Resource Allocation Strategies to Increase the Efficiency and Sustainability of Gavi's Health System Strengthening Grants.

BACKGROUND: Despite the increase in Health System Strengthening (HSS) grants, there is no consensus among global health actors about how to maximize the efficiency and sustainability of HSS programs and their resulting gains. To formally analyze and compare the efficiency and sustainability of Gavi's HSS grants, we investigated the factors, events and root causes that increased the time and effort needed to implement HSS grants, decreased expected outcomes and threatened the continuity of activities and the sustainability of the results gained through these grants in Cameron and Chad. METHODS: We conducted 2 retrospective independent evaluations of Gavi's HSS support in Cameroon and Chad using a mixed methodology. We investigated the chain of events and situations that increased the effort and time required to implement the HSS programs, decreased the value of the funds spent and hindered the sustainability of the implemented activities and gains achieved. RESULTS: Root causes affecting the efficiency and sustainability of HSS grants were common to Cameroon and Chad. Weaknesses in health workforce and leadership/governance of the health system in both countries led to interrupting the HSS grants, reprogramming them, almost doubling their implementation period, shifting their focus during implementation toward procurements and service provision, leaving both countries without solid exit plans to maintain the results gained. CONCLUSIONS: To increase the efficiency and sustainability of Gavi's HSS grants, recipient countries need to consider health workforce and leadership/governance prior, or in parallel to strengthening other building blocks of their health systems.

Challenges in promoting joint use agreements: experiences from Community Transformation Grant awardees in North Carolina, Illinois, and Wisconsin, 2011-2014.

Community Transformation Grant awardees in North Carolina, Illinois, and Wisconsin promoted joint use agreements (formal agreements between 2 parties for the shared use of land or facilities) as a strategy to increase access to physical activity in their states. However, awardees experienced significant barriers to establishing joint use agreements, including 1) confusion about terminology and an aversion to complex legal contracts, 2) lack of applicability to single organizations with open use policies, and 3) questionable value in nonurban areas where open lands for physical activity are often available and where the need is instead for physical activity programs and infrastructure. Furthermore, promotion of formal agreements may unintentionally reduce access by raising concerns regarding legal risks and costs associated with existing shared use of land. Thus, joint use agreements have practical limitations that should be considered when selecting among strategies to promote physical activity participation.

El papel del modelo Demandas-Control-Apoyo en la salud de trabajadores de la construcción / The effects of the Demand-Support-Control model on construction workers’ health

Este estudio toma como referencia el modelo Demandas-Control-Apoyo y analiza el rol del control y del apoyo social entre algunas demandas laborales y el malestar físico en una muestra de 285 trabajadores de la construcción. En general, se observa que las demandas laborales, la exposición a condiciones nocivas, el control del trabajo y el apoyo social se asocian con el malestar físico. También se comprueban los efectos moduladores del control y del apoyo. El control modula los efectos negativos de las demandas. Además, el apoyo amortigua el estrés derivado de la exposición a condiciones nocivas. Se encuentra una interacción triple pero el incremento de varianza explicada no es significativo, por tanto, no se encuentra evidencia del modelo Demandas-Control-Apoyo. El artículo finaliza planteando las limitaciones del estudio y sus implicaciones prácticas (AU)

This work takes as reference the Demand-Control-Support model and analyzes the relation of job control and social support and some job demands and physical well-being in a sample of 285 construction workers. In general, job demands, exposure to harmful conditions, social support, and job control were found to be related to physical well-being. The modulator effects of job control and social support were verified. Job control modulates the negative effects of stress, mainly in situations of high demand. Moreover, social support modulates the negative effects of stress in situations of high exposure to harmful conditions. A three-way interaction effect was found but the increase in explained variance was not significant. Thus, the results do not reveal empirical evidence of the Demand-Control-Support model. The limitations and practical implications of this study are discussed (AU)

A cooperative extension service for primary care in Oklahoma.

Lessons learned and practiced in agriculture for 100 years are now informing the development of a primary care extension program that has the potential to provide substantial support for primary care practices throughout Oklahoma and to make it easier for all agencies and organizations working to improve our state's health to do so more effectively.

Policy evaluation for the subsidy for influenza vaccination in elderly.

OBJECTIVE: In Japan, the subsidy of influenza vaccination for the elderly was introduced in November 2001. This paper examines its policy evaluation from the viewpoint of cost-benefit analysis. MATERIALS: The data of copayment of influenza vaccination, population and shot rate of the elderly are surveyed by telephone interview to the correspondents in the local governments of Tokyo metropolitan and other 12 big cities in Japan. The mortality due to pneumonia or influenza is obtained from Vital Statistics of Population. METHOD: At first, I examine the impact of amount of copayment, through its effect on shot rate, on the percentage of elderly receiving influenza vaccinations. Using these estimation results, benefit-cost ratio (BCR) is calculated. RESULTS: The estimated coefficient of copayment on shot rate is -0.007 and statistically significant. Shot rate significantly reduces pneumonia and influenza mortality and its magnitude is -0.0028. The obtained net benefit (NB) is 134.9 million yen or US$1.08 billion and benefit-cost ratio is 22.9 and its 95% confidence interval is [2.2, 43.7]. DISCUSSION: If copayment would be cut by a 1000 yen (US$8), it could avoid about 400 deaths in average big city. The benefit-cost ratio is quite high compared with the other countries or other vaccinations. CONCLUSION: We found the strong evidence in a sense of cost-benefit analysis in the subsidy for influenza vaccination in the elderly.

Does federal funding for breastfeeding research target our national health objectives?

OBJECTIVE: To determine the number and dollar amount of federally funded research projects in the area of infant nutrition/breastfeeding/lactation from 1994 to 1996, and the impact of these funded projects on the achievement of our national goals for increasing the rates of breastfeeding initiation and duration. METHODS: Data were obtained from the Computer Retrieval of Information on Scientific Projects database, available through the National Institutes of Health. Abstracts of funded projects were identified, printed, and subjected to content analysis. Key information identified from the abstracts included: National Institutes of Health institute, center, or division funding the project; type of extramural funding; amount of federal dollars awarded; and a classification of the project's impact (direct, indirect, or none) on achievement of the Healthy People 2000 goals for breastfeeding. RESULTS: The final sample consisted of 362 abstracts in the broad category of infant nutrition/breastfeeding/lactation, which were awarded approximately 40.4 million dollars in federal research funds over the 3 years addressed in this study. Of this amount, only 13.7% (5.6 million dollars) was awarded to projects determined to have either a direct or indirect impact on achieving the Healthy People 2000 goals for increasing the incidence and duration of breastfeeding. A total of 27 (7.5%) funded projects in this category, reflecting $4.1 million, had no relationship to breastfeeding per se, as they involved the use of human milk composition and technologies to improve artificial milks and develop new pharmaceuticals and therapies. CONCLUSIONS: These findings suggest an incongruity between the national priorities for breastfeeding and the funding of scientific research in this content area, and provide important information for researchers and policymakers with respect to identification and redirection of funding priorities.

Informe sobre el trabajo de equipo apoyo a la puesta en marcha de la Ley Dialogo Nacional y El fortalecimiento del Municipio de Oruro

La Organización Panamericana de la Salud/Organización Mundial de la Salud, (OPS/OMS), en Cooperación con la Ley del Diálogo, ha tomado la iniciativa de prestar asistencia técnica de forma directa a los municipios del Departamento de Oruro en el ciclo de formulación de perfiles de proyestos y proyectos a diseño final para inversión en salud. La problemática del sector salud en el departamento de Oruro está intimamente ligada a las malas condiciones de vida del poblador, como consecuencia de un precario y lento desarrollo de la región y también por periodos más o menos sostenidos de crisis económica en el país, especialmente en los útimos años, reflejando en cuanto a materia de salud se refiere en las denominadas "enfermedades de la pobreza", vale decir desnutrición, infecciones respiratorias agudas, diarreas agudas, zarcoptosis, enfermedades transmisibles, tuberculosis pulmonar, estas últimas con disminución en su prevalencia(27,4 por 100000hab.) en comparación con los otros departamentos Oruro se encuentra con una de las tasas mas bajas de prevalencia en comparación a la media nacional que es de 73,8 por cien mil

Public support for medical research in the 21st century.

Key public policies that have contributed to the rise of modern medical research in the 20th Century are reviewed, focusing especially on the United States and the post-World War II period. Drawing on this history, the question is posed: "Are these policies sufficient to insure vigorous medical research in the 21st Century?" Although radical policy changes are not needed, several proposals for policy and medical research portfolio redirection are offered, including a rebalancing of public supported research in all fields of science that contribute to medical advances. Medical research must also invest in a national and international information infrastructure that will allow the linking of researchers, clinical experimenters, practicing physicians, and the public in ways heretofore not imagined. Medical researchers must be leaders and advocates for the whole research enterprise in the 21st Century.

Request for comments: technical assistance to rural hospitals--HRSA. Notice: request for comments.

The Health Resources and Services Administration (HRSA), Office of Rural Health Policy (ORHP), is interested in obtaining public comments and suggestions to assist the Office in planning a program of technical assistance to rural hospitals. The ORHP is anticipating that funds may become available in Fiscal Year 1991 for technical assistance to rural hospitals. The ORHP invites comments on the needs of rural hospitals for technical assistance and support.

Grants to State Health Planning and Development Agencies--HRSA. Notice regarding grants to State Health Planning and Development Agencies--determination of population of the States.

This notice provides the population figures the Department will use when it determines the amount of grants to State Health Planning and Development Agencies (States Agencies).