Development Of National Health Policies Research Articles

Economic evaluations of maternal health interventions: a scoping review.

Background Evidence on the affordability and cost-effectiveness of interventions is critical to decision-making for clinical practice guidelines and development of national health policies. This study aimed to develop a repository of primary economic evaluations to support global maternal health guideline development and provide insights into the body of research conducted in this field. Methods A scoping review was conducted to identify and map available economic evaluations of maternal health interventions. We searched six databases (NHS Economic Evaluation Database, EconLit, PubMed, Embase, CINAHL and PsycInfo) on 20 November 2020 with no date, setting or language restrictions. Two authors assessed eligibility and extracted data independently. Included studies were categorised by subpopulation of women, level of care, intervention type, mechanism, and period, economic evaluation type and perspective, and whether the intervention is currently recommended by the World Health Organization. Frequency analysis was used to determine prevalence of parameters. Results In total 923 studies conducted in 72 countries were included. Most studies were conducted in high-income country settings (71.8%). Over half pertained to a general population of pregnant women, with the remainder focused on specific subgroups, such as women with preterm birth (6.2%) or those undergoing caesarean section (5.5%). The most common interventions of interest related to non-obstetric infections (23.9%), labour and childbirth care (17.0%), and obstetric complications (15.7%). Few studies addressed the major causes of maternal deaths globally. Over a third (36.5%) of studies were cost-utility analyses, 1.4% were cost-benefit analyses and the remainder were cost-effectiveness analyses. Conclusions This review provides a navigable, consolidated resource of economic evaluations in maternal health. We identified a clear evidence gap regarding economic evaluations of maternal health interventions in low- and middle-income countries. Future economic research should focus on interventions to address major drivers of maternal morbidity and mortality in these settings.

Economic evaluations of maternal health interventions: a scoping review

Background Evidence on the affordability and cost-effectiveness of interventions is critical to decision-making for clinical practice guidelines and development of national health policies. This study aimed to develop a repository of primary economic evaluations to support global maternal health guideline development and provide insights into the body of research conducted in this field. Methods A scoping review was conducted to identify and map available economic evaluations of maternal health interventions. We searched six databases (NHS Economic Evaluation Database, EconLit, PubMed, Embase, CINAHL and PsycInfo) on 20 November 2020 with no date, setting or language restrictions. Two authors assessed eligibility and extracted data independently. Included studies were categorised by subpopulation of women, level of care, intervention type, mechanism, and period, economic evaluation type and perspective, and whether the intervention is currently recommended by the World Health Organization. Frequency analysis was used to determine prevalence of parameters. Results In total 923 studies conducted in 72 countries were included. Most studies were conducted in high-income country settings (71.8%). Over half pertained to a general population of pregnant women, with the remainder focused on specific subgroups, such as women with preterm birth (6.2%) or those undergoing caesarean section (5.5%). The most common interventions of interest related to non-obstetric infections (23.9%), labour and childbirth care (17.0%), and obstetric complications (15.7%). Few studies addressed the major causes of maternal deaths globally. Over a third (36.5%) of studies were cost-utility analyses, 1.4% were cost-benefit analyses and the remainder were cost-effectiveness analyses. Conclusions This review provides a navigable, consolidated resource of economic evaluations in maternal health. We identified a clear evidence gap regarding economic evaluations of maternal health interventions in low- and middle-income countries. Future economic research should focus on interventions to address major drivers of maternal morbidity and mortality in these settings.

Incidence and Risk Factors for Pregnancy-Related de Quervain's Tenosynovitis in South Korea: A Population-Based Epidemiologic Study.

Although pregnant or lactating women have been recognized to be predisposed to de Quervain's tenosynovitis (DQT), there is a lack of epidemiologic evidence. The purpose of this study was to estimate the nationwide incidence of pregnancy-related DQT (PRDQT) and to analyze risk factors using the Korean National Health Insurance (NHI) database. A retrospective epidemiologic study of pregnant women in South Korea from 2013 to 2017 was conducted using the NHI claims database. Using corresponding diagnostic codes, we identified women diagnosed with DQT during pregnancy or the postpartum period. We calculated the cumulative incidence and analyzed risk factors such as demographics, pregnancy type, delivery method, gestational complications, and comorbidities using multivariate logistic regression analysis. Between 2013 and 2017, 34,342 patients with PRDQT were identified among 1,601,501 pregnant women, representing a cumulative incidence of approximately 2.1%. Age ≥ 30 years, multiple gestation, cesarean delivery, hypertensive disorders in pregnancy, and underlying rheumatoid arthritis were all identified as significant risk factors for the occurrence of PRDQT, whereas diabetic disorders in pregnancy and underlying diabetes mellitus were not. In South Korea, PRDQT was found to affect approximately 2.1 out of 100 pregnant women between 2013 and 2017. The incidence and risk factors identified in this study can be used for clinical consultations and prediction, as well as for development of national health policies.

Family Medicine Academic Workforce of Medical Schools in Taiwan: A Nationwide Survey

Little is known about family medicine academic workforce in Taiwan, and basic data on this may aid healthcare decision-makers and contribute to the limited literature. We analyzed data from 13 medical schools in Taiwan collected by the Taiwan Association of Family Medicine from June to September 2019, regarding characteristics of medical schools, and total staff, gender, age, degree, working title (adjunct/full-time), academic level, and subspecialty of each current family medicine faculty member. Total 13 medical schools in Taiwan with an undergraduate education program in family medicine, but only nine of the 13 medical schools had family medicine departments, while four still do not. A total of 116 family medicine faculty members ranging from 33–69 years. Of these, most were male (n = 85, 73.3%), with a mean age of 43.3 years. Most faculty members possessed a master’s degree (n = 49, 42.2%), were academic lecturers (n = 49, 42.2%), were located in northern Taiwan (n = 79, 68.1%), and subspecialize in gerontology and geriatrics (n = 55, 47.4%) and hospice palliative care (n = 53, 45.7%). Additionally, most family medicine faculty in medical schools were adjunct faculty (n = 90, 77.6%), with only about one-fourth (n = 26, 22.4%) working full-time. Our study provides the most holistic census to date on academic family medicine faculty from all medical schools in Taiwan. The novel information can provide educational leaders, health policy managers, and decision-makers about the current developments of the family medicine departments in Taiwan’s medical schools. The basic data will help formulate an effective medical school family medicine education plan and improve the establishment and development of the family medicine faculty workforce to help medical education and national health policy development in the future in Taiwan.

May Measurement Month 2018: an analysis of blood pressure screening results from Sudan.

To raise awareness of high blood pressure (BP) levels and associated risk factors among the Sudanese population. A cross-sectional study was conducted in six Sudanese states during the period May–August 2018. The study area included public indoor and outdoor areas, institutes, and service facilities. A questionnaire for collecting the data was employed including demographic data, along with three consecutive BP measurements. Data were collected by trained volunteers. Hypertension (HTN) was defined as a systolic blood pressure ≥140 mmHg or a diastolic blood pressure ≥90 mmHg based on the mean of the second and third measurements, or in those on antihypertensive medication. The current study indicated a high prevalence of HTN (28.2%) among 40 779 participants and a low level of awareness (20.7%) amongst these participants. Of all, 18.2% of hypertensive participants were on medication and of these, 54.6% were controlled. Of all hypertensives, only 9.9% were controlled. Further action needs to be taken by all stakeholders for raising awareness and increasing screening provision of HTN, which are essential for the development of national health policies for control and management of HTN in Sudan.

The Burden of Disease in Mexican Older Adults: Premature Mortality Challenging a Limited-Resource Health System.

Objectives: To assess the burden of disease and disability in older persons in Mexico from the Global Burden of Disease (GBD) 2016 study data. Methods: Analysis of the Mexican data from the GBD 2016 study is presented by state, sex, and stratified into four age groups: 60 to 69, 70 to 79, 80 to 89, and 90+ years. Results: The majority of disability-adjusted life-years (DALYs) attributable to disorders in persons 60+ in Mexico were due to premature mortality (68%). Diabetes mellitus, ischemic heart disease, and chronic kidney disease were the main causes of DALYs. With progressing age, sense organ diseases, dementias, and falls climbed to the top causes of years lived with disability (YLDs) in both sexes. Discussion: Most of the burden of disease in older Mexicans is due to premature mortality, underlining the need to strengthen the health system to respond better to health care needs of older persons with non-communicable diseases. This analysis provides information for the development of national health policies.

Contribution of specific diseases and injuries to changes in health adjusted life expectancy in 187 countries from 1990 to 2013: retrospective observational study

ObjectiveTo quantify and compare the contribution of 306 diseases and injuries to the changes in health adjusted life expectancy at birth (HALE0) between 1990 and 2013.DesignRetrospective demographic analysis based on...

Public health and the ultra-processed food and drink products industry: corporate political activity of major transnationals in Latin America and the Caribbean.

To identify examples of the 'corporate political activity' (CPA) of the industry producing and selling ultra-processed food and drink products (UPP) in Latin America and the Caribbean. Searches were conducted on the national websites and social media accounts of large industry actors. Coding was deductive and based on a framework for classifying the CPA of the food industry. Fifteen countries in Latin America and the Caribbean.ParticipantsTwelve members of the International Food and Beverage Alliance (IFBA) and major trade associations and chambers of commerce in the region. During the current pilot study, more than 200 examples of CPA were found in Latin America and the Caribbean. The UPP industry lobbied governments during the development of national health policies. UPP companies tried to build alliances with health professionals, but also with communities where they operated and with policy makers. In addition, the UPP industry fought against regulation in court and proposed weaker alternatives to public health policies, such as self-regulation. Food systems in low- and middle-income countries, including in Latin America and the Caribbean, are increasingly penetrated by the UPP industry. These countries are at risk of being influenced by the CPA strategies described in the present study. There is a need to further identify, monitor and evaluate the impact of these CPA strategies on public health policies and public opinion in the region, in order to develop mechanisms to effectively prevent such interference.

The role of non-governmental organizations in the health sector in the occupied Palestinian territory: a cross-sectional qualitative study

BackgroundNon-governmental organizations (NGOs) have had an important role in the Palestinian health sector before and after the creation of the Palestinian Ministry of Health (PMoH) in 1994. Few studies have addressed the role of NGOs in the Palestinian health sector. The aim of this study was to investigate the current role of local and international NGOs (INGOs) in the development of the Palestinian health system's policies and programmes. MethodsA qualitative study of nine semi-structured interviews was conducted with key representatives from the main actors in the Palestinian health sector: the PMoH, five local NGOs and three INGOs. After obtaining verbal consent, interviews were conducted from October to December 2014, and focused on the NGO's scope of work, priority setting, regulation, coordination and influence on national health policies. FindingsThe majority of the local NGOs focused on primary healthcare and rehabilitation, while most of the INGOs worked on health development and emergency response. Local NGOs and INGOs complemented the work of the PMoH in health-service provision. Both were constrained by the predetermined national health strategy set by the PMoH without the active involvement of other actors. INGOs’ activities were constrained by pre-determined international health agendas, available funding and restrictions related to the military occupation. The coordination mechanism between the PMoH, local NGOs, and INGOs is limited to a health and nutrition cluster, a partnership of organisations that is committed to providing needs and evidence-based responses, with little effect on policies and plans. Despite available methods to avoid duplication and fragmentation of work and to fill service provision gaps, some NGOs agreed that the limited coordination and discontinuity of certain projects restrict their ability to fully meet the health needs of the Palestinian population. InterpretationLocal and international NGOs have a crucial role in providing essential services for Palestinians, with the PMoH as the main actor. Although there is some coordination between the PMoH, local NGOs and INGOs on meeting community needs, this remains limited by funding constraints. The contribution of NGOs to policy formulation is small. Stakeholders’ active involvement in national health policy development, with a focus on local needs, should be encouraged. FundingNone.

Developing a Pro-people Health Policy

In India, the election of a new government in 2014 with a massive mandate on the agenda of ‘change’ set in motion the process of drafting new policies in many sectors. A new health policy was also envisaged. Further impetus was provided by the emerging challenges, particularly those pertaining to high out of pocket expenditure and catastrophic expenditure on health. At the same time, global opportunities such as the adoption of Sustainable Development Goals combined with local positives such as the robust growth of healthcare industry in India and better fiscal capacity of the government also drove this ambition. The new National Health Policy 2017 is now adopted by the country and has been driven by the spirit of ‘cooperative governance’ and ‘participatory approach’. This article details these background processes involved in the development of National Health Policy 2017 for India.

Improved harmonisation from policy dialogue? Realist perspectives from Guinea and Chad.

BackgroundHarmonisation is a key principle of the Paris Declaration. The Universal Health Coverage (UHC) Partnership, an initiative of the European Union, the Government of Luxembourg and the World Health Organization, supported health policy dialogues between 2012 and 2015 in identified countries in the WHO African Region. The UHC Partnership has amongst its key objectives to strengthen national health policy development. In Guinea and Chad, policy dialogue focused on elaborating the national health plan and other key documents. This study is an analytical reflection inspired by realist evaluative approaches to understand whether policy dialogue led to improved harmonisation amongst health actors in Guinea and Chad, and if so, how and why.MethodsInterviews were conducted in Guinea and Chad with key informants at the national and sub-national government levels, civil society, and development partners. A review of relevant policy documents and reports was added to data collection to construct a full picture of the policy dialogue process. Context-mechanism-outcome configurations were used as the realist framework to guide the analysis on how participants’ understanding of what policy dialogue was and the way the policy dialogue process unfolded led to improved harmonisation.ResultsImproved harmonisation as a result of policy dialogue was perceived to be stronger in Guinea than in Chad. While in both countries the participants held a shared view of what policy dialogue was and what it could achieve, and both policy dialogue processes were considered to be well implemented (i.e., well-facilitated, evidence-based, participatory, and consisted of recurring meetings and activities), certain contextual factors in Chad tempered the view of harmonisation as having improved. These were the pre-existence of dialogic policy processes that had exposed the actors to the potential that policy dialogue could have; a focus on elaborating provincial level strategies, which gave the sense that the process was more bottom-up; and the perception that there were acute resource constraints, which conditioned partners’ interactions.ConclusionsPolicy dialogue improves harmonisation in terms of fostering information exchange amongst partners; however, it does not appear to influence the operational procedures of the actors. This has implications for aid effectiveness.

Factors That Influence a Mother's Willingness to Preserve Umbilical Cord Blood: A Survey of 5120 Chinese Mothers.

BackgroundUmbilical Cord blood (UCB), which contains a substantive number of stem cells, could be widely used in transplants to treat a variety of oncologic, genetic, hematologic, and immunodeficiency disorders. However, only a small portion of mothers preserve or donate their UCB in China. The limited availability of UCB has hampered stem cell research and therapy nowadays. To date, no systemic investigations regarding factors that influence a mother’s willingness to preserve UCB have been performed in China. In the current study, we are trying to determine those factors which will provide useful information for national health policy development and will raise awareness of the importance of UCB preservation.MethodsDuring 2011 to 2013, 5120 mothers with the average age of 26.1±8.4 years were included in this study. Those mothers participated in a standardized survey. The information gathered consisted of delivery time, occupation, level of education, knowledge of preservation of UCB, willingness to store UCB, and related concerns. The results have been analyzed with SPSS 16.0.ResultsThe results showed that first-time mothers showed a greater willingness to preserve their UCB (73.3%) compared to those having their second (48.9%) or third child (40.3%). Mothers who were employed at Government Agencies and Organizations were more willing to preserve their UCB (87.3%) than those employed at factories (62.0%), and those who were unemployed (27.3%). Mothers holding master’s or college degrees were more willing to preserve their UCB (72.5% and 71.1%, respectively) than mothers with high school diplomas (48.7%) or those who only went to preliminary school or middle school (40.7%). The two strongest factors that influenced an unwillingness to preserve UCB were the high cost and concerns regarding the safety of the preservation.ConclusionsThe results showed that mothers with higher education or those having better occupations are more likely to preserve their UCB in China. These mothers have related knowledge and understand the importance of the preservation and they could more readily afford the relatively high cost. The government, clinicians and UCB banks should combine efforts to take measures, such as increasing public knowledge of the importance of UCB preservation and decreasing the high cost for its storage will most likely increase the frequency of UCB preservation which will further benefit stem cell research and therapy.

Health in all policies as a priority in Finnish health policy: A case study on national health policy development

This article describes national level development towards a Health in All Policies approach in Finland over the past four decades. In the early 1970s, improving public health became a political priority, and the need to influence key determinants of health through sectors beyond the health sector became evident. The work began with policy on nutrition, smoking and accident prevention. Intersectoral health policy was developed together with the World Health Organization (WHO). When Finland joined the European Union in 1995, some competencies were delegated to the EU which complicated national intersectoral work. The priority in the EU is economy, but the Constitution's requirement to protect health in all policies gives legal backing for including health consideration in the EU-level work. To promote that, Finland adopted 'Health in All Policies' (HiAP) as the health theme for its EU Presidency in 2006. The intersectoral work on health has developed from tackling single health problems, through large-scale programmes, further to systematic work based on legislation and permanent structures. In the 2000s, work at local level was strengthened by introducing more focused and tighter legislation and by providing expert support for implementation. Recently, emphasis has been on broad objectives and Governmental intersectoral programmes, and actors outside the administrative machinery. Great improvements in the population health have been gained over the past few decades. However, health inequalities across social groups have remained unacceptably large. Major decisions on economic policy with varying impacts by the social groups have been made without health impact assessment, or ignoring assessments conducted.

Knowledge and involvement of nurses regarding health policy development in Thailand

The purpose of this descriptive study was to explain the levels of knowledge about and involvement in national health policy development by nurses in Thailand. The study used quantitative and qualitative means to gather data about the topic from two groups of professional nurses: 2121 nurses who worked in hospitals around the country and 26 nurse leaders who were members of steering committees in nursing professional organizations. A self-administered questionnaire and an interview guide regarding knowledge and involvement in national health policy were used for collecting the data. The content validity and reliability of the questionnaire were assured. The results showed that almost two-thirds of the sample had a high level of knowledge about national health policy development but that almost three-quarters of the sample had no involvement in national health policy development. The interviews of the nurse leaders showed that some of them had been involved directly in formulating health policy but most of them thought that they had not been involved directly. The results demonstrated that it is essential that nurses understand and be actively involved in national health policy development.

ASN Policy on Managing Conflicts of Interest

The federal government, foundations, associations, and the Institute of Medicine (IOM) are examining the relationships between physicians and “commercial interests,” particularly biotechnology, medical device, and pharmaceutical companies (Table 1). Discovering a lack of “systematic information” about conflicts of interest (COI) and commercial bias, IOM recently recommended that the federal government study the effect of such conflicts “on the quality of medical research, education, and practice.”1 View this table: Table 1. Recent activity concerning COI and commercial bias The American Society of Nephrology (ASN) shares IOM's concern over the lack of data related to COI and agrees that more research is needed. However, even in the absence of concrete information, it is the responsibility of a professional society to try to understand the extent to which COI interface with its missions. Perhaps no single aspect of COI for societies and those who represent them is as visible and subject to scrutiny as continuing medical education (CME). The longest phase of the educational continuum for physicians, CME is also a critical element of the country's health care system. “Given the accelerating pace of change in clinical information and technology, continuing education has never been more important,” observed the Josiah Macy, Jr., Foundation.2 By providing a preponderance of CME, professional societies such as ASN improve the quality of health care.3 In addition to CME, societies like ASN provide access to new knowledge by publishing peer-reviewed journals, support basic and clinical investigation through research grants, and advocate for the development of national health policies. To support these missions, many societies—including ASN—solicit funding from commercial interests. Although some have argued that professional societies should begin to eliminate such funding, others have suggested that such a restriction “would marginalize critical roles that industry, and many physicians working in industry, play in critical medical research alliances.”3,4 …

Health care reform: looking back to go ahead

Health was a prominent policy issue in the 1972 Australian federal government elections, and the policy of the new Labor Government at that time emphasised the regional approach to health service delivery, including community-based services and preventive health programs, in close cooperation with the states. The Hospitals and Health Services Commission Act 1973 (Cwlth) was passed in December 1973 and members of the new Commission were appointed in April 1974. The Commission had broad-ranging functions and powers that had major influences on national health policy development in Australia. Major accomplishments of the Commission included the Community Health Program, which incorporated: the Hospitals Development Program, health services planning and research, a review of the School of Public Health and Tropical Medicine at the University of Sydney, diagnostic services, rehabilitation, Aboriginal health, rural health, health transport, nursing personnel, health careers and occupational health, many of which were long-neglected areas of public health. The National Health and Hospitals Reform Commission established by the Rudd Labor Government in February, 2008, while welcome, is an investigative body, whereas the Hospitals and Health Services Commission was responsible for both health policy development and implementation.

Tackling social inequality through the development of health policy in Lithuania

The major aim of this study was to assess existing inequalities in health of Lithuanian population and to present the process of health policy development as a major tool for reducing inequalities. The objectives were: to present life expectancy and mortality trend analysis in comparison with other European countries; to demonstrate risk profile of Lithuanian population to major noncommunicable diseases related to social inequalities and inequities in health; and to present the process of National health policy development as potential for effective reduction of inequalities in health of Lithuanian population. Information about demographic, general health situation and inequalities in health was obtained from Lithuanian Department of Statistics, National Health Information Centre and research studies performed at Kaunas University of Medicine. Considerable demographic, social and territorial inequalities in health were disclosed in Lithuania. Large proportion of them might be related to social inequalities in the society. Substantial improvements in health status of Lithuanian population could be expected if due attention was paid to social determinants of health. Implementation of balanced national health policy involving all sectors of the society is the solution.

Better health in developing countries: are sector-wide approaches the way of the future?

Most aid for health in developing countries is invested into projects, with each project separately developed and negotiated between the donor and the national authorities involved with implementation. Projects, however, can lead to fragmentation and duplication of effort, especially if many donors are involved. Rather than choosing individual projects, international agencies employing sector-wide approaches to development assistance contribute to the funding of the entire health sector. In exchange for giving up the right to choose projects according to their own priorities, donors gain a say in the development of national health policies and in decisions about how both external and domestic resources are allocated. Experiences with sector-wide approaches in Zambia, Ghana, Pakistan, Bangladesh, and other countries are described. A new approach to development cooperation can yield considerable rewards as well as risks; those emerging challenges and concerns are discussed. While common principles are clear, sector-wide approaches in practice are far from uniform. The movement away from projects toward more effective forms of partnership will require accommodation, compromise, and sensitivity to the political forces influencing national governments and international agencies.

Current perspectives on biomedical research in the United States.

I am delighted to be able to join you at this First National Conference on Research Goals and Methods for your specialty. You have set yourself a formidable task, and, please believe me, I want you—and the country wants you—to succeed. I am not saying that because it is the proper thing to say on such an occasion. I say it because it is true. We have been traveling through a period that many people in medicine have found to be disturbing. It has been a period in which the issues in medicine, eg, the nature of the profession and its standards and the role of medicine in the development of national health policy, all these important issues for physicians, have either been preempted by government or by other interest groups or they were simply abandoned along the way by physicians themselves. I think the time has arrived—as this conference

Belangrike ontwikkelings in gesondheidsdienslewering in die republiek van suid-afrika gedurende die sewentigerjare

A number of major developments have brought about important changes in the delivery and co-ordination of health services in South Africa. Some of these developments are: — the hospital-centric community-directed health services which were developed in the national states; — the changes to programme-budgeting which highlighted priority areas; — the Health Act 63 o f 1977 which provides for a formal structure for co-ordination of health services and the development of national health policy; — rationalisation in the civil service by which one Department of Health, Welfare and Pensions was created; — the Health Services Facilities Plan announced by the Minister of Health in 1980. This plan will greatly enhance the development of comprehensive health services for the South African community. The plan describes six levels according to which health services will be developed: providing for basic health needs; health education; primary health care (including self-care, community responsibility, community nursing and community health centres); the community hospital; the regional hospital; the academic hospital.