International Journal of Health Policy and Management
Volume:10 Issue: 9, Sep 2021

Considering the coronavirus disease 2019 (COVID-19) pandemic, scholars were encouraged to cease collocated meetings. Many researchers have turned to remote collaboration to continue group-based projects. This paper focuses on the structure, processes, and outcomes that a group of physically distanced, embedded researchers used to collaborate across Canada to produce research outputs prior to the pandemic. The intent of this paper is to provide an overview of mechanisms that can facilitate meaningful and productive remote collaboration using online and digital technologies as a feasible and effective alternative mode of communication for research teams.

Healthcare systems across the globe are adopting patient-centred care (PCC) approach to empower patients in taking charge of their illnesses and improve the quality of care. Although models of patient‐centredness vary, respecting the needs and preferences of individuals receiving care is important. South Africa has implemented an integrated chronic disease management (ICDM) which has PCC component. The ICDM aims to empower chronic care patients to play an active role in disease management process, whilst simultaneously intervening at a community/ population and health service level. However, chronic care is still fragmented due to systemic challenges that have hindered the practice of PCC. In this article, we explore provider perspectives on PCC for patients with comorbid type 2 diabetes and HIV at a public tertiary hospital in urban South Africa. 

This study utilizes ethnographic methods, encompassing clinical observations, and qualitative interviews with healthcare providers (n = 30). Interview recordings were transcribed verbatim and data were analyzed inductively using a grounded theory approach.

Providers reported various ways in which they conceptualized and practiced PCC. However, structural challenges such as staff shortages, lack of guidelines for comorbid care, and fragmented care, and patient barriers such as poverty, language, and missed appointments, impeded the possibility of practicing PCC.

Health systems could be strengthened by: (i) ensuring appropriate multidisciplinary guidelines for managing comorbidities exist, are known, and available, (ii) strengthening primary healthcare (PHC) clinics by ensuring access to necessary resources that will facilitate successful integration and management of comorbid diabetes and HIV, (iii) training medical practitioners on PCC and structural competence, so as to better understand patients in their sociocultural contexts, and (iv) understanding patient challenges to effective care to improve attendance and adherence.

In low- and middle-income settings, many people with mental health problems cannot or do not access psychiatric services. Few studies of people with epilepsy and mental problems have evaluated the effectiveness of a predominantly psycho-social intervention, delivered by lay community workers. The aim of this study was to assess the effectiveness of a community-based complex mental health intervention within informal urban communities while simultaneously addressing social determinants of mental health among disadvantaged people with severe and common mental disorders (CMDs), and epilepsy.

In this observational, prospective cohort study set in Uttarakhand, India, the lay-worker led intervention included psychoeducation, behavioural activation, facilitation of access to care, and facilitated psycho-social support groups. Participants were categorised as having a severe or CMD or epilepsy and assessed 5 times over 24 months using primary outcome measures, including the Patient Health Questionnaire (PHQ9) (severity of depression), the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the Recovery Star, and scoring of a bespoke Engagement Index. Analysis included descriptive statistics as well as hierarchical linear regression models to report fixed effects as regression coefficients.

Among the 297 (baseline) participants only 96 people (31%) regularly used psychotropic medication (at least 4 weeks) and over 60% could not or did not consult a psychiatrist at all in the study period. Nonetheless, people with CMDs showed a significant reduction in their depression severity (PHQ9: B = -6.94, 95% CI -7.37 to -6.51), while people with severe mental disorders (SMDs) showed a significant reduction in their disability score (WHODAS 2.0: B = -4.86, 95% CI - 7.14 to- 2.57). People with epilepsy also reduced their disability score (WHODAS 2.0: B = -5.22, 95% CI -7.29 to -3.15).

This study shows significant improvements in mental health, depression, recovery, disability and social engagement for people with common and SMDs, and epilepsy, through a community-based intervention that was nonpharmaceutical. It provides preliminary evidence of the value of predominantly psycho-social interventions implemented by lay health workers among people with limited or no access to psychiatric services.

In low- and middle-income settings, many people with mental health problems cannot or do not access psychiatric services. Few studies of people with epilepsy and mental problems have evaluated the effectiveness of a predominantly psycho-social intervention, delivered by lay community workers. The aim of this study was to assess the effectiveness of a community-based complex mental health intervention within informal urban communities while simultaneously addressing social determinants of mental health among disadvantaged people with severe and common mental disorders (CMDs), and epilepsy.

In this observational, prospective cohort study set in Uttarakhand, India, the lay-worker led intervention included psychoeducation, behavioural activation, facilitation of access to care, and facilitated psycho-social support groups. Participants were categorised as having a severe or CMD or epilepsy and assessed 5 times over 24 months using primary outcome measures, including the Patient Health Questionnaire (PHQ9) (severity of depression), the World Health Organization Disability Assessment Schedule (WHODAS 2.0), the Recovery Star, and scoring of a bespoke Engagement Index. Analysis included descriptive statistics as well as hierarchical linear regression models to report fixed effects as regression coefficients.

Among the 297 (baseline) participants only 96 people (31%) regularly used psychotropic medication (at least 4 weeks) and over 60% could not or did not consult a psychiatrist at all in the study period. Nonetheless, people with CMDs showed a significant reduction in their depression severity (PHQ9: B = -6.94, 95% CI -7.37 to -6.51), while people with severe mental disorders (SMDs) showed a significant reduction in their disability score (WHODAS 2.0: B = -4.86, 95% CI - 7.14 to- 2.57). People with epilepsy also reduced their disability score (WHODAS 2.0: B = -5.22, 95% CI -7.29 to -3.15).

This study shows significant improvements in mental health, depression, recovery, disability and social engagement for people with common and SMDs, and epilepsy, through a community-based intervention that was nonpharmaceutical. It provides preliminary evidence of the value of predominantly psycho-social interventions implemented by lay health workers among people with limited or no access to psychiatric services.

Cost is a major barrier to maternal health service utilisation for many women in low- and middle-income countries (LMICs). However, comparable evidence of the available cost data in these countries is limited. We conducted a systematic review and comparative analysis of costs of utilising maternal health services in these settings.

We searched peer-reviewed and grey literature databases for articles reporting cost of utilising maternal health services in LMICs published post-2000. All retrieved records were screened and articles meeting the inclusion criteria selected. Quality assessment was performed using the relevant cost-specific criteria of the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. To guarantee comparability, disaggregated costs data were inflated to 2019 US dollar equivalents. Total adjusted costs and cost drivers associated with utilising each service were systematically compared. Where heterogeneity in methods or non-disaggregated costs was observed, narrative synthesis was used to summarise findings.

Thirty-six studies met our inclusion criteria. Many of the studies costed multiple services. However, the most frequently costed services were utilisation of normal vaginal delivery (22 studies), caesarean delivery (13), and antenatal care (ANC) (10). The least costed services were post-natal care (PNC) and post-abortion care (PAC) (5 each). Studies used varied methods for data collection and analysis and their quality ranged from low to high with most assessed as average or high. Generally, across all included studies, cost of utilisation progressively increased from ANC and PNC to delivery and PAC, and from public to private providers. Medicines and diagnostics were main cost drivers for ANC and PNC while cost drivers were variable for delivery. Women experienced financial burden of utilising maternal health services and also had to pay some unofficial costs to access care, even where formal exemptions existed.

Consensus regarding approach for costing maternal health services will help to improve their relevance for supporting policy-making towards achieving universal health coverage. If indeed the post-2015 mission of the global community is to “leave no one behind,” then we need to ensure that women and their families are not facing unnecessary and unaffordable costs that could potentially tip them into poverty.

This commentary considers the impact of the coronavirus disease 2019 (COVID-19) pandemic on the study of populist radical right (PRR) politicians and their influence on public health and health policy. A systematic review of recent research on the influence of PRR politicians on the health and welfare policies shows that health is not a policy arena that these politicians have much experience in. In office, their effects can be destructive, primarily because they subordinate health to their other goals. Brazil, the US and the UK all show this pattern. PRR politicians in opposition such as the Freedom Party of Austria (FPÖ) in Austria or the Lega in Italy, said very little during the actual health crisis, but once the public no longer appeared afraid they lost no time in reactivating anti-European Union (EU) sentiments. Whether in government or in opposition, PRR politicians opted for distraction and denial. Their effects ranged from making the pandemic worse.

In this short commentary, we examine the implications of the welfare chauvinism of the populist radical right (PRR) for health inequalities by examining the international evidence about the impact of previous periods of welfare state contraction on population health and health inequalities. We argue that parties from various political traditions have in fact long engaged in stigmatisation of welfare recipients to justify welfare state retrenchment, a technique that the PRR have now ‘weaponised.’ We conclude by reflecting on implications of the rise of the PRR for the future of welfare states and health inequalities in the context of coronavirus disease 2019 (COVID-19).

This commentary focuses on Latin America, a region known for its rich variety of populist politicians and some of the most extensive welfare states in the Global South. Contemporary Latin America offers examples of left-wing and right-wing populist leaders, none of whom demonstrate the same focus on excluding immigrants from welfare state benefits as that noted by Chiari Rinaldi and Marleen Bekker in the European context. We see this contrast not because immigrants’ access to health services is less important in Latin America, but because Latin American populists are more focused on internal “enemies.” The commentary concludes with observations regarding Latin American populist leaders’ handling of the Coronavirus disease 2019 (COVID-19) pandemic.

Based on a scoping review of empirical studies accompanied by interviews with experts, Rinaldi and Bekker studied the impact of populist radical right (PRR) parties on access to welfare provisions – the latter standing proxy for population health and for health inequalities in particular. We argue that populism can impact on migrant and ethnic minority health in multiple ways, in addition to the welfare mechanism specified in that review. These include institutionalised discrimination affecting individuals’ positions in the social hierarchy, experiences of discrimination in interpersonal relationships, and a weakened legitimacy of health policies. Interdisciplinary teams that include public health scholars and political scientists should take up the challenge of understanding migrant and ethnic minority health from a systems perspective.

Rinaldi and Bekker ask whether populist radical right (PRR) parties have an influence on population health and health equity. The assumption is that this influence is negative, but mediated by political system characteristics. Starting from the authors’ premise that the positions of PRR parties on welfare policies are a good proxy for health outcomes, we build on political science literature to suggest further avenues for research. The equivocal relationship between political parties and the ownership of specific healthcare, health insurance and public health issues invites studies that break down party positions relating to different health policy issues. As policy-makers use social representations of target populations to make policy decisions and anticipate the feedback these decisions might generate, it is worth studying how PRR parties influence societal, institutional and partisan perceptions of deserving and undeserving populations, even when they are not in government.

To what extent has the rise of populist radical right (PRR) parties in Europe affected welfare policies? Based on a scoping review of studies that address the relationship between PRR parties and welfare policy, Chiara Rinaldi and Marleen Bekker conclude that, due to their welfare chauvinistic positions, the participation of PRR parties in government coalitions is likely to have negative effects on the access to welfare provisions and health of vulnerable population groups. This short commentary reflects on this review article and critically examines its conclusion. It suggests some conceptual clarifications, raises some reservations about the review’s main claim, and provides some follow-up questions.

In this commentary, we reflect on Rinaldi and Bekker’s scoping review of the literature on populist radical right (PRR) parties and welfare policies. We argue that their review provides political scientists and healthcare scholars with a firm basis to further explore the relationships between populism and welfare policies in different political systems. In line with the authors, we furthermore (re)emphasize the need for additional empirical inquiries into the relationship between populism and healthcare. But instead of expanding the research agenda suggested – for instance by adding categories or niches in which this relationship can be observed – we would like to challenge some of the premises of the studies conducted and reviewed thus far. We do so by identifying two concerns and by illustrating these concerns with two examples from the Netherlands.