Health Policy Challenges Research Articles

An effective approach to tackling complex health policy challenges. Using a clinical microsystems approach and rethinking codesign.

That people with serious mental illness have poor physical health and face a significant life expectancy gap compared with the general population is well known. Despite considerable policy focus in some countries, the gap in life expectancy remains. Tackling complex and persistent health problems such as this requires a systems-based approach, recognising the complexity of interacting components and their effects on the problem and on each other and applying collaborative analysis, design and implementation by those with knowledge of and expertise in the problem and the context. This paper describes the methods used to develop the Australian Being Equally Well National Policy Roadmap for better physical health care and longer lives for people with severe mental illness. Whilst recognising that high rates of physical health comorbidities are caused by many factors including lifestyle, access to high-quality healthcare and medication side effects, the work was focused on what could be done within Australian primary care to improve the physical health of this cohort. A Clinical Microsystem Approach was applied to synthesise clinical evidence with professional and lived experience, and an innovative policy development process was established, creating trust across all system levels. Participants with different kinds of knowledge and experience worked in discrete groups according to their professional or expert role whilst also being supported to participate in an intensive cross-collaboration. The potential value of this methodology for tackling other complex problems in health policy is discussed.

Uncovering the universe of New Psychoactive Substances (NPS): Understanding the mechanisms of action and adverse effects in an accessible and didactic way

New Psychoactive Substances (NPS) constitute a heterogeneous group of drugs associated with a range of health harms, producing more intense effects than traditional drugs. NPS pose a challenge for public health policies due to the limited information available about their effects on the body. Understanding the primary effects of NPS and their mechanisms of action is crucial for guiding healthcare professionals and raising awareness about the dangers associated with their use. In this context, the aim of this study was to gather the most current scientific information on the mechanisms of action and adverse effects of NPS, transforming it into a simple and accessible educational material for the public. Based on the information collected in this review, it was possible to develop a playful educational tool that not only informs about the effects of NPS but also provides clear information about the mechanisms of action of these substances in the CNS, as currently known for the wide variety of NPS. By making this information accessible and understandable, the booklet contributes to public awareness and empowers individuals to make informed and responsible decisions about the use of psychoactive substances. Additionally, it serves as a valuable educational tool for healthcare professionals and educators.

Putting patients first: when home-based care staff prioritise loyalty to patients above the system and themselves. An ethnographic study

BackgroundThe growing number of older people worldwide poses challenges for health policy, particularly in the Global North, where policymakers increasingly expect seniors to live and receive care at home. However, healthcare professionals, particularly in home-based care, face dilemmas between adhering to care ideals and meeting external demands. Although they strive to uphold ethical care standards, they must deal with patients’ needs, cooperation with colleagues and management guidelines. Home-based care is an essential part of healthcare services in Norway, but staff struggle with high patient numbers and time management. This article focuses on how staff deal with ethical challenges related to contextual and organisational constraints.MethodsAn ethnographic fieldwork in three municipalities in South-East Norway. The first author conducted three to four months of participant observation in each municipality. In addition, she conducted in-depth interviews with key informants in two municipalities and a focus group interview with seven home-based care workers in one municipality. The data was analysed by using a reflexive thematic analysis.ResultsStaff in home-based care are frequently more loyal to the patient than to the system and to their own needs. To provide good care, all informants disregarded the patient’s formal decision, i.e. they provided more care than the formalised decision stipulated. To prioritise beneficence to patients, informants also disregarded some of the rules applicable in home-based care. In addition, staff accepted risks to their own safety and health to provide care in the patient’s home.ConclusionThe loyalty of home-based care staff to their patients can go beyond their loyalty to the rules of the system and even their own safety. This commitment might be attributed to a sense of doing meaningful work, to providing relationship-based and individualised care, and to strong moral courage. However, the staff’s emphasis on flexibility and individualised care also brings challenges related to unclear boundaries related to patient care.

Fentanyl and xylazine on the Northern Border of Mexico: A New Challenge for Drug Health Policy

Fentanyl and xylazine on the Northern Border of Mexico: A New Challenge for Drug Health Policy

Learnings from the vaccines taskforce: an apotheosis in mission, purpose and handling risk.

The Vaccines Task Force was established by the UK government in April 2020, with the objective of securing early access to effective COVID-19 vaccines for the UK population and internationally. The VTF was successful in securing the earliest access to the Oxford/Astra Zeneca and Pfizer/BioNTech vaccines, allowing the UK to be the first country in the world to deploy an approved COVID-19 vaccine. The VTF also played a critical role in supporting efforts to distribute vaccines globally, as one of COVAX's earliest and largest donors. This article presents the perspectives of senior members of the VTF on the features of the task force model which enabled this success, and considers lessons for when and how a similar approach should be applied to other public health and public policy challenges. We seek to identify principles for mission led government, and implications for how the structure and apparatus of governance can be organised to support this, including the application of the Task Force model where appropriate.

Understanding the impact of the COVID-19 pandemic and its control measures on women and children: A Zimbabwe case study.

COVID-19 presented countries with unprecedented health policy challenges. For low-income countries in particular, policymakers had to contend with both the direct threats posed by COVID-19 as well as the social, educational, and economic harms associated with lockdown and other infection prevention and control measures. We present a holistic and contextualised case study of the direct and indirect impacts of COVID-19 on women and children, with some assessment of their uneven distribution across socio-economic, age and gender groups. We used different types of primary and secondary data from multiple sources to produce a holistic descriptive analysis. Primary data included: qualitative data obtained from 28 in-depth interviews of key informants, six focus group discussions; and 40 household interviews. We also extracted data from government reports and announcements, the District Health Information Software version 2 (DHIS2), newspaper articles and social media, as well as from published research articles. Our findings show that the direct and indirect adverse impacts of COVID-19 were compounded by many years of severe political economic challenges, and consequent deterioration of the healthcare system. The indirect effects of the pandemic had the most severe impacts on the poorest segment of society and widened age and gender inequalities. The pandemic and its accompanying infection prevention and control measures negatively affected health service delivery and uptake. The management of COVID-19 presented enormous challenges to policymakers and public health specialists. These included managing the greatest tension between direct and indirect harms; short-term and long-term effects; and the unequal distribution of harms across different segments of society.

Navigating the path towards successful implementation of the EU HTA Regulation: key takeaways from the 2023 Spring Convention of the European Access Academy

BackgroundThe European Regulation on Health Technology Assessment (EU HTA R), effective since January 2022, aims to harmonize and improve the efficiency of common HTA across Member States (MS), with a phased implementation from January 2025. At “midterms” of the preparation phase for the implementation of the Regulation our aim was to identify and prioritize tangible action points to move forward.MethodsDuring the 2023 Spring Convention of the European Access Academy (EAA), participants from different nationalities and stakeholder backgrounds discussed readiness and remaining challenges for the Regulation’s implementation and identified and prioritized action points. For this purpose, participants were assigned to four working groups: (i) Health Policy Challenges, (ii) Stakeholder Readiness, (iii) Approach to Uncertainty and (iv) Challenges regarding Methodology. Top four action points for each working group were identified and subsequently ranked by all participants during the final plenary session.ResultsOverall “readiness” for the Regulation was perceived as neutral. Prioritized action points included the following: Health Policy, i.e. assess adjustability of MS laws and health policy processes; Stakeholders, i.e. capacity building; Uncertainty, i.e. implement HTA guidelines as living documents; Methodology, i.e. clarify the Population, Intervention, Comparator(s), Outcomes (PICO) identification process.ConclusionsAt “midterms” of the preparation phase, the focus for the months to come is on executing the tangible action points identified at EAA’s Spring Convention. All action points centre around three overarching themes: harmonization and standardization, capacity building and collaboration, uncertainty management and robust data. These themes will ultimately determine the success of the EU HTA R in the long run.

Prevalence of neonatal screening and associated factors in Brazil: a comparison of the 2013 and 2019 National Health Surveys.

This study analyzed the prevalence of complete neonatal screening (CNS) of children aged under 2 years in Brazil and associated factors using data from the 2013 (n=4,442) and 2019 (n=5,643) national health surveys. We conducted a cross-sectional study to compare prevalence of CNS (eye, ear and heel prick tests) adopting 95% confidence intervals (95%CI) and a 5% significance level. Crude and adjusted Poisson regression was performed to estimate prevalence ratios (PR) and 95%CI to assess the association between socioeconomic, demographic and health variables and CNS. There was a statistically significant increase in CNS prevalence, from 49.2% (95%CI: 47.1-51.3) in 2013 to 67.4% (95%CI: 65.5-69.3) in 2019. However, large disparities persist across states and between sociodemographic groups. In both years, CNS prevalence was lowest among brown and black children, those from families in the three lowest income quintiles, children without health insurance, those from families registered in the Family Health Strategy and children living in the North, cities outside the state capital/metropolitan regions and rural areas. Despite the increase in prevalence of CNS, deep individual and contextual inequalities persist, posing challenges for health policies.

Prevalência e fatores associados à realização dos exames de triagem neonatal no Brasil: comparação da PNS 2013 e 2019

Abstract This study analyzed the prevalence of complete neonatal screening (CNS) of children aged under 2 years in Brazil and associated factors using data from the 2013 (n=4,442) and 2019 (n=5,643) national health surveys. We conducted a cross-sectional study to compare prevalence of CNS (eye, ear and heel prick tests) adopting 95% confidence intervals (95%CI) and a 5% significance level. Crude and adjusted Poisson regression was performed to estimate prevalence ratios (PR) and 95%CI to assess the association between socioeconomic, demographic and health variables and CNS. There was a statistically significant increase in CNS prevalence, from 49.2% (95%CI: 47.1-51.3) in 2013 to 67.4% (95%CI: 65.5-69.3) in 2019. However, large disparities persist across states and between sociodemographic groups. In both years, CNS prevalence was lowest among brown and black children, those from families in the three lowest income quintiles, children without health insurance, those from families registered in the Family Health Strategy and children living in the North, cities outside the state capital/metropolitan regions and rural areas. Despite the increase in prevalence of CNS, deep individual and contextual inequalities persist, posing challenges for health policies.

Sustainability challenges concerning the effects of high-priced drugs on the day-to-day operations of community pharmacies in Finland

BackgroundHigh-priced drugs pose a challenge for health budgets, policies, and patient safety. One of the key roles of community pharmacies is to ensure availability to prescription drugs regardless of their price. This has been identified as challenging in certain situations concerning high-priced drugs. ObjectivesThe aim is to investigate the views of proprietary pharmacists regarding the effects of high-priced drugs on the day-to-day operations of pharmacies. MethodsThe data collection of the study was performed as a national cross-sectional online survey. The inclusion criteria were being a proprietary pharmacist and a member of the Association of Finnish Pharmacies. The survey contained questions yielding both quantitative and qualitative answers. The study focused on the qualitative data which was analysed by deductive thematic analysis. ResultsIn total 604 proprietary pharmacists were sent the survey, and 174 eligible answers were included in the study, giving a response rate of 29%. The result describes the relationships between the economic, social, and environmental dimensions of sustainable development based on a framework by Wanamaker, with respect to high-priced drugs and community pharmacy operations as viewed by proprietary pharmacists. The main findings of the study show that proprietary pharmacists find the implementation of real-time reimbursement payments, a further reform of the pharmacy tax, and the abolishment of return bans to the wholesaler as risk mitigations and means to attain sustainability with respect to high-priced drugs and pharmacy practice. They experience that these changes would diminish high-priced drugs unnecessarily ending up as medical waste and improve the working conditions of the pharmacy staff by alleviating stress. ConclusionsAccording to the respondents, high-priced drugs pose challenges for community pharmacies and the legislation and reimbursement system need to adapt to these challenges. If not, community pharmacies in Finland continue to face severe financial declines based on the study results.

The Importance of Involving a Multidisciplinary Team in the Management of a Patient Diagnosed with TB, Associating Erythema Nodosum

Tuberculosis (TB) is an important and topical problem at global level, so it remains a challenge for public health policies . According to the World Health Organization (WHO), in 2018, about 10 million new TB cases worldwide were estimated. Of these, 11% are children under the age of 15. In addition to these alarming data, TB is responsible for 130,000 deaths per year in children and it is estimated that there are approximately 1 million TB-cases in the global population of children, being one of the top 10 causes of death in children worldwide. According to the WHO, there are economic, social, cultural, ethnic/racial, psychological and behavioral factors that interfere with the occurrence of diseases, and these factors are attributed to the persistence of infectious diseases such as TB in the population, even today. Numerous specialized studies strengthen the hypothesis of associating social vulnerability with TB emergence and distribution in the community.
 Therefore, the development of more accurate estimates of pediatric TB cases is an urgent need for public policy scheduling and resource allocation and, consequently, for reducing morbidity and mortality from TB among children.

Understanding epidemic spread patterns: a visual analysis approach

ABSTRACT Epidemics present significant challenges for public health policy globally, but current tools for visualizing and analyzing epidemic spread are limited, especially at a large scale. This paper presents a novel visual analysis approach for exploring and comparing pandemic patterns in spatial and temporal dimensions across various regions. The method incorporates a potential flow technique to model the spatiotemporal dynamics of epidemics and a visual exploration tool, EPViz, for interactive data analysis. Utilizing COVID-19 data from Illinois and Pennsylvania in the United States, the paper evaluates the method and tool’s effectiveness. These states were chosen for their differing epidemic scenarios and policies. Additionally, interviews with public health policy experts were conducted to gather feedback on the approach and EPViz’s effectiveness, design, and usability. The findings indicate that this new approach and tool enhance expert understanding, support decision-making, and can inform effective strategies for epidemic prevention and control.

Health policy and regulatory authorities: challenges of technology regulation in Public Health Emergencies.

Public Health Emergencies (PHE) have had repercussions on health systems on a global scale, and timely access to new health technologies is a challenge for health policy. The national regulatory authorities (NRA) play a key role in the evaluation and regulation of these technologies. The present study aims to analyze the main strategies and regulatory instruments used to deal with the challenges of regulating new technologies necessary for the health system's effective response during a PHE. This research, based on WHO and Brazilian NRA norms and documents, considered dimensions related to strategies for strengthening regulatory activities and regulatory instruments used to accelerate access to technologies, especially during PHEs. International cooperation between the NRA and the WHO were important strategies for strengthening the NRA, with emphasis on the use of reliance, regionalization, accelerated assessments, and work/information sharing, as well as the processes of regulatory harmonization and convergence. In addition to the use of existing regulatory instruments, efforts were also identified in order to implement new ones.

Política de saúde e Autoridades Reguladoras: desafios da regulação de tecnologias nas Emergências em Saúde Pública

Abstract Public Health Emergencies (PHE) have had repercussions on health systems on a global scale, and timely access to new health technologies is a challenge for health policy. The national regulatory authorities (NRA) play a key role in the evaluation and regulation of these technologies. The present study aims to analyze the main strategies and regulatory instruments used to deal with the challenges of regulating new technologies necessary for the health system’s effective response during a PHE. This research, based on WHO and Brazilian NRA norms and documents, considered dimensions related to strategies for strengthening regulatory activities and regulatory instruments used to accelerate access to technologies, especially during PHEs. International cooperation between the NRA and the WHO were important strategies for strengthening the NRA, with emphasis on the use of reliance, regionalization, accelerated assessments, and work/information sharing, as well as the processes of regulatory harmonization and convergence. In addition to the use of existing regulatory instruments, efforts were also identified in order to implement new ones.

Role of policy makers, health researchers, and challenges in clinical drug trial and health policy: a review

Role of policy makers, health researchers, and challenges in clinical drug trial and health policy: a review

A Flight or Plight: Mental Health Policy Challenges of Philippine Government Agencies A Flight Or Plight: Mental Health Policy Challenges of Philippine Government Agencies

A Flight or Plight: Mental Health Policy Challenges of Philippine Government Agencies A Flight Or Plight: Mental Health Policy Challenges of Philippine Government Agencies

A Flight or Plight: Mental Health Policy Challenges of Philippine Government Agencies

A Flight or Plight: Mental Health Policy Challenges of Philippine Government Agencies

INTEGRATING AI INTO HEALTH INFORMATICS FOR ENHANCED PUBLIC HEALTH IN AFRICA: A COMPREHENSIVE REVIEW

This study delves into the integration of Artificial Intelligence (AI) within the field of health informatics and its transformative effect on public health outcomes in Africa. It will cover how AI-driven solutions are being implemented to overcome challenges in disease surveillance, healthcare delivery, and public health policy. The paper aims to provide an in-depth analysis of current innovations, the effectiveness of these technological interventions, and their broader implications for health policy and management across the African continent. The integration of Artificial Intelligence (AI) into health informatics holds transformative potential for enhancing public health in Africa. This comprehensive review explores the multifaceted applications, challenges, and opportunities associated with the convergence of AI and health informatics on the African continent. The review encompasses various domains, including disease surveillance, diagnostics, treatment optimization, and public health management. Key themes addressed in the review include the adoption of AI-driven technologies in healthcare, the impact on disease detection and monitoring, and the potential for improving healthcare accessibility in resource-constrained settings. Moreover, the ethical considerations, regulatory challenges, and disparities in technology adoption across diverse African regions are examined, providing insights into the complexities of implementing AI in the African public health landscape. Through an in-depth analysis of current initiatives, case studies, and emerging trends, this review aims to contribute a comprehensive understanding of the opportunities and challenges associated with integrating AI into health informatics for the advancement of public health in Africa. Ultimately, this exploration seeks to inform policymakers, healthcare professionals, and researchers on the critical role AI can play in addressing public health challenges on the continent and fostering sustainable healthcare solutions.
 Keywords: Artificial Intelligence, Health Informatics, Health Management, Africa, Review, Disease Surveillance.

Socially sustainable housing and built environments to support the health and social inclusion of older adults: protocol for a scoping review and stakeholder consultation

IntroductionHousing and the ageing population are issues that pose challenges for social, health and economic policies. Therefore, there is a need for more knowledge on how to design housing and...

Policy Complexities in Financing First Episode Psychosis Services: Implementation Realities from a Home Rule State.

Over the past decade, significant investments have been made in coordinated specialty care (CSC) models for first episode psychosis (FEP), with the goal of promoting recovery and preventing disability. CSC programs have proliferated as a result, but financing challenges imperil their growth and sustainability. In this commentary, the authors discuss (1) entrenched and emergent challenges in behavioral health policy of consequence for CSC financing; (2) implementation realities in the home rule context of Ohio, where significant variability exists across counties; and (3) recommendations to improve both care quality and access for individuals with FEP. The authors aim to provoke careful thought about policy interventions to bridge science-to-service gaps, and in this way, advance behavioral health equity.