Government Health Programs Research Articles

Data Integration of Health Financing Systems as a Critical Enabler for Objective-Oriented Health System Reform: A Scoping Review from India

ABSTRACT Health financing fragmentation poses a challenge to reforms intended to address system-wide objectives vis-à-vis universal health coverage (UHC). India’s experience with publicly subsidized health insurance schemes (PSHIs), such as Rashtriya Swasthya Bima Yojana (RSBY) and its state adaptations, testify to the challenges inherent in effecting objective-oriented health systems reforms, particularly owing to wide variation in programmatic and operational design. Recent efforts to defragment PSHIs under the aegis of a new government initiative called Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PMJAY) using, inter alia, a unified information and communication technology (ICT) interface provide important policy lessons. This paper presents a theory of change for the role that ICT systems can play in promoting the objectives of UHC and highlights the early effects of ICT reforms in India on UHC. Holistic and defragmented ICT systems have a positive effect on the processes and operations of government health programs, according to the literature reviewed. Streamlined ICT systems promote equity through the introduction of portability modules, which increase access to services and facilitate stronger transparency and accountability measures by using big data and machine learning for fraud detection. Although reliability issues persist on certain fronts, India’s experience with homegrown, incremental reforms to defragment ICT systems for health financing have proven of paramount importance for progressing toward UHC.

The Status of Nationwide Implementation of Integrative Medicine Programs by Japanese Local Government from a “Social Model” Viewpoint

Background: The world's demographics are transitioning, prompting governments globally to adopt diverse health promotion and disease prevention programs to enhance people's quality of life. While several integrative medicine (IM) programs, including traditional or alternative medicine, may be in place, the level of implementation nationwide is unknown. This research represents the first nationwide study in Japan, conducted in 2018 before local government health programs were cancelled due to the COVID-19 pandemic. The study examines the use of IM by local government in Japan and its safety and effectiveness as a “social model.”Methods: IM programs for disease prevention and health promotion of all 1,944 Japanese local governments in 2018, were retrieved the using the Web Archive Project of the National Diet Library, which is a maintained website repository for all Japanese local government including IM and health programs.Results: A total of 1,739 IM programs were implemented in 537 local governments (27.6% among all Japanese local governments). These included programs for Yoga (1,242; 71.4% of the projects), Qigong (211; 12.1%), and Aromatherapy (145; 8.3%). Among the providers of the programs, only 16 (0.9%) were national medical-related license holders. The purpose of disease prevention or health promotion was not described with scientific basis (safety and effectiveness).Conclusion: Japanese local government conduct health-promoting IM programs, but untrained providers administer many of them. There needs to be more evidence to support the alleged health promotion objectives. Local governments require better support and evidence-based planning to rectify this situation.

Health care prioritization process for the elderly in rural Tanzania under decentralized system: Prospects and challenges.

Beginning the early 1990s, many countries globally adopted the third-generation health sector reforms with a focus of strengthening the primary health care system through community participation. On the contrary, three decades later, primary health care systems in many Low- and Middle-Income countries (LMICs) including Tanzania have remained weak. Specifically, priority setting for the vulnerable groups including the elderly have been weak. We aimed to analyse the prospects and challenges of the priority setting process for the elderly health care services following the 1990s health sector reforms in Tanzania. We conducted an exploratory case study on priority setting process for the elderly healthcare services in Igunga and Nzega Tanzania. We carried out 24 Key Informant Interviews (KIIs) with the positions of District medical officers, social welfare, Medical Officers in-charge (MOI), planning officers and health system information focal person. Additionally, we carried out two focus group discussions (FGDs), one from each district with six participants from each group. Participants for the FGDs were MOI, health secretary, representative members of Health Facility Governing Committee (HFGC) and Council Health Management Team (CHMT). Data were analyzed using the qualitative content analysis. Two categories emerged from the analysis of the transcripts. These were the prospects and challenges in priority setting for the elderly population under the decentralized health sector in rural Tanzania. The prospects included; the capacity of the LGAs on priority setting; existence of strategies used by LGAs; availability of teamwork spirit and the existence of guidelines for priority setting at LGAs. The challenges included difficulties of elderly identification, insufficient resources to implement the planned activities at the LGAs, unintegrated digitalized government health information tools or programs at the LGAs, interference of LGAs by the Central Government and low interest of stakeholders on elderly health care. This study highlights the prospects and challenges facing priority setting for elderly care at the centralized health system in rural Tanzania. From the results the process is well organized but faces some challenges which if not addressed jeopardized and has potential to continue affecting the priority setting. Addressing the challenges highlighted requires joint efforts from both the elderly population in the community, healthcare providers and decision makers across all levels of the health system. This study serves as an eye-opener and calls for a bigger study to get a comprehensive picture of priority setting of the elderly health care in Tanzania.

Moral Hazard in Government Health Programs - New Evidence from Georgia

In this paper, we studied the moral hazard in healthcare. As part of the analysis, we looked at 126.3 thousand hospitalization cases in the Georgian healthcare system in 2018-2019. According to the group of diagnoses, we compared the length of stay of inpatients funded under government programs with the cases covered by a pocket of patients or private insurance companies. As a result of the study, we found that the length of stay under the universal health care program is, on average, 0.26 days (CI 95%; [0.22-0.30]) longer than in other circumstances. The difference is statistically significant (t = -12.58; P<.05). Thus, our result is the empirical evidence of theoretical reasoning that predicts an increase in the moral hazard under the government healthcare program.

SELF CARE TRAININGS FOR NCD MANAGEMENT IN OLD AGE IN INDIA

Abstract With over 100 million older people, India has the second largest elderly population in the world. Older people in many parts of India, especially in the rural settings live in vulnerable conditions with limited facilities and with an overall poor health status. GRAVIS has been working actively in the Thar Desert of India to address older people’s health. It has multi-layered health intervention combining medical services, public health activities and research component. Self-care training is integral part of our work with older people. With help of locally designed contents, GRAVIS team trains older people on healthy ageing. The curriculum includes 10 modules focusing on basics of human body and biology of ageing, Common diseases in old age, prevention of common diseases, management of common diseases and useful information on Government health programmes. Older people in groups of 12-15 attend trainings once in 15 days. To provide service to older people and to take self care education further, GRAVIS also works with a cadre of Village based Health Workers (VHWs). The impact of our self-care training interventions has been quite positive. The trainings are well received within the community. Over 1,500 older people have been trained and over 85% report a significant increase in their knowledge levels. GRAVIS has been able to draw the attention of local health authorities and hopes that the trainings could be scaled up further. Self care and improved health knowledge are critically important for older people to stay healthy, particularly in remote and resource scarce settings.

Mechanisms Involved in the Arthropod Transmission of Leishmania spp.

Due to the great complexity of the transmission of Leishmania spp parasites. Due to its arthropod vectors and the general need to gather the existing information in precise and rigorously commented writings, this document was prepared, based on the consultation of scientific articles of proven methodological quality and with reproducible results, focused on vector-parasite interactions and parasite-host cell as a tool for the adjustment or design of government health programs aimed at hindering or interrupting transmission and thereby controlling American tegumentary and visceral leishmaniasis.

A review paper on anganwadi workers knowledge on maternal nutrition

The present study reviews the Maternal Nutrition knowledge of health care providers (ANMs and ASHAs) of Primary Health Centers (PHCs) and Community Health Centers (CHCs) and attempts to find out the existing gaps in their knowledge level related to maternal nutrition as well as discusses strategies to bridge those gaps. Good nutrition is the core pillar for human development and its necessity varies with respect to age, gender and during physiological changes such as pregnancy which is a critical phase in a woman's life when the expectant mother needs optimal nutrients to support the developing fetus. Awareness about appropriate nutrition during pregnancy is a serious concern and lack of it may lead to child morbidity and mortality. Therefore it is imperative to address this issue properly in various government policies and schemes. ICDS scheme initiated by Government of India is a major step in this regard which provides nutrition and health education, supplementary nutrition, family planning tips etc. to the pregnant women. The Anganwadi workers are the basic functionaries of the ICDS scheme and their services (providing counseling, supplementary nutrition, distribution of Iron & Folic acid tablets) are transmitted to the beneficiaries through a channel of Anganwadi centers (AWCs). Keeping the above background in mind relevant literature such as journals, newspapers, articles, research papers from Scopus, Pub Med, research gate, and Google scholar related to national and state policies pertinent to maternal nutrition were reviewed to find out the existing gaps in the knowledge level of health care providers. It is concluded from the study that maternal nutritional needs have to be prioritized in government health programmes and strategies to improve the status of expectant mothers need to be implemented to address nutritional challenges. Government schemes can be strengthened by promoting integration of services, ensuring effective procurement mechanisms for supplementary nutrition and food supplements, establishing regional training facilities and strengthening program monitoring and evaluation.

Бренд Wellness: языковая репрезентация в медиадискурсе

The article deals with the detection and analysis of the language means of Wellness brand representation in the media discourse. The aim of the article is to identify the peculiarities of language representation of the Wellness brand in the texts of media discourse, represented by printed publications (newspapers and magazines about health, fashion, beauty, psychology of family life, etc.). and audiovisual content on the Internet (podcasts about Wellness and healthy lifestyles, official English and Russian-language websites of government health programs, clinics and companies whose products and services are related to the promotion of Wellness in the service market), as well as blogs on fitness, healthy eating, meditation, psychological trainings that promote the principles of a healthy lifestyle. The goal is achieved by referring to modern scientific, both domestic and foreign research in the field of Wellness. The relevance of the presented research is determined by the need to understand which language means help to form a positive image of the Wellness brand in the open media space, which branding practices are the most successful, due to what means and speech strategies. The novelty of this study is that for the first time the Wellness brand is studied from the perspective of sociolinguistic and linguistic analysis of texts, aimed at promoting not only beauty services, but the health of the nation in the harmonization of the physical, social, spiritual, mental, emotional and intellectual aspects. The result of the research is the revealing the differences in the representation of Wellness in English- and Russian-speaking linguistic cultures of media space, effective language means of Wellness brand representation, productive appeals to stereotypes in creating advertising descriptions of Wellness products, and also the role of precedence in informing the public from different platforms - from printed media to official websites and Internet-communities.

Strengthening local government policies to address health inequities: perspectives from Australian local government stakeholders

BackgroundWith their close connection to community and increasing preventive health remit, local governments are well positioned to implement policies and programs to address health inequities. Nevertheless, there is a lack of evidence of equity-focused policy action in this sector. We aimed to understand how local government representatives approach equity in the development and implementation of health and wellbeing policies and programs, and to identify potential enablers for strengthening an equity focus.MethodsWe conducted semi-structured interviews (June 2022-January 2023) with 29 health directorate representatives from 21 local governments in Victoria, Australia. Representatives were recruited from urban, regional and rural local government areas, with varying levels of socioeconomic position. Data was analysed inductively using Braun and Clarke’s reflexive thematic analysis, informed by social determinants of health theory and a public policy decision making framework.ResultsLocal governments approach health equity in different ways including focusing on priority populations, disadvantaged geographic areas, or by targeting the upstream determinants of health, such as housing and employment. Enabling factors for more equity-oriented local government policy action included those internal to local governments: (i) having a clear conceptualisation of equity, (ii) fostering a strong equity-centric culture, and (iii) developing organisational-wide competency in health equity. External factors related to key stakeholder groups that support and/or influence local governments included: (iv) strong support from community, (v) state government leadership and legislation, and (vi) supportive local partners, networks and NGO’s.ConclusionsLocal governments have a responsibility to implement policies and programs that improve health and reduce health inequities. Local government’s capacity to leverage resources, structures, processes and relationships, internally and across sectors and community, will be key to strengthening equity-oriented local government health policies and programs.

Monitoring and Combating Waterpipe Tobacco Smoking Through Surveillance and Taxation

Waterpipe tobacco smoking (WTS) is a traditional tobacco use method that originated in the Eastern Mediterranean Region (EMR) and has resurged in recent decades. WTS rates in the EMR are the highest worldwide, especially among youth, exceeding cigarette-smoking rates in select jurisdictions. Despite its documented harm, the growing prevalence of WTS has been met with a poor regulatory response globally. At the epicenter of the WTS epidemic, countries in the EMR are in urgent need of effective tobacco control strategies that consider the particularities of WTS. A roundtable session, titled "Monitoring and Combating WTS Through Taxation and the Global Tobacco Surveillance System (GTSS)," was held as part of the 7th Eastern Mediterranean Public Health Network's regional conference. The session provided an overview of evidence to date about WTS policy control, the taxation of WTS, volumetric choice experiments for tobacco control research, and monitoring WTS patterns and control policies among adults and youth through the GTSS. The session highlighted the need to update the regulation of WTS in the current global tobacco control policy frameworks and the need for developing tailored, evidence-based, and WTS-specific regulations to complement current tobacco control policy frameworks. Raising taxes to increase the price of tobacco products is the single most effective tobacco control measure, and these taxes can fund expanded government health programs. The effectiveness of taxation can be measured via volumetric choice experiments, which allow for the estimation of a complete set of own-price and cross-price elasticities that are instrumental for fiscal policy simulations. Finally, the surveillance of WTS (for example, through the GTSS) is critical to informing policy and decision makers. The Global Youth Tobacco Survey (GYTS) and Global Adult Tobacco Survey (GATS) are 2 GTSS products that provide nationally representative data among students aged 13-15 years and persons ≥15 years, respectively.

Stroke intervention and pharmacotherapy guidelines: Knowledge-to-practice translation gaps among the emergency resident physicians in Riyadh, Saudi Arabia

Translating the updated medical guidelines into routine clinical practice is an important initiative to improve the population's health and decrease disease outcomes. A cross-sectional survey-based study was conducted in Riyadh City, Saudi Arabia, to evaluate the knowledge and degree of application (practice) of the stroke management guidelines among emergency resident physicians. An interview-based self-administered questionnaire was used to survey the emergency resident doctors in Riyadh hospitals from May 2019 to January 2020. Of 129 participants, 78 valid, complete responses were obtained (60.5% response rate). Descriptive statistics, principle component, and correlation analyses were used. Most resident doctors were men(69.4%) with a mean age of 28.4±3.37 years. More than 60% of the residents were satisfied with their knowledge of the stroke guidelines; meanwhile, 46.2% were satisfied with their application of the guidelines. Both Knowledge and practice compliance components were significantly and positively correlated. Also, both components were significantly correlated with being updated, aware of, and strictly following these guidelines. The mini-test challenge showed a negative result with a mean knowledge score of 1.03±0.88. Even though the majority of participants utilized different tools of education and were aware of the American Stroke Association Guidelines. It was concluded that a considerable gap in the residents’ knowledge regarding the current stroke management guidelines was present in Saudi hospitals. Also, it was reflected on their actual implementation and application into clinical practice. Continuous medical education, training, and follow-up of the emergency resident doctors, administered as a part of the government health programs, are crucial to improve the health care delivery for acute stroke patients.

Economic impact of vaccine safety incident in Ukraine: The economic case for safety system investment

BackgroundVaccine confidence and coverage decreased following a death temporally but not causally related to measles vaccination in Ukraine in 2008. Large measles outbreaks including international exportations followed. Herein we characterize this experience including associated costs. MethodsMixed-methods were used to characterize this vaccine safety incident and quantify health and economic costs. Qualitative interviews illuminate the incident, social climate, and corruption that influenced vaccine confidence in Ukraine. A literature review explored attitudes toward vaccines in the USSR and post-independence Ukraine. Infectious disease incidence was examined before and after the vaccine safety incident. An economic analysis estimated associated healthcare costs, including prevention and outbreak control measures, additional vaccination activities due to failure of the 2008 campaign, treatment costs for new cases domestically and foreign exportation, and productivity loss from treatment time and mortality for new cases. FindingsVaccine hesitancy and distrust in government and public health programs due to corruption existed in Ukraine before the vaccine safety incident. The mishandling of the 2008 incident catalyzed the decline of vaccine confidence and prompted poor procurement decisions, leading to a drop in infant vaccination coverage, increased domestic measles cases, and exportation of measles. The estimated cost of this incident was approximately $140 million from 2008 to 2018. InterpretationAbsent a rapid and credible vaccine safety response, a coincidental death following immunization resulted in major outbreaks of measles with substantial economic costs. Adequate investments in a post-licensure safety system may help avoid similar future incidents.

Maternal and Newborn Care Practices among the Muslim Slum Dwellers in India: Does the Popular Common Sense Matter?

Despite a large number of government health programs, schemes and incentives, India is trailing in achieving global sustainable development goals on ensuring healthy lives and reducing maternal mortality ratio, under-five mortality and neonatal mortality. For improving maternal and child health, one of the possible ways could be making sense of maternal and newborn care practices. These practices are dynamic and interwoven in the socio-cultural milieu. Many of these practices have detrimental effect on the health of mother and newborn. There is need to explore, understand and negotiate with maternal and newborn care practices for locating elements of ‘good sense’ in these practices, which could be helpful in promoting better maternal and child health. It is in this context that an attempt is made to describe the maternal and newborn care practices among the Muslim slum dwellers in Hyderabad, Telangana (India).

Factors Influencing Dementia-Screening Behaviors of Community-Dwelling Adults Using the Korean Community Health Survey in 2018

Background: This study aimed to identify factors influencing dementia-screening behaviors among community-dwelling middle-aged and older adults using the Korean Community Health Survey data in 2018.Methods: This cross-sectional study included community-dwelling adults aged ≥50 years. We used data related to socio-demographic and health-related factors and subjective cognitive function. We conducted a chi-squared test and multiple logistic regression analysis with weighted analysis.Results: Of 108,050 participants (men, 46.6%; ≥65 years old, 41.5%), only 13.4% (20,404 participants) performed dementia-screening. Using multiple logistic regression, we found that advanced age, female, and unemployed, having a low level of education, low monthly family income, and rural residence, no alcohol intake, no-smoking, hypertension, cognitive dysfunction, and awareness of the dementia helpline service center were positively associated with dementia-screening behaviors.Conclusions: This study suggests the application of holistic approaches to improve dementia-screening behaviors among middle-aged and older adults considering their socioeconomic and health related conditions. Our findings highlight that government health programs should consider socio-economic status and awareness of dementia helpline services in designing dementia prevention programs.

ASHA - World’s Largest All-female Frontline Community Health Worker: Features and Challenges

India accounts for the second-highest number of maternal deaths all over the world. India has shown a remarkable decline in MMR (Maternal Mortality Ratio) during the last two decades. According to the SRS (Sample Registration System), MMR dropped from more than 556 per 100,000 in 1990 to 113 in 2018 and the proportion of deliveries attended by skilled health personnel has increased from 58% in the 1990s to 81% in 2019. In the year 2005, the Government of India launched the National Rural Health Mission (NRHM) with the purpose of improving the existing health facilities provided to the community with a special focus on the poor and vulnerable states and societies. NRHM identified ASHA (Accredited Social Health Activist), a voluntary community health worker, to provide services to the community on incentives. ASHA workers are the female health workers who have hailed from the same community where they serve. An ASHA worker acts as a link person between the health system and the community. At present, ASHA services are utilised in a number of programmes including maternal and child health, Various studies have extensively documented about ASHAs dissatisfaction with their pay and workload. ASHA services are widely accepted by societies, especially the poor, but issues like sexual harassment, violence, unsafe working conditions, and cast discrimination were also reported.ASHA programme plays a critical role in implementing Government health programmes, especially on MCH. Therefore keeping the ASHA updated and motivated is very important for performing her duties efficiently and effectively.

PROVIDING POST TRUTH ERA: SOCIAL MOVEMENT OF CADRE TEAMS IN RESOLVE THE HOAX OF HEALTH INFORMATION

The post truth era has become a new vocabulary for cadres who never give up in following the times. But who would have thought that the post truth era would also lead to a dilemma that never ended after unsettling the cadre team in Cibeusi village. The cadre team that was incorporated from 3 RWs including RW 06, RW 014, and RW 015 also showed their dedication through regular social activities. Therefore, the authors use a qualitative approach through data collection techniques in the form of observation and interviews. The results obtained show the following; 1) designing social movements as an effort made by the Cibeusi cadre team in overcoming health information hoaks and the post truth era; 2) the Cibeusi cadre team's social movement implementation consists of 3 words, namely active, innovative, and creative; 3) cadre team social movements include communication programs in the form of counseling and training involving academics or related medical personnel as the main sources in providing literacy movement training programs; 4) Evaluation of the ongoing literacy movement as part of the success of the government health program output.

PROVIDING POST TRUTH ERA: SOCIAL MOVEMENT OF CADRE TEAMS IN RESOLVE THE HOAX OF HEALTH INFORMATION

The post truth era has become a new vocabulary for cadres who never give up in following the times. But who would have thought that the post truth era would also lead to a dilemma that never ended after unsettling the cadre team in Cibeusi village. The cadre team that was incorporated from 3 RWs including RW 06, RW 014, and RW 015 also showed their dedication through regular social activities. Therefore, the authors use a qualitative approach through data collection techniques in the form of observation and interviews. The results obtained show the following; 1) designing social movements as an effort made by the Cibeusi cadre team in overcoming health information hoaks and the post truth era; 2) the Cibeusi cadre team's social movement implementation consists of 3 words, namely active, innovative, and creative; 3) cadre team social movements include communication programs in the form of counseling and training involving academics or related medical personnel as the main sources in providing literacy movement training programs; 4) Evaluation of the ongoing literacy movement as part of the success of the government health program output.

Mind the gap: an analysis of core capacities of the international health regulations (2005) to respond to outbreaks in Yemen

BackgroundYemen that has been devastated by war is facing various challenges to respond to the recent potential outbreaks and other public health emergencies due to lack of proper strategies and regulations, which are essential to public health security. The aim of this study is to assess the implementation of the International Health Regulations (IHR 2005) core capacities under the current ongoing conflict in Yemen.MethodsThe study simulated the World Health Organization (WHO) Joint External Evaluation (JEE) tool to assess the IHR core capacities in Yemen. Qualitative research methods were used, including desk reviews, in-depth interviews with key informants and analysis of the pooled data.ResultBased on the assessment of the three main functions of the IHR framework (prevention, detection, and response), Yemen showed a demonstrated or developed capacity to detect outbreaks, but nevertheless limited or no capacity to prevent and respond to outbreaks.ConclusionThis study shows that there has been poor implementation of IHR in Yemen. Therefore, urgent interventions are needed to strengthen the implementation of the IHR core capacities in Yemen. The study recommends 1) raising awareness among national and international health staff on the importance of IHR; 2) improving alignment of INGO programs with government health programs and aligning both towards better implementation of the IHR; 3) improving programmatic coordination, planning and implementation among health stakeholders; 4) increasing funding of the global health security agenda at country level; 5) using innovative approaches to analyze and address gaps in the disrupted health system, and; 6) addressing the root cause of the collapse of the health services and overall health system in Yemen by ending the protracted conflict situation.

¿Agua de consumo humano con o sin flúor?

Los beneficios de la utilización de Flúor en la salud dental han sido convencionalmente aceptados, sinembargo en la actualidad nuevas investigaciones en salud humana revelan la urgencia por evitar la ingestión de Fluor al punto de inclusive modificar programas de salud e implementar nuevas investigaciones. Los gobiernos como Canadá, Estados Unidos Chile, Países Europeos y Asiáticos que han invertido cifras millonarias en Fluorización pública; ahora deben modificar sus programas e investigar daños causados. Por este motivo la dotación de agua deberá seguir estas directrices.

Prevention and control of cardiovascular diseases in India needs a strengthened and well-functioning primary health care system: A narrative review

This article reviews the ongoing initiatives to prevent and control cardiovascular diseases (CVDs) and non-communicable diseases (NCDs) in India and analyses the role of primary health care (PHC) system. The authors note that in last 2 decades, there has been increasing policy recognition of the challenges posed by CVDs and NCDs in India. The review of ongoing government health program in India indicate that while the interventions to tackle CVDs and NCD have also been launched and scaled up, a majority of these initiatives continue to be delivered through district or sub-district levels. Though, there has been plans, the scale up through PHC system is at early stage only. There is sufficient scientific evidence that the effective prevention and control of CVDs need accessible health services and a series of public health interventions through strengthened PHC system. There are learnings from COVID-19 pandemic response in India (in areas such as private sector engagement, effective enforcement of health regulation, community engagement and the use of tele-consultations), which can be useful. The authors conclude that a strengthened and well-functioning PHC system can ensure increased access to CVD and NCD services. As India plans to scale up ongoing health programs and launch a few new initiatives, the learnings from the past, documented in this paper, could be useful. These steps would help India to accelerate progress towards universal health coverage.