Health Policy Dialogue Research Articles

A health policy dialogue on emergency use authorization during Covid-19: a case of a YouTube influencer with millions of subscribers

A health policy dialogue on emergency use authorization during Covid-19: a case of a YouTube influencer with millions of subscribers

A study on risk perception, cognitive awareness and emotional responses to identify unmet training needs of frontline health care workers for COVID-19 containment in India

Aim: Frontline Health Care Workers (FLHCWs) are the key workforce in the fight against ongoing COVID-19 pandemic. They hail from the community and are responsible for supporting the health system in generating awareness, implementing preventive strategies, contact tracing and isolating potential cases. In their job responsibilities, FLHCWs thus may perceive heightened risk of exposure to the virus, leading to overwhelming emotional response and psychological distress. The objective of this study was to investigate risk perception, cognitive awareness and emotional responses among FLHCWs trained to deal with Covid 19, to identify unmet needs of this training in India.Methods: A cross-sectional study was conducted in a total of 131 frontline workers selected by a multistage sampling process from two states (Odisha and Himachal Pradesh) of India. The FLHCWs were interviewed personally (when feasible) with the help of a predesigned pretested semi-structured questionnaire.Results: The findings suggested that majority (90%) of the FLHCWs perceived that they are susceptible to nCoV-19 infection and 77.1% of FLHCWs felt high probability of them getting infected with the nCoV-19. Almost 90% of them responded that it is something they think about all the time and 41% of FLHCWs admitted that they feel helpless in the situation. About 63% of FLHCWs perceived that the nCoV-19 infection was a severe illness and 35% perceived it to be very severe and life threatening. Although most of them had received some unstructured and non-uniform training on preventive measures against COVID-19, yet only 38% felt that the knowledge was adequate to protect themselves from the nCoV-19 infection. The training sessions lacked psychological component for capacitating them with coping skills to address their emotional and psychological responses. Conclusion: The FLHCWs experienced heightened risk perception and symptoms of emotional distress in significant numbers even after trainings. A more inclusive public health policy dialogue to address the emotional and psychological coping skills is needed for capacitation of these frontline workers to address the challenges of Pandemic response now and in future.

Health inequities in Bhutan's free healthcare system: a health policy dialogue summary

AbstractBhutan has a free healthcare system that covers almost 90% of the population within 2 h of travel distance. The country has achieved remarkable success in many public health indicators despite the chronic shortage of financial resources and trained manpower. However, there are many aspects of health inequities in the government's health policies, programmes and health services. The Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu in 2020 hosted a policy dialogue on health equity in the context of the Bhutanese health system. With changing demographics and socioeconomic conditions, some of the factors that earlier determined an equitable distribution of services and resources are no longer relevant now. The referral system is easily bypassed not only because the patients have easy access to transportation to tertiary hospitals, but because of frequent interruptions in the service and the non‐availability of doctors in the district and general hospitals. The role of the private sector is restricted to a few diagnostic services while there is an apparent adequate spending capacity of consumers. There is an important component of out‐of‐pocket expenditure and catastrophic health expenditure in patients seeking treatments outside the country. The current health policies and strategic plans for the future lack a measure of health equity. We recommend conscientious assessment of health inequities in the current system and introducing policies and programmes to prevent the worsening of such inequities.

Oral Health & Dentistry in Bhutan: call for actions to address a public health urgency

Introduction: Bhutan’s healthcare approach in achieving the sustainable development goal 3 (SDG 3) has been largely through primary healthcare as enshrined in the universal health coverage (UHC). Bhutan has forged a unique primary healthcare model in which oral health is integrated in its primary care initiatives. The Oral Health program under the Department of public health was established in 1999 with clear line objectives. The program has achieved commendable successes over the years. However, with changing needs, enhancing and mainstreaming of oral health and dentistry in the country must be accorded a top priority. This is particularly important as the Oral Health Policy and service standards were drafted fourteen years ago in 2007. The 2021 World Health Orgnization (WHO) agreement “to provide basic oral health services to all”, to which Bhutan is signatory, needs to be strictly implemented. Therefore, oral health dialogue was conducted to deliberate on the oral health systems in the country with experts from the field who were from within and outside Bhutan. This oral health policy dialogue generated important themes such as strategic and competent workforce, capacity development, need to transform oral health services in more people centric ways and mainstreaming oral health in other health policies.

Policy dialogue and participation: a new way of crafting a national health financing strategy in Morocco

BackgroundPolicy dialogue for health policies has started to gain importance in recent years, especially for complex issues such as health financing. Moroccan health financing has faced several challenges during the last years. This study aims to document the Moroccan experience in developing a consolidated health financing strategy according to the policy dialogue approach. It especially considers the importance of conceptualising this process in the Moroccan context.MethodWe documented the process of developing a health financing strategy in Morocco. It concerned four steps, as follows: (1) summarising health financing evidence in preparation of the policy dialogue; (2) organising the health policy dialogue process with 250 participants (government, private sector, NGOs, civil society, parliamentarians, technical and financial partners); (3) a technical workshop to formulate the strategy actions; and (4) an ultimate workshop for validation with decision-makers. The process lasted 1 year from March 2019 to February 2020. We have reviewed all documents related to the four steps of the process through our active participation in the policy debate and the documentation of two technical workshops to produce the strategy document.ResultsThe policy dialogue approach showed its usefulness in creating convergence among all health actors to define a national shared vision on health financing in Morocco. There was a high political commitment in the process and all actors officially adopted recommendations on health financing actions. A strategy document produced within a collaborative approach was the final output. This experience also marked a shift from previous top-down approaches in designing health policies for more participation and inclusion. The evidence synthesis played a crucial role in facilitating the debate. The collaborative approach seems to work in favouring national consensus on practical health financing actions.ConclusionThe policy dialogue process adopted for health financing in Morocco helped to create collective ownership of health financing actions. Despite the positive results in terms of national mobilisation around the health financing vision in Morocco, there is a need to institutionalise the policy dialogue with a more decentralised approach to consider subnational specificities.

IRDI Public Health Policy Dialogue Series No. 4: The Malaysian National Immunization Programme: Should childhood immunization be made compulsory by law?

IRDI Public Health Policy Dialogue Series No. 4: The Malaysian National Immunization Programme: Should childhood immunization be made compulsory by law?

IRDI Public Health Policy Dialogue Series No.1: Control of Sugar Sweetened Beverage (SSB): Regulation or Taxation?

IRDI Public Health Policy Dialogue Series No.1: Control of Sugar Sweetened Beverage (SSB): Regulation or Taxation?

IRDI Public Health Policy Dialogue Series No. 2: Inclusion of Pneumococcal Conjugate Vaccine (PCV) into the National Immunisation Programme (NIP)

IRDI Public Health Policy Dialogue Series No. 2: Inclusion of Pneumococcal Conjugate Vaccine (PCV) into the National Immunisation Programme (NIP)

Harmonisation and standardisation of health sector and programme reviews and evaluations - how can they better inform health policy dialogue?

BackgroundHealth sector and programme performance assessments provide a rich source of contextual data directly linked to implementation of programmes and can inform health policy dialogue, planning and resource allocation. In seeking to maximise this opportunity, there are challenges to overcome. A meeting convened by the World Health Organization African Region discussed the strengths, weaknesses and challenges to harmonising and standardising health sector and programme performance assessments, as well as use of evidence from such processes in decision making. This article synthesises the deliberations which emerged from the meeting. Discussing these in light of other literature we propose practical options to standardising health sector and programme performance assessment and improve realisation of using evidence in decision making.DiscussionUse of evidence generated from health sector and programme performance assessments into regular country processes of sectoral monitoring, dialogue and policy modification is crucial. However, this process faces several challenges. Identified challenges were categorised under several themes, namely the weak institutional capacities for monitoring and evaluation in reference to weak health information systems, a lack of tools and skills, and weak accountability mechanisms; desynchronised planning timeframes between programme and overall health sector strategies; inadequate time to undertake comprehensive and good quality performance assessment; weak mechanisms for following up on implementation of recommendations; lack of effective stakeholder participation; and divergent political aspirations.ConclusionThe question of what performance assessment is for in a country must be asked and answered clearly if the utility of these processes is to be realised. Standardising programme and sector reviews offers numerable opportunities that need to be maximised. Identified challenges need to be overcome through strengthened Ministry of Health leadership, effective stakeholder engagement and institutionalising follow-up mechanisms for agreed recommendations. In addition, health sector performance assessments need to be institutionalised as part of the accountability mechanism, and they must be planned for and funding secured within annual budget and medium term expenditure frameworks.

Perspectives on health policy dialogue: definition, perceived importance and coordination.

BackgroundCountries in the World Health Organization African Region have witnessed an increase in global health initiatives in the recent past. Although these have provided opportunities for expanding coverage of health interventions; their poor alignment with the countries’ priorities and weak coordination, are among the challenges that have affected their impact. A well-coordinated health policy dialogue provides an opportunity to address these challenges, but calls for common understanding among stakeholders of what policy dialogue entails. This paper seeks to assess stakeholders’ understanding and perceived importance of health policy dialogue and of policy dialogue coordination.MethodsThis was a cross-sectional descriptive study using qualitative methods. Interviews were conducted with 90 key informants from the national and sub-national levels in Lusophone Cabo Verde, Francophone Chad, Guinea and Togo, and Anglophone Liberia using an open-ended interview guide. The interviews were transcribed verbatim, coded and then put through inductive thematic content analysis using QRS software Version 10.ResultsThere were variations in the definition of policy dialogue that were not necessarily linked to the linguistic leaning of respondents’ countries or whether the dialogue took place at the national or sub-national level. The definitions were grouped into five categories based on whether they had an outcome, operational, process, forum or platform, or interactive and evidence-sharing orientation. The stakeholders highlighted multiple benefits of policy dialogue including ensuring stakeholder participation, improving stakeholder harmonisation and alignment, supporting implementation of health policies, fostering continued institutional learning, providing a guiding framework and facilitating stakeholder analysis.ConclusionPolicy dialogue offers the opportunity to improve stakeholder participation in policy development and promote aid effectiveness. However, conceptual clarity is needed to ensure pursuance of common objectives. While it is clear that stakeholder involvement is an important component of policy dialogue, numbers must be manageable for meaningful dialogue. Ownership and coordination of the policy dialogue are important aspects of the process, and building the institutional capacity of the ministry of health requires a comprehensive approach as opposed to strengthening selected departments within it. Likewise, capacity for policy dialogue needs to be built at the sub-national level, alongside improving the bottom-up approach in policy processes.

Health policy dialogue: experiences from Africa.

Background The high volume of investments in health seen in Africa over the last decade, mainly through global health initiatives [1], has enabled significant improvements in some health indicators in many of the countries [2]. However, these gains have not always translated into sustained improvements in the health sector’s capacity or health system’s performance [3]. Countries in the World Health Organization African Region continue to face serious challenges among which are major inadequacies in the health workforce, low levels of health spending with significant out of pocket payments, weak procurement and supply systems, poor information and monitoring systems, [4] and weak community engagement [5]. The 2014–2016 Ebola virus disease outbreak in West Africa illustrated the importance of a functional health system in sustaining health service delivery and economic and social development amidst a crisis [6, 7]. Weaknesses in health sectors’ organisation and governance continue to undermine the efficiency of health service delivery [8]. The adoption of the 17 Sustainable Development Goals in September 2015 raises questions about the countries’ capacity to attain these new and broader goals when most of them failed to reach the targets of the Millennium Development Goals [4]. Realising the Sustainable Development Goals requires making good policy and strategic choices in the effort to achieve universal health coverage. Effective country stewardship, and governance and leadership of the health sector, along with ownership of the goals, will be needed to mobilise relevant stakeholders and to guide domestic and external investments towards the agreed goals. This will also require strengthening of partnerships, effective intersectoral engagement and collaboration, and community engagement. An important element in moving forward will be government leadership and coordination of effective policy dialogues and strategic planning to arrive at wellconsidered and evidence-based national health policies and sector strategic plans that are owned and supported by all stakeholders. In Africa, with its looming noncommunicable disease catastrophe and vibrant social, demographic and economic growth, sophisticated policy dialogue and evidence-based choices will increasingly be essential. The challenge of getting from research evidence to policy decisions will fare better with effective policy dialogue. The papers in this supplement review present recent experiences from some countries in the World Health Organization Africa Region from a programme to expand and support policy dialogue in the health sector. The experience has been illuminating with regard to the factors relating to the political players and processes, and the subjective elements that fuel policy debates. The themes of the papers were generated based on the critical questions on how policy dialogue would work in the various contexts found in a set of low income countries that receive substantial external aid inputs and therefore see significant influence in policy development and decision-making processes. It was important to determine what the enablers of effective policy dialogue were in those contexts and what incentives or motivators guided the stakeholders towards a viable policy dialogue. The papers highlight the fact that policy dialogue requires resources in terms of time, space, evidence, good facilitation, dialogue skills and advocacy. Informal and formal platforms need to be employed for consensus building, and potential influence and power imbalance need to be anticipated and mitigated. Often, as with any policy change or choice, there will be winners and losers—both metaphorically and concretely—in terms of access to health services and shifts in other interests. Understanding the impact of choices made should be a critical part of the dialogue processes. Timely and innovative dissemination of relevant information is needed to ensure that the dialogue is informed. * Correspondence: dovlod@who.int Health Systems and Services Cluster, World Health Organization Regional Office for Africa, B.P. 06 Brazzaville, Congo

Policy dialogue to improve health outcomes in low income countries: what are the issues and way forward?

BackgroundThis paper has three objectives: to review the health development landscape in the World Health Organization African Region, to discuss the role of health policy dialogue in improving harmonisation and alignment to national health policies and strategic plans, and to provide an analytical view of the critical factors in realising a good outcome from a health policy dialogue process.DiscussionStrengthening policy dialogue to support the development and implementation of robust and comprehensive national health policies and plans, as well as to improve aid effectiveness, is seen as a strategic entry point to improving health sector results. However, unbalanced power relations, the lack of contextualised and relevant evidence, the diverse interests of the actors involved, and the lack of conceptual clarity on what policy dialogue entails impact the outcomes of a policy dialogue process. The critical factors for a successful policy dialogue have been identified as adequate preparation; secured time and resources to facilitate an open, inclusive and informed discussion among the stakeholders; and stakeholders’ monitoring and assessment of the dialogue’s activities for continued learning. Peculiarities of low income countries pose a challenge to their policy dialogue processes, including the chaotic-policy making processes, the varied capacity of the actors and donor dependence.ConclusionPolicy dialogue needs to be appreciated as a complex and iterative process that spans the whole process of policy-making, implementation, review and monitoring, and subsequent policy revisions. The existence of the critical factors for a successful policy dialogue process needs to be ensured whilst paying special attention to the peculiarities of low income countries and potential power relations, and mitigating the possible negative consequences. There is need to be cognisant of the varied capacities and interests of stakeholders and the need for capacity building, and to put in place mechanisms to manage conflict of interest. The likelihood of a favourable outcome from a policy dialogue process will depend on the characteristics of the issue under consideration and whether it is contested or not, and the policy dialogue process needs to be tailored accordingly.

Coordination of the health policy dialogue process in Guinea: pre- and post-Ebola.

BackgroundPolicy dialogue can be defined as an iterative process that involves a broad range of stakeholders discussing a particular issue with a concrete purpose in mind. Policy dialogue in health is increasingly being recognised by health stakeholders in developing countries, as an important process or mechanism for improving collaboration and harmonization in health and for developing comprehensive and evidence-based health sector strategies and plans. It is with this perspective in mind that Guinea, in 2013, started a policy dialogue process, engaging a plethora of actors to revise the country’s national health policy and develop a new national health development plan (2015–2024). This study examines the coordination of the policy dialogue process in developing these key strategic governance documents of the Guinean health sector from the actors’ perspective.MethodsA qualitative case study approach was undertaken, comprising of interviews with key stakeholders who participated in the policy dialogue process. A review of the literature informed the development of a conceptual framework and the data collection survey questionnaire. The results were analysed both inductively and deductively.ResultsA total of 22 out of 32 individuals were interviewed. The results suggest both areas of strengths and weaknesses in the coordination of the policy dialogue process in Guinea. The aspects of good coordination observed were the iterative nature of the dialogue and the availability of neutral and well-experienced facilitators. Weak coordination was perceived through the unavailability of supporting documentation, time and financial constraints experienced during the dialogue process. The onset of the Ebola epidemic in Guinea impacted on coordination dynamics by causing a slowdown of its activities and then its virtual halt.ConclusionsThe findings herein highlight the need for policy dialogue coordination structures to have the necessary administrative and institutional support to facilitate their effective functioning. The findings also point to the need for further research on the practical and operational aspects of national dialogue coordination structures to determine how to best strengthen their capacities.

Evangelical theology, health care, and the third way

ABSTRACTIn the context of American health care, considerable attention has been paid to health disparities based on both race and socioeconomic status. Scholars of public health and other social scientists agree that these inequities are enduring and tied to important social factors. Recently, community-based interventions have become popular to address population health and improve health outcomes. These projects that occur in the third sector are thought to be successful because of the full participation of community members who are familiar with local problems and prepared to design appropriate solutions. In many ways, community-based philosophy is consistent with the commitment to voluntarism found in Evangelical theology and religious practice. We, therefore, offer a framework for future collaboration and health policy dialogue in the third sector between community-based activists and American Evangelicals.

Evangelical Protestants and the ACA: An Opening for Community-Based Primary Care?

Evangelical Protestants make up the largest religious subgroup in the United States, and previous research has shown that Evangelical churches are disproportionately active in community engagement and efforts toward social change. Although Evangelical Protestant perspectives have been considered with regard to persistent socioeconomic stratification and racial discrimination, less focus has been given to how churches interpret poor health outcomes within the United States. In particular, this research addresses how enduring health disparities are understood within the larger discussion of healthcare reform. Due to the similarity of approaches favored by participants in this study and community-based philosophy, a suggestion is made for future health policy dialogue. Although Evangelical Protestants have been most likely to reject all aspects of the Affordable Care Act, in many ways the findings of this study suggest the potential for successful future health policy collaboration. In particular, community-based primary care might appeal to Evangelicals and health professionals in the ongoing effort to improve population health and the quality of healthcare in the United States.

2014 Black Women and Health Politics Panel-Het Heru Healing Dance and Auset Aum Tam Qi Gong Healing: Holistic Approaches to Dance/Movement Therapy

After ten years of research on Black women and breast cancer, I have concluded that there are structural prohibitions against Black women being able to shape the national public health policy dialogue on breast cancer. Despite being the demographic most likely to die from this disease, stigma against Black women (Motsemme 2004, 2007, 2011; Jordan-Zachery 2008; Berger 2004; Cohen 1999) still shapes survival rates. In the struggle to survive in a context in which political institutions ignore their lives, Black women have taken their health into their own hands. Thus, in this paper, I have begun to examine the and collective alternative healing strategies and practices of Black women that constitute a wholly distinctive location for mobilization and collective action by Black women in pursuit of their health.According to the American Dance Therapy Association (ADTA), dance/movement therapy is the psychotherapeutic use of movement to further the emotional, cognitive, physical and social integration of the individual (www.adta.org). Psychological and physical interventions including dance and movement creative art therapies have been studied for use with oncology, orthopedic and mental health patients, to name a few, measuring a variety of outcomes including those relating to quality of life. In this paper, I will examine the Het Heru Healing Dance (2010) and the and Auset Aum Tam Qi Gong for women, to further explore the potential contributions of dance and movement as creative arts therapies for women’s wellness and improvement in overall quality of life. The increasing desire for alternative treatment options and the increasing popularity of dance/movement therapy opens the way for the Het Heru Healing Dance and Auset Aum Tam Qi Gong to increase the quality of life for women by providing (1) an accessible and fundamentally unique method of dance and movement therapy, (2) an opportunity for group support, and (3) a space for women to reflect on how they holistically understand and perceive their health, to ask questions, and to expand discussions on innovative new ways to enhance wellness. Unlike the ADTA dance/movement therapy based on the limited mind/body binary intervention, I argue the Het Heru Healing Dance and Auset Aum Tam Qi Gong create new possibilities for optimizing health and healing because they are holistic dance and movement forms rooted in the Metu Neter Paut Neteru methodology based on the complimentary, interdependent and unifying 11 Laws of Maat (Amen 1990, 2003). The Paut Neteru method is the cosmologic basis of behavioral change in Kamitic spiritual science. African worldview theory, therefore, provides the theoretical framework for this study, and scholarship on dance/movement therapy in Psychology, African Studies, Africana Studies, Women’s and Gender Studies and and Cultural Studies provides the historical context and contributes to the overall thesis.

The Clinical and Translational Science Institute at Children's National: Improving Health through pediatric Research

The Clinical and Translational Science Institute at Children's National: Improving Health through pediatric Research

History and Health Policy in the United States: Putting the Past Back in

History and Health Policy in the Untied States offers an important interdisciplinary collection of essays on the history of health policies that range from the creation of federal research agencies, to insurance coverage and Health Maintenance Organization (HMO), to patients' influence on the burgeoning field of medicine. The authors included in this collection won Robert Wood Johnson Investigator Awards in Health Policy Research since 1992, and as their work attests, they engage in critical questions about how and why a cultural, social, and political lens is paramount to understanding health policy in the United States. The collection includes thirteen essays and is divided into four parts. As Rosemary Stevens states in her introduction, the collection is designed to demonstrate the importance of history when evaluating health-care policy, reconceptualizing policy to acknowledge historical roots, and recognizing the contributions of social scientists to health policy dialogue. The volume accomplishes these goals and more. In short, it is an excellent resource for health policy dialogue. It offers a concise and accessible introduction to the field while simultaneously evoking thoughtful responses to some of the most fundamental and important issues facing the country today.

Confronting Trade-Offs In Health Care: Harvard Pilgrim Health Care’s Organizational Ethics Program

Patients, providers, and policy leaders need a new moral compass to guide them in the turbulent U.S. health care system. Task forces have proposed excellent ethical codes, but these have been seen as too abstract to provide guidance at the front lines. Harvard Pilgrim Health Care's ten-year experience with an organizational ethics program suggests ways in which health care organizations can strengthen transparency, consumer focus, and overall ethical performance and contribute to the national health policy dialogue.

Hospital Admission Through the Emergency Department-Reply

In Reply. —We agree with Dr Pane that delays in seeking care and low socioeconomic status are among the several reasons patients admitted through the ED use more health care resources. Because of these patterns of resource use, it is important to consider modification of the existing hospital payment system. We concur that entry of emergency physicians into the current health policy dialogue is a positive development. The informal study by Tachakra et al demonstrates differences in length of stay nearly identical to those we noted. We were unable to account fully for these differences using established measures of severity and socioeconomic status. We agree with Tachakra et al that prospective collection of data on patients' social supports, socioeconomic status, and severity of illness would be useful in efforts to assess patients' resource needs and determine equitable payment to hospitals under per case or global budgeting systems of health care