Health policy and planning最新文献

Health system resilience refers to the capacity of a health system to effectively anticipate, assimilate, adjust to and recuperate from unforeseen disruptions and pressures. Evidence indicates that low- and middle-income countries (LMICs) have a double burden of dealing with the existing shortage of health resources in managing both non-emergency care and emergency care during epidemics. Intersectoral collaboration plays a pivotal role in managing crises such as pandemics. The World Health Organization has emphasized that effective intersectoral collaboration is vital for uninterrupted essential services during a pandemic. The study aimed to look at the collaborations entered into at various levels for managing the COVID-19 pandemic, taking as an example the municipal corporation in Ahmedabad, India. We undertook a qualitative study that involved conducting 52 in-depth interviews with officials from the health department, and other departments at the Ahmedabad Municipal Corporation (AMC), including firefighting, estate, engineering and education, as well as private stakeholders. Many diverse observations were documented in this study as collaboration varied across the sectors. A lack of hospital beds and shortage of essential drugs and oxygen posed challenges for healthcare providers and provided an opportunity to collaborate with private stakeholders. Mandatory COVID testing and mobile units such as the Sanjivani van and Vadil ghar seva were examples of some of the initiatives taken by the AMC to manage the pandemic that were instigated and implemented with support from various departments such as education, engineering, tax, estate, animal husbandry and firefighting. Proper communication between public and private entities will result in unfragmented efforts to combat emergencies. Thus, a resilient health system is necessary as well as systematic intersectoral collaboration to ensure the uninterrupted delivery of essential health services during health emergencies.

The maldistribution of physicians, especially in rural areas, remains a global public health challenge. The internship programme for medical doctors is one of the efforts undertaken to address this issue. However, evidence aiming to disentangle this persistent challenge in the Indonesian context has been scant. This study aims to identify factors influencing medical doctors' intentions to practise in rural areas and how these factors affect their decisions. We adopted a sequential-explanatory mixed-method design using a validated questionnaire. Then, focus group discussions were conducted with medical doctors from three different regions (West, Central, and East) to gain in-depth understanding of motivations, intentions, and barriers to practising in rural areas. Participants were intern doctors who had been practising for at least six months in their internship locations. Quantitative analysis was based on a questionnaire addressing each factor, rated using 5-point Likert scales, with bivariate and multivariate logistic regression analyses. The qualitative results were analysed using thematic analysis. In total, 498 respondents completed the questionnaire where 9.6%, 49%, and 40.9% intend to practise in rural, suburban, and urban areas, respectively. Three factors were positively associated with a preference for rural practise: prior living experience in rural areas, accessibility to cultural centres and events, and personal savings as funding resources during medical school. However, the importance of "internet accessibility" was negatively associated with a preference for rural practise. Furthermore, the qualitative study involving 18 participants resulted in four main themes: the role of the internship programme in enhancing motivation as medical doctors; factors generally influencing the intention to practise; factors influencing the intention to practise in rural areas; and policy recommendations to increase the intention to practise in rural areas. Addressing the challenge of attracting and retaining medical doctors in rural areas requires multisectoral approaches involving both personal and professional factors.

India's healthcare landscape is characterized by a multitude of public and private healthcare providers, yet its health systems remain weak in many areas. Informal healthcare providers (IHPs) bridge this gap, particularly in rural India, and are deeply embedded within local communities. While their importance is widely recognized, there is a knowledge gap regarding the specifics of their social networks with actors in health systems. The aim of this study was to map the social networks of IHPs to elucidate the type and nature of their relationships, in order to explore opportunities for intersectoral collaboration to achieve universal health coverage (UHC). We have adopted the social network analysis (SNA) approach using qualitative ego-network methodology to evaluate the types and strengths of ties in the Indian Sundarbans. A total of 34 IHPs participated in the study. Qualitative data were analysed using NVivo10 and Kumu.io was used to visualize the social networks. Results show that the 34 IHPs had a total of 1362 ties with diverse actors, spanning the government, private sector and community. The majority of the ties were strong, with various motivating factors underpinning the relationships. Most of these ties were active and have continued for over a decade. The robust presence of IHPs in the Indian Sundarbans is attributable to the numerous, strong and often mutually beneficial ties. The findings suggest a need to reconsider the engagement of IHPs within formal health systems. Rather than isolation, a nuanced approach is required based on intersectoral collaboration capitalizing on these social ties with other actors to achieve UHC in impoverished and underserved regions globally.

Policy engagement is an essential component of implementation research for scaling up interventions targeting non-communicable diseases (NCDs). It refers to the many ways that research team members, implementers and policymakers, who represent government decision-making, connect and interact to explore common interests. Well-conducted engagement activities foster co-production, local contextualization and assist in the successful translation of research evidence into policy and practice. We aimed to identify the challenges and facilitators to policy engagement during the early implementation phase of scale-up research studies. This qualitative study was focused on the research projects that were funded through the Global Alliance for Chronic Diseases in the 2019 round. Nineteen project teams opted to participate, with these studies implemented in 20 countries. Forty-three semi-structured stakeholder interviews, representing research, implementation and government were undertaken between August 2020 and July 2021. Transcripts were open-coded using thematic analysis to extract 63 codes which generated 15 themes reflecting both challenges and facilitators to undertaking policy engagement. Knowledge of the local government structures and trusting relationships provided the foundation for successful engagement and were strengthened by the research. Four cross-cutting concepts for engagement were identified and included: (1) the importance of understanding the policy landscape; (2) facilitating a network of suitable policy champions, (3) providing an environment for policy leaders to genuinely contribute to co-creation and (4) promoting two-way learning during researcher-policymaker engagement. We recommend undertaking formative policy analysis to gain a strategic understanding of the policy landscape and develop targeted engagement plans. Through engagement, researchers must facilitate cohesive vision and build a team of policy champions to advocate NCD research within their networks and spheres of influence. Ensuring equitable partnerships is essential for enabling local ownership and leadership. Further, engagement efforts must create a synergistic policymaker-researcher lens to promote the uptake of evidence into policy.

In Zambia, efforts to produce a tobacco control policy have stalled for over a decade, and the country is not yet close to developing one. Limited studies have explored the dynamics in this policy process and how they affect the attainment of policy goals and outcomes. This study explored how collaborative dynamics within tobacco control policy development shaped shared motivation among stakeholders in Zambia. The study used a qualitative case study design that adopted a collaborative governance lens, comprising an in-depth exploration of the tobacco control policy working group meetings and their internal collaborative dynamics. The integrative framework for collaborative governance, which identifies mutual trust, mutual understanding, internal legitimacy and shared commitment as key elements of shared motivation, was adapted for this study. Data were collected from 27 key informants and analysed using thematic analysis. Several collaborative dynamics thwarted mutual trust among tobacco control stakeholders, including concerns about associated loyalties, fear of a ban on tobacco production, silo-mentality and lack of comprehensive dialogue. All stakeholders agreed that the limited sharing of information on tobacco control and the lack of reliable local evidence on the tobacco burden hindered mutual understanding. Diverse factors hampered internal legitimacy, including sector representatives' lack of authority and the perceived lack of contextualization of the proposed policy content. Acknowledgement of the need for multisectoral action, lack of political will from other sectors and limited local allocation of funds to the process were some of the factors that shaped shared commitment. To accelerate the development of tobacco control policies in Zambia and elsewhere, policymakers must adopt strategies founded on shared motivation that deliberately create opportunities for open discourse and respectful interactions, promote a cultural shift towards collaborative information sharing and address unequal power relations to enable shaping of appropriate tobacco control actions in respective sectors.

Our paper examines the political considerations in the intersectoral action that was evident during the SAR-COV-2 virus (COVID-19) pandemic through case studies of political and institutional responses in 16 nations (Australia, Belgium, Brazil, Ethiopia, India, New Zealand, Nigeria, Peru, South Africa, South Korea, Spain, Taiwan, Thailand, Vietnam, UK, and USA). Our qualitative case study approach involved an iterative process of data gathering and interpretation through the three Is (institutions, ideas and interests) lens, which we used to shape our understanding of political and intersectoral factors affecting pandemic responses. The institutional factors examined were: national economic and political context; influence of the global economic order; structural inequities; and public health structures and legislation, including intersectoral action. The ideas explored were: orientation of governments; political actors' views on science; willingness to challenge neoliberal policies; previous pandemic experiences. We examined the interests of political leaders and civil society and the extent of public trust. We derived five elements that predict effective and equity-sensitive political responses to a pandemic. Firstly, effective responses have to be intersectoral and led from the head of government with technical support from health agencies. Secondly, we found that political leaders' willingness to accept science, communicate empathetically and avoid 'othering' population groups was vital. The lack of political will was found in those countries stressing individualistic values. Thirdly, a supportive civil society which questions governments about excessive infringement of human rights without adopting populist anti-science views, and is free to express opposition to the government encourages effective political action in the interests of the population. Fourthly, citizen trust is vital in times of uncertainty and fear. Fifthly, evidence of consideration is needed regarding when people's health must be prioritized over the needs of the economy. All these factors are unlikely to be present in any one country. Recognizing the political aspects of pandemic preparedness is vital for effective responses to future pandemics and while intersectoral action is vital, it is not enough in isolation to improve pandemic outcomes.

Although Population-Health-Environment (PHE) approaches have been implemented and studied for several decades, there are limited data on whether, how and why they work. This study provides a process evaluation of the 'Healthy Wetlands for the Cranes and People of Rukiga, Uganda' project, implemented by an NGO-local hospital consortium. This programme involved a research design element, testing two delivery modalities to understand the added benefit of integrating conservation, livelihoods and human health interventions, compared to delivering sector support services separately (as is more usual). The process evaluation sought to understand how the programme was implemented, the mechanisms of impact, how it was shaped by the context in which it was delivered and whether there were discernable differences across the two delivery arms. Methods involved key informant interviews with implementing staff and community educators, a review of programme documents and secondary qualitative analysis of interviews and focus groups with community members. The findings include a statistically significant increase in the reach of the programme, in both service delivery and sensitization activities, when the sectors were fully integrated. It appears that this comparative advantage of integration is because of the improved acceptability and motivation among stakeholders, and increased initiative (and agency) taken by community-based peer educators and community members. We argue that the 'software' of the programme underpins these mechanisms of impact: trust-based relationships embedded in the system enabled coordinated leadership, supported local staff agency and encouraged motivation.

Leveraging the co-benefits of investments in health and climate can be best achieved by moving away from isolated financing approaches and adopting co-financing strategies, which aim to improve the outcomes of both sectors. We propose a framework for studying co-financing for health and climate that considers the degree of integration between sector funding, and whether arrangements are 'passive', when cross-sectoral goals are indirectly affected, or 'strategic', when they are pre-emptively supported to build resilience and sustainability. We conducted a rigorous, evidence-focused review to describe co-financing mechanisms according to a framework, including the context in which they have been employed, and to identify enablers and barriers to implementation. We searched the international literature using Pubmed and Web of Science from 2013 to 2023, the websites of key health and climate agencies for grey literature and consulted with stakeholders. Our review underscores the significant impact of climate change and related hazards on government, health insurance and household health-related costs. Current evidence primarily addresses passive co-financing, reflecting the financial consequences of inaction. Strategic co-financing is under explored, as are integrative co-financing models demanding cross-sectoral coordination. Current instances of strategic co-financing lack sufficient funding to demonstrate their effectiveness. Climate finance, an under used resource for health, holds potential to generate additional revenue for health. Realizing these advantages necessitates co-benefit monitoring to align health, climate mitigation and adaptation goals, alongside stronger advocacy for the economic and environmental benefits of health investments. Strategic co-financing arrangements are vital at all system levels, demanding increased cross-sectoral collaboration, additional funding and skills for climate integration within health sector plans and budgets, and mainstreaming health into climate adaptation and mitigation plans. Supporting persistent health needs post-disasters, promoting adaptive social protection for health and climate risks, and disseminating best practices within and among countries are crucial, supported by robust evaluations to enhance progress.

The health workforce (HWF) is a critical component of the health sector. Intersectoral/multisectoral collaboration and action is foundational to strengthening the HWF, enabling responsiveness to dynamic population health demands and supporting broader goals around social and economic development-such development underpins the need for health in all policies (HiAP). To identify what can be learned from intersectoral/multisectoral activity for HWF strengthening to advance HiAP, we carried out a scoping review. Our review included both peer-reviewed and grey literature. Search terms encompassed terminology for the HWF, intersectoral/multisectoral activities and governance or management. We carried out a framework analysis, extracting data around different aspects of HiAP implementation. With the aim of supporting action to advance HiAP, our analysis identified core recommendations for intersectoral/multisectoral collaboration for the HWF, organized as a 'pathway to HiAP'. We identified 93 documents-67 (72%) were journal articles and 26 (28%) were grey literature. Documents reflected a wide range of country and regional settings. The majority (80, 86%) were published within the past 10 years, reflecting a growing trend in publications on the topic of intersectoral/multisectoral activity for the HWF. From our review and analysis, we identified five areas in the 'pathway to HiAP': ensure robust coordination and leadership; strengthen governance and policy-making and implementation capacities; develop intersectoral/multisectoral strategies; build intersectoral/multisectoral information systems and identify transparent, resources financing and investment opportunities. Each has key practical and policy implications. Although we introduce a 'pathway', the relationship between the areas is not linear, rather, they both influence and are influenced by one another, reflecting their shared importance. Underscoring this 'pathway' is the shared recognition of the importance of intersectoral/multisectoral activity, shared vision and political will. Advancing health 'for' all policies-generating evidence about best practices to identify and maximize co-benefits across sectors-is a next milestone.