The International journal of health planning and management最新文献

Background: Decentralisation has been adopted by many governments to strengthen national systems, including the health system. Decision space is used to describe the decision-making power devolved to local government. Human resource Management (HRM) is a challenging area that District Health Management Teams (DHMT) need some control over its functions to develop innovative ways of improving health services. The study aims to examine the use of DHMTs' reported decision space for HRM functions in Uganda.

Methods: Mixed methods approach was used to examine the DHMTs' reported decision space for HRM functions in three districts in Uganda, which included self-assessment questionnaires and focus group discussions (FGDs).

Results: The decision space available for the DHMTs varied across districts, with Bunyangabu and Ntoroko DHMTs reporting having more control than Kabarole. All DHMTs reported full control over the functions of performance management, monitoring policy implementation, forecasting staffing needs, staff deployment, and identifying capacity needs. However, they reported narrow decision space for developing job descriptions, resources mobilisation, and organising training; and no control over modifying staffing norms, setting salaries and developing an HR information system (HRIS). Nevertheless, DHMTs tried to overcome their limitations by adjusting HR policies locally, better utilising available resources and adapting the HRIS to local needs.

Conclusions: Decentralisation provides a critical opportunity to strengthen HRM in low-and-middle-income countries. Examining decision space for HRM functions can help identify areas where district health managers can change or improve their actions. In Uganda, decentralisation helped the DHMTs be more responsive to the local workforce needs and analysing decision space helped identify areas for improvement in HRM. There are some limitations and more power over HRM functions and strong management competencies would help them become more resourceful.

The coronavirus disease 2019 (COVID-19) pandemic resulted in an enormous influx of seriously ill patients in the hospitals worldwide. After its initial impact in Asia, Europe also suffered greatly. Caring for COVID-19 patients whist maintaining treatment for patients with other conditions was a complex planning and management challenge. A series of interventions has been implemented to increase hospital capacity in response to the pandemic. Hospital provision interventions included the purchase of equipment, the establishment of additional hospital facilities and the redeployment of staff and other resources. Ensuring safe and high quality care to both COVID-19 patients and those with other conditions was a crucial aspect of the Belgian response in this current health crisis.

Background: The Chinese government has taken many incentives to promote the implementation of the family doctor (FD) contract service; however, whether primary health care providers establishing a strong relationship with patients that shapes their loyalty is still unknown. Under this circumstance, drawing the public attention to patient loyalty in primary care and clarifying the underlying mechanism of loyalty is imperative to the development of primary care.

Objective: To analyse the effect of patient perceived involvement on patient loyalty in primary care, investigate the mediating role of patient satisfaction, and explore the moderating role of the FD contract service on the relationship between patient perceived involvement and patient loyalty.

Methods: A cross-sectional questionnaire survey of patients in primary health facilities was conducted in Jilin province of China. Participants comprised 1334 patients selected via a multi-stage sampling method.

Results: Patient perceived involvement not only had a direct positive impact on patient loyalty but also had an indirect effect on patient loyalty via patient satisfaction. Furthermore, for patients who contracted with FDs, patient perceived involvement had a higher direct effect and indirect effect on patient loyalty when compared with patients who did not contract with FDs.

Conclusions: Our findings suggest that health managers should encourage patients to participate in medical visits to improve patient satisfaction. Additionally, customised and tailored health services that meet individuals' specific needs and preferences should be designed and implemented to attract more patients to contract the FD contract service.

Universal Health Coverage (UHC) is where people have access to health services without suffering financial hardship to pay for it, provide equitable health-care services that are appropriate, accessible and affordable for all people, particularly poor and disadvantaged communities. However, optimal intervention in relation to oral disease is not universally available or affordable specifically in developing countries because of limited resources at public sector, escalating costs of treatment and inadequate emphasis on primary prevention of oral diseases. Similar barriers also exist in utilisation of dental services among the Indian population. Integrating oral health into UHC will help improve oral health outcomes and reduce inequalities in access to care. To strengthen the oral health system towards UHC, public sector spending on oral health-care should be equally focused on primary care instead of directing mainly into only tertiary care, which could help reduce the number of complications progress to more expensive and more aggressive treatment.

Background: Adequate levels of health literacy (HL) are crucial to ensure good quality of health, social life and wellbeing. HL is a mediating factor in health disparities. Low HL hampers interaction with healthcare. HL is a shared responsibility of individuals and the healthcare system. Multi-dimensional programs and policies should be set up.

Aim: To learn from current HL policies and action plans and to identify elements to consider for the development of national HL plans.

Method: Transversal analysis of HL policies in six countries, based on a preliminary scoping review. A combination of document analysis and key informant approach. Local experts validated and completed information for their country. A transversal comparison was performed.

Results: Several approaches were identified, often influenced by contextual factors, healthcare reforms and existence of centers of expertise. Some governments developed full-fledged, standalone plans, while others developed broader plans covering the entire health and care sector. Some took a conceptually driven, high level approach. Others took a pragmatic approach. And some did not have a governmental plan at all.

Conclusion: Policy makers should analyse their state structure and health system, and search for local 'pockets of excellence', to develop a well-planned, substantiated HL approach for their country.

The COVID-19 pandemic struck the world unawares. The virus is now spreading as never before, despite the initial progress recorded by several countries towards kerbing the pandemic. As the pandemic continues to spread across Africa, there is a need for countries in the continent to re-evaluate, re-strategise, and re-invigorate their COVID-19 responses and efforts based on lessons from the first wave, and Nigeria is no exception. Before the second wave was officially announced by the health authorities on 17 December 2020, there were 78,434 confirmed cases and 1221 deaths reported with a case fatality rate (CFR) of 1.6%. To ensure that Nigeria achieves total pandemic control and reacts better given the possibility of a second wave, we propose workable recommendations to strengthen our preparedness and readiness efforts. Here, we argue that lessons learnt from the first wave of the COVID-19 pandemic can help Nigeria better react to the second wave.

Globally, human immunodeficiency syndrome (HIV) and its accompanying acquired immune deficiency syndrome (AIDS) have long been a public health threat due to the high death toll and the various effects on individuals and societies. Unfortunately, in developing countries such as Ghana, persons living with HIV/AIDS are victims of discrimination and rejection and are often excluded from social activities. Consequently, there is a need for mitigation strategies aimed at reducing the spread of the disease. Indeed, in human society, beliefs are fundamental to understanding people's intentions towards a given phenomenon. The purpose of this study was to assess students' perceived self-efficacy, attitude towards and knowledge about HIV/AIDS. In this study, Bandura's self-efficacy theory was used as a framework to assess the relationship between students' perceived self-efficacy, attitude towards and knowledge about HIV/AIDS. A total of 342 students of at least 15 years old were recruited from junior and senior high schools and a public university to complete two scales: the general self-efficacy and attitude and knowledge about HIV/AIDS scales. While there was a positive correlation among self-efficacy, attitude and knowledge, attitude and knowledge combined to predict self-efficacy. The limitations of the study, recommendations for future research and policy implications are discussed herein.

Diabetes mellitus (DM) is a complex, chronic, multifactorial, and costly health problem representing 8% of total public health expenditures in Spain. The objective of this study was to analyse the prevalence and costs of Anxiety (AX) and Depression (DP) in the Spanish working population with DM. Data were obtained from the National Health Survey of Spain 2017. A multivariate analysis was conducted to predict the use of resources and absenteeism/presenteeism. Direct and indirect costs were calculated. The final population analysed contained 15,822 subjects (18-65 years old). DM prevalence was 4.8%, and AX-DP 10.6% (50.5% were men). Self-diagnosed health was rated as regular, poor or very poor in 89% of DM subjects with DP-AX. The average costs estimated were €24,643.41 for DM subjects with AX-DP and €20,059.53 for those with only DM. The total estimated 2017 economic impact of DM was 2.4% of Spanish gross domestic product (13% directly related to DP-AX). Indirect costs represented 72.7% of total DP-AX costs. Spanish society is paying a considerable price for the incidence of DP-AX levels with DM in the working population. This global challenge has important repercussions for individuals' quality of life, health systems, and countries' development and economic growth.

Internal migrants are more disadvantaged than non-migrants in terms of their health. However, the extent of this difference is unclear. Following the PRISMA guideline, we conducted a systematic review to explore the existing evidence on the health of internal migrants of Bangladesh. We searched Pubmed, Web of Science and Google Scholar to identify peer-reviewed literature on health related issues of the internal migrant population and identified 29 papers for inclusion. Included studies reported health issues or risk factors relating to water, sanitisation and hygiene access and practice, risky sexual behaviour and sexually transmitted infection, mental health status, occupational health status, general healthcare availability, healthcare service utilisation and healthcare seeking behaviour. This systematic review reveals that research on health issues of internal migrants of Bangladesh is limited for common communicable and noncommunicable diseases like waterborne and skin disease, tuberculosis, hypertension and diabetes. Further, despite that many of these migrants are labourers, occupational health related issues like work place accidents, musculoskeletal disorders are insufficiently explored. Barriers to healthcare accessibility in this population are poor socioeconomic status, illiteracy and low general health knowledge. For improved development and implementation of health policies targeting this important population, future studies should focus on understudied diseases and disease prevalence and be designed to elicit from the perspectives of internal migrants, their key health needs around risk factors and health services accessibility.