International Journal of Health Policy and Management
Volume:8 Issue: 3, Mar 2019

Although leadership has been studied extensively, most research has focused on the political and military spheres. More recent work has also examined the role of leadership in sectors such as manufacturing and technology, both areas where it is essential to encourage and nurture innovation. Yet, in the health sector, where innovation is now high on the policy agenda in many countries, there is a paucity of research on how leadership can foster a culture of innovation. In this perspective, written for those seeking to foster innovation in the health sector, we offer a narrative synthesis approach of eight theories and concepts that have been empirically shown to support innovation through all phases of the innovation process.

Over the years, national and sub-national governments have introduced several initiatives to improve access to maternal and child health services in India. However, financial barriers have posed major constraints. Based upon the data of National Family Health Survey (NFHS) round 4 for Odisha state, our paper examines the out-of-pocket expenditure (OOPE) borne by households for accessing maternal and child healthcare services in a low resource setting of India. We have interpreted results of NFHS-4 by drawing inferences from literature for understanding the rising OOPE in the public health system. Findings suggests that OOPE is considerably high for maternal and child health conditions in Odisha and ranks fifth, despite the coverage of 72% women under Janani Suraksha Yojana (JSY), a condition cash transfer scheme with majority utilizing the public health system. The high OOPE on child delivery raises numerous pertinent questions about the effectiveness of the public health delivery system, and thus requires financial protection in the interest of the population that accesses public health systems in the state.

  Vietnam’s network of commune health centers (CHCs) have historically managed acute infectious diseases and implemented national disease-specific vertical programs. Vietnam has undergone an epidemiological transition towards non-communicable diseases (NCDs). Limited data exist on Vietnamese CHC capacity to prevent, diagnose, and treat NCDs. In this paper, we assess NCD service readiness, availability, and utilization at rural CHCs in 3 provinces in northern Vietnam.

Between January 2014 and April 2014, we conducted a cross-sectional survey of a representative sample of 89 rural CHCs from 3 provinces. Our study outcomes included service readiness, availability of equipment and medications, and utilization for five NCD conditions: hypertension, diabetes, chronic pulmonary diseases, cancer, and mental illnesses.

NCD service availability was limited, except for mental health. Only 25% of CHCs indicated that they conducted activities focused on NCD prevention. Patient utilization of CHCs was approximately 223 visits per month or 8 visits per day. We found a statistically significant difference (P < .05) for NCD service availability, medication availability and CHC utilization among the 3 provinces studied.

This is the first multi-site study on NCD service availability in Vietnam and the first study in a mountainous region consisting predominately of ethnic minorities. Despite strong government support for NCD prevention and control, Vietnam’s current network of CHCs has limited NCD service capacity.

United Nations’ (UN) data indicate that conflict-affected low- and middle-income countries (LMICs) contribute considerably to global maternal deaths. Maternal care usage patterns during conflict have not been rigorously quantitatively examined for policy insights. This study analysed associations between acute conflict and maternal services usage and quality in Egypt using reliable secondary data (as conflict-affected settings generally lack reliable primary data).

An uncontrolled before-and-after study used data from the 2014 Egypt Demographic and Health Survey (EDHS). The ‘pre-conflict sample’ included births occurring from January 2009 to January 2011. The ‘peri-conflict sample’ included births from February 2011 to December 2012. The hierarchical nature of demographic and household survey (DHS) data was addressed using multi-level modelling (MLM).

In total, 2569 pre-conflict and 4641 peri-conflict births were reported. After adjusting for socioeconomic variables, conflict did not significantly affect antenatal service usage. Compared to the pre-conflict period, peri-conflict births had slightly lower odds of delivery in public institutions (odds ratio [OR]: 0.987; 95% CI: 0.975-0.998; P < .05), institutional postnatal care (OR: 0.995; 95% CI: 0.98-1.00; P = .05), and at least 24 hours post-delivery stay (OR: 0.921; 95% CI: 0.906-0.935; P < .01). Peri-conflict births had relatively higher odds of doctor-assisted deliveries (OR: 1.021; 95% CI: 1.004-1.035; P < .05), institutional deliveries (OR: 1.022; 95% CI: 1.00-1.04; P < .05), private institutional deliveries (OR: 1.035; 95% CI: 1.017-1.05; P < .001), and doctor-assisted postnatal care (OR: 1.015; 95% CI: 1.003-1.027; P < .05). Sensitivity analysis did not change results significantly.

Maternal care showed limited associations with the acute conflict, generally reflecting pre-conflict usage patterns. Further qualitative and quantitative research could identify the effects of larger conflicts on maternal care-seeking and usage, and inform approaches to building health system resilience.

  Health apps are a booming, yet under-regulated market, with potential consumer harms in privacy and health safety. Regulation of the health app market tends to be siloed, with no single sector holding comprehensive oversight. We sought to explore this phenomenon by critically analysing how the problem of health app regulation is being presented and addressed in the policy arena.

We conducted a critical, qualitative case study of regulation of the Australian mental health app market. We purposively sampled influential policies from government, industry and non-profit organisations that provided oversight of app development, distribution or selection for use. We used Bacchi’s critical, theoretical approach to policy analysis, analysing policy solutions in relation to the ways the underlying problem was presented and discussed. We analysed the ways that policies characterised key stakeholder groups and the rationale policy authors provided for various mechanisms of health app oversight.

We identified and analysed 29 policies from Australia and beyond, spanning 5 sectors: medical device, privacy, advertising, finance, and digital content. Policy authors predominantly framed the problem as potential loss of commercial reputations and profits, rather than consumer protection. Policy solutions assigned main responsibility for app oversight to the public, with a heavy onus on consumers to select safe and high-quality apps. Commercial actors, including powerful app distributors and commercial third parties were rarely subjects of policy initiatives, despite having considerable power to affect app user outcomes.

A stronger regulatory focus on app distributors and commercial partners may improve consumer privacy and safety. Policy-makers in different sectors should work together to develop an overarching regulatory framework for health apps, with a focus on consumer protection.

The Disease Control Priorities (DCP) project has substantially influenced national and global health priorities since 1993. DCP’s basic framework involves identification of disease burdens based on premature deaths and disability and application of the most cost-effective interventions to the largest burdens, taking into account local feasibility. The future impact of DCP will need to take into account growing national wealth and needs for endogenous capacity to design and implement evidence-based interventions, the rapid emergence of non-communicable disease (NCD), and the universal health coverage (UHC) agenda. This in turn requires three improvements to the DCP framework: greater local capacity, supported by a global effort to cost health interventions, stronger national and international technical capacity and networks, and the use of direct, versus modelled, mortality data to assign priorities and to assess progress. Properly done, DCP could be as important over the next 25 years as it has been in the past 25 years.

The Disease Control Priorities (DCP) publications have pioneered new ways of thinking about investing in health. We agree with Norheim, that a useful first step to advance efforts to translate DCP’s global evidence into local health priorities, is to develop a clear Theory of Change (ToC). However, a ToC that aims to define how global evidence (DCP and others) can be used to inform national policy is too narrow an undertaking. We propose efforts should be directed towards developing a ToC to define how to support progressive institutional development to deliver on universal health coverage (UHC), putting the client at the center. Enhancing efforts to meet the new global health imperatives requires a shift in focus of attention to move radically from global to local. In order to achieve this we need to reorganize the nature of technical assistance (TA) along three major lines (1) examine and act to clarify the mandates and roles to be played by multilateral normative and convening agencies, (2) ensure detailed understanding of local institutions, their needs and their demands, and (3) provide TA over time and in trust with local counterparts. This last requirement implies the need for long-term local presence as well as an international network of expertise centers, to share scarce technical capabilities as well as to learn together across country engagements. Financing will need to be reorganized to incentivize and support demand-led capacity strengthening.

Over just a six-year period from 2005-2011, five aid effectiveness initiatives were launched: the Paris Declaration on Aid Effectiveness (2005), the International Health Partnership plus (2007), the Accra Agenda for Action (2008), the Busan Partnership for Effective Cooperation (2011), and the Global Partnership for Effective Development Cooperation (GPEDC) (2011). More recently, in 2015, the Addis Ababa Action Agenda (AAAA) was signed at the third international conference on financing for development and the Universal Health Coverage (UHC) 2030 Global Compact was signed in 2017. Both documents espouse principles of aid effectiveness and would most likely guide financing decisions in the Sustainable Development Goals (SDG) era. This is therefore a good moment to assess whether the aid effectiveness agenda made a difference in development and its relevance in the SDG era.

We are delighted to have received three responses to our recent paper ‘contextual factors influencing cost and quality decisions in health and care’1 and would like to revisit a few of the many interesting points raised... (Read more...)