Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Disease Control Priorities Third Edition Is Published: A Theory of Change Is Needed for Translating Evidence to Health Policy771777350910.15171/ijhpm.2018.60ENOle F.NorheimDepartment of Global Public Health and Primary Care, University of Bergen, Bergen, Norway0000-0002-5748-5956Journal Article20180301<span class="fontstyle0">How can evidence from economic evaluations of the type the Disease Control Priorities project have synthesized be translated to better priority setting? This evidence provides insights into how investing in health, particularly though priority interventions and expanded access to health insurance and prepaid care, can not only save lives but also help alleviate poverty and provide financial risk protection. The article discusses some of the relevant factors needed to develop a Theory of Change for translating economic evidence to better priority setting within countries, and proposes some key strategic choices that are necessary to achieve the desired outputs and outcomes.</span> <br /><br />Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901The Qualitative Descriptive Approach in International Comparative Studies: Using Online Qualitative Surveys778781344510.15171/ijhpm.2017.142ENBrayanV. SeixasSchool of Population and Public Health, Faculty of Medicine, University of
British Columbia, Vancouver, BC, CanadaNealeSmithCentre for Clinical Epidemiology &
Evaluation, Vancouver Coastal Health Research Institute, University of British
Columbia, Vancouver, BC, CanadaCraigMittonCentre for Clinical Epidemiology &
Evaluation, Vancouver Coastal Health Research Institute, University of British
Columbia, Vancouver, BC, CanadaJournal Article20170927<span class="fontstyle0">International comparative studies constitute a highly valuable contribution to public policy research. Analysing different policy designs offers not only a mean of knowing the phenomenon itself but also gives us insightful clues on how to improve existing practices. Although much of the work carried out in this realm relies on quantitative appraisal of the data contained in international databases or collected from institutional websites, countless topics may simply not be studied using this type of methodological design due to, for instance, the lack of reliable databases, sparse or diffuse sources of information, etc. Here then we discuss the use of the qualitative descriptive approach as a methodological tool to obtain data on how policies are structured. We propose the use of online qualitative surveys with key stakeholders from each relevant national context in order to retrieve the fundamental pieces of information on how a certain public policy is addressed there. Starting from Sandelowski’s seminal paper on qualitative descriptive studies, we conduct a theoretical reflection on the current methodological proposition. We argue that a researcher engaged in this endeavour acts like a composite-sketch artist collecting pieces of information from witnesses in order to draw a valid depiction of reality. Furthermore, we discuss the most relevant aspects involving sampling, data collection and data analysis in this context. Overall, this methodological design has a great potential for allowing researchers to expand the international analysis of public policies to topics hitherto little appraised from this perspective.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901The International Landscape of Medical Licensing Examinations: A Typology Derived From a Systematic Review782790349110.15171/ijhpm.2018.32ENTristanPriceCollaboration for the Advancement of Medical Education Research &
Assessment (CAMERA), University of Plymouth, Plymouth, UKPeninsula
Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UKNickLynnCollaboration for the Advancement of Medical Education Research &
Assessment (CAMERA), University of Plymouth, Plymouth, UKPeninsula
Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UKLeeCoombesSchool
of Medicine, Cardiff University, Wales, UKMartinRobertsCollaboration for the Advancement of Medical Education Research &
Assessment (CAMERA), University of Plymouth, Plymouth, UKPeninsula
Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UKTomGaleCollaboration for the Advancement of Medical Education Research &
Assessment (CAMERA), University of Plymouth, Plymouth, UKPeninsula
Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UKSamRegan De BereCollaboration for the Advancement of Medical Education Research &
Assessment (CAMERA), University of Plymouth, Plymouth, UKPeninsula
Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UKJulianArcherCollaboration for the Advancement of Medical Education Research &
Assessment (CAMERA), University of Plymouth, Plymouth, UKPeninsula
Schools of Medicine & Dentistry, University of Plymouth, Plymouth, UKJournal Article20170707<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">National licensing examinations (NLEs) are large-scale examinations usually taken by medical doctors close to the point of graduation from medical school. Where NLEs are used, success is usually required to obtain a license for full practice. Approaches to national licensing, and the evidence that supports their use, varies significantly across the globe. This paper aims to develop a typology of NLEs, based on candidacy, to explore the implications of different examination types for workforce planning.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">A systematic review of the published literature and medical licensing body websites, an electronic survey of all medical licensing bodies in highly developed nations, and a survey of medical regulators.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">The evidence gleaned through this systematic review highlights four approaches to NLEs: where graduating medical students wishing to practice in their national jurisdiction must pass a national licensing exam before they are granted a license to practice; where </span><span class="fontstyle0">all </span><span class="fontstyle0">prospective doctors, whether from the national jurisdiction or international medical graduates, are required to pass a national licensing exam in order to practice within that jurisdiction; where international medical graduates are required to pass a licensing exam if their qualifications are not acknowledged to be comparable with those students from the national jurisdiction; and where there are no NLEs in operation. This typology facilitates comparison across systems and highlights the implications of different licensing systems for workforce planning.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">The issue of national licensing cannot be viewed in isolation from workforce planning; future research on the efficacy of national licensing systems to drive up standards should be integrated with research on the implications of such systems for the mobility of doctors to cross borders.</span> <br /><br />Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Development and Content Validation of a Transcultural Instrument to Assess Organizational Readiness for Knowledge Translation in Healthcare Organizations: The OR4KT791797347410.15171/ijhpm.2018.17ENMarie-PierreGagnonPopulation Health and Optimal Health Practices Research Unit, CHU de
Québec-Université Laval Research Centre, Québec, QC, CanadaFaculty
of Nursing, Université Laval, Québec, QC, Canada0000000207825457RandaAttiehPopulation Health and Optimal Health Practices Research Unit, CHU de
Québec-Université Laval Research Centre, Québec, QC, CanadaCRED Research Centre
– École Supérieure des Affaires, Beirut, LebanonSandraDunnCHEO Research Institute,
Centre for Practice Changing Research Building, Ottawa, ON, CanadaBetter
Outcomes Registry & Nerwork (BORN) Ontario, Ottawa, ON, CanadaGonzaloGrandesPrimary
Care Research Unit of Bizkaia – Osakidetza, Basque Health Service, Bilbao,
SpainBioCruces Health Research Institute, Baracaldo, SpainPaolaBullyPrimary
Care Research Unit of Bizkaia – Osakidetza, Basque Health Service, Bilbao,
SpainBioCruces Health Research Institute, Baracaldo, SpainCarole AEstabrooksFaculty of
Nursing and School of Public Health, University of Alberta, Edmonton, AB,
CanadaFranceLégaréDepartment of Family Medicine, Université Laval, Québec, QC,
CanadaGenevièveRochPopulation Health and Optimal Health Practices Research Unit, CHU de
Québec-Université Laval Research Centre, Québec, QC, CanadaFaculty
of Nursing, Université Laval, Québec, QC, CanadaMathieuOuimetPopulation Health and Optimal Health Practices Research Unit, CHU de
Québec-Université Laval Research Centre, Québec, QC, CanadaDepartment of Nursing Sciences, Université Laval, Québec, QC,
CanadaJournal Article20170821<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Implementing effective interventions in healthcare requires organizations to be ready to support change. This study aimed to develop, adapt transculturally, and assess the content and face validity of the Organizational Readiness for Knowledge Translation (OR4KT) tool. The OR4KT was designed to measure the readiness of healthcare organizations to implement evidence-informed change across a variety of services.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Based on systematic reviews of the literature, a Delphi exercise, and expert consultation, we first generated an initial pool of items. Second, we developed and assessed content validity of the pilot OR4KT questionnaire in English. Third, we created French and Spanish versions using a sequential forward and backward translation approach, and transcultural adaptation by a consensus process. Finally, we conducted pilot studies in three contexts – the Basque country region (Spain), and the provinces of Québec and Ontario (Canada) – where 30 experts assessed the face validity of the three versions of OR4KT.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">We selected 59 items, grouped in 6 dimensions (organizational climate, context, change content, leadership, organizational support, and motivation) for the final English version of OR4KT. Translation and transcultural adaptation did not identify any content or language problems. Our findings indicate that the English, French and Spanish versions of OR4KT are linguistically equivalents and have high face validity. Only minor revisions to the wording of some items were recommended.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">The OR4KT holds promise as a measure of readiness for knowledge translation (KT) in healthcare organizations. The validity and reliability of the three versions of the OR4KT will be assessed in real-life contexts of implementation of evidence-based changes in healthcare.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria 2010798806347710.15171/ijhpm.2018.19ENBolajiSamson AregbesholaDepartment of Community Health & Primary Care, College of Medicine,
University of Lagos, Lagos, Nigeria0000-0001-9944-2543SaminaMohsin KhanDepartment of Public Health Sciences,
Karolinska Institutet, Stockholm, SwedenJournal Article20170627<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">There is high reliance on out-of-pocket (OOP) health payments as a means of financing health system in Nigeria. OOP health payments can make households face catastrophe and become impoverished. The study aims to examine the financial burden of OOP health payments among households in Nigeria.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Secondary data from the Harmonized Nigeria Living Standard Survey (HNLSS) of 2009/2010 was utilized to assess the catastrophic and impoverishing effects of OOP health payments on households in Nigeria. Data analysis was carried out using ADePT 6.0 and STATA 12.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">We found that a total of 16.4% of households incurred catastrophic health payments at 10% threshold of total consumption expenditure while 13.7% of households incurred catastrophic health payments at 40% threshold of nonfood expenditure. Using the $1.25 a day poverty line, poverty headcount was 97.9% gross of health payments. OOP health payments led to a 0.8% rise in poverty headcount and this means that about 1.3 million Nigerians are being pushed below the poverty line. Better-off households were more likely to incur catastrophic health payments than poor households.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Our study shows the urgency with which policy makers need to increase public healthcare funding and provide social health protection plan against informal OOP health payments in order to provide financial risk protection which is currently absent among high percentage of households in Nigeria.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Health Promotion at Local Level in Norway: The Use of Public Health Coordinators and Health Overviews to Promote Fair Distribution Among Social Groups807817347910.15171/ijhpm.2018.22ENSusanneHagenDepartment of Health, Social and Welfare Studies, University College of
Southeast Norway, Kongsberg, Norway0000-0003-3392-160XKjellIvar ØvergårdDepartment of Maritime Operations,
University College of Southeast Norway, Kongsberg, Norway0000-0002-4029-4344MaritHelgesenInstitute for
Urban and Regional Research, OsloMet – Oslo Metropolitan University, Oslo,
NorwayElisabethFosseDepartment of Health Promotion and Development, University of
Bergen, Bergen, Norway0000-0002-6038-5059SteffenTorpDepartment of Health, Social and Welfare Studies, University College of
Southeast Norway, Kongsberg, NorwayJournal Article20170710<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Norway is internationally known today for its political and socio-economic prioritization of equity. The 2012 Public Health Act (PHA) aimed to further equity in the domain of health by addressing the social gradient in health. The PHA’s main policy measures were (1) delegation to the municipal level of responsibility for identifying and targeting underserved groups and (2) the imposition on municipalities of a “Health in All Policies” (HiAP) approach where local policy-making </span><span class="fontstyle0">generally </span><span class="fontstyle0">is considered in light of public health impact. In addition, the act recommended municipalities employ a public health coordinator (PHC) and required a development of an overview of their citizens’ health to reveal underserved social segments. This study investigates the relationship between changes in municipal use of HiAP tools (PHC and health overviews) with regard to the PHA implementation and municipal prioritization of fair distribution of social and economic resources among social groups.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Data from two surveys, conducted in 2011 and 2014, were merged with official register data. All Norwegian municipalities were included (N = 428). Descriptive statistics as well as bi- and multivariate logistic regression analyses were performed.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Thirty-eight percent of the municipalities reported they generally considered fair distribution among social groups in local policy-making, while 70% considered fair distribution in their local health promotion initiatives. Developing health overviews after the PHA’s implementation was positively associated with prioritizing fair distribution in political decision-making (odds ratio [OR] = 2.54; CI: 1.12-5.76), compared to municipalities that had not developed such overviews. However, the employment of PHCs after the implementation was negatively associated with prioritizing fair distribution in local health promotion initiatives (OR = 0.22; CI: 0.05-0.90), compared to municipalities without that position.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Development of health overviews </span><span class="fontstyle0">— </span><span class="fontstyle0">as requested by the PHA — may contribute to prioritization of fair distribution among social groups with regard to the social determinants of health at the local level.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901An Investigation of Prescription Indicators and Trends Among General Practitioners and Specialists From 2005 to 2015 in Kerman, Iran818827348910.15171/ijhpm.2018.28ENAliMasoudHealth Services Management Research Center, Institute for Futures Studies
in Health, Kerman University of Medical Sciences, Kerman, IranSomayehNoori HekmatResearch
Center for Modeling in Health, Institute for Futures Studies in Health, Kerman
University of Medical Sciences, Kerman, IranRezaDehnaviehHealth Services Management Research Center, Institute for Futures Studies
in Health, Kerman University of Medical Sciences, Kerman, IranNaserHaj-AkbariPhysiology Research Center,
Kerman University of Medical Sciences, Kerman, IranAtousaPoursheikhaliHealth Services Management Research Center, Institute for Futures Studies
in Health, Kerman University of Medical Sciences, Kerman, IranZhalehAbdiNational Institute of
Health Research (NIHR), Tehran University of Medical Sciences, Tehran, IranJournal Article20170112<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">The World Health Organization (WHO) aims to promote strategies that ensure efficacy, safety, suitability, and cost effectiveness of medicine prescription. Health systems should design effective mechanisms to monitor prescription and rational use of medicines at all healthcare settings. This study aimed to determine and analyze prescription patterns of general practitioners and specialists in Kerman/Iran from 2005 to 2015.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> This is an explanatory mixed method study. Data were gathered during two phases. At the first phase, prescriptions issued by physicians during 2005-2015 were reviewed to extract information required to develop eight main prescription indicators. In the second phase, the indicators trends were presented to experts participating in expert panel to have their opinions and analyses on the data obtained in the first phase. Experts were selected based on their experience and expertise in medicine and/or health policy and/or experience in implementation of polices to promote rational use of medicines. Some experts attending the panel were a sample of physicians whose prescriptions were included in the first phase.<br /> <br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Findings revealed that two indicators of the average price of prescriptions and the maximum number of medicines </span>in each prescription had an increasing trend over the study period. Reasons including unprecedented devaluation of the Iranian Rial and willingness of young physicians to prescribe more medications were proposed as the primary contributors to the observed increasing trends. However, other indicators including types of prescribed medicines, average number of medicines per prescription, the percentage of prescriptions with more than four medications, a percentage of encounters with a corticosteroid prescribed, a percentage of encounters with an antibiotic prescribed, and a percentage of encounters with an injection prescribed decreased in the study period. Reasons of controlling initiatives adopted by the Ministry of Health, the higher responsibility of physicians, adoption of continued medical education (CME) programs, and improved knowledge of pharmacists, physicians, and patients about irrational use of medicines were proposed by participants as the main reasons for the decreasing trend.<br /> <br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Findings indicated that prescription indicators were better in Kerman than those of country average over the study period based on comparing the results of this study and others in Iran. However, they were non-desirable when compared to the international average. The number of factors contributes to the irrational use of medicines, including lack of knowledge among healthcare providers and patients, patients’ misunderstanding about the efficacy of some particular medicines, the high cost of drug development and manufacturing, and unavailability of effective medicines.</span> <br /><br />Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Inclusion of Health in Environmental Impact Assessment of Major Transport Infrastructure Projects in Vietnam828835349210.15171/ijhpm.2018.36ENTracyPhamFaculty of Science, The University of Sydney, Sydney, NSW, AustraliaEmilyRileyMenzies Centre for Health Policy, School of Public Health, Sydney Medical
School, The University of Sydney, Sydney, NSW, AustraliaPatrickHarrisMenzies Centre for Health Policy, School of Public Health, Sydney Medical
School, The University of Sydney, Sydney, NSW, Australia0000-0002-4649-4013Journal Article20170719<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Infrastructure spending, especially in the transport sector, is expected to increase rapidly in Vietnam. This boost in transportation investment impacts health. Environmental impact assessments (EIAs) are essential tools for decision-making to reduce and mitigate anticipated impacts of development projects, and integration of health assessment as an essential part of the EIA process has been regulated in many high-income countries. There is, however, limited knowledge about how health is evaluated in these environmental assessments in low- and middle-income countries (LMICs) such as Vietnam.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">We did an analysis of EIAs of four major transport projects in Vietnam, applying a six-step coding framework previously used to investigate EIAs in the Australian context.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">We found that health was inadequately considered in all four EIAs. There was no direct health assessment within the four EIAs due to the lack of formal requirements from either Government or the financing agency, the Asian Development Bank (ADB). Health issues were often identified as risks posed by the projects within the assessment of impacts on environmental conditions. A broader consideration of health was limited. When social outcomes of the projects were present in EIAs, they were often mentioned once without any detailed assessment or linking to health. There was no evidence linking health benefits and shifts towards active travel with the construction of two metro rail projects. Mitigation measures offered in all four EIAs were found to be generic and insubstantial.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">The health assessments in the EIAs of four transport projects in Vietnam were significantly less detailed than those in Australia, mainly due to the lack of legislative requirements. The lack of health content indicates the need for involvement of health experts in the environmental assessment process, as well as requirements for the health assessment to be integrated in EIA. Our findings suggest there is the need to build capacity both within and outside of government to fully consider the health impacts of infrastructure in EIA practice.</span> <br /><br />Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Volunteering for Health Services in the Middle Part of Ghana: In Whose Interest?836846349410.15171/ijhpm.2018.38ENSamuelAfari-AsieduKintampo Health Research Centre, Ghana Health Service, Kintampo, GhanaKwaku PokuAsanteKintampo Health Research Centre, Ghana Health Service, Kintampo, GhanaKodjoSenahDepartment of Sociology, School of Social Science, University of Ghana,
Accra, GhanaMartha AliAbdulaiKintampo Health Research Centre, Ghana Health Service, Kintampo, GhanaStephenAfranieDepartment of Sociology, School of Social Science, University of Ghana,
Accra, GhanaEmmanuelMahamaKintampo Health Research Centre, Ghana Health Service, Kintampo, GhanaEdward AprakuAnaneKintampo Health Research Centre, Ghana Health Service, Kintampo, GhanaMahamaAbukariKintampo Health Research Centre, Ghana Health Service, Kintampo, GhanaMartin LutherDarkoDepartment of Sociology, School of Social Science, University of Ghana,
Accra, GhanaLawrence G.FebirKintampo Health Research Centre, Ghana Health Service, Kintampo, GhanaSethOwusu-AgyeiInstitute of Health Research, University of Health and Allied
Sciences, Ho, GhanaKintampo Health Research Centre, Ghana Health Service, Kintampo, GhanaJournal Article20170215<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">In many developing countries like Ghana, community volunteers assist in the provision of certain health services to rural and hard-to-reach communities. This study examined factors that influence the motivation and retention of community-based volunteers supporting with work on health-related activities at the community level in Ghana.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Using a sequential mixed-method design, a cross-sectional survey was carried out among 205 selected community-based volunteers in Kintampo North Municipality (KNM) and Kintampo South District (KSD) of Ghana between December, 2014 and February, 2015. Qualitative interviews, including 12 in-depth interviews (IDIs) among health workers and community opinion leaders and 2 focus group discussion (FGD) sessions with volunteers were conducted.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Personal interest (32.7%) and community leaders’ selection of volunteers (30.2%) were key initial reasons for volunteering. Monetary incentives such as allowance for extra duty (88.8%) and per diem (49.3%) and non-monetary incentives such as T-shirts/bags (45.4 %), food during training (52.7%), community recognition, social prestige and preferential treatment at health facilities were the facilitators of volunteers’ retention. There was a weak evidence (</span><span class="fontstyle0">P </span><span class="fontstyle0">= .051) to suggest that per diem for their travels is a reason for volunteers’ satisfaction.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Community-based volunteers’ motivation and retention were influenced by their personal interest in the form of recognition by community members and health workers, community leaders’ selection and other nonmonetary incentives. Volunteers were motivated by extra-duty allowance but not per diems paid for accommodation and feeding when they travel. Organizations that engage community volunteers are encouraged to strengthen the selection of volunteers in collaboration with community leaders, and to provide both non-monetary and monetary incentives to motivate volunteers.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Retaining Doctors in Rural Bangladesh: A Policy Analysis847858349510.15171/ijhpm.2018.37ENTaufiqueJoarderJames P Grant School of Public Health, BRAC University, Dhaka, Bangladesh0000-0002-3299-2628Lal B.RawalHERD International,
Kathmandu, NepalSyed MasudAhmedCentre of Excellence for Health Systems and Universal
Health Coverage, James P Grant School of Public Health, BRAC University,
Dhaka, BangladeshAftabUddinInternational Center for Diarrheal Disease Research,
Bangladesh (icddr,b), Dhaka, BangladeshTimothy G.EvansHealth Nutrition and Population,
Human Development Network, The World Bank, Washington, DC, USAJournal Article20170805<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Retaining doctors in rural areas is a challenge in Bangladesh. In this study, we analyzed three rural retention policies: career development programs, compulsory services, and schools outside major cities – in terms of context, contents, actors, and processes.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Series of group discussions between policy-makers and researchers prompted the selection of policy areas, which were analyzed using the policy triangle framework. We conducted document and literature reviews (1971-2013), key informant interviews (KIIs) with relevant policy elites (n = 11), and stakeholder analysis/position-mapping.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">In policy-1, we found, applicants with relevant expertise were not leveraged in recruitment, promotions were often late and contingent on post-graduation. Career tracks were porous and unplanned: people without necessary expertise or experience were deployed to high positions by lateral migration from unrelated career tracks or ministries, as opposed to vertical promotion. Promotions were often politically motivated. In policy-2, females were not ensured to stay with their spouse in rural areas, health bureaucrats working at district and sub-district levels relaxed their monitoring for personal gain or political pressure. Impractical rural posts were allegedly created to graft money from applicants in exchange for recruitment assurance. Compulsory service was often waived for political affiliates. In policy-3, we found an absence of clear policy documents obligating establishment of medical colleges in rural areas. These were established based on political consideration (public sector) or profit motives (private sector).<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Four cross-cutting themes were identified: lack of proper systems or policies, vested interest or corruption, undue political influence, and imbalanced power and position of some stakeholders. Based on findings, we recommend, in policy-1, applicants with relevant expertise to be recruited; recruitment should be quick, customized, and transparent; career tracks (General Health Service, Medical Teaching, Health Administration) must be clearly defined, distinct, and respected. In policy-2, facilities must be ensured prior to postings, female doctors should be prioritized to stay with the spouse, field bureaucrats should receive non-practising allowance in exchange of strict monitoring, and no political interference in compulsory service is assured. In policy-3, specific policy guidelines should be developed to establish rural medical colleges. Political commitment is a key to rural retention of doctors.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Malaria Knowledge and Treatment Practices in Enugu State, Nigeria: A Qualitative Study859866349610.15171/ijhpm.2018.41ENBenjamin Sunday C.UzochukwuDepartment of Community Medicine, College of Medicine, University of Nigeria,
Enugu Campus, Enugu State, NigeriaHealth Policy and Research Group
Enugu, Enugu State, Nigeria0000-0002-0794-0455Edmund NdudiOssaiDepartment of Community Medicine, College
of Health Sciences, Ebonyi State University, Abakaliki, Nigeria0000-0002-4098-4898Chinyere CeciliaOkekeDepartment
of Community Medicine, University of Nigeria Teaching Hospital Ituku-Ozalla,
Enugu State, Nigeria0000-0002-2599-537XAnne ChigeduNduDepartment of Community Medicine, College of Medicine, University of Nigeria,
Enugu Campus, Enugu State, NigeriaObinna E.OnwujekweHealth Policy and Research Group
Enugu, Enugu State, NigeriaJournal Article20170315<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Malaria accounts for 60% of outpatient visits in Nigeria. The aim of the study was to assess the knowledge of malaria and its treatment practices in Enugu state, Nigeria.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Qualitative data was collected through the use of focus group discussions (FGDs), from six villages three each from urban and rural areas of Enugu state, Nigeria. A total of 18 FGDs involving 189 participants were conducted and data on place of treatment for malaria and drug of choice for malaria treatment were collected.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">Most discussants had a good knowledge of the signs and symptoms of malaria. They reported late for treatment when they had symptoms suggestive of malaria. Treatment timing was affected by financial capability and perceived severity of disease. There was preference for patent medicine dealers (PMDs) and pharmacies for malaria treatment. The reasons included drug affordability, obtaining preferred drug, short waiting time and polite treatment from the providers. Treatment in most cases was without proper malaria diagnosis. Cost was an important factor in determining the drug of choice for malaria treatment. This could explain why people were not aware of the use of artemisininbased combination therapy while preferring mono-therapies and herbal drugs. Public hospitals were considered as good sources of treatment for malaria although they remain the last resort when treatment from these drug outlets failed.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">The community members preferred PMDs and pharmacies for malaria treatment. Unfortunately, these drug outlets do not encourage the use of artemisinin combination therapy (ACT). This makes it necessary that pharmacists and PMDs are trained on management of malaria. Also, improving the knowledge of the public on the need for malaria diagnosis before treatment and use of artemisinin-based combination therapy will improve the control of malaria. The populace should be instructed to seek treatment early while also discouraging the use of herbal drugs for malaria treatment. There is also the need to improve service delivery at public health facilities.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Disturbing the Doxa of Patient Safety; Comment on “False Dawns and New Horizons in Patient Safety Research and Practice”867869349310.15171/ijhpm.2018.26ENJoanneTravagliaCentre for Health Services Management, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia0000-0002-7537-0466Journal Article20171204<span class="fontstyle0">In a recent edition of this journal, Mannion and Braithwaite provide a succinct analysis of the emergence, and ultimately limited impact, of what they term the current ‘Safety I’ movement in healthcare. They describe the arc of this field from denial, through engagement via mechanisms and approaches imported from other industries, to the current situation where, despite ‘best efforts,’ error rates remain stubbornly recalcitrant.<br /></span><br /> <span class="fontstyle0">In examining the failure of system-wide efforts to produce sustained reductions in errors and adverse events, that article exposes the doxa, or what Bourdieu calls ‘the taken for granted’ which is central to this latest wave of patient safety movement. In this commentary, I would like to take focus on two key elements of Mannion and Braithwaite’s argument: that harm is caused by misguided but otherwise well-intentioned actions and the ‘embracing’ of patient safety. I then conclude by briefly considering the implications of these for Safety II, particularly as envisaged by the authors as an evolutionary, and therefore linear progression, from Safety I.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Achieving Integrated Care for Older People: What Kind of Ship?; Comment on “Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight for the Future?”870873349810.15171/ijhpm.2018.44ENRodSheaffUniversity of Plymouth, Plymouth, UK0000-0002-7984-2627Journal Article20180221<span class="fontstyle0">This paper considers an implication of the idea that proposals for integrated care for older people should start from a focus on the patient, consider co-production solutions to the problems of care fragmentation, and be at a system-wide, cross-organisational level. It follows that the analysis, design and therefore evaluation of integrated care projects should be based upon the journeys which older patients with multiple chronic conditions usually have to make from professional to professional and service to service. A systematic realistic review of recent research on integrated care projects identified a number of key mechanisms for care integration, including multidisciplinary care teams, care planning, suitable IT support and changes to organisational culture, besides other activities and contexts which assist care ‘integration.’ Those findings suggest that bringing the diverse services that older people with multiple chronic conditions need into a single organisation would remove many of the inter-organisational boundaries that impede care ‘integration’ and make it easier to address the interprofessional and inter-service boundaries.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Researching Healthy Public Policy: Navigating the ‘Black Box’ Means Thinking More About Power; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”874876350410.15171/ijhpm.2018.52ENPatrickHarrisUniversity of Sydney, School of Public Health, Menzies Centre for Health Policy, Sydney, NSW, Australia0000-0002-4649-4013Journal Article20180319<span class="fontstyle0">Lawless et al provide a valuable narrative of using program logic to develop an evaluation of Health in All Policies (HiAP) in South Australia. In this commentary I argue that the paper and analysis is an extremely useful example of navigating the supposed black box of policy-making. However the original makes the reader work too hard and is distracting from the main narrative of explaining the logic behind the HiAP approach in South Australia. My response covers avoiding epistemological traps and weighing up the pragmatics of collaborative policy research with more complex institutional policy issues like power.</span>Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397920180901Inpatient Out-of-Pocket in Iran After Health Transformation Plan877878348710.15171/ijhpm.2018.34ENSulmazGhahramaniHealth Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran0000-0002-4161-5146KamranBagheri LankaraniHealth Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, IranJournal Article20180103Inpatient Out-of-Pocket in Iran After Health Transformation Plan