Health System Development Research Articles

Employment policy in the COVID-19

The paper analyses the macroeconomic situation in the labor market and proposes measures to restore employment to the pre-COVID -19 level. The study of the basic concepts of state regulation methods of employment demonstrates that various forms of their application are used on the country’s macroeconomic level. In developing countries long-term COVID-19 related restrictive measures result in the dramatic decline of economic activity, contraction of production, unemployment rise, drop in labor productivity. The countries with high macroeconomic indicators have better social cohesion and reliable systems of social protection. This has consequences that are more reliable on the employment level compared to the developing countries. Assessment of various policy approaches of full lockdown measures for localization of disease dissemination, imposition of restrictions on the working life, introduction of new remote forms of work and education, force countries to define special policy, which depends on the national economic and financial potential. Health system development and adoption of stabilizing measures of the epidemic situation in the country form the basis to restore confidence and trust in the society. The article proposes a deep account of the challenges that the Ukrainian economy has faced and continues to face due to the COVID-19 pandemic effects, deterioration of macroeconomic indicators, including employment decline. The application of the “adaptive quarantine measures” in the regions demonstrates adequate consequences for business SME's development. The estimation results depict the tendencies of increasing unemployment, inflation, and a decreasing population’s ability to pay and lowering business activity in certain sectors of the economy. Numerous forms related to the support and professional development of the unemployed population are proposed.

THE CONCEPT AND CURRENT TRENDS OF PUBLIC HEALTH SYSTEM IN UKRAINE

Purpose: to highlight the concept of public health system and public health services in Ukraine.
 Materials and Methods. Scientific methods of analysis, synthesis and generalization were used in order to achieve this goal.
 Results. Considering in detail the functioning of public health institutions in Ukraine at the national and regional levels, we can note that to ensure the epidemiological surveillance and assessment of health and well-being of the population modern new tools were created. These tools have been used to monitor public health. The basic standards of activity and priorities are used. There are new structures, such as a clear reporting system, financing, monitoring of the quality of labor resources and rendering of services to consumers.
 The current state of social programs in public health research has shown the presence of a number of theoretical, methodological, economic, organizational, legal problems. Evidence suggests that investing in public health is generally cost-effective for the health care sector, other sectors, and the economy in a broad sense. A clear position of the state is important for the further development of social programs in public health. The state created the basic conditions for the development of such programs and these conditions were important for the initial stage of their formation. It is a need for creation a regulation system of such programs, which will reflect not only tax benefits, but also other preferences for developers of such programs. Particular attention should be paid to overcome the COVID-19 pandemic, which has made significant changes to the number of chronic and acute diseases and to the public health system.
 Conclusions. The adoption of the Concept for the Development of the Public Health System in Ukraine in 2016 was a driving stage in the modernization of public health in Ukraine and had a positive impact on its development. There are still problems with the need to improve the further development and modernization of the public health system in Ukraine, which ought to be addressed at the national and regional levels, taking into account the international experience of the highly efficient systems in Europe and the World.

Hospital-Based Palliative and End-of-Life Care in the COVID-19 Pandemic: A Scoping Review.

Aim: To identify the nature of the evidence reporting hospital-based palliative and end-of-life care during the COVID-19 pandemic. Background: The COVID-19 pandemic has seen an increase in the numbers of seriously ill people being cared for across all health services worldwide. Due to the rapid progression of severe symptoms, the majority of staff working in hospitals and other healthcare centres were providing end-of-life care. Little is known about the level of hospital-based palliative care service provided during the COVID-19 pandemic, particularly during surges in admission rates with an increased number of deaths accruing. Methods: A scoping review was conducted to search and select potential studies. The scoping review was guided by the framework of Arskey and O’Malley and advanced by the use of the methodology of the Joanna Briggs Institute. Results: Eighteen studies published between March 2020 and July 2021 were identified. Three broad categories included overall management strategy and logistics, symptom prevalence and management of patients with COVID-19 and end-of-life care needs within the current pandemic. Conclusions: This review highlights increased awareness and knowledge of palliative and end-of-life care provided in hospitals. The review also highlights the response of hospital-based palliative care teams to an evolving crisis, within the context of developed health systems under sustained and overwhelming pressure. Implications: Newly established clinical links and referral pathways developed during the initial COVID-19 surge between hospital-based palliative care and other healthcare teams, be continued and further enhanced. Understanding of the role of specialist palliative care providers in supporting palliative and end-of-life care within the hospital setting needs further investigation.

Legal basis for the development of the Slovenian health system - from the enlightenment to the second world war

Throughout the history of medicine, patient-doctor relationships remained intimate and were based on the patient’s expectations, which were more or less limited by the expert knowledge of the physician. At first, the economic relationship between patient and doctor was based on a personal agreement; state regulations were only involved later. In Roman times the relationship was affected indirectly by the state, mostly by the adoption of the Act on Hygiene and partly by various socialeconomic regulations. However, in the early Middle Ages, the charitable activities undertaken by the monastic population, with their limited medical knowledge, proved to be a backward step in the development of the healthcare system. It was not until the development of medical knowledge at the emerging universities, especially during the Renaissance, that regulations reentered healthcare and the better education of physicians marked the new era. During the investigated period (from the Enlightenment to the Second World War), the state, as a third party, was completely integrated in the system. Furthermore, in addition to the existing health services, health insurance was established, which marked the beginning of a healthcare system. This formed a solid foundation for the development of modern medicine and the regulation of the so-called welfare state. This article discusses the basic healthcare legislation in Slovenia during four different development periods; the Habsburg Monarchy, the Austro- Hungarian Monarchy, the State of Slovenes, Croats and Serbs, and the Kingdom of Yugoslavia. The development of the healthcare system during this sensitive era is clearly described; the changes in healthcare services are presented and healthcare insurance is analysed from a legal point of view. All of this led to the formation of the social healthcare policy, which signifies the existence of a modern state.
 The development of the health system in Slovenia was mainly influenced by two significant factors: firstly, by the reforms initiated by Empress Maria Theresa and her son Joseph II at the end of the 18th century and, secondly, by the establishment of insurance some one hundred years later.

Implementation, interrupted: Identifying and leveraging factors that sustain after a programme interruption

ABSTRACT Many implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform re-implementation strategies. We sought to devise an approach for evaluating interruptions by exploring the sustainability of a programme that implemented diabetes mellitus (DM) screening within tuberculosis clinics in Uganda in 2017. In 2019, we conducted nine interviews with clinic staff and observed clinic visits to determine their views and practices on providing integrated care. We mapped themes to a social ecological model with three levels derived from the Consolidated Framework for Implementation Research (CFIR): outer setting (i.e. community), inner setting (i.e. clinic), and individuals (i.e. clinicians). Respondents explained that DM screening ceased due to disruptions in the national supply chain for glucose test strips, which had cascading effects on clinics and clinicians. Lack of screening supplies in clinics limited clinicians’ opportunities to perform DM screening, which contributed to diminished self-efficacy. However, culture, compatibility and clinicians’ beliefs about DM screening sustained throughout the interruption. We propose an approach for evaluating interruptions using the CFIR and social ecological model; other programmes can adapt this approach to identify cascading effects of interruptions and target them for re-implementation.

Using Co-design in Mobile Health System Development: A Qualitative Study With Experts in Co-design and Mobile Health System Development.

BackgroundThe proliferation of mobile devices has enabled new ways of delivering health services through mobile health systems. Researchers and practitioners emphasize that the design of such systems is a complex endeavor with various pitfalls, including limited stakeholder involvement in design processes and the lack of integration into existing system landscapes. Co-design is an approach used to address these pitfalls. By recognizing users as experts of their own experience, co-design directly involves users in the design process and provides them an active role in knowledge development, idea generation, and concept development.ObjectiveDespite the existence of a rich body of literature on co-design methodologies, limited research exists to guide the co-design of mobile health (mHealth) systems. This study aims to contextualize an existing co-design framework for mHealth applications and construct guidelines to address common challenges of co-designing mHealth systems.MethodsTapping into the knowledge and experience of experts in co-design and mHealth systems development, we conducted an exploratory qualitative study consisting of 16 semistructured interviews. Thereby, a constructivist ontological position was adopted while acknowledging the socially constructed nature of reality in mHealth system development. Purposive sampling across web-based platforms (eg, Google Scholar and ResearchGate) and publications by authors with co-design experience in mHealth were used to recruit co-design method experts (n=8) and mHealth system developers (n=8). Data were analyzed using thematic analysis along with our objectives of contextualizing the co-design framework and constructing guidelines for applying co-design to mHealth systems development.ResultsThe contextualized framework captures important considerations of the mHealth context, including dedicated prototyping and implementation phases, and an emphasis on immersion in real-world contexts. In addition, 7 guidelines were constructed that directly pertain to mHealth: understanding stakeholder vulnerabilities and diversity, health behavior change, co-design facilitators, immersion in the mHealth ecosystem, postdesign advocates, health-specific evaluation criteria, and usage data and contextual research to understand impact.ConclusionsSystem designers encounter unique challenges when engaging in mHealth systems development. The contextualized co-design framework and constructed guidelines have the potential to serve as a shared frame of reference to guide the co-design of mHealth systems and facilitate interdisciplinary collaboration at the nexus of information technology and health research.

Strategies for post-conflict development of the Health Systems in Somalia: lessons from selected countries

Until the beginning of 1991, Somalia had a reasonable health care system with a good number of tertiary hospitals in Mogadishu and Hargeisa, some regional hospitals, district hospitals, clinics, child and mother health centres (CMH) and out-patient dispensaries. However, the conflict resulting from the civil war has destroyed the public health care system which existed in the country. Somalia was not alone in having conflicts. The total number of conflicts in the world in 2017 was 49, many of them have now entered post-conflict phases, where open warfare has come to an end. There is growing evidence that conflict has a devastating impact on health systems and the health status of the population. In Somalia, the post-conflict phase provides a unique window of opportunity for health sector development and reform. At this juncture, health systems in Somalia face the double burden of a flawed pre-conflict health system, characterised by deficiencies and inequities, and the long-term impact of conflict on the health status of the population and its resultant strain on the health system. This review article analyses the framework for the rehabilitation of health systems in post-conflict countries. Such knowledge can be applied in the rehabilitation and development of health systems in Somalia along the lines of the World Health Organization’s health system building blocks. The impact of conflict on the health status of the population as well as the health system can be catastrophic and be felt for years after the State has entered the post-conflict phase, but also provides an opportunity for reforms of the affected State’s health sector.

Association between Patient Satisfaction and the Willingness to Return for Rehabilitation- A Pilot Study

Background: Patient satisfaction has played an important role in the development of health systems. However, the information on patient satisfaction and the returning of the patients for rehabilitation is limited. This study aims to explore the role of different domains in patient satisfaction with the willingness to return for further rehabilitation. Methods: The cross-sectional study was conducted among all 163 patients who were treated at different departments but needed a combination of treatment with rehabilitation at Viettiep hospital, Haiphong city. The Patient Satisfaction Index (PSI) Questionnaire was applied to record the average score of satisfaction. Multivariate logistic regression was used to determine the association between each domain of the PSI and the return for rehabilitation treatment. Results: Among the PSI scale, the strongest correlation was observed between the attitude of medical staff and the equipment and infrastructure of the hospital (r=0.305). The linear regression model indicated that patient satisfaction was associated significantly with the willingness to return for further rehabilitation (OR= 58.442). There were significant associations between the accessibility, equipment and infrastructure, quality of care and treatment, and cost of treatment with the returning for treatment of the patients. Conclusion: The patient satisfaction regarding individual domains should be considered in more detail in order to enhance the rehabilitation treatment of patients after discharging them from the hospital.

The impact of the COVID-19 response on the provision of other public health services in the U.S.: A cross sectional study.

IntroductionFunding and staff formerly dedicated to routine public health tasks (e.g., responding to communicable and non-communicable diseases, investigating foodborne outbreaks, conducting routine surveillance) and services (e.g., environmental health, substance abuse, maternal-child health) may no longer be available in many public health departments due to the COVID-19 response. The objective of this study was to assess the extent to which staffing for essential public health services has been redirected to the COVID-19 response.Materials and methodsThis is a cross-sectional study using a survey distributed through the Qualtrics platform. Individuals (N = 298) working in public health across governmental and academic public health departments in the U.S. during the ongoing COVID-19 pandemic response were surveyed. Survey items measured multiple domains including professional experience (i.e., training, years of experience, content expertise, job functions, hours worked), mental and physical health status (i.e., generalized anxiety, depression, burnout), and career plans (i.e., pre-pandemic vs. current career plans).ResultsThe total number of content expertise areas and programmatic functions covered by individual public health workers increased between January and September of 2020, with 26% (73 of 282) of respondents reporting an increase in both. The total number of respondents working in infectious disease and preparedness remained constant, while declines were reported in program evaluation (-36%) and health education (-27%) and increases were reported in disease investigation (+35%).ConclusionsThe provision of many essential public health functions and tasks have been limited or eliminated while the U.S. public health workforce responds to the COVID-19 pandemic. These findings highlight opportunities for funding and professional development of public health systems, both during and after the COVID-19 response, to help ensure the continuity of essential public health services, staffing sustainability, and preparedness for future public health emergencies in the U.S.

Corruption in the Healthcare Sector During the Covid-19 Pandemic: Causes, Consequences and Responses

The purpose of this article is to analyze the main causes of corruption in the healthcare sector during the COVID-19 pandemic. The study identified the main problems of national health during the pandemic, such as theft and resale of state-funded medicines, vaccines, and medical supplies (medical equipment), reduced availability and quality of medical services, low wages of medical workers, limited supervision and control (monitoring) in the healthcare sector and etc. As a result of the analysis, it was concluded that there is a need for additional work to identify cases of those types of corruption that are indicated in the article. Also, citizens should be involved in suppressing corruption in the health sector - documenting all cases of corruption that can be detected at the place of service delivery. They will serve as strong evidence to advocate for transparency and accountability mechanisms that guarantee more equitable access to health services. The authors argue that one of the important recommendations for preventing corruption in the health sector is investing in prevention as well as enforcing it: developing health system reforms and new health programs to reduce incentives and opportunities for corruption. The results showed that the method of statistical analysis is quite effective in the field of studying corruption. The study of the statistics of corruption crimes allows us to adequately characterize the level of corruption. The sources are statistical data of the Agency of the Republic of Kazakhstan for Combating Corruption, the Bureau of National Statistics, data from international organizations.

Aligning priorities in Ethiopian health finance: How do the essential health services package and health benefit plans compare?

Priority setting is a key function of health systems in low- and middle-income countries that seek to achieve universal health coverage. Essential health services packages (EHSPs) and health benefit plans are two types of instruments used in setting health care priorities. Both instruments exist in Ethiopia, but little is known about how they are aligned. To gain insights into the evolution, purpose, policy objectives, and governance of the EHSP, community-based health insurance (CBHI), and social health insurance (SHI) in Ethiopia, we conducted a case study. This included a desk review of relevant documents as well as qualitative analysis of key informant interviews conducted with 15 leading health finance experts in Addis Ababa. Interviewees understood the EHSP to be a key priority-setting instrument in the country by coordinating the activities of health system stakeholders, and guaranteeing the right of citizens to a basic level of care. Community-based health insurance and SHI were described as mechanisms for the government to expand health coverage and provide financial protection. Interviewees acknowledged that Ethiopia had drawn on the experience of other countries when designing health benefit plans, but contrasted Ethiopia's experience with that of other countries. We found that in Ethiopia, the EHSP, CBHI, and SHI are not explicitly aligned. We propose that EHSPs play an important role in early stages of health systems development. However, as governments develop health benefit plans with expansive packages of services, the importance of EHSPs becomes less clear.

Efficiency of stroke networks for referral of mechanical thrombectomy: The more the better?

Endovascular therapy (EVT) has revolutionized stroke care with the publication of several landmark stroke trials since 2015.1 At the same time, EVT imposes major changes on systems of stroke care. While EVT is highly efficacious, its use is restricted to stroke patients with large vessel occlusion (LVO) and these form a minority of stroke patients only.

When Covid-19 first struck: Analysis of the influence of structural characteristics of countries - technocracy is strengthened by open democracy.

ContextThe Covid-19 pandemic hit the developed world differentially due to accidental factors, and countries had to respond rapidly within existing resources, structures, and processes to manage totally new health challenges. This study aimed to identify which pre-existing structural factors facilitated better outcomes despite different starting points, as understanding of the relative impact of structural aspects should facilitate achieving optimal forward progress.MethodsDesk study, based on selecting and collecting a range of measures for 48 representative characteristics of 42 countries’ demography, society, health system, and policy-making profiles, matched to three pandemic time points. Different analytic approaches were employed including correlation, multiple regression, and cluster analysis in order to seek triangulation.FindingsPopulation structure (except country size), and volume and nature of health resources, had only minor links to Covid impact. Depth of social inequality, poverty, population age structure, and strength of preventive health measures unexpectedly had no moderating effect. Strongest measured influences were population current enrolment in tertiary education, and country leaders’ strength of seeking scientific evidence. The representativeness, and by interpretation the empathy, of government leadership also had positive effects.ConclusionStrength of therapeutic health system, and indeed of preventive health services, surprisingly had little correlation with impact of the pandemic in the first nine months measured in death- or case-rates. However, specific political system features, including proportional representation electoral systems, and absence of a strong single party majority, were consistent features of the most successful national responses, as was being of a small or moderate population size, and with tertiary education facilitated. It can be interpreted that the way a country was lead, and whether leadership sought evidence and shared the reasoning behind resultant policies, had notable effects. This has significant implications within health system development and in promoting the population’s health.

Measuring the Efficiency of Health System Developments in the Covid 19 Pandemic: A Study on the G-20

Toplum sağlığının en önemli göstergelerinden birisi sağlık hizmetlerinin kalitesi ve işlevselliğidir. Geçmiş dönemde yapılan yatırım ve gelişmelerin sağlık sistemindeki etkisi Covid 19 pandemisinde daha açık gözlenebilmiştir. Bu çalışmada G-20 ülkelerinin sağlık sistemi gelişmelerinin Covid 19 performansı değerlendirilmiştir. Dünya Bankası veri tabanında sağlık başlığı altında yer alan 5 gösterge girdi iken Covid 19 bağlantılı ölüm, iyileşen ve test sayıları çıktı olarak kullanılmıştır. Girdi değişkeni olan sağlık göstergeleri için 2000-2018 yılları arasındaki 19 yıllık verilerin ortalama değerleri kullanılmıştır. Uygulamada veri zarflama analizi kullanılarak çıktı yönelimli sabit ve değişken getiri yöntemleri ile ölçek etkinlik skorları ve süper etkinlik değerleri hesaplanmıştır. Analiz sonucunda ölçek etkinlik skorlarına göre Amerika, Arjantin, Brezilya, Çin, Fransa, İngiltere ve Türkiye etkin olarak bulunmuştur.

Spatial Pattern and Spatial Heterogeneity of Chinese Elite Hospitals: A Country-Level Analysis.

Elite hospitals represent the highest level of Chinese hospitals in medical service and management, medical quality and safety, technical level and efficiency, which are also one of the important indicators reflecting high-quality medical resources in the region, and their spatial allocation is directly related to the fairness of health resource allocation. We explored the allocation pattern of high-quality resources and its influencing factors in the development of China's health system using geographic weighted regression (GWR), Multi-scale Geographically Weighted Regression (MGWR), GWR and MGWR with Spatial Autocorrelation(GWR-SAR and MGWR-SAR), spatial lag model (SLM), and spatial error model (SEM). The results of OLS regression showed that city level, number of medical colleges, urbanization rate, permanent population and GDP per capita were its significant variables. And spatial auto-correlation of elite hospitals in China is of great significance. Further, its spatial agglomeration phenomenon was confirmed through SLM and SEM. Among them, the city level is the most important factor affecting the spatial allocation of elite hospitals in China. Its action intensity shows a solid and weak mosaic trend in the Middle East, relatively concentrated in some areas with medium intensity and concentrated in the West China. Obviously, China's elite hospitals are unevenly distributed and have evident spatial heterogeneity. Therefore, we suggest that we should pay attention to the spatial governance of high-quality medical resources, attract medical elites in the region, increase investment in medical education in the scarce areas of elite hospitals and develop tele-medicine service.

Health-care system's development in the regional eco-economic space

Subject. This article looks into the economic and environmental aspects of the public health system's development at the regional level. Objectives. The article aims to reveal the trends of the impact of environmental and economic parameters of individual areas of the region on the population incidence rate. Methods. For the study, we used a correlation analysis. Results. The article determines a direct relationship between the environmental situation in the analyzed areas and their economic potential, emphasizing that a high economic potential of the area provokes a high anthropogenic load on it. However, there is no obvious dependence of cancer morbidity rate on the ecological state of the administrative territories. Conclusions. Insufficient funding in certain territories can be a factor in the deterioration of the quality of human capital due to the low medical services availability level. Public-private partnership can be a way to attract additional sources of financing.

Responsibilities and mission of the Public Health System in promoting the development of Healthy China

In order to promote the development of Healthy China and improve the health of the Chinese people, the Chinese government released the Outline of the Healthy China 2030 Plan in 2016. However, whether current construction and development of public health system in China can promote the implementation of the Healthy China Strategy or not needs to be further evaluated. In the study, we summarize the achievements and challenges in the development of the public health system in China, draw conclusions about the weakness and structural contradiction in the process, and propose relevant policy recommendations in order to bring into better play the role of the public health system.

Community context of health system development: implications for health sector reform in Pakistan

To describe local sociopolitical and organizational factors that influence health system development in Karachi, Pakistan, we conducted participant observation while working with health providers and communities in one urban district to reorient services towards a primary health care district health system. We found that the community characteristics, particularly the diverse socialpolitical and cultural make-up and organizational complexity that involved multiple levels of government, influenced efforts towards collaboration and shaped the development of the health system. We conclude that for effective implementation of health sector reform there is a need to comprehend fully the community context and complexity of existing health service provision.

Effects of Virtual Education of Nutrition Programs in the Health System Evolution Plan on the Knowledge and Performance of Primary Health Workers (Behvarzes) in Mashhad, Iran Based on the Kirkpatrick Model in 2020

Background: In recent years, virtual education has emerged as one of the important applications of new information and communication technologies in the world. This study was conducted to determine the effect of the virtual training course of nutrition programs in the Health System Evolution Plan on the knowledge and practice of primary health workers in Mashhad, Iran based on the Kirkpatrick Model.Methods: This cross-sectional study was performed on 94 primary health workers in Health Center No. 1 in Mashhad. The sample size was calculated at 45 subjects and the samples were selected using a random number table. According to the staff training criteria, the training course with special conditions was held virtually based on the approved lesson plan. During the course, based on the Kirkptrick Model, a researcher-made questionnaire included four levels (reaction, learning, behavior, and results) was completed and scored based on a Likert scale. The data were analyzed in SPSS software (version 21).Results: The mean score of the content quality of the course was 4.61±0.45; it means that the participants were very satisfied with the quality of the course content. The mean score of the presentation of the course was 4.5±0.6 indicatings the presentation of the course was very good. The mean score obtained from the course exam was 85.9±10.3. Besides, the mean score of skills acquired by the subjects was 4.75±0.34 which is considered a very good level. The mean score of the job performance of subjects was 4.55±0.54 which is also a very good level.Conclusion: The in-service training course of nutrition programs in the Health System Evolution Plan was effective on the knowledge and performance of primary health workers in Mashhad.

Interdisciplinary Health Care Evaluation Instruments: A Review of Psychometric Evidence

Teamwork among health care professionals has been found to improve patient outcomes and reduce burnout. Surveys from individual team members are often used to measure the effectiveness of teamwork performance, as they provide an efficient way to capture various constructs of teamwork. This allows evaluators to better understand team functioning, areas of strength, and to identify potential areas for improvement. However, the majority of published surveys are yet to be validated. We conducted a review of psychometric evidence to identify instruments frequently used in practice and identified in the literature. The databases searched included MEDLINE, EMBASE, CINAHL, and PsycINFO. After excluding duplicates and irrelevant articles, 15 articles met the inclusion criteria for full assessment. Seven surveys were validated and most frequently identified in the literature. This review aims to facilitate the selection of instruments that are most appropriate for research and clinical practice. More research is required to develop surveys that better reflect the current reality of teamwork in our evolving health system, including a greater consideration for patient as team members. Additionally, more research is needed to encompass an increasing development of team assessment tools.