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Health Policy and Planning

Sadie Bell, Laurence Blanchard, Helen Walls, Sandra Mounier-Jack, Natasha Howard
The Global Vaccine Action Plan proposes that every country establish or have access to a National Immunization Technical Advisory Group (NITAG) by 2020. The NITAG role is to produce evidence-informed recommendations that incorporate local context, to guide national immunization policies and practice. This study aimed to explore the value and effectiveness of NITAGs in low- and middle-income countries (LMICs), identifying areas in which NITAGs may require further support to improve their functionality and potential barriers to global investment...
May 10, 2019: Health Policy and Planning
Charles A Ameh, Mselenge Mdegela, Sarah White, Nynke van den Broek
Providing quality emergency obstetric care (EmOC) reduces the risk of maternal and newborn mortality and morbidity. There is evidence that over 50% of maternal health programmes that result in improving access to EmOC and reduce maternal mortality have an EmOC training component. The objective was to review the evidence for the effectiveness of training in EmOC. Eleven databases and websites were searched for publications describing EmOC training evaluations between 1997 and 2017. Effectiveness was assessed at four levels: (1) participant reaction, (2) knowledge and skills, (3) change in behaviour and clinical practice and (4) availability of EmOC and health outcomes...
May 5, 2019: Health Policy and Planning
Jody Harris
Stunted growth in children and multisectoral action to address it are dominant ideas in the international nutrition community today, and this study finds that these ideas are increasingly evident over time in nutrition policy in Zambia, with stunting largely displacing other framings of nutrition. This study is based on key informant interviews (70 interviews with 61 interviewees), policy document review, and social network mapping, with iterative data collection and analysis taking place over 6 years (2011-2016)...
April 21, 2019: Health Policy and Planning
Radha Adhikari, Jeevan Raj Sharma, Pam Smith, Address Malata
Malawi has a long history of receiving foreign aid, both monetary and technical support, for its health and other services provision. In the past two decades, foreign aid has increased, with the aim of the country being able to achieve its Millennium Development Goals by the end of 2015. It is currently moving towards achieving the sustainable development goals. Despite increased donor support, progress in the Malawian health service has remained very slow. This article discusses how trusting relationships amongst the stakeholders is vital in proper financial management, including of foreign aid and effective functioning of the health system in Malawi...
April 21, 2019: Health Policy and Planning
Eryn Eby, Tewoldeberhan Daniel, Olivia Agutu, Pedro Gonzalez Cortijo, Grainne Moloney
Integration of parallel health commodities supply chains into one national supply chain is becoming more common globally as national health systems are strengthened and organizations realize the potential for increased effectiveness and cost reduction from integration. UNICEF conducted a 10-week pilot to integrate its supply chain for nutrition commodities into the national Ministry of Health supply chain for medical commodities. This paper is a cost analysis of the integration process in two counties, comparing four scenarios of cost structures before, during and after integration...
April 19, 2019: Health Policy and Planning
Mishal S Khan, Anna Durrance-Bagale, Helena Legido-Quigley, Ana Mateus, Rumina Hasan, Julia Spencer, Johanna Hanefeld
Antimicrobial resistance (AMR) has recently emerged as a salient global issue, and policy formulation to address AMR has become a contested space, with various actors sharing competing-and sometimes contradictory-explanations of the problem and the range of possible solutions. To facilitate national policy setting and implementation around AMR, more needs to be done to effectively engage policymakers in low- and middle-income countries (LMICs). However, there is a dearth of research on differences in issue framing by external agencies and LMIC's national policymakers on the problem of AMR; such analyses are imperative to identify areas of conflict and/or potential convergence...
April 11, 2019: Health Policy and Planning
Isabelle Uny, Bregje de Kok, Suzanne Fustukian
To address its persistently high maternal mortality, the Malawi government has prioritized strategies promoting skilled birth attendance and institutional delivery. However, in a country where 80% of the population resides in rural areas, the barriers to institutional deliveries are considerable. As a response, Malawi issued Community Guidelines in 2007 that both promoted skilled birth attendance and banned the utilization of traditional birth attendants for routine deliveries. This grounded theory study used interviews and focus groups to explore community actors' perceptions regarding the implementation of this policy and the related affects that arose from its implementation...
April 2, 2019: Health Policy and Planning
Kun Tang, Yingxi Zhao
Civil wars, political conflicts, ethnic issues and stagnant social development have resulted in fragile health systems in Northeastern Myanmar. The healthcare provision continues to be fragile and inefficient, with prevalent health inequity. Limited service point, poor financial protection mechanism and gender-based inequity restrain the population's access to healthcare services, not to mention local authority's lacking participation in the making, implementation and evaluation of health policies. The issuance of the National Health Plan (NHP) 2017-2021 brought huge potential for the ethnic health organizations to strengthen the health system in ethnic regions...
April 2, 2019: Health Policy and Planning
Jorge Pacheco, Cristóbal Cuadrado, María Soledad Martínez-Gutiérrez
The aim of this study is to evaluate the impact of urgent care centres' (UCCs) implementation on emergency department (ED) and same-day visits in primary care in a Chilean public healthcare network. Quasi-experimental design study assessing changes in patient visits after UCC implementation in a local health district. Ten family health centres (FHC), nine UCCs and three EDs in the Talcahuano Health District, Chile. A total of 1 603 055 same-day visits to FHC, 1 528 319 visits to UCCs and 1 727 429 visits to EDs, monthly grouped, from 2008 to 2014...
April 2, 2019: Health Policy and Planning
Spencer Rutherford, Shadi Saleh
War and conflict negatively impact all facets of a health system; services cease to function, resources become depleted and any semblance of governance is lost. Following cessation of conflict, the rebuilding process includes a wide array of international and local actors. During this period, stakeholders must contend with various trade-offs, including balancing sustainable outcomes with immediate health needs, introducing health reform measures while also increasing local capacity, and reconciling external assistance with indigenous legitimacy...
March 30, 2019: Health Policy and Planning
Marta Schaaf, Stephanie M Topp
Informal payments for healthcare are widely acknowledged as undercutting health care access, but empirical research is somewhat limited. This article is a critical interpretive synthesis that summarizes the evidence base on the drivers and impact of informal payments in maternal health care and critically interrogates the paradigms that are used to describe informal payments. Studies and conceptual articles identified both proximate and systems drivers of informal payments. These include norms of gift giving, health workforce scarcity, inadequate health systems financing, the extent of formal user fees, structural adjustment and the marketization of health care, and patient willingness to pay for better care...
March 21, 2019: Health Policy and Planning
Mohammad Hifz Ur Rahman, Ashish Singh, Harilal Madhavan
Health system responsiveness (HSR) has been identified as one of the intrinsic goals of health systems for improvement in health and well-being of population. The HSR deals with the non-medical, legitimate expectations of a population in its interaction with the health system. It becomes essential in case of vulnerable groups like older adults with disability, who are more sensitive and risk-prone to the adversities of healthcare challenges. This paper uses data from the Study on Global Ageing and Adult Health conducted in China, Ghana, India, Mexico, Russia and South Africa during 2007-10 and examines the disability-based disparity in outpatient HSR among the older adults in the above-mentioned countries...
March 19, 2019: Health Policy and Planning
Carrie Brooke-Sumner, Petal Petersen-Williams, James Kruger, Hassan Mahomed, Bronwyn Myers
Building resilience in health systems is an imperative for low- and middle- income countries. Health service managers' ability to implement health innovations may be a key aspect of resilience in primary healthcare facilities, promoting adaptability and functionality. This study investigated health service managers' perceptions and experiences of adopting health innovations. We aimed to identify perceptions of constraints to adoption and emergent behaviours in response to these constraints. A convenience sample of 34 facility, clinical service and sub-district level managers was invited to participate...
March 12, 2019: Health Policy and Planning
Mardieh L Dennis, Lenka Benova, Timothy Abuya, Matteo Quartagno, Ben Bellows, Oona M R Campbell
This study explores the relationship between two health financing initiatives on women's progression through the maternal health continuum in Kenya: a subsidized reproductive health voucher programme (2006-16) and the introduction of free maternity services in all government facilities (2013). Using cross-sectional survey data, we ran three multivariable logistic regression models examining the effects of the voucher programme, free maternity policy, health insurance and other determinants on (1) early antenatal care (ANC) initiation (first visit within the first trimester of pregnancy), (2) receiving continuous care (1+ ANC, facility birth, 1+ post-natal care (PNC) check) and (3) completing the maternal health pathway as recommended (4+ ANC, facility birth, 1+ PNC, with first check occurring within 48 h of delivery)...
March 6, 2019: Health Policy and Planning
Andy Guise, James Ndimbii, Emmy Kageha Igonya, Frederick Owiti, Steffanie A Strathdee, Tim Rhodes
Integrating methadone and HIV care is a priority in many low- and middle-income settings experiencing a growing challenge of HIV epidemics linked to injecting drug use. There is as yet little understanding of how to integrate methadone and HIV care in these settings and how such services can be implemented; such a gap reflects, in part, limitations in theorizing an implementation science of integrated care. In response, we qualitatively explored the delivery of methadone after its introduction in Kenya to understand integration with HIV care...
February 20, 2019: Health Policy and Planning
Calvin Chiu, Nancy A Scott, Jeanette L Kaiser, Thandiwe Ngoma, Jody R Lori, Carol J Boyd, Peter C Rockers
Financial barriers cause many women in low- and middle-income countries to deliver outside of a health facility, contributing to maternal and neonatal mortality. Savings accrued during pregnancy can increase access to safe delivery services. We investigated the relationship between household saving during pregnancy and facility delivery. A cross-section of 2381 women who delivered a child in the previous 12 months was sampled from 40 health facility catchment areas across eight districts in three provinces in Zambia in April and May of 2016...
February 14, 2019: Health Policy and Planning
Mardieh L Dennis, Onikepe O Owolabi, Jenny A Cresswell, Nachela Chelwa, Manuela Colombini, Bellington Vwalika, Michael T Mbizvo, Oona M R Campbell
Several tools have been developed to collect information on health facility preparedness to provide sexual violence response services; however, little guidance exists on how this information can be used to better understand which functions a facility can perform. Our study therefore aims to propose a set of signal functions that provide a framework for monitoring the availability of clinical sexual violence services. To illustrate the potential insights that can be gained from using our proposed signal functions, we used the framework to analyse data from a health facility census conducted in Central Province, Zambia...
February 8, 2019: Health Policy and Planning
Stephen R Kodish, Aline Simen-Kapeu, Jean-Max Beauliere, Ismael Ngnie-Teta, Mohammed B Jalloh, Solade Pyne-Bailey, Helen Schwartz, James P Wirth
There are important lessons learned from the 2014-16 Ebola virus disease outbreak in West Africa. However, there has not been a systematic documentation of nutrition lessons specifically. Therefore, this study sought to generate multiple stakeholder perspectives for understanding the nutrition challenges faced during the Ebola virus disease outbreak, as well as for consensus building around improved response strategies. Participatory workshops with 17 and 19 participants in Guinea and Sierra Leone, respectively, were conducted in February 2017...
February 7, 2019: Health Policy and Planning
Jiwei Qian, Alex Jingwei He, Jason Dean-Chen Yin
The rapid diffusion of medical technologies is widely recognized as a key driver of healthcare cost escalation. The excessive duplication of technologies gives rise to the so-called medical arms race. Conventional wisdom tends to explain this phenomenon by external reimbursement mechanisms and hospitals' competitive strategies, but has largely neglected the role played by health regulations that may also affect hospitals' technology adoption decisions. This study sheds new light on the medical arms race with evidence from China, which has witnessed an unprecedented expansion of big tertiary hospitals and a keen pursuit of expensive medical technologies...
January 30, 2019: Health Policy and Planning
Connie A Haley, Marie A Brault, Kasonde Mwinga, Teshome Desta, Kenneth Ngure, Stephen B Kennedy, Margaret Maimbolwa, Precious Moyo, Sten H Vermund, Aaron M Kipp
Despite numerous international and national efforts, only 12 countries in the World Health Organization's African Region met the Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across sub-Saharan Africa, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia and Zambia were chosen to represent countries making substantial progress towards MDG#4, while Kenya and Zimbabwe represented countries making less progress...
January 29, 2019: Health Policy and Planning
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