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Kesale AM. Do community health committees participate in governing health workers in primary healthcare facilities under fiscal decentralization?-An explanatory qualitative study from Tanzania. Health Sci Rep 2024; 7:e1866. [PMID: 38361807 PMCID: PMC10867382 DOI: 10.1002/hsr2.1866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 02/17/2024] Open
Abstract
Background Decentralization is implemented at the local level to increase community participation in improving service delivery. Majority of developing countries are implementing Fiscal decentralization in primary healthcare through various approaches such as Direct Health Facility Financing, among other things, to empower Community governance structures to govern Primary Health Facility operations to improve the responsiveness of health service delivery and achieve Universal Health Coverage. One of the primary functions of these governance committees is to oversee health workers in their health facilities. Aims This aimed at assessing how empowered governance committees govern health workers in their facilities under fiscal decentralization. Methods To collect data for this study, an explanatory qualitative design with phenomenology traditions was used. To select the area of study, health facilities, and participants, a purposeful sampling procedure was used. Data were gathered through interviews and Focus Group Discussions to explore committee participation in governing health workers in primary care. Thematic analysis was used to analyze the collected data. Result The findings of the study suggest that community governance committees' participation in governing health workers under fiscal decentralization remains limited. Majority of the committees have found to have low limited participation in governing different aspects of health workers. The majority of the committees have discovered that hiring casual workers such as security guards and cleaners is more important than other functions. Conclusion The study implies that lower and middle-income countries' willingness to implement fiscal reforms at the local level and empower communities to take the lead in governing health workers still there are very limited specific powers granted to them to govern health workers. Therefore, capacity building to the governance actors is critical if we are to achieve the benefit of fiscal decentralization.
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Affiliation(s)
- Anosisye Mwandulusya Kesale
- Department of Local Government Management, School of Public Administration and ManagementMzumbe UniversityMorogoroTanzania
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Kesale AM, Kinyaga A, Mwakasangula E, Mollel H, Rashid SS. Who makes health governance decisions at the local level? A cross sectional study from primary health facilities in Tanzania. Health Sci Rep 2023; 6:e1691. [PMID: 37936618 PMCID: PMC10626029 DOI: 10.1002/hsr2.1691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 10/16/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023] Open
Abstract
Background and Aims Lower- and middle-income countries have decentralized decision-making at the community level, as well as community governance structures, to encourage community participation in governance processes, particularly in primary healthcare (PHC). In Tanzania, decentralization resulted in the establishment of Health Facility Governing Committees (HFGCs) to encourage community participation in the governance of primary health facilities to improve the quality and responsiveness of health service delivery. Nonetheless, despite the presence of HFGCs, PHC delivery remains ineffective and of poor quality. It is unclear who makes governance decisions at PHC facilities to ensure that services delivered are of expected quality and respond the community's needs, tastes, and preferences. This paper aims to assess the perspectives of members of the HFGC on who make governance decision in the context of fiscal decentralization. Design and Methods A cross-section design was used to collect both quantitative and qualitative data. A four-multistage sampling technique was adopted to selects regions, council, health facilities, and HFGC members. Respondents who participated in structured questionnaire responses were chosen using proportional sampling, whereas those who participated in in-depth interviews and Focus Group Discussions were chosen using purposive selection. The data was analyzed descriptively and thematically. Results The study revealed that HFGCs members perceive that governance decisions in primary health facilities are primarily made by the health facility management, and later are presented in HFGCs. As such, HFGCs are used a passively used to justify participation in decision that was already made by the management, which contradict with the principal of decentralization that emphasizes community participation on fiscal decisions. Conclusion Decentralization of PHC facilities does not guarantee the participation of community members in fiscal decision of their respective primary health facilities through HFGCs. HFGC is passively used governance structure to substitute community participation in primary health facilities' fiscal decisions. Enforcement mechanisms are required to facilitate effective community participation.
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Affiliation(s)
- Anosisye M. Kesale
- Department of Local Government Management, School of Public Administration and ManagementMzumbe UniversityMorogoroTanzania
| | - Ally Kinyaga
- Center for ReformsInnovation, Health Policies and Implementation Research (CeRIHI)DodomaTanzania
| | - Eliza Mwakasangula
- Department of Public Service and Human Resource Management, School of Public Administration and ManagementMzumbe UniversityMorogoroTanzania
| | - Henry Mollel
- Department of Health SystemMzumbe UniversityMbeyaTanzania
| | - Seif S. Rashid
- PATH, Data Use PartnershipCenter of Digital and Data ExcellenceDar Es SalaamTanzania
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Tun SYY, Madanian S. Clinical information system (CIS) implementation in developing countries: requirements, success factors, and recommendations. J Am Med Inform Assoc 2023; 30:761-774. [PMID: 36749093 PMCID: PMC10018272 DOI: 10.1093/jamia/ocad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 12/15/2022] [Accepted: 01/26/2023] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE Clinical Information System (CIS) usage can reduce healthcare costs over time, improve the quality of medical care and safety, and enhance clinical efficiency. However, CIS implementation in developing countries poses additional, different challenges from the developed countries. Therefore, this research aimed to systematically review the literature, gathering and integrating research findings on Success Factors (SFs) in CIS implementation for developing countries. This helps to integrate past knowledge and develop a set of recommendations, presented as a framework, for implementing CIS in developing countries. MATERIALS AND METHODS A systematic literature review was conducted, followed by qualitative data analysis on the published articles related to requirements and SF for CIS implementation. Eighty-three articles met the inclusion criteria and were included in the data analysis. Thematic analysis and cross-case analysis were applied to identify and categorize the requirements and SF for CIS implementation in developing countries. RESULTS Six major requirement categories were identified including project management, financial resources, government involvement and support, human resources, organizational, and technical requirements. Subcategories related to SF are classified under each major requirement. A set of recommendations is provided, presented in a framework, based on the project management lifecycle approach. CONCLUSION The proposed framework could support CIS implementations in developing countries while enhancing their rate of success. Future studies should focus on identifying barriers to CIS implementation in developing countries. The country-specific empirical studies should also be conducted based on this research's findings to match the local context.
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Affiliation(s)
- Soe Ye Yint Tun
- Department of Computer Science and Software Engineering, School of Engineering, Computer and Mathematical Science, Auckland University of Technology (AUT), Auckland 1010, New Zealand
| | - Samaneh Madanian
- Department of Computer Science and Software Engineering, School of Engineering, Computer and Mathematical Science, Auckland University of Technology (AUT), Auckland 1010, New Zealand
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Kim S, Seshadrinathan S, Jenkins KJ, Murala JS. Can the Public-Private Business Model Provide a Sustainable Quality Pediatric Cardiac Surgery Program in Low- and Middle-Income Countries? World J Pediatr Congenit Heart Surg 2023; 14:316-325. [PMID: 36788012 PMCID: PMC10115927 DOI: 10.1177/21501351221151057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Over 90% of the world's children with congenital heart disease do not have access to cardiac care. Although many models provide pediatric cardiac surgery in low- and middle-income countries, sustainability poses a barrier. We explore one model providing care for the underserved in Chennai, India, that came into existence through trial and error over 30 years across three phases. Phase 1 was a Tamilnadu state government-sponsored program that soon became unsustainable with unmet demands. Phase 2 utilized a grassroots foundation of a public-private partnership (PPP) with few donors and a hospital with suboptimal infrastructure. Phase 3 is the ongoing fine-tuning of the PPP model, with upgraded infrastructure and a well-trained team. Through indigenization, an average cardiac surgery costs Rupees (Rs.) 1,80,000 ($2400). The government funds Rs. 60,000 to 80,000 ($800-$1066.67), and the rest is funded through the fund pool. The goal is to perform 100 free surgeries annually by maintaining a fund pool of Rs. 50 lakhs ($66,666.67), which supplements government funds. This ensures equitable distribution of funds with no compromise on resources (disposables, single-use cannulas, etc). Our model ensures the dignity of the patient, fair compensation for workers, and is practical, affordable, and easily adaptable. Thus far, this model provided free cardiac surgery for 357 children from Risk Adjusted Congenital Heart Surgery Score of 1 to 4, with an overall mortality of 2.73%. The prerequisites for this model are having a "spark plug," a dedicated surgical team, a partnership with state-of-the-art infrastructure, and a steady flow of funds.
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Affiliation(s)
- Stephany Kim
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sreemathi Seshadrinathan
- Department of Cardiovascular and Thoracic Surgery, Public Health Centre, Chennai, Tamil Nadu, India
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA
| | - John S Murala
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Hanson K, Brikci N, Erlangga D, Alebachew A, De Allegri M, Balabanova D, Blecher M, Cashin C, Esperato A, Hipgrave D, Kalisa I, Kurowski C, Meng Q, Morgan D, Mtei G, Nolte E, Onoka C, Powell-Jackson T, Roland M, Sadanandan R, Stenberg K, Vega Morales J, Wang H, Wurie H. The Lancet Global Health Commission on financing primary health care: putting people at the centre. Lancet Glob Health 2022; 10:e715-e772. [PMID: 35390342 PMCID: PMC9005653 DOI: 10.1016/s2214-109x(22)00005-5] [Citation(s) in RCA: 118] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Kara Hanson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Nouria Brikci
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Darius Erlangga
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Abebe Alebachew
- Breakthrough International Consultancy, Addis Ababa, Ethiopia
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Ina Kalisa
- World Health Organization, Kigali, Rwanda
| | | | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - David Morgan
- Health Division, The Organisation for Economic Co-operation and Development, Paris, France
| | | | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Chima Onoka
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | | | | | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, Adetifa IMO, Colbourn T, Ogunlesi AO, Onwujekwe O, Owoaje ET, Okeke IN, Adeyemo A, Aliyu G, Aliyu MH, Aliyu SH, Ameh EA, Archibong B, Ezeh A, Gadanya MA, Ihekweazu C, Ihekweazu V, Iliyasu Z, Kwaku Chiroma A, Mabayoje DA, Nasir Sambo M, Obaro S, Yinka-Ogunleye A, Okonofua F, Oni T, Onyimadu O, Pate MA, Salako BL, Shuaib F, Tsiga-Ahmed F, Zanna FH. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet 2022; 399:1155-1200. [PMID: 35303470 PMCID: PMC8943278 DOI: 10.1016/s0140-6736(21)02488-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Blake Angell
- UCL Institute for Global Health, London, UK; The George Institute for Global Health, UNSW Sydney, Sydney, Australia
| | - Olutobi Sanuade
- UCL Institute for Global Health, London, UK; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Aishatu Lawal Adamu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria; Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ifedayo M O Adetifa
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; Department of Epidemiology and Demography, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics and Child Health, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | | | - Obinna Onwujekwe
- Health Policy Research Group, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Eme T Owoaje
- Department of Community Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Iruka N Okeke
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, USA
| | - Gambo Aliyu
- National Agency for the Control of AIDS, Abuja, Nigeria
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sani Hussaini Aliyu
- Infectious Disease and Microbiology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emmanuel A Ameh
- Division of Paediatric Surgery, National Hospital, Abuja, Nigeria
| | - Belinda Archibong
- Department of Economics, Barnard College, Columbia University, New York, NY, USA
| | - Alex Ezeh
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Muktar A Gadanya
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | | | | | - Zubairu Iliyasu
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Aminatu Kwaku Chiroma
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
| | - Diana A Mabayoje
- Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Stephen Obaro
- Department of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska, USA; International Foundation Against Infectious Diseases in Nigeria, Abuja, Nigeria
| | | | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria; University of Medical Sciences, Ondo City, Nigeria
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK; Research Initiative for Cities Health and Equity, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Olu Onyimadu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Muhammad Ali Pate
- Health, Nutrition and Population (HNP) Global Practice and Global Financing Facility for Women, Children and Adolescents, World Bank, Washington DC, WA, USA; Harvard T Chan School of Public Health, Boston, MA, USA
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Fatimah Tsiga-Ahmed
- Department of Community Medicine, Bayero University, Nigeria; Aminu Kano Teaching Hospital Kano, Nigeria
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7
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Wishnia J, Goudge J. Strengthening public financial management in the health sector: a qualitative case study from South Africa. BMJ Glob Health 2021; 6:e006911. [PMID: 34728478 PMCID: PMC8565558 DOI: 10.1136/bmjgh-2021-006911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/11/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Effective public financial management (PFM) ensures public health funds are used to deliver services in the best way possible. Given the global call for universal health coverage, and concerns about the management of public funds in many low-income and middle-income countries, PFM has become an important area of research. South Africa has a robust PFM framework, that is generally adhered to, and yet financial outcomes have remained poor. In this paper, we describe how a South African provincial department of health tried to strengthen its PFM processes by deploying finance managers into service delivery units, involving service delivery managers in the monthly finance meeting, using a weekly committee to review expenditure requests and starting a weekly managers' 'touch-base' meeting. We assess whether these strategies strengthened collaboration and trust and how this impacted on PFM. METHOD This research used a case study design with ethnographic methods. Semi-structured interviews (n=30) were conducted with participant observations. Thematic analysis was used to identify emergent themes and collaborative public management theory was then used to frame the findings. The authors used reflexive methods, and member checking was conducted. RESULTS The deployment of staff and touch-base meeting illustrated the potential of multidisciplinary teams when members share power, and the importance of impartial leadership when trying to achieve consensus on how to prioritise resource use. However, the service delivery and finance managers did not manage to collaborate in the monthly finance meeting to develop realistic budgets, or to reprioritise expenditure when required. The resulting mistrust threatened to derail the other strategies, highlighting how critical trust is for collaboration. CONCLUSION Effective PFM requires authentic collaboration between service delivery and finance managers; formal processes alone will not achieve this. We recommend more opportunities for 'boundary crossing', embedding finance managers in service delivery units and impartial effective leadership.
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Affiliation(s)
- Jodi Wishnia
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Akintunde TY, Akintunde OD, Musa TH, Sayibu M, Tassang AE, Reed LM, Chen S. Expanding telemedicine to reduce the burden on the healthcare systems and poverty in Africa for a post-coronavirus disease 2019 (COVID-19) pandemic reformation. GLOBAL HEALTH JOURNAL 2021; 5:128-134. [PMID: 36338822 PMCID: PMC9625850 DOI: 10.1016/j.glohj.2021.07.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/21/2021] [Accepted: 07/16/2021] [Indexed: 11/21/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) global public health emergency, has exposed the fragility of health systems. Access to healthcare became a scarce commodity as healthcare providers and resource-poor populations became victims of the novel corona virus. Therefore, this study focuses on Africa's readiness to integrate telemedicine into the weak health systems and its adoption may help alleviate poor healthcare and poverty after COVID-19. We conducted a narrative review through different search strategies in Scopus on January 20, 2021, to identify available literature reporting implementation of various telemedicine modes in Africa from January 1, 2011 to December 31, 2020. We summarized 54 studies according to geographies, field, and implementation methods. The results show a willingness to adopt telemedicine in the resource-poor settings and hard-to-reach populations, which will bring relief to the inadequate healthcare systems and alleviate poverty of those who feel the burden of healthcare cost the most. With adequate government financing, telemedicine promises to enhance the treating of communicable and non-communicable diseases as well as support health infrastructure. It can also alleviate poverty among vulnerable groups and hard-to-reach communities in Africa with adequate government financing. However, given the lack of funding in Africa, the challenges in implementing telemedicine require global and national strategies before it can yield promising results. This is especially true in regards to alleviating the multidimensionality of poverty in post-COVID-19 Africa.
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Affiliation(s)
- Tosin Yinka Akintunde
- Department of Demography and Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Osun State 220282, Nigeria
- Department of Sociology, School of Public Administration, Hohai University, Jiangsu, Nanjing 211100, China
| | - Oluseye David Akintunde
- Management Science Engineering, School of Economics and Finance, Jiangsu University, Zhenjiang, Jiangsu 212013, China
| | - Taha Hussein Musa
- Biomedical Research Institute, Darfur College, Nyala, South Darfur 63313, Sudan
- Department Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, Jiangsu 210009, China
| | - Muhideen Sayibu
- Department of Philosophy of Science and Technology, University of Science and Technology of China, Hefei, Anhui 230026, China
| | - Angwi Enow Tassang
- Department of Sociology, School of Public Administration, Hohai University, Jiangsu, Nanjing 211100, China
| | - Linda M Reed
- Meten International Education Group, Nanjing, Jiangsu 200009, China
| | - Shaojun Chen
- Department of Sociology, School of Public Administration, Hohai University, Jiangsu, Nanjing 211100, China
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McGuire C, Calhoun LM, Mumuni T, Maytan-Joneydi A, Odeku M, Speizer IS. Government stakeholders' perspectives on the family planning environment in three Nigerian cities: qualitative findings from the Nigerian Urban Reproductive Health Initiative (NURHI) Sustainability Study. Glob Health Action 2020; 13:1847821. [PMID: 33373279 PMCID: PMC7717862 DOI: 10.1080/16549716.2020.1847821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: The Nigerian government has made numerous commitments to expanding access to family planning services for its population yet has faced many challenges in implementing these commitments. Foreign donors provide support for expanding access to family planning in key populations. Objective: This study examines the family planning environment after donor funding has ended, including how government stakeholders perceive family planning services and their role in providing them post donor funding. Methods: The NURHI Sustainability Study used qualitative data to evaluate the sustainability of the Nigerian Urban Reproductive Health Initiative (NURHI), which focused on increasing the use of modern contraceptive methods, particularly among the urban poor. This study presents results from in-depth interviews with 16 key government stakeholders, selected using purposive sampling methods, in three cities: Ilorin (where NURHI Phase 1 programming discontinued in 2015), Kaduna (where programming continued under NURHI Phase 2), and Jos (a comparison city). A thematic analysis was employed to identify key themes related to government stakeholders’ perspectives on the family planning environment and sustainability of NURHI programming. Results: Respondents from all three cities highlighted local political leaders’ positive perceptions about family planning. All respondents were open to continued foreign donor support for family planning services while respondents in Kaduna and Jos emphasized the need for governments to lead efforts among all family planning actors. Stakeholders highlighted the benefits of a dedicated and implemented family planning budget line and encouraged continued state financial support. Respondents in Kaduna and Ilorin praised the positive influence of NURHI programming while those from Ilorin reflected on the need for future programs to gradually close-out their efforts to support sustainability. Conclusions: As donors look to transition to government ownership of family planning efforts, it is important for family planning programs to understand and incorporate government stakeholders’ perspectives into their sustainability planning efforts.
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Affiliation(s)
- Courtney McGuire
- Carolina Population Center, The University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Lisa M Calhoun
- Carolina Population Center, The University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Tolulope Mumuni
- Center for Population and Reproductive Health, University of Ibadan , Ibadan, Nigeria
| | - Amelia Maytan-Joneydi
- Carolina Population Center, The University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
| | - Mojisola Odeku
- Nigerian Urban Reproductive Health Initiative , Abuja, Nigeria
| | - Ilene S Speizer
- Carolina Population Center, The University of North Carolina at Chapel Hill , Chapel Hill, NC, USA.,Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, NC, USA
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [PMID: 32185365 PMCID: PMC7059551 DOI: 10.12688/gatesopenres.13110.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 10/03/2023] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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Affiliation(s)
- Kalipso Chalkidou
- Global Health Policy, Center for Global Development, London, UK
- Medicine, School of Public Health, Imperial College London, London, UK
| | - Karl Claxton
- Department of Economics, University of York, UK, York, UK
| | | | - Prashant Yadav
- Global Health Policy, Center for Global Development, London, UK
- Technology and Operations Management, INSEAD, Fontainebleau, France
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11
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [PMID: 32185365 PMCID: PMC7059551 DOI: 10.12688/gatesopenres.13110.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 01/29/2023] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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Affiliation(s)
- Kalipso Chalkidou
- Global Health Policy, Center for Global Development, London, UK.,Medicine, School of Public Health, Imperial College London, London, UK
| | - Karl Claxton
- Department of Economics, University of York, UK, York, UK
| | | | - Prashant Yadav
- Global Health Policy, Center for Global Development, London, UK.,Technology and Operations Management, INSEAD, Fontainebleau, France
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Chalkidou K, Claxton K, Silverman R, Yadav P. Value-based tiered pricing for universal health coverage: an idea worth revisiting. Gates Open Res 2020; 4:16. [DOI: 10.12688/gatesopenres.13110.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 11/20/2022] Open
Abstract
The pricing of medicines and health products ranks among the most hotly debated topics in health policy, generating controversy in richer and poorer markets alike. Creating the right pricing structure for pharmaceuticals and other healthcare products is particularly important for low- and middle-income countries, where pharmaceuticals account for a significant portion of total health expenditure; high medicine prices therefore threaten the feasibility and sustainability of nascent schemes for universal health coverage (UHC). We argue that a strategic system of value-based tiered pricing (VBTP), wherein each country would pay a price for each health product commensurate with the local value it provides, could improve access, enhance efficiency, and empower countries to negotiate with product manufacturers. This paper attempts to further understanding on the potential value of tiered pricing, barriers to its implementation, and potential strategies to overcome those.
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Malakoane B, Heunis JC, Chikobvu P, Kigozi NG, Kruger WH. Public health system challenges in the Free State, South Africa: a situation appraisal to inform health system strengthening. BMC Health Serv Res 2020; 20:58. [PMID: 31973740 PMCID: PMC6979387 DOI: 10.1186/s12913-019-4862-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background Since the advent of democracy, the South African government has been putting charters, policies, strategies and plans in place in an effort to strengthen public health system performance and enhance service delivery. However, public health programme performance and outcomes remained poor while the burden of disease increased. This was also the case in the Free State Province, where major public health system challenges occurred around 2012. Assessment was necessary in order to inform health system strengthening. Methods The study entailed a multi-method situation appraisal utilising information collated in 44 reports generated in 2013 through presentations by unit managers, subdistrict assessments by district clinical specialist teams, and group discussions with district managers, clinic supervisors, primary health care managers and chief executive and clinical officers of hospitals. These data were validated through community and provincial health indabas including non-governmental organisations, councils and academics, as well as unannounced facility visits involving discussions with a wide range of functionaries and patients. The reports were reviewed using the World Health Organization health system building blocks as a priori themes with subsequent identification of emerging subthemes. Data from the different methods employed were triangulated in a causal loop diagram showing the complex interactions between the components of an (in) effective health system. Results The major subthemes or challenges that emerged under each a priori theme included: firstly, under the ‘service delivery’ a priori theme, ‘fragmentation of health services’ (42 reports); secondly, under the ‘health workforce’ a priori theme, ‘staff shortages’ (39 reports); thirdly, under the ‘health financing’ a priori theme, ‘financial/cash-flow problems’ (39 reports); fourthly, under the ‘leadership and governance’ a priori theme, ‘risk to patient care’ (38 reports); fifthly, under the ‘medical products/technologies’ a priori theme, ‘dysfunctional communication technology’ (27 reports); and, sixthly, under the ‘information’ a priori theme, ‘poor information management’ (26 reports). Conclusion The major overall public health system challenges reported by stakeholders involved fragmentation of services, staff shortages and financial/cash-flow problems. In order to effect health systems strengthening there was particularly a need to improve integration and address human and financial deficiencies in this setting.
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Affiliation(s)
- B Malakoane
- Department of Community Health, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa
| | - J C Heunis
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa.
| | - P Chikobvu
- Department of Community Health, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa.,Free State Department of Health, P.O. Box 277, Bloemfontein, 9300, South Africa
| | - N G Kigozi
- Centre for Health Systems Research & Development, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa
| | - W H Kruger
- Department of Community Health, University of the Free State, P.O. Box 339, Bloemfontein, 9300, South Africa.,Free State Department of Health, P.O. Box 277, Bloemfontein, 9300, South Africa
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Tan SY, Qian J. An unintended consequence of provider payment reform: The case of capitation grants in the National Health Insurance reform of Indonesia. Int J Health Plann Manage 2019; 34:e1688-e1710. [PMID: 31423635 DOI: 10.1002/hpm.2883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 11/06/2022] Open
Abstract
One of the most important components of the ambitious 2014 National Health Insurance reform in Indonesia is the implementation of prospective payment system known as capitation grants, paid monthly to the primary health providers based on the enrolment rate. This has ushered in additional financial resources for the health managers in resource allocations, especially in the hiring of manpower. Drawing data from the Indonesia Family Life Survey (1993-2015), this paper uses difference-in-differences method to evaluate the effects of the payment method reform on the allocation of human resources for health among the primary health providers. To our surprise, there was no statistically significant change in the total number of full-time staff among the capitated facilities after the reform. However, capitation grants caused an increase in the number of full-time equivalent and part-time equivalent contract staff, but a significant decline in the number of full-time permanent staff among the urban capitated facilities. It is likely that more contract health workers were hired at the expense of full-time permanent staff among the capitated facilities in the urban regions. This unintended consequence shed light on the need to develop nuanced and contextual understanding of payment reforms in developing countries.
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Affiliation(s)
- Si Ying Tan
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - Jiwei Qian
- East Asian Institute, National University of Singapore, Singapore
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