Health Policy Open最新文献

Background

Health planning and priority setting with a gender lens can help to anticipate and mitigate vulnerabilities that women and girls may experience in health systems, which is especially relevant during health emergencies. This study examined how gender considerations were accounted for in COVID-19 pandemic response planning in a subset of countries in Africa.

Methods

Multi-country document review of national pandemic response plans (published before July 2020 and as of March 2022) from Ethiopia, Ghana, Kenya, Nigeria, Rwanda, South Africa, Uganda, and Zambia, supplemented with secondary data on gender representation on planning committees. A gender analysis framework informed the study design and the Morgan et al. matrix guided data extraction and analysis.

Results

All plans reflected implicit and explicit considerations of the impacts of the pandemic responses on women and girls. Through a gender lens, the implicit considerations focused on ensuring safety and protections (e.g., training, access to personal protective equipment) for community and facility-based health care workers and broad engagement of the community in risk communication. The explicit gender considerations, reflected in a minority of plans, focused on addressing gender-based violence and providing access to essential services (e.g., sexual and reproductive health care, psychosocial supports), products (e.g., menstrual hygiene products) and social protection measures. Women were underrepresented on the COVID-19 planning committees in all countries.

Conclusions

The plans reflected varying national efforts to develop pandemic responses that anticipated and reflected unique vulnerabilities faced by women, though subsequent plans reflected further consideration of gender-relevant impacts compared to initial plans. Embedding a gender lens in emergency preparedness planning furthers equity and could support anticipation and timely mitigation of negative outcomes for women and girls who are often further marginalized during health emergencies.

Background

This targeted and comprehensive policy scan examined how different levels of governments in Australia and Canada responded to the financial crisis brought on by the COVID-19 pandemic. We mapped the types of early policy responses addressing financial strain and promoting financial wellbeing. We also examined their equity considerations.

Methods

Through a systematic search, snowballing, and manual search, we identified Canadian and Australian policies at all government levels related to financial strain or financial wellbeing enacted or amended in 2019–2020. Using a deductive-inductive approach, policies were categorized by jurisdiction level, focal areas, and target population groups.

Results

In total, 213 and 97 policies in Canada and Australia, respectively, were included. Comparisons between Canadian and Australian policies indicated a more diversified and equity-targeted policy landscape in Canada. In both countries, most policies focused on individual and family finances, followed by housing and employment areas.

Conclusions

The policy scan identified gaps and missed opportunities in the early policies related to financial strain and financial wellbeing. While fast, temporary actions addressed individuals’ immediate needs, we recommend governments develop a longer-term action plan to tackle the root causes of financial strain and poor financial wellbeing for better health and non-health crisis preparedness.

Statement on Ethics and Informed Consent

This research reported in this paper did not require ethical clearance or patient informed consent as the data sources were published policy documents. This study did not involve data collection with humans (or animals), nor any secondary datasets involving data provided by humans (or from animal studies).

This study discusses findings from comparative case studies of the governance of health services purchasing agencies in 10 eastern European and central Asian countries established over the past 30 years, and the relationship between governance attributes, institutional development, and the progress made in strategic purchasing. The feasibility and effectiveness of implementing international recommendations from the health sector and wider public sector governance literature and practice are also discussed. The study finds that only those countries that have transitioned from middle to high-income status during the study period have been successful in comprehensively and consistently implementing internationally recommended practices. Moreover, these countries have made varying progress in developing capable purchasers with technical and operational independence, as well as advancing strategic purchasing. However, the current middle-income countries (MICs) in the study have implemented only certain elements of recommended governance practices, often superficially. Notably, the study reveals that some international recommendations, particularly those related to higher degrees of purchaser autonomy and the associated governance structures observed in western European social health insurance funds, have proven challenging to implement effectively or sustain in the MICs. None of the MICs succeeded in strategic purchasing beyond a limited agenda or scale, and even then, only implementing and sustaining them during favorable conditions. Difficulties in maintaining these achievements can be attributed, in part, to governance deficiencies. However, setbacks are commonly linked to periods of political and economic instability, which in turn lead to fluctuations in policy priorities, institutional instability, and inadequacies in health budgets. The study findings point to some actions related to civil society and stakeholder engagement, accountability frameworks, and digitalization in MICs that can facilitate continuity in health reforms and the functioning of purchasing institutions despite these challenges. The findings of the study provide important lessons for countries designing or newly implementing health purchasing agencies and for countries reviewing the performance and governance of their health purchasing agencies with a view to developing or strengthening strategic purchasing.

This article reviews progress in primary care reforms in the four Central Asian countries Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan. It draws on the country monitoring work of the European Observatory on Health Systems and Policies, a review of the peer-reviewed literature and an analysis of data available in international databases. The retrieved information was organized according to key health system functions (governance, provision, financing and resource generation), as well as key aims of universal health coverage (access to and quality of primary care and financial protection). The article finds that the four countries have made substantial reforms in all of these areas, but that there is still some way to go towards universal health coverage. Key challenges are the overall lack of public funding for primary care, poor financial protection due to prescribed outpatient medications being generally outside of publicly funded benefits packages, the low status and salary of primary care workers, problems of access to primary care in rural areas, and underdeveloped quality monitoring and improvement systems.

Background

Health technology assessment (HTA) bodies across Europe rely on explicit factors for decision making. However, additional undefined factors play a role. This mixed-methods research aimed to identify the implicit factors involved in HTA deliberative processes in five European countries, and to analyze their impact on decision making.

Methods

Between February and May 2021, semi-structured interviews (n = 20) were conducted with HTA experts of three different profiles (chair, advisor, and committee member) from France, Germany, Italy, Spain, and the United Kingdom. The degree of influence of a set of implicit factors and attributes that play a role in the HTA deliberative process, as previously identified in a systematic literature review, was scored by the experts. Experts were also asked to make recommendations on ways of improving the deliberative process. A qualitative analysis and descriptive statistics of quantitative variables are reported.

Results

Most (18/20) experts concurred that implicit factors play a role in the HTA deliberative process. Recommendations for improving the process fell into three categories: transparency, methodology improvement, and stakeholder involvement. The results suggest a need for 1) increased external involvement HTA and 2) development of a methodology to mitigate the influence of implicit factors in the deliberative process. This could be achieved by updating the current frameworks to acknowledge these implicit factors and by developing methods to address them.

This paper explores Itinerant Medicine Sellers’ (IMSs) operations at loading bays within bus terminals in the Kumasi metropolis. The paper examines how the sellers negotiated access into the loading bays, how they marketed their medicines, where they sourced their medicines from, and the challenges they faced. An exploratory qualitative survey design was adopted for the study. Through convenience sampling, 18 IMSs operating within the bus terminals in the Kumasi metropolis participated in this study. In-depth interviews were conducted, audio-recorded and transcribed. The transcripts were thematically analysed. The study found that these hawkers negotiated access to the loading bays through multiple informal gatekeepers and employed direct customer engagement in marketing their medicines. It was further revealed that the IMSs sourced their medicines from both formal and informal sources for different reasons, such as affordability and informality of medicines acquisition. The participants operated outside government-prescribed regulations and faced challenges of low capital and sales revenue, poor reception by prospective clients, and government clampdown. The study concludes that medicine hawking is an illegal livelihood strategy and a public health concern. As a phenomenon outside government’s policy guidelines, it is recommended that government intensifies its clampdown activities on these hawkers and engage in public health education on the negative implications of accessing medicines from these IMSs.

The study investigated infection variables and control strategies in 2020 and 2021 and their influence on COVID-19 deaths in the United States, with a particular focus on comparing red (Republican) and blue (Democratic) states. The analysis reviewed cumulative COVID-19 deaths per 100,000 by year, state political affiliation, and a priori latent factor groupings of mitigation strategies (lockdown days in 2020, mask mandate days, vaccination rates), social demographic variables (ethnicity, poverty rate), and biological variables (median age, obesity). Analyses first identified possible relationships between all assessed variables using K-means clustering for red, blue, and purple states. Then, a series of regression models were fit to assess the effects of mitigation strategies, social, and biological factors specifically on COVID-19 deaths in red and blue states. Results showed distinct differences in responding to COVID infections between red states to blue states, particularly the red states lessor adoption of mitigation factors leaving more sway on biological factors in predicting deaths. Whereas in blue states, where mitigation factors were more readily implemented, vaccinations had a more significant influence in reducing the probability of infections ending in death. Overall, study findings suggest politicalization of COVID-19 mitigation strategies played a role in death rates across the United States.

Introduction

Community health workers (CHW) were integral in the COVID-19 response, particularly concerning services for populations vulnerable to HIV. Little is known regarding the mental health of CHW during the COVID-19 crisis. The objective of this study was to study resilience of CHW working in HIV non-governmental organizations.

Methods

An anonymous online, cross-sectional questionnaire was implemented during 2021 among CHW in Benin, Colombia, Guatemala, and Spain. Three scales were used to assess mental health: the 6-item Brief-Resilience Scale, the 9-item Patient Scale Questionnaire and the 7‐item Generalized-Anxiety-Disorder scale. Logistic regression models were used to identify factors associated with “low” resilience vs “normal” or “high” resilience.

Results

Among 295 respondents, the median standardized resilience score was 58.33 (IQR = [50.0–75.0], n = 267), 18.52 (IQR = [7.4–33.3], n = 282) for standardized depression score and 19.05 (IQR = [4.8–33.3], n = 274) for standardized anxiety score. Standardized resilience score was negatively correlated with standardized anxiety score (rho = -0.49, p < 0.001, n = 266) and standardized depression score (rho = -0.44, p < 0.001, n = 267).

Conclusions

Normal or high level of resiliency in the HIV CHW were observed during the COVID-19 crisis. Self-efficacy, through COVID-19 prevention training, was a factor associated with resilience. Health policy must place CHW at the core of the healthcare system response to Covid‐19 and to future health emergencies, as they ensure continuity of care for many diseases including HIV among vulnerable populations.

In recent decades, external financing of health systems in low- and middle-income countries has helped achieve remarkable improvements across the world. However, these successes have not come without problems. There are a growing number of areas where external assistance can cause harm and even undermine the development of national health systems. Recent decades have seen a surge of knowledge on investing in health systems. We propose the setting up of investment standards for external assistance that aim to incentivize a more efficient evidence-based investment in a country’s health system, led by decision-makers in country. Using a more standardized process would lead to a better use of precious external assistance resources. The long-term goal would be fully functioning health systems with all the necessary essential public health functions in all countries.