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The incipient HIV/AIDS epidemic in Chile poses challenges for responsiveness of the Chilean national health care system, Fondo Nacional de Salud (FONASA) (National Health Funds), especially given the sociocultural forces for inertia in FONASA. Thus, the issue is what is the nature of the forces for change. A grounded theory approach was applied to interview data from two qualitative studies, one with HIV/AIDS advocates and activists as interviewees and the other with Chilean low-income women. The stories of their experiences with and perceptions of FONASA revealed major issues facing FONASA, including quality of care and ethics. Ways in which these issues are being addressed by the activists result in constructed environmental dynamism. A conceptual model of the forces for change was developed including actors, strategies, and targets of change that constitutes organizational environmental dynamism. The construct of environmental dynamism has international applicability, particularly to governmental health systems, which are influenced by strong sociocultural forces.

The devastating 2014 Ebola outbreak caused human and economic loss, but it also resulted in remarkable improvement in healthcare leadership. The impact is most evident in the affected West African countries of Guinea, Liberia and Sierra Leone. In this chapter, the Ebola experience is used as a framework to explore the essential elements of healthcare leadership, with particular attention to healthcare crises in under-resourced communities. Overall, healthcare leadership presents unique challenges. In common with leaders of other industries, healthcare leaders must inspire others, create a sense of purpose, make difficult decisions and collaborate with a range of people. But, because their focus is on complex systems that aim to improve people's physical and mental well-being, expectations of healthcare leaders are especially high. Their work can be a matter of life or death. For the leader in an under-resourced area, the challenge and expectations are even higher, particularly in the face of new or emerging health threats. The key to effective healthcare leadership is systems thinking which involves looking at the entire system of care as an integrated whole, rather than discrete parts that operate in isolation. Healthcare leaders must understand that health means mobilizing multisectoral knowledge and resources and applying innovative and multiactor approaches to prevent, detect and address health problems. Since the 2014 Ebola crisis, healthcare leaders are increasingly using a systems approach by looking at the culture of health systems, the impact of diseases locally and globally, and the applicability of health interventions in different environments. In the post-Ebola era, steps to strengthen the healthcare system are described which includes the roles of healthcare leaders. These steps include deployment of field epidemiologists and community health agents, community education and fuller use of the One Health Platform, which allows actors from different sectors (human health, animal health and environmental health) to collaborate. Finally, suggestions for healthcare leadership training are offered.

We hope this research volume will change the way scholars and managers think about health care management in two fundamental ways. First, we want to challenge the superficial separations between national and international health care management. To dissolve these distinctions, the “not-invented-here” or “who cares about a Belgian, Indian, or Thai medical center,” or “that won’t work in our policy system” attitudes must change. Second, we want scholars and managers to learn how to transfer innovative ideas and management practices across cultures and around policy barriers. Cultural, language, and policy differences present formidable barriers, but we believe lessons about managing human resources, informatics, quality, services, and strategies in health care organizations can be transferred.

Anchoring vignettes have become a popular method to adjust self-assessed data for systematic differences in reporting behaviour to aid comparability, for example, of cross-country analyses. The method relies on the two fundamental assumptions of response consistency and vignette equivalence. Evidence on the validity of these assumptions is equivocal. This chapter considers the utility of the vignette approach by considering how successful the method is in moving self-assessed reports of health mobility towards objective counterparts. We draw on data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and undertake pairwise country comparisons of cumulative distributions of self-reports, their objective counterparts and vignette adjusted reports. Comparison of distributions is based on tests for stochastic dominance. Multiple cross-country comparisons are undertaken to assess the consistency of results across contexts and settings. Both non-parametric and parametric approaches to vignette adjustment are considered. In general, we find the anchoring vignette methodology poorly reconciles self-reported data with objective counterparts.

Much of the theoretical literature on inequality assumes that the equalisand is a cardinal variable like income or wealth. However, health status is generally measured as a categorical variable expressing a qualitative order. Traditional solutions involve reclassifying the variable by means of qualitative models and relying on inequality measures that are mean independent. We argue that the way status is conceptualised has important theoretical implications for measurement as well as for policy analysis. We also bring to the data a recently proposed approach to measuring self-reported health inequality that meets both rigorous and practical considerations. We draw upon the World Health Survey data to examine alternative pragmatic methods for making health-inequality comparisons. Findings suggest significant differences in health-inequality measurement and that regional and country patterns of inequality orderings do not coincide with any reasonable categorisation of countries by health system organisation.

Indigenous health workforce development has been identified as a key strategy to improve Indigenous health and reduce ethnic inequities in health outcomes. Likewise, development of a culturally safe and culturally competent non-Indigenous health workforce must also occur if the elimination of health inequities is to be fully realised. Tertiary education providers responsible for training health professionals must face the challenge of engaging the Indigenous learner within health sciences, exposing the ‘hidden curriculum’ that undermines professional Indigenous health learning and ensuring tertiary success for Indigenous students within their academy. This chapter summarises recent developments, research and interventions within the Faculty of Medical and Health Sciences at the University of Auckland that aims to address these challenges by re-presenting Indigenous student recruitment, selection and support, re-presenting bridging/foundation education and representing Māori health teaching and learning within the curriculum.

The aim of the paper is to review the experiences of developing countries in collecting disability data with regard to the methods and definitions used. The review is based on data in the United Nations Disability Statistics Database, version 2 (DISTAT-2). We analyze the prevalence rates of disability in relation to the characteristics of questions used to identify persons with disabilities and the relationship between disability prevalence and other social and economic indicators. The wide difference in approaches used by countries to identify persons with disabilities result in very different rates of disability prevalence, thus making the comparison of these rates very problematic. The paper gives suggestions on how to improve methods to collect data on disability.

This study proposes targeted modernization of the Department of Defense (DoD's) Joint Forces Ammunition Logistics information system by implementing the optimized innovative information technology open architecture design and integrating Radio Frequency Identification Device data technologies and real-time optimization and control mechanisms as the critical technology components of the solution. The innovative information technology, which pursues the focused logistics, will be deployed in 36 months at the estimated cost of $568 million in constant dollars. We estimate that the Systems, Applications, Products (SAP)-based enterprise integration solution that the Army currently pursues will cost another $1.5 billion through the year 2014; however, it is unlikely to deliver the intended technical capabilities.

The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be different from those directed at adults and considered how these models might be appraised. The project took the multiple and interrelated dimensions of primary care and simplified them into a conceptual framework for appraisal. A general description of the models in existence in all 30 countries of the EU and EEA countries, focusing on lead practitioner, financial and regulatory and service provision classifications, was created. We then used the WHO ‘building blocks’ for high-performing health systems as a starting point for identifying a good system for children. The building blocks encompass safe and good quality services from an educated and empowered workforce, providing good data systems, access to all necessary medical products, prevention and treatments, and a service that is adequately financed and well led. An extensive search of the literature failed to identify a suitable appraisal framework for MOCHA, because none of the frameworks focused on child primary care in its own right. This led the research team to devise an alternative conceptualisation, at the heart of which is the core theme of child centricity and ecology, and the need to focus on delivery to the child through the life course. The MOCHA model also focuses on the primary care team and the societal and environmental context of the primary care system.