Health Systems & Reform最新文献

{"title":"Strengthening the Primary Care Delivery System: A Catalytic Investment Toward Achieving Universal Health Coverage in Nigeria","authors":"R. Tilley-Gyado, Oyebanji Filani, I. Morhason-Bello, I. Adewole","doi":"10.1080/23288604.2016.1234427","DOIUrl":"https://doi.org/10.1080/23288604.2016.1234427","url":null,"abstract":"A Framework for Implementation Conclusion References Nigeria, with its current population estimated at 184 million people (accounting for 20% of the African population), has 36 states and 774 local government areas (LGAs). The country operates a presidential system of governance. Health care provision is a responsibility of all three tiers of government, with federal government primarily responsible for tertiary health care, state government responsible for secondary care, and local government authority responsible for primary health care. Over the years, successive governments have not paid desired attention to primary health care as a gateway to accessing health care delivery in the country. Nigeria devolved primary health care services to the LGAs in the late 1980s, but the local government structure had little capacity for governance and resource mobilization, with weak absorptive capacity to manage allocated resources and take on an implementation role. In 1992, the National Primary Healthcare Development Agency was established to represent the federal government’s support to primary health care with a mandate to provide technical assistance to states for primary health care development, planning, management, monitoring and evaluation, and mobilization of national and international resources. Management of Nigeria’s primary health care system has been fragmented with the involvement of different stakeholder institutions. This has included federal institutions— the Federal Ministry of Health and National Primary Healthcare Development Agency—and state and local government platforms: the State Ministry of Health, Local Government Service Commission, Local Government Council, and Local Government Health Department/Local Government Primary Health Care Authority individually responsible for provision of services, recruitment, retention and deployment of staff, mobilization and allocation of funds, development of support Received 18 July 2016; revised 2 September 2016; accepted 2 September 2016. *Correspondence to: Isaac F. Adewole; Email: ifadewole@yahoo.co.uk Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/khsr.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2016-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78089660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Assessment of Data Availability, Quality, and Use in Malaria Program Decision Making in Nigeria","authors":"Kelechi Ohiri, Ndukwe Kalu Ukoha, Chike William Nwangwu, Charles C. Chima, Y. Ogundeji, A. Rone, M. Reich","doi":"10.1080/23288604.2016.1234864","DOIUrl":"https://doi.org/10.1080/23288604.2016.1234864","url":null,"abstract":"Abstract—In 2014, Nigeria shifted its malaria policy and strategy from control to elimination. Studies show that data-driven decision making is essential to achieving elimination. It is therefore important that policy makers have access to and use good quality and relevant data to inform program decisions. This article presents findings from an assessment of availability, quality, and use of malaria data in three states in Nigeria, namely, Akwa-Ibom, Cross River, and Niger, as part of a larger study on how organizational structure affects outcomes of malaria programs. A literature search to determine the availability and range of malaria data in Nigeria was conducted, followed by 65 key informant interviews to understand how malaria data are used in the study states. It was observed that the District Health Information System (DHIS) was the major source of data used in managing programs; however, the range of malaria indicators in the DHIS is limited, lacking indicators such as active case detection and entomological data, which are important for surveillance and decision making toward malaria elimination. On data quality, routine data from the DHIS were reviewed using the national protocol for data quality assessment. Data quality was found to be suboptimal, with quality scores ranging from 54% to 64% compared to the national target of 80%. DHIS data were reportedly used most often for performance and/or supply chain management. Overall, the study demonstrates gaps in data availability and quality and highlights the need for more data sources and improved quality data to inform decision making toward malaria elimination in Nigeria.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2016-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77503192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health System in Nigeria: From Underperformance to Measured Optimism","authors":"O. Adeyi","doi":"10.1080/23288604.2016.1224023","DOIUrl":"https://doi.org/10.1080/23288604.2016.1224023","url":null,"abstract":"Why Has the System not Achieved Effective Coverage for all Nigerians, Especially the Poor? Prospects References Fifty-five years after independence, indicators of Nigeria’s health outcomes and coverage of basic health services show underperformance, both in absolute terms and relative to other countries at similar levels of economic development. Yet, though the decline in infant and child mortality could be swifter, the trend of these indicators overall is in the right direction. Furthermore, the country’s recent successes against Guinea worm disease, poliomyelitis, and Ebola Virus Disease show areas of high performance despite systemic weaknesses. There are marked variations across geopolitical zones and states; some of these, such as indicators of maternal and child health service coverage and outcomes, correlate strongly with educational status and wealth. Significant positive associations between education and the use of maternal health services in Nigeria are well documented, and so are the historical crossregional variations in education policies and school enrollment. The past five decades have seen numerous health policies and development plans in Nigeria, culminating in the National Health Act of 2014. The Act provides for a range of responsibilities, instruments, and institutions, covering but not limited to responsibility for health, eligibility for health services, and establishment of a national health system; financing; health establishments and technologies; rights and obligations of patients and health care personnel; national health research and information system; human resources for health; control of blood, blood products, tissue, and gametes in humans; and regulations and miscellaneous provisions. It is, potentially, a very consequential Act. To understand what needs to be different for this Act to succeed where prior national policies mostly underachieved, it is worth examining the context and some key drivers of Nigeria’s health.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2016-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79987373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Knowledge Brokering Program in Burkina Faso (West Africa): Reflections from Our Experience","authors":"C. Dagenais, Esther McSween-Cadieux, P. Somé, V. Ridde","doi":"10.1080/23288604.2016.1202368","DOIUrl":"https://doi.org/10.1080/23288604.2016.1202368","url":null,"abstract":"Abstract—In Burkina Faso, inadequate interaction among researchers, decision makers, and practitioners, together with low use of research results, impedes the development of health policies and interventions to improve equity. A knowledge translation strategy was implemented as part of a research program. The broker and his team promoted links between actors (health agents, nongovernmental organizations, public administration, policy makers, researchers), provided them with research results related to their needs, and supported them in applying this knowledge in their practices. The strategy was first implemented in Kaya District, Burkina Faso. To increase impact on population health, the strategy included widening the sphere of action through collaboration with the Ministry of Health. The broker was affiliated with a public health consulting firm in the capital, Ouagadougou, and supported by Canadian experts and a senior Burkinabè broker. Evaluation shows that research use increased at the local level among health mutuals, regional nongovernmental organizations, and health professionals in Kaya, but the objective of reaching Ministry of Health decision makers was not achieved. Results highlight the need for better training in knowledge transfer for both local and international researchers and proper identification of the gateways to reach high level decision makers. This ambitious strategy encountered several obstacles: difficult access to decision makers, poor team communication, and broker's nonconducive working environment. Future brokering strategies should analyze the political situation in depth to determine when and how to approach national and regional decision makers; invest time and effort in developing different actors' (including researchers') knowledge transfer skills; and ensure sufficient and good quality communications and resources within the team.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2016-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91044778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Everyday Politics and the Leadership of Health Policy Implementation","authors":"","doi":"10.1080/23288604.2016.1217367","DOIUrl":"https://doi.org/10.1080/23288604.2016.1217367","url":null,"abstract":"Abstract This article aims to prompt reflection about the everyday politics of health systems, their importance to health policy implementation, and what sort of leadership, provided by whom, is required to address them. It is founded on insights drawn from empirical and theoretical literature, combined with practical experience developed through relevant research and teaching. Ultimately it argues that the everyday politics of the health system represent the multiple actors, interests, and choices that frontline leaders routinely address and that influence the collective action taken through the system in pursuit of public value. Leadership to address these everyday politics entails the practice of power and support for collective sense-making. Nurturing these political leadership skills through new forms of leadership development is therefore a vital component of health system development.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73266649","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Designing a Resilient National Health System in Ethiopia: The Role of Leadership","authors":"Kesetebirhan Admasu","doi":"10.1080/23288604.2016.1217966","DOIUrl":"https://doi.org/10.1080/23288604.2016.1217966","url":null,"abstract":"What is a Resilient Health System? The Ethiopian Experience Successes Remaining Challenges Reasons for Success References The global community has recently agreed on a number of health targets in line with the United Nations’ Sustainable Development Goals adopted in 2015 to be achieved by 2030. Among the most important of these are achieving universal health coverage, ending preventable child and maternal deaths, ending the HIV/AIDS epidemic, and controlling the emergence of chronic diseases, most notably cardiovascular diseases, diabetes, and mental illness. The recent Ebola outbreak affected Guinea, Liberia, and Sierra Leone in many aspects. Not only did thousands of people, including hundreds of health workers, lose their lives but the economies of the region took a nosedive and the costs to the rest of the world for controlling this epidemic were astronomical. The devastation of the Ebola epidemic exposed the lack of resilience of the health systems in these countries and the need for strong leadership. It also highlighted the potential for similar crises from infectious disease outbreaks in other settings where systems are weak. Security from global health threats is now reaching a level of importance on par with security from military threats throughout the world. Hence, resilient health systems and effective leadership are needed now more than ever to meet the challenges that lie ahead over the next decades. For Ethiopia, this will require continuing to improve our primary health care system by: expanding services provided by health extension workers (HEWs) at the community level; establishing higher-trained personnel at primary health centers; and improving access to basic and essential surgical services at first-level referral hospitals.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75885592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Health Partnerships for Continuing Medical Education: Lessons from Successful Partnerships","authors":"A. Sriharan, Janet Harris, D. Davis, M. Clarke","doi":"10.1080/23288604.2016.1220776","DOIUrl":"https://doi.org/10.1080/23288604.2016.1220776","url":null,"abstract":"Abstract The past decade has witnessed an increase in global partnerships created to strengthen health systems and provide training to health professionals in low- and middle-income countries. These partnerships are complex interventions. This study focused on unpacking the characteristics of global partnerships that provide continuing education for health professionals. A realist approach underpinned the research design to identify the mechanisms that shape successful global partnerships. Two case studies focusing on global continuing medical education (CME) were studied longitudinally using a realist evaluation approach. To complement that finding, published research reports of global CME partnerships were synthesized using a realist synthesis approach. Data were collected over a three-year period and included interviews, participant observations, document reviews, and surveys. A hybrid thematic approach guided the data analysis. The study results suggested that global CME partnerships are highly dependent on human factors. On the one hand, motivational factors related to individual players help to shape the partnership goals, directions, and outcomes. On the other hand, relational factors such as trust, communication, and understanding play a key role in developing and sustaining global partnerships. As such, these partnerships highly rely on the individuals who champion the partnership at the country level or at the partnership level and in their ability to build relationships as well as empower key stakeholders.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85291548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Leadership Vision for the Future of Japan's Health System","authors":"Yasuhisa Shiozaki","doi":"10.1080/23288604.2016.1188607","DOIUrl":"https://doi.org/10.1080/23288604.2016.1188607","url":null,"abstract":"Japan Vision: Health Care 2035 Paradigm Shift in Health Care Lean Health Care: Maximizing Patient Value Life Design: Empowering Society and Support Individual Choices Global Health Leader: Lead and Contribute to Global Health Conclusion References Japan achieved universal health coverage (UHC) in 1961. This happened when Japan was still poor but beginning a period of rapid economic growth. Over the next 50 years of economic development, Japan became a wealthy country and continued to develop its health system of good health at low cost with equity. Through UHC, Japan improved its population’s health outcomes, economic growth, social stability, equity, and solidarity. Japan’s life expectancy has increased by more than 30 years and health outcomes have been topranked globally since the early 1980s. However, growth has slowed and the demographic transition is projected to lead to increases in health care and social security costs, which will place pressure on public financing and threaten the sustainability of the health and social care systems. By 2015 social security spending accounted for a third of government expenditure and this proportion is expected to grow. To ensure sustainability and prepare the health care system for current and future health care needs, we need comprehensive reform based on a forward-looking, long-term vision. The health and social care system must engage all sectors through shared vision and values, rather than maintaining the current system through basic cost increases and benefit cuts. In January 2015, I joined discussions at the World Economic Forum annual meeting in Davos, Switzerland. There, I found a surprisingly strong interest in the way Japan tackles the challenges of aging. Richard Horton, the editor-in-chief of the Lancet, once wrote, “Japan is a mirror for our future.” He identified that “the success of Japan’s health system matters not only because of its importance to Japanese citizens, but also because Japan is a barometer of Western health.” Like him, I believe that Japan can offer lessons—and hope— for the future of health in other societies.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89978757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The InterAcademy Partnership's Young Physician Leaders: A Leadership Training and Networking Program","authors":"Peter F. McGrath, J. Boufford, Muthoni Kareithi","doi":"10.1080/23288604.2016.1220777","DOIUrl":"https://doi.org/10.1080/23288604.2016.1220777","url":null,"abstract":"Abstract The research, clinical, public health, and health policy areas of the health sector all need effective leaders. However, many young professionals learn their leadership skills by trial and error as they advance through their careers. Though some countries are making efforts to incorporate leadership training programs into their medical curricula, the provision of such training is available in too few countries. To fill this gap and contribute to building capacity for future leadership among health professionals worldwide, the InterAcademy Partnership for Health launched its Young Physician Leaders (YPL) program in 2011. The program provides a tailored workshop on leadership; the opportunity, via the World Health Summit, to engage with global leaders in the field of medicine and health; a matchmaking mentorship scheme; a network of peers with whom to share experiences and exchange best practices; and an interactive website to post real-time professional information and gain visibility both nationally and internationally. To date, some 107 YPL, nominated by some 30 academies of science and medicine and six other institutions, have participated in the scheme. In addition, some 30 YPL alumni from about 20 countries were selected to attend the recent World Health Assembly (WHA69). As well as gaining first-hand experience of the decision-making processes of the WHA, the event helped build their individual capacities because they had the opportunity to link with their national decision makers in global health policy. Though there is room for expansion of the program, it has been well received as an approach to supporting the leadership development of a new generation of physicians who will eventually lead clinical, educational, and research institutions and contribute to their societies and globally to improve health for all.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84508705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Women Who Lead: Successes and Challenges of Five Health Leaders","authors":"D. Javadi, J. Vega, C. Etienne, Speciosa Wandira, Y. Doyle, S. Nishtar","doi":"10.1080/23288604.2016.1225471","DOIUrl":"https://doi.org/10.1080/23288604.2016.1225471","url":null,"abstract":"Abstract Women make up approximately 75% of the health workforce and yet their representation at higher levels of health leadership is limited. Untapped potential of women in health undermines the contribution they could make to effective leadership for health systems strengthening. Lived experiences of women leaders can help understand how to unlock this potential by identifying the challenges, highlighting enablers, and sharing successful strategies used to become effective health leaders. This article uses phenomenological inquiry to understand the subjective experiences of five influential women in their paths to health leadership. Interviews were conducted with these women and key messages were identified. A grounding theme—defined as the essential element for the subjective experience of leading as a woman in the health system—was revealed to be the women's “drive for equity.” This drive motivated them to pursue a career in health and to break through perceived gender-related barriers. Three figural themes around how to practice effective health leadership to promote equity were identified: (1) challenging status quos and norms; (2) leading by listening and leveraging others' expertise to build a common vision for health; and (3) having social support early on to develop confidence and credibility. Stories from the individual women's experiences are presented. Finally, three recommendations are made for system-level mechanisms that could contribute to expanding the number of women leaders in health.","PeriodicalId":46168,"journal":{"name":"Health Systems & Reform","volume":null,"pages":null},"PeriodicalIF":4.1,"publicationDate":"2016-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83815679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}