Health Sector Leaders Research Articles

Professional development: a mixed methods study of Masters of Public Health alumni.

We examined the perceptions of the Master of Public Health (MPH) degree graduates regarding their personal competencies, job performance and professional development using a mixed method, explanatory sequential design. A cross-sectional, self-administered questionnaire of the Haifa School of Public Health alumni who graduated between 2005 and 2022 was disseminated to 849 graduates between March and June 2022, from which 127 responded (response rate: 14.90%). This was followed by 24 in-depth interviews with alumni from the same sample (conducted between November 2022 and March 2023). The sample included 74.8% of females with a mean age of 40.7 years, 35% of alumni agreed that the MPH degree helped them attain a promotion in their present position (in rank or salary), and 63.8% felt that the degree helped them improve their job performance and contribute to their current workplace. Most (80.3%) alumni reported not changing jobs after graduation. The interview themes revealed that the MPH contributed to their personal and professional lives, provided them with a holistic view of public health and health systems, and improved their in-depth scientific skills. The main reported barriers to professional development included missing core competencies, low salaries, and a lack of information regarding suitable jobs. Surprisingly, an MPH was not a requirement for some public health sector jobs. Alumni reported that the MPH degree contributed to improving many graduates' careers and satisfaction levels and to build their leadership competencies in public health. There seems to be a lack of coordination between the academic curriculum and the jobs available for alumni, hindering better alumni professional development. Regular discussions, information sharing, and curriculum refinements between MPH program leaders and health sector leaders might help address many of the concerns of MPH degree graduates.

“I would love to see these big institutions… throwing their weight around”: qualitative findings regarding health and social sector collaborations to address community-level socioeconomic adversity

BackgroundHealth and social sector organizations are increasingly working together to mitigate socioeconomic adversity within their communities. We sought to learn about the motivations, experiences, and perspectives of organizations engaged in these collaborations.MethodsWe conducted semi-structured, 60-minute interviews with 34 leaders from 25 health and social sector organizations between January-April 2021. Interviews explored motivations, benefits and challenges, and ways in which health sector organizations can most effectively address community-level socioeconomic adversity. Interviews were audio recorded and transcribed; themes were coded using Dedoose software.ResultsPartnerships were primarily motivated by mission-driven organizations and key health sector leaders who were interested in addressing root causes of poor health; policies such as certificate of need laws and value-based care incentives that aligned community-level investments with health sector organizations’ financial interests facilitated these efforts. While partnerships were mostly regarded as mutually beneficial ways to increase impact (for the health sector) and resource access (for the social sector), social sector organizations voiced frustrations regarding the outsized expectations, unsustained interest, and lack of partnership from their health sector collaborators. Despite these frustrations, both health and social sector interviewees supported the health sector’s continued involvement in community-level socioeconomic initiatives and expansion of policy and systems efforts.ConclusionsCross-sector, community-level socioeconomic initiatives were mutually beneficial, but social sector organizations experienced more frustrations. Policy and organizational changes within the health sector can further mobilize and sustain support for these efforts.

An Assessment of the Knowledge and Perceptions of Precision Medicine (PM) in the Rwandan Healthcare Setting.

Precision medicine (PM) or personalized medicine is an innovative approach that aims to tailor disease prevention and treatment to consider the differences in people's genes, environments, and lifestyles. Although many efforts have been made to accelerate the universal adoption of PM, several challenges need to be addressed in order to advance PM in Africa. Therefore, our study aimed to establish baseline data on the knowledge and perceptions of the implementation of PM in the Rwandan healthcare setting. A descriptive qualitative study was conducted in five hospitals offering diagnostics and oncology services to cancer patients in Rwanda. To understand the existing policies regarding PM implementation in the country, two additional institutions were surveyed: the Ministry of Health (MOH), which creates and sets policies for the overall vision of the health sector, and the Rwanda Biomedical Center (RBC), which coordinates the implementation of health sector policies in the country. The researchers conducted 32 key informant interviews and assessed the functionality of available PM equipment in the 5 selected health facilities. The data were thematically categorized and analyzed. The study revealed that PM is perceived as a complex and expensive program by most health managers and health providers. The most cited challenges to implementing PM included the following: the lack of policies and guidelines; the lack of supportive infrastructures and limited suppliers of required equipment and laboratory consumables; financial constraints; cultural, behavioral, and religious beliefs; and limited trained, motivated, and specialized healthcare providers. Regarding access to health services for cancer treatment, patients with health insurance pay 10% of their medical costs, which is still too expensive for Rwandans. The study participants highlighted the importance of PM to enhance healthcare delivery if the identified barriers are addressed. For instance, Rwandan health sector leadership might consider the creation of specialized oncology centers in all or some referral hospitals with all the necessary genomic equipment and trained staff to serve the needs of the country and implement a PM program.

What does it take to make a wrong decision? A qualitative study from Pakistan's health sector.

Pakistan's health system over the past three decades has experienced social, economic, geopolitical instability, and notwithstanding man-made and natural catastrophes. Since 2001, the health system in Pakistan has undergone three phases of organizational and management reforms and does not have a unified national health policy since then. The aim of this research was to assess the factors behind the decision-making by policy planners in the health system of Pakistan. An exploratory qualitative study based on grounded theory was designed where in-depth interviews conducted with 20 representatives of the political constituencies, civil bureaucracy, health planners and managers, research and educational institutions, NGOs providing technical support in the health sector, development partners and media. There leading reason cited was the dearth of leadership in health sector, which is compounded by a range of factors such as "institutional monopoly", "contextual deterrents", "power for turf"; "inadequate knowledge", and "design faults". Such factors were perceived to have a serious effect on the competencies, roles and responsibilities, use of knowledge for decision making. The behavioral aspects of decision makers include the "mindset," and "conflicting interests". The multitude of factors and complexities within the health sector of Pakistan continue to widen the vacuum in the leadership echelons. Hence, there is a high probability of taking wrong decisions not based on evidence, and resulting in a grossly under-performing health system.

Barriers, promoters, and strategies for improving task shifting and task sharing implementation in Nigeria: qualitative perspectives of policymakers

Background Nigeria developed a National Task Shifting and Sharing Policy due to protracted inequitable distribution of health workers, especially at the primary level of care, and the low stock and production rate of skilled health workforce. Following the development of Nigeria’s task shifting and sharing policy and strategy, implementation was promulgated at various levels, with States adopting and implementing the national policy. However, the policy environment for task shifting and sharing varies widely. Consequently, evidence on barriers to and factors promoting successful implementation are inconclusive. Hence, strategies for improving implementation are needed. The evidence from this study can inform the scale-up and strengthening of implementation approaches as Nigeria strives to achieve the national goals, universal health coverage and sustainable development goals. Methods An explorative, descriptive research study approach was applied with 20 key informant interviews conducted to explore the perception of policymakers on barriers and promoters of task shifting and sharing in Nigeria. In addition, strategies for improving task shifting and sharing implementation were explored. Results The barriers to effective implementation of task shifting ad sharing from our study were the persistent shortage of health workers, inter-cadre rivalry, perceived sub-optimal capacity of the beneficiary cadres, and lack of adequate equipment for delivery of needed services. The factors promoting the implementation of task shifting and sharing were the availability of adapted policies, the political will of the health sector leadership, acceptance of task shifting and sharing implementation by health workers, and the implementation of actions to improve knowledge and skills of health workers to implement shifted or shared tasks by various actors. The strategies to improve future task shifting and sharing implementation include improving staffing levels, scaling up training and periodic retraining, mentoring and supportive supervision, and improving the, use and dissemination of evidence generated. Conclusions Several factors influence the implementation of task shifting and sharing. Hence the identification and implementation of relevant strategies are pertinent in achieving set objectives and national goals. In policy and practice, therefore, a proactive exploration of the contextual understanding, barriers to implementation, enablers and learning from the performance of similar interventions is pertinent in shaping strategies for translating evidence to practice through an implementation framework. This should be done in collaboration with stakeholders to foster acceptance and participation.

The political economy offinancing traditional vaccines andvitamin A supplements insix African countries.

Vaccines and vitamin A supplementation (VAS) are financed by donors in several countries, indicating that challenges remain with achieving sustainable government financing of these critical health commodities. This qualitative study aimed to explore political economy variables of actors' interests, roles, power and commitment to ensure government financing of vaccines and VAS. A total of 77 interviews were conducted in Burundi, Comoros, Ethiopia, Madagascar, Malawi and Zimbabwe. Governments and development partners had similar interests. Donor commitment to vaccines and VAS was sometimes dependent on the priorities and political situation of the donor country. Governments' commitment to financing vaccines was demonstrated through policy measures, such as enactment of immunization laws. Explicit government financial commitment to VAS was absent in all six countries. Some development partners were able to influence governments directly via allocation of health funding while others influenced indirectly through coordination, consolidation and networks. Government power was exercised through multiple systemic and individual processes, including hierarchy, bureaucracy in governance and budgetary process, proactiveness of Ministry of Health officials in engaging with Ministry of Finance, and control over resources. Enablers that were likely to increase government commitment to financing vaccines and VAS included emerging reforms, attention to the voice of citizens and improvements in the domestic economy that in turn increased government revenues. Barriers identified were political instability, health sector inefficiencies, overly complicated bureaucracy, frequent changes of health sector leadership and non-health competing needs. Country governments were aware of their role in financing vaccines, but only a few had made tangible efforts to increase government financing. Discussions on government financing of VAS were absent. Development partners continue to influence government health commodity financing decisions. The political economy environment and contextual factors work together to facilitate or impede domestic financing.

Learning from COVID and climatic events to build a resilient health system: Western Cape Department of Health

Background The devastating KwaZulu-Natal floods in early 2022 were a reminder of the extensive damage to property and loss of life that climate change will exacerbate in South Africa. Extreme weather events are projected to increase in frequency and intensity in the southern African region. In recent years, the Western Cape has experienced fires, floods, drought, load-shedding, and COVID-19. Approach This chapter reflects on the experience of the Western Cape Department of Health around a series of adverse events in the province. The main lessons are identified, and a framework is suggested to strengthen the health sector’s response to climate change. The Department has been on an intentional learning journey to strengthen the health system, build health-system resilience, and to learn from these events. In addition to the need to adapt to external events, the health system itself contributes to greenhouse gas emissions. As such, the Department has discussed the mitigation activities it is engaged in to reduce its contribution to climate change. Building on the lessons learned from adverse events, the Department has identified five focus areas to strengthen the health sector’s ability to respond to climate change: (i) structural and relational aspects of governance; (ii) stewardship, leadership, and management; (iii) partnerships and intersectoral collaboration; (iv) system capacities; and (v) learning oriented culture. Conclusions As the impacts of climate change are increasingly felt, there is an urgent need to share lessons from the health sector’s response to adverse events. This learning can assist in implementing adaptive actions that strengthen health-system functions and that mitigate the health sector’s greenhouse gas emissions. Health-sector leadership in South Africa needs to participate actively in climate action through the Presidential Climate Commission and other fora. The chapter concludes with recommendations that speak to the focus areas and shared learnings that can be helpful in other settings where health systems face climate risks.

Engaging the health sector in climate-resilient WASH development.

The impact of climate change on water, sanitation, and hygiene (WASH) has driven an increased focus on climate-resilient WASH development. Evidence suggests that adaptation in the WASH sector is underway, but the progress is limited in certain domains and the participation of the public health community may be lacking. Using the Lake Victoria Basin (LVB) as a climate vulnerability setting for this analysis, this study aimed to identify factors that impede full engagement of the health sector in climate-resilient WASH development. In-depth semi-structured interviews were conducted with 13 WASH sector stakeholders across lakeside urban centers in Kenya, Uganda, and Tanzania. Several barriers to health sector engagement were identified including factors related to donor-driven financing and priority setting, a relative neglect of climate vulnerabilities associated with sanitation and hygiene, ministerial siloes, and broader systems of adaptation governance which compromise health sector leadership in climate adaptation. These results suggest room for expansion of interdisciplinary collaborations and deepened involvement of the health sector in WASH-related climate adaptation, which starts with addressing these and other barriers to full health sector engagement.

Community-based health insurance, healthcare service utilization and associated factors in South Gondar Zone Northwest, Ethiopia, 2021: A comparative cross-sectional study.

Community-based health insurance schemes are becoming increasingly recognized as a potential strategy to achieve universal health coverage in developing countries. Ethiopia has implemented community-based health insurance in piloted regions of the country. The scheme aims to improve the utilization of healthcare services by removing financial barriers. There is a dearth of literature regarding the effect of the insurance scheme on the utilization of healthcare services. A community-based comparative cross-sectional study was conducted in the south Gondar Zone. Six hundred fifty-eight participants were selected using a systematic random sampling method. Data were entered into EPI data version 4.4.1 and exported to SPSS version 25 for analysis. Binary logistic regression was used to measure the association of factors with the outcome variable. The result of the final model was expressed in terms of Adjusted Odd Ratios (AOR) and 95% CI. Two hundred twenty-three (67.8%) and 111 (33.7%) of the respondents reported that their family members went to health institutions within three months among CBHI users and non-users respectively. The presence of under-five children (AOR = 2, 95% CI = 1.6-2.4), CBHI scheme membership times (AOR = 3, 95% CI = 2.6-3.4), household wealth index rich (AOR = 4, 95% CI = 2.3-6.3), household wealth index medium (AOR = 3, 95% CI = 1.8-5.8) and presence of chronic illness (AOR = 0.5, 95% CI = 0.2-0.8) was associated with health care service utilization. Households who were enrolled in CBHI were more likely to use healthcare services than households who were not enrolled. Households who were enrolled in CBHI were more likely to use healthcare services than households who were not enrolled. Therefore, health sector leaders and managers in the study area should strengthen their efforts for increasing the enrollment of the community into CBHI.

Examination of studies on transformational leadership in health sector through content analysis

Liderlik, insanoğlu kadar eski bir kavram olsa da literatürde ölçümü ve tanımı noktasında bir fikir birliği bulunmamaktadır. Bu durumun doğal bir sonucu olarak, zaman içerisinde farklı liderlik tanım ve tarzları ortaya çıkmıştır. Günümüzde dönüşümcü, etkileşimci ve karizmatik liderlik gibi farklı liderlik tarzları sıklıkla tartışılmaktadır. Ancak literatür incelendiğinde, sağlık sektöründe dönüşümcü liderlik ile ilgili genel eğilimin net olmadığı ve ulusal literatürde de bu türden kavramların son yıllarda tartışılmaya başlandığı görülmektedir. Dahası Türkiye’de söz konusu kavramlar ile ilgili genel eğilim oldukça belirsizdir. Bu nedenle bu araştırmada, Türkiye’de sağlık sektöründe dönüşümcü liderlik ile ilgili yapılmış olan ulusal ve uluslararası çalışmaların içerik ve kapsam bakımından ele alınması amaçlanmıştır. Bu amaçla, Ebscohost, Google Akademik, Sciencedirect, Scopus, TÜBİTAK ULAKBİM ve YÖK Ulusal Tez Merkezi taranmış ve tarama sonucunda, 57’si Türkçe ve 9’u İngilizce olmak üzere toplamda 66 çalışma değerlendirmeye alınmıştır. Araştırma sonucunda, sağlık sektöründe dönüşümcü liderlik ile ilgili ilk çalışmaların 2006 yılında yapıldığı ve çalışmaların büyük bir çoğunluğunun son 5 yılda yapıldığı tespit edilmiştir. Araştırma kapsamına alınan çalışmalarda kullanılan anahtar kelimeler incelendiğinde ise; liderlik, örgütsel bağlılık ve çalışan performansı gibi bazı kavramların sıklıkla kullanıldığı görülmektedir. Bu araştırmanın, sağlık sektöründe dönüşümcü liderlik ile ilgili genel eğilimi ortaya koyması ve çalışılmamış araştırma konularının tespit edilmesi bakımından önemli olduğu düşünülmektedir.

Australian health sector leadership and roadmap for healthcare decarbonisation to net zero emissions

Australian health sector leadership and roadmap for healthcare decarbonisation to net zero emissions

Teamwork, Professional Identities, Conflict, and Industrial Action in Nigerian Healthcare.

PurposeModern healthcare is delivered by teams of multidisciplinary professionals. Conflicts have been widely reported between these professionals in Nigeria. Furthermore, the health system is frequently crippled by industrial actions by trade unions representing these professionals. This study aimed to shed light on the complexities of factors perceived to cause workplace conflicts, including the extent to which these are thought to link to industrial action.Materials and methodsFocus group discussions and in-depth interviews were conducted with nurses, doctors, and medical laboratory scientists who work in multiprofessional settings giving a total of 41 participants. Results were analyzed within the framework of the social identity theory.Results and conclusionsThe dominant themes that emerged as barriers to teamwork include professional hierarchy, role ambiguity, and poor communication. At the same time, the health sector leadership and remuneration were the main themes concerning industrial actions. The salience of professional identities was also demonstrated, providing a link between interprofessional conflict in the workplace and competitive industrial actions by trade unions representing health professionals. The implications for educational and clinical practice and the need for interprofessional education are discussed.

Understanding women’s leadership in health sector; findings of a qualitative study in Kerala, India

Abstract Background The lack of women's representation in health and medicine, especially in leadership positions, is a major global challenge. An exception to this is the state of Kerala in India, where female representation is high, defying national trends. We undertook a study to understand the contexts undergirding women's rise to leadership in Kerala and their experiences in leadership. Methods We employed a qualitative research methodology like in-depth interviews. We identified 16 women by peer nomination (respondent-driven sampling) or from public records as leaders in health, working in Kerala's health system, in civil society or political leaders dealing with health issues. Following informed consent procedures, interviews were carried out seeking to understand the work-life balance, challenges, gender norms, motivation and leadership styles of participants. Transliterated English transcripts were analyzed by three researchers using a thematic analysis approach and Atlas.Ti8 software. Results Participants were aged 42 years and older, with between 19 and 60 years of occupying senior managerial positions in different levels. Most emphasized family members' influence and support for their leadership roles. Their work in communities and in primary care was described as formative. Women leaders reported a combination of leadership styles to accommodate and adapt to varying circumstances, emphasizing motivation and coalition building. Challenges like false allegations, non-recognition of competence and discrimination were overcome through self-determination and perseverance. Conclusions Kerala women leaders have faced hardships and challenges and rely on reflexive and variable strategies. They have climbed up the ranks and developed their leadership styles mindful of and benefitting from the maintenance of community and family relationships, suggesting a different kind of leadership model altogether. Key messages Women leaders from Kerala’s health sector have faced unique challenges. Women leaders from the health sector have addressed different challenges by developing a hybrid, distinct leadership style.

Factors affecting health sector involvement in public policies addressing the social determinants of health: a critical realist case study of cash transfers in Ghana

ABSTRACT In spite of the consistent evidence of cash transfers’ (CTs) impact on the social determinants of health (SDoH) in low-and middle-income countries, and their potential for achieving health sector objectives, there is a growing concern that the health sector has not been actively involved in these programs. This study used a critical realist approach to examine the factors affecting health sector involvement in CTs in Ghana. In-depth semi-structured interviews were conducted with 20 health promoters comprising national policymakers, District Directors of Health Service, Regional/District Health Promotion Managers and health promotion academics between October 2017 and February 2018. Interviews were audio-recorded and transcripts were analysed using thematic framework analysis. In addition, policy documents concerning the Ghana CT program were reviewed. All the participants were aware of the CT program, but had limited or no involvement in it to date. The findings indicate that CTs’ cross-cutting goals and health sector mandates and responsibilities constitute the key structures and powers with the potential to trigger a more substantive involvement of the health sector in the program. Factors found to shape health sector involvement in CTs included CT policymakers’ understanding of the SDoH, national health sector leadership, evidence linking CTs to SDoH, intersectoral collaboration and politicisation of CTs. As CTs continue to adapt and expand across low-and middle-income countries, the findings from this study can help the health sector to take a more substantive role in the programs to optimise their impacts on the SDoH and health inequities.

National Health Policy Reform for Primary Care in Chile: A Qualitative Analysis of the Health Program Documents.

Introduction: Chilean policy makers reformed the national health policy for primary health care (PHC), shifting from the traditional biomedical model to the integral family and community health model with a biopsychosocial approach, to guide the delivery of PHC throughout the country. Purpose: To evaluate the implementation of the national health policy for PHC through an analysis of the program documents for PHC; and to identify to what extent the national health policy is expressed in each program document, and across all the documents. Methods: A qualitative document analysis with a purposive sample of program documents for PHC. The Chilean Ministry of Health website was systematically searched between October and December 2018 to identify relevant program documents. Thematic and content analysis were performed to identify evidence of the biopsychosocial approach to care delivery with each program document, including the types of interactions between professionals that contribute to person-centered or fragmented care. Results: The study included 13 PHC program documents. Three themes and 10 categories emerged from the data. Most program justifications focused on the biopsychosocial approach to care while including biomedical interventions and supporting independent professional work. Only 4 of the 13 programs were consistent in the justification, interventions, and types of stated professional interactions: 2 from the biopsychosocial and 2 from the biomedical perspectives. Conclusion: In terms of the national health policy for PHC in Chile, interprofessional collaboration and person-centered care processes and practices were partially aligned with the written content of the health program documents. As such, policy makers and health sector leaders are advised to analyze draft health program documents for consistency in translating national health policies into the written communications that define the actualization of the care model in PHC and direct professionals how to provide PHC to individuals and families.

Better Board Education for Better Leadership and Management in the Health Sectors of Low and Middle Income Countries.

Board member education must be elevated within the curricula of leadership development programming in Low and Middle Income Countries (LMICs) across the globe. When properly trained and supported, the community, business, and health sector leaders serving on these boards can create the conditions within which those who deliver and manage health services are more likely to successfully achieve the mission of their organizations. The importance of incorporating education for governing body members into health sector leadership development programming, and three strategies for board development, are defined in in this article.

Bridging worldviews: Toward a common model of leadership across the health professions.

BackgroundAs the pace of health sector transformation accelerates, the importance of leadership continues to grow across all health professions. Advances in a variety of disciplines can inform effective leadership development. However, at present, most health sector leadership competency models do not incorporate these advances and are instead developed using consensus-based methods within specific professions. An interprofessional approach to leadership competencies could help incorporate these advances and support better interdisciplinary leadership development.PurposeThis study was pursued to revise and revalidate a widely used health sector leadership competency model and assess its potential for providing greater interoperability across the professions.Methodology/ApproachUsing the National Center for Healthcare Leadership’s interprofessional competency model Version 2.1 as the starting point, we developed a revised and revalidated model in four phases: (a) we completed a future scan using methods described in Garman et al. [Garman, A. N., Johnson, T. J., & Royer, T. (2011). The future of healthcare: Global trends worth watching. Chicago, IL: Health Administration Press.]; (b) we collected behavioral event interview data from pairs of leaders representing different organizational and performance levels, using methods developed by Boyatzis [Boyatzis, R. E. (1982). The competent manager: A model for effective performance. New York, NY: John Wiley & Sons.]; (c) we conducted a validity study via electronic survey of 145 working managers and calculated content validity ratios using methods described by Lawshe [Lawshe, C. H. (1975). A quantitative approach to content validity. Personnel Psychology, 38(4), 563–575.]; and (d) we used natural language processing to assess the extent to which existing leadership models in the health professions will crosswalk to the new model.FindingsAll competencies in the revised model successfully met criteria for validity. The revised model also successfully crosswalked against, on average, 85% of the competencies in the other five health professions leadership models.Practice ImplicationsBased on the results of this research, we conclude the revised model can provide a “common language” framework in support of interdisciplinary leadership development. The availability of such a model may also assist human resource and development executives in better aligning learning resources with organizational goals.

Trends and Patterns of Burden of Disease and Injuries in Korea Using Disability-Adjusted Life Years.

BackgroundIt is extremely important to objectively take a view of population health to provide useful information to decision makers, health-sector leaders, researchers, and informed citizens. This study aims to examine the burden of disease in Korea as of 2015, and to study how the burden of disease changes with the passage of time.MethodsWe used results from the Korean National Burden of Disease and Injuries Study 2015 for all-cause mortality, cause-specific mortality, and non-fatal disease burden to derive disability-adjusted life years (DALYs) by gender and age groups from 2007 to 2015. DALYs were calculated as the sum of the years of life lost (YLLs) and the years lived with disability (YLDs).ResultsIn 2015, the burden of disease for Korean people was calculated at 29,476 DALYs per 100,000 population. DALYs caused by low back pain were the highest, followed by diabetes mellitus and chronic obstructive pulmonary disease. The burden of disease showed a consistently increasing trend from 2007 to 2015. Although YLLs have been on the decrease since 2011, the increase in YLDs has contributed to the overall rise in DALYs. The DALYs per 100,000 population in 2015 increased by 28.1% compared to 2007.ConclusionAs for the diseases for which the burden of disease is substantially increasing, it is needed to establish appropriate policies in a timely manner. The results of this study are expected to be the basis for prioritizing public health and health care policies in Korea.

A National Priority: Improving Outcomes for Aboriginal and Torres Strait Islander People With Cancer Through an Optimal Care Pathway

Background and context: Cancer survival rates in Australia are among the best in the world, yet Aboriginal and Torres Strait Islander (indigenous) people continue to experience disparities in the distribution and burden of cancer, and unwarranted variations in outcomes. Indigenous Australians are 40% more likely to die of cancer than non-Indigenous Australians. Cancer Australia developed the National Aboriginal and Torres Strait Islander Cancer Framework (the framework), which identified 7 national priorities to address disparities in cancer outcomes experienced by indigenous Australians. An ongoing collaboration with indigenous Australians was integral to developing this shared agenda. Priority 5 in the framework highlights the need to ensure indigenous Australians affected by cancer receive optimal and culturally appropriate treatment, services, and supportive and palliative care. Aim: To improve cancer outcomes for indigenous Australians through the development and national endorsement of a population-specific Optimal Care Pathway (OCP) to guide the delivery of consistent, safe, high-quality, culturally appropriate and evidence-based care. Strategy/Tactics: Cancer Australia formed a partnership with the Victorian Department of Health and Human Services (DHHS) to address Priority 5 and develop the OCP. The approach to development was underpinned by Cancer Australia's Model of Engagement for Aboriginal and Torres Strait Islander People and guided by the national Leadership Group on Aboriginal and Torres Strait Islander Cancer Control (Leadership Group). Program/Policy process: Cancer Australia, in collaboration with DHHS: • reviewed experiences of care and the framework's comprehensive evidence base • developed a draft OCP to complement tumor-specific pathways • facilitated an Expert Working Group, comprising indigenous health sector leaders and consumers to refine and validate the draft OCP • undertook national public consultation, including with the indigenous health sector and community, health professionals and professional colleges • received an indication of support to proceed to endorsement from the Leadership Group. Outcomes: The first population-specific OCP for Aboriginal and Torres Strait Islander people with cancer received national endorsement. It will guide the delivery of consistent, safe, high-quality, culturally appropriate and evidence-based care. What was learned: Key elements of optimal care include: addressing the cultural appropriateness of the healthcare environment; improving cross-cultural communication; relationship building with local community; optimizing health literacy; recognition of men's and women's business; and the need to use culturally appropriate resources. The national priority in the framework informed and unified high-level direction, which was integral to effective OCP development and endorsement. The evidence-based, step-wise development approach contributed to its relevance, utility and quality.

Brief Critiques on Chain of Command, Unity of Command, Span of Control and Leadership in Health Sector of Nepal

DOI: http://dx.doi.org/10.3126/hprospect.v10i0.5644Health Prospect Vol.10 2011, pp.27