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1.
NEJM Evid ; 3(1): EVIDctw2300024, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38320517

RESUMO

Danish NUDGE Trial ConceptRandomized encouragement trials randomize to an opportunity to receive treatment instead of to the treatment. Here, Johansen and colleagues combine randomized encouragement trials with several advantages inherent in the Danish health system.


Assuntos
Programas Governamentais , Promoção da Saúde , Dinamarca
2.
PLoS One ; 19(2): e0297109, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38315690

RESUMO

BACKGROUND AND OBJECTIVE: The need for rehabilitation is growing due to health and demographic trends, especially the rise of non-communicable diseases and the rapid ageing of the global population. However, the extent to which rehabilitation is integrated into health systems is mostly unclear. Our objective is to describe and compare the nature and extent of integration of rehabilitation within health systems across nine middle-income countries using available Systematic Assessment of Rehabilitation Situation (STARS) reports. METHODS: Cross-country comparative study with variable-oriented design using available rehabilitation health system assessment reports from nine middle income countries. FINDINGS: The integration of rehabilitation into health systems is limited across countries. Governance and financing for rehabilitation are mostly established within health ministries but weakly so, while health information systems are characterized by no available data or data that is insufficient or not routinely generated. The overall numbers of rehabilitation workforce per capita are low, with frequent reports of workforce challenges. In most countries the availability of longer-stay, high-intensity rehabilitation is extremely low, the availability of rehabilitation in tertiary hospitals is modest and in government supported primary care its almost non-existent. Multiple concerns about rehabilitation quality arose but the lack of empirical data hinders formal appraisal. CONCLUSION: The study sheds light on the limited integration of rehabilitation in health systems and common areas of difficulty and challenge across nine middle income countries. All countries were found to have a basis on which to strengthen rehabilitation and there were often multiple areas within each health system building block that required action in order to improve the situation. Findings can inform governments, regional and global agencies to support future efforts to strengthen rehabilitation. Additionally, our study demonstrates the value of STARS reports for health policy and systems research and can serve as a model for further comparative studies.


Assuntos
Países em Desenvolvimento , Assistência Médica , Programas Governamentais , Política de Saúde , Organização Mundial da Saúde , Saúde Global
3.
Health Res Policy Syst ; 22(1): 29, 2024 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-38378688

RESUMO

BACKGROUND: In 2006, the Ministry of Health in the Democratic Republic of Congo designed a strategy to strengthen the health system by developing health districts. This strategy included a reform of the provincial health administration to provide effective technical support to district health management teams in terms of leadership and management. The provincial health teams were set up in 2014, but few studies have been done on how, for whom, and under what circumstances their support to the districts works. We report on the development of an initial programme theory that is the first step of a realist evaluation seeking to address this knowledge gap. METHODS: To inform the initial programme theory, we collected data through a scoping review of primary studies on leadership or management capacity building of district health managers in sub-Saharan Africa, a review of policy documents and interviews with the programme designers. We then conducted a two-step data analysis: first, identification of intervention features, context, actors, mechanisms and outcomes through thematic content analysis, and second, formulation of intervention-context-actor-mechanism-outcome (ICAMO) configurations using a retroductive approach. RESULTS: We identified six ICAMO configurations explaining how effective technical support (i.e. personalised, problem-solving centred and reflection-stimulating) may improve the competencies of the members of district health management teams by activating a series of mechanisms (including positive perceived relevance of the support, positive perceived credibility of provincial health administration staff, trust in provincial health administration staff, psychological safety, reflexivity, self-efficacy and perceived autonomy) under specific contextual conditions (including enabling learning environment, integration of vertical programmes, competent public health administration staff, optimal decision space, supportive work conditions, availability of resources and absence of negative political influences). CONCLUSIONS: We identified initial ICAMO configurations that explain how provincial health administration technical support for district health management teams is expected to work, for whom and under what conditions. These ICAMO configurations will be tested in subsequent empirical studies.


Assuntos
Liderança , Resolução de Problemas , Humanos , República Democrática do Congo , Programas Governamentais
4.
Cien Saude Colet ; 29(1): e00322023, 2024 Jan.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38198316

RESUMO

This study aimed to identify the regulatory framework and federal guidelines that support the process of implementing health technologies in the Unified Health System (SUS) through analysis of documents and legislation related to the National Health Technology Management Policy, published between 2009 and 2021. The search and selection of documents and subsequent data extraction were carried out. The documents were grouped into three categories: structural regulatory documents, recommendations on evaluation of technologies, and recommendations on clinical guidelines. In 38.8% of the regulatory documents, citations to implementation related mainly to SUS clinical guidelines were identified; however, no document dedicated to guiding implementation actions was identified. Recommendations related to implementations were identified in 27.1% of the reports and 66.1% of the guidelines, although without standardization and, in general, in little detail, focusing on resources and actions needed for making technology available rather than on methods and interventions for its implementation. The results evidence a gap in formal guidelines to guide the implementation process in Brazil, representing an opportunity for the development of models aligned with the reality of the SUS.


O objetivo foi identificar o arcabouço regulatório e as orientações federais que sustentam o processo de implementação de tecnologias em saúde no Sistema Único de Saúde (SUS), por meio da análise de documentos e legislações relacionados à Política Nacional de Gestão de Tecnologias de Saúde, publicados entre 2009 e 2021. Foi realizada busca e seleção dos documentos e posterior extração de dados, agrupados por três categorias: normativas estruturantes, recomendações na avaliação de tecnologias e recomendações nas diretrizes clínicas. Em 38,8% das normativas, foram identificadas citações à implementação relacionadas principalmente às diretrizes clínicas do SUS, mas nenhum documento dedicado a orientar as ações de implementação. As recomendações relacionadas às implementações foram identificadas em 27,1% dos relatórios e em 66,1% das diretrizes, mas sem padronização e, de modo geral, pouco detalhadas, com foco em recursos e ações necessárias para a disponibilização da tecnologia, ao invés de métodos e intervenções para implementação. Os resultados confirmam a existência de uma lacuna de diretrizes formais para guiar o processo de implementação no Brasil, o que se constitui em oportunidade para o desenvolvimento de modelos alinhados à realidade do SUS.


Assuntos
Tecnologia Biomédica , Saúde Pública , Humanos , Brasil , Programas Governamentais , Tecnologia
5.
Cien Saude Colet ; 29(1): e19352022, 2024 Jan.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38198336

RESUMO

Through quantitative exploratory research, the present study analyzed the amount foreseen in the Federal Budget and the amounts paid (nominal and deflated) for programs and actions to promote body practices and physical activities (Health Academy Program and the Federal Incentive for Physical Activity in Primary Health Care) from 2019 to 2022. The values of investment in body practices and physical activities in SUS per capita, according to the population covered by Primary Health Care (PHC) and per participant in public programs, were also calculated. The following was found: (1) that the resources that were actually paid were 3.31% to 15.06% lower than those approved in the budget (nominal) and (2) the low annual (maximum) values found, regardless of whether nominal or deflated - per capita (R$ 0.21 to 0.30) per population covered by PHC (R$ 0.25 to 0.40) and per participant (R$ 10.61 to 14.61). It was concluded that the low investment in the promotion of body practices and physical activities decreases access and does not contribute to the full functioning of SUS by preventing or hindering the expansion of possibilities of comprehensive health care.


Por meio de pesquisa quantitativa de caráter exploratório, o presente estudo teve o objetivo de analisar o orçamento e o financiamento federal de programas e ações de promoção das práticas corporais e atividades físicas no Sistema Único de Saúde (SUS) de 2019 a 2022 (Programa Academia da Saúde e o Incentivo Federal de Custeio da Atividade Física na Atenção Primária). Foram analisados e calculados os valores per capita, pela população coberta pela atenção primária e por participante de programas públicos. Os recursos efetivamente pagos foram de 3,31% a 15,06% menores dos que os aprovados no orçamento (nominal), e também foram identificados os baixos valores (máximos) anuais, independentemente se nominal ou deflacionado per capita (R$ 0,21 a 0,30) por população coberta pela atenção primária (R$ 0,25 a 0,40) e por participante (R$ 10,61 a 14,61). Concluiu-se que o baixo investimento na promoção das práticas corporais e atividades físicas diminui o acesso e não contribui para o pleno funcionamento do SUS ao impedir ou dificultar a ampliação de possibilidades do cuidado integral em saúde.


Assuntos
Programas Governamentais , Governo , Humanos , Governo Federal , Exercício Físico , Academias e Institutos
6.
BMC Health Serv Res ; 24(1): 54, 2024 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-38200522

RESUMO

BACKGROUND: Despite three decades of policy initiatives to improve integration of health care, delivery of health care in New Zealand remains fragmented, and health inequities persist for Maori and other high priority populations. An evidence base is needed to increase the chances of success with implementation of large-system transformation (LST) initiatives in a complex adaptive system. METHODS: This research aimed to identify key elements that support implementation of LST initiatives, and to investigate contextual factors that influence these initiatives. The realist logic of enquiry, nested within the macro framing of complex adaptive systems, formed the overall methodology for this research and involved five phases: theory gleaning from a local LST initiative, literature review, interviews, workshop, and online survey. NVivo software programme was used for thematic analysis of the interview, workshop, and the survey data. We identified key elements and explained variations in success (outcomes) by identifying mechanisms triggered by various contexts in which LST initiatives are implemented. RESULTS: The research found that a set of 10 key elements need to be present in the New Zealand health system to increase chances of success with implementation of LST initiatives. These are: (i) an alliancing way of working; (ii) a commitment to te Tiriti o Waitangi; (iii) an understanding of equity; (iv) clinical leadership and involvement; (v) involved people, whanau, and community; (vi) intelligent commissioning; (vii) continuous improvement; (viii) integrated health information; (ix) analytic capability; and (x) dedicated resources and time. The research identified five contextual factors that influenced implementation of LST initiatives: a history of working together, distributed leadership from funders, the maturity of Alliances, capacity and capability for improvement, and a continuous improvement culture. The research found that the key mechanism of trust is built and nurtured over time through sharing of power by senior health leaders by practising distributed leadership, which then creates a positive history of working together and increases the maturity of Alliances. DISCUSSION: Two authors (KMS and PBJ) led the development and implementation of the local LST initiative. This prior knowledge and experience provided a unique perspective to the research but also created a conflict of interest and introduced potential bias, these were managed through a wide range of data collection methods and informed consent from participants. The evidence-base for successful implementation of LST initiatives produced in this research contains knowledge and experience of senior system leaders who are often in charge of leading these initiatives. This evidence base enables decision makers to make sense of complex processes involved in the successful implementation of LST initiatives. CONCLUSIONS: Use of informal trust-based networks provided a critical platform for successful implementation of LST initiatives in the New Zealand health system. Maturity of these networks relies on building and sustaining high-trust relationships among the network members. The role of local and central agencies and the government is to provide the policy settings and conditions in which trust-based networks can flourish. OTHER: This study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).


Assuntos
Atenção à Saúde , Programas Governamentais , Humanos , Governo , Nova Zelândia , Atenção à Saúde/organização & administração
7.
Health Res Policy Syst ; 22(1): 1, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38167041

RESUMO

BACKGROUND: Decision-making about the design and implementation of health care policies should be supported by research evidence. This article reports on a qualitative study on the experiences of both research institutes and policymakers in Ethiopia in generating and using research evidence to inform health policy decision-making. METHODS: Semi-structured interviews were conducted from January through March 2020, with representatives of research institutes and with policymakers in Ethiopia. The data collected during the interviews were analyzed thematically. RESULTS: Half of the institutions represented had engaged in health policy and systems research (HPSR). These institutes' capacities were limited by multiple factors, including unsupportive research environments; the limited number of researchers with extensive experience; high turnover among senior researchers; lack of staff motivation mechanisms; underdeveloped research culture; limited technical and analytical capacity among researchers; lack of core funding for HPSR; ineffective financial management; and, lack of connections with health policy platforms. Research institutes also lacked the capacity in strategic packaging of findings to influence policy decision-making, although some programs have recently improved in this area. Meanwhile, there lacked a culture of using evidence in policymaking settings. In general, we found that policymakers had poor attitudes towards the quality or value of the evidence, and had little capacity to interpret evidence and apply findings to policy options. As a result, much of the research produced by the institutes have only been relevant academically, with little impact on policy. However, respondents reported that the environment is slowly changing, and the recent creation of a Research Advisory Council at the Ministry of Health offers a promising model. CONCLUSIONS: Despite some recent changes, in Ethiopia researchers and policymakers alike often tend to consider health policy and systems research (HPSR) to be not very valuable since the findings generated are rarely used for evidence-informed policy development. Research institutes and researchers need to strengthen their technical, analytical, and administrative capacities (through, among other efforts, seeking more funding for research, and better incentives to attract, retain and build skills among qualified researchers); they also need to improve their understanding of the evidence-to-policy cycle and how to engage effectively with policymakers.


Assuntos
Política de Saúde , Formulação de Políticas , Humanos , Etiópia , Programas Governamentais , Pesquisa Qualitativa
8.
BMC Health Serv Res ; 24(1): 55, 2024 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-38212788

RESUMO

BACKGROUND: Community-based health programmes have been a cornerstone of primary care in Laos for decades. The study presented here aimed to document prospects for the development of current programmes, considering perceptions about health and health care priorities in the communities, implementation challenges, the policy landscape and opportunities associated with the availability of new technologies. METHODS: The research design primarily involved qualitative in-depth interviews with stakeholders (n = 35) responsible for the planning, management, or implementation of community-based care in Laos at different levels of the health system. These included health managers at central departments or institutes of the Ministry of Health, provincial health departments, district health offices, heads of health centres, village health volunteers, community representatives, and international stakeholders. RESULTS: There was consensus that service delivery is still a challenge in many areas, due to geographic inaccessibility of health facilities, communication barriers, health-seeking behaviour, trust, and gender discrimination, particularly among ethnic minorities. In these settings, community health workers have the potential to extend the reach of the formal health system, acting as cultural brokers across sectors of society, ethnicities, and worldviews. To maximise impact, planners need to carefully consider the implementation model, financing arrangements, health system integration, and changing health priorities in the communities. CONCLUSIONS: This study examined challenges to, and opportunities for, the expansion and health system integration of community-based care in Laos. Further development and horizontal integration of community-based care remains a complex financing and governance challenge, although the renewed emphasis on primary care and the ongoing process of decentralisation provide a favourable policy environment in the country to sustain and potentially expand existing programmes.


Assuntos
Programas Governamentais , Prioridades em Saúde , Humanos , Laos , Agentes Comunitários de Saúde , Comportamentos Relacionados com a Saúde
9.
Health Policy Plan ; 39(Supplement_1): i93-i106, 2024 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-38253450

RESUMO

Since the launch of the Global Polio Eradication Initiative in 1988, more than US$20 billion has been invested globally in polio eradication. The World Health Organization and its partners are currently supporting Member States to transition the functions used to eradicate polio to strengthen their health systems. This study analyses global polio activities through the lens of health systems and the Common Goods for Health (CGH). Polio activities include key health system functions such as surveillance and response systems and immunization, which are essential to maintaining resilient health systems. They also support essential functions such as policy development, planning, training and capacity building, which are often underfunded in many countries. To improve overall resilience, it is critical to continue to integrate these functions into local health systems so that the capacity built through the polio eradication programme can be used for broader public health purposes. It is vital that this integration process be tailored to each country's unique health system context, rather than using a one-size-fits-all approach. While integration of all polio activities into local health systems is ideal, the transition to domestic financing may be coordinated with other global health financing mechanisms. This would reduce funding fragmentation and transaction costs, and allow for a focus on health system functions as a whole rather than just disease-specific efforts. The transition to domestic financing of polio activities could be staggered, prioritizing the transition to domestic funding for activities with limited global externalities, while seeking longer-term external funding for those that are global CGH.


Assuntos
Poliomielite , Resiliência Psicológica , Humanos , Fortalecimento Institucional , Programas Governamentais , Imunização , Poliomielite/prevenção & controle
10.
Health Policy Plan ; 39(Supplement_1): i4-i8, 2024 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-38253446

RESUMO

Health System strengthening is high on the agenda of the global health community. We review some of the specific challenges faced by Small Island Developing States in the development of their health systems. We propose a list of action points for aid actors willing to adapt their health programs and interventions.


Assuntos
Programas Governamentais , Promoção da Saúde , Humanos
11.
BMJ Open ; 14(1): e073316, 2024 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-38195169

RESUMO

INTRODUCTION: South Africa has a high prevalence of gestational diabetes mellitus (GDM; 15%) and many of these women (48%) progress to type 2 diabetes mellitus (T2DM) within 5 years post partum. A significant proportion (47%) of the women are not aware of their diabetes status after the index pregnancy, which may be in part to low postnatal diabetes screening rates. Therefore, we aim to evaluate a intervention that reduces the subsequent risk of developing T2DM among women with recent GDM. Our objectives are fourfold: (1) compare the completion of the nationally recommended 6-week postpartum oral glucose tolerance test (OGTT) between intervention and control groups; (2) compare the diabetes risk reduction between control and intervention groups at 12 months' post partum; (3) assess the process of implementation; and (4) assess the cost-effectiveness of the proposed intervention package. METHODS AND ANALYSES: Convergent parallel mixed-methods study with the main component being a pragmatic, 2-arm individually randomised controlled trial, which will be carried out at five major referral centres and up to 26 well-baby clinics in the Western Cape and Gauteng provinces of South Africa. Participants (n=370) with GDM (with no prior history of either type 1 or type 2 diabetes) will be recruited into the study at 24-36 weeks' gestational age, at which stage first data collection will take place. Subsequent data collection will take place at 6-8 weeks after delivery and again at 12 months. The primary outcome for the trial is twofold: first, the completion of the recommended 2-hour OGTT at the well-baby clinics 6-8 weeks post partum, and second, a composite diabetes risk reduction indicator at 12 months. Process evaluation will assess fidelity, acceptability, and dose of the intervention. ETHICS AND DISSEMINATION: Ethics approval has been granted from University of Cape Town (829/2016), University of the Witwatersrand, Johannesburg (M170228), University of Stellenbosch (N17/04/032) and the University of Montreal (2019-794). The results of the trial will be disseminated through publication in peer-reviewed journals and presentations to key South African Government stakeholders and health service providers. PROTOCOL VERSION: 1 December 2022 (version #2). Any protocol amendments will be communicated to investigators, Human Ethics Research Committees, trial participants, and trial registries. TRIAL REGISTRATION NUMBER: PAN African Clinical Trials Registry (https://pactr.samrc.ac.za) on 11 June 2018 (identifier PACTR201805003336174).


Assuntos
Prestação Integrada de Cuidados de Saúde , Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Lactente , Gravidez , Feminino , Humanos , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/prevenção & controle , África do Sul/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/prevenção & controle , Programas Governamentais , Ensaios Clínicos Controlados Aleatórios como Assunto
12.
J Public Health Manag Pract ; 30(2): E47-E53, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38271111

RESUMO

OBJECTIVE: Partnerships are increasingly critical to achieve the mission of public health. We sought to understand the levers and tools that states use to better connect public health and primary care in efforts to strengthen public health. DESIGN: We reviewed literature focused on collaborative or integrative efforts between primary care and public health and examined strategies employed by 4 innovative states: North Carolina, Oregon, Rhode Island, and Washington. Using a purposive convenience sample, we conducted semistructured interviews with 17 state experts from January to March 2023. We asked leaders to describe their approaches to data sharing, communication, and systems change that could be adopted or adapted by other states interested in better connecting primary care and public health systems. We recorded and coded interviews. PARTICIPANTS: Seventeen state leaders from North Carolina, Oregon, Rhode Island, and Washington. MAIN OUTCOME MEASURES: Key experiences, strategies, policy levers, and lessons for integration or collaboration between primary care and public health sectors, both common and divergent, across the states. RESULTS: State activity can be categorized by 3 actions: (1) endeavors to support relationship building, both formal and informal; (2) efforts to employ coordinating bodies and champions to ensure all necessary actors are included in planning and communications with clear roles; and (3) approaches to identifying and elevating essential system elements and the change levers to support them. The integration is built primarily on the well-resourced medical care system rather than the public health system. CONCLUSION: States are engaged in creative approaches to collaboration between public health and primary care. Building blocks include backbone organizations, leadership training programs, payment reform spheres, interoperable data platforms, and intentional efforts to build relationships. Collaboration between primary care, public health, and community-based organizations is an opportunity to strengthen public health systems while staying focused on improving the public's health.


Assuntos
Programas Governamentais , Saúde Pública , Humanos , Washington , Oregon , Atenção Primária à Saúde
13.
PLoS One ; 19(1): e0297438, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38289943

RESUMO

INTRODUCTION: Kenya faces significant challenges related to health worker shortages, low retention rates, and the equitable distribution of Human Resource for Health (HRH). The Ministry of Health (MOH) in Kenya has established HRH norms and standards that define the minimum requirements for healthcare providers and infrastructure at various levels of the health system. The study assessed on the progress of Universal Health Coverage (UHC) piloting on Human Resource for Health in the country. METHODS: The study utilized a Convergent-Parallel-Mixed-Methods design, incorporating both quantitative and qualitative approaches. The study sampled diverse population groups and randomly selected health facilities. Four UHC pilot counties are paired with two non-UHC pilot counties, one neighboring county and the second county with a geographically distant and does not share a border with any UHC pilot counties. Stratification based on ownership and level was performed, and the required number of facilities per stratum was determined using the square root allocation method. Data on the availability of human resources for health was collected using a customized Kenya Service Availability and Readiness Assessment Mapping (SARAM) tool facilitated by KoBo ToolKitTM open-source software. Data quality checks and validation were conducted, and the HRH general service availability index was measured on availability of Nurses, Clinician, Nutritionist, Laboratory technologist and Pharmacist which is a minimum requirement across all levels of health facilities. Statistical analyses were performed using IBM SPSS version 27 and comparisons between UHC pilot counties and non-UHC counties where significance threshold was established at p < 0.05. Qualitative data collected using focus group discussions and in-depth interview guides. Ethical approval and research permits were obtained, and written informed consent was obtained from all participants. RESULTS: The study assessed 746 health facilities with a response rate of 94.3%. Public health facilities accounted for 75% of the sample. The overall healthcare professional availability index score was 17.2%. There was no significant difference in health workers' availability between UHC pilot counties and non-UHC pilot counties at P = 0.834. Public health facilities had a lower index score of 14.7% compared to non-public facilities at 27.0%. Rural areas had the highest staffing shortages, with only 11.1% meeting staffing norms, compared to 31.8% in urban areas and 30.4% in peri-urban areas. Availability of health workers increased with the advancement of The Kenya Essential Package for Health (KEPH Level), with all Level 2 facilities across counties failing to meet MOH staffing norms (0.0%) except Taita Taveta at 8.3%. Among specific cadres, nursing had the highest availability index at 93.2%, followed by clinical officers at 52.3% and laboratory professionals at 55.2%. The least available professions were nutritionists at 21.6% and pharmacist personnel at 33.0%. This result is corroborated by qualitative verbatim. CONCLUSION: The study findings highlight crucial challenges in healthcare professional availability and distribution in Kenya. The UHC pilot program has not effectively enhanced healthcare facilities to meet the standards for staffing, calling for additional interventions. Rural areas face a pronounced shortage of healthcare workers, necessitating efforts to attract and retain professionals in these regions. Public facilities have lower availability compared to private facilities, raising concerns about accessibility and quality of care provided. Primary healthcare facilities have lower availability than secondary facilities, emphasizing the need to address shortages at the community level. Disparities in the availability of different healthcare cadres must be addressed to meet diverse healthcare needs. Overall, comprehensive interventions are urgently needed to improve access to quality healthcare services and address workforce challenges.


Assuntos
Atenção à Saúde , Cobertura Universal do Seguro de Saúde , Humanos , Quênia , Recursos Humanos , Programas Governamentais
15.
Global Health ; 20(1): 5, 2024 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-38167205

RESUMO

BACKGROUND: This article explores the concept of institutionalization, which is the process of transforming ideas into programs and automating actions, in the context of health system governance and sustainable development. Institutionalization is a key mechanism for creating accountable and transparent institutions, which are essential for achieving health system resilience and sustainability. This study identifies the components and dimensions of institutionalization in the health system and its relationship with good governance and sustainable health development. MAIN TEXT: We applied a scoping review method in five steps. First, we formulated a question for our research. Then, we concluded a comprehensive literature search in five electronic databases for identifying relevant studies. This review has two phases: identifying the concept of institutional approach and its components in health system, and its relationship with good governance to reach Sustainable Health Development (SHD). The third step was study selection, and the 1st author performed data abstraction. The key issues which are identified in our review, related to the concepts of SDH, its goals, pillars and principles; positive peace; good governance; components of institutional approach components, and their relations. Finally, we summarized and organized our findings in a format of a proposed conceptual framework, to underpin the role of institutionalization in the health system to achieve sustainable development. CONCLUSION: Institutionalization is a key concept for achieving positive peace and good governance, which requires meaningful involvement of leaders, politicians, civil society, and public participation. It also depends on the conditions of justice, human rights, transparency, accountability and rule of law. In the wake of COVID-19, institutionalization is more crucial than ever for advancing sustainable development, especially in the context of low and middle-income countries (LMICs).


Assuntos
Participação da Comunidade , Programas Governamentais , Humanos , Países em Desenvolvimento , Desenvolvimento Sustentável , Institucionalização
16.
BMC Health Serv Res ; 24(1): 130, 2024 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-38267945

RESUMO

BACKGROUND: Health systems worldwide struggled to obtain sufficient personal protective equipment (PPE) and ventilators during the COVID-19 pandemic due to global supply chain disruptions. Our study's aim was to create a proof-of-concept model that would simulate the effects of supply strategies under various scenarios, to ultimately help decision-makers decide on alternative supply strategies for future similar health system related crises. METHODS: We developed a system dynamics model that linked a disease transmission model structure (susceptible, exposed, infectious, recovered (SEIR)) with a model for the availability of critical supplies in hospitals; thereby connecting care demand (patients' critical care in hospitals), with care supply (available critical equipment and supplies). To inform the model structure, we used data on critical decisions and events taking place surrounding purchase, supply, and availability of PPE and ventilators during the first phase of the COVID-19 pandemic within the English national health system. We used exploratory modelling and analysis to assess the effects of uncertainties on different supply strategies in the English health system under different scenarios. Strategies analysed were: (i) purchasing from the world market or (ii) through direct tender, (iii) stockpiling, (iv) domestic production, (v) supporting innovative supply strategies, or (vi) loaning ventilators from the private sector. RESULTS: We found through our exploratory analysis that a long-lasting shortage in PPE and ventilators is likely to be apparent in various scenarios. When considering the worst-case scenario, our proof-of-concept model shows that purchasing PPE and ventilators from the world market or through direct tender have the greatest influence on reducing supply shortages, compared to producing domestically or through supporting innovative supply strategies. However, these supply strategies are affected most by delays in their shipment time or set-up. CONCLUSION: We demonstrated that using a system dynamics and exploratory modelling approach can be helpful in identifying the purchasing and supply chain strategies that contribute to the preparedness and responsiveness of health systems during crises. Our results suggest that to improve health systems' resilience during pandemics or similar resource-constrained situations, purchasing and supply chain decision-makers can develop crisis frameworks that propose a plan of action and consequently accelerate and improve procurement processes and other governance processes during health-related crises; implement diverse supplier frameworks; and (re)consider stockpiling. This proof-of-concept model demonstrates the importance of including critical supply chain strategies as part of the preparedness and response activities to contribute to health system resilience.


Assuntos
COVID-19 , Resiliência Psicológica , Humanos , Pandemias , COVID-19/epidemiologia , Cuidados Críticos , Programas Governamentais
18.
J Acquir Immune Defic Syndr ; 95(1S): e24-e33, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38180736

RESUMO

BACKGROUND: Quantifying subnational need for antiretroviral therapy (ART) for HIV is challenging because people living with HIV (PLHIV) access health facilities in areas that may differ from their residence. We defined and demonstrated new indicators for PLHIV treatment needed to guide health system target setting and resource allocation. SETTING: Botswana. METHODS: We extended Naomi, a Bayesian small-area model for estimating district-level HIV indicators from national household survey and HIV service delivery data. We used model outputs for ART seeking probabilities in neighboring districts to define the "PLHIV (attending)" indicator representing the estimated number of PLHIV who would seek treatment at health facilities in a district, and "Untreated PLHIV attending" representing gaps in ART service provision. Botswana 2021 district HIV estimates were used to demonstrate new outputs and assess the sensitivity to uncertainty in district population sizes. RESULTS: Across districts of Botswana, estimated adult ART coverage in December 2021 ranged 90%-96%. In the capital city Gaborone, there were 50,400 resident PLHIV and 64,200 receiving ART, of whom 24% (95% CI: 20 to 32) were estimated to reside in neighboring districts. Applying ART attendance probabilities gave a "PLHIV attending" denominator of 68,300 and unmet treatment need of 4100 adults (95% CI: 3000 to 5500) for Gaborone health facilities. The facility-based "PLHIV attending" denominator was less-sensitive to fluctuations in district population size assumptions. CONCLUSIONS: New indicators provided more consistent targets for HIV service provision, but are limited by ART data quality. This challenge will increase as treatment coverage reaches high levels and treatment gaps are smaller.


Assuntos
Infecções por HIV , Adulto , Humanos , Teorema de Bayes , Infecções por HIV/tratamento farmacológico , Antirretrovirais/uso terapêutico , Botsuana , Programas Governamentais
20.
J Pediatr ; 264: 113764, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37777171

RESUMO

OBJECTIVES: To describe relationships between parental incarceration and child health and flourishing-a measure of curiosity, resilience, and self-regulation-and to identify government programs that moderate this relationship. METHODS: Using the National Survey of Children's Health data from 2016 through 2019 for children 6-17 years old, we estimated associations with logistic regression between parental incarceration and overall health and flourishing, adjusting for child, caregiver, and household factors. We secondarily examined physical health (asthma, headaches), mental health (attention deficit disorder/attention deficit hyperactivity disorder, depression), developmental needs (learning disability, special educational plan use), and educational (missing ≥11 school days, repeated grade) outcomes. We performed interaction analyses to determine whether government program participation (eg, free/reduced lunch, cash assistance) moderated relationships between parental incarceration and child outcomes. RESULTS: Children with parental incarceration accounted for 9.3% of the sample (weighted n = 4 400 000). Black, American Indian/Alaska Native, and multiracial children disproportionately experienced parental incarceration. Parental incarceration was associated with worse health (aOR, 1.31; 95% CI, 1.11-1.55) and higher odds of not flourishing (aOR, 1.66; 95% CI, 1.46-1.89). Physical health, mental health, developmental issues, and educational needs were also associated with parental incarceration. Participation in free and reduced lunch moderated the relationships between parental incarceration and general health and flourishing, and cash assistance moderated the association between parental incarceration and flourishing. For each, parental incarceration had an attenuated association with health among people who participated in government programs. CONCLUSIONS: Parental incarceration is disproportionately experienced by Black and Indigenous children and associated with worse child health and well-being. Government support program participation may mitigate negative associations between parental incarceration and child outcomes.


Assuntos
Saúde da Criança , Criança , Humanos , Adolescente , Estudos Transversais , Pais/psicologia , Programas Governamentais , Governo
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