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Health Policy and Management - Volume:10 Issue: 10, Oct 2021

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

  • تاریخ انتشار: 1400/07/09
  • تعداد عناوین: 12
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  • Lukoye Atwoli, Abdullah H. Baqui, Thomas Benfield, Raffaella Bosurgi, Fiona Godlee, Stephen Hancocks, Richard Horton, Laurie Laybourn Langton *, Carlos Augusto Monteiro, Ian Norman, Kirsten Patrick, Nigel Praities, Marcel GM Olde Rikkert, Eric J. Rubin, Peush Sahni, Richard Smith, Nicholas J. Talley, Sue Turale, Damián Vázquez Pages 602-604
  • Sara Campagna, Alberto Borraccino *, Gianfranco Politano, Alfredo Benso, Marco Dalmasso, Valerio Dimonte, Maria Michela Gianino Pages 605-612
    BackgroundAllowing patients to remain at home and decreasing the number of unnecessary emergency room visits have become important policy goals in modern healthcare systems. However, the lack of available literature makes it critical to identify determinants that could be associated with increased emergency department (ED) visits in patients receiving integrated home care (IHC). MethodsA retrospective observational study was carried out in a large Italian region among patients with at least one IHC event between January 1, 2012 and December 31, 2017. IHC is administered from 8 am to 8 pm by a team of physicians, nurses, and other professionals as needed based on the patient’s health conditions. A clinical record is opened at the time a patient is enrolled in IHC and closed after the last service is provided. Every such clinical record was defined as an IHC event, and only ED visits that occurred during IHC events were considered. Sociodemographic, clinical and IHC variables were collected. A multivariate, stepwise logistic analysis was then performed, using likelihood of ED visit as a dependent variable. ResultsA total of 29 209 ED visits were recorded during the 66 433 IHC events that took place during the observation period. There was an increased risk of ED visits in males (odds ratio [OR] = 1.29), younger patients, those with a family caregiver (OR = 1.13), and those with a higher number of cohabitant family members. Long travel distance from patients’ residence to the ED reduced the risk of ED visits. The risk of ED visits was higher when patients were referred to IHC by hospitals or residential facilities, compared to referrals by general practitioners. IHC events involving patients with neoplasms (OR = 1.91) showed the highest risk of ED visits. ConclusionEvidence of sociodemographic and clinical determinants of ED visits may offer IHC service providers a useful perspective to implement intervention programmes based on appropriate individual care plans and broad-based client assessment.
    Keywords: Emergency Department Visits, Integrated Home Care, Administrative Health Data, Risk Factors, Retrospective Study Italy, Ethical Issues
  • Belinda Townsend *, Sharon Friel, Ashley Schram, Fran Baum, Ronald Labonté Pages 613-624
    BackgroundDespite greater attention to the nexus between trade and investment agreements and their potential impacts on public health, less is known regarding the political and governance conditions that enable or constrain attention to health issues on government trade agendas. Drawing on interviews with key stakeholders in the Australian trade domain, this article provides novel insights from policy actors into the range of factors that can enable or constrain attention to health in trade negotiations. MethodsA qualitative case study was chosen focused on Australia’s participation in the Trans-Pacific Partnership (TPP) negotiations and the domestic agenda-setting processes that shaped the government’s negotiating mandate. Process tracing via document analysis of media reporting, parliamentary records and government inquiries identified key events during Australia’s participation in the TPP negotiations. Semi-structured interviews were undertaken with 25 key government and non-government policy actors including Federal politicians, public servants, representatives from public interest nongovernment organisations and industry associations, and academic experts. ResultsInterviews revealed that domestic concerns for protecting regulatory space for access to generic medicines and tobacco control emerged onto the Australian government’s trade agenda. This contrasted with other health issues like alcohol control and nutrition and food systems that did not appear to receive attention. The analysis suggests sixteen key factors that shaped attention to these different health issues, including the strength of exporter interests; extent of political will of Trade and Health Ministers; framing of health issues; support within the major political parties; exogenous influencing events; public support; the strength of available evidence and the presence of existing domestic legislation and international treaties, among others. ConclusionThese findings aid understanding of the factors that can enable or constrain attention to health issues on government trade agendas, and offer insights for potential pathways to elevate greater attention to health in future. They provide a suite of conditions that appear to shape attention to health outside the biomedical health domain for further research in the commercial determinants of health.
    Keywords: Agenda-Setting, Trade Policy, Governance, Non-communicable Disease, Health Policy
  • August Kuwawenaruwa *, Fabrizio Tediosi, Emmy Metta, Brigit Obrist, Karin Wiedenmayer, Vicky Sidney Msamba, Kaspar Wyss Pages 625-637

    BackgroundPharmaceutical supply chain management in low- and middle-income countries has received substantial attention to address the shortage of medicines at peripheral facilities. The focus has been on health system interventions, including the establishment of public-private partnerships (PPPs). In 2014, the United Republic of Tanzania began implementing the Jazia prime vendor system (Jazia PVS) with a contracted private wholesale supplier to complement the national medicines supply chain in public facilities. Few studies have investigated the acceptability of such a prime vendor system. This study analyses factors that contributed to the acceptability of Jazia PVS introduced in Tanzania. We used qualitative analytical methods to study experiences of Jazia PVS implementers in 4 districts in mid-2018. MethodsData were drawn from 14 focus group discussions (FGDs), 7 group discussions (GDs) and 30 in-depth interviews (IDIs) with a range of actors involved in Jazia PVS. The study analysed 7 acceptability dimensions as defined in the acceptability framework by Sekhon et al. Framework analysis was adopted to summarise the results using a deductive and an inductive approach. ResultsThe findings show that participants’ acceptability of Jazia PVS was influenced by the increased availability of essential medicines at the facilities, higher order fulfilment rates, and timely delivery of the consignment. Furthermore, acceptability was also influenced by the good reputation of the prime vendor, close collaboration with district managers, and participants’ understanding that the prime vendor was meant to complement the existing supply chain. Intervention coherence, experienced opportunity cost and intervention burden, affective attitude and self-efficacy were also important in explaining the acceptability of the Jazia PVS. ConclusionIn conclusion, the most critical factor contributing to the acceptability of the Jazia PVS was the perceived effectiveness of the system in achieving its intended purpose. Districts purchasing directly from the prime vendor have a policy based on the possibility to increase availability of essential medicines at peripheral facilities in a low income setting; however, it is crucial to select a reputable and competent vendor, as well as to abide by the contractual agreements.

    Keywords: Acceptability, Supply Chain, Prime Vendor, Tanzania
  • Ffion Lloyd Williams *, Rebecca Masters, Lirije Hyseni, Emily St. Denny, Martin O’Flaherty, Simon Capewell Pages 638-646

    BackgroundNon-communicable diseases (NCDs) account for some 90% of premature UK deaths, most being preventable. However, the systems driving NCDs are complex. This complexity can make NCD prevention strategies difficult to develop and implement. We therefore aimed to explore with key stakeholders the upstream policies needed to prevent NCDs and related inequalities. MethodsWe developed a theory-based co-production process and used a mixed methods approach to engage with policy- and decision-makers from across the United Kingdom in a series of 4 workshops, to better understand and respond to the complex systems in which they act. The first and fourth workshops (London) aimed to better understand the public health policy agenda and effective methods for co-production, communication and dissemination. In workshops 2 and 3 (Liverpool and Glasgow), we used nominal group techniques to identify policy issues and equitable prevention strategies, we prioritised emerging policy options for NCD prevention, using the MoSCoW approach. ResultsWe engaged with 43 diverse stakeholders. They identified ‘healthy environment’ as an important emerging area. Reducing NCDs and inequalities was identified as important, underpinned by a frustration relating to the evidence/policy gap. Evidence for NCD risk factor epidemiology was perceived as strong, the evidence underpinning the best NCD prevention policy interventions was considered patchier and more contested around the social, commercial and technological determinants of health. A comprehensive communications strategy was considered essential. The contribution of ‘elite actors’ (ministers, public sector leaders) was seen as key to the success of NCD prevention policies. ConclusionsNCDs are generated by complex adaptive systems. Early engagement of diverse stakeholders in a theory-based co-production process can provide valuable context and relevance. Subsequent partnership-working will then be essential to develop, disseminate and implement the most effective NCD prevention strategies.

    Keywords: Co-production, Policy, Inequalities, Public Health, NCDs
  • Bernard Hope Taderera * Pages 647-649
    The study of healthcare personnel migration in Ireland reports that most medical graduates plan to leave the country’s health system. It may be possible to address this challenge by understanding and addressing the reasons why young doctors plan to leave. Future studies should contribute to the retention of early career doctors in high-income countries such as Ireland. This will help reduce the migration of doctors from low- and middle-income countries in order to address the global health workforce crisis and its impact on the attainment of universal health coverage in all health systems.
    Keywords: Health Personnel, Policy, Retention, Migration, Ireland
  • Gozie Offiah *, Frank Murray, Consilia Walsh Pages 650-653
    The issue of doctor retention has been a challenge in Ireland for many years. Poor working conditions including poor supervision, cost of training, bullying, worsening mentoring experiences and speciality specific issues are a substantial challenge faced by doctors in Ireland, thus leading to a higher degree of emigration. While some changes have been introduced to the system and have some positive effects, the root causes of doctor emigration have not been addressed. This commentary reviews the publication by Brugha et al published in the IJHPM in April 2020 on “Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle” and explains why the current system needs to change for the benefit of patient safety, doctor well-being and better patient care. Ireland’s Health Service Executive intends to take steps towards developing a new model of medical workforce to address the issue of recruitment and retention challenges within the healthcare system.
    Keywords: Workforce, Doctor Retention, Migration, WHO Global Code, Ireland, Training
  • John Connell * Pages 654-657
    The recent study of prospective doctor migration and retention suggests that more than half of junior doctors intend to migrate from Ireland. While intent is not necessarily outcome, such intentions match similar survey results in Ireland and elsewhere. The rationale for migration is described as a function of difficult workplace circumstances (notably long hours and mismanagement). Lifestyle factors may however also be important for both migration and significant levels of return migration. These are related to family formation, and to an established culture of migration, that has contributed to a considerable circularity of mobility and migration, primarily between Anglophone countries. International migration may also have unspecified regional variations and impacts. Migration has taken a similar form for half a century and longstanding policies to constrain its more damaging impacts have been conspicuously unsuccessful yet responses remain urgent.
    Keywords: Doctors, Migration, Workplaces, Livelihoods, Ireland, Policy
  • Guillaume Chevillard * Pages 658-659
    In a context of global shortage of doctors, Ireland is in a paradoxical situation: the country trained a lot of medical students, native or foreign, but has difficulties to retain them. The paper of Brugha and his colleagues analyzes junior doctors’ migration intentions, the reasons they leave, the likelihood of them returning and the characteristics of those who plan to emigrate. Results show determinants of junior doctor’s emigration and may be useful to better calibrate the doctors’ retention strategy of Ireland.
    Keywords: Workforce, Doctor Retention, Migration, WHO Global Code, Ireland, Training
  • Akhenaten Siankam Tankwanchi *, Amy Hagopian, Sten H. Vermund Pages 660-663
    Research in assessing the global and asymmetric flows of health workers in general, and international medical graduates in particular, is fraught with controversy. The complex goal of improving health status of the citizens of home nations while ensuring the right of health workers to migrate generates policy discussions and decisions that often are not adequately informed by evidence. In times of global public health crises like the current coronavirus disease 2019 (COVID-19) global pandemic, the need for equitable distribution and adequate training of health workers globally becomes even more pressing. Brugha et al report suboptimal training and working conditions among Irish and foreign medical doctors practicing in Ireland, while predicting large-scale outward migration. We comment on health personnel migration and retention based on our own experience in this area of research. Drawing from our examination of medical migration dynamics from sub-Saharan Africa, we argue for greater consideration of health workforce retention in research and policy related to resource-limited settings. The right to health suggests the need to retain healthcare providers whose education was typically subsidized by the home nation. The right to migrate may conflict with the right to health. Hence, a deeper understanding is needed as to healthcare worker motives based on interactions of psychosocial processes, economic and material determinants, and quality of work environments.
    Keywords: Global Labor Mobility, Health Workforce Migration, Health Personnel Retention, Right to Health, Freedom of Movement, Sub-Saharan Africa
  • Daniel R. Arnold * Pages 664-666
    Brugha et al provide convincing evidence that Ireland stills need to overcome many hurdles, including poor training and working experiences in Irish hospitals, before it can significantly improve its record on doctor retention. The findings reported by Brugha et al are particularly disappointing in light of the fact that Ireland implemented a doctor retention strategy in early 2015. Ultimately, doctor retention is important because it can help alleviate the health workforce shortages that many countries face currently and that are projected to worsen over the next decade. The purpose of this commentary is to highlight two additional strategies for alleviating health workforce shortages – expanding medical education and task shifting.
    Keywords: Doctor Retention, Medical Education, Task Shifting, Ireland
  • Latha S. Davda *, David R. Radford, Jennifer E. Gallagher Pages 667-669
    Medical education and training of health professionals are linked with their recruitment and retention. Practising as a competent health professional requires life-long continuous training and therefore training structures in health systems appear to influence doctors job satisfaction, their well-being and their intentions to remain in that health system. The commentary critiques aspects of the paper on doctors retention in Ireland, while drawing some parallels with the United Kingdom. There appears to be an emerging type of health professional migrants ‘education tourists’ who travel to other countries to obtain medical education creating new routes of migration and this presents new challenges to source and destination countries. The global shortage of doctors and other health professionals further exacerbates health inequalities as seen in the present pandemic and therefore the increased need for research into health professionals’ migration and their integration.
    Keywords: Retention, Migration Motivation, International Recruitment