International Journal of Health Policy and Management最新文献

This commentary piece on the editorial piece by Eivind Engebretsen and Mona Baker entitled "The Rhetoric of Decolonizing Global Health Fails to Address the Reality of Settler Colonialism: Gaza as a Case in Point" explores the interconnected contexts of settler colonialism affecting health in occupied Turtle Island (also known as Canada) to Palestine. Addressing true and authentic health equity work means sharpening our politics and rhetoric beyond decolonizing "global health" as epistemically colonial and towards meaningful solidarity work and framings of liberatory or revolutionary health. There is a moral obligation to contextualize and historicize, rather than depoliticize. This ultimately means supporting through unwavering solidarity for collective liberation through the Indigenous resistance and resurgence movements in Turtle Island to Palestine if we are serious about decolonizing global health. Moving towards rhetoric and actions for collective liberation must be the focused goal of all who care deeply about true and authentic health equity work towards just and life-affirming systems for health for all.

McDonald and colleagues' paper on "Achieving Diagnostic Excellence: Roadmaps to Develop and Use Patient-Reported Measures With an Equity Lens" describes seven goals for using patient-reported measures (PRMs) to promote diagnostic excellence and describes roadmaps to plan the development and implementation of PRMs. Incorporating more patient voices into diagnostic measurement and measure development can improve the patient-centricity of processes and outcomes. Additionally, organizations beginning their measure development journeys may find road-mapping tools helpful, especially the focus on setting goals and engaging stakeholders. However, the authors do not offer suggestions for prioritizing measure concepts for development, and the long timeframes of the examples may dissuade some organizations from engaging in measurement to begin with. Real-world examples of measure development processes and potential applications of emerging technologies are important complements to aspirational roadmap goals and processes.

Background: Child restraint systems (CRS) can lead to a 60% reduction in child deaths, yet few low- and middle-income countries (LMICs) have comprehensive policies to enforce best practice standards. In 2019, the Philippines established such a policy: the Child Safety in Motor Vehicles (CSMV) Act.

Methods: Drawing on framing theory, this study aims to understand the social dimensions of policy change to identify the Act's origins, design, and implementation. Three sources of data - 25 articles, 27 key-informant interviews, and field notes - were collected and thematically analysed.

Results: We present the findings according to two features of the framing process: storytelling and naming. The policy process can be sharply distinguished into two sections: the Act's passage into law (which was swift and successful) and its implementation (which to date has not been). The Act's implementation was stymied by three overarching frames - that it is "anti-poor," "unnecessary," and a "strategic political distraction." A media backlash at the time of implementation solidified these frames, leading President Duterte to indefinitely defer enforcement of the Act.

Conclusion: The CSMV Act emphasises that passing a law is insufficient. The trajectory of the act highlights the combined importance of (a) the framing of policy, (b) framing processes operate throughout a policy's lifecycle, and (c) the media in creating a narrative. Our findings offer valuable insights for other LMICs implementing evidence-based road safety measures, suggesting that successful implementation requires not only strong legislation but also strategic communication and frame management throughout the policy process. Understanding framing dynamics can help policy-makers anticipate and address potential resistance to life-saving public health interventions.

Background: Public health is a core governmental responsibility, with ministries or departments of health responsible for setting and ensuring adherence to standards, managing performance and instituting reforms as required. Although North Queensland (NQ), Australia has a well-developed health infrastructure, the COVID-19 pandemic exposed significant vulnerabilities in its public health surveillance and response system. Globally, research has highlighted how human and cultural elements ("system software") influence the effectiveness of infrastructure, governance, and data systems ("system hardware"). This study examines the interaction between these elements to examine specific governance challenges and opportunities for strengthening communicable disease surveillance and response in NQ.

Methods: Using an embedded case study design, we analysed four disease units-COVID-19, tuberculosis (TB), arboviruses, and sexually transmitted infections (STIs)-through interviews (n=47), document review, and observations across NQ health services (October 2020-December 2021). Data were mapped against Sheikh and colleagues' hardware-software framework to examine the nature of governance bottlenecks in this region of northern Australia.

Results: Two key governance challenges emerged: (1) Accountability deficits-Hospital and Health Services (HHSs) lacked clear reporting or performance monitoring systems within Queensland's devolved health service governance model, contributing to inconsistent prioritisation of resourcing for communicable disease functions by health service leadership. Within HHSs, public health units (PHUs) faced systemic underfunding, with prevention services accounting for as little as 0.1% of some health service budgets. (2) Data governance failures-Fragmented, siloed data systems, restrictive data-sharing norms, and risk-averse culture hindered coordinated surveillance and response efforts. Weak interoperability and mistrust in data-sharing partnerships further compromised system effectiveness.

Conclusion: This study highlights how political, normative, and structural factors shape public health performance alongside the more commonly assessed functional and technical dimensions. Findings suggest the need to improve performance monitoring systems, leadership, and data governance to build an effective, accountable, and data-driven surveillance and response system in NQ.

Background: Ensuring the quality and safety of service delivery extends beyond the realm of health and care professionals, necessitating collaboration among various stakeholders, including external regulatory organizations. The policy agenda of care regulators increasingly features the topic of service user involvement. Despite the extensive research on participatory healthcare, scholarly attention to service user involvement in regulatory practices has been limited. This scoping review delves into the landscape of service user involvement in the regulation of care services of all types and for all different age groups, examining the characteristics and focus of peer reviewed original research. In particular, it addresses a notable knowledge gap by examining how these studies report on the practical utilization of service user input, as well as the regulator's perspective on service user involvement.

Methods: We conducted a literature search in PubMed, Embase, CINAHL, APA PsycInfo, and Scopus from inception to July 14, 2023. Thirteen (n=13) empirical studies were included.

Results: The underlying motives for service user involvement vary, ranging from legal imperatives and political pressure to enhancing institutional legitimacy and regulatory decision-making. Care regulators employ both reactive and proactive involvement methods. Empirical evidence delineates the challenges and benefits of service user involvement, highlighting concerns about bias, time investments, and the need for a distinct skillset for inspectors. Despite the valuable insights gained, there are instances where service user input is downplayed in practice.

Conclusion: The findings underscore the importance of additional research on users' preferences for involvement, optimal communication conditions to honor the collected input, and the challenges inspectors encounter in fostering meaningful involvement with service users. Addressing these challenges is crucial for aligning regulatory efforts with the genuine needs and experiences of services users.

Shikako et al analysis highlights that needs of persons with disability (PwD) were often overlooked, with policies primarily focused on general population health measures rather than specific accommodations for PwD. This commentary suggests adopting universal design principles in policy development to ensure inclusivity and advocate for maintaining services essential for PwD even during crises. It emphasizes the importance of involving PwD in policy-making processes and enhancing data collection for better policy analysis and concludes with recommendations for creating more inclusive policies, stressing the need for international collaboration and the integration of PwD needs into all policy levels.

President Trump's 2025 decision to remove the United States (US) from the World Health Organization (WHO), echoing his initial 2020 move, raises existential questions about the future of global health governance. This editorial explores the immediate and long-term potential impacts of the withdrawal, noting that it poses a significant threat to the WHO financing. This, in turn, will have adverse consequences for future pandemic preparedness, health inequities, and cross-border collaboration. We also explore the potential role of private philanthropies in bridging the funding gap, against the risk of shifting health priorities away from local needs. For the US, withdrawal means diminished influence on global health policies and weaker alignment with new international regulations. Moving forward, structural reforms within the WHO, equitable contributions from global powers, and renewed US involvement are essential to maintain strong health systems worldwide. Ultimately, a collaborative approach is necessary to uphold collective preparedness against emerging health crises.

Background: The journey towards universal health coverage (UHC) began decades ago but has recently moved to centre stage in global health discourses with its inclusion in the Sustainable Development Goals (SDGs). As part of this renewed interest, 193 countries have committed to introducing UHC by 2030. However, its implementation often necessitates far-reaching health system reforms. This, coupled with the struggles countries face in relation to health financing, as well as distinct political, social and cultural contexts, means there are significant challenges to UHC implementation. This article contributes new knowledge to these discourses by identifying key contexts and mechanisms that facilitate the successful implementation of UHC reforms, as well as barriers that can impede progress.

Methods: This realist review identifies key contexts and mechanisms that can facilitate the successful implementation of UHC reforms. EMBASE, MEDLINE and Web of Science were searched (1995-2022), resulting in 957 articles with the protocol published through Prospero (PROSPERO 2023: CRD42023394427). Further theory-driven searches resulted in an additional 988 studies. Descriptive, inductive, deductive, and retroductive realist analysis aided the development of Context-Mechanism-Outcome Configurations (CMOCs), along with stakeholder engagement to confirm or refute results. Causal pathways, and the interplay between contexts and mechanisms that triggered outcomes, were revealed.

Results: How each country goes about implementing UHC reforms depends on its context. Cohesion across all systems, as well as the functions of financing, governance and service delivery, facilitates these reforms. Implementation can also be facilitated through political commitment, communication between stakeholders in the public health system and the development of a strong primary care sector. Conversely, fragmentation across these functions pose significant barriers to UHC reforms.

Conclusion: Examining international experiences of UHC reforms supports learning around the mechanisms that support or hinder implementation processes. These learnings can empower policy-makers and health system leaders by providing roadmaps for reform implementation.