Making doctors stay: Rethinking doctor retention policy in a contracted-out primary healthcare setting in urban Bangladesh.

BACKGROUND: "Contracting Out" is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor's retention both in managerial as well as service provision level in the contracted-out setting. METHODOLOGY: In this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation. RESULTS: The most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion. CONCLUSIONS: An adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.

Realizing Public Rights Through Government Patent Use.

A substantial portion of biomedical R&D is publicly funded. But resulting medicines are typically covered by patents held by private firms, and priced without regard to the public's investment. The Bayh-Dole Act provides a possible remedy, but its scope is limited.

O estado de calamidade pode ser prorrogado no Brasil?

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A review of the public sector substance use disorder treatment and prevention systems in Kenya.

BACKGROUND: The burden of substance use disorders in sub-Saharan Africa has been projected to increase by an estimated 130% by 2050. Despite this, little is known about the substance use disorder treatment and prevention systems in the region. OBJECTIVES: The objective of this review is to describe the public sector substance use disorder treatment and prevention systems in Kenya guided by the World Health Organization health systems framework model, with the aim of informing decision-making. METHODS: We reviewed official government documents obtained from hand-searching the websites of relevant governmental organizations including: Ministry of Health, National Authority for the Campaign Against Alcohol and Drug Abuse, Parliament of Kenya, Ministry of Treasury & National Planning, National Law Reporting Council, Kenya National Bureau of Statistics, the National Non-Governmental Organization (NGO) Coordination Board and the 47 County Governments. We augmented those searches with official documents that the authors were aware of by virtue of being practitioners in the field. Draft and retired documents were excluded. The findings of the search are presented as a narrative review. DISCUSSION: The Mental Health Act 1989, the main legislative framework governing substance use disorder treatment and prevention, focuses on institutional care only. While there are only three public health facilities offering substance use disorder treatment in Kenya, several non-public sector actors are involved in SUD treatment and prevention activities. Unfortunately, there is limited cross-sector collaboration. The Ministry of Health has no specific budget for substance use disorder treatment and prevention, while the National Authority for the Campaign Against Alcohol and Drug Abuse has an annual resource gap of about US$ 5,000,000. The substance use disorder workforce in Kenya has not been characterized. CONCLUSION: We propose five key strategies for strengthening substance use disorder treatment and prevention systems in Kenya including: (1) Enactment of the Mental Health (Amendment) bill 2018. (2) Integration of substance use disorder treatment and prevention into primary health care to increase access to care. (3) Utilization of money from taxation of alcohol, tobacco and betting to increase funding for substance use disorder treatment and prevention. (4) Characterization of the substance use disorder workforce to inform planning. (5) Enhanced collaboration between the government and non-state actors in order to increase access to SUD treatment and prevention.

Projeto Contratualização no SUS

Thiago Campos, advogado, especialista em Direito Sanitário e diretor Regional do IDISA/Nordeste, fala sobre o Projeto Contratualização no SUS.

Aplicação de Multas Pessoais aos Gestores da Saúde

Carlos Ferraz, secretário de Controle Externo da Saúde do TCU fala a respeito da plicação de multas pessoais aos gestores da Saúde.

Improbidade Administrativa

Brunno Carrijo, coordenador-geral do DCEBAS/MS, fala sobre improbidade administrativa.

Responsabilização do Gestor Público

Arnaldo Hossepian, Procurador de Justiça do Ministério Público de São Paulo, discute o tema "Responsabilização do Gestor Público", na CTDS do Conass.

Compliance em Contratos Administrativos

Vinícius Guimarães, Auditor do TCU fala, na CTDS do Conass, sobre o tema "Compliance em Contratos Administrativos".

Não aplicação de penalidades pessoais aos gestores

Sérgio Santana, Procurador do Estado de Pernambuco fala sobre a "Não aplicação de penalidades pessoais aos gestores".

Responsabilização dos Gestores

Dandara Ronconi, assessora Jurídica da SES/PR, fala, na CTDS do Conass, sobre a responsabilização dos gestores.

Public Health Strategies for the Gradual Lifting of the Public Sector Lockdown in Jordan and the United Arab Emirates During the COVID-19 Crisis.

In this viewpoint, we present public policies and public health strategies for a gradual lockdown lifting during the coronavirus disease (COVID-19) crisis in two country cases, Jordan and the United Arab Emirates. While managing pandemics is critical in terms of preparedness, response, and recovery, it is equally vital to ensure that the measures for a lockdown exit are both efficient and effective. It is critical to learn from first-wave lessons to systematize responses during times of crisis and execute appropriate public policies and public health strategies. This viewpoint highlights the importance of the following during lockdown lifting: pandemic control, health care capacity, training, scaling up of resources and systems, and priority setting of public policies by acknowledging challenges, developing policy insights, and setting the policy direction. The systematic approaches and leadership thinking required for lifting lockdowns during a crisis include the three Rs: Readiness, Responses, and Resilience & Recovery.

Coronavírus: o Estado decretou Luto Oficial pelas vítimas do Coronavírus?

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Coronavírus: Pacto Federativo

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Coronavírus: qual o protocolo será adotado para a reabertura gradual dos setores?

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Coletiva de imprensa: medidas de combate ao coronavírus (COVID-19) - 29/04/2020

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Coronavírus: a PEC do orçamento é uma medida positiva?

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Coronavírus: existe um Decreto Municipal para reduzir os impactos da crise?

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