Role In Health System Research Articles

The Role of Health Systems in Cross-Sector Collaboration in Addressing Social Determinants of Health and Promoting Health and Well-Being.

The articles featured underscore the critical role of trust, strategic planning, and cross-sector partnerships in addressing health inequities, while emphasizing the need for further research on sustainable and cost-effective collaboration models. Tocco and colleagues from Northwell Health describe the formation of the Health Equity Taskforce (HET), initially aimed at equitable COVID-19 vaccine distribution on Long Island. The HET has since expanded to address broader health disparities, focusing on community involvement, strategic partnerships, and sustainability. Nemiroff and colleagues discuss collaborations with community partners and payors to address social determinants of health in underserved populations, highlighting opportunities that can facilitate collaborations such as the New York State's Medicaid 1115 Demonstration Waiver.

The Role of Health Systems in Cross-Sector Collaboration in Addressing Social Determinants of Health and Promoting Health and Well-Being.

The articles featured underscore the critical role of trust, strategic planning, and cross-sector partnerships in addressing health inequities, while emphasizing the need for further research on sustainable and cost-effective collaboration models. Tocco and colleagues from Northwell Health describe the formation of the Health Equity Taskforce (HET), initially aimed at equitable COVID-19 vaccine distribution on Long Island. The HET has since expanded to address broader health disparities, focusing on community involvement, strategic partnerships, and sustainability. Nemiroff and colleagues discuss collaborations with community partners and payors to address social determinants of health in underserved populations, highlighting opportunities that can facilitate collaborations such as the New York State's Medicaid 1115 Demonstration Waiver.

Preferences and expectations of end-users from a mental health educational portal: A qualitative study

Background: Digital technologies play an essential role in health systems by providing new solutions to reduce the burden of mental illnesses and disorders. However, in many cases, user preferences and expectations are not considered in the design of portals. This study aims to explore the preferences and expectations of end-users from the features and capabilities of mental health educational portals. Methods: This qualitative study was conducted from January 2022 to January 2023 using the conventional content analysis approach. The participants were 20 individuals, selected through purposive sampling, ranging in age from 18 to 61, all of whom had prior experience using an educational portal. Data were collected via individual semi-structured interviews. Qualitative analysis was performed using MAXQDA 10 software. Results: After analyzing the data, the preferences and expectations of end-users were categorized into five main themes: to be reliable, mutual interaction capability, to be accessible, creating a stylish and attractive design, and attention to the quality and structure of the content. Conclusion: Considering the expectations and needs of users will enhance their acceptance and satisfaction with the portals. From the end-users’ perspectives, the content, appearance, and structural or technical features a mental health educational portal are crucial for its effectiveness.

“We want to get out” – A qualitative study on reasons for nurses’ early retirement intentions

Abstract Background Nurses, the largest workforce in healthcare, play a central role in health systems. There is a severe global shortage of nurses, which is expected to worsen as a significant portion approaches retirement age. Early retirements can harm care quality and healthcare access, thus significantly impacting public health. Identifying reasons is crucial to prevent this trend. This study examined factors behind nurses’ early retirement intentions. Methods A descriptive qualitative study was conducted in an Irish hospital (July to September 2023) including individual interviews with 10 nurses aged 55 and over. A thematic analysis was conducted collaboratively by three researchers to identify key factors influencing nurses’ intentions to retire early. Results Five main themes emerged: 1) Health concerns, encompassing physical strain and psychological stress, significantly influencing early retirement intentions; 2) Struggling to balance job demands with personal responsibilities such as caring for ageing parents due to inflexible work schedules; 3) Need for more support from senior leaders to address staffing shortages and investment in aging nurses’ career and retirement planning to make staying more desirable and easier; 4) Feelings about nurses’ experience being undervalued in the evolving healthcare; and 5) Facing constant heavy responsibility in guiding new nurses, while simultaneously fearing patient safety risks and encountering generational differences. Conclusions Developing support systems for ageing nurses, encompassing strategies to ease workload strain, enhancing career opportunities, and promoting intergenerational collaboration are critical for reducing early retirement trends and sustaining a resilient healthcare workforce. By implementing tailored approaches, such as flexible scheduling and mentorship programs for ageing nurses, healthcare organisations can promote workforce longevity and enhance public health outcomes through improved care delivery. Key messages • Health challenges and struggles in work-life balance influence early retirement intentions among nurses, urging flexible work arrangements and improved recognition and leadership in healthcare. • To extend work careers, organisations must invest in ageing nurses’ career and retirement planning, value experience, and acknowledge potential challenges and benefits in intergenerational nursing.

Exploring the risks of fragmentation in health care markets – An analysis of inpatient care in Georgia

Private providers play an important role in health systems in low-and middle-income countries. In many such contexts, markets are characterized by a high number of relatively small private facilities. The potential risks from highly concentrated healthcare markets are well-researched, and feature in the “Theories of Harm” investigated by competition regulators. However, there is limited evidence on markets that exhibit substantial harms as a result of very low concentration. This paper explores the risks associated with such market fragmentation, drawing on the example of Georgia, which has a largely privatized provider network.We used a mixed-method study design to analyze the inpatient market in Georgia. Market structure was described using administrative data on bed capacity and discharge numbers and geo-location data on travel time between facilities. The implications of the market structure were explored through in-depth interviews (n = 35) with policymakers, healthcare managers, and local experts and an anonymous online survey of similar groups (n = 97).Georgia's inpatient sector is characterized by a high number of small hospitals in terms of bed numbers and inpatient volumes, mitigated to a limited degree by the presence of provider networks. Travel time to the 3rd nearest competitor was extremely short, ranging from 3 to 5 min in big cities to 10 min in small towns and 33 min in remote locations. The fragmented nature of the market, together with inadequate regulatory and purchasing mechanisms, was argued to exacerbate challenges in the availability and competence of clinical staff, while the financial challenges caused by intense competition encouraged wasteful marketing, harmful cost-cutting measures, and demand inducement.We present “Theories of Harm” from market fragmentation, and argue that an effective policy response requires market-shaping activities using regulatory, financing, and purchasing mechanisms to encourage appropriate levels of market consolidation and so enhance quality, efficiency, and effective governance.

Interventions on informal healthcare providers to improve the delivery of healthcare services in low-and middle-income countries: a systematic review.

Informal healthcare providers (IHCPs) play a big role in health systems in low-and middle-income countries (LMICs) and are often the first point of contact for healthcare in rural and underserved areas where formal healthcare infrastructure is insufficient or absent. This study was performed to systematically review the literature on interventions targeting IHCPs in improving the delivery of healthcare services in LMICs. PubMed, Embase, and Cochrane CENTRAL databases were searched for studies that assessed any type of intervention among IHCPs to improve the delivery of healthcare services in any LMIC. Outcomes included changes in knowledge, attitude, and reported practice of appropriate case diagnosis and management; improved referral services; effective contraceptive use; and medication appropriateness (PROSPERO ID: CRD42024521739). A total of 7,255 studies were screened and 38 were included. Most of the studies were conducted in Africa and Asia. The IHCPs who were trained included medicine sellers, community health workers/traditional healers, and traditional birth attendants. The main intervention used was educational programs in the form of training. The other interventions were health services, policy and guidelines, and community-based interventions. Most of the interventions were multi-faceted. The disease/service areas targeted were mainly maternal and child health, sexually transmitted diseases, common infectious diseases, medicine use/dispensing practices, and contraception. The outcomes that showed improvements were knowledge, attitude, and reported practice; diagnosis and case management; improved referral services; contraceptive uses; and medication appropriateness. Around one-fourth of the studies reported negative results. The certainty of evidence generated (GRADE criteria) was very low. Some multifaceted interventions coupled with training showed improvements in the delivery of healthcare services by IHCPs. However, the improvements were inconsistent. Hence, it is unclear to identify any context-specific optimum intervention to improve the delivery of healthcare services by IHCPs.

Evaluation of preparedness and response competency of healthcare administrative staff of the public hospitals during the Covid-19 pandemic and its impact on the resilience of health system in Greece

Introduction: The role of health systems and hospital administrative system in Covid-19 pandemic period is of utmost importance. Objective: The scope of study is to assess the preparedness, response competencies of administrative staff and resilience of health system as well as to highlight the need of modernizing the role of the above three com¬ponents. Methods: 175 executives from public hospitals of the seven Regional Health Authorities in Greece partici¬pated in an online survey. Demographic, occupational data were collected and presented with correlations of individual variables. Results: The mental working condition of staff became much worse. The 96,7% of participants believed that the country does not implement a pandemic preparedness plan while 83,3% think that this plan has not been updated. Also, 38.9% of participants had no idea whether the strengthening of health system resilience is a current preoccu¬pation of health policy makers. Conclusions: Measures of new managements are considered necessary for a suc¬cessful reform effort. The organization of health systems and development of medical countermeasures are suggested as essential for the preparedness and response of Healthcare Administrative Staff of the Public Hospitals as well as the resilience of Greek Health System.

A qualitative analysis of community health worker perspectives on the implementation of the preconception and pregnancy phases of the Bukhali randomised controlled trial.

Community health workers (CHWs) play an important role in health systems in low- and middle-income countries, including South Africa. Bukhali is a CHW-delivered intervention as part of a randomised controlled trial, to improve the health trajectories of young women in Soweto, South Africa. This study aimed to qualitatively explore factors influencing implementation of the preconception and pregnancy phases of Bukhali, from the perspective of the CHWs (Health Helpers, HHs) delivering the intervention. As part of the Bukhali trial process evaluation, three focus group discussions were conducted with the 13 HHs employed by the trial. A thematic approach was used to analyse the data, drawing on elements of a reflexive thematic and codebook approach. The following six themes were developed, representing factors impacting implementation of the HH roles: interaction with the existing public healthcare sector; participant perceptions of health; health literacy and language barriers; participants' socioeconomic constraints; family, partner, and community views of trial components; and the HH-participant relationship. HHs reported uses of several trial-based tools to overcome implementation challenges, increasing their ability to implement their roles as planned. The relationship of trust between the HH and participants seemed to function as one important mechanism for impact. The findings supported a number of adaptations to the implementation of Bukhali, such as intensified trial-based follow-up of referrals that do not receive management at clinics, continued HH training and community engagement parallel to trial implementation, with an increased emphasis on health-related stigma and education. HH perspectives on intervention implementation highlighted adaptations across three broad strategic areas: navigating and bridging healthcare systems, adaptability to individual participant needs, and navigating stigma around disease. These findings provide recommendations for the next phases of Bukhali, for other CHW-delivered preconception and pregnancy trials, and for the strengthening of CHW roles in clinical settings with similar implementation challenges. Trial registration: Pan African Clinical Trials Registry; PACTR201903750173871, Registered March 27, 2019.

Unleashed Treasures of Solanaceae: Mechanistic Insights into Phytochemicals with Therapeutic Potential for Combatting Human Diseases.

Plants that possess a diverse range of bioactive compounds are essential for maintaining human health and survival. The diversity of bioactive compounds with distinct therapeutic potential contributes to their role in health systems, in addition to their function as a source of nutrients. Studies on the genetic makeup and composition of bioactive compounds have revealed them to be rich in steroidal alkaloids, saponins, terpenes, flavonoids, and phenolics. The Solanaceae family, having a rich abundance of bioactive compounds with varying degrees of pharmacological activities, holds significant promise in the management of different diseases. Investigation into Solanum species has revealed them to exhibit a wide range of pharmacological properties, including antioxidant, hepatoprotective, cardioprotective, nephroprotective, anti-inflammatory, and anti-ulcerogenic effects. Phytochemical analysis of isolated compounds such as diosgenin, solamargine, solanine, apigenin, and lupeol has shown them to be cytotoxic in different cancer cell lines, including liver cancer (HepG2, Hep3B, SMMC-772), lung cancer (A549, H441, H520), human breast cancer (HBL-100), and prostate cancer (PC3). Since analysis of their phytochemical constituents has shown them to have a notable effect on several signaling pathways, a great deal of attention has been paid to identifying the biological targets and cellular mechanisms involved therein. Considering the promising aspects of bioactive constituents of different Solanum members, the main emphasis was on finding and reporting notable cultivars, their phytochemical contents, and their pharmacological properties. This review offers mechanistic insights into the bioactive ingredients intended to treat different ailments with the least harmful effects for potential applications in the advancement of medical research.

The Role of Health Systems in Black Maternal Mental Health Care Delivery: a Socio-Ecological Framework

The Role of Health Systems in Black Maternal Mental Health Care Delivery: a Socio-Ecological Framework

Prevalence, patterns of multimorbidity and associations with health care utilization among middle-aged and older people in China

BackgroundMultimorbidity has become one of the main challenges in health care system. The association between prevalence, patterns of multimorbidity and health care utilization is less often discussed in China. The purpose of this study is to examine this association among Chinese middle-aged and older adults and take into account different sociodemographic, behavioral and health characteristics. Based on this, implications of current evidence and effective intervention on multimorbidity and health care utilization can be identified and put into practice.MethodsThe wave 4 in 2018 of the China Health and Retirement Longitudinal Study (CHARLS) was used in the study. Multimorbidity was defined as the co-occurrence of two or more chronic medical condition of a list of fourteen chronic diseases in one person. The presence of chronic diseases was assessed through self-report. Health care utilization include whether the respondents received outpatient service last month and inpatient service in the past year. Latent Class Analysis was conducted to identify the clustering pattern of chronic diseases. Logistic regressions were employed to explore the association between prevalence, patterns of multimorbidity and health care utilization. Analyses were weighted using individual sample weights, adjusted for non-response of individual and household.ResultsAmong 19,559 participants aged 45 and older, 23.10% were aged above 70 years and 52.42% were female. The prevalence of multimorbidity was 56.73%. Four patterns were identified: relatively healthy class, respiratory class, stomach-arthritis class and vascular class. Multimorbid individuals used more outpatient services (OR = 1.89, 95%CI = 1.65–2.17) and more inpatient services (OR = 2.52, 95%CI = 2.22–2.86) compared to their no-multimorbid counterparts. Compared to relatively healthy class, the respondents classified into respiratory class, stomach-arthritis class and vascular class used more outpatient services (OR = 1.90, 95%CI = 1.57–2.30; OR = 2.39, 95%CI = 2.06–2.78; OR = 1.53, 95%CI = 1.32–1.79 respectively) and more inpatient services (OR = 2.19, 95%CI = 1.83–2.62; OR = 2.93, 95%CI = 2.53–3.40; OR = 1.90, 95%CI = 1.65–2.19 respectively).ConclusionOur study provided evidence that multimorbidity is high among Chinese older adults and is associated substantially higher health care utilization in China. Four multimorbidity patters were identified. Policy should prioritize improving the management of individuals with multimorbidity to increase healthcare efficiency. Further research is necessary with special emphasis on the trajectory of multimorbidity and the role of health system in satisfying needs of multimorbid individuals.

The Role of Health Systems in Emergency Response Planning

Abstract The history of mankind is pervaded by many events that have had an incredible influence on the further development of civilization. Unfortunately, many historical milestones have also been marked by unimaginable disasters that have sometimes threatened the very existence of the human race. One of the most important links in the chain of readiness in emergencies and disasters is the national health system with all its institutions at the primary and secondary levels of healthcare. Their capacities and capabilities for adequate response can be significantly enhanced by the development and implementation of appropriate Emergency Response Plans (ERPs). The necessity of ERPs is considered for several important elements: to protect lives, property and the environment; to mitigate the consequences caused by emergencies and disasters and ensure the con-tinuity of general health services; to create a system and network to respond to and recover from the consequences of emergencies and disasters; to use of available resources optimally; and to provide additional resources if needed and improve the cooperation between sectors and agencies. The overall quality of a healthcare system is also measured by its readiness to respond to mass casualty events, emergencies and disasters. The lack of an ERP, a poor ERP, or a nonunderstandable or inaccessible plans leads to partial preparedness that can cause unimaginable consequences to overall health and loss of life of the population.

Dietary practices, physical activity and social determinants of non-communicable diseases in Nepal: A systemic analysis.

Unhealthy dietary habits and physical inactivity are major risk factors of non-communicable diseases (NCDs) globally. The objective of this paper was to describe the role of dietary practices and physical activity in the interaction of the social determinants of NCDs in Nepal, a developing economy. The study was a qualitative study design involving two districts in Nepal, whereby data was collected via key informant interviews (n = 63) and focus group discussions (n = 12). Thematic analysis of the qualitative data was performed, and a causal loop diagram was built to illustrate the dynamic interactions of the social determinants of NCDs based on the themes. The study also involved sense-making sessions with policy level and local stakeholders. Four key interacting themes emerged from the study describing current dietary and physical activity practices, influence of junk food, role of health system and socio-economic factors as root causes. While the current dietary and physical activity-related practices within communities were unhealthy, the broader determinants such as socio-economic circumstances and gender further fuelled such practices. The health system has potential to play a more effective role in the prevention of the behavioural and social determinants of NCDs.

‘It never rains, but it pours’–Disasters triggered by natural hazards, sexual risk-taking behavior, and the role of health systems: A worldwide ecological analysis

Natural hazards have become more frequent and more severe as a result of climate change. Their increasing impact has a negative effect on people's health, including mental health. The aim of this ecological study is to investigate the association between exposure to disasters triggered by natural hazards and higher sexual risk-taking behavior as measured by one of its consequences, increased human immunodeficiency virus (HIV) incidence, at the country-level, worldwide. All data were extracted from publicly available sources. Crude and adjusted linear regression models were built to explore the association between the proportion of people affected by natural hazards and HIV incidence. Multivariable models included socio-demographic variables (literacy, income and age), and therapy coverage and the healthcare access and quality index. In the crude regression model, the total number of people affected by natural hazards over a 5 year time period is positively associated with HIV incidence. For every 10 new people per 100,000/year affected by natural hazards, the HIV incidence in the country was 1.5 higher per 1,000 uninfected. However, when adjusting for socio-demographic variables, the association is lost. In the fully adjusted multivariable model, only antiretroviral therapy coverage and health care access and quality were significantly positively and negatively associated with HIV incidence. No interaction was found by income groups, world regions or categories of high and low HIV prevalence. No association between exposure to natural hazards and increased sexual risk-taking behavior at country level worldwide was detected after accounting for socio-demographic variables. Nonetheless, countries with a higher proportion of the population affected by disasters triggered by natural hazards were also those witnessing a higher incidence rate of HIV, possibly through the mediating effect of disrupted health system coverage, highlighting the coexistence of different vulnerabilities for public health.

Framing rehabilitation through health policy and systems research: priorities for strengthening rehabilitation

BackgroundRecent estimates report that 2.4 billion people with health conditions globally could benefit from rehabilitation. While the benefits of rehabilitation for individuals and society have been described in the literature, many individuals, especially in low- and middle-income countries do not have access to quality rehabilitation. As the need for rehabilitation continues to increase, it is crucial that health systems are adequately prepared to meet this need. Practice- and policy-relevant evidence plays an important role in health systems strengthening efforts. The aim of this paper is to report on the outcome of a global consultative process to advance the development of a research framework to stimulate health policy and systems research (HPSR) for rehabilitation, in order to generate evidence needed by key stakeholders.MethodsA multi-stakeholder participatory technical consultation was convened by WHO to develop a research framework. This meeting included participants from selected Member States, rehabilitation experts, HPSR experts, public health researchers, civil society and other stakeholders from around the world. The meeting focused on introducing systems approaches to stakeholders and deliberating on priority rehabilitation issues in health systems. Participants were allocated to one of four multi-stakeholder groups with a facilitator to guide the structured technical consultations. Qualitative data in the form of written responses to guiding questions were collected during the structured technical consultations. A technical working group was then established to analyse the data and extract its emerging themes. This informed the development of the HPSR framework for rehabilitation and a selection of preliminary research questions that exemplify how the framework might be used.ResultsA total of 123 individuals participated in the multi-stakeholder technical consultations. The elaborated framework is informed by an ecological model and puts forth elements of the six WHO traditional building blocks of the health system, while emphasizing additional components pertinent to rehabilitation, such as political priority, engagement and participatory approaches, and considerations regarding demand and access. Importantly, the framework highlights the multilevel interactions needed across health systems in order to strengthen rehabilitation. Additionally, an initial set of research questions was proposed as a primer for how the framework might be used.ConclusionsStrengthening health systems to meet the increasing need for rehabilitation will require undertaking more HPSR to inform the integration of rehabilitation into health systems globally. We anticipate that the proposed framework and the emerging research questions will support countries in their quest to increase access to rehabilitation for their populations.

Partners in prevention: the role of health systems in the prevention of youth violence in post-conflict Northern Ireland

Interpersonal violence is a wicked and complex issue with youth disproportionately affected. Its effects are multifaceted, placing an additional burden across systems. Despite this, there continues to be an exclusive focus on police recorded crime data in the context of post-conflict Northern Ireland. Given the enduring issue around police legitimacy, it is likely that police-related crime data are limited in its capacity to estimate incidences and trends of youth violence. Leveraging insights from other sources of data can add significant value in the prevention of youth violence. For example, there is significant utility in the use of health-related data in the prevention of higher-harm violence; however, in the context of Northern Ireland this has been under-evaluated. This retrospective cohort study sought to illustrate what could be gleaned using a novel approach to Emergency Department (ED) data. Routinely collected data captured from youth aged 12–25 attending an ED trauma centre for violence-related injuries between August 2020 and August 2021 were collated, coded and analysed. We found that young men were most likely to present to ED with violence-related injuries; incidences were temporally clustered across several months of the year (i.e. Summer); and younger aged youth were at greater risk of violence-related injuries during the afternoon and early evening. These findings illustrate the utility of health data for violence prevention and the potential for integrating administrative datasets in the design of prevention policy. Limitations and implications for practice are discussed.

Medicinal plants available in local markets contaminated with human pathogenic bacteria - Bacillus cereus and Pseudomonas gessardii

Medicinal plants are known to be a potential source of therapeutic aids. Different uses of medicinal plants have attained a powerful role in health system throughout the world. To study the microbial risk factor associated with medicinal plants, medicinal plant and part of plant samples (10 from each location) were collected from three different local markets (Nabinagar, Amin Bazar, and Savar) of Savar area, Dhaka, Bangladesh. A total number of fifty five (55) bacterial isolates have been isolated through their growth on Nutrient Agar media. Out of 55 isolates 31 isolates (56%) were identified as Bacillus cereus and 7 isolates (13%) were identified as Pseudomonas sp. through different morphological and biochemical tests. The CFU value of different samples revealed that all the values were higher than the accepted value (recommended by WHO, 2007) of 105 CFU/g except Phyllanthus emblica. The PCR and 16S rRNA sequencing confirmed the identification similarity values among two isolates of B. cereus and Pseudomonas gessardii. Both B. cereus and Pseudomonas gessardii showed sensitivity to the antibiotics Kanamycin, Gentamycin, Tigecycline, Ciprofloxacin and Amikacin where resistance to the antibiotics Amoxycilin, Aztreonam, Penicillin-G, Cefixime, Cefotaxime, Cefepime, Ceftriaxone, Meropenem, Cotrimoxazole and Ceftazidime. Therefore, quality assessment of herbal medicines should be ensured to make them safer for human consumption. Asian J. Med. Biol. Res. 2022, 8 (2), 69-78

Experiences of Black and Latinx health care workers in support roles during the COVID-19 pandemic: A qualitative study.

Black and Latinx individuals, and in particular women, comprise an essential health care workforce often serving in support roles such as nursing assistants and dietary service staff. Compared to physicians and nurses, they are underpaid and potentially undervalued, yet play a critical role in health systems. This study examined the impact of the coronavirus disease 2019 (COVID-19) pandemic from the perspective of Black and Latinx health care workers in support roles (referred to here as HCWs). From December 2020 to February 2021, we conducted 2 group interviews (n = 9, 1 group in English and 1 group in Spanish language) and 8 individual interviews (1 in Spanish and 7 in English) with HCWs. Participants were members of a high-risk workforce as well as of communities that suffered disproportionately during the pandemic. Overall, they described disruptive changes in responsibilities and roles at work. These disruptions were intensified by the constant fear of contracting COVID-19 themselves and infecting their family members. HCWs with direct patient care responsibilities reported reduced opportunities for personal connection with patients. Perspectives on vaccines reportedly changed over time, and were influenced by peers' vaccination and information from trusted sources. The pandemic has exposed the stress endured by an essential workforce that plays a critical role in healthcare. As such, healthcare systems need to dedicate resources to improve the work conditions for this marginalized workforce including offering resources that support resilience. Overall working conditions and, wages must be largely improved to ensure their wellbeing and retain them in their roles to manage the next public health emergency. The role of HCWs serving as ambassadors to provide accurate information on COVID-19 and vaccination among their coworkers and communities also warrants further study.

The effectiveness of supervision strategies to improve health care provider practices in low- and middle-income countries: secondary analysis of a systematic review

BackgroundAlthough supervision is a ubiquitous approach to support health programs and improve health care provider (HCP) performance in low- and middle-income countries (LMICs), quantitative evidence of its effects is unclear. The objectives of this study are to describe the effect of supervision strategies on HCP practices in LMICs and to identify attributes associated with greater effectiveness of routine supervision.MethodsWe performed a secondary analysis of data on HCP practice outcomes (e.g., percentage of patients correctly treated) from a systematic review on improving HCP performance. The review included controlled trials and interrupted time series studies. We described distributions of effect sizes (defined as percentage-point [%-point] changes) for each supervision strategy. To identify attributes associated with supervision effectiveness, we performed random-effects linear regression modeling and examined studies that directly compared different approaches of routine supervision.ResultsWe analyzed data from 81 studies from 36 countries. For professional HCPs, such as nurses and physicians, primarily working at health facilities, routine supervision (median improvement when compared to controls: 10.7%-points; IQR: 9.9, 27.9) had similar effects on HCP practices as audit with feedback (median improvement: 10.1%-points; IQR: 6.2, 23.7). Two attributes were associated with greater mean effectiveness of routine supervision (p < 0.10): supervisors received supervision (by 8.8–11.5%-points), and supervisors participated in problem-solving with HCPs (by 14.2–20.8%-points). Training for supervisors and use of a checklist during supervision visits were not associated with effectiveness. The effects of supervision frequency (i.e., number of visits per year) and dose (i.e., the number of supervision visits during a study) were unclear. For lay HCPs, the effect of routine supervision was difficult to characterize because few studies existed, and effectiveness in those studies varied considerably. Evidence quality for all findings was low primarily because many studies had a high risk of bias.ConclusionsAlthough evidence is limited, to promote more effective supervision, our study supports supervising supervisors and having supervisors engage in problem-solving with HCPs. Supervision’s integral role in health systems in LMICs justifies a more deliberate research agenda to identify how to deliver supervision to optimize its effect on HCP practices.

The private health sector's capitalist dynamic in Brazil from 2009 to 2015

Hospitals have shown changes in their role in health systems. In Brazil, private hospitals have always stood out, with charitable hospitals gaining increasing importance in the 21st century. Especially in the United States, there has been a trend towards consolidation of hospitals, concentrating great market power, in keeping with the capitalist phenomenon of financialization. This study aims to describe the current evolution in the Brazilian context in private hospitals and hospital groups, identifying the principal characteristics and trends according to the current capital dynamics. A descriptive exploratory study was performed, focused on dimensions of net worth, accounting-finance, and policy. The study covered the period from 2009 to 2015, analyzing 10 hospitals and 3 hospital groups selected intentionally. Datasets were created from different sources, used to calculate indicators and to analyze information on each of these dimensions. The private hospital sector in Brazil, including charitable hospitals, already displayed strategies that are characteristic of financialization, such as the formation of oligopolies through mergers and acquisitions and diversification to other areas such as teaching and management of public units, a focus on high profit, and internationalization, backed by the sector's own policy agenda. The trend is intrinsically exclusionary, concentrating wealth, inconsistent with the constitutional principles of universal care and the right to health, and it requires the adoption of public policies, regulation, and social control to contain it.