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Beiter D, Koy S, Flessa S. Improving the technical efficiency of public health centers in Cambodia: a two-stage data envelopment analysis. BMC Health Serv Res 2023; 23:912. [PMID: 37641129 PMCID: PMC10463960 DOI: 10.1186/s12913-023-09570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Cambodia is undergoing a series of reforms with the objective of reaching universal health coverage. Information on the causes of inefficiencies in health facilities could pave the way for a better utilization of limited resources available to ensure the best possible health care for the population. OBJECTIVES The purpose of this study is to evaluate the technical efficiency of health centers and the determinants for inefficiencies. METHODS This cross-sectional study used secondary data from a costing study on 43 health centers in six Cambodian provinces (2016-2017). Firstly, the Data Envelopment Analysis method with output-orientation was applied to calculate efficiency scores by selecting multiple input and output variables. Secondly, a tobit regression was performed to analyze potential explanatory variables that could influence the inefficiency of health centers. RESULTS Study findings showed that 18 (43%) health centers were operating inefficiently with reference to the variable returns to scale efficiency frontier and had a mean pure technical efficiency score of 0.87. Overall, 22 (51%) revealed deficits in producing outputs at an optimal scale size. Distance to the next referral hospital, size and quality performance of the health centers were significantly correlated with health center inefficiencies. CONCLUSION Differences in efficiency exist among health centers in Cambodia. Inefficient health centers can improve their technical efficiency by increasing the utilization and quality of health services, even if it involves higher costs. Technical efficiency should be continuously monitored to observe changes in health center performance over time.
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Affiliation(s)
- Dominik Beiter
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia.
| | - Sokunthea Koy
- Social Health Protection Programme, Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ), Phnom Penh, Cambodia
| | - Steffen Flessa
- Department of General Business Administration and Health Care Management, University of Greifswald, Greifswald, Germany
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Cheng J, Kuang X, Zeng L. The impact of human resources for health on the health outcomes of Chinese people. BMC Health Serv Res 2022; 22:1213. [PMID: 36175870 PMCID: PMC9521871 DOI: 10.1186/s12913-022-08540-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
Human resources for health (HRH) is a cornerstone in the medical system. This paper combined data envelopment analysis (DEA) with Tobit regression analysis to evaluate the efficiency of health care services in China over the years between 2007 and 2019. Efficiency was first estimated by using DEA with the choice of inputs and outputs being specific to health care services and residents' health status. Malmquist index model was selected for estimating the changes in total factor productivity of provinces and exploring whether their performance had improved over the years. Tobit regression model was then employed in which the efficiency score obtained from the DEA computations used as the dependent variable, and HRH was chosen as the independent variables. The results showed that all kinds of health personnel had a significantly positive impact on the efficiency, and more importantly, pharmacists played a critical role in affecting both the provincial and national efficiency. Therefore, the health sector should pay more attention to optimizing allocation of HRH and focusing on professional training of clinical pharmacists.
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Affiliation(s)
- Jingjing Cheng
- School of Business Administration, Northeastern University, Shenyang, 110819, Liaoning, China.
| | - Xianming Kuang
- Center for Economic Research, China Institute for Reform and Development, Haikou, 570311, Hainan, China
| | - Linghuang Zeng
- Human Resources Department, The First Affiliated Hospital of Hainan Medical University, Haikou, 570102, Hainan, China
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Shokri Jamnani ASJ, Rezapour A, Moradi N, Langarizadeh M. Women's Preference for Cervical Cancer Screening Methods in Iran: A Contingent Valuation Survey. Med J Islam Repub Iran 2022; 36:72. [PMID: 36128303 PMCID: PMC9448453 DOI: 10.47176/mjiri.36.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 06/30/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Cervical cancer is the fifth most deadly cancer in women in Iran. The present study aimed to investigate the monetary value of cervical cancer screening benefits from a social perspective. Methods: A cross-sectional study was conducted among 480 women aged 30 to 59 years in Mazandaran province, Iran, from 2020-21. The willingness to pay (WTP) for screening tests- Pap smear and simultaneous tests- was investigated using a researcher-made questionnaire based on the contingent valuation method (CVM) in 2 separate sample groups. The first group received basic information regarding cervical cancer (Scenario 1), while the second received complementary information in addition to basic knowledge (Scenario 2). Multivariate regression was applied to examine factors affecting WTP and the difference between the mean WTP in 2 scenarios was analyzed by a t-test. Results: The mean WTP of Pap smear and simultaneous tests was estimated at US$135.08 and US$160.19, respectively. There were significant and negative relationships between age and household size with the WTP of the Pap smear test. The number of people with income, household expenses, a chronic illness, and suggested base price indicated significant and positive effects on WTP of the Pap smear test. The number of people with income and household expenses showed significant and positive relationships with the WTP of simultaneous tests. There was no significant difference between the mean WTP of each group and the demand for screening tests was not elastic. Conclusion: The mean WTP of screening tests is notable when compared to their cost, demonstrating the need of concentrating on screening programs.
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Affiliation(s)
| | - Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran,Corresponding author: Dr Aziz Rezapour,
| | - Najmeh Moradi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Langarizadeh
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Kazibwe J, Gheorghe A, Wilson D, Ruiz F, Chalkidou K, Chi YL. The Use of Cost-Effectiveness Thresholds for Evaluating Health Interventions in Low- and Middle-Income Countries From 2015 to 2020: A Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:385-389. [PMID: 35227450 PMCID: PMC8885424 DOI: 10.1016/j.jval.2021.08.014] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 08/08/2021] [Accepted: 08/24/2021] [Indexed: 05/22/2023]
Abstract
OBJECTIVES Evidence-informed priority setting, in particular cost-effectiveness analysis (CEA), can help target resources better to achieve universal health coverage. Central to the application of CEA is the use of a cost-effectiveness threshold. We add to the literature by looking at what thresholds have been used in published CEA and the proportion of interventions found to be cost-effective, by type of threshold. METHODS We identified CEA studies in low- and middle-income countries from the Global Health Cost-Effectiveness Analysis Registry that were published between January 1, 2015, and January 6, 2020. We extracted data on the country of focus, type of interventions under consideration, funder, threshold used, and recommendations. RESULTS A total of 230 studies with a total 713 interventions were included in this review; 1 to 3× gross domestic product (GDP) per capita was the most common type of threshold used in judging cost-effectiveness (84.3%). Approximately a third of studies (34.2%) using 1 to 3× GDP per capita applied a threshold at 3× GDP per capita. We have found that no study used locally developed thresholds. We found that 79.3% of interventions received a recommendation as "cost-effective" and that 85.9% of studies had at least 1 intervention that was considered cost-effective. The use of 1 to 3× GDP per capita led to a higher proportion of study interventions being judged as cost-effective compared with other types of thresholds. CONCLUSIONS Despite the wide concerns about the use of 1 to 3× GDP per capita, this threshold is still widely used in the literature. Using this threshold leads to more interventions being recommended as "cost-effective." This study further explore alternatives to the 1 to 3× GDP as a decision rule.
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Affiliation(s)
- Joseph Kazibwe
- Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK
| | - Adrian Gheorghe
- Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK
| | - David Wilson
- Bill & Melinda Gates Foundation, London, England, UK
| | - Francis Ruiz
- Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK
| | - Kalipso Chalkidou
- Global Health and Development Group, School of Public Health, Imperial College London, Norfolk Place, London, England, UK; International Decision Support Initiative, Center for Global Development, London, England, UK; MRC Centre for Global Infectious Disease Analysis and the Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, England, UK
| | - Y-Ling Chi
- International Decision Support Initiative, Center for Global Development, London, England, UK.
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Amgalan N, Shin JS, Lee SH, Badamdorj O, Ravjir O, Yoon HB. The socio-economic transition and health professions education in Mongolia: a qualitative study. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:16. [PMID: 33678178 PMCID: PMC7938553 DOI: 10.1186/s12962-021-00269-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 02/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Former socialist countries have undergone a socio-economic transition in recent decades. New challenges for the healthcare system have arisen in the transition economy, leading to demands for better management and development of the health professions. However, few studies have explored the effects of this transition on health professions education. Thus, we investigated the effects of the socio-economic transition on the health professions education system in Mongolia, a transition economy country, and to identify changes in requirements. Methods We used a multi-level perspective to explore the effects of the transition, including the input, process, and output levels of the health professions education system. The input level refers to planning and management, the process level refers to the actual delivery of educational services, and the output level refers to issues related to the health professionals, produced by the system. This study utilized a qualitative research design, including document review and interviews with local representatives. Content analysis and the constant comparative method were used for data analysis. Results We explored tensions in the three levels of the health professions education system. First, medical schools attained academic authority for planning and management without proper regulation and financial support. The government sets tuition fees, which are the only financial resource of medical schools; thus, medical schools attempt to enroll more students in order to adapt to the market environment. Second, the quality of educational services varies across institutions due to the absence of a core curriculum and differences in the learning environment. After the transition, the number of private medical schools rapidly increased without quality control, while hospitals started their own specialized training programs. Third, health professionals are struggling to maintain their professional values and development in the market environment. Fixed salaries lead to a lack of motivation, and quality evaluation measures more likely reflect government control than quality improvement. Conclusions Mongolia continues to face the consequences of the socio-economic transition. Medical schools’ lack of financial authority, the varying quality of educational services, and poor professional development are the major adverse effects. Finding external financial support, developing a core curriculum, and reforming a payment system are recommended.
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Affiliation(s)
- Nomin Amgalan
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jwa-Seop Shin
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Seung-Hee Lee
- Department of Medical Education, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Oyungoo Badamdorj
- Division of Educational Policy and Management, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Oyungerel Ravjir
- Department of Infectious Diseases, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Hyun Bae Yoon
- Office of Medical Education, Seoul National University College of Medicine, Seoul, Korea.
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Understanding variation in health service coverage and maternal health outcomes among districts in Rwanda - A qualitative study of local health workers' perceptions. PLoS One 2019; 14:e0223357. [PMID: 31589635 PMCID: PMC6779235 DOI: 10.1371/journal.pone.0223357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 09/04/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To obtain the perspectives of health professionals and community health workers on factors that determine health service coverage and maternal health outcomes so as to understand variations between districts. METHODS 16 Focus group discussions involving four different groups of participants were conducted in May 2015 in four purposively selected districts, complemented by three key informant interviews in one of the districts. RESULTS The solidarity support for poor people and the interconnectedness between local leaders and heads of health facilities were identified as enablers of health service utilization. Geographical factors, in particular location close to borders with mobile populations and migrants, and large populations with sparsely distributed health infrastructure, exacerbated by hilly topography and muddy roads were identified as barriers. Shortages of skilled health providers at the level of district hospitals were cited as contributing to poor maternal health outcomes. CONCLUSION There is a need to take into account disparities between districts when allocating staff and financial resources in order to achieve universal coverage for high-quality maternal health services and better outcomes. Local innovations such as the use of SMS and WhatsApp text messages by health workers and financial protection schemes for poor patients improve solidarity and are worth to be scaled up.
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Technical efficiency and its influencing factors in Malaysian hospital pharmacy services. Health Care Manag Sci 2019; 22:462-474. [PMID: 30868325 DOI: 10.1007/s10729-019-09470-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 01/24/2019] [Indexed: 10/27/2022]
Abstract
Various pharmacy services are offered in public health facilities, ranging from distributive activities (dispensing) to patient-oriented services (pharmaceutical care). These activities are monitored through indicators established at the national level. In Malaysia, the indicators have not been transformed into a measurement of hospital pharmacy service efficiency. The main objectives of this study were to assess the relative performance of hospital pharmacy services and to investigate the factors that may affect the performance levels. Double-bootstrap data envelopment analysis was applied to measure the technical efficiency levels of 124 public hospital pharmacies in 2014. An input-oriented variable returns to scale model was adopted in the study, while bootstrap truncated regression was conducted to identify the factors that may explain the differences in the efficiency levels. The average bias-corrected technical efficiency score varies according to the hospital size (0.84, 0.78 and 0.82 in small, medium and large hospitals, respectively). The hospital size, hospital age, urban location and information technology are important determinants of the efficiency levels. The study contributes to establishing baseline technical efficiency information for public hospital pharmacy services in Malaysia. The measurement of hospital pharmacy efficiency can guide future policy making to improve performance and ensure the optimum level of available resources.
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Alfredsson M, San Sebastian M, Jeghannathan B. Attitudes towards mental health and the integration of mental health services into primary health care: a cross-sectional survey among health-care workers in Lvea Em District, Cambodia. Glob Health Action 2018; 10:1331579. [PMID: 29261452 PMCID: PMC5496090 DOI: 10.1080/16549716.2017.1331579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Cambodia is a country where the resources for treating mental health disorders are far from sufficient. One strategy to narrow the treatment gap is to integrate mental health into primary health care (PHC). Understanding the knowledge and attitudes towards mental health integration that health-care workers have is important for assessing the challenges and opportunities when planning a potential integration project. Objective: The aim of this study was to assess these basic conditions in Lvea Em District, Cambodia. Design: A structured self-reporting questionnaire regarding attitudes and knowledge about mental health and its integration into PHC was collected from 75 health-care workers in Lvea Em District, Cambodia in October 2015. Firstly, descriptive analyses were carried out, and secondly, linear regression analyses to assess the relationship between attitudes and socio-demographic variables were conducted. Results: There was clear support towards integrating mental health services into PHC among these participants as 81.3% were interested in personally delivering mental health care at their units. Respondents who reported having received some kind of mental health-care training tended to have a more positive attitude towards mentally ill people (p = 0.005) and those who thought there was a high need for mental health care had a more favourable attitude towards the integration of mental health services (p = 0.007). Conclusions: The most important finding from this survey was the willingness and the acceptance of the need for integration of mental health care. This enhances the feasibility of integrating mental health services at the PHC level. Improving the competence of mental health care in these settings will likely help to reduce the treatment gap for mental, neurological and substance use disorders in Cambodia.
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Affiliation(s)
- Maria Alfredsson
- a Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Miguel San Sebastian
- a Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Bhoomikumar Jeghannathan
- b Centre for Child and Adolescent Mental Health, Chey Chumenas Hospital Takhmau , Kandal Province , Cambodia
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Martineau T, McPake B, Theobald S, Raven J, Ensor T, Fustukian S, Ssengooba F, Chirwa Y, Vong S, Wurie H, Hooton N, Witter S. Leaving no one behind: lessons on rebuilding health systems in conflict- and crisis-affected states. BMJ Glob Health 2017; 2:e000327. [PMID: 29082000 PMCID: PMC5656126 DOI: 10.1136/bmjgh-2017-000327] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/23/2017] [Accepted: 05/26/2017] [Indexed: 11/03/2022] Open
Abstract
Conflict and fragility are increasing in many areas of the world. This context has been referred to as the 'new normal' and affects a billion people. Fragile and conflict-affected states have the worst health indicators and the weakest health systems. This presents a major challenge to achieving universal health coverage. The evidence base for strengthening health systems in these contexts is very weak and hampered by limited research capacity, challenges relating to insecurity and apparent low prioritisation of this area of research by funders. This article reports on findings from a multicountry consortium examining health systems rebuilding post conflict/crisis in Sierra Leone, Zimbabwe, northern Uganda and Cambodia. Across the ReBUILD consortium's interdisciplinary research programme, three cross-cutting themes have emerged through our analytic process: communities, human resources for health and institutions. Understanding the impact of conflict/crisis on the intersecting inequalities faced by households and communities is essential for developing responsive health policies. Health workers demonstrate resilience in conflict/crisis, yet need to be supported post conflict/crisis with appropriate policies related to deployment and incentives that ensure a fair balance across sectors and geographical distribution. Postconflict/crisis contexts are characterised by an influx of multiple players and efforts to support coordination and build strong responsive national and local institutions are critical. The ReBUILD evidence base is starting to fill important knowledge gaps, but further research is needed to support policy makers and practitioners to develop sustainable health systems, without which disadvantaged communities in postconflict and postcrisis contexts will be left behind in efforts to promote universal health coverage.
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Affiliation(s)
- Tim Martineau
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanna Raven
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tim Ensor
- Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
| | - Suzanne Fustukian
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Freddie Ssengooba
- Department of Health Policy, Planning and Management at the School of Public Health, Makerere University, Kampala, Uganda
| | - Yotamu Chirwa
- Centre for International Health Policy, Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Haja Wurie
- Department of Biochemistry, College of Medicine and Applied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Nick Hooton
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Witter S, Bertone MP, Chirwa Y, Namakula J, So S, Wurie HR. Evolution of policies on human resources for health: opportunities and constraints in four post-conflict and post-crisis settings. Confl Health 2017; 10:31. [PMID: 28115986 PMCID: PMC5241914 DOI: 10.1186/s13031-016-0099-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/20/2016] [Indexed: 11/23/2022] Open
Abstract
Background Few studies look at policy making in the health sector in the aftermath of a conflict or crisis and even fewer specifically focus on Human Resources for Health, which is a critical domain for health sector performance. The main objective of the article is to shed light on the patterns and drivers of post-conflict policy-making. In particular, we explore whether the post -conflict period offers increased chances for the opening of ‘windows for opportunity’ for change and reform and the potential to reset health systems. Methods This article uses a comparative policy analysis framework. It is based on qualitative data, collected using three main tools - stakeholder mapping, key informant interviews and document reviews - in Uganda, Sierra Leone, Cambodia and Zimbabwe. Results We found that HRH challenges were widely shared across the four cases in the post-conflict period but that the policy trajectories were different – driven by the nature of the conflicts but also the wider context. Our findings suggest that there is no formula for whether or when a ‘window of opportunity’ will arise which allows health systems to be reset. Problems are well understood in all four cases but core issues – such as adequate pay, effective distribution and HRH management – are to a greater or lesser degree unresolved. These problems are not confined to post-conflict settings, but underlying challenges to addressing them – including fiscal space, political consensus, willingness to pursue public objectives over private, and personal and institutional capacity to manage technical solutions – are liable to be even more acute in these settings. The role of the MoH emerged as weaker than expected, while the shift from donor dependence was clearly not linear and can take a considerable time. Conclusions Windows of opportunity for change and reform can occur but are by no means guaranteed by a crisis – rather they depend on a constellation of leadership, financing, and capacity. Recognition of urgency is certainly a facilitator but not sufficient alone. Post-conflict environments face particularly severe challenges to evidence-based policy making and policy implementation, which also constrain their ability to effectively use the windows which are presented.
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Affiliation(s)
- Sophie Witter
- ReBUILD and Institute for Global Health and Development, Queen Margaret University, Edinburgh, EH21 6UU UK
| | - Maria Paola Bertone
- Department of Global Health and Development & ReBUILD Consortium, London School of Hygiene and Tropical Medicine, London, UK
| | - Yotamu Chirwa
- ReBUILD and Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Justine Namakula
- ReBUILD and Department of Health Policy, Planning and Management, Makerere School of Public Health, Kampala, Uganda
| | - Sovannarith So
- ReBUILD and Cambodian Development Resource Institute, Phnom Penh, Cambodia
| | - Haja R Wurie
- ReBUILD Consortium and College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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