Health System Development Research Articles

Service user and family participation in mental health policy making in Timor-Leste: a qualitative study with multiple stakeholders

BackgroundParticipation in mental health system strengthening by people with mental health problems and their families is a cornerstone of people-centred mental health care, yet there is a dearth of research about participation from low- and middle-income countries (LMICs), particularly from the Asia Pacific region. Hence, this study aimed to assess the current situation, challenges, enabling factors and future actions for service user and family participation in mental health policy making in Timor-Leste.MethodsIn-depth interviews were conducted with 85 adults (≥18 years) who were: (1) mental health service users (n = 20) and their families (n = 10); (2) government decision makers (n = 10); (3) mental health and social service providers (n = 23); (4) civil society (n = 9); and (5) other groups (n = 13). Interview data was analysed using framework analysis.ResultsThere was limited service user, family and community participation in mental health policy making in Timor-Leste. Perceptions that policy making is a technical exercise and that people with mental health problems lack cognitive capacity, and a lack of supportive mechanisms challenged participation. Enabling factors were a strong focus on human rights within the social sector, and existing mechanisms for advocacy and representation of people with disabilities in social policy making. Participants suggested bolstering civil society representation of people with mental health problems, and increasing mental health awareness and literacy, including government competencies to facilitate service user participation.ConclusionThe findings highlight the need for theoretical and practical focus on the role of family within mental health system development in LMICs. Global mental health research and practice should adopt a critical approach to mental health service user and family participation to ensure that the concept and strategies to achieve this are embedded in LMIC knowledge.

From malaria control to elimination within a decade: lessons learned from Timor Leste, a newly independent country

BackgroundTimor Leste has made remarkable progress from malaria control to malaria elimination in a span of 10 years during which organized malaria control efforts were instituted. The good practices and possible factors that have contributed to the remarkable transition from malaria control to elimination in a newly independent country devastated by civil unrest which left the entire administrative structure including the health sector in a disrupted non-functional state are highlighted.MethodsData from the National Malaria Control Programme were reviewed. A literature search was carried out using the key words “malaria”, “Timor Leste”, “East Timor”, and “malaria control” and “malaria elimination”. All relevant manuscripts and reports that were identified in the search were reviewed. Key personnel of the NMCP, WHO and the GFATM involved in the project were interviewed.ResultsWith the setting up of the National Malaria Control Programme just after independence in 2003 with two officers, the programme expanded over the years and strategic malaria control activities in an organized manner commenced in 2009 with funding from the Global Fund to fight AIDS, Tuberculosis and Malaria. The incidence of malaria declined dramatically from 223,002 cases in 2006 with the last indigenous case being reported in June 2017. The decline in malaria was associated with strategic application of key evidence-based interventions taking into account the burden of disease, characteristics of vectors, and stratification of risk areas ensuring universal access to malaria prevention, and quality assured diagnostic tools and effective anti-malarial medicines at point of care, intensified surveillance, monitoring and evaluation, and capacity building, including training of staff, with adequate programme funding. The programme was provided with technical expertise and sustained political commitment that ensured uninterrupted implementation of interventions based on national strategic plans. The incorporation of the malaria control programme within an evolving health system helped the transition from malaria control to malaria elimination.ConclusionUniversal access to quality assured malaria diagnosis and treatment and focussed vector control, implemented throughout the country in an organized manner with adequate funding and political commitment were key to the successful interruption of malaria transmission in the country. All the practices or factors listed did not work in isolation but rather synergistically in an integrated manner. Malaria elimination is possible even in tropical areas of South and Southeast Asia.

The future of nurse education in Australia and implications for perioperative nursing

A national review into nurse education in Australia examined the current educational preparation of Australian nurses to ensure the profession is adequately equipped to meet the future needs of the nation’s evolving health system. This editorial outlines and reviews some of the key recommendations from the report and their potential implications for perioperative nursing and nursing education.

ПРОФІЛАКТИКА НАДЛИШКОВОЇ МАСИ ТІЛА НАСЕЛЕННЯ В УМОВАХ КАРАНТИННИХ ОБМЕЖЕНЬ ПІД ЧАС ПАНДЕМІЇ

The article highlights the negative trends of deteriorating health of the population in our country, which requires a responsible attitude of society and the state to strengthen and preserve the health. It becomes necessary to identify new approaches and develop programs of problems solving in the field of public health, because the current system of health care in Ukraine does not actually provide a preventive component, as it is stated in the Concept of Public Health System Development. It is noted that among a number of dangerous diseases and other important health problems, the problem of overweight remains relevant for all age groups and has no boundaries. One of the causes of overweight and obesity is the disturbance of the energy balance between the calories consumed and the calories expended, that is, excessive consumption of high-calorie foods and low levels of physical activity, especially during a pandemic. Ensuring the health and well-being of people is one of the most important goals of the world community, reflected in the basis of European policy. The achievement of European standards of quality of life and well-being of the population is one of the main tasks defined by the Strategy for Sustainable Development «Ukraine–2020». The main directions of reforms should be to increase the personal responsibility of citizens for their own health, ensuring their free choice of health-care providers of appropriate quality, the provision of targeted assistance to the most vulnerable segments of the population, and the creation of a business-friendly environment in the health-care market. Theoretical studies on the choice of efficient methods for studying overweight suggest that scientists have proposed dozens of different approaches, including both simple measurements and the most modern and expensive. But the the definition of the body mass index (BMI) remains the most convenient. This index is more closely related to the fat content of the human body than other anthropometric body mass-to-height ratios, and is therefore widely used in clinical practice. The dynamics have been investigated and important questions of preventive action on overweight and obesity have been pointed out, the reasons for the increase of the respondent body weight have been indicated, and recommendations have been made for the preservation of individual health in the context of a pandemic.

역사적 관점으로 본 자본주의와 건강, 그리고 한국의 의료민영화

This paper reviews the current medical privatization in Korea through the lens of the historical development and decline of the public health system in the western countries, examined by three recent works in the field. For the review, this paper focuses on the three main topics regarding the relationship between health and capitalism: the right to health, the multinational companies in the global medical industry, and the concepts of health and disease. First, this paper examines the right to health and the formation of public health system based on it. Second, this paper shows the strategies of multinational companies for extending their medical markets and the frustration of public health due to it. Lastly, this paper discusses how multinational pharmaceutical companies have changed disease concepts and health care practices in the development of new drugs. On the basis of these topics, this paper emphasizes the importance of critical approach to the medical privatization and its effect on public health in Korea.

The Relationship Between Distribution of Human Resources Distribution and Performance Indicators of Hospitals Before and After Implementation of Health System Evolution Plan in Iran

The implementation of the Health System Evolution Plan has resulted in an increase in the rate of patient’s referral to hospitals of medical universities, and thus, hospitals’ performance indicators. The aim of the present study is to investigate the changes in hospital indicators after the implementation of the Health System Evolution Plan and the relationship between this plan and distribution of human resources in hospitals of Tehran University of Medical Sciences. This was a descriptive-analytical and cross-sectional study. The research population consisted of information about human resources and performance indicators before and after the implementation of the Health System Evolution Plan in the hospitals. The research tool was a data collection form. The collected data were analyzed in SPSS software, and analytical results were obtained using the Pearson correlation test and Two Sample t-test. The results showed that there was a significant relationship between hospitals performance indicators and the distribution of human resources after the implementation of the Health System Evolution Plan. In fact, this plan has increased the deficit of nursing and paraclinical staff. In addition, the results showed as hospitals’ performance indicators have increased, more human resources has been recruited in these hospitals. The success of Implementation of Health System Evolution Plan and development of general hospitals indicators need comprehensive. Planning for retainment of all groups of health workers and paying attention to appropriate distribution of physicians, nurses, and paraclinical staff in public hospitals and finally a comprehensive review of human resources standards by the Iranian Ministry of Health. © 2019 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2019;57(8):510-517.

El envejecimiento: principal reto del Siglo XXI en la gestión política de los servicios de salud

Introducción: El envejecimiento “es un fenómeno demográfico asociado con la revolución científico técnica del siglo XXI; sus consecuencias unidas a características socio-demográficas pueden afectar la calidad de vida”. Nunca antes en la historia y evolución de los sistemas nacionales de salud y seguridad social, se ha hecho más urgente la necesidad de realizar una reflexión crítica profunda sobre la eficiencia administrativa de los actuales modelos de atención en la prestación, la calidad y la seguridad de los servicios de salud, concentrados por la naturaleza del perfil epidemiológico de la población, el comportamiento de la demanda y las limitaciones propias de su gestión, casi exclusivamente, en la atención de la enfermedad; el clásico paradigma de la atención fundamentado en la teoría del modelo biomédico, el cual establece factores de riesgo como variables a nivel individual, partiendo del principio de que las enfermedades y sus síntomas y signos, provienen de una anomalía o por un mal funcionamiento de los sistemas orgánicos. Como se observa, todavía en los tiempos actuales, en ausencia de un análisis sistemático y más riguroso de los nuevos contextos históricos y cambios constantes en los determinantes sociales, económicos y culturales del mundo moderno, se han diseñado y desarrollado políticas públicas que, por lo general, han fracasado en asegurar la equidad en los derechos de las personas a una atención oportuna e integral de sus necesidades para el mantenimiento de su salud y su calidad de vida, especialmente en la creciente población de las personas adulta mayores. Metodología: Para la realización de este editorial, se realizó una revisión bibliográfica, con selección de artículos en diferentes bases de datos, como PsycInfo, Scopus, Google Scholar, Medline, PubMed, EBSCO Health, Cochrane, entre otras, con el propósito de establecer la relación entre el gran reto de las actuales tendencias demográficas de la población adulta mayor en el mundo, su impacto sobre la demanda de servicios públicos y la necesidad de replantear las políticas públicas en función de los factores determinantes estructurales de la salud. Resultados: Se logra identificar la magnitud y complejidad del fenómeno del envejecimiento humano y la necesidad de replantear el proceso de formulación de la política social en salud, desde la perspectiva de los determinantes estructurales de la salud y la atención de las verdaderas necesidades de la población adulta mayor. Dentro del marco de estos resultados, el presente editorial, está orientado a llamar objetivamente la atención sobre el fenómeno del envejecimiento poblacional, su impacto en las políticas públicas de salud y la necesidad de replantear la gestión política de los servicios de salud con énfasis en la promoción de la salud.

Nurses, Nursing Associations, and Health Systems Evolution in Canada

Canada and the United States are geographically large federal states with strong central (national) governments. These governments connect to partially self-governing provincial, state, and/or territorial governments that pose ongoing tensions in health systems. Like most countries, both are confronted with the need to contain spiraling costs while delivering better healthcare and promoting better population health. At the same time, they are challenged by global authorities, such as the United Nations, to deliver universal healthcare, primary healthcare, respond to development goals, and address the structural drivers of health inequities. Data from both countries affirms public trust in nurses, with the expectation that they will act in the public interest to improve care and population health. In this article, we focus on Canada. First, we briefly describe the history of health system development and reform, and then consider nursing policy and advocacy in the 21st century. Finally, we offer examples of nurse-led solutions from Canadian nurses and nursing associations to build, overhaul and improve health systems and influence health policy.

Brief outcome of five decades of battle with infectious diseases in Iran.

According to WHO health profile, Iran has better situation in controlling some infection disease like leprosy, dengue fever, tularemia and hepatitis B than United States, even though Iran is in a more dangerous area than the USA. Achieving optimum control for infectious disease in the Middle East requires huge financial costs, equipment and a great time. Some of Iran's actions to control infectious diseases include: special attention of the Iran government to the health issue, training and developing human resources, membership and close cooperation with international organizations like WHO, detecting and monitoring emerging diseases before their arrival and distribution in Iran, expanding and updating national immunization and vaccination program since 1992, national project implementation titled "Health system development plan", supplying and manufacturing most of drugs required in Iran by the Iranian companies as a strategic planning, great coordination between different departments of the MOHME and other relevant institutions to Iran Army and Ministry of Intelligence to prevent the emergence of bioterrorism, and etc. We believe that Iran has obtained an acceptable score in the control of infectious diseases; but it still has very big challenges to reach the ideal level.

Using the WHO-AIMS to inform development of mental health systems: the case study of Makueni County, Kenya

BackgroundIn order to develop a context appropriate in mental health system, there is a need to document relevant existing resources and practices with a view of identifying existing gaps, challenges and opportunities at baseline for purposes of future monitoring and evaluation of emerging systems. The World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) was developed as a suitable tool for this purpose. Our overall objective of this study, around which research questions and specific aims were formulated, was to establish a baseline on mental health system as at the time of the study, at Makueni County in Kenya, using the WHO-AIMS.MethodsTo achieve our overall objective, answer our research questions and achieve specific aims, we conducted a mixed methods approach in which we did an audit of DHIS records and county official records, and conducted qualitative interviews with the various officers to establish the fidelity of the data according to their views. The records data was processed via the prescribed WHO-Aims 2.2 excel spreadsheet while the qualitative data was analyzed thematically. This was guided by the six domains stipulated in the WHO AIMS.ResultsWe found that at the time point of the study, there were no operational governance, policy or administrative structures specific to mental health, despite recognition by the County Government of the importance of mental health. The identified interviewees and policy makers were cooperative and participatory in identifying the gaps, barriers and potential solutions to those barriers. The main barriers and gaps were human and financial resources and low prioritization of mental health in comparison to physical conditions. The solutions lay in bridging of the gaps and addressing the barriers.ConclusionThere is a need to address the identified gaps and barriers and follow up on solutions suggested at the time of the study, if a functional mental health system is to be achieved at Makueni County.

Multisite Implementation of Radiology-TEACHES (Technology-Enhanced Appropriateness Criteria Home for Education Simulation).

After encouraging results from a single-institution pilot, a novel case-based education portal using integrated clinical decision support at the simulated point of order entry was implemented at multiple institutions to evaluate whether the program is scalable and results transferable. The program was designed to fill key health systems' science gaps in traditional medical education curricula, ultimately aiding the transition from volume to value in health care. The module described uses commonly encountered medical vignettes to provide learners with a low-stakes educational environment to improve their awareness and apply curricular content regarding appropriate resource utilization, patient safety, and cost. In 2016 and 2017, the team implemented the modules at eight US medical schools. A total of 199 learners participated in this institutional review board-approved study; 108 completed the module, and 91 were in the control group. The module group had higher posttest scores than their control group peers, after controlling for pretest scores (β= 4.05, P < .001). The greatest knowledge gains were on questions related to chest radiography (22% improvement) and adnexal cysts (20.33% improvement) and the least on items related to pulmonary embolism (0.33% improvement). The majority of learners expressed satisfaction with the educational content provided (70.4%) and an increased perception to appropriately select imaging studies (65.2%). This program is promising as a standardized educational resource for widespread implementation in developing health systems science curricula. Learners at multiple institutions judged this educational resource as valuable and, through this initiative, synthesized practice behaviors by applying evidence-based guidelines in a cost-effective, safe, and prudent manner.

ENSURING OFOPH “PROMOTING THE DEVELOPMENT OF SCIENTIFIC RESEARCH IN THE FIELD OF HEALTH CARE FOR SCIENTIFIC JUSTIFICATION OF POLITICS AND PRACTICE” AT UZHHOROD NATIONAL UNIVERSITY

The goal of study: to evaluate the implementation at Uzhhorod National University of OFOPH "Promoting the development of scientific research in the field of health care for scientific justification of policy and practice".Materials and methods. Analytical method and method of structural-and-logical analysis were applied in the course of study. The materials of scientific activity of employees of the Department of Health Sciences of UzhNU were used as the materials of this study. The study covered the period 2017–2020.Results. Employees of the Department of Health Sciences conduct significant scientific activity in the direction of scientific support of the development of the public health system, which consists in the implementation of research work "Medical-and-demographic and sanitary-and-epidemiological situation in Transcarpathian region as a factor of formation of the regional public health system". In addition, original researches are conducted, employees take part in scientific conferences. Masters are involved in this type of activity.Conclusions. For scientists of Uzhhorod National University and directly the Department of Health Sciences, scientific researches on the development of the public health system are a priority.

Health System Development in Nepal

The development of health system in Nepal dates back from ancient period to the modern period starting from ayurvedic medicine to today's modern allopathic treatment. With regard to the different rulers in different time period, the number of improvements and changes in the health system of Nepal has been made. Moreover, the health system is further strengthened by the involvement of people and better management of health information and drug supply. Keywords: Bir Hospital; Community health; Health; Nepal.

A systematic review of the cost-effectiveness of emergency interventions for stroke in low- and middle-income countries.

BackgroundStroke is a leading cause of death and disability globally, with an increasing incidence in low- and middle-income countries (LMICs). The successful treatment of acute stroke requires an organized, efficient and well-resourced emergency care system. However, debate exists surrounding the prioritization of stroke treatment programs given the high costs of treatment and the increased incidence of hemorrhagic stroke in LMICs. Economic data is helpful to guide evidence-based priority setting in health systems development, particularly in low-resource settings where scarcity requires careful stewardship of resources. This systematic review surveys the existing evidence surrounding the cost-effectiveness of interventions to address acute stroke in LMIC settings.MethodsThe authors conducted a PRISMA style systematic review of economic evaluations of interventions to address acute stroke in LMICs. Five databases were systematically searched for articles, which were then reviewed for inclusion.ResultsOf the 153 unique articles identified, 11 met the inclusion criteria. Four studies demonstrate the heavy economic burden on patients and households due to stroke. Two studies estimate that preventive measures are more cost-effective than acute treatments. Four studies directly examine the cost-effectiveness of thrombolysis and thrombectomy in three middle-income countries (Iran, China, and Brazil) with results ranging from roughly $2578 to $34,052 (2019 USD) per quality adjusted life-year saved. These results are similar to the cost-effectiveness ratios estimated in high-income settings. Finally, one study examined a care bundle that included acute treatment elements.ConclusionsThe findings reinforce the need for additional research support informed decision-making. The available evidence suggests that preventive measures should be prioritized over emergency treatment for acute stroke, particularly in settings of resource scarcity. Cost-effectiveness ratios do not compare favorably to estimates for other emergency care interventions in LMICs, such as basic emergency care training, implementation of triage systems, and basic trauma care. Cost-effectiveness is also likely to vary depending on local epidemiology. Overall, decision-makers should balance the economic evidence alongside social, political and cultural priorities when making resource allocation choices.

40 years of Alma Ata Malaysia: targeting equitable access through organisational and physical adaptations in the delivery of public sector primary care.

This paper illustrates the development of Primary Health Care (PHC) public sector in Malaysia, through a series of health reforms in addressing equitable access. Malaysia was a signatory to the Alma Ata Declaration in 1978. The opportunity provided the impetus to expand the Rural Health Services of the 1960s, guided by the principles of PHC which attempts to address the urban-rural divide to improve equity and accessibility. The review was made through several collation of literature searches from published and unpublished research papers, the Ministry of Health annual reports, the 5-year Malaysia Plans, National Statistics Department, on health systems programme and infrastructure developments in Malaysia. The Public Primary Care Health System has evolved progressively through five phases of organisational reforms and physical restructuring. It responded to growing needs over a 40-year period since the Alma Ata Declaration in 1978, keeping equity, accessibility, efficiency and universal health coverage consistently in the backdrop. There were improvements of maternal, infant mortality rates as well as accessibility to health services for the population. The PHC Reforms in Malaysia are the result of structured and strategic investment. However, there will be continuing dilemma between cost-effectiveness and equity. Hence, continuous efforts are required to look at opportunity costs of alternative strategies to provide the best available solution given the available resources and capacities. While recognising that health systems development is complex with several layers and influencing factors, this paper focuses on a small but crucial aspect that occupies much time and energies of front-line managers in the health.

Delivering primary healthcare in conflict-affected settings: A review of the literature.

Conflict is often destructive to existing services and exacerbates population health inequities and the vulner-abilities of existing healthcare. We undertook a scoping review of the literature concerning delivery of primary healthcare (PHC) in post-conflict settings. We undertook a scoping review of the peer-reviewed and gray literature to identify articles related to the development and delivery of PHC in post-conflict settings. We searched PubMed/Medline, Cochrane Library, Em-base/Ovid, CAB abstracts, POPLINE, and WHO.int. between January 1990 through the December end of 2017, for arti-cles in the English language. Two researchers independently assessed each article and applied inclusion criteria: refer-ring to post-conflict settings and a range of terms related to PHC or health system development. Search terms were selected by careful review of the World Health Organization's analytical framework for developing a strategy on univer-sal coverage and analysis according to the availability, accessibility, affordability, and acceptability of healthcare and further themes involving demand-side or user-side concerns. Findings were captured to reflect a range of conflict-affected settings and varied priorities and approaches to PHC reconstruction. Integrated immediate and longer-term strategies, involving needs-assessments, effective ad-ministration, development of institutions, and cost-efficient investment in human resources, infrastructure, and capacity building are needed to deliver expanded and equitable services, responsive to population health needs, critical to the delivery of equitable PHC. Scoping review of the literature may be formative in the generation of evidence-base to inform delivery of universal PHC, when applied according to context specificity of conflict-affected setting.

Оценка влияния развития системы здравоохранения на показатели демографии Республики Казахстан

Оценка влияния развития системы здравоохранения на показатели демографии Республики Казахстан

Impact of COVID-19 pandemic on health system & Sustainable Development Goal 3.

Impact of COVID-19 pandemic on health system & Sustainable Development Goal 3.

Primary health care “approach” and medical education: New opportunities for revitalizing the bond

The importance of primary health care (PHC) has once again been reiterated in the Astana Declaration of 2018. PHC is an approach to health systems development rather than just a level of health-care service delivery. Understanding the PHC “approach” is crucial for doctors, across specializations and levels, as they are one of the prominent players in the country's health system. Undergraduate medical education offers an ideal window of opportunity to do so. The medical education policy, time and again, has acknowledged this need and has created mechanisms to fulfill it. The role of departments of community medicine has been kept central in these policy prescriptions. This, in practice, has led other departments to play only a weak role in the teaching and application of PHC. The Medical Council of India's new competency-based medical curriculum, with a renewed focus on integrated teaching, offers fresh opportunities to change this situation.

독일의 정신건강제도 발전과 정신건강 현황

한국에서 1995년에 정신보건법이 처음 제정된 후 2017년에 개정되면서 정신건강정책 및 제도에 대한 논의가 활발히 진행되고 있다. 본 논문에서는 독일의 정신건강제도 발전의 역사적 배경과 변화과정을 살펴보고, 이러한 변화에 따른 최근의 독일 정신건강 현황을 분석함으로써 한국의 정신장애인을 위한 정책 및 제도 마련에 기초자료를 제공하고자 하였다. 독일에서 정신장애인은 빈민구제의 대상이었다가 1800년대 이후에는 대형정신병원에 격리되어서 치료 및 보호를 받았다. 이후 1960년대 시작된 사회개혁을 통해 정신장애인을 인권을 가진 인격체로 인정하게 되었고, 사회정신의학이 발전하면서 정신장애인을 치료하고, 이들이 다시 사회로 복귀할 수 있도록 정신건강제도 및 정신건강서비스가 지역사회를 중심으로 구축되었다. 또한 정신장애는 신체질환과 같은 지위를 인정받게 되면서 사회보험의 대상이 되었다. 이러한 정신건강 체계에서 정신장애인의 치료 및 재활과 인식에도 큰 변화가 있었다. 특히 정신건강제도와 정신건강서비스가 안정되게 운영된 지난 20여 년간 정신장애에 대한 인식과 정신장애의 양상 및 분포에 큰 변화가 있었다. 정신장애가 소수에게서 발생하는 질병이라는 인식에서 우울증의 확산을 계기로 누구에게나 발생할 수 있는 장애라는 인식으로 변화하였고, 최근에 와서는 정신건강이 삶의 질과 현재의 산업구조에서 전면으로 부상하면서 독일 사회 전체의 주제가 되었다. 정신건강은 더 이상 정신의학적인 서비스로 제한되는 것이 아니라 육아, 교육, 노동 등을 포함하는 ‘크로스 커팅 이슈(cross-cutting issue)’가 되었다는 점은 한국의 정신건강제도 및 정책 마련에 시사하는 바가 크다.