Health systems and reform最新文献_第2页

Does Provider Autonomy Work Well in Tanzania? Perspectives of Primary Care Facilities on Budget Execution under Direct Facility Financing and Factors Affecting Provider Autonomy in Singida Region.

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-12-09 DOI: 10.1080/23288604.2024.2432043

Peter Binyaruka, John Maiba, Dastan Mshana, Agnes Gatome-Munyua, Gemini Mtei

{"title":"Does Provider Autonomy Work Well in Tanzania? Perspectives of Primary Care Facilities on Budget Execution under Direct Facility Financing and Factors Affecting Provider Autonomy in Singida Region.","authors":"Peter Binyaruka, John Maiba, Dastan Mshana, Agnes Gatome-Munyua, Gemini Mtei","doi":"10.1080/23288604.2024.2432043","DOIUrl":"https://doi.org/10.1080/23288604.2024.2432043","url":null,"abstract":"Primary care facilities' autonomy and the factors that influence it are understudied. Direct facility financing (DFF) is gaining popularity in low- and middle-income countries as a modality to finance primary care facilities. Tanzania has introduced DFF with the objectives of streamlining resource allocation, fostering fiscal decentralization, and granting autonomy to health facilities for enhanced service readiness and responsiveness. This study aims to contribute evidence on primary care facilities' autonomy to execute DFF funds and the factors influencing this autonomy.Qualitative interviews and group discussions were conducted with health workers, managers, and community representatives from two councils to understand their perceptions of the autonomy of primary care facilities under DFF and remaining bottlenecks to effective budget execution. Data were analyzed using thematic content analysis to explore factors that influence facility autonomy to execute DFF funds.Primary care facilities are well informed on financial management and have adequate autonomy to execute DFF funds. However, several factors constrain their autonomy, including delays in funds disbursement, complex procurement and approval processes, rigid spending caps, restrictions on reallocations, and weaknesses in financial management capacity.DFF is a promising modality for health financing that supports health system goals. However, various challenges continue to hinder the autonomy of frontline service providers to fully execute DFF funds. To improve DFF budget execution, policy makers in Tanzania and elsewhere should consider reforms to better align public financial management and health financing.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2432043"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Objective-Oriented Health Systems Reform. 以目标为导向的卫生系统改革。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-11-27 DOI: 10.1080/23288604.2024.2428415

Joseph Kutzin, Susan P Sparkes, Alexandra J Earle, Agnes Gatome-Munyua, Nirmala Ravishankar

{"title":"Objective-Oriented Health Systems Reform.","authors":"Joseph Kutzin, Susan P Sparkes, Alexandra J Earle, Agnes Gatome-Munyua, Nirmala Ravishankar","doi":"10.1080/23288604.2024.2428415","DOIUrl":"10.1080/23288604.2024.2428415","url":null,"abstract":"This paper emphasizes the importance of orienting health system reforms to address underlying system-level performance problems. Too often in practice, the objective-orientation that is stressed in health system frameworks gets lost in relation to policies or schemes that are promoted without plausible linkages to the actual objectives of the reforms. The objective-orientation can also get subsumed by political agendas that are disconnected, or can even detract from, people's health needs. There are three core attributes to objective-oriented health system reform: (i) problem-oriented; (ii) consistent (extent to which reforms are connected to the problems they are meant to address and reflect lessons from global and national experience); and (iii) continuously evaluated. Country experiences reviewed in the paper, and presented in this special issue, illustrate how taking an objective-orientation led reformers to alter the details of implementation. Continuous learning also informed adaptations needed to strategically sequence and link reforms with objectives. An objective-oriented approach enables reformers to: (i) seize windows of opportunity; (ii) find room to maneuver under the label of the reform; (iii) integrate applied research into reform implementation; and (iv) skillfully interpret political statements to align with technical best practices. The approach and attributes laid out in this paper put forward considerations for policy makers as they design, implement, evaluate, and adapt policies to feasibly improve health system performance. They also, importantly, help guard against a rush toward policies or schemes that may sound good in speeches or declarations but do not have a plausible link to objectives.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2428415"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142735204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rwanda's Single Project Implementation Unit: An Effective Donor Coordination Platform in the Journey to Achieving Universal Health Coverage. 卢旺达单一项目执行股：卢旺达单一项目执行单位：实现全民医保过程中的有效捐助方协调平台》。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-11-12 DOI: 10.1080/23288604.2024.2403527

Parfait Uwaliraye, Valencia Lyle, James Mwanza, Gilbert Biraro

{"title":"Rwanda's Single Project Implementation Unit: An Effective Donor Coordination Platform in the Journey to Achieving Universal Health Coverage.","authors":"Parfait Uwaliraye, Valencia Lyle, James Mwanza, Gilbert Biraro","doi":"10.1080/23288604.2024.2403527","DOIUrl":"https://doi.org/10.1080/23288604.2024.2403527","url":null,"abstract":"Following the devastating 1994 Genocide, the Government of Rwanda and its citizens have worked relentlessly to rebuild the country and reassemble a strong health system. Immediately after the genocide, global development partners sought to swiftly provide aid and support to the country to address urgent health system needs. However, inadequate coordination of the influx of aid resulted in duplicated efforts and inefficient health sector management. In 1998, the Central Public Investments and External Finance Bureau undertook the monitoring and evaluation of donor-funded projects and management of the Public Investment Program. However, the Bureau had limited time, resources, and health system expertise, impeding its efforts to effectively coordinate development partners. To address these inefficiencies, the Rwandan government next adopted a Sector-Wide Approach to coordinate the support of development partners at the sector level. Again, this coordination approach did not adequately consider the health sector's needs. In 2011, the Single Project Implementation Unit (SPIU) structure was created to coordinate national- and district-level government sectoral initiatives, including ensuring that intended populations were included in planning and decision-making processes. In the health sector, this included a focus on the overall goal of achieving universal health coverage. The health sector SPIU has aided Rwanda in addressing systemic financing issues at all health system levels. Challenges remain; in particular, the SPIU has struggled to align some development partners with the Government's planning calendar to maximize efficiency. It also needs to optimize the use of technology in the health sector to ensure timely decision making.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2403527"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Applied Political Analysis for Health System Reform.

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-12-06 DOI: 10.1080/23288604.2024.2430284

Michael R Reich, Paola Abril Campos Rivera

{"title":"Applied Political Analysis for Health System Reform.","authors":"Michael R Reich, Paola Abril Campos Rivera","doi":"10.1080/23288604.2024.2430284","DOIUrl":"https://doi.org/10.1080/23288604.2024.2430284","url":null,"abstract":"Understanding and managing the political context of health policies is crucial to improving the chances of effectively designing, adopting, and implementing health policies and reforms that can achieve their intended objectives. This article focuses on applied political analysis as an approach to assist policymakers and public health professionals in improving political feasibility for policies and reforms. The article draws on our experience in doing applied political analysis and in advising and teaching others how to do applied political analysis. We describe the role of applied political analysis at six stages of the policy cycle (problem definition, diagnosis, policy development, political decision, implementation, and evaluation). We then present four steps for doing applied political analysis, using a concrete example at each step: 1) agree on the objectives and methods of analysis, 2) conduct a stakeholder analysis, 3) design a set of political strategies, and 4) assess the impact of the strategies on policitcal feasibility of the desired change. Political landscapes can change suddenly in unexpected ways. Doing applied political analysis, however, can increase the likelihood that the proposed policy changes will be adopted and achieve the desired outcomes in implementation. Repeating the analysis over time as the policy process unfolds and keeping track of stakeholders and strategies can increase the chances that health reform teams successfully manage the politics of policy change.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2430284"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Technological Innovation in International Training and Advancing Health Services: Two Cases During the COVID-19 Pandemic. 国际培训中的技术创新与医疗服务的进步：COVID-19 大流行期间的两个案例。

Health systems and reform Pub Date : 2024-12-17 Epub Date: 2024-10-22 DOI: 10.1080/23288604.2024.2387646

Caroline Benski, Aya Goto, Abéline Hantavololona, Vonimboahangy Andrianarisoa, Paulin Ramasy Manjary, Giovanna Stancanelli, Saekhol Bakri, Muflihatul Muniroh, Chihaya Koriyama

{"title":"Technological Innovation in International Training and Advancing Health Services: Two Cases During the COVID-19 Pandemic.","authors":"Caroline Benski, Aya Goto, Abéline Hantavololona, Vonimboahangy Andrianarisoa, Paulin Ramasy Manjary, Giovanna Stancanelli, Saekhol Bakri, Muflihatul Muniroh, Chihaya Koriyama","doi":"10.1080/23288604.2024.2387646","DOIUrl":"https://doi.org/10.1080/23288604.2024.2387646","url":null,"abstract":"Beginning in 2020, the COVID-19 pandemic limited onsite international activities and challenged us to plan and implement new ways of collaboration. We reviewed our online trials during a three-year period to better understand how to use digital technologies to continue knowledge and skills transfer. In this cross-national case study, we compare two illustrative cases: Japanese experts training Indonesian health professionals for participatory school health education, and Swiss experts training Malagasy health providers for respectful obstetric and newborn emergencies. We first describe our cases, referring to Vargo's framework for summarizing reports on digital technology usage. Second, we draw commonalities between the two cases. Third, gleaned from these experiences during the pandemic, we offer a practical framework for efficient and effective international collaboration using new technologies. For both cases, basic digital technologies, such as online meetings and e-mailing, were used and training sessions were successfully conducted. Trusting relationships between the training and participant groups were in place before the pandemic. This led to enthusiasm for continuing learning even after the pandemic started. Our case comparison presents the usefulness of digital technologies for continuing international collaboration and highlights the importance of human factors, such as trusting relationships and enthusiasm to pursue a shared goal, as the basic condition for success.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 2","pages":"2387646"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Vaccine Hesitancy and COVID-19 Risk Behaviors Associated with Social Media Use in Japan. 日本与社交媒体使用相关的疫苗接种犹豫和 COVID-19 风险行为。

Health systems and reform Pub Date : 2024-12-17 Epub Date: 2024-10-22 DOI: 10.1080/23288604.2024.2377070

Shuko Takahashi, Naomi Takahashi, Masaru Nohara, Ichiro Kawachi

{"title":"Vaccine Hesitancy and COVID-19 Risk Behaviors Associated with Social Media Use in Japan.","authors":"Shuko Takahashi, Naomi Takahashi, Masaru Nohara, Ichiro Kawachi","doi":"10.1080/23288604.2024.2377070","DOIUrl":"https://doi.org/10.1080/23288604.2024.2377070","url":null,"abstract":"We examined the associations between the use of different types of media and COVID-19 vaccine hesitancy, as well as risk behaviors of COVID-19 infection, in Japan in late 2021. Cross-sectional surveys were conducted using rapid online surveys of residents in Iwate Prefecture from February 5 to 7, 2021, and from October 1 to 3, 2021. Each individual's risk of acquiring SARS-CoV-2 infection was calculated using a quantitative assessment tool (the microCOVID). Intention to get vaccinated for COVID-19 was assessed by self-report. Usage of five types of media for obtaining COVID-related information was assessed: (1) newspapers, (2) television or radio, (3) internet or news apps, (4) social network services (SNS) (excluding LINE, a popular messaging app), and (5) other. Reliance on SNS did not show significant associations with either intention to get vaccinated or engaging in risky behavior for acquiring COVID-19. Although users of the internet or news apps were marginally significantly less likely to engage in high-risk behavior, significant associations between vaccine hesitancy and the usage of the internet or news apps were found in the middle age and elderly groups (OR [95% confidence interval (CI)] in middle age: 1.55 [1.07-2.23]; in elderly; 9.24 [3.28-26.02]). The differential associations between different types of media use and COVID-19 prevention behaviors may assist in preparing for future pandemic outbreaks. One implication for public health risk communication is audience segmentation, such as emphasizing vaccine safety and effectiveness for older audiences.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 2","pages":"2377070"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Ayushman Bharat Digital Mission of India: An Assessment. 印度的 Ayushman Bharat 数字任务：评估。

Health systems and reform Pub Date : 2024-12-17 Epub Date: 2024-10-22 DOI: 10.1080/23288604.2024.2392290

Udaya Shankar Mishra, Suryakant Yadav, William Joe

引用次数: 0

Preface to the Special Issue by Keizo Takemi, Minister of Health, Labor and Welfare, Japan. 日本厚生劳动大臣 Keizo Takemi 为特刊作序。

Health systems and reform Pub Date : 2024-12-17 Epub Date: 2024-10-22 DOI: 10.1080/23288604.2024.2390851

Keizo Takemi

引用次数: 0

The Digital Transformation in Health: How AI Can Improve the Performance of Health Systems. 卫生领域的数字化转型：人工智能如何提高医疗系统的绩效》。

Health systems and reform Pub Date : 2024-12-17 Epub Date: 2024-10-22 DOI: 10.1080/23288604.2024.2387138

África Periáñez, Ana Fernández Del Río, Ivan Nazarov, Enric Jané, Moiz Hassan, Aditya Rastogi, Dexian Tang

{"title":"The Digital Transformation in Health: How AI Can Improve the Performance of Health Systems.","authors":"África Periáñez, Ana Fernández Del Río, Ivan Nazarov, Enric Jané, Moiz Hassan, Aditya Rastogi, Dexian Tang","doi":"10.1080/23288604.2024.2387138","DOIUrl":"https://doi.org/10.1080/23288604.2024.2387138","url":null,"abstract":"Mobile health has the potential to revolutionize health care delivery and patient engagement. In this work, we discuss how integrating Artificial Intelligence into digital health applications focused on supply chain operation, patient management, and capacity building, among other use cases, can improve the health system and public health performance. We present the Causal Foundry Artificial Intelligence and Reinforcement Learning platform, which allows the delivery of adaptive interventions whose impact can be optimized through experimentation and real-time monitoring. The system can integrate multiple data sources and digital health applications. The flexibility of this platform to connect to various mobile health applications and digital devices, and to send personalized recommendations based on past data and predictions, can significantly improve the impact of digital tools on health system outcomes. The potential for resource-poor settings, where the impact of this approach on health outcomes could be decisive, is discussed. This framework is similarly applicable to improving efficiency in health systems where scarcity is not an issue.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 2","pages":"2387138"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Leveraging Digital Health Data to Transform the United Nations Systems for Palestine Refugees for the Post Pandemic Time. 利用数字健康数据改造联合国巴勒斯坦难民系统，迎接大流行病后的时代。

Health systems and reform Pub Date : 2024-12-17 Epub Date: 2024-10-22 DOI: 10.1080/23288604.2024.2378505

Akihiro Seita, Ghada Ballout, Shatha Albeik, Zaid Salameh, Wafaa Zeidan, Sayed Shah, Saed Atallah, Masako Horino

{"title":"Leveraging Digital Health Data to Transform the United Nations Systems for Palestine Refugees for the Post Pandemic Time.","authors":"Akihiro Seita, Ghada Ballout, Shatha Albeik, Zaid Salameh, Wafaa Zeidan, Sayed Shah, Saed Atallah, Masako Horino","doi":"10.1080/23288604.2024.2378505","DOIUrl":"10.1080/23288604.2024.2378505","url":null,"abstract":"The COVID-19 pandemic presented a grave threat to the continuity of health services that UNRWA provides to 5.9 million Palestine Refugees in the Near East. UNRWA runs 140 primary health care clinics, providing approximately nine million medical consultations a year. During the pandemic, UNRWA's e-Health system (and other digital health tools) were crucial in maintaining health services. The e-Health system enabled the identification of at-risk patients and transformed UNRWA's services for sustainability and efficiency. Innovations like telemedicine and two smartphone applications (e-NCD and e-MCH) enhanced service delivery and staff management. To evaluate the effectiveness of digital health integration in UNRWA's services during and after the pandemic, the team analyzed reports, events, and e-Health data from 2019-2022. Results show that digital tools, like e-NCD and e-MCH applications, helped reduce COVID-19 among Palestine Refugees, enabling remote care and continuous access to essential health services. Digital health has now become essential in UNRWA's post-pandemic operations. This paper offers a paradigm for future outbreak responses. By harnessing the power of digital health, UNRWA's e-Health system served as a beacon of hope, demonstrating how innovative approaches can empower patients, enhance health care outcomes, and ensure equitable access to health care services during crisis situations and beyond.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 2","pages":"2378505"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142514148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0