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1.
Br J Nurs ; 31(1): 52-53, 2022 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-35019743

RESUMO

John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham, looks forward to government deliberations and a report in 2022 on the reform of the clinical negligence compensation system.


Assuntos
Imperícia , Medicina Estatal , Governo , Humanos , Segurança do Paciente , Instituições Acadêmicas , Reino Unido
2.
J Epidemiol Community Health ; 76(1): 100-104, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34407995

RESUMO

As the COVID-19 pandemic took hold in 2020, Chief Medical Officers (CMOs) entered the public spotlight like never before. Amidst this increased visibility, the role is deeply contested. Much of the disagreement concerns whether CMOs should act independently of the government: while some argue CMOs should act as independent voices who work to shape government policy to protect public health, others stress that CMOs are civil servants whose job is to support the government. The scope and diversity of debates about the CMO role can be explained by its inherently contradictory nature, which requires incumbents to balance their commitments as physicians with their mandates as civil servants who advise and speak on the government's behalf. The long-haul COVID-19 pandemic has further tested the CMO role and has shone light on its varying remits and expectations across different jurisdictions, institutions and contexts. It is perhaps unsurprising, then, that calls to amend the CMO role have emerged in some jurisdictions during the pandemic. However, any discussions about changing the CMO role need a stronger understanding of how different institutional and individual approaches impact what incumbents feel able to do, say and achieve. Based on an ongoing comparative analysis of the position across five countries with Westminster-style political systems, we provide an overview of the CMO role, explain its prominence in a pandemic, examine some debates surrounding the role and discuss a few unanswered empirical questions before describing our ongoing study in greater detail.


Assuntos
COVID-19 , Pandemias , COVID-19/complicações , Governo , Humanos , SARS-CoV-2
3.
J Environ Manage ; 303: 114283, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34902656

RESUMO

Environmental monitoring of rivers is a cornerstone of the European Union's Water Framework Directive. It requires the estimation and reporting of environmental flows in rivers whose characteristics vary widely across the EU member states. This variability has resulted in a fragmentation of estimation and reporting methods for environmental flows and is exhibited by the myriad of regulatory guidelines and estimation procedures. To standardise and systematically evaluate environmental flows at the pan-European scale, we propose to formalise the estimation procedures through automation by reusing existing river monitoring resources. In this work, we explore how sensor-generated hydrological open government data can be repurposed to automate the estimation and monitoring of river environmental flows. In contrast to existing environmental flows estimation methods, we propose a scalable IoT-based architecture and implement its cloud-layer web service. The major contribution of this work is the demonstration of an automated environmental flows system based on open river monitoring data routinely collected by national authorities. Moreover, the proposed system adds value to existing environmental monitoring data, reduces development and operational costs, facilitates streamlining of environmental compliance and allows for any authority with similar data to reuse or scale it with new data and methods. We critically discuss the opportunities and challenges associated with open government data, including its quality. Finally, we demonstrate the proposed system using the Estonian national river monitoring network and define further research directions.


Assuntos
Ecossistema , Rios , Monitoramento Ambiental , Governo , Hidrologia
4.
J Environ Manage ; 301: 113910, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34626950

RESUMO

The effectiveness of campaign-style enforcement (CSE) on water pollution, especially the long-term effectiveness, is controversial, and little knowledge is known about the channels through which the effectiveness happens. We take advantage of China's Environmental Protection Interview (EPI)- a distinguished form of CSE launched in 2014, as a natural experiment to estimate the short-term and long-term effects of CSE on water pollution. Using a time-varying difference-in-differences model based on city panel data from 2006 to 2018, we find that EPI can lead to an average 14.5% reduction in water pollution, and this effect is still persistent in the long term. Mechanism analysis shows that EPI reduces water pollution mainly through the pressure effect on the government, the penalty effect on the firms, and the mobilization effect on the public. Heterogeneity analysis shows that the effect of EPI on water pollution is more significant in cities with high initial pollution, low public complaints, and low economic levels. Further cost-benefit analysis based on the estimated value of water pollution reduction shows that the upper health benefit of EPI is $520.97 billion, which is 4.87 times higher than its estimated cost of $107.05 billion.


Assuntos
Conservação dos Recursos Naturais , Poluição da Água , China , Cidades , Governo , Poluição da Água/prevenção & controle
5.
Int J Health Serv ; 52(1): 73-88, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33019862

RESUMO

What can national governments do to improve their capacity for well-being? While increasing public medical care expenditures can facilitate increased well-being in developing nations, cross-national research often finds that public medical care expenditures have no effect on indicators of well-being, such as child mortality. This ineffective public spending could be due to a lack of governance; however, this relationship is understudied in the cross-national literature. Using 2-way fixed and generalized least squares random effects models for a sample of 74 low- and middle-income nations from 1996 to 2012, I examine how the interaction among 5 measures of national governance and public medical care expenditures impact child mortality. The findings reveal the importance of governance in determining the effectiveness of public medical care expenditures. Both public medical care expenditures and governance improvements are essential to reduce child mortality.


Assuntos
Mortalidade da Criança , Países em Desenvolvimento , Criança , Financiamento Governamental , Governo , Gastos em Saúde , Humanos
6.
Int J Health Serv ; 52(1): 30-37, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33375883

RESUMO

The purpose of this study is to find the demographic factors associated with the spread of COVID-19 and to suggest a measure for identifying the effectiveness of government policies in controlling COVID-19. The study hypothesizes that the cumulative number of confirmed COVID-19 patients depends on the urban population, rural population, number of persons older than 50, population density, and poverty rate. A log-linear model is used to test the stated hypothesis, with the cumulative number of confirmed COVID-19 patients up to period t as a dependent variable and demographic factors as an independent variable. The policy effectiveness indicator is calculated by taking the difference of the COVID rank of the ith state based on the predicted model and the actual COVID rank of the ith state. Our study finds that the urban population significantly impacts the spread of COVID-19. On the other hand, demographic factors such as rural population, density, and age structure do not impact the spread of COVID-19 significantly. Thus, people residing in urban areas face a significant threat of COVID-19 as compared to people in rural areas.


Assuntos
COVID-19 , Governo , Humanos , Índia , Políticas , SARS-CoV-2
7.
Waste Manag ; 137: 31-38, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34731678

RESUMO

This study aimed to examine the government's cost efficiency considering the high-risk/high-return mechanism of PPP. Faced with increasing demand but with limited budget, the Korean government has relied on the Public-Private Partnership (PPP) to provide waste treatment services for the last couple of decades to expand fiscal space. However, most of waste treatment facilities projects have been promoted using the BTO (Build-Transfer-Operate) method with high rate of return due to the demand risk that is transferred to the private. We performed a conversion analysis of a BTO to a BTL (Build-Transfer-Lease) method, in which demand risk is borne by the government, for 18 PPP waste treatment cases with actual operation records. The result of comparing the life-cycle costs of government in employing each project method shows that the BTL can provide 5.26% of Value for Money (VfM) compared to the BTO as the government takes the demand risk and lowers the required rate of return of the private. This implies that transferring the demand risk to the private sector may not always be the best option for the government. From the government's perspective, instead of transferring the demand risk to the private and providing a high rate of return, the government can retain the demand risk and reduce the rate of return, and it can be fiscally more advantageous considering the cost structure of each PPP method. Through Korean PPP waste treatment cases, this study suggests that policy makers who implement PPP should consider the government's strategic risk sharing by understanding the predictability of demand and the nature of cost structure of each PPP method.


Assuntos
Setor Privado , Parcerias Público-Privadas , Conservação dos Recursos Naturais , Governo , República da Coreia
8.
Health Policy ; 126(1): 1-6, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34961678

RESUMO

The COVID-19 pandemic is a catastrophe. It was also preventable. The potential impacts of a novel pathogen were foreseen and for decades scientists and commentators around the world warned of the threat. Most governments and global institutions failed to heed the warnings or to pay enough attention to risks emerging at the interface of human, animal, and environmental health. We were not ready for COVID-19, and people, economies, and governments around the world have suffered as a result. We must learn from these experiences now and implement transformational changes so that we can prevent future crises, and if and when emergencies do emerge, we can respond in more timely, robust and equitable ways, and minimize immediate and longer-term impacts. In 2020-21 the Pan-European Commission on Health and Sustainable Development assessed the challenges posed by COVID-19 in the WHO European region and the lessons from the response. The Commissioners have addressed health in its entirety, analyzing the interactions between health and sustainable development and considering how other policy priorities can contribute to achieving both. The Commission's final report makes a series of policy recommendations that are evidence-informed and above all actionable. Adopting them would achieve seven key objectives and help build truly sustainable health systems and fairer societies.


Assuntos
COVID-19 , Pandemias , Governo , Política de Saúde , Humanos , Pandemias/prevenção & controle , SARS-CoV-2
9.
J Environ Manage ; 304: 114278, 2022 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-34920285

RESUMO

This article investigates the politics behind the technologies used in Soochow Creek's environmental management during the 1920s-1970s. The management of Soochow Creek was quietly introduced in the 1920s. Under the pattern of "One City of Three Governments", the Nanking National Government did not adopt opinions from either the British or the American concessions. With limited resources for governance, the Communist Party of China (CPC) regime transformed an environmental governance project into one designed to win the public mind. The case of Soochow Creek confirms that even in Shanghai, the most modernized city in China, not only did Western technology have little influence on regional contamination governance before 1949 but also the Soviet model was consistently excluded from the Tu (local approach) due to its Yang (foreign approach). Although large-scale mass movements rarely worked to address river pollution, they did strategically guarantee a stable government under continuous environmental contamination. The findings also indicate that the adoption of foreign or local approaches was as much a political issue as a technical issue in the context of modern China.


Assuntos
Conservação dos Recursos Naturais , Política Ambiental , China , Poluição Ambiental , Governo
10.
J Environ Sci (China) ; 113: 165-178, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34963526

RESUMO

Strict air pollution control measures were conducted during the Youth Olympic Games (YOG) period at Nanjing city and surrounding areas in August 2014. This event provides a unique chance to evaluate the effect of government control measures on regional atmospheric pollution and greenhouse gas emissions. Many previous studies have observed significant reductions of atmospheric pollution species and improvement in air quality, while no study has quantified its synergism on anthropogenic CO2 emissions, which can be co-reduced with air pollutants. To better understand to what extent these pollution control measures have reduced anthropogenic CO2 emissions, we conducted atmospheric CO2 measurements at the suburban site in Nanjing city from 1st July to 30th September 2014 and 1st August to 31st August 2015, obvious decrease in atmospheric CO2 was observed between YOG and the rest period. By coupling the a priori emission inventory with atmospheric transport model, we applied the scale factor Bayesian inversion approach to derive the posteriori CO2 emissions in YOG period and regular period. Results indicate CO2 emissions from power industry decreased by 45%, and other categories also decreased by 16% for manufacturing combusting, and 37% for non-metallic mineral production. Monthly total anthropogenic CO2 emissions were 9.8 (±3.6) × 109 kg/month CO2 for regular period and decreased to 6.2 (±1.9) × 109 kg/month during the YOG period in Nanjing city, with a 36.7% reduction. When scaling up to whole Jiangsu Province, anthropogenic CO2 emissions were 7.1 (±2.4) × 1010 kg/month CO2 for regular period and decreased to 4.4 (±1.2) × 1010 kg/month CO2 during the YOG period, yielding a 38.0% reduction.


Assuntos
Poluentes Atmosféricos , Poluição do Ar , Adolescente , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Poluição do Ar/prevenção & controle , Teorema de Bayes , Dióxido de Carbono , Monitoramento Ambiental , Governo , Humanos , Material Particulado/análise
11.
Infectio ; 25(4): 205-206, oct.-dic. 2021.
Artigo em Espanhol | LILACS, COLNAL | ID: biblio-1286714

RESUMO

La pandemia por COVID-19 ha obligado a los gobiernos de todo el mundo a la toma de decisiones con información preliminar, insuficiente o discutible en argumentos científicos, algo que como académicos debemos entender y acompañar y se convierte en un reto mayor: ¿cómo dar recomendaciones con información limitada y reducir las incertidumbres? Para ello, primero que todo, se debe reconocer que estos procesos están sometidos a cambios según la evolución del conocimiento y la comunicación de la información se vuelve crucial para evitar minar la confianza pública ante los cambios. Es así como muchas recomendaciones para el manejo de COVID 19 han venido evolucionando a medida que se conoce mejor la patogénesis, sus mecanismos de transmisión y las particularidades en la respuesta inmune y, por ejemplo, pasamos de una recomendación inicial de medidas de prevención que incluía limpieza de superficies a una en la cual el énfasis es la limitación en número de personas en reunión. La Asociación Colombiana de infectología junto con otras 27 sociedades científicas lleva tres diferentes actualizaciones de recomendaciones basadas en evidencia en los primeros 12 meses de pandemia, es decir cada tres meses se han venido revisando las más de 250 recomendaciones, lo cual ha significado un trabajo enorme de revisión, discusión y presentación final las cuales, afortunadamente, han sido acogidas y tomadas como base de las decisiones gubernamentales.


The COVID-19 pandemic has forced governments around the world to take decisions on preliminary, insufficient The COVID-19 pandemic has forced governments around the world to make decisions with preliminary, insufficient or debatable information on scientific grounds, something that as academics we must understand and accompany and which becomes a major challenge: how to give recommendations with limited information and reduce uncertainties? To do this, first of all, it must be recognised that these processes are subject to change as knowledge evolves and the communication of information becomes crucial to avoid undermining public confidence in the face of change. Thus, many recommendations for the management of COVID 19 have evolved as the pathogenesis, transmission mechanisms and particularities of the immune response have become better understood and, for example, we have gone from an initial recommendation of measures to be taken in response to COVID 19 to a recommendation of measures to be taken in response to COVID 19, we have moved from an initial recommendation for prevention measures that included surface cleaning to one in which the emphasis is on limiting the number of people at a meeting. The Colombian Association of Infectious Diseases, together with 27 other scientific societies, has scientific societies has three different updates of evidence-based evidence-based recommendations in the first 12 months of a pandemic, i.e. every months of the pandemic, i.e. every three months, the more than 250 recommendations have been This has meant an enormous work of review, discussion and final presentation which, fortunately, have been accepted and taken as a basis for governmental decisions. and taken as a basis for governmental decisions.


Assuntos
Humanos , Masculino , Feminino , Comunicação , Informação , Ciência , Sociedades Científicas , Tomada de Decisões , Decisões , Pandemias , Governo
12.
Health Res Policy Syst ; 19(1): 147, 2021 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-34923970

RESUMO

BACKGROUND: Australian governments are increasingly mandating the use of cost-benefit analysis (CBA) to inform the efficient allocation of government resources. CBA is likely to be useful when evaluating preventive health interventions that are often cross-sectoral in nature and require Cabinet approval prior to implementation. This study outlines a CBA framework for the evaluation of preventive health interventions that balances the need for consistency with other agency guidelines whilst adhering to guidelines and conventions for health economic evaluations. METHODS: We analysed CBA and other evaluation guidance documents published by Australian federal and New South Wales (NSW) government departments. Data extraction compared the recommendations made by different agencies and the impact on the analysis of preventive health interventions. The framework specifies a reference case and sensitivity analyses based on the following considerations: (1) applied economic evaluation theory; (2) consistency between CBA across different government departments; (3) the ease of moving from a CBA to a more conventional cost-effectiveness/cost-utility analysis framework often used for health interventions; (4) the practicalities of application; and (5) the needs of end users being both Cabinet decision-makers and health policy-makers. RESULTS: Nine documents provided CBA or relevant economic evaluation guidance. There were differences in terminology and areas of agreement and disagreement between the guidelines. Disagreement between guidelines involved (1) the community included in the societal perspective; (2) the number of options that should be appraised in ex ante analyses; (3) the appropriate time horizon for interventions with longer economic lives; (4) the theoretical basis and value of the discount rate; (5) parameter values for variables such as the value of a statistical life; and (6) the summary measure for decision-making. CONCLUSIONS: This paper addresses some of the methodological challenges that have hindered the use of CBA in prevention by outlining a framework that is consistent with treasury department guidelines whilst considering the unique features of prevention policies. The effective use and implementation of a preventive health CBA framework is likely to require considerable investment of time and resources from state and federal government departments of health and treasury but has the potential to improve decision-making related to preventive health policies and programmes.


Assuntos
Governo , Política de Saúde , Austrália , Análise Custo-Benefício , Humanos , Serviços Preventivos de Saúde
13.
BMC Health Serv Res ; 21(1): 1359, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930246

RESUMO

BACKGROUND: In 2019, the South Korean government started designating rehabilitation medical institutions to facilitate the early return of patients with stroke (PWS) to their communities after discharge. However, a detailed operating model has not yet been suggested. We aimed to develop a hospital-based early supported community reintegration model for PWS that is suitable for South Korea based on knowledge translation in cooperation with clinical experts and PWS. METHODS: Clinical experts (n = 13) and PWS (n = 20) collaboratively participated in the process of developing the early supported community reintegration model at a national hospital in South Korea, using the following phases of the knowledge-to-action cycle: (1) identifying knowledge, (2) adapting the knowledge to the local situation, (3) assessing barriers and facilitators to local use of knowledge, and (4) tailoring and developing the program. Barriers and facilitators to local use of knowledge were assessed multidimensionally at the individual, interpersonal, organizational, and community level based on the social-ecological model. Literature reviews, workshops, individual and group interviews, and group meetings using nominal group technique were conducted in each phase of the knowledge-to-action cycle. RESULTS: Each phase of the knowledge-to-action cycle for developing the early supported community reintegration model and a newly developed model including the following components were reported: (1) revision of strategies of organizations related to community reintegration support, (2) establishment of a multidepartmental and multidisciplinary community reintegration support system, (3) standardization of patient-centered multidisciplinary goal setting, (4) multidimensional classification of community reintegration support areas, and (5) development of guidelines for a tailored community reintegration support program. CONCLUSIONS: We designed a hospital-based multidimensional and multidisciplinary early supported community reintegration model that comprehensively included several elements of community rehabilitation in connection with hospitals and communities, taking into account the South Korean situation of lacking community rehabilitation infrastructure. In developing a guideline for a tailored community reintegration support program, we attempted to take into consideration various situations faced by PWS in South Korea, which is in a transitional stage for community rehabilitation. It is expected that this early supported community reintegration model can be referenced in other countries that are in a transitional stage of community rehabilitation.


Assuntos
Acidente Vascular Cerebral , Governo , Hospitais , Humanos , República da Coreia
14.
BMC Res Notes ; 14(1): 458, 2021 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-34930427

RESUMO

The adoption and incentivisation of open and transparent research practices is critical in addressing issues around research reproducibility and research integrity. These practices will require training and funding. Individuals need to be incentivised to adopt open and transparent research practices (e.g., added as desirable criteria in hiring, probation, and promotion decisions, recognition that funded research should be conducted openly and transparently, the importance of publishers mandating the publication of research workflows and appropriately curated data associated with each research output). Similarly, institutions need to be incentivised to encourage the adoption of open and transparent practices by researchers. Research quality should be prioritised over research quantity. As research transparency will look different for different disciplines, there can be no one-size-fits-all approach. An outward looking and joined up UK research strategy is needed that places openness and transparency at the heart of research activity. This should involve key stakeholders (institutions, research organisations, funders, publishers, and Government) and crucially should be focused on action. Failure to do this will have negative consequences not just for UK research, but also for our ability to innovate and subsequently commercialise UK-led discovery.


Assuntos
Governo , Projetos de Pesquisa , Humanos , Reprodutibilidade dos Testes , Reino Unido
15.
Cien Saude Colet ; 26(12): 6175-6187, 2021 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34910008

RESUMO

Food insecurity is a worldwide public health problem. In Brazil, the configuration of a Food and Nutrition Security (FNS) policy has gained prominence in the government agenda since 1980. We highlight the creation of the National Council for Food and Nutrition Security (CONSEA) aiming at articulation between sectors and social participation. This article examines the role of CONSEA in coordinating FNS policy in Brazil from 2006 to 2016. The research was based on the approaches of historical institutionalism and used the dynamics of action and the CONSEA agenda as axes of analysis. The methodological strategies carried out were: bibliographic review, document analysis and semi-structured interviews. It was observed that CONSEA was marked by an expressive performance by civil society and variable participation of government representatives. Regarding the agenda, conflicting topics were much debated, but had little impact on the adoption of legal and normative measures. It is concluded that the strengthening of CONSEA, combined with the confrontation of economic interests, adequate financing and the performance of the State in social protection, are essential for overcoming challenges, implementing the FNS policy and promoting the health of the population.


Assuntos
Governo , Política Pública , Brasil , Abastecimento de Alimentos , Humanos , Política Nutricional , Saúde Pública
16.
Front Public Health ; 9: 714812, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34900886

RESUMO

Africa is home to 54 United Nation member states, each possessing a wealth of ethno-cultural, physiographic, and economic diversity. While Africa is credited as having the youngest population in the world, it also exhibits a unique set of "unfortunate realties" ranging from famine and poverty to volatile politics, conflicts, and diseases. These unfortunate realities all converge around social inequalities in health, that are compounded by fragile healthcare systems and a lack of political will by the continent's leaders to improve smart investment and infrastructure planning for the benefit of its people. Noteworthy are the disparities in responsive approaches to crises and emergencies that exist across African governments and institutions. In this context, the present article draws attention to 3 distinct public health emergencies (PHEs) that have occurred in Africa since 2010. We focus on the 2013-2016 Ebola outbreak in Western Africa, the ongoing COVID-19 pandemic which continues to spread throughout the continent, and the destructive locust swarms that ravaged crops across East Africa in 2020. Our aim is to provide an integrated perspective on how governments and institutions handled these PHEs and how scientific and technological innovation, along with educational response played a role in the decision-making process. We conclude by touching on public health policies and strategies to address the development of sustainable health care systems with the potential to improve the health and well-being of the African people.


Assuntos
COVID-19 , Saúde Pública , Emergências , Governo , Humanos , Pandemias , SARS-CoV-2
17.
Kennedy Inst Ethics J ; 31(4): 405-428, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34897118

RESUMO

Were governments justified in imposing lockdowns to contain the spread of the COVID-19 pandemic? We argue that a convincing answer to this question is to date wanting, by critically analyzing the factual basis of a recent paper, "How Government Leaders Violated Their Epistemic Duties During the SARS-CoV-2 Crisis" (Winsberg, Brennan, and Suprenant 2020). In their paper, Winsberg, Brennan, and Suprenant argue that government leaders did not, at the beginning of the pandemic, meet the epistemic requirements necessitated to impose lockdowns. We focus on Winsberg, Brennan, and Suprenant's contentions that knowledge about COVID-19 resultant projections were inadequate; that epidemiologists were biased in their estimates of relevant figures; that there was insufficient evidence supporting the efficacy of lockdowns; and that lockdowns cause more harm than good. We argue that none of these claims are sufficiently supported by evidence, thus impairing their case against lockdowns, and leaving open the question of whether lockdowns were justified.


Assuntos
COVID-19 , Pandemias , Controle de Doenças Transmissíveis , Governo , Humanos , SARS-CoV-2
19.
Sex Reprod Health Matters ; 29(2): 1992199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34939899

RESUMO

The majority of adolescent girls in rural India lack awareness regarding menstrual hygiene management (MHM), access to sanitary absorbents and necessary facilities in schools, homes, and workplaces. This study evaluated an intervention to strengthen a public health programme aimed to increase the use of safe, sanitary absorbents and knowledge of MHM among tribal adolescent girls. This project was implemented in 202 villages of two sub-districts of Narmada district in Gujarat, India, for one year (2018-2019). The intervention consisted of capacity building of 892 government frontline health workers and teachers, followed by supportive supervision. Convergence with concerned departments was achieved through meetings with stakeholders. "MHM-corners" and "MHM-Committees" were created at schools and Anganwadi-centres to improve access to menstrual absorbents and information. Household surveys of adolescent girls were conducted at baseline (n = 507) and end-line (n = 550) in 27 randomly selected villages to evaluate outcomes. Of 550 girls at the end-line, mean age 16.3 years, 487 (88.5%) were tribal, and 243 (44%) were out-of-school. The primary outcome of interest, the proportion of adolescent girls using safe, sanitary absorbents, increased from 69% to 90.5% (OR: 5.19, CI: 3.61-7.47). Their knowledge of the uterus as the origin of menstrual blood and hormonal changes as the cause for menstruation improved from 6.3% to 66% (p-value < 0.001) and 7.5% to 73% (p-value < 0.001), respectively. School absenteeism during menstruation reduced from 24% to 14% (p-value < 0.001). It is possible to improve MHM knowledge and practices among adolescent girls from tribal communities by utilising existing government systems. Awareness and access to safe absorbents can lead to safe and hygienic MHM practices.


Assuntos
Higiene , Menstruação , Adolescente , Feminino , Governo , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Produtos de Higiene Menstrual
20.
Health Res Policy Syst ; 19(1): 150, 2021 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-34949207

RESUMO

BACKGROUND: Over the past three decades, allocation of foreign currency subsidies has been the primary strategy of various administrations in Iran to improve access to medicines. This strategy has resulted in several challenges, including stakeholder conflicts of interest. OBJECTIVE: To identify the power, interest, and role of the stakeholders in allocating foreign currency subsidies to medicines in the Iranian health system. METHODS: In this qualitative study, 39 semi-structured interviews were conducted. Key informants were recruited using a purposive sampling technique. The theoretical framework adopted by Varvasovszky and Brugha was employed. The data were analysed using directed content analysis. RESULTS: The foreign currency subsidy for medicines included 21 stakeholders in five main categories: governmental organizations, Iranian Parliament, general population, nongovernmental organizations (NGOs), and the pharmaceutical industry. Stakeholders varied in their level of participation and support in the policy-making process. Among them, the Iranian Government, Planning and Budget Organization, the Ministry of Health and Medical Education (MoHME), and Iran Food and Drug Administration (IFDA) were the most important stakeholders, with highly supportive positions, while domestic drug manufacturers were the strongest opponents of this policy. The Government of Iran is the most powerful institution with regard to the ability to allocate foreign currency subsidies to medicines, followed by the MoHME and the IFDA. CONCLUSION: This study demonstrated that identifying and analysing the stakeholders involved in allocating foreign currency subsidies to medicines can provide valuable information for policy-makers to enable a more comprehensive understanding and better capacity to determine whether or not to eliminate these subsidies. Moreover, decision-making in this process is a long-term issue that requires consensus among all stakeholders. Because of the political and social consequences of eliminating foreign currency subsidies, the necessary political will is not institutionalized. We recommend a step-by-step approach in eliminating foreign currency subsidies if the requirements are met (i.e., those related to the consequences of such interventions). Therefore, revision of the current policy along with these requirements, in addition to financial transparency and enhanced efficiency, will facilitate progress towards achieving the Sustainable Development Goals by improving access to medicines.


Assuntos
Preparações Farmacêuticas , Formulação de Políticas , Governo , Política de Saúde , Humanos , Irã (Geográfico) , Políticas
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