Implementation Of National Health Policy Research Articles

Trends in incidence and survival of childhood cancers in Khon Kaen, Thailand (2000–2019): a population-based Khon Kaen Cancer Registry study

BackgroundIn Thailand, the national health care system and nationwide standard treatment protocols have evolved over time, potentially influencing the trends in the incidence and survival rates of childhood cancers. However, further investigations are required to comprehensively study these trends in Khon Kaen, Thailand.MethodsChildhood cancer patients aged 0–14 years (n = 541) who were diagnosed with one of the five most common cancers between 2000 and 2019 from the population-based Khon Kaen Cancer Registry were enrolled. Descriptive statistics were used to analyse the demographic data, which are presented as numbers, percentages, means, and standard deviations. The trends in incidence between 2000 and 2019, including age-standardized incidence rates (ASRs) and annual percent changes (APCs), were analysed using the Joinpoint regression model. Survival analysis was performed for 5-year relative survival rates (RSRs) according to the Pohar Perme estimator and Kaplan–Meier survival curves.ResultsThe ASRs of the overall top 5 childhood cancer groups were 67.96 and 106.12 per million person-years in 2000 and 2019, respectively. Overall, the APC significantly increased by 2.37% each year for both sexes. The overall 5-year RSRs were 60.5% for both sexes, 58.2% for males, and 63.9% for females. The highest 5-year RSR was for germ cell tumours (84.3%), whereas the lowest 5-year RSR was for neuroblastoma (29.1%).ConclusionsThe incidence and survival rates of childhood cancers in Khon Kaen, Thailand, varied according to sex. The incidence trends increased over time, meanwhile, the relative survival rates rose to satisfactory levels and were comparable to those of other nations with similar financial status. The implementation of national health policies and adherence to national treatment guidelines have improved cancer diagnosis and treatment outcomes.

ГЕНДЕРНЫЕ ОСОБЕННОСТИ ВОСПРИЯТИЯ ВИЗУАЛЬНОГО ОБЛИКА МЕДИЦИНСКИХ ОРГАНИЗАЦИЙ

The article presents the results of an analytical sociological research on the population’s opinion study in the gender aspect regarding the perception and approval of various attributes of the visual image of medical organizations in the Russian Federation. The research found that women are more likely than men to pay attention to design solutions for elements of a visual image. The construction of the Kano matrix made it possible to determine the most attractive attributes of medical imaging systems – a single design of pointers and the presence of graphic elements that received great approval from women. Accounting for gender balance in the formation and implementation of national health policy can become the basis for the development of multi-purpose strategies aimed at creating maximum compliance for both men and women in terms of the conditions for providing medical care.

The Use of Research for Health Systems Policy Development and Implementation in Mozambique: A Descriptive Study.

Health policy and systems research (HPSR) is generating an increasing amount of evidence in Mozambique, where implementation of a wide range of public health policies and interventions, and innovative technologies and solutions, is underway. We used qualitative methods to explore the relationship between HPSR and policy development and implementation in Mozambique. We conducted a literature review and in-depth interviews with researchers, experts, and policy makers. Through our analysis, we assessed barriers to the use of research evidence in the development and implementation of national health policies and identified potential opportunities to improve evidence use in this context.We found an increasing number of research institutions producing solid scientific evidence in the country, with activities in health in general and health systems specifically. There is also a growing trend for decision makers and policy makers to use the results of research during the design, formulation, and implementation of health policies. Most HPSR conducted in Mozambique is funded by international donors and focused on research questions of international interest. Therefore, research generated in Mozambique does not always address questions that are relevant to the local health system development agenda.While Mozambique has a lot of "gray literature" outlets, few of its publications support the translation of research evidence into policy. Much of the evidence generated in country is disseminated through project reports and briefings, not peer-reviewed literature. Furthermore, when the research evidence generated is not locally relevant, results may be published only in English and in scientific articles, instead of in formats useful to Mozambican policy makers-to the detriment of national-level understanding and use. We recommend that research institutions and policy makers in Mozambique collaborate on developing a platform that consolidates HPSR, making it more accessible and useful to policy makers.

A Case Report of Extensively Drug Resistant Typhoid in Karachi, Pakistan: A Major Health Concern to Curb the Outbreak

The disease burden of extensively drug resistant typhoid in developing countries is a major emerging issue that cannot be ignored. Since its emergence from multidrug strains, the majority of typhoid cases in Karachi, Pakistan, have been extensively drug resistant, mostly infecting younger patients. In the study, the authors analysed one such case in an adolescent male and discussed how, by the implementation of national health policies, the spread of these infectious diseases could be prevented and the overall burden on the healthcare system decreased in areas with already limited resources.

Applying the Realist Evaluation Approach to the Complex Process of Policy Implementation-The Case of the User Fee Exemption Policy for Cesarean Section in Benin.

Realist evaluation is making inroads in the field of health policy and systems research to a large extent because of its good fit with complex issues. Until now, most realist studies focused on evaluating interventions or projects related to health care delivery, organization of health services, education, management, and leadership of health workers in high income countries. With this paper, we apply the realist approach to the study of national health policy implementation in a low resource country. We use the case of the user fee exemption policy for cesarean section in Benin, which we followed up from 2009 to 2018. We report on how realist evaluation can be applied for policy implementation research. We illustrate how we developed the initial programme theory—the starting point of any realist evaluation -, how we designed the study and data collection tools, and how we analyzed the data. For each step, we present current good practices, how we adapted them when needed, the challenges and the lessons learned. We report also on how the dynamic interactions between the central level (the national implementing agency) and the peripheral level (an implementing hospital) shaped the policy implementation. We found that at central level, availability of resources for a given policy is constantly challenged in the competitive national resource allocation arena. Key factors include the political power and the legitimacy of the group supporting the policy. These are influenced by the policy implementation structure, how the actual outputs of the implementation align with promises of the group supporting the policy and consequently how these outputs, the policy and its promoters are perceived by the community. We found that the service providers are key to the implementation, and that they are constrained or influenced by the dependability of the funding, their autonomy, their personal background, and the accountability arrangements. This study can inform the design and implementation of national health policies that involve interactions between central and operational level in other low-income countries.

Prevalence of chronic morbidities and healthcare seeking behavior among urban community dwelling elderly population residing in Kalyani Municipality area of West Bengal, India.

Introduction:Demographic transition has resulted in higher proportion of elderly population in every community. The pattern of chronic morbidity along with healthcare seeking behavior and factors associated with it are important for implementation of national health policies targeted toward elderly population.Methods:A community based cross-sectional study was done including 457 urban dwelling elderly population of Kalyani Municipality area of West Bengal. Sociodemographic details, profile of chronic morbidities, and healthcare seeking behavior for chronic morbidities were studied using a pretested semi structured questionnaire.Results:The average education and financial independence were high among study participants. The prevalence of chronic morbidities was 82.3% and hypertension was the most common morbidity in both male and female. Around half of the individuals with chronic morbidities (57.7%) sought healthcare advice at least once in last 6 months. Most of the study participants preferred private healthcare setup and allopathic system of medicine. Females have been found to have higher treatment seeking behavior than males in logistic regression.Conclusion:We found hypertension and diabetes were more prevalent in the study population. Higher financial independence and education among study participants might have influenced the healthcare seeking behavior, which was mainly from private setup. Implementation of national health policies for elderly has to be accelerated in acceptable ways to promote health among elderly.

Implementation of National Health Policy for the Prevention and Control of Cardiovascular Disease in South Korea: Regional-Local Cardio-Cerebrovascular Center and Nationwide Registry.

Cardiovascular disease (CVD) remains the leading cause of morbidity, mortality, and health care costs in South Korea. The prevalence of preventable and treatable risk factors for CVD such as obesity, hypercholesterolemia, and smoking has continued to increase, despite improvements management of hypertension. Active leadership, participation, and support of professional organizations and medical institutions in national cardiovascular registries and regional treatment network have proven to be effective models to reduce the global burden of CVD in the Europe and North America. Regional treatment network systems for ST-segment elevation myocardial infarction have established to coordinate percutaneous coronary intervention (PCI) treatment centers, non-PCI treatment centers, and emergency centers especially across the Europe. The Act on the Prevention and Management of Cardio-cerebrovascular Disease was enacted in South Korea in 2017 to establish the legal frameworks and a comprehensive plan for the prevention and management CVD and risk factors. To fully achieve the goal of a National Health Plan for Cardiovascular Disease, it is necessary to embark on a nationwide registry project and to promote the regional acute treatment accessibility which can therefore play a key role in achieving the objectives of the 2017 Act. In this regard, the Korean Society of Cardiology advocates a national project for health promotion and cardiovascular prevention to improve cardiovascular outcomes, which includes the expansion and establishment of regional cardio-cerebrovascular centers (CCVCs) and new local CCVCs.

Vaccination Inequality in India, 2002–2013

India's childhood vaccination coverage has increased amid the implementation of national health policies intended to improve immunization levels. However, there is a dearth of contemporary studies comparing state-level childhood vaccination rates across India's highly diverse states and territories. This study assesses SES-based inequalities in childhood vaccination by state for 2002-2013. National surveys from 2002 to 2004, 2007 to 2008, and 2012 to 2013 were used for analyses. Household SES was assessed using an asset index created through principal component analysis. Full vaccination comprised 1 dose bacille Calmette-Guerin, 3 doses diphtheria-pertussis-tetanus vaccine, 3 doses oral polio vaccine, and 1 dose measles-containing vaccine at age 12-60 months. Inequality analyses were stratified by 3 time periods and by government-designated high focus group versus non-high focus group states. Childhood vaccination steadily increased between 2002 and 2013 in high focus group states but fell in some non-high focus group states, whereas SES-based vaccination inequalities generally decreased in both. In 2012-2013, rural areas had lower vaccination rates than urban areas in high focus group states but similar vaccination rates as urban areas in non-high focus group states. Increases in vaccination rates were not consistently accompanied by improvements in SES-based inequalities in vaccination. Childhood vaccination in India has improved overall, although increases are more pronounced in high focus group states than in non-high focus group states over the study period. The gap in coverage between these states decreased over time owing in part to the latter experiencing reductions in full vaccination rates during 2007-2013. SES-based vaccination disparities persist in India, highlighting the need to improve vaccination rates for all children, especially those from disadvantaged and underserved groups. This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.

Shaping access to health care for refugees at the local level in Germany

Abstract Background In Germany, the federal states and even the municipalities have considerable scope for shaping implementation of national health policies for newly arrived refugees, including in the way they organize access to health services. We analysed how gatekeepers can shape access to health care at the local level, exploring access models in six municipalities in the federal state of North Rhine-Westphalia. Methods We assessed the implementation of local access models and the consequences for access for refugees. Our study covered three municipalities with a health care voucher model and three with an electronic health card model. We combined data from official reports and from 21 semi-structured interviews with gatekeepers. Results Our research illustrates how gatekeepers at the local level can shape and facilitate access to health care for refugees, irrespective of the access model chosen. Larger municipalities are more likely to implement an electronic health card model. Gatekeepers report that costs, workload and control are the major aspects underlying the choice of model in municipalities. Access plays only a minor role, although some gatekeepers claim that the electronic health card model can improve access. Conclusions National health policies can support gatekeepers in their role as facilitators, such as through financial incentives or a minimum amount of bureaucracy. They can also allow newly arrived refugees to become members of the statutory health insurance system, which would relieve social welfare offices and general practitioners (GPs) from their role of gatekeepers.

Assessment of prevalence of risk factors for non-communicable diseases in early adolescent age group using Global School Health Survey in Ujjain, Madhya Pradesh, India

Introduction: There has been a global rise in non-communicable diseases and a shift in trends from infectious to chronic lifestyle-related diseases, roots of which are behaviourally acquired and begin during adolescence. Adolescence constitutes a natural partner for their prevention. Objective: To determine the prevalence of risk factors for non-communicable diseases in the early adolescent age group using a global school-based health survey among students of Ujjain. Method: Cross-sectional study was done for 24 months from August 2017 to August 2019 in schools of Ujjain, Madhya Pradesh. Sampling was done using a cluster sampling technique. Students who participated were administered a questionnaire based on the GLOBAL SCHOOL HEALTH SURVEY. Appropriate statistical methods were used to find the odds ratio for the prevalence of the risk factors and differences among sex, residence (urban or rural), and type of school (government or private). Result: This study documents that among 400 students lack exercise, consumption of junk food =44.5%, high alcohol consumption 16.8 %, smoking cigarettes was found to be prevalent risk factors of NCDs. There was a statistically significant difference noted among types of school, residence, and sex. Conclusion: This is the first study done in this region and emphasizes individual health interventions along with the implementation of national health policies targeting the adolescent age group to lower the financial and health care burden of the region.

The Evolution of Government’s Attention Towards Older Person: a Critical Review of Malaysia 5 Years Plan

This paper analyses the evolution of government’s attention towards older person in Malaysia by reviewing Malaysia five years plan. Malaysia began to emphasise older person issues in 1995, following the introduction of the National Policy of Older Person. In 1997, the idea of healthy ageing was brought into attention through the first introduction of National Health Policy for Older Person. Subsequently in 20 eras, Malaysia started to grasp the idea of active ageing and productive ageing and this could be seen through the emphasised implementation of National Health Policy for Older Person, life-long learning programs as well as the improved retirement age of 60 years to promote productive ageing. In the Tenth Malaysia Plan, the government highlighted issues namely improvement of facilities, provision of accessible health care, and utilization of ICT on public services for older person. The ongoing plan emphasises the preparation of older person after retirement. This paper concludes that the attention for older person in Malaysia is still far behind compared to other developed countries. This is among the gaps that Malaysia needs to take a heed in order to be ready to take on ageing country status by 2030.

Genesis of the professional work of nurses in Brazil (1920-1925)

Objective: To analyze the genesis of the professional work of Brazilian nurses between 1920 and 1925. Methods: This is a historical research, qualitative in nature. The theoretical framework used was the Micro-history. The sources were official and institutional documents, agents' speeches, in addition to investigations related to the subject matter. Results: The historical evidence analyzed allows us to state that the genesis of the professional work of Brazilian nurses occurred under a state project of public health, enabled the implementation of national health policy in the 1920s, and established the practice bases of professional nurses in Brazil. Conclusions: Nursing structuring in the 1920s was a state strategy, which supported the implementation of the early health policy, whose operating axis was hygiene education. We may also conclude that nurses were important agents in the Brazilian public health history at that time.

Wealthiest is Not Always Healthiest: What Explains Differences in Child Mortality in West Africa?

Ghana has the lowest under-five mortality rate in West Africa. Understanding why Ghana’s child mortality rate is lower than in neighboring countries may offer useful insights for other developing countries that are trying to improve child health. This paper explores whether Ghana’s lower mortality rate is mostly a result of greater household wealth, better implementation of national health policies, or more favorable geography. The paper uses micro level data for children under five to examine relative child mortality risk between Ghana and each of its three immediate neighbors — Burkina Faso, the Ivory Coast and Togo. A Cox proportional hazards model is used to test which of the three ‘contenders’ — health policy, wealth or geography — best explains Ghana’s mortality advantage. The results of the analysis indicate that wealth variables are not able to explain any of the child mortality variation between Ghana and its neighbors. Geography and health policy variables each explain about 40% of the mortality gap between Ghana and Burkina Faso. Health policy differences alone are able to explain about 70% of the child mortality gap between Ghana and the Ivory Coast. These results suggest that even poor countries that have been 'cursed' by bad geography can potentially improve development outcomes and save children’s lives.

Wealthiest Is Not Always Healthiest: What Explains Differences in Child Mortality in West Africa?

Ghana has the lowest under-five mortality rate in West Africa. Understanding why Ghana’s child mortality rate is lower than in neighboring countries may offer useful insights for other developing countries that are trying to improve child health. This paper explores whether Ghana’s lower mortality rate is mostly a result of greater household wealth, better implementation of national health policies, or more favorable geography. The paper uses micro level data for children under five to examine relative child mortality risk between Ghana and each of its three immediate neighbors -- Burkina Faso, Cote d’Ivoire, and Togo. A Cox proportional hazards model is used to test which of the three ‘contenders’ – health policy, wealth, or geography – best explains Ghana’s mortality advantage. The results of the analysis indicate that wealth variables are not able to explain any of the child mortality variation between Ghana and its neighbors. Geography and health policy variables each explain about 40% of the mortality gap between Ghana and Burkina Faso. Health policy differences alone are able to explain about 70% of the child mortality gap between Ghana and Cote d’Ivoire. These results suggest that even poor countries that have been ‘cursed’ by bad geography can potentially improve development outcomes and save children’s lives.

The problems and prospects of public health care development in Nigeria\'s local government system

The abysmal failure of public health care system in Nigeria has attracted comments and criticisms from local and national levels. The provision of adequate health care services to the citizens, particularly those residing at the rural areas has left much to be desired. In spite of media propaganda and the current health sector reforms by the government, the public health care system in Nigeria is still inefficient in all ramifications. It is therefore argued that the problems facing the public health care system in Nigeria could be traced to poor implementation of National Health Policy as well as other health-related policies and programmes. Also, the implementation of National Health Policy and the current reforms in the health sector are therefore expected to address the perennial problems inflicting public health care development in Nigeria. The paper further argues that it is only when the government ensures that health is regarded as the right of all citizens of the country, irrespective of status that the public health care system is said to be developed in Nigeria. The paper adopts descriptive method and content analysis to arrive at the conclusion that poor implementation of health care policies and programmes is the major constraint to the achievement of desired goals in public health care provision in Nigeria, particularly at the local government level. For better improvement, the paper suggests the need for political commitment as well as elimination of bureaucratic bottlenecks in public health care provision in Nigeria. Global Journal of Social Sciences Vol. 6 (1) 2007: pp. 51-56