Health systems and reform最新文献_第9页

Potential Strengths and Weaknesses in Hospital Resilience in the Context of the COVID-19 Pandemic in Brazil: A Case Study. COVID-19大流行背景下巴西医院复原力的潜在优势和劣势:案例研究

Health systems and reform Pub Date : 2023-06-15 DOI: 10.1080/23288604.2023.2177242

Sydia Rosana de Araújo Oliveira, Gisele Cazarin, Aletheia Soares Sampaio, Ana Lúcia Ribeiro de Vasconcelos, Betise Furtado, Stéphanie Gomes de Medeiros, Amanda Correia Paes Zacarias, Andréa Carla Reis Andrade, Karla Myrelle Paz de Sousa, Kate Zinszer, Valéry Ridde

{"title":"Potential Strengths and Weaknesses in Hospital Resilience in the Context of the COVID-19 Pandemic in Brazil: A Case Study.","authors":"Sydia Rosana de Araújo Oliveira, Gisele Cazarin, Aletheia Soares Sampaio, Ana Lúcia Ribeiro de Vasconcelos, Betise Furtado, Stéphanie Gomes de Medeiros, Amanda Correia Paes Zacarias, Andréa Carla Reis Andrade, Karla Myrelle Paz de Sousa, Kate Zinszer, Valéry Ridde","doi":"10.1080/23288604.2023.2177242","DOIUrl":"https://doi.org/10.1080/23288604.2023.2177242","url":null,"abstract":"The analysis of hospital resilience is essential in understanding how health services prepared for and responded to sudden shocks and unexpected challenges in the COVID-19 health crisis. This study aimed to analyze the resilience of a referral hospital in the state of Pernambuco, Brazil, in the context of the COVID-19 pandemic. The main theoretical approach based on resilience is the system's capacity to maintain essential functions and to absorb, adapt, and transform in the face of unprecedented or unexpected changes. A single case study approach was used to identify the strengths and weaknesses of this response capacity. Data triangulation was employed. Data were collected from April (beginning of case discharges) to October 2020 (decrease in the moving average of cases in 2020). A content analysis was then conducted. Data were analyzed in relation to context, effects, strategies, and impacts in facing the disruptions caused by the pandemic. The results indicated the occurrence of four configurations mostly favorable to hospital resilience during the study period. Among the main strengths were: injection of financial resources; implementation of new hospital protocols; formation of a support network; equipping and continuing education of professionals; and proactive leadership. Weaknesses found in the analysis included: initial insufficiency of personal protective equipment and confirmatory tests; difficulties in restructuring work schedules; increasing illness among professionals; stress generated by constant changes and work overload; sense of discrimination for being a health professional; lack of knowledge about the clinical management of the disease; and the reduction of non-COVID assistance services.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"9 2","pages":"2177242"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9294408","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: 2

Attributes and Organizational Factors that Enabled Innovation in Health Care Service Delivery during the COVID-19 Pandemic - Case Studies from Brazil, Canada and Japan. 在COVID-19大流行期间实现医疗保健服务提供创新的属性和组织因素——来自巴西、加拿大和日本的案例研究。

Health systems and reform Pub Date : 2023-06-15 DOI: 10.1080/23288604.2023.2176022

Ayako Honda, Sydia Rosana de Araujo Oliveira, Valéry Ridde, Kate Zinszer, Lara Gautier

{"title":"Attributes and Organizational Factors that Enabled Innovation in Health Care Service Delivery during the COVID-19 Pandemic - Case Studies from Brazil, Canada and Japan.","authors":"Ayako Honda, Sydia Rosana de Araujo Oliveira, Valéry Ridde, Kate Zinszer, Lara Gautier","doi":"10.1080/23288604.2023.2176022","DOIUrl":"https://doi.org/10.1080/23288604.2023.2176022","url":null,"abstract":"Innovation by health service organizations can enable adaptation to and transformation of challenges caused by health shocks. Drawing on results from case studies in Brazil, Canada, and Japan, this study looked at innovations the study hospitals introduced in response to challenges caused by COVID-19 to identify: 1) attributes of the innovations that make them conducive to adoption; and 2) organizational factors that facilitate the creation and implementation of innovative health care approaches during health system shocks. Qualitative information was gathered using key informant interviews, participatory observations at the study hospitals and a review of relevant documentation. A thematic approach was used for analysis, and a cross-country comparison framework was prepared to synthesize findings from the case studies in the three countries. In response to the disruptions caused by COVID-19, the study hospitals undertook innovative changes in services, processes, organizational structures, and operational policy. The driving force behind the innovations was the need and urgency generated by the unprecedented nature of the pandemic. With COVID-19, if an innovation met the perceived needs of hospitals and provided an operational advantage, some level of complexity in the implementation appeared to be acceptable. The study findings suggest that for hospitals to create and implement innovations in response to health shocks, they need to: have adaptive and flexible organizational structures; build and maintain functioning communication systems; have committed leadership; ensure all staff share an understanding of hospital organizational and professional missions; and establish social networks that facilitate the creation and implementation of new ideas.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"9 2","pages":"2176022"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9282390","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: 3

Hospital Governance During the COVID-19 Pandemic: A Multiple-Country Case Study. COVID-19 大流行期间的医院管理：多国案例研究。

Health systems and reform Pub Date : 2023-06-15 DOI: 10.1080/23288604.2023.2173551

Lara Gautier, Shinichiro Noda, Fanny Chabrol, Pierre-Marie David, Arnaud Duhoux, Renyou Hou, Sydia Rosana de Araújo Oliveira, Lola Traverson, Kate Zinszer, Valéry Ridde

{"title":"Hospital Governance During the COVID-19 Pandemic: A Multiple-Country Case Study.","authors":"Lara Gautier, Shinichiro Noda, Fanny Chabrol, Pierre-Marie David, Arnaud Duhoux, Renyou Hou, Sydia Rosana de Araújo Oliveira, Lola Traverson, Kate Zinszer, Valéry Ridde","doi":"10.1080/23288604.2023.2173551","DOIUrl":"10.1080/23288604.2023.2173551","url":null,"abstract":"In response to the disruptions caused by COVID-19, hospitals around the world proactively or reactively developed and/or re-organized their governance structures to manage the COVID-19 response. Hospitals' governance played a crucial role in their ability to reorganize and respond to the pressing needs of their staff. We discuss and compare six hospital cases from four countries on different continents: Brazil, Canada, France, and Japan. Our study examined how governance strategies (e.g., special task forces, communications management tools, etc.) were perceived by hospital staff. Key findings from a total of 177 qualitative interviews with diverse hospital stakeholders were analyzed using three categories drawn from the European Observatory on Health Systems and Policies framework on health systems resilience during the COVID-19 pandemic: 1) delivering a clear and timely COVID-19 response strategy; 2) coordinating effectively within (horizontally) and across (vertically) levels of decision-making; and 3) communicating clearly and transparently with the hospital's diverse stakeholders. Our study gleaned rich accounts for these three categories, highlighting significant variations across settings. These variations were primarily determined by the hospitals' environment prior to the COVID-19 crisis, namely whether there already existed a culture of managerial openness (including spaces for social interactions among hospital staff) and whether preparedness planning and training had been routinely integrated into their activities.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"9 2","pages":"2173551"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9667919","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

Responses to Hospital Restrictions on Family Visits during the COVID-19 Epidemic in Mali and France. 马里和法国COVID-19疫情期间医院限制家属探视的对策

Health systems and reform Pub Date : 2023-06-15 DOI: 10.1080/23288604.2023.2241188

Abdourahmane Coulibaly, Fanny Chabrol, Laurence Touré, Renyou Hou, Boubacar Sidiki Ibrahim Dramé, Kate Zinszer, Valéry Ridde

{"title":"Responses to Hospital Restrictions on Family Visits during the COVID-19 Epidemic in Mali and France.","authors":"Abdourahmane Coulibaly, Fanny Chabrol, Laurence Touré, Renyou Hou, Boubacar Sidiki Ibrahim Dramé, Kate Zinszer, Valéry Ridde","doi":"10.1080/23288604.2023.2241188","DOIUrl":"https://doi.org/10.1080/23288604.2023.2241188","url":null,"abstract":"Few studies have focused on the presence of families in the hospital in the context of an epidemic. The present study aims to contribute to filling this gap by answering the following question: How did professionals, patients and their families cope with more or less drastic restrictions to family visits and presence during the COVID-19 pandemic in a French and a Malian hospital during the COVID-19 pandemic? Data were collected during the first two waves of the pandemic through 111 semi-structured interviews (France = 55, Mali = 56). Most of the interviews were conducted with staff (n = 103), but also with families in the case of Mali (n = 8). The investigators also conducted 150 days of field observations, 44 in France and 106 in Mali. Thematic analysis was applied using an inductive approach. Interviews were content analyzed to identify passages in the interviews that were relevant to these different themes. The study highlighted the difficulty for the medical-clinical system to provide appropriate responses to the many emotional needs of patients in a pandemic context. Families in France benefited from a support service to reduce stress, while in Mali, no initiative was taken in this sense. In both countries, families often used the telephone as an alternative means of communicating with relatives. The results showed that in the two contexts, the presence and involvement of the families contributed to a better response to the patients' psycho-affective demands and thus promoted resilience in this field.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"9 2","pages":"2241188"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10201318","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: 1

Communication and Information Strategies Implemented by Four Hospitals in Brazil, Canada, and France to Deal with COVID-19 Healthcare-Associated Infections. 巴西、加拿大和法国四家医院应对COVID-19医疗保健相关感染的沟通和信息战略

Health systems and reform Pub Date : 2023-06-15 DOI: 10.1080/23288604.2023.2223812

Renyou Hou, Lola Traverson, Fanny Chabrol, Lara Gautier, Sydia Rosana de Araújo Oliveira, Pierre-Marie David, Jean-Christophe Lucet, Kate Zinszer, Valéry Ridde

{"title":"Communication and Information Strategies Implemented by Four Hospitals in Brazil, Canada, and France to Deal with COVID-19 Healthcare-Associated Infections.","authors":"Renyou Hou, Lola Traverson, Fanny Chabrol, Lara Gautier, Sydia Rosana de Araújo Oliveira, Pierre-Marie David, Jean-Christophe Lucet, Kate Zinszer, Valéry Ridde","doi":"10.1080/23288604.2023.2223812","DOIUrl":"https://doi.org/10.1080/23288604.2023.2223812","url":null,"abstract":"During the COVID-19 pandemic outbreak, COVID-19 healthcare-associated infections (HAI) and risk management became major challenges facing hospitals. Using evidence from a research project, this commentary presents: 1) various communication and information strategies implemented by four hospitals and their staff in Brazil, Canada and France to reduce the risks of COVID-19 HAIs, and how they were perceived by hospital staff; 2) the flaws in communication in the hospitals; and 3) a proposed agenda for research on and action to improve institutional communications for future pandemics. By analyzing \"top-down\" strategies at the organizational level and spontaneous strategies initiated by and between professionals, this study shows that during the first waves of the pandemic, reliable information and clear communication about guidelines and health protocols' changes can help alleviate fears among staff and avoid misapplication of protocols, thereby reducing infection risks. There was a lack of a \"bottom-up\" communication channel, while, when making decisions, it is crucial to listen to and fully take into account staff's voices, experiences, and feelings. More balanced communication between hospital administrators and staff could strengthen team cohesion and lead to better enforcement of protocols, which in turn will reduce the risk of contamination, alleviate the potential impacts on staff health, and improve the quality of care provided to patients.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"9 2","pages":"2223812"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10169785","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: 1

How Did an Integrated Health and Social Services Center in the Quebec Province Respond to the COVID-19 Pandemic? A Qualitative Case Study. 魁北克省的综合卫生和社会服务中心如何应对COVID-19大流行?定性案例研究。

Health systems and reform Pub Date : 2023-06-15 DOI: 10.1080/23288604.2023.2186824

Morgane Gabet, Arnaud Duhoux, Valéry Ridde, Kate Zinszer, Lara Gautier, Pierre-Marie David

{"title":"How Did an Integrated Health and Social Services Center in the Quebec Province Respond to the COVID-19 Pandemic? A Qualitative Case Study.","authors":"Morgane Gabet, Arnaud Duhoux, Valéry Ridde, Kate Zinszer, Lara Gautier, Pierre-Marie David","doi":"10.1080/23288604.2023.2186824","DOIUrl":"https://doi.org/10.1080/23288604.2023.2186824","url":null,"abstract":"During the first and second waves of the pandemic, Quebec was among the Canadian provinces with the highest COVID-19 mortality rates. Facing particularly large COVID-19 outbreaks in its facilities, an integrated health and social services center in the province of Quebec (Canada), developed resilience strategies. To explore these diverse responses to the crisis, we conducted a case study analysis of a Quebec integrated health and social services center, building on a conceptualization of resilience strategies using \"configurations\" of effects, strategies, and impacts. Qualitative data from 14 indepth interviews conducted in the summer and fall of 2020 with managers and frontline practitioners were analyzed through the lens of situations of \"anticipation,\" \"reaction,\" or \"inaction.\" The findings were discussed in three results dissemination workshops, two with practitioners and one with managers, to discern lessons they learned. Three major configurations emerged: 1) reorganization of services and spaces to accommodate more COVID-19 patients; 2) management of contamination risks for patients and professionals; and 3) management of personal protective equipment (PPE), supplies, and medications. Within these configurations, the responses to the crisis were strongly shaped by the 2015 health care system reforms in Quebec and were constrained by organizational challenges that included a centralized model of governance, a history of substantial budget cuts to longterm care facilities, and a systematic lack of human resources.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"9 2","pages":"2186824"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9264176","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: 7

Adapting Hospital Work During COVID-19 in Quebec (Canada). 加拿大魁北克省COVID-19期间医院工作的调整

Health systems and reform Pub Date : 2023-06-15 DOI: 10.1080/23288604.2023.2200566

Pierre-Marie David, Morgane Gabet, Arnaud Duhoux, Lola Traverson, Valéry Ridde, Kate Zinszer, Lara Gautier

{"title":"Adapting Hospital Work During COVID-19 in Quebec (Canada).","authors":"Pierre-Marie David, Morgane Gabet, Arnaud Duhoux, Lola Traverson, Valéry Ridde, Kate Zinszer, Lara Gautier","doi":"10.1080/23288604.2023.2200566","DOIUrl":"https://doi.org/10.1080/23288604.2023.2200566","url":null,"abstract":"Among hospital responses to the COVID19 pandemic worldwide, service reorganization and staff reassignment have been some of the most prominent ways of adapting hospital work to the expected influx of patients. In this article, we examine work reorganization induced by the pandemic by identifying the operational strategies implemented by two hospitals and their staff to contend with the crisis and then analyzing the implications of those strategies. We base our description and analysis on two hospital case studies in Quebec. We used a multiple case study approach, wherein each hospital is considered a unique case. In both cases, work adaptation through staff reassignment was one of the critical measures undertaken to ensure absorption of the influx of patients into the hospitals. Our results showed that this general strategy was designed and applied differently in the two cases. More specifically, the reassignment strategies revealed numerous healthcare resource disparities not only between health territories, but also between different types of facilities within those territories. Comparing the two hospitals' adaptation strategies showed that past reforms in Quebec determined what these reorganizations could achieve, as well as how they would affect workers and the meaning they gave to their work.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"9 2","pages":"2200566"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9421115","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: 4

Lessons Learned from Field Experiences on Hospitals' Resilience to the COVID-19 Pandemic: A Systematic Approach. 从医院应对COVID-19大流行的实地经验中吸取的教训:一种系统方法。

Health systems and reform Pub Date : 2023-06-15 DOI: 10.1080/23288604.2023.2231644

Christian Dagenais, Muriel Kielende, Abdourahmane Coulibaly, Lara Gautier, Pierre-Marie David, Nathan Peiffer-Smadja, Ayako Honda, Sydia Rosana de Araújo Oliveira, Lola Traverson, Kate Zinszer, Valéry Ridde

{"title":"Lessons Learned from Field Experiences on Hospitals' Resilience to the COVID-19 Pandemic: A Systematic Approach.","authors":"Christian Dagenais, Muriel Kielende, Abdourahmane Coulibaly, Lara Gautier, Pierre-Marie David, Nathan Peiffer-Smadja, Ayako Honda, Sydia Rosana de Araújo Oliveira, Lola Traverson, Kate Zinszer, Valéry Ridde","doi":"10.1080/23288604.2023.2231644","DOIUrl":"https://doi.org/10.1080/23288604.2023.2231644","url":null,"abstract":"In this concluding article of the special issue, we examine lessons learned from hospitals' resilience to the COVID-19 pandemic in Brazil, Canada, France, Japan, and Mali. A quality lesson learned (QLL) results from a systematic process of collecting, compiling, and analyzing data derived ideally from sustained effort over the life of a research project and reflecting both positive and negative experiences. To produce QLLs as part of this research project, a guide to their development was drafted. The systematic approach we adopted to formulate quality lessons, while certainly complex, took into account the challenges faced by the different stakeholders involved in the fight against the COVID-19 pandemic. Here we present a comparative analysis of the lessons learned by hospitals and their staff with regard to four common themes that were the subject of empirical analyses: 1) infrastructure reorganization; 2) human resources management; 3) prevention and control of infection risk; and 4) logistics and supply. The lessons learned from the resilience of the hospitals included in this research indicate several factors to consider in preparing for a health crisis: 1) strengthening the coordination and leadership capacities of hospital managers and health authorities; 2) improving communication strategies; 3) strengthening organizational capacity; and 4) adapting resources and strategies, including for procurement and infection risk management.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"9 2","pages":"2231644"},"PeriodicalIF":0.0,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9871744","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: 2

Strategic Purchasing Arrangements in Uganda and Their Implications for Universal Health Coverage. 乌干达的战略采购安排及其对全民健康覆盖的影响。

Health systems and reform Pub Date : 2022-03-01 DOI: 10.1080/23288604.2022.2084215

Elizabeth Ekirapa-Kiracho, Aloysius Ssennyonjo, Cheryl Cashin, Agnes Gatome-Munyua, Nkechi Olalere, Richard Ssempala, Chrispus Mayora, Freddie Ssengooba

{"title":"Strategic Purchasing Arrangements in Uganda and Their Implications for Universal Health Coverage.","authors":"Elizabeth Ekirapa-Kiracho, Aloysius Ssennyonjo, Cheryl Cashin, Agnes Gatome-Munyua, Nkechi Olalere, Richard Ssempala, Chrispus Mayora, Freddie Ssengooba","doi":"10.1080/23288604.2022.2084215","DOIUrl":"https://doi.org/10.1080/23288604.2022.2084215","url":null,"abstract":"Several purchasing arrangements coexist in Uganda, creating opportunities for synergy but also leading to conflicting incentives and inefficiencies in resource allocation and purchasing functions. This paper analyzes the key health care purchasing functions in Uganda and the implications of the various purchasing arrangements for universal health coverage (UHC). The data for this paper were collected through a document review and stakeholder dialogue. The analysis was guided by the Strategic Health Purchasing Progress Tracking Framework created by the Strategic Purchasing Africa Resource Center (SPARC) and its technical partners. Uganda has a minimum health care package that targets the main causes of morbidity and mortality as well as specific vulnerable groups. However, provision of the package is patchy, largely due to inadequate domestic financing and duplication of services funded by development partners. There is selective contracting with private-sector providers. Facilities receive direct funding from both the government budget and development partners. Unlike government-budget funding, payment from output-based donor-funded projects and performance-based financing (PBF) projects is linked to service quality and has specified conditions for use. Specification of UHC targets is still nascent and evolving in Uganda. Expansion of service coverage in Uganda can be achieved through enhanced resource pooling and harmonization of government and donor priorities. Greater provider autonomy, better work planning, direct facility funding, and provision of flexible funds to service providers are essential elements in the delivery of high-quality services that meet local needs and Uganda's UHC aspirations.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":" ","pages":"2084215"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40562545","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: 3

Has Strategic Purchasing Led to Improvements in Health Systems? A Narrative Review of Literature on Strategic Purchasing. 战略采购是否改善了卫生系统?战略采购相关文献述评。

Health systems and reform Pub Date : 2022-03-01 DOI: 10.1080/23288604.2022.2151698

Fred Matovu, Agnes Gatome-Munyua, Richard Sebaggala

{"title":"Has Strategic Purchasing Led to Improvements in Health Systems? A Narrative Review of Literature on Strategic Purchasing.","authors":"Fred Matovu, Agnes Gatome-Munyua, Richard Sebaggala","doi":"10.1080/23288604.2022.2151698","DOIUrl":"https://doi.org/10.1080/23288604.2022.2151698","url":null,"abstract":"Strategic purchasing is noted in the literature as an approach that can improve the efficiency of health spending, increase equity in access to health care services, improve the quality of health care delivery, and advance progress toward universal health coverage. However, the evidence on how strategic purchasing can achieve these improvements is sparse. This narrative review sought to address this evidence gap and provide decision makers with lessons and policy recommendations. The authors conducted a systematic review based on two research questions: 1) What is the evidence on how purchasing functions affect purchasers' leverage to improve: resource allocation, incentives, and accountability; intermediate results (allocative and technical efficiency); and health system outcomes (improvements in equity, access, quality, and financial protection)? and 2) What conditions are needed for a country to make progress on strategic purchasing and achieve health system outcomes? We used database searches to identify published literature relevant to these research questions, and we coded the themes that emerged, in line with the purchasing functions-benefits specification, contracting arrangements, provider payment, and performance monitoring-and the outcomes of interest. The extent to which strategic purchasing affects the outcomes of interest in different settings is partly influenced by how the purchasing functions are designed and implemented, the enabling environment (both economic and political), and the level of development of the country's health system and infrastructure. For strategic purchasing to provide more value, sufficient public funding and pooling to reduce fragmentation of schemes is important.","PeriodicalId":73218,"journal":{"name":"Health systems and reform","volume":"8 2","pages":"2151698"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10475722","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