| 11. |
- Colombini, Manuela, et al.
(författare)
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Agenda setting and framing of gender-based violence in Nepal : how it became a health issue.
- 2016
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Ingår i: Health Policy and Planning. - : Oxford University Press (OUP). - 0268-1080 .- 1460-2237. ; 31:4, s. 493-503
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Tidskriftsartikel (refereegranskat)abstract
- Gender-based violence (GBV) has been addressed as a policy issue in Nepal since the mid 1990s, yet it was only in 2010 that Nepal developed a legal and policy framework to combat GBV. This article draws on the concepts of agenda setting and framing to analyse the historical processes by which GBV became legitimized as a health policy issue in Nepal and explored factors that facilitated and constrained the opening and closing of windows of opportunity. The results presented are based on a document analysis of the policy and regulatory framework around GBV in Nepal. A content analysis was undertaken. Agenda setting for GBV policies in Nepal evolved over many years and was characterized by the interplay of political context factors, actors and multiple frames. The way the issue was depicted at different times and by different actors played a key role in the delay in bringing health onto the policy agenda. Women's groups and less powerful Ministries developed gender equity and development frames, but it was only when the more powerful human rights frame was promoted by the country's new Constitution and the Office of the Prime Minister that legislation on GBV was achieved and a domestic violence bill was adopted, followed by a National Plan of Action. This eventually enabled the health frame to converge around the development of implementation policies that incorporated health service responses. Our explicit incorporation of framing within the Kindgon model has illustrated how important it is for understanding the emergence of policy issues, and the subsequent debates about their resolution. The framing of a policy problem by certain policy actors, affects the development of each of the three policy streams, and may facilitate or constrain their convergence. The concept of framing therefore lends an additional depth of understanding to the Kindgon agenda setting model.
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| 12. |
- D'Ambruoso, Lucia, et al.
(författare)
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Rethinking collaboration : developing a learning platform to address under-five mortality in Mpumalanga province, South Africa
- 2019
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Ingår i: Health Policy and Planning. - : Oxford University Press. - 0268-1080 .- 1460-2237. ; 34:6, s. 418-429
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Tidskriftsartikel (refereegranskat)abstract
- Following 50 years of apartheid, South Africa introduced visionary health policy committing to the right to health as part of a primary health care (PHC) approach. Implementation is seriously challenged, however, in an often-dysfunctional health system with scarce resources and a complex burden of avoidable mortality persists. Our aim was to develop a process generating evidence of practical relevance on implementation processes among people excluded from access to health systems. Informed by health policy and systems research, we developed a collaborative learning platform in which we worked as co-researchers with health authorities in a rural province. This article reports on the process and insights brought by health systems stakeholders. Evidence gaps on under-five mortality were identified with a provincial Directorate after which we collected quantitative and qualitative data. We applied verbal autopsy to quantify levels, causes and circumstances of deaths and participatory action research to gain community perspectives on the problem and priorities for action. We then re-convened health systems stakeholders to analyse and interpret these data through which several systems issues were identified as contributory to under-five deaths: staff availability and performance; service organization and infrastructure; multiple parallel initiatives; and capacity to address social determinants. Recommendations were developed ranging from immediate low- and no-cost re-organization of services to those where responses from higher levels of the system or outside were required. The process was viewed as acceptable and relevant for an overburdened system operating 'in the dark' in the absence of local data. Institutional infrastructure for evidence-based decision-making does not exist in many health systems. We developed a process connecting research evidence on rural health priorities with the means for action and enabled new partnerships between communities, authorities and researchers. Further development is planned to understand potential in deliberative processes for rural PHC.
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| 13. |
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| 14. |
- Deuba, Keshab, et al.
(författare)
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Assessing the Nepalese health system’s readiness to manage gender-based violence and deliver psychosocial counselling
- 2024
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Ingår i: Health Policy and Planning. - 0268-1080 .- 1460-2237. ; 39:2, s. 198-212
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Tidskriftsartikel (refereegranskat)abstract
- Violence against women (VAW), particularly intimate partner violence (IPV) or domestic violence, is a major public health issue, garnering more attention globally post-coronavirus disease 2019 (COVID-19) lockdown. Health providers often represent the first point of contact for IPV victims. Thus, health systems and health providers must be equipped to address survivors’ physical, sexual and mental health care needs. However, there is a notable lack of evidence regarding such readiness in Nepal. This study, utilizing a concurrent triangulation design, evaluated the readiness of public health facilities in Nepal’s Madhesh Province in managing VAW, focusing on providers’ motivation to offer psychosocial counselling to survivors. A cross-sectional study was conducted across 11 hospitals and 17 primary health care centres, where 46 health care providers were interviewed in February–April 2022. The study employed the World Health Organization’s tools for policy readiness and the Physician Readiness to Manage IPV Survey for data collection. Quantitative and qualitative data were collected via face-to-face interviews and analysed using descriptive and content analysis, respectively. Only around 28% of health facilities had trained their staff in the management of VAW. Two out of 11 hospitals had a psychiatrist, and a psychosocial counsellor was available in four hospitals and two out of 17 primary health care centres. Two-thirds of all health facilities had designated rooms for physical examinations, but only a minority had separate rooms for counselling. Though a few health facilities had guidelines for violence management, the implementation of these guidelines and the referral networks were notably weak. Hospitals with one-stop crisis management centres demonstrated readiness in VAW management. Health providers acknowledged the burden of IPV or domestic violence and expressed motivation to deliver psychosocial counselling, but many had limited knowledge. This barrier can only be resolved through appropriate training and investment in violence management skills at all tiers of the health system.
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| 15. |
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| 16. |
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| 17. |
- Ekman, Björn, et al.
(författare)
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Health insurance reform in Vietnam: a review of recent developments and future challenges.
- 2008
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Ingår i: Health Policy and Planning. - : Oxford University Press (OUP). - 0268-1080 .- 1460-2237. ; 23, s. 252-263
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Tidskriftsartikel (refereegranskat)abstract
- Vietnam is undertaking health financing reform with a view to achieve universal coverage of health insurance within the coming years. To date, around half of the population is covered with some type of health insurance or prepayment. This review applies a conceptual framework of health financing to provide a coherent assessment of the reforms to date with respect to a set of key policy objectives of health financing, including financial sustainability, efficiency in service provision, and equity in health financing. Based on the assessment, the review discusses the main implications of the reforms focusing on achievements and remaining challenges, the nature of the Vietnamese reforms in an international perspective, and the role of the government. The main lessons from the Vietnamese experiences, from which other reforming countries may draw, are the need for sustained resource mobilization, comprehensive reform involving all functions of the health financing system, and to adopt a long-term view of health insurance reform. Future analysis should include continued evaluation of the reforms in terms of impacts on key outcomes and the political dimensions of health reform.
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| 18. |
- El Amin, Seif, et al.
(författare)
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Introducing qualitative perinatal audit in a tertiary hospital in Sudan
- 2002
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Ingår i: Health Policy and Planning. - 0268-1080 .- 1460-2237. ; 17:3, s. 296-303
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Tidskriftsartikel (refereegranskat)abstract
- In a 3-month period, May to August 2000, the perinatal mortality rate at Omdurman Maternity Hospital (OMH), Sudan, was 8.2%. Two groups of perinatal deaths, intrapartum deaths of non-malformed infants and neonatal deaths of mature infants above 34 weeks, both considered to be potentially avoidable by improved care, were in excess when compared with other regions. It was therefore decided to perform in-depth assessment of cases in these two groups. An interdisciplinary internal audit was designed in collaboration with two external obstetricians. The audit activity was preceded by a 2-day workshop at the hospital. Individual assessments based on 43 detailed narratives were followed by regular consensus meetings. This structure seemed useful for interdisciplinary discussions, and the audit process resulted in several specific suggestions for quality improvement in data collection, interdisciplinary collaboration, and obstetric and neonatal care. The present audit activity is not very resource demanding and therefore a good starting point for quality assurance in a developing country. However, since adverse outcome audit only focuses on selected cases and may encourage interventions without considering the full impact on the population, it should not stand alone. Audit of perinatal deaths should be combined with other quantitative and qualitative quality assessment activities for improvement of perinatal care.
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| 19. |
- Eslava-Schmalbach, Javier, et al.
(författare)
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Considering health equity when moving from evidence-based guideline recommendations to implementation : a case study from an upper-middle income country on the GRADE approach
- 2017
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Ingår i: Health Policy and Planning. - : Oxford University Press. - 0268-1080 .- 1460-2237. ; 32:10, s. 1484-1490
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Tidskriftsartikel (refereegranskat)abstract
- The availability of evidence-based guidelines does not ensure their implementation and use in clinical practice or policy making. Inequities in health have been defined as those inequalities within or between populations that are avoidable, unnecessary and also unjust and unfair. Evidence-based clinical practice and public health guidelines ('guidelines') can be used to target health inequities experienced by disadvantaged populations, although guidelines may unintentionally increase health inequities. For this reason, there is a need for evidence-based clinical practice and public health guidelines to intentionally target health inequities experienced by disadvantaged populations. Current guideline development processes do not include steps for planned implementation of equity-focused guidelines. This article describes nine steps that provide guidance for consideration of equity during guideline implementation. A critical appraisal of the literature followed by a process to build expert consensus was undertaken to define how to include consideration of equity issues during the specific GRADE guideline development process. Using a case study from Colombia we describe nine steps that were used to implement equity-focused GRADE recommendations: (1) identification of disadvantaged groups, (2) quantification of current health inequities, (3) development of equity-sensitive recommendations, (4) identification of key actors for implementation of equity-focused recommendations, (5) identification of barriers and facilitators to the implementation of equity-focused recommendations, (6) development of an equity strategy to be included in the implementation plan, (7) assessment of resources and incentives, (8) development of a communication strategy to support an equity focus and (9) development of monitoring and evaluation strategies. This case study can be used as model for implementing clinical practice guidelines, taking into account equity issues during guideline development and implementation.
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| 20. |
- Falkenberg, T, et al.
(författare)
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The World Bank and pharmaceuticals
- 2000
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Ingår i: Health policy and planning. - : Oxford University Press (OUP). - 0268-1080 .- 1460-2237. ; 15:1, s. 52-58
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Tidskriftsartikel (refereegranskat)
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