Impact of sustained health policy and population-level interventions on reducing the prevalence of obesity in the Caribbean region: A qualitative study from The Bahamas.

Background: The 2020 Global Nutrition Report highlights that despite improvements in select nutrition indicators, progress is too slow to meet the 2025 Global Nutrition Targets. While the Latin America and the Caribbean (LAC) region has achieved the greatest global reduction in undernutrition (stunting, underweight, and wasting) in the past decade, it also has the highest prevalence of people with overweight worldwide. Since the early 2000s, the region has mounted increasingly comprehensive and multi-sectoral policy interventions to address nutritional health outcomes. The Bahamas is one such LAC country that has used consistent policy responses to address evolving nutritional challenges in its population. After addressing the initial problems of undernutrition in the 1970s and 80s, however, overconsumption of unhealthy foods has led to a rising prevalence of obesity which The Bahamas has grappled with since the early 2000s. Objective: This study develops a timeline of obesity-related health policy responses and explores the macrosocial factors and conditions which facilitated or constrained public health policy responses to obesity in The Bahamas over a 20-year period. Methods: This multi-method case study was conducted between 2019 and 2021. A document review of health policies was combined with secondary analysis of a range of other documents and semi-structured interviews with key actors (policymakers, health workers, scholars, and members of the public). Data sources for secondary data analysis included policy documents, national survey data on obesity, national and regional newspaper websites, and the Digital Library of the Caribbean database. An adapted framework approach was used for the analysis of semi-structured interviews. Results: Between 2000 and 2019, a series of national policies and community-level interventions were enacted to address the prevalence of obesity. Building on previous interventions, obtaining multi-sectoral collaboration, and community buy-in for policy action contributed to reducing obesity prevalence from 49.2 to 43.7% between 2012 and 2019. There are, however, constraining factors, such as political and multi-sectoral challenges and gaps in legislative mandates and financing. Conclusion: Sustained multilevel interventions are effective in addressing the prevalence of obesity. To maintain progress, there is a need to implement gender-specific responses while ensuring accessibility, availability, and affordability of nutritious food for all.

Framework for assessing the capacity of a health ministry to conduct health policy processes--a case study from Tajikistan.

An adequate capacity of ministries of health (MOH) to develop and implement policies is essential. However, no frameworks were found assessing MOH capacity to conduct health policy processes within developing countries. This paper presents a conceptual framework for assessing MOH capacity to conduct policy processes based on a study from Tajikistan, a former Soviet republic where independence highlighted capacity challenges. The data collection for this qualitative study included in-depth interviews, document reviews and observations of policy events. Framework approach for analysis was used. The conceptual framework was informed by existing literature, guided the data collection and analysis, and was subsequently refined following insights from the study. The Tajik MOH capacity, while gradually improving, remains weak. There is poor recognition of wider contextual influences, ineffective leadership and governance as reflected in centralised decision-making, limited use of evidence, inadequate actors' participation and ineffective use of resources to conduct policy processes. However, the question is whether this is a reflection of lack of MOH ability or evidence of constraining environment or both. The conceptual framework identifies five determinants of robust policy processes, each with specific capacity needs: policy context, MOH leadership and governance, involvement of policy actors, the role of evidence and effective resource use for policy processes. Three underlying considerations are important for applying the capacity to policy processes: the need for clear focus, recognition of capacity levels and elements, and both ability and enabling environment. The proposed framework can be used in assessing and strengthening of the capacity of different policy actors.

An appraisal of the oral health care system in Nigeria.

OBJECTIVES: This study aimed to assess the strengths and weaknesses of the oral health care system in Nigeria and to outline broad policy options for strengthening the system. METHODS: A critical appraisal of the oral health care system in Nigeria was conducted. The Maxwell criteria were used to assess performance. RESULTS: There has been some progress and growth in the oral health care system in Nigeria. However, it is clear that the system falls short on many desirable attributes. The system is neither effective nor efficient and the resources available are grossly inadequate and are overstretched in many areas. The oral health care system is unresponsive to the needs of the populace and there is little stewardship of the system. CONCLUSIONS: Urgent action in the Nigerian oral health care system is required on the part of all stakeholders. The first step should involve the provision of adequate resources for the immediate implementation of the national oral health policy. There is also a need for more research on oral health-related issues in the country. Efforts towards improving the system must be properly coordinated by the Federal Ministry of Health and involve all stakeholders in the sector in order to achieve success.

Influências do contexto político: o desenvolvimento da política de saúde ambiental no Recife, Brasil. / The influence of political Context: the development of environmental health policy in Recife, Brazil.

O presente artigo apresenta a importância do contexto para o surgimento de novas políticas públicas no Recife, Brasil. Optou-se por analisar o Programa de Saúde Ambiental (PSA), elaborado e implantado em 2001 no período de um novo governo municipal que apresentou plataforma de mudanças no setor saúde. Realizou-se um estudo qualitativo, com 20 entrevistas semiestruturadas com informantes-chave e análise documental. As entrevistas foram analisadas utilizando-se o triângulo de governo de Matus. Foi realizada uma análise de política utilizando o modelo de Walt e Gilson. Os resultados referem-se ao contexto político de formulação de uma política de Saúde Ambiental, na qual fatores contextuais foram destacados como determinantes para o surgimento do PSA, notadamente a eleição do novo governo municipal. Também foi identificada a escolha do Secretário de Saúde e de sua equipe, comprometidos com o SUS. A adesão do corpo técnico ao novo projeto eo aumento de recursos setoriais foram relevantes. Considerou-se que os gestores da Secretaria de Saúde souberam captar a oportunidade para implantar políticas de saúde inovadoras, como o Programa de Saúde Ambiental (PSA), e que o equilíbrio no triângulo de governo foi determinante para tal.

This article presents the importance of the context to the emergence of new public policies in the city of Recife, Brazil. We chose to examine the Environmental Health Program (EHP), elaborated and implemented in 2001 during a new municipal government, which presented a platform including changes in the health sector. It was a qualitative study, with 20 semi-structured interviews with key informers and documentary analysis. Interviews were analyzed using Carlos Matus? government triangle. A policy analysis using Walt and Gilson?s model was performed. The main results pointed to the political context of formulating an Environmental Health policy, in which contextual factors were highlighted, notably the election of the new municipal government as crucial to the rise of EHP. The choice of the Secretary of Health and his team, committed to the SUS (Brazilian public health system), was also identified. The strong support of the technical staff to the new project and the increase in the resources in the health sector were relevant. The Secretary of Health managers were considered able to capture the opportunity to implement innovativehealth policies such as the EHP, and that the balance in Matus? overnment triangle.was invaluable for that.