Pub Date : 2017-01-02DOI: 10.1080/23288604.2016.1272983
Huihui Wang, A. Yazbeck
Abstract—Health systems are not easy to benchmark, in part because the health sector produces more than one outcome. This article offers two ways of benchmarking the health systems of countries in the Middle East and North Africa (MENA) focusing on two different outcomes, health status and financial protection. The first approach is by measuring the gap between predicted health outcomes based on country socioeconomic status and actual health outcomes. The second approach is by simply comparing the levels of out-of-pocket (OOP) spending in MENA countries. The article offers some interesting findings about the large heterogeneity in both health system outcome achievements despite considerable cultural and linguistic similarities in the region. Moreover, three discrete clusters of countries are found on the health status measure. The findings also give specific health system target outcomes for MENA countries to focus their reform efforts.
{"title":"Benchmarking Health Systems in Middle Eastern and North African Countries","authors":"Huihui Wang, A. Yazbeck","doi":"10.1080/23288604.2016.1272983","DOIUrl":"https://doi.org/10.1080/23288604.2016.1272983","url":null,"abstract":"Abstract—Health systems are not easy to benchmark, in part because the health sector produces more than one outcome. This article offers two ways of benchmarking the health systems of countries in the Middle East and North Africa (MENA) focusing on two different outcomes, health status and financial protection. The first approach is by measuring the gap between predicted health outcomes based on country socioeconomic status and actual health outcomes. The second approach is by simply comparing the levels of out-of-pocket (OOP) spending in MENA countries. The article offers some interesting findings about the large heterogeneity in both health system outcome achievements despite considerable cultural and linguistic similarities in the region. Moreover, three discrete clusters of countries are found on the health status measure. The findings also give specific health system target outcomes for MENA countries to focus their reform efforts.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"8 1","pages":"13 - 7"},"PeriodicalIF":4.1,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79638197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/23288604.2016.1272980
J. Alaref, J. Awwad, E. Araújo, C. Lemière, S. Hillis, Emre Özaltin
Abstract—Dual practice, health professionals working simultaneously in the public and private sectors, is perceived to negatively impact quality of health care. Though a range of policy options exists to regulate dual practice, little is known about the impact of different options on quality of care. Successful policy is dependent on a country's health care system, health labor market, monitoring of private sector activity, and enforceability of regulations. This article provides evidence on the potential impact of banning dual practice in Palestine. We apply theoretical evidence and international experience, together with context-specific primary and secondary data, to assess the policy's enforceability, implications, and sustainability in the Palestinian context. In this setting, though the risk of losing health workers to the private sector is low, banning dual practice will most likely lead to the “brain drain” of rare specialists from the public sector. Moreover, though there is some evidence that dual practice is negatively impacting quality of care, poor quality in public facilities associated with shortages in supplies and equipment, poor organizational and management practices, low motivation, and absence of monitoring and accountability systems are unlikely to change by banning dual practice. Finally, the ban, as conceptualized, is fiscally unsustainable in a strained health budget and may be challenging to enforce due to a weak monitoring system. Overall, it was found that an outright ban on dual practice would not reduce the financial burden on patients and enhance their access to quality services in the public sector.
{"title":"To Ban or Not to Ban? Regulating Dual Practice in Palestine","authors":"J. Alaref, J. Awwad, E. Araújo, C. Lemière, S. Hillis, Emre Özaltin","doi":"10.1080/23288604.2016.1272980","DOIUrl":"https://doi.org/10.1080/23288604.2016.1272980","url":null,"abstract":"Abstract—Dual practice, health professionals working simultaneously in the public and private sectors, is perceived to negatively impact quality of health care. Though a range of policy options exists to regulate dual practice, little is known about the impact of different options on quality of care. Successful policy is dependent on a country's health care system, health labor market, monitoring of private sector activity, and enforceability of regulations. This article provides evidence on the potential impact of banning dual practice in Palestine. We apply theoretical evidence and international experience, together with context-specific primary and secondary data, to assess the policy's enforceability, implications, and sustainability in the Palestinian context. In this setting, though the risk of losing health workers to the private sector is low, banning dual practice will most likely lead to the “brain drain” of rare specialists from the public sector. Moreover, though there is some evidence that dual practice is negatively impacting quality of care, poor quality in public facilities associated with shortages in supplies and equipment, poor organizational and management practices, low motivation, and absence of monitoring and accountability systems are unlikely to change by banning dual practice. Finally, the ban, as conceptualized, is fiscally unsustainable in a strained health budget and may be challenging to enforce due to a weak monitoring system. Overall, it was found that an outright ban on dual practice would not reduce the financial burden on patients and enhance their access to quality services in the public sector.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"10 1","pages":"42 - 55"},"PeriodicalIF":4.1,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86966304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/23288604.2016.1272979
J. Khalife, N. Rafeh, Jihad Makouk, F. El-Jardali, B. Ekman, N. Kronfol, G. Hamadeh, W. Ammar
Abstract Abstract—Since 2009, the Ministry of Public Health (MoPH) in Lebanon has been going through a major reform initiative to improve its contracting system with private and public hospitals. The private sector is the main provider of hospital care in the country and the main contractor to the MoPH for the provision of curative care. As an “insurer of last resort,” the MoPH plays an important role in providing hospital coverage to 53% of the population who lack coverage by private or public insurance schemes, through contractual arrangements with the private sector. Historically, the MoPH used hospital accreditation as the basis for contracting and for determining the reimbursement rate. However, recent studies by the MoPH showed that reimbursing hospitals solely on accreditation results was not appropriate and led to an unfair and inefficient reimbursement system. The reform program included the development of several components, in particular, an automated billing system, a utilization review function, standardized admission criteria, and a hospital case mix index that accounts for case complexity. In 2014, the MoPH started implementing a new mixed-model contracting system with private and public hospitals. Preliminary evaluation of the new model suggests that the system incentivized hospitals to admit fewer inappropriate cases and more cases that are more complex/serious. This article shares one experience of how to introduce a merit-based system to face the common practice of political clientelism and confessional/religious-based favoritism in Lebanon. It highlights the importance of stakeholder engagement in a framework of networking and participatory governance that proved to be a key element behind the resilience of a diversified health system.
{"title":"Hospital Contracting Reforms: The Lebanese Ministry of Public Health Experience","authors":"J. Khalife, N. Rafeh, Jihad Makouk, F. El-Jardali, B. Ekman, N. Kronfol, G. Hamadeh, W. Ammar","doi":"10.1080/23288604.2016.1272979","DOIUrl":"https://doi.org/10.1080/23288604.2016.1272979","url":null,"abstract":"Abstract Abstract—Since 2009, the Ministry of Public Health (MoPH) in Lebanon has been going through a major reform initiative to improve its contracting system with private and public hospitals. The private sector is the main provider of hospital care in the country and the main contractor to the MoPH for the provision of curative care. As an “insurer of last resort,” the MoPH plays an important role in providing hospital coverage to 53% of the population who lack coverage by private or public insurance schemes, through contractual arrangements with the private sector. Historically, the MoPH used hospital accreditation as the basis for contracting and for determining the reimbursement rate. However, recent studies by the MoPH showed that reimbursing hospitals solely on accreditation results was not appropriate and led to an unfair and inefficient reimbursement system. The reform program included the development of several components, in particular, an automated billing system, a utilization review function, standardized admission criteria, and a hospital case mix index that accounts for case complexity. In 2014, the MoPH started implementing a new mixed-model contracting system with private and public hospitals. Preliminary evaluation of the new model suggests that the system incentivized hospitals to admit fewer inappropriate cases and more cases that are more complex/serious. This article shares one experience of how to introduce a merit-based system to face the common practice of political clientelism and confessional/religious-based favoritism in Lebanon. It highlights the importance of stakeholder engagement in a framework of networking and participatory governance that proved to be a key element behind the resilience of a diversified health system.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"12 1 1","pages":"34 - 41"},"PeriodicalIF":4.1,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84966374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/23288604.2016.1272981
Aaka Pande, Amr El Shalakani, A. Hamed
Abstract—Social justice, broadly defined as providing equal access to liberties, rights, and opportunities especially for the least advantaged members of society, is a priority of several governments in the Middle East and North Africa (MENA) post−Arab Spring as well as globally. Achieving social justice in the field of health care is consistent with the principles of universal health coverage and is an important means to achieve this aim. To translate this abstract concept into concrete action, we propose a novel diagnostic method and then apply it to the case of Egypt, a country with a stated goal of achieving social justice in health care. This allows us to assess progress and then suggest targeted recommendations through which to improve social justice in health care. Through a comprehensive analysis of primary and secondary qualitative and quantitative data sources, we first identify six disadvantaged groups in Egypt and then analyze the status of these groups with respect to the three objectives of a health system—improving health outcomes, financial protection, and public satisfaction. Our results suggest that Egypt faces 11 challenges to achieving social justice in health care that can be addressed through 14 short- and medium-term recommendations drawn from global evidence of what works. Implementing these health system changes can help advance social justice in health care in Egypt.
{"title":"How Can We Measure Progress on Social Justice in Health Care? The Case of Egypt","authors":"Aaka Pande, Amr El Shalakani, A. Hamed","doi":"10.1080/23288604.2016.1272981","DOIUrl":"https://doi.org/10.1080/23288604.2016.1272981","url":null,"abstract":"Abstract—Social justice, broadly defined as providing equal access to liberties, rights, and opportunities especially for the least advantaged members of society, is a priority of several governments in the Middle East and North Africa (MENA) post−Arab Spring as well as globally. Achieving social justice in the field of health care is consistent with the principles of universal health coverage and is an important means to achieve this aim. To translate this abstract concept into concrete action, we propose a novel diagnostic method and then apply it to the case of Egypt, a country with a stated goal of achieving social justice in health care. This allows us to assess progress and then suggest targeted recommendations through which to improve social justice in health care. Through a comprehensive analysis of primary and secondary qualitative and quantitative data sources, we first identify six disadvantaged groups in Egypt and then analyze the status of these groups with respect to the three objectives of a health system—improving health outcomes, financial protection, and public satisfaction. Our results suggest that Egypt faces 11 challenges to achieving social justice in health care that can be addressed through 14 short- and medium-term recommendations drawn from global evidence of what works. Implementing these health system changes can help advance social justice in health care in Egypt.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"25 1","pages":"14 - 25"},"PeriodicalIF":4.1,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80808543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-01-02DOI: 10.1080/23288604.2017.1265041
M. L. Le Pape, Juan Carlos Núñez Suárez, Abdelkader Mhayi, Dominic S. Haazen, Emre Özaltin
Abstract Abstract—An increasing number of low- and middle-income countries are receiving significant investments to implement health reform strategies featuring a health management information system (HMIS) as a fundamental eHealth intervention. We present the case of Morocco's first step toward the implementation of a national HMIS: the “urbanization” of its health information systems—an information architecture methodology designed to leverage existing capacity while ensuring sustainability of the new HMIS. We report on this process and share lessons learned, applicable to similar countries involved in HMIS interventions, including involving all stakeholders from inception to rollout, encouraging local ownership of the new HMIS, fostering active data usage among users, and leveraging existing personnel rotation policies when developing adoption strategies and facilitating capacity building efforts.
{"title":"Developing an HMIS Architecture Framework to Support a National Health Care eHealth Strategy Reform: A Case Study from Morocco","authors":"M. L. Le Pape, Juan Carlos Núñez Suárez, Abdelkader Mhayi, Dominic S. Haazen, Emre Özaltin","doi":"10.1080/23288604.2017.1265041","DOIUrl":"https://doi.org/10.1080/23288604.2017.1265041","url":null,"abstract":"Abstract Abstract—An increasing number of low- and middle-income countries are receiving significant investments to implement health reform strategies featuring a health management information system (HMIS) as a fundamental eHealth intervention. We present the case of Morocco's first step toward the implementation of a national HMIS: the “urbanization” of its health information systems—an information architecture methodology designed to leverage existing capacity while ensuring sustainability of the new HMIS. We report on this process and share lessons learned, applicable to similar countries involved in HMIS interventions, including involving all stakeholders from inception to rollout, encouraging local ownership of the new HMIS, fostering active data usage among users, and leveraging existing personnel rotation policies when developing adoption strategies and facilitating capacity building efforts.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"59 1","pages":"56 - 67"},"PeriodicalIF":4.1,"publicationDate":"2017-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88161750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-01DOI: 10.1080/23288604.2016.1242453
A. Mckenzie, A. Abdulwahab, E. Sokpo, J. Mecaskey
Abstract Abstract—The experience of a donor-supported Reproductive, Maternal, Newborn, and Child Health (RMNCH) program in four states of Northern Nigeria illustrates how a Complex Adaptive System (CAS) approach to health system strengthening can lead to health systems becoming more resilient. The program worked with the array of political, cultural and social determinants which interact to shape the health system and its functionality. It worked in an environment marked by weak governance with little public accountability and by very limited management capability in inadequately regulated markets. To these conditions of fragility was added the shock from the rapidly deteriorating security situation caused in 2011 by the Boko Haram insurgency and the government's ensuing response. A CAS theory of change provided the basis for the multi-faceted approach that identified critical points of leverage among institutions in social as well as professional systems and helped achieve significant improvements in health service delivery in the RMNCH continuum of care. It also established the foundation for Primary Health Care Under One Roof, which has emerged as a central national strategy in Nigeria for strengthening health sector governance and services under the 2014 Health Act. This article draws on the experience of work undertaken in Northern Nigeria over the course of the last 10 years. A team largely of Nigerian professionals from an array of disciplines worked widely across the health system, addressing issues of governance, finance, institutional management, community systems support, access and accountability, and service delivery—frequently at the same time. This experience provides lessons for efforts elsewhere on how to strengthen health systems during and after emergencies (such as Ebola in West Africa) and in situations affected by conflict.
{"title":"Creating the Foundation for Health System Resilience in Northern Nigeria","authors":"A. Mckenzie, A. Abdulwahab, E. Sokpo, J. Mecaskey","doi":"10.1080/23288604.2016.1242453","DOIUrl":"https://doi.org/10.1080/23288604.2016.1242453","url":null,"abstract":"Abstract Abstract—The experience of a donor-supported Reproductive, Maternal, Newborn, and Child Health (RMNCH) program in four states of Northern Nigeria illustrates how a Complex Adaptive System (CAS) approach to health system strengthening can lead to health systems becoming more resilient. The program worked with the array of political, cultural and social determinants which interact to shape the health system and its functionality. It worked in an environment marked by weak governance with little public accountability and by very limited management capability in inadequately regulated markets. To these conditions of fragility was added the shock from the rapidly deteriorating security situation caused in 2011 by the Boko Haram insurgency and the government's ensuing response. A CAS theory of change provided the basis for the multi-faceted approach that identified critical points of leverage among institutions in social as well as professional systems and helped achieve significant improvements in health service delivery in the RMNCH continuum of care. It also established the foundation for Primary Health Care Under One Roof, which has emerged as a central national strategy in Nigeria for strengthening health sector governance and services under the 2014 Health Act. This article draws on the experience of work undertaken in Northern Nigeria over the course of the last 10 years. A team largely of Nigerian professionals from an array of disciplines worked widely across the health system, addressing issues of governance, finance, institutional management, community systems support, access and accountability, and service delivery—frequently at the same time. This experience provides lessons for efforts elsewhere on how to strengthen health systems during and after emergencies (such as Ebola in West Africa) and in situations affected by conflict.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"81 1","pages":"357 - 366"},"PeriodicalIF":4.1,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88212456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-10-01DOI: 10.1080/23288604.2016.1247556
M. Reich
Reference This issue of Health Systems & Reform is dedicated to the challenges of improving health system performance in Nigeria. This is no small task. The Nigerian population was estimated at 182 million in 2015, making it the most populous country in Africa and including one out of five people in the sub-Saharan region. While the country is rich in material resources (especially oil) and human resources (with many universities and educational institutions), the obstacles to development remain daunting. The New York Times captured this challenge succinctly (and provocatively) in its summer 2016 article titled “Nigeria Finds a National Crisis in Every Direction it Turns.” In this issue, we examine the deep-seated challenges in Nigeria’s health system and the efforts of various organizations—governmental, multilateral development banks, nongovernmental development consultants, and private foundations—to make progress. What can be done to improve the quantity and quality of health services delivered? How can those improvements be achieved in the Nigerian context? This is the first issue of an international journal devoted to the Nigeria health system. We hope that the articles will help advance both understanding and actions for innovative reforms that will make tangible improvements in the Nigerian health system. We begin the issue with two commentaries: one from current Nigerian Minister of Health Isaac Adewole and his team, and the other from seasoned Nigerian global health expert Olusoji Adeyi, who has participated in many health reform efforts around the world (through his position at the World Bank). Minister Adewole and his team at the Federal Ministry of Health recognize Nigeria’s long history of seeking to develop its primary health care system, starting with the establishment of a federal agency in 1992. They also recognize that primary care suffers from institutional fragmentation across three levels of government and within each one as well. They call this the “most critical challenge for primary health care in Nigeria” along with the assignment of managing primary health care to the “weakest and most chronically underfunded tier *Correspondence to: Michael R. Reich; Email: reich@hsph.harvard.edu
{"title":"Introduction to the HS&R Nigeria Issue","authors":"M. Reich","doi":"10.1080/23288604.2016.1247556","DOIUrl":"https://doi.org/10.1080/23288604.2016.1247556","url":null,"abstract":"Reference This issue of Health Systems & Reform is dedicated to the challenges of improving health system performance in Nigeria. This is no small task. The Nigerian population was estimated at 182 million in 2015, making it the most populous country in Africa and including one out of five people in the sub-Saharan region. While the country is rich in material resources (especially oil) and human resources (with many universities and educational institutions), the obstacles to development remain daunting. The New York Times captured this challenge succinctly (and provocatively) in its summer 2016 article titled “Nigeria Finds a National Crisis in Every Direction it Turns.” In this issue, we examine the deep-seated challenges in Nigeria’s health system and the efforts of various organizations—governmental, multilateral development banks, nongovernmental development consultants, and private foundations—to make progress. What can be done to improve the quantity and quality of health services delivered? How can those improvements be achieved in the Nigerian context? This is the first issue of an international journal devoted to the Nigeria health system. We hope that the articles will help advance both understanding and actions for innovative reforms that will make tangible improvements in the Nigerian health system. We begin the issue with two commentaries: one from current Nigerian Minister of Health Isaac Adewole and his team, and the other from seasoned Nigerian global health expert Olusoji Adeyi, who has participated in many health reform efforts around the world (through his position at the World Bank). Minister Adewole and his team at the Federal Ministry of Health recognize Nigeria’s long history of seeking to develop its primary health care system, starting with the establishment of a federal agency in 1992. They also recognize that primary care suffers from institutional fragmentation across three levels of government and within each one as well. They call this the “most critical challenge for primary health care in Nigeria” along with the assignment of managing primary health care to the “weakest and most chronically underfunded tier *Correspondence to: Michael R. Reich; Email: reich@hsph.harvard.edu","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"76 1","pages":"273 - 276"},"PeriodicalIF":4.1,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78649184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-29DOI: 10.1080/23288604.2016.1234865
Ndukwe Kalu Ukoha, Kelechi Ohiri, Charles C. Chima, Y. Ogundeji, A. Rone, Chike William Nwangwu, Heather Lanthorn, K. Croke, M. Reich
Abstract Abstract—Studies have found links between organizational structure and performance of public organizations. Considering the wide variation in uptake of malaria interventions and outcomes across Nigeria, this exploratory study examined how differences in administrative location (a dimension of organizational structure), the effectiveness of administrative processes (earmarking and financial control, and communication), leadership (use of data in decision making, state ownership, political will, and resourcefulness), and external influences (donor influence) might explain variations in performance of state malaria programs in Nigeria. We hypothesized that states with malaria program administrative structures closer to state governors will have greater access to resources, greater political support, and greater administrative flexibility and will therefore perform better. To assess these relationships, we conducted semistructured interviews across three states with different program administrative locations: Akwa-Ibom, Cross River, and Niger. Sixty-five participants were identified through a snowballing approach. Data were analyzed using a thematic framework. State program performance was assessed across three malaria service delivery domains (prevention, diagnosis, and treatment) using indicators from Nigeria Demographic and Health Surveys conducted in 2008 and 2013. Cross River State was best performing based on 2013 prevention data (usage of insecticide-treated bednets), and Niger State ranked highest in diagnosis and treatment and showed the greatest improvement between 2008 and 2013. We found that organizational structure (administrative location) did not appear to be determinative of performance but rather that the effectiveness of administrative processes (earmarking and financial control), strong leadership (assertion of state ownership and resourcefulness of leaders in overcoming bottlenecks), and donor influences differed across the three assessed states and may explain the observed varying outcomes.
{"title":"Influence of Organizational Structure and Administrative Processes on the Performance of State-Level Malaria Programs in Nigeria","authors":"Ndukwe Kalu Ukoha, Kelechi Ohiri, Charles C. Chima, Y. Ogundeji, A. Rone, Chike William Nwangwu, Heather Lanthorn, K. Croke, M. Reich","doi":"10.1080/23288604.2016.1234865","DOIUrl":"https://doi.org/10.1080/23288604.2016.1234865","url":null,"abstract":"Abstract Abstract—Studies have found links between organizational structure and performance of public organizations. Considering the wide variation in uptake of malaria interventions and outcomes across Nigeria, this exploratory study examined how differences in administrative location (a dimension of organizational structure), the effectiveness of administrative processes (earmarking and financial control, and communication), leadership (use of data in decision making, state ownership, political will, and resourcefulness), and external influences (donor influence) might explain variations in performance of state malaria programs in Nigeria. We hypothesized that states with malaria program administrative structures closer to state governors will have greater access to resources, greater political support, and greater administrative flexibility and will therefore perform better. To assess these relationships, we conducted semistructured interviews across three states with different program administrative locations: Akwa-Ibom, Cross River, and Niger. Sixty-five participants were identified through a snowballing approach. Data were analyzed using a thematic framework. State program performance was assessed across three malaria service delivery domains (prevention, diagnosis, and treatment) using indicators from Nigeria Demographic and Health Surveys conducted in 2008 and 2013. Cross River State was best performing based on 2013 prevention data (usage of insecticide-treated bednets), and Niger State ranked highest in diagnosis and treatment and showed the greatest improvement between 2008 and 2013. We found that organizational structure (administrative location) did not appear to be determinative of performance but rather that the effectiveness of administrative processes (earmarking and financial control), strong leadership (assertion of state ownership and resourcefulness of leaders in overcoming bottlenecks), and donor influences differed across the three assessed states and may explain the observed varying outcomes.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"47 1","pages":"331 - 356"},"PeriodicalIF":4.1,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82229277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-29DOI: 10.1080/23288604.2016.1234861
D. Kress, Yanfang Su, Hong Wang
Abstract Abstract—Health gains oftentimes associated with income growth have been stubbornly slow in Nigeria in the past 25 years. One plausible reason for this stagnation is underperformance in the country's primary health care (PHC) system. The Primary Health Care Performance Indicators conceptual framework is used to examine Nigeria's PHC system and possible causes of underperformance. Analysis was conducted using a variety of sources including recent facility level information from the World Bank Service Delivery Indicators Survey. Results show that Nigeria has a relative abundance of PHC centers, reasonable geographic access to PHC, and relatively high health worker density. However, the performance of the PHC system is hindered by (1) segmented supply chains; (2) a lack of financial access to PHC; (3) a lack of infrastructure, drugs, equipment, and vaccines at the facility level; and (4) poor health worker performance. Altogether, these factors reflect two overarching system-level challenges—financing and governance—that are key root causes of the dysfunctions observed in the PHC system in Nigeria. Compared with peer African countries, Nigeria ranks low on nearly all PHC performance indicators. The government has taken important steps to address these root causes of underperformance, but policy gaps remain in achieving sustainable and equitable provision of PHC for the people of Nigeria.
{"title":"Assessment of Primary Health Care System Performance in Nigeria: Using the Primary Health Care Performance Indicator Conceptual Framework","authors":"D. Kress, Yanfang Su, Hong Wang","doi":"10.1080/23288604.2016.1234861","DOIUrl":"https://doi.org/10.1080/23288604.2016.1234861","url":null,"abstract":"Abstract Abstract—Health gains oftentimes associated with income growth have been stubbornly slow in Nigeria in the past 25 years. One plausible reason for this stagnation is underperformance in the country's primary health care (PHC) system. The Primary Health Care Performance Indicators conceptual framework is used to examine Nigeria's PHC system and possible causes of underperformance. Analysis was conducted using a variety of sources including recent facility level information from the World Bank Service Delivery Indicators Survey. Results show that Nigeria has a relative abundance of PHC centers, reasonable geographic access to PHC, and relatively high health worker density. However, the performance of the PHC system is hindered by (1) segmented supply chains; (2) a lack of financial access to PHC; (3) a lack of infrastructure, drugs, equipment, and vaccines at the facility level; and (4) poor health worker performance. Altogether, these factors reflect two overarching system-level challenges—financing and governance—that are key root causes of the dysfunctions observed in the PHC system in Nigeria. Compared with peer African countries, Nigeria ranks low on nearly all PHC performance indicators. The government has taken important steps to address these root causes of underperformance, but policy gaps remain in achieving sustainable and equitable provision of PHC for the people of Nigeria.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":"3 1","pages":"302 - 318"},"PeriodicalIF":4.1,"publicationDate":"2016-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80524675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-09-26DOI: 10.1080/23288604.2016.1234863
O. Odutolu, N. Ihebuzor, R. Tilley-Gyado, Valentina Martufi, Michael Ajuluchukwu, O. Olubajo, Bolanle Banigbe, Opeyemi Fadeyibi, Rabiya Abdullhai, A. Muhammad
Abstract Abstract—Within the last two decades, the Nigerian government has committed to strengthening its primary health care system, through reforms addressing institutional restructuring, deepening decentralized governance, and the incorporation of an alternative health care financing strategy. One of these reforms prescribed the establishment of state primary health care agencies/boards (SPHCDBs) as an integral part of the national health system, with the principal responsibility “for the coordination of planning, budgeting, provision and monitoring of all primary health care services that affect residents of the state.” Central to this reform is the integration of primary health care (PHC) governance and management, popularly called primary health care under one roof. Another reform, piloting results-based financing, has been implemented since 2011 in three states under the Nigeria State Health Investment Project. This study assesses the implementation of the Primary Health Care Under One Roof (PHCUOR) policy as part of the broader PHC reforms, with a specific focus on how this policy has been strengthened through the Nigeria State Health Investment Project (NSHIP) in Adamawa, Nasarawa, and Ondo states, documenting the evolution of SPHCDB and PHC service delivery, with a focus on management, accountability, and incentives. The study shows that, in the above-mentioned states, significant milestones were achieved in the establishment of the SPHCDB, the strengthening of PHC systems, the improvement of accountability linkages, and an increase in service utilization. The authors therefore argue that integrated PHC systems through SPHCDBs, as enshrined in the PHCUOR guidelines, are a panacea for effective provision of primary health care and a potential game changer for health outcomes, especially when reinforced with a results-based financing approach.
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