International Journal of Health Planning and Management最新文献

This article serves as a guide to the Tobacco-Free Generation policy (TFG) for policy-makers, drawing on experiences of negotiations regarding TFG in a wide number of jurisdictions. It explains the underlying concept: the highly addictive nature of nicotine prompts policy focus on preventing initial use by forbidding sales to those born after a prescribed cut-off birthdate, while resisting prohibition for those in older cohorts who may already be nicotine-dependent. The policy signals that there is no safe age for tobacco products. We examine how to assess whether a jurisdiction is ready for TFG, and then, how to maximise its effectiveness. That involves considering preparatory steps. Implementation of TFG is discussed, including which tobacco or nicotine products should be covered, on which actions there should be focus, choice of a suitable cut-off birthdate, and the most helpful companion measures. We also outline potential pushback from the tobacco industry and others, and indicate appropriate responses.

Introduction: Sub-Saharan Africa is facing a severe crisis in human resources for health. Primary healthcare is the most affected. This problem is aggravated by absenteeism, implying that healthcare workers are absent on duty during scheduled working hours. This scoping review maps existing literature on absenteeism among primary healthcare workers in Sub-Saharan Africa.

Methods: This scoping review complies with the Population Concept Context guidelines of Arksey and O'Malley and the PRISMA 2020 checklist. A literature search (Medline, Embase, Scopus, Africa Index Medicus) was performed from inception until December 2023 in collaboration with a medical information specialist. Peer-reviewed English-published literature was considered. Two independent reviewers screened titles, abstracts, and full-texts.

Results: Twenty-four studies were included from 7 of 46 Sub-Saharan countries (15%). Prevalence of absenteeism varied from 14% to 49%. Causes at individual and health-system levels were explored in 16 studies (67%) and included physician dual practices (75%), low wages (69%), and insufficient supervision (56%). Consequences at the healthcare worker and patient level were described in 14 studies (58%) and included hindered/delayed access to care (64%), high workload (29%), and increased treatment costs when patients are forced to attend private facilities (22%). Recommendations to address absenteeism were provided in 18 studies (75%) and included regular supervision (33%), performance-based rewards/punishments (33%), and augmented salaries (33%).

Conclusion: Absenteeism is highly prevalent among primary healthcare workers in Sub-Sahara Africa. Its adverse impact on both healthcare workers and patients is profound. The complexity of different individual and health system causal factors shows that a multifactorial approach to address absenteeism is warranted.

Health care systems are confronted with an increasing burden of (multi-)morbidity and a shortfall of healthcare providers. Coordination and continuity of care in chronic and multi-morbid patient is especially important. As qualitative patient experience data within care processes is scarce, we aim to increase the understanding of chronically ill patient's perspectives by assessing patient experiences in different health systems while treated in primary care. Patients were recruited via GPs from Germany, Sweden, Switzerland, and the British island of Jersey. To ascertain regular healthcare utilisation, inclusion criteria were either a stroke, and/or a myocardial infarction or heart failure during the past year, and an underlying metabolic syndrome. Identical semi-structured interview-guides were used in the respective language. Transcribed interviews were analysed according to inductive-deductive qualitative content analysis. Based on 22 interviews we derived four main categories (patient centeredness, continuity, coordination, access). Overall, healthcare processes were considered positive if information flow was personal and functional. Non-physician staff seemed to create reassurance. A long-lasting doctor-patient relationship was connected to the context of trust and security. Patients were critical of a perceived lack of time, inducing insufficient counselling and information-flow. This international explorative study suggests that patients' experiences can provide important information about care provision. Patients consistently focused more on relational aspects rather than on structures or functions. This has connotations for healthcare planning; for example, by providing non-physician staff to support patients through their care pathway and to improve the cooperation between providers.

Health care is changing rapidly. Hospitals are, and will remain, an essential setting to deliver it. We discuss how to maximise the benefits of hospitals in the future in different geographic and health system settings, highlighting a series of cross-cutting issues. We do this by exploring the evolving roles of hospitals and the main factors that we must consider as they adapt. These include changing population and disease profiles, the impact of evolving technology, and new concepts in hospital design and planning. Our focus is on delivering high-quality, patient-centred care while ensuring equitable access, even if strategic decisions require compromise across these functions. The COVID-19 pandemic has shown the importance of hospitals in societies while also revealing the limitations of current structures and the potential of technology to transform hospital services within the broader healthcare system. The aim of this multidisciplinary perspective is to provide an overview of pertinent issues whilst highlighting the challenges and opportunities in optimising future hospital planning, construction, design, and development in high-income (HIC) and low -and medium-income country (LMIC) settings.

Strategic planning and strategic plans have gained popularity in the public sectors, including the health sector. However, the factors that facilitate and constrain the achievement of strategic planning outcomes have remained key research questions in the public sector and the health sector. From the perspectives of the council health managers, we explored the factors that facilitated or constrained the achievement of strategic results set out in the 2015-2020 Health Sector Strategic Plan in Tanzania Mainland. We conducted a qualitative study using a purposive sample of 15 council health managers from 15 councils in Tanzania. Qualitative data were collected using semi-structured interviews. We analysed our data using a thematic analysis approach. Our study found facilitators and barriers to achieving strategic health sector results grouped under five domains: resources availability; management, leadership and governance; strategic collaboration and joint working with implementing partners (NGOs); community factors; and recent reforms in the health sector. Our study has generated insights into factors that facilitate or hinder the effective achievement of strategic health sector results at the council level. The Ministry of Health, the President's Office- Regional Administration and Local governments, and health sector development partners should timely provide funds, human resources, health commodities and medical equipment to councils, strengthen health management and leadership at the council level, ensure health education is provided to the community members on health services.

Background: Reducing inequities in hypertension control among those affected in low- and middle-income countries requires person-centred health system responses based on a contextualised understanding of the choices and care pathways taken by those who rely on the services provided, particularly those from poor and marginalised communities. We examine patterns of care seeking and pathways followed by individuals with hypertension from low-income households in the Philippines and Malaysia. This study aims to fill a significant gap in the literature by analysing the stages at which individuals make decisions that may affect the successful control of their blood pressure.

Methods: This study presents cross-sectional survey data collected as part of the Responsive and Equitable Health Systems-Partnership on Non-Communicable Diseases (RESPOND) project, a longitudinal observational study in low-income communities. The study participants were 1191 randomly selected adults aged 35-70 years with a self-reported history of hypertension or identified as hypertensive through blood pressure screening.

Results: While most low-income individuals with hypertension in both countries were diagnosed and receiving medication, Malaysians demonstrated higher self-reported medication adherence. Urban areas in the Philippines showed better hypertension management outcomes compared to rural areas. The study also provides insights into the care seeking pathways followed by low-income adults diagnosed with hypertension. Nearly half of these individuals in Malaysia and a third in the Philippines were following pathways where they had never changed or stopped treatment without professional advice, and where they were using and adhering to their prescribed medication. Following such pathways was strongly associated with a greater likelihood blood pressure control in the Philippines, but less so in Malayisa.

Conclusions: These findings highlight the need for a contextualised understanding of care seeking choices and the importance of person-centred solutions. They offer a typology of hypertension care seeking pathways and a foundation for similar research in other settings.

The study investigates the role of governance quality on the effect of health expenditure on health outcomes captured by life expectancy at birth, infant mortality, under-five mortality, crude mortality and maternal mortality rates in West African Countries. Although these countries have made significant efforts to increase health expenditure over the years, health outcomes have only responded marginally in West African Countries, raising concerns about the importance of health expenditure in improving health outcomes. This study analyses the relationship between the role of governance and health expenditure and health outcomes using the feasible generalised least squares estimation techniques. The data for the study were sourced from the World Development Indicators and World Governance Indicators for the 15 West African countries from 1996 to 2022. The findings indicate that improving the governance composite index improves selected health outcomes in West African Countries. Furthermore, improving the interaction term between the composite index of governance and health expenditure improves health outcomes in West Africa. Therefore, the study recommends that governments make conscious efforts to allocate more resources to the health sector to improve health outcomes; and fully implement universal healthcare coverage (UHC) as the Côte d'Ivoire government in 2012 to alleviate high poverty levels and health expenses for people. Also, to improve public funds' efficiency and effectiveness and achieve better health outcomes, it is imperative to implement national policies on the institutional environment, and consistently improve governance issues plaguing the health sector. Increasing the salaries of public health workers could help to curb corruption and income inequality and improve their living and working conditions. Doing so will enable the West African countries to achieve health goals and agenda, as outlined in the SDGs.

Background: Health planning is essential for effective public health interventions and optimal resource utilisation. The Portuguese Directorate-General of Health has a long history of developing health plans and programmes, for communicable and noncommunicable diseases, and their determinants. This study aimed to review the current 24 programmes and assess the adequacy of their structure and content.

Methods: A document analysis was conducted using a programme assessment matrix developed by the research group. Two independent researchers evaluated each programme, scoring items as 'absent', 'present', or 'not applicable'. A quantitative analysis was employed to analyse compliance scores between priority and non-priority programmes and across the year of publication.

Results: Priority programs demonstrated higher and more consistent compliance scores compared to non-priority programs. Compliance scores ranged from 19% in the Sexual and Reproductive Health Programme to 100% in the Healthy Eating Programme. The item least commonly present was 'updated time scope', in only 21% of the programmes. Most recently published programmes were more likely to have a higher compliance score (Β = 0.76, 95% CI: [0.46, 1.05]). Not all programmes were publicly available in the same digital location.

Conclusions: There was heterogeneity in the 24 health promotion programmes in terms of structure, content, timeliness, and accessibility. A standardised structure could enhance their quality and ease their interpretation and dissemination.

The impact of income on health expenditure has been studied extensively using national-level data; however, studies estimating the household-level income elasticity of health expenditure, particularly by provider types, remain limited. Analysing nationally representative household survey data, we examine outpatient and inpatient out-of-pocket (OOP) expenses across healthcare providers and by various income levels. We employed the Heckman two-step model and OLS regression to estimate income elasticity separately for outpatient and inpatient services. Our findings indicate that income elasticity varies significantly by service type, provider, and income level. Outpatient care at private facilities is a luxury good for the lower-income households, while outpatient expenses for public and informal outpatient care providers remain inelastic across income levels. Private inpatient care is also income inelastic, whereas public inpatient care shows non-uniform elasticity. Overall, lower-income households showed greater elasticity than wealthier ones. The results imply, during income shocks, poorer households switch to cheaper public and informal care. Inpatient care is prioritised over other expenses, increasing the risk of poverty among low-income households. The study suggests the dire need for financial protection measures, particularly for low-income groups, as OOP health expenditure often becomes catastrophic for those households. In addition, higher income resulting from economic growth will increase the demand for private outpatient services, suggesting quality improvement for public health facilities as well as the importance of adapting healthcare policies to evolving income dynamics.

Objectives: The COVID-19 pandemic has highlighted the significance of comprehending social vulnerability as a pivotal element in public health. This study investigated the perceptions and practices of a Brazilian Afro-derived community (quilombo), descendants of enslaved Africans, regarding COVID-19.

Methods: This cross-sectional study was conducted in July 2021 by administering a survey to an adult representative from each household in a Brazilian quilombola community.

Results: Among the 188 interviewed individuals, 45.2% reported that they did not feel adequately informed by healthcare professionals. The study found high adherence to preventive measures (wearing masks, using alcohol-based gel sanitiser, leaving home only when necessary and COVID-19 vaccination). Only 6.9% reported a household member contracting COVID-19, with only one case requiring hospitalisation and no deaths. Higher education was associated with an increased diagnosis of COVID-19 in their household (OR: 37.058, 95% CI: 4.053-338.837, p = 0.001), while feeling well or very well informed by television/radio was associated with a reduced diagnosis (OR: 0.223, 95% CI: 0.057-0.878, p = 0.032). Being married was associated with increased adherence to all prevention measures (OR: 4.598, 95% CI: 1.481-14.27, p = 0.008), whereas internet use as a source of information was independently associated with a reduced chance of adherence (OR: 0.240; 95% CI: 0.080-0.722, p = 0.011).

Conclusion: Despite many individuals reporting a lack of information from healthcare professionals about the pandemic, substantial adherence to protective measures was observed. Our findings highlight the critical importance of preventive measures during the pandemic, especially for vulnerable populations with limited access to healthcare services, and underscore the need for effective communication strategies to combat misinformation, particularly on social media platforms.