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Frustrations of a Longtime Global Issues Activist Comment on "Ensuring Global Health Equity in a Post-pandemic Economy" 一位长期关注全球问题的活动家的挫败感 就 "在后流行病经济中确保全球健康公平 "发表评论
IF 3.5 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-23 DOI: 10.34172/ijhpm.2023.8242
Claudio Schuftan
Labonté’s first commentary1 concluded with what I wholeheartedly agree, namely that "we need an activist public health movement to ensure there is sufficient political will to adopt them." In their follow-up commentary, Moers and colleagues2 looked at things from a slightly different angle saying that to achieve equity will need radical changes in economic thinking and policies; they added that advocates needed to be strategic about framing and use hope-based communication and develop attractive and convincing narratives: "By doing so, hopefully we can bring these messages across to larger groups of people." Well, I think that, together with many others, I have been strategic and radical, but only to accumulate a large bag of disappointments and broken hopes in trying to ‘bring the message across.’ But I come back to memories of so many defeats that I, with others, have lived through. Here, I describe my frustrations but explain why I do not give up hope.
拉邦泰的第一篇评论1 最后说,我完全同意他的观点,即 "我们需要一场积极的公共卫生运动,以确保有足够的政治意愿来采取这些措施"。在后续评论中,莫尔斯及其同事2 从一个略有不同的角度看待问题,他们说,要实现公平,就需要彻底改变经济思想和政策;他们还说,倡导者需要战略性地制定框架,使用基于希望的沟通方式,并制定有吸引力和说服力的叙述方式:"他们还补充说,倡导者需要从战略的角度来制定框架,使用以希望为基础的传播方式,并制定有吸引力和有说服力的叙述方式:"通过这样做,希望我们能将这些信息传达给更多的人。我想,我和其他许多人一样,一直都很有策略,也很激进,但只是在试图'传达信息'的过程中积累了一大袋失望和破灭的希望。但是,我又回想起我和其他人经历的那么多失败。在这里,我描述了我的挫折,但也解释了我为什么没有放弃希望。
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引用次数: 0
Do ChatGPT and Other Artificial Intelligence Bots Have the Potential to Apply in Health Policy-Making? Opportunities and Threats ChatGPT 和其他人工智能机器人有潜力应用于卫生政策制定吗?机遇与威胁
IF 3.5 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-17 DOI: 10.34172/ijhpm.2023.8131
P. Morita, S. Abhari, Jasleen Kaur
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引用次数: 0
Understanding the Wide-Reaching Impact of Healthcare Merger and Acquisition Activity 了解医疗并购活动的广泛影响
IF 3.5 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-09 DOI: 10.34172/ijhpm.2023.8049
David B. Burmeister
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引用次数: 0
Addressing the UHC Challenge Using the Disease Control Priorities 3 Approach: Lessons Learned and an Overview of the Pakistan Experience 利用疾病控制优先事项 3 方法应对全民保健挑战:巴基斯坦的经验教训和经验概述
IF 3.5 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-08 DOI: 10.34172/ijhpm.2023.8003
A. Alwan, S. Siddiqi, Malik Safi, Raza Zaidi, Muhammad Khalid, Rob Baltussen, Ina Gudumac, M. Huda, Maarten Jansen, Wajeeha Raza, S. Torres-Rueda, Wahaj Zulfiqar, Anna Vassall
Background: Pakistan developed its first national Essential Package of Health Services (EPHS) as a key step towards accelerating progress in achieving Universal Health Coverage (UHC). We describe the rationale, aims, the systematic approach followed to EPHS development, methods adopted, outcomes of the process, challenges encountered, and lessons learned. Methods: EPHS design was led by the Ministry of National Health Services, Regulations & Coordination. The methods adopted were technically guided by the Disease Control Priorities 3 Country Translation project and existing country experience. It followed a participatory and evidence-informed prioritisation and decision-making processes. Results: The full EPHS covers 117 interventions delivered at the community, health centre and first-level hospital platforms at a per capita cost of US$29.7. The EPHS also includes an additional set of 12 population-based interventions at US$0.78 per capita. An immediate implementation package (IIP) of 88 district-level interventions costing US$12.98 per capita will be implemented initially together with the population-based interventions until government health allocations increase to the level required to implement the full EPHS. Interventions delivered at the tertiary care platform were also prioritised and costed at US$6.5 per capita, but they were not included in the district-level package. The national EPHS guided the development of provincial packages using the same evidence-informed process. The government and development partners are in the process of initiating a phased approach to implement the IIP. Conclusion: Key ingredients for a successful EPHS design requires a focus on package feasibility and affordability, national ownership and leadership, and solid engagement of national stakeholders and development partners. Major challenges to the transition to implementation are to continue strengthening the national technical capacity, institutionalise priority setting and package design and its revision in ministries of health, address health system gaps and bridge the current gap in financing with the progressive increase in coverage towards 2030.
背景:巴基斯坦制定了首个国家基本卫生服务包(EPHS),作为加快实现全民健康覆盖(UHC)的关键一步。我们介绍了制定一揽子基本保健服务的基本原理、目标、所遵循的系统方法、所采用的方法、过程中取得的成果、遇到的挑战以及汲取的经验教训。方法:EPHS 的设计由国家卫生服务、法规和协调部领导。所采用的方法在技术上以疾病控制优先事项 3 国家翻译项目和现有的国家经验为指导。在确定优先事项和决策过程中,采用了参与式和以证据为依据的方法。成果:完整的 EPHS 涵盖了在社区、保健中心和一级医院平台上实施的 117 项干预措施,人均成本为 29.7 美元。EPHS 还包括一套额外的 12 项基于人口的干预措施,人均成本为 0.78 美元。由 88 项地区级干预措施组成的即时实施一揽子计划(IIP)的人均成本为 12.98 美元,将在政府卫生拨款增加到实施整个 EPHS 所需的水平之前,与基于人口的干预措施一起实施。在三级医疗保健平台上提供的干预措施也被列为优先事项,其人均成本为 6.5 美元,但未被纳入县级一揽子计划。全国 EPHS 采用同样的循证过程指导省级一揽子计划的制定。政府和发展伙伴正在分阶段实施综合投资计划。结论:EPHS 设计成功的关键因素要求关注一揽子计划的可行性和可负担性、国家自主权和领导权,以及国家利益相关方和发展伙伴的扎实参与。向实施过渡所面临的主要挑战是继续加强国家技术能力,将卫生部的优先事项确定和一揽子计划的设计及其修订制度化,解决卫生系统的差距,弥合目前的资金缺口,逐步扩大覆盖面,直至 2030 年。
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引用次数: 0
Widening the Lens: Reflecting on the Mixing of System Dynamics With Action Research Alongside Work Within the Problem Structuring Methods Field Comment on "Insights Gained From a Re-analysis of Five Improvement Cases in Healthcare Integrating System Dynamics Into Action Research" 拓宽视野:反思系统动力学与行动研究的混合以及问题结构方法领域内的工作评论“从将系统动力学纳入行动研究的医疗保健五个改进案例的重新分析中获得的见解”
3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-08 DOI: 10.34172/ijhpm.2023.7620
Fran Ackermann
This commentary reflects upon the insights for improvement cases reported by Holmström et al where they consider the integration of action research (AR)—a research methodology—and system dynamics (SD)—a modelling technique—to manage the complexity of patient care pathways. Whilst this combination can be effective, recognising that SD is a simulation model whereas AR is a research approach is important for both practical and conceptual reasons. In addition, some of the benefits noted can also be achieved through taking a wider examination of modelling techniques, particularly problem structuring methods (PSMs) as SD has been considered a PSM and PSMs are designed to effectively engage multi-disciplinary group members in the search for solutions as this will provide further avenues for both engagement and learning.
这篇评论反映了Holmström等人报告的改进案例的见解,他们考虑将行动研究(AR) -一种研究方法-和系统动力学(SD) -一种建模技术-整合在一起,以管理患者护理路径的复杂性。虽然这种结合是有效的,但认识到SD是一种模拟模型,而AR是一种研究方法,这在实践和概念上都很重要。此外,通过对建模技术进行更广泛的检查,特别是问题结构方法(PSM)也可以获得一些好处,因为可持续发展被认为是一种PSM, PSM旨在有效地吸引多学科小组成员寻找解决方案,因为这将为参与和学习提供进一步的途径。
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引用次数: 0
Benchmarking Drug Regulatory Systems for Capacity Building: An Integrative Review of Tools, Practice and Recommendations 为能力建设制定药品监管体系基准:对工具、实践和建议的综合审查
3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-04 DOI: 10.34172/ijhpm.2023.8100
Junnan Shi, Xianwen Chen, Hao Hu, Carolina Oi Lam Ung
Background: Benchmarking has been increasingly used on drug regulatory systems to achieve sustainable pharmaceutical system strengthening. This study aimed to identify the scope, tools and benefits of benchmarking regulatory capacities and the most recent development in such phenomenon. Method: This study employed an integrative and critical review of the literature and documents on benchmarking drug regulatory capacities identified from 6 databases and 5 websites of related organizations and government agencies in compliance with the Preferred Reporting Items for Systematic Review (PRISMA) guidelines. Results: Forty-three studies and 6 documents about regulatory benchmarking published between 2005 and 2022 were included in this review. Five benchmarking assessment tools or programmes recommended or adopted by international organizations or government agencies had been identified, which collectively covered 12 major regulatory functions (4 at system level and 8 at operational level) involving 9 indicator categories and 382 sub-indicators. Benchmarking drug regulatory systems was reportedly employed at national, regional and international levels for either internal assessment (mostly on regulatory system establishment, drug review process and post marketing surveillance) or external evaluation (mostly on regulatory standards, drug review process and pharmacovigilance systems) to assess current status, monitor performance, determine major challenges and inform actions for capacity building. Priority of actions in areas such as regulatory process, resources allocation, cooperation and communication, and stakeholder engagement have been suggested for strengthening drug regulatory systems. Nevertheless, the evidence about benchmarking in optimizing regulatory capacities remained underreported. Conclusion: This integrative review depicted a framework for decision-makers about why and how benchmarking drug regulatory systems should be undertaken. For effective benchmarking, well-informed decisions about the goals, the scope, the choice of reference points and benchmarking tools are essential to guide the implementation strategies. Further studies about the positive effects of regulatory benchmarking are warranted to engage continuous commitment to the practice.
背景:标杆管理越来越多地用于药物监管系统,以实现可持续的制药系统加强。本研究旨在确定基准管理能力的范围、工具和好处,以及这种现象的最新发展。方法:本研究根据系统评价首选报告项目(PRISMA)指南,对相关组织和政府机构的6个数据库和5个网站中关于基准药品监管能力的文献和文件进行了综合和批判性的综述。结果:本综述纳入了2005年至2022年间发表的43项关于监管基准的研究和6份文件。确定了国际组织或政府机构建议或通过的五个基准评估工具或方案,共涵盖12个主要管制职能(4个在制度一级,8个在业务一级),涉及9个指标类别和382个次级指标。据报告,在国家、区域和国际各级采用基准药物监管系统进行内部评估(主要是关于监管系统建立、药物审查程序和上市后监督)或外部评估(主要是关于监管标准、药物审查程序和药物警戒系统),以评估现状、监测绩效、确定主要挑战并为能力建设行动提供信息。建议在监管程序、资源分配、合作与沟通以及利益攸关方参与等领域优先采取行动,以加强药品监管制度。然而,关于优化监管能力的基准的证据仍然被低估。结论:这篇综合综述为决策者描述了一个框架,说明为什么以及如何开展基准药物监管系统。为了有效地进行基准测试,就目标、范围、参考点的选择和基准测试工具做出明智的决策,对于指导实施战略至关重要。进一步研究监管基准的积极影响是有必要的,以参与持续的实践承诺。
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引用次数: 0
Adaptive Mechanisms of Health Zones to Chronic Traumatics Events in Eastern DRC: A Mul-tiple Case Study 刚果民主共和国东部卫生区对慢性创伤事件的适应机制:一个多案例研究
3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-04 DOI: 10.34172/ijhpm.2023.8001
Samuel Makali Lwamushi, Hermès karemere, Robert Banywesize, Christian Molima Eboma, Pacifique Mwene-Batu, Corneille Lembebu, Giovanfrancesco Ferrari, Elisabeth Paul, Ghislain Bisimwa Balaluka, Philippe Donnen
Background: The Eastern part of the Democratic Republic of Congo (DRC) has been affected by armed conflict for several years. Despite the growing interest in the impact of these conflicts on health service utilisation, few studies have addressed the coping mechanisms of the health system. The purpose of this study is to describe the traumatic events and coping mechanisms used by the health zones (HZs) in conflict settings to maintain good performance. Methods: This multiple case study took place from July to October 2022 in four HZs in the South Kivu Province of DRC. HZs were classified into "cases" according to their conflict profile: accessible and stable (Case 1), accessible but remote (Case 2), unstable (Case 3), and intermediate (Case 4). Eight performance indicators and the amount of funding provided to the HZs by non-governmental organizations (NGOs) were recorded. A graph was created to compare their evolution from 2013 to 2018. A thematic analysis of qualitative data from individual interviews with selected health workers was conducted. Results: Both battle-related events (war and its effects) and non-battle-related events (epidemics, disasters, strikes) were recorded according to the case conflict-profile. Although the cases (3 and 4) most affected by armed conflicts occasionally performed better than the stable ones (1 and 2), their operational action plan was poorly carried out. The coping mechanisms developed in cases 3 and 4 were the deployment of military nurses in preventive and supervisory activities, the solicitations of subsidies from NGOs, the relocation of health care facilities and the implementation of negotiation strategies with the belligerents. Conclusion: Armed conflict results in traumatic events that disrupt the execution of the operational action plan of HZs. The HZs’ management team expertise, its strong leadership, and substantial financial support would enable this system to develop reliable and sustainable adaptive mechanisms.
背景:刚果民主共和国东部地区多年来一直受到武装冲突的影响。尽管人们对这些冲突对卫生服务利用的影响越来越感兴趣,但很少有研究涉及卫生系统的应对机制。本研究的目的是描述创伤事件和应对机制的卫生区(HZs)使用在冲突环境中保持良好的表现。方法:该多案例研究于2022年7月至10月在刚果民主共和国南基伍省的四个经济区进行。根据冲突情况将隔离区分为“案例”:可达且稳定(案例1)、可达但偏远(案例2)、不稳定(案例3)和中间(案例4)。记录了8项绩效指标和非政府组织(ngo)向隔离区提供的资金数额。我们制作了一张图表来比较它们从2013年到2018年的演变。对与选定的卫生工作者进行个别访谈所得的定性数据进行了专题分析。结果:根据病例冲突档案记录了与战斗有关的事件(战争及其影响)和与战斗无关的事件(流行病、灾害、罢工)。虽然受武装冲突影响最严重的情况(第3和第4)有时比稳定的情况(第1和第2)的情况要好,但其业务行动计划执行得很差。在案例3和案例4中建立的应对机制是:在预防和监督活动中部署军事护士、向非政府组织征求补贴、重新安置保健设施以及执行与交战各方的谈判战略。结论:武装冲突导致创伤性事件,破坏了防空区作战行动计划的执行。特区管理团队的专业知识、强有力的领导和大量的财政支持将使该系统能够发展可靠和可持续的适应机制。
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引用次数: 0
The Macroeconomic Impact of Increasing Investments in Malaria Control in 26 High Malaria Burden Countries: An Application of the Updated EPIC Model 26个疟疾高负担国家增加疟疾控制投资的宏观经济影响:更新的EPIC模型的应用
3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-04 DOI: 10.34172/ijhpm.2023.7132
Edith Patouillard, Seoni Han, Jeremy Lauer, Mara Barschkett, Jean-Louis Arcand
Background: Malaria remains a major public health problem. While globally malaria mortality affects predominantly young children, clinical malaria affects all age groups throughout life. Malaria not only threatens health but also child education and adult productivity while burdening government budgets and economic development. Increased investments in malaria control can contribute to reduce this burden but have an opportunity cost for the economy. Quantifying the net economic value of investing in malaria can encourage political and financial commitment. Methods: We adapted an existing macroeconomic model to simulate the effects of reducing malaria on the gross domestic product (GDP) of 26 high burden countries while accounting for the opportunity costs of increased investments in malaria. We compared two scenarios differing in their level of malaria investment and associated burden reduction: sustaining malaria control at 2015 intervention coverage levels, time at which coverage levels reached their historic peak and scaling-up coverage to reach the 2030 global burden reduction targets. We incorporated the effects that reduced malaria in children and young adolescents may have on the productivity of working adults and on the future size of the labour force augmented by educational returns, skills, and experience. We calibrated the model using estimates from linked epidemiologic and costing models on these same scenarios and from published country-specific macroeconomic data. Results: Scaling-up malaria control could produce a dividend of US$ 152 billion in the modelled countries, equivalent to 0.17% of total GDP projected over the study period across the 26 countries. Assuming a larger share of malaria investments is paid out from domestic savings, the dividend would be smaller but still significant, ranging between 0.10% and 0.14% of total projected GDP. Annual GDP gains were estimated to increase over time. Lower income and higher burden countries would experience higher gains. Conclusion: Intensified malaria control can produce a multiplied return despite the opportunity cost of greater investments.
背景:疟疾仍然是一个主要的公共卫生问题。虽然全球疟疾死亡率主要影响幼儿,但临床疟疾影响所有年龄组的终生。疟疾不仅威胁健康,也威胁儿童教育和成人生产力,同时给政府预算和经济发展带来负担。增加对疟疾控制的投资可有助于减轻这一负担,但会给经济带来机会成本。量化投资于疟疾的净经济价值可以鼓励政治和财政承诺。方法:我们调整了现有的宏观经济模型,以模拟减少疟疾对26个高负担国家的国内生产总值(GDP)的影响,同时考虑到增加疟疾投资的机会成本。我们比较了在疟疾投资水平和相关负担减少方面存在差异的两种情景:将疟疾控制维持在2015年干预措施覆盖水平,覆盖水平达到历史峰值的时间,以及扩大覆盖以实现2030年全球减少负担目标。我们纳入了儿童和青少年疟疾发病率降低可能对工作成年人的生产力以及未来因教育回报、技能和经验而增加的劳动力规模产生的影响。我们使用基于这些相同情景的相关流行病学和成本模型的估计值以及已公布的具体国家宏观经济数据对模型进行了校准。结果:扩大疟疾控制可以在模拟国家产生1520亿美元的红利,相当于研究期间26个国家预计GDP总额的0.17%。假设疟疾投资的更大份额是由国内储蓄支付的,那么红利将较小,但仍然很大,占预计GDP总额的0.10%至0.14%。据估计,年度GDP增长将随着时间的推移而增加。收入较低和负担较高的国家将获得更高的收益。结论:尽管加大投资的机会成本,加强疟疾控制仍可产生成倍的回报。
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引用次数: 0
Harnessing Country Experiences for Health Benefit Package Design: Evidence-Informed Deliberative Processes and Experiences from the Joint Learning Network; Comment on" Evidence-Informed Deliberative Processes for Health Benefit Package Design – Part II: A Practical Guide" 利用国家经验设计卫生福利包:循证审议过程和来自联合学习网络的经验对“健康福利包设计循证审议程序-第二部分:实用指南”的评论
3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-04 DOI: 10.34172/ijhpm.2023.7856
Somil Nagpal, Naina Ahluwalia, Lauren Oliveira Hashiguchi, Kathleen McGee, Martin Lutalo
Amidst competing priorities for allocating finite health resources, using evidence-informed priority setting is a valuable tool for achieving population-level health goals. The paper by Baltussen, Jansen, and Oortwin (2021) comprehensively reports on the development of practical guidance for evidence-informed deliberative processes (EDPs) which will help with sustainability of programs aimed at universal health coverage (UHC). The authors’ experience with the Joint Learning Network for UHC’s (JLN) peer-to-peer learning platform on evidence-informed priority setting offers insights on the practical challenges faced by countries in HBP design, especially to draw in actors to advocate for the priorities and values across the health system. Lessons harvested from JLN countries that have established such advisory committees can provide practical insights for countries in earlier stages of establishing a systematic process for HBP design. Peer-to-peer learning modalities among countries offer viable and effective approaches to institutionalizing EDPs and systematic priority setting.
在分配有限卫生资源的相互竞争的优先事项中,利用循证确定优先事项是实现人口一级卫生目标的宝贵工具。Baltussen、Jansen和Oortwin(2021)的论文全面报告了为循证审议过程(EDPs)制定实用指南的情况,这将有助于实现全民健康覆盖(UHC)计划的可持续性。作者在全民健康覆盖联合学习网络(JLN)关于循证优先事项确定的点对点学习平台上的经验,为各国在全民健康覆盖设计方面面临的实际挑战提供了见解,特别是在吸引行为体倡导整个卫生系统的优先事项和价值观方面。从建立了此类咨询委员会的JLN国家获得的经验可以为处于建立HBP设计系统过程早期阶段的国家提供实际见解。国家间的对等学习模式为将电子教育方案制度化和系统地确定优先事项提供了可行和有效的方法。
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引用次数: 0
Evolving Power Dynamics in Global Health: From Biomedical Hegemony to Market Dynamics in Global Health Financing; A Response to the Recent Commentaries 全球卫生权力动态的演变:从生物医学霸权到全球卫生融资的市场动态对最近评论的回应
3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-02 DOI: 10.34172/ijhpm.2023.8264
Samuel Lassa, Muhammed Saddiq, Jenny Owen, Christopher Burton, Julie Balen
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引用次数: 0
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International Journal of Health Policy and Management
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