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Health Sector (health + sector)
Selected AbstractsCitizen Participation in the Health Sector in Rural Bangladesh: Perceptions and RealityIDS BULLETIN, Issue 2 2004Simeen Mahmud First page of article [source] Tuberculosis control and managed competition in ColombiaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2004Maria Patricia Arbelaez Abstract Law 100 introduced the Health Sector Reform in Colombia, a model of managed competition. This article addresses the effects of this model in terms of output and outcomes of TB control. Trends in main TB control indicators were analysed using secondary data sources, and 25 interviews were done with key informants from public and private insurers and provider institutions, and from the health directorate level. We found a deterioration in the performance of TB control: a decreasing number of BCG vaccine doses applied, a reduction in case finding and contacts identification, low cure rates and an increasing loss of follow up, which mainly affects poor people. Fragmentation occurred as the atomization and discontinuity of the technical processes took place, there was a lack of coordination, as well as a breakdown between individual and collective interventions, and the health information system began to disintegrate. The introduction of the Managed Competition (MC) in Colombia appeared to have adverse effects on TB control due to the dominance of the economic rationality in the health system and the weak state stewardship. Our recommendations are to restructure the reform's public health component, strengthen the technical capacity in public health of the state, mainly at the local and departmental levels, and to improve the health information system by reorienting its objectives to public health goals. Copyright © 2004 John Wiley & Sons, Ltd. [source] Integrating Gender Interests into Health PolicyDEVELOPMENT AND CHANGE, Issue 2 2006Jasmine Gideon This article reviews current initiatives to integrate gender interests into health policy in Chile. The analysis outlines the debates that have arisen around the questions of mainstreaming gender, in relation to state institutions, NGOs and grassroots organizations. The discussion highlights both the constraints and opportunities identified in the literature. The study locates the Chilean case study within these broader debates and draws some overall conclusions. Despite the limitations posed by the broader context of neo-liberal health sector reforms, the experience of the Chilean gender mainstreaming initiative does suggest that there is some cause for optimism. [source] Decentralisation, Governance and Health-System Performance: ,Where You Stand Depends on Where You Sit'DEVELOPMENT POLICY REVIEW, Issue 6 2010Andrew Mitchell Advocates of local government often argue that when decentralisation is accompanied by adequate mechanisms of accountability, particularly those responsive to local preferences, improved service delivery will result. From the perspective of the health sector, the appropriate degree of decentralisation and the necessary mechanisms of accountability depend upon the achievement of health system goals. Drawing on evidence from six countries (Bolivia, Chile, India, Pakistan, Philippines, Uganda), this article comes to the conclusion that a balance between centralisation of some functions and decentralisation of others, along with improved mechanisms of accountability, is needed to achieve health system objectives. [source] Inter-State Disparities in Health Outcomes in Rural India: An Analysis Using a Stochastic Production Frontier ApproachDEVELOPMENT POLICY REVIEW, Issue 2 2005Vinish Kathuria In an era of reforms in the health sector and with the role of government in health provision diminishing, emphasis is shifting to making the sector efficient. This article analyses the performance of the rural public health systems of 16 major States in India, using stochastic production frontier techniques and panel data for the period 1986-97. The results show that States differ not only in capacity-building in terms of health infrastructure created, but also in efficiency in using these inputs. There is scope for health systems to re-orient their strategies in order to provide the best health in the most efficient way or at the lowest possible cost. [source] Vested Interests in Addiction Research and Policy Poisonous partnerships: health sector buy-in to arrangements with government and addictive consumption industriesADDICTION, Issue 4 2010Peter J. Adams ABSTRACT Aim This paper critically appraises relationship arrangements among three broadly conceived sectors: the government sector, the health sector (including researchers) and addictive consumption industries (particularly tobacco, alcohol and gambling). Method Three models for involvement are examined. In the ,tripartite partnership model' health sector agencies engage as co-equals with the government and industry sectors in order to implement public health initiatives such as host responsibility and public education. In the ,non- association model' the health sector engages with government agencies but not with the industry sector. In the ,managed association model' the health sector engages for specific purposes with the industry sector but contact is monitored and managed by government agencies. Findings Government and industry sectors commonly favour tripartite partnership arrangements. Health sector agencies that opt to engage in these partnership arrangements can encounter conflicts of interest and find their voice subsumed by dominant influences. Furthermore, their partnership compliance generates divisions within the health sector, with partnership dissenters often silenced and excluded from policy processes and funding. The non-association model is the least hazardous to the health sector because it protects against compromise and dominance. The managed association model is an option only when the government sector as a whole is committed strongly and clearly to the public health objectives. Conclusion In contexts where key parts of the government sector are conflicted over their public health responsibilities, health sector engagement in partnership arrangements entails too many risks. [source] Cost-effectiveness of interventions to prevent alcohol-related disease and injury in AustraliaADDICTION, Issue 10 2009Linda Cobiac ABSTRACT Aims To evaluate cost-effectiveness of eight interventions for reducing alcohol-attributable harm and determine the optimal intervention mix. Methods Interventions include volumetric taxation, advertising bans, an increase in minimum legal drinking age, licensing controls on operating hours, brief intervention (with and without general practitioner telemarketing and support), drink driving campaigns, random breath testing and residential treatment for alcohol dependence (with and without naltrexone). Cost-effectiveness is modelled over the life-time of the Australian population in 2003, with all costs and health outcomes evaluated from an Australian health sector perspective. Each intervention is compared with current practice, and the most cost-effective options are then combined to determine the optimal intervention mix. Measurements Cost-effectiveness is measured in 2003 Australian dollars per disability adjusted life year averted. Findings Although current alcohol intervention in Australia (random breath testing) is cost-effective, if the current spending of $71 million could be invested in a more cost-effective combination of interventions, more than 10 times the amount of health gain could be achieved. Taken as a package of interventions, all seven preventive interventions would be a cost-effective investment that could lead to substantial improvement in population health; only residential treatment is not cost-effective. Conclusions Based on current evidence, interventions to reduce harm from alcohol are highly recommended. The potential reduction in costs of treating alcohol-related diseases and injuries mean that substantial improvements in population health can be achieved at a relatively low cost to the health sector. [source] Keeping nurses at work: a duration analysisHEALTH ECONOMICS, Issue 6 2002Tor Helge HolmåsArticle first published online: 9 AUG 200 Abstract A shortage of nurses is currently a problem in several countries, and an important question is therefore how one can increase the supply of nursing labour. In this paper, we focus on the issue of nurses leaving the public health sector by utilising a unique data set containing information on both the supply and demand side of the market. To describe the exit rate from the health sector we apply a semi-parametric hazard rate model. In the estimations, we correct for unobserved heterogeneity by both a parametric (Gamma) and a non-parametric approach. We find that both wages and working conditions have an impact on nurses' decision to quit. Furthermore, failing to correct for the fact that nurses' income partly consists of compensation for inconvenient working hours results in a considerable downward bias of the wage effect. Copyright © 2002 John Wiley & Sons, Ltd. [source] Assessing the impact of information services in the health sectorHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 2007Rowena Cullen No abstract is available for this article. [source] The education and training needs of health librarians,the generalist versus specialist dilemmaHEALTH INFORMATION & LIBRARIES JOURNAL, Issue 3 2007Tatjana Petrinic Aims and objectives:, The aims of the study were to examine whether and how librarians with a generalist background can transfer to roles demanding more expert knowledge in the health sector. The objectives were (i) to compare the education and training needs of health librarians with science degrees with the education and training needs of health librarians with arts and humanities degrees; (ii) to compare the education and training needs of librarians working in the National Health Service (NHS) sector with the education and training needs of librarians working for the health sector but within higher education. Methods:, Face-to-face interviews with 16 librarians, a convenience sample of librarians working in the Thames Valley NHS region. Results:, The main findings confirmed that structured continuing professional development (CPD) is required to meet the rapidly changing needs in the health sector. The emphasis ought to be on teaching skills, outreach work, marketing and promotion, research skills and methods, subject knowledge and terminology, and management skills. Library school curricula do not appear to meet the demands of medical library posts. A first degree in scientific subjects is advantageous in the early stages of a career but diminishes with continuing training and experience. There is no evidence of a significant difference in training needs and provision between the librarians in NHS posts as opposed to those in higher education (HE) posts. Conclusions:, The conclusions suggest that library schools need to update their programmes to include teaching skills, advanced search skills, project management skills, research methods, with more practical exercises. Particular attention should be given to librarians with a first degree in non-scientific subjects in terms of time allocated for CPD, quality of training and access to reliable mentorship. [source] ,By papers and pens, you can only do so much': views about accountability and human resource management from Indian government health administrators and workersINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2009Asha George Abstract Although accountability drives in the Indian health sector sporadically highlight egregious behaviour of individual health providers, accountability needs to be understood more broadly. From a managerial perspective, while accountability functions as a control mechanism that involves reviews and sanctions, it also has a constructive side that encourages learning from errors and discretion to support innovation. This points to social relationships: how formal rules and hierarchies combine with informal norms and processes and more fundamentally how power relations are negotiated. Drawing from this conceptual background and based on qualitative research, this article analyses the views of government primary health care administrators and workers from Koppal district, northern Karnataka, India. In particular, the article details how these actors view two management functions concerned with internal accountability: supervision and disciplinary action. A number of disjunctures are revealed. Although extensive information systems exist, they do not guide responsiveness or planning. While supportive supervision efforts are acknowledged and practiced, implicit quid-pro-quo bargains that justify poor service delivery performance are more prevalent. Despite the enactment of numerous disciplinary measures, little discipline is observed. These disjunctures reflect nuanced and layered relationships between health administrators and workers, as well as how power is negotiated through corruption and elected representatives within the broader political economy context of health systems in northern Karnataka, India. These various dimensions of accountability need to be addressed if it is to be used more equitably and effectively. Copyright © 2009 John Wiley & Sons, Ltd. [source] Are reproductive health NGOs in Uganda able to engage in the health SWAp?INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2005Frank Mugisha Abstract This paper explores the ability for reproductive health (RH) non-governmental organizations (NGO) in Uganda to survive in the context of SWAp and decentralization. The authors argue that, contrary to the perceptions that this context may increase NGO's financial vulnerability, a SWAp and a decentralized system may provide an opportunity that should be embraced by NGOs to enhance their sustainability and effectiveness by reducing their current dependency on donor funding. The paper discusses the systemic weaknesses of many NGOs that currently make them vulnerable, and observes that unless these weaknesses are addressed, such NGOs will lose their space in the SWAp and decentralization arena. The authors suggest that NGOs need to recognize the opportunities that participating in public-private partnerships through a SWAp can offer them for long-term and significant funding. They need also to develop their capacity to pro-actively participate in a SWAp and decentralized context by becoming more entrepreneurial in nature, through re-orienting their organizational philosophies and strategic planning and budgeting so as to be able to partner effectively with the public sector in accessing funds made available through health sector reform. Copyright © 2005 John Wiley & Sons, Ltd. [source] Key issues relating to decentralization at the provincial level of health management in CambodiaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2005Bunnan Men Abstract The following study was conducted as part of a review of management systems at a Provincial Health Department (Kampong Cham Province) and a National Health Programme (National Immunization Program) in 2002,2003 in Cambodia. The aim of this paper is to identify, analyse and recommend those management system factors that are critical to the success of health management performance, with a particular focus on provincial management. The review has identified critical success factors associated with health management performance at the sub-national level that include a stronger role for effective human resource management in health sector reform, elevation of the status of planning in senior level management, and the development of a more comprehensive and transparent finance system. These success factors will position the provincial level of health management to respond more effectively to the reform challenges of administrative de-concentration and political decentralization that are currently underway across a range of government sectors in Cambodia. Copyright © 2005 John Wiley & Sons, Ltd. [source] Provision and financial burden of TB services in a financially decentralized system: a case study from Shandong, ChinaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2004Qingyue Meng Abstract Both challenges and opportunities have been created by health sector reforms for TB control programmes in developing countries. China has initiated radical economic and health reforms since the late 1970s and is among the highest TB endemic countries in the world. This paper examines the operation of TB control programmes in a decentralized financial system. A case study was conducted in four counties of Shandong Province and data were collected from document reviews, and key informant and TB patient interviews. The main findings include: direct government support to TB control weakened in poorer counties after its decentralization to township and county governments; DOTS programmes in poorer counties was not implemented as well as in more affluent ones; and TB patients, especially the low-income patients, suffered heavy financial burdens. Financial decentralization negatively affects the public health programmes and may have contributed to the more rapid increase in the number of TB cases seen over the past decade in the poorer areas of China compared with the richer ones. Establishing a financial transfer system at central and provincial levels, correcting financial incentives for health providers, and initiating pro-poor projects for the TB patients, are recommended. Copyright © 2004 John Wiley & Sons, Ltd. [source] Revenue-driven in TB control,three cases in ChinaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue S1 2004Shaokang Zhan Abstract One quarter of all TB cases occur in China, which, during the past 20 years has moved from a planned economy to a socialist market economy. In the health sector, an important proportion of the financing originates from user payment. TB control is not an exception and different programmatic models are in place. This study examines, using a case study approach, three different TB programmes, one supposed to provide free service, one subsidized service and one with full cost recovery. The aim was to better understand the driving forces for programme performance in terms of case detection, case management and patient payments. The study found for all models that control and case management approaches were, to some extent, adapted to generate maximum income to the providers. The drive for income led to fewer cases detected, administration of unnecessary procedures and drugs, and a higher than necessary cost to the patients. The latter possibly leading to exclusion of poor people from the services. If user charges are to stay, TB control programmes need to be designed to take advantage of the financial incentives to improve performance. The referral system needs to be restructured, not to provide disincentives for good practices. Copyright © 2004 John Wiley & Sons, Ltd. [source] Changing medical doctor productivity and its affecting factors in rural ChinaINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2004Tim Martineau Abstract Using the data collected from the health facility-based survey, part of the national health service survey conducted in 1993 and 1998, this paper tries to examine changes in labour productivity among the county-level hospitals and township health centres in rural China, and to analyse factors affecting the changes. The results presented in the paper show that the average number of outpatient visits per doctor per day and the average number of inpatient days per doctor per day declined significantly over the period from 1986 to 1997. The main factors resulting in the reduction of productivity are associated with the increase of inappropriate staff recruitment in these health facilities, the significant decline of rural population covered by health insurance, particularly rural cooperative medical schemes (CMS), and the rapid rise of health care costs. The latter two factors also have brought about a reduction in the use of these health facilities by the rural population. The paper suggests that the government should tighten up the entrance of health and non-health staff into the rural health sector and develop effective measures aimed to avoid providing pervasive financial incentives to the over-provision of services and over-use of drugs. In addition, other measures that help to increase the demand for health services, such as the establishment of rural health insurance, should be considered seriously. Copyright © 2004 John Wiley & Sons, Ltd. [source] Privatization and the allure of franchising: a Zambian feasibility study,INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 3 2003John L. Fiedler Abstract Efforts to privatize portions of the health sector have proven more difficult to implement than had been anticipated previously. One common bottleneck encountered has been the traditional organizational structure of the private sector, with its plethora of independent, single physician practices. The atomistic nature of the sector has rendered many privatization efforts difficult, slow and costly,in terms of both organizational development and administration. In many parts of Africa, in particular, the shortages of human and social capital, and the fragile nature of legal institutions, undermine the appeal of privatization. The private sector is left with inefficiencies, high prices and costs, and a reduced effective demand. The result is the simultaneous existence of excess capacity and unmet need. One potential method to improve the efficiency of the private sector, and thereby enhance the likelihood of successful privatization, is to transfer managerial technology,via franchising,from models that have proven successful elsewhere. This paper presents a feasibility analysis of franchizing the successful Bolivian PROSALUD system's management package to Zambia. The assessment, based on PROSALUD's financial model, demonstrates that technology transfer requires careful adaptation to local conditions and, in this instance, would still require significant external assistance. Copyright © 2003 John Wiley & Sons, Ltd. [source] Globalization, global health, and access to healthcare,INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2003Téa Collins Abstract It is now commonly realized that the globalization of the world economy is shaping the patterns of global health, and that associated morbidity and mortality is affecting countries' ability to achieve economic growth. The globalization of public health has important implications for access to essential healthcare. The rise of inequalities among and within countries negatively affects access to healthcare. Poor people use healthcare services less frequently when sick than do the rich. The negative impact of globalization on access to healthcare is particularly well demonstrated in countries of transitional economies. No longer protected by a centralized health sector that provided free universal access to services for everyone, large segments of the populations in the transition period found themselves denied even the most basic medical services. Only countries where regulatory institutions are strong, domestic markets are competitive and social safety nets are in place, have a good chance to enjoy the health benefits of globalization. Copyright © 2003 John Wiley & Sons, Ltd. [source] Mapping capacity in the health sector: a conceptual frameworkINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2002Anne K. LaFond Abstract Capacity improvement has become central to strategies used to develop health systems in low-income countries. Experience suggests that achieving better health outcomes requires both increased investment (i.e. financial resources) and adequate local capacity to use resources effectively. International donors and non-governmental agencies, as well as ministries of health, are therefore increasingly relying on capacity building to enhance overall performance in the health sector. Despite the growing interest in capacity improvement, there has been little consensus among practitioners and academics on definitions of ,capacity building' and how to evaluate it. This paper aims to review current knowledge and experiences from ongoing efforts to monitor and evaluate capacity building interventions in the health sector in developing countries. It draws on a wide range of sources to develop (1) a definition of capacity building and (2) a conceptual framework for mapping capacity and measuring the effects of capacity building interventions. Mapping is the initial step in the design of capacity building interventions and provides a framework for monitoring and evaluating their effectiveness. Capacity mapping is useful to planners because it makes explicit the assumptions underlying the relationship between capacity and health system performance and provides a framework for testing those assumptions. Copyright © 2002 John Wiley & Sons, Ltd. [source] Prescription practices of public and private health care providers in Attock District of PakistanINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2002S. Siddiqi Abstract The irrational use of drugs is a major problem of present day medical practice and its consequences include the development of resistance to antibiotics, ineffective treatment, adverse effects and an economic burden on the patient and society. A study from Attock District of Pakistan assessed this problem in the formal allopathic health sector and compared prescribing practices of health care providers in the public and private sector. WHO recommended drug use indicators were used to study prescription practices. Prescriptions were collected from 60 public and 48 private health facilities. The mean (±,SE) number of drugs per prescription was 4.1,±,0.06 for private and 2.7,±,0.04 for public providers (,p,<,0.0001). General practitioners (GPs) who represent the private sector prescribed at least one antibiotic in 62% of prescriptions compared with 54% for public sector providers. Over 48% of GP prescriptions had at least one injectable drug compared with 22.0% by public providers (,p,<,0.0001). Thirteen percent of GP prescriptions had two or more injections. More than 11% of GP prescriptions had an intravenous infusion compared with 1% for public providers (,p,<,0.001). GPs prescribed three or more oral drugs in 70% of prescriptions compared with 44% for public providers (,p,<,0.0001). Prescription practices were analysed for four health problems, acute respiratory infection (ARI), childhood diarrhoea (CD), fever in children and fever in adults. For these disorders, both groups prescribed antibiotics generously, however, GPs prescribed them more frequently in ARI, CD and fever in children (,p,<,0.01). GPs prescribed steroids more frequently, however, it was significantly higher in ARI cases (,p,<,0.001). For all the four health problems studied, GPs prescribed injections more frequently than public providers (,p,<,0.001). In CD cases GPs prescribed oral rehydration salt (ORS) less frequently (33.3%) than public providers (57.7%). GPs prescribed intravenous infusion in 12.3% cases of fever in adults compared with none by public providers (,p,<,0.001). A combination of non-regulatory and regulatory interventions, directed at providers as well as consumers, would need to be implemented to improve prescription practices of health care providers. Regulation alone would be ineffective unless it is supported by a well-established institutional mechanism which ensures effective implementation. The Federal Ministry of Health and the Provincial Departments of Health have to play a critical role in this respect, while the role of the Pakistan Medical Association in self-regulation of prescription practices can not be overemphasized. Improper prescription practices will not improve without consumer targeted interventions that educate and empower communities regarding the hazards of inappropriate drug use. Copyright © 2002 John Wiley & Sons, Ltd. [source] Application of activity-based costing (ABC) for a Peruvian NGO healthcare providerINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2001Dr. Hugh Waters Abstract This article describes the application of activity-based costing (ABC) to calculate the unit costs of the services for a health care provider in Peru. While traditional costing allocates overhead and indirect costs in proportion to production volume or to direct costs, ABC assigns costs through activities within an organization. ABC uses personnel interviews to determine principal activities and the distribution of individual's time among these activities. Indirect costs are linked to services through time allocation and other tracing methods, and the result is a more accurate estimate of unit costs. The study concludes that applying ABC in a developing country setting is feasible, yielding results that are directly applicable to pricing and management. ABC determines costs for individual clinics, departments and services according to the activities that originate these costs, showing where an organization spends its money. With this information, it is possible to identify services that are generating extra revenue and those operating at a loss, and to calculate cross subsidies across services. ABC also highlights areas in the health care process where efficiency improvements are possible. Conclusions about the ultimate impact of the methodology are not drawn here, since the study was not repeated and changes in utilization patterns and the addition of new clinics affected applicability of the results. A potential constraint to implementing ABC is the availability and organization of cost information. Applying ABC efficiently requires information to be readily available, by cost category and department, since the greatest benefits of ABC come from frequent, systematic application of the methodology in order to monitor efficiency and provide feedback for management. The article concludes with a discussion of the potential applications of ABC in the health sector in developing countries. Copyright © 2001 John Wiley & Sons, Ltd. [source] Vertical or holistic decentralization of the health sector?INTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 4 2000Experiences from Zambia, Uganda Abstract Many countries in Africa have embarked on health sector reforms. The design of the reforms differs considerably. A key feature of the reforms is decentralization, of which Uganda and Zambia are implementing two different models. This paper analyses the two models of health sector reform, and their implications for ultimate development goals. In Uganda, the whole government has been decentralized, with a wide range of powers and resources transferred to the districts. The health care system is part of the political set up of the country. In Zambia, only the health sector has been decentralized. Power and resources for health care have been divested to new parallel organizations. While useful lessons can be drawn from the managerial and administrative experience in the two countries, not least concerning donor coordination, it seems that neither form of decentralization has so far led to a clear and appreciable improvement of health services and, ultimately, to a clear focus on development goals, such as poverty alleviation. The conditions for this to happen are discussed in this paper. Copyright © 2000 John Wiley & Sons, Ltd. [source] Mental health nurse practitioners in Australia: Improving access to quality mental health careINTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 4 2005Jacklin E. Fisher ABSTRACT:, Under The Nurses Amendment (Nurse Practitioners) Act 1998, New South Wales became the first state in Australia to legislate for nurse practitioners. Mental health was identified as a priority ,area of practice' for nurse practitioners. Issues surrounding the implementation of the nurse practitioner role in Australia and the potential for the role to address the current crisis in mental health nursing and the mental health sector will be discussed. The potential for partnerships with other health-care providers, in particular medical practitioners, will demonstrate how successful implementation of the role can fulfil consumer demand for primary prevention counselling, improve access to mental health services and early intervention, and provide mental health services that better reflect national priorities. This examination of the Australian context will be contrasted with a review of the overseas literature on mental health nurse practitioners. [source] High incidence of rheumatic fever and Rheumatic heart disease in the republics of Central AsiaINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2009Nazgul A. OMURZAKOVA Abstract The epidemiological situation involving rheumatic fever (RF) and rheumatic heart disease (RHD) not only remains unresolved but is also a cause of serious concern due to the rapid increase in the incidence of RF/RHD in many developing countries. After the collapse of the Soviet Union, the republics of Central Asia experienced an economic decline that directly affected the public health sector of this region. This is the main cause of the high prevalence of many infectious diseases in Central Asia, including streptococcal tonsillopharyngitis, which carries the risk of complications such as RF. The difficulty involved in early diagnosis of RF and the development of RHD among children and adolescents causes early mortality and sudden death, leading to economic damage in these countries due to the loss of the young working population. Among all the developing countries, Kyrgyzstan, which is located in the heart of Central Asia, has the highest prevalence of RF/RHD. The increase in the prevalence of RF in Central Asia can be attributed to factors such as the low standard of living and changes in the virulence of streptococci and their sensitivity to antibiotics. [source] An educational process to strengthen primary care nursing practices in São Paulo, BrazilINTERNATIONAL NURSING REVIEW, Issue 4 2007A.M. Chiesa rn Objective:, To describe the experience of a registered nurse (RN) training process related to the Family Health Program (FHP) developed in the city of São Paulo, Brazil. Background:, The FHP is a national, government strategy to restructure primary care services. It focuses on the family in order to understand its physical and social structure in regards to the health,illness process. In the FHP, the RN is a member of a team with the same number as medical doctors , an unprecedented situation. The FHP requires a discussion of the RNs' practice, by qualifying and empowering them with tools and knowledge. Methods:, The training process was based on Freire's approach founded on critical pedagogy in order to address the fundamental problem of inequalities in health. The first phase included workshops and the second one included a course. The workshops identified the following problems related to the RN's work: lack of tools to identify the population's needs; overload of work due to the accumulation of management and assistance activities; difficulties regarding teamwork; lack of tools to evaluate the impact of nursing interventions; lack of tools to improve the participation of the community. The course was organized to tackle these problems under five thematic headings. Results:, The RN's training process allowed the group to reflect deeply on its work. This experience led to the need for the construction of tools to intervene in the reality, mainly against social exclusion, rescuing and adapting of the knowledge accumulated in the healthcare practice, identifying settings which demand institutional solutions and engaging the RN in research groups in order to develop projects according to the complexity of the primary care services. Conclusion:, The application of the concept of equity in the health sector represented a reaction against the processes of social exclusion, starting from performance at a local level to become a reality in the accomplishments achieved by the Brazilian National Health System. This training process allowed us to evaluate that partnership, which has produced many concrete results in addressing both parts of the Inequalities in Health dilemma and which is a productive way of building up a new model of health. [source] Nursing, midwifery and allied health education programmes in AfghanistanINTERNATIONAL NURSING REVIEW, Issue 2 2005P. Herberg phd Background:, In 2001, Afghanistan was the centre of the world's attention. By 2002, following 23 years of internal conflict , including Soviet invasion, civil war and Taliban rule, plus 3 years of drought, the country was just beginning the process of re-establishing its internal structures and processes. In the health sector, this included the revival of the Ministry of Health (MOH). The MOH was assisted in its efforts by multiple partners, including the UN, donor and aid agencies, and a variety of non-governmental organizations. The author served as a consultant to the Aga Khan University School of Nursing, in partnership with the World Health Organization and the MOH, as it took on the work of strengthening nursing, midwifery and allied health education programmes for Afghanistan. Aim:, This paper will focus on the initial assessment of that sector. It will describe the situation as it existed in 2002, by examining the Kabul Institute of Health Sciences (IHS) and then turn briefly to the current state of affairs. Conclusions:, Despite the uncertainties of daily life in Afghanistan, the country has successfully initiated the reconstruction process. In the health sector, this can be seen in the work done at the Kabul IHS. Progress has been made in a number of areas, most notably in development and implementation of nursing and midwifery curricula. However, no one would deny that much more work is needed. [source] Workplace violence in the health sector: a problem of epidemic proportionINTERNATIONAL NURSING REVIEW, Issue 3 2001Article first published online: 20 DEC 200 [source] Can paying for results help to achieve the Millennium Development Goals?JOURNAL OF EVIDENCE BASED MEDICINE, Issue 2 2009Overview of the effectiveness of results-based financing Abstract Objective Results-based financing and pay-for-performance refer to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. Results-based financing is widely advocated for achieving health goals, including the Millennium Development Goals. Methods We undertook an overview of systematic reviews of the effectiveness of RBF. We searched the Cochrane Library, EMBASE, and MEDLINE (up to August 2007). We also searched for related articles in PubMed, checked the reference lists of retrieved articles, and contacted key informants. We included reviews with a methods section that addressed the effects of any results-based financing in the health sector targeted at patients, providers, organizations, or governments. We summarized the characteristics and findings of each review using a structured format. Results We found 12 systematic reviews that met our inclusion criteria. Based on the findings of these reviews, financial incentives targeting recipients of health care and individual healthcare professionals are effective in the short run for simple and distinct, well-defined behavioral goals. There is less evidence that financial incentives can sustain long-term changes. Conditional cash transfers to poor and disadvantaged groups in Latin America are effective at increasing the uptake of some preventive services. There is otherwise very limited evidence of the effects of results-based financing in low- or middle-income countries. Results-based financing can have undesirable effects, including motivating unintended behaviors, distortions (ignoring important tasks that are not rewarded with incentives), gaming (improving or cheating on reporting rather than improving performance), widening the resource gap between rich and poor, and dependency on financial incentives. Conclusion There is limited evidence of the effectiveness of results-based financing and almost no evidence of the cost-effectiveness of results-based financing. Based on the available evidence and likely mechanisms through which financial incentives work, they are more likely to influence discrete individual behaviors in the short run and less likely to create sustained changes. [source] Health, Social Movements, and Rights-based Litigation in South AfricaJOURNAL OF LAW AND SOCIETY, Issue 3 2008Marius Pieterse This article investigates the impact of rights-based litigation on social struggles in the South African health sector. It considers the manner in which individuals and social movements have utilized rights and the legal process in their efforts to dismantle the ill-health/poverty cycle, in the particular context of the struggle for universal access to treatment for HIV/AIDS. Relying on literature concerning the transformative potential of socio-economic rights litigation and on examples from South African case law, the article critically evaluates the gains that have been made and the obstacles that have been encountered in this context. It argues that rights-based litigation presents a powerful tool in the struggle against poverty, but also elaborates on structural and institutional hurdles that continue to inhibit the effectiveness of rights-based strategies in this regard. [source] Interdisciplinary team leadership: a revisionist approach for an old problem?JOURNAL OF NURSING MANAGEMENT, Issue 6 2003Antoinette McCallin BA, MA (Hons) Understanding of interdisciplinary teamwork is evolving. During health care restructuring, leaders across organizations have challenging responsibilities when work groups must integrate changing organizational values with new modes of service delivery. In this environment, a well-functioning interdisciplinary team in which clinicians work as member-leaders has the potential to further organizational change and foster improvements in patient outcomes. In this paper it is argued that the term interdisciplinary team leadership should be embraced cautiously as it may be a revisionist approach to an old problem, namely a means to modify existing theories of leadership that have been vague and continue to be poorly understood despite considerable effort to explicate knowledge over several decades. Preliminary research suggests that interdisciplinary team leadership is a model of shared leadership that requires more development if it is to become the cornerstone of interdisciplinary team practice in a radically reforming health sector. Stewardship is proposed as a potential philosophy for interdisciplinary team leadership, and a new, shared leadership role of practice leader is suggested. [source] | ||||||||||||||||