Health Policy Open最新文献

Despite renewed policy priorities to universalise health coverage, unmet need for healthcare is long-standing concern in India. The recent data suggests the unmet healthcare need amounts to a notable share of twelve per cent. While studies have examined inequalities in healthcare utilisation in single axes of social power, there was no consensus on the role of the intersectionality between class, caste and gender in shaping the unmet health need. Utilising data from National Sample survey 75th round (2017–18), this paper identifies the factors contributing to such unmet need and investigate the intersectionality of class with caste and gender in determining unmet need. The contribution of socioeconomic factors was assessed by the decomposition method & multivariate logistic regression was used to measure inter and intra-class differentials in unmet need.

The analysis informs that class inequality is fundamental to having unmet need with limited role of gender and caste. Economic class however, interacting with caste and gender unfolds wider gaps in access to healthcare. While inter-class differences in unmet need are observed across caste as well as gender, intra-class differences intensify more by caste inequalities. The findings indicate the significance of the intersectional approach in identifying the sources of health inequity and special recognition to the income-poor and socially marginalised in policy agenda. Eliminating the barriers to health care access therefore needs a multidimensional construct of identifying combination of attributes to be focused towards realization of universal health coverage. These observations should aid in formulation and restructuring of the existing healthcare interventions to achieve equity in healthcare provision.

Background

Adolescent fertility is a global health and sustainable development indicator, and requires robust information systems for priority setting and decision-making to control. Evidence-based decision making for health stresses the use of scientific objective data and methodologies, which typically sieve out the more contextually understood social and economic factors that impact health.

Main Text: The rising adolescent fertility rates in Zambia warrant the use of robust information systems for planning and resource allocation. In addition to the shortage of information on adolescent health in general, the existing information systems are limited. Sustainable information systems require an investment in data collection that transcends the existing and heavily relied on quantitative evidence base on adolescent sexual and reproductive health, arguing for the need to include data generated through qualitative and participatory methodologies, generating a more holistic understanding of health phenomena.

Conclusion: There is a need to collect data on adolescent fertility using alternative methods to make decisions that work for adolescents.

Poor vision due to unaddressed refractive error in children is considered to be a public health problem in many low- and middle-income countries. Research shows that correcting refractive error with spectacles could have a positive impact on school attendance and academic performance for children. The aim of this study was to estimate the cost of integrating vision screening and provision of spectacles in existing school health programmes in Cambodia and Ghana. Budget impact analysis of the intervention scale up is also reported, including univariate and multivariate sensitivity analyses. This study suggests that the scale up of school-based vision screening programmes is affordable in resource limited settings, such as Cambodia and Ghana, considering the current education budgets, and providing there is sufficient in-country capacity to deliver such interventions at scale. The study highlights several policy and programme implications and provides suggestions for minimising costs and maximising efficiencies of vision screening in a school setting. Findings from this analysis can help education planners and international partners to improve their planning and budgeting processes for school-based interventions to improve health and learning outcomes for children in low- and middle-income countries.

Introduction

Many Omani nationals travel to India for Spine surgery. Surgical site infection (SSI) rates in these patients is considered more than normal. The indications for surgery are also deemed liberal. Objective: To determine whether SSI rates are more in medical tourists.

Materials & Methods

Design: The submission is a retrospective observational study done at a tertiary care referral hospital in Oman. The participants were a cohort of 125 patients who had travelled to India for spine surgery between January 2013 and December 2015. Their data was retrieved from the hospital information system. They were evaluated for satisfaction, residual complaints, surgical site infection and putative indications for surgery. The primary outcome measure was surgical site infection. The SSI rates were compared to a group of patients treated in-house during the same period.

Results

All the surgeries done were in the private sector. Fifty-four of the 80 cases were advised surgery locally as well, while 26 were advised against intervention. There were 15 cases of SSI, 10 of them needing re-operation. Four patients had neurological deterioration with 2 wrong level surgeries.

Discussion & Conclusions:

The rate of SSI in medical tourism patients was 12% compared to the 2.7% native cases. There was a 78% chance of improvement when the surgery was locally approved and 74% chance of worsening when not approved.

This study examines the impact of in utero exposure to household air pollution on child health. By using a pseudo panel data compiled from three rounds of two separate household datasets in Ghana, we investigate the impacts of dirty fuel use which leads to household air pollution on child stunting at the district level. The results after analysis using the two stage residual inclusion approach indicate that exposure to household air pollution in utero causes stunting in children after birth. We found that children born in the districts using firewood or charcoal as a main cooking fuel are shorter on average after birth. The estimated impacts are sizable: for example, by switching cooking fuel from dirty fuels to LPG, the average height for age Z score in the sample would increase from –1.269 to –0.43. The gender dimensions of the household air pollution effects were further explored. Boys were found to take a worse hit from in utero exposures compared to girls. The findings imply that policy to enhance clean cooking fuel use will help reduce child stunting in developing countries. An increase in clean cooking fuel usage and a reduction in child stunting are both necessary to support the success of the SDGs.

Background

Oral conditions remain a major health problem worldwide. Primary Health Care (PHC) has been recognized as a strategy to construct integrated health systems in order to produce the best health outcomes and reduce inequities through its attributes. Nevertheless, oral health integration in PHC remains unclear due to a lack of systematic knowledge.

Aim

To summarize oral health guidelines focused on the comprehensiveness component of PHC in the health system and on the intersectoral component of health promotion and disease prevention actions in five selected countries.

Methods

An integrative review of scientific and grey literature was led. Australia, Canada, New Zealand, United Kingdom and Brazil were selected. Content analysis was performed based on the comprehensiveness of care and health promotion and disease prevention categories.

Results

Forty-one studies were selected to compose the review. Regarding the comprehensiveness of care, the horizontal dimension was more prominent, suggesting that oral care should be provided in cooperation with other health areas. Health promotion and disease prevention actions in intersectoral contexts are complex but seem to be effective. Programs for spreading access to fluorides and actions with the education sector are the most established ones.

Conclusion

The integration of oral health in PHC policies is recommended in the guidelines of all countries, however, it stills represents a major challenge for the health care systems. These guidelines represent an important source to support decision-makers, policy-makers and stakeholders.

Free Trade Agreements (FTA) are controversial for threatening essential aspects of health, especially access to affordable medicines. The US-Peru FTA required changes in the Peruvian pharmaceutical legislation that resulted in the implementation of the National Drug Policy (NDP) of 2009. The NDP included more robust technical requirements for registration, a Peruvian Good Manufacturing Practices certificate, a longer timeline for drug registration, and an increase in registration fees. This study evaluated the impact of the FTA on the number of registrations and competition in the Peruvian pharmaceutical market.

Data for the period January 2005 to April 2014 were provided by the Peruvian drug regulatory authority (Dirección General de Medicamentos, Insumos y Drogas, DIGEMID). A total of 31,114 pharmaceutical products with unique registration numbers were evaluated. Brand drug new registrations decreased from 1789 in 2005 to 455 in 2013, and the number of generic registrations decreased from 621 in 2005 to 114 in 2013. Brand re-registrations also decreased from 714 in 2005 to 58 in 2013. There were 228 brand products awaiting registration in 2009 and 1,908 in 2013. The proportion of products awaiting registration was three times greater for brand than for generic products in 2009–2013.

Registration of brand and generic medicines significantly declined after the implementation of the US-Peru FTA in 2009. The decline in the number of registrations was associated with more robust technical requirements, a longer DIGEMID registration timeline, and an increase in registration fees. The stronger registration requirements are expected to increase the quality of the drugs marketed in the country, but also less competition and a reduction in domestic registrations.

Background

UC San Diego Health System (UCSDHS) is the largest academic medical center and integrated care network in US-Mexico border area of California contiguous to the Northern Baja region of Mexico. The COVID-19 pandemic compelled several UCSDHS and local communities to create awareness around best methods to promote regional health in this economically, socially, and politically important border area.

Purpose

To improve understanding of optimal strategies to execute critical care collaborative programs between academic and community health centers facing public health emergencies during the COVID-19 pandemic, based on the experience of UCSDHS and several community hospitals (one US, two Mexican) in the US-Mexico border region.

Methods

After taking several preparatory steps, we developed a two-phase program that included 1) in-person activities to perform needs assessments, hands-on training and education, and morale building and 2) creation of a telemedicine-based (Tele-ICU) service for direct patient management and/or educational coaching experiences.

Findings.

A clinical and educational program between academic and community border hospitals was feasible, effective, and well received.

Conclusion

We offer several policy-oriented recommendations steps for academic and community healthcare programs to build educational, collaborative partnerships to address COVID-19 and other cross-cultural, international public health emergencies.

Introduction

Patient-Public Engagement (PPE) is central to most community and public health interventions. There are reports on PPE’s impact on improving health and health systems. Yet, PPE initiatives are infrequent in Sub-Saharan Africa (SSA). A key step to enhancing engagement is identifying facilitators and barriers of PPE. Evidence synthesis of PPE’s effect on improving health systems is lacking. This study seeks to address this knowledge gap.

Methods

This review (Protocol published) followed Arksey and O’Malley’s guidelines for conducting and reporting scoping reviews. A systematic search of peer-reviewed English language literature published between January 1999 and December 2019 on Scopus, Medline (Ovid), CINAHL and Embase databases was conducted. A thematic framework synthesis was employed.

Results

Eighteen articles from ten Sub-Saharan African countries met the inclusion criteria of studies focusing on patient, public, citizen or community consultation/engagement/involvement in health services in Sub-Saharan Africa; as well as on barriers and facilitators for health systems improvement. The identified barriers and facilitators for health systems improvement were categorised onto a framework comprising individual-level, community-level and macro/strategic-level factors. Previous reviews on PPE have not focused on barriers and facilitators and its effect on improving health delivery in SSA, yet important for any successful PPE implementation. Barriers and facilitators of PPE largely differ from one health system level to another.

Conclusion

Policymakers need to consider the individual and community level contextual factors that influence PPE for effective implementation. Adopting context-specific approaches at all health system levels rather than a one-size-fit-all approach is recommended.

Stakeholders play an important role in health priority setting, and their roles have been discussed in the literature, mainly in relationship to their power. An emerging body of literature is focusing on the legitimacy of the stakeholders. Using the case of the Uganda health system, the overall aim of this paper is to assess the utility of the salience stakeholder analysis framework in identifying the most salient stakeholders in health-care priority setting.

Methods

This was a qualitative case study involving 57 key informant interviews with national and district level policy makers and a review of policy documents. Interview data were analyzed using QSR NVivo10 qualitative data analysis software. Analysis was guided by the salience stakeholder analysis framework.

Findings

Among the eight groups of stakeholders identified by the respondents, the politicians were found to be the most salient stakeholders. However, stakeholders’ salience varied depending on the type of decision, the nature of health issue and how and who tabled the health issue.

Conclusion

The salience stakeholder analysis framework, originating from the business management and political science disciplines, provided a more comprehensive stakeholder analysis by supporting the concurrent consideration of power, legitimacy and urgency in stakeholder analysis for health care priority setting.