Leadership, governance and partnerships are essential One Health competencies.

Science.gov (United States)

Stephen, Craig; Stemshorn, Barry

2016-12-01

One Health is held as an approach to solve health problems in this era of complexity and globalization, but inadequate attention has been paid to the competencies required to build successful teams and programs. Most of the discussion on developing One Health teams focuses on creating cross-disciplinary awareness and technical skills. There is, however, evidence that collaborative, multi-disciplinary teams need skills, processes and institutions that enable policy and operations to be co-managed and co-delivered across jurisdictions. We propose that competencies in leadership and human resources; governance and infrastructure; and partnership and stakeholder engagement are essential, but often overlooked One Health attributes. Competencies in these staple attributes of leadership and management need to be more prominent in training and One Health capacity development. Although One Health has been in existence for over a decade, there has been no systematic evaluation of the essential attributes of successful and sustainable One Health programs. As such, much of this paper borrows from experience in other sectors dealing with complex, cross and inter-sectoral problems. Our objective is to advocate for increased investment in One Health leadership, governance and partnership skills to balance the focus on creating cross-disciplinary awareness and technical proficiency in order to maintain One Health as a viable approach to health issues at the human-animal-environment interface.

Why the MDGs need good governance in pharmaceutical systems to promote global health.

Science.gov (United States)

Kohler, Jillian Clare; Mackey, Tim Ken; Ovtcharenko, Natalia

2014-01-21

Corruption in the health sector can hurt health outcomes. Improving good governance can in turn help prevent health-related corruption. We understand good governance as having the following characteristics: it is consensus-oriented, accountable, transparent, responsive, equitable and inclusive, effective and efficient, follows the rule of law, is participatory and should in theory be less vulnerable to corruption. By focusing on the pharmaceutical system, we explore some of the key lessons learned from existing initiatives in good governance. As the development community begins to identify post-2015 Millennium Development Goals targets, it is essential to evaluate programs in good governance in order to build on these results and establish sustainable strategies. This discussion on the pharmaceutical system illuminates why. Considering pharmaceutical governance initiatives such as those launched by the World Bank, World Health Organization, and the Global Fund, we argue that country ownership of good governance initiatives is essential but also any initiative must include the participation of impartial stakeholders. Understanding the political context of any initiative is also vital so that potential obstacles are identified and the design of any initiative is flexible enough to make adjustments in programming as needed. Finally, the inherent challenge which all initiatives face is adequately measuring outcomes from any effort. However in fairness, determining the precise relationship between good governance and health outcomes is rarely straightforward. Challenges identified in pharmaceutical governance initiatives manifest in different forms depending on the nature and structure of the initiative, but their regular occurrence and impact on population-based health demonstrates growing importance of addressing pharmaceutical governance as a key component of the post-2015 Millennium Development Goals. Specifically, these challenges need to be acknowledged and

Governing how we care: contesting community and defining difference in U.S. public health programs

National Research Council Canada - National Science Library

Shaw, Susan J., Dr

2012-01-01

.... In Governing How We Care, medical anthropologist Susan Shaw examines the relationship between government and citizens using case studies of needle exchange and Welfare-to-Work programs to illustrate...

42 CFR 137.275 - May Self-Governance Tribes include IHS construction programs in a construction project agreement...

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May Self-Governance Tribes include IHS construction... OF HEALTH AND HUMAN SERVICES TRIBAL SELF-GOVERNANCE Construction Purpose and Scope § 137.275 May Self-Governance Tribes include IHS construction programs in a construction project agreement or in a funding...

How the Avahan HIV prevention program transitioned from the Gates Foundation to the government of India.

Science.gov (United States)

Sgaier, Sema K; Ramakrishnan, Aparajita; Dhingra, Neeraj; Wadhwani, Alkesh; Alexander, Ashok; Bennett, Sara; Bhalla, Aparajita; Kumta, Sameer; Jayaram, Matangi; Gupta, Pankaj; Piot, Peter K; Bertozzi, Stefano M; Anthony, John

2013-07-01

Developing countries face diminishing development aid and time-limited donor commitments that challenge the long-term sustainability of donor-funded programs to improve the health of local populations. Increasing country ownership of the programs is one solution. Transitioning managerial and financial responsibility for donor-funded programs to governments and local stakeholders represents a highly advanced form of country ownership, but there are few successful examples among large-scale programs. We present a transition framework and describe how it was used to transfer the Bill & Melinda Gates Foundation's HIV/AIDS prevention program, the Avahan program, to the Government of India. Essential features recommended for the transition of donor-funded programs to governments include early planning with the government, aligning donor program components with government structures and funding models prior to transition, building government capacity through active technical and management support, budgeting for adequate support during and after the transition, and dividing the transition into phases to allow time for adjustments and corrections. The transition of programs to governments is an important sustainability strategy for efforts to scale up HIV prevention programs to reach the populations most at risk.

Reducing Health Services for Refugees Through Reforms to the Interim Federal Health Program

Directory of Open Access Journals (Sweden)

Andrew C. Stevenson

2018-04-01

Full Text Available Since 1957 the Interim Federal Health Program (IFHP has provided temporary health care coverage to refugees and refugee claimants, but in 2012 the Conservative government reformed the IFHP, reducing, or eliminating access to health services for these groups. The government framed the changes around fairness and safety, stating that it would save tax payers $100 million over five years, reduce incentive for migrants with unfounded refugee claims from coming to Canada, protect public health and safety, and defend the integrity of the immigration system. With a Conservative majority, the reform was easily implemented despite a lack of evidence supporting these claims. In 2014, the Federal Court rejected the government's notion of fairness and safety, ruling that the cuts were cruel and unusual treatment of an already vulnerable population. The government appealed this ruling but, in 2016, the Liberals took power and restored funding to the IFHP to pre-2012 levels. Ad hoc evaluations predicted inequitable and adverse impacts on refugees, negative impacts on health, and increased costs to refugees, provincial governments, and health providers. Overall the threats and weaknesses of this reform clearly outweighed the few and unconvincing opportunities and strengths of the program, leading to its demise.

Digital Government and Public Health

OpenAIRE

Fountain, Jane E.

2004-01-01

Digital government is typically defined as the production and delivery of information and services inside government and between government and the public using a range of information and communication technologies. Two types of government relationships with other entities are government-to-citizen and government-to-government relationships. Both offer opportunities and challenges. Assessment of a public health agencys readiness for digital government includes examination of technical, manage...

20 CFR 638.520 - Student government and leadership programs.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Student government and leadership programs... Student government and leadership programs. The center operator shall establish an elected student government and student leadership program in accordance with procedures established by the Job Corps Director. ...

Governance of global health research consortia: Sharing sovereignty and resources within Future Health Systems.

Science.gov (United States)

Pratt, Bridget; Hyder, Adnan A

2017-02-01

Global health research partnerships are increasingly taking the form of consortia that conduct programs of research in low and middle-income countries (LMICs). An ethical framework has been developed that describes how the governance of consortia comprised of institutions from high-income countries and LMICs should be structured to promote health equity. It encompasses initial guidance for sharing sovereignty in consortia decision-making and sharing consortia resources. This paper describes a first effort to examine whether and how consortia can uphold that guidance. Case study research was undertaken with the Future Health Systems consortium, performs research to improve health service delivery for the poor in Bangladesh, China, India, and Uganda. Data were thematically analysed and revealed that proposed ethical requirements for sharing sovereignty and sharing resources are largely upheld by Future Health Systems. Facilitating factors included having a decentralised governance model, LMIC partners with good research capacity, and firm budgets. Higher labour costs in the US and UK and the funder's policy of allocating funds to consortia on a reimbursement basis prevented full alignment with guidance on sharing resources. The lessons described in this paper can assist other consortia to more systematically link their governance policy and practice to the promotion of health equity. Copyright © 2016 Elsevier Ltd. All rights reserved.

Global Health Governance at a Crossroads.

Science.gov (United States)

Ng, Nora Y; Ruger, Jennifer Prah

2011-06-21

This review takes stock of the global health governance (GHG) literature. We address the transition from international health governance (IHG) to global health governance, identify major actors, and explain some challenges and successes in GHG. We analyze the framing of health as national security, human security, human rights, and global public good, and the implications of these various frames. We also establish and examine from the literature GHG's major themes and issues, which include: 1) persistent GHG problems; 2) different approaches to tackling health challenges (vertical, horizontal, and diagonal); 3) health's multisectoral connections; 4) neoliberalism and the global economy; 5) the framing of health (e.g. as a security issue, as a foreign policy issue, as a human rights issue, and as a global public good); 6) global health inequalities; 7) local and country ownership and capacity; 8) international law in GHG; and 9) research gaps in GHG. We find that decades-old challenges in GHG persist and GHG needs a new way forward. A framework called shared health governance offers promise.

Workshop: health workforce governance and integration.

NARCIS (Netherlands)

Batenburg, R.

2014-01-01

Background: Health workforce governance is increasingly recognized as a burning policy issue and focused on workforce shortages. Yet the most pressing problem is to solve maldistributions through governance and integration. Poor management of health 242 European Journal of Public Health, Vol. 24,

Status of the U.S. Department of Energy (DOE) Government to Government Program in Russia

International Nuclear Information System (INIS)

Olascoaga, M.T.

1996-01-01

The US-Russian Government-to-Government Program of Cooperation on Nuclear Material Protection, Control, and Accounting (MPC ampersand A) evolved from the Nunn-Lugar Cooperative Threat Reduction Program. In 1995, the US Department of Energy (DOE) assumed responsibility as the executive agent for implementation of the Government-to-Government MPC ampersand A Program, followed by the programmatic responsibility for funding. The Russian Program initially emphasized limited exchanges, demonstrations, and upgrades at low-enriched uranium (LEU) fuel fabrication facility at Elektrostal in 1994. The program has expanded to include upgrades at nuclear facilities across Russia, development of the Russian Methodological Training Center (RMTC) in Obninsk; and cooperation with Gosatomnadzor, the Russian Federal Nuclear Radiation and Safety Authority. This paper describes the overall program including program objectives, approach, and US-Russian participation, with an emphasis on DOE-GAN cooperation

Governance within the World Health Assembly: a 13-year analysis of WHO Member States' contribution to global health governance.

Science.gov (United States)

van der Rijt, Tess; Pang Pangestu, Tikki

2015-03-01

There is a widespread perception that developed countries in the Western world dictate the shaping and governance of global health. While there are many bodies that engage in global health governance, the World Health Organisation (WHO) is the only entity whereby 194 countries are invited to congregate together and engage in global health governance on an equal playing field. This paper examines the diversity of governance within the World Health Assembly (WHA), the supreme decision-making body of the WHO. It explores the degree and balance of policy influence between high, middle and low-income countries and the relevance of the WHO as a platform to exercise global governance. It finds that governance within the WHA is indeed diverse: relative to the number of Member States within the regions, all regions are well represented. While developed countries still dominate WHA governance, Western world countries do not overshadow decision-making, but rather there is evidence of strong engagement from the emerging economies. It is apparent that the WHO is still a relevant platform whereby all Member States can and do participate in the shaping of global health governance. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Regional health governance: A suggested agenda for Southern African health diplomacy.

Science.gov (United States)

Penfold, Erica Dale; Fourie, Pieter

2015-12-01

Regional organisations can effectively promote regional health diplomacy and governance through engagement with regional social policy. Regional bodies make decisions about health challenges in the region, for example, the Union of South American Nations (UNASUR) and the World Health Organisation South East Asia Regional Office (WHO-SEARO). The Southern African Development Community (SADC) has a limited health presence as a regional organisation and diplomatic partner in health governance. This article identifies how SADC facilitates and coordinates health policy, arguing that SADC has the potential to promote regional health diplomacy and governance through engagement with regional social policy. The article identifies the role of global health diplomacy and niche diplomacy in health governance. The role of SADC as a regional organisation and the way it functions is then explained, focusing on how SADC engages with health issues in the region. Recommendations are made as to how SADC can play a more decisive role as a regional organisation to implement South-South management of the regional social policy, health governance and health diplomacy agenda.

Health consequences and health systems response to the Pacific U.S. Nuclear Weapons Testing Program.

Science.gov (United States)

Palafox, Neal A; Riklon, Sheldon; Alik, Wilfred; Hixon, Allen L

2007-03-01

Between 1946 and 1958, the United States detonated 67 thermonuclear devices in the Pacific as part of their U.S. Nuclear Weapons Testing Program (USNWTP). The aggregate explosive power was equal to 7,200 Hiroshima atomic bombs. Recent documents released by the U.S. government suggest that the deleterious effects of the nuclear testing were greater and extended farther than previously known. The Republic of the Marshall Islands (RMI) government and affected communities have sought refress through diplomatic routes with the U.S. government, however, existing medical programs and financial reparations have not adequately addressed many of the health consequences of the USNWTP. Since radiation-induced cancers may have a long latency, a healthcare infrastructure is needed to address both cancer and related health issues. This article reviews the health consequences of the Pacific USNWTP and the current health systems ability to respond.

Health sector governance: should we be investing more?

Science.gov (United States)

Fryatt, Robert; Bennett, Sara; Soucat, Agnes

2017-01-01

Governance is central to improving health sector performance and achieving Universal Health Coverage (UHC). However, the growing body of research on governance and health has not yet led to a global consensus on the need for more investment in governance interventions to improve health. This paper aims to summarise the latest evidence on the influence of governance on health, examines how we can assess governance interventions and considers what might constitute good investments in health sector governance in resource constrained settings. The paper concludes that agendas for improving governance need to be realistic and build on promising in-country innovation and the growing evidence base of what works in different settings. For UHC to be achieved, governance will require new partnerships and opportunities for dialogue, between state and non-state actors. Countries will require stronger platforms for effective intersectoral actions and more capacity for applied policy research and evaluation. Improved governance will also come from collective action across countries in research, norms and standards, and communicable disease control.

Game theoretic considerations for Kenyan health governance ...

African Journals Online (AJOL)

Game theoretic considerations for Kenyan health governance. ... theoretic considerations in their practice in order to achieve market-driven competition ... Key words: Game theory, social capital, good governance, health policy, health systems.

PEPFAR Investments In Governance And Health Systems Were One-Fifth Of Countries' Budgeted Funds, 2004-14.

Science.gov (United States)

Moucheraud, Corrina; Sparkes, Susan; Nakamura, Yoriko; Gage, Anna; Atun, Rifat; Bossert, Thomas J

2016-05-01

Launched in 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) is the largest disease-focused assistance program in the world. We analyzed PEPFAR budgets for governance and systems for the period 2004-14 to ascertain whether PEPFAR's stated emphasis on strengthening health systems has been manifested financially. The main outcome variable in our analysis, the first of its kind using these data, was the share of PEPFAR's total annual budget for a country that was designated for governance and systems. The share of planned PEPFAR funding for governance and systems increased from 14.9 percent, on average, in 2004 to 27.5 percent in 2013, but it declined in 2014 to 20.8 percent. This study shows that the size of a country's PEPFAR budget was negatively associated with the share allocated for governance and systems (compared with other budget program areas); it also shows that there was no significant relationship between budgets for governance and systems and HIV prevalence. It is crucial for the global health policy community to better understand how such investments are allocated and used for health systems strengthening. Project HOPE—The People-to-People Health Foundation, Inc.

Governing health equity in Scandinavian municipalities

DEFF Research Database (Denmark)

Scheele, Christian Elling; Little, Ingvild; Diderichsen, Finn

2018-01-01

AIMS: Local governments in the Scandinavian countries are increasingly committed to reduce health inequity through 'health equity in all policies' (HEiAP) governance. There exists, however, only very sporadic implementation evidence concerning municipal HEiAP governance, which is the focus...... of this study. METHODS: Data are based on qualitative thematic network analysis of 20 interviews conducted from 2014 to 2015 with Scandinavian political and administrative practitioners. RESULTS: We identify 24 factors located within three categories; political processes, where insufficient political commitment...... to health equity goals outside of the health sector and inadequate economic prioritization budget curbs implementation. Concerning evidence, there is a lack of epidemiological data, detailed evidence of health equity interventions as well as indicators relevant for monitoring implementation. Concerted...

Regional governance: strategies and disputes in health region management

Directory of Open Access Journals (Sweden)

Adriano Maia dos Santos

2014-08-01

Full Text Available OBJECTIVE To analyze the regional governance of the health systemin relation to management strategies and disputes. METHODOLOGICAL PROCEDURES A qualitative study with health managers from 19 municipalities in the health region of Bahia, Northeastern Brazil. Data were drawn from 17 semi-structured interviews of state, regional, and municipal health policymakers and managers; a focus group; observations of the regional interagency committee; and documents in 2012. The political-institutional and the organizational components were analyzed in the light of dialectical hermeneutics. RESULTS The regional interagency committee is the chief regional governance strategy/component and functions as a strategic tool for strengthening governance. It brings together a diversity of members responsible for decision making in the healthcare territories, who need to negotiate the allocation of funding and the distribution of facilities for common use in the region. The high turnover of health secretaries, their lack of autonomy from the local executive decisions, inadequate technical training to exercise their function, and the influence of party politics on decision making stand as obstacles to the regional interagency committee’s permeability to social demands. Funding is insufficient to enable the fulfillment of the officially integrated agreed-upon program or to boost public supply by the system, requiring that public managers procure services from the private market at values higher than the national health service price schedule (Brazilian Unified Health System Table. The study determined that “facilitators” under contract to health departments accelerated access to specialized (diagnostic, therapeutic and/or surgical services in other municipalities by direct payment to physicians for procedure costs already covered by the Brazilian Unified Health System. CONCLUSIONS The characteristics identified a regionalized system with a conflictive pattern of

The corporate determinants of health: how big business affects our health, and the need for government action!

Science.gov (United States)

Millar, John S

2013-05-14

Corporations have a great effect on the health of Canadians.Good companies create jobs, sell valued products at market value, pay a living wage, empower employees, have progressive human resource policies (parental, mental health leaves, workplace wellness programs, day care), and pay their appropriate corporate taxes. They embrace corporate social responsibility and some have a triple bottom line - people, planet and profits. More good corporations are needed.But others are selling products that are damaging to health and the environment, at prices that do not account for these damaging effects and often target consumers that are ill-informed and susceptible (e.g., children). These include businesses involving tobacco, alcohol, drugs, junk foods and beverages, resource extraction, arms production and the electronic media.Governments have a responsibility to take action when the market mechanism fails in this way.A priority for action is the food and beverage sector. The overconsumption of sugar, fat and salt is causing a rising prevalence of all the major chronic diseases, rising health care costs and declining population health and productivity. Urgent government action is required: taxation, advertising and sales restrictions, and a salt reduction program.

Future-proofing global health: Governance of priorities.

Science.gov (United States)

Bennett, Belinda; Cohen, I Glenn; Davies, Sara E; Gostin, Lawrence O; Hill, Peter S; Mankad, Aditi; Phelan, Alexandra L

2018-05-01

The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global Fund to Fight AIDS, TB and Malaria. 2015 was also the 10-year anniversary of the adoption of the International Health Regulations (May 2005) and the formal entering into force of the Framework Convention on the Tobacco Control (February 2005). The anniversary of these frameworks and institutions illustrates the growth and contribution of 'global' health diplomacy. Each initiative has also revealed on-going issues with compliance, sustainable funding and equitable attention in global health governance. In this paper, we present four thematic challenges that will continue to challenge prioritisation within global health governance into the future unless addressed: framing and prioritising within global health governance; identifying stakeholders of the global health community; understanding the relationship between health and behaviour; and the role of governance and regulation in supporting global health.

Health contribution to local government planning

International Nuclear Information System (INIS)

France, Cheryl

2004-01-01

When local government considers future land-use plans, the local health authorities are not always included as a key partner. In Cambridgeshire, England, the former Cambridgeshire Health Authority formed a partnership with local government to address this issue. The relationship that developed and the subsequent health impact review provided an opportunity to influence strategic policy and ensure that health objectives are taken into account. Through partnership working, lessons were learned about how to incorporate health issues into a strategic land-use planning document to the overall benefit of the community

Governance and health in the Arab world.

Science.gov (United States)

Batniji, Rajaie; Khatib, Lina; Cammett, Melani; Sweet, Jeffrey; Basu, Sanjay; Jamal, Amaney; Wise, Paul; Giacaman, Rita

2014-01-25

Since late 2010, the Arab world has entered a tumultuous period of change, with populations demanding more inclusive and accountable government. The region is characterised by weak political institutions, which exclude large proportions of their populations from political representation and government services. Building on work in political science and economics, we assess the extent to which the quality of governance, or the extent of electoral democracy, relates to adult, infant, and maternal mortality, and to the perceived accessibility and improvement of health services. We compiled a dataset from the World Bank, WHO, Institute for Health Metrics and Evaluation, Arab Barometer Survey, and other sources to measure changes in demographics, health status, and governance in the Arab World from 1980 to 2010. We suggest an association between more effective government and average reductions in mortality in this period; however, there does not seem to be any relation between the extent of democracy and mortality reductions. The movements for changing governance in the region threaten access to services in the short term, forcing migration and increasing the vulnerability of some populations. In view of the patterns observed in the available data, and the published literature, we suggest that efforts to improve government effectiveness and to reduce corruption are more plausibly linked to population health improvements than are efforts to democratise. However, these patterns are based on restricted mortality data, leaving out subjective health metrics, quality of life, and disease-specific data. To better guide efforts to transform political and economic institutions, more data are needed for health-care access, health-care quality, health status, and access to services of marginalised groups. Copyright © 2014 Elsevier Ltd. All rights reserved.

Health aid and governance in developing countries.

Science.gov (United States)

Fielding, David

2011-07-01

Despite anecdotal evidence that the quality of governance in recipient countries affects the allocation of international health aid, there is no quantitative evidence on the magnitude of this effect, or on which dimensions of governance influence donor decisions. We measure health-aid flows over 1995-2006 for 109 aid recipients, matching aid data with measures of different dimensions of governance and a range of country-specific economic and health characteristics. Everything else being equal, countries with more political rights receive significantly more aid, but so do countries with higher corruption levels. The dependence of aid on political rights, even when we control for other governance indicators, suggests that health aid is sometimes used as an incentive to reward political reforms. Copyright © 2010 John Wiley & Sons, Ltd.

Governance of public health: Norway in a Nordic context.

Science.gov (United States)

Helgesen, Marit K

2014-11-01

The two pillars of public health are health promotion and disease prevention. Based on a notion of governance in the state -local relation as changing from hierarchical via New Public Management (NPM) to New Public Governance (NPG), the governance of public health in Norway is contrasted to governance of public health in the other Nordic states: Denmark, Finland and Sweden. The article aims to present and discuss the governance of public health as it is played out in the state-local relationship. The method is to study central state documents in the four countries, as well as articles, research reports and papers on public health. The article shows that the governance modes (hierarchy, NPM and NPG) exist in parallel, but that their mechanisms actually vary in use. Legal, economic and informational mechanisms are, to a varying degree, in use. In Finnish and Swedish public health policies, health promotion is at the forefront; while Danish and Norwegian public health policies spur the local governments to carry out interventions to prevent disease and hospital admissions. © 2014 the Nordic Societies of Public Health.

Impact of global health governance on country health systems: the case of HIV initiatives in Nigeria.

Science.gov (United States)

Chima, Charles Chikodili; Homedes, Nuria

2015-06-01

, strategic planning and coordination, and regulation of externally-financed HIV programs by the government and this poses a great limitation to the optimal use of HIV-specific foreign aid in Nigeria. A few reforms are necessary to improve the strengthening effect of GHIs and to minimize their negative and unintended consequences. This will require stronger leadership from the Nigerian government with regards to better coordination of externally-financed health programs. Also, donors need to play a greater role in addressing the negative consequences of foreign aid. The findings highlight important unintended consequences and system-wide impacts that get little attention in traditional program evaluation.

Governance structures impact on eHealth

DEFF Research Database (Denmark)

Kierkegaard, Patrick

2015-01-01

Background National eHealth implementation efforts need to move beyond the scope of making technology the primary focus and instead consider the broader spectrum of influences that can either hinder or facilitate eHealth adoption such as governance structures and policies. In this study, Denmark...... serves as an ideal candidate for further examination due to the country׳s rich history of intertwining events that have played an important role in the dynamic relationship between governance and eHealth success and failures. Methods A case study approach was used to gather a combination of primary...... and secondary data sources. All data collection was carried out through desk-research. Data collection relied on performing an extensive search of literature for relevant studies using combinations of keywords that reflected eHealth and governance-related topics. Inclusion and exclusion criteria׳s were applied...

Aboriginal and Torres Strait Islander community governance of health research: Turning principles into practice.

Science.gov (United States)

Gwynn, Josephine; Lock, Mark; Turner, Nicole; Dennison, Ray; Coleman, Clare; Kelly, Brian; Wiggers, John

2015-08-01

Gaps exist in researchers' understanding of the 'practice' of community governance in relation to research with Aboriginal and Torres Strait Islander peoples. We examine Aboriginal community governance of two rural NSW research projects by applying principles-based criteria from two independent sources. One research project possessed a strong Aboriginal community governance structure and evaluated a 2-year healthy lifestyle program for children; the other was a 5-year cohort study examining factors influencing the mental health and well-being of participants. The National Health and Medical Research Council of Australia's 'Values and ethics: guidelines for ethical conduct in Aboriginal and Torres Strait Islander research' and 'Ten principles relevant to health research among Indigenous Australian populations' described by experts in the field. Adopt community-based participatory research constructs. Develop clear governance structures and procedures at the beginning of the study and allow sufficient time for their establishment. Capacity-building must be a key component of the research. Ensure sufficient resources to enable community engagement, conduct of research governance procedures, capacity-building and results dissemination. The implementation of governance structures and procedures ensures research addresses the priorities of the participating Aboriginal and Torres Strait Islander communities, minimises risks and improves outcomes for the communities. Principles-based Aboriginal and Torres Strait Islander community governance of research is very achievable. Next steps include developing a comprehensive evidence base for appropriate governance structures and procedures, and consolidating a suite of practical guides for structuring clear governance in health research. © 2015 National Rural Health Alliance Inc.

Child survival in England: Strengthening governance for health.

Science.gov (United States)

Wolfe, Ingrid; Mandeville, Kate; Harrison, Katherine; Lingam, Raghu

2017-11-01

The United Kingdom, like all European countries, is struggling to strengthen health systems and improve conditions for child health and survival. Child mortality in the UK has failed to improve in line with other countries. Securing optimal conditions for child health requires a healthy society, strong health system, and effective health care. We examine inter-sectoral and intra-sectoral policy and governance for child health and survival in England. Literature reviews and universally applicable clinical scenarios were used to examine child health problems and English policy and governance responses for improving child health through integrating care and strengthening health systems, over the past 15 years. We applied the TAPIC framework for analysing policy governance: transparency, accountability, participation, integrity, and capacity. We identified strengths and weaknesses in child health governance in all the five domains. However there remain policy failures that are not fully explained by the TAPIC framework. Other problems with successfully translating policy to improved health that we identified include policy flux; policies insufficiently supported by delivery mechanisms, measurable targets, and sufficient budgets; and policies with unintended or contradictory aspects. We make recommendations for inter-sectoral and intra-sectoral child health governance, policy, and action to improve child health in England with relevant lessons for other countries. Copyright © 2017 The Author(s). Published by Elsevier B.V. All rights reserved.

78 FR 64873 - Federal Employees Health Benefits Program and Federal Employees Dental and Vision Insurance...

Science.gov (United States)

2013-10-30

... family members under the FEHB and the Federal Employees Dental and Vision Insurance Program (FEDVIP... procedure, Government employees, Health facilities, Health insurance, Health professions, Hostages, Iraq... Administrative practice and procedure, Government employees, Health insurance, Taxes, Wages. 5 CFR Part 894...

Health in All Policies (HiAP) governance: lessons from network governance.

Science.gov (United States)

Khayatzadeh-Mahani, Akram; Ruckert, Arne; Labonté, Ronald; Kenis, Patrick; Akbari-Javar, Mohammad Reza

2018-05-25

The Health in All Policies (HiAP) approach requires formal and sustained governance structures and mechanisms to ensure that the policies of various non-health sectors maximize positive and minimize negative impacts on population health. In this paper, we demonstrate the usefulness of a network perspective in understanding and contributing to the effectiveness of HiAP. We undertook an exploratory, qualitative case study of a HiAP structure in Iran, the Kerman province Council of Health and Food Security (CHFS) with diverse members from health and non-health sectors. We analyzed relevant policy texts and interviewed 32 policy actors involved in the CHFS. Data were analyzed using within-case analysis and constant comparative methodology. Our findings suggest that CHFS governance from a network perspective drew in practice on elements of two competing network governance modes: the network administrative organization (NAO) and the lead organization mode. Our results also show that a shift from a hierarchical and market-based mode of interaction to a network logic within CHFS has not yet taken place. In addition, CHFS suffers from large membership and an inability to address complex 'wicked problems', as well as low trust, legitimacy and goal consensus among its members. Drawing on other HiAP studies and commentaries, insights from organization network theory, and in-depth findings from our case study, we conclude that a NAO may be the most effective mode of governance for tackling complex social problems in HiAP structures. Since similar studies are limited, and our single case study may not be transferable across all contexts, we suggest that further research be undertaken to explore HiAP structures from a network perspective in different institutional and cultural settings. With increasing emphasis given to HiAP approaches in national and international health policy discourse, it is important that comparative knowledge about the effectiveness of HiAP governance

Chronic beryllium disease prevention program; worker safety and health program. Final rule.

Science.gov (United States)

2006-02-09

The Department of Energy (DOE) is today publishing a final rule to implement the statutory mandate of section 3173 of the Bob Stump National Defense Authorization Act (NDAA) for Fiscal Year 2003 to establish worker safety and health regulations to govern contractor activities at DOE sites. This program codifies and enhances the worker protection program in operation when the NDAA was enacted.

Computer Programming Languages for Health Care

Science.gov (United States)

O'Neill, Joseph T.

1979-01-01

This paper advocates the use of standard high level programming languages for medical computing. It recommends that U.S. Government agencies having health care missions implement coordinated policies that encourage the use of existing standard languages and the development of new ones, thereby enabling them and the medical computing community at large to share state-of-the-art application programs. Examples are based on a model that characterizes language and language translator influence upon the specification, development, test, evaluation, and transfer of application programs.

76 FR 43571 - Small Business HUBZone Program; Government Contracting Programs

Science.gov (United States)

2011-07-21

... SMALL BUSINESS ADMINISTRATION 13 CFR Part 126 RIN 3245-AG45 Small Business HUBZone Program; Government Contracting Programs AGENCY: U.S. Small Business Administration. ACTION: Interim final rule with request for comments. SUMMARY: This interim final rule amends the U.S. Small Business Administration's...

Global health governance - the next political revolution.

Science.gov (United States)

Kickbusch, I; Reddy, K S

2015-07-01

The recent Ebola crisis has re-opened the debate on global health governance and the role of the World Health Organization. In order to analyze what is at stake, we apply two conceptual approaches from the social sciences - the work on gridlock and the concept of cosmopolitan moments - to assess the ability of the multilateral governance system to reform. We find that gridlock can be broken open by a health crisis which in turn generates a political drive for change. We show that a set of cosmopolitan moments have led to the introduction of the imperative of health in a range of policy arenas and moved health into 'high politics' - this has been called a political revolution. We contend that this revolution has entered a second phase with increasing interest of heads of state in global health issues. Here lies the window of opportunity to reform global health governance. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

[Governance of primary health-care-based health-care organization].

Science.gov (United States)

Báscolo, Ernesto

2010-01-01

An analytical framework was developed for explaining the conditions for the effectiveness of different strategies promoting integrated primary health-care (PHC) service-based systems in Latin-America. Different modes of governance (clan, incentives and hierarchy) were characterised from a political economics viewpoint for representing alternative forms of regulation promoting innovation in health-service-providing organisations. The necessary conditions for guaranteeing the modes of governance's effectiveness are presented, as are their implications in terms of posts in play. The institutional construction of an integrated health system is interpreted as being a product of a social process in which different modes of governance are combined, operating with different ways of resolving normative aspects for regulating service provision (with the hierarchical mode), resource distribution (with the incentives mode) and on the social values legitimising such process (with the clan mode).

Qualitative analysis of governance trends after health system reforms in Latin America: lessons from Mexico.

Science.gov (United States)

Arredondo, A; Orozco, E; Recaman, A L

2018-03-01

Health policies in Latin America are centered on the democratization of health. Since 2003, during the last generation of reforms, health systems in this region have promoted governance strategies for better agreements between governments, institutions, and civil society. In this context, we develop an evaluative research to identify trends and evidence of governance after health care reforms in six regions of Mexico. Evaluative research was developed with a retrospective design based on qualitative analysis. Primary data were obtained from 189 semi-structured interviews with purposively selected health care professionals and key informants. Secondary data were extracted from a selection of 95 official documents on results of the reform project at the national level, national health policies, and lines of action for good governance. Data processing and analysis were performed using ATLAS.ti and PolicyMaker. A list of main strengths and weaknesses is presented as evidence of health system governance. Accountability at the federal level remains prescriptive; in the regions, a system of accountability and transparency in the allocation of resources and in terms of health democratization strategies is still absent. Social protection and decentralization schemes are strategies that have allowed for improvements with a proactive role of users and civil society. Regarding challenges, there are still low levels of governance and difficulties in the effective conduct of programs and reform strategies together with a lack of precision in the rules and roles of the different actors of the health system. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Frameworks to assess health systems governance: a systematic review.

Science.gov (United States)

Pyone, Thidar; Smith, Helen; van den Broek, Nynke

2017-06-01

Governance of the health system is a relatively new concept and there are gaps in understanding what health system governance is and how it could be assessed. We conducted a systematic review of the literature to describe the concept of governance and the theories underpinning as applied to health systems; and to identify which frameworks are available and have been applied to assess health systems governance. Frameworks were reviewed to understand how the principles of governance might be operationalized at different levels of a health system. Electronic databases and web portals of international institutions concerned with governance were searched for publications in English for the period January 1994 to February 2016. Sixteen frameworks developed to assess governance in the health system were identified and are described. Of these, six frameworks were developed based on theories from new institutional economics; three are primarily informed by political science and public management disciplines; three arise from the development literature and four use multidisciplinary approaches. Only five of the identified frameworks have been applied. These used the principal-agent theory, theory of common pool resources, North's institutional analysis and the cybernetics theory. Governance is a practice, dependent on arrangements set at political or national level, but which needs to be operationalized by individuals at lower levels in the health system; multi-level frameworks acknowledge this. Three frameworks were used to assess governance at all levels of the health system. Health system governance is complex and difficult to assess; the concept of governance originates from different disciplines and is multidimensional. There is a need to validate and apply existing frameworks and share lessons learnt regarding which frameworks work well in which settings. A comprehensive assessment of governance could enable policy makers to prioritize solutions for problems identified

A New Frontier for LIS Programs: E-Government Education, Library/Government Partnerships, and the Preparation of Future Information Professionals

Science.gov (United States)

Jaeger, Paul T.; Bertot, John Carlo; Shuler, John A.; McGilvray, Jessica

2012-01-01

This paper examines the implications of the continued growth of e-government information, communication, and services for Library and Information Science programs in the United States in light of the development of e-government educational programs and library/government partnerships. The implementation of e-government raises several important…

Governing how we care: contesting community and defining difference in U.S. public health programs

National Research Council Canada - National Science Library

Shaw, Susan J., Dr

2012-01-01

"As local governments and organizations assume more responsibility for ensuring the public health, identity politics play an increasing yet largely unexamined role in public and policy attitudes toward local problems...

Framing global health: the governance challenge.

Science.gov (United States)

McInnes, Colin; Kamradt-Scott, Adam; Lee, Kelley; Reubi, David; Roemer-Mahler, Anne; Rushton, Simon; Williams, Owain David; Woodling, Marie

2012-01-01

With the emergence of global health comes governance challenges which are equally global in nature. This article identifies some of the initial limitations in analyses of global health governance (GHG) before discussing the focus of this special supplement: the framing of global health issues and the manner in which this impacts upon GHG. Whilst not denying the importance of material factors (such as resources and institutional competencies), the article identifies how issues can be framed in different ways, thereby creating particular pathways of response which in turn affect the potential for and nature of GHG. It also identifies and discusses the key frames operating in global health: evidence-based medicine, human rights, security, economics and development.

Impacts of NRC programs on state and local governments

International Nuclear Information System (INIS)

Nussbaumer, D.A.; Lubenau, J.O.

1983-12-01

This document reports the results of an NRC staff examination of the impacts of NRC regulatory programs on State and local governments. Twenty NRC programs are identified. For each, the source of the program (e.g., statutory requirement) and NRC funding availability are described and the impacts upon State and local governments are assessed. Recommendations for NRC monitoring and assessing impacts and for enhancing NRC staff awareness of the impacts are offered

Health domains for sale: the need for global health Internet governance.

Science.gov (United States)

Mackey, Tim Ken; Liang, Bryan A; Kohler, Jillian C; Attaran, Amir

2014-03-05

A debate on Internet governance for health, or "eHealth governance", is emerging with the impending award of a new dot-health (.health) generic top-level domain name (gTLD) along with a host of other health-related domains. This development is critical as it will shape the future of the health Internet, allowing largely unrestricted use of .health second-level domain names by future registrants, raising concerns about the potential for privacy, use and marketing of health-related information, credibility of online health content, and potential for Internet fraud and abuse. Yet, prospective .health gTLD applicants do not provide adequate safeguards for use of .health or related domains and have few or no ties to the global health community. If approved, one of these for-profit corporate applicants would effectively control the future of the .health address on the Internet with arguably no active oversight from important international public health stakeholders. This would represent a lost opportunity for the public health, medical, and broader health community in establishing a trusted, transparent and reliable source for health on the Internet. Countries, medical associations, civil society, and consumer advocates have objected to these applications on grounds that they do not meet the public interest. We argue that there is an immediate need for action to postpone awarding of the .health gTLD and other health-related gTLDs to address these concerns and ensure the appropriate development of sound eHealth governance rules, principles, and use. This would support the crucial need of ensuring access to quality and evidence-based sources of health information online, as well as establishing a safe and reliable space on the Internet for health. We believe, if properly governed, .health and other domains could represent such a promise in the future.

Parallel processor programs in the Federal Government

Science.gov (United States)

Schneck, P. B.; Austin, D.; Squires, S. L.; Lehmann, J.; Mizell, D.; Wallgren, K.

1985-01-01

In 1982, a report dealing with the nation's research needs in high-speed computing called for increased access to supercomputing resources for the research community, research in computational mathematics, and increased research in the technology base needed for the next generation of supercomputers. Since that time a number of programs addressing future generations of computers, particularly parallel processors, have been started by U.S. government agencies. The present paper provides a description of the largest government programs in parallel processing. Established in fiscal year 1985 by the Institute for Defense Analyses for the National Security Agency, the Supercomputing Research Center will pursue research to advance the state of the art in supercomputing. Attention is also given to the DOE applied mathematical sciences research program, the NYU Ultracomputer project, the DARPA multiprocessor system architectures program, NSF research on multiprocessor systems, ONR activities in parallel computing, and NASA parallel processor projects.

Program governance

CERN Document Server

Khan, Muhammad Ehsan

2014-01-01

FOUNDATION OF GOVERNANCEGovernanceDefining GovernanceGovernance at Multiple LevelsSummaryReferencesTransaction Cost EconomicsTransactions-Core Elements and Attributes     Behavioral Assumptions     Governance Structure AttributesHazards of Concern     Incomplete Contracting     Bilateral Dependency and Fundamental Transformation     Adaptation or MaladaptationLinking Governance, Governance Structures, and ContractsThe Impact of Asset Specificity and Behavioral Assumptions on ContractsAp

Alternative transportation fuels in the USA: government hydrogen vehicle programs

International Nuclear Information System (INIS)

Cannon, J.S.

1993-01-01

The linkage between natural gas-based transportation and hydrogen-based transportation strategies, two clean burning gaseous fuels, provides a strong policy rationale for increased government sponsorship of hydrogen vehicle research and demonstration programs. Existing federal and state government hydrogen vehicle projects are discussed in this paper: research at the NREL, alternate-fueled buses, Renewable Hydrogen for the State of Hawaii program, New York state alternative transportation fuels program, Colorado program. 9 refs

A health equity impact assessment umbrella program (AAPRISS) to tackle social inequalities in health: program description.

Science.gov (United States)

Lang, Thierry; Bidault, Elsa; Villeval, Mélanie; Alias, François; Gandouet, Benjamin; Servat, Martine; Theis, Ivan; Breton, Eric; Haschar-Noé, Nadine; Grosclaude, Pascale

2016-09-01

The failure to simultaneously address two objectives (increasing the average health of the population and reducing health inequalities) may have led to what has been observed in France so far: an overall decrease in mortality and increase in inequality. The Apprendre et Agir pour Réduire les Inégalités Sociales de Santé (AAPRISS) methodology is to analyze and modify interventions that are already underway in terms of their potential impact on health inequalities. It relies on partnership between researchers and actors in the health field, as well as policy makers. In this paper, we describe the program and discuss its feasibility and acceptability. This program is not a single intervention, but a process aiming at assessing and reshaping existing health programs, therefore acting as a kind of meta-intervention. The program develops scientific and methodological support stemming from co-construction methods aimed at increasing equity within the programs. Stakeholders from prevention policy-making and the health care system, as well as researchers, collaborate in defining interventions, monitoring their progress, and choosing indicators, methods and evaluation procedures. The target population is mainly the population of the greater Toulouse area. The steps of the process are described: (1) establishment of AAPRISS governance and partnerships; (2) inclusion of projects; and (3) the projects' process. Many partners have rallied around this program, which has been shown to be feasible and acceptable by partners and health actors. A major challenge is understanding each partner's expectations in terms of temporality of interventions, expected outcomes, assessment methods and indicators. Analyzing the projects has been quite feasible, and some modifications have been implemented in them in order to take inequalities in health into account. © The Author(s) 2015.

National poverty reduction strategies and HIV/AIDS governance in Malawi: a preliminary study of shared health governance.

Science.gov (United States)

Wachira, Catherine; Ruger, Jennifer Prah

2011-06-01

The public health and development communities understand clearly the need to integrate anti-poverty efforts with HIV/AIDS programs. This article reports findings about the impact of the Poverty Reduction Strategy Paper (PRSP) process on Malawi's National HIV/AIDS Strategic Framework (NSF). In this article we ask, how does the PRSP process support NSF accountability, participation, access to information, funding, resource planning and allocation, monitoring, and evaluation? In 2007, we developed and conducted a survey of Malawian government ministries, United Nations agencies, members of the Country Coordination Mechanism, the Malawi National AIDS Commission (NAC), and NAC grantees (N = 125, 90% response rate), seeking survey respondents' retrospective perceptions of NSF resource levels, participation, inclusion, and governance before, during, and after Malawi's PRSP process (2000-2004). We also assessed principle health sector and economic indicators and budget allocations for HIV/AIDS. These indicators are part of a new conceptual framework called shared health governance (SHG), which seeks congruence among the values and goals of different groups and actors to reflect a common purpose. Under this framework, global health policy should encompass: (i) consensus among global, national, and sub-national actors on goals and measurable outcomes; (ii) mutual collective accountability; and (iii) enhancement of individual and group health agency. Indicators to assess these elements included: (i) goal alignment; (ii) adequate resource levels; (iii) agreement on key outcomes and indicators for evaluating those outcomes; (iv) meaningful inclusion and participation of groups and institutions; (v) special efforts to ensure participation of vulnerable groups; and (vi) effectiveness and efficiency measures. Results suggest that the PRSP process supported accountability for NSF resources. However, the process may have marginalized key stakeholders, potentially undercutting the

Governance and mental health: contributions for public policy approach.

Science.gov (United States)

Díaz-Castro, Lina; Arredondo, Armando; Pelcastre-Villafuerte, Blanca Estela; Hufty, Marc

2017-01-30

To analyze the conceptualization of the term governance on public mental health programs. In this systematic review, we analyzed the scientific literature published in the international scenario during 15 years (from 2000 to 2015). The databases analyzed were: Medline, CINAHL, PsycINFO and PubMed. Governance and mental health were the descriptors. We included relevant articles according to our subject of study and levels of analysis: (i) the concept of governance in mental health; (ii) process and decision spaces; (iii) strategic and pertinent actors who operate in the functioning of the health system, and (iv) social regulations. We excluded letters to the editor, news articles, comments and case reports, incomplete articles and articles whose approach did not include the object of study of this review. We have found five conceptualizations of the term governance on mental health in the area of provision policies and service organization. The agents were both those who offer and those who receive the services: we identified several social norms. The concept of governance in mental health includes standards of quality and attention centered on the patient, and incorporates the consumers of mental healthcare in the decision-making process. Analizar la conceptualización del término gobernanza en las políticas de salud mental. En esta revisión sistemática se analizó literatura científica publicada en el ámbito internacional durante 15 años (de 2000 hasta 2015). Las bases de datos analizadas fueron: Medline, CINAHL, PsycINFO y PubMed. Los descriptores fueron gobernanza y salud mental. Fueron incluidos artículos relevantes de acuerdo a nuestro objeto de estudio y niveles de análisis: (i) concepto de gobernanza en salud mental; (ii) proceso y espacios de decisión; (iii) actores estratégicos y de interés que intervienen en el funcionamiento del sistema de salud, y (iv) normas sociales. Se excluyeron cartas al editor, noticias, comentarios y reporte de caso

Strengthening Governance in Health Systems for Reproductive ...

International Development Research Centre (IDRC) Digital Library (Canada)

Home · What we do ... As a result, Pakistan's health system has suffered and health service delivery has worsened. ... This four-year project aims to strengthen health systems governance for reproductive health and rights in Pakistan.

The link between health governance models and global health innovation: an exploration of OECD nations.

Science.gov (United States)

Schnarr, Karin; Snowdon, Anne; Cramm, Heidi; Cohen, Jason; Alessi, Charles

2015-01-01

While there is established research that explores individual innovations across countries or developments in a specific health area, there is less work that attempts to match national innovations to specific systems of health governance to uncover themes across nations. We used a cross-comparison design that employed content analysis of health governance models and innovation patterns in eight OECD nations (Australia, Britain, Canada, France, Germany, The Netherlands, Switzerland, and the United States). Country-level model of health governance may impact the focus of health innovation within the eight jurisdictions studied. Innovation across all governance models has targeted consumer engagement in health systems, the integration of health services across the continuum of care, access to care in the community, and financial models that drive competition. Improving our understanding of the linkage between health governance and innovation in health systems may heighten awareness of potential enablers and barriers to innovation success.

Polycentrism in Global Health Governance Scholarship; Comment on “Four Challenges That Global Health Networks Face”

Directory of Open Access Journals (Sweden)

Jale Tosun

2018-01-01

Full Text Available Drawing on an in-depth analysis of eight global health networks, a recent essay in this journal argued that global health networks face four challenges to their effectiveness: problem definition, positioning, coalition-building, and governance. While sharing the argument of the essay concerned, in this commentary, we argue that these analytical concepts can be used to explicate a concept that has implicitly been used in global health governance scholarship for quite a few years. While already prominent in the discussion of climate change governance, for instance, global health governance scholarship could make progress by looking at global health governance as being polycentric. Concisely, polycentric forms of governance mix scales, mechanisms, and actors. Drawing on the essay, we propose a polycentric approach to the study of global health governance that incorporates coalitionbuilding tactics, internal governance and global political priority as explanatory factors.

Polycentrism in Global Health Governance Scholarship Comment on "Four Challenges That Global Health Networks Face".

Science.gov (United States)

Tosun, Jale

2017-05-23

Drawing on an in-depth analysis of eight global health networks, a recent essay in this journal argued that global health networks face four challenges to their effectiveness: problem definition, positioning, coalition-building, and governance. While sharing the argument of the essay concerned, in this commentary, we argue that these analytical concepts can be used to explicate a concept that has implicitly been used in global health governance scholarship for quite a few years. While already prominent in the discussion of climate change governance, for instance, global health governance scholarship could make progress by looking at global health governance as being polycentric. Concisely, polycentric forms of governance mix scales, mechanisms, and actors. Drawing on the essay, we propose a polycentric approach to the study of global health governance that incorporates coalitionbuilding tactics, internal governance and global political priority as explanatory factors. © 2018 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Health workforce governance and oral health: Diversity and challenges in Europe.

Science.gov (United States)

Gallagher, Jennifer E; Eaton, Kenneth A

2015-12-01

Throughout the life course, oral diseases are some of the most common non-communicable diseases globally, and in Europe. Human resources for oral health are fundamental to healthcare systems in general and dentistry is no exception. As political and healthcare systems change, so do forms of governance. The aim of this paper is to examine human resources for oral health in Europe, against a workforce governance framework, using England as a case study. The findings suggest that neo-liberalist philosophies are leading to multiple forms of soft governance at professional, system, organisational and individual levels, most notably in England, where there is no longer professional self-regulation. Benefits include professional regulation of a wider cadre of human resources for oral health, reorientation of care towards evidence-informed practice including prevention, and consideration of care pathways for patients. Across Europe there has been significant professional collaboration in relation to quality standards in the education of dentists, following transnational policies permitting freedom of movement of health professionals; however, the distribution of dentists is inequitable. Challenges include facilitating employment of graduates to serve the needs and demands of the population in certain countries, together with governance of workforce production and migration across Europe. Integrated trans-European approaches to monitoring mobility and governance are urgently required. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Democratising health care governance? New Zealand's inaugural district health board elections, 2001.

Science.gov (United States)

Gauld, Robin

2002-01-01

New Zealand's 'district health board' (DHB) system has been under implementation since the 1999 general election. A key factor motivating the change to DHBs is the democratisation of health care governance. A majority of the new DHB members are popularly elected. Previously, hospital board members were government appointees. Inaugural DHB elections were held in October 2001. This article reports on the election results and the wider operating context for DHBs. It notes organisational issues to be considered for the next DHB elections in 2004, and questions the extent to which the elections and DHB governance structure will enhance health care democratisation in New Zealand.

A survey of the governance capacity of national public health associations to enhance population health.

Science.gov (United States)

Chauvin, James; Shukla, Mahesh; Rice, James; Rispel, Laetitia

2016-03-11

National public health associations (PHAs) are key partners with governments and communities to improve, protect and promote the public's health. Governance and organizational capacity are among the key determinants of a PHA's effectiveness as an advocate for appropriate public health policies and practice. During 2014, the World Federation of Public Health Associations (WFPHA) conducted an on-line survey of its 82 PHA members, to identify the state of organizational governance of national public health associations, as well as the factors that influence optimal organizational governance. The survey consisted of 13 questions and focused on the main elements of organizational governance: cultivating accountability; engaging stakeholders; setting shared direction; stewarding resources; and, continuous governance enhancement. Four questions included a qualitative open-ended response for additional comments. The survey data were analyzed using Microsoft Excel. The qualitative data was analyzed using thematic content analysis Responses were received from 62 PHAs, constituting a 75.6 % response rate. The two most important factors that support governance effectiveness were a high degree of integrity and ethical behavior of the PHA's leaders (77 %) and the competence of people serving on the PHA's governing body (76 %). The lack of financial resources was considered as the most important factor that negatively affected organizational governance effectiveness (73 %). The lack of mentoring for future PHA leaders; ineffective or incompetent leadership; lack of understanding about good governance practices; and lack of accurate information for strategic planning were identified as factors influencing PHA governance effectiveness. Critical elements for PHA sustainability included diversity, gender-responsiveness and inclusive governance practices, and strategies to build the future generation of public health leaders. National PHA have a responsibility to put into place

Engagement of Sectors Other than Health in Integrated Health Governance, Policy, and Action.

Science.gov (United States)

de Leeuw, Evelyne

2017-03-20

Health is created largely outside the health sector. Engagement in health governance, policy, and intervention development and implementation by sectors other than health is therefore important. Recent calls for building and implementing Health in All Policies, and continued arguments for intersectoral action, may strengthen the potential that other sectors have for health. This review clarifies the conceptual foundations for integral health governance, policy, and action, delineates the different sectors and their possible engagement, and provides an overview of a continuum of methods of engagement with other sectors to secure integration. This continuum ranges from institutional (re)design to value-based narratives. Depending on the lens applied, different elements can be identified within the continuum. This review is built on insights from political science, leadership studies, public health, empirical Health in All Policy research, knowledge and evidence nexus approaches, and community perspectives. Successful integration of health governance, policy, and action depends on integration of the elements on the continuum.

Including oral health training in a health system strengthening program in Rwanda

Directory of Open Access Journals (Sweden)

Brittany Seymour

2013-03-01

Full Text Available Objective: Rwanda's Ministry of Health, with the Clinton Health Access Initiative, implemented the Human Resources for Health (HRH Program. The purpose of the program is to train and retain high-quality health care professionals to improve and sustain health in Rwanda. Design: In May 2011, an oral health team from Rwanda and the United States proposed that oral health be included in the HRH Program, due to its important links to health, in a recommendation to the Rwandan Ministry of Health. The proposal outlined a diagonal approach to curriculum design that supports the principles of global health through interconnected training for both treatment and collaborative prevention, rather than discipline-based fragmented training focused on isolated risk factors. It combined ‘vertical’ direct patient care training with ‘horizontal’ interdisciplinary training to address common underlying risk factors and associations for disease through primary care, program retention, and sustainability. Results: The proposal was accepted by the Ministry of Health and was approved for funding by the US Government and The Global Fund. Rwanda's first Bachelor of Dental Surgery program, which is in the planning phase, is being developed. Conclusions: Competencies, the training curriculum, insurance and payment schemes, licensure, and other challenges are currently being addressed. With the Ministry of Health supporting the dental HRH efforts and fully appreciating the importance of oral health, all are hopeful that these developments will ultimately lead to more robust oral health data collection, a well-trained and well-retained dental profession, and vastly improved oral health and overall health for the people of Rwanda in the decades to come.

Including oral health training in a health system strengthening program in Rwanda

Science.gov (United States)

Seymour, Brittany; Muhumuza, Ibra; Mumena, Chris; Isyagi, Moses; Barrow, Jane; Meeks, Valli

2013-01-01

Objective Rwanda's Ministry of Health, with the Clinton Health Access Initiative, implemented the Human Resources for Health (HRH) Program. The purpose of the program is to train and retain high-quality health care professionals to improve and sustain health in Rwanda. Design In May 2011, an oral health team from Rwanda and the United States proposed that oral health be included in the HRH Program, due to its important links to health, in a recommendation to the Rwandan Ministry of Health. The proposal outlined a diagonal approach to curriculum design that supports the principles of global health through interconnected training for both treatment and collaborative prevention, rather than discipline-based fragmented training focused on isolated risk factors. It combined ‘vertical’ direct patient care training with ‘horizontal’ interdisciplinary training to address common underlying risk factors and associations for disease through primary care, program retention, and sustainability. Results The proposal was accepted by the Ministry of Health and was approved for funding by the US Government and The Global Fund. Rwanda's first Bachelor of Dental Surgery program, which is in the planning phase, is being developed. Conclusions Competencies, the training curriculum, insurance and payment schemes, licensure, and other challenges are currently being addressed. With the Ministry of Health supporting the dental HRH efforts and fully appreciating the importance of oral health, all are hopeful that these developments will ultimately lead to more robust oral health data collection, a well-trained and well-retained dental profession, and vastly improved oral health and overall health for the people of Rwanda in the decades to come. PMID:23473054

Theoretical reflections on governance in health regions.

Science.gov (United States)

Bretas, Nilo; Shimizu, Helena Eri

2017-04-01

This article analyzes governance in health regions, through the contributions of two studies: one on a governance model and the other on duties in the management of public policies networks. The former conducted a meta-analysis of 137 case studies in the literature on collaborative governance aimed at preparing an explanatory and analytical model. Authors identified critical variables that will influence the results: a previous history of conflict or cooperation, incentives for participation, power imbalances, leadership and institutional design. They also identified key factors: face-to-face dialogue, trust building and development of commitment and shared vision. The latter study examined networks of public policies in the analytic tradition and the perspective of governance, incorporating concepts from the field of political science, economics and interorganizational relations, in order to support the management of public policies networks. The study identified network management as equivalent to a strategic game involving functions: network activation, framework of relations, intermediation, facilitation and consensus building and mediation and arbitration. The combination of the two reflections provides a conceptual reference for better understanding of governance in health regions.

Understanding global health governance as a complex adaptive system.

Science.gov (United States)

Hill, Peter S

2011-01-01

The transition from international to global health reflects the rapid growth in the numbers and nature of stakeholders in health, as well as the constant change embodied in the process of globalisation itself. This paper argues that global health governance shares the characteristics of complex adaptive systems, with its multiple and diverse players, and their polyvalent and constantly evolving relationships, and rich and dynamic interactions. The sheer quantum of initiatives, the multiple networks through which stakeholders (re)configure their influence, the range of contexts in which development for health is played out - all compound the complexity of this system. This paper maps out the characteristics of complex adaptive systems as they apply to global health governance, linking them to developments in the past two decades, and the multiple responses to these changes. Examining global health governance through the frame of complexity theory offers insight into the current dynamics of governance, and while providing a framework for making meaning of the whole, opens up ways of accessing this complexity through local points of engagement.

The role of health system governance in strengthening the rural health insurance system in China.

Science.gov (United States)

Yuan, Beibei; Jian, Weiyan; He, Li; Wang, Bingyu; Balabanova, Dina

2017-05-23

Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. China's success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes' designs, coverage, and funding

Australian Government health advisory groups and health policy: seeking a horse, finding a camel.

Science.gov (United States)

Russell, Lesley M; Boxall, Anne-Marie; Leeder, Stephen R

2008-11-17

Since its election, the Rudd Labor Government has created 10 new advisory bodies in the health portfolio, in addition to the 100 or more that were already established. An expansive and devolved advisory system could improve the health policy-making process, but only if it is integrated into the processes of government. We outline eight simple and practical measures that, if implemented, would make Australia's health advisory system more transparent and effective. Past experience shows that the most important factor governing the impact of health policy advisory bodies is political leadership.

The Fiscal Consequences Attributed to Changes in Morbidity and Mortality Linked to Investments in Health Care: A Government Perspective Analytic Framework.

Science.gov (United States)

Connolly, Mark P; Kotsopoulos, Nikolaos; Postma, Maarten J; Bhatt, Aomesh

2017-02-01

Governments have an enormous economic and political stake in the health of their populations. Population health is not only fundamental to economic growth but also affects short-term and long-term government expenditure on health care, disability, and other social programs and influences direct and indirect tax receipts. Fiscal transfers between citizen and state are mostly ignored in conventional welfare economics analyses based on the hypothesis that there are no winners or losers through transference of wealth. However, from the government perspective, this position is flawed, as disability costs and lost taxes attributed to poor health and reduced productive output represent real costs that pose budgetary and growth implications. To address the value of health and health care investments for government, we have developed a fiscal health analytic framework that captures how changes in morbidity and mortality influence tax revenue and transfer costs (e.g., disability, allowances, ongoing health costs). The framework can be used to evaluate the marginal impact of discrete investments or a mix of interventions in health care to inform governmental budgetary consequences. In this context, the framework can be considered as a fiscal budget impact and/or cost-benefit analysis model that accounts for how morbidity and mortality linked to specific programs represent both ongoing costs and tax revenue for government. Mathematical models identical to those used in cost-effectiveness analyses can be employed in fiscal analysis to reflect how disease progression influences public accounts (e.g., tax revenue and transfers). Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Conditional cash transfer programs and the health and nutrition of Latin American children

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Sofia Segura-Pérez

Full Text Available ABSTRACT Objective To 1 describe the benefits, conditions, coverage, funding, goals, governance, and structure of well-established conditional cash transfer programs (CCTs in Latin America and 2 identify their health and nutritional impacts among children under 5 years old. Methods A realist review was conducted. CCTs were included if they met the following inclusion criteria: 1 current national-level program; 2 coverage of at least 50% of the target population; 3 continuous operation at scale for 10+ years; 4 clear description of structure, funding sources, and governance; 5 both health/nutrition- and education-related conditions for participation; and 6 available impact evaluation studies with health, development, and/or nutrition indicators among children under 5 years old. Three CCTs (one each in Brazil, Colombia, and Mexico met the criteria. Results There was consistent evidence that the three CCTs selected for review had positive impacts on child health and nutrition outcomes in their respective countries. In all three countries, the programs were scaled up and positive impacts were documented relatively quickly. All three programs had strong political support and clear and transparent governance structures, including accountability and social participation mechanisms, which might explain their success and sustainability. Conclusions CCTs in Latin America have had a positive impact on child health and nutrition outcomes among the poorest families. A key challenge for the future is to reform these programs to help families move out of not only extreme poverty but all poverty in order to lead healthy and productive lives, as called for in the post-2105 Sustainable Development Goals.

Governance and human resources for health

Directory of Open Access Journals (Sweden)

Dieleman Marjolein

2011-11-01

Full Text Available Abstract Despite an increase in efforts to address shortage and performance of Human Resources for Health (HRH, HRH problems continue to hamper quality service delivery. We believe that the influence of governance is undervalued in addressing the HRH crisis, both globally and at country level. This thematic series has aimed to expand the evidence base on the role of governance in addressing the HRH crisis. The six articles comprising the series present a range of experiences. The articles report on governance in relation to developing a joint vision, building adherence and strengthening accountability, and on governance with respect to planning, implementation, and monitoring. Other governance issues warrant attention as well, such as corruption and transparency in decision-making in HRH policies and strategies. Acknowledging and dealing with governance should be part and parcel of HRH planning and implementation. To date, few experiences have been shared on improving governance for HRH policy making and implementation, and many questions remain unanswered. There is an urgent need to document experiences and for mutual learning.

Governance and human resources for health.

Science.gov (United States)

Dieleman, Marjolein; Hilhorst, Thea

2011-11-24

Despite an increase in efforts to address shortage and performance of Human Resources for Health (HRH), HRH problems continue to hamper quality service delivery. We believe that the influence of governance is undervalued in addressing the HRH crisis, both globally and at country level. This thematic series has aimed to expand the evidence base on the role of governance in addressing the HRH crisis. The six articles comprising the series present a range of experiences. The articles report on governance in relation to developing a joint vision, building adherence and strengthening accountability, and on governance with respect to planning, implementation, and monitoring. Other governance issues warrant attention as well, such as corruption and transparency in decision-making in HRH policies and strategies. Acknowledging and dealing with governance should be part and parcel of HRH planning and implementation. To date, few experiences have been shared on improving governance for HRH policy making and implementation, and many questions remain unanswered. There is an urgent need to document experiences and for mutual learning.

Governance in Health - The Need for Exchange and Evidence Comment on "Governance, Government, and the Search for New Provider Models".

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Chanturidze, Tata; Obermann, Konrad

2016-05-17

Governance in health is cited as one of the key factors in balancing the concerns of the government and public sector with the interests of civil society/private players, but often remains poorly described and operationalized. Richard Saltman and Antonio Duran look at two aspects in the search for new provider models in a context of health markets signalling liberalisation: (i) the role of the government to balance public and private interests and responsibilities in delivering care through modernised governance arrangements, and (ii) the finding that operational complexities may hinder well-designed provider governance models, unless governance reflects country-specific realities. This commentary builds on the discussion by Saltman and Duran, and argues that the concept of governance needs to be clearly defined and operationalized in order to be helpful for policy debate as well as for the development of an applicable framework for performance improvement. It provides a working definition of governance and includes a reflection on the prevailing cultural norms in an organization or society upon which any governance needs to be build. It proposes to explore whether the "evidence-based governance" concept can be introduced to generate knowledge about innovative and effective governance models, and concludes that studies similar to the one by Saltman and Duran can inform this debate. © 2016 by Kerman University of Medical Sciences.

A survey of the governance capacity of national public health associations to enhance population health

Directory of Open Access Journals (Sweden)

James Chauvin

2016-03-01

Full Text Available Abstract Background National public health associations (PHAs are key partners with governments and communities to improve, protect and promote the public’s health. Governance and organizational capacity are among the key determinants of a PHA’s effectiveness as an advocate for appropriate public health policies and practice. Methods During 2014, the World Federation of Public Health Associations (WFPHA conducted an on-line survey of its 82 PHA members, to identify the state of organizational governance of national public health associations, as well as the factors that influence optimal organizational governance. The survey consisted of 13 questions and focused on the main elements of organizational governance: cultivating accountability; engaging stakeholders; setting shared direction; stewarding resources; and, continuous governance enhancement. Four questions included a qualitative open-ended response for additional comments. The survey data were analyzed using Microsoft Excel. The qualitative data was analyzed using thematic content analysis Results Responses were received from 62 PHAs, constituting a 75.6 % response rate. The two most important factors that support governance effectiveness were a high degree of integrity and ethical behavior of the PHA’s leaders (77 % and the competence of people serving on the PHA’s governing body (76 %. The lack of financial resources was considered as the most important factor that negatively affected organizational governance effectiveness (73 %. The lack of mentoring for future PHA leaders; ineffective or incompetent leadership; lack of understanding about good governance practices; and lack of accurate information for strategic planning were identified as factors influencing PHA governance effectiveness. Critical elements for PHA sustainability included diversity, gender-responsiveness and inclusive governance practices, and strategies to build the future generation of public health

Single, Integrated, Service-Centric Model of Military Health System Governance

Science.gov (United States)

of the research is to establish what the model of governance of the Military Health System should be. That, with other recommendations, should be the...foundation for the impending transformation. The research found that the model of governance should be a single service model with regional health...commands that support the geographic combatant commander (GCC). With an organization based on the presented model of governance , the Military Health

Global health governance in the sustainable development goals: Is it grounded in the right to health?

Science.gov (United States)

Van de Pas, Remco; Hill, Peter S; Hammonds, Rachel; Ooms, Gorik; Forman, Lisa; Waris, Attiya; Brolan, Claire E; McKee, Martin; Sridhar, Devi

2017-01-01

This paper explores the extent to which global health governance - in the context of the early implementation of the Sustainable Development Goals is grounded in the right to health. The essential components of the right to health in relation to global health are unpacked. Four essential functions of the global health system are assessed from a normative, rights-based, analysis on how each of these governance functions should operate. These essential functions are: the production of global public goods, the management of externalities across countries, the mobilization of global solidarity, and stewardship. The paper maps the current reality of global health governance now that the post-2015 Sustainable Development Goals are beginning to be implemented. In theory, the existing human rights legislation would enable the principles and basis for the global governance of health beyond the premise of the state. In practice, there is a governance gap between the human rights framework and practices in global health and development policies. This gap can be explained by the political determinants of health that shape the governance of these global policies. Current representations of the right to health in the Sustainable Development Goals are insufficient and superficial, because they do not explicitly link commitments or right to health discourse to binding treaty obligations for duty-bearing nation states or entitlements by people. If global health policy is to meaningfully contribute to the realization of the right to health and to rights based global health governance then future iterations of global health policy must bridge this gap. This includes scholarship and policy debate on the structure, politics, and agency to overcome existing global health injustices.

[Organization and functioning of health services of the IMSS-Solidaridad program].

Science.gov (United States)

Velázquez-Díaz, G

1992-01-01

In this report the organization and performance of the IMSS-Solidaridad Program of Mexico is described. This program is managed by the Mexican Institute for Social Security, which services 10.5 million inhabitants of the rural underserved areas, with federal government resources in 18 states. This study compares the structure and functioning of the IMSS-Solidaridad Program with Local Health Systems, as they have been proposed by the Panamerican Health Organization for country members and by the Ministry of Health of Mexico, particularly in relation to the decision-making process at local level. Some assets and limitations of the IMSS-Solidaridad Program are analyzed and, finally, concrete procedures to improve coordination between the IMSS-Solidaridad Program and other health services for similar populations (populations without social security protection) in Mexico are suggested, with the purpose of using resources more adequately and succeed in the national goal to achieve equity in health.

Effective and Efficient Training Programs in Jeddah Government Hospitals: A Case Study of Saudi Arabia

Directory of Open Access Journals (Sweden)

Hasan Salih Suliman Al-Qudah

2016-10-01

Full Text Available Hospital care broadly covers and encompasses complete range of personal health service like promotion of health service, prevention of disease, early detection of disease, diagnosis and treatment, rehabilitation of the patient. This study will try to identify the" Effective and Efficient Training Programs in Jeddah government hospitals: Case Study of Saudi Arabia”. The study will examine the demographic aspects of employees (Gender and experience and the value of what can deferent training programmes can have deep impact on their performance. The total study sample was 291 of identify employees, but 275 were suitable for statistical analysis, descriptive and analytical approach was also used to achieve the study objectives. The study major finding that there was a medium degree of effective and efficient training programs held’s in Jeddah public hospitals, also the study found that there are no statistically significant differences at  α ≤ 0.05 related to training of human resources. The study has recommended the need to improve employee’s skills in Jeddah government hospitals through actual employees participation at any training courses on a regular basis, also there is a need for continue training program for employee’s to qualify them at any future development in the deferent department of  the  hospital.

77 FR 71016 - Renewal of Agency Information Collection for Tribal Self-Governance Program

Science.gov (United States)

2012-11-28

... Tribal Self- Governance Program AGENCY: Bureau of Indian Affairs, Interior. ACTION: Notice of submission... collection of information for Tribal Self-Governance Program. The information collection is currently... send a copy of your comments to Ken Reinfeld, Office of Self-Governance, 1951 Constitution Avenue NW...

Development of Combination HIV Prevention Programs for People Who Inject Drugs through Government and Civil Society Collaboration in the Russian Federation

Directory of Open Access Journals (Sweden)

M. V. Volik

2012-01-01

Full Text Available Population Services International (PSI has worked collaboratively with several government institutions of the Russian Federation to develop and implement a model program to access health services for individuals who are opioid dependent, including those with HIV infection. Through the development of partnership agreements between government organizations (GOs and non-government organizations (NGOs, a model of the continuum of care has been developed that identifies a Recommended Package of HIV Prevention Services for Injecting Drug Users (RPS-IDU. The implementation of the RPS-IDU in the Russian Federation offers a model for other countries with HIV epidemics associated with injection drug use. This paper will describe the model program and its implementation in one of the pilot program regions.

National healthcare systems and the need for health information governance.

Science.gov (United States)

Hovenga, Evelyn J S

2013-01-01

This chapter gives an overview of health data, information and knowledge governance needs and associated generic principles so that information systems are able to automate such data collections from point-of-care operational systems. Also covered are health information systems' dimensions and known barriers to the delivery of quality health services, including environmental, technology and governance influences of any population's health status within the context of national health systems. This is where health information managers and health informaticians need to resolve the many challenges associated with eHealth implementations where data are assets, efficient information flow is essential, the ability to acquire new knowledge desirable, and where the use of data and information needs to be viewed from a governance perspective to ensure reliable and quality information is obtained to enhance decision making.

Strengthening Health Systems Governance in Latin American ...

International Development Research Centre (IDRC) Digital Library (Canada)

This project seeks to improve the governance of health systems by designing and ... of the data (locally elected officials, health authorities, civil society groups), the ... In partnership with UNESCO's Organization for Women in Science for the ...

Reprioritizing government spending on health: pushing an elephant up the stairs?

Science.gov (United States)

Tandon, Ajay; Fleisher, Lisa; Li, Rong; Yap, Wei Aun

2014-01-01

Countries vary widely with respect to the share of government spending on health, a metric that can serve as a proxy for the extent to which health is prioritized by governments. World Health Organization (WHO) data estimate that, in 2011, health's share of aggregate government expenditure averaged 12% in the 170 countries for which data were available. However, country differences were striking: ranging from a low of 1% in Myanmar to a high of 28% in Costa Rica. Some of the observed differences in health's share of government spending across countries are unsurprisingly related to differences in national income. However, significant variations exist in health's share of government spending even after controlling for national income. This paper provides a global overview of health's share of government spending and summarizes some of the key theoretical and empirical perspectives on allocation of public resources to health vis-à-vis other sectors from the perspective of reprioritization, one of the modalities for realizing fiscal space for health. The paper argues that theory and cross-country empirical analyses do not provide clear-cut explanations for the observed variations in government prioritization of health. Standard economic theory arguments that are often used to justify public financing for health are equally applicable to many other sectors including defence, education and infrastructure. To date, empirical work on prioritization has been sparse: available cross-country econometric analyses suggest that factors such as democratization, lower levels of corruption, ethnolinguistic homogeneity and more women in public office are correlated with higher shares of public spending on health; however, these findings are not robust and are sensitive to model specification. Evidence from case studies suggests that country-specific political economy considerations are key, and that results-focused reform efforts - in particular efforts to explicitly expand the

Health promotion activities in annual reports of local governments: 'Health for All' targets as a tool for content analysis.

Science.gov (United States)

Andersson, Camilla M; Bjärås, Gunilla E M; Tillgren, Per; Ostenson, Claes-Göran

2003-09-01

This article presents an instrument to study the annual reporting of health promotion activities in local governments within the three intervention municipalities of the Stockholm Diabetes Prevention Program (SDPP). The content of health promotion activities are described and the strengths, weaknesses and relevance of the method to health promotion discussed. A content analysis of local governmental reports from 1995-2000 in three Swedish municipalities. A matrix with WHO's 38 'Health for All' (HFA) targets from 1991 was used when coding the local health promotion activities. There are many public health initiatives within the local governmental structure even if they are not always addressed as health promotion. The main focuses in the local governmental reports were environmental issues, unemployment, social care and welfare. Local governmental reports were found to be a useful source of information that could provide knowledge about the priorities and organizational capacities for health promotion within local authorities. Additionally the HFA targets were an effective tool to identify and categorize systematically local health promotion activities in the annual reports of local governments. Identifying local health promotion initiatives by local authorities may ease the development of a health perspective and joint actions within the existing political and administrative structure. This paper provides a complementary method of attaining and structuring information about the local community for developments in health promotion.

77 FR 43353 - Renewal of Agency Information Collection for Tribal Self-Governance Program

Science.gov (United States)

2012-07-24

... Tribal Self- Governance Program AGENCY: Bureau of Indian Affairs, Interior. ACTION: Notice of request for... collection of information for Tribal Self-Governance Program authorized by OMB Control Number 1076-0143. This... Self-Governance, 1951 Constitution Avenue NW., Mail Stop 355-G SIB, Washington, DC 20240; telephone...

Health systems performance in sub-Saharan Africa: governance, outcome and equity.

Science.gov (United States)

Olafsdottir, Anna E; Reidpath, Daniel D; Pokhrel, Subhash; Allotey, Pascale

2011-04-16

The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR) was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the causal relationship, and its generalizability beyond U5MR as a health

Health systems performance in sub-Saharan Africa: governance, outcome and equity

Directory of Open Access Journals (Sweden)

Pokhrel Subhash

2011-04-01

Full Text Available Abstract Background The literature on health systems focuses largely on the performance of healthcare systems operationalised around indicators such as hospital beds, maternity care and immunisation coverage. A broader definition of health systems however, needs to include the wider determinants of health including, possibly, governance and its relationship to health and health equity. The aim of this study was to examine the relationship between health systems outcomes and equity, and governance as a part of a process to extend the range of indicators used to assess health systems performance. Methods Using cross sectional data from 46 countries in the African region of the World Health Organization, an ecological analysis was conducted to examine the relationship between governance and health systems performance. The data were analysed using multiple linear regression and a standard progressive modelling procedure. The under-five mortality rate (U5MR was used as the health outcome measure and the ratio of U5MR in the wealthiest and poorest quintiles was used as the measure of health equity. Governance was measured using two contextually relevant indices developed by the Mo Ibrahim Foundation. Results Governance was strongly associated with U5MR and moderately associated with the U5MR quintile ratio. After controlling for possible confounding by healthcare, finance, education, and water and sanitation, governance remained significantly associated with U5MR. Governance was not, however, significantly associated with equity in U5MR outcomes. Conclusion This study suggests that the quality of governance may be an important structural determinant of health systems performance, and could be an indicator to be monitored. The association suggests there might be a causal relationship. However, the cross-sectional design, the level of missing data, and the small sample size, forces tentative conclusions. Further research will be needed to assess the

Local health systems in 21st century: who cares?-An exploratory study on health system governance in Amsterdam.

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Plochg, T; Delnoij, D M J; Hogervorst, W V G; van Dijk, P; Belleman, S; Klazinga, N S

2006-10-01

There is a growing awareness that there should be a public health perspective to health system governance. Its intrinsic population health orientation provides the ultimate ground for determining the health needs and governing collaborative care arrangements within which these needs can be met. Notwithstanding differences across countries, population health concerns are not central to European health reforms. Governments currently withdraw leaving governance roles to care providers and/or financiers. Thereby, incentives that trigger the uptake of a public health perspective are often ignored. In this study we addressed this issue in the city of Amsterdam. Using a qualitative study design, we explored whether there is a public health perspective to the governance practices of the municipality and the major sickness fund in Amsterdam. And if so, what the scope of this perspective is. And if not, why not. Findings indicate that the municipality has a public health perspective to local health system governance, but its scope is limited. The municipality facilitates rather than governs health care provision in Amsterdam. Furthermore, the sickness fund runs major financial risks when adapting a public health perspective. It covers an insured population that partly overlaps the Amsterdam population. Returns on investments in population health are therefore uncertain, as competitors would also profit from the sickness fund's investments. The local health system in Amsterdam is not consistently aligned to the health needs of the Amsterdam population. The Amsterdam case is not unique and general consequences for local health system governance are discussed.

A Progressively Realizable Right to Health and Global Governance.

Science.gov (United States)

Daniels, Norman

2015-12-01

A moral right to health or health care is a special instance of a right to fair equality of opportunity. Nation-states generally have the capabilities to specify the entitlements of such a right and to raise the resources needed to satisfy those entitlements. Can these functions be replicated globally, as a global right to health or health care requires? The suggestion that "better global governance" is needed if such a global right is to be claimed requires that these two central capabilities be present. It is unlikely that nation-states would concede these two functions to a form of global governance, for doing so would seriously compromise the authority that is generally included in sovereignty. This claim is a specification of what is often recognized as the "sovereignty problem." The argument of this paper is not an "impossibility" claim, but a best guess about whether the necessary conditions for better global governance that supports a global right to health or health care can be achieved.

The roles of government in improving health care quality and safety.

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Tang, Ning; Eisenberg, John M; Meyer, Gregg S

2004-01-01

Discussions surrounding the role of government have been and continue to be a favorite American pastime. A framework is provided for understanding the 10 roles that government plays in improving health care quality and safety in the United States. Examples of proposed federal actions to reduce medical errors and enhance patient safety are provided to illustrate the 10 roles: (1) purchase health care, (2) provide health care, (3) ensure access to quality care for vulnerable populations, (4) regulate health care markets, (5) support acquisition of new knowledge, (6) develop and evaluate health technologies and practices, (7) monitor health care quality, (8) inform health care decision makers, (9) develop the health care workforce, and (10) convene stakeholders from across the health care system. Government's responsibility to protect and advance the interests of society includes the delivery of high-quality health care. Because the market alone cannot ensure all Americans access to quality health care, the government must preserve the interests of its citizens by supplementing the market where there are gaps and regulating the market where there is inefficiency or unfairness. The ultimate goal of achieving high quality of care will require strong partnerships among federal, state, and local governments and the private sector. Translating general principles regarding the appropriate role of government into specific actions within a rapidly changing, decentralized delivery system will require the combined efforts of the public and private sectors.

An analysis of local government health policy against state priorities and a social determinants framework.

Science.gov (United States)

Browne, Geoffrey R; Davern, Melanie T; Giles-Corti, Billie

2016-04-01

Victorian local governments are required to develop Municipal Public Health and Wellbeing Plans that incorporate state-level health planning priorities and address the social determinants of health. This paper describes a novel method for evaluating councils' performance against these requirements. Deductive content analysis was used to categorise all actions in 14 local government MPHWPs against Victorian state priorities as well as against social determinants of health policy areas. More than 1,000 actions were identified. However, fewer than half directly addressed a state priority, with many actions addressing policy areas known to be broader determinants of health. In particular, there was a marked focus on leisure and culture, and on building social cohesion through changes to living and working conditions. Councils are working beyond state priorities and there was a clear emphasis on addressing the diverse upstream 'causes of the causes' of health, rather than health promotion behaviour change programs. The approach for data analysis and presentation provides a useful method for rapid appraisal of health and wellbeing actions relative to councils', and the State's, responsibility and efficacy in public health. © 2015 Public Health Association of Australia.

The construction of a governable health care

DEFF Research Database (Denmark)

Peyton, Margit Malmmose

Many studies have been conducted on the issue of New Public Management (NPM) and health care, not always quoting directly the philosophies of NPM, but using methods deriving from it. This study seeks to explore the development of studies on NPM in health care since the 1970s. The following resear...... construction of the governable person” as a theoretical framework, all academic articles from AA journals on the issues of NPM, health care and/or hospitals are analyzed.......Many studies have been conducted on the issue of New Public Management (NPM) and health care, not always quoting directly the philosophies of NPM, but using methods deriving from it. This study seeks to explore the development of studies on NPM in health care since the 1970s. The following research...... questions will be addressed: What types of studies are conducted on NPM in health care and how do these studies relate to the construction of the governable person? What are the changes in these relations and is the acceptance of this nationally dependent? Using Miller and O’Leary’s (1987), “The...

Do governance choices matter in health care networks?: an exploratory configuration study of health care networks

Science.gov (United States)

2013-01-01

Background Health care networks are widely used and accepted as an organizational form that enables integrated care as well as dealing with complex matters in health care. However, research on the governance of health care networks lags behind. The research aim of our study is to explore the type and importance of governance structure and governance mechanisms for network effectiveness. Methods The study has a multiple case study design and covers 22 health care networks. Using a configuration view, combinations of network governance and other network characteristics were studied on the level of the network. Based on interview and questionnaire data, network characteristics were identified and patterns in the data looked for. Results Neither a dominant (or optimal) governance structure or mechanism nor a perfect fit among governance and other characteristics were revealed, but a number of characteristics that need further study might be related to effective networks such as the role of governmental agencies, legitimacy, and relational, hierarchical, and contractual governance mechanisms as complementary factors. Conclusions Although the results emphasize the situational character of network governance and effectiveness, they give practitioners in the health care sector indications of which factors might be more or less crucial for network effectiveness. PMID:23800334

Participatory health councils and good governance: healthy democracy in Brazil?

Science.gov (United States)

Kohler, Jillian Clare; Martinez, Martha Gabriela

2015-02-19

The Brazilian Government created Participatory Health Councils (PHCs) to allow citizen participation in the public health policy process. PHCs are advisory bodies that operate at all levels of government and that bring together different societal groups to monitor Brazil's health system. Today they are present in 98% of Brazilian cities, demonstrating their popularity and thus their potential to help ensure that health policies are in line with citizen preferences. Despite their expansive reach, their real impact on health policies and health outcomes for citizens is uncertain. We thus ask the following question: Do PHCs offer meaningful opportunities for open participation and influence in the public health policy process? Thirty-eight semi-structured interviews with health council members were conducted. Data from these interviews were analyzed using a qualitative interpretive content analysis approach. A quantitative analysis of PHC data from the Sistema de Acompanhamento dos Conselhos de Saude (SIACS) database was also conducted to corroborate findings from the interviews. We learned that PHCs fall short in many of the categories of good governance. Government manipulation of the agenda and leadership of the PHCs, delays in the implementation of PHC decision making, a lack of training of council members on relevant technical issues, the largely narrow interests of council members, the lack of transparency and monitoring guidelines, a lack of government support, and a lack of inclusiveness are a few examples that highlight why PHCs are not as effective as they could be. Although PHCs are intended to be inclusive and participatory, in practice they seem to have little impact on the health policymaking process in Brazil. PHCs will only be able to fulfil their mandate when we see good governance largely present. This will require a rethinking of their governance structures, processes, membership, and oversight. If change is resisted, the PHCs will remain largely

Challenges confronting health care workers in government's ARV ...

African Journals Online (AJOL)

Challenges confronting health care workers in government's ARV rollout: rights and responsibilities. ... Potchefstroom Electronic Law Journal/Potchefstroomse Elektroniese Regsblad ... Unless the rights of HCWs are recognised and their needs adequately addressed, the best laid plans of government will be at risk.

ERDA LWR plant technology program: role of government/industry in improving LWR performance

International Nuclear Information System (INIS)

1975-01-01

Information is presented under the following chapter headings: executive summary; LWR plant outages; LWR plant construction delays and cancellations; programs addressing plant outages, construction delays, and cancellations; need for additional programs to remedy continuing problems; criteria for government role in LWR commercialization; and the proposed government program

Postings and transfers in the Ghanaian health system: a study of health workforce governance.

Science.gov (United States)

Kwamie, Aku; Asiamah, Miriam; Schaaf, Marta; Agyepong, Irene Akua

2017-09-15

Decision-making on postings and transfers - that is, the geographic deployment of the health workforce - is a key element of health workforce governance. When poorly managed, postings and transfers result in maldistribution, absenteeism, and low morale. At stake is managing the balance between organisational (i.e., health system) and individual (i.e., staff preference) needs. The negotiation of this potential convergence or divergence of interests provides a window on practices of postings and transfers, and on the micro-practices of governance in health systems more generally. This article explores the policies and processes, and the interplay between formal and informal rules and norms which underpin postings and transfers practice in two rural districts in the Greater Accra Region of Ghana. Semi-structured interviews were conducted with eight district managers and 87 frontline staff from the district health administration, district hospital, polyclinic, health centres and community outreach compounds across two districts. Interviews sought to understand how the postings and transfers process works in practice, factors in frontline staff and district manager decision-making, personal experiences in being posted, and study leave as a common strategy for obtaining transfers. Differential negotiation-spaces at regional and district level exist and inform postings and transfers in practice. This is in contrast to the formal cascaded rules set to govern decision-making authority for postings and transfers. Many frontline staff lack policy clarity of postings and transfers processes and thus 'test' the system through informal staff lobbying, compounding staff perception of the postings and transfers process as being unfair. District managers are also challenged with limited decision-space embedded in broader policy contexts of systemic hierarchy and resource dependence. This underscores the negotiation process as ongoing, rather than static. These findings point to

Design of an indicator for health and safety governance

OpenAIRE

Minguillón, Roberto F.; Yacuzzi, Enrique

2009-01-01

Occupational Health and Safety Governance (OHSG) is a branch of Corporate Governance by which the board directs and controls labor risks created by their own enterprise. The OHSG concept is relatively new; unlike Occupational Health and Safety Management, which is mostly related to the work of managerial ranks, OHSG deals with principles, the interests of stakeholders, and the work of directors. The paper defines the new concept, OHSG, develops an original health and safety indicator, and pre...

Governance Analytical Framework : an Approach to Health Systems ...

International Development Research Centre (IDRC) Digital Library (Canada)

Researchers will develop and test a methodology - Governance Analytical Framework - for analyzing and assessing the influence of governance pattern on health ... IDRC and the São Paulo Research Foundation (FAPESP) signed a scientific and technological cooperation agreement to support joint research projects in ...

The representation of health professionals on governing boards of health care organizations in New York City.

Science.gov (United States)

Mason, Diana J; Keepnews, David; Holmberg, Jessica; Murray, Ellen

2013-10-01

The Representation of Health Professionals on Governing Boards of Health Care Organizations in New York City. The heightened importance of processes and outcomes of care-including their impact on health care organizations' (HCOs) financial health-translate into greater accountability for clinical performance on the part of HCO leaders, including their boards, during an era of health care reform. Quality and safety of care are now fiduciary responsibilities of HCO board members. The participation of health professionals on HCO governing bodies may be an asset to HCO governing boards because of their deep knowledge of clinical problems, best practices, quality indicators, and other issues related to the safety and quality of care. And yet, the sparse data that exist indicate that physicians comprise more than 20 % of the governing board members of hospitals while less than 5 % are nurses and no data exist on other health professionals. The purpose of this two-phased study is to examine health professionals' representations on HCOs-specifically hospitals, home care agencies, nursing homes, and federally qualified health centers-in New York City. Through a survey of these organizations, phase 1 of the study found that 93 % of hospitals had physicians on their governing boards, compared with 26 % with nurses, 7 % with dentists, and 4 % with social workers or psychologists. The overrepresentation of physicians declined with the other HCOs. Only 38 % of home care agencies had physicians on their governing boards, 29 % had nurses, and 24 % had social workers. Phase 2 focused on the barriers to the appointment of health professionals to governing boards of HCOs and the strategies to address these barriers. Sixteen health care leaders in the region were interviewed in this qualitative study. Barriers included invisibility of health professionals other than physicians; concerns about "special interests"; lack of financial resources for donations to the organization

Urbanism, climate change and health: systems approaches to governance.

Science.gov (United States)

Capon, Anthony G; Synnott, Emma S; Holliday, Sue

2009-01-01

Effective action on climate change health impacts and vulnerability will require systems approaches and integrated policy and planning responses from a range of government agencies. Similar responses are needed to address other complex problems, such as the obesity epidemic. Local government, with its focus on the governance of place, will have a key role in responding to these convergent agendas. Industry can also be part of the solution - indeed it must be, because it has a lead role in relevant sectors. Understanding the co-benefits for health of climate mitigation actions will strengthen the case for early action. There is a need for improved decision support tools to inform urban governance. These tools should be based on a systems approach and should incorporate a spatial perspective.

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

Science.gov (United States)

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

Introduction Health Governance in Africa: Taking Stock

African Journals Online (AJOL)

Council for the Development of Social Science Research in Africa, 2017. (ISSN: 0850 ... The theme of this issue, Public Health Governance in Africa, is within the framework of ... She stresses, however, that the innovations developed by community ... policies, while insisting, however, on the fact that health insurance should.

Making sense of the global health crisis: policy narratives, conflict, and global health governance.

Science.gov (United States)

Ney, Steven

2012-04-01

Health has become a policy issue of global concern. Worried that the unstructured, polycentric, and pluralist nature of global health governance is undermining the ability to serve emergent global public health interests, some commentators are calling for a more systematic institutional response to the "global health crisis." Yet global health is a complex and uncertain policy issue. This article uses narrative analysis to explore how actors deal with these complexities and how uncertainties affect global health governance. By comparing three narratives in terms of their basic assumptions, the way they define problems as well as the solutions they propose, the analysis shows how the unstructured pluralism of global health policy making creates a wide scope of policy conflict over the global health crisis. This wide scope of conflict enables effective policy-oriented learning about global health issues. The article also shows how exclusionary patterns of cooperation and competition are emerging in health policy making at the global level. These patterns threaten effective learning by risking both polarization of the policy debate and unanticipated consequences of health policy. Avoiding these pitfalls, the analysis suggests, means creating global health governance regimes that promote openness and responsiveness in deliberation about the global health crisis.

Governance in Health – The Need for Exchange and Evidence; Comment on “Governance, Government, and the Search for New Provider Models”

Directory of Open Access Journals (Sweden)

Tata Chanturidze

2016-08-01

Full Text Available Governance in health is cited as one of the key factors in balancing the concerns of the government and public sector with the interests of civil society/private players, but often remains poorly described and operationalized. Richard Saltman and Antonio Duran look at two aspects in the search for new provider models in a context of health markets signalling liberalisation: (i the role of the government to balance public and private interests and responsibilities in delivering care through modernised governance arrangements, and (ii the finding that operational complexities may hinder well–designed provider governance models, unless governance reflects country-specific realities. This commentary builds on the discussion by Saltman and Duran, and argues that the concept of governance needs to be clearly defined and operationalized in order to be helpful for policy debate as well as for the development of an applicable framework for performance improvement. It provides a working definition of governance and includes a reflection on the prevailing cultural norms in an organization or society upon which any governance needs to be build. It proposes to explore whether the “evidence-based governance” concept can be introduced to generate knowledge about innovative and effective governance models, and concludes that studies similar to the one by Saltman and Duran can inform this debate.

Global constitutionalism, applied to global health governance: uncovering legitimacy deficits and suggesting remedies.

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Ooms, Gorik; Hammonds, Rachel

2016-12-03

Global constitutionalism is a way of looking at the world, at global rules and how they are made, as if there was a global constitution, empowering global institutions to act as a global government, setting rules which bind all states and people. This essay employs global constitutionalism to examine how and why global health governance, as currently structured, has struggled to advance the right to health, a fundamental human rights obligation enshrined in the International Covenant on Economic, Social and Cultural Rights. It first examines the core structure of the global health governance architecture, and its evolution since the Second World War. Second, it identifies the main constitutionalist principles that are relevant for a global constitutionalism assessment of the core structure of the global health governance architecture. Finally, it applies these constitutionalist principles to assess the core structure of the global health governance architecture. Leading global health institutions are structurally skewed to preserve high incomes countries' disproportionate influence on transnational rule-making authority, and tend to prioritise infectious disease control over the comprehensive realisation of the right to health. A Framework Convention on Global Health could create a classic division of powers in global health governance, with WHO as the law-making power in global health governance, a global fund for health as the executive power, and the International Court of Justice as the judiciary power.

Federal Employees Health Benefits Program and Federal Employees Dental and Vision Insurance Program: eligibility for Pathway Programs participants. Interim final rule with request for comments.

Science.gov (United States)

2014-01-06

The U.S. Office of Personnel Management (OPM) is issuing an interim final regulation to update the Federal Employees Health Benefits Program (FEHBP) and the Federal Employees Dental and Vision Insurance Program (FEDVIP) regulations to reflect updated election opportunities for participants in the Pathways Programs. The Pathways Programs were created by Executive Order (E.O.) 13562, signed by the President on December 27, 2010, and are designed to enable the Federal Government to compete effectively for students and recent graduates by improving its recruitment efforts through internships and similar programs with Federal agencies. This interim final rule furthers these recruitment and retention efforts by providing health insurance, as well as dental and vision benefits, to eligible program participants and their families.

Advocacy for mental health: roles for consumer and family organizations and governments.

Science.gov (United States)

Funk, Michelle; Minoletti, Alberto; Drew, Natalie; Taylor, Jacob; Saraceno, Benedetto

2006-03-01

The World Health Organization urges countries to become more active in advocacy efforts to put mental health on governments' agendas. Health policy makers, planners and managers, advocacy groups, consumer and family organizations, through their different roles and actions, can move the mental health agenda forward. This paper outlines the importance of the advocacy movement, describes some of the roles and functions of the different groups and identifies some specific actions that can be adopted by Ministries of Health. The mental health advocacy movement has developed over the last 30 years as a means of combating stigma and prejudice against people with mental disorders and improving services. Consumer and family organizations and related NGOs have been able to influence governments on mental health policies and laws and educating the public on social integration of people with mental disorders. Governments can promote the development of a strong mental health advocacy sector without compromising this sector's independence. For instance, they can publish and distribute a directory of mental health advocacy groups, include them in their mental health activities and help fledgling groups become more established. There are also some advocacy functions that government officials can, and indeed, should perform themselves. Officials in the ministry of health can persuade officials in other branches of government to make mental health more of a priority, support advocacy activities with both general health workers and mental health workers and carry out public information campaigns about mental disorders and how to maintain good mental health. In conclusion, the World Health Organization believes mental health advocacy is one of the pillars to improve mental health care and the human rights of people with mental disorders. It is hoped that the recommendations in this article will help government officials and activists to strengthen national advocacy movements.

Community health worker programs in India: a rights-based review.

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Bhatia, Kavita

2014-09-01

This article presents a historical review of national community health worker (CHW) programs in India using a gender- and rights-based lens. The aim is to derive relevant policy implications to stem attrition and enable sustenance of large-scale CHW programs. For the literature review, relevant government policies, minutes of meetings, reports, newspaper articles and statistics were accessed through official websites and a hand search was conducted for studies on the rights-based aspects of large-scale CHW programs. The analysis shows that the CHWs in three successive Indian national CHW programs have consistently asked for reforms in their service conditions, including increased remuneration. Despite an evolution in stakeholder perspectives regarding the rights of CHWs, service reforms are slow. Performance-based payments do not provide the financial security expected by CHWs as demonstrated in the recent Accredited Social Health Activist (ASHA) program. In most countries, CHWs, who are largely women, have never been integrated into the established, salaried team of health system workers. The two hallmark characteristics of CHWs, namely, their volunteer status and the flexibility of their tasks and timings, impede their rights. The consequences of initiating or neglecting standardization should be considered by all countries with large-scale CHW programs like the ASHA program. © Royal Society for Public Health 2014.

28 CFR 90.51 - Program criteria for Indian tribal government discretionary grants.

Science.gov (United States)

2010-07-01

... government discretionary grants. 90.51 Section 90.51 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED... tribal government discretionary grants. (a) The Assistant Attorney General for the Office of Justice Programs is authorized to make grants to Indian tribal governments for the purpose of developing and...

A survey of suppression of public health information by Australian governments.

Science.gov (United States)

Yazahmeidi, Boshra; Holman, C D'Arcy J

2007-12-01

It is cause for concern when a democratically elected government suppresses embarrassing information by hindering public health research or the publication of research findings. We conducted a survey of Australian public health academics to estimate the level of acts of suppression of research by Australian governments, to characterise these events, and to gather views on what interventions might be effective in curbing them. A total of 302 academics in 17 institutions completed a postal questionnaire in August 2006 (46% of 652 invited). The instrument sought details of suppression events they had witnessed since 2001. There were 142 suppression events, including 85 personally experienced by 21.2% (n=64) of respondents. The rates were higher in 2005/06 than in earlier years. No State or Territory was immune from suppression. Although governments most commonly hindered research by sanitising, delaying or prohibiting publications (66% of events), no part of the research process was unaffected. Researchers commonly believed their work was targeted because it drew attention to failings in health services (48%), the health status of a vulnerable group (26%), or pointed to a harm in the environment (11%). The government agency seeking to suppress the health information mostly succeeded (87%) and, consequently, the public was left uninformed or given a false impression. Respondents identified a full range of participative, cognitive, structural and legislative control strategies. The suppression of public health information is widely practised by Australian governments. Systemic interventions are necessary to preserve the integrity of public health research conducted with government involvement.

The link between UHC reforms and health system governance: lessons from Asia.

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Hort, Krishna; Jayasuriya, Rohan; Dayal, Prarthna

2017-05-15

Purpose The purpose of this paper is to examine how and to what extent the design and implementation of universal health coverage (UHC) reforms have been influenced by the governance arrangements of health systems in low- and middle-income countries (LMIC); and how governments in these countries have or have not responded to the challenges of governance for UHC. Design/methodology/approach Comparative case study analysis of three Asian countries with substantial experience of UHC reforms (Thailand, Vietnam and China) was undertaken using data from published studies and grey literature. Studies included were those which described the modifications and adaptations that occurred during design and implementation of the UHC programme, the actors and institutions involved and how these changes related to the governance of the health system. Findings Each country adapted the design of their UHC programmes to accommodate their specific institutional arrangements, and then made further modifications in response to issues arising during implementation. The authors found that these modifications were often related to the impacts on governance of the institutional changes inherent in UHC reforms. Governments varied in their response to these governance impacts, with Thailand prepared to adopt new governance modes (which the authors termed as an "adaptive" response), while China and Vietnam have tended to persist with traditional hierarchical governance modes ("reactive" responses). Originality/value This study addresses a gap in current knowledge on UHC reform, and finds evidence of a complex interaction between substantive health sector reform and governance reform in the LMIC context in Asia, confirming recent similar observations on health reforms in high-income countries.

Governance and human resources for health

NARCIS (Netherlands)

Dieleman, Marjolein; Hilhorst, Thea

2011-01-01

Despite an increase in efforts to address shortage and performance of Human Resources for Health (HRH), HRH problems continue to hamper quality service delivery. We believe that the influence of governance is undervalued in addressing the HRH crisis, both globally and at country level. This thematic

Government, politics and health policy: A quantitative analysis of 30 European countries.

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Mackenbach, Johan P; McKee, Martin

2015-10-01

Public health policies are often dependent on political decision-making, but little is known of the impact of different forms of government on countries' health policies. In this exploratory study we studied the association between a wide range of process and outcome indicators of health policy and four groups of political factors (levels of democracy, e.g. voice and accountability; political representation, e.g. voter turnout; distribution of power, e.g. constraints on the executive; and quality of government, e.g. absence of corruption) in contemporary Europe. Data on 15 aspects of government and 18 indicators of health policy as well as on potential confounders were extracted from harmonized international data sources, covering 30 European countries and the years 1990-2010. In a first step, multivariate regression analysis was used to relate cumulative measures of government to indicators of health policy, and in a second step panel regression with country fixed effects was used to relate changes in selected measures of government to changes in indicators of health policy. In multivariate regression analyses, measures of quality of democracy and quality of government had many positive associations with process and outcome indicators of health policy, while measures of distribution of power and political representation had few and inconsistent associations. Associations for quality of democracy were robust against more extensive control for confounding variables, including tests in panel regressions with country fixed effects, but associations for quality of government were not. In this period in Europe, the predominant political influence on health policy has been the rise of levels of democracy in countries in the Central & Eastern part of the region. In contrast to other areas of public policy, health policy does not appear to be strongly influenced by institutional features of democracy determining the distribution of power, nor by aspects of political

Global Governance for Health: how to motivate political change?

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McNeill, D; Ottersen, O P

2015-07-01

In this article, we address a central theme that was discussed at the Durham Health Summit: how can politics be brought back into global health governance and figure much more prominently in discussions around policy? We begin by briefly summarizing the report of the Lancet - University of Oslo Commission on Global Governance for Health: 'The Political Origins of Health Inequity' Ottersen et al. In order to provide compelling evidence of the central argument, the Commission selected seven case studies relating to, inter alia, economic and fiscal policy, food security, and foreign trade and investment agreements. Based on an analysis of these studies, the report concludes that the problems identified are often due to political choices: an unwillingness to change the global system of governance. This raises the question: what is the most effective way that a report of this kind can be used to motivate policy-makers, and the public at large, to demand change? What kind of moral or rational argument is most likely to lead to action? In this paper we assess the merits of various alternative perspectives: health as an investment; health as a global public good; health and human security; health and human development; health as a human right; health and global justice. We conclude that what is required in order to motivate change is a more explicitly political and moral perspective - favouring the later rather than the earlier alternatives just listed. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

48 CFR 301.607-77 - Governance.

Science.gov (United States)

2010-10-01

... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Governance. 301.607-77 Section 301.607-77 Federal Acquisition Regulations System HEALTH AND HUMAN SERVICES GENERAL HHS... Governance. The Departmental ACM, in ASFR/OGAPA/DA, serves as the Departmental FAC-P/PM Program Manager and...

Restructuring brain drain: strengthening governance and financing for health worker migration.

Science.gov (United States)

Mackey, Tim K; Liang, Bryan A

2013-01-15

Health worker migration from resource-poor countries to developed countries, also known as ''brain drain'', represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Using acceptable methods of policy analysis, we first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.

Quality, risk management and governance in mental health: an overview.

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Callaly, Tom; Arya, Dinesh; Minas, Harry

2005-03-01

To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health. Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement. Many psychiatrists will find the reduction in clinical autonomy, the need to consider the welfare of the whole population as well as the individual patient for whom they are responsible, and the requirement that they play a part in a complex systems approach to quality improvement to be a challenge. Avoiding or ignoring this challenge will potentially lead to conflict with modern management approaches and increased loss of influence on future developments in mental health services.

Governance in managing public health resources in Brazilian municipalities.

Science.gov (United States)

Avelino, George; Barberia, Lorena G; Biderman, Ciro

2014-09-01

This study contributes to the health governance discussion by presenting a new data set that allows for comparisons of the management of health resources among Brazilian municipalities. Research on Brazil is particularly important as the provision of health services was decentralized in 1988 and since then municipalities have been given greater responsibilities for the management of fiscal resources for public health service provision. Based on detailed information on corruption practices (such as over-invoicing, illegal procurement and fake receipts) from audit reports of health programmes in 980 randomly selected Brazilian municipalities, this study deepens understanding of the relationship between health governance institutions and the incidence of corruption at the local level by exploring the extent to which horizontal and vertical accountabilities contribute to reducing the propensity of municipal government officials to divert public health resources for private gain. The results of our multiple regression analysis suggest that the experience of health municipal councils is correlated with reductions in the incidence of corruption in public health programmes. This impact is significant over time, with each additional year of health council experience reducing corruption incidence levels by 2.1% from baseline values. The findings reported in this study do not rely on the subjectivity of corruption measures which usually conflate the actual incidence of corruption with its perception by informants. Based on our results, we provide recommendations that can assist policy makers to reduce corruption. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Practicing governance towards equity in health systems: LMIC perspectives and experience.

Science.gov (United States)

Gilson, Lucy; Lehmann, Uta; Schneider, Helen

2017-09-15

The unifying theme of the papers in this series is a concern for understanding the everyday practice of governance in low- and middle-income country (LMIC) health systems. Rather than seeing governance as a normative health system goal addressed through the architecture and design of accountability and regulatory frameworks, these papers provide insights into the real-world decision-making of health policy and system actors. Their multiple, routine decisions translate policy intentions into practice - and are filtered through relationships, underpinned by values and norms, influenced by organizational structures and resources, and embedded in historical and socio-political contexts. These decisions are also political acts - in that they influence who accesses benefits and whose voices are heard in decision-making, reinforcing or challenging existing institutional exclusion and power inequalities. In other words, the everyday practice of governance has direct impacts on health system equity.The papers in the series address governance through diverse health policy and system issues, consider actors located at multiple levels of the system and draw on multi-disciplinary perspectives. They present detailed examination of experiences in a range of African and Indian settings, led by authors who live and work in these settings. The overall purpose of the papers in this series is thus to provide an empirical and embedded research perspective on governance and equity in health systems.

The Pan American Health Organization and the mainstreaming of human rights in regional health governance.

Science.gov (United States)

Meier, Benjamin Mason; Ayala, Ana S

2014-01-01

In the absence of centralized human rights leadership in an increasingly fragmented global health policy landscape, regional health offices have stepped forward to advance the rights-based approach to health. Reviewing the efforts of the Pan American Health Organization (PAHO), this article explores the evolution of human rights in PAHO policy, assesses efforts to mainstream human rights in the Pan American Sanitary Bureau (PASB), and analyzes the future of the rights-based approach through regional health governance, providing lessons for other regional health offices and global health institutions. This article explores PAHO's 15-year effort to mainstream human rights through PASB technical units, national capacity-building, the Inter-American human rights system, and the PAHO Directing Council. Through documentary analysis of PAHO policies and semi-structured interviews with key PASB stakeholders, the authors analyze the understandings and actions of policymakers and technical officers in implementing human rights through PAHO governance. Analyzing the themes arising from this narrative, the authors examine the structural role of secretariat leadership, state support, legal expertise, and technical unit commitment in facilitating a rights-based approach to the health in the Americas. Human rights are increasingly framing PAHO efforts, and this analysis of the structures underlying PAHO's approach provides an understanding of the institutional determinants of the rights-based approach to health, highlighting generalizable themes for the mainstreaming of human rights through regional health governance. With this regional-level understanding of health governance, future national-level research can begin to understand the causal forces linking regional human rights work with national policy reforms and public health outcomes. © 2014 American Society of Law, Medicine & Ethics, Inc.

Federal government information handbook formerly utilized sites remedial action program

International Nuclear Information System (INIS)

1980-01-01

This volume is one of a series produced under contract with the DOE, by Politech Corporation to develop a legislative and regulatory data base to assist the FUSRAP management in addressing the institutional and socioeconomic issues involved in carrying out the Formerly Utilized Sites Remedial Action Program. This Information Handbook series contains information about all relevant government agencies at the Federal and state levels, the pertinent programs they administer, each affected state legislature, and current Federal and state legislative and regulatory initiatives. This volume is a compilation of information about the Federal Government. It contains: a summary of the organization and responsibilities of agencies within the executive branch of the Federal government which may be relevant to FUSRAP activities; a brief summary of relevant Federal statutes and regulations; a description of the structure of the US Congress, identification of the officers, relevant committees and committee chairmen; a description of the Federal legislative process; a summary of legislation enacted and considered in the recently-adjourned 96th Congress; a description of the Federal budgetary process; a summary of the Carter Administration's comprehensive radioactive waste management program; and excerpts from the text of relevant Federal statutes and regulations

Federal government information handbook: formerly utilized sites remedial action program

International Nuclear Information System (INIS)

1980-01-01

This volume is one of a series produced under contract with the DOE, by Politech Corporation to develop a legislative and regulatory data base to assist the FUSRAP management in addressing the institutional and socioeconomic issues involved in carrying out the Formerly Utilized Sites Remedial Action Program. This Information Handbook series contains information about all relevant government agencies at the Federal and state levels, the pertinent programs they administer, each affected state legislature, and current Federal and state legislative and regulatory initiatives. This volume is a compilation of information about the Federal Government. It contains a summary of the organization and responsibilities of agencies within the executive branch of the Federal government which may be relevant to FUSRAP activities; a brief summary of relevant Federal statutes and regulations; a description of the structure of the US Congress, identification of the officers, relevant committees and committee chairmen; a description of the Federal legislative process; a summary of legislation enacted and considered in the recently-adjourned 96th Congress; a description of the Federal budgetary process; a summary of the Carter Administration's comprehensive radioactive waste management program; and excerpts from the text of relevant federal statutes and regulations

Federal government information handbook: formerly utilized sites remedial action program

Energy Technology Data Exchange (ETDEWEB)

1980-12-31

This volume is one of a series produced under contract with the DOE, by Politech Corporation to develop a legislative and regulatory data base to assist the FUSRAP management in addressing the institutional and socioeconomic issues involved in carrying out the Formerly Utilized Sites Remedial Action Program. This Information Handbook series contains information about all relevant government agencies at the Federal and state levels, the pertinent programs they administer, each affected state legislature, and current Federal and state legislative and regulatory initiatives. This volume is a compilation of information about the Federal Government. It contains a summary of the organization and responsibilities of agencies within the executive branch of the Federal government which may be relevant to FUSRAP activities; a brief summary of relevant Federal statutes and regulations; a description of the structure of the US Congress, identification of the officers, relevant committees and committee chairmen; a description of the Federal legislative process; a summary of legislation enacted and considered in the recently-adjourned 96th Congress; a description of the Federal budgetary process; a summary of the Carter Administration's comprehensive radioactive waste management program; and excerpts from the text of relevant federal statutes and regulations.

FORMATION OF THE FINANCIAL BASIS FOR GOVERNMENT GUARANTEES OF HEALTH CARE IN RUSSIA

Directory of Open Access Journals (Sweden)

E. V. Sinicyna

2014-01-01

Full Text Available Organization of the health system of theRussian Federationin the conditions of limited fi nancial resources needed to develop and implement new methods and management mechanisms. Conducted a study in the article allowed to formulate the basic problems of development management of medical organizations and off er possible solutions through the formation of the fi nancial basis for government guarantees of health care inRussia. The article deals with the current reform in the Russian budget-insurance model of health care fi nancing, reveals the content and direction of the program of state guarantees of medical care in the new fi nancing mechanism of public services. Development and implementation of a new funding system in the management of medical organization will help to reduce costs, improve staff effi ciency, improve the quality of public health services.

Community health workers providing government community case management for child survival in sub-Saharan Africa: who are they and what are they expected to do?

Science.gov (United States)

George, Asha; Young, Mark; Nefdt, Rory; Basu, Roshni; Sylla, Mariame; Clarysse, Guy; Bannicq, Marika Yip; de Sousa, Alexandra; Binkin, Nancy; Diaz, Theresa

2012-11-01

We describe community health workers (CHWs) in government community case management (CCM) programs for child survival across sub-Saharan Africa. In sub-Saharan Africa, 91% of 44 United Nations Children's Fund (UNICEF) offices responded to a cross-sectional survey in 2010. Frequencies describe CHW profiles and activities in government CCM programs (N = 29). Although a few programs paid CHWs a salary or conversely, rewarded CHWs purely on a non-financial basis, most programs combined financial and non-financial incentives and had training for 1 week. Not all programs allowed CHWs to provide zinc, use timers, dispense antibiotics, or use rapid diagnostic tests. Many CHWs undertake health promotion, but fewer CHWs provide soap, water treatment products, indoor residual spraying, or ready-to-use therapeutic foods. For newborn care, very few promote kangaroo care, and they do not provide antibiotics or resuscitation. Even if CHWs are as varied as the health systems in which they work, more work must be done in terms of the design and implementation of the CHW programs for them to realize their potential.

Can health systems be enhanced for optimal health services through disease-specific programs? Results of field studies in Viet Nam and Cambodia.

Science.gov (United States)

Egami, Y; Fujita, N; Akashi, H; Matsumoto, Y; Ohara, H; Takeuchi, M

2012-02-01

Developing better health systems is the key to delivering optimal health services, although more evidence of effective strategies to do so is needed. Field surveys were conducted in Viet Nam and Cambodia to identify best practices in addressing health system bottlenecks to scale up disease control programs. The two countries were compared over time using a framework for analysis developed by the authors. In Viet Nam, a health system was in place for decades at the central to municipal levels, although it was fragile until the 1990s, when the government started taking measures. In Cambodia, the previous health system had been destroyed during previous internal conflict. In the post-conflict period, the health system was rebuilt with support for programs followed by centralization of health services. In different settings, different measures were taken to deal with similar bottlenecks. In Cambodia, vertical programs were dominant, so the government sought to centralize drug management to deal with shortages of essential drugs, while Viet Nam sought to mobilize resources to ensure drug distribution at all levels. This study shows there is no single successful approach to health systems, and a systemic approach needs to be taken because elimination of one bottleneck may reveal another. Efforts to enhance disease-specific programs may not always contribute to overall enhancement of the health system, and the best possible approach may not be the same in different countries. Further study is needed to explore common issues and principles for effective strategies to enhance health systems in different contexts.

McGovern-Dole International Food for Education and Child Nutrition Program. Fact Sheet

Science.gov (United States)

US Department of Agriculture, 2009

2009-01-01

The McGovern-Dole International Food for Education and Child Nutrition Program (McGovern-Dole program) helps support education, child development, and food security for some of the world's poorest children. It provides for donations of U.S. agricultural products, as well as financial and technical assistance, for school feeding and maternal and…

Policy uncertainty and corporate performance in government-sponsored voluntary environmental programs.

Science.gov (United States)

Liu, Ning; Tang, Shui-Yan; Zhan, Xueyong; Lo, Carlos Wing-Hung

2018-08-01

This study combines insights from the policy uncertainty literature and neo-institutional theory to examine corporate performance in implementing a government-sponsored voluntary environmental program (VEP) during 2004-2012 in Guangzhou, China. In this regulatory context, characterized by rapid policy changes, corporate performance in VEPs is affected by government surveillance, policy uncertainty, and peer pressures. Specifically, if VEP participants have experienced more government surveillance, they tend to perform better in program implementation. Such positive influence of government surveillance is particularly evident among those joining under high and low, rather than moderate uncertainty. Participants also perform better if they belong to an industry with more certified VEP firms, but worse if they are located in a regulatory jurisdiction with more certified VEP firms. At a moderate level of policy uncertainty, within-industry imitation is most likely to occur but within-jurisdiction imitation is least likely to occur. Copyright © 2018 Elsevier Ltd. All rights reserved.

Critical interactions between the Global Fund-supported HIV programs and the health system in Ghana.

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Atun, Rifat; Pothapregada, Sai Kumar; Kwansah, Janet; Degbotse, D; Lazarus, Jeffrey V

2011-08-01

The support of global health initiatives in recipient countries has been vigorously debated. Critics are concerned that disease-specific programs may be creating vertical and parallel service delivery structures that to some extent undermine health systems. This case study of Ghana aimed to explore how the Global Fund-supported HIV program interacts with the health system there and to map the extent and nature of integration of the national disease program across 6 key health systems functions. Qualitative interviews of national stakeholders were conducted to understand the perceptions of the strengths and weaknesses of the relationship between Global Fund-supported activities and the health system and to identify positive synergies and unintended consequences of integration. Ghana has a well-functioning sector-wide approach to financing its health system, with a strong emphasis on integrated care delivery. Ghana has benefited from US $175 million of approved Global Fund support to address the HIV epidemic, accounting for almost 85% of the National AIDS Control Program budget. Investments in infrastructure, human resources, and commodities have enabled HIV interventions to increase exponentially. Global Fund-supported activities have been well integrated into key health system functions to strengthen them, especially financing, planning, service delivery, and demand generation. Yet, with governance and monitoring and evaluation functions, parallel structures to national systems have emerged, leading to inefficiencies. This case study demonstrates that interactions and integration are highly varied across different health system functions, and strong government leadership has facilitated the integration of Global Fund-supported activities within national programs.

The Ebola Outbreak: Catalyzing a "Shift" in Global Health Governance?

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Mackey, Tim K

2016-11-24

As the 2014 Ebola virus disease outbreak (EVD) transitions to its post-endemic phase, its impact on the future of global public health, particularly the World Health Organization (WHO), is the subject of continued debate. Criticism of WHO's performance grew louder in the outbreak's wake, placing this international health UN-specialized agency in the difficult position of navigating a complex series of reform recommendations put forth by different stakeholders. Decisions on WHO governance reform and the broader role of the United Nations could very well shape the future landscape of 21st century global health and how the international community responds to health emergencies. In order to better understand the implications of the EVD outbreak on global health and infectious disease governance, this debate article critically examines a series of reports issued by four high-level commissions/panels convened to specifically assess WHO's performance post-Ebola. Collectively, these recommendations add increasing complexity to the urgent need for WHO reform, a process that the agency must carry out in order to maintain its legitimacy. Proposals that garnered strong support included the formation of an independent WHO Centre for Emergency Preparedness and Response, the urgent need to increase WHO infectious disease funding and capacity, and establishing better operational and policy coordination between WHO, UN agencies, and other global health partners. The recommendations also raise more fundamental questions about restructuring the global health architecture, and whether the UN should play a more active role in global health governance. Despite the need for a fully modernized WHO, reform proposals recently announced by WHO fail to achieve the "evolution" in global health governance needed in order to ensure that global society is adequately protected against the multifaceted and increasingly complex nature of modern public health emergencies. Instead, the lasting

Restructuring brain drain: strengthening governance and financing for health worker migration

Directory of Open Access Journals (Sweden)

Tim K. Mackey

2013-01-01

Full Text Available Background: Health worker migration from resource-poor countries to developed countries, also known as ‘‘brain drain’’, represents a serious global health crisis and a significant barrier to achieving global health equity. Resource-poor countries are unable to recruit and retain health workers for domestic health systems, resulting in inadequate health infrastructure and millions of dollars in healthcare investment losses. Methods: Using acceptable methods of policy analysis, we first assess current strategies aimed at alleviating brain drain and then propose our own global health policy based solution to address current policy limitations. Results: Although governments and private organizations have tried to address this policy challenge, brain drain continues to destabilise public health systems and their populations globally. Most importantly, lack of adequate financing and binding governance solutions continue to fail to prevent health worker brain drain. Conclusions: In response to these challenges, the establishment of a Global Health Resource Fund in conjunction with an international framework for health worker migration could create global governance for stable funding mechanisms encourage equitable migration pathways, and provide data collection that is desperately needed.

Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies.

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Petersen, Inge; Marais, Debbie; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Chisholm, Dan; Egbe, Catherine; Gureje, Oye; Hanlon, Charlotte; Lund, Crick; Shidhaye, Rahul; Jordans, Mark; Kigozi, Fred; Mugisha, James; Upadhaya, Nawaraj; Thornicroft, Graham

2017-06-01

Poor governance has been identified as a barrier to effective integration of mental health care in low- and middle-income countries. Governance includes providing the necessary policy and legislative framework to promote and protect the mental health of a population, as well as health system design and quality assurance to ensure optimal policy implementation. The aim of this study was to identify key governance challenges, needs and potential strategies that could facilitate adequate integration of mental health into primary health care settings in low- and middle-income countries. Key informant qualitative interviews were held with 141 participants across six countries participating in the Emerging mental health systems in low- and middle-income countries (Emerald) research program: Ethiopia, India, Nepal, Nigeria, South Africa, and Uganda. Data were transcribed (and where necessary, translated into English) and analysed thematically using framework analysis, first at the country level, then synthesized at a cross-country level. While all the countries fared well with respect to strategic vision in the form of the development of national mental health policies, key governance strategies identified to address challenges included: strengthening capacity of managers at sub-national levels to develop and implement integrated plans; strengthening key aspects of the essential health system building blocks to promote responsiveness, efficiency and effectiveness; developing workable mechanisms for inter-sectoral collaboration, as well as community and service user engagement; and developing innovative approaches to improving mental health literacy and stigma reduction. Inadequate financing emerged as the biggest challenge for good governance. In addition to the need for overall good governance of a health care system, this study identifies a number of specific strategies to improve governance for integrated mental health care in low- and middle-income countries. © The

Community governance in primary health care: towards an international Ideal Type.

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Meads, Geoffrey; Russell, Grant; Lees, Amanda

2017-10-01

Against a global background of increased resource management responsibilities for primary health care agencies, general medical practices, in particular, are increasingly being required to demonstrate the legitimacy of their decision making in market oriented environments. In this context a scoping review explores the potential utility for health managers in primary health care of community governance as a policy concept. The review of recent research suggests that applied learning from international health systems with enhanced approaches to public and patient involvement may contribute to meeting this requirement. Such approaches often characterise local health systems in Latin America and North West Europe where innovative models are beginning to respond effectively to the growing demands on general practice. The study design draws on documentary and secondary data analyses to identify common components of community governance from the countries in these regions, supplemented by other relevant international studies and sources where appropriate. Within a comprehensive framework of collaborative governance the components are aggregated in an Ideal Type format to provide a point of reference for possible adaptation and transferable learning across market oriented health systems. Each component is illustrated with international exemplars from recent organisational practices in primary health care. The application of community governance is considered for the particular contexts of GP led Clinical Commissioning Groups in England and Primary Health Networks in Australia. Some components of the Ideal Type possess potentially powerful negative as well as positive motivational effects, with PPI at practice levels sometimes hindering the development of effective local governance. This highlights the importance of careful and competent management of the growing resources attributed to primary health care agencies, which possess an increasingly diverse range of non

Health Care Practices for Medical Textiles in Government Hospitals

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Akubue, B. N.; Anikweze, G. U.

2015-01-01

The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…

Health Research Governance: Introduction of a New Web-based Research Evaluation Model in Iran: One-decade Experience

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MALEKZADEH, Reza; AKHONDZADEH, Shahin; EBADIFAR, Asghar; BARADARAN EFTEKHARI, Monir; OWLIA, Parviz; GHANEI, Mostafa; FALAHAT, Katayoun; HABIBI, Elham; SOBHANI, Zahra; DJALALINIA, Shirin; PAYKARI, Niloofar; MOJARRAB, Shahnaz; ELTEMASI, Masoumeh; LAALI, Reza

2016-01-01

Background: Governance is one of the main functions of Health Research System (HRS) that consist of four essential elements such as setting up evaluation system. The goal of this study was to introduce a new web based research evaluation model in Iran. Methods: Based on main elements of governance, research indicators have been clarified and with cooperation of technical team, appropriate software was designed. Three main steps in this study consist of developing of mission-oriented program, creating enabling environment and set up Iran Research Medical Portal as a center for research evaluation. Results: Fifty-two universities of medical sciences in three types have been participated. After training the evaluation focal points in all of medical universities, access to data entry and uploading all of documents were provided. Regarding to mission – based program, the contribution of medical universities in knowledge production was 60% for type one, 31% for type two and 9% for type three. The research priorities based on Essential National Health Research (ENHR) approach and mosaic model were gathered from universities of medical sciences and aggregated to nine main areas as national health research priorities. Ethical committees were established in all of medical universities. Conclusion: Web based research evaluation model is a comprehensive and integrated system for data collection in research. This system is appropriate tool to national health research ranking. PMID:27957437

National findings regarding health IT use and participation in health care delivery reform programs among office-based physicians.

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Heisey-Grove, Dawn; Patel, Vaishali

2017-01-01

Our objective was to characterize physicians' participation in delivery and payment reform programs over time and describe how participants in these programs were using health information technology (IT) to coordinate care, engage patients, manage patient populations, and improve quality. A nationally representative cohort of physicians was surveyed in 2012 (unweighted N = 2567) and 2013 (unweighted N = 2399). Regression analyses used those survey responses to identify associations between health IT use and participation in and attrition from patient-centered medical homes (PCMHs), accountable care organizations (ACOs), and pay-for-performance programs (P4Ps). In 2013, 45% of physicians participated in PCMHs, ACOs, or P4Ps. While participation in each program increased (P payment reform programs increased between 2012 and 2013. Participating physicians were more likely to use health IT. There was significant attrition from and switching between PCMHs, ACOs, and P4Ps. This work provides the basis for understanding physician participation in and attrition from delivery and payment reform programs, as well as how health IT was used to support those programs. Understanding health IT use by program participants may help to identify factors enabling a smooth transition to alternative payment models. Published by Oxford University Press on behalf of the American Medical Informatics Association 2016. This work is written by US Government employees and is in the public domain in the United States.

Increasing the minimum age of marriage program to improve maternal and child health in Indonesia

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Anjarwati

2017-08-01

The objective of the article is to review the importance of understanding the adolescent reproductive health, especially the impact of early marriage to have commitment for health maintenance by increasing the minimum age of marriage. There are countless studies describing the impact of pregnancy at a very young age, the risk that young people must understand to support the program of increasing minimum age of marriage in Indonesia. Increasing the minimum age of marriage is as one of the government programs in improving maternal and child health. It also supports the Indonesian government's program about a thousand days of life. It is required that teens understand the impact of early marriage to prepare for optimal health for future generations. The maternal mortality rate and infant mortality rate in Indonesia is still high because health is not optimal since the early period of pregnancy. These studies reveal that the increased number of early marriages leads to rising divorce rate, maternal mortality rate, and infant mortality and intensifies the risk of cervical cancer. The increase in early marriage is mostly attributed to unwanted pregnancy. It is revealed that early marriage increases the rate of pregnancy at too young an age with the risk of maternal and child health in Indonesia.

Privacy, Security, and Patient Engagement: The Changing Health Data Governance Landscape.

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Holmes, John H

2016-01-01

The rapid emergence of new technologies support collection and use of a wide variety of data from clinical, genomic, social and behavioral, environmental, and financial sources, and have a great impact on the governance of personal health information. The papers in this special issue on governance touch on the topic from a variety of focuses, including leadership perspectives, local and federal case studies, and the future importance of patient engagement. This special issue focuses on three major themes-that data governance is growing in importance and presenting new challenges that must be addressed, that health care organizations must prioritize governance design, implementation, and functions as a priority, and that governance seems to be naturally converging on an archetype as described by this set of papers. In order to deal with issues such as data de- and re-identification, data governance must be studied as its own field.

Government programs for climate change mitigation in Japan. An analysis based on public budget documents and Government Project Review Sheets

International Nuclear Information System (INIS)

Kimura, Osamu

2016-01-01

The Japanese government has been spending huge public budgets for various programs to mitigate climate change, such as subsidy programs for energy efficient and renewable technologies, and R and D programs to develop innovative low carbon technologies. This report makes a comprehensive review of government projects and expenditure related to climate change mitigation in order to grasp their total expenditure and to analyze portfolio of supported technology and activity types, outcome, and the cost-effectiveness. It is estimated that the total expenditure for climate change mitigation excluding nuclear energy and forest sink projects amounts to 4.8 trillion JPY (approximately 40 billion USD) in the period of 2008 to 2014. 40% of the total expenditure went to only three largest programs, namely the Eco Car Subsidy, the Eco Point Programs for Appliances and Houses, all of which have gone through virtually no or only poor evaluations by the implementing ministries. While some programs had decent cost-effectiveness of reducing carbon dioxide emission at below 10,000 JPY/t-CO 2 (approximately 90 USD), there are also programs with very low cost-effectiveness at more than 100,000 JPY/t-CO 2 . Moreover, all of the evaluation was based on 'gross' reduction, not on 'net' of freeriders, rebound and other factors, which may lead to overestimation of performances. The result shows the need for a much larger resource for evaluation activities by the government. (author)

[Research within the reach of Osakidetza professionals: Primary Health Care Research Program].

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Grandes, Gonzalo; Arce, Verónica; Arietaleanizbeaskoa, María Soledad

2014-04-01

To provide information about the process and results of the Primary Health Care Research Program 2010-2011 organised by the Primary Care Research Unit of Bizkaia. Descriptive study. Osakidetza primary care. The 107 health professionals who applied for the program from a total of 4,338 general practitioners, nurses and administrative staff who were informed about it. Application level, research topics classification, program evaluation by participants, projects funding and program costs. Percentage who applied, 2.47%; 95% CI 2.41-2.88%. Of the 28 who were selected and 19 completed. The research topics were mostly related to the more common chronic diseases (32%), and prevention and health promotion (18%). Over 90% of participants assessed the quality of the program as good or excellent, and half of them considered it as difficult or very difficult. Of the18 new projects generated, 12 received funding, with 16 grants, 10 from the Health Department of the Basque Government, 4 from the Carlos III Institute of Health of the Ministry of Health of Spain, and 2 from Kronikgune. A total of €500,000 was obtained for these projects. This program cost €198,327. This experience can be used by others interested in the promotion of research in primary care, as the program achieved its objectives, and was useful and productive. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Audit of a diabetic health education program at a large Primary Health Care Center in Asir region.

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Al-Khaldi, Y M; Khan, M Y

2000-09-01

To evaluate the health education program in a large Primary Health Care Center, to find out the problems faced by the staff and to suggest the practical and relevant solutions. This study was carried out at Wasat Abha Primary Health Care Center, Asir region during 1997. The files of diabetics who attended the center were evaluated for health education topics by using a checklist. The essential structure of diabetic health education program was assessed by using another check list designed by the investigators. Data entry and analysis was carried out through SPSS package. Chi-square test was applied wherever necessary. The total number of diabetics who attended Wasat Abha Primary Health Care Center was 198. The duration of diabetes mellitus was 7.7+5.8 years. Ninety percent of these were married, 50.5% were educated and 79% were employed. Compliance to appointment was good in 60% and poor in 30% of diabetics. About 73% of the diabetics received at least one health education topic while 27% did not receive any health education at all. Only 33% of diabetic patients had adequate health education. Ninety one percent were provided with diabetic identification cards, 80% were explained about diabetes and 77% were educated about the role of diet. Essential structure for diabetes education program was found to be unsatisfactory. Effective diabetic health education program needs the availability of all essential structures, community participation and integration of the government and private sectors. The deficiencies in the structures and the process of health education programs in our practice are almost universal to other Primary Health Care Centers in the Asir region. Providing the Primary Health Care Centers with all essential structures and annual auditing are complimentary to a successful diabetic health education program.

Young people's comparative recognition and recall of an Australian Government Sexual Health Campaign.

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Lim, Megan S C; Gold, Judy; Bowring, Anna L; Pedrana, Alisa E; Hellard, Margaret E

2015-05-01

In 2009, the Australian Government's National Sexually Transmitted Infection Prevention Program launched a multi-million dollar sexual health campaign targeting young people. We assessed campaign recognition among a community sample of young people. Individuals aged 16-29 years self-completed a questionnaire at a music festival. Participants were asked whether they recognised the campaign image and attempted to match the correct campaign message. Recognition of two concurrent campaigns, GlaxoSmithKline's The Facts genital herpes campaign (targeting young women) and the Drama Downunder campaign (targeting gay men) were assessed simultaneously. Among 471 participants, just 29% recognised the National Sexually Transmitted Infection Prevention Program campaign. This compared to 52% recognising The Facts and 27% recognising Drama Downunder. Of 134 who recognised the National Sexually Transmitted Infection Prevention Program campaign, 27% correctly recalled the campaign messages compared to 61% of those recognising the Facts campaign, and 25% of those recognising the Drama Downunder campaign. There was no difference in National Sexually Transmitted Infection Prevention Program campaign recognition by gender or age. Campaign recognition and message recall of the National Sexually Transmitted Infection Prevention Program campaign was comparatively low. Future mass media sexual health campaigns targeting young people can aim for higher recognition and recall rates than that achieved by the National Sexually Transmitted Infection Prevention Program campaign. Alternative distribution channels and message styles should be considered to increase these rates. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The Public Health Service guidelines. Governing research involving human subjects: An analysis of the policy-making process

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Frankel, M. S.

1972-01-01

The policy making process which led to development of the Public Health Service Guidelines governing research involving human subjects is outlined. Part 1 examines the evolution of PHS Guidelines, tracing (1) evolution of thought and legal interpretation regarding research using human subjects; (2) initial involvement of the Federal government; (3) development of the government's research program; (4) the social-political environment in which formal government policy was developed; and (5) various policy statements issued by the government. Part 2 analyzes the process by which PHS Guidelines were developed and examines the values and other underlying factors which contributed to their development. It was concluded that the evolution of the Guidelines is best understood within the context of a mixed-scanning strategy. In such a strategy, policy makers make fundamental decisions regarding the basic direction of policy and subsequent decisions are made incrementally and within the contexts set by the original fundamental decisions.

Oral Health Status among 12- and 15-Year-Old Children from Government and Private Schools in Hyderabad, Andhra Pradesh, India.

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Sukhabogi, J R; Shekar, Cbr; Hameed, Ia; Ramana, Iv; Sandhu, G

2014-09-01

The assessment of oral health status of children in government and private schools provide data on the oral health status of children from different socio-economic background. The aim of the following study is to assess and to compare the oral hygiene status, gingival status and caries experience between children from government and private schools in Andhra Pradesh, India. A combination of cluster and stratified random sampling was employed to select the study participants. Oral hygiene status, gingival status and caries experience was assessed and compared among 12- and 15-year-old children from three government and private schools each. The examination was carried out by three trained and calibrated investigators using a mouth mirror and explorer under natural daylight. A total of 604 children (331 government and 273 private) were examined in the study. The mean oral hygiene index-simplified (OHI-S) was higher among government school children (2.9 [1.1]) compared private school children (0.6 [0.4]). The mean gingival score and mean decayed missing filled teeth were also higher among government school children compared with private school children. A significantly higher number of children in the government schools had poor oral hygiene status, moderate to severe gingivitis and caries experience. The prevalence of oral diseases was relatively less among children from private schools in comparison with those from government schools. Hence, the children from government schools should be given the priority compared with private school children in any school dental health programs planned on a statewide basis.

Overview of systematic reviews on the health-related effects of government tobacco control policies.

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Hoffman, Steven J; Tan, Charlie

2015-08-05

Government interventions are critical to addressing the global tobacco epidemic, a major public health problem that continues to deepen. We systematically synthesize research evidence on the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force. An overview of systematic reviews was prepared through systematic searches of five electronic databases, published up to March 2014. Additional reviews were retrieved from monthly updates until August 2014, consultations with tobacco control experts and a targeted search for reviews on mass media interventions. Reviews were assessed according to predefined inclusion criteria, and ratings of methodological quality were either extracted from source databases or independently scored. Of 612 reviews retrieved, 45 reviews met the inclusion criteria and 14 more were identified from monthly updates, expert consultations and a targeted search, resulting in 59 included reviews summarizing over 1150 primary studies. The 38 strong and moderate quality reviews published since 2000 were prioritized in the qualitative synthesis. Protecting people from tobacco smoke was the most strongly supported government intervention, with smoke-free policies associated with decreased smoking behaviour, secondhand smoke exposure and adverse health outcomes. Raising taxes on tobacco products also consistently demonstrated reductions in smoking behaviour. Tobacco product packaging interventions and anti-tobacco mass media campaigns may decrease smoking behaviour, with the latter likely an important part of larger multicomponent programs. Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well. Although the findings for bans on tobacco advertising were

Health worker posting and transfer at primary level in Tamil Nadu: Governance of a complex health system function

Directory of Open Access Journals (Sweden)

Surekha Garimella

2016-01-01

Full Text Available Background: Posting and transfer (PT of health personnel - placing the right health workers in the right place at the right time - is a core function of any large-scale health service. In the context of government health services, this may be seen as a simple process of bureaucratic governance and implementation of the rule of law. However the literature from India and comparable low and middle-income country health systems suggests that in reality PT is a contested domain, driven by varied expressions of private and public interest throughout the chain of implementation. Objective: To investigate policymaking for PT in the government health sector and implementation of policies as experienced by different health system actors and stakeholders at primary health care level. Methodology: We undertook an empirical case study of a PT reform policy at primary health care level in Tamil Nadu State, to understand how different groups of health systems actors experience PT. In-depth qualitative methods were undertaken to study processes of implementation of PT policies enacted through ′counselling′ of health workers (individualized consultations to determine postings and transfers. Results: PT emerges as a complex phenomenon, shaped partially by the laws of the state and partially as a parallel system of norms and incentives requiring consideration and coordination of the interests of different groups. Micro-practices of governance represent homegrown coping mechanisms of health administrators that reconcile public and private interests and sustain basic health system functions. Beyond a functional perspective of PT, it also reflects justice and fairness as it plays out in the health system. It signifies how well a system treats its employees, and by inference, is an index of the overall health of the system. Conclusions: For a complex governance function such as PT, the roles of private actors and private interests are not easily separable from the

The effects of Global Fund financing on health governance in Brazil.

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Gómez, Eduardo J; Atun, Rifat

2012-07-16

The impact of donors, such as national government (bi-lateral), private sector, and individual financial (philanthropic) contributions, on domestic health policies of developing nations has been the subject of scholarly discourse. Little is known, however, about the impact of global financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on policies and health governance of countries receiving funding from such initiatives. This study employs a qualitative methodological design based on a single case study: Brazil. Analysis at national, inter-governmental and community levels is based on in-depth interviews with the Global Fund and the Brazilian Ministry of Health and civil societal activists. Primary research is complemented with information from printed media, reports, journal articles, and books, which were used to deepen our analysis while providing supporting evidence. Our analysis suggests that in Brazil, Global Fund financing has helped to positively transform health governance at three tiers of analysis: the national-level, inter-governmental-level, and community-level. At the national-level, Global Fund financing has helped to increased political attention and commitment to relatively neglected diseases, such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-governmental-level, Global Fund financing has motivated the National Tuberculosis Programme to strengthen its ties with state and municipal health departments, and non-governmental organisations (NGOs); while at the community-level, the Global Fund's financing of civil societal institutions has encouraged the emergence of new civic movements, participation, and the creation of new municipal participatory institutions designed to monitor the disbursement of funds for Global Fund grants. Global Fund financing can help deepen health governance at multiple levels. Future work will need to explore how the financing of civil society by the

Does fiscal discipline towards subnational governments affect citizens' well-being? Evidence on health.

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Piacenza, Massimiliano; Turati, Gilberto

2014-02-01

This paper aims to assess the impact on citizens' well-being of fiscal discipline imposed by the central government on subnational governments. Because healthcare policies involve strategic interactions between different layers of governments in many different countries, we focus on a particular dimension of well-being, namely citizens' health. We model fiscal discipline by considering government expectations of future deficit bailouts from the central government. We then study how these bailout expectations affect the expenditure for healthcare policies carried out by decentralized governments. To investigate this issue, we separate efficient health spending from inefficiencies by estimating an input requirement frontier. This allows us to assess the effects of bailout expectations on both the structural component of health expenditure and its deviations from the 'best practice'. The evidence from the 15 Italian ordinary statute regions (observed from 1993 to 2006) points out that bailout expectations do not significantly influence the position of the frontier, thus not affecting citizens' health. However, they do appear to exert a remarkable impact on excess spending. Copyright © 2013 John Wiley & Sons, Ltd.

The organizational structure and governing principles of the Food and Drug Administration's Mini-Sentinel pilot program.

Science.gov (United States)

Forrow, Susan; Campion, Daniel M; Herrinton, Lisa J; Nair, Vinit P; Robb, Melissa A; Wilson, Marcus; Platt, Richard

2012-01-01

The US Food and Drug Administration's Mini-Sentinel pilot program is developing an organizational structure as well as principles and policies to govern its operations. These will inform the structure and function of the eventual Sentinel System. Mini-Sentinel is a collaboration that includes 25 participating institutions. We describe the program's current organizational structure and its major principles and policies. The organization includes a coordinating center with program leadership provided by a principal investigator; a planning board and subcommittees; an operations center; and data, methods, and protocol cores. Ad hoc workgroups are created as needed. A privacy panel advises about protection of individual health information. Principles and policies are intended to ensure that Mini-Sentinel conforms to the principles of fair information practices, protects the privacy of individual health information, maintains the security and integrity of data, assures the confidentiality of proprietary information, provides accurate and timely communications, prevents or manages conflicts of interest, and preserves respect for intellectual property rights. Copyright © 2012 John Wiley & Sons, Ltd.

13 CFR 121.402 - What size standards are applicable to Federal Government Contracting programs?

Science.gov (United States)

2010-01-01

... Size Eligibility Requirements for Government Procurement § 121.402 What size standards are applicable... being purchased. Other factors considered include previous Government procurement classifications of the... to Federal Government Contracting programs? 121.402 Section 121.402 Business Credit and Assistance...

Data governance and data sharing agreements for community-wide health information exchange: lessons from the beacon communities.

Science.gov (United States)

Allen, Claudia; Des Jardins, Terrisca R; Heider, Arvela; Lyman, Kristin A; McWilliams, Lee; Rein, Alison L; Schachter, Abigail A; Singh, Ranjit; Sorondo, Barbara; Topper, Joan; Turske, Scott A

2014-01-01

Unprecedented efforts are underway across the United States to electronically capture and exchange health information to improve health care and population health, and reduce costs. This increased collection and sharing of electronic patient data raises several governance issues, including privacy, security, liability, and market competition. Those engaged in such efforts have had to develop data sharing agreements (DSAs) among entities involved in information exchange, many of whom are "nontraditional" health care entities and/or new partners. This paper shares lessons learned based on the experiences of six federally funded communities participating in the Beacon Community Cooperative Agreement Program, and offers guidance for navigating data governance issues and developing DSAs to facilitate community-wide health information exchange. While all entities involved in electronic data sharing must address governance issues and create DSAs accordingly, until recently little formal guidance existed for doing so - particularly for community-based initiatives. Despite this lack of guidance, together the Beacon Communities' experiences highlight promising strategies for navigating complex governance issues, which may be useful to other entities or communities initiating information exchange efforts to support delivery system transformation. For the past three years, AcademyHealth has provided technical assistance to most of the 17 Beacon Communities, 6 of whom contributed to this collaborative writing effort. Though these communities varied widely in terms of their demographics, resources, and Beacon-driven priorities, common themes emerged as they described their approaches to data governance and DSA development. The 6 Beacon Communities confirmed that DSAs are necessary to satisfy legal and market-based concerns, and they identified several specific issues, many of which have been noted by others involved in network data sharing initiatives. More importantly, these

The Long Way From Government Open Data to Mobile Health Apps: Overcoming Institutional Barriers in the US Federal Government.

Science.gov (United States)

Mergel, Ines

2014-12-23

Government agencies in the United States are creating mobile health (mHealth) apps as part of recent policy changes initiated by the White House's Digital Government Strategy. The objective of the study was to understand the institutional and managerial barriers for the implementation of mHealth, as well as the resulting adoption pathways of mHealth. This article is based on insights derived from qualitative interview data with 35 public managers in charge of promoting the reuse of open data through Challenge.gov, the platform created to run prizes, challenges, and the vetting and implementation of the winning and vendor-created apps. The process of designing apps follows three different pathways: (1) entrepreneurs start to see opportunities for mobile apps, and develop either in-house or contract out to already vetted Web design vendors; (2) a top-down policy mandates agencies to adopt at least two customer-facing mobile apps; and (3) the federal government uses a policy instrument called "Prizes and Challenges", encouraging civic hackers to design health-related mobile apps using open government data from HealthData.gov, in combination with citizen needs. All pathways of the development process incur a set of major obstacles that have to be actively managed before agencies can promote mobile apps on their websites and app stores. Beyond the cultural paradigm shift to design interactive apps and to open health-related data to the public, the managerial challenges include accessibility, interoperability, security, privacy, and legal concerns using interactive apps tracking citizen.

Linking governance mechanisms to health outcomes: a review of the literature in low- and middle-income countries.

Science.gov (United States)

Ciccone, Dana Karen; Vian, Taryn; Maurer, Lydia; Bradley, Elizabeth H

2014-09-01

We conducted a synthesis of peer-reviewed literature to shed light on links between governance mechanisms and health outcomes in low- and middle-income countries. Our review yielded 30 studies, highlighting four key governance mechanisms by which governance may influence health outcomes in these settings: Health system decentralization that enables responsiveness to local needs and values; health policymaking that aligns and empowers diverse stakeholders; enhanced community engagement; and strengthened social capital. Most, but not all, studies found a positive association between governance and health. Additionally, the nature of the association between governance mechanisms and health differed across studies. In some studies (N = 9), the governance effect was direct and positive, while in others (N = 5), the effect was indirect or modified by contextual factors. In still other studies (N = 4), governance was found to have a moderating effect, indicating that governance mechanisms influenced other system processes or structures that improved health. The remaining studies reported mixed findings about the association between governance and health (N = 6), no association between governance and health (N = 4), or had inconclusive results (N = 2). Further exploration is needed to fully understand the relationship between governance and health and to inform the design and delivery of evidence-based, effective governance interventions around the world. Copyright © 2014 Elsevier Ltd. All rights reserved.

Governance for Equity in Health Systems Deadline

International Development Research Centre (IDRC) Digital Library (Canada)

Jean-Claude Dumais

2012-09-12

Sep 12, 2012 ... of training and mentorship in research, research management, and grant administration allows awardees to pursue their research goals in a dynamic team environment in one of the world's leaders in generating new knowledge to meet global challenges. IDRC's Governance for Equity in Health Systems ...

The Ebola Outbreak: Catalyzing a “Shift” in Global Health Governance?

Directory of Open Access Journals (Sweden)

Tim K. Mackey

2016-11-01

Full Text Available Abstract Background As the 2014 Ebola virus disease outbreak (EVD transitions to its post-endemic phase, its impact on the future of global public health, particularly the World Health Organization (WHO, is the subject of continued debate. Criticism of WHO’s performance grew louder in the outbreak’s wake, placing this international health UN-specialized agency in the difficult position of navigating a complex series of reform recommendations put forth by different stakeholders. Decisions on WHO governance reform and the broader role of the United Nations could very well shape the future landscape of 21st century global health and how the international community responds to health emergencies. Discussion In order to better understand the implications of the EVD outbreak on global health and infectious disease governance, this debate article critically examines a series of reports issued by four high-level commissions/panels convened to specifically assess WHO’s performance post-Ebola. Collectively, these recommendations add increasing complexity to the urgent need for WHO reform, a process that the agency must carry out in order to maintain its legitimacy. Proposals that garnered strong support included the formation of an independent WHO Centre for Emergency Preparedness and Response, the urgent need to increase WHO infectious disease funding and capacity, and establishing better operational and policy coordination between WHO, UN agencies, and other global health partners. The recommendations also raise more fundamental questions about restructuring the global health architecture, and whether the UN should play a more active role in global health governance. Summary Despite the need for a fully modernized WHO, reform proposals recently announced by WHO fail to achieve the “evolution” in global health governance needed in order to ensure that global society is adequately protected against the multifaceted and increasingly complex

Genuine federalism in the Russian health care system: changing roles of government.

Science.gov (United States)

Chernichovsky, D; Potapchik, E

1999-02-01

The reforms that have affected the Russian health care system since the breakup of the Soviet Union, principally those in the general administration of the Russian Federation, have suffered from inconsistency and the absence of a strategy. The various reforms have caused a shift from a national health system characterized by highly centralized management and control, typical of the totalitarian uniform state, to a highly decentralized but fragmented multitude of state systems. Each of these systems is relatively centralized at the local level and run by local administrations with limited government infrastructure and experience. The role of government in the emerging system, and in particular the role of the federal government, remains ill defined. As a result, there is a grave risk that the Russian health care system may disintegrate as a national system. This undermines (a) the prevailing universal and fairly equitable access to care, (b) stabilization of the system following a long period of transition, and (c) the long-term reform that is required to bring the Russian health care system up to par with the health care systems in other developed countries. A rapid transition to a genuine federal health system with well-articulated roles for different levels of government, in tandem with implementation of the 1993 Compulsory Health Insurance System, is essential for the stabilization and reform of the Russian health care system.

Green power programs in Canada : 2002 : Overview of Government green power policies, utility green power development programs, green power and certificate marketing initiatives, and their benefits

International Nuclear Information System (INIS)

Bramley, M.; Boustie, S.; Vadgama, J.; Wieler, C.; Pape-Salmon, A.; Holmes, R.

2003-11-01

Green power is generally defined as electricity produced from renewable sources, and whose production has low adverse impacts on the environment, human health and communities. Green power has near-zero greenhouse gas (GHG) emissions and includes sources such as wind, hydro, and solar power. Green power offers several environmental benefits, as well as the enhancement of energy security, regional development, economic diversification and the creation of skilled jobs. There are four categories of programs related to green power development in Canada: government green power policies, utility green power development programs, green power marketing initiatives, and green power certificate marketing initiatives. Most of the activities associated with these four categories in 2002 were discussed in this report. However, difficulties with quantification prevented the inclusion of some green power activities in the report, such as (1) the generation of green power not certified or identified by the generator as green power, (2) industry or residential self-generation, (3) net metering, and (4) small government programs. Each category was presented in detail. The information included in the report was based on surveys sent to each program proponent. Follow-up communications and other publicly available information was also included. New programs operating in 2003 or currently under development were listed. refs., 8 tabs

Recommendations on health care and medical monitoring to the governments of Belarus, Russian Federation and Ukraine

International Nuclear Information System (INIS)

Repacholi, M.; Carr, Z.

2005-01-01

The following recommendations on health care and medical monitoring to the governments of Belarus, Russian Federation and Ukraine were presented: Continue annual medicals, including cardiovascular exams, on ARS survivors. Reconsider medical follow-up of persons exposed to < 1 Gy. Such follow-up programs are very unlikely to be cost-effective use funds saved to improve general health care programs, continue thyroid cancer screening for adults exposed as children, but evaluate this at intervals for cost-benefit and expected number of cases. Maintain high quality cancer registries to assist allocate public health resources and research. Monitor incidence rates of childhood leukaemia in highly exposed populations. Continue eye examinations in highly exposed populations; new information on radiation-induced cataracts at lower doses may come. Continue local registers on reproductive effects; may not be useful for research but may reassure the population. Inform local populations of the Forum results, including through health care professionals Chernobyl. Some key questions to follow-up: What will be the incidence of various cancers in highly exposed Chernobyl populations (emergency workers and resident of highly contaminated territories)? Will there be an excess risk of thyroid cancers in adults? What are the uncertainties in the estimates of thyroid doses? What is the role of radiation on the induction of cardiovascular disease? Studies should be conducted under a joint protocol with the 3 affected countries participating cooperatively. What is the effect of high doses of radiation on the immune. WHO will continue to participate in activities related to the health consequences and research. The Chernobyl Forum's goals of providing scientifically sound information and recommendations to the affected governments on how to provide more effective health care is a good model that should be used for other large accident areas

NGOs and government partnership for health systems strengthening: A qualitative study presenting viewpoints of government, NGOs and donors in Pakistan

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Rizvi Narjis

2011-05-01

Full Text Available Abstract Background Health systems are expected to serve the population needs in an effective, efficient and equitable manner. Therefore, the importance of strengthening of public, private and community health systems has been emphasized time and again. In most of the developing countries, certain weaknesses and gaps in the government health systems have been hampering the achievement of improved health outcomes. Public sector in Pakistan has been deficient in the capacity to deliver equitable and quality health services and thus has been grossly underutilized. Methods A qualitative study comprising in-depth interviews was conducted capturing the perceptions of the government functionaries, NGO representatives and donor community about the role and position of NGOs in health systems strengthening in Pakistan's context. Analysis of the data was done manually to generate nodes, sub-nodes and themes. Results Since many years, international and local non-governmental organizations (NGOs have endeavored to fill the gaps in health service delivery, research and advocacy. NGOs have relatively performed better and achieved the results because of the flexible planning and the ability to design population based projects on health education, health promotion, social marketing, community development and advocacy. This paper captures the need and the opportunity of public private partnership in Pakistan and presents a framework for a meaningful engagement of the government and the private and nonprofit NGOs. Conclusion Involving the NGOs for health system strengthening may eventually contribute to create a healthcare system reflecting an increased efficiency, more equity and good governance in the wake of the Millennium Development Goals. Nevertheless, few questions need to be answered and pre-requisites have to be fulfilled before moving on.

Quality of governance, public spending on health and health status in Sub Saharan Africa: a panel data regression analysis.

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Makuta, Innocent; O'Hare, Bernadette

2015-09-21

The population in Sub Saharan Africa (SSA) suffers poor health as manifested in high mortality rates and low life expectancy. Economic growth has consistently been shown to be a major determinant of health outcomes. However, even with good economic growth rates, it is not possible to achieve desired improvements in health outcomes. Public spending on health (PSH) has long been viewed as a potential complement to economic growth in improving health. However, the relationship between PSH and health outcomes is inconclusive and this inconclusiveness may, in part, be explained by governance-related factors which mediate the impact of the former on the latter. Little empirical work has been done in this regard on SSA. This paper investigates whether or not the quality of governance (QoG) has a modifying effect on the impact of public health spending on health outcomes, measured by under-five mortality (U5M) and life expectancy at birth (LE), in SSA. Using two staged least squares regression technique on panel data from 43 countries in SSA over the period 1996-2011, we estimated the effect of public spending on health and quality of governance U5M and LE, controlling for GDP per capita and other socio-economic factors. We also interacted PSH and QoG to find out if the latter has a modifying effect on the former's impact on U5M and LE. Public spending on health has a statistically significant impact in improving health outcomes. Its direct elasticity with respect to under-five mortality is between -0.09 and -0.11 while its semi-elasticity with respect to life expectancy is between 0.35 and 0.60. Allowing for indirect effect of PSH spending via interaction with quality of governance, we find that an improvement in QoG enhances the overall impact of PSH. In countries with higher quality of governance, the overall elasticity of PSH with respect to under-five mortality is between -0.17 and -0.19 while in countries with lower quality of governance, it is about -0.09. The

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

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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.

THE AFFORDABLE CARE ACT AND INCENTIVIZED HEALTH WELLNESS PROGRAMS--A TALE OF FEDERALISM AND SHIFTING ADMINISTRATIVE BURDEN.

Science.gov (United States)

Sirpal, Sanjeev

2014-01-01

The Patient Protection and Affordable Care Act creates new incentives and builds on existing wellness program policies to promote employer wellness programs and encourage opportunities to support healthier workplaces. The proposed rules are promulgated by the Department of Health and Human Services (HHS), the Department of Labor, and the Treasury Department, and seek to encourage appropriately designed, consumer-protective wellness programs in group health coverage. This legislative landscape raises significant federalism concerns insofar as it largely shifts the responsibility for administration of health incentive programs to the states. Little attention has been paid to the shifting "administrative burden" that would thereby ensue. This paper will address the distribution of power in the American federal system vis-à-vis subnational counterparts in the wake of rampant, recent health care reform efforts. This paper will therefore explore the willingness of the national government to delegate policymaking responsibility to state governments in the context of an important aspect of healthcare reform. This, in turn, can be used to assess the distribution of powers between governmental levels--a subject that has received little systematic inquiry to date. Finally, this paper will explore the degree of administrative burden shifting that may likely occur as a result of these changes in health reform and what potential impacts it may have on individual health.

Spousal labor market effects from government health insurance: Evidence from a veterans affairs expansion.

Science.gov (United States)

Boyle, Melissa A; Lahey, Joanna N

2016-01-01

Measuring the total impact of health insurance receipt on household labor supply is important in an era of increased access to publicly provided and subsidized insurance. Although government expansion of health insurance to older workers leads to direct labor supply reductions for recipients, there may be spillover effects on the labor supply of uncovered spouses. While the most basic model predicts a decrease in overall household work hours, financial incentives such as credit constraints, target income levels, and the need for own health insurance suggest that spousal labor supply might increase. In contrast, complementarities of spousal leisure would predict a decrease in labor supply for both spouses. Utilizing a mid-1990s expansion of health insurance for U.S. veterans, we provide evidence on the effects of public insurance availability on the labor supply of spouses. Using data from the Current Population Survey and Health and Retirement Study, we employ a difference-in-differences strategy to compare the labor market behavior of the wives of older male veterans and non-veterans before and after the VA health benefits expansion. Although husbands' labor supply decreases, wives' labor supply increases, suggesting that financial incentives dominate complementarities of spousal leisure. This effect is strongest for wives with lower education levels and lower levels of household wealth and those who were not previously employed full-time. These findings have implications for government programs such as Medicare and Social Security and the Affordable Care Act. Copyright © 2015 Elsevier B.V. All rights reserved.

Rural health prepayment schemes in China: towards a more active role for government.

Science.gov (United States)

Bloom, G; Shenglan, T

1999-04-01

A large majority of China's rural population were members of health prepayment schemes in the 1970's. Most of these schemes collapsed during the transition to a market economy. Some localities subsequently reestablished schemes. In early 1997 a new government policy identified health prepayment as a major potential source of rural health finance. This paper draws on the experience of existing schemes to explore how government can support implementation of this policy. The decision to support the establishment of health prepayment schemes is part of the government's effort to establish new sources of finance for social services. It believes that individuals are more likely to accept voluntary contributions to a prepayment scheme than tax increases. The voluntary nature of the contributions limits the possibilities for risk-sharing and redistribution between rich and poor. This underlines the need for the government to fund a substantial share of health expenditure out of general revenues, particularly in poor localities. The paper notes that many successful prepayment schemes depend on close supervision by local political leaders. It argues that the national programme will have to translate these measures into a regulatory system which defines the responsibilities of scheme management bodies and local governments. A number of prepayment schemes have collapsed because members did not feel they got value for money. Local health bureaux will have to cooperate with prepayment schemes to ensure that health facilities provide good quality services at a reasonable cost. Users' representatives can also monitor performance. The paper concludes that government needs to clarify the relationship between health prepayment schemes and other actors in rural localities in order to increase the chance that schemes will become a major source rural health finance.

The role of urban municipal governments in reducing health inequities: A meta-narrative mapping analysis

Directory of Open Access Journals (Sweden)

Hayes Michael V

2010-05-01

Full Text Available Abstract Background The 1986 Ottawa Charter for Health Promotion coincided with a preponderance of research, worldwide, on the social determinants of health and health inequities. Despite the establishment of a 'health inequities knowledge base', the precise roles for municipal governments in reducing health inequities at the local level remain poorly defined. The objective of this study was to monitor thematic trends in this knowledge base over time, and to track scholarly prescriptions for municipal government intervention on local health inequities. Methods Using meta-narrative mapping, four bodies of scholarly literature - 'health promotion', 'Healthy Cities', 'population health' and 'urban health' - that have made substantial contributions to the health inequities knowledge base were analyzed over the 1986-2006 timeframe. Article abstracts were retrieved from the four literature bodies using three electronic databases (PubMed, Sociological Abstracts, Web of Science, and coded for bibliographic characteristics, article themes and determinants of health profiles, and prescriptions for municipal government interventions on health inequities. Results 1004 journal abstracts pertaining to health inequities were analyzed. The overall quantity of abstracts increased considerably over the 20 year timeframe, and emerged primarily from the 'health promotion' and 'population health' literatures. 'Healthy lifestyles' and 'healthcare' were the most commonly emphasized themes in the abstracts. Only 17% of the abstracts articulated prescriptions for municipal government interventions on local health inequities. Such interventions included public health campaigns, partnering with other governments and non-governmental organizations for health interventions, and delivering effectively on existing responsibilities to improve health outcomes and reduce inequities. Abstracts originating from Europe, and from the 'Healthy Cities' and 'urban health' literatures

Routine health information system utilization and factors associated thereof among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia.

Science.gov (United States)

Shiferaw, Atsede Mazengia; Zegeye, Dessalegn Tegabu; Assefa, Solomon; Yenit, Melaku Kindie

2017-08-07

Using reliable information from routine health information systems over time is an important aid to improving health outcomes, tackling disparities, enhancing efficiency, and encouraging innovation. In Ethiopia, routine health information utilization for enhancing performance is poor among health workers, especially at the peripheral levels of health facilities. Therefore, this study aimed to assess routine health information system utilization and associated factors among health workers at government health institutions in East Gojjam Zone, Northwest Ethiopia. An institution based cross-sectional study was conducted at government health institutions of East Gojjam Zone, Northwest Ethiopia from April to May, 2013. A total of 668 health workers were selected from government health institutions, using the cluster sampling technique. Data collected using a standard structured and self-administered questionnaire and an observational checklist were cleaned, coded, and entered into Epi-info version 3.5.3, and transferred into SPSS version 20 for further statistical analysis. Variables with a p-value of less than 0.05 at multiple logistic regression analysis were considered statistically significant factors for the utilization of routine health information systems. The study revealed that 45.8% of the health workers had a good level of routine health information utilization. HMIS training [AOR = 2.72, 95% CI: 1.60, 4.62], good data analysis skills [AOR = 6.40, 95%CI: 3.93, 10.37], supervision [AOR = 2.60, 95% CI: 1.42, 4.75], regular feedback [AOR = 2.20, 95% CI: 1.38, 3.51], and favorable attitude towards health information utilization [AOR = 2.85, 95% CI: 1.78, 4.54] were found significantly associated with a good level of routine health information utilization. More than half of the health workers working at government health institutions of East Gojjam were poor health information users compared with the findings of others studies. HMIS training, data

Government-to-Government E-Government: A Case Study of a Federal Financial Program

Science.gov (United States)

Faokunla, Olumide Adegboyega

2012-01-01

The problem with the study of the concept of electronic government (e-Gov) is that scholars in the field have not adequately explored various dimensions of the concept. Literature on e-Gov is replete with works on the form of government to consumer e-Gov. Much less work had been done on the government to government (G2G) e-Gov. This qualitative…

The effects of Global Fund financing on health governance in Brazil

Science.gov (United States)

2012-01-01

Objectives The impact of donors, such as national government (bi-lateral), private sector, and individual financial (philanthropic) contributions, on domestic health policies of developing nations has been the subject of scholarly discourse. Little is known, however, about the impact of global financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on policies and health governance of countries receiving funding from such initiatives. Methods This study employs a qualitative methodological design based on a single case study: Brazil. Analysis at national, inter-governmental and community levels is based on in-depth interviews with the Global Fund and the Brazilian Ministry of Health and civil societal activists. Primary research is complemented with information from printed media, reports, journal articles, and books, which were used to deepen our analysis while providing supporting evidence. Results Our analysis suggests that in Brazil, Global Fund financing has helped to positively transform health governance at three tiers of analysis: the national-level, inter-governmental-level, and community-level. At the national-level, Global Fund financing has helped to increased political attention and commitment to relatively neglected diseases, such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-governmental-level, Global Fund financing has motivated the National Tuberculosis Programme to strengthen its ties with state and municipal health departments, and non-governmental organisations (NGOs); while at the community-level, the Global Fund’s financing of civil societal institutions has encouraged the emergence of new civic movements, participation, and the creation of new municipal participatory institutions designed to monitor the disbursement of funds for Global Fund grants. Conclusions Global Fund financing can help deepen health governance at multiple levels. Future work will need to explore how

The effects of Global Fund financing on health governance in Brazil

Directory of Open Access Journals (Sweden)

Gómez Eduardo J

2012-07-01

Full Text Available Abstract Objectives The impact of donors, such as national government (bi-lateral, private sector, and individual financial (philanthropic contributions, on domestic health policies of developing nations has been the subject of scholarly discourse. Little is known, however, about the impact of global financial initiatives, such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria, on policies and health governance of countries receiving funding from such initiatives. Methods This study employs a qualitative methodological design based on a single case study: Brazil. Analysis at national, inter-governmental and community levels is based on in-depth interviews with the Global Fund and the Brazilian Ministry of Health and civil societal activists. Primary research is complemented with information from printed media, reports, journal articles, and books, which were used to deepen our analysis while providing supporting evidence. Results Our analysis suggests that in Brazil, Global Fund financing has helped to positively transform health governance at three tiers of analysis: the national-level, inter-governmental-level, and community-level. At the national-level, Global Fund financing has helped to increased political attention and commitment to relatively neglected diseases, such as tuberculosis, while harmonizing intra-bureaucratic relationships; at the inter-governmental-level, Global Fund financing has motivated the National Tuberculosis Programme to strengthen its ties with state and municipal health departments, and non-governmental organisations (NGOs; while at the community-level, the Global Fund’s financing of civil societal institutions has encouraged the emergence of new civic movements, participation, and the creation of new municipal participatory institutions designed to monitor the disbursement of funds for Global Fund grants. Conclusions Global Fund financing can help deepen health governance at multiple levels. Future work

Increasing health insurance coverage through an extended Federal Employees Health Benefits Program.

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Fuchs, B C

2001-01-01

The Federal Employees Health Benefits Program (FEHBP) could be combined with health insurance tax credits to extend coverage to the uninsured. An extended FEHBP, or "E-FEHBP," would be open to all individuals who were not covered through work or public programs and who also were eligible for the tax credits on the basis of income. E-FEHBP also would be open to employees of very small firms, regardless of their eligibility for tax credits. Most plans available to FEHBP participants would be required to offer enrollment to E-FEHBP participants, although premiums would be rated separately. High-risk individuals would be diverted to a separate high-risk pool, the cost of which would be subsidized by the federal government. E-FEHBP would be administered by the states, or if a state declined, by an entity that contracted with the Office of Personnel Management. While E-FEHBP would provide group insurance to people who otherwise could not get it, premiums could exceed the tax-credit amount and some people still might find the coverage unaffordable.

A meta-level analysis of major trends in environmental health risk governance

NARCIS (Netherlands)

Runhaar, H.A.C.; Driessen, P.P.J.; Bree, L. van; Sluijs, J.P. van der

2010-01-01

Internationally but also within countries, large differences exist regarding how environmental health risks (EHRs) are governed. Despite these differences, at a meta-level some general trends can be discerned that may point to a convergence of EHR governance regimes. One, EHR governance regimes are

Strengthening government health and family planning programs: findings from an action research project in rural Bangladesh.

Science.gov (United States)

Simmons, R; Phillips, J F; Rahman, M

1984-01-01

An ongoing study at the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) is based on the premise that public sector health and family planning programs can be improved through an assessment of the dysfunctional aspects of their operations, the development of problem-solving capabilities, and the transfer of strategies successfully tested in a small-scale pilot project. This paper reports findings from a field trial implemented in a subunit of the project area at an early stage of the project. Operational barriers to public sector program implementation are discussed with regard to the quantity of work, the quality of work, supplies and facilities, integration of health and family planning, and leadership, supervision, and decision making. Initial results of the ICDDR,B intervention on these managerial processes are also indicated.

Challenges and opportunities of integration of community based Management of Acute Malnutrition into the government health system in Bangladesh: a qualitative study.

Science.gov (United States)

Ireen, Santhia; Raihan, Mohammad Jyoti; Choudhury, Nuzhat; Islam, M Munirul; Hossain, Md Iqbal; Islam, Ziaul; Rahman, S M Mustafizur; Ahmed, Tahmeed

2018-04-10

Severe acute malnutrition (SAM) in children is the most serious form of malnutrition and is associated with very high rates of morbidity and mortality. For sustainable SAM management, United Nations recommends integration of community based management of acute malnutrition (CMAM) into the health system. The objective of the study was to assess the preparedness of the health system to implement CMAM in Bangladesh. The assessment was undertaken during January to May 2014 by conducting document review, key informant interviews, and direct observation. A total of 38 key informant interviews were conducted among government policy makers and program managers (n = 4), nutrition experts (n = 2), health and nutrition implementing partners (n = 2), development partner (n = 1), government health system staff (n = 5), government front line field workers (n = 22), and community members (n = 2). The assessment was based on: workforce, service delivery, financing, governance, information system, medical supplies, and the broad socio-political context. The government of Bangladesh has developed inpatient and outpatient guidelines for the management of SAM. There are cadres of community health workers of government and non-government actors who can be adequately trained to conduct CMAM. Inpatient management of SAM is available in 288 facilities across the country. However, only 2.7% doctors and 3.3% auxiliary staff are trained on facility based management of SAM. In functional facilities, uninterrupted supply of medicines and therapeutic diet are not available. There is resistance and disagreement among nutrition stakeholders regarding import or local production of ready-to-use therapeutic food (RUTF). Nutrition coordination is fragile and there is no functional supra-ministerial coordination platform for multi-sectoral and multi-stakeholder nutrition. There is an enabling environment for CMAM intervention in Bangladesh although health system

25 CFR 170.623 - How are IRR Program projects and activities included in a self-governance agreement?

Science.gov (United States)

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false How are IRR Program projects and activities included in a self-governance agreement? 170.623 Section 170.623 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE... self-governance agreement? To include an IRR Program project or activity in a self-governance agreement...

Analisis Kepatuhan Supervisor Terhadap Implementasi Program Occupational Health & Safety (Ohs) Planned Inspection Di PT. Ccai

OpenAIRE

Sarah, Dewi; Ekawati, Ekawati; Widjasena, Baju

2015-01-01

The Government has issued Regulation Legislation No. 50 Year 2012 on Health and Safety Management System (SMK3). CCAI is a company that has implemented SMK3. The application of the CCAI SMK3 supported by K3 program one of them is OHS Planned Inspection. This study aimed to analyze the implementation of Occupational Health & Safety (OHS) program Planned Inspection in CCAI. The subjects of this study amounted to five people as the main informants and 2 as an informant triangulation. The res...

Role of government in public health: Current scenario in India and future scope

Directory of Open Access Journals (Sweden)

Subitha Lakshminarayanan

2011-01-01

Full Text Available The new agenda for Public Health in India includes the epidemiological transition, demographical transition, environmental changes and social determinants of health. Based on the principles outlined at Alma-Ata in 1978, there is an urgent call for revitalizing primary health care in order to meet these challenges. The role of the government in influencing population health is not limited within the health sector but also by various sectors outside the health systems. This article is a literature review of the existing government machinery for public health needs in India, its success, limitations and future scope. Health system strengthening, human resource development and capacity building and regulation in public health are important areas within the health sector. Contribution to health of a population also derives from social determinants of health like living conditions, nutrition, safe drinking water, sanitation, education, early child development and social security measures. Population stabilization, gender mainstreaming and empowerment, reducing the impact of climate change and disasters on health, improving community participation and governance issues are other important areas for action. Making public health a shared value across the various sectors is a politically challenging strategy, but such collective action is crucial.

Governance and assessment in a widely distributed medical education program in Australia.

Science.gov (United States)

Solarsh, Geoff; Lindley, Jennifer; Whyte, Gordon; Fahey, Michael; Walker, Amanda

2012-06-01

The learning objectives, curriculum content, and assessment standards for distributed medical education programs must be aligned across the health care systems and community contexts in which their students train. In this article, the authors describe their experiences at Monash University implementing a distributed medical education program at metropolitan, regional, and rural Australian sites and an offshore Malaysian site, using four different implementation models. Standardizing learning objectives, curriculum content, and assessment standards across all sites while allowing for site-specific implementation models created challenges for educational alignment. At the same time, this diversity created opportunities to customize the curriculum to fit a variety of settings and for innovations that have enriched the educational system as a whole.Developing these distributed medical education programs required a detailed review of Monash's learning objectives and curriculum content and their relevance to the four different sites. It also required a review of assessment methods to ensure an identical and equitable system of assessment for students at all sites. It additionally demanded changes to the systems of governance and the management of the educational program away from a centrally constructed and mandated curriculum to more collaborative approaches to curriculum design and implementation involving discipline leaders at multiple sites.Distributed medical education programs, like that at Monash, in which cohorts of students undertake the same curriculum in different contexts, provide potentially powerful research platforms to compare different pedagogical approaches to medical education and the impact of context on learning outcomes.

Trust in government and support for governmental regulation: the case of electronic health records.

Science.gov (United States)

Herian, Mitchel N; Shank, Nancy C; Abdel-Monem, Tarik L

2014-12-01

This paper presents results from a public engagement effort in Nebraska, USA, which measured public opinions about governmental involvement in encouraging the use of electronic health records (EHRs). We examine the role of trust in government in contributing to public support for government involvement in the development of EHR technologies. We hypothesize that trust in government will lead to support for federal and state governmental encouragement of the use of EHRs among doctors and insurance companies. Further, because individual experiences with health-care professionals will reduce perceptions of risk, we expect that support for governmental involvement will be tempered by greater personal experience with the health-care industry. Examining a small survey of individuals on the issue, we find general support for both of our hypotheses. The findings suggest that trust in government does have a positive relationship with support for government involvement in the policy domain, but that the frequency of personal experiences with health-care providers reduces the extent to which the public supports governmental involvement in the development of EHR technology. This inquiry contributes to our understanding of public attitudes towards government involvement in EHRs in the United States specifically and contributes to social science examining links between trust in government and support for governmental activity in the emerging policy domain regarding electronic health records systems. © 2012 John Wiley & Sons Ltd.

Women Health Outreach Program; a New Experience for all Egyptian Women

International Nuclear Information System (INIS)

SALEM, D.S.; KAMAL, R.M.; HELAL, M.H.

2008-01-01

The global health community faces a challenge with breast cancer being the most common cause of cancer related death among women around the globe. Since breast cancer’s pathogenesis is poorly understood, primary prevention is still a distant goal. Thus secondary prevention through early detection is the only feasible approach at present. With this strong conviction, the launching o f the first Egyptian national screening program W omen Health Outreach Program ( WHOP), was announced on October 30 th 2007. This project is a government- funded program that offers free breast screening for all Egyptian women above the age of 45 years. In addition to free mammograms, the program gives the participants a chance to be screened for diabetes, hypertension and obesity as well. Positively detected cases are also offered the option of free management. During the period from October 30 th , 2007, up to February 9 th , 2009, 20, 098 women in Cairo, Alexandria and Suez governorates were screened for breast cancer, diabetes, hypertension and obesity through the program. In this article we will represent the achievements, challenges and services delivered by WHOP

Strategic governance: Addressing neonatal mortality in situations of political instability and weak governance.

Science.gov (United States)

Wise, Paul H; Darmstadt, Gary L

2015-08-01

Neonatal mortality is increasingly concentrated globally in situations of conflict and political instability. In 1991, countries with high levels of political instability accounted for approximately 10% of all neonatal deaths worldwide; in 2013, this figure had grown to 31%. This has generated a "grand divergence" between those countries showing progress in neonatal mortality reduction compared to those lagging behind. We present new analyses demonstrating associations of neonatal mortality with political instability (r = 0.55) and poor governance (r = 0.70). However, heterogeneity in these relationships suggests that progress is possible in addressing neonatal mortality even in the midst of political instability and poor governance. In order to address neonatal mortality more effectively in such situations, we must better understand how specific elements of "strategic governance"--the minimal conditions of political stability and governance required for health service implementation--can be leveraged for successful introduction of specific health services. Thus, a more strategic approach to policy and program implementation in situations of conflict and political instability could lead to major accelerations in neonatal mortality reduction globally. However, this will require new cross-disciplinary collaborations among public health professionals, political scientists, and country actors. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

Governance through Economic Paradigms: Addressing Climate Change by Accounting for Health

Directory of Open Access Journals (Sweden)

Kristine Belesova

2016-12-01

Full Text Available Climate change is a major challenge for sustainable development, impacting human health, wellbeing, security, and livelihoods. While the post-2015 development agenda sets out action on climate change as one of the Sustainable Development Goals, there is little provision on how this can be achieved in tandem with the desired economic progress and the required improvements in health and wellbeing. This paper examines synergies and tensions between the goals addressing climate change and economic progress. We identify reductionist approaches in economics, such as ‘externalities’, reliance on the metric of the Gross Domestic Product, positive discount rates, and short-term profit targets as some of the key sources of tensions between these goals. Such reductionist approaches could be addressed by intersectoral governance mechanisms. Health in All Policies, health-sensitive macro-economic progress indicators, and accounting for long-term and non-monetary values are some of the approaches that could be adapted and used in governance for the SDGs. Policy framing of climate change and similar issues should facilitate development of intersectoral governance approaches.

PROGRAM APRESIASI BAGI PEMERINTAH DAERAH (PEMDA DALAM MELAKSANAKAN TATA KELOLA (GOOD GOVERNANCE GUNA MEMAJUKAN KEPARIWISATAAN DI DAERAH

Directory of Open Access Journals (Sweden)

Ismayanti Ismayanti

2015-09-01

Full Text Available The success of region is largely determined by the commitment of the local government in the development of tourism. Good governance will certainly provide prosperity for the community. This first year multi-disciplinary research has a purpose: to design blueprint appreciation program for local governments that are committed in developing regions of Tourism through good governance and delivering award of appreciation to the government. This study examines several aspects of appreciation  through commitment identification and governance survey using analytical methods of AHP. Tourism appreciation blueprint is implemented with program testing. The results achieved is the publication and implementation of the blueprint of appreciation in cooperation with the Eljohn Publishing through Travel Club Tourism Award 2012 from the magazine Travel Club. The results is 40 nominees from the provincial governments, district and city governments. From the nominees, it is determined the winner of the provincial government consisting of 3 province, 9 city and 13 district government. Positive implications occurs after administration of appreciation and local prideness increases when each winner received awars and regional leaders gave speech in front of live audience and broadcasting live all over Indonesia. Besides these, dignity of each government showed in local and national publications in the electronic media and print media. Of these positive implications, it is recommended to conduct a similar program on a regular basis and measured the impact of the annual tribute to the development of tourism in the area so that the program becomes one measure the progress of regional tourismDOI: 10.15408/ess.v4i1.1962

Identifying state resources and support programs on e-government websites for persons with intellectual and developmental disabilities.

Science.gov (United States)

Fisher, Kathleen M; Peterson, Justin D; Albert, Jon D

2015-01-01

This descriptive cross-sectional study identified resources and programs that are available nationwide on the Internet to support individuals and families with intellectual and developmental disabilities (I/DD), with a focus on intellectual disability. This evaluation included easily identifiable information on specific resources and highlighted unique programs found in individual states that were linked from e-government websites. Researchers documented the ease of access and available information for all 50 states and the District of Columbia. A number of disparities and areas for improvement were recorded for states and I/DD websites. The researchers conclude that a number of additional health and support services will be needed to address the growing needs of this vulnerable population.

Politics, Programs, and Local Governments: The Case of Community Colleges.

Science.gov (United States)

Bers, Trudy Haffron

1980-01-01

Focuses on two aspects of governance and policy: the electoral process by which community college trustees are selected and the responsiveness of colleges to their communities as manifested by their programs. Available from Journal of Politics, University of Florida, Gainesville, FL 32611. (Author/IRT)

China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries

Science.gov (United States)

Tambo, Ernest; Ugwu, Chidiebere E.; Guan, Yayi; Wei, Ding; Xiao-Ning; Xiao-Nong, Zhou

2016-01-01

Background and Introduction: This review paper examines the growing implications of China’s engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. Methods: We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Results: Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China’s significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Conclusions and Global Health Implications: Strengthening China-Africa health development agenda towards collective commitment and investment

77 FR 47405 - Funding Opportunity: Tribal Self-Governance Program; Negotiation Cooperative Agreement

Science.gov (United States)

2012-08-08

... first and then access the CCR online registration through the CCR home page at https://www.bpn.gov/ccr... Agreement Catalog of Federal Domestic Assistance Number: 93.444. Announcement Type: New--Limited Competition... Self-Governance Program (TSGP). This program is authorized under Public Law (Pub. L.) 106-260, the...

Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition.

Science.gov (United States)

Busse, Reinhard; Blümel, Miriam; Knieps, Franz; Bärnighausen, Till

2017-08-26

Bismarck's Health Insurance Act of 1883 established the first social health insurance system in the world. The German statutory health insurance system was built on the defining principles of solidarity and self-governance, and these principles have remained at the core of its continuous development for 135 years. A gradual expansion of population and benefits coverage has led to what is, in 2017, universal health coverage with a generous benefits package. Self-governance was initially applied mainly to the payers (the sickness funds) but was extended in 1913 to cover relations between sickness funds and doctors, which in turn led to the right for insured individuals to freely choose their health-care providers. In 1993, the freedom to choose one's sickness fund was formally introduced, and reforms that encourage competition and a strengthened market orientation have gradually gained importance in the past 25 years; these reforms were designed and implemented to protect the principles of solidarity and self-governance. In 2004, self-governance was strengthened through the establishment of the Federal Joint Committee, a major payer-provider structure given the task of defining uniform rules for access to and distribution of health care, benefits coverage, coordination of care across sectors, quality, and efficiency. Under the oversight of the Federal Joint Committee, payer and provider associations have ensured good access to high-quality health care without substantial shortages or waiting times. Self-governance has, however, led to an oversupply of pharmaceutical products, an excess in the number of inpatient cases and hospital stays, and problems with delivering continuity of care across sectoral boundaries. The German health insurance system is not as cost-effective as in some of Germany's neighbouring countries, which, given present expenditure levels, indicates a need to improve efficiency and value for patients. Copyright © 2017 Elsevier Ltd. All rights

Governance and Justice | IDRC - International Development ...

International Development Research Centre (IDRC) Digital Library (Canada)

This program fosters better governance and justice systems so people can lead ... A man peers through a hole in a wall that separates Tijuana, Mexico, from the United States. ... Denial of health care or an education is unthinkable for most.

Health data research in New Zealand: updating the ethical governance framework.

Science.gov (United States)

Ballantyne, Angela; Style, Rochelle

2017-10-27

Demand for health data for secondary research is increasing, both in New Zealand and worldwide. The New Zealand government has established a large research database, the Integrated Data Infrastructure (IDI), which facilitates research, and an independent ministerial advisory group, the Data Futures Partnership (DFP), to engage with citizens, the private sector and non-government organisations (NGOs) to facilitate trusted data use and strengthen the data ecosystem in New Zealand. We commend these steps but argue that key strategies for effective health-data governance remain absent in New Zealand. In particular, we argue in favour of the establishment of: (1) a specialist Health and Disability Ethics Committee (HDEC) to review applications for secondary-use data research; (2) a public registry of approved secondary-use research projects (similar to a clinical trials registry); and (3) detailed guidelines for the review and approval of secondary-use data research. We present an ethical framework based on the values of public interest, trust and transparency to justify these innovations.

Canadian governance of health research involving human subjects: is anybody minding the store?

Science.gov (United States)

McDonald, M

2001-01-01

From an ethical perspective, good governance involves the translation of collective moral intentions into effective and accountable institutional actions. With respect to the use of human subjects in Canadian health research, I contend that there have been many good intentions but very little in the way of appropriate governance arrangements. Hence, the question, "who minds the store?" is especially acute with respect to the protection of vulnerable individuals and groups that are typically recruited as subjects for health research in Canada. Beyond diagnosing failures in governance and their causes, I offer suggestions for significant reforms, including evidence-based ethics assessment, independent oversight, and greater participation of research subjects in governance. I will close with some more general reflections on ethics, law, and governance.

A Policy Review on The Distribution of Health Operational Aid Funds in Achieving Maternal and Child Health Program (MDGs 4, 5 in Three Districts/Cities of East Java Province

Directory of Open Access Journals (Sweden)

Niniek Lely Pratiwi

2015-06-01

Full Text Available Background: Health Policy Regulation Number 494/Menkes/SK/IV/2010 on the distribution of BOK funds to local government is one of the government’s responsibility for the development of public health in improving health promotion and prevention efforts in order to accelerate the achievement of MDGs in Health. The purpose of the study is to provide policy recommendations regarding to BOK in achieving the goals of maternal and child health programs. Methods: Secondary data review of the district health profile in 2009-2011 and analysis on the primary data collected from focus group discussion (FGD with invited technical implementor from district health office and health centers as well as some of the staffs of the local government that handle BOK. Results: The decline in maternal and infant mortality rates are still slow and cases of malnutrition increased from the three profile data review Sampang, Gresik and Sidoarjo. Local governments pay little commitment in developing priority strategies of maternal and child health programs in the form of a local action and innovation plan. BOK preventive promotive activities are lacking of monitoring and accountability controls, especially in health centers located far from the district center. Financial accountability is less precise to the programs and targetes, having seen the data of maternal and child health outcomes KN1-KN4 coverage which rose in 2010, but then fell back in 2011. Conclusion: Evaluation and monitoring are needed on the utilization of BOK funds, supervising the activities by the district/city health office, as well as by local community leaders. Prioritise monitoring the health centers in the area with high MMR and IMR. Suggestion: Needed routine and periodic mentoring and coaching in the form of technical assistance related to the utilization of BOK.

China-Africa Health Development Initiatives: Benefits and Implications for Shaping Innovative and Evidence-informed National Health Policies and Programs in Sub-saharan African Countries.

Science.gov (United States)

Tambo, Ernest; Ugwu, Chidiebere E; Guan, Yayi; Wei, Ding; Xiao-Ning; Xiao-Nong, Zhou

2016-01-01

This review paper examines the growing implications of China's engagement in shaping innovative national initiatives against infectious diseases and poverty control and elimination in African countries. It seeks to understand the factors and enhancers that can promote mutual and innovative health development initiatives, and those that are necessary in generating reliable and quality data for evidence-based contextual policy, priorities and programs. We examined the China-Africa health cooperation in supporting global health agenda on infectious diseases such as malaria, schistosomiasis, Ebola, TB, HIV/AIDS, neglected tropical diseases (NTDs) prevention, control and elimination spanning a period of 10 years. We reviewed referenced publications, global support data, and extensive sources related to and other emerging epidemics and infectious diseases of poverty, programs and interventions, health systems development issues, challenges, opportunities and investments. Published literature in PubMed, Scopus, Google Scholar, Books and web-based peer-reviewed journal articles, government annual reports were assessed from the first Forum on China-Africa Cooperation (FOCAC) in November 2006 to December 2015 Third Ministerial conferences. Our findings highlight current shared public health challenges and emphasize the need to nurture, develop and establish effective, functional and sustainable health systems capacity to detect and respond to all public health threats and epidemic burdens, evidence-based programs and quality care outcomes. China's significant health diplomacy emphasizes the importance of health financing in establishing health development commitment and investment in improving the gains and opportunities, importantly efficiency and value health priorities and planning. Strengthening China-Africa health development agenda towards collective commitment and investment in quality care delivery, effective programs coverage and efficiency, preparedness and

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

Science.gov (United States)

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.

77 FR 47399 - Funding Opportunity: Tribal Self-Governance Program; Planning Cooperative Agreement

Science.gov (United States)

2012-08-08

... first and then access the CCR online registration through the CCR home page at https://www.bpn.gov/ccr... Catalog of Federal Domestic Assistance Number: 93.444. Announcement Type: New--Limited Competition. Key...-Governance Program (TSGP). This program is authorized under Public Law (Pub. L.) 106-260, the Tribal Self...

Global health initiatives in Africa - governance, priorities, harmonisation and alignment.

Science.gov (United States)

Mwisongo, Aziza; Nabyonga-Orem, Juliet

2016-07-18

The advent of global health initiatives (GHIs) has changed the landscape and architecture of health financing in low and middle income countries, particularly in Africa. Over the last decade, the African Region has realised improvements in health outcomes as a result of interventions implemented by both governments and development partners. However, alignment and harmonisation of partnerships and GHIs are still difficult in the African countries with inadequate capacity for their effective coordination. Both published and grey literature was reviewed to understand the governance, priorities, harmonisation and alignment of GHIs in the African Region; to synthesise the knowledge and highlight the persistent challenges; and to identify gaps for future research. GHI governance structures are often separate from those of the countries in which they operate. Their divergent funding channels and modalities may have contributed to the failure of governments to track their resources. There is also evidence that basically, earmarking and donor conditions drive funding allocations regardless of countries' priorities. Although studies cite the lack of harmonisation of GHI priorities with national strategies, evidence shows improvements in that area over time. GHIs have used several strategies and mechanisms to involve the private sector. These have widened the pool of health service policy-makers and providers to include groups such as civil society organisations (CSOs), with both positive and negative implications. GHI strategies such as co-financing by countries as a condition for support have been positive in achieving sustainability of interventions. GHI approaches have not changed substantially over the years but there has been evolution in terms of donor funding and conditions. GHIs still largely operate in a vertical manner, bypassing country systems; they compete for the limited human resources; they influence country policies; and they are not always harmonised with

Why do some countries spend more for health? An assessment of sociopolitical determinants and international aid for government health expenditures.

Science.gov (United States)

Liang, Li-Lin; Mirelman, Andrew J

2014-08-01

A consensus exists that rising income levels and technological development are among key drivers of total health spending. Determinants of public sector health expenditure, by contrast, are less well understood. This study examines a complex relationship across government health expenditure (GHE), sociopolitical risks, and international aid, while taking into account the impacts of national income, debt and tax financing and aging populations on health spending. We apply a fixed-effects two-stage least squares regression method to a panel dataset comprising 120 countries for the years 1995 through 2010. Our results show that democratic accountability has a diminishing positive correlation with GHE, and that levels of GHE are higher when government is more stable. Corruption is associated with less GHE in developing countries, but with higher GHE in developed countries. We also find that development assistance for health (DAH) is fungible with domestically financed government health expenditure (DGHE). For an average country, a 1% increase in DAH to government is associated with a 0.03-0.04% decrease in DGHE. Furthermore, the degree of fungibility of DAH to government is higher in countries where corruption or ethnic tensions are widespread. However, DAH to non-governmental organizations is not fungible with DGHE. Copyright © 2014 Elsevier Ltd. All rights reserved.

41 CFR 300-80.4 - How many test programs may be authorized by GSA throughout the government?

Science.gov (United States)

2010-07-01

... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false How many test programs may be authorized by GSA throughout the government? 300-80.4 Section 300-80.4 Public Contracts and... TEST PROGRAMS § 300-80.4 How many test programs may be authorized by GSA throughout the government? No...

The multiple meanings of global health governance: a call for conceptual clarity.

Science.gov (United States)

Lee, Kelley; Kamradt-Scott, Adam

2014-04-28

The term global health governance (GHG) is now widely used, with over one thousand works published in the scholarly literature, almost all since 2002. Amid this rapid growth there is considerable variation in how the term is defined and applied, generating confusion as to the boundaries of the subject, the perceived problems in practice, and the goals to be achieved through institutional reform. This paper is based on the results of a separate scoping study of peer reviewed GHG research from 1990 onwards which undertook keyword searches of public health and social science databases. Additional works, notably books, book chapters and scholarly articles, not currently indexed, were identified through Web of Science citation searches. After removing duplicates, book reviews, commentaries and editorials, we reviewed the remaining 250 scholarly works in terms of how the concept of GHG is applied. More specifically, we identify what is claimed as constituting GHG, how it is problematised, the institutional features of GHG, and what forms and functions are deemed ideal. After examining the broader notion of global governance and increasingly ubiquitous term "global health", the paper identifies three ontological variations in GHG scholarship - the scope of institutional arrangements, strengths and weaknesses of existing institutions, and the ideal form and function of GHG. This has produced three common, yet distinct, meanings of GHG that have emerged - globalisation and health governance, global governance and health, and governance for global health. There is a need to clarify ontological and definitional distinctions in GHG scholarship and practice, and be critically reflexive of their normative underpinnings. This will enable greater precision in describing existing institutional arrangements, as well as serve as a prerequisite for a fuller debate about the desired nature of GHG.

Health research and systems' governance are at risk: should the right to data protection override health?

Science.gov (United States)

Di Iorio, C T; Carinci, F; Oderkirk, J

2014-07-01

The European Union (EU) Data Protection Regulation will have profound implications for public health, health services research and statistics in Europe. The EU Commission's Proposal was a breakthrough in balancing privacy rights and rights to health and healthcare. The European Parliament, however, has proposed extensive amendments. This paper reviews the amendments proposed by the European Parliament Committee on Civil Liberties, Justice and Home Affairs and their implications for health research and statistics. The amendments eliminate most innovations brought by the Proposal. Notably, derogation to the general prohibition of processing sensitive data shall be allowed for public interests such as the management of healthcare services,but not health research, monitoring, surveillance and governance. The processing of personal health data for historical, statistical or scientific purposes shall be allowed only with the consent of the data subject or if the processing serves an exceptionally high public interest, cannot be performed otherwise and is legally authorised. Research, be it academic, government,corporate or market research, falls under the same rule.The proposed amendments will make difficult or render impossible research and statistics involving the linkage and analysis of the wealth of data from clinical,administrative, insurance and survey sources, which have contributed to improving health outcomes and health systems performance and governance; and may illegitimise efforts that have been made in some European countries to enable privacy-respectful data use for research and statistical purposes. If the amendments stand as written, the right to privacy is likely to override the right to health and healthcare in Europe.

The Syrian public health and humanitarian crisis: A 'displacement' in global governance?

Science.gov (United States)

Akbarzada, Sumaira; Mackey, Tim K

2018-07-01

Ongoing failure by the international community to resolve the Syrian conflict has led to destruction of critical infrastructure. This includes the collapse of the Syrian health system, leaving millions of internally displaced persons (IDPs) in urgent need of healthcare services. As the conflict intensifies, IDP populations are suffering from infectious and non-communicable disease risks, poor maternal and child health outcomes, trauma, and mental health issues, while healthcare workers continually exit the country. Healthcare workers who remain face significant challenges, including systematic attacks on healthcare facilities and conditions that severely inhibit healthcare delivery and assistance. Within this conflict-driven public health crisis, the most susceptible population is arguably the IDP. Though the fundamental 'right to health' is a recognised international legal principle, its application is inadequate due to limited recognition by the UN Security Council and stymied global governance by the broader international community. These factors have also negatively impacted other vulnerable groups other than IDPs, such as refugees and ethnic minorities, who may or may not be displaced. Hence, this article reviews the current Syrian conflict, assesses challenges with local and global governance for IDPs, and explores potential governance solutions needed to address this health and humanitarian crisis.

Good collaborative practice: reforming capacity building governance of international health research partnerships.

Science.gov (United States)

Ward, Claire Leonie; Shaw, David; Sprumont, Dominique; Sankoh, Osman; Tanner, Marcel; Elger, Bernice

2018-01-08

In line with the policy objectives of the United Nations Sustainable Development Goals, this commentary seeks to examine the extent to which provisions of international health research guidance promote capacity building and equitable partnerships in global health research. Our evaluation finds that governance of collaborative research partnerships, and in particular capacity building, in resource-constrained settings is limited but has improved with the implementation guidance of the International Ethical Guidelines for Health-related Research Involving Humans by The Council for International Organizations of Medical Sciences (CIOMS) (2016). However, more clarity is needed in national legislation, industry and ethics guidelines, and regulatory provisions to address the structural inequities and power imbalances inherent in international health research partnerships. Most notably, ethical partnership governance is not supported by the principal industry ethics guidelines - the International Conference on Harmonization Technical Requirements for Registration of Pharmaceutical for Human Use (ICH) Good Clinical Practice (ICH-GCP). Given the strategic value of ICH-GCP guidelines in defining the role and responsibility of global health research partners, we conclude that such governance should stipulate the minimal requirements for creating an equitable environment of inclusion, mutual learning, transparency and accountability. Procedurally, this can be supported by i) shared research agenda setting with local leadership, ii) capacity assessments, and iii) construction of a memorandum of understanding (MoU). Moreover, the requirement of capacity building needs to be coordinated amongst partners to support good collaborative practice and deliver on the public health goals of the research enterprise; improving local conditions of health and reducing global health inequality. In this respect, and in order to develop consistency between sources of research governance, ICH

Government regulation of forestry practices on private forest land in the United States: an assessment of state government responsibilities and program performance

Science.gov (United States)

Paul V. Ellefson; Michael A. Kilgore; James E. Granskog

2006-01-01

In 2003, a comprehensive assessment of state government, forest practice regulatory programs in the United States was undertaken. Involved was an extensive review of the literature and information gathering h m program administration in all 50 states. The assessment determined that regulatory programs focus on a wide range of forestry practices applied to private...

Trade policy governance: What health policymakers and advocates need to know.

Science.gov (United States)

Jarman, Holly

2017-11-01

Trade policies affect determinants of health as well as the options and resources available to health policymakers. There is therefore a need for health policymakers and related stakeholders in all contexts to understand and connect with the trade policymaking process. This paper uses the TAPIC (transparency, accountability, participation, integrity, capacity) governance framework to analyze how trade policy is commonly governed. I conclude that the health sector is likely to benefit when transparency in trade policymaking is increased, since trade negotiations to date have often left out health advocates and policymakers. Trade policymakers and negotiators also tend to be accountable to economic and trade ministries, which are in turn accountable to economic and business interests. Neither tend to appreciate the health consequences of trade and trade policies. Greater accountability to health ministries and interests, and greater participation by them, could improve the health effects of trade negotiations. Trade policies are complex, requiring considerable policy capacity to understand and influence. Nevertheless, investing in understanding trade can pay off in terms of managing future legal risks. Copyright © 2017. Published by Elsevier B.V.

International obligations through collective rights: Moving from foreign health assistance to global health governance.

Science.gov (United States)

Meier, Benjamin Mason; Fox, Ashley M

2010-06-15

This article analyzes the growing chasm between international power and state responsibility in health rights, proposing an international legal framework for collective rights - rights that can reform international institutions and empower developing states to realize the determinants of health structured by global forces. With longstanding recognition that many developing state governments cannot realize the health of their peoples without international cooperation, scholars have increasingly sought to codify international obligations under the purview of an evolving human right to health, applying this rights-based approach as a foundational framework for reducing global health inequalities through foreign assistance. Yet the inherent limitations of the individual human rights framework stymie the right to health in impacting the global institutions that are most crucial for realizing underlying determinants of health through the strengthening of primary health care systems. Whereas the right to health has been advanced as an individual right to be realized by a state duty-bearer, the authors find that this limited, atomized right has proven insufficient to create accountability for international obligations in global health policy, enabling the deterioration of primary health care systems that lack the ability to address an expanding set of public health claims. For rights scholars to advance disease protection and health promotion through national primary health care systems - creating the international legal obligations necessary to spur development supportive of the public's health - the authors conclude that scholars must look beyond the individual right to health to create collective international legal obligations commensurate with a public health-centered approach to primary health care. Through the development and implementation of these collective health rights, states can address interconnected determinants of health within and across countries

Assessment of the relationship of government spending on social assistance programs with Brazilian macroeconomic variables

Science.gov (United States)

de Senna, Viviane; Souza, Adriano Mendonça

2016-11-01

Since the 1988 Federal Constitution social assistance has become a duty of the State and a right to everyone, guaranteeing the population a dignified life. To ensure these rights federal government has created programs that can supply the main needs of people in extreme poverty. Among the programs that provide social assistance to the population, the best known are the ;Bolsa Família; Program - PBF and the Continuous Cash Benefit - Continuous Cash Benefit - BPC. This research's main purpose is to analyze the relationship between the main macroeconomic variables and the Federal government spending on social welfare policy in the period from January 2004 to August 2014. The used methodologies are the Vector auto regression model - VAR and Error Correction Vector - VEC. The conclusion, was that there is a meaningful relationship between macroeconomic variables and social assistance programs. This indicates that if the government takes a more abrupt resolution in changing the existing programs it will result in fluctuations in the main macroeconomic variables interfering with the stability of Brazilian domestic economy up to twelve months.

Experiences with recruitment of marginalized groups in a Danish health promotion program

DEFF Research Database (Denmark)

Rasmussen, Marianne; Poulsen, Eva Kanstrup; Rytter, Anne Stoffersen

2016-01-01

neighborhoods across Denmark between 2010 and 2014. The aim of this study was to understand how recruitment approaches could promote participation in health programs within deprived neighborhoods to reach marginalized groups. METHOD: Documents from all 12 of the included municipalities were collected to conduct......BACKGROUND: Studies have found that marginalized groups living in deprived neighborhoods are less likely to participate in health programs compared to the majority of society. This study evaluates recruitment approaches conducted during a national government-funded project in 12 deprived...... have developed evaluations related to recruitment, and only three evaluations provided a description of which marginalized groups were recruited. Challenges related to recruitment consist of difficulties involving the target group, including general distrust, language barriers and a lack of ability...

Responsibility without legal authority? Tackling alcohol-related health harms through licensing and planning policy in local government.

Science.gov (United States)

Martineau, F P; Graff, H; Mitchell, C; Lock, K

2014-09-01

The power to influence many social determinants of health lies within local government sectors that are outside public health's traditional remit. We analyse the challenges of achieving health gains through local government alcohol control policies, where legal and professional practice frameworks appear to conflict with public health action. Current legislation governing local alcohol control in England and Wales is reviewed and analysed for barriers and opportunities to implement effective population-level health interventions. Case studies of local government alcohol control practices are described. Addressing alcohol-related health harms is constrained by the absence of a specific legal health licensing objective and differences between public health and legal assessments of the relevance of health evidence to a specific place. Local governments can, however, implement health-relevant policies by developing local evidence for alcohol-related health harms; addressing cumulative impact in licensing policy statements and through other non-legislative approaches such as health and non-health sector partnerships. Innovative local initiatives-for example, minimum unit pricing licensing conditions-can serve as test cases for wider national implementation. By combining the powers available to the many local government sectors involved in alcohol control, alcohol-related health and social harms can be tackled through existing local mechanisms. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health.

Strengthening stakeholder involvement in health workforce governance: why we need to talk about power.

Science.gov (United States)

Kuhlmann, Ellen; Burau, Viola

2018-01-01

There is now widespread agreement on the benefits of an integrated, people-centred health workforce, but the implementation of new models is difficult. We argue that we need to think about stakeholders and power, if we want to ensure change in the health workforce. We discuss these issues from a governance perspective and suggest a critical approach to stakeholder involvement as an indicator of good governance. Three models of involving stakeholders in health workforce governance can be identified: corporatist professional involvement either in a continental European model of conservative corporatism or in a Nordic model of public corporatism; managerialist and market-centred involvement of professions as organizational agents; and a more inclusive, network-based involvement of plural professional experts at different levels of governance. The power relations embedded in these models of stakeholder involvement have different effects on capacity building for an integrated health workforce.

The place of health and the health of place: dengue fever and urban governance in Putrajaya, Malaysia.

Science.gov (United States)

Mulligan, K; Elliott, S J; Schuster-Wallace, C

2012-05-01

This case study investigates the connections among urban planning, governance and dengue fever in an emerging market context in the Global South. Key informant interviews were conducted with leading figures in public health, urban planning and governance in the planned city of Putrajaya, Malaysia. Drawing on theories of urban political ecology and ecosocial epidemiology, the qualitative study found the health of place - expressed as dengue-bearing mosquitoes and dengue fever in human bodies in the urban environment - was influenced by the place of health in a hierarchy of urban priorities. Copyright © 2012 Elsevier Ltd. All rights reserved.

Final report of the National Health and Hospitals Reform Commission: will we get the health care governance reform we need?

Science.gov (United States)

Stoelwinder, Johannes U

2009-10-05

The National Health and Hospitals Reform Commission (NHHRC) has recommended that Australia develop a "single health system", governed by the federal government. Steps to achieving this include: a "Healthy Australia Accord" to agree on the reform framework; the progressive takeover of funding of public hospitals by the federal government; and the possible implementation of a consumer-choice health funding model, called "Medicare Select". These proposals face significant implementation issues, and the final solution needs to deal with both financial and political sustainability. If the federal and state governments cannot agree on a reform plan, the Prime Minister may need to go to the electorate for a mandate, which may be shaped by other economic issues such as tax reform and intergenerational challenges.

Health Insurance for Government Employees in Bangladesh: A Concept Paper

OpenAIRE

Hamid, Syed Abdul

2014-01-01

Introducing compulsory health insurance for government employees bears immense importance for stepping towards universal healthcare coverage in Bangladesh. Lack of scientific study on designing such scheme, in the Bangladesh context, motivates this paper. The study aims at designing a comprehensive insurance package simultaneously covering health, life and accident related disability risks of the public employees, where the health component would extend to all dependent family members. ...

Health system governance in Tanzania : impact on service delivery in the public sector

OpenAIRE

Mikkelsen-Lopez, Inez K.

2014-01-01

Governance in the health system has perhaps been the least explored building block of the health system, receiving less attention due to its vague definition and complex nature. When discussed at the country level it often focuses on single elements such as corruption or accountability and doesn’t consider wider interactions of relevance to how policies are formed. How well governed a health system is can often mean the difference between the efficient use of resources and inefficient waste, ...

Do reimbursement recommendation processes used by government drug plans in Canada adhere to good governance principles?

Directory of Open Access Journals (Sweden)

Rawson NS

2017-11-01

Full Text Available Nigel SB Rawson,1–3 John Adams4 1Eastlake Research Group, Oakville, ON, 2Canadian Health Policy Institute, Toronto, ON, 3Fraser Institute, Vancouver, BC, 4Canadian PKU and Allied Disorders Inc., Toronto, ON, Canada Abstract: In democratic societies, good governance is the key to assuring the confidence of stakeholders and other citizens in how governments and organizations interact with and relate to them and how decisions are taken. Although defining good governance can be debatable, the United Nations Development Program (UNDP set of principles is commonly used. The reimbursement recommendation processes of the Canadian Agency for Drugs and Technologies in Health (CADTH, which carries out assessments for all public drug plans outside Quebec, are examined in the light of the UNDP governance principles and compared with the National Institute for Health and Care Excellence system in England. The adherence of CADTH's processes to the principles of accountability, transparency, participatory, equity, responsiveness and consensus is poor, especially when compared with the English system, due in part to CADTH's lack of genuine independence. CADTH's overriding responsibility is toward the governments that "own," fund and manage it, while the agency’s status as a not-for-profit corporation under federal law protects it from standard government forms of accountability. The recent integration of CADTH’s reimbursement recommendation processes with the provincial public drug plans’ collective system for price negotiation with pharmaceutical companies reinforces CADTH's role as a nonindependent partner in the pursuit of governments’ cost-containment objectives, which should not be part of its function. Canadians need a national organization for evaluating drugs for reimbursement in the public interest that fully embraces the principles of good governance – one that is publicly accountable, transparent and fair and includes all stakeholders

An Enterprise Architecture Perspective to Electronic Health Record Based Care Governance.

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Motoc, Bogdan

2017-01-01

This paper proposes an Enterprise Architecture viewpoint of Electronic Health Record (EHR) based care governance. The improvements expected are derived from the collaboration framework and the clinical health model proposed as foundation for the concept of EHR.

Governance for Urban Health Equity: Mobilizing Demand for Primary ...

International Development Research Centre (IDRC) Digital Library (Canada)

Home · What we do ... New research will identify opportunities to improve health care for the urban poor and involve communities ... Addressing this governance crisis will be paramount to improving service delivery for slum residents and to ...

The World Health Organization and Global Health Governance: post-1990.

Science.gov (United States)

Lidén, J

2014-02-01

This article takes a historical perspective on the changing position of WHO in the global health architecture over the past two decades. From the early 1990s a number of weaknesses within the structure and governance of the World Health Organization were becoming apparent, as a rapidly changing post Cold War world placed more complex demands on the international organizations generally, but significantly so in the field of global health. Towards the end of that decade and during the first half of the next, WHO revitalized and played a crucial role in setting global health priorities. However, over the past decade, the organization has to some extent been bypassed for funding, and it lost some of its authority and its ability to set a global health agenda. The reasons for this decline are complex and multifaceted. Some of the main factors include WHO's inability to reform its core structure, the growing influence of non-governmental actors, a lack of coherence in the positions, priorities and funding decisions between the health ministries and the ministries overseeing development assistance in several donor member states, and the lack of strong leadership of the organization. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Electronic Government Information and the Depository Library Program: Paradise Found?

Science.gov (United States)

Dugan, Robert E.; Cheverie, Joan F.

1992-01-01

The trend in the 1980s to provide an increasingly larger amounts of government information in electronic formats has led to concerns regarding the inclusion of electronic items in the depository library program (DLP). Inclusion of electronic formats in the DLP provides increased public access but also poses technical problems for the depository…

Corporate social responsibility in health sector: a case study in the government hospitals in Medan, Indonesia

Directory of Open Access Journals (Sweden)

Arlina Nurbaity Lubis

2018-03-01

Full Text Available Contemporary society demands that every organization operate with a sense of social responsibility. Many organizations now include corporate social responsibility (CSR activities in their work programs. In the health sector, however, the role of CSR has not been studied as intensively as in private corporations because the services provided by the health sector are already valued as directly serving humanity. This research aims to evaluate the impact of CSR on the health sector, specifically on government hospitals. This model was developed by analyzing the influence of CSR on hospital reputation, customer loyalty, and hospital values. By answering questionnaires, a total of 200 hospital patients from four government hospitals participated in the study. The proposed model was evaluated using path analysis with AMOS tools. The results of this study provide empirical evidence that overall, CSR positively affects the reputation of the hospital, patient loyalty, and hospital value. Although there is a direct negative effect of CSR on hospital value, the larger influence of indirect effect that occurs through the mediating role of reputation and patient loyalty variables shows that CSR is able to increase the hospital value. Practically, these results imply that CSR should be applied as a strategic tool in improving the value of the hospital.

The multiple meanings of global health governance: a call for conceptual clarity

Science.gov (United States)

2014-01-01

Background The term global health governance (GHG) is now widely used, with over one thousand works published in the scholarly literature, almost all since 2002. Amid this rapid growth there is considerable variation in how the term is defined and applied, generating confusion as to the boundaries of the subject, the perceived problems in practice, and the goals to be achieved through institutional reform. Methodology This paper is based on the results of a separate scoping study of peer reviewed GHG research from 1990 onwards which undertook keyword searches of public health and social science databases. Additional works, notably books, book chapters and scholarly articles, not currently indexed, were identified through Web of Science citation searches. After removing duplicates, book reviews, commentaries and editorials, we reviewed the remaining 250 scholarly works in terms of how the concept of GHG is applied. More specifically, we identify what is claimed as constituting GHG, how it is problematised, the institutional features of GHG, and what forms and functions are deemed ideal. Results After examining the broader notion of global governance and increasingly ubiquitous term “global health”, the paper identifies three ontological variations in GHG scholarship - the scope of institutional arrangements, strengths and weaknesses of existing institutions, and the ideal form and function of GHG. This has produced three common, yet distinct, meanings of GHG that have emerged – globalisation and health governance, global governance and health, and governance for global health. Conclusions There is a need to clarify ontological and definitional distinctions in GHG scholarship and practice, and be critically reflexive of their normative underpinnings. This will enable greater precision in describing existing institutional arrangements, as well as serve as a prerequisite for a fuller debate about the desired nature of GHG. PMID:24775919

Reflections on Government Service Rotations by an Academic Health Education Professional

Science.gov (United States)

Green, Lawrence W.

2016-01-01

This reflection is on a health education professional's rotation from professor in a school of public health to a government position and back parallels that of Professor Howard Koh's journey to Assistant Secretary of Health, one level higher in the same federal bureaucracy. We both acknowledge the steep learning curve and some bureaucratic…

The role of managerial stock option programs in governance: evidence from REIT stock repurchases

NARCIS (Netherlands)

Ghosh, C.; Giambona, E.; Harding, J.P.; Sezer, O.; Sirmans, C.F.

2010-01-01

This article examines the role of stock option programs and executive holdings of stock options in real estate investment trust (REIT) governance. We study the issue by analyzing how the market reaction to a stock repurchase announcement varies as a function of the individual REIT's governance

The Legal Strength of International Health Instruments - What It Brings to Global Health Governance?

Directory of Open Access Journals (Sweden)

Haik Nikogosian

2016-12-01

Full Text Available Public health instruments have been under constant development and renewal for decades. International legal instruments, with their binding character and strength, have a special place in this development. The start of the 21st century saw, in particular, the birth of the first World Health Organization (WHO-era health treaties – the WHO Framework Convention on Tobacco Control (WHO FCTC and its first Protocol. The authors analyze the potential impact of these instruments on global health governance and public health, beyond the traditional view of their impact on tobacco control. Overall, the very fact that globally binding treaties in modern-era health were feasible has accelerated the debate and expectations for an expanded role of international legal regimes in public health. The impact of treaties has also been notable in global health architecture as the novel instruments required novel institutions to govern their implementation. The legal power of the WHO FCTC has enabled rapid adoption of further instruments to promote its implementation, thus, enhancing the international instrumentarium for health, and it has also prompted stronger role for national legislation on health. Notably, the Convention has elevated several traditionally challenging public health features to the level of international legal obligations. It has also revealed how the legal power of the international health instrument can be utilized in safeguarding the interests of health in the face of competing agendas and legal disputes at both the domestic and international levels. Lastly, the legal power of health instruments is associated with their potential impact not only on health but also beyond; the recently adopted Protocol to Eliminate Illicit Trade in Tobacco Products may best exemplify this matter. The first treaty experiences of the 21st century may provide important lessons for the role of legal instruments in addressing the unfolding challenges in global

The impact of health system governance and policy processes on health services in Iraqi Kurdistan.

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Tawfik-Shukor, Ali; Khoshnaw, Hiro

2010-06-08

Relative to the amount of global attention and media coverage since the first and second Gulf Wars, very little has been published in the health services research literature regarding the state of health services in Iraq, and particularly on the semi-autonomous region of Kurdistan. Building on findings from a field visit, this paper describes the state of health services in Kurdistan, analyzes their underlying governance structures and policy processes, and their overall impact on the quality, accessibility and cost of the health system, while stressing the importance of reinvesting in public health and community-based primary care. Very little validated, research-based data exists relating to the state of population health and health services in Kurdistan. What little evidence exists, points to a region experiencing an epidemiological polarization, with different segments of the population experiencing rapidly-diverging rates of morbidity and mortality related to different etiological patterns of communicable, non-communicable, acute and chronic illness and disease. Simply put, the rural poor suffer from malnutrition and cholera, while the urban middle and upper classes deal with issues of obesity and Type 2 diabetes. The inequity is exacerbated by a poorly governed, fragmented, unregulated, specialized and heavily privatized system, that not only leads to poor quality of care and catastrophic health expenditures, but also threatens the economic and political stability of the region. There is an urgent need to revisit and clearly define the core values and goals of a future health system, and to develop an inclusive governance and policy framework for change, towards a more equitable and effective primary care-based health system, with attention to broader social determinants of health and salutogenesis. This paper not only frames the situation in Kurdistan in terms of a human rights or special political issue of a minority population, but provides important

The impact of health system governance and policy processes on health services in Iraqi Kurdistan

Directory of Open Access Journals (Sweden)

Khoshnaw Hiro

2010-06-01

Full Text Available Abstract Background Relative to the amount of global attention and media coverage since the first and second Gulf Wars, very little has been published in the health services research literature regarding the state of health services in Iraq, and particularly on the semi-autonomous region of Kurdistan. Building on findings from a field visit, this paper describes the state of health services in Kurdistan, analyzes their underlying governance structures and policy processes, and their overall impact on the quality, accessibility and cost of the health system, while stressing the importance of reinvesting in public health and community-based primary care. Discussion Very little validated, research-based data exists relating to the state of population health and health services in Kurdistan. What little evidence exists, points to a region experiencing an epidemiological polarization, with different segments of the population experiencing rapidly-diverging rates of morbidity and mortality related to different etiological patterns of communicable, non-communicable, acute and chronic illness and disease. Simply put, the rural poor suffer from malnutrition and cholera, while the urban middle and upper classes deal with issues of obesity and Type 2 diabetes. The inequity is exacerbated by a poorly governed, fragmented, unregulated, specialized and heavily privatized system, that not only leads to poor quality of care and catastrophic health expenditures, but also threatens the economic and political stability of the region. There is an urgent need to revisit and clearly define the core values and goals of a future health system, and to develop an inclusive governance and policy framework for change, towards a more equitable and effective primary care-based health system, with attention to broader social determinants of health and salutogenesis. Summary This paper not only frames the situation in Kurdistan in terms of a human rights or special political

Social determinants of health and local government: understanding and uptake of ideas in two Australian states.

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Lawless, Angela; Lane, Anna; Lewis, Felicity-Ann; Baum, Fran; Harris, Patrick

2016-10-23

To examine the awareness and perceptions of local government staff about the social determinants of health (SDoH) and health inequity and use of these ideas to shape policy and practice. 96 staff at 17 councils in South Australia or New South Wales responded to questions in a pilot online survey concerning: sources of knowledge about, familiarity with the evidence on, attitudes towards, and uses of ideas about the social determinants of health. Eight of 68 SA councils and 16 of 152 NSW councils were randomly selected stratified by state and metropolitan status. Differences between states and metropolitan/non-metropolitan status were explored. The majority of respondents (88.4%) reported some familiarity with ideas about the broad determinants of health and 90% agreed that the impact of policy action on health determinants should be considered in all major government policy and planning initiatives. Research articles, government/professional reports, and professional contacts were rated as important sources of knowledge about the social determinants of health. Resources need to be dedicated to systematic research on practical implementation of interventions on social determinants of health inequities and towards providing staff with more practical information about interventions and tools to evaluate those interventions. The findings suggest there is support for action addressing the social determinants of health in local government. The findings extend similar research regarding SDoH and government in NZ and Canada to Australian local government. © 2016 Public Health Association of Australia.

Implications of Harmonizing the Future of the Federal Depository Library Program within E-Government Principles and Policies

Science.gov (United States)

Shuler, John A.; Jaeger, Paul T.; Bertot, John Carlo

2010-01-01

For more than 150 years, the United States Government Printing Office (GPO), along with its Federal Depository Library Program (FDLP), has supported an informed citizenry and democracy by ensuring access and preservation to a broad swath of federal government information. This collaborative national public information program between local…

Leadership by example: coordinating government roles in improving health care quality

National Research Council Canada - National Science Library

Smith, Barbara M; Corrigan, Janet M; Eden, Jill

.... Leadership by Example explores how the federal government can leverage its unique position as regulator, purchaser, provider, and research sponsor to improve care - not only in these six programs...

Using the RE-AIM framework to evaluate physical activity public health programs in México.

Science.gov (United States)

Jauregui, Edtna; Pacheco, Ann M; Soltero, Erica G; O'Connor, Teresia M; Castro, Cynthia M; Estabrooks, Paul A; McNeill, Lorna H; Lee, Rebecca E

2015-02-19

Physical activity (PA) public health programming has been widely used in Mexico; however, few studies have documented individual and organizational factors that might be used to evaluate their public health impact. The RE-AIM framework is an evaluation tool that examines individual and organizational factors of public health programs. The purpose of this study was to use the RE-AIM framework to determine the degree to which PA programs in Mexico reported individual and organizational factors and to investigate whether reporting differed by the program's funding source. Public health programs promoting PA were systematically identified during 2008-2013 and had to have an active program website. Initial searches produced 23 possible programs with 12 meeting inclusion criteria. A coding sheet was developed to capture behavioral, outcome and RE-AIM indicators from program websites. In addition to targeting PA, five (42%) programs also targeted dietary habits and the most commonly reported outcome was change in body composition (58%). Programs reported an average of 11.1 (±3.9) RE-AIM indicator items (out of 27 total). On average, 45% reported reach indicators, 34% reported efficacy/effectiveness indicators, 60% reported adoption indicators, 40% reported implementation indicators, and 35% reported maintenance indicators. The proportion of RE-AIM indicators reported did not differ significantly for programs that were government supported (M = 10, SD = 3.1) and programs that were partially or wholly privately or corporately supported (M = 12.0, SD = 4.4). While reach and adoption of these programs were most commonly reported, there is a need for stronger evaluation of behavioral and health outcomes before the public health impact of these programs can be established.

Health Games: A Key Component for the Evolution of Wellness Programs.

Science.gov (United States)

Lenihan, David

2012-06-01

Healthcare cost growth has been a major concern for both governments and employers. Considerable efforts have been made to "bend the trend" or find ways to control costs. At the highest levels, this has been the move from indemnity care models to managed care and then to consumer-directed health models using Healthcare Reimbursement Accounts and Healthcare Spending Accounts in plan designs. Accompanying this move in plan design has been an effort to get the consumer/patient/employee more engaged and responsible for his or her health expenditures, health decision-making, and activities. Consumers have gone through the phases of health being doctor-centric (indemnity care model), to health plan-centric (managed care models), to consumer-centric (consumer-directed health models). There is currently a need to incorporate wellness into the equation. Simply put, wellness is intended to keep people out of the health system by reducing the risk factors that would put them into the system in the first place. This includes things like smoking cessation, exercise, weight management, nutrition, and other factors over which individuals have a significant level of control over, as well as condition management such as medication adherence, and condition monitoring (such as glucose monitoring for diabetics). Wellness will become increasingly more common for major buyers, initially large self-funded employers and then health plans that will offer it as a part of their overall Plan Design and Administration services. Wellness initiatives will also be offered by Federal and State governments and will include programs for the elderly and at-risk populations as well as for the general population. The measure of success of wellness programs to actually "bend the trend" will be engagement. How large a piece of the population can be captured and retained will be the critical metric for success…and metrics require real data and will be used by the entire healthcare value-chain to measure

Use of Local Health Department Websites: A Study of E-Government Adoption and Diffusion

Science.gov (United States)

Aaltonen, Pamela Massie

2013-01-01

Two distinct but converging activities have the potential to alter the way local public health departments conduct business. These activities are the emergence of e-government and the addition of preparedness as a basic function of the public health system. Preparedness implies timely collaboration with government entities, community partners and…

Combating healthcare corruption and fraud with improved global health governance.

Science.gov (United States)

Mackey, Tim K; Liang, Bryan A

2012-10-22

Corruption is a serious threat to global health outcomes, leading to financial waste and adverse health consequences. Yet, forms of corruption impacting global health are endemic worldwide in public and private sectors, and in developed and resource-poor settings alike. Allegations of misuse of funds and fraud in global health initiatives also threaten future investment. Current domestic and sectorial-level responses are fragmented and have been criticized as ineffective. In order to address this issue, we propose a global health governance framework calling for international recognition of "global health corruption" and development of a treaty protocol to combat this crucial issue.

Global health promotion: how can we strengthen governance and build effective strategies?

Science.gov (United States)

Lee, Kelley

2006-12-01

This paper discusses what is meant by 'global health promotion' and the extent to which global governance architecture is emerging, enabling people to increase control over, and to improve, their health within an increasingly global context. A review of selected initiatives on breast-milk substitutes, healthy cities, tobacco control and diet and nutrition suggests that existing institutions are uneven in their capacity to tackle global health issues. The strategic building of a global approach to health promotion will draw on a broad range of governance instruments, give careful attention to implementation in the medium to longer term, reflect on the nature and appropriateness of partnerships and develop fuller understanding of effective policies for harnessing the positive influences of globalization and countering the negatives.

School Health: Findings from Evaluated Programs.

Science.gov (United States)

Public Health Service (DHHS), Rockville, MD. Office of Disease Prevention and Health Promotion.

This publication presents findings from evaluations of many school health programs from across the United States. Each program includes at least one of the following eight components of a comprehensive school health program: health education, clinical services, counseling and mental health services, school environment, school food programs,…

Nursing domain of CI governance: recommendations for health IT adoption and optimization.

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Collins, Sarah A; Alexander, Dana; Moss, Jacqueline

2015-05-01

There is a lack of recommended models for clinical informatics (CI) governance that can facilitate successful health information technology implementation. To understand existing CI governance structures and provide a model with recommended roles, partnerships, and councils based on perspectives of nursing informatics leaders. We conducted a cross-sectional study through administering a survey via telephone to facilitate semistructured interviews from June 2012 through November 2012. We interviewed 12 nursing informatics leaders, across the United States, currently serving in executive- or director-level CI roles at integrated health care systems that have pioneered electronic health records implementation projects. We found the following 4 themes emerge: (1) Interprofessional partnerships are essential. (2) Critical role-based levels of practice and competencies need to be defined. (3) Integration into existing clinical infrastructure facilitates success. (4) CI governance is an evolving process. We described specific lessons learned and a model of CI governance with recommended roles, partnerships, and councils from the perspective of nursing informatics leaders. Applied CI work is highly interprofessional with patient safety implications that heighten the need for best practice models for governance structures, adequate resource allocation, and role-based competencies. Overall, there is a notable lack of a centralized CI group comprised of formally trained informaticians to provide expertise and promote adherence to informatics principles within EHR implementation governance structures. Our model of the nursing domain of CI governance with recommended roles, partnerships, and councils provides a starting point that should be further explored and validated. Not only can the model be used to understand, shape, and standardize roles, competencies, and structures within CI practice for nursing, it can be used within other clinical domains and by other informaticians

Nanny or steward? The role of government in public health.

Science.gov (United States)

Jochelson, Karen

2006-12-01

The past year has witnessed contentious debates about public health in England around smoking bans, alcohol licencing, food labelling and junk food advertising. Some people argue that any government intervention in these areas is 'nanny statist'--an unnecessary intrusion into people's lives and what they do, eat and drink. Others argue that only the state can alter the environment that shapes people's decisions and behaviour. This paper suggests that there is a strong argument to be made for government intervention to safeguard public health. Legislation brings about changes that individuals on their own cannot, and sets new standards for the public good. Rather than condemning such activity as 'nanny statist', it might be more appropriate to view it as a form of 'stewardship'. The paper draws on international evidence about alcohol use, smoking and road safety to show how taxation, advertising bans, regulations proscribing behaviour and education create a public health framework and shape individual choices towards healthier and safer behaviour.

Quality improvement in clinical documentation: does clinical governance work?

Directory of Open Access Journals (Sweden)

Dehghan M

2013-12-01

Full Text Available Mahlegha Dehghan,1 Dorsa Dehghan,2 Akbar Sheikhrabori,3 Masoume Sadeghi,4 Mehrdad Jalalian5 1Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, 2Department of Pediatric Nursing, School of Nursing and Midwifery, Islamic Azad University Kerman Branch, Kerman, 3Department of Medical Surgical Nursing, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, 4Research Center for Modeling in Health, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 5Electronic Physician Journal, Mashhad, Iran Introduction: The quality of nursing documentation is still a challenge in the nursing profession and, thus, in the health care industry. One major quality improvement program is clinical governance, whose mission is to continuously improve the quality of patient care and overcome service quality problems. The aim of this study was to identify whether clinical governance improves the quality of nursing documentation. Methods: A quasi-experimental method was used to show nursing documentation quality improvement after a 2-year clinical governance implementation. Two hundred twenty random nursing documents were assessed structurally and by content using a valid and reliable researcher made checklist. Results: There were no differences between a nurse's demographic data before and after 2 years (P>0.05 and the nursing documentation score did not improve after a 2-year clinical governance program. Conclusion: Although some efforts were made to improve nursing documentation through clinical governance, these were not sufficient and more attempts are needed. Keywords: nursing documentation, clinical governance, quality improvement, nursing record

Pharmaceutical digital marketing and governance: illicit actors and challenges to global patient safety and public health.

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Mackey, Tim K; Liang, Bryan A

2013-10-16

Digital forms of direct-to-consumer pharmaceutical marketing (eDTCA) have globalized in an era of free and open information exchange. Yet, the unregulated expansion of eDTCA has resulted in unaddressed global public health threats. Specifically, illicit online pharmacies are engaged in the sale of purportedly safe, legitimate product that may in fact be counterfeit or substandard. These cybercriminal actors exploit available eDTCA mediums over the Internet to market their suspect products globally. Despite these risks, a detailed assessment of the public health, patient safety, and cybersecurity threats and governance mechanisms to address them has not been conducted. Illicit online pharmacies represent a significant global public health and patient safety risk. Existing governance mechanisms are insufficient and include lack of adequate adoption in national regulation, ineffective voluntary governance mechanisms, and uneven global law enforcement efforts that have allowed proliferation of these cybercriminals on the web. In order to effectively address this multistakeholder threat, inclusive global governance strategies that engage the information technology, law enforcement and public health sectors should be established. Effective global "eHealth Governance" focused on cybercrime is needed in order to effectively combat illicit online pharmacies. This includes building upon existing Internet governance structures and coordinating partnership between the UN Office of Drugs and Crime that leads the global fight against transnational organized crime and the Internet Governance Forum that is shaping the future of Internet governance. Through a UNODC-IGF governance mechanism, investigation, detection and coordination of activities against illicit online pharmacies and their misuse of eDTCA can commence.

Does foreign aid crowd out government investments? Evidence from rural health centres in Rwanda

Science.gov (United States)

Lu, Chunling; Cook, Benjamin; Desmond, Chris

2017-01-01

Background Rural healthcare facilities in low-income countries play a major role in providing primary care to rural populations. We examined the link of foreign aid with government investments and medical service provision in rural health centres in Rwanda. Methods Using the District Health System Strengthening Tool, a web-based database built by the Ministry of Health in Rwanda, we constructed two composite indices representing provision of (1) child and maternal care and (2) HIV, tuberculosis (TB) and malaria services in 330 rural health centres between 2009 and 2011. Financing variables in a healthcare centre included received funds from various sources, including foreign donors and government. We used multilevel random-effects model in regression analyses and examined the robustness of results to a range of alternative specification, including scale of dependent variables, estimation methods and timing of aid effects. Findings Both government and foreign donors increased their direct investments in the 330 rural healthcare centres during the period. Foreign aid was positively associated with government investments (0.13, 95% CI 0.06 to 0.19) in rural health centres. Aid in the previous year was positively associated with service provision for child and maternal health (0.008, 95% CI 0.002 to 0.014) and service provision for HIV, TB and malaria (0.014, 95% CI 0.004 to 0.022) in the current year. The results are robust when using fixed-effects models. Conclusions These findings suggest that foreign aid did not crowd out government investments in the rural healthcare centres. Foreign aid programmes, conducted in addition to government investments, could benefit rural residents in low-income countries through increased service provision in rural healthcare facilities. PMID:29082015

Collaboration between local health and local government agencies for health improvement.

Science.gov (United States)

Hayes, Sara L; Mann, Mala K; Morgan, Fiona M; Kelly, Mark J; Weightman, Alison L

2012-10-17

In many countries, national, regional and local inter- and intra-agency collaborations have been introduced to improve health outcomes. Evidence is needed on the effectiveness of locally developed partnerships which target changes in health outcomes and behaviours. To evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes in any population or age group. We searched the Cochrane Public Health Group Specialised Register, AMED, ASSIA, CENTRAL, CINAHL, DoPHER, EMBASE, ERIC, HMIC, IBSS, MEDLINE, MEDLINE In-Process, OpenGrey, PsycINFO, Rehabdata, Social Care Online, Social Services Abstracts, Sociological Abstracts, TRoPHI and Web of Science from 1966 through to January 2012. 'Snowballing' methods were used, including expert contact, citation tracking, website searching and reference list follow-up. Randomized controlled trials (RCTs), controlled clinical trials (CCTs), controlled before-and-after studies (CBAs) and interrupted time series (ITS) where the study reported individual health outcomes arising from interagency collaboration between health and local government agencies compared to standard care. Studies were selected independently in duplicate, with no restriction on population subgroup or disease. Two authors independently conducted data extraction and assessed risk of bias for each study. Sixteen studies were identified (28,212 participants). Only two were considered to be at low risk of bias. Eleven studies contributed data to the meta-analyses but a narrative synthesis was undertaken for all 16 studies. Six studies examined mental health initiatives, of which one showed health benefit, four showed modest improvement in one or more of the outcomes measured but no clear overall health gain, and one showed no evidence of health gain. Four studies considered lifestyle improvements, of which one showed some limited short-term improvements, two failed to show health gains for the intervention

The decriminalization of prostitution is associated with better coverage of health promotion programs for sex workers.

Science.gov (United States)

Harcourt, Christine; O'Connor, Jody; Egger, Sandra; Fairley, Christopher K; Wand, Handan; Chen, Marcus Y; Marshall, Lewis; Kaldor, John M; Donovan, Basil

2010-10-01

In order to assess whether the law has an impact on the delivery of health promotion services to sex workers, we compared health promotion programs in three Australian cities with different prostitution laws. The cities were Melbourne (brothels legalized if licensed, unlicensed brothels criminalized), Perth (criminalization of all forms of sex work) and Sydney (sex work largely decriminalized, without licensing). We interviewed key informants and gave questionnaires to representative samples of female sex workers in urban brothels. Despite the different laws, each city had a thriving and diverse sex industry and a government-funded sex worker health promotion program with shopfront, phone, online and outreach facilities. The Sydney program was the only one run by a community-based organisation and the only program employing multi-lingual staff with evening outreach to all brothels. The Melbourne program did not service the unlicensed sector, while the Perth program accessed the minority of brothels by invitation only. More Sydney workers reported a sexual health centre as a source of safer sex training and information (Sydney 52% v Melbourne 33% and Perth 35%; plegal context appeared to affect the conduct of health promotion programs targeting the sex industry. Brothel licensing and police-controlled illegal brothels can result in the unlicensed sector being isolated from peer-education and support. © 2010 The Authors. Journal Compilation © 2010 Public Health Association of Australia.

Delivering on a gendered definition of health needs in local government budgeting: experiences and concepts.

Science.gov (United States)

Buyana, K

2009-10-01

Local governments are granted budgetary power in the Local Governments Act of the Republic of Uganda, which allows for local-level participation and flexibility in the allocation of financial grants channelled annually from central to local governments. The act prescribes a legal mandate to allocate public resources based on local priorities including the health needs of women compared with men. This study investigated the responsiveness of local government budgeting to the health needs of women as compared to men. A qualitative study was conducted in Mpigi district using a set of data collection methods including: a) three (3) focus group discussions with 8 female and 8 male respondents in each group; b) face-to-face interviews with a random sample of 120 households, 75% of which were male-headed and 25% female-headed ; c) key informant interviews with a sample of 10 administrative officers in Mpigi district ; and d) desk-review of the Mpigi district Budget Framework Paper. Health needs consist of the daily requirements, which, arise out of common disease infections and the socioeconomic constraints that affect the well-being of women and men. However, the primary concern of the district health sector is disease control measures, without emphasis on the differing socio-economic interests of women as compared to men. Local government budgeting, therefore, does not reflect the broad community-wide understanding of health needs. Local government budgeting should be informed by a two-fold framework for the gendered definition of health needs. The two-fold framework combines both disease-based health needs and socio-economic needs of women as compared to men.

Local government household battery collection programs: Costs and benefits

Energy Technology Data Exchange (ETDEWEB)

Shapek, Raymond A [Department of Public Administration, University of Central Florida, Orlando, FL (United States)

1995-10-01

Nearly three billion dry-cell household batteries are discarded in the municipal waste stream annually. While the mercury content of newer batteries has been reduced, older batteries and the accumulated total of mercury and cadmium, as well as other metals in the newer batteries still constitute a potential health risk. Many communities have initiated collection programs to remove this source of contamination from the municipal waste stream, but most have not. Fourteen states have enacted legislation regulating the disposal of household batteries, while nine states require the collection of rechargeable batteries. This article describes the potential health risks associated with continued disposal and incineration of household dry-cell batteries, reviews a sampling of existing municipal collection programs in US communities, and examines the costs and benefits and program options of collection programs

Workplace Participatory Occupational Health/Health Promotion Program

Science.gov (United States)

Zhang, Yuan; Flum, Marian; Kotejoshyer, Rajashree; Fleishman, Jane; Henning, Robert; Punnett, Laura

2018-01-01

Nursing home employees experience high physical and psychosocial workloads, resulting in poor health outcomes. An occupational health/health promotion program, designed to facilitate employee participation, was initiated in three nursing homes. The aim of the current study was to evaluate facilitators and barriers of the program after 3-year implementation. Focus groups with employees and in-depth interviews with top and middle managers were conducted. The Social Ecological Model was used to organize the evaluation. Facilitators and barriers were reported from both managers’ and employees’ perspectives, and were categorized as intrapersonal, interpersonal, institutional, and corporate level. Management support, financial resources, and release time for participation were identified as the three most important factors. Supports from multiple levels including both human and environment, and managers and employees, are important for a successful participatory occupational health/health promotion program. PMID:26977705

Evidence-based health care: its place within clinical governance.

Science.gov (United States)

McSherry, R; Haddock, J

This article explores the principles of evidence-based practice and its role in achieving quality improvements within the clinical governance framework advocated by the recent White Papers 'The New NHS: Modern, Dependable' (Department of Health (DoH), 1997) and 'A First Class Service: Quality in the New NHS' (DoH, 1998a). Within these White Papers there is an emphasis on improving quality of care, treatment and services through employing the principles of clinical governance. A major feature of clinical governance is guaranteeing quality to the public and the NHS, and ensuring that clinical, managerial and educational practice is based on scientific evidence. This article also examines what evidence-based practice is and what processes are required to promote effective healthcare interventions. The authors also look at how clinical governance relates to other methods/systems involved in clinical effectiveness. Finally, the importance for nurses and other healthcare professionals of familiarizing themselves with the development of critical appraisal skills, and their implications for developing evidence-based practice, is emphasized.

34 CFR 400.9 - What additional requirements govern the Vocational and Applied Technology Education Programs?

Science.gov (United States)

2010-07-01

... Applied Technology Education Programs? 400.9 Section 400.9 Education Regulations of the Offices of the... VOCATIONAL AND APPLIED TECHNOLOGY EDUCATION PROGRAMS-GENERAL PROVISIONS § 400.9 What additional requirements govern the Vocational and Applied Technology Education Programs? In addition to the Act, applicable...

Identifying Procurement Fraud in Defense Agencies: An Analysis of the Government Purchase Card Program

Science.gov (United States)

2011-04-30

fielding, contracting, interoperability, organizational behavior, risk management , cost estimating, and many others. Approaches range from... COSO ), (Whittington & Pany, 2012). In addition, the Federal Financial Management Improvement Act of 1996 identified internal control as an...fraud indicators within the DoD Government Purchase Card Programs and provides recommendations for improving the management of Government Purchase

Combating healthcare corruption and fraud with improved global health governance

Science.gov (United States)

2012-01-01

Corruption is a serious threat to global health outcomes, leading to financial waste and adverse health consequences. Yet, forms of corruption impacting global health are endemic worldwide in public and private sectors, and in developed and resource-poor settings alike. Allegations of misuse of funds and fraud in global health initiatives also threaten future investment. Current domestic and sectorial-level responses are fragmented and have been criticized as ineffective. In order to address this issue, we propose a global health governance framework calling for international recognition of “global health corruption” and development of a treaty protocol to combat this crucial issue. PMID:23088820

40 CFR 3.1000 - How does a state, tribe, or local government revise or modify its authorized program to allow...

Science.gov (United States)

2010-07-01

... government revise or modify its authorized program to allow electronic reporting? 3.1000 Section 3.1000... government revise or modify its authorized program to allow electronic reporting? (a) A state, tribe, or local government that receives or plans to begin receiving electronic documents in lieu of paper...

Variation in school health policies and programs by demographic characteristics of US schools, 2006.

Science.gov (United States)

Balaji, Alexandra B; Brener, Nancy D; McManus, Tim

2010-12-01

To identify whether school health policies and programs vary by demographic characteristics of schools, using data from the School Health Policies and Programs Study (SHPPS) 2006. This study updates a similar study conducted with SHPPS 2000 data and assesses several additional policies and programs measured for the first time in SHPPS 2006. SHPPS 2006 assessed the status of 8 components of the coordinated school health model using a nationally representative sample of public, Catholic, and private schools at the elementary, middle, and high school levels. Data were collected from school faculty and staff using computer-assisted personal interviews and then linked with extant data on school characteristics. Results from a series of regression analyses indicated that a number of school policies and programs varied by school type (public, Catholic, or private), urbanicity, school size, discretionary dollars per pupil, percentage of white students, percentage of students qualifying for free lunch funds, and, among high schools, percentage of college-bound students. Catholic and private schools, smaller schools, and those with low discretionary dollars per pupil did not have as many key school health policies and programs as did schools that were public, larger, and had higher discretionary dollars per pupil. However, no single type of school had all key components of a coordinated school health program in place. Although some categories of schools had fewer policies and programs in place, all had both strengths and weaknesses. Regardless of school characteristics, all schools have the potential to implement a quality school health program. © Published 2010. This article is a US Government work and is in the public domain in the USA.

[Diffusion of clinical governance among the Italian Local Health Units (LHUs). Analysis of the Health Surveys, the Firm Acts and the Health Plans].

Science.gov (United States)

de Belvis, A G; Biasco, A; Pelone, F; Romaniello, A; De Micco, F; Volpe, M; Ricciardi, W

2009-01-01

The objective of our research is to report on the diffusion of Clinical Governance, as introduced with the National Health Plan 2006-2008, by analysing the planning instruments set up by each Region (Regional Health Plans and Emergency Plans in regions with budget deficit), the organizational frameworks (Atti Aziendali, firm acts), and the surveys on performance and quality of healthcare among the Italian Local Health Units (Health Surveys). Our research was realized on September-December 2007 and consisted of the collection of all retrieved documents available on the web and on the online public access catalog (OPAC SBN) of the National Library Service. Futhermore, each document has been classified and analysed according to Chambers' Clinical Governance definition. A descriptive statistical and inferential analysis by applying the Chi-2 Test was performed to test the correlation between the diffusion of such a classified documents and the geographical partition of each LHU. Our results show a scarce diffusion of Firm acts (43%) and Health Surveys (24.9% of the total). Any remind to Clinical Governance instruments and methods inside each document resulted even poorer among both the organizational and performance surveys and the regional health planning frameworks, respectively.

Governance arrangements for health systems in low-income countries: an overview of systematic reviews.

Science.gov (United States)

Herrera, Cristian A; Lewin, Simon; Paulsen, Elizabeth; Ciapponi, Agustín; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Wiysonge, Charles S; Bastías, Gabriel; Garcia Marti, Sebastian; Okwundu, Charles I; Peñaloza, Blanca; Oxman, Andrew D

2017-09-12

Governance arrangements include changes in rules or processes that determine authority and accountability for health policies, organisations, commercial products and health professionals, as well as the involvement of stakeholders in decision-making. Changes in governance arrangements can affect health and related goals in numerous ways, generally through changes in authority, accountability, openness, participation and coherence. A broad overview of the findings of systematic reviews can help policymakers, their technical support staff and other stakeholders to identify strategies for addressing problems and improving the governance of their health systems. To provide an overview of the available evidence from up-to-date systematic reviews about the effects of governance arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on governance arrangements and informing refinements of the framework for governance arrangements outlined in the overview. We searched Health Systems Evidence in November 2010 and PDQ Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of governance arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use (health expenditures, healthcare provider costs, out-of-pocket payments, cost-effectiveness), healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment) and that were published after April 2005. We excluded reviews with limitations that were important enough to compromise the reliability of the findings of the review. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared

The New Political Economy of Health Care in the European Union: The Impact of Fiscal Governance.

Science.gov (United States)

Greer, Scott L; Jarman, Holly; Baeten, Rita

2016-01-01

We argue that the political economy of health care in the European Union is being changed by the creation of a substantial new apparatus of European fiscal governance. A series of treaties and legal changes since 2008 have given the European Union new powers and duties to enforce budgetary austerity in the member states, and this apparatus of fiscal governance has already extended to include detailed and sometimes coercive policy recommendations to member states about the governance of their health care systems. We map the structures of this new fiscal governance and the way it purports to affect health care decision making. © The Author(s) 2016.

Getting Your Ducks in a Row: IT Governance, Risk, and Compliance Programs in Higher Education

Science.gov (United States)

Bichsel, Jacqueline; Feehan, Patrick

2014-01-01

Higher education IT governance, risk, and compliance (GRC) programs are in the development stage. Few institutions have all three programs in place, and many institutions are unclear where they should start when instituting or maturing their IT GRC programs. In addition, they are often uncertain as to whether GRC programs should be developed in…

[Governance and health: meaning and implications in Latin America].

NARCIS (Netherlands)

Rodriguez, C.; Lamothe, L.; Barten, F.J.M.H.; Haggerty, J.

2010-01-01

The term governance is used more and more often in the formulation, implementation, and evaluation of public policies. The purpose of this paper is twofold: to shed light on its meaning, and to study its applicability for the study of recent public health policies in Latin America. After discussing

Demographic indicators of trust in federal, state and local government: implications for Australian health policy makers.

Science.gov (United States)

Meyer, Samantha B; Mamerow, Loreen; Taylor, Anne W; Henderson, Julie; Ward, Paul R; Coveney, John

2013-02-01

To provide baseline findings regarding Australians' trust in federal, state and local government. A computer-assisted telephone interviewing (CATI) survey was administrated during October to December 2009 to a random sample (n=1109) across Australia (response rate 41.2%). Binary logistic regression analyses were carried out by means of SPSS. Age, household size, household income, IRSD and ARIA were found to be significant indicators for trust in federal, state and local government. Trust in state government is lower for older respondents and respondents living in inner and outer regional areas. Trust in local council is lower in respondents living in inner regional areas, respondents living in disadvantaged areas, and respondents in the income bracket of $60001 to $100000. Trust in federal government is lower for older respondents and respondents living in disadvantaged areas. Of note is diminished trust in government among older, regional and lower income ($30001-$60000) respondents. Trust in all levels of government was found to be the lowest in population groups that are identified by empirical research and media to have the poorest access to government services. As a consequence, improved access to services for these populations may increase trust in health policy. Increased trust in health governance may in turn, ensure effective dissemination and implementation of health policies and that existing inequities are not perpetuated through distrust of health information and policy initiatives.

The road to developing an advanced degree program in public health preparedness.

Science.gov (United States)

Cherry, Robert A; Davis, Tom

2007-08-01

The master of homeland security (MHS) degree in public health preparedness at the Pennsylvania State University College of Medicine is the first degree program of its kind offered by any U.S. medical school. The field of public health preparedness has been increasingly viewed as a new, emerging professional discipline, which academic medicine is well positioned to complement. The process by which the MHS program has evolved from conception to realization is a case study in the mission-based alignment of core values and leadership between the government and academic medicine. Recognizing the need for multidisciplinary involvement, the program architects reconsidered the traditional approach to the development and implementation of new graduate degree programs. Instead, a more flexible, loosely connected network of strategic partners and alliances was adopted. These partnerships were developed and cultivated by vested individuals who excelled in specific core competencies and came together to create value. This allowed for both the expertise and flexibility needed to adapt quickly to the evolving homeland security environment in the United States. To that end, this article describes the 10-step multidisciplinary program-development process that spanned three years and culminated in the establishment of this new graduate degree program. The MHS program as it now stands focuses on public health preparedness, including epidemiological evaluation, disaster communication and psychology, agricultural biosecurity, and critical infrastructure protection. The program is geared toward the practicing professional already working in the field, and its graduates are positioned to be among the top leaders, educators, and researchers in homeland security.

Policing Visible Sexual/Gender Diversity as a Program of Governance

Directory of Open Access Journals (Sweden)

Angela Dwyer

2012-11-01

Full Text Available Using interview data on LGBT young people’s policing experiences, I argue policing and security works as a program of government (Dean 1999; Foucault 1991; Rose 1999 that constrains the visibilities of diverse sexuality and gender in public spaces. While young people narrated police actions as discriminatory, the interactions were complex and multi-faceted with police and security working to subtly constrain the public visibilities of ‘queerness’. Same sex affection, for instance, was visibly yet unverifiably (Mason 2002 regulated by police as a method of governing the boundaries of proper gender and sexuality in public. The paper concludes by noting how the visibility of police interactions with LGBT young people demonstrates to the public that public spaces are, and should remain, heterosexual spaces.

Pharmaceutical digital marketing and governance: illicit actors and challenges to global patient safety and public health

Science.gov (United States)

2013-01-01

Background Digital forms of direct-to-consumer pharmaceutical marketing (eDTCA) have globalized in an era of free and open information exchange. Yet, the unregulated expansion of eDTCA has resulted in unaddressed global public health threats. Specifically, illicit online pharmacies are engaged in the sale of purportedly safe, legitimate product that may in fact be counterfeit or substandard. These cybercriminal actors exploit available eDTCA mediums over the Internet to market their suspect products globally. Despite these risks, a detailed assessment of the public health, patient safety, and cybersecurity threats and governance mechanisms to address them has not been conducted. Discussion Illicit online pharmacies represent a significant global public health and patient safety risk. Existing governance mechanisms are insufficient and include lack of adequate adoption in national regulation, ineffective voluntary governance mechanisms, and uneven global law enforcement efforts that have allowed proliferation of these cybercriminals on the web. In order to effectively address this multistakeholder threat, inclusive global governance strategies that engage the information technology, law enforcement and public health sectors should be established. Summary Effective global “eHealth Governance” focused on cybercrime is needed in order to effectively combat illicit online pharmacies. This includes building upon existing Internet governance structures and coordinating partnership between the UN Office of Drugs and Crime that leads the global fight against transnational organized crime and the Internet Governance Forum that is shaping the future of Internet governance. Through a UNODC-IGF governance mechanism, investigation, detection and coordination of activities against illicit online pharmacies and their misuse of eDTCA can commence. PMID:24131576

Historical context for the creation of the Office of Adolescent Health and the Teen Pregnancy Prevention Program.

Science.gov (United States)

Kappeler, Evelyn M; Farb, Amy Feldman

2014-03-01

In Fiscal Year 2010, Federal funds were dedicated to support evidence-based approaches to effectively target teen pregnancy prevention and resulted in the establishment of the Office of Adolescent Health (OAH) and the Teen Pregnancy Prevention (TPP) Program. Through the tiered TPP Program, OAH supports replication and evaluation of programs using models whose effectiveness has been demonstrated through rigorous evaluation and the development and testing of promising or innovative pregnancy prevention strategies and approaches. This article documents the creation of OAH and the development of the TPP Program, the identification of a TPP evidence base, current program and evaluation efforts at OAH, and government coordination and partnerships related to reducing teen pregnancy. This article is of interest to those working to improve the health and wellbeing of adolescents. Published by Elsevier Inc.

The NADI program and the JOICFP integrated project: partners in delivering primary health care.

Science.gov (United States)

Arshat, H; Othman, R; Kuan Lin Chee; Abdullah, M

1985-10-01

The NADI program (pulse in Malay) was initially launched as a pilot project in 1980 in Kuala Lumpur, Malaysia. It utilized an integrated approach involving both the government and the private sectors. By sharing resources and expertise, and by working together, the government and the people can achieve national development faster and with better results. The agencies work through a multi-level supportive structure, at the head of which is the steering committee. The NADI teams at the field level are the focal points of services from the various agencies. Members of NADI teams also work with urban poor families as well as health groups, parents-teachers associations, and other similar groups. The policy and planning functions are carried out by the steering committee, the 5 area action committees and the community action committees, while the implementation function is carried out by the area program managers and NADI teams. The chairman of each area action committee is the head of the branch office of city hall. Using intestinal parasite control as the entry point, the NADI Integrated Family Development Program has greatly helped in expanding inter-agency cooperation and exchange of experiences by a coordinated, effective and efficient resource-mobilization. The program was later expanded to other parts of the country including the industrial and estate sectors. Services provided by NADI include: comprehensive health services to promote maternal and child health; adequate water supply, proper waste disposal, construction of latrines and providing electricity; and initiating community and family development such as community education, preschool education, vocational training, family counseling and building special facilities for recreational and educational purposes.

22 CFR 3.12 - Exemption of grants and other foreign government assistance in cultural exchange programs from...

Science.gov (United States)

2010-04-01

... FOREIGN GOVERNMENTS § 3.12 Exemption of grants and other foreign government assistance in cultural... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Exemption of grants and other foreign government assistance in cultural exchange programs from coverage of foreign gifts and decorations...

Participatory health impact assessment for the development of local government regulation on hazard control

International Nuclear Information System (INIS)

Inmuong, Uraiwan; Rithmak, Panee; Srisookwatana, Soomol; Traithin, Nathathai; Maisuporn, Pornpun

2011-01-01

The Thai Public Health Act 1992 required the Thai local governments to issue respective regulations to take control of any possible health-hazard related activities, both from commercial and noncommercial sources. Since 1999, there has been centrally decentralized of power to a new form of local government establishment, namely Sub-district Administrative Organization (SAO). The SAO is asmall-scale local governing structure while its legitimate function is for community services, including control of health impact related activities. Most elected SAO administrators and officers are new and less experience with any of public health code of practice, particularly on health-hazard control. This action research attempted to introduce and apply a participatory health impact assessment (HIA) tool for the development of SAO health-hazard control regulation. The study sites were at Ban Meang and Kok See SAOs, Khon Kaen Province, Thailand, while all intervention activities conducted during May 2005-April 2006. A set of cooperative activities between researchers and community representatives were planned and organized by; surveying and identifying place and service base locally causing local environmental health problems, organizing community participatory workshops for drafting and proposing the health-hazard control regulation, and appropriate practices for health-hazard controlling measures. This action research eventually could successfully enable the SAO administrators and officers understanding of local environmental-related health problem, as well as development of imposed health-hazard control regulation for local community.

Future and potential spending on health 2015-40: development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries.

Science.gov (United States)

2017-05-20

The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. We estimated that global spending on health will increase from US$9·21 trillion in 2014 to $24·24 trillion (uncertainty interval [UI] 20·47-29·72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5·3% (UI 4·1-6·8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4·2% (3·8-4·9). High-income countries are expected to grow at 2·1% (UI 1·8-2·4) and low-income countries are expected to grow at 1·8% (1·0-2·8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending

Impact of Government Shutdown on Child Care and Early Education Programs

Science.gov (United States)

Center for Law and Social Policy, Inc. (CLASP), 2013

2013-01-01

Congress did not enact a continuing resolution bill by midnight September 30, 2013, thereby triggering a partial government shutdown effective October 1, 2013. October 1 began the federal fiscal year 2014. Most discretionary programs, those that are subject to the annual Congressional appropriations process, will not receive 2014 funding. Most,…

Green power programs in Canada : 2003 : overview of Government green power policies, utility green power implementation initiatives, green power and certificate marketing programs, and their benefits

International Nuclear Information System (INIS)

Whitmore, J.; Bramley, M.; Holmes, R.

2004-09-01

Green power is defined as electricity produced from renewable sources, and whose production has low adverse impacts on the environment, human health and communities. Green power has near-zero greenhouse gas (GHG) emissions and includes sources such as wind, hydro, and solar power. It offers several environmental benefits, as well as the enhancement of energy security, regional development, economic diversification and the creation of skilled jobs. There are four categories of programs related to green power development in Canada: government green power policies, utility green power development programs, green power marketing initiatives, and green power certificate marketing initiatives. Most of the activities in Canada associated with these four categories in 2003 were discussed in this report. However, difficulties with quantification prevented the inclusion of some green power activities such as (1) the generation of green power not certified or identified by the generator as green power, (2) industry or residential self-generation, (3) net metering, and (4) small government programs. Green power generation facilities in 2003 totaled 775 MW of capacity compared to 539 MW in 2002. Hydro capacity represented 41 per cent, followed by wind capacity at 40 per cent and wood waste at 17 per cent. Most of the green power generation facilities in 2003 were located in Alberta, followed by British Columbia, Ontario and Quebec. 230 refs., 8 tabs., 1 fig

Data governance tools evaluation criteria, big data governance, and alignment with enterprise data management

CERN Document Server

Soares, Sunil

2015-01-01

Data governance programs often start off using programs such as Microsoft Excel and Microsoft SharePoint to document and share data governance artifacts. But these tools often lack critical functionality. Meanwhile, vendors have matured their data governance offerings to the extent that today's organizations need to consider tools as a critical component of their data governance programs. In this book, data governance expert Sunil Soares reviews the Enterprise Data Management (EDM) reference architecture and discusses key data governance tasks that can be automated by tools for business glossa

Evaluation of capacity-building program of district health managers in India: a contextualized theoretical framework.

Science.gov (United States)

Prashanth, N S; Marchal, Bruno; Kegels, Guy; Criel, Bart

2014-01-01

Performance of local health services managers at district level is crucial to ensure that health services are of good quality and cater to the health needs of the population in the area. In many low- and middle-income countries, health services managers are poorly equipped with public health management capacities needed for planning and managing their local health system. In the south Indian Tumkur district, a consortium of five non-governmental organizations partnered with the state government to organize a capacity-building program for health managers. The program consisted of a mix of periodic contact classes, mentoring and assignments and was spread over 30 months. In this paper, we develop a theoretical framework in the form of a refined program theory to understand how such a capacity-building program could bring about organizational change. A well-formulated program theory enables an understanding of how interventions could bring about improvements and an evaluation of the intervention. In the refined program theory of the intervention, we identified various factors at individual, institutional, and environmental levels that could interact with the hypothesized mechanisms of organizational change, such as staff's perceived self-efficacy and commitment to their organizations. Based on this program theory, we formulated context-mechanism-outcome configurations that can be used to evaluate the intervention and, more specifically, to understand what worked, for whom and under what conditions. We discuss the application of program theory development in conducting a realist evaluation. Realist evaluation embraces principles of systems thinking by providing a method for understanding how elements of the system interact with one another in producing a given outcome.

On a hiding to nothing? Assessing the corporate governance of hospital and health services in New Zealand 1993-1998.

Science.gov (United States)

Barnett, P; Perkins, R; Powell, M

2001-01-01

In New Zealand the governance of public sector hospital and health services has changed significantly over the past decade. For most of the century hospitals had been funded by central government grants but run by locally elected boards. In 1989 a reforming Labour government restructured health services along managerialist lines, including changing governance structures so that some area health board members were government appointments, with the balance elected by the community. More market oriented reform under a new National government abolished this arrangement and introduced (1993) a corporate approach to the management of hospitals and related services. The hospitals were established as limited liability companies under the Companies Act. This was an explicitly corporate model and, although there was some modification of arrangements following the election of a more politically moderate centre-right coalition government in 1996, the corporate model was largely retained. Although significant changes occurred again after the election of a Labour government in 1999, the corporate governance experience in New Zealand health services is one from which lessons can, nevertheless, be learnt. This paper examines aspects of the performance and process of corporate governance arrangements for public sector health services in New Zealand, 1993-1998.

48 CFR 45.303 - Use of Government property on independent research and development programs.

Science.gov (United States)

2010-10-01

... development programs. The contracting officer may authorize a contractor to use the property on an independent... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Use of Government property on independent research and development programs. 45.303 Section 45.303 Federal Acquisition...

Operationalizing the One Health approach: the global governance challenges.

Science.gov (United States)

Lee, Kelley; Brumme, Zabrina L

2013-10-01

While there has been wide-ranging commitment to the One Health approach, its operationalisation has so far proven challenging. One Health calls upon the human, animal and environmental health sectors to cross professional, disciplinary and institutional boundaries, and to work in a more integrated fashion. At the global level, this paper argues that this vision is hindered by dysfunctions characterising current forms of global health governance (GHG), namely institutional proliferation, fragmentation, competition for scarce resources, lack of an overarching authority, and donor-driven vertical programmes. This has contributed, in part, to shortcomings in how One Health has been articulated to date. An agreed operational definition of One Health among key global institutions, efforts to build One Health institutions from the ground up, comparative case studies of what works or does not work institutionally, and high-level global support for research, training and career opportunities would all help to enable One Health to help remedy, and not be subsumed by, existing dysfunctions in GHG.

Drop the Salt! Assessing the impact of a public health advocacy strategy on Australian government policy on salt.

Science.gov (United States)

Webster, Jacqui; Dunford, Elizabeth; Kennington, Sarah; Neal, Bruce; Chapman, Simon

2014-01-01

In 2007 the Australian Division of World Action on Salt and Health (AWASH) launched a campaign to encourage the Australian government to take action to reduce population salt intake. The objective of the present research was to assess the impact of the Drop the Salt! campaign on government policy. A review of government activities related to salt reduction was conducted and an advocacy strategy implemented to increase government action on salt. Advocacy actions were documented and the resulting outcomes identified. An analysis of stakeholder views on the effectiveness of the advocacy strategy was also undertaken. Settings Advocacy activities were coordinated through AWASH at the George Institute for Global Health in Sydney. All relevant State and Federal government statements and actions were reviewed and thirteen stakeholders with known interests or responsibilities regarding dietary salt, including food industry, government and health organisations, were interviewed. Stakeholder analysis affirmed that AWASH influenced the government's agenda on salt reduction and four key outputs were attributed to the campaign: (i) the Food Regulation Standing Committee discussions on salt, (ii) the Food and Health Dialogue salt targets, (iii) National Health and Medical Research Council partnership funding and (iv) the New South Wales Premier's Forum on Fast Foods. While it is not possible to definitively attribute changes in government policy to one organisation, stakeholder research indicated that the AWASH campaign increased the priority of salt reduction on the government's agenda. However, a coordinated government strategy on salt reduction is still required to ensure that the potential health benefits are fully realised.

Governance in genomics: a conceptual challenge for public health genomics law

Directory of Open Access Journals (Sweden)

Tobias Schulte in den Bäumen

2006-12-01

Full Text Available Increasing levels of genomic knowledge has led to awareness that new governance issues need to be taken into consideration. While some countries have created new statutory laws in the last 10 years, science supports the idea that genomic data should be treated like other medical data. In this article we discuss the three core models of governance in medical law on a conceptual level. The three models, the Medical, Public Health and Fundamental Rights Model stress different values, or in legal terms serve different principles. The Medical Model stands for expert knowledge and the standardisation of quality in healthcare. The Public Health Model fosters a social point of view as it advocates distribution justice in healthcare and an awareness of healthcare as a broader concept. The Fundamental Rights Model focuses on individual rights such as the right to privacy and autonomy. We argue that none of the models can be used in a purist fashion as governance in genomics should enable society and individuals to protect individual rights, to strive for a distribution justice and to ensure the quality of genomic services in one coherent process. Thus, genomic governance in genomics requires procedural law and a set of applicable principles. The principle which underlies all three models is the principle of medical beneficence. Therefore genomic governance should refer to it as a key principle when conflicting rights of individuals or communities need to be balanced.

Applying Best Practices to Florida Local Government Retrofit Programs

Energy Technology Data Exchange (ETDEWEB)

McIlvaine, J. [National Renewable Energy Lab. (NREL), Golden, CO (United States); Sutherland, K. [National Renewable Energy Lab. (NREL), Golden, CO (United States)

2013-12-01

In some communities, local government and non-profit entities have funds to purchase and renovate distressed, foreclosed homes for resale in the affordable housing market. Numerous opportunities to improve whole house energy efficiency are inherent in these comprehensive renovations. BA-PIRC worked together in a multi-year field study making recommendations in individual homes, meanwhile compiling improvement costs, projected energy savings, practical challenges, and labor force factors surrounding common energy-related renovation measures. The field study, Phase 1 of this research, resulted in a set of best practices appropriate to the current labor pool and market conditions in central Florida to achieve projected annual energy savings of 15-30% and higher. This report describes Phase 2 of the work where researchers worked with a local government partner to implement and refine the 'current best practices.' A simulation study was conducted to characterize savings potential under three sets of conditions representing varying replacement needs for energy-related equipment and envelope components. The three scenarios apply readily to the general remodeling industry as for renovation of foreclosed homes for the affordable housing market. Our new local government partner, the City of Melbourne, implemented the best practices in a community-scale renovation program that included ten homes in 2012.

Applying Best Practices to Florida Local Government Retrofit Programs

Energy Technology Data Exchange (ETDEWEB)

McIlvaine, J. [Building America Partnership for Improved Residential Construction (BA-PIRC), Cocoa, FL (United States); Sutherland, K. [Building America Partnership for Improved Residential Construction (BA-PIRC), Cocoa, FL (United States)

2013-12-01

In some communities, local government and non-profit entities have funds to purchase and renovate distressed, foreclosed homes for resale in the affordable housing market. Numerous opportunities to improve whole house energy efficiency are inherent in these comprehensive renovations. BA-PIRC worked together in a multiyear field study making recommendations in individual homes, meanwhile compiling improvement costs, projected energy savings, practical challenges, and labor force factors surrounding common energy-related renovation measures. The field study, Phase 1 of this research, resulted in a set of best practices appropriate to the current labor pool and market conditions in central Florida to achieve projected annual energy savings of 15%-30% and higher. This report describes Phase 2 of the work where researchers worked with a local government partner to implement and refine the "current best practices". A simulation study was conducted to characterize savings potential under three sets of conditions representing varying replacement needs for energy-related equipment and envelope components. The three scenarios apply readily to the general remodeling industry as for renovation of foreclosed homes for the affordable housing market. The new local government partner, the City of Melbourne, implemented the best practices in a community-scale renovation program that included ten homes in 2012.

Translating the Elements of Health Governance for Integrated Care from Theory to Practice: A Case Study Approach.

Science.gov (United States)

Nicholson, Caroline; Hepworth, Julie; Burridge, Letitia; Marley, John; Jackson, Claire

2018-01-31

Against a paucity of evidence, a model describing elements of health governance best suited to achieving integrated care internationally was developed. The aim of this study was to explore how health meso-level organisations used, or planned to use, the governance elements. A case study design was used to offer two contrasting contexts of health governance. Semi-structured interviews were conducted with participants who held senior governance roles. Data were thematically analysed to identify if the elements of health governance were being used, or intended to be in the future. While all participants agreed that the ten elements were essential to developing future integrated care, most were not used. Three major themes were identified: (1) organisational versus system focus, (2) leadership and culture, and, (3) community (dis)engagement. Several barriers and enablers to the use of the elements were identified and would require addressing in order to make evidence-based changes. Despite a clear international policy direction in support of integrated care this study identified a number of significant barriers to its implementation. The study reconfirmed that a focus on all ten elements of health governance is essential to achieve integrated care.

Tax Governance

DEFF Research Database (Denmark)

Boll, Karen; Brehm Johansen, Mette

to wider international trends within tax administration, especially concerning the development of risk assessments and internal control in the corporations and a greater focus on monitoring of these elements by the tax authorities. Overall, the working paper concludes that Tax Governance as a model......This working paper presents an analysis of the experiences of Cooperative Compliance in Denmark. Cooperative Compliance denotes a specific kind of collaborative program for the regulation of large corporate taxpayers by the tax authorities. Cooperative Compliance programs have been implemented...... in several countries worldwide. In Denmark the program is called Tax Governance. Tax Governance has been studied using qualitative method and the analyses of the working paper build on an extensive base of in-depth interviews – primarily with tax directors from corporations participating in the program...

Public health and English local government: historical perspectives on the impact of 'returning home'.

Science.gov (United States)

Gorsky, Martin; Lock, Karen; Hogarth, Sue

2014-12-01

This article uses history to stimulate reflection on the present opportunities and challenges for public health practice in English local government. Its motivation is the paradox that despite Department of Health policy-makers' allusions to 'a long and proud history' and 'returning public health home' there has been no serious discussion of that past local government experience and what we might learn from it. The article begins with a short resumé of the achievements of Victorian public health in its municipal location, and then considers the extensive responsibilities that it developed for environmental, preventive and health services by the mid-twentieth century. The main section discusses the early NHS, explaining why historians see the era as one of decline for the speciality of public health, leading to the reform of 1974, which saw the removal from local government and the abolition of the Medical Officer of Health role. Our discussion focuses on challenges faced before 1974 which raise organizational and political issues relevant to local councils today as they embed new public health teams. These include the themes of leadership, funding, integrated service delivery, communication and above all the need for a coherent vision and rationale for public health action in local authorities. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health.

32 CFR 37.220 - How involved should the Government program official be in the project?

Science.gov (United States)

2010-07-01

... official be in the project? 37.220 Section 37.220 National Defense Department of Defense OFFICE OF THE... Technology Investment Agreements § 37.220 How involved should the Government program official be in the project? (a) TIAs are used to carry out cooperative relationships between the Federal Government and the...

Disparity and convergence: Chinese provincial government health expenditures.

Science.gov (United States)

Pan, Jay; Wang, Peng; Qin, Xuezheng; Zhang, Shufang

2013-01-01

The huge regional disparity in government health expenditures (GHE) is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed.

Disparity and convergence: Chinese provincial government health expenditures.

Directory of Open Access Journals (Sweden)

Jay Pan

Full Text Available The huge regional disparity in government health expenditures (GHE is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed.

Into the deep end: incorporating a global health governance and diplomacy experience in graduate public health training.

Science.gov (United States)

Wipfli, Heather; Kotlewski, Jennifer A

2014-01-01

Global health governance benefits from participants well-versed in the realities of international policy-making. Consequently, educational programmes must establish more opportunities for students to engage in global health policy development. This paper examines a unique global health governance and diplomacy practicum programme at the University of Southern California, designed for Master of Public Health candidates. Through the programme, students act as official non-governmental delegates to the World Health Assembly in Geneva, Switzerland through organisational partnerships. Students and collaborating organisations were asked to complete an online post-participation survey examining the perceived quality of the experience. Through the survey, students indicated reinforcement of classroom learning, continued or heightened interest in global health policy and enthusiasm in recommending the programme to other students. Organisations perceived students to be adequately prepared and indicated their continued desire to work with students in the programme. The data collected suggest that the programme was successful in providing students with a worthwhile experience that developed skills in global health diplomacy and promoted interest and critical thinking concerning international policy-making processes. A discussion of strengths and challenges serves as a blueprint for the creation of future practicum programmes.

Governing decentralization in health care under tough budget constraint: what can we learn from the Italian experience?

Science.gov (United States)

Tediosi, Fabrizio; Gabriele, Stefania; Longo, Francesco

2009-05-01

In many European countries, since the World War II, there has been a trend towards decentralization of health policy to lower levels of governments, while more recently there have been re-centralization processes. Whether re-centralization will be the new paradigm of European health policy or not is difficult to say. In the Italian National Health Service (SSN) decentralization raised two related questions that might be interesting for the international debate on decentralization in health care: (a) what sort of regulatory framework and institutional balances are required to govern decentralization in health care in a heterogeneous country under tough budget constraints? (b) how can it be ensured that the most advanced parts of the country remain committed to solidarity, supporting the weakest ones? To address these questions this article describes the recent trends in SSN funding and expenditure, it reviews the strategy adopted by the Italian government for governing the decentralization process and discusses the findings to draw policy conclusions. The main lessons emerging from this experience are that: (1) when the differences in administrative and policy skills, in socio-economic standards and social capital are wide, decentralization may lead to undesirable divergent evolution paths; (2) even in decentralized systems, the role of the Central government can be very important to contain health expenditure; (3) a strong governance of the Central government may help and not hinder the enforcement of decentralization; and (4) supporting the weakest Regions and maintaining inter-regional solidarity is hard but possible. In Italy, despite an increasing role of the Central government in steering the SSN, the pattern of regional decentralization of health sector decision making does not seem at risk. Nevertheless, the Italian case confirms the complexity of decentralization and re-centralization processes that sometimes can be paradoxically reinforcing each other.

Analysis of the distributional impact of out-of-pocket health payments: evidence from a public health insurance program for the poor in Mexico.

Science.gov (United States)

Garcia-Diaz, Rocio; Sosa-Rubi, Sandra G; Sosa-Rub, Sandra G

2011-07-01

Many governments have health programs focused on improving health among the poor and these have an impact on out-of-pocket health payments made by individuals. Therefore, one of the objectives of these programs is to reach the poorest and reduce their out-of-pocket expenditure. In this paper we propose the distributional poverty impact approach to measure the poverty impact of out-of-pocket health payments of different health financing policies. This approach is comparable to the impoverishment methodology proposed by Wagstaff and van Doorslaer (2003) that compares poverty indices before and after out-of-pocket health payments. In order to escape the specification of a particular poverty index, we use the marginal dominance approach that uses non-intersecting curves and can rank poverty reducing health financing policies. We present an empirical application of the out-of-pocket health payments for an innovative social financing policy implemented in Mexico named Seguro Popular. The paper finds evidence that Seguro Popular program has a better distributional poverty impact when families face illness when compared to other poverty reducing policies. The empirical dominance approach uses data from Mexico in 2006 and considers international poverty standards of $2 per person per day. Copyright © 2011 Elsevier B.V. All rights reserved.

Delivering proportionate governance in the era of eHealth

Science.gov (United States)

Sethi, Nayha; Laurie, Graeme T.

2013-01-01

This article advances a principled proportionate governance model (PPGM) that overcomes key impediments to using health records for research. Despite increasing initiatives for maximising benefits of data linkage, significant challenges remain, including a culture of caution around data sharing and linkage, failure to make use of flexibilities within the law and failure to incorporate intelligent iterative design. The article identifies key issues for consideration and posits a flexible and accessible governance model that provides a robust and efficient means of paying due regard to both privacy and the public interests in research. We argue that proportionate governance based on clear guiding principles accurately gauges risks associated with data uses and assigns safeguards accordingly. This requires a clear articulation of roles and responsibilities at all levels of decision-making and effective training for researchers and data custodians. Accordingly, the PPGM encourages and supports defensible judgements about data linkage in the public interest. PMID:24634569

Improving health research governance and management in the Western Pacific: a WHO expert consultation.

Science.gov (United States)

Rani, Manju; Bekedam, Hendrik; Buckley, Brian S

2011-11-01

Repeated calls have been made in recent decades to increase investments in health research, especially in low- and middle-income countries (LMIC). However, the perceived low relevance and quality of health research, poor visibility of outputs, and difficulties in tracking current levels of and returns on investments have undermined efforts to advocate for additional investments in these countries. Some of these issues emanate from inadequate governance and management systems for health research at the national level, which are ineffective in tracking and steering the research portfolio and investments, ensuring quality, and facilitating access to research outputs. In spite of this, the value, necessity, and cost of performing health research management and governance functions are not well appreciated, especially in LMIC. To address this, the World Health Organization (WHO) Regional Office for the Western Pacific organized an expert consultation in August 2011, involving experts from 14 of its developed and developing member states and from leading research organizations such as the Wellcome Trust. The consultation identified essential health research governance and management functions that must be performed by appropriate organizational entities to maximize returns on health research investments. In addition, three specific areas for intervention were considered: (1) prospective research registration in publicly accessible national health research registries; (2) systematic health research data archiving and wider access; and (3) national research ethics systems. A consensus was reached on the need to invest more in essential health research and management functions, including establishing publicly accessible web-based national health research registries for prospective registration of health research, setting up systems to archive and share health research data, and improving the governance of research ethics committees. The consultation also concluded that the

75 FR 2549 - Health Center Program

Science.gov (United States)

2010-01-15

... Program AGENCY: Health Resources and Services Administration, HHS ACTION: Notice of Noncompetitive Replacement Award to Regional Health Care Affiliates. SUMMARY: The Health Resources and Services Administration (HRSA) will be transferring Health Center Program (section 330 of the Public Health Service Act...

AIDS activists take South African government to court.

Science.gov (United States)

Baleta, A

2000-08-26

In South Africa, AIDS activists are taking legal action against their government because of its refusal to provide HIV-positive women with drugs to prevent mother-to-child transmission of HIV. The Treatment Action Campaign gave the health department an ultimatum to make moves to change policy on treating infected mothers; however, since the department had not responded, the legal process was set to begin. Mark Heywood, the Campaign's spokesman, said that the campaign is pushing for the implementation of programs on a phased basis to provide zidovudine or nevirapine at facilities where it is possible. It is noted that the government has remained steadfast in its opposition to an expansion of the program to all HIV-positive women attending state health services. Although Health Minister Mantho Tshabalala Msimang said that the drug regulatory authority is reviewing results of studies on nevirapine use, with a view to possible registration of the drug, Heywood argues that such an action continues to question the efficacy of antiretrovirals since these tests have already been done.

Women's use of private and government health facilities for childbirth in Nairobi's informal settlements.

Science.gov (United States)

Bazant, Eva S; Koenig, Michael A; Fotso, Jean-Christophe; Mills, Samuel

2009-03-01

The private sector's role in increasing the use of maternal health care for the poor in developing countries has received increasing attention, yet few data exist for urban slums. Using household-survey data from 1,926 mothers in two informal settlements in Nairobi, Kenya, collected in 2006, we describe and examine the factors associated with women's use of private and government health facilities for childbirth. More women gave birth at private facilities located in the settlements than at government facilities, and one-third of the women gave birth at home or with the assistance of a traditional birth attendant. In multivariate models, women's education, ethnic group, and household wealth were associated with institutional deliveries, especially in government hospitals. Residents in the more disadvantaged settlement were more likely than those in the better-off settlement to give birth in private facilities. In urban areas, maternal health services in both the government and private sectors should be strengthened, and efforts made to reach out to women who give birth at home.

The Legal Strength of International Health Instruments - What It Brings to Global Health Governance?

Science.gov (United States)

Nikogosian, Haik; Kickbusch, Ilona

2016-09-04

Public health instruments have been under constant development and renewal for decades. International legal instruments, with their binding character and strength, have a special place in this development. The start of the 21st century saw, in particular, the birth of the first World Health Organization (WHO)-era health treaties - the WHO Framework Convention on Tobacco Control (WHO FCTC) and its first Protocol. The authors analyze the potential impact of these instruments on global health governance and public health, beyond the traditional view of their impact on tobacco control. Overall, the very fact that globally binding treaties in modern-era health were feasible has accelerated the debate and expectations for an expanded role of international legal regimes in public health. The impact of treaties has also been notable in global health architecture as the novel instruments required novel institutions to govern their implementation. The legal power of the WHO FCTC has enabled rapid adoption of further instruments to promote its implementation, thus, enhancing the international instrumentarium for health, and it has also prompted stronger role for national legislation on health. Notably, the Convention has elevated several traditionally challenging public health features to the level of international legal obligations. It has also revealed how the legal power of the international health instrument can be utilized in safeguarding the interests of health in the face of competing agendas and legal disputes at both the domestic and international levels. Lastly, the legal power of health instruments is associated with their potential impact not only on health but also beyond; the recently adopted Protocol to Eliminate Illicit Trade in Tobacco Products may best exemplify this matter. The first treaty experiences of the 21st century may provide important lessons for the role of legal instruments in addressing the unfolding challenges in global health. © 2016 The

Exploring the nature of governance at the level of implementation for health system strengthening: the DIALHS experience.

Science.gov (United States)

Scott, Vera; Schaay, Nikki; Olckers, Patti; Nqana, Nomsa; Lehmann, Uta; Gilson, Lucy

2014-09-01

Health system governance has been recognized as a critical element of the health system strengthening agenda. To date, health governance research often focuses at national or global levels, adopting a macro-perspective that deals with governance structures, forms and principles. Little attention has been given to a micro-perspective which recognizes the role of health system actors in governance, or to considering the operational level of the health system. This article presents a South African case study of an intervention to address conflict in roles and responsibilities between multiple actors supporting service delivery at the local level, and explores the broader insights this experience generates about the nature of local health system governance. In an embedded case study, action learning and reflection theory were used to design and implement the intervention. Data in this article were drawn from minutes, observations and recorded reflections of the meetings and workshops that comprised the intervention. A theoretical governance framework was used both to understand the context of the intervention and to analyse the dimensions of governance relevant in the experience. The study shows how, through action learning and reflection, local managers in two organizations came to understand how the higher level misalignment of organizational structures and processes imposed governance constraints on them, and to see the impact this had on their organizational relationships. By re-framing the conflict as organizational, they were then able to create opportunities for staff to understand their context and participate in negotiating principles for communication and collaborative work. The result reduced conflict between staff in the two organizations, leading to improved implementation of programme support. Strengthening relationships among those working at local level by building collaborative norms and values is an important part of local health system governance for

History, Structure and Agency in Global Health Governance Comment on "Global Health Governance Challenges 2016 - Are We Ready?"

Science.gov (United States)

Gill, Stephen; Benatar, Solomon R

2016-08-29

Ilona Kickbusch's thought provoking editorial is criticized in this commentary, partly because she fails to refer to previous critical work on the global conditions and policies that sustain inequality, poverty, poor health and damage to the biosphere and, as a result, she misreads global power and elides consideration of the fundamental historical structures of political and material power that shape agency in global health governance. We also doubt that global health can be improved through structures and processes of multilateralism that are premised on the continued reproduction of the ecologically myopic and socially unsustainable market civilization model of capitalist development that currently prevails in the world economy. This model drives net financial flows from poor to rich countries and from the poor to the affluent and super wealthy individuals. By contrast, we suggest that significant progress in global health requires a profound and socially just restructuring of global power, greater global solidarity and the "development of sustainability." © 2017 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Health and equity in all policies in local government: processes and outcomes in two Norwegian municipalities.

Science.gov (United States)

Von Heimburg, Dina; Hakkebo, Berit

2017-08-01

To identify key factors in implementing Health and Equity in All Policies (HEiAP) at the local level in two Norwegian municipalities in order to accelerate the progress of promoting health, well-being and equity in other local governments. This case study is presented as a narrative from policy-making processes in two Norwegian municipalities. The story is told from an insider perspective, with a focus on HEiAP policy makers in these two municipalities. The narrative identified key learning from implementing HEiAP at the local level, i.e. the importance of strengthening system and human capacities. System capacity is strengthened by governing HEiAP according to national legislation and a holistic governance system at the local level. Municipal plans are based on theory, evidence and local data. A 'main story' is developed to support the vision, defining joint societal goals and co-creation strategies. Policies are anchored by measuring and monitoring outcomes, sharing accountability and continuous dialogue to ensure political commitment. Human capacity is strengthened through participatory leadership, soft skills and health promotion competences across sectors. Health promotion competence at a strategic level in the organization, participation in professional networks, crowd sourcing toward common goals, and commitment through winning hearts and minds of politicians and other stakeholders are vital aspects. Our experience pinpoints the importance of strengthening system and human capacity in local governments. Further, we found it important to focus on the two strategic objectives in the European strategy 'Health 2020': (1) Improving health for all and reducing health inequalities; (2) improving leadership and participatory governance for health.

The health worker recruitment and deployment process in Kenya: an emergency hiring program.

Science.gov (United States)

Adano, Ummuro

2008-09-16

Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy (ART). Because in the current system it takes one to two years to fill vacant positions, even when funding is available, an emergency approach was needed to fast-track the hiring and deployment process. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model that would mobilize 830 additional health workers. This model used the private sector to recruit and deploy new health workers and manage the payroll and employment contracts, with an agreement from the government to transfer these staff to the government payroll after three years. The recruitment process was shortened to less than three months. By providing job orientation and on-time pay checks, the program increased employee retention and satisfaction. Most of the active roadblocks to changes in the health workforce policies and systems are 'human' and not technical, stemming from a lack of leadership, a problem-solving mindset and the alignment of stakeholders from several sectors. It is essential to establish partnerships and foster commitment and collaboration to create needed change in human resource management (HRM). Strengthening appointment on merit is one of the most powerful, yet simplest ways in which the health sector and governments that seek to tackle the challenges of corruption and poor governance can improve their image and efficiency. The quality and integrity of the public health sector can be improved only through professionalizing HRM, reformulating and consolidating the currently fragmented HR functions, and bringing all the pieces together under the authority and influence of HR departments and units with expanded scopes. HR staff must be specialists with strategic HR functions and not generalists who are

The health worker recruitment and deployment process in Kenya: an emergency hiring program

Directory of Open Access Journals (Sweden)

Adano Ummuro

2008-09-01

Full Text Available Abstract Despite a pool of unemployed health staff available in Kenya, staffing levels at most facilities were only 50%, and maldistribution of staff left many people without access to antiretroviral therapy (ART. Because in the current system it takes one to two years to fill vacant positions, even when funding is available, an emergency approach was needed to fast-track the hiring and deployment process. A stakeholder group was formed to bring together leaders from several sectors to design and implement a fast-track hiring and deployment model that would mobilize 830 additional health workers. This model used the private sector to recruit and deploy new health workers and manage the payroll and employment contracts, with an agreement from the government to transfer these staff to the government payroll after three years. The recruitment process was shortened to less than three months. By providing job orientation and on-time pay checks, the program increased employee retention and satisfaction. Most of the active roadblocks to changes in the health workforce policies and systems are 'human' and not technical, stemming from a lack of leadership, a problem-solving mindset and the alignment of stakeholders from several sectors. It is essential to establish partnerships and foster commitment and collaboration to create needed change in human resource management (HRM. Strengthening appointment on merit is one of the most powerful, yet simplest ways in which the health sector and governments that seek to tackle the challenges of corruption and poor governance can improve their image and efficiency. The quality and integrity of the public health sector can be improved only through professionalizing HRM, reformulating and consolidating the currently fragmented HR functions, and bringing all the pieces together under the authority and influence of HR departments and units with expanded scopes. HR staff must be specialists with strategic HR functions

History, Structure and Agency in Global Health Governance; Comment on “Global Health Governance Challenges 2016 – Are We Ready?”

Directory of Open Access Journals (Sweden)

Stephen Gill

2017-04-01

Full Text Available Ilona Kickbusch’s thought provoking editorial is criticized in this commentary, partly because she fails to refer to previous critical work on the global conditions and policies that sustain inequality, poverty, poor health and damage to the biosphere and, as a result, she misreads global power and elides consideration of the fundamental historical structures of political and material power that shape agency in global health governance. We also doubt that global health can be improved through structures and processes of multilateralism that are premised on the continued reproduction of the ecologically myopic and socially unsustainable market civilization model of capitalist development that currently prevails in the world economy. This model drives net financial flows from poor to rich countries and from the poor to the affluent and super wealthy individuals. By contrast, we suggest that significant progress in global health requires a profound and socially just restructuring of global power, greater global solidarity and the “development of sustainability.”

Government health insurance for people below poverty line in India: quasi-experimental evaluation of insurance and health outcomes.

Science.gov (United States)

Sood, Neeraj; Bendavid, Eran; Mukherji, Arnab; Wagner, Zachary; Nagpal, Somil; Mullen, Patrick

2014-09-11

To evaluate the effects of a government insurance program covering tertiary care for people below the poverty line in Karnataka, India, on out-of-pocket expenditures, hospital use, and mortality. Geographic regression discontinuity study. 572 villages in Karnataka, India. 31,476 households (22,796 below poverty line and 8680 above poverty line) in 300 villages where the scheme was implemented and 28,633 households (21,767 below poverty line and 6866 above poverty line) in 272 neighboring matched villages ineligible for the scheme. A government insurance program (Vajpayee Arogyashree scheme) that provided free tertiary care to households below the poverty line in about half of villages in Karnataka from February 2010 to August 2012. Out-of-pocket expenditures, hospital use, and mortality. Among households below the poverty line, the mortality rate from conditions potentially responsive to services covered by the scheme (mostly cardiac conditions and cancer) was 0.32% in households eligible for the scheme compared with 0.90% among ineligible households just south of the eligibility border (difference of 0.58 percentage points, 95% confidence interval 0.40 to 0.75; Ppoverty line (households above the poverty line were not eligible for the scheme), with a mortality rate from conditions covered by the scheme of 0.56% in eligible villages compared with 0.55% in ineligible villages (difference of 0.01 percentage points, -0.03 to 0.03; P=0.95). Eligible households had significantly reduced out-of-pocket health expenditures for admissions to hospitals with tertiary care facilities likely to be covered by the scheme (64% reduction, 35% to 97%; PIndia. © Sood et al 2014.

Management and governance processes in community health coalitions: a procedural justice perspective.

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Weiner, Bryan J; Alexander, Jeffrey A; Shortell, Stephen M

2002-12-01

Community-based coalitions are a popular strategy for promoting community health despite the fact that coalitions often fail to achieve measurable results. Using a procedural justice framework, this study seeks to advance knowledge about the relationship between coalition governance and management processes and indicators of coalition functioning. Member survey data from 25 coalitions participating in the Community Care Network Demonstration Program were analyzed using two-stage least squares regression. Results show that personal influence in decision making. decision process clarity, and collaborative conflict resolution were significantly associated with procedural fairness perceptions. Procedural fairness perceptions, in turn, were positively associated with member satisfaction with coalition decisions, but not personal engagement in the coalition or organizational integration of coalition goals and activities. Personal influence in decision making and collaborative conflict resolution also exhibited direct relationships with all three indicators of coalition functioning examined in the study.

[Public health stewardship and governance regarding the Colombian healthcare system, 2012-2013].

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Roth-Deubel, André N; Molina-Marín, Gloria

2013-01-01

Analysing decision-making concerning public health issues regarding the Colombian healthcare system from a market economy-based approach. This study involved applying Glaser and Strauss's grounded theory in six Colombian cities during 2012: Bogotá, Barranquilla, Bucaramanga, Leticia, Medellin and Pasto. 120 individual interviews were conducted with professionals involved in decision-making, running public healthcare programmes and making policy within public and private institutions. Fourteen focus groups were held with community organisation leaders. The findings suggested national and municipal health authorities' weak stewardship and ineffective governance regarding public healthcare policy and programmes, related to a lack of staff trained in public health management issues. In turn, this was related to political parties' interference and private insurers' particular interests and the structural fragmentation of functions and actors within the health system, thereby limiting public health development. A new axiology is necessary for achieving effective governance (I.e. cooperation between Colombian Healthcare Social Security System actors) to overcome current incompetence and financial self-interest predominating within the Colombian healthcare system.

Governance of health care networks: Assessment of the health care integrating councils in the context of the health sector reform in Chile.

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Osvaldo Artaza-Barrios

2013-11-01

Full Text Available Objective. This paper aims at assessing the contribution of Chile’s Health Care Integrating Councils (CIRA, Spanish acronym to strengthening governance in health. Materials and methods. A literature review on the official documents related to the process of creation and development of CIRA was carried out; an ad hoc questionnaire was applied to all 29 health services of the country; finally, 35 semi-structure in-depth interviews were carried on a sample of six CIRA. Results. The CIRAs have become a tool for functional integration and a valuable space for dialogue, cooperation and learning for all of the actors of the Chilean public health network. Conclusions. In this study, we conclude that there is room for improvements of CIRA’s role regarding governance of the health care network as long as CIRA is authorized to deal with strategic topics, such as investment in infrastructure, technology and human resources, and budgeting.

The Chinese Government Scholarship Program: An Effective Form of Foreign Assistance?

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Dong, Lili; Chapman, David W.

2008-03-01

This study investigates the effectiveness of Chinese international education assistance through an examination of student experience in the Chinese Government Scholarship Program, an important mechanism of Chinese foreign aid. Grounded in Pascarella's (1985) model of the impact of college on students, the study investigates participants' level of satisfaction with their higher education experience in China and their perception of the role of the scholarship program in promoting positive relationships between China and the scholarship students' home countries. Findings indicate that participants are generally satisfied with their experiences in China and are positive about the impact of the program in building friendships with their home countries. The authors discuss the implications of these findings in terms of China's emerging prominence as a provider of international development assistance.

Global Health Governance Challenges 2016 - Are We Ready?

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Kickbusch, Ilona

2016-02-29

The year 2016 could turn out to be a turning point for global health, new political realities and global insecurities will test governance and financing mechanisms in relation to both people and planet. But most importantly political factors such as the global power shift and "the rise of the rest" will define the future of global health. A new mix of health inequity and security challenges has emerged and the 2015 humanitarian and health crises have shown the limits of existing systems. The global health as well as the humanitarian system will have to prove their capacity to respond and reform. The challenge ahead is deeply political, especially for the rising political actors. They are confronted with the consequences of a model of development that has neglected sustainability and equity, and was built on their exploitation. Some direction has been given by the path breaking international conferences in 2015. Especially the agreement on the Sustainable Development Goals (SDGs) and the Paris agreement on climate change will shape action. Conceptually, we will need a different understanding of global health and its ultimate goals - the health of people can no longer be seen separate from the health of the planet and wealth measured by parameters of growth will no longer ensure health. © 2016 by Kerman University of Medical Sciences.

Lessons from Canada's health program.

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Terris, M

1990-01-01

The Canadian health program is described and analyzed. Positive features include financing through progressive taxation; complete coverage of physician and hospital services; complete absence of deductibles, copayments, and extra charges by physicians and hospitals; lower administrative costs because private insurance companies are excluded from the program; and avoidance of the straitjacket of a single federal program by decentralization to the provinces. Negative features include ever-rising costs due to the almost complete dominance of fee-for-service payment to physicians; failure to monitor the quality of care; and neglect of serious support for preventive services and improved living standards--the two most important determinants of health status. Recommendations are made for a U.S. national health program that would incorporate the positive features of the Canadian program and avoid its deficiencies.

Primary health care lessons from the northeast of Brazil: the Agentes de Saúde Program.

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Cufino Svitone, E; Garfield, R; Vasconcelos, M I; Araujo Craveiro, V

2000-05-01

Market-led economic reforms are usually viewed as being in conflict with government-stimulated socioeconomic development for disadvantaged groups. Nevertheless, Ceará, a poor state in the Northeast of Brazil, has since 1987 pursued both of those strategies simultaneously. One part of that approach has been a program of nurse-directed auxiliary health workers serving about 5 million people--almost all the persons outside the capital city and half of those in the capital. The system requires that the auxiliaries, called agentes de saúde, live in the local communities that they serve. The health agents visit each home once a month to carry out a small number of priority health activities. While health agent positions are in high demand, the minimum-wage salary that the agents receive makes up only a small portion of the state budget. A key aspect of the system is timely and comprehensive information, which is based on agent visits and is managed by trained nurses. Since the health agents system was launched, there has been a rapid decline in infant mortality, a rapid rise in immunization, identification of bottlenecks limiting the utilization of other medical resources, and timely interventions in times of crisis. The health agents system has combined administrative decentralization with financial centralization during a period of electoral democratization. The system has strengthened Ceará's commitment to primary care even as market-oriented changes have reduced the overall role of government. The Ceará program is being copied throughout the Northeast and other regions of Brazil. The key role that nurses play in the Ceará program in organizing and leading a system of basic primary care in poor neighborhoods and rural areas may provide useful lessons for other countries. In addition, Ceará does not have many of the favorable characteristics of other countries that have successfully invested in primary health care. Ceará thus represents a more achievable model

The impact of IMF conditionality on government health expenditure: A cross-national analysis of 16 West African nations.

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Stubbs, Thomas; Kentikelenis, Alexander; Stuckler, David; McKee, Martin; King, Lawrence

2017-02-01

How do International Monetary Fund (IMF) policy reforms-so-called 'conditionalities'-affect government health expenditures? We collected archival documents on IMF programmes from 1995 to 2014 to identify the pathways and impact of conditionality on government health spending in 16 West African countries. Based on a qualitative analysis of the data, we find that IMF policy reforms reduce fiscal space for investment in health, limit staff expansion of doctors and nurses, and lead to budget execution challenges in health systems. Further, we use cross-national fixed effects models to evaluate the relationship between IMF-mandated policy reforms and government health spending, adjusting for confounding economic and demographic factors and for selection bias. Each additional binding IMF policy reform reduces government health expenditure per capita by 0.248 percent (95% CI -0.435 to -0.060). Overall, our findings suggest that IMF conditionality impedes progress toward the attainment of universal health coverage. Copyright © 2016 Elsevier Ltd. All rights reserved.

Basic Program Elements for Federal employee Occupational Safety and Health Programs and related matters; Subpart I for Recordkeeping and Reporting Requirements. Final rule.

Science.gov (United States)

2013-08-05

OSHA is issuing a final rule amending the Basic Program Elements to require Federal agencies to submit their occupational injury and illness recordkeeping information to the Bureau of Labor Statistics (BLS) and OSHA on an annual basis. The information, which is already required to be created and maintained by Federal agencies, will be used by BLS to aggregate injury and illness information throughout the Federal government. OSHA will use the information to identify Federal establishments with high incidence rates for targeted inspection, and assist in determining the most effective safety and health training for Federal employees. The final rule also interprets several existing basic program elements in our regulations to clarify requirements applicable to Federal agencies, amends the date when Federal agencies must submit to the Secretary of Labor their annual report on occupational safety and health programs, amends the date when the Secretary of Labor must submit to the President the annual report on Federal agency safety and health, and clarifies that Federal agencies must include uncompensated volunteers when reporting and recording occupational injuries and illnesses.

Social Media for e-Government in the Public Health Sector: Protocol for a Systematic Review

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Franco, Massimo; Tursunbayeva, Aizhan

2016-01-01

Background Public sector organizations worldwide are engaging with social media as part of a growing e-government agenda. These include government departments of health, public health agencies, and state-funded health care and research organizations. Although examples of social media in health have been described in the literature, little is known about their overall scope or how they are achieving the objectives of e-government. A systematic literature review is underway to capture and synthesize existing evidence on the adoption, use, and impacts of social media in the public health sector. A series of parallel scoping exercises has taken place to examine (1) relevant existing systematic reviews, to assess their focus, breadth, and fit with our review topic, (2) existing concepts related to e-government, public health, and the public health sector, to assess how semantic complexity might influence the review process, and (3) the results of pilot searches, to examine the fit of social media within the e-government and health literatures. The methods and observations of the scoping exercises are reported in this protocol, alongside the methods and interim results for the systematic review itself. Objective The systematic review has three main objectives: To capture the corpus of published studies on the uses of social media by public health organizations; to classify the objectives for which social media have been deployed in these contexts and the methods used; and to analyze and synthesize evidence of the uptake, use, and impacts of social media on various outcomes. Methods A set of scoping exercises were undertaken, to inform the search strategy and analytic framework. Searches have been carried out in MEDLINE, the Cochrane Library, Web of Science, and the Scopus international electronic databases, and appropriate gray literature sources. Articles published between January 1, 2004, and July 12, 2015, were included. There was no restriction by language. One

Social Media for e-Government in the Public Health Sector: Protocol for a Systematic Review.

Science.gov (United States)

Franco, Massimo; Tursunbayeva, Aizhan; Pagliari, Claudia

2016-03-11

Public sector organizations worldwide are engaging with social media as part of a growing e-government agenda. These include government departments of health, public health agencies, and state-funded health care and research organizations. Although examples of social media in health have been described in the literature, little is known about their overall scope or how they are achieving the objectives of e-government. A systematic literature review is underway to capture and synthesize existing evidence on the adoption, use, and impacts of social media in the public health sector. A series of parallel scoping exercises has taken place to examine (1) relevant existing systematic reviews, to assess their focus, breadth, and fit with our review topic, (2) existing concepts related to e-government, public health, and the public health sector, to assess how semantic complexity might influence the review process, and (3) the results of pilot searches, to examine the fit of social media within the e-government and health literatures. The methods and observations of the scoping exercises are reported in this protocol, alongside the methods and interim results for the systematic review itself. The systematic review has three main objectives: To capture the corpus of published studies on the uses of social media by public health organizations; to classify the objectives for which social media have been deployed in these contexts and the methods used; and to analyze and synthesize evidence of the uptake, use, and impacts of social media on various outcomes. A set of scoping exercises were undertaken, to inform the search strategy and analytic framework. Searches have been carried out in MEDLINE, the Cochrane Library, Web of Science, and the Scopus international electronic databases, and appropriate gray literature sources. Articles published between January 1, 2004, and July 12, 2015, were included. There was no restriction by language. One reviewer (AT) has independently

Governance, Government, and the Search for New Provider Models

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Richard B. Saltman

2016-01-01

Full Text Available A central problem in designing effective models of provider governance in health systems has been to ensure an appropriate balance between the concerns of public sector and/or government decision-makers, on the one hand, and of non-governmental health services actors in civil society and private life, on the other. In tax-funded European health systems up to the 1980s, the state and other public sector decision-makers played a dominant role over health service provision, typically operating hospitals through national or regional governments on a command-and-control basis. In a number of countries, however, this state role has started to change, with governments first stepping out of direct service provision and now de facto pushed to focus more on steering provider organizations rather than on direct public management. In this new approach to provider governance, the state has pulled back into a regulatory role that introduces market-like incentives and management structures, which then apply to both public and private sector providers alike. This article examines some of the main operational complexities in implementing this new governance reality/strategy, specifically from a service provision (as opposed to mostly a financing or even regulatory perspective. After briefly reviewing some of the key theoretical dilemmas, the paper presents two case studies where this new approach was put into practice: primary care in Sweden and hospitals in Spain. The article concludes that good governance today needs to reflect practical operational realities if it is to have the desired effect on health sector reform outcome.

Governance, Government, and the Search for New Provider Models.

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Saltman, Richard B; Duran, Antonio

2015-11-03

A central problem in designing effective models of provider governance in health systems has been to ensure an appropriate balance between the concerns of public sector and/or government decision-makers, on the one hand, and of non-governmental health services actors in civil society and private life, on the other. In tax-funded European health systems up to the 1980s, the state and other public sector decision-makers played a dominant role over health service provision, typically operating hospitals through national or regional governments on a command-and-control basis. In a number of countries, however, this state role has started to change, with governments first stepping out of direct service provision and now de facto pushed to focus more on steering provider organizations rather than on direct public management. In this new approach to provider governance, the state has pulled back into a regulatory role that introduces market-like incentives and management structures, which then apply to both public and private sector providers alike. This article examines some of the main operational complexities in implementing this new governance reality/strategy, specifically from a service provision (as opposed to mostly a financing or even regulatory) perspective. After briefly reviewing some of the key theoretical dilemmas, the paper presents two case studies where this new approach was put into practice: primary care in Sweden and hospitals in Spain. The article concludes that good governance today needs to reflect practical operational realities if it is to have the desired effect on health sector reform outcome. © 2016 by Kerman University of Medical Sciences.

Collaboration between Government and Non-Governmental Organizations (NGOs) in Delivering Curative Health Services in North Darfur State, Sudan- a National Report.

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I A Yagub, Abdallah

2014-05-01

North Darfur State has been affected by conflict since 2003 and the government has not been able to provide adequate curative health services to the people. The government has come to rely on Non-Governmental Organizations (NGOs) to provide curative health services. This study was conducted to examine the existing collaboration between government and NGOs in curative health service delivery in North Darfur State, and to identify the challenges that affect their collaboration. Documentary data were collected from government offices and medical organizations. Primary data were obtained through interviews with government and NGOs representatives. The interviews were conducted with (1) expatriates working for international NGOs (N=15) and (2), health professionals and administrators working in the health sector (N= 45). The collaboration between the government and NGOs has been very weak because of security issues and lack of trust. The NGOs collaborate by providing human and financial resources, material and equipment, and communication facilities. The NGOs supply 70% of curative health services, and contribute 52.9% of the health budget in North Darfur State. The NGOs have employed 1 390 health personnel, established 44 health centres and manage and support 83 health facilities across the State. The NGOs have played a positive role in collaborating with the government in North Darfur State in delivering curative health services, while government's role has been negative. The problem that faces the government in future is how health facilities will be run should a peaceful settlement be reached and NGOs leave the region.

Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement.

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Abdulmalik, J; Kola, L; Gureje, O

2016-01-01

A health systems approach to understanding efforts for improving health care services is gaining traction globally. A component of this approach focuses on health system governance (HSG), which can make or mar the successful implementation of health care interventions. Very few studies have explored HSG in low- and middle-income countries, including Nigeria. Studies focusing on mental health system governance, are even more of a rarity. This study evaluates the mental HSG of Nigeria with a view to understanding the challenges, opportunities and strategies for strengthening it. This study was conducted as part of the project, Emerging Mental Health Systems in Low and Middle Income Countries (Emerald). A multi-method study design was utilized to evaluate the mental HSG status of Nigeria. A situational analysis of the health policy and legal environment in the country was performed. Subsequently, 30 key informant interviews were conducted at national, state and district levels to explore the country's mental HSG. The existing policy, legislative and institutional framework for HSG in Nigeria reveals a complete exclusion of mental health in key health sector documents. The revised mental health policy is however promising. Using the Siddiqi framework categories, we identified pragmatic strategies for mental health system strengthening that include a consideration of existing challenges and opportunities within the system. The identified strategies provide a template for the subsequent activities of the Emerald Programme (and other interventions), towards strengthening the mental health system of Nigeria.

Health Impact Assessment (HIA) in Ireland and the role of local government

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O' Mullane, Monica, E-mail: Monica.omullane@truni.sk [Department of Public Health, Faculty of Health Care and Social Work/Fakulta Zdravotnictva a Socialnej Prace, Trnavska univerzita, Univerzitne namestie 1, 917 01 Trnava (Slovakia); Quinlivan, Aodh, E-mail: A.quinlivan@ucc.ie [Department of Government, College of Business and Law, 2nd Floor O' Rahilly Building, University College Cork (Ireland)

2012-01-15

Background: Health Impact Assessment (HIA) in Ireland has developed significantly since its endorsement in the health strategies of the Republic of Ireland (2001) and Northern Ireland (2002). Throughout 2007 and 2008, research was conducted to examine HIA as a policy-informing tool throughout both jurisdictions. One aspect of this research investigated the role of local government and its relationship in advancing HIA practise and use in Ireland. Methods: A case study research design was used which employed qualitative research methods, including semistructured interviewing and participant observation. In total 48 interviews were conducted with members of the HIA steering committees and individuals closely involved in the HIAs. Results: The relationship between local government and HIA in Northern Ireland is a positive one given the strong tradition of local government in the jurisdiction. The Review of Public Administration (RPA) negatively influenced the integration of HIA into local authority procedures. In the Republic of Ireland, the influence of social values and political will was found to be negatively present with the HIA on Traveller accommodation. Evidence from the HIA conducted on traffic and transport in Dublin was used to plan further health promotion and community planning activities in the area. Conclusion: Local government plays a vital role in HIA practise and development in both jurisdictions. The willingness to work with external partners (such as the health care services) was an important enabler or barrier to HIA operation. This will remain the case in the foreseeable future. - Highlights: Black-Right-Pointing-Pointer We investigated influences on the use of HIA knowledge of four cases from Northern Ireland and the Republic of Ireland. Black-Right-Pointing-Pointer The engagement of the public authorities assists implementation of the findings of the HIA. Black-Right-Pointing-Pointer Tension continues between positivist and incrementalist

Health Impact Assessment (HIA) in Ireland and the role of local government

International Nuclear Information System (INIS)

O'Mullane, Monica; Quinlivan, Aodh

2012-01-01

Background: Health Impact Assessment (HIA) in Ireland has developed significantly since its endorsement in the health strategies of the Republic of Ireland (2001) and Northern Ireland (2002). Throughout 2007 and 2008, research was conducted to examine HIA as a policy-informing tool throughout both jurisdictions. One aspect of this research investigated the role of local government and its relationship in advancing HIA practise and use in Ireland. Methods: A case study research design was used which employed qualitative research methods, including semistructured interviewing and participant observation. In total 48 interviews were conducted with members of the HIA steering committees and individuals closely involved in the HIAs. Results: The relationship between local government and HIA in Northern Ireland is a positive one given the strong tradition of local government in the jurisdiction. The Review of Public Administration (RPA) negatively influenced the integration of HIA into local authority procedures. In the Republic of Ireland, the influence of social values and political will was found to be negatively present with the HIA on Traveller accommodation. Evidence from the HIA conducted on traffic and transport in Dublin was used to plan further health promotion and community planning activities in the area. Conclusion: Local government plays a vital role in HIA practise and development in both jurisdictions. The willingness to work with external partners (such as the health care services) was an important enabler or barrier to HIA operation. This will remain the case in the foreseeable future. - Highlights: ► We investigated influences on the use of HIA knowledge of four cases from Northern Ireland and the Republic of Ireland. ► The engagement of the public authorities assists implementation of the findings of the HIA. ► Tension continues between positivist and incrementalist approaches towards HIA.

3 CFR - State Children's Health Insurance Program

Science.gov (United States)

2010-01-01

... 3 The President 1 2010-01-01 2010-01-01 false State Children's Health Insurance Program... Insurance Program Memorandum for the Secretary of Health and Human Services The State Children's Health Insurance Program (SCHIP) encourages States to provide health coverage for uninsured children in families...

"With human health it's a global thing": Canadian perspectives on ethics in the global governance of an influenza pandemic.

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Thompson, Alison K; Smith, Maxwell J; McDougall, Christopher W; Bensimon, Cécile; Perez, Daniel Felipe

2015-03-01

We live in an era where our health is linked to that of others across the globe, and nothing brings this home better than the specter of a pandemic. This paper explores the findings of town hall meetings associated with the Canadian Program of Research on Ethics in a Pandemic (CanPREP), in which focus groups met to discuss issues related to the global governance of an influenza pandemic. Two competing discourses were found to be at work: the first was based upon an economic rationality and the second upon a humanitarian rationality. The implications for public support and the long-term sustainability of new global norms, networks, and regulations in global public health are discussed.

EPIC Studies: Governments Finance, On Average, More Than 50 Percent Of Immunization Expenses, 2010-11.

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Brenzel, Logan; Schütte, Carl; Goguadze, Keti; Valdez, Werner; Le Gargasson, Jean-Bernard; Guthrie, Teresa

2016-02-01

Governments in resource-poor settings have traditionally relied on external donor support for immunization. Under the Global Vaccine Action Plan, adopted in 2014, countries have committed to mobilizing additional domestic resources for immunization. Data gaps make it difficult to map how well countries have done in spending government resources on immunization to demonstrate greater ownership of programs. This article presents findings of an innovative approach for financial mapping of routine immunization applied in Benin, Ghana, Honduras, Moldova, Uganda, and Zambia. This approach uses modified System of Health Accounts coding to evaluate data collected from national and subnational levels and from donor agencies. We found that government sources accounted for 27-95 percent of routine immunization financing in 2011, with countries that have higher gross national product per capita better able to finance requirements. Most financing is channeled through government agencies and used at the primary care level. Sustainable immunization programs will depend upon whether governments have the fiscal space to allocate additional resources. Ongoing robust analysis of routine immunization should be instituted within the context of total health expenditure tracking. Project HOPE—The People-to-People Health Foundation, Inc.

Exploring shared risks through public-private partnerships in public health programs: a mixed method

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Wadi B. Alonazi

2017-06-01

Full Text Available Abstract Background The natural assimilation of the process through which health partners sustain long-term relationships is a key issue in maintaining social well-being, reducing health risk factors, and sustaining public health programs. One global initiative in building effective healthcare systems is public-private partnerships (PPPs. This study elucidates the proposed key performance indicators initiated by the Ministry of Health of Saudi Arabia based on the projections of the government, known as Vision 2030, from the perspective of health risk factors. Methods Through an inductive content analysis, this study assessed primary and secondary data in relation to the Saudi National Transformation Program (NTP. To identify the institutions that played a role in formulating the new Saudi Healthcare System, health policies, regulations, and reports published between 1996 and 2016 were categorized. After ranking the risk factors, the investigator selected 13 healthcare professionals in four focus group interviews to insightfully explore the challenges that the NTP faces from a health risk perspective. Thus, the study employed qualitative data gathered through focus group interviews with key figures as well as data extracted from written sources to identify distinct but interrelated partnerships practiced within risk management. Results A methodological overview of NTP priority and implementation offered practical guidance in the healthcare context. The five critical factors in maintaining successful and sustainable PPPs were (1 trustworthiness, (2 technological capability, (3 patient-centeredness, (4 competence, and (5 flexibility. Concession on primary and secondary healthcare services might be a good option based on the literature review and considering its popularity in other countries. A high outcome-based risk of PPPs was found as the most commonly shared perspective in risk management. Conclusions Although the impact of the NTP rise has yet

Exploring shared risks through public-private partnerships in public health programs: a mixed method.

Science.gov (United States)

Alonazi, Wadi B

2017-06-12

The natural assimilation of the process through which health partners sustain long-term relationships is a key issue in maintaining social well-being, reducing health risk factors, and sustaining public health programs. One global initiative in building effective healthcare systems is public-private partnerships (PPPs). This study elucidates the proposed key performance indicators initiated by the Ministry of Health of Saudi Arabia based on the projections of the government, known as Vision 2030, from the perspective of health risk factors. Through an inductive content analysis, this study assessed primary and secondary data in relation to the Saudi National Transformation Program (NTP). To identify the institutions that played a role in formulating the new Saudi Healthcare System, health policies, regulations, and reports published between 1996 and 2016 were categorized. After ranking the risk factors, the investigator selected 13 healthcare professionals in four focus group interviews to insightfully explore the challenges that the NTP faces from a health risk perspective. Thus, the study employed qualitative data gathered through focus group interviews with key figures as well as data extracted from written sources to identify distinct but interrelated partnerships practiced within risk management. A methodological overview of NTP priority and implementation offered practical guidance in the healthcare context. The five critical factors in maintaining successful and sustainable PPPs were (1) trustworthiness, (2) technological capability, (3) patient-centeredness, (4) competence, and (5) flexibility. Concession on primary and secondary healthcare services might be a good option based on the literature review and considering its popularity in other countries. A high outcome-based risk of PPPs was found as the most commonly shared perspective in risk management. Although the impact of the NTP rise has yet to be explored, its potential for challenging health

Shelter from the Storm: Roles, responsibilities, and challenges in United States housing policy governance.

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Willison, Charley

2017-11-01

Housing is a critical social determinant of health. Housing policy not only affects health by improving housing quality, affordability, and insecurity; housing policy affects health upstream through the politics that shape housing policy design, implementation, and management. These politics, or governance strategies, determine the successes or failures of housing policy programs. This paper is an overview of challenges in housing policy governance in the United States. I examine the important relationship between housing and health, and emphasize why studying housing policy governance matters. I then present three cases of housing governance challenges in the United States, from each pathway by which housing affects health - housing quality, affordability, and insecurity. Each case corresponds to an arm of the TAPIC framework for evaluating governance (Krieger and Higgins) [1], to assess mechanisms of housing governance in each case. While housing governance has come a long way over the past century, political decentralization and the expansion of the submerged state have increased the number of political actors and policy conflict in many areas. This creates inherent challenges for improving accountability, transparency, and policy capacity. In many instances, too, reduced government accountability and transparency increases the risk of harm to the public and lessens governmental integrity. Copyright © 2017 The Author. Published by Elsevier B.V. All rights reserved.

Tobacco industry globalization and global health governance: towards an interdisciplinary research agenda

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