National cancer control plans across the Eastern Mediterranean region: challenges and opportunities to scale-up.

National cancer control planning is crucial for countries in the WHO Eastern Mediterranean region. This region is challenged with an increase in cancer incidence leading to substantial disease burden, premature deaths, and increasing health-care costs in most countries. Huge inequity in cancer control planning and implementation exists between and within the countries. Over half of the countries (12 [55%] of 22) have standalone comprehensive National Cancer Control Plans and six (27%) have non-communicable disease plans that include cancer. The implementation of cancer plans has common challenges related to weak governance structure, few coordination mechanisms within countries, and inadequate human and financial resources. In most countries, the plan is not costed. Yet, the majority of countries (20 [91%]) reported having fully or partially funded plans. Additionally, political instability and conflicts affecting over half of the countries in the Eastern Mediterranean region have enormously affected cancer planning and implementation, both among the affected countries and those that host large numbers of refugees. In this Policy Review, we used the WHO regional framework for action on cancer to systematically analyse the status of cancer control planning and implementation across the six domains of cancer control, from prevention to palliation. We highlight the gaps, and the opportunities for bridging these gaps, to achieve scale-up on implementation of cancer control programmes in the Eastern Mediterranean region.

Core elements of national cancer control plans: a tool to support plan development and review.

When developed and implemented effectively, national cancer control plans (NCCPs) improve cancer outcomes at the population level. However, many countries do not have a high-quality, operational NCCP, contributing to disparate cancer outcomes globally. Until now, a standard reference of NCCP core elements has not been available to guide development and evaluation across diverse countries and contexts. In this Policy Review, we describe the methods, process, and outcome of an initiative to develop an itemised and evidence-based comprehensive checklist of core elements for NCCP formulation. The final list provides a ready-to-use guide to support NCCP development and to facilitate internal and external critical appraisal of existing NCCPs for countries of all income levels and settings. Governments, policy makers, and stakeholders can utilise this checklist, while considering their own unique contexts and priorities, from the drafting through to the implementation of NCCPs.

Moonshot to Cancer Cure: Recruiting Policy to Break Down Silos.

Funded by the 21st Century Cures Act, The Beau Biden Cancer Moonshot Initiative is broad, deep, integrative, and intended to expediently address cancer's most vexing problems. Launched in 2015, it is an effort to accelerate the pace of cancer research with a focus on breaking down silos through cross-pollination of research, recruitment of multidisciplinary clinical and basic science research teams, sharing of complex scientific databases, and the creation of public-private research partnerships. This audacious approach to cancer treatment is intended to alleviate the current burden of cancer within countries and across borders. At its core is the rapid development of safe drug therapies across different disciplines through the employment of genomics, targeted proteomics with predictive analytics, and other emerging drug therapies. It will use expansive patient registries and increase early access to clinical trials. The initiative is cocooned in forward-thinking drug policies that consider the specific needs of all oncology stakeholder groups both nationally and internationally.

The evolution of New Zealand's health workforce policy and planning system: a study of workforce governance and health reform.

INTRODUCTION: While considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand's health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives. CASE DESCRIPTION: New Zealand's health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations. DISCUSSION AND EVALUATION: The case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand's more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care. CONCLUSION: The case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.

Developing governance models and funding mechanisms of state-civil society partnerships for HIV/AIDS treatment and prevention based on lessons from Ghana.

The contribution of civil society organisations (CSOs) to national HIV/AIDS responses in sub-Saharan African countries, with Global Health Initiatives' (GHIs) funding channelled through National AIDS Commissions (NACs), is well researched. Less well understood are the governance models and funding mechanisms being used to successfully engage CSOs in the HIV/AIDS response. Using data from government, donor, CSO and documentary sources, this article characterises the organisational principles and practices and unique funding models adopted by the Ghana AIDS Commission (GAC) to effectively and efficiently engage CSOs in the HIV/AIDS response. It found four major governance principles and practices that target: 1) strategic planning for service delivery; 2) focussed expressions of interest; 3) competitive tendering and contracting for service delivery; and 4) adoption of results-based management. It also identified three predominant funding models that illustrate the application of these guiding principles to harness the inherent strengths of CSOs to more effectively respond to HIV/AIDS, namely: 1) direct funding of locally-based CSOs; 2) funding international and national NGOs to engage local CSOs in partnership; and 3) funding umbrella organisations. These findings are significant for Ghana but they may also have relevance for other low- or middle-income countries (LMICs) that have limited experience delivering HIV/AIDS services through state-civil society partnerships, as well as broader debates on the role of donors, governments and CSOs working in partnership to fight HIV/AIDS.

National cancer control plans: a global analysis.

There is increasing global recognition that national cancer plans are crucial to effectively address the cancer burden and to prioritise and coordinate programmes. We did a global analysis of available national cancer-related health plans using a standardised assessment questionnaire to assess their inclusion of elements that characterise an effective cancer plan and, thereby, improve understanding of the strengths and limitations of existing plans. The results show progress in the development of cancer plans, as well as in the inclusion of stakeholders in plan development, but little evidence of their implementation. Areas of continued unmet need include setting of realistic priorities, specification of programmes for cancer management, allocation of appropriate budgets, monitoring and evaluation of plan implementation, promotion of research, and strengthening of information systems. We found that countries with a non-communicable disease (NCD) plan but no national cancer control plan (NCCP) were less likely than countries with an NCCP and NCP plan or an NCCP only to have comprehensive, coherent, or consistent plans. As countries move towards universal health coverage, greater emphasis is needed on developing NCCPs that are evidence based, financed, and implemented to ensure translation into action.

Planning for large epidemics and pandemics: challenges from a policy perspective.

PURPOSE OF REVIEW: Less than two decades into the 21st century, the world has already witnessed numerous large epidemics or pandemics. These events have highlighted inadequacies in both national and international capacity for outbreak prevention, detection, and response. Here, we review some of the major challenges from a policy perspective. RECENT FINDINGS: The most important challenges facing policymakers include financing outbreak preparedness and response in a complex political environment with limited resources, coordinating response efforts among a growing and diverse range of national and international actors, accurately assessing national outbreak preparedness, addressing the shortfall in the global biomedical workforce, building surge capacity of both human and material resources, balancing investments in public health and curative services, building capacity for outbreak-related research and development, and reinforcing measures for infection prevention and control. SUMMARY: In recent years, numerous epidemics and pandemics have caused not only considerable loss of life but also billions of dollars of economic loss. Although the events have served as a wake-up call and led to the implementation of relevant policies and counter-measures, such as the Global Health Security Agenda, many questions remain and much work to be done. Wise policies and approaches for outbreak control exist, but will require the political will to implement them.

Expanding state laws and a growing role for pharmacists in vaccination services.

OBJECTIVES: Gaps in vaccination coverage leave populations vulnerable to illnesses. Since the 1990s, there has been a growing movement to improve vaccination access by giving pharmacists the authority to administer vaccines according to state laws. Understanding the variation of pharmacist vaccination laws over time is critical to understanding the effect of improving access to vaccination services. METHODS: We identified relevant statutes and regulations with the use of Westlaw legal databases. A 4-stage coding process identified 220 legal variables of pharmacist vaccination authority. Each jurisdiction's laws were coded against these 220 legal variables. The resulting legal dataset was then evaluated to determine whether jurisdictions expanded or restricted pharmacist vaccination authorities over time. RESULTS: From 1971 to 2016, jurisdictions made 627 changes to statutes and regulations relating to pharmacist vaccination authority. There were 85 expansions, 3 restrictions, and 22 regulatory clarifications. Eight changes were deemed to be unclear, and 479 changes did not substantively alter the scope of pharmacist vaccination authority. CONCLUSION: Collectively, the laws in 50 states and DC paint a clear picture: the scope of pharmacists' vaccination authority is expanding. Jurisdictions are allowing pharmacists to administer more vaccines to younger patients with less direct prescriber oversight. This clear expansion of pharmacist vaccination authority stands in contrast to the reservations expressed by some physician groups for pharmacists as vaccination providers. However, laws in some states still do not permit pharmacists to vaccinate according to the Advisory Committee on Immunization Practices recommendations.

An Operational Framework for Insecticide Resistance Management Planning.

Arthropod vectors transmit organisms that cause many emerging and reemerging diseases, and their control is reliant mainly on the use of chemical insecticides. Only a few classes of insecticides are available for public health use, and the increased spread of insecticide resistance is a major threat to sustainable disease control. The primary strategy for mitigating the detrimental effects of insecticide resistance is the development of an insecticide resistance management plan. However, few examples exist to show how to implement such plans programmatically. We describe the formulation and implementation of a resistance management plan for mosquito vectors of human disease in Zambia. We also discuss challenges, steps taken to address the challenges, and directions for the future.

[Prospective planning of activity of the Medical service of the Armed Forces of the Russian Federation for 2016-2020].

The article reflects the characteristics of the Plan of activities of the Ministry of Defence of the Russian Federation for 2016-2020--an important long-term planning document of the Armed Forces. It stressed the need for synchronization of activities for chain of command and deadline. Presented structure of the Medical Service Plan Military District operations (fleet) military medical organization. The attention is focused on the content of its sections. For example, a military hospital layouts presented an action plan and a schedule of events. Reflecting the requirements of the Minister of Defense for the development and adjustment plans, indicators of their performance.

The epistemology of AIDS in South Africa: lessons from three scenario projects.

This article reviews the methodology of future scenario-building in the context of HIV and AIDS in Africa. It considers three scenario studies conducted in the past decade: UNAIDS (2005), Metropolitan Holdings (2006) and the AIDS Governance scenarios (2015). The article is a critical reflection of Future Studies epistemology which claims to contribute a unique heuristic niche in the study of AIDS. The article offers several methodological insights: (1) despite claims to the contrary, scenario methodology remains profoundly influenced by existing political and research agenda; instead of denying these, scenarists should acknowledge this; (2) the utility of scenario studies is strongly influenced by their unit of analysis and their time frame, which determine their applicability and therefore their policy relevance; and (3) scenario planners should guard against perpetuating the myth that this methodology is a crystal ball into the future because they are powerful tools for strategic planning about the present, rather than the distant future. In addition to these methodological insights, the article finds that future scenario studies are useful in identifying significant discursive and policy shifts in the AIDS response.

Response to Ebola virus disease outbreak in West Africa by the Ministry of Health, Labour and Welfare of Japan in 2014-2015.

Ebola Virus Disease (EVD) is categorized in the Category 1 Infectious Disease under the Act on Infectious Disease Control. Since the Act came into effect in 1999, no confirmed case of viral hemorrhagic fevers (VHF) has been reported, though some clinical samples have been tested for VHF in the National Institute of Infectious Diseases of Japan. Ministry of Health, Labour and Welfare has monitored the situation of the EVD outbreak in West Africa since the first report from Guinea in March 2014 and reinforced quarantine and public health preparedness in August. The whole-of-government response was activated at the end of October, establishing the Ministerial meeting on the Response to the EVD presided by the Prime Minister. The responses have raised the level of preparedness for such a rare import disease like VHF; however elicited many lessons. Even if the current VHF outbreak is over, the risk of the global infectious diseases outbreak will be unchanged. The maintenance and improvement of preparedness and response for infectious diseases emergency such as the Category 1 Infectious Disease outbreak by the improvement of manuals and continuous exercises are crucial for a future domestic response. In addition, human resource development is essential for contributing to global response efforts.

[Reviewing the shared strategy health bill: further measures to meet the structural challenges of the health system]. / Orientations du projet de loi de santé : aller plus loin pour «?répondre aux défis structurels du système de santé?¼

This article reviews the draft health bill entitled "Federate health professionals around a shared strategy", currently submitted for consultation in the context of the national health strategy in France. This bill comprises innovative measures for prevention and health care in France. In particular, it is designed to develop, strengthen and structure the prevention sector, especially in children and young people. It is also designed to organize health care trajectories and acquire the necessary tools to promote their development. However, the bill sometimes presents limited ambitions in terms of objectives and means. In particular, the project comprises almost none of the necessary actions on the social determinants of health. Overall, the orientations of this bill represent a first major step towards a health policy in France beyond the field of health care. However, we must remain vigilant concerning application of these orientations in the process of elaboration of the bill and its related regulations, and implementation of the national health strategy.

The status of legal authority for injury prevention practice in state health departments.

Despite the potential for public health strategies to decrease the substantial burden of injuries, injury prevention infrastructure in state health departments is underdeveloped. We sought to describe the legal support for injury prevention activities at state health departments. We searched the Lexis database for state laws providing authority for those activities, and categorized the scope of those laws. Only 10 states have authority that covers the full scope of injury prevention practice; in the others, legal authority is piecemeal, nonspecific, or nonexistent. More comprehensive legal authority could help health departments access data for surveillance, work with partners, address sensitive issues, and garner funding. Efforts should be undertaken to enhance legal support for injury prevention activities across the country.

The health care workforce: will it be ready as the boomers age? A review of how we can know (or not know) the answer.

The baby-boom generation will reach the age of eligibility for Medicare starting in 2011. This large group of Americans will require more health care, and more health care workers will be needed to meet those needs. Understanding the needs as well as the size of the workforce needed requires substantial analysis and extensive data. Two major approaches can be used to make these estimates, and the choice of both methods and assumptions can affect the outcomes of any analysis. For the United States to make workforce policy decisions with the best information, we must invest in systems and resources to generate those data and support policy-making bodies that can interpret and make recommendations consistent with the analyses.

Pandemic ventilator rationing and appeals processes.

In a severe influenza pandemic, hospitals will likely experience serious and widespread shortages of patient pulmonary ventilators and of staff qualified to operate them. Deciding who will receive access to mechanical ventilation will often determine who lives and who dies. This prospect raises an important question whether pandemic preparedness plans should include some process by which individuals affected by ventilator rationing would have the opportunity to appeal adverse decisions. However, the issue of appeals processes to ventilator rationing decisions has been largely neglected in state pandemic planning efforts. If we are to devise just and effective plans for coping with a severe influenza pandemic, more attention to the issue of appeals processes for pandemic ventilator rationing decisions is needed. Arguments for and against appeals processes are considered, and some suggestions are offered to help efforts at devising more rational pandemic preparedness plans.

[Reevaluation criteria for health care capacity allocation according to current legislation in Hungary]. / Az egészségügyi kapacitásfelosztás módosításának szempontjai a hatályos törvény alapján.

Act CXXXII of the year 2006 - amended several times - on the development of the health care system requires that health insurance authorities should regularly review utilization of the contracted capacity of professional medical care providers, and the need for change of capacities. The first such analysis should be carried out in 2013, according to the current laws in Hungary. The law lists 16 items, which are the basis for evaluation of the performance of providers. Among them some items are difficult to analyse specifically even for health insurance specialists. This study aims to review aspects of the reevaluation process and their associated concepts. Author wants to provide help for setting up the analysis in practice by going through and analysing the requirements of the law in detail.