Health systems and reform最新文献_第2页

Using a Small Lever to Achieve Big Outcomes in a Devolved Health System: 20 Years of Programa Sumar in Argentina. 在权力下放的卫生系统中利用小杠杆实现大成果：阿根廷 Sumar 计划 20 年。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-11-12 DOI: 10.1080/23288604.2024.2422105

Martin Sabignoso, Susan P Sparkes, Alexandra J Earle

{"title":"Using a Small Lever to Achieve Big Outcomes in a Devolved Health System: 20 Years of Programa Sumar in Argentina.","authors":"Martin Sabignoso, Susan P Sparkes, Alexandra J Earle","doi":"10.1080/23288604.2024.2422105","DOIUrl":"10.1080/23288604.2024.2422105","url":null,"abstract":"Incremental health system transformations towards universal health coverage run the risk of losing sight of the overarching objectives and can lose momentum in the implementation process. Argentina's Programa Sumar is a program born out of response to both urgent and long-standing health challenges. Starting with a relatively small share of the government's budget for health, the Program over the last 20 years has gradually expanded in pursuit of increasing access to quality health care, fostering coherence through policy alignment and coordination in a highly decentralized system, and achieving its performance objectives through conditional transfers linked to results. This commentary reflects on how Programa Sumar created and has sustained its approach to health system transformation and provides four lessons: 1) distribute leadership across levels of government to enhance autonomy, collaboration, and implementation; 2) expand gradually, with a clear long-term vision - Programa Sumar took an incremental approach to expansion in terms of regions, populations, services, and management capacities; 3) ensure evolution through solid and flexible design - the Program needed both the flexibility to adapt strategies to various challenges and a constancy of purpose; and 4) compromise to make progress. The Argentine experience with Programa Sumar shows that strengthening a scheme does not have to mean adopting a fragmented approach. Instead, by implementing Programa Sumar thoughtfully and collaboratively, the reform has developed a solid foundation with the flexibility to adapt across geographies and time, creating the necessary conditions for expansion to and greater coherence across the entire system.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2422105"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634218","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

Public Financial Management: A Pathway to Universal Health Coverage in Low-and-Middle Income Countries. 公共财政管理：公共财政管理：中低收入国家实现全民医保的途径》。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-12-09 DOI: 10.1080/23288604.2024.2368051

Hélène Barroy, Pierre Yameogo, Mark Blecher, Martin Sabignoso, Moritz Piatti, Joseph Kutzin

引用次数: 0

Examining the Implementation Experience of the Universal Health Coverage Pilot in Kenya. 研究肯尼亚全民医保试点的实施经验。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2024-11-19 DOI: 10.1080/23288604.2024.2418808

Lizah Nyawira, Yvonne Machira, Kenneth Munge, Jane Chuma, Edwine Barasa

{"title":"Examining the Implementation Experience of the Universal Health Coverage Pilot in Kenya.","authors":"Lizah Nyawira, Yvonne Machira, Kenneth Munge, Jane Chuma, Edwine Barasa","doi":"10.1080/23288604.2024.2418808","DOIUrl":"https://doi.org/10.1080/23288604.2024.2418808","url":null,"abstract":"The Kenyan government implemented a Universal Health Coverage (UHC) pilot project in four (out of 47) counties in 2019 to address supply-side gaps and remove user fees at county referral hospitals. The objective of this study was to examine the UHC pilot implementation experience using a mixed-methods cross-sectional study in the four UHC pilot counties (Isiolo, Kisumu, Machakos, and Nyeri). We conducted exit interviews (n = 316) with health facility clients, in-depth interviews (n = 134) with national and county-level health sector stakeholders, focus group discussions (n = 22) with community members, and document reviews. We used a thematic analysis approach to analyze the qualitative data and descriptive analysis for the quantitative data. The UHC pilot resulted in increased utilization of healthcare services due to removal of user fees at the point of care and increased availability of essential health commodities. Design and implementation challenges included: a lack of clarity about the relationship between the UHC pilot and existing health financing arrangements, a poorly defined benefit package, funding flow challenges, limited healthcare provider autonomy, and inadequate health facility infrastructure. There were also persistent challenges with the procurement and supply of healthcare commodities and with accountability mechanisms between the Ministry of Health and county health departments. The study underscores the need for whole-system approaches to healthcare reform in order to ensure that the capacity to implement reforms is strengthened, and to align new reforms with existing system features.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2418808"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142677966","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

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. 提供者自治在坦桑尼亚运作良好吗？新加坡地区基层医疗机构直接融资对预算执行的影响及影响因素

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

Objective-Oriented Health Systems Reform: Implications for Moving Towards Universal Health Coverage. 面向目标的卫生系统改革：对实现全民健康覆盖的影响。

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2025-01-08 DOI: 10.1080/23288604.2024.2440214

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

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

Policy Options for Contributory Health Insurance Schemes in Low and Lower-Middle Income Countries to Enable Progress Towards Universal Health Coverage.

Health systems and reform Pub Date : 2024-12-18 Epub Date: 2025-01-23 DOI: 10.1080/23288604.2025.2449905

Agnes Gatome-Munyua, Joseph Kutzin, Cheryl Cashin

{"title":"Policy Options for Contributory Health Insurance Schemes in Low and Lower-Middle Income Countries to Enable Progress Towards Universal Health Coverage.","authors":"Agnes Gatome-Munyua, Joseph Kutzin, Cheryl Cashin","doi":"10.1080/23288604.2025.2449905","DOIUrl":"https://doi.org/10.1080/23288604.2025.2449905","url":null,"abstract":"The promise of contributory health insurance to generate additional, self-sustaining funding for the health sector has not been achieved in many low- and lower-middle-income countries. Instead, contributory health insurance has been found to exacerbate inequities in access to health care because entitlements are linked to contributions. For these countries with contributory health insurance schemes, with separate institutional arrangements for revenue collection and purchasing, that operate alongside budget-funded and other health financing schemes, it is usually not politically or technically feasible to reverse or eliminate these arrangements even when they fragment the health system. We propose three complementary policy options for countries in this difficult position to enable progress towards UHC: (1) Merge existing schemes into a single scheme (or fewer schemes) to consolidate pooling and purchasing functions. (2) Build on what they have by: reducing reliance on contributions by increasing budget transfers; using existing revenue collection mechanisms to allow the insurance agency to focus on the purchasing function; and strengthening insurance agencies' operational capacity for purchasing. (3) Reframe the insurance agency's role within the overall health system, rather than treating it as a distinct system by: unifying data collection and analysis for all patient visits irrespective of scheme membership, and universalizing core benefits across the population. We urge countries to review the patchwork of schemes and avoid worsening fragmentation that compromises health system performance. Countries can then create a strategy to expand coverage more equitably in a sequential manner, while consolidating institutional capacity for purchasing and unifying data systems.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"10 3","pages":"2449905"},"PeriodicalIF":0.0,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143029997","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. 医疗体制改革的应用政治分析。

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