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6.
Global Health ; 15(1): 69, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31753038

RESUMO

BACKGROUND: There is a current need to build the capacity of Health Policy and Systems Research + Analysis (HPSR+A) in low and middle-income countries (LMICs) as this enhances the processes of decision-making at all levels of the health system. This paper provides information on the HPSR+A knowledge and practice among producers and users of evidence in priority setting for HPSR+A regarding control of endemic diseases in two states in Nigeria. It also highlights the HPSR+A capacity building needs and interventions that will lead to increased HPSR+A and use for actual policy and decision making by the government and other policy actors. METHODS: Data was collected from 96 purposively selected respondents who are either researchers/ academia (producers of evidence) and policy/decision-makers, programme/project managers (users of evidence) in Enugu and Anambra states, southeast Nigeria. A pre-tested questionnaire was the data collection tool. Analysis was by univariate and bivariate analyses. RESULTS: The knowledge on HPSR+A was moderate and many respondents understood the importance of evidence-based decision making. Majority of researcher stated their preferred channel of dissemination of research finding to be journal publication. The mean percentage of using HPSR evidence for programme design & implementation of endemic disease among users of evidence was poor (18.8%) in both states. There is a high level of awareness of the use of evidence to inform policy across the two states and some of the respondents have used some evidence in their work. CONCLUSION: The high level of awareness of the use of HPSR+A evidence for decision making did not translate to the significant actual use of evidence for policy making. The major reasons bordered on lack of autonomy in decision making. Hence, the existing yawning gap in use of evidence has to be bridged for a strengthening of the health system with evidence.


Assuntos
Fortalecimento Institucional/organização & administração , Doenças Endêmicas/prevenção & controle , Política de Saúde , Pesquisa sobre Serviços de Saúde , Pessoal Administrativo/psicologia , Pessoal Administrativo/estatística & dados numéricos , Adulto , Tomada de Decisões , Prática Clínica Baseada em Evidências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Formulação de Políticas , Análise de Sistemas
7.
Prog Cardiovasc Dis ; 62(5): 406-413, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31672610

RESUMO

In our increasingly cost-conscious health system, patients, clinicians, hospitals, and payers all agree about the urgent need to rein in runaway healthcare costs. High pharmaceutical costs make drugs unaffordable to many patients who may benefit from them, including some insured patients who face prohibitive out-of-pocket costs. Health systems and payers can use the systematic framework of cost-effectiveness analysis and estimated budgetary impact to prioritize the adoption of new therapies and technologies. In this review article, we discuss basic principles of cost-effectiveness research for practicing clinicians, the concept of cost-effectiveness versus affordability, other considerations relevant to resource allocation, and limitations of cost-effectiveness research. We use the example of lipid lowering therapies to discuss application of cost-effectiveness research in informing health care policy, its use for health care systems and in the development of clinical practice guidelines, and its implications for clinicians and patients. As clinicians and patients become more cognizant of the cost-implications of new therapies, professional societies can help improve the quality of decision-making by incorporating unbiased value statements into their expert guidelines.


Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/economia , Custos de Medicamentos , Dislipidemias/tratamento farmacológico , Dislipidemias/economia , Hipolipemiantes/economia , Hipolipemiantes/uso terapêutico , Formulação de Políticas , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Análise Custo-Benefício , Dislipidemias/diagnóstico , Dislipidemias/epidemiologia , Humanos , Guias de Prática Clínica como Assunto , Prevenção Primária/economia , Prevenção Primária/legislação & jurisprudência , Prevenção Secundária/economia , Prevenção Secundária/legislação & jurisprudência , Resultado do Tratamento
9.
Am J Law Med ; 45(2-3): 130-170, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31722626

RESUMO

In many areas of innovation, the United States is a leader, but this characterization does not apply to the United States' position in assisted reproductive technology innovation and clinical use. This article uses a political science concept, the idea of the "democratic deficit" to examine the lack of American public discourse on innovations in ART. In doing so, the article focuses on America's missing public consultation in health care innovation. This missing discourse is significant, as political and ethical considerations may impact regulatory decisions. Thus, to the extent that these considerations are influencing the decisions of federal agency employees, namely those who work within the U.S. Food and Drug Administration, the public is unable to participate in the decision-making process. This lack of a public discourse undermines the goals of the administrative state, which include democratic participation, transparency, and accountability. The United Kingdom, on the other hand, has had a markedly divergent experience with assisted reproductive technology innovation. Instead of ignoring the various ethical, social, and legal issues surrounding assisted reproductive technology innovation, the United Kingdom engaged in a five-strand public consultation on the topic of mitochondrial transfer, a form of assisted reproductive technology that uses genetic modification in order to prevent disease transmission. This article argues that after a multi-decade standstill in terms of the public discourse related to ethical issues associated with assisted reproductive technology and germline modification, it is time for the United States to institute a more democratic inquiry into the scientific, ethical, and social implications of new forms of assisted reproductive technology and ultimately, forthcoming medical innovations that involve genetic modification.


Assuntos
Democracia , Invenções/legislação & jurisprudência , Formulação de Políticas , Técnicas de Reprodução Assistida/legislação & jurisprudência , Participação da Comunidade , Governo Federal , Fertilização In Vitro/ética , Fertilização In Vitro/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Humanos , Invenções/ética , Técnicas de Reprodução Assistida/ética , Responsabilidade Social , Participação dos Interessados , Governo Estadual , Inquéritos e Questionários , Reino Unido , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência
12.
Pan Afr Med J ; 33: 318, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692720

RESUMO

Reliable data on the cause of child death is the cornerstone for evidence-informed health policy making towards improving child health outcomes. Unfortunately, accurate data on cause of death is essentially lacking in most countries of sub-Saharan Africa due to the widespread absence of functional Civil Registration and Vital Statistics (CRVS) systems. To address this problem, verbal autopsy (VA) has gained prominence as a strategy for obtaining Cause of Death (COD) information in populations where CRVS are absent. This study reviewed publications that investigated the validation of VA methods for assessment of COD. A MEDLINE PubMed search was undertaken in June 2018 for studies published in English that investigated the validation of VA methods in sub-Saharan Africa from 1990-2018. Of the 17 studies identified, 9 fulfilled the study inclusion criteria from which additional five relevant studies were found by reviewing their references. The result showed that Physician-Certified Verbal Autopsy (PCVA) was the most widely used VA method. Validation studies comparing PCVA to hospital records, expert algorithm and InterVA demonstrated mixed and highly varied outcomes. The accuracy and reliability of the VA methods depended on level of healthcare the respondents have access to and the knowledge of the physicians on the local disease aetiology and epidemiology. As the countries in sub-Saharan Africa continue to battle with dysfunctional CRVS system, VA will remain the only viable option for the supply of child mortality data necessary for policy making.


Assuntos
Autopsia/métodos , Mortalidade da Criança , Política de Saúde , África ao Sul do Saara , Causas de Morte , Criança , Humanos , Formulação de Políticas , Reprodutibilidade dos Testes
13.
14.
Sante Publique ; Vol. 31(3): 367-375, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31640324

RESUMO

Health impact assessment (HIA) is defined as a method by which a policy, program or project may be judged as to its potential effects on the health of a population in order to mitigate negative impacts and strengthen the positive ones. During the 2017 French presidential elections, health promotion actors decided to conduct an HIA on the political platforms of the five main candidates. The assessment of each political platform was conducted by 7 evaluators and reviewed by 35 health promotion experts. Then, a comparative analysis of the platforms was led on 3 specific topics. This HIA was conducted in accordance with the international standards of practice. Within all of the 5 political platforms, the proposals related to Environmental and energy policy, and to Agricultural policy were the ones with widely positive impacts on the determinants of health. Concerning all of the other policy proposals, their respective impacts and affected populations broadly change from one platform to another. Due to its political object, this HIA had to deal with methodological challenges such as platform instability, uncertainty over the genuine implementation of measures as well as the importance of the underlying platform values. Nonetheless, such an implementation of the HIA process on the political platforms of candidates running for an important position is interesting because it represents an opportunity to look at the platforms with fresh eyes and enriches the advocacy to take public health into account in the policy making processes and tries to operationalize the concept of health in all policies.


Assuntos
Avaliação do Impacto na Saúde , Política , França , Humanos , Formulação de Políticas , Saúde Pública , Política Pública
15.
Int J Public Health ; 64(8): 1159-1172, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31606749

RESUMO

OBJECTIVES: This paper examines the opportunities and barriers that the South Australian Health in all Policies (SA HiAP) approach encountered when seeking to establish a whole-of-government response to promoting healthy weight. METHODS: The paper draws on data collected during 31 semi-structured interviews, analysis of 113 documents, and a program logic model developed via workshops to show the causal links between strategies and anticipated outcomes. RESULTS: A South Australian Government target to increase healthy weight was supported by SA HiAP to develop a cross-government response. Our analysis shows what supported and hindered implementation. A combination of economic and systemic framing, in conjunction with a co-benefits approach, facilitated intersectoral engagement. The program logic shows how implementation can be expected to contribute to a population with healthy weight. CONCLUSIONS: The HiAP approach achieved some success in encouraging a range of government departments to contribute to a healthy weight target. However, a comprehensive approach requires national regulation to address the commercial determinants of health and underlying causes of population obesity in addition to cross-government action to promote population healthy weight through regional government action.


Assuntos
Política de Saúde , Promoção da Saúde , Obesidade , Perda de Peso , Governo , Órgãos Governamentais , Humanos , Entrevistas como Assunto , Obesidade/epidemiologia , Obesidade/prevenção & controle , Obesidade/terapia , Formulação de Políticas , Saúde da População , Austrália do Sul/epidemiologia
16.
Glob Health Action ; 12(1): 1670015, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31587621

RESUMO

Child health is taking the back seat in development strategies. In summarising a newly released collaborative report, this paper calls for a novel conceptual model where child health takes centre stage in relation to the 2030 Agenda and the Sustainable Development Goals. It lays out five principles by which renewed effort and focus would yield the most benefit for children and adolescents. These include: re-defining global child health in the post-2015 era by placing children and adolescents at the centre of the Sustainable Development Goals; striving for equity; realising the rights of the child to thrive throughout the life-course; facilitating evidence informed policy-making and implementation; and capitalising on interlinkages within the SDGs to galvanise multisectoral action. These five principles offer models that together have the potential of improving design, return and quality of global child health programs while re-energising the 2030 Agenda and the Sustainable Development Goals.


Assuntos
Saúde da Criança , Saúde Global , Metas , Formulação de Políticas , Desenvolvimento Sustentável , Adolescente , Criança , Humanos , Responsabilidade Social
17.
Int J Equity Health ; 18(1): 144, 2019 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521177

RESUMO

BACKGROUND: The economic crisis posed various challenges to policy-makers who had to decide on which health policy measures to focus on and on which to refrain from. The aim of this research was to assess the relevance of ethics and to highlight ethical dimensions in decision-taking by policy-makers with regard to policy and priority-setting in health systems posed by the economic crisis. METHODS: Semi-structured qualitative interviews were conducted with eight European policy-makers from six countries. RESULTS: All interviewees recalled difficult and strenuous situations where they had to prioritise between distinct areas to focus on and invest in, for example around choices between prioritising medications, health professional staffing, care specific equipment, or urgent infrastructure issues. Values could be identified which they deemed as important within the policy-making process, such as trust and responsibility. They explicitly expressed the need for ethical tools and assistance in terms of policy advice for reaching morally sustainable decisions in health policy matters. CONCLUSIONS: The study showed that ethical concepts and values frequently come into play in health policy-making, and that ethics is highly relevant in policy-makers' daily decision-taking, yet that they lack ethical guidance on what to base their decisions. The study is of relevance since it can provide future decisions on austerity-related issues with an ethical underpinning and could identify areas of moral concern.


Assuntos
Pessoal Administrativo/psicologia , Tomada de Decisões/ética , Recessão Econômica , Política de Saúde , Formulação de Políticas , Europa (Continente) , Humanos , Pesquisa Qualitativa
18.
Int J Equity Health ; 18(1): 138, 2019 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-31558166

RESUMO

INTRODUCTION: At the turn of the century, when the Millennium Development Goals placed maternal mortality reduction high on the global agenda, Ethiopia relaxed its restrictive abortion law to expand grounds on which a woman could legally obtain an abortion. This radical policy shift took place within a context of predominant anti-abortion public opinion shaped by strong religious convictions. Drawing upon Walt and Gilson's policy analysis framework, this paper explores the tension between public policy and religious dogma for the strategies chosen by the Ethiopian Ministry of Health and its partners implementing the new policy, and for access to safe abortion services. METHODS: The study employed a qualitative research methodology. It targeted organizations that are key stakeholders in the field of reproductive health. These included policy makers and policy implementers like ministries, UN agencies and international and national NGOs as well as religious organizations as key opinion leaders. The data collection took place in Addis Ababa between 2016 and 2018. A total of 26 interviews were conducted, transcribed, and analyzed using the principles of qualitative content analysis. RESULTS: Our analysis showed that the implementing organizations adopted a strategy of silence not to provoke anti-abortion sentiments and politicization of the abortion issue which was seen as a threat to the revised law and policy. This strategy has facilitated a rollout of services and has improved access to safe abortion care. Nevertheless informants were concerned that the silence strategy has prevented dissemination of knowledge about the revised law to the general public, to health workers and to the police. In turn this has caused confusion about eligibility to legal and safe abortion procedures. CONCLUSIONS: While silence as a strategy works to protect the law enhancing the health and survival of young women, it may at the same time prevent the law from being fully effective. As a long term strategy, silence fails to expand awareness and access to safe abortion services, and may not sufficiently serve to fulfill the potential of the law to prevent abortion related maternal deaths.


Assuntos
Aborto Induzido/legislação & jurisprudência , Política de Saúde , Formulação de Políticas , Etiópia , Feminino , Humanos , Gravidez
20.
BMC Health Serv Res ; 19(1): 670, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533710

RESUMO

BACKGROUND: Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. Today, the Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). This study aimed to analyze the HTP at the PHC level in Iran. METHODS: Qualitative data were collected through document analysis, round-table discussion, and semi-structured interviews with stakeholders at the micro, meso and macro levels of the health system. A tailored version of Walt & Gilson's policy triangle model incorporating the stages heuristic model was used to guide data analysis. RESULTS: The HTP emerged through a political process. Although the initiative aimed to facilitate the achievements of UHC by improving the entire health system of Iran, little attention was given to PHC especially during the first phases of policy development - a gap that occurred because politicians were in a great haste to fulfil a campaign promise. CONCLUSIONS: Health reforms targeting UHC and the health-related Sustainable Development Goals require the political will to improve PHC through engagements of all stakeholders of the health system, plus improved fiscal capacity of the country and financial commitments to implement evidence-informed initiatives.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Planejamento em Saúde/organização & administração , Política de Saúde , Formulação de Políticas , Atenção Primária à Saúde/organização & administração , Programas Governamentais , Humanos , Irã (Geográfico) , Programas Nacionais de Saúde/organização & administração , Política , Cobertura Universal do Seguro de Saúde/organização & administração
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