Health Bureaucracy Research Articles

MHealth for diabetes self-management in the Kingdom of Saudi Arabia: barriers and solutions.

PurposeIn this paper I present a perspective of mobile health (mHealth) technologies for diabetes in conjunction with an overview of the current status of mHealth technologies for diabetes self-management and the clinical evidence in the Kingdom of Saudi Arabia. In addition, a small survey to identify the barriers to mHealth for diabetes care in the Kingdom and the relevant solutions are discussed.Participants and methodsIn order to study the relevant obstacles for adopting mHealth solutions for diabetes care and to suggest appropriate solutions, a small survey study was conducted with a specific questionnaire deployed to >40 anonymous leading health care professionals and decision-makers of the Kingdom. The survey was distributed by means of a link to the target population through a WhatsApp group. The data were collected during 1 month, and three reminders were sent to the group to complete the survey. Basic descriptive statistics were used to analyze the survey data.ResultsThe high percentages of agreement among the participants suggest that mHealth expertise and human shortage; funding and infrastructure investments; legal, privacy standardization and regulatory obstacles; and health care organizational and bureaucracy impediments are barriers to the implementation of mHealth technologies in the self-management of diabetes in this region. However, most of these barriers can be mitigated by the creation of the appropriate leadership and clinical environment in the current health care system.ConclusionThe mHealth technologies for diabetes self-management have not yet been translated successfully in the Kingdom of Saudi Arabia as it was detected in the literature review carried out in this work. Among other possibilities, the causes of this situation are the existence of human, organizational, funding, bureaucracy, and legal barriers, as shown by the results of the survey conducted among decision-makers and senior clinicians of the Kingdom of Saudi Arabia.

Factors influencing e-health implementation by medical doctors in public hospitals in Zimbabwe

Background: Improving access to health care services in both developed and developing countries through information communication technology (ICT) has been getting particular attention from government, medical researchers and practitioners. This has seen many governments proposing the implementation of healthcare systems that are centred on technology, while researchers and practitioners have been arguing for policies that promote the use of technology in healthcare provision. Objective: The main objective of this study was to determine the factors influencing implementation of e-health by medical doctors in public hospitals in Zimbabwe. Methods: The study was guided by a qualitative research in conjunction with multiple-case studies. Qualitative data were collected using 20 semi-structured interviews from selected hospitals concerning the implementation of e-health by medical doctors in public hospitals. Hospitals were selected using random sampling, while purposive sampling was used to select the 20 doctors. In addition, the researcher conducted direct observations at five hospitals. Furthermore, data concerning policy issues in Zimbabwe’s e-health were collected using document review process. Data from the interviews were analysed using data-driven thematic coding. This solo approach was conducted because the researcher intended to reveal e-health influencing factors that could not be revealed by related literature. Results: This study reveals that the implementation of e-health by medical doctors in public hospitals in Zimbabwe is influenced by both internal and external factors. Internal factors include ICT infrastructure and e-health technologies, ICT skills and knowledge, technical support, security concerns, lack of basic medical facilities, demographic factors such as age and doctor–patient relationship. External factors are health policy, funding and bureaucracy. Conclusion: The idea of e-health is relatively new to healthcare centres in Zimbabwe. Its application has not been sufficiently addressed. The study shows that the success of an e-health system depends on internal and external factors. There is a great potential for implementing e-health in Zimbabwe if these factors are taken into consideration. Otherwise, Zimbabwe will continue to lag behind in the implementation of e-health systems in public hospitals.

Retaining Doctors in Rural Bangladesh: A Policy Analysis.

Background: Retaining doctors in rural areas is a challenge in Bangladesh. In this study, we analyzed three rural retention policies: career development programs, compulsory services, and schools outside major cities – in terms of context, contents, actors, and processes. Methods: Series of group discussions between policy-makers and researchers prompted the selection of policy areas, which were analyzed using the policy triangle framework. We conducted document and literature reviews (1971-2013), key informant interviews (KIIs) with relevant policy elites (n=11), and stakeholder analysis/position-mapping. Results: In policy-1, we found, applicants with relevant expertise were not leveraged in recruitment, promotions were often late and contingent on post-graduation. Career tracks were porous and unplanned: people without necessary expertise or experience were deployed to high positions by lateral migration from unrelated career tracks or ministries, as opposed to vertical promotion. Promotions were often politically motivated. In policy-2, females were not ensured to stay with their spouse in rural areas, health bureaucrats working at district and sub-district levels relaxed their monitoring for personal gain or political pressure. Impractical rural posts were allegedly created to graft money from applicants in exchange for recruitment assurance. Compulsory service was often waived for political affiliates. In policy-3, we found an absence of clear policy documents obligating establishment of medical colleges in rural areas. These were established based on political consideration (public sector) or profit motives (private sector). Conclusion: Four cross-cutting themes were identified: lack of proper systems or policies, vested interest or corruption, undue political influence, and imbalanced power and position of some stakeholders. Based on findings, we recommend, in policy-1, applicants with relevant expertise to be recruited; recruitment should be quick, customized, and transparent; career tracks (General Health Service, Medical Teaching, Health Administration) must be clearly defined, distinct, and respected. In policy-2, facilities must be ensured prior to postings, female doctors should be prioritized to stay with the spouse, field bureaucrats should receive non-practising allowance in exchange of strict monitoring, and no political interference in compulsory service is assured. In policy-3, specific policy guidelines should be developed to establish rural medical colleges. Political commitment is a key to rural retention of doctors.

Hygiene in a Landlord State: Health, Cleanliness and Chewing Gum in Late Twentieth Century Singapore

This article provides historical context for Singapore’s fabled preoccupation with cleanliness. Beyond the legacy of British colonialism and post-colonial concerns with international branding, the city-state was globally unique in shifting nearly all its citizens into a new urban infrastructure in one sustained campaign. Public health bureaucracies came to play an important supporting role in the creation of this ‘landlord state’, in which health became imbricated with cleanliness and habitation, all three becoming realms of state responsibility. The ban on the importation of chewing gum in the early 1990s can also be set within this context, that substance having emerged for infrastructure builders as not just a nuisance, but a tool of low-level sabotage.

Partnering for Universal Health Coverage in Thailand

The Thai National Health Security Act of 2002 established a universal health coverage program that extended health care to 18 million previously uninsured Thais and significantly reduced rates of medical impoverishment. This article highlights the key role that a coalition of health bureaucrats and NGOs played in achieving this outcome.

Maternal and child health in Bangladesh: a critical look at the policy and the sustainable development goals

Based on secondary analysis, this paper places a critical discussion looking back in history of maternal health achievements by Bangladesh, future adaptability and potentials forwarding to the sustainable development goals (SDGs) set by United Nations. Since the transition from MDGs to SDGs, Bangladesh achieved a many progress in maternal health development but still grappling with many structural and cultural barriers. Implementation of policy documents in community level, lack of better infrastructure, health bureaucracy induced delays, culture of absenteeism among practitioners and lack good health governance are some major challenges still hindering a fostered progress in achieving the expected improvement in maternal and child health condition in community and broader level. Evidences discussed in this paper suggests that, the clauses related to implementation and maintenance need to be stronger in the maternal health policy for future direction and sustainable progress in maternal health. The policy should act in practice, not as a document, to improve maternal health and reducing mortality that would finally speed up the progress in achieving SDGs target in more pragmatic sense.Asian J. Med. Biol. Res. September 2017, 3(3): 298-304

Recycling the Disabled: Army, Medicine, and Modernity in WWI Germany

The ‘total war’ of World War I touched many aspects of German life. Heather Perry’s book looks at how soldiers’ bodies were affected, and she looks at both the effect on the bodies and how those partial bodies affected German society. Perry starts by contextualizing a lack of scholarly studies of German medicine in World War I. Chapter 1 looks at how orthopaedists moved from mainly focusing on congenital defects in children to trauma work, which had been the preserve of trauma doctors, of whom no more is heard. German orthopaedists blended surgery and physical therapy, but had to fight the traumatologists for surgical opportunities on adults. The war gave orthopaedists scope for professional growth, and the involvement of Kaiserin Augusta Viktoria smoothed their road into working with soldiers. One facet that is not explored is how the military health bureaucracy and its leaders welcomed orthopaedists; Perry looks at sources from and about orthopaedists, but not from the military. In Chapter 2, she works through new models of artificial limbs (especially arms) developed during the war. Function topped form, and Germans sought domestically manufactured arms to replace foreign suppliers. Perry draws attention to the orthopaedists taking control of limb design and manufacture from artisans and craftsmen, drawing both on their increasing body of knowledge and on the need for larger supplies. Chapter 3 looks more at policy. Initially, healthcare was split between military and civilian, and rehabilitation came after discharge from the military as disabled. (Perry does not explore wounded men who were retained in the military in a lower fitness category.) Just as peacetime ‘cripples’ were to be rehabilitated for work, the wartime cripples were to be rehabilitated, with both physical therapy and occupational therapy and/or vocational training. Many times the paternalistic doctor (and state) determined the training, just as the doctor determined the course of treatment. In Chapter 4, Perry identifies a medicalization of disability. This is a stronger change than in other countries, since the Bismarckian social security system had only a small role for doctors (and orthopaedists) with the disabled, and Perry ably tracks the changes, including trying to get patients to stop thinking of an injury as leading to a pension and not rehabilitation. Orthopaedists (somewhat shrilly) tried to get patients to see themselves as re-abled, not disabled. Chapter 5 looks at how the disabled were worked back into the war economy, although there is little comparison or contrast with other groups mobilized under the Auxiliary Service Law. Perry finds some effective case studies in lieu of pan-German analysis. In her conclusion Perry draws these threads together: doctors, patients, societal attitudes and the war.

Counselling for Depression: a response to counselling education in the twenty-first century. Ethical conflicts for a counselling approach operating within a medicalised bureaucratic health service

ABSTRACTIn this article, we consider the ethical issues arising from training counsellors in ‘Counselling for Depression’ in the UK. We describe Counselling for Depression (CfD), a competency-based approach to counselling accredited by the Improving Access to Psychological Therapies (IAPT) agenda in the National Health Service in the UK. We question whether creating a career path for counsellors in the NHS within IAPT compromises the values of the CfD approach and whether the person-centred and experiential approach and the counsellors providing it are able to survive intact. We consider the inherent conflicts within the value bases of CfD and IAPT and discuss how we address these conflicts within the training for CfD. We also describe the ongoing ethical conflicts we live with and what supports us to continue to engage in these conflicts.

The correct secret

In this article I argue that the global biosecurity project that arose out of the events of the SARS epidemic of 2003 created a new balance of secrecy and transparency within the public health arm of the Chinese state. In an effort to meet national and international demands for greater transparency in support of a “common good,” local public health officials engaged in what I call hypertransparency. This hypertransparency took two forms: the real-time online sharing of disease incidence data within the public health bureaucracy, and the over-performance of disease fighting strategies in front of a wider local and global public. Because local Chinese officials interpreted the “common good” differently from their international partners, neither of these efforts succeeded in erasing the crucial role that local officials continued to play in determining what should and should not be shared, and with whom. Secrecy continued to be an important component of China’s securitization efforts, with hypertransparency ultimately concealing more than it revealed.

Forceps: towards obsolescence or revival?

Cesarean section rates have become a political issue, attracting the attention of governments, health bureaucrats and professional organizations. In some instances this has led to a renewed interest in forceps delivery, even Kielland's rotational forceps. It is suggested that calls for a greater use of forceps, especially rotational forceps, are ill-advised and commonly based on ignorance of recent urogynecological and imaging literature. Forceps use is associated with a much higher likelihood of major maternal trauma, especially to the anal sphincter and levator ani muscles, which may result in substantial future morbidity. Hence, its use should be avoided whenever possible. This is particularly obvious for rotational forceps.

The Alien Within

Cancer is a disease for which the English language reserves some of its most sinister epithets: cancer is said to ‘devour’, ‘ruin’, ‘ravage’ and ‘deform’, and relentlessly to consume flesh with insatiable rapacity. Conceived of as an unknowable and uncontrollable force from the outside, cancer is paradoxically created within the cancer subject’s own body, a body which profoundly questions the comfortable separation of the human from the animal. For many writing about their experiences of the disease, the ramifications can be multifaceted: robbed of faith in the body’s willingness to bend to regulation, objectified by economically straitened health bureaucracies, trapped in the headlights of mortality, unable to find adequate means for conveying contradictory emotional registers and disabled by others’ fear of the abject, these individuals often understand their subjectivity as inhabiting the liminal space between the human and the creaturely. This essay explores the ways in which cancer subjects represent the processes of defamiliarisation that diagnosis often initiates through three recent autobiographical accounts of men coming to terms with their incurable cancers. Philip Gould’s When I Die: Lessons from the Death Zone (2012), Christopher Hitchens’ Mortality (2012) and Tom Lubbock’s Until Further Notice, I Am Alive (2012) are autopathographies that give utterance to experiences of subjectivity that are increasingly compromised owing to the effects of illness and the knowledge of the irreversibility of the cancer subject’s condition. Through examining the writers’ use of creaturely metaphors to describe both the nature and the effects of their cancers, this essay argues that in an age of advanced medical intervention, the language we use to describe cancer still reveals potent anxieties about the exceptionality of the human and the proximity of the animal.

The rise and fall of the nation's doctor Surgeon General's Warning: How Politics Crippled the Nation's Doctor Mike Stobbe University of California Press, 2014. 393 pp.

The rise and fall of the nation's doctor <b>Surgeon General's Warning: How Politics Crippled the Nation's Doctor</b> <i>Mike Stobbe</i> University of California Press, 2014. 393 pp.

Are all Italian newborns equal?

The debate on the restructuring of Chapter Five (Titolo Quinto) of the Italian Constitution has brought once again the issue of the allocation of powers between the State and its regions under the spotlight. According to Article 117 of the Italian Constitution, as reformed in 2001, the State and its regions share normative competences in regulating certain matters. In the field of core civil and social rights, including health care, it is the responsibility of the State to identify fundamental levels of services and assistance that have to be guaranteed to everyone across the nation. The aim of this provision was to prevent unacceptable disparities in the enjoyment of the right to health. In practice, however, this has not been the case. On the one hand, Italian regions have disciplined certain matters in fairly different ways, forcing the Ministry of Health to exercise its role of warrantor of fairness more than expected. On the other hand, the quality of services has been greatly affected by a “geographical” factor, depending on availability of resources, different organization of health system and bureaucracy at regional level. Health care services for newborns are a case in point. Two examples – among others – are worth exploring further. The neonatal screening programmes for cystic fibrosis and inherited metabolic diseases are a lot different among different regions and sometimes even among different towns or hospitals in the same town. Some legislative measures have been taken to overcome this situation, but the implementation of the national regulation remains difficult to attain. Should the responsibilities and decisions involved depend on the place a baby is born? As a matter of fact, this observation keeps playing an important role as to the possibility of addressing the most critical situations in a successful way. Even though the neonatal mortality rate in Italy is nowadays among the lowest in the world, infants born in Southern Italy still run a higher risk of dying in the neonatal period. Against this background, the situation of neonatal intensive care units points to inequalities that are not new for the country and yet hard to reconcile with the idea of sharing the same fundamental constitutional rights. Starting with everyone’s birth.

Hospitals' Responses to Administrative Cost-containment Policy in Urban China: The Case of Fujian Province

AbstractThe patterns of hospitals' behavioural changes in response to different insurance systems and payment arrangements have been well documented in the literature on health economics and policy. To understand these changes, it is necessary to look at the shifts in fundamental economic incentives. Meanwhile, hospital practices are also subject to adjustment when administrative tools are realigned. This article examines the dynamics of a health policy campaign started in 2005 by a Chinese provincial health administration that was committed to containing health expenditures using administrative measures. Through a combination of qualitative in-depth interviews and quantitative panel data analysis comprising 30 public hospitals in the sample, this article finds that by revising the structure of administrative measures on the supply side, the Chinese health bureaucracy is able to curb rapid cost inflation in the short term. However, while having to meet the cost control mandate imposed by the health administration, Chinese public hospitals still managed to defend their economic interests by engaging in various unintended opportunistic behaviour. This article analyses a panel database from Fujian province and reveals the strategies adopted by public hospitals and considers their implications for China's ongoing national healthcare reform.

The impact of HPV vaccination delays in China: Lessons from HBV control programs

It is well-known that vaccination efforts are often limited by available funds, despite being widely considered a cost-effective health intervention. In contrast, few consider the excess disease burden associated with vaccination delays due to failed health policy and bureaucracy. The history of the hepatitis B virus (HBV) vaccine in China is a case in point.

Health system strengthening in Myanmar during political reforms: perspectives from international agencies

Myanmar has undergone a remarkable political transformation in the last 2 years, with its leadership voluntarily transitioning from an isolated military regime to a quasi-civilian government intent on re-engaging with the international community. Decades of underinvestment have left the country underdeveloped with a fragile health system and poor health outcomes. International aid agencies have found engagement with the Myanmar government difficult but this is changing rapidly and it is opportune to consider how Myanmar can engage with the global health system strengthening (HSS) agenda. Nineteen semi-structured, face-to-face interviews were conducted with representatives from international agencies working in Myanmar to capture their perspectives on HSS following political reform. They explored their perceptions of HSS and the opportunities for implementation. Participants reported challenges in engaging with government, reflecting the disharmony between actors, economic sanctions and barriers to service delivery due to health system weaknesses and bureaucracy. Weaknesses included human resources, data and medical products/infrastructure and logistical challenges. Agencies had mixed views of health system finance and governance, identifying problems and also some positive aspects. There is little consensus on how HSS should be approached in Myanmar, but much interest in collaborating to achieve it. Despite myriad challenges and concerns, participants were generally positive about the recent political changes, and remain optimistic as they engage in HSS activities with the government.

Madness or Mental Illness? Revisiting Historians of Psychiatry

Is madness medical disease, problems in living, or social labeling of deviance? Does the word merely refer to behavior peculiar enough to be disturbing? Are the mad mad because of mental, physical, or environmental vulnerabilities? No one knows the answers to these questions because there is no scientific validation for any theory or specific causes of madness. Nonetheless, a view of madness as medical/bodily disease has been receiving concrete and rhetorical support from the government mental health bureaucracy, Big Pharma, mental health lobby groups, the organized profession of psychiatry, hundreds of thousands of providers of mental health services and countless books and articles. This article explores the role that medicalized language and its use by seven noted historians of psychiatry (Norman Dain, Albert Deutsch, Gerald Grob, Roy Porter, Charles Rosenberg, Andrew Scull, and Edward Shorter) might have played in shaping the contemporary view of madness as mental illness. The evidence we uncover suggests that historical “facts” about madness, much as psychiatric “facts” supporting the disease model, are shaped by belief, bias, error or ambiguous rhetoric rather than the facts of the matter.

Inadequate acute hospital beds and the limits of primary care and prevention

Metropolitan Australia is suffering from a serious shortage of acute hospital beds. Simplistic comparisons with the Organisation for Economic Co-operation and Development bed numbers are misleading because of the hybrid Australian public/private hospital system. The unavailability of most private beds for acute emergency cases and urban/rural bed imbalances have not been adequately considered. There is a lack of advocacy for acute bed availability. This attitude permeates government, health professions and the health bureaucracy. Planners, politicians, analysts and the media have adopted false hopes of reducing acute demand by prevention and primary care strategies, vital as these services are to a balanced healthcare system. This paper directly challenges the ideology that says Australia depends too heavily on hospital-based healthcare. Rebuilding the bed base requires recognition of the need for an adequate acute hospital service and strong advocacy for bed-based care in the medical and nursing professionals who should be driving policy. The forces opposing bed-based care are strong and solutions might include legislative definition of bed numbers and availability.

An empirical study on relationship between organizational culture and administrative corruption

Article history: Received January 8, 2012 Received in Revised form April, 25, 2012 Accepted 1 May 2012 Available online May 4 2012 Bureaucratic corruption is an organizational phenomenon, which faces the trend of countries’ development with serious problems. In spite of all planning and respects of countries to fight against this phenomenon, we are still observing its growth in various aspects of the community. The basic approach emphasized by present study is that it is necessary to establish a corruption prevention system whose central element is social culture and organizational culture rather than relying upon the trends based on punishment after corruption. To perceive the relationship between organizational culture and bureaucratic health of organizations, we used a field approach and selected four governmental organizations namely “governorship”, “municipality”, “traffic police” and “customs to gather the data. We used two questionnaires A and B to gather the data on organizational culture and the relationship between culture and corruption, respectively. Initially, by distributing questionnaire A, we evaluated all four organizations in a manner that two organizations have bureaucratic culture and two organizations with organic culture. Then, questionnaire B was distributed among employees and clients of studied organizations (to acquire realer information on bureaucratic health rate) to study the relationship between the type of organizational culture and bureaucratic health. Research statistical population consists of all employees and clients of bureaucratic organizations in Chabahar province located in south east of Iran. Statistical sample consists of 146 clients and 146 employees of all four studied organizations. The results from data analysis show that there is no significant relationship between organic or mechanic organizational culture and employees’ bureaucratic health. © 2012 Growing Science Ltd. All rights reserved.

Is the Chinese Health Bureaucracy Incapable of Leading Healthcare Reforms?: The Case of Fujian Province

The competency of the Chinese health bureaucracy has long been questioned in light of past healthcare reform failures. This article, however, by analysing the case of the Fujian Provincial Health Bureau and a policy intervention led by it aimed at curbing rampant cost inflation, demonstrates that with a conducive political environment and firm policy determination, it is possible to achieve effective cost containment without touching fundamental economic levers. The health bureaucracy is not inherently incapable. It still possesses essential authority and policy instruments to exercise strong stewardship. The reassertion of its legitimacy, reinforcement of government stewardship, restoration of the collapsed accountability mechanisms and realignment of government tools epitomise the experiences of Fujian's healthcare reforms.