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1.
Health Aff (Millwood) ; 43(6): 846-855, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38830150

RESUMO

Revenue diversification may be a synergistic strategy for transforming public health, yet few national or trend data are available. This study quantified and identified patterns in revenue diversification in public health before and during the COVID-19 pandemic. We used National Association of County and City Health Officials' National Profile of Local Health Departments study data for 2013, 2016, 2019, and 2022 to calculate a yearly diversification index for local health departments. Respondents' revenue portfolios changed fairly little between 2016 and 2022. Compared with less-diversified local health departments, well-diversified departments reported a balanced portfolio with local, state, federal, and clinical sources of revenue and higher per capita revenues. Less-diversified local health departments relied heavily on local sources and saw lower revenues. The COVID-19 period exacerbated these differences, with less-diversified departments seeing little revenue growth from 2019 to 2022. Revenue portfolios are an underexamined aspect of the public health system, and this study suggests that some organizations may be under financial strain by not having diverse revenue portfolios. Practitioners have ways of enhancing diversification, and policy attention is needed to incentivize and support revenue diversification to enhance the financial resilience and sustainability of local health departments.


Assuntos
COVID-19 , Saúde Pública , COVID-19/economia , Humanos , Estados Unidos , Saúde Pública/economia , SARS-CoV-2 , Pandemias , Governo Local , Financiamento Governamental/economia , Administração em Saúde Pública/economia
2.
Health Aff (Millwood) ; 43(6): 864-872, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38830165

RESUMO

Oregon's public health system uses accountability metrics to improve health, eliminate inequities, and practice stewardship. First enacted into law during the 2015 legislative session, with additions and clarifications made in the 2017 session, these metrics promote collective action across sectors, bring attention to the root causes of health inequities, and hold public health authorities accountable for performance improvement as they carry out core public health functions. This article describes the development of Oregon's accountability metrics and implications for future practice. In 2023, Oregon's public health leaders adopted a new set of health outcome indicators and process measures for communicable disease control and environmental health, with performance tied to financial incentives. Oregon's process is a model for other states developing an accountability framework in their pursuit of public health transformation. Oregon's work contributes to legislative and other policy decisions for measuring the success of approaches to eliminating health inequities and for applying performance-based incentives within the public health system.


Assuntos
Responsabilidade Social , Oregon , Humanos , Saúde Pública , Administração em Saúde Pública
3.
Health Aff (Millwood) ; 43(6): 840-845, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38830170

RESUMO

Public health departments in the US have experienced workforce shortages and challenges in recruiting new employees for decades. Reimagining the public health system will require sufficiently staffed health departments. This Commentary summarizes what is known about the issues that state and local health departments face during the hiring process, with a focus on civil service and merit-based hiring barriers. Although health departments have recently received funding to recruit new employees, they still struggle to hire them. Recommendations for change include tracking hiring process metrics; implementing formal quality improvement to strategically resolve delays; developing formal pathways for converting fellows, interns, and contractors into staff positions; and initiating workarounds in the short term and legal changes to hiring rules as necessary and feasible.


Assuntos
Seleção de Pessoal , Humanos , Estados Unidos , Administração em Saúde Pública/economia , Saúde Pública
5.
Am J Public Health ; 114(6): 626-632, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38603662

RESUMO

The COVID-19 pandemic presented wide-ranging leadership challenges to public health leaders and public health organizations. In its wake, as the necessity of reconstructing public health and modernizing the Centers for Disease Control and Prevention (CDC) is considered, we reviewed reports from the Commonwealth Fund and the CDC and other leadership-focused literature to identify common themes for a new generation of public health leaders. We posit that this new generation must have the ability to communicate (build and maintain trust and accountability); forge, facilitate, and promote partnerships; connect public health and health care systems; build information systems that provide accessible, actionable data; engage in systems and strategic thinking and action; center equity and inclusivity and understand structural racism as a fundamental driver and creator of health inequities; and achieve and maintain resilience and self-care. For each of the 7 abilities, we offer a description, assess what COVID-19 taught us about the necessity of the ability for public health leaders, and offer suggestions for developing (or honing) one's skill set, mindset, and tool set in this regard. (Am J Public Health. 2024;114(6):626-632. https://doi.org/10.2105/AJPH.2024.307633).


Assuntos
COVID-19 , Liderança , Saúde Pública , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Estados Unidos , SARS-CoV-2 , Centers for Disease Control and Prevention, U.S./organização & administração , Pandemias/prevenção & controle , Administração em Saúde Pública
8.
Gesundheitswesen ; 86(6): 404-411, 2024 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-38467149

RESUMO

OBJECTIVES: Disease prevention and health promotion are among the core tasks of German public health services (Öffentlicher Gesundheitsdienst - ÖGD), particularly local public health departments (Gesundheitsämter). Little is known about the extent to which the departments were able to continue activities in the field of health promotion and prevention of non-communicable diseases (HPP-NCDs) during the COVID-19 pandemic. Using the example of public health departments in Baden-Württemberg (BW), we therefore investigated how much staff was available to the departments for HPP-NCDs services, how much staff was actually dedicated to HPP-NCDs during the COVID-19 pandemic, which HPP-NCDs activities were carried out during the pandemic, which were cancelled, and which should be resumed as a priority, according to the public health departments. METHODS: We developed a largely standardized online questionnaire for the survey of the 38 public health departments in BW. Per department one questionnaire was to be completed. The survey took place from 9/1/2022 to 11/4/2022. The data of this explorative cross-sectional study were analyzed in a descriptive-statistical manner using SPSS, version 28. RESULTS: Of the 38 departments, 34 participated in the survey (89%). Departments had a mean of 2.44 full HPP-NCDs staff as planned (median 2.00; SD 1.41; range 0.20-5.00). Under pandemic conditions, a mean of 1.23 full HPP-NCDs staff were deployed (median 0.95; SD 1.24; range 0.00-4.50). Respondents gave examples of 61 HPP-NCDs activities that were conducted under pandemic conditions, and they described 69 HPP-NCDs activities that had to be cancelled. Of the latter, respondents felt that 40 should be resumed as a matter of highest priority. Analysis of the priority activities to be resumed reveals characteristic differences: e. g., resumption of structural prevention activities was viewed more frequently as a matter of hightest priority than resumption of behavioral prevention activities. CONCLUSIONS: During the pandemic, local public health departments in BW deployed, on average, actually only half of their full staff allocated as planned to HPP-NCDs. Comparing different categories of HPP-NCDs activities (cancelled during the pandemic) in terms of the relative frequency with which their resumption is viewed as matter of highest priority, characteristic differences can be observed. It remains an open question which conclusions can be drawn from such differences.


Assuntos
COVID-19 , Promoção da Saúde , Doenças não Transmissíveis , Pandemias , COVID-19/prevenção & controle , COVID-19/epidemiologia , Alemanha/epidemiologia , Humanos , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Pandemias/prevenção & controle , Doenças não Transmissíveis/prevenção & controle , Doenças não Transmissíveis/epidemiologia , SARS-CoV-2 , Saúde Pública , Inquéritos e Questionários , Administração em Saúde Pública/estatística & dados numéricos
9.
Am J Public Health ; 114(5): 489-494, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38452301

RESUMO

The landmark 1988 Institute of Medicine report The Future of Public Health served the public health community well by pointing to what needed to be done, fostering a sense of urgency, and offering concrete directions to be pursued. In this article, the impact of the 1988 report, and of the subsequent 2003 report on the Centers for Disease Control and Prevention (CDC), is considered by tracing the course of the ideas that influenced the consciousness of the public health community and subsequently catalyzed concrete action. Among these ideas was that "public health is in disarray." This assessment led to an awareness that something needed to be done. Further, by stating that the public health enterprise had 3 core functions (assessment, policy development, and assurance), the 1988 report set in motion policy development to address the "disarray." At a more fundamental level, both reports championed the need for governmental public health (particularly at the CDC) to take action to strengthen the capacity of local and state public health agencies to address a growing range of public health threats and emergencies. (Am J Public Health. 2024;114(5):489-494. https://doi.org/10.2105/AJPH.2024.307598).


Assuntos
Administração em Saúde Pública , Saúde Pública , Estados Unidos , Humanos , National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division , Centers for Disease Control and Prevention, U.S. , Previsões
10.
BMJ Open ; 14(3): e078182, 2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38448061

RESUMO

INTRODUCTION: The COVID-19 pandemic has shown the importance of resilient, modern, and well-equipped public health administrations from national to communal levels. In Germany, the surveillance, contact tracing, and local adaptions went through local health offices, revealing both their important role and also their lack of equipment and general preparation for health crises. Research on the mode of operation of the public health service (PHS), especially in a time of crisis, is rare. The present study aims to qualitatively and quantitatively assess problem areas, conflict potentials, and challenges that have become apparent for the PHS of Saxony-Anhalt during the pandemic. It focuses on the individual insight of employees of the PHS of Saxony-Anhalt and its 14 health offices to derive concrete needs and fields of action for increasing pandemic preparedness. Furthermore, the prospective personnel and resource-based requirements as well as the necessary structural and organisational changes of the public health departments are to be considered. METHODS AND ANALYSIS: The study will follow a sequential mixed-methods approach. Introductory expert interviews (n=12) with leading staff of Saxony-Anhalt's PHS will be conducted, followed by focus group interviews (n=4) with personnel from all departments involved in the pandemic response. Thereafter, a quantitative survey will be carried out to validate and complement the results of the qualitative phase. ETHICS AND DISSEMINATION: Ethical approval was obtained by the Martin-Luther-Universität Halle-Wittenberg ethics commission (Ref number 2023-102). The authors will submit the results of the study to relevant peer-reviewed journals and give national and international oral presentations to researchers, members of the PHS, and policymakers.


Assuntos
Pandemias , Resiliência Psicológica , Humanos , Pandemias/prevenção & controle , Estudos Prospectivos , Administração em Saúde Pública , Alemanha/epidemiologia
12.
Sci Rep ; 13(1): 18159, 2023 10 24.
Artigo em Inglês | MEDLINE | ID: mdl-37875546

RESUMO

Epidemic spatial-temporal risk analysis, e.g., infectious number forecasting, is a mainstream task in the multivariate time series research field, which plays a crucial role in the public health management process. With the rise of deep learning methods, many studies have focused on the epidemic prediction problem. However, recent primary prediction techniques face two challenges: the overcomplicated model and unsatisfactory interpretability. Therefore, this paper proposes an Interpretable Spatial IDentity (ISID) neural network to predict infectious numbers at the regional weekly level, which employs a light model structure and provides post-hoc explanations. First, this paper streamlines the classical spatio-temporal identity model (STID) and retains the optional spatial identity matrix for learning the contagion relationship between regions. Second, the well-known SHapley Additive explanations (SHAP) method was adopted to interpret how the ISID model predicts with multivariate sliding-window time series input data. The prediction accuracy of ISID is compared with several models in the experimental study, and the results show that the proposed ISID model achieves satisfactory epidemic prediction performance. Furthermore, the SHAP result demonstrates that the ISID pays particular attention to the most proximate and remote data in the input sequence (typically 20 steps long) while paying little attention to the intermediate steps. This study contributes to reliable and interpretable epidemic prediction through a more coherent approach for public health experts.


Assuntos
Epidemias , Redes Neurais de Computação , Saúde Pública , Administração em Saúde Pública , Análise Espaço-Temporal
13.
BMC Health Serv Res ; 23(1): 1143, 2023 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-37875901

RESUMO

BACKGROUND: Physicians in public health administration agencies (public health physicians: PHP) play important roles in public health; however, there are not enough such physicians in Japan. This study aimed to elucidate the factors related to the resignation and migration of PHPs using nationwide survey data. METHODS: Data from the Survey of Physicians, Dentists, and Pharmacists (2010, 2012, 2014, and 2016) were analyzed. The outcome was the resignation of PHPs or migration to public health administration agencies. The explanatory variables in the resignation analysis were age, sex, workplace, and board certification status. The type of work was added as an explanatory variable in the migration analysis, and clinical specialty was added to the clinical doctor-restricted analysis. The odds ratios (ORs) of the explanatory variables were calculated using generalized estimation equations. RESULTS: In the resignation analysis among PHPs, women had a significantly lower OR, whereas younger PHPs and those with board certifications had significantly higher ORs. In the migration to public health administration agencies analysis among medical doctors, women and those aged between 35 and 39 years had significantly higher ORs, but those with board certifications had significantly lower ORs. Hospital/clinic founders or directors had significantly lower ORs, but the clinic staff and 'others/not working' had significantly higher ORs. In the migration to public health administration agencies analysis among clinical physicians, those aged between 35 and 39 years had significantly higher ORs. Still, those with two or more board certifications had significantly lower ORs. Hospital/clinic founders or directors had significantly lower ORs, but the clinic staff had significantly higher ORs. Clinical doctors specializing in surgery and other specialties had significantly lower ORs, but those specializing in pediatrics and psychiatry/psychosomatic medicine had significantly higher ORs. CONCLUSIONS: Having board certifications were significantly related to the resignation of PHPs and migration to public health administration agencies. Women migrated to public health administration agencies more than men and younger PHPs were more likely to resign. However, medical doctors aged between 35 and 39 years were more likely to migrate to public health administration agencies. Similarly, clinic staff, non-clinical physicians, and those whose specialties were pediatrics and psychiatry/psychosomatic medicine were more likely to migrate to public health administration agencies.


Assuntos
Médicos , Administração em Saúde Pública , Masculino , Humanos , Feminino , Criança , Adulto , Japão , Médicos/psicologia , Certificação , Saúde Pública
14.
BMC Health Serv Res ; 23(1): 1162, 2023 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-37884946

RESUMO

BACKGROUND: A structured and organized public health set up with systematically trained personnel to manage and deliver public health services from grassroot levels to higher administrative levels with separate public health directorate is the need of the hour. The objective of this study was to conduct a situational analysis of public health cadre in select states in India to gain an in-depth understanding of the progress and explore the gaps and challenges in its implementation. METHODS: Four states from the country were selected based on stages of implementation of the cadre. The WHO health systems framework was the basis of assessment. In-depth interviews of 78 stakeholders from public health system across various categories and levels were conducted. RESULTS: Every state has a dedicated cadre for public health in the form of a separate hierarchical structure and Directorate. There are deficits in human resources skilled enough to manage and implement public health across all levels. Its penetration below districts level is limited. There are limited opportunities available for contractual staffs in terms of remuneration and job progression. The respondents strongly emphasized on having personnel with training in public health, especially at leadership positions. Funding was not reported to be a problem although some challenges in the timeliness of release of funds were reported. Under the existing Health Management Information System, duplication of data exists and there is underutilization of data for policy making. CONCLUSION: A dedicated public health cadre is under evolution in India. The main challenge is inadequate workforce skilled in public health management. States are committed to finding solutions to overcome these barriers.


Assuntos
Administração em Saúde Pública , Saúde Pública , Humanos , Programas Governamentais , Liderança , Índia/epidemiologia
17.
Afr Health Sci ; 23(1): 747-764, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37545955

RESUMO

Background: A system-wide health system strengthening (HSS) initiative, the Health Systems Governance and Accountability (HSGA) intervention, was developed, translated to policy, and implemented in the Free State province. This study assessed health managers (HMs) and community representatives' (CRs) views of the intervention and whether it improved integration and performance. Method: A questionnaire survey among 147 HMs and 78 CRs and 14 focus group discussions (FGDs) with a mean of 10.3 participants and a total of 102 HMs and 42 CRs, were conducted. The questionnaire and FGD data were descriptively and thematically analysed to triangulate findings. Results: Many HMs (44%) mostly positioned at the operational levels indicated that implementation of the HSGA intervention did contribute to integration of health services. Most CRs (54%) believed that communities were actively involved in the intervention. However, both the self-administered questionnaire and the FGD data evidenced lack of policy awareness among, especially, operational-level HMs. Conclusion: From the perspectives of HMs and CRs, the implementation of the intervention was viewed as a step forward in strengthening public healthcare to respond to system deficiencies in the Free State province. Earlier engagement of especially operational-level HMs during reforms may be beneficial in successfully implementing HSS interventions.


Assuntos
Atitude do Pessoal de Saúde , Agentes Comunitários de Saúde , Prestação Integrada de Cuidados de Saúde , Administração em Saúde Pública , Humanos , Agentes Comunitários de Saúde/psicologia , Prestação Integrada de Cuidados de Saúde/organização & administração , Grupos Focais , África do Sul , Inquéritos e Questionários , Estudos Transversais
18.
Afr Health Sci ; 23(1): 469-482, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37545966

RESUMO

Background: Based on the World Health Organization's health systems strengthening framework, the Health Systems Governance and Accountability (HSGA) intervention to strengthen public health leadership/management, service integration and outcomes was developed in the Free State. Objectives: This study describes the process to implement and measure the effects of the HSGA intervention for system-wide improvement of leadership/management under routine conditions in a resource-constrained setting. Methods: Based on normalisation process theory, participatory discussions were held with health managers, staff and local stakeholders to attain buy-in. Evaluation of the implementation process considered progress in improving leadership/management through application of the Balanced Scorecard (BSC). All provincial reporting units were assessed during 2014/15 and again during 2015/16. Results: The mean scores on three BSC perspectives improved statistically significantly from 2014/15 to 2015/16: customer (p=0.0085), internal business processes (p=0.0008) and finance (p=0.0001). Overall leadership/management also improved significantly (p=0.0007). Conclusion: Improvement in leadership/management resulting from implementation of the HSGA intervention was observed during the two years under study. From this experience, successful implementation of a health systems strengthening intervention hinges on a participatory design, appropriate use of theory, as well as application of an evaluation approach to assess the success of implementation.


Assuntos
Liderança , Administração em Saúde Pública , Humanos , África do Sul , Pesquisa sobre Serviços de Saúde
19.
Afr J Reprod Health ; 27(5s): 15-26, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37584916

RESUMO

The late Professor Olikoye Ransome-Kuti, Nigeria's longest-serving Health Minister since independence to date, has been variedly referred to as a distinguished academic, professional, public servant, technocrat, reformer, change agent, and mentor. His name is widely known not only within Nigeria but in Africa and, indeed, globally. Based on my knowledge of him as a result of working and interacting very closely with him in various capacities during the last twenty-seven (27) years of his life (1976-2003), I have highlighted in this paper some of his efforts and achievements for which he will forever be remembered.


Assuntos
Reforma dos Serviços de Saúde , Administração em Saúde Pública , Humanos , Reforma dos Serviços de Saúde/história , Nigéria , História do Século XX , História do Século XXI , Administração em Saúde Pública/história
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