| 1. |
- Deuba, Keshab, et al.
(author)
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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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In: Health Policy and Planning. - 0268-1080 .- 1460-2237. ; 39:2, s. 198-212
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Journal article (peer-reviewed)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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| 2. |
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| 3. |
- Ekman, Björn, et al.
(author)
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Health insurance reform in Vietnam: a review of recent developments and future challenges.
- 2008
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In: Health Policy and Planning. - : Oxford University Press (OUP). - 0268-1080 .- 1460-2237. ; 23, s. 252-263
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Journal article (peer-reviewed)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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| 4. |
- Hjortsberg, Catharina, et al.
(author)
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Cost of access to health services in Zambia.
- 2002
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In: Health Policy and Planning. - : Oxford University Press (OUP). - 0268-1080 .- 1460-2237. ; 17:1, s. 7-71
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Journal article (peer-reviewed)abstract
- Equity is an important policy objective in the health care field. The importance of equity in health care provision can be argued from various points of view. As a result governments in all countries attempt to provide health care systems that enable equal access for everyone. Zambia is no exception. In the health care reforms the objective of the national health strategy is to provide Zambians with equity of access to health care. We focus on access defined as the costs (both monetary and time) an individual incurs when visiting a health care facility. Using a survey of 900 households, this article explores equality of access to health care among Zambians. Four areas are compared: urban high cost, urban low cost, townships and rural areas. The results of the analysis indicate that there are inequalities among residential areas, especially between rural and urban areas. In particular these differences exist because of differing distances to the nearest health facility. Large distances make it very costly for rural dwellers to seek medical care, especially during the high season for farming. The analysis suggests that obtaining equality of access to health care poses a challenge for the Zambian Government.
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| 5. |
- Jeppsson, Anders, et al.
(author)
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Restructuring a ministry of health - an issue of structure and process: a case study from Uganda.
- 2003
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In: Health Policy and Planning. - : Oxford University Press (OUP). - 0268-1080 .- 1460-2237. ; 18:1, s. 68-73
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Journal article (peer-reviewed)abstract
- This paper analyzes the recently undertaken restructuring of the Ministry of Health in Uganda, which was carried out because the previous structure did not comply well with the decentralization framework or policy. The Ministry was put under pressure by higher political levels, supported by the donor community, to restructure. The paper describes the principles that were guiding this operation, and assesses whether these principles relate to the final outcome and whether the outcome was actually as expected. This paper also analyzes the reasons for the achieved, or not achieved, results and suggests the way forward. The outcome of the restructuring procedure in terms of change in number of employees was small. The foundation, in terms of a certain structure, has been laid for the Ministry of Health to function in its new role as a coach more than a player, but the work to establish a functioning process is far from complete. The issue is to make actors at various levels relate to each other, and thereby establish appropriate processes within the existing structure that will help the Ministry develop into a dynamic body. The importance of finding forms for interaction, involving face-to-face relationships between the Ministry and service delivery level, is stressed.
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| 6. |
- Jönsson, Kristina, et al.
(author)
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Health policy evolution in Lao People’s Democratic Republic: Context, processes and agency
- 2015
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In: Health Policy and Planning. - : Oxford University Press (OUP). - 0268-1080 .- 1460-2237. ; 30:4, s. 518-527
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Research review (peer-reviewed)abstract
- Abstract in UndeterminedDuring the last 20 years Lao People's Democratic Republic has successfully developed and adopted some 30 health policies, strategies, decrees and laws in the field of health. Still, the implementation process remains arduous. This article aims at discussing challenges of health policy development and effective implementation by contextualizing the policy evolution over time and by focusing particularly on the National Drug Policy and the Health Care Law. Special attention is given to the role of research in policymaking. The analysis was guided by the conceptual framework of policy context, process, content and actors, combined with an institutional perspective, and showed that effective implementation of a health policy is highly dependent on both structures and agency of those involved in the policy process. The National Drug Policy was formulated and adopted in a short period of time in a resource-scarce setting, but with dedicated policy entrepreneurs and support of concerned international collaborators. Timely introduction of operational health systems research played a crucial role to support the implementation, as well as the subsequent revision of the policy. The development of the Health Care Law took several years and once adopted, the implementation was delayed by institutional legacies and issues concerning the choice of institutional design and financing, despite strong support of the law among the policymakers. Among many factors, timing of the implementation appeared to be of crucial importance, in combination with strong leadership. These two examples show that more research, that problematizes the complex policy environment in combination with improved communication between researchers and policymakers, is necessary to inform about measures for effective implementation. A way forward can be to strengthen the domestic research capacity and the international research collaboration regionally as well as globally.
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| 7. |
- Behrns, Ingrid, 1961, et al.
(author)
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Aphasia and Computerised Writing Aid Supported Treatment
- 2009
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In: Aphasiology. - London : Psychology Press. - 0268-7038 .- 1464-5041. ; 23:10, s. 1276-1294
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Journal article (peer-reviewed)abstract
- Background:Individuals with aphasia often experience difficulties in writing. Word processors with a spell checker and a grammar checker can compensate for some of the writing difficulties associated with aphasia.Aims:To determine if writing difficulties associated with aphasia may be reduced by the use of a computerised writing aid when training patients.Methods & Procedures:The writing aids used in this study were originally designed specifically for persons with developmental reading and writing difficulties and are based on statistics of frequent misspellings and phonotactic rules. Three participants with aphasia selected one of two offered writing aids. Written production during treatment and evaluation was recorded and analysed by keystroke logging. The study had a single-subject ABA design replicated across three participants. The baseline (A) was established by measuring four dependent variables. During a 9-week intervention phase (B) the dependent variables were measured once a week. A follow-up (A) was done 10 months after the training was finished. The dependent variables were: total number of words in a writing task; proportion of correctly written words; words per minute; proportion of successful edits. The results were analysed both visually and by statistical calculations. Outcomes & Results:All participants experienced a positive improvement in their writing ability. Results showed individual differences; after completed training the first participant made more successful edits, the second wrote more words, had a larger proportion of correctly written words, and made more successful edits. The third participant's results did not show any improvement that could be statistically supported.Conclusions:This study showed that the computerised training facilitated the generating process and made the revision process more efficient for the participants. The results are important in that they indicate possible ways of designing writing treatment. However, they also show the need for careful analyses when evaluating different treatment strategies and in discussing what improved writing ability may be.
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| 8. |
- Ekelund, A, et al.
(author)
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Additional colloids have only a minor haemodilutive effect after surgery for aneurysmal subarachnoid haemorrhage
- 1999
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In: British Journal of Neurosurgery. - : Informa UK Limited. - 0268-8697 .- 1360-046X. ; 13:4, s. 399-404
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Journal article (peer-reviewed)abstract
- Haemodilution is commonly used as prophylaxis, as well as treatment for cerebral ischaemia after aneurysmal subarachnoid haemorrhage (SAH). Thirty-six patients operated for aneurysmal SAH were evaluated retrospectively; 24 received haemodilutive therapy and 12 patients, as a control group, received no additional therapy. There was a 'spontaneous' drop in haematocrit by 22% in both groups, and a corresponding drop in haemoglobin by 23% in the treatment group and 19% in the non-haemodiluted group, during the first 4 days after the SAH. After the initial decrease the haematocrit remained stable between 0.28 and 0.33 until day 14 in both groups. The haemodilutive group had only a minor lower haematocrit level during days 8-12 as the additional fluid resulted in increased renal excretion. This minor difference was, however, significant (p < 0.02).
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| 9. |
- Hansen-Schwartz, J, et al.
(author)
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Expression of ETA and ETB receptor mRNA in human cerebral arteries
- 2002
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In: British Journal of Neurosurgery. - : Informa UK Limited. - 0268-8697 .- 1360-046X. ; 16:2, s. 149-153
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Journal article (peer-reviewed)abstract
- The vascular effects of endothelins (ET) are in mammals mediated via two receptor subtypes, endothelin A (ETA, mainly constrictive) and endothelin B (ETB, mainly dilating) receptors. We have examined the presence of ETA and ETB receptor mRNA using the reverse transcription polymerase chain reaction (RT-PCR) in both normal human cerebral arteries and cerebral arteries from patients with cerebrovascular disease. Two vessel preparations were studied: macroscopic arteries and microvessels, the latter obtained through a sensitive separation method. In endothelial cells both ETA and ETB receptor mRNA was detected. In almost all samples from normal cerebral arteries only ETA receptor mRNA was detected, whereas in vessel samples from patients with cerebrovascular disease as well as cerebral neoplasms, additional ETB receptor mRNA was detected significantly more frequently. The pathophysiological significance of this difference is at present speculative, but does point to a vascular involvement of this receptor in cerebrovascular disease.
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