جستجوی مقالات مرتبط با کلیدواژه "reform" در نشریات گروه "پزشکی"

This commentary expresses appreciation for Professor Labonté’s work, along with some hopefully constructive suggestions. Professor Labonté’s editorial shows ambivalence about reforms within capitalism. Such reforms remain contradictory and unlikely to prevail. Transformation to post-capitalist political economies is an exciting focus of moving beyond the hurtful effects of capitalism. Can “the state … mitigate capitalism’s inherent inegalitarianism”? Problematically, government resides in the capitalist state, whose main purpose is to protect the capitalist economic system. The state’s contradictory characteristics manifest in inadequate measures to protect health, as during the COVID-19 pandemic. “Social determination,” referring to illness-generating structures of power and finance, is replacing “social determinants,” referring mainly to demographic variables. Problems warranting attention include: capitalist industrial agriculture causing pandemics through destruction of protective natural habitat, structural racism, sexism and social reproduction, social class structure linked to inequality, and expropriation of nature to accumulate capital. Transformation to post-capitalism involves creative construction of new solidarity economies, while creative destructions block smooth functioning of the capitalist system.

Since 1995, the Ethiopian health system has been managed through decentralizing functions, resources, and authorities to local levels. As a result, health centers are led and managed by governing boards. In addition, the national health system strives to transform the performance of health centers through the implementation of reforms. Therefore, this study aims to examine the relationship between governing board functions and health center performances within a health reform context in 4 agrarian regions of Ethiopia.

A cross-sectional survey was conducted from August 28, 2018 to September 30, 2018. Primary data were collected from governing board chairpersons or their designees using interviewer-administered structured questionnaires. The performance of each health center was rated out of 100 percentage points against the Ethiopian Health Center Reform Guideline (EHCRIG) standards. Secondary data were abstracted from a routine health information database using customized tools to capture achievements on 69 EHCRIG standards and its 174 validation criteria. Since the data violate the assumptions of the parametric test, the Spearman’s rank (rho) correlation test, (a non-parametric test) was employed to see if any correlation exists among 4 parameters; namely: structure, roles and responsibilities, training and development of governing boards, and performance of health centers against EHCRIGs standards. A statistically significant relationship was claimed at P < .050.

All 83 health center governing boards or designees who were approached for this study, participated. The mean health center governing board function score with standard deviation was 56.0% (SD ± 14.5%). The overall performance of health centers against EHCRIGs was 70.4% (SD ± 15.0%). There was a statistically significant and strong correlation (Spearman rho correlation coefficient) between health center performance scores measured against reform standards with governing board scores of (rho = 0.866, P < .001) and overall governance scores (rho = 0.828, P < .001).

Based on the results of this study, we can conclude that well-functioning health center governing boards can improve the performance of health centers against clinical, and management reform standards. Therefore, continuous strengthening of the capacity of governing boards, focusing on improving implementation of their roles and responsibilities, and continuing training on business management is recommended.

Health transformation plan (HTP) in Iran was established in 2014 to promote primary health care through expanding and strengthening the first level of services in urban and rural areas. The activities of physicians and their colleagues in comprehensive health service centers have increased access and improved community health. Conducting various studies on the urban physicians’ roles can help policymakers achieve the goals.

This study aimed to explain the role of physicians working in urban, comprehensive health service centers after implementing the HTP.

Participants in this qualitative study consisted of physicians, healthcare providers, managers, and experts, working in urban health centers selected by a purposive sampling method. The data were collected by semi-structured interviews. After data saturation, they were analyzed by conventional content analysis.

After interviewing 35 people and several stages of review, coding, and using the experience of experts, the data were classified into six main categories, 11 subcategories, and 33 codes. Factors influencing the role of physicians were service delivery, electronic health records, resources, community culture, monitoring, supervision, and practical suggestion. The participants expressed the workload, referral system, integrated electronic health record, financial resources, human resources, equipment, and public participation as some aspects related to the role of physicians.

Based on the current study, human and financial resources should be managed to retain the physicians in this plan. In addition, increasing the quality of services, improving electronic health records, and attention to public culture can be considered.

Integration is accepted as an important strategy in medical education and its final results depend on organizing different topics. In this method, the subjects (based on content) which are often included separately in a curriculum, are integrated in order to link and combine the content of the curriculum to create a cohesive learning experience. Development of this method is among the objectives of the medical education reform.

The present applied cross-sectional study was performed on a statistical population (n=602) consisting of general medicine students of Mashhad University of Medical Sciences at the level of basic sciences. The participants were selected using the census sampling method and included 150 and 130 students who were admitted in February 2017 (the reformed curriculum) and in February 2016 (the conventional curriculum), respectively. The curriculums were compared in terms of learning outcomes and the number of vulnerable students. Moreover, the research hypotheses were tested using the independent t-test and chi-square test in SPSS software (version 22).

Based on the findings, with 95% confidence, the learning outcomes of the students who followed the reformed curriculum were better than those of the students who followed the conventional curriculum. According to the analysis of the collected data, the mean learning outcomes for the conventional and the reformed curriculum groups were 14.30±3.28 and 16.76±2.80 for the subject of anatomy, 14.10±2.62 and 15.13±2.93 for the subject of physiology, and 14.35±3.13 and 15.44±2.85 for the subject of biochemistry. However, no significant difference was observed in the number of vulnerable students in two groups.

Based on the findings, basic sciences curriculum reform in medical education can improve the academic achievement of the general medicine students.

The Islamic revolution of 1979 in Iran emphasized social justice as a pillar for development. The fundamental steps towards universal equitable access to high-quality healthcare services began with the creation of the Ministry of Health and Medical Education (MoHME) and the nationwide establishment of primary healthcare (PHC) network in 1985. Now, in the 40th anniversary of the Islamic revolution, the history of health system development in Iran is characterized by constant policy changes; i.e. structural and procedural transformations. Ever since and despite the imposed 8-year war with Iraq and continuous unfair sanctions against the country, noticeable progress has been achieved in the health system that has led to better population health including among others: self-sufficiency in training health workforce; advances in public health and medical sciences; establishment and expansion of health facilities within the hard-to-reach areas aiming to enhance equity in access to needed healthcare services; domestic production of most medicines and medical equipment; and meaningful expansion of health insurance coverage. These have led to admirable improvement in public health indicators; i.e. maternal mortality, child mortality, life expectancy, and vaccination coverage. Despite achievements, there still remain challenges in health financing, protecting the public against high expenditure of medical care, establishment of referral system and rationalization of service utilization, provision of high quality healthcare services to all in need, and conflict of interest in health policy making, all of which may hinder the goal to reach "universal health coverage", identified as the main goal of the health system in Iran by 2025. Recently, the MoHME began structural and functional reforms to boost societal efforts and enhance intersectoral collaboration to address social determinants of health, improve actions for prevention and control of non-communicable diseases and other social health problems. Drawing upon the World Health Organization (WHO)’s "six building blocks" model, this article presents an analytical description of the main health policy reforms during the last four decades after the Islamic revolution in Iran, divided by each decade. Learning from the historical reforms will create, we envisage, a better understanding of health system developments, its advances and challenges, which might in turn contribute to better evidence-informed policy making and sustainable health development in the country, and perhaps beyond.