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1.
Front Public Health ; 10: 910073, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36091569

RESUMO

Health systems are comprised of complex interactions between multiple different actors with differential knowledge and understanding of the subject and system. It is exactly this complexity that makes it particularly vulnerable to corruption, which has a deleterious impact on the functioning of health systems and the health of populations. Consequently, reducing corruption in the health sector is imperative to strengthening health systems and advancing health equity, particularly in low- and middle-income countries (LMICs). Although health sector corruption is a global problem, there are key differences in the forms of and motivations underlying corruption in health systems in LMICs and high-income countries (HICs). Recognizing these differences and understanding the underlying system structures that enable corruption are essential to developing anti-corruption interventions. Consequently, health sector corruption is a problem in need of a systems-thinking approach. Anti-corruption strategies that are devised without this understanding of the system may have unintended consequences that waste limited resources, exacerbate corruption, and/or further weaken health systems. A systems-thinking approach is important to developing and successfully implementing corruption mitigation strategies that result in sustainable improvements in health systems and consequently, the health of populations.


Assuntos
Programas Governamentais , Pobreza , Humanos
3.
Glob Health Sci Pract ; 10(Suppl 1)2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109062

RESUMO

Ghana is positioned to become the first country in sub-Saharan Africa to implement universal health coverage based on nationwide expansion of geographic access through the Community-based Health Planning and Services initiative. This achievement is the outcome of 3 decades of implementation research that health authorities have used for guiding the development of its primary health care program. This implementation research process has comprised Ghana's official endorsement of the 1978 Alma Ata Declaration, leading to the institutionalization of evidence relevant to the strategic design of primary health care and national health insurance policies and services. Rather than relying solely upon the dissemination of project results, Ghana has embraced a continuous and systemic process of knowledge capture, curation, and utilization of evidence in expanding geographic access by a massive expansion in the number of community health service points that has taken decades. A multisectoral approach has been pursued that has involved the creation of systematic partnerships that included all levels of the political system, local development officials, community groups and social networks, multiple university-based disciplines, external development partners, and donors. However, efforts to achieve high levels of financial access through the roll-out of the National Health Insurance Scheme have proceeded at a less consistent pace and been fraught with many challenges. As a result, financial access has been less comprehensive than geographical access despite sequential reforms having been made to both programs. The legacy of activities and current research on primary health care and national health insurance are reviewed together with unaddressed priorities that merit attention in the future. Factors that have facilitated or impeded progress with research utilization are reviewed and implications for health systems strengthening in Ghana and elsewhere in Africa and globally are discussed.


Assuntos
Assistência Médica , Cobertura Universal do Seguro de Saúde , Gana , Programas Governamentais , Política de Saúde , Humanos , Estados Unidos
5.
Glob Health Sci Pract ; 10(Suppl 1)2022 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-36109065

RESUMO

Health policy and systems research (HPSR) is generating an increasing amount of evidence in Mozambique, where implementation of a wide range of public health policies and interventions, and innovative technologies and solutions, is underway. We used qualitative methods to explore the relationship between HPSR and policy development and implementation in Mozambique. We conducted a literature review and in-depth interviews with researchers, experts, and policy makers. Through our analysis, we assessed barriers to the use of research evidence in the development and implementation of national health policies and identified potential opportunities to improve evidence use in this context.We found an increasing number of research institutions producing solid scientific evidence in the country, with activities in health in general and health systems specifically. There is also a growing trend for decision makers and policy makers to use the results of research during the design, formulation, and implementation of health policies. Most HPSR conducted in Mozambique is funded by international donors and focused on research questions of international interest. Therefore, research generated in Mozambique does not always address questions that are relevant to the local health system development agenda.While Mozambique has a lot of "gray literature" outlets, few of its publications support the translation of research evidence into policy. Much of the evidence generated in country is disseminated through project reports and briefings, not peer-reviewed literature. Furthermore, when the research evidence generated is not locally relevant, results may be published only in English and in scientific articles, instead of in formats useful to Mozambican policy makers-to the detriment of national-level understanding and use. We recommend that research institutions and policy makers in Mozambique collaborate on developing a platform that consolidates HPSR, making it more accessible and useful to policy makers.


Assuntos
Política de Saúde , Formulação de Políticas , Pessoal Administrativo , Programas Governamentais , Humanos , Moçambique
8.
BMJ ; 378: o2239, 2022 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-36104072
9.
BMJ ; 378: o2210, 2022 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-36100272
10.
Health Res Policy Syst ; 20(1): 99, 2022 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-36088365

RESUMO

During the SARS-CoV-2 pandemic, astonishingly rapid research averted millions of deaths worldwide through new vaccines and repurposed and new drugs. Evidence use informed life-saving national policies including non-pharmaceutical interventions. Simultaneously, there was unprecedented waste, with many underpowered trials on the same drugs. We identified lessons from COVID-19 research responses by applying WHO's framework for research systems. It has four functions-governance, securing finance, capacity-building, and production and use of research-and nine components. Two linked questions focused the analysis. First, to what extent have achievements in knowledge production and evidence use built on existing structures and capacity in national health research systems? Second, did the features of such systems mitigate waste? We collated evidence on seven countries, Australia, Brazil, Canada, Germany, New Zealand, the United Kingdom and the United States, to identify examples of achievements and challenges.We used the data to develop lessons for each framework component. Research coordination, prioritization and expedited ethics approval contributed to rapid identification of new therapies, including dexamethasone in the United Kingdom and Brazil. Accelerated vaccines depended on extensive funding, especially through the Operation Warp Speed initiative in the United States, and new platforms created through long-term biomedical research capacity in the United Kingdom and, for messenger ribonucleic acid (mRNA) vaccines, in Canada, Germany and the United States. Research capacity embedded in the United Kingdom's healthcare system resulted in trial acceleration and waste avoidance. Faster publication of research saved lives, but raised challenges. Public/private collaborations made major contributions to vastly accelerating new products, available worldwide, though unequally. Effective developments of living (i.e. regularly updated) reviews and guidelines, especially in Australia and Canada, extended existing expertise in meeting users' needs. Despite complexities, effective national policy responses (less evident in Brazil, the United Kingdom and the United States) also saved lives by drawing on health research system features, including collaboration among politicians, civil servants and researchers; good communications; and willingness to use evidence. Comprehensive health research strategies contributed to success in research production in the United Kingdom and in evidence use by political leadership in New Zealand. In addition to waste, challenges included equity issues, public involvement and non-COVID research. We developed recommendations, but advocate studies of further countries.


Assuntos
COVID-19 , Pandemias , Fortalecimento Institucional , Programas Governamentais , Humanos , SARS-CoV-2 , Estados Unidos
11.
BMC Health Serv Res ; 22(1): 1161, 2022 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-36104727

RESUMO

BACKGROUND: Achieving equity in the distribution of health services is one major goal in the health system. This study aimed to determine equality in distributing health human resources (physicians) in the Qazvin University of Medical Sciences before and after the Health Transformation Plan (HTP) based on the Hirschman-Herfindahl index (HHI). METHODS: In this descriptive-analytical study, the statistical population was general practitioners (GPs), specialists and subspecialists in the Qazvin University of Medical Sciences from 2011-to 2017. We extracted demographic statistics of the cities from the Statistical Center of Iran. Physicians' statistics were obtained from the Curative Affairs Deputy at the Qazvin University of Medical Sciences. We assessed inequality using the HHI. RESULTS: The highest number of GPs was in 2014, and specialists and subspecialists were in 2017. The lowest number of GPs, specialists, and subspecialists were in 2016, 2011 and 2015. The HHI for GPs in 2011-2017 was between 4300 and 5200. The lowest concentration for specialists before the HTP plan was the cardiologist with 3300, and after the HTP, the internal specialist with 3900. Also, the numerical value of this index for all subspecialty physicians after the HTP was 10,000, the highest level of concentration. CONCLUSION: The values obtained from the HHI index indicate the high concentration and disproportionate and inequitable distribution of human resources in the health sector in this province. The number of specialists in some cities is still much less than acceptable, and some cities even have shortcomings in the critical specialists.


Assuntos
Clínicos Gerais , Mão de Obra em Saúde , Programas Governamentais , Humanos , Especialização , Recursos Humanos
13.
Health Aff (Millwood) ; 41(9): 1353-1356, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36067435

RESUMO

When a patient dies from a medical error, there often is no recourse for the family.


Assuntos
Programas Governamentais , Humanos
14.
East Mediterr Health J ; 27(8): 610-613, 2022 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-36134493

RESUMO

Since 2014 WHO has been advocating for the integration of palliative care into health systems. Although there has been some progress in the development of palliative care in the Eastern Mediterranean Region, many countries in the region still have no palliative care activity and none has achieved integration. The WHO Regional Office for the Eastern Mediterranean has been engaged in activities aimed to develop palliative care in the region since 2010. We report on the establishment of the Eastern Mediterranean Regional Palliative Care Expert Network and its mandate, activities, and plans.


Assuntos
Programas Governamentais , Cuidados Paliativos , Humanos , Região do Mediterrâneo
15.
Cien Saude Colet ; 27(10): 3987-3992, 2022 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-36134804

RESUMO

The text presents and discusses a new direction of the Unified Health System (SUS) policy geared toward the Health Industrial Complex. A policy aimed at the technological and productive development of public and private companies in the health field flourished from 2007 to 2016 and has been weakened and deformed since then. Despite its success, the so-called Productive Development Policy (PDP) evidenced some weaknesses that must be tackled during its resumption. Besides suggesting this resumption, the text proposes to expand the policy by articulating the primary PDP tool - Public-Private Partnerships - with other related policies that involve the health industry operated by the Ministry of Health.


O texto apresenta e discute novo encaminhamento da política do SUS dirigida ao Complexo Industrial da Saúde. Uma política dirigida à capacitação tecnológica e produtiva de empresas públicas e privadas no campo sanitário floresceu entre 2007 e 2016 tendo sido, a partir daí, enfraquecida e deformada. A despeito de seu sucesso, a denominada Política de Desenvolvimento Produtivo (PDP) apresentou algumas fragilidades que devem ser enfrentadas na eventualidade de sua retomada. Além de sugerir essa retomada, o texto propõe a ampliação da política a partir de uma articulação da principal ferramenta da PDP - as parcerias público-privadas - com outras políticas que envolvam a indústria da saúde em curso no Ministério da Saúde.


Assuntos
Política de Saúde , Parcerias Público-Privadas , Programas Governamentais , Humanos , Indústrias
17.
Health Res Policy Syst ; 20(1): 101, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36127696

RESUMO

BACKGROUND: Recent estimates report that 2.4 billion people with health conditions globally could benefit from rehabilitation. While the benefits of rehabilitation for individuals and society have been described in the literature, many individuals, especially in low- and middle-income countries do not have access to quality rehabilitation. As the need for rehabilitation continues to increase, it is crucial that health systems are adequately prepared to meet this need. Practice- and policy-relevant evidence plays an important role in health systems strengthening efforts. The aim of this paper is to report on the outcome of a global consultative process to advance the development of a research framework to stimulate health policy and systems research (HPSR) for rehabilitation, in order to generate evidence needed by key stakeholders. METHODS: A multi-stakeholder participatory technical consultation was convened by WHO to develop a research framework. This meeting included participants from selected Member States, rehabilitation experts, HPSR experts, public health researchers, civil society and other stakeholders from around the world. The meeting focused on introducing systems approaches to stakeholders and deliberating on priority rehabilitation issues in health systems. Participants were allocated to one of four multi-stakeholder groups with a facilitator to guide the structured technical consultations. Qualitative data in the form of written responses to guiding questions were collected during the structured technical consultations. A technical working group was then established to analyse the data and extract its emerging themes. This informed the development of the HPSR framework for rehabilitation and a selection of preliminary research questions that exemplify how the framework might be used. RESULTS: A total of 123 individuals participated in the multi-stakeholder technical consultations. The elaborated framework is informed by an ecological model and puts forth elements of the six WHO traditional building blocks of the health system, while emphasizing additional components pertinent to rehabilitation, such as political priority, engagement and participatory approaches, and considerations regarding demand and access. Importantly, the framework highlights the multilevel interactions needed across health systems in order to strengthen rehabilitation. Additionally, an initial set of research questions was proposed as a primer for how the framework might be used. CONCLUSIONS: Strengthening health systems to meet the increasing need for rehabilitation will require undertaking more HPSR to inform the integration of rehabilitation into health systems globally. We anticipate that the proposed framework and the emerging research questions will support countries in their quest to increase access to rehabilitation for their populations.


Assuntos
Programas Governamentais , Política de Saúde , Humanos , Saúde Pública
18.
Int Health ; 14(Supplement_2): ii64-ii66, 2022 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-36130245

RESUMO

The Ascend West and Central Africa programme, a UK aid-funded programme, was implemented across 12 countries. The programme focused on strengthening national health systems for sustainable neglected tropical disease (NTD) control and elimination. This commentary presents how Ascend's approach contributed to developing country-driven sustainable systems for NTDs and offers learnings to inform future sustainable NTD programming.


Assuntos
Doenças Negligenciadas , Medicina Tropical , Programas Governamentais , Humanos , Doenças Negligenciadas/prevenção & controle
19.
BMJ Glob Health ; 7(Suppl 7)2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36130794

RESUMO

This paper presents a case example from China, where detailed deliberations were instrumental in bringing together national and subnational managers to tailor implementation protocols for neonatal care strategies at provincial and county levels. The China National Health Development Research Center (CNHDRC) organised deliberations to support the formulation of strategies for improving early essential neonatal care for rural areas. The aim was to help counties, the lowest level jurisdiction in China, learn what could work locally, and to help provinces and the national government learn what should inform national policy and be disseminated widely in China's decentralised health system. It became clear that central-level stakeholders needed to learn how to help counties support the pilots. CNHDRC staff, national-level experts and academics visited pilot provinces and counties to discuss local policies, initiatives and challenges (including with patients), build a common understanding of the project and identify local support needs including by examining health records and observing health facilities. What followed were county-specific reports with priority interventions and implementation plans, which were further refined through county-level meetings. They helped central stakeholders better understand and address variations in county capacities and needs.


Assuntos
Programas Governamentais , China , Humanos , Recém-Nascido
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