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1 – 10 of 561Blender Muzvondiwa and Roy Batterham
Gweru District, Zimbabwe faces a major challenge of noncommunicable diseases (NCDs). Globally, health systems have not responded successfully to problems in prevention and…
Abstract
Purpose
Gweru District, Zimbabwe faces a major challenge of noncommunicable diseases (NCDs). Globally, health systems have not responded successfully to problems in prevention and management of NCDs. Despite numerous initiatives, reorienting health services has been slow in many countries. Gweru District has similar challenges. The purpose of this paper is to explore what the health systems in Zimbabwe have done, and are doing to respond to increasing numbers of NCD cases in adults in the nation, especially in the district of Gweru
Design/methodology/approach
The study employed a descriptive narrative review of the academic and grey literature, supplemented by semi-structured key informant interviews with 14 health care staff and 30 adults living with a disease or caring for an adult with a disease in Gweru District.
Findings
Respondents identified many limitations to the response in Gweru. Respondents said that screening and diagnosis cease to be helpful when it is difficult securing medications. Nearly all community respondents reported not understanding why they are not freed of the diseases, showing poor understanding of NCDs. The escalating costs and scarcity of medications have led people to lose trust in services. Government and NGO activities include diagnosis and screening, provision of health education and some medication. Health personnel mentioned gaps in transport, medication shortages, poor equipment and poor community engagement. Suggestions include: training of nurses for a greater role in screening and management of NCDs, greater resourcing, outreach activities/satellite clinics and better integration of diverse NCD policies.
Originality/value
This research offers an understanding of NCD strategies and their limitations from the bottom-up, lived experience perspective of local health care workers and community members.
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Tina Bedenik, Claudine Kearney and Éidín Ní Shé
In this viewpoint article, the authors recognize the increased focus in health systems on co-design for innovation and change. This article explores the role of leaders and…
Abstract
Purpose
In this viewpoint article, the authors recognize the increased focus in health systems on co-design for innovation and change. This article explores the role of leaders and mangers in developing and enhancing a culture of trust in their organizations to enable co-design, with the potential to drive innovation and change in healthcare.
Design/methodology/approach
Using social science analyses, the authors argue that current co-design literature has limited focus on interactions between senior leaders and managers, and healthcare staff and service users in supporting co-designed innovation and change. The authors draw on social and health science studies of trust to highlight how the value-based co-design process needs to be supported and enhanced. We outline what co-design innovation and change involve in a health system, conceptualize trust and reflect on its importance within the health system, and finally note the role of senior leaders and managers in supporting trust and responsiveness for co-designed innovation and change.
Findings
Healthcare needs leaders and managers to embrace co-design that drives innovation now and in the future through people – leading to better healthcare for society at large. As authors we argue that it is now the time to shift our focus on the role of senior managers and leaders to embed co-design into health and social care structures, through creating and nurturing a culture of trust.
Originality/value
Building public trust in the health system and interpersonal trust within the health system is an ongoing process that relies upon personal behavior of managers and senior leaders, organizational practices within the system, as well as political processes that underpin these practices. By implementing managerial, leadership and individual practices on all levels, senior managers and leaders provide a mechanism to increase both trust and responsiveness for co-design that supports innovation and change in the health system.
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Manesh Muraleedharan and Alaka Omprakash Chandak
The substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and…
Abstract
Purpose
The substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.
Design/methodology/approach
A systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.
Findings
Chronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.
Research limitations/implications
The present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.
Originality/value
Given the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.
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This paper aims to examine the factors that affect the quality of healthcare services in the implementation of the National Health Insurance Scheme (NHIS) at the local level in…
Abstract
Purpose
This paper aims to examine the factors that affect the quality of healthcare services in the implementation of the National Health Insurance Scheme (NHIS) at the local level in Ghana from the perspectives of health policy implementers and beneficiaries in public-private organisations.
Design/methodology/approach
This paper has adopted a mixed research method with both qualitative and quantitative data, with in-depth interviews, document analysis and focus groups discussions. A total of 107 participants took part in the interviews and the questionnaire survey.
Findings
The study found that these factors greatly affect the quality of healthcare services from the implementers’ perspectives — referrals, effectiveness in monitoring, timeliness, efficiency, reimbursement, compliance with standard guidelines of Ghana Health Service (GHS) and accreditation process. For the beneficiaries, three healthcare services factors are important, including medical consultations, diagnostic services and the supply of drugs and medicines. Some other factors are found to be the least prioritized healthcare services, namely the issuance of prescription forms, verification of identification (ID) cards and staff attitude. However, the study found that implementers and beneficiaries exhibited a mixed reaction (perspectives) on accessing some healthcare services. In some healthcare services where the implementers perceived that beneficiaries have more access to such services, the beneficiaries think otherwise, an irony in the perspectives of the two actors.
Originality/value
This paper adds to the extant literature on the perspectives of policy implementers and beneficiaries on factors that affect the quality of healthcare services in general and specifically on the implementation of NHIS in Ghana with the public-private dimension.
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Mitch Blair, Mariana Miranda Autran Sampaio, Michael Rigby and Denise Alexander
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…
Abstract
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.
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Santosh Kumar Shrivastav and Surajit Bag
The purpose of this study is to examine various data sources to identify trends and themes in humanitarian supply chain management (HSCM) in the digital age.
Abstract
Purpose
The purpose of this study is to examine various data sources to identify trends and themes in humanitarian supply chain management (HSCM) in the digital age.
Design/methodology/approach
In this study, various data sources such as published literature and social media content from Twitter, LinkedIn, blogs and forums are used to identify trending topics and themes on HSCM using topic modelling.
Findings
The study examined 33 published literature and more than 94,000 documents, including tweets and expert opinions, and identified eight themes related to HSCM in the digital age namely “Digital technology enabled global partnerships”, “Digital tech enabled sustainability”, “Digital tech enabled risk reduction for climate changes and uncertainties”, “Digital tech enabled preparedness, response and resilience”, “Digital tech enabled health system enhancement”, “Digital tech enabled food system enhancement”, “Digital tech enabled ethical process and systems” and “Digital tech enabled humanitarian logistics”. The study also proposed a framework of drivers, processes and impacts for each theme and directions for future research.
Originality/value
Previous research has predominantly relied on published literature to identify emerging themes and trends on a particular topic. This study is unique because it examines the ability of social media sources such as blogs, websites, forums and published literature to reveal evolving patterns and trends in HSCM in the digital age.
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J. Anke M. van Eekelen, Justine A. Ellis, Craig E. Pennell, Richard Saffery, Eugen Mattes, Jeff Craig and Craig A. Olsson
Genetic risk for depressive disorders is poorly understood despite consistent suggestions of a high heritable component. Most genetic studies have focused on risk associated with…
Abstract
Genetic risk for depressive disorders is poorly understood despite consistent suggestions of a high heritable component. Most genetic studies have focused on risk associated with single variants, a strategy which has so far only yielded small (often non-replicable) risks for depressive disorders. In this paper we argue that more substantial risks are likely to emerge from genetic variants acting in synergy within and across larger neurobiological systems (polygenic risk factors). We show how knowledge of major integrated neurobiological systems provides a robust basis for defining and testing theoretically defensible polygenic risk factors. We do this by describing the architecture of the overall stress response. Maladaptation via impaired stress responsiveness is central to the aetiology of depression and anxiety and provides a framework for a systems biology approach to candidate gene selection. We propose principles for identifying genes and gene networks within the neurosystems involved in the stress response and for defining polygenic risk factors based on the neurobiology of stress-related behaviour. We conclude that knowledge of the neurobiology of the stress response system is likely to play a central role in future efforts to improve genetic prediction of depression and related disorders.
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Peter Littlejohns, Katharina Kieslich, Albert Weale, Emma Tumilty, Georgina Richardson, Tim Stokes, Robin Gauld and Paul Scuffham
In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While…
Abstract
Purpose
In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process.
Design/methodology/approach
Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach.
Findings
A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool.
Research limitations/implications
The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience.
Practical implications
All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges.
Social implications
This study helps in increasing public involvement in complex health challenges.
Originality/value
No other groups have used this combination of approaches to address this issue.
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Vartika Sharma, Nikki Singh, Annie Chiang, Janine Paynter and Rachel Simon-Kumar
With global migration, the number of ethnic minority and migrant women receiving maternity health care in dominantly Anglo-European societies has increased significantly but they…
Abstract
Purpose
With global migration, the number of ethnic minority and migrant women receiving maternity health care in dominantly Anglo-European societies has increased significantly but they consistently have among the worst pregnancy and maternal outcomes. This paper aims to analyse gaps in structural (migration-related inequalities) and cultural (responsiveness to ethno-cultural practices) competencies among maternal health practitioners in Aotearoa New Zealand (NZ).
Design/methodology/approach
Using a semi-structured interview guide, in-depth interviews were conducted with 13 maternal health practitioners in NZ. Data were analysed using a thematic analysis framework.
Findings
The results highlight significant barriers around language and communication, cultural stereotyping by professionals, ethnic women’s own constraints around family and cultural expectations and their lack of knowledge about reproductive health. In addition, practitioners’ own ethnic differences are inseparable from their approach to structural and cultural competencies; there were instances of ‘over-’ or ‘under-’ reading of culture, practitioner constructions of ideal pregnancies and anti-racism concerns that shaped maternal care practices that were sensitive to, but also marginalised, ethnic migrant women who attended maternity services.
Originality/value
To the best of the authors’ knowledge, this is the only study in NZ that examines the impact of complex dynamics of migration and culture on knowledge, beliefs and values of practitioners, in context of their own personal biographies. Identifying strategies to improve the way diversity is practiced in hospital settings can be transformational in improving maternal outcomes for ethnic migrant women in NZ.
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Purwoko Aji Prabowo, Bambang Supriyono, Irwan Noor and M. Khairul Muluk
The purpose of this study is to evaluate the Special Autonomy policy to improve the community welfare of Papua Province.
Abstract
Purpose
The purpose of this study is to evaluate the Special Autonomy policy to improve the community welfare of Papua Province.
Design/methodology/approach
This study was carried out using a qualitative approach assessing program activities and client satisfaction. It focused on program activity, target and implementation effectively and efficiently, involving the client’s evaluation process. Research data was obtained from the Papua Regional Development Planning Agency and separated into primary and secondary sources. Primary data was obtained through observation, interview and documentation from several informants. The informants were determined based on the role and involvement in the Papua Province Special Autonomy. Secondary data sources were obtained through field studies, scientific journals, previous research, written documents from relevant agencies, internet and electronic and print media.
Findings
This study exhibits characteristics of Papua Province Special Autonomy, which are identical to an asymmetric decentralization model, although it took 20 years of implementation because of the lack of evaluation and improvement. It disproves Katorobo’s (2004) theory that the said asymmetric decentralization model is more effective than symmetrical decentralization. Material requirement planning (MRP) empowerment or abolition should be considered important because of the lack of positive results. Otsus needs to improve the system and financial management, considering financial distribution for developed regions in the coastal areas and plains rather than mountainous regions.
Originality/value
This research was conducted because of the phenomenon of Papua Province Special Autonomy, also driven by the problems in the implementation of Special Autonomy Policy for Papua Province that had not borne optimum results. This study aimed to make recommendations for the Special Autonomy policy of the Papua Province to improve community welfare.
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