Health and wellness trends in the oil and gas sector : insights from the Shepell-fgi Research Group

    NONE

    2009-07-01

    This report discussed health and wellness trends in the oil and gas sector in relation to employee assistance program (EAP) data. The data were derived from oil and gas client organizations across Canada for 2008, and represented a population base of 14,685 employees. The data demonstrated that EAP utilization in the petroleum industry increased by approximately 5 per cent from 2006 to 2008. The sector's utilization was 34 per cent higher than the Canadian norm in 2006, and 40 per cent higher than in 2007 and 2008. Females used the EAP to a greater extent than males. A higher proportion of the spouses of workers accessed EAP than the national norm. Employees accessed EAP for assistance with work-life issues; family support services; and substance abuse interventions. Weight management and dietary consultations in relation to disease control were also of concern within the sector. A 66 per cent increase in childcare issues was noted, as well as a 148 per cent increase in eldercare issues, and a 112 per cent increase in addiction issues. The findings indicated that the EAP is being effectively communicated as a relevant and accessible tool. As the industry continues to develop in remote regions, new services and resources will be required to retain existing workforces and attract new employees. Prevention-focused training and services and program for at-risk groups are needed to ensure that employee health and productivity is maintained. 1 tab., 4 figs.

  14. CRM 2.0 within E-Health Systems: Towards Achieving Health Literacy & Customer Satisfaction

    Anshari, Muhammad; Low, Patrick Kim Cheng

    2012-01-01

    Customer Relationship Management (CRM) within healthcare organization can be viewed as a strategy to attract new customers and retaining them throughout their entire lifetime of relationships. At the same time, the advancement of Web technology known as Web 2.0 plays a significant part in the CRM transition which drives social change that impacts all institutions including business and healthcare organizations. This new paradigm has been named as Social CRM or CRM 2.0 because it is based on Web 2.0. We conducted survey to examine the features of CRM 2.0 in healthcare scenario to the customer in Brunei Darussalam. We draw the conclusion that the CRM 2.0 in healthcare technologies has brought a possibility to extend the services of e-health by enabling patients, patient's families, and community at large to participate more actively in the process of health education; it helps improve health literacy through empowerment, social networking process, and online health educator. This paper is based on our works pre...

  15. Risk and protective factors associated with being a victim of aggression in the health sector. Research protocol

    Giovanna Parmigiani

    2016-09-01

    Full Text Available Background: aggression against healthcare workers is an alarming issue worldwide. However, there is lack of data on psychological vulnerability factors (such as personality traits, attachment style which can constitute a risk or a protective factor for being a victim of an episode of violence in the health sector. Methods/design: the present protocol is a cross-sectional study on prevalence and characteristics of violent episodes experienced by nursing students in the clinical setting. Its aim is to identify risk and protective factors for becoming a victim of verbal and/or physical aggression among healthcare workers. Participants will undergo an intensive battery of psychometric tests, dealing with episodes of aggression in the previous year, attachment style, personality traits, perceived stress, health related quality of life and job strain. Conclusions: the findings derived from this study may be of value in identifying vulnerability factors in experiencing an episode of aggression in the health sector. In this respect, it is a step towards the development of valid training and support focused on health workers, aimed at teaching them how to modulate and manage their vulnerability factors in an efficient way.

  16. [The climate change policy of the city of São Paulo, Brazil: reflexivity and permeability of the health sector].

    Landin, Rubens; Giatti, Leandro Luiz

    2014-10-01

    São Paulo is today an unsustainable city in which social and environmental vulnerabilities are obliged to tackle the uncertainties of climate change. To face up to this situation, in 2009 the city unveiled its Climate Change Policy. The scope of this paper is to analyze how the health sector is preparing to contribute to the implementation of this policy by 2012. Content analysis was the method adopted by examining official documents and conducting semi-structured interviews. In a context of social transformation affected by environmental degradation and socio-environmental consequences there is a need for the cessation of inertia and a demand for new knowledge systems. The outcomes of the study showed a positive intersectorial dialectic relationship, since the research hypothesis was that the health sector would be called upon to back actions on air quality monitoring. Its verification showed a broad scope introducing health promotion and preventive actions as the determinant focus, especially influencing other public policies. Thus, the process under scrutiny acquired reflexivity when evolving with interactive measures breaking with the traditional sectorial and reductionist policy model. It shows an intersectorial perspective based on the importance of issues related to local public health.

  17. Advances in participatory occupational health aimed at good practices in small enterprises and the informal sector.

    Kogi, Kazutaka

    2006-01-01

    Participatory programmes for occupational risk reduction are gaining importance particularly in small workplaces in both industrially developing and developed countries. To discuss the types of effective support, participatory steps commonly seen in our "work improvement-Asia" network are reviewed. The review covered training programmes for small enterprises, farmers, home workers and trade union members. Participatory steps commonly focusing on low-cost good practices locally achieved have led to concrete improvements in multiple technical areas including materials handling, workstation ergonomics, physical environment and work organization. These steps take advantage of positive features of small workplaces in two distinct ways. First, local key persons are ready to accept local good practices conveyed through personal, informal approaches. Second, workers and farmers are capable of understanding technical problems affecting routine work and taking flexible actions leading to solving them. This process is facilitated by the use of locally adjusted training tools such as local good examples, action checklists and group work methods. It is suggested that participatory occupational health programmes can work in small workplaces when they utilize low-cost good practices in a flexible manner. Networking of these positive experiences is essential.

  18. Climate variability and change and their potential health effects in small island states: information for adaptation planning in the health sector.

    Ebi, Kristie L; Lewis, Nancy D; Corvalan, Carlos

    2006-12-01

    Small island states are likely the countries most vulnerable to climate variability and longterm climate change. Climate models suggest that small island states will experience warmer temperatures and changes in rainfall, soil moisture budgets, prevailing winds (speed and direction), and patterns of wave action. El Niño events likely will strengthen shortterm and interannual climate variations. In addition, global mean sea level is projected to increase by 0.09-0.88 m by 2100, with variable effects on regional and local sea level. To better understand the potential human health consequences of these projected changes, a series of workshops and a conference organized by the World Health Organization, in partnership with the World Meteorological Organization and the United Nations Environment Programme, addressed the following issues: the current distribution and burden of climate-sensitive diseases in small island states, the potential future health impacts of climate variability and change, the interventions currently used to reduce the burden of climate-sensitive diseases, additional interventions that are needed to adapt to current and future health impacts, and the health implications of climate variability and change in other sectors. Information on these issues is synthesized and key recommendations are identified for improving the capacity of the health sector to anticipate and prepare for climate variability and change in small island states.

  19. Measuring sustainability as a programming tool for health sector investments: report from a pilot sustainability assessment in five Nepalese health districts.

    Sarriot, Eric; Ricca, Jim; Ryan, Leo; Basnet, Jagat; Arscott-Mills, Sharon

    2009-01-01

    Sustainability is a critical determinant of scale and impact of health sector development assistance programs. Working with USAID/Nepal implementing partners, we adapted a sustainability assessment framework to help USAID test how an evaluation tool could inform its health portfolio management. The essential first process step was to define the boundaries of the local system being examined. This local system-the unit of analysis of the study-was defined as the health district.We developed a standardized set of assessment tools to measure 53 indicators. Data collection was carried out over 4 weeks by a Nepalese agency. Scaling and combining indicators into six component indices provided a map of progress toward sustainable maternal, child, health, and family planning results for the five districts included in this pilot study, ranked from "no sustainability" to "beginning of sustainability."We conclude that systematic application of the Sustainability Framework could improve the health sector investment decisions of development agencies. It could also give districts an information base on which to build autonomy and accountability. The ability to form and test hypotheses about the sustainability of outcomes under various funding strategies-made possible by this approach-will be a prerequisite for more efficiently meeting the global health agenda.

  20. An assessment of health sector guidelines and services for treatment of sexual violence in El Salvador, Guatemala, Honduras and Nicaragua.

    McNaughton Reyes, H Luz; Billings, Deborah L; Paredes-Gaitan, Yolanda; Padilla Zuniga, Karen

    2012-12-01

    In Central America, approximately 12% of women report ever having been forced to have sex by an intimate male partner, and sexual violence by others is also a frequent experience. All Central American countries are signatories to human rights agreements that oblige States to ensure access to comprehensive health services for victims of sexual violence, but there is limited information as to whether these agreements have been translated into policy and practice. This article critically examines health sector guidelines for the treatment of sexual violence in El Salvador, Guatemala, Honduras and Nicaragua, and reports on an assessment of services in 34 private- and public-sector facilities in the four countries. Overall, policies were consistent with international agreements and included guidance on detection and documentation of violence, forensic examination, treatment, referral and follow-up care. However, only a small proportion of women who experience sexual violence actually seek care. The challenge facing all four countries is to turn policy into practice. Screening practices were inconsistent, and policies needed to indicate more clearly the roles and responsibilities of health care providers and forensic specialists. Finally, women's right to privacy and confidentiality in reports of cases to legal authorities needed further consideration, as well as the importance of providing all services at a single location.

  1. Factors influencing decision-making by social care and health sector professionals in cases of elder financial abuse.

    Davies, Miranda L; Gilhooly, Mary L M; Gilhooly, Kenneth J; Harries, Priscilla A; Cairns, Deborah

    2013-01-01

    This study aimed to identify the factors that have the greatest influence on UK social care and health sector professionals' certainty that an older person is being financially abused, their likelihood of intervention, and the type of action most likely to be taken. A factorial survey approach, applying a fractional factorial design, was used. Health and social care professionals (n = 152) viewed a single sample of 50 elder financial abuse case vignettes; the vignettes contained seven pieces of information (factors). Following multiple regression analysis, incremental F tests were used to compare the impact of each factor on judgements. Factors that had a significant influence on judgements of certainty that financial abuse was occurring included the older person's mental capacity and the nature of the financial problem suspected. Mental capacity accounted for more than twice the variance in likelihood of action than the type of financial problem. Participants from social care were more likely to act and chose more actions compared to health sector participants. The results are discussed in relation to a bystander intervention model. The impact of the older person's mental capacity on decision-making suggests the need for training to ensure action is also taken in cases where older people have full mental capacity and are being abused. Training also needs to highlight the more subtle types of financial abuse, the types that appear not to lead to certainty or action.

  2. Innovative health service delivery models in low and middle income countries - what can we learn from the private sector?

    Daar Abdallah S

    2010-07-01

    Full Text Available Abstract Background The poor in low and middle income countries have limited access to health services due to limited purchasing power, residence in underserved areas, and inadequate health literacy. This produces significant gaps in health care delivery among a population that has a disproportionately large burden of disease. They frequently use the private health sector, due to perceived or actual gaps in public services. A subset of private health organizations, some called social enterprises, have developed novel approaches to increase the availability, affordability and quality of health care services to the poor through innovative health service delivery models. This study aims to characterize these models and identify areas of innovation that have led to effective provision of care for the poor. Methods An environmental scan of peer-reviewed and grey literature was conducted to select exemplars of innovation. A case series of organizations was then purposively sampled to maximize variation. These cases were examined using content analysis and constant comparison to characterize their strategies, focusing on business processes. Results After an initial sample of 46 studies, 10 case studies of exemplars were developed spanning different geography, disease areas and health service delivery models. These ten organizations had innovations in their marketing, financing, and operating strategies. These included approaches such a social marketing, cross-subsidy, high-volume, low cost models, and process reengineering. They tended to have a narrow clinical focus, which facilitates standardizing processes of care, and experimentation with novel delivery models. Despite being well-known, information on the social impact of these organizations was variable, with more data on availability and affordability and less on quality of care. Conclusions These private sector organizations demonstrate a range of innovations in health service delivery that have

  3. Comprehensive approach to improving maternal health and achieving MDG 5: report from the mountains of Lesotho.

    Hind Satti

    Full Text Available BACKGROUND: Although it is now widely recognized that reductions in maternal mortality and improvements in women's health cannot be achieved through simple, vertical strategies, few programs have provided successful models for how to integrate services into a comprehensive program for maternal health. We report our experience in rural Lesotho, where Partners In Health (PIH in partnership with the Ministry of Health and Social Welfare implemented a program that provides comprehensive care of pregnant women from the community to the clinic level. METHODS: Between May and July 2009, PIH trained 100 women, many of whom were former traditional birth attendants, to serve as clinic-affiliated maternal health workers. They received performance-based incentives for accompanying pregnant women during antenatal care (ANC visits and facility-based delivery. A nurse-midwife provided ANC and delivery care and supervised the maternal health workers. To overcome geographic barriers to delivering at the clinic, women who lived far from the clinic stayed at a maternal lying-in house prior to their expected delivery dates. We analyzed data routinely collected from delivery and ANC registers to compare service utilization before and after implementation of the program. RESULTS: After the establishment of the program, the average number first ANC visits increased from 20 to 31 per month. The clinic recorded 178 deliveries in the first year of the program and 216 in the second year, compared to 46 in the year preceding the program. During the first two years of the program, 49 women with complications were successfully transported to the district hospital, and no maternal deaths occurred among the women served by the program. CONCLUSIONS: Our results demonstrate that it is possible to achieve dramatic improvements in the utilization of maternal health services and facility-based delivery by strengthening human resource capacity, implementing active follow-up in the

  4. Information technology systems in public sector health facilities in developing countries: the case of South Africa

    Cline Gregory B

    2013-01-01

    Full Text Available Abstract Background The public healthcare sector in developing countries faces many challenges including weak healthcare systems and under-resourced facilities that deliver poor outcomes relative to total healthcare expenditure. Global references demonstrate that information technology has the ability to assist in this regard through the automation of processes, thus reducing the inefficiencies of manually driven processes and lowering transaction costs. This study examines the impact of hospital information systems implementation on service delivery, user adoption and organisational culture within two hospital settings in South Africa. Methods Ninety-four interviews with doctors, nurses and hospital administrators were conducted in two public sector tertiary healthcare facilities (in two provinces to record end-user perceptions. Structured questionnaires were used to conduct the interviews with both qualitative and quantitative information. Results Noteworthy differences were observed among the three sample groups of doctors, nurses and administrators as well as between our two hospital groups. The impact of automation in terms of cost and strategic value in public sector hospitals is shown to have yielded positive outcomes with regard to patient experience, hospital staff workflow enhancements, and overall morale in the workplace. Conclusion The research provides insight into the reasons for investing in system automation, the associated outcomes, and organisational factors that impact the successful adoption of IT systems. In addition, it finds that sustainable success in these initiatives is as much a function of the technology as it is of the change management function that must accompany the system implementation.

  5. Information technology systems in public sector health facilities in developing countries: the case of South Africa

    2013-01-01

    Background The public healthcare sector in developing countries faces many challenges including weak healthcare systems and under-resourced facilities that deliver poor outcomes relative to total healthcare expenditure. Global references demonstrate that information technology has the ability to assist in this regard through the automation of processes, thus reducing the inefficiencies of manually driven processes and lowering transaction costs. This study examines the impact of hospital information systems implementation on service delivery, user adoption and organisational culture within two hospital settings in South Africa. Methods Ninety-four interviews with doctors, nurses and hospital administrators were conducted in two public sector tertiary healthcare facilities (in two provinces) to record end-user perceptions. Structured questionnaires were used to conduct the interviews with both qualitative and quantitative information. Results Noteworthy differences were observed among the three sample groups of doctors, nurses and administrators as well as between our two hospital groups. The impact of automation in terms of cost and strategic value in public sector hospitals is shown to have yielded positive outcomes with regard to patient experience, hospital staff workflow enhancements, and overall morale in the workplace. Conclusion The research provides insight into the reasons for investing in system automation, the associated outcomes, and organisational factors that impact the successful adoption of IT systems. In addition, it finds that sustainable success in these initiatives is as much a function of the technology as it is of the change management function that must accompany the system implementation. PMID:23347433

  6. Early hearing detection and intervention services in the public health sector in South Africa.

    Theunissen, Marianne; Swanepoel, DeWet

    2008-01-01

    The purpose of this study was to examine the current status of newborn/infant hearing screening programs in public sector hospitals in South Africa by means of a descriptive survey. Data was gathered using a self-administered postal questionnaire, which included questions on screening resources and protocols, follow-up, diagnostic, and information management procedures as well as timing of intervention. The questionnaire was sent to 86 speech therapy and audiology departments within public sector hospitals throughout South Africa and 44 questionnaires were returned. The findings indicated that 27% (n=12) of respondents were conducting some form of hearing screening. The most frequently reported reasons for the absence of a screening program were a lack of appropriate equipment and a shortage of staff. Institutions with active screening programs face many challenges and programs are mostly unsystematic. Reported findings make a valuable contribution to the field of early hearing detection and intervention by providing a baseline for the development and structuring of early hearing detection and intervention services as a priority in the public healthcare sector of South Africa.

  7. From health services to medical markets: the commodity transformation of medical production and the nonprofit sector.

    Imershein, A W; Estes, C L

    1996-01-01

    In recent years the language and logic of medical care have moved from providing medical services to marketing product lines. Analysis in this article examines this task transformation and its implications for transformation of the nonprofit sector and of the state. The authors argue that these transformations are essential explanatory elements to account for the origins of medical services in the nonprofit sector, the early exclusion of capitalist organizations from hospital care, and the changes that fostered corporate entry. To wit, medical care tasks have undergone a two-stage transformation. The first transformation changed open-ended, ill-defined services with uncertain funding into more highly organized and codified services with stable funding, attracting both capitalist enterprises and capitalist logic into the nonprofit sector. The second transformation standardized medical care tasks into product lines, a process that also challenged the status of the nonprofit organizations performing these tasks. In an analysis of the second transformation, the authors argue that this challenge is in the process of turning back upon itself, undermining the conditions that fostered capitalist entry into medical care delivery in the first place.

  8. Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing.

    Tangcharoensathien, Viroj; Limwattananon, Supon; Patcharanarumol, Walaiporn; Thammatacharee, Jadej; Jongudomsuk, Pongpisut; Sirilak, Supakit

    2015-11-01

    Strategic purchasing is one of the key policy instruments to achieve the universal health coverage (UHC) goals of improved and equitable access and financial risk protection. Given favourable outcomes of Universal Coverage Scheme (UCS), this study synthesized strategic purchasing experiences in the National Health Security Office (NHSO) responsible for the UCS in contributing to achieving UHC goals. The UCS applied the purchaser-provider split concept where NHSO, as a purchaser, is in a good position to enforce accountability by public and private providers to the UCS beneficiaries, through active purchasing. A comprehensive benefit package resulted in high level of financial risk protection as reflected by low incidence of catastrophic health spending and impoverished households. The NHSO contracted the District Health System (DHS) network, to provide outpatient, health promotion and disease prevention services to the whole district population, based on an annual age-adjusted capitation payment. In most cases, the DHS was the only provider in a district without competitors. Geographical monopoly hampered the NHSO to introduce a competitive contractual agreement, but a durable, mutually dependent relationship based on trust was gradually evolved, while accreditation is an important channel for quality improvement. Strategic purchasing services from DHS achieved a pro-poor utilization due to geographical proximity, where travel time and costs were minimal. Inpatient services paid by Diagnostic Related Group within a global budget ceiling, which is estimated based on unit costs, admission rates and admission profiles, contained cost effectively. To prevent potential under-provisions of the services, some high cost interventions were unbundled from closed end payment and paid on an agreed fee schedule. Executing monopsonistic purchasing power by NHSO brought down price of services given assured quality. Cost saving resulted in more patients served within a finite

  9. On the Path to SunShot - The Environmental and Public Health Benefits of Achieving High Penetrations of Solar Energy in the United States

    Wiser, Ryan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Mai, Trieu [National Renewable Energy Lab. (NREL), Golden, CO (United States); Millstein, Dev [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Macknick, Jordan [National Renewable Energy Lab. (NREL), Golden, CO (United States); Carpenter, Alberta [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cohen, Stuart [National Renewable Energy Lab. (NREL), Golden, CO (United States); Cole, Wesley [National Renewable Energy Lab. (NREL), Golden, CO (United States); Frew, Bethany [National Renewable Energy Lab. (NREL), Golden, CO (United States); Heath, Garvin [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2016-05-01

    Monetizing the environmental health benefits of solar could add ~3.5¢/kWh to the value of solar energy (see Wiser et al. 2016). The monetary impacts due to environmental degradation and public health impacts seem far removed from the apparent “sticker price” of electricity. Yet quantifying these impacts is essential to understanding the true costs and benefits of solar and conventional generating technologies. Compared with fossil fuel generators, PV and CSP produce far lower lifecycle levels of greenhouse gas (GHG) emissions and harmful pollutants including fine particular matter (PM2.5), sulfur dioxide (SO2), and nitrogen oxides (NOx). Achieving the SunShot-level solar deployment targets—14% of U.S. electricity demand met by solar in 2030 and 27% in 2050—could reduce cumulative power-sector GHG emissions by 10% between 2015 and 2050, resulting in savings of $238–$252 billion. This is equivalent to 2.0–2.2 cents per kilowatt-hour of solar installed (¢/kWh-solar). Similarly, realizing these levels of solar deployment could reduce cumulative power-sector emissions of PM2.5 by 8%, SO2 by 9%, and NOx by 11% between 2015 and 2050. This could produce $167 billion in savings from lower future health and environmental damages, or 1.4¢/kWh-solar—while also preventing 25,000–59,000 premature deaths. To put this in perspective, the estimated 3.5¢/kWh-solar in benefits due to SunShot-level solar deployment is approximately equal to the additional LCOE reduction needed to make unsubsidized utility-scale solar competitive with conventional generators today. In addition, water savings from achieving the SunShot goals, could result in the 2015–2050 cumulative savings of 4% of total power-sector withdrawals and 9% of total power-sector consumption—a particularly important consideration for arid states where substantial solar will be deployed. Improving public health and the environment is but one aspect of solar’s many costs and benefits. Clearly, however

  10. Problems and tendencies in management optimisation of hospital sector within health care system of Republic of Bulgaria

    M.G. Stoycheva

    2013-03-01

    Full Text Available The aim of the article. The purpose of this article is to analyze the specifics, priorities and tendencies of the reforms in hospital sector management within the health care system of Republic of Bulgaria, the hospital care organization practices in relation to the National discussions on issues of hospital sector of the health care system.The results of the analysis. The accession of Republic of Bulgaria to the EU has created new conditions in defining the priorities in the area of public health care, including hospital medical aid. Summarizing, accumulation and transfer of experience in reforming of health care systems of the European Union member states, development of unified requirements, harmonization of legislation, financing, structure of functioning and management of hospital care within the health care system, lead to the need of deep analysis of situation, strategic priorities renewal, management optimization of whole health care system, and in particular the hospital care system in Republic of Bulgaria.In the article the author analyses the research and publications of some major materials, regulations and documents, which provided the basis for the reforms in the health care management system in Republic of Bulgaria in its continuing integration into the pan-European system. Illustrating current situation analysis, the author shares the opinion that the most important part in the organization of common management system in health care is the sector responsible for the development of hospital financing.The author pays special attention to the issues of economic activity of health care institutions.The author cites a number of documents of the National Centre for Medical Information (NCMI noting that leading specialists of the Centre: .Dikov, R.Kolarova, T.Hundurzhievhave prepared detailed reports on economics 2001-2008 and comparative analysis of the medical institutions operation as well as those for outpatient care in Republic of

  11. Achieving the health Millennium Development Goals for South Africa: challenges and priorities.

    Chopra, Mickey; Lawn, Joy E; Sanders, David; Barron, Peter; Abdool Karim, Salim S; Bradshaw, Debbie; Jewkes, Rachel; Abdool Karim, Quarraisha; Flisher, Alan J; Mayosi, Bongani M; Tollman, Stephen M; Churchyard, Gavin J; Coovadia, Hoosen

    2009-09-19

    15 years after liberation from apartheid, South Africans are facing new challenges for which the highest calibre of leadership, vision, and commitment is needed. The effect of the unprecedented HIV/AIDS epidemic has been immense. Substantial increases in mortality and morbidity are threatening to overwhelm the health system and undermine the potential of South Africa to attain the Millennium Development Goals (MDGs). However The Lancet's Series on South Africa has identified several examples of leadership and innovation that point towards a different future scenario. We discuss the type of vision, leadership, and priority actions needed to achieve such a change. We still have time to change the health trajectory of the country, and even meet the MDGs. The South African Government, installed in April, 2009, has the mandate and potential to address the public health emergencies facing the country--will they do so or will another opportunity and many more lives be lost?

  12. Capacity building in the health sector to improve care for child nutrition and development.

    Yousafzai, Aisha K; Rasheed, Muneera A; Daelmans, Bernadette; Manji, Sheila; Arnold, Caroline; Lingam, Raghu; Muskin, Joshua; Lucas, Jane E

    2014-01-01

    The effectiveness of interventions promoting healthy child growth and development depends upon the capacity of the health system to deliver a high-quality intervention. However, few health workers are trained in providing integrated early child-development services. Building capacity entails not only training the frontline worker, but also mobilizing knowledge and support to promote early child development across the health system. In this paper, we present the paradigm shift required to build effective partnerships between health workers and families in order to support children's health, growth, and development, the practical skills frontline health workers require to promote optimal caregiving, and the need for knowledge mobilization across multiple institutional levels to support frontline health workers. We present case studies illustrating challenges and success stories around capacity development. There is a need to galvanize increased commitment and resources to building capacity in health systems to deliver early child-development services.

  13. Understanding and benchmarking health service achievement of policy goals for chronic disease

    Bell Erica

    2012-09-01

    Full Text Available Abstract Background Key challenges in benchmarking health service achievement of policy goals in areas such as chronic disease are: 1 developing indicators and understanding how policy goals might work as indicators of service performance; 2 developing methods for economically collecting and reporting stakeholder perceptions; 3 combining and sharing data about the performance of organizations; 4 interpreting outcome measures; 5 obtaining actionable benchmarking information. This study aimed to explore how a new Boolean-based small-N method from the social sciences—Qualitative Comparative Analysis or QCA—could contribute to meeting these internationally shared challenges. Methods A ‘multi-value QCA’ (MVQCA analysis was conducted of data from 24 senior staff at 17 randomly selected services for chronic disease, who provided perceptions of 1 whether government health services were improving their achievement of a set of statewide policy goals for chronic disease and 2 the efficacy of state health office actions in influencing this improvement. The analysis produced summaries of configurations of perceived service improvements. Results Most respondents observed improvements in most areas but uniformly good improvements across services were not perceived as happening (regardless of whether respondents identified a state health office contribution to that improvement. The sentinel policy goal of using evidence to develop service practice was not achieved at all in four services and appears to be reliant on other kinds of service improvements happening. Conclusions The QCA method suggested theoretically plausible findings and an approach that with further development could help meet the five benchmarking challenges. In particular, it suggests that achievement of one policy goal may be reliant on achievement of another goal in complex ways that the literature has not yet fully accommodated but which could help prioritize policy goals. The

  14. Tool, weapon, or white elephant? A realist analysis of the five phases of a twenty-year programme of occupational health information system implementation in the health sector

    Spiegel Jerry M

    2012-08-01

    Full Text Available Abstract Background Although information systems (IS have been extensively applied in the health sector worldwide, few initiatives have addressed the health and safety of health workers, a group acknowledged to be at high risk of injury and illness, as well as in great shortage globally, particularly in low and middle-income countries. Methods Adapting a context-mechanism-outcome case study design, we analyze our team’s own experience over two decades to address this gap: in two different Canadian provinces; and two distinct South African settings. Applying a realist analysis within an adapted structuration theory framing sensitive to power relations, we explore contextual (socio-political and technological characteristics and mechanisms affecting outcomes at micro, meso and macro levels. Results Technological limitations hindered IS usefulness in the initial Canadian locale, while staffing inadequacies amid pronounced power imbalances affecting governance restricted IS usefulness in the subsequent Canadian application. Implementation in South Africa highlighted the special care needed to address power dynamics regarding both worker-employer relations (relevant to all occupational health settings and North–south imbalances (common to all international interactions. Researchers, managers and front-line workers all view IS implementation differently; relationships amongst the workplace parties and between community and academic partners have been pivotal in determining outcome in all circumstances. Capacity building and applying creative commons and open source solutions are showing promise, as is international collaboration. Conclusions There is worldwide consensus on the need for IS use to protect the health workforce. However, IS implementation is a resource-intensive undertaking; regardless of how carefully designed the software, contextual factors and the mechanisms adopted to address these are critical to mitigate threats and achieve

  15. Achieving Continuity of Care: Facilitators and Barriers in Community Mental Health Teams

    Jones Ian Rees

    2011-03-01

    Full Text Available Abstract Background The integration of mental health and social services for people diagnosed with severe mental illness (SMI has been a key aspect of attempts to reform mental health services in the UK and aims to minimise user and carer distress and confusion arising from service discontinuities. Community mental health teams (CMHTs are a key component of UK policy for integrated service delivery, but implementing this policy has raised considerable organisational challenges. The aim of this study was to identify and explore facilitators and barriers perceived to influence continuity of care by health and social care professionals working in and closely associated with CMHTs. Methods This study employed a survey design utilising in-depth, semi-structured interviews with a proportionate, random sample of 113 health and social care professionals and representatives of voluntary organisations. Participants worked in two NHS Mental Health Trusts in greater London within eight adult CMHTs and their associated acute in-patient wards, six local general practices, and two voluntary organisations. Results Team leadership, decision making, and experiences of teamwork support were facilitators for cross boundary and team continuity; face-to-face communication between teams, managers, general practitioners, and the voluntary sector were facilitators for information continuity. Relational, personal, and longitudinal continuity were facilitated in some local areas by workforce stability. Barriers for cross boundary and team continuity were specific leadership styles and models of decision making, blurred professional role boundaries, generic working, and lack of training for role development. Barriers for relational, personal, and longitudinal continuity were created by inadequate staffing levels, high caseloads, and administrative duties that could limit time spent with users. Incompatibility of information technology systems hindered information

  16. Health impact and cost-effectiveness of a private sector bed net distribution: experimental evidence from Zambia

    2013-01-01

    Background Relatively few programmes have attempted to actively engage the private sector in national malaria control efforts. This paper evaluates the health impact of a large-scale distribution of insecticide-treated nets (ITNs) conducted in partnership with a Zambian agribusiness, and its cost-effectiveness from the perspective of the National Malaria Control Programme (NMCP). Methods The study was designed as a cluster-randomized controlled trial. A list of 81,597 cotton farmers was obtained from Dunavant, a contract farming company in Zambia’s cotton sector, in December 2010. 39,963 (49%) were randomly selected to obtain one ITN each. Follow-up interviews were conducted with 438 farmers in the treatment and 458 farmers in the control group in June and July 2011. Treatment and control households were compared with respect to bed net ownership, bed net usage, self-reported fever, and self-reported confirmed malaria. Cost data was collected throughout the programme. Results The distribution effectively reached target beneficiaries, with approximately 95% of households in the treatment group reporting that they had received an ITN through the programme. The average increase in the fraction of household members sleeping under an ITN the night prior to the interview was 14.6 percentage points (p-value <0.001). Treatment was associated with a 42 percent reduction in the odds of self-reported fever (p-value <0.001) and with a 49 percent reduction in the odds of self-reported malaria (p-value 0.002). This was accomplished at a cost of approximately five US$ per ITN to Zambia’s NMCP. Conclusions The results illustrate that existing private sector networks can efficiently control malaria in remote rural regions. The intra-household allocation of ITNs distributed through this channel was comparable to that of ITNs received from other sources, and the health impact remained substantial. PMID:23506170

  17. Efficiency of Health Care Sector at Sub-State Level in India: A Case of Punjab

    Brijesh C. Purohit

    2009-11-01

    Full Text Available In recent years, WHO and other individual researchers have advocated estimation of health system performance through stochastic frontier models. It provides an idealized yardstick to evaluate economic performance of health system. So far attempts in India have remained focused at state level analysis. This paper attempts a sub-state level analysis for an affluent Indian state, namely Punjab, by using stochastic frontier technique. Our results provide pertinent insight into state health system and facilitate health facility planning at the sub-state level. Carried out in two stages of estimation, our results suggest that life expectancy in the Indian state could be enhanced considerably by correcting the factors that are adversely influencing the sub-state level health system efficiency. A higher budgetary allocation for health manpower is recommended by us to improve efficiency in poorly performing districts. This may be supported by policy initiatives outside the health system by empowering women through better education and work participation.

  18. The Ha Noi Expert Statement: recognition of maternal mental health in resource-constrained settings is essential for achieving the Millennium Development Goals

    Izutsu Takashi

    2011-01-01

    mortality, promote gender equality and empower women, achieve universal primary education and eradicate extreme poverty and hunger cannot be attained without a specific focus on women's mental health. It was co-signed by the international expert group; relevant WHO and UNFPA departmental representatives and international authorities. They concur that social rather than medical responses are required. Improvements in maternal mental health require a cross-sectoral response addressing poverty reduction, women's rights, social protection, violence prevention, education and gender in addition to health. Additional file 1 Maternal mental health and child survival, health and development in resource-constrained settings: essential for achieving the Millennium Development Goals. This additional file is the Hanoi Expert Statement which is the outcome of the meeting described in this paper. Click here for file

  19. Optimising value and quality in general practice within the primary health care sector through relationship marketing: a conceptual framework.

    Bansal, Manjit K

    2004-01-01

    Discusses the rationale of applying relationship marketing and service quality concepts within the primary health care sector. The use of relational strategies in general practice, by modelling the relationships between practitioners and patients from a marketing perspective, could potentially lead to sustained high quality service being provided, and to more efficient use of resources. This essentially conceptually focused paper addresses an area that has not yet been researched in detail, and furthers understanding of the relationships that facilitate exchange within general practice and service delivery in non-profit, resource-constrained conditions. Deeper understanding of the needs and expectations of patients and the way these can be delivered by general practice can only lead to improvements for all parties involved. The relationship marketing paradigm presents itself as a potentially exciting way of addressing issues associated with ensuring that the highest level of quality is delivered in this area of the UK National Health Service.

  20. Empiricism, ethics and orthodox economic theory: what is the appropriate basis for decision-making in the health sector?

    Richardson, Jeff; McKie, John

    2005-01-01

    Economics is commonly defined in terms of the relationship between people's unlimited wants and society's scarce resources. The definition implies a central role for an understanding of what people want, i.e. their objectives. This, in turn, suggests an important role for both empirical research into people's objectives and debate about the acceptability of the objectives. In contrast with this expectation, economics has avoided these issues by the adoption of an orthodoxy that imposes objectives. However evidence suggests, at least in the health sector, that people do not have the simple objectives assumed by economic theory. Amartya Sen has advocated a shift from a focus on "utility" to a focus on "capabilities" and "functionings" as a way of overcoming the shortcomings of welfarism. However, the practicality of Sen's account is threatened by the range of possible "functionings", by the lack of guidance about how they should be weighted, and by suspicions that they do not capture the full range of objectives people appear to value. We argue that "empirical ethics", an emerging approach in the health sector, provides important lessons on overcoming these problems. Moreover, it is an ethically defensible methodology, and yields practical results that can assist policy makers in the allocation of resources.

  1. Artificial interfaces ("AI") in surgery: historic development, current status and program implementation in the public health sector.

    Healy, Donagh A; Murphy, Shane P; Burke, John P; Coffey, John C

    2013-06-01

    The past two decades have seen considerable advances in the application of artificial interfaces (AI) in surgery. Several have been developed including AESOP (Automated Endoscopic System for Optimal Positioning), Zeus and the Da Vinci Surgical System (DVSS). Whilst each has advantages DVSS is being used increasingly across multiple surgical specialities. These developments generate many challenges in an era where the emphasis is increasingly on safer and cost-effective surgery. Whilst the role of DVSS is firmly established in urologic and gynaecologic surgery, the role of DVSS in gastrointestinal surgery is evolving. Recent data indicate that it is at least as oncologically effective, whilst providing numerous benefits (e.g. reduced conversion and complication rates) over traditional laparoscopic approaches. The increasing adoption of AI/DVSS worldwide places institutes and health sectors under increasing pressure to adopt and develop such programs. This article provides (1) an update on the current status of AI in surgery in general and in colorectal surgery and (2) an appraisal of the cost implications of the establishment and implementation of AI/DVSS-based provisions in the public health sector. The numerous challenges faced generate many opportunities in the implementation of present and future surgical technologies.

  2. Common Health, Safety and Environmental Concerns in Upstream Oil and Gas Sector: Implications for HSE Management in Ghana

    Seth Oppong

    2014-01-01

    Full Text Available This paper explores the literature to identify common occupational injuries, diseases, and psychological wellbeing on oil rigs as well as the negative environmental impacts of the upstream oil and gas sector. It ends by making recommendations for effective health, safety, and environmental (HSE management. Review of the literature showed that contusion (bruise, cuts, and laceration are the commonest occupational injuries that workers on the oil rig suffer and that the injuries mostly affect the hand and finger, leg, and eyes of the offshore workers. These injuries were found to be caused mostly by direct stroke, jamming and overstrain. Similarly, accidental poisoning, musculoskeletal disorders, respiratory disorders and diseases of the digestive system were also documented as the commonest occupational diseases among offshore workers. The literature also shows that working offshore is associated with poorer psychological wellbeing or health; this is to say that offshore workers tend to experience higher levels of stress, burnout, anxiety, depression, low job satisfaction (particularly with the environmental conditions associated with their work, and sleep disorders. Finally, the literature review indicated that land-use problems, air pollution, acid rain, climate change, habitat disruption, environmental degradation, oil spills and leakages are some of environmental impacts of upstream oil production. This review was concluded by recommending some measures for the management of the HSE hazards associated with the oil and gas sector.

  3. Findings from a hepatitis B birth dose assessment in health facilities in the Philippines: opportunities to engage the private sector

    Patel, Minal K.; Capeding, Rosario Z.; Ducusin, Joyce U.; de Quiroz Castro, Maricel; Garcia, Luzviminda C.; Hennessey, Karen

    2015-01-01

    Background Hepatitis B vaccination in the Philippines was introduced in 1992 to reduce the high burden of chronic hepatitis B virus (HBV) infection in the population; in 2007, a birth dose (HepB-BD) was introduced to decrease perinatal HBV transmission. Timely HepB-BD coverage, defined as doses given within 24 hours of birth, was 40% nationally in 2011. A first step in improving timely HepB-BD coverage is to ensure that all newborns born in health facilities are vaccinated. Methods In order to assess ways of improving the Philippines’ HepB-BD program, we evaluated knowledge, attitudes, and practices surrounding HepB-BD administration in health facilities. Teams visited selected government clinics, government hospitals, and private hospitals in regions with low reported HepB-BD coverage and interviewed immunization and maternity staff. HepB-BD coverage was calculated in each facility for a 3 month period in 2011. Results Of the 142 health facilities visited, 12 (8%) did not provide HepB-BD; seven were private hospitals and five were government hospitals. Median timely HepB-BD coverage was 90% (IQR 80%–100%) among government clinics, 87% (IQR 50%–97%) among government hospitals, and 50% (IQR 0%–90%) among private hospitals (p=0.02). The private hospitals were least likely to receive supervision (53% versus 6%–31%, p=0.0005) and to report vaccination data to the national Expanded Programme on Immunization (36% vs. 96%–100%, p<0.0001). Conclusions Private sector hospitals in the Philippines, which deliver 18% of newborns, had the lowest timely HepB-BD coverage. Multiple avenues exist to engage the private sector in hepatitis B prevention including through existing laws, newborn health initiatives, hospital accreditation processes, and raising awareness of the government’s free vaccine program. PMID:24361121

  4. The costs of mergers and acquisitions in the U.S. health care sector.

    Bond, P; Weissman, R

    1997-01-01

    Important trends are emerging from evidence of health care industry concentration in the United States. Some of these are the durable consumer concerns--cost, choice, and access--which have received attention throughout the introduction of managed care. But with the intensified industry concentration, these have been joined by concerns about pricing power, control and quality, integrity of health system and health policy-making, and clashing institutional mandates. Such trends are particularly evident in the hospital and pharmaceutical industries.

  5. Exploring the influence of trust relationships on motivation in the health sector: a systematic review.

    Okello, DR; Gilson, L

    2015-01-01

    Background Dedicated and motivated health workers (HWs) play a major role in delivering efficient and effective health services that improve patients’ experience of health care. Growing interest in HW motivation has led to a global focus on pay for performance strategies, but less attention has been paid to nurturing intrinsic motivation. Workplace trust relationships involve fair treatment and respectful interactions between individuals. Such relationships enable cooperation among HWs and th...

  6. Formative assessment and academic achievement in pre-graduate students of health sciences.

    Carrillo-de-la-Peña, María T; Baillès, Eva; Caseras, Xavier; Martínez, Alvar; Ortet, Generós; Pérez, Jorge

    2009-03-01

    Although educational experts recommend the use of formative assessment, there is a dearth of empirical studies on its impact on academic achievement. In this research the authors analyse to what extent participation and performance in formative assessment are associated with positive academic outcomes of pre-graduate students of health sciences. A total of 548 students from three health science degrees (Medicine, Psychology and Biology) from four Spanish universities were involved in this study. The students who carried out mid-term formative assessment got better marks and had higher success rates in final summative assessment that the students who did not participate. In addition, success in formative assessment tests was associated with better summative marks. Interestingly, participation in formative assessment was a better predictor of final outcome than success in formative assessment, a result that supports the key role of feedback in formative assessment. Students who took the mid-term examination, irrespective of their success, obtained feedback about their achievement and probably this determined their greater involvement in the learning process. Although causal relationships between formative and summative assessment cannot be established from this research, the generalized benefits of formative assessments found here encourage the practice of them in health sciences education.

  7. THE PUBLIC INTERNAL AUDIT COMMITTEE IN THE SOCIAL HEALTH INSURANCE SECTOR- A NECESSITY IN ROMANIA

    Iulian Bogdan Dobra; Attila Szora Tamas

    2009-01-01

    Health care reform and health system financing required to meet population needsand current financial constraints proved to be a major challenge worldwide. In these conditions therole of Public Internal Audit Committee in the public system is extremely important. It is known thatthe requirement to provide proposals to the Board, to the overall management and grant supportrequired for their implementation has led to these structures.

  8. Do multi-sectoral development programmes affect health? A Bolivian case study.

    Gonzales, F; Dearden, K; Jimenez, W

    1999-12-01

    This cross-sectional study, carried out in Inquisivi, Bolivia, a rural area where Save the Children/US works, tests the hypothesis that participation in multisectoral development programmes results in improved health behaviours and better health outcomes. To test this hypothesis, four groups of households were compared: those participating in Save the Children's health-only programmes; those with access to health and micro-enterprise credit or health and literacy programmes; those participating in all three programmes (health, credit and literacy); and households from comparison communities (no access to any of Save the Children's programmes). Data come from a stratified sample of 499 households in the altiplano, foothills and valleys of the Andes. Findings reported here suggest that there is no clear association between participation in one or more of Save the Children's programmes and parents' actions to prevent and treat diarrhoea. Additionally, the point prevalence of diarrhoea was similar for all four groups. However, children of individuals participating in health, credit and literacy were significantly less likely than children from comparison communities to be malnourished or at risk of becoming malnourished, even after controlling for such potentially confounding factors as social class, source of drinking water, and the availability of health facilities.

  9. Providers’ perspectives on inbound medical tourism in Central America and the Caribbean: factors driving and inhibiting sector development and their health equity implications

    Rory Johnston

    2016-11-01

    Full Text Available Background: Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. Objective: To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. Design: In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. Results: Four common drivers of medical tourism development were identified: 1 unused capacity in existing private hospitals, 2 international portability of health insurance, vis-a-vis international hospital accreditation, 3 internationally trained physicians as both marketable assets and industry entrepreneurs, and 4 promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1 the high expense of market entry, 2 poor sector-wide planning, and 3 structural socio-economic issues such as insecurity or relatively high business costs and financial risks. Conclusion: There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public

  10. Providers’ perspectives on inbound medical tourism in Central America and the Caribbean: factors driving and inhibiting sector development and their health equity implications

    Johnston, Rory; Crooks, Valorie A.; Cerón, Alejandro; Labonté, Ronald; Snyder, Jeremy; Núñez, Emanuel O.; Flores, Walter G.

    2016-01-01

    Background Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector. Objective To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equity implications. Design In-depth, semi-structured interviews were conducted in Mexico, Guatemala, and Barbados with 150 health system stakeholders. Participants were recruited from private and public sectors working in various fields: trade and economic development, health services delivery, training and administration, and civil society. Transcribed interviews were coded using qualitative data management software, and thematic analysis was used to identify cross-cutting issues regarding the drivers and inhibitors of medical tourism development. Results Four common drivers of medical tourism development were identified: 1) unused capacity in existing private hospitals, 2) international portability of health insurance, vis-a-vis international hospital accreditation, 3) internationally trained physicians as both marketable assets and industry entrepreneurs, and 4) promotion of medical tourism by public export development corporations. Three common inhibitors for the development of the sector were also identified: 1) the high expense of market entry, 2) poor sector-wide planning, and 3) structural socio-economic issues such as insecurity or relatively high business costs and financial risks. Conclusion There are shared factors shaping the development of medical tourism in Central America and the Caribbean that help explain why it is being pursued by many hospitals and governments in the region. Development of the sector is primarily being driven by public investment promotion

  11. An informatics system to support knowledge management in the health sector--the South African National Health Knowledge Network.

    Louw, J A; Seebregts, C J; Makgoba, W M; Fouché, B

    2001-01-01

    This paper discusses the planning and development of a South African national health knowledge network. The methodology is in essence based on the principles of knowledge management and the drivers of a system of innovation. The knowledge network, SA HealthInfo, aims to provide a one-stop interactive forum/resource, for quality-controlled and evidence-based health research information, to a wide spectrum of users, at various levels of aggregation, with the necessary security arrangements and facilities for interaction among users to promote explicit (codified) and tacit knowledge flow. It will therefore stimulate the process of innovation within the South African health system.

  12. The public health sector supply of modern contraceptives in rural Nigeria: an analysis of selection, forecasting and inventory control

    Asa Auta

    2011-07-01

    Full Text Available Public health facilities in rural Nigeria have been experiencing a long period of stock-outs and unavailability of modern contraceptives. This work was carried out to review the public health sector supply of modern contraceptives in rural Nigeria in order to make recommendations on how to improve the supply of modern contraceptives in this area. The study reviewed secondary data from country documents and literature obtained from Pubmed, Popline, and Global Health databases; as well as websites of USAID/DELIVER Project, Measure DHS and Federal Ministry of Health. The study revealed that a wide range of contraceptives are included in the essential drug list to be used in secondary facilities, while only a few ones are selected to be used in primary facilities which serve the majority of rural population. Forecasting is done using issue data from the central warehouse because facilities are not generating reliable consumption data. Inventory control is poor in rural facilities, and these facilities do not follow the established inventory control guidelines. The study therefore demonstrates that the current essential drug list should be reviewed in order to include injectables for use in primary facilities, strengthen the current forecasting, data reporting and inventory control system.

  13. Improving health and education outcomes for children in remote communities: A cross-sector and developmental evaluation approach

    Debra Maria Jones

    2015-09-01

    Full Text Available Early childhood is one of the most influential developmental life stages. Attainments at this stage will have implications for the quality of life children experience as they transition to adulthood. Children residing in remote Australia are exposed to socioeconomic disadvantage that can contribute to developmental delays and resultant poorer education and health outcomes. Complex contributing factors in far west New South Wales have resulted in children with speech and fine motor skill delays experiencing no to limited access to allied health services for a number of decades. More recently, growing awareness that no single policy, government agency, or program could effectively respond to these complexities or ensure appropriate allied health service access for children in these communities has led to the development of the Allied Health in Outback Schools Program, which has been operational since 2009. The program is underpinned by cross-sector partnerships and a shared aspirational aim to improve the developmental outcomes of children to enhance their later life opportunities. It was identified early that the initiative had the potential to deliver mutually beneficial outcomes for communities and participating partner organisations. Over the last five years the program has been the catalyst for partnership consolidation, expansion and diversification. The developmental evaluation approach to continuous program adaptation and refinement has provided valuable insights that have informed health and education policy and enabled the program to be responsive to changing community needs, emerging policy and funding reforms. This article explores the evolution of the program partnerships, their contribution to program success and longevity, and their capacity to respond to an emergent and dynamic environment. The authors propose that a community-centred and developmental approach to program innovation and implementation in remote locations is

  14. Patterns of perceptions of workplace violence in the Portuguese health care sector

    Craveiro Isabel

    2003-11-01

    Full Text Available Abstract This article characterizes the problem of violence against health professionals in the workplace (VAHPITWP in selected settings in Portugal. It addresses the questions of what types of violence are most frequent and who are the most affected health professionals. Three methodological approaches were followed: (i documentary studies, (ii a questionnaire-based hospital and health centre (HC complex case study and (iii semi-structured interviews with stakeholders. Of the different types of violence, all our study approaches confirm that verbal violence is the most frequent. Discrimination, not infrequent in the hospital, seems to be underestimated by the stakeholders interviewed. Violence seems much more frequent in the HC than in the hospital. In the HC, all types of violence are also most frequently directed against female health workers and, in the hospital, against male workers. These studies allow us to conclude that violence is frequent but underreported.

  15. Estimating the number of paediatric fevers associated with malaria infection presenting to Africa's public health sector in 2007.

    Peter W Gething

    2010-07-01

    Full Text Available BACKGROUND: As international efforts to increase the coverage of artemisinin-based combination therapy in public health sectors gather pace, concerns have been raised regarding their continued indiscriminate presumptive use for treating all childhood fevers. The availability of rapid-diagnostic tests to support practical and reliable parasitological diagnosis provides an opportunity to improve the rational treatment of febrile children across Africa. However, the cost effectiveness of diagnosis-based treatment polices will depend on the presumed numbers of fevers harbouring infection. Here we compute the number of fevers likely to present to public health facilities in Africa and the estimated number of these fevers likely to be infected with Plasmodium falciparum malaria parasites. METHODS AND FINDINGS: We assembled first administrative-unit level data on paediatric fever prevalence, treatment-seeking rates, and child populations. These data were combined in a geographical information system model that also incorporated an adjustment procedure for urban versus rural areas to produce spatially distributed estimates of fever burden amongst African children and the subset likely to present to public sector clinics. A second data assembly was used to estimate plausible ranges for the proportion of paediatric fevers seen at clinics positive for P. falciparum in different endemicity settings. We estimated that, of the 656 million fevers in African 0-4 y olds in 2007, 182 million (28% were likely to have sought treatment in a public sector clinic of which 78 million (43% were likely to have been infected with P. falciparum (range 60-103 million. CONCLUSIONS: Spatial estimates of childhood fevers and care-seeking rates can be combined with a relational risk model of infection prevalence in the community to estimate the degree of parasitemia in those fevers reaching public health facilities. This quantification provides an important baseline comparison

  16. Stakeholder views on factors influencing the wellbeing and health sector engagement of young Asian New Zealanders.

    Peiris-John, Roshini; Wong, Agnes; Sobrun-Maharaj, Amritha; Ameratunga, Shanthi

    2016-03-01

    INTRODUCTION In New Zealand, while the term 'Asians' in popular discourse means East and South-east Asian peoples, Statistics New Zealand's definition includes people of many nationalities from East, South and South-east Asia, all with quite different cultural norms, taboos and degrees of conservatism. In a context where 'Asian' youth data are typically presented in aggregate form, there are notable gaps in knowledge regarding the contextual determinants of health in this highly heterogeneous group. This qualitative study explored key stakeholder views on issues that would be most useful to explore on the health and wellbeing of Asian youth and processes that would foster engagement of Asian youth in health research. METHODS Interviews were conducted with six key stakeholders whose professional activities were largely focused on the wellbeing of Asian people. The general inductive approach was used to identify and analyse themes in the qualitative text data. FINDINGS Six broad themes were identified from the key stakeholder interviews framed as priority areas that need further exploration: cultural identity, integration and acculturation; barriers to help-seeking; aspects to consider when engaging Asian youth in research (youth voice, empowerment and participatory approach to research); parental influence and involvement in health research; confidentiality and anonymity; and capacity building and informing policy. CONCLUSION With stakeholders strongly advocating the engagement of Asian youth in the health research agenda this study highlights the importance of engaging youth alongside service providers to collaborate on research and co-design responsive primary health care services in a multicultural setting. KEYWORDS Asian youth; New Zealand; health research; minority health; Community and social participation.

  17. Efficiency of resource allocation in the hospital sector after global budgeting under National Health Insurance

    Victor Kreng; YANG Shao-wei

    2013-01-01

    Background Taiwan has implemented a National Health Insurance (NHI) program to provide uniform comprehensive coverage since 1995.Forced by the severe financial deficit,global budgeting is introduced to replace the original payment system in Taiwan's NHI.Under global budgeting system,the total budget is distributed to six geographical regions in Taiwan.There is no pre-determined budget for each hospital.In order to investigate the longitudinal trend of how global budgeting influences health care resource,it is essential to estimate the efficiency of resource allocation in Taiwan's NHI.Methods Data Envelopment Analysis (DEA) and Malmquist index (MI) are used to investigate the 8-year panel data of 23 cities and counties which was collected from the annual report from the Department of Health,Taiwan,China.A value of MI greater than 1 indicates that total factor productivity progress has occurred,while a value of MI less than 1 indicates productivity loss.Results As a result,37 of the 184 DMUs in the analysis were found to be relatively efficient during the period,in which 14 of 23 DMUs are efficient in 2002 right after adopting globe budgeting.A trend of MI declines between 2002 and 2009implies the volume of health care services decrease after adopting global budgeting system.Production efficiency has been improved after global budgeting implies that behaviors of health providers control cost and avoid wasting resource at macro level.Conclusions The regressive MI indicates the hospitals redistribute health care resource to eliminate unnecessary treatment and to control the growth of service volume under global budgeting system.Hence,a trend of declining MI focuses on health care resource redistribution rather than efficiency improvement in this study.

  18. "In the driver's seat": the Health Sector Strategic Master Plan as an instrument for aid coordination in Mongolia.

    Ulikpan, Anar; Narula, Indermohan; Malik, Asmat; Hill, Peter

    2014-04-03

    In 2005, the Ministry of Health (MoH) in Mongolia initiated the process of developing its Health Sector Strategic Master Plan (HSSMP), using a wide-ranging consultative process, driven by the MoH, and requiring participation from all levels of health facilities, other ministries, donor agencies and NGOs. Among other objectives, the MoH sought to coordinate the disparate inputs from key donors through the HSSMP, aligning them with the Plan's structure. This research explores the extent to which the HSSMP process served as a mechanism for effective aid coordination while promoting ownership and capacity building and the lessons learned for the wider international development community. The study is based on document review, key-informant interviews and authors' experience and participation in the MoH planning processes. The HSSMP process improved alignment and harmonisation. It enabled a better local understanding of the benefits of aid coordination, and the recognition that aid coordination as not only a mere administrative task, but a strategic step towards comprehensive management of both domestic and external resources. The process was not challenge free; the fractious political environment, the frequent turnover of key MoH staff, the resistance of some donors towards MoH scrutiny over their programmes and the dismantling of the central coordination and return of seconded staff following completion of the HSSMP, has slowed the pace of reform. Despite the challenges, the approach resulted in positive outcomes in the areas of ownership and better aid coordination, with HSSMP development emphasising ownership and capacity building. This contrasted with the usual outcomes focus, and neglect of the capacity building learning processes and structural and policy changes needed to ensure sustainable change. The largest and most influential programmes in the health sector are now largely aligned with HSSMP strategies, enabling the MoH to utilize these opportunities to

  19. Providers’ perspectives on inbound medical tourism in Central America and the Caribbean: factors driving and inhibiting sector development and their health equity implications

    2016-01-01

    Background: Many governments and health care providers worldwide are enthusiastic to develop medical tourism as a service export. Despite the popularity of this policy uptake, there is relatively little known about the specific local factors prospectively motivating and informing development of this sector.Objective: To identify common social, economic, and health system factors shaping the development of medical tourism in three Central American and Caribbean countries and their health equit...

  20. District decision-making for health in low-income settings: a qualitative study in Uttar Pradesh, India, on engaging the private health sector in sharing health-related data.

    Gautham, Meenakshi; Spicer, Neil; Subharwal, Manish; Gupta, Sanjay; Srivastava, Aradhana; Bhattacharyya, Sanghita; Avan, Bilal Iqbal; Schellenberg, Joanna

    2016-09-01

    Health information systems are an important planning and monitoring tool for public health services, but may lack information from the private health sector. In this fourth article in a series on district decision-making for health, we assessed the extent of maternal, newborn and child health (MNCH)-related data sharing between the private and public sectors in two districts of Uttar Pradesh, India; analysed barriers to data sharing; and identified key inputs required for data sharing. Between March 2013 and August 2014, we conducted 74 key informant interviews at national, state and district levels. Respondents were stakeholders from national, state and district health departments, professional associations, non-governmental programmes and private commercial health facilities with 3-200 beds. Qualitative data were analysed using a framework based on a priori and emerging themes. Private facilities registered for ultrasounds and abortions submitted standardized records on these services, which is compulsory under Indian laws. Data sharing for other services was weak, but most facilities maintained basic records related to institutional deliveries and newborns. Public health facilities in blocks collected these data from a few private facilities using different methods. The major barriers to data sharing included the public sector's non-standardized data collection and utilization systems for MNCH and lack of communication and follow up with private facilities. Private facilities feared information disclosure and the additional burden of reporting, but were willing to share data if asked officially, provided the process was simple and they were assured of confidentiality. Unregistered facilities, managed by providers without a biomedical qualification, also conducted institutional deliveries, but were outside any reporting loops. Our findings suggest that even without legislation, the public sector could set up an effective MNCH data sharing strategy with private

  1. Challenges in Achieving Collaboration in Clinical Practice: The Case of Norwegian Health Care

    Sissel Steihaug

    2016-07-01

    Full Text Available Introduction: This article summarizes and synthesizes the findings of four separate but inter-linked empirical projects which explored challenges of collaboration in the Norwegian health system from the perspectives of providers and patients. The results of the four projects are summarised in eight articles. Methods: The eight articles constituted our empirical material. Meta-ethnography was used as a method to integrate, translate, and synthesize the themes and concepts contained in the articles in order to understand how challenges related to collaboration impact on clinical work. Results: Providers’ collaboration across all contexts was hampered by organizational and individual factors, including, differences in professional power, knowledge bases, and professional culture. The lack of appropriate collaboration between providers impeded clinical work. Mental health service users experienced fragmented services leading to insecurity and frustration. The lack of collaboration resulted in inadequate rehabilitation services and lengthened the institutional stay for older patients. Conclusion: Focusing on the different perspectives and the inequality in power between patients and healthcare providers and between different providers might contribute to a better environment for achieving appropriate collaboration. Organizational systems need to be redesigned to better nurture collaborative relationships and information sharing and support integrated working between providers, health care professionals and patients.

  2. Future funding for mental health and substance abuse: increasing burdens for the public sector.

    Levit, Katharine R; Kassed, Cheryl A; Coffey, Rosanna M; Mark, Tami L; Stranges, Elizabeth M; Buck, Jeffrey A; Vandivort-Warren, Rita

    2008-01-01

    Spending on mental health (MH) and substance abuse (SA) treatment is expected to double between 2003 and 2014, to $239 billion, and is anticipated to continue falling as a share of all health spending. By 2014, our projections of SA spending show increasing responsibility for state and local governments (45 percent); deteriorating shares financed by private insurance (7 percent); and 42 percent of SA spending going to specialty SA centers. For MH, Medicaid is forecasted to fund an increasingly larger share of treatment costs (27 percent), and prescription medications are expected to capture 30 percent of MH spending by 2014.

  3. Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises

    Schlein Karen

    2013-01-01

    Full Text Available Abstract Background Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. Methods The study included three data sources and levels of investigation: 1 Self-reported program data; 2 Scoping telephone interviews; and 3 In-depth field interviews and clinic visits. Results Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. Conclusions These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance

  4. Private sector delivery of health services in developing countries: a mixed-methods study on quality assurance in social franchises

    2013-01-01

    Background Across the developing world health care services are most often delivered in the private sector and social franchising has emerged, over the past decade, as an increasingly popular method of private sector health care delivery. Social franchising aims to strengthen business practices through economies of scale: branding clinics and purchasing drugs in bulk at wholesale prices. While quality is one of the established goals of social franchising, there is no published documentation of how quality levels might be set in the context of franchised private providers, nor what quality assurance measures can or should exist within social franchises. The aim of this study was to better understand the quality assurance systems currently utilized in social franchises, and to determine if there are shared standards for practice or quality outcomes that exist across programs. Methods The study included three data sources and levels of investigation: 1) Self-reported program data; 2) Scoping telephone interviews; and 3) In-depth field interviews and clinic visits. Results Social Franchises conceive of quality assurance not as an independent activity, but rather as a goal that is incorporated into all areas of franchise operations, including recruitment, training, monitoring of provider performance, monitoring of client experience and the provision of feedback. Conclusions These findings are the first evidence to support the 2002 conceptual model of social franchising which proposed that the assurance of quality was one of the three core goals of all social franchises. However, while quality is important to franchise programs, quality assurance systems overall are not reflective of the evidence to-date on quality measurement or quality improvement best practices. Future research in this area is needed to better understand the details of quality assurance systems as applied in social franchise programs, the process by which quality assurance becomes a part of the

  5. Competition in the Chinese Health Care Sector - Important pre-conditions to be fulfilled

    W. Xu (Weiwei)

    2013-01-01

    markdownabstract__Abstract__ Since 1950, the Chinese government has been building and rebuilding a healthcare system to improve the health status of the Chinese population. The accomplishments are significant. Some communicable diseases such as tuberculosis and malaria have been largely controlled.

  6. The match between motivation and performance management of health sector workers in Mali

    Dieleman, Marjolein; Toonen, Jurrien; Touré, Hamadassalia; Martineau, Tim

    2006-01-01

    Human resources for health (HRH) play a central role in improving accessibility to services and quality of care. Their motivation influences this. In Mali, operational research was conducted to identify the match between motivation and the range and use of performance management activities. Objectives To describe the factors motivating and demotivating health workers in Mali and match the motivators with the implementation of performance management. Methods First an exploratory qualitative study was conducted: 28 interviews and eight group discussions were held. This was followed by a cross-sectional survey, during which 370 health workers were interviewed. The study population consisted of health workers of eight professional groups. The following issues were investigated: • motivating and demotivating factors; • experiences with performance management, including: job descriptions, continuous education, supervision, performance appraisal and career development. Findings The study showed that the main motivators of health workers were related to responsibility, training and recognition, next to salary. These can be influenced by performance management (job descriptions, supervisions, continuous education and performance appraisal). Performance management is not optimally implemented in Mali, as job descriptions were not present or were inappropriate; only 13% of interviewees received 4× per year supervision, and training needs were not analysed. Some 48% of the interviewees knew their performance had been appraised in the last two years; the appraisals were perceived as subjective. No other methods were in place to show recognition. The results enabled the research team to propose adaptations or improvements upon existing performance management. Conclusion The results showed the importance of adapting or improving upon performance management strategies to influence staff motivation. This can be done by matching performance management activities to motivators

  7. The match between motivation and performance management of health sector workers in Mali

    Touré Hamadassalia

    2006-02-01

    Full Text Available Abstract Human resources for health (HRH play a central role in improving accessibility to services and quality of care. Their motivation influences this. In Mali, operational research was conducted to identify the match between motivation and the range and use of performance management activities. Objectives To describe the factors motivating and demotivating health workers in Mali and match the motivators with the implementation of performance management. Methods First an exploratory qualitative study was conducted: 28 interviews and eight group discussions were held. This was followed by a cross-sectional survey, during which 370 health workers were interviewed. The study population consisted of health workers of eight professional groups. The following issues were investigated: • motivating and demotivating factors; • experiences with performance management, including: job descriptions, continuous education, supervision, performance appraisal and career development. Findings The study showed that the main motivators of health workers were related to responsibility, training and recognition, next to salary. These can be influenced by performance management (job descriptions, supervisions, continuous education and performance appraisal. Performance management is not optimally implemented in Mali, as job descriptions were not present or were inappropriate; only 13% of interviewees received 4× per year supervision, and training needs were not analysed. Some 48% of the interviewees knew their performance had been appraised in the last two years; the appraisals were perceived as subjective. No other methods were in place to show recognition. The results enabled the research team to propose adaptations or improvements upon existing performance management. Conclusion The results showed the importance of adapting or improving upon performance management strategies to influence staff motivation. This can be done by matching performance management

  8. Contribution from the ten major emission sectors in Europe to the Health-Cost Externalities of Air Pollution using the EVA Model System - an integrated modelling approach

    Brandt, Jørgen; Silver, Jeremy D.; Christensen, Jesper H.; Andersen, Mikael S.; Bønløkke, Jakob H.; Sigsgaard, Torben; Geels, Camilla; Gross, Allan; Hansen, Ayoe B.; Hansen, Kaj M.; Hedegaard, Gitte B.; Kaas, Eigil; Frohn, Lise M.

    2013-04-01

    We have developed an integrated model system, EVA (Economic Valuation of Air pollution), based on the impact-pathway chain, to assess the health-related economic externalities of air pollution resulting from specific emission sources or sectors, which can be used to support policy-making with respect to emission control. Central for the system is a tagging method capable of calculating the contribution from a specific emission source or sector to the overall air pollution levels, taking into account the non-linear atmospheric chemistry. The main objective of this work is to identify the anthropogenic emission sources in Europe and Denmark that contribute the most to human health impacts. In this study, we applied the EVA system to Europe and Denmark, with a detailed analysis of health-related external costs from the ten major emission sectors and their relative contributions. The paper contains a thorough description of the EVA system. The conclusions in the paper are sensitive to the toxicity of the different types of atmospheric particles, and therefore the existing knowledge of health impacts from particles is reviewed. We conclude that with our present knowledge we are not able to distinguish between the impacts from different particle types and therefore the toxicity of the particles is handled equally in the overall results. The main conclusion from the analysis of the ten major emission sectors in Europe and Denmark is that the major contributors to health-related external costs are major power production, agriculture, road traffic, and non-industrial domestic combustion, including wood combustion. The major power plants in Europe contribute with around 25% of the total health related external costs relative to all sources in Europe, while the Danish power plants only contribute with less than 10% relative to all Danish sources. Our results suggest that the agricultural sector contributes with 25% to health impacts and related external costs. We conclude

  9. Perceptions of per diems in the health sector: evidence and implications.

    Vian, Taryn; Miller, Candace; Themba, Zione; Bukuluki, Paul

    2013-05-01

    Per diems are used to pay work-related expenses and motivate employees, yet they also can distort incentives and may be abused. This study was designed to explore perceptions of per diems among 41 high-, mid- and low-level government officers and non-governmental organization (NGO) officials in Malawi and Uganda. Interviews explored attitudes about per diems, benefits and problems for organizations and individuals, and risks and patterns of abuse. The study found that per diems provide benefits such as encouraging training, increasing staff motivation and supplementing salary. Despite these advantages, respondents voiced many discontents about per diems, stating that they create conflict, contribute to a negative organizational culture where people expect to be paid for all activities, and lead to negative changes in work time allocation. Work practices are also manipulated in order to maximize financial gain by slowing work, scheduling unnecessary trainings, or exaggerating time needed for tasks. Officials may appropriate per diems meant for others or engage in various forms of fraud for personal financial gain. Abuse seemed more common in the government sector due to low pay and weaker controls. A striking finding was the distrust that lower-level workers felt toward their superiors: allowances were perceived to provide unfair financial advantages to already better-off and well-connected staff. To curb abuse of per diems, initiatives must reduce pressures and incentives to abuse, while controlling discretion and increasing transparency in policy implementation. Donors can play a role in reform by supporting development of policy analysis tools, design of control mechanisms and evaluation of reform strategies.

  10. Korea : Financial Sector Assessment

    World Bank; International Monetary Fund

    2003-01-01

    Since the financial crisis in 1997-98, Korea has made major progress in financial, and corporate sector reform - the supervisory and regulatory regime for the financial sector has been substantially strengthened, and recent reforms helped achieve a high degree of observance of international standards, and codes. Moreover, significant consolidation in the banking system took place, with ban...

  11. Achievements, Problems and Prospects of the Scientific Approach Aimed for Ensuring Resource-Efficient Technologies in the Context of Personnel Policy in the Energy Sector

    Rostovtseva Veronika M.

    2016-01-01

    Full Text Available The article is devoted to the increasing role of human resources in the field of energy policy. Basic directions for the development of personnel policy, the ways of their implementation in the modern HR environment have been outlined. The results of the content analysis of the research on personnel policy and personnel training for the energy sector in the context of the whole spectrum of science have been introduced; certain specific features of the process have been studied.

  12. Policy entrepreneurship in the development of public sector strategy: the case of London health reform.

    Oborn, Eivor; Barrett, Michael; Exworthy, Mark

    2011-01-01

    The development of health policy is recognized as complex; however, there has been little development of the role of agency in this process. Kingdon developed the concept of policy entrepreneur (PE) within his ‘windows’ model. He argued inter-related ‘policy streams' must coincide for important issues to become addressed. The conjoining of these streams may be aided by a policy entrepreneur. We contribute by clarifying the role of the policy entrepreneur and highlighting the translational processes of key actors in creating and aligning policy windows. We analyse the work in London of Professor Sir Ara Darzi as a policy entrepreneur. An important aspect of Darzi's approach was to align a number of important institutional networks to conjoin related problems. Our findings highlight how a policy entrepreneur not only opens policy windows but also yokes together a network to make policy agendas happen. Our contribution reveals the role of clinical leadership in health reform.

  13. Quality in the Danish health care sector – patient identity in transition?

    Ottesen, Aase Marie; Strunck, Jeanne; Lassen, Inger Marie

    2015; Ministry of Health 2015). The change implies a gradual transition from an evidence based activity model to a value based quality model centered on patient involvement (Mainz et al 2015; Porter 2010; Rostgaard 2015). As a parallel trend over the past 30 years, welfare state ideology seems to have...... come under rising pressure by economic rationales combined with ideas of lean management and New Public Management (Valgårda 2003; Niklassson 2006; Lassen, Ottesen and Strunck 2015). Seeing that shifting quality perceptions and a stronger focus on patient involvement invites questions about the role...... of the patient in the Danish welfare system, we ask: 1) how is patient identity construed in selected legislation, steering instruments and reports issued by the Danish Board of Health, and 2) how may variation in the construal of patient identity be indicative of discursive struggle at the level of national...

  14. An Asset Based Approach to Health Care and Wider Public Sector Reform in the Wigan Borough

    Wilson, Robert Lee; Blandamer, Will

    2016-01-01

    Introduction: The Wigan Borough’s system wide approach is based on the fastest and greatest improvement in the health of the population of the Borough. The way services are delivered to citizens are being reformed to include improved access, standardisation to best practice, technology deployment, integrated approaches to care, shifts to community and primary care orientated service delivery.Description: Wigan Borough has developed integrated care based on populations’ assets and is actively ...

  15. Moderators between work context and psychological health in a public service sector / S. Williams

    Wiliams, Shelley-Ann

    2009-01-01

    Work context has many consequences for the psychological outcomes of employees. These outcomes also have consequences for the employer through possible loss of productivity, impaired health of employees which may be associated with absenteeism and turnover intention, among others. The literature also shows that these outcomes are not always the same even under similar working conditions. Theorising in cognitive psychology indicates that the way in which an individual appraises a situation may...

  16. [Descriptive study of morbidity and mortality due to asthma at a Health Sector institution].

    Segura Méndez, N H; Salas Ramírez, M; Martínez-Cairo Cueto, S

    1994-01-01

    The objective of this study was to determine the morbidity and mortality rate due to asthma from a Health Institution, which represents the majority of working population. Asthma data were obtained from the National Institute of Informatical, Geography and Statistics (INEGI), Mexican Health Secretary (SS) and Mexican Social Security Institute (IMSS). The underlying cause of death hospitalization or visit were obtained. Asthma was coded according to the International Classification of Disease (ninth revision). Asthma death rate was adjusted by age using direct method. In the IMSS, asthma death rate increased from 3.24/200,000 in 1980 to 12.76/100,000 in 1990. The asthma letality increased from 0.34 in 1980 to 1.23 in 1990. The average length of hospital stay was 3.96 days in 1990; there was noy significant differences by sex the most affected groups were children under 4 years of age and persons older than 65 years of age. In conclusion, from 1980 to 1990, the morbidity and mortality rate due to asthma in IMSS increased. It suggests that future health policy efforts should be focused to reduce the morbidity, mainly in high risk groups.

  17. The Ha Noi Expert Statement: recognition of maternal mental health in resource-constrained settings is essential for achieving the Millennium Development Goals.

    Fisher, Jane Rw; de Mello, Meena Cabral; Izutsu, Takashi; Tran, Tuan

    2011-01-07

    and empower women, achieve universal primary education and eradicate extreme poverty and hunger cannot be attained without a specific focus on women's mental health. It was co-signed by the international expert group; relevant WHO and UNFPA departmental representatives and international authorities. They concur that social rather than medical responses are required. Improvements in maternal mental health require a cross-sectoral response addressing poverty reduction, women's rights, social protection, violence prevention, education and gender in addition to health.

  18. Towards elimination of hepatitis B and C in European Union and European Economic Area countries: monitoring the World Health Organization's global health sector strategy core indicators and scaling up key interventions.

    Duffell, Erika F; Hedrich, Dagmar; Mardh, Otilia; Mozalevskis, Antons

    2017-03-02

    The World Health Organization 'Global Health Sector Strategy on Viral Hepatitis 2016-2021' aimed at the elimination of viral hepatitis as a public health threat provides a significant opportunity to increase efforts for tackling the epidemics of hepatitis B and hepatitis C virus infections across Europe. To support the implementation and monitoring of this strategy, core epidemiological and programmatic indicators have been proposed necessitating specific surveys, the systematic collection of programmatic data and the establishment of monitoring across the care pathway. European Union and European Economic Area countries already made progress in recent years implementing primary and secondary prevention measures. Indeed, harm reduction measures among people who inject drugs reach many of those who need them and most countries have a universal hepatitis B vaccination programme with high coverage above 95%. However, while a further scaling up of prevention interventions will impact on incidence of new infections, treating those already infected is necessary to achieve reductions in mortality. The epidemiological, demographic and socio-political situation in Europe is complex, and considerable diversity in the programmatic responses to the hepatitis epidemic exists. Comprehension of such issues alongside collaboration between key organisations and countries will underpin any chance of successfully eliminating hepatitis.

  19. Private sector, for-profit health providers in low and middle income countries: can they reach the poor at scale?

    2014-01-01

    Background The bottom of the pyramid concept suggests that profit can be made in providing goods and services to poor people, when high volume is combined with low margins. To-date there has been very limited empirical evidence from the health sector concerning the scope and potential for such bottom of the pyramid models. This paper analyzes private for-profit (PFP) providers currently offering services to the poor on a large scale, and assesses the future prospects of bottom of the pyramid models in health. Methods We searched published and grey literature and databases to identify PFP companies that provided more than 40,000 outpatient visits per year, or who covered 15% or more of a particular type of service in their country. For each included provider, we searched for additional information on location, target market, business model and performance, including quality of care. Results Only 10 large scale PFP providers were identified. The majority of these were in South Asia and most provided specialized services such as eye care. The characteristics of the business models of these firms were found to be similar to non-profit providers studied by other analysts (such as Bhattacharya 2010). They pursued social rather than traditional marketing, partnerships with government, low cost/high volume services and cross-subsidization between different market segments. There was a lack of reliable data concerning these providers. Conclusions There is very limited evidence to support the notion that large scale bottom of the pyramid models in health offer good prospects for extending services to the poor in the future. In order to be successful PFP providers often require partnerships with government or support from social health insurance schemes. Nonetheless, more reliable and independent data on such schemes is needed. PMID:24961496

  20. Use of nuclear energy: the perception of public risk from radiation. Experience from health sector

    Leopoldo Arranz y Carrillo de Albornoz

    2010-12-01

    Full Text Available Radiological risks are, probably by the fact that Hiroshima and Nagasaki bombs still are a part of the collective nightmares of the humankind, always with the sword of Damocles of a possible use of nuclear weapons, the paradigm of subjectivity. And their negative perception by the citizens has turned into a growing interest for people responsible of the management of any of the applications of the ionizing radiations. In this work the opinion of communication experts, some based on their experience in the health care system, with regard to radiological risks and what can be done in order to modify such negative perception are set out.

  1. Achievements and challenges on policies for allied health professionals who use telehealth in the Canadian Arctic.

    Hailey, D; Foerster, V; Nakagawa, B; Wapshall, T M; Murtagh, J A; Smitten, J; Steblecki, J A; Wong, G

    2005-01-01

    We formulated policies and procedures for allied health professionals (AHPs) who provide services using telehealth in Nunavut, Canada's newest Arctic territory. These are a supplement to the clinical policies and procedures already established for Nunavut physicians and nurses. The services were in the areas of audiology, dietetics/nutrition, midwifery, occupational therapy, ophthalmic services, pharmacy, physiotherapy, psychology, respiratory therapy, social work and speech therapy. Documents specific to each of the services were developed, drawing on information from Government of Nunavut data, Nunavut healthcare providers and links made through the Internet. Topics included the scope and limitations of telehealth services, staff responsibilities, training and reporting, professional standards and cultural considerations. We also considered generic policies covering common issues such as jurisdiction, licensing and liability. The policies and procedures for AHPs will enhance and expand the successes already achieved with telehealth in Nunavut. The challenges are to balance the preferred approaches to service provision with the realities of health care and communications in an Arctic setting.

  2. Family socioeconomic status, family health, and changes in students' math achievement across high school: A mediational model.

    Barr, Ashley Brooke

    2015-09-01

    In response to recent calls to integrate understandings of socioeconomic disparities in health with understandings of socioeconomic disparities in academic achievement, this study tested a mediational model whereby family socioeconomic status predicted gains in academic achievement across high school through its impact on both student and parent health. Data on over 8000 high school students in the U.S. were obtained from wave 1 (2009-2010) and wave 2 (2012) of the High School Longitudinal Study of 2009 (HSLS:09), and structural equation modeling with latent difference scores was used to determine the role of family health problems in mediating the well-established link between family SES and gains in academic achievement. Using both static and dynamic indicators of family SES, support was found for this mediational model. Higher family SES in 9th grade reduced the probability of students and their parents experiencing a serious health problem in high school, thereby promoting growth in academic achievement. In addition, parent and student health problems mediated the effect of changes in family SES across high school on math achievement gains. Results emphasize the importance of considering the dynamic nature of SES and that both student and parent health should be considered in understanding SES-related disparities in academic achievement. This relational process provides new mechanisms for understanding the intergenerational transmission of socioeconomic status and the status attainment process more broadly.

  3. Improvements in access to malaria treatment in Tanzania following community, retail sector and health facility interventions -- a user perspective

    Obrist Brigit

    2010-06-01

    Full Text Available Abstract Background The ACCESS programme aims at understanding and improving access to prompt and effective malaria treatment. Between 2004 and 2008 the programme implemented a social marketing campaign for improved treatment-seeking. To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO was created in Tanzania in 2006. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP to artemether-lumefantrine (ALu in 2007 and subsidized ALu was made available in both health facilities and ADDOs. The effect of these interventions on understanding and treatment of malaria was studied in rural Tanzania. The data also enabled an investigation of the determinants of access to treatment. Methods Three treatment-seeking surveys were conducted in 2004, 2006 and 2008 in the rural areas of the Ifakara demographic surveillance system (DSS and in Ifakara town. Each survey included approximately 150 people who had suffered a fever case in the previous 14 days. Results Treatment-seeking and awareness of malaria was already high at baseline, but various improvements were seen between 2004 and 2008, namely: better understanding causes of malaria (from 62% to 84%; an increase in health facility attendance as first treatment option for patients older than five years (27% to 52%; higher treatment coverage with anti-malarials (86% to 96% and more timely use of anti-malarials (80% to 93-97% treatments taken within 24 hrs. Unfortunately, the change of treatment policy led to a low availability of ALu in the private sector and, therefore, to a drop in the proportion of patients taking a recommended malaria treatment (85% to 53%. The availability of outlets (health facilities or drug shops is the most important determinant of whether patients receive prompt and effective treatment, whereas affordability and accessibility contribute to a lesser extent. Conclusions An

  4. A retrospective content analysis of studies on factors constraining the implementation of health sector reform in Ghana.

    Sakyi, E Kojo

    2008-01-01

    Ghana has undertaken many public service management reforms in the past two decades. But the implementation of the reforms has been constrained by many factors. This paper undertakes a retrospective study of research works on the challenges to the implementation of reforms in the public health sector. It points out that most of the studies identified: (1) centralised, weak and fragmented management system; (2) poor implementation strategy; (3) lack of motivation; (4) weak institutional framework; (5) lack of financial and human resources and (6) staff attitude and behaviour as the major causes of ineffective reform implementation. The analysis further revealed that quite a number of crucial factors obstructing reform implementation which are particularly internal to the health system have either not been thoroughly studied or overlooked. The analysis identified lack of leadership; weak communication and consultation; lack of stakeholder participation, corruption and unethical professional behaviour as some of the missing variables in the literature. The study, therefore, indicated that there are gaps in the literature that needed to be filled through rigorous reform evaluation based on empirical research particularly at district, sub-district and community levels. It further suggested that future research should be concerned with the effects of both systems and structures and behavioural factors on reform implementation.

  5. Milestones in Implementation of an Integrated Management System in the Health Sector. Case Study Radiologische Netzwerk Rheinland

    Claus Nagel-Picioruş

    2016-05-01

    Full Text Available Healthcare organizations in Germany exploit the benefits of the ISO 9000 family of international standards as it became compulsory to implement a quality management system in accordance with ISO 9001 requirements. Until the innovative ISO 9001:2015 proposal it was no direct connection to the other management systems like risk management, knowledge management or environmental management. So far, only few bodies ensured interconnections between different systems of management or associated the quality management system with the strategic planning process. However, healthcare encapsulates supplementary requirements which affect a number of different systems. Additionally, the financial crisis has encouraged the trend to operate integrated reporting beyond financial aspects. This paper aims at presenting the experience on the development of integrated management and reporting system integrated in an organization belonging to the health sector. The work clarifies the steps towards merging distinctly regulated management systems (quality, health or environmental management with strategic planning and controlling, via a Balanced Dashboard (Balanced Scorecard - BSC as well as integrated reporting according to the model International Integrated Reporting Initiative (IIRI in a German medical company - Radiologische Netzwerk Rheinland - RNR AG. Using the case study method, the paper's purpose is to highlight approaches and results of the company that could support practitioners from medical area and bezound. The literature review clarified theoretical concepts while the case study allowed converging comprehensive information and knowledge accumulated by RNR AG, thus helping to bridge the gap between literature on total integrated management reporting and reporting system in healthcare.

  6. The implications of Herzberg's "motivation-hygiene" theory for management in the Irish health sector.

    Byrne, Michael

    2006-01-01

    Given that they create what it sells, employees are the Irish Health service's most valuable asset. They are increasingly being asked to embrace change on many different levels. In order to facilitate this process, it behooves management to actively promote employee motivation. Herzberg et al's "motivation-hygiene" theory of motivation proposes that certain "motivator" and "hygiene" factors can respectively affect job satisfaction and dissatisfaction. Considering "motivators," better on-the-job performance may increase motivation. However, work overload can become a dissatisfier. Devolving equal levels of authority and responsibility and providing appropriate recognition may also serve to motivate. Likewise, providing opportunities for promotion and personal growth may maintain motivation, as might re-engineering of jobs so that work remains meaningful. Over time both salary and incentives may come to be viewed as entitlements and lose their ability to motivate. Other "hygiene" factors such as organizational policy and administrative structure, relations with others, job insecurity, physical working conditions, and quality of supervision can lead to job dissatisfaction. Hence, the theory of Herzberg et al usefully highlights many factors that may serve to motivate or demotivate employees. However, this theory does not reflect some of the realities of the modern health care work environment.

  7. Employer, insurance, and health system response to long-term sick leave in the public sector: policy implications.

    Heijbel, Bodil; Josephson, Malin; Jensen, Irene; Vingård, Eva

    2005-06-01

    This study has been conducted to describe the situation of long-term sick-listed persons employed in the public sector regarding the medical reasons of their sick leave, the duration of their problems, the duration of the actual sick leave, rehabilitation support, rehabilitation measures, and the persons expectations of the future. Response rate of a postal questionnaire, where 484 women and 51 men on long-term sick leave answered, was 69%. The study-group consisted of 90% women with a median age of 50 years. The most common reasons for sick listing were long-lasting musculoskeletal problems, especially neck/shoulder pain, low back pain and osteoarthritis or other joint problems and mental problems, especially depression and burn-out syndromes. Forty-seven procent of the men and 57% of the women had been on the sick list for more than a year. Only half of them had been subjected to the legally required rehabilitation investigation of the employer This half got access to rehabilitation programs and/or vocational rehabilitation to a greater extent than those who not had been subjected to rehabilitation investigation. Less than half had been in contact with the workplace-connected rehabilitation actors, the Occupational Health Service or the Trade Union. In spite of this the sick-listed persons had a positive view of their future return to work. For long-term sick-listed persons in the public sector, there is a great potential for improvements of the rehabilitation at the workplace arena, in the involvement and cooperation between the already existing rehabilitation actors, in order to promote return to work.

  8. Descentralización del sector salud en América Latina Descentralization of the health sector in Latin America

    A. Ugalde

    2002-02-01

    Full Text Available Este trabajo analiza la experiencia latinoamericana con la descentralización de servicios de salud. Los autores examinan el significado de la descentralización: geográfica, institucional y de funciones. Se identifican los objetivos que según los promotores de la descentralización la justifican y se documenta que, en general, no se han conseguido. Una revisión de la bibliografía y los estudios llevados a cabo por los autores sugieren que con frecuencia la descentralización ha producido resultados opuestos a los buscados, es decir, ha incrementado la inequidad, ha disminuido la eficiencia y calidad de los servicios, y ha aumentado los costes. Se señala que la información existente no permite determinar con seguridad si el fracaso de la descentralización se debe a la selección de políticas inadecuadas o a fallos en el proceso de implementación. Se reconoce que la descentralización es un proceso político complejo que no se puede diseñar ni imponer desde fuera y que antes de tomar la decisión de descentralizar es necesario identificar cuál de las muchas modalidades de descentralización se quiere implementar, estimar los costes, anticipar los problemas que se pueden presentar en su proceso de implementación y buscar soluciones a los mismos. Los autores concluyen sugiriendo que los bancos multilaterales han errado al forzar a los países a descentralizar de una manera improvisada sin tener en cuenta los diferentes contextos históricos, políticos y socioeconómicos.This paper analyzes the Latin American experience of decentralizing health services within the context of health reform. We examine the meaning of the term decentralization and discuss the various modalities of this concept: geographical, institutional and functional. The objectives that, in general, these objectives have not been achieved. After reviewing the literature and drawing on our own fieldwork, we conclude that in many instances the Latin American

  9. Autonomous public organization policy: a case study for the health sector in Thailand.

    Rajataramya, B; Fried, B; van der Pütten, M; Pongpanich, S

    2009-09-01

    This paper describes factors affecting autonomous public organization (APO) policy agenda setting and policy formation through comparison of policy processes applied to one educational institute under the Ministry of Education and the other educational institute under the Ministry of Public Health in Thailand. This study employs mixed method including a qualitative approach through documentary research, in-depth interviews, and participant observation. Factors that facilitated the formulation of the APO policy were: (1) awareness of need; (2) clarity of strategies; (3) leadership, advocacy, and strategic partnerships, (4) clear organizational identity; (5) participatory approach to policy formulation, and (6) identification of a policy window. Factors that impeded the formulation of the APO policy were: (1) diverting political priorities; (2) ill-defined organizational identity; (3) fluctuating leadership direction, (4) inadequate participation of stakeholders; and (5) political instability. Although findings cannot be generalized, this case study does offer benchmarking for those in search of ways to enhance processes of policy formulation.

  10. The third sector for supporting sustainability and innovation in health field

    Ilaria Oberti

    2015-04-01

    Full Text Available In a precarious general framework, in which the quality of the Italian healthcare system is getting worse and worse, there are examples of excellence, such as the Maria Letizia Verga Center for the Study and Treatment of child leukemia. This is a new pavilion for the Pediatric Hematology of S. Gerardo Hospital in Monza, fourth center in the world to bring together in a single organization the medical care and the research/training activities. The building architectural design aimed at coordinating the efficiency of medical procedures together with the criteria of humanization of the spaces and the new partnership model, revolutionary within the Italian National Health Service, represent two of the aspects that contribute this Center to be a distinctive case.

  11. Measuring Use and Cost of Health Sector and Related Care in a Population of Girls and Young Women with Rett Syndrome

    Hendrie, Delia; Bebbington, Ami; Bower, Carol; Leonard, Helen

    2011-01-01

    This study measured use and cost of health sector and related services in Rett syndrome and effects of socio-demographic, clinical severity and genetic factors on costs. The study population consisted of individuals with Rett syndrome registered with the Australian Rett Syndrome Database in 2004. Descriptive analysis was used to examine patterns…

  12. The construction and legitimation of workplace bullying in the public sector: insight into power dynamics and organisational failures in health and social care.

    Hutchinson, Marie; Jackson, Debra

    2015-03-01

    Health-care and public sector institutions are high-risk settings for workplace bullying. Despite growing acknowledgement of the scale and consequence of this pervasive problem, there has been little critical examination of the institutional power dynamics that enable bullying. In the aftermath of large-scale failures in care standards in public sector healthcare institutions, which were characterised by managerial bullying, attention to the nexus between bullying, power and institutional failures is warranted. In this study, employing Foucault's framework of power, we illuminate bullying as a feature of structures of power and knowledge in public sector institutions. Our analysis draws upon the experiences of a large sample (n = 3345) of workers in Australian public sector agencies - the type with which most nurses in the public setting will be familiar. In foregrounding these power dynamics, we provide further insight into how cultures that are antithetical to institutional missions can arise and seek to broaden the debate on the dynamics of care failures within public sector institutions. Understanding the practices of power in public sector institutions, particularly in the context of ongoing reform, has important implications for nursing.

  13. Introducing a model of cardiovascular prevention in Nairobi's slums by integrating a public health and private-sector approach: the SCALE-UP study

    Steven van de Vijver

    2013-10-01

    Full Text Available Introduction: Cardiovascular disease (CVD is a leading cause of death in sub-Saharan Africa (SSA, with annual deaths expected to increase to 2 million by 2030. Currently, most national health systems in SSA are not adequately prepared for this epidemic. This is especially so in slum settlements where access to formal healthcare and resources is limited. Objective: To develop and introduce a model of cardiovascular prevention in the slums of Nairobi by integrating public health and private sector approaches. Study design: Two non-profit organizations that conduct public health research, Amsterdam Institute for Global Health and Development (AIGHD and African Population and Health Research Center (APHRC, collaborated with private-sector Boston Consulting Group (BCG to develop a service delivery package for CVD prevention in slum settings. A theoretic model was designed based on the integration of public and private sector approaches with the focus on costs and feasibility. Results: The final model includes components that aim to improve community awareness, a home-based screening service, patient and provider incentives to seek and deliver treatment specifically for hypertension, and adherence support. The expected outcomes projected by this model could prove potentially cost effective and affordable (1 USD/person/year. The model is currently being implemented in a Nairobi slum and is closely followed by key stakeholders in Kenya including the Ministry of Health, the World Health Organization (WHO, and leading non-governmental organizations (NGOs. Conclusion: Through the collaboration of public health and private sectors, a theoretically cost-effective model was developed for the prevention of CVD and is currently being implemented in the slums of Nairobi. If results are in line with the theoretical projections and first impressions on the ground, scale-up of the service delivery package could be planned in other poor urban areas in Kenya by

  14. A Qualitative Study on Experience of Stigma and Discrimination in Health Care Sector among PLHA Attending VCTC of New Civil Hospital and GSNP+ of Surat

    Bharat H Patel; Ratan K. Srivastava; Rashmi Sharma; Mohua Moitra

    2016-01-01

    "Introduction: Within health care settings, HIV-related stigma is a recognized barrier to access of HIV prevention and treatment services. The current study was undertaken with the objective to study various forms of stigma and discrimination towards PLHA in health care sector. Methods: Total 30 PLHA were selected from VCTC of tertiary care hospital and GSNP+ in Surat city. Information on stigma and dis-crimination gathered through in-depth interview. Results: Stigma and/or discriminat...

  15. Competition in the Dutch hospital sector: an analysis of health care volume and cost.

    Krabbe-Alkemade, Y J F M; Groot, T L C M; Lindeboom, M

    2017-03-01

    This paper evaluates the impact of market competition on health care volume and cost. At the start of 2005, the financing system of Dutch hospitals started to be gradually changed from a closed-end budgeting system to a non-regulated price competitive prospective reimbursement system. The gradual implementation of price competition is a 'natural experiment' that provides a unique opportunity to analyze the effects of market competition on hospital behavior. We have access to a unique database, which contains hospital discharge data of diagnosis treatment combinations (DBCs) of individual patients, including detailed care activities. Difference-in-difference estimates show that the implementation of market-based competition leads to relatively lower total costs, production volume and number of activities overall. Difference-in-difference estimates on treatment level show that the average costs for outpatient DBCs decreased due to a decrease in the number of activities per DBC. The introduction of market competition led to an increase of average costs of inpatient DBCs. Since both volume and number of activities have not changed significantly, we conclude that the cost increase is likely the result of more expensive activities. A possible explanation for our finding is that hospitals look for possible efficiency improvements in predominantly outpatient care products that are relatively straightforward, using easily analyzable technologies. The effects of competition on average cost and the relative shares of inpatient and outpatient treatments on specialty level are significant but contrary for cardiology and orthopedics, suggesting that specialties react differently to competitive incentives.

  16. [Governance and health: the rise of the managerialism in public sector reform].

    Denis, Jean L; Lamothe, Lise; Langley, Ann; Stéphane, Guérard

    2010-01-01

    The article examines various healthcare systems reform projects in Canada and some Canadian provinces and reveals some tendencies in governance renewal. The analisis is based on the hypothesis that reform is an exercise aiming at the renewal of governance conception and practices. In renewing governance, reform leaders hope to use adequate and effective levers to attain announced reform objectives. The article shows that the conceptions and operational modalities of governance have changed over time and that they reveal tensions inherent to the transformation and legitimation process of public healthcare systems. The first section discusses the relationships between reform and change. The second section defines the conception of gouvernance used for the analisis. Based on a content analisis of the various reform reports, the third section reveals the evolution of the conception of governance in healthcare systems in Canada. In order to expose the new tendencies, ideologies and operational principles at the heart of the reform projects are analysed. Five ideologies are identified: the democratic ideology, the "population health" ideology, the business ideology, the managerial ideology and the ideology of equity and humanism. This leads to a discussion on the dominant influence of the managerial ideology in the current reform projects.

  17. Resource based view of the firm: measures of reputation among health service-sector businesses.

    Smith, Alan D

    2008-01-01

    Application of the strategic leverage of Resource Based View of the Firm (RBV) directly advocates that a company's competitive advantage is derived from its ability to assemble and exploit an appropriate combination of resources (both tangible and intangible assets). The three companies that were selected were Pittsburgh-based companies that were within relatively easy access, representing healthcare service-related industries, and can be reviewed for the principles of the RBV. The particular firms represented a variety of establishments and included Baptist Homes (a long-term care facility), University of Pittsburgh Medical Center (UPMC)(a provider of hospital and other health services), and GlaxoSmithKline, Consumer Healthcare, North America (GSK-CHNA)(a global provider of healthcare products and services). Through the case studies, it was found that not all intangible assets are strategic, and by extension, not all measures of reputation are strategic either. For an intangible asset to be considered strategic, in this case reputation, it must be valuable, rare, imperfectly imitable, and non-substitutable.

  18. Factors influencing HAART adherence among private health care sector patients in a suburb of the Ethekwini Metro

    Panjasaram Naidoo

    2009-04-01

    Full Text Available Background: The advent of highly active antiretroviral therapy (HAART ushered in a new era in the management of the AIDS pandemic with new drugs, new strategies, new vigour from treating clinicians and enthusiasm on the part of their patients. What soon became evident, however, was the vital importance of patient adherence to prescribed medication in order to obtain full therapeutic benefits. Several factors can influence adherence to HIV drug regimens. Many treatment regimes are complex, requiring patients to take a number of drugs at set times during the day, some on a full stomach and others on an empty one. Other factors that could contribute to non-adherence include: forgetting to take medications, cost factor, side effects, incorrect use of drug, social reasons, denial or poor knowledge of drug regime. If the correct regimen is not prescribed and if patients do not adhere to therapy, then the possibility of resistant strains is high. Improving adherence is therefore arguably the single most important means of optimising overall therapeutic outcomes. Although several studies regarding patient adherence have been performed in the public health care sector, data on adherence in patients from the private health care sector of South Africa remain limited. Many factors influence compliance and identifying these factors may assist in the design of strategies to enhance adherence to such demanding regimens. This study aimed to identify these factors among private sector patients.Method: Descriptive cross-sectional study was conducted among all consenting patients with HIV who visited the rooms of participating private sector doctors from May to July 2005. A questionnaire was administered to consenting participants. Participants who reported missing any medication on any day were considered non-adherent. The data obtained was analysed using SPSS 11.5. A probability value of 5% or less was regarded as being statistically significant. Categorical

  19. Proof of impact and pipeline planning: directions and challenges for social audit in the health sector

    Andersson Neil

    2011-12-01

    Full Text Available Abstract Social audits are typically observational studies, combining qualitative and quantitative uptake of evidence with consultative interpretation of results. This often falters on issues of causality because their cross-sectional design limits interpretation of time relations and separation out of other indirect associations. Social audits drawing on methods of randomised controlled cluster trials (RCCT allow more certainty about causality. Randomisation means that exposure occurs independently of all events that precede it – it converts potential confounders and other covariates into random differences. In 2008, CIET social audits introduced randomisation of the knowledge translation component with subsequent measurement of impact in the changes introduced. This “proof of impact” generates an additional layer of evidence in a cost-effective way, providing implementation-ready solutions for planners. Pipeline planning is a social audit that incorporates stepped wedge RCCTs. From a listing of districts/communities as a sampling frame, individual entities (communities, towns, districts are randomly assigned to waves of intervention. Measurement of the impact takes advantage of the delay occasioned by the reality that there are insufficient resources to implement everywhere at the same time. The impact in the first wave contrasts with the second wave, which in turn contrasts with a third wave, and so on until all have received the intervention. Provided care is taken to achieve reasonable balance in the random allocation of communities, towns or districts to the waves, the resulting analysis can be straightforward. Where there is sufficient management interest in and commitment to evidence, pipeline planning can be integrated in the roll-out of programmes where real time information can improve the pipeline. Not all interventions can be randomly allocated, however, and random differences can still distort measurement. Other issues

  20. Achieving Universal Coverage; Lessons From The Experience of Other Countries for National Health Insurance Implementation in Indonesia

    Misnaniarti Misnaniarti

    2015-08-01

    Full Text Available Indonesia is not the only country that will lead to universal coverage. Several countries took an initiative to develop social security, through Universal Health Coverage (UHC to achieve health insurance and welfare for all residents. Even, some countries have already reached universal health coverage since a few years ago. The purpose of this paper is to assess the achievement of universal coverage of the health insurance implementation in several countries. In general, some countries require considerable time to achieve universal coverage. Mechanisms and stages that need attention is on the univeral registration aspects that cover the entire population, progressive and continuous funding sources, comprehensive benefits package, the expansion of gradual coverage for diseases that can cause catastrophic expenditure, increasing capacity and mobilizing supporting resource. National Health Insurance policy in some countries can improve access to care, utilization and quality of quality health services to all citizens. Indonesia is expected to learn from the experience of other countries to achieve UHC, so that the projection of the entire population of Indonesia to have health insurance in 2019 will be reached soon.

  1. Learning styles, academic achievement, and mental health problems among medical students in Thailand

    Salilthip Paiboonsithiwong

    2016-10-01

    Full Text Available Purpose This study aimed to investigate the prevalence of various learning styles among medical students and their correlations with academic achievement and mental health problems in these students. Methods This study was conducted among 140 first-year medical students of Chiang Mai University, Thailand in 2014. The participants completed the visual-aural-read/write-kinesthetic (VARK questionnaire, the results of which can be categorized into 4 modes, corresponding to how many of the 4 types are preferred by a respondent. The 10-item Perceived Stress Scale (PSS-10 and the 21-item Outcome Inventory (OI-21 were also used. The participants’ demographic data, grade point average (GPA, and scores of all measurements are presented using simple statistics. Correlation and regression analysis were employed to analyze differences in the scores and to determine the associations among them. Results Sixty percent of the participants were female. The mean age was 18.86±0.74 years old. Quadmodal was found to be the most preferred VARK mode (43.6%. Unimodal, bimodal, and trimodal modes were preferred by 35%, 12.9%, and 18.6% of the participants, respectively. Among the strong unimodal learners, visual, aural, read/write, and kinesthetic preferences were reported by 4.3%, 7.1%, 11.4%, and 12.1% of participants, respectively. No difference was observed in the PSS-10, OI-anxiety, OI-depression, and OI-somatization scores according to the VARK modes, although a significant effect was found for OI-interpersonal (F=2.788, P=0.043. Moreover, neither VARK modes nor VARK types were correlated with GPA. Conclusion The most preferred VARK learning style among medical students was quadmodal. Learning styles were not associated with GPA or mental health problems, except for interpersonal problems.

  2. Prevention, control, and elimination of neglected diseases in the Americas: Pathways to integrated, inter-programmatic, inter-sectoral action for health and development

    Genovese Miguel A

    2007-01-01

    Full Text Available Abstract Background In the Latin America and Caribbean region over 210 million people live below the poverty line. These impoverished and marginalized populations are heavily burdened with neglected communicable diseases. These diseases continue to enact a toll, not only on families and communities, but on the economically constrained countries themselves. Discussion As national public health priorities, neglected communicable diseases typically maintain a low profile and are often left out when public health agendas are formulated. While many of the neglected diseases do not directly cause high rates of mortality, they contribute to an enormous rate of morbidity and a drastic reduction in income for the most poverty-stricken families and communities. The persistence of this "vicious cycle" between poverty and poor health demonstrates the importance of linking the activities of the health sector with those of other sectors such as education, housing, water and sanitation, labor, public works, transportation, agriculture, industry, and economic development. Summary The purpose of this paper is three fold. First, it focuses on a need for integrated "pro-poor" approaches and policies to be developed in order to more adequately address the multi-faceted nature of neglected diseases. This represents a move away from traditional disease-centered approaches to a holistic approach that looks at the overarching causes and mechanisms that influence the health and well being of communities. The second objective of the paper outlines the need for a specific strategy for addressing these diseases and offers several programmatic entry points in the context of broad public health measures involving multiple sectors. Finally, the paper presents several current Pan American Health Organization and other institutional initiatives that already document the importance of integrated, inter-programmatic, and inter-sectoral approaches. They provide the framework for a

  3. Evolution of the health sector response to HIV in Myanmar: progress, challenges and the way forward.

    Oo, Htun Nyunt; Hone, San; Fujita, Masami; Maw-Naing, Amaya; Boonto, Krittayawan; Jacobs, Marjolein; Phyu, Sabe; Bollen, Phavady; Cheung, Jacquie; Aung, Htin; Aung Sang, May Thu; Myat Soe, Aye; Pendse, Razia; Murphy, Eamonn

    2016-11-28

    Critical building blocks for the response to HIV were made until 2012 despite a series of political, social and financial challenges. A rapid increase of HIV service coverage was observed from 2012 to 2015 through collaborative efforts of government and non-governmental organisations (NGOs). Government facilities, in particular, demonstrated their capacity to expand services for antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT) of HIV, tuberculosis and HIV co-infection and methadone-maintenance therapy (MMT). After nearly three decades into the response to HIV, Myanmar has adopted strategies to provide the right interventions to the right people in the right places to maximise impact and cost efficiency. In particular, the country is now using strategic information to classify areas into high-, medium- and low-HIV burden and risk of new infections for geographical prioritisation - as HIV remains concentrated among key population (KP) groups in specific geographical areas. Ways forward include: •Addressing structural barriers for KP to access services, and identifying and targeting KPs at higher risk;•Strengthening the network of public facilities, NGOs and general practitioners and introducing a case management approach to assist KPs and other clients with unknown HIV status, HIV-negative clients and newly diagnosed clients to access the health services across the continuum to increase the number of people testing for HIV and to reduce loss to follow-up in both prevention and treatment;•Increasing the availability of HIV testing and counselling services for KPs, clients of female sex workers (FSW), and other populations at risk, and raising the demand for timely testing including expansion of outreach and client-initiated voluntary counselling and testing (VCT) services;•Monitoring and maximising retention from HIV diagnosis to ART initiation and expanding quality HIV laboratory services, especially viral load

  4. How can insulin initiation delivery in a dual-sector health system be optimised? A qualitative study on healthcare professionals’ views

    Lee Ping Yein

    2012-04-01

    Full Text Available Abstract Background The prevalence of type 2 diabetes is increasing at an alarming rate in developing countries. However, glycaemia control remains suboptimal and insulin use is low. One important barrier is the lack of an efficient and effective insulin initiation delivery approach. This study aimed to document the strategies used and proposed by healthcare professionals to improve insulin initiation in the Malaysian dual-sector (public–private health system. Methods In depth interviews and focus group discussions were conducted in Klang Valley and Seremban, Malaysia in 2010–11. Healthcare professionals consisting of general practitioners (n = 11, medical officers (n = 8, diabetes educators (n = 3, government policy makers (n = 4, family medicine specialists (n = 10 and endocrinologists (n = 2 were interviewed. We used a topic guide to facilitate the interviews, which were audio recorded, transcribed verbatim and analysed using a thematic approach. Results Three main themes emerged from the interviews. Firstly, there was a lack of collaboration between the private and public sectors in diabetes care. The general practitioners in the private sector proposed an integrated system for them to refer patients to the public health services for insulin initiation programmes. There could be shared care between the two sectors and this would reduce the disproportionately heavy workload at the public sector. Secondly, besides the support from the government health authority, the healthcare professionals wanted greater involvement of non-government organisations, media and pharmaceutical industry in facilitating insulin initiation in both the public and private sectors. The support included: training of healthcare professionals; developing and disseminating patient education materials; service provision by diabetes education teams; organising programmes for patients’ peer group sessions; increasing awareness and demystifying

  5. La atención gerenciada en América Latina. Transnacionalización del sector salud en el contexto de la reforma Managed care in Latin America: transnationalization of the health sector in a context of reform

    Celia Iriart

    2000-01-01

    Full Text Available Este artículo presenta resultados de la investigación comparativa "Atención Gerenciada en América Latina: Su Papel en la Reforma de los Sistemas de Salud", realizada por equipos de Argentina, Brasil, Chile, Ecuador y Estados Unidos. El objetivo del estudio fue analizar el proceso de exportación de la atención gerenciada, especialmente desde Estado Unidos, y su incorporación en los países latinoamericanos. Los métodos utilizados incluyeron técnicas cualitativas y cuantitativas. La adopción de la atención gerenciada muestra el proceso de transnacionalización del sector salud. Nuestros hallazgos demuestran el ingreso de los principales capitales financieros multinacionales en el sector privado de seguros y de prestadores de salud, y su intencionalidad de participar en la administración de las instituciones estatales y de los fondos de la seguridad social médica. Concluimos que este proceso de cambio sustancial, que implica la paulatina adopción de la atención gerenciada, es facilitado por las transformaciones operadas a nivel ideológico.This article presents the results of the comparative research project "Managed Care in Latin America: Its Role in Health Reform". The project was conducted by teams in Argentina, Brazil, Chile, Ecuador, and the United States. The study's objective was to analyze the process by which managed care is exported, especially from the United States, and how managed care is adopted in Latin American countries. Our research methods included qualitative and quantitative techniques. Adoption of managed care reflects transnationalization of the health sector. Our findings demonstrate the entrance of large multinational financial capital into the private insurance and health services sectors and their intention of participating in the administration of government institutions and medical/social security funds. We conclude that this basic change involving the slow adoption of managed care is facilitated by

  6. [Users and the technological transition in the supplemental health sector: case study of a health insurance plan company].

    Meneses, Consuelo Sampaio; Cecilio, Luiz Carlos de Oliveira; Andreazza, Rosemarie; Araújo, Eliane Cardoso de; Cuginotti, Aloísio Punhagui; Reis, Ademar Arthur Chioro dos

    2013-01-01

    This paper presents the results obtained from qualitative research conducted with a group of users involved in Case Management, a program which was developed by a company of a medical group to provide healthcare for patients in situations of high vulnerability. The study sought to create a perspective in which the experience of the user, instead of representing merely additional or superimposed information upon the quality of services, is considered an inherent part of the arrangement under scrutiny, with the ability to highlight its internal qualities and contradictions. The results show how patients attribute high value to the healthcare they receive, with special emphasis on the bond that is created with the health team in charge, even when contact is only by telephone. Simultaneously, they are able to perceive the double-sided aspect presented by the regulation/assistance model found in the technological arrangement at issue, notably in relation to the prominent role played by the economic bias towards cost reduction--which lies in the forefront of its operationalization--and the final impact it has upon the final quality of healthcare.

  7. Nexus between preventive policy inadequacies, workplace bullying, and mental health: Qualitative findings from the experiences of Australian public sector employees.

    Hurley, John; Hutchinson, Marie; Bradbury, Joanne; Browne, Graeme

    2016-02-01

    Public sector organizations have been shown to have high levels of workplace bullying, despite widespread adoption of zero-tolerance policy. Given the level of harm that stems from bullying, it has been suggested that it might be one of the most serious problems facing modern organizations. The qualitative findings from a large cross sectional study of public servants in Australia are reported in the present study. The results highlight palpable mental distress and illness stemming from exposure to workplace bullying. This distress was exacerbated by failures in prohibitive workplace procedures. Reporting bullying through formal organization processes did not lead to resolution of the problem; it instead highlighted feelings of powerlessness and mistrust. In light of the findings, we suggest that an alternative discourse is required, one that gives attention to enhancing employee resilience and self-healing behaviours to the emotional trauma of workplaces. Organizations might be better placed investing resources in fostering the resilience and emotional intelligence of their workforce, rather than continuing to invest resources in prohibitive policies that fail to address the problem. Employees should be supported to prioritize responsibility for their own mental health, rather than an overreliance on organizational responses.

  8. Identifying unmet mental health needs in children of formerly homeless mothers living in a supportive housing community sector of care.

    Lee, Susanne S; August, Gerald J; Gewirtz, Abigail H; Klimes-Dougan, Bonnie; Bloomquist, Michael L; Realmuto, George M

    2010-04-01

    This study reports psychosocial characteristics of a sample of 111 children (K to 2nd grade) and their mothers who were living in urban supportive housings. The aim of this study was to document the various types and degree of risk endemic to this population. First, we describe the psychosocial characteristics of this homeless sample. Second, we compared this homeless sample with a grade-matched, high-risk, school-based sample of children (n = 146) who were identified as showing early symptoms of disruptive behaviors. Third, we compared the parents in both samples on mental health, parenting practices, and service utilization. Results showed that children living in supportive housing were in the at-risk range and had comparable levels of externalizing problems, internalizing problems, school problems and emotional strengths with the school-based risk sample receiving prevention services at a family support community agency. Mothers in supportive housing reported significantly higher psychological distress, less optimal parenting practices and greater service utilization. These findings are among the first to provide empirical support for the need to deliver prevention interventions in community sectors of care.

  9. Unemployment, public–sector health care expenditure and HIV mortality: An analysis of 74 countries, 1981–2009

    Mahiben Maruthappu

    2015-06-01

    Full Text Available Background: The global economic downturn has been associated with increased unemployment and reduced public–sector expenditure on health care (PSEH. We determined the association between unemployment, PSEH and HIV mortality. Methods: Data were obtained from the World Bank and the World Health Organisation (1981–2009. Multivariate regression analysis was implemented, controlling for country–specific demographics and infrastructure. Time–lag analyses and robustness–checks were performed. Findings: Data were available for 74 countries (unemployment analysis and 75 countries (PSEH analysis, equating to 2.19 billion and 2.22 billion people, respectively, as of 2009. A 1% increase in unemployment was associated with a significant increase in HIV mortality (men: 0.1861, 95% CI: 0.0977 to 0.2744, P<0.0001, women: 0.0383, 95% CI: 0.0108 to 0.0657, P=0.0064. A 1% increase in PSEH was associated with a significant decrease in HIV mortality (men: –0.5015, 95% CI: –0.7432 to –0.2598, P=0.0001; women: –0.1562, 95% CI: –0.2404 to –0.0720, P=0.0003. Time–lag analysis showed that significant changes in HIV mortality continued for up to 5 years following variations in both unemployment and PSEH. Interpretation: Unemployment increases were associated with significant HIV mortality increases. PSEH increases were associated with reduced HIV mortality. The facilitation of access–to–care for the unemployed and policy interventions which aim to protect PSEH could contribute to improved HIV outcomes.

  10. Plansalud: Plan sectorial concertado y descentralizado para el desarrollo de capacidades en salud, Perú 2010 - 2014 Plansalud: Decentralized and agreed sector plan for the capacity development in health, Peru 2010-2014

    Lizardo Huamán-Angulo

    2011-06-01

    Full Text Available Los recursos humanos son el eje del accionar del sector salud; sin embargo, no necesariamente son el aspecto mejor atendido, por ello el Ministerio de Salud del Perú (MINSA conjuntamente con los gobiernos regionales generó el Plan Sectorial Concertado y Descentralizado para el Desarrollo de Capacidades en Salud 2010-2014 (PLANSALUD con el propósito de fortalecer las capacidades de los Recursos Humanos en Salud (RHUS y contribuir para que la atención de salud se desarrolle con eficiencia, calidad, pertinencia, equidad e interculturalidad en el marco de la descentralización, el Aseguramiento Universal de la Salud (AUS y las políticas de la salud. Con ese objeto se han propuesto tres componentes (asistencia técnica, capacitación y articulación educación - salud que agrupan a un conjunto importante de intervenciones, las cuales son planteadas y definidas de acuerdo al contexto nacional, regional y local, contribuyendo de ese modo a la mejora de las capacidades de gobierno, de gestión por competencias y la prestación de servicios de salud. El presente artículo muestra una primera aproximación de PLANSALUD, incluyendo aspectos relacionados a su planificación, gestión, financiamiento, estructura y funcionamiento, así como las medidas de monitoreo y evaluación.Human resources are the backbone of health sector actions; however, they are not necessarily the area with the greatest attention, therefore, the Ministry of Health of Peru (MINSA together with regional governments, led the Decentralized and Agreed Sector Plan for the Capacity Development in Health 2010-2014 (PLANSALUD with the aim of strengthening the capacities of Human Resources for Health (HRH and contribute to health care efficient development, quality, relevance, equity and multiculturalism, in the context of descentralization, the Universal Health Insurance (AUS and health policies. To achieve this goal, they have proposed three components (technical assistance, joint

  11. Introduction of EDI in the public sector

    Falch, Morten

    1997-01-01

    Reviews the status of EDI in the sectors of health, public transport and taxation and public administration. The impact of this on the diffusion of EDI in other sectors is analysed.......Reviews the status of EDI in the sectors of health, public transport and taxation and public administration. The impact of this on the diffusion of EDI in other sectors is analysed....

  12. Exploring the Nutrition and Health Claims Regulation (EC) No. 1924/2006: What is the impact on innovation in the EU food sector?

    Khedkar, Sukhada; Bröring, Stefanie; Ciliberti, Stefano

    2017-02-01

    Literature suggests that despite its positive aim of promoting innovation, the Nutrition and Health Claims Regulation (EC) No. 1924/2006 (NHCR) may bring along several compliance challenges, which might affect innovation in the EU food sector. This study investigates the challenges faced by companies to comply with the NHCR (specifically Article 13.1) and their impact on innovation. To this end, we conducted an online survey with 105 companies involved in the EU food sector. Results indicate that companies perceive wording of claims, missing transparency and limited financial resources as major challenges to comply with the NHCR (Article 13.1). Companies reported not to have increased their R&D expenditure or innovation activities after the NHCR (Article 13.1) was implemented. Thus, this study highlights specific compliance challenges related to the NHCR (Article 13.1) and indicates that currently, the regulation does not seem to have fostered innovation in the EU food sector.

  13. Patterns of case management and chemoprevention for malaria-in-pregnancy by public and private sector health providers in Enugu state, Nigeria

    Onwujekwe Ogochukwu C

    2012-07-01

    Full Text Available Abstract Background Malaria in pregnancy (MIP is a major disease burden in Nigeria and has adverse consequences on the health of the mother, the foetus and the newborn. Information is required on how to improve its prevention and treatment from both the providers’ and consumers’ perspectives. Methods The study sites were two public and two private hospitals in Enugu, southeast Nigeria. Data was collected using a pre-tested structured questionnaire. The respondents were healthcare providers (doctors, pharmacists and nurses providing ante-natal care (ANC services. They consisted of 32 respondents from the public facilities and 20 from the private facilities. The questionnaire elicited information on their: knowledge about malaria, attitude, chemotherapy and chemoprophylaxis using pyrimethamine, chloroquine proguanil as well as IPTp with sulphadoxine-pyrimethamine (SP. The data was collected from May to June 2010. Results Not many providers recognized maternal and neonatal deaths as potential consequences of MIP. The public sector providers provided more appropriate treatment for the pregnant women, but the private sector providers found IPTp more acceptable and provided it more rationally than public sector providers (p  Conclusions There is sub-optimal level of knowledge about current best practices for treatment and chemoprophylaxis for MIP especially in the private sector. Also, IPTp was hardly used in the public sector. Interventions are required to improve providers’ knowledge and practices with regards to management of MIP.

  14. In place of fear: aligning health care planning with system objectives to achieve financial sustainability.

    Birch, Stephen; Murphy, Gail Tomblin; MacKenzie, Adrian; Cumming, Jackie

    2015-04-01

    The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management of health care to reflect needs for care in populations and to integrate planning and management functions for health care expenditure, health care services and the health care workforce. We present a Health Care Sustainability Framework based on disaggregating the health care expenditure into separate planning components. Unlike other approaches to planning health care expenditure, this framework explicitly incorporates population health needs as a determinant of health care requirements, and provides a diagnostic tool for understanding the sources of expenditure increase.

  15. Using portfolios to evaluate achievement of population-based public health nursing competencies in baccalaureate nursing students.

    Schaffer, Marjorie A; Nelson, Pamela; Litt, Emily

    2005-01-01

    Public health nurses from 13 local public health agencies and nurse educators from five schools of nursing developed population-based public health nursing competencies for new graduates and novice public health nurses. Educators in one nursing program used a portfolio assignment to measure achievement of the competencies by traditional and RN to BSN students in a community health nursing course. Data were collected from surveys and focus groups to determine students' responses to the portfolio and their use of population-based public health nursing concepts. The assignment enhanced students' critical thinking skills; however, concerns about the structure and evaluation of the portfolio decreased student satisfaction. Recommendations are made for improving the portfolio format, increasing students' valuing of the portfolio, managing the tension between assessment and learning, and orienting clinical agency staff and nursing instructors.

  16. What is Health and What is Important for its Achievement? A Qualitative Study on Adolescent Boys’ Perceptions and Experiences of Health

    Randell, Eva; Jerdén, Lars; Öhman, Ann; Flacking, Renée

    2016-01-01

    Few qualitative studies have explored adolescent boys’ perceptions of health. Aim: The aim of this study was therefore to explore how adolescent boys understand the concept of health and what they find important for its achievement Methods: Grounded theory was used as a method to analyse interviews with 33 adolescent boys aged 16 to 17 years attending three upper secondary schools in a relatively small town in Sweden. Results: There was a complexity in how health was perceived, experienced, dealt with, and valued. Although health on a conceptual level was described as ‘holistic’, health was experienced and dealt with in a more dualistic manner, one in which the boys were prone to differentiate between mind and body. Health was experienced as mainly emotional and relational, whereas the body had a subordinate value. The presence of positive emotions, experiencing self-esteem, balance in life, trustful relationships, and having a sense of belonging were important factors for health while the body was experienced as a tool to achieve health, as energy, and as a condition. Conclusion: Our findings indicate that young, masculine health is largely experienced through emotions and relationships and thus support theories on health as a social construction of interconnected processes. PMID:27347252

  17. Discussing Women's Reproductive Health, Religion, Roles and Rights: Achieving Women's Empowerment.

    Sousa, Isabela Cabral Felix de

    1995-01-01

    A health education program in Brazil trained 26 women as community health educators. Only four used their roles to foster social change. Discussing women's reproductive health in the context of religion and social values contributed to successful training; economic and political empowerment was hampered by perpetuation of traditional role…

  18. Meteorology and oceanography of the Atlantic sector of the Southern Ocean—a review of German achievements from the last decade

    Hellmer, Hartmut H.; Rhein, Monika; Heinemann, Günther; Abalichin, Janna; Abouchami, Wafa; Baars, Oliver; Cubasch, Ulrich; Dethloff, Klaus; Ebner, Lars; Fahrbach, Eberhard; Frank, Martin; Gollan, Gereon; Greatbatch, Richard J.; Grieger, Jens; Gryanik, Vladimir M.; Gryschka, Micha; Hauck, Judith; Hoppema, Mario; Huhn, Oliver; Kanzow, Torsten; Koch, Boris P.; König-Langlo, Gert; Langematz, Ulrike; Leckebusch, Gregor C.; Lüpkes, Christof; Paul, Stephan; Rinke, Annette; Rost, Bjoern; van der Loeff, Michiel Rutgers; Schröder, Michael; Seckmeyer, Gunther; Stichel, Torben; Strass, Volker; Timmermann, Ralph; Trimborn, Scarlett; Ulbrich, Uwe; Venchiarutti, Celia; Wacker, Ulrike; Willmes, Sascha; Wolf-Gladrow, Dieter

    2016-09-01

    In the early 1980s, Germany started a new era of modern Antarctic research. The Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research (AWI) was founded and important research platforms such as the German permanent station in Antarctica, today called Neumayer III, and the research icebreaker Polarstern were installed. The research primarily focused on the Atlantic sector of the Southern Ocean. In parallel, the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) started a priority program `Antarctic Research' (since 2003 called SPP-1158) to foster and intensify the cooperation between scientists from different German universities and the AWI as well as other institutes involved in polar research. Here, we review the main findings in meteorology and oceanography of the last decade, funded by the priority program. The paper presents field observations and modelling efforts, extending from the stratosphere to the deep ocean. The research spans a large range of temporal and spatial scales, including the interaction of both climate components. In particular, radiative processes, the interaction of the changing ozone layer with large-scale atmospheric circulations, and changes in the sea ice cover are discussed. Climate and weather forecast models provide an insight into the water cycle and the climate change signals associated with synoptic cyclones. Investigations of the atmospheric boundary layer focus on the interaction between atmosphere, sea ice and ocean in the vicinity of polynyas and leads. The chapters dedicated to polar oceanography review the interaction between the ocean and ice shelves with regard to the freshwater input and discuss the changes in water mass characteristics, ventilation and formation rates, crucial for the deepest limb of the global, climate-relevant meridional overturning circulation. They also highlight the associated storage of anthropogenic carbon as well as the cycling of carbon, nutrients and trace metals

  19. Meteorology and oceanography of the Atlantic sector of the Southern Ocean—a review of German achievements from the last decade

    Hellmer, Hartmut H.; Rhein, Monika; Heinemann, Günther; Abalichin, Janna; Abouchami, Wafa; Baars, Oliver; Cubasch, Ulrich; Dethloff, Klaus; Ebner, Lars; Fahrbach, Eberhard; Frank, Martin; Gollan, Gereon; Greatbatch, Richard J.; Grieger, Jens; Gryanik, Vladimir M.; Gryschka, Micha; Hauck, Judith; Hoppema, Mario; Huhn, Oliver; Kanzow, Torsten; Koch, Boris P.; König-Langlo, Gert; Langematz, Ulrike; Leckebusch, Gregor C.; Lüpkes, Christof; Paul, Stephan; Rinke, Annette; Rost, Bjoern; van der Loeff, Michiel Rutgers; Schröder, Michael; Seckmeyer, Gunther; Stichel, Torben; Strass, Volker; Timmermann, Ralph; Trimborn, Scarlett; Ulbrich, Uwe; Venchiarutti, Celia; Wacker, Ulrike; Willmes, Sascha; Wolf-Gladrow, Dieter

    2016-11-01

    In the early 1980s, Germany started a new era of modern Antarctic research. The Alfred Wegener Institute Helmholtz Centre for Polar and Marine Research (AWI) was founded and important research platforms such as the German permanent station in Antarctica, today called Neumayer III, and the research icebreaker Polarstern were installed. The research primarily focused on the Atlantic sector of the Southern Ocean. In parallel, the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG) started a priority program `Antarctic Research' (since 2003 called SPP-1158) to foster and intensify the cooperation between scientists from different German universities and the AWI as well as other institutes involved in polar research. Here, we review the main findings in meteorology and oceanography of the last decade, funded by the priority program. The paper presents field observations and modelling efforts, extending from the stratosphere to the deep ocean. The research spans a large range of temporal and spatial scales, including the interaction of both climate components. In particular, radiative processes, the interaction of the changing ozone layer with large-scale atmospheric circulations, and changes in the sea ice cover are discussed. Climate and weather forecast models provide an insight into the water cycle and the climate change signals associated with synoptic cyclones. Investigations of the atmospheric boundary layer focus on the interaction between atmosphere, sea ice and ocean in the vicinity of polynyas and leads. The chapters dedicated to polar oceanography review the interaction between the ocean and ice shelves with regard to the freshwater input and discuss the changes in water mass characteristics, ventilation and formation rates, crucial for the deepest limb of the global, climate-relevant meridional overturning circulation. They also highlight the associated storage of anthropogenic carbon as well as the cycling of carbon, nutrients and trace metals

  20. Change Theory for Accounting System Reform in Health Sector: A Case Study of Kerman University of Medical Sciences in Iran

    Mohammad Hossein Mehrolhasani

    2013-11-01

    Full Text Available BackgroundChange theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin’s change theory or not. MethodsThis study which adopted a mixed methodology approach, qualitative and quantitative methods, was conducted in 2012. In the first phase of the study, 41 participants using purposive sampling and in the second phase, 32 affiliated units of Kerman University of Medical Sciences (KUMS were selected as the study sample. Also, in phase one, we used face-to-face in-depth interviews (6 participants and the quote method (35 participants for data collection. We used a thematic framework analysis for analyzing data. In phase two, a questionnaire with a ten-point Likert scale was designed and then, data were analyzed using descriptive indicators, principal component and factorial analyses. ResultsThe results of phase one yielded a model consisting of four categories of superstructure, apparent infrastructure, hidden infrastructure and common factors. By linking all factors, totally, 12 components based on the quantitative results showed that the state of all components were not satisfactory at KUMS (5.06±2.16. Leadership and management; and technology components played the lowest and the greatest roles in implementing the accrual accounting system respectively. ConclusionThe results showed that the unfreezing stage did not occur well and the components were immature, mainly because the emphasis was placed on superstructure components rather than the components of hidden infrastructure. The study suggests that a road map should be developed in the financial system based on Kurt Lewin’s change theory and

  1. Change Theory for Accounting System Reform in Health Sector: A Case Study of Kerman University of Medical Sciences in Iran

    Mehrolhassani, Mohammad Hossein; Emami, Mozhgan

    2013-01-01

    Background: Change theories provide an opportunity for organizational managers to plan, monitor and evaluate changes using a framework which enable them, among others, to show a fast response to environmental fluctuations and to predict the changing patterns of individuals and technology. The current study aimed to explore whether the change in the public accounting system of the Iranian health sector has followed Kurt Lewin’s change theory or not. Methods: This study which adopted a mixed methodology approach, qualitative and quantitative methods, was conducted in 2012. In the first phase of the study, 41 participants using purposive sampling and in the second phase, 32 affiliated units of Kerman University of Medical Sciences (KUMS) were selected as the study sample. Also, in phase one, we used face-to-face in-depth interviews (6 participants) and the quote method (35 participants) for data collection. We used a thematic framework analysis for analyzing data. In phase two, a questionnaire with a ten-point Likert scale was designed and then, data were analyzed using descriptive indicators, principal component and factorial analyses. Results: The results of phase one yielded a model consisting of four categories of superstructure, apparent infrastructure, hidden infrastructure and common factors. By linking all factors, totally, 12 components based on the quantitative results showed that the state of all components were not satisfactory at KUMS (5.06±2.16). Leadership and management; and technology components played the lowest and the greatest roles in implementing the accrual accounting system respectively. Conclusion: The results showed that the unfreezing stage did not occur well and the components were immature, mainly because the emphasis was placed on superstructure components rather than the components of hidden infrastructure. The study suggests that a road map should be developed in the financial system based on Kurt Lewin’s change theory and the

  2. Sector Economic Outlook. Energy

    NONE

    2013-04-15

    The energy sector is a key driver of the economic pillar of Vision 2030. As the economy grows, urbanization intensifies and incomes increase, corporate and household demand for energy also rises. To meet this growth in demand for energy, the sector needs to increase investments and diversify into more sources of energy such as geothermal and wind power. It is therefore critical that focus is directed towards development and sustainability of the energy sector to ensure delivery of least cost power that will improve Kenya's competitiveness and achieve the Vision 2030 objective of 10% average annual economic growth.

  3. Accelerated reforms in healthcare financing: the need to scale up private sector participation in Nigeria

    Ejughemre, Ufuoma John

    2014-01-01

    The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government’s commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage. PMID:24596895

  4. Accelerated Reforms in Healthcare Financing: The Need to Scale up Private Sector Participation in Nigeria

    Ufuoma John Ejughemre

    2014-01-01

    Full Text Available The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government’s commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage.

  5. Differences in wage rates for males and females in the health sector: a consideration of unpaid overtime to decompose the gender wage gap

    Vecchio Nerina

    2013-02-01

    Full Text Available Abstract Background In Australia a persistent and sizable gender wage gap exists. In recent years this gap has been steadily widening. The negative impact of gender wage differentials is the disincentive to work more hours. This implies a substantial cost on the Australian health sector. This study aimed to identify the magnitude of gender wage differentials within the health sector. The investigation accounts for unpaid overtime. Given the limited availability of information, little empirical evidence exists that accounts for unpaid overtime. Methods Information was collected from a sample of 10,066 Australian full-time employees within the health sector. Initially, ordinary least-squares regression was used to identify the gender wage gap when unpaid overtime was included and then excluded from the model. The sample was also stratified by gender and then by occupation to allow for comparisons. Later the Blinder–Oaxaca decomposition method was employed to identify and quantify the contribution of individual endowments to wage differentials between males and females. Results The analyses of data revealed a gender wage gap that varied across occupations. The inclusion of unpaid overtime in the analysis led to a slight reduction in the wage differential. The results showed an adjusted wage gap of 16.7%. Conclusions Unpaid overtime made a significant but small contribution to wage differentials. Being female remained the major contributing factor to the wage gap. Given that wage differentials provide a disincentive to work more hours, serious attempts to deal with the skilled labour shortage in the health sector need to address the gender wage gap.

  6. Professionalising counter fraud specialists (fraud investigators) in the UK public sector: a focus upon Department for Work and Pensions, National Health Service and the Local Authority

    Frimpong, KO

    2013-01-01

    This thesis seeks to examine and explore the professionalisation initiatives of the UK public sector counter fraud specialists (fraud investigators), with a focus upon the Department for Work and Pensions (DWP), National Health Service (NHS) and Local Authority (LA). The conceptual framework used to underpin the study was functionalist / “traits” theory of a profession and professionalisation. The main research question for the thesis concerns the issue of whether counter fraud specialism is ...

  7. Predicting Early Adolescents' Academic Achievement, Social Competence, and Physical Health from Parenting, Ego Resilience, and Engagement Coping

    Swanson, Jodi; Valiente, Carlos; Lemery-Chalfant, Kathryn; O'Brien, T. Caitlin

    2011-01-01

    This study examined ego resilience and engagement coping as mediators of the relationships between supportive and controlling parenting practices and early adolescents' academic achievement, social competence, and physical health. Participants were 240 predominantly Mexican American early adolescents, their parents, and their teachers. There were…

  8. The Perceptions of Principals and Teachers Regarding Mental Health Providers' Impact on Student Achievement in High Poverty Schools

    Perry, Teresa

    2012-01-01

    This study examined the perceptions of principals and teachers regarding mental health provider's impact on student achievement and behavior in high poverty schools using descriptive statistics, t-test, and two-way ANOVA. Respondents in this study shared similar views concerning principal and teacher satisfaction and levels of support for the…

  9. Addressing the social determinants of health through health system strengthening and inter-sectoral convergence: the case of the Indian National Rural Health Mission

    Amit Mohan Prasad

    2013-03-01

    Full Text Available Background: At the turn of the 21st century, India was plagued by significant rural–urban, inter-state and inter-district inequities in health. For example, in 2004, the infant mortality rate (IMR was 24 points higher in rural areas compared to urban areas. To address these inequities, to strengthen the rural health system (a major determinant of health in itself and to facilitate action on other determinants of health, India launched the National Rural Health Mission (NRHM in April 2005. Methods: Under the NRHM, Rs. 666 billion (US$12.1 billion was invested in rural areas from April 2005 to March 2012. There was also a substantially higher allocation for 18 high-focus states2 and 264 high-focus districts, identified on the basis of poor health and demographic indicators. Other determinants of health, especially nutrition and decentralized action, were addressed through mechanisms like State/District Health Missions, Village Health, Sanitation and Nutrition Committees, and Village Health and Nutrition Days. Results: Consequently, in bigger high-focus states, rural IMR fell by 15.6 points between 2004 and 2011, as compared to 9 points in urban areas. Similarly, the maternal mortality rate in high-focus states declined by 17.9% between 2004–2006 and 2007–2009 compared to 14.6% in other states. Conclusion: The article, on the basis of the above approaches employed under NRHM, proposes the NRHM model to ‘reduce health inequities and initiate action on SDH’.

  10. A Survey on Smart use of BBM and its Influence on Academic Achievement in SMK Health PGRI Denpasar

    I Wayan Gede Narayana

    2015-09-01

    Full Text Available Black Berry Messenger chat facility is very popular in the process of communicating through text messages, pictures and videos, so that the process of communication in the interaction between users can be carried out actively in virtual world. In this study, it will be examined as to whether the Black Berry Messenger has a significant influence on academic achievement in SMK Health PGRI Denpasar. This study will show the effect of the BBM in the improvement of academic achievement, using quantitative methods by distributing questionnaires from a random sample of the student population of SMK health PGRI Denpasar. The correlation analysis uses the correlation coefficient Kendall's tau which managed to deliver the results that the BBM is very influential with the increase of academic achievement.

  11. Descentralización del sector de salud y conflictos con el gremio médico en México Health sector decentralization and divergences with the medical society in Mexico

    Raquel Abrantes Pêgo

    2002-06-01

    Full Text Available OBJETIVO: Investigar la percepción y acción del gremio médico en el marco de la descentralización del Sector de Salud en dos estados de México, Guanajuato y Sonora. MÉTODOS: Se han utilizado técnicas cualitativas de investigación. Fueron realizadas 35 entrevistas, semiestructuradas, en total entre los dos estados, a médicos colegiados, Guanajuato y Sonora, tanto de instituciones públicas como privadas y representantes de las asociaciones gremiales y sindicales. RESULTADOS: Para el gremio médico de los dos estados investigados, la descentralización ha implicado en inseguridad, como resultado de la falta de claridad en la regulación del Sector de Salud. La acción de los Colegios de Médicos de ambos estados, se tradujo en una mayor politización de los Colegios de Médicos estatales, en la elaboración de propuestas con el objetivo de incidir en el control del mercado laboral médico de dichos estados y participación en la estructura de poder regional. CONCLUSIONES: La investigación comprueba una readaptación del gremio médico en el ámbito regional, indicando su permanencia como grupo de poder. Contrariamente a lo que informa la literatura estadounidense en México, los médicos han logrado influenciar en la regulación, con la finalidad de no perder su status privilegiado dentro de la competencia existente.OBJECTIVE: To evaluate the medical society's perception and actions in the context of health sector decentralization in the states of Guanajuato and Sonora, Mexico. METHODS: Qualitative research techniques were applied. Thirty-five semi-structured interviews were conducted with medical college members of both public and private institutions, and collegiate and union representatives of both states studied. RESULTS: Members of medical society in both states acknowledged that decentralization implied in insecurity due to the lack of clarity of health sector regulations. As a result of actions of the medical college in both

  12. [The relationship between the contents and the level of achievement of objectives in an occupational health nursing practicum].

    Nakatani, Junko; Hara, Yoshiko; Ikeda, Tomoko; Ishihara, Itsuko

    2010-03-01

    The purpose of this study was to evaluate the program and teaching methods of the occupational health nursing practicum in order to enforce students' learning experience in the clinical practice. Self-evaluation sheets graded from levels 1 to 4 were from 63 students, and statistical analysis was performed in relation to their performance levels. The results of the analysis of 63 students' performance sheets indicated that the students achieved 3 points above average in all 14 course objectives. Scales analysis of the students' evaluation sheets also revealed that students' achievement levels were lower at the Industrial Health Organization in comparison with those at the industrial enterprises. To make students' practice more valuable, students' assessment skills of the workers and working environment should be emphasized in the classroom teaching and experience of learning at the laboratory. Moreover, the course objectives should be sufficiently linked to the practice areas in order to differentiate between the features of the Health organizations and enterprises.

  13. Achieving the Promise: The Significant Role of Schools in Transforming Children's Mental Health in America

    Lechtenberger, DeAnn; Mullins, Frank Edward; Greenword, Dale

    2008-01-01

    Teacher preparation programs can play an essential role in disseminating information on children's mental health and design curricula that teach the skills necessary for promoting good mental health in schools to preservice and inservice professionals from diverse backgrounds and disciplines. The strategies presented in this article will provide…

  14. Developing cross-sectoral quality assurance for cataract surgery in the statutory quality assurance program of the German health care system: Experiences and lessons learned.

    Bramesfeld, Anke; Pauletzki, Jürgen; Behrenz, Lars; Szecsenyi, Joachim; Willms, Gerald; Broge, Björn

    2015-08-01

    Since 2001, statutory external quality assurance (QA) for hospital care has been in place in the German health system. In 2009, the decision was taken to expand it to cross-sectoral procedures. This novel and unprecedented form of national QA aims at (1) making the quality procedures comparable that are provided both in inpatient and outpatient care, (2) following-up outcomes of hospital care after patients' discharge and (3) measuring the quality of complex treatment chains across interfaces. As a pioneer procedure a QA procedure in cataract surgery QA was developed. Using this as an example, challenges of cross-sectoral QA are highlighted. These challenges relate, in particular, to three technical problems: triggering cases for documentation, following-up patients' after hospital discharge, and the burden of documentation in outpatient care. These problems resulted finally in the haltering of the development of the QA procedure. However, the experiences gained with this first development of cross-sectoral QA inspired the reorientation and further development of the field in Germany. Future cross-sectoral QA will rigorously aim at keeping burden of documentation small. It will draw data for QA mainly at three sources: routine data, patient surveys and peer reviews using indicators. Policy implications of this reorientation are discussed.

  15. Achieving a shared vision for girls' health in a low-income community.

    Miller, M Elizabeth; Vaughn, Lisa M

    2015-01-01

    In response to a lack of information related to girls' health in a low-income community, an initiative was developed to create a community-wide vision for girls' health. A forum was conducted following a photovoice project to generate sustainable action steps. Forty-four participants attended the forum. Key action steps included decreasing barriers to participation in girls' programs, offering leadership roles and interpersonal communication skills for girls in the community, and engaging girls in community organizations. Integral to the forum's success were the initial photos, which provided a bridge from understanding the issues of girls' health to the development of the action steps.

  16. Achieving U.S. Health information technology adoption: the need for a third hand.

    Middleton, Blackford

    2005-01-01

    The U.S. health care information technology (HIT) market is broken; broad-scale adoption of HIT is not occurring despite considerable evidence of its impact on the quality of care and patient safety. Although adoption of HIT will not cure all that ails health care, it is an important step toward transformation of the U.S. health care delivery system. In this commentary I describe several critical issues pertaining to the HIT market failure and several ways in which the federal government may act as a deft and gentle "Third Hand" to assist the Invisible Hand of Adam Smith.

  17. Artemisinin combination therapies price disparity between government and private health sectors and its implication on antimalarial drug consumption pattern in Morogoro Urban District, Tanzania

    Malisa Allen

    2012-03-01

    Full Text Available Abstract Background Universal access to effective treatments is a goal of the Roll Back Malaria Partnership. However, despite official commitments and substantial increases in financing, this objective remains elusive, as development assistance continue to be routed largely through government channels, leaving the much needed highly effective treatments inaccessible or unaffordable to those seeking services in the private sector. Methods To quantify the effect of price disparity between the government and private health systems, this study have audited 92 government and private Drug Selling Units (DSUs in Morogoro urban district in Tanzania to determine the levels, trend and consumption pattern of antimalarial drugs in the two health systems. A combination of observation, interviews and questionnaire administered to the service providers of the randomly selected DSUs were used to collect data. Results ALU was the most selling antimalarial drug in the government health system at a subsidized price of 300 TShs (0.18 US$. By contrast, ALU that was available in the private sector (coartem was being sold at a price of about 10,000 TShs (5.9 US$, the price that was by far unaffordable, prompting people to resort to cheap but failed drugs. As a result, metakelfin (the phased out drug was the most selling drug in the private health system at a price ranging from 500 to 2,000 TShs (0.29–1.18 US$. Conclusions In order for the prompt diagnosis and treatment with effective drugs intervention to have big impact on malaria in mostly low socioeconomic malaria-endemic areas of Africa, inequities in affordability and access to effective treatment must be eliminated. For this to be ensued, subsidized drugs should be made available in both government and private health sectors to promote a universal access to effective safe and affordable life saving antimalarial drugs.

  18. Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease

    Hansen, Kristian Schultz; Chapman, Glyn

    2008-01-01

    estimates of the burden of disease, the present paper developed packages of health interventions using the estimated cost-effectiveness ratios. These packages could avert a quarter of the burden of disease at total costs corresponding to one tenth of the public health budget in the financial year 1997...... if more research resources were available. Conclusions: The present study showed that it was feasible to conduct cost-effectiveness analyses for a large number of health interventions in a developing country like Zimbabwe using a consistent methodology.......Background: This study aimed at providing information for priority setting in the health care sector of Zimbabwe as well as assessing the efficiency of resource use. A general approach proposed by the World Bank involving the estimation of the burden of disease measured in Disability-Adjusted Life...

  19. Using Disability-Adjusted Life Years and Cost-Effectiveness Analysis to define Priorities for the Public Health Care Sector in Zimbabwe

    Hansen, Kristian Schultz

    There is not much knowledge at present of the relative cost-effectiveness of health services offered in the Zimbabwean public health care sector. In addition, the information on the relative importance of diseases is less than complete. Such information may however be useful for assessing...... was utilised to calculate the burden of disease as measured by DALYs lost. HIV infection emerged from the information collected as the single most serious public health problem in Zimbabwe responsible for 49% of the total disease burden.In order to confirm some of the findings of the above study component......, a small population survey was designed to estimate the population prevalence of serious health problems in an urban area of Zimbabwe through the application of verbal autopsy and morbidity interview techniques. The survey confirmed to some extent the pattern of diseases found in the nationwide study.Cost...

  20. Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease

    Hansen, Kristian Schultz; Chapman, Glyn

    2008-01-01

    estimates of the burden of disease, the present paper developed packages of health interventions using the estimated cost-effectiveness ratios. These packages could avert a quarter of the burden of disease at total costs corresponding to one tenth of the public health budget in the financial year 1997...... if more research resources were available. CONCLUSION: The present study showed that it was feasible to conduct cost-effectiveness analyses for a large number of health interventions in a developing country like Zimbabwe using a consistent methodology.......BACKGROUND: This study aimed at providing information for priority setting in the health care sector of Zimbabwe as well as assessing the efficiency of resource use. A general approach proposed by the World Bank involving the estimation of the burden of disease measured in Disability-Adjusted Life...

  1. Towards sustainability of health information systems: how can we define, measure and achieve it?

    Garde, Sebastian; Hullin, Carola M; Chen, Rong; Schuler, Thilo; Gränz, Jana; Knaup, Petra; Hovenga, Evelyn J S

    2007-01-01

    Health information systems (HIS) in their current form are rarely sustainable. In order to sustain our health information systems and with it our health systems, we need to focus on defining and maintaining sustainable Health Information System building blocks or components. These components need to be easily updatable when clinical knowledge (or anything else) changes, easily adaptable when business requirements or processes change, and easily exchangeable when technology advances. One major prerequisite for this is that we need to be able to define and measure sustainability, so that it can become one of the major business drivers in HIS development. Therefore, this paper analyses general definitions and indicators for sustainability, and analyses their applicability to HIS. We find that general 'Emergy analysis' is one possibility to measure sustainability for HIS. Based on this, we investigate major enablers and inhibitors to sustainability in a highlevel framework consisting of four pillars: clinical, technical, socio-technical, and political/business.

  2. Modelling energy savings in the Danish building sector combined with internalisation of health related externalities in a heat and power system optimisation model

    Zvingilaite, Erika

    2013-01-01

    A substantial untapped energy saving potential rests in the building sector and is expected to play an important role in achieving reduction of environmental impacts of energy. In order to utilise this potential, effective policy measures need to be adopted to remove the existing barriers...... and create incentives. For that purpose, the cost effective energy saving options together with an optimal level of savings and expected environmental benefits have to be identified. The paper reports on a study that analyses these questions by including heat-saving measures in buildings into an energy....... Furthermore, the results suggest that changes in the energy generation sector are the prime driver behind the reduction of environmental externalities of energy. Heat savings in buildings play only a small role under model assumptions. © 2012Elsevier Ltd. All rights reserved....

  3. Association between scores in high school, aptitude and achievement exams and early performance in health science college

    Al-Alwan Ibrahim

    2009-01-01

    Full Text Available This retrospective study was carried out to assess the correlation between admi-ssion criteria to health science colleges, namely, final high school grade and Saudi National Apti-tude and Achievement exams, and early academic performance in these colleges. The study inclu-ded 91 male students studying in the two-year pre-professional program at the King Saud bin Abdulaziz University for Health Sciences (KSAU-HS, Riyadh, Saudi Arabia. Records of these students were used to extract relevant information and their academic performance (based on the grade point average achieved at the end of the first semester of the pre-professional program, which were analytically studied. Pearson correlation coefficient was used to assess the associa-tions between the different scores. SPSS statistical program (version 12.0 was used for data ana-lyses. We found a strong correlation between the academic performance and the Achievement Exam, Aptitude Exam and high school final grade, with Pearson Correlation Coefficients of 0.96, 0.93, 0.87, respectively. The Saudi National Achievement Exam showed the most significant correla-tion. Our results indicate that academic performance showed good correlation with the admission criteria used, namely final high school grade, Saudi National Aptitude and Achievement Exams.

  4. Electronic health record meets digital library: a new environment for achieving an old goal.

    Humphreys, B L

    2000-01-01

    Linking the electronic health record to the digital library is a Web-era reformulation of the long-standing informatics goal of seamless integration of automated clinical data and relevant knowledge-based information to support informed decisions. The spread of the Internet, the development of the World Wide Web, and converging format standards for electronic health data and digital publications make effective linking increasingly feasible. Some existing systems link electronic health data and knowledge-based information in limited settings or limited ways. Yet many challenging informatics research problems remain to be solved before flexible and seamless linking becomes a reality and before systems become capable of delivering the specific piece of information needed at the time and place a decision must be made. Connecting the electronic health record to the digital library also requires positive resolution of important policy issues, including health data privacy, government encouragement of high-speed communications, electronic intellectual property rights, and standards for health data and for digital libraries. Both the research problems and the policy issues should be important priorities for the field of medical informatics.

  5. Political and cultural factors in achieving continuity with a primary health care provider at an Indian Health Service hospital.

    Dietrich, A J; Olson, A L

    1981-01-01

    A primary care system was established at Zuni-Ramah Indian Health Service Hospital and clinic in New Mexico. Continuity and coordination of care were added to a health care system that was already accountable, accessible, and comprehensive. The new system offered each patient a personal health care provider who worked as a member of a multidisciplinary team. In changing the health care system, special attention was given to its cultural and political setting, the village of Zuni. After thorough discussion with community and staff, community members' concerns about patients' privacy and free choice were better understood, and special efforts were made to safeguard them. Ongoing evaluation is essential to maintain continuity. Eight months after the primary care system was begun, 64 percent of patients who came for care had established a personal relationship with a health care provider. For 59 percent of the visits during the 1-month evaluation period, patients saw their regular provider and, for 82 percent, patients saw their provider or one of his or her team colleagues. These percentages include night and walk-in visits. The system required no extra funding or staff. The political process of planning and consultation helped anticipate and alleviate the community's concerns, but resistance from physician's assistants and some physicians was unexpected. A flexible approach has led to a gradual acceptance of this voluntary system. This experience with the people of Zuni village shows that a primary care system can be started in a rural Indian Health Service facility with minimal outside help. Apparent improvements in quality of care make the continuity of primary care worthy of further consideration in the IHS and similar health services systems.

  6. Achieving smoke-free mental health services: lessons from the past decade of implementation research.

    Lawn, Sharon; Campion, Jonathan

    2013-09-10

    The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from smoke-free policy because of complex held views about the capacity of people with mental disorder to tolerate such policy whilst they are acutely unwell, with stakeholders' continuing fierce debate about rights, choice and duty of care. This culture has played a significant role in perpetuating physical, social and economic smoking associated impacts experienced by people with mental disorder who receive care within mental health care settings. The past decade has seen a clear policy shift towards smoke-free mental health settings in several countries. While many services have been successful in implementing this change, many issues remain to be resolved for genuine smoke-free policy in mental health settings to be realized. This literature review draws on evidence from the international published research, including national audits of smoke-free policy implementation in mental health units in Australia and England, in order to synthesise what we know works, why it works, and the remaining barriers to smoke-free policy and how appropriate interventions are provided to people with mental disorder.

  7. Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research

    Jonathan Campion

    2013-09-01

    Full Text Available The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from smoke-free policy because of complex held views about the capacity of people with mental disorder to tolerate such policy whilst they are acutely unwell, with stakeholders’ continuing fierce debate about rights, choice and duty of care. This culture has played a significant role in perpetuating physical, social and economic smoking associated impacts experienced by people with mental disorder who receive care within mental health care settings. The past decade has seen a clear policy shift towards smoke-free mental health settings in several countries. While many services have been successful in implementing this change, many issues remain to be resolved for genuine smoke-free policy in mental health settings to be realized. This literature review draws on evidence from the international published research, including national audits of smoke-free policy implementation in mental health units in Australia and England, in order to synthesise what we know works, why it works, and the remaining barriers to smoke-free policy and how appropriate interventions are provided to people with mental disorder.

  8. Experiences and attitudes towards evidence-informed policy-making among research and policy stakeholders in the Canadian agri-food public health sector.

    Young, I; Gropp, K; Pintar, K; Waddell, L; Marshall, B; Thomas, K; McEwen, S A; Rajić, A

    2014-12-01

    Policy-makers working at the interface of agri-food and public health often deal with complex and cross-cutting issues that have broad health impacts and socio-economic implications. They have a responsibility to ensure that policy-making based on these issues is accountable and informed by the best available scientific evidence. We conducted a qualitative descriptive study of agri-food public health policy-makers and research and policy analysts in Ontario, Canada, to understand their perspectives on how the policy-making process is currently informed by scientific evidence and how to facilitate this process. Five focus groups of 3-7 participants and five-one-to-one interviews were held in 2012 with participants from federal and provincial government departments and industry organizations in the agri-food public health sector. We conducted a thematic analysis of the focus group and interview transcripts to identify overarching themes. Participants indicated that the following six key principles are necessary to enable and demonstrate evidence-informed policy-making (EIPM) in this sector: (i) establish and clarify the policy objectives and context; (ii) support policy-making with credible scientific evidence from different sources; (iii) integrate scientific evidence with other diverse policy inputs (e.g. economics, local applicability and stakeholder interests); (iv) ensure that scientific evidence is communicated by research and policy stakeholders in relevant and user-friendly formats; (V) create and foster interdisciplinary relationships and networks across research and policy communities; and (VI) enhance organizational capacity and individual skills for EIPM. Ongoing and planned efforts in these areas, a supportive culture, and additional education and training in both research and policy realms are important to facilitate evidence-informed policy-making in this sector. Future research should explore these findings further in other countries and contexts.

  9. Addressing inequity to achieve the maternal and child health millennium development goals: looking beyond averages

    Ruhago George M

    2012-12-01

    Full Text Available Abstract Background Inequity in access to and use of child and maternal health interventions is impeding progress towards the maternal and child health Millennium Development Goals. This study explores the potential health gains and equity impact if a set of priority interventions for mothers and under fives were scaled up to reach national universal coverage targets for MDGs in Tanzania. Methods We used the Lives Saved Tool (LiST to estimate potential reductions in maternal and child mortality and the number of lives saved across wealth quintiles and between rural and urban settings. High impact maternal and child health interventions were modelled for a five-year scale up, by linking intervention coverage, effectiveness and cause of mortality using data from Tanzania. Concentration curves were drawn and the concentration index estimated to measure the equity impact of the scale up. Results In the poorest population quintiles in Tanzania, the lives of more than twice as many mothers and under-fives were likely to be saved, compared to the richest quintile. Scaling up coverage to equal levels across quintiles would reduce inequality in maternal and child mortality from a pro rich concentration index of −0.11 (maternal and −0.12 (children to a more equitable concentration index of −0,03 and −0.03 respectively. In rural areas, there would likely be an eight times greater reduction in maternal deaths than in urban areas and a five times greater reduction in child deaths than in urban areas. Conclusions Scaling up priority maternal and child health interventions to equal levels would potentially save far more lives in the poorest populations, and would accelerate equitable progress towards maternal and child health MDGs.

  10. Achieving meaningful learning in health information management students: the importance of professional experience.

    Marks, Anne; McIntosh, Jean

    2006-01-01

    Learning is a complex process, not merely a transfer of information from teacher to student. for learning to be meaningful, students need to adopt a deep approach, and in the case of vocational students, to be given the opportunity to learn experientially. Health information management is a practice profession for which students are educated through theory at university and professional experience in the workplace. This article discusses how, through the process of experiential learning, professional experience can promote reflective thinking and thus deep learning, that is, the ability to integrate theory and practice, as well as professional and personal development in health information management students.

  11. Minimalist Medical Diplomacy - Do Engagements Achieve US National Strategy Global Health Security Objectives?

    2015-04-01

    Meetings], Infrastructure Development, Foreign Military Sales [military equipment sales] and Biosurveillance [Public Health, Emerging Disease and...strengthening and linking biosurveillance networks, normalizing reporting and sample sharing, developing novel diagnostic and strengthening laboratory systems...9 10 HA/DR Coordination Patient Movement Expeditionary Medical Support Infrastructure Development FMS Biosurveillance 10 10 10 10 10 5 10 Development

  12. An Achievable Vision: Report of the Department of Defense Task Force on Mental Health

    2007-06-01

    the complex process by which individuals change behaviors and address mental health concerns ( Prochaska , Diclemente & Norcross, 1992). In this process... Prochaska J.O., Diclemente C.C., & Norcross J.C. (1992) In search of how people change: Applications to addictive behaviors. American Psychologist, 47

  13. Zika Virus -10 Public Health Achievements in 2016 and Future Priorities.

    Oussayef, Nadia L; Pillai, Satish K; Honein, Margaret A; Ben Beard, C; Bell, Beth; Boyle, Coleen A; Eisen, Lars M; Kohl, Katrin; Kuehnert, Matthew J; Lathrop, Eva; Martin, Stacey W; Martin, Rebecca; McAllister, Janet C; McClune, Elizabeth Pantino; Mead, Paul; Meaney-Delman, Dana; Petersen, Brett; Petersen, Lyle R; Polen, Kara N D; Powers, Ann M; Redd, Stephen C; Sejvar, James J; Sharp, Tyler; Villanueva, Julie; Jamieson, Denise J

    2017-01-06

    The introduction of Zika virus into the Region of the Americas (Americas) and the subsequent increase in cases of congenital microcephaly resulted in activation of CDC's Emergency Operations Center on January 22, 2016, to ensure a coordinated response and timely dissemination of information, and led the World Health Organization to declare a Public Health Emergency of International Concern on February 1, 2016. During the past year, public health agencies and researchers worldwide have collaborated to protect pregnant women, inform clinicians and the public, and advance knowledge about Zika virus (Figure 1). This report summarizes 10 important contributions toward addressing the threat posed by Zika virus in 2016. To protect pregnant women and their fetuses and infants from the effects of Zika virus infection during pregnancy, public health activities must focus on preventing mosquito-borne transmission through vector control and personal protective practices, preventing sexual transmission by advising abstention from sex or consistent and correct use of condoms, and preventing unintended pregnancies by reducing barriers to access to highly effective reversible contraception.

  14. Leveraging HIV-related human rights achievements through a Framework Convention on Global Health.

    Buse, Kent; Eba, Patrick; Sigurdson, Jason; Thomson, Kate; Timberlake, Susan

    2013-06-14

    Although AIDS remains a leading cause of death, especially in low- and middle-income countries, the movement to address it has greatly contributed to changing the world's response to health challenges. By fusing activism, political leadership, domestic and international investment, and accountability for results, the course of the epidemic has been radically shifted. People living with HIV and others directly affected by the epidemic have exerted immense leadership since the first days of the response: they have fought to end discrimination on the basis of sero-status, gender, sexual orientation, disability, migration status, drug use, or participation in sex work. Some of this mobilization has taken the form of strategic litigation, drawing human rights down into concrete demands and defining social, health, legal, and economic policy. The global AIDS response has shown that at the core of health lie considerations of social justice, human rights, and accountability. As momentum builds for a Framework Convention on Global Health (FCGH), we believe there is an opportunity to take stock of lessons learned from the response to HIV and ensure that they are replicated and institutionalized in an eventual Convention. We argue that the most critical aspect to the success of the HIV response has been the leadership and activism of civil society. Conventions do not lead to results on their own, and there should be every expectation that the FCGH will be no different. Success requires active monitoring of progress and shortcomings, combined with political and social mobilization to expand investment and access to the services and underlying conditions that protect and advance health. While the FCGH must make civil society support and engagement an indispensable principle, the AIDS movement can contribute substantive content and mobilization for its adoption. A broad international legal framework for health can help address some of the key legal, policy, regulatory, and

  15. ITC SOLUTIONS TO ACHIEVE PERFORMANCE AND EFFICIENCY OF HEALTH SERVICES: ONLINE VIRTUAL CLINIC

    Adina BĂLAN

    2010-01-01

    Full Text Available The digital era modified the way people work, how the information and the informational resources are defined and organized. The organization which holds, uses and correctly reproduces the piece of information, the knowledge, the intellectual capital, becomes a leader in the proper field of activity. Following the actual tendencies in the digital era connected to the exchange of professional information, I can say that the exchange and sharing of digital information in a global multitude of interconnected computers are essential instruments that can contribute to the development and consolidation of the intellectual potential of the organization. This is why, the access of the individuals to information is an actual requirement of the development of the Romanian society in the context of globalization and world implication o contemporary processes and phenomena. The Digital integration eliminates the barriers that traditionally suppress the circuit of the medical information, lets the goods and services circulate to and from Romania by promoting efficiency as final purpose. Performance is needed in the health system, the transformation of the system of medical services by bringing the benefits of the medical science and technology to all individuals from every community. In order to accomplish these expectations it is needed that all the components that form the health system look at it as a whole and subscribe to modern solutions for improvement so that the quality of health should raise to an unprecedented level. Even if health systems differ from country to country from the organizational and financial point of view, they face the same challenges and problems, respectively the supply of medical care of better quality and keeping under control the health expenses. The use of information and communication technology in the field of medical assistance in order to stock, share, transmit and analyze clinical data and knowledge is more necessary

  16. Organizational health and the achievement level of students in science at the secondary-level schools in Sri Lanka

    Pakkeer-Jaufar, Pakkeer Cadermohideen

    This study sought to identify those organizational health factors that might have overriding influence on the achievement level of students in science in Sri Lankan secondary schools. This study involved 752 students, 33 science teachers, and 10 principals from two different districts, Ampara and Colombo, in Sri Lanka. Ten Tamil medium, secondary level, public schools were selected to participate in this study. Data were collected using four types of instruments: a questionnaire for pupils; interview schedules for science teachers and principals; checklists for classroom/school facilities, science laboratory facilities, and science practicals; and a science achievement test. The analysis focused on the collective perceptions of students, science teachers, and principals. Regression and path analyses were used as major analysis techniques, and the qualitative data provided by science teachers and principals were considered for a crosschecking of the quantitative inferences. The researcher found teacher affiliation, academic emphasis, and instructional leadership of the principal, in descending order, were the overriding influential factors on the achievement level of students in science in Sri Lankan secondary schools. At the same time a similar descending order was found in their mean values and qualities. The researcher concluded that increasing the quality of the organizational health factors in Sri Lankan secondary schools would result in improved better achievement in science. The findings further indicate that instructional leadership of the principal had both direct and indirect effects on students' achievement in science when academic emphasis and teacher affiliation were taken into account. In addition, the resource support of the principal did not make any difference in students' science achievement and the findings stress the availability of the resources for individual students instead of assuming the general facilities of the school are available to all

  17. The health marketing mix

    Pralea, A. R.

    2011-01-01

    The well-known marketing mix of the commercial sector has found its application and has been developing in the non-profit sector. In most of the cases, the techniques and tools of commercial marketing are used to change behaviours in order to achieve social good. The targeted behaviours range widely from environmental ones to health related behaviours. The aim of the current paper is to highlight some of the characteristics of the marketing mix when applied to change health related behaviours...

  18. Achieving healthy school siting and planning policies: understanding shared concerns of environmental planners, public health professionals, and educators.

    Cohen, Alison

    2010-01-01

    Policy decisions regarding the quality of the physical school environment-both, school siting and school facility planning policies-are often considered through the lens of environmental planning, public health, or education policy, but rarely through all three. Environmental planners consider environmental justice issues on a local level and/or consider the regional impact of a school. Public health professionals focus on toxic exposures and populations particularly vulnerable to negative health outcomes. Educators and education policymakers emphasize investing in human capital of both students and staff. By understanding these respective angles and combining these efforts around the common goals of achieving adequacy and excellence, we can work toward a regulatory system for school facilities that recognizes children as a uniquely vulnerable population and seeks to create healthier school environments in which children can learn and adults can work.

  19. Determining the impact of computer-aided control of educational achievements for the health of students

    Savonova A.V.

    2013-06-01

    Full Text Available The problem of the health of students during the control of knowledge on the example of studying valeological disciplines. In the experiment involved 186 students. Age 17-19 years. The positive effect of regular thematic automated monitoring the health of students. In particular, during unit of knowledge and at exam time. Showed a statistically significant reduction in the average level of reactive anxiety in students of the experimental group, compared to its initial values (before the final test, it fell by 37.91. For comparison, before final testing of the control group, it only reduced by 10.42%. It was determined that a regular automated testing knowledge can be used to organize healthkeeping support professional development of future teachers.

  20. Achieving Smoke-Free Mental Health Services: Lessons from the Past Decade of Implementation Research

    Jonathan Campion; Sharon Lawn

    2013-01-01

    The culture of smoking by patients and staff within mental health systems of care has a long and entrenched history. Cigarettes have been used as currency between patients and as a patient management tool by staff. These settings have traditionally been exempt from smoke-free policy because of complex held views about the capacity of people with mental disorder to tolerate such policy whilst they are acutely unwell, with stakeholders’ continuing fierce debate about rights, choice and duty of ...

  1. Constraining National Health Care Expenditures. Achieving Quality Care at an Affordable Cost.

    1985-09-30

    performed on an outpatient basis. Such procedures include dilatation and curettage tubal ligations , tonsillectomies, and herniarepairs.147 Medicare...example, the commission concluded that a healthy Down’s syndrome child whose life is in danger from a surgically correctable condition should receive the...for post -hospital nursing home and home health care may increase. HHS has predicted that the number of persons qualifying for the Medicare skilled

  2. Defense Health: Actions Needed to Help Ensure Combat Casualty Care Research Achieves Goals

    2013-02-01

    Department of Health and Human Services JPC -6 Joint Program Committee for Combat Casualty Care MRMC Army Medical Research and...and development.) Note: The JPC -6 includes representatives from each military service (Army, Navy, Air Force, and Marine Corps) and is chartered...care, which is managed by the Joint Program Committee for Combat Casualty Care ( JPC -6). The JPC -6 includes representatives from the DOD biomedical

  3. Contribution analysis as an evaluation strategy in the context of a sector-wide approach: Performance-based health financing in Rwanda

    Martin Noltze

    2014-12-01

    Full Text Available Sector-wide approaches (SWAps emerged as a response to donor fragmentation and non-adjusted and parallel programming. In the health sector, SWAps have received considerable support by the international donor community due to their potential to reduce inefficiencies through alignment to common procedures and hence to increase development effectiveness. Evaluating development cooperation in the context of a SWAp, however, translates into methodological challenges for evaluators who have to disentangle the cumulative effects in strongly donor-aligned, complex sector environments. In this article the authors discussed the application of a methodological strategy for evaluating development interventions in complex settings – for example in the context of a SWAp –and reflected the suitability of the approach. The authors conducted a contribution analysis, a theory-based approach to evaluation, and exemplified the approach for an intervention of performance-based financing for Rwandan health workers supported by the Rwanda-German cooperation. The findings suggested that the Rwandan system of performance based financing increased service orientation and outputs of health professionals, but also indicated that negative motivational side effects and resource constraints are real. With regard to the methodological approach, the authors conclude that contribution analysis has a high potential to evaluate development cooperation in the context of a SWAp dueto its high flexibility to use different data collection tools and its capability to assess risks and rival explanations. Challenges can be identified with regard to the efficiency of the evaluation strategy and a remaining trade-off between scope and causal strength ofevidence.

  4. Governance processes and change within organizational participants of multi-sectoral community health care alliances: the mediating role of vision, mission, strategy agreement and perceived alliance value.

    Hearld, Larry R; Alexander, Jeffrey A

    2014-03-01

    Multi-sectoral community health care alliances are organizations that bring together individuals and organizations from different industry sectors to work collaboratively on improving the health and health care in local communities. Long-term success and sustainability of alliances are dependent on their ability to galvanize participants to take action within their 'home' organizations and institutionalize the vision, goals, and programs within participating organizations and the broader community. The purpose of this study was to investigate two mechanisms by which alliance leadership and management processes may promote such changes within organizations participating in alliances. The findings of the study suggest that, despite modest levels of change undertaken by participating organizations, more positive perceptions of alliance leadership, decision making, and conflict management were associated with a greater likelihood of participating organizations making changes as a result of their participation in the alliance, in part by promoting greater vision, mission, and strategy agreement and higher levels of perceived value. Leadership processes had a stronger relationship with change within participating organizations than decision-making style and conflict management processes. Open-ended responses by participants indicated that participating organizations most often incorporated new measures or goals into their existing portfolio of strategic plans and activities in response to alliance participation.

  5. The role of intermediaries in delivering an occupational health and safety programme designed for small business - a case study of an insurance incentive programme in the agriculture sector

    Olsen, Kirsten Bendix; Hasle, Peter

    2015-01-01

    Intermediaries play an important role in disseminating national Occupational Health and Safety (OHS) programmes to small businesses but not much is known about the factors that influence their role. The aim of this paper is to elucidate the factors that influence intermediaries’ contribution...... to the transformation and dissemination of a national OHS programme for small business that built on an Insurance incentive scheme – the New Zealand Workplace Safety Discount scheme. It is a case study of this scheme implementation in the agriculture sector. Data was collected from scheme documentation and semi...

  6. Critical Connections: Health and Academics

    Michael, Shannon L.; Merlo, Caitlin L.; Basch, Charles E.; Wentzel, Kathryn R.; Wechsler, Howell

    2015-01-01

    Background: While it is a national priority to support the health and education of students, these sectors must better align, integrate, and collaborate to achieve this priority. This article summarizes the literature on the connection between health and academic achievement using the Whole School, Whole Community, and Whole Child (WSCC) framework…

  7. Achieving organizational change: findings from a case study of health promoting hospitals in Taiwan.

    Lee, Chiachi Bonnie; Chen, Michael S; Powell, Michael; Chu, Cordia Ming-Yeuk

    2014-06-01

    The Taiwanese Network of Health Promoting Hospitals (HPH) has been in place since 2006 and developing rapidly. The criticism of inadequate evaluation of the HPH approach taken elsewhere also holds true for the Taiwan HPH Network. Organizational change is a key to sustainable and effective health promotion, and it is also an important aspect in the European HPH movement. Therefore, this study aims to evaluate changes in organizational capacity for the implementation of HPH in Taiwan. All 55 HPH coordinators were invited to participate in the study, and 52 of them completed the questionnaires. The survey covered seven dimensions of HPH organizational capacity, and a total score of each dimension was calculated and converted to a figure on a scale of 10. This study has shown that HPH made a positive impact on HP hospitals in Taiwan regarding organizational change in capacity building for HPH. Leadership, organization culture and mission and strategy received the top three highest mean scores (8.19 ± 1.25, 8.08 ± 1.39, 7.99 ± 1.42), while staff participation received the lowest score (7.62 ± 1.26). The high level of organizational change was associated with the high satisfaction levels of organizational support from the viewpoint of the HPH coordinators. Based on a cluster analysis, a majority of the HP hospitals in Taiwan seemed to have adopted the addition model in putting the HPH initiative into practice; a few hospitals appeared to have accepted HPH initiative well through the integration model. These results presented evidence that HPH contributed to organizational capacity building of hospitals for health promotion.

  8. Achieving shift work excellence: maximizing health, safety and operating efficiency in round-the-clock operations

    Sirois, W. G. (circadian Technologies Ltd., Cambridge, MA (United States))

    1999-01-01

    Alertness Assurance techniques, Lifestyle Training and Shift Scheduling practices are described as weapons in the fight against the consequences of sleep deprivation and fatigue, higher operating risks , the adverse health, safety and quality of life effects on workers. Fatigue is a fundamental problem for all round-the-clock industries. The central message of this paper is that by making appropriate interventions and taking counter-measures to fatigue, the risks and liabilities of human error can be dramatically minimized through increased employee alertness, vigilance and cognitive reasoning skills around-the-clock. 12 refs., 1 fig.

  9. Moving Toward Universal Health Coverage (UHC to Achieve Inclusive and Sustainable Health Development: Three Essential Strategies Drawn From Asian Experience; Comment on “Improving the World’s Health Through the Post-2015 Development Agenda: Perspectives from Rwanda”

    Ye Xu

    2015-12-01

    Full Text Available Binagwaho and colleagues’ perspective piece provided a timely reflection on the experience of Rwanda in achieving the Millennium Development Goals (MDGs and a proposal of 5 principles to carry forward in post-2015 health development. This commentary echoes their viewpoints and offers three lessons for health policy reforms consistent with these principles beyond 2015. Specifically, we argue that universal health coverage (UHC is an integrated solution to advance the global health development agenda, and the three essential strategies drawn from Asian countries’ health reforms toward UHC are: (1 Public financing support and sequencing health insurance expansion by first extending health insurance to the extremely poor, vulnerable, and marginalized population are critical for achieving UHC; (2 Improved quality of delivered care ensures supply-side readiness and effective coverage; (3 Strategic purchasing and results-based financing creates incentives and accountability for positive changes. These strategies were discussed and illustrated with experience from China and other Asian economies.

  10. Moving Toward Universal Health Coverage (UHC) to Achieve Inclusive and Sustainable Health Development: Three Essential Strategies Drawn From Asian Experience Comment on "Improving the World's Health Through the Post-2015 Development Agenda: Perspectives from Rwanda".

    Xu, Ye; Huang, Cheng; Colón-Ramos, Uriyoán

    2015-08-26

    Binagwaho and colleagues' perspective piece provided a timely reflection on the experience of Rwanda in achieving the Millennium Development Goals (MDGs) and a proposal of 5 principles to carry forward in post-2015 health development. This commentary echoes their viewpoints and offers three lessons for health policy reforms consistent with these principles beyond 2015. Specifically, we argue that universal health coverage (UHC) is an integrated solution to advance the global health development agenda, and the three essential strategies drawn from Asian countries' health reforms toward UHC are: (1) Public financing support and sequencing health insurance expansion by first extending health insurance to the extremely poor, vulnerable, and marginalized population are critical for achieving UHC; (2) Improved quality of delivered care ensures supply-side readiness and effective coverage; (3) Strategic purchasing and results-based financing creates incentives and accountability for positive changes. These strategies were discussed and illustrated with experience from China and other Asian economies.

  11. Achieving polio eradication: a review of health communication evidence and lessons learned in India and Pakistan.

    Obregón, Rafael; Chitnis, Ketan; Morry, Chris; Feek, Warren; Bates, Jeffrey; Galway, Michael; Ogden, Ellyn

    2009-08-01

    Since 1988, the world has come very close to eradicating polio through the Global Polio Eradication Initiative, in which communication interventions have played a consistently central role. Mass media and information dissemination approaches used in immunization efforts worldwide have contributed to this success. However, reaching the hardest-to-reach, the poorest, the most marginalized and those without access to health services has been challenging. In the last push to eradicate polio, Polio Eradication Initiative communication strategies have become increasingly research-driven and innovative, particularly through the introduction of sustained interpersonal communication and social mobilization approaches to reach unreached populations. This review examines polio communication efforts in India and Pakistan between the years 2000 and 2007. It shows how epidemiological, social and behavioural data guide communication strategies that have contributed to increased levels of polio immunity, particularly among underserved and hard-to-reach populations. It illustrates how evidence-based and planned communication strategies - such as sustained media campaigns, intensive community and social mobilization, interpersonal communication and political and national advocacy combined - have contributed to reducing polio incidence in these countries. Findings show that communication strategies have contributed on several levels by: mobilizing social networks and leaders; creating political will; increasing knowledge; ensuring individual and community-level demand; overcoming gender barriers and resistance to vaccination; and reaching out to the poorest and marginalized populations. The review concludes with observations about the added value of communication strategies in polio eradication efforts and implications for global and local public health communication interventions.

  12. A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737

    Braithwaite Jeffrey

    2006-09-01

    Full Text Available Abstract Background Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted. Methods/design To understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation. Discussion The accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it.

  13. Novel method to achieve price-optimized, fully nutritious, health-promoting and acceptable national food baskets

    Parlesak, Alexandr; Robertson, Aileen

    2015-01-01

    Purpose: The purpose of this study was to generate a framework for the development of health-promoting, fully nutritious, socially acceptable, and affordable national food baskets to be used as an advocacy tool by governments. In addition to containing all (micro-)nutrient requirements, food bask....... Fully nutritious and health-promoting food baskets can be achieved at a relatively low price. However if these are not socially acceptable to the target population, the use of a framework using linear programming based solely on nutritional values seems limited.......Purpose: The purpose of this study was to generate a framework for the development of health-promoting, fully nutritious, socially acceptable, and affordable national food baskets to be used as an advocacy tool by governments. In addition to containing all (micro-)nutrient requirements, food...... baskets should also reflect dietary guidelines to prevent non-communicable diseases and be optimized to achieve the highest possible social acceptance. So far, integrative approaches that include all these aspects are lacking. Methods: Food composition, local availability, food prices, national...

  14. The Implementation of Right-Fulfillment to the Health Care in Achieving the Millennium Development Goal (MDG’S

    Muhammad Zuhri

    2016-04-01

    Full Text Available The vision of Aceh Government in 2012-2017 is Aceh are dignified, prosperous, just, and independent based on the legislation of Aceh government as a form of Memorandum of Understanding. One of the visions of Aceh government 2012-2017 is the improved welfare of Acehnese people through quality health services through increasing life expectancy, infant mortality, decreasing the prevalence of malnutrition as well as the effectiveness of the treatment of infectious diseases to the achievement of the MDG’s. Model policies adopted by the Aceh government is monitoring and track record of cases, tv monitor, routine and case sms, a special program policy model, and the model of budget balancing. Model policies adopted by the district/city government is making a supporting program, All Village Midwives Must Live in the Village, deliveries assistance is performed by professional health workers, adjustment to the ability of APBK. Support new regulation of Regent Regulation (Perbub on Malaria Elimination and No Smoking Area. MDG’s target is not entirely in accordance with the indicator being built, because it requires adjustments in accordance with the ability of both district or city areas. Regulatory support is not adequate to support the achievement of the MDG’s in the field of health.

  15. Health sector costs of self-reported food allergy in Europe : A patient-based cost of illness study

    Fox, Margaret; Mugford, Miranda; Voordouw, Jantine; Cornelisse-Vermaat, Judith; Antonides, Gerrit; de la Hoz Caballer, Belen; Cerecedo, Inma; Zamora, Javier; Rokicka, Ewa; Jewczak, Maciej; Clark, Allan B; Kowalski, Marek L; Papadopoulos, Nikos; Knulst, Anna C; Seneviratne, Suranjith; Belohlavkova, Simona; Asero, Roberto; de Blay, Frederic; Purohit, Ashok; Clausen, Michael; Flokstra de Blok, Bertine; Dubois, Anthony E; Fernandez-Rivas, Montserrat; Burney, Peter; Frewer, Lynn J; Mills, Clare E N

    2013-01-01

    Introduction: Food allergy is a recognized health problem, but little has been reported on its cost for health services. The EuroPrevall project was a European study investigating the patterns, prevalence and socio-economic cost of food allergy. Aims: To investigate the health service cost for food-

  16. Health sector costs of self-reported food allergy in Europe : a patient-based cost of illness study

    Fox, Margaret; Mugford, Miranda; Voordouw, Jantine; Cornelisse-Vermaat, Judith; Antonides, Gerrit; de la Hoz Caballer, Belen; Cerecedo, Inma; Zamora, Javier; Rokicka, Ewa; Jewczak, Maciej; Clark, Allan B; Kowalski, Marek L; Papadopoulos, Nikos; Knulst, Anna C; Seneviratne, Suranjith; Belohlavkova, Simona; Asero, Roberto; de Blay, Frederic; Purohit, Ashok; Clausen, Michael; Flokstra de Blok, Bertine; Dubois, Anthony E; Fernandez-Rivas, Montserrat; Burney, Peter; Frewer, Lynn J; Mills, Clare E N

    2013-01-01

    INTRODUCTION: Food allergy is a recognized health problem, but little has been reported on its cost for health services. The EuroPrevall project was a European study investigating the patterns, prevalence and socio-economic cost of food allergy. AIMS: To investigate the health service cost for food-

  17. Towards a decision support tool for real estate management in the health sector using real options and scenario planning

    Reedt Dortland, van M.W.J.; Voordijk, J.T.; Dewulf, G.P.M.R.

    2012-01-01

    Purpose – Uncertainties affecting health organizations inevitably influence real estate decisions since real estate is required to facilitate the primary health process. The purpose of this study is to develop a decision support tool that supports health organisations in defining what flexibility th

  18. An Integrated Framework to Achieve Interoperability in Person-Centric Health Management

    Fabio Vergari

    2011-01-01

    Full Text Available The need for high-quality out-of-hospital healthcare is a known socioeconomic problem. Exploiting ICT's evolution, ad-hoc telemedicine solutions have been proposed in the past. Integrating such ad-hoc solutions in order to cost-effectively support the entire healthcare cycle is still a research challenge. In order to handle the heterogeneity of relevant information and to overcome the fragmentation of out-of-hospital instrumentation in person-centric healthcare systems, a shared and open source interoperability component can be adopted, which is ontology driven and based on the semantic web data model. The feasibility and the advantages of the proposed approach are demonstrated by presenting the use case of real-time monitoring of patients' health and their environmental context.

  19. Quality of Vegetable Oil Prior to Fortification Is an Important Criteria to Achieve a Health Impact

    Nuri Andarwulan

    2014-11-01

    Full Text Available Unbranded palm cooking oil has been fortified for several years and can be found in the market with different oxidation levels. This study aimed to investigate the stability and shelf life of unbranded, bulk, vitamin A-fortified palm oils with the most commonly observed oxidation levels in Indonesia. Three types of cooking oils were tested: (i cooking oil with a peroxide value (PV below 2 mEq O2/kg (PO1; (ii cooking oil with a PV around 4 mEq O2/kg (PO2; and (iii cooking oil with a PV around 9 mEq O2/kg (PO3. The oil shelf life was determined by using accelerated shelf life testing (ASLT, where the product was stored at 60, 75 and 90 °C, and then PV, free fatty acid and vitamin A concentration in the oil samples were measured. The results showed that PO1 had a shelf life of between 2–3 months, while PO2’s shelf life was a few weeks and PO3’s only a few days. Even given those varying shelf lives, the vitamin A loss in the oils was still acceptable, at around 10%. However, the short shelf life of highly oxidized cooking oil, such as PO3, might negatively impact health, due to the potential increase of free radicals of the lipid peroxidation in the oil. Based on the results, the Indonesian government should prohibit the sale of highly-oxidized cooking oil. In addition, government authorities should promote and endorse the fortification of only cooking oil with low peroxide levels to ensure that fortification is not associated with any health issues associated with high oxidation levels of the cooking oil.

  20. I. An introduction to the relation of physical activity to cognitive and brain health, and scholastic achievement.

    Hillman, Charles H

    2014-12-01

    The current pandemic of physical inactivity threatens both physical and cognitive health throughout the lifespan. This monograph describes the multidisciplinary study of aspects of childhood health and its relationship to cognitive and brain function, and scholastic performance. Specifically, we focus on physical activity and physical fitness along with nutrition and obesity; interconnected aspects of health that have declined over the past 30 years in children of industrialized nations. Although much emphasis has been placed on correcting physical aspects of these public health concerns, it is only more recently that attention has been paid to the relation between physical health and cognitive health among school age children. The monograph begins with an overview of current behavioral trends that compete with physical activity engagement and contribute to the failure to achieve the public health recommendations for physical activity among children in the United States. Following the epidemiological overview, the relation of childhood fitness to brain structure and function is examined among children with varying fitness levels. The observed dissimilarities between higher- and lower-fit children are discussed within the context of typical brain development. To broaden the scope of research presented herein, the relation of nutrient intake--among both undernourished and well-nourished children--and obesity on cognition and brain are discussed. Next, novel empirical data are presented from a correlational study that indicates a differential relation between childhood fitness and adiposity on various aspects of cognition. In an effort to provide a more comprehensive review, a later chapter is dedicated to describing a small body of literature investigating the relation of physical activity to special populations of children, including those with learning disorders. In doing so, practical applications as well as challenges and limitations of implementing physical

  1. State-of-the-Art: Research Theoretical Framework of Information Systems Implementation Research in the Health Sector in Sub-Saharan Africa

    Tetteh, Godwin Kofi

    2014-01-01

    This study is about the state-of-the-art of reference theories and theoretical framework of information systems implementation research in the health industry in the Sub-Saharan countries from a process perspective. A process – variance framework, Poole et al, (2000), Markus & Robey, (1988......, CINAHL, Science Direct and Emerald, we identified 41 published research articles that met our inclusion criteria. The articles were mapped unto the process-variance framework. A significant finding in this critical review is that, the state-of-the-art of a large proportion of the studies was underpinned...... the process theoretical framework to enhance our insight into successful information systems implementation in the region. It is our optimism that the process based theoretical framework will be useful for, information system practitioners and organisational managers and researchers in the health sector...

  2. Achieving Universal Health Coverage by Focusing on Primary Care in Japan: Lessons for Low- and Middle-Income Countries

    Naoki Ikegami

    2016-05-01

    Full Text Available When the Japanese government adopted Western medicine in the late nineteenth century, it left intact the infrastructure of primary care by giving licenses to the existing practitioners and by initially setting the hurdle for entry into medical school low. Public financing of hospitals was kept minimal so that almost all of their revenue came from patient charges. When social health insurance (SHI was introduced in 1927, benefits were focused on primary care services delivered by physicians in clinics, and not on hospital services. This was reflected in the development and subsequent revisions of the fee schedule. The policy decisions which have helped to retain primary care services might provide lessons for achieving universal health coverage in low- and middle-income countries (LMICs.

  3. Public sector innovation

    Wegener, Charlotte

    2012-01-01

    This paper explores the value dimension of public innovation in the light of practitioners’ values and asks why there seems to be a clash between innovation imperatives and workplace practices in the public sector. The paper contributes to the research on public innovation from a practice...... perspective by providing evidence from an ethnographic field study on innovation in social and health care studies in Denmark. These studies are part of the vocational education and training (VET) system, which combines coursework at a college and internship in the elder care sector. The study is thus cross...

  4. Occupational health nurses’ achievement of competence and comfort in respiratory protection and preferred learning methods results of a nationwide survey.

    Burgel, Barbara J; Novak, Debra A; Carpenter, Holly Elizabeth; Gruden, MaryAnn; Lachat, Ann M; Taormina, Deborah

    2014-02-01

    Additional findings are presented from a 2012 nationwide survey of 2,072 occupational health nurses regarding how they achieved competence in respiratory protection, their preferred methods of learning, and how they motivated employees to use respiratory protection. On-the-job training, taking a National Institute for Occupational Safety and Health spirometry course, or attending professional conferences were the primary ways occupational health nurses gained respiratory protection knowledge. Attending professional conferences was the preferred method of learning, varying by type of industry and years of occupational health nurse experience. Employee motivational strategies were not widely used; the most common strategy was to tailor respiratory protection training to workplace culture. Designing training methods that match learning preferences, within the context of the organization's safety and quality improvement culture, is a key recommendation supported by the literature and these findings. Including respiratory protection content and competencies in all levels of academic nursing education is an additional recommendation. Additional research is needed to link training strategies with consistent and correct use of respiratory protection by employees.

  5. Barriers and Potential Improvements for Needle and Syringe Exchange Programs (NSPs) in China: A Qualitative Study from Perspectives of Both Health and Public Security Sectors.

    Koo, Fung Kuen; Chen, Xi; Chow, Eric P F; Jing, Jun; Zheng, Jun; Zhao, Junshi; Zhang, Lei

    2015-01-01

    This study explores the acceptability, the barriers to the implementation of needle and syringe exchange programs (NSPs) and the potential improvement strategies in China from the perspectives of governmental health and public security officials. Purposive sampling was used for recruitment of participants who had been involved in NSPs implementation. Semi-Structured individual interviews were conducted in Mandarin to address three aspects of NSPs: (1) participants' attitudes towards NSPs, (2) participants' opinions on the effectiveness and barriers of NSPs, and (3) suggestions for improving the program. Content analysis was used to analyse the translated interview data. A total of 68 participants from 12 Hunan counties were interviewed (34 from each of the Bureau of Health and the Narcotic Division). Both groups recognised the importance and effectiveness of NSPs in HIV prevention, but public security officials regarded NSPs as a temporary intervention in place of punitive measures. Most health officials (32/34) regarded the main barriers to its implementation as administrative and structural, whereas participants from Narcotics Division (n=24) questioned the legitimacy of NSPs and concerned about the poor management of drug users' risk behaviours. Close cooperation between the health and public security sectors, engagement of the drug user community and an enabling policy environment were reportedly to be critical for potential improvements of NSPs in China. Misconceptions about NSPs encourage drug users' addictive behaviour, and an unclear leadership and insufficient support de-motivate the participants from the Bureau of Health and the Narcotics Division to actively support the program implementation.

  6. Dual job holding by public sector health professionals in highly resource-constrained settings: problem or solution?

    Jan, Stephen; Bian, Ying; Jumpa, Manuel; Meng, Qingyue; Nyazema, Norman; Prakongsai, Phusit; Mills, Anne

    2005-10-01

    This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. Such activity is generally driven by a lack of resources in the public sector and low pay, and has been associated with the unauthorized use of public resources and corruption. It is also typically poorly regulated; regulations are either lacking, or when they exist, are vague or poorly implemented because of low regulatory capacity. This paper draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. The approach taken in highlighting these broader social objectives seeks to avoid the value judgements regarding dual working and some of its associated forms of behaviour that have tended to characterize previous analyses. Dual practice is viewed as a possible system solution to issues such as limited public sector resources (and incomes), low regulatory capacity and the interplay between market forces and human resources. This paper therefore offers some support for policies that allow for the official recognition of such activity and embrace a degree of professional self-regulation. In providing clearer policy guidance, future research in this area needs to adopt a more evaluative approach than that which has been used to date.

  7. The role of the organizational champion in achieving health system change.

    Hendy, Jane; Barlow, James

    2012-02-01

    In healthcare there is a long held wisdom that 'champions' are a key aspect of organizational change. Drawing on organizational management theory, we examine the role of champions in three health and social care organizations in England as they attempt to move services to a remote model of delivery, 'telecare'. The delivery of remote care is a significant policy in the U.K. and elsewhere, but its introduction has been challenging. Over three years ethnographic methods (observations, informed discussions and interviews) were used to analyze the role of organizational champions in implementing remote care. Cases were local authorities and associated primary care trusts. Participants were champions and organizational members involved in implementation. Our study shows that organizational champions are highly effective in the first phase of adoption, when change is contained within distinct sub-sets of practice. Moving beyond local contexts the effectiveness of the champions varied. Identification centered on the remote care work. This identification enabled the champions to motivate others and move beyond their normally prescribed roles, contributing to innovation ideas, processes and practices. When required to shift their work organization-wide, and share ideas outside their professional culture, some champions responded with resistance, resulting in a lack of innovation spread. These results caution against allowing change to become positioned within the remit of a few individuals. Whilst this strategy may be initially beneficial, the role of champion may be less useful, even detrimental to progress, in the later stages of implementation, particularly if identification with the new circumstances is not established.

  8. Positive futures? The impact of HIV infection on achieving health, wealth and future planning.

    Harding, Richard; Molloy, Tim

    2008-05-01

    Although HIV is now cast as a chronic condition with favourable clinical outcomes under new treatments, it is unclear how living with HIV affects expectations and planning for the future. This mixed-methods study aimed to investigate UK gay men's expectations of their own future when living with HIV, and to identify the heath and social interventions required to enhance roles, participation and personal fulfilment. A preliminary focus group identified relevant domains of enquiry for a subsequent online cross-sectional survey. A total of 347 gay men living in the UK with HIV participated in the survey, and 56.6% were currently on treatment. However, high 7-day prevalence of psychological and physical symptoms was identified (42.6% in pain, 80.2% worrying); 57.8% perceived reduced career options due to their infection and 71.8% reduced life expectancy. Being on treatment was not significantly associated with perceived life expectancy. Coded open-ended survey data identified eight principle themes related to goal planning and attainment. The integrated open and closed data items offer an understanding of barriers and challenges that focus on poor mental health due to clinical inattention, discrimination and stigma, poor career and job opportunities due to benefit and workplace inflexibility and lack of understanding, a lack of personal goals and associated skills deficit related to confidence and self esteem. Gay men living with HIV require an integrated holistic approach to wellbeing that incorporates clinical, social and individual intervention in order to lead productive lives with maximum benefit from treatment gains.

  9. Just in Time: How Evidence-on-Demand Services Support Decision Making in Ontario's Child and Youth Mental Health Sector

    Notarianni, Maryann; Sundar, Purnima; Carter, Charles

    2016-01-01

    Using the best available evidence to inform decision making is important for the design or delivery of effective health-related services and broader public policy. Several studies identify barriers and facilitators to evidence-informed decision making in Canadian health settings. This paper describes how the Ontario Centre of Excellence for Child…

  10. Evaluation of skill achievement levels and practical experiences of public health nursing students before and after the introduction of the public health nursing course as an elective.

    Suzuki, Yoshimi; Saito, Emiko; Sawai, Minako; Kishi, Emiko; Kakemoto, Satori; Nakada, Harumi; Igarashi, Chiyo; Asahara, Kiyomi

    2016-01-01

    Objective To equip public health nurses (PHNs) with higher qualifications, PHN education is shifting from an integrated curriculum for PHNs and registered nurses to a specific elective system of undergraduate or postgraduate programs. Most colleges in the special wards of Tokyo introduced the elective system in 2014 before the remaining areas. The outcomes of this must be evaluated. This study aimed to evaluate the achievement levels and practical experiences of PHN students at seven colleges in the special wards before and after introduction of the PHN course as an elective.Method Self-administered, anonymous questionnaires were completed by senior PHN students at seven colleges in the special wards who underwent training in 2013, the last year of an integrated curriculum, and in 2014, the first year of the elective system. The target numbers of participants were 663 in 2013 and 136 in 2014 with 20 students from each school exposed to the elective system. Our study focused on whether they achieved the 98 "technical items of PHN training and achievement levels at the time of graduation" required by the Ministry of Health, Labour and Welfare. The study also determined whether participants obtained practical experience in 15 items developed by the special wards based on the standards set for training.Results In 2013, there were 348 total responses (52.5%) and 310 valid responses. In 2014, there were 136 total responses (88.2%) and 120 valid responses. The average achievement rate at which the student answered, "I was able to arrive at it," at an arrival degree level for the 98 technical items was 72.6% in 2014, an increase compared to the 67.9% obtained in 2013. Moreover, the average practical experience rate at which the student answered, "I was able to have an experience," regarding the 15 items was 85.7% in 2014, which constituted an increase compared to 70.5% attained in 2013. However, the number of items with an achievement rate of more than 80% remained

  11. Deep Reductions in Greenhouse Gas Emissions from the California Transportation Sector: Dynamics in Vehicle Fleet and Energy Supply Transitions to Achieve 80% Reduction in Emissions from 1990 Levels by 2050

    Leighty, Wayne Waterman

    California's "80in50" target for reducing greenhouse gas emissions to 80 percent below 1990 levels by the year 2050 is based on climate science rather than technical feasibility of mitigation. As such, it raises four fundamental questions: is this magnitude of reduction in greenhouse gas emissions possible, what energy system transitions over the next 40 years are necessary, can intermediate policy goals be met on the pathway toward 2050, and does the path of transition matter for the objective of climate change mitigation? Scenarios for meeting the 80in50 goal in the transportation sector are modelled. Specifically, earlier work defining low carbon transport scenarios for the year 2050 is refined by incorporating new information about biofuel supply. Then transition paths for meeting 80in50 scenarios are modelled for the light-duty vehicle sub-sector, with important implications for the timing of action, rate of change, and cumulative greenhouse gas emissions. One aspect of these transitions -- development in the California wind industry to supply low-carbon electricity for plug-in electric vehicles -- is examined in detail. In general, the range of feasible scenarios for meeting the 80in50 target is narrow enough that several common themes are apparent: electrification of light-duty vehicles must occur; continued improvements in vehicle efficiency must be applied to improving fuel economy; and energy carriers must de-carbonize to less than half of the carbon intensity of gasoline and diesel. Reaching the 80in50 goal will require broad success in travel demand reduction, fuel economy improvements and low-carbon fuel supply, since there is little opportunity to increase emission reductions in one area if we experience failure in another. Although six scenarios for meeting the 80in50 target are defined, only one also meets the intermediate target of reducing greenhouse gas emissions to 1990 levels by the year 2020. Furthermore, the transition path taken to reach any

  12. [Prioritizing prescriptions in a ambulatory care setting: a tool to achieve appropriateness of care in public health management].

    Semeraro, V; Zantedeschi, E; Pasquarella, A; Guerrera, C; Guasticchi, G

    2012-01-01

    Waiting lists are one of the main Public Health issues within developed countries. To promote appropriateness about General Practitioners' (GPs) prescriptions, during 2009 the project "Priority setting in outpatient prescriptions" in Latium Region has been approved. Regional referees, Latium Public Health Agency managers and advisors, managers and advisors of three Local Public Health Units (LPHUs) within the Latium region and some voluntarily recruited General Practitioners (each one with more than 800 patients enrolled) were included in a team work with the duty to develop the project. During two selected months of 2010, 46 GPs have forwarded overall 2.229 medical prescriptions. The six most numerous prescriptions were picked out and analyzed by the team work. 42% of these prescriptions were identified as belonging to category D of the priority level--"standard", while 42% and 41% of prescriptions bore the expressions of "control" and "diagnostic purpose" respectively. Among these ones, 75% were represented by bilateral mammography, prescribed to women aged between 50 and 69 years: but for those people bilateral mammography is already provided free of charge within the regional program of breast cancer screening, making the routine prescription by their physician a useless duplication, unacceptable in a healthcare system of good quality. Therefore at the conclusion of the project, the team work suggests proper standards be applied by healthcare professionals and GPs to achieve a significant objective: mammography appropriateness prescriptions.

  13. Facilitating Sustainable Waste Management Behaviors Within the Health Sector: A Case Study of the National Health Service (NHS in Southwest England, UK

    Janet Richardson

    2012-04-01

    Full Text Available Waste costs the National Health Service (NHS £71.2 million in 2007/2008; recycling all papers, newspapers and cardboard produced by the NHS in England and Wales could save up to 42,000 tonnes of CO2. As the largest employer in the UK, the NHS is in a prime position to both lead the way towards a sustainable future, but also act as a test bed for organizational change and provide evidence of what works at an individual level to change attitudes and behavior. However these require changes in mindset, including values, attitudes, norms and behaviors which are required along with clear definitions of the problems faced in terms of economics, society and culture. Initial investigations of the literature indicate that behavior change theory may provide a feasible means of achieving constructive changes in clinical waste management; such approaches require further investigation. This paper describes a feasibility study designed to examine issues that might affect the introduction of a behavior change strategy and improve waste management in a healthcare setting. Guided by the evidence gained from our systematic review, 20 interviews were carried out with senior managers, clinicians and support staff involved in the management of healthcare waste from a broad range of agencies in South West England. Interviews were audio-recorded and transcribed for analysis. Thematic content analysis was conducted in order to identify key issues and actions. Data extraction, coding and analysis were cross checked independently by the four members of the research team. Initial findings suggest tensions, between Government and local policies, between packaging and storage space at ward level and, and between the operational requirements of infection control and maintaining appropriate and ethical patient care. These tensions increase pressures on staff already trying to maintain high quality care in a resource restricted and changing environment.

  14. Sector Switching

    Newman, Carol; Rand, John; Tarp, Finn

    Much of the literature on industry evolution has found firm dynamics to be an important source of sector-level productivity growth. In this paper, we ask whether the delineation of entry and exit firms matters in assessing the impact of firm turnover. Using detailed firm level data from Vietnam......-level determinants of firm exit and switching, which need to be carefully considered in the search for effective policy...

  15. Sector Switching

    Newman, Carol; Rand, John; Tarp, Finn

    Much of the literature on industry evolution has found firm dynamics to be an important source of sector-level productivity growth. In this paper, we ask whether the delineation of entry and exit firms matters in assessing the impact of firm turnover. Using detailed firm level data from Vietnam, ......-level determinants of firm exit and switching, which need to be carefully considered in the search for effective policy...

  16. Extending transaction cost economics: towards a synthesised approach for analysing contracting in health care markets with experience from the Australian private sector.