Senior Health Officials Research Articles

Preferral Antibiotic Treatment Policy to be adopted in the 'Integrated Management of Childhood Illness Strategy in all the Developing Countries?

To review the rationale and practice for the use of single dose antibiotics in 'children below five years' as pre-referral treatment in the emergency triage and treatment protocol of IMCI in the developing countries and also, to assess the available evidence on the suitability of adopting the use of pre-referral antibiotic treatment as a standard strategy of Emergency Triage and Treatment (ETAT) in "Integrated Management of Childhood Illnesses" (IMCI) for all developing countries. Scientific, reliable information from the international articles (published and unpublished) were collected. A series of Medline search with key words were performed. Opinions of epidemiologists, public health officers and researchers University Alumni and senior health officials of some developing countries were included in this review. Indirect evidence regarding for or against adopting pre-referral antibiotic treatment were found in developing countries where IMCI was implemented. It was also noted that the efficiency ranking based on the health system performance correlated negatively with the per capita income (r=-0.7, p=<0.001) and the per capita health expenditure. (r=-0.6, p=0.001). The gap between mortality rates of the '<1' and '1 to 4' years age groups was narrower in countries such as Oman and Argentina compared to the other developing countries. While the doctor population ratio was higher in countries with better efficiency rankings, (r=-0.66, p=0.01). The differences found within the developing world indicate that the use of pre-referral antibiotic is certainly open to modification depending on the resources and health system performance.

National newspaper coverage of minority health disparities.

To assess American newspaper coverage regarding racial and ethnic minority health disparities (MHDs). LexisNexis was queried with specific word combinations to elicit all MHD articles printed in 257 newspapers from 2000-2004. The full texts were read and articles categorized by racial/ethnic group and specific MHD topics mentioned. In the five years from 2000-2004, 1188 MHD articles were published, representing 0.09% of all articles about health. Newspapers gave much attention to MHD when discussed in conferences and meetings and speeches by senior health officials and politicians. Cancer, cardiovascular disease and HIV/AIDS were most frequent among disease-specific mentions. Articles about African Americans comprised 60.4% of all race/ethnicity-mentioning articles. Despite the release of major organizational reports and the publication of many studies confirming the prevalence of MHD, few newspaper articles have been published explaining MHD to the public. Because of the general public's low rate of health literacy, the health world should collaborate with the media to present a consistent, simple message concerning gaps in care experienced by all racial/ethnic minority groups. In a time of consumer-directed healthcare, if Americans understand that MHDs exist, they may galvanize to advocate for disparity elimination and quality improvement.

Acute care restructuring in Newfoundland and Labrador: the history and impact on expenditure

To document the history of regionalization and its effects on the Newfoundland and Labrador acute care health system, and to describe changes in acute care expenditure in the St John's region where hospital redesign, closure and aggregation occurred in relation to other regions not exposed to aggregation. Interviews were conducted with senior health officials. Transcripts and other reports were reviewed. Financial data were abstracted from audited general ledger statements received from the Ministry of Health. Regionalization achieved its objectives of hospital aggregation in St John's. The average number of full-time equivalent employees increased slightly by 2% (5304-5416). In some regions, integration of services was delayed because of conflict and resistance to change. There was some disparity between the Provincial Government's objectives for cost control and the CEOs' perceptions of economies of scale. Between 1995/96 and 2002/03, total expenditures for the St John's region and the other five regional hospitals increased by 46% and 54%, respectively; total personal income of the population and government revenues increased by only 18% and 16%, respectively. Regionalization in Newfoundland and Labrador facilitated aggregation of hospitals, but did not control the number of front-line workers and, consequently, total acute care expenditure. Expenditure increased significantly between 1995 and 2002, at a rate which exceeded the increase in government revenues. The government's ability to pay for acute care will not be achieved unless employee costs are controlled or provincial income increases.

Regionalization of health services in Newfoundland and Labrador: perceptions of the planning, implementation and consequences of regional governance

To describe the context and key drivers for regionalization of one provincial health care system in Canada; to document the original expectations of regionalization on governance and the extent to which these expectations were met; to identify the perceived successes and weaknesses of the process; and to examine the key issues and concerns that warrant further consideration and action in the future. Forty-five CEO/senior administrator or senior health department officials in the period 1993-2001 were invited to participate, of whom 35 were interviewed (67% of senior health officials and 85% of CEOs/senior administrators). For the most part, key informants felt that expectations of reform with respect to reduction in the number of boards and integration of services under each board's mandate did occur. However, ongoing financial restraint, failure to include the full range of health services under the regional board mandate (including physician and pharmaceutical services), uncertainty regarding the level of authority the regional boards had for decision-making, and unclear accountability mechanisms between the regional boards and the provincial Ministry of Health limited the extent to which broader expectations related to development of a population health focus, and improved continuity of care for individuals and families was achieved. Implications for policy-makers were identified in four main areas: alignment between health policy goals and the governance structure; clarification of authority and accountability relationships; clarification of roles and responsibilities among all key actors; and strengthening of mechanisms that support accountability.

TECHNOCRATS AT THE HELM?: THE ATTITUDES OF NEW ZEALAND'S SENIOR HEALTH OFFICIALS

ABSTRACT This paper presents the results of two surveys, conducted in 1993 and 1997, which inquired into the attitudes towards aspects of their immediate and external working environments of New Zealand's senior health officials. The surveys are in the tradition of a growing body of international research which seeks to categorize respondents in terms of their bureaucratic “type.” Where the 1993 survey produced baseline information, the 1997 exercise served as a follow-up. Accordingly, the paper compares various results and discusses shifts in attitudinal orientation and bureaucratic classification. Key findings are that, in 1997, there has been a growth in both the number of “technocrats,” respondents with an aversion to politics but a strong commitment to policy programmes, and in the number of “classical bureaucrats,” respondents, again, with a dislike of politics but, in contrast to technocrats, with a short-term focus and tendency to react to policy problems as they arise. It is concluded that, while restructuring of the New Zealand health sector continues, there is a need to nurture “political bureaucrats:” those who can operate in a politicized environment and who can plan ahead with the participation of the attentive public.

Towards the Eradication of Guinea Worm: A Danish–Ghanaian Collaboration

The workshop in Tamale, Ghana, 31 August – 2 September 1998, was attended by European researchers and by a number of senior health officials and researchers from the Region and other parts of Ghana, including the newly designated Deputy Minister of Health. The District Directors and Guinea worm eradication co-ordinators from the whole Region also attended most of the presentations, providing a guarantee, if any were needed, that the results will directly affect their practice. The workshop was followed by another workshop devoted to Oesophagostomum, with additional support from the University of Leiden (see A.M. Polderman, S.D. Anemana and V. Asigri, this issue).

Wilhelm Schallmayer and the logic of German eugenics.

N 1917 THE PLANT GENETICIST ERWIN BAUR, a recent convert to the cause of eugenics, wrote a letter to the imperial government in which he attempted to awaken senior health officials in the Reich to the national importance and cost effectiveness of Rassenhygiene. Rather than spend large amounts of money on welfare at a time when all of Germany's limited financial resources were needed to defeat the enemy at the front, Baur queried, Would it not be more expedient to prevent invalidism and hereditary inferiority by means of an energetic race hygiene? This prototype of a rational management of human life, as Baur succinctly defined the new science of eugenics, would undoubtedly also prove necessary even after the Great War was over.2 Because Baur's letter was designed at least in part to secure badly needed funds for the Berlin chapter of the German Society for Race Hygiene, it is not surprising that he emphasized an argument likely to appeal to a government in serious fiscal trouble. Yet the language employed reveals far more about the nature of German eugenics than it does about Baur's ability to sell the new science. It reveals the managerial and technocratic logic underlying German race hygiene. Eugenics in Germany (and probably elsewhere as well) was implicitly viewed by its advocates as a form of rational management or managerial control over the reproductive capacities of various groups and classes. This, of course, implies that race hygiene is a tool. However, since a tool does not define its function, it is necessary to ask why race hygiene was embraced in the first place. My own research into the history of Wilhelmine eugenics suggests that German eugenics can best be understood as a sometimes conscious, oftentimes unconscious strategy to boost national efficiency-national efficiency denoting not only economic productivity but also, in the German context, cultural hegemony. German eugenicists believed that a rational administration of human resources would ensure the necessary level of hereditary fitness thought to be a prerequisite for the long-term survival of Germany, Western Europe, and the superior cultural traditions they supposedly embodied.3