Bridges to sustainable health systems: public-private interaction for market access

2020 ◽  
Vol 35 (12) ◽  
pp. 1929-1939
Author(s):  
Simone Guercini ◽  
Matilde Milanesi ◽  
Andrea Runfola
Keyword(s):  
Health System ◽  
Health Systems ◽  
Market Access ◽  
Content Type ◽  
Industrial Marketing ◽  
The Public ◽  
Recent Debate ◽  
Public Actor ◽  
Sustainable Health

Purpose This paper aims to investigate the market access (MA) of ethical drugs, the underlying public-private interaction (PPI) between pharmaceutical companies and public actors, and the implications for the sustainability of the health system. Design/methodology/approach A qualitative interpretivist approach was selected. Interviews were carried out as the primary method of data collection: 27 interviews were conducted with 13 key informants from the pharmaceutical industry. Findings The perspective of MA evolves from formal negotiation with the public actor at various levels to PPI, which should include aspects of interactions with other actors in the network. Conceptualization in these terms is fundamental because it allows an understanding of the implications in terms of the sustainability of the health system. Originality/value The paper discusses MA by highlighting the shift from a “market access as formal negotiation” perspective to a “public-private interaction for market access” perspective, in which the focus is on the content of the interaction and the representation of the network of relevant actors for MA. It contributes to the debate on the sustainability of health systems by suggesting the adoption of a medium-to-long-term approach to economic and social sustainability based on PPI; it adopts an industrial marketing approach and contributes to the recent debate on PPI.

scholarly journals The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

2022 ◽  
pp. 73-91
Author(s):  
Meredith G. Marten
Keyword(s):  
Health System ◽  
Health Systems ◽  
Newborn Care ◽  
Health System Strengthening ◽  
Respectful Maternity Care ◽  
Health Issues ◽  
The Public ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Sustainable Health

AbstractStrengthening health systems to provide equitable, sustainable health care has been identified as essential for improving maternal and reproductive health. Many donors and non-governmental organizations (NGOs) have contributed to undermining health system strengthening, however, through adhering to what Swidler and Watkins call the “sustainability doctrine,” policies that prioritize time-limited, targeted interventions best suited for short-term funding streams, rather than the long-term needs of local populations. This chapter presents ethnographic data from semi-structured and key informant interviews with 16 policymakers and NGO directors in Dar es Salaam, Tanzania from 2011 to 2012. I illustrate how sustainability doctrine policies were put into practice, and how they have persisted, despite their shortcomings, using examples of donor-prioritized maternal healthcare initiatives in Tanzania rolled-out several years apart: prevention of mother-to-child transmission of HIV (PMTCT) and basic emergency obstetric and newborn care (BEmONC) programs in the late 2000s, and more recent efforts to implement respectful maternity care (RMC) programs. I focus on several issues informants identified as crippling efforts to build strong health systems, particularly the internal brain drain of healthcare workers from the public sector to higher-paying NGO jobs, and the prioritization of types of programs donors believed could be sustained after the funding period ended, specifically trainings and workshops. I describe how despite these issues, international organizations still design and implement less effective programs that often fail to account for local circumstances in their efforts to solve some of the more intractable health issues facing Tanzania today, in particular, the country’s stagnating maternal mortality rate. In this chapter, I argue that practices promoted and implemented under the guise of “sustainability” in policy papers and reports generated by donors paradoxically contribute to health system precarity in Tanzania.

scholarly journals Creating sustainable health care systems

2019 ◽  
Vol 33 (1) ◽  
pp. 18-34 ◽  
Author(s):  
Peter Littlejohns ◽  
Katharina Kieslich ◽  
Albert Weale ◽  
Emma Tumilty ◽  
Georgina Richardson ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Systems ◽  
Public Involvement ◽  
Health Care Systems ◽  
Ethical Challenge ◽  
Content Type ◽  
The Public ◽  
Care Systems ◽  
Sustainable Health

Purpose In order to create sustainable health systems, many countries are introducing ways to prioritise health services underpinned by a process of health technology assessment. While this approach requires technical judgements of clinical effectiveness and cost effectiveness, these are embedded in a wider set of social (societal) value judgements, including fairness, responsiveness to need, non-discrimination and obligations of accountability and transparency. Implementing controversial decisions faces legal, political and public challenge. To help generate acceptance for the need for health prioritisation and the resulting decisions, the purpose of this paper is to develop a novel way of encouraging key stakeholders, especially patients and the public, to become involved in the prioritisation process. Design/methodology/approach Through a multidisciplinary collaboration involving a series of international workshops, ethical and political theory (including accountability for reasonableness) have been applied to develop a practical way forward through the creation of a values framework. The authors have tested this framework in England and in New Zealand using a mixed-methods approach. Findings A social values framework that consists of content and process values has been developed and converted into an online decision-making audit tool. Research limitations/implications The authors have developed an easy to use method to help stakeholders (including the public) to understand the need for prioritisation of health services and to encourage their involvement. It provides a pragmatic way of harmonising different perspectives aimed at maximising health experience. Practical implications All health care systems are facing increasing demands within finite resources. Although many countries are introducing ways to prioritise health services, the decisions often face legal, political, commercial and ethical challenge. The research will help health systems to respond to these challenges. Social implications This study helps in increasing public involvement in complex health challenges. Originality/value No other groups have used this combination of approaches to address this issue.

scholarly journals The woes of Swedish private archival institutions

2017 ◽  
Vol 27 (3) ◽  
pp. 275-285 ◽  
Author(s):  
Proscovia Svärd
Keyword(s):  
Systematic Investigation ◽  
Digital Information ◽  
National Narrative ◽  
Digital Repository ◽  
Content Type ◽  
The Public ◽  
Active Involvement ◽  
Organization And Management ◽  
Long Term Preservation

Purpose The purpose of this paper is to highlight the long-term preservation challenges that the Swedish private archives are faced with. In as much as they offer a complement to the public archives and hence offer a nuanced national narrative, they lack both financial and human resources to effectively deal with the digital information management environment. Design/methodology/approach Participatory Action Research (PAR) was used to identify the challenges of long-term preservation together with the six private archives institutions that were involved in the collaboration. The collaboration was financially facilitated by the Södertörn University. PAR is defined as a systematic investigation, with the collaboration of those affected by the issue being studied, for the purposes of education and taking action or effecting social change. What is distinctive of PAR is the active involvement of people whose lives are affected by the phenomenon under study. Findings The private archival institutions face long-term preservation challenges such as lack of a digital repository that would facilitate the capture, organization and management of digital records that are of different formats and in a dispersed environment. There are no stringent legal requirements to facilitate the creation and management of the records in a standardized way and the institutions fear that imposing such requirements might deter their clients from depositing archival materials with them. The institutions will also need to espouse the business-oriented archival descriptions where private organizations are concerned to identify relevant archival materials and to promote participatory archival descriptions that would allow the creators to tag their records with metadata. Digital information requires a proactive approach, that is, planning for the long-term preservation of the information before it is created. Private archives need to invest in education packages that will facilitate their clientele’s understanding of the challenges of digital long-term preservation. Research limitations/implications The findings cannot be generalized to all private archival institutions, as it was only six institutions that participated, but the issues discussed are relevant to most archival institutions. Practical implications A lot of research has been carried out in the area of long-term preservation, but researchers have not paid enough attention to the woes of the private archives. To sustain a nuanced national narrative, the private archives need all the support to be able to live up to their mission of preserving archives of the private sector that are not captured by the public archival institutions. This is important in a pluralistic society such as Sweden. Highlighting the challenges might enable the institutions to work towards finding common challenges. Social implications The private archives are part of Sweden’s national heritage. Their preservation matters to the society as a whole and to enhancing the voices of the underrepresented. Originality/value The literature review revealed that not much research has paid attention to the challenges being faced by the private archives. This paper, therefore, contributes to this knowledge gap.

The regulation of health care in Scandinavia: professionals, the public interest and trust

2018 ◽  
pp. 61-76
Author(s):  
Karsten Vrangbæk
Keyword(s):  
Health Care ◽  
Public Policy ◽  
Health Insurance ◽  
Health System ◽  
Health Systems ◽  
Public Interest ◽  
State Level ◽  
Professional Regulation ◽  
The Public ◽  
Voluntary Health Insurance

Scandinavian health systems have traditionally been portrayed as relatively similar examples of decentralised, public integrated health systems. However, recent decades have seen significant public policy developments in the region that should lead us to modify our understanding. Several dimensions are important for understanding such developments. First, several of the countries have undergone structural reforms creating larger governance units and strengthening the state level capacity to regulate professionals and steer developments at the regional and municipal levels. Secondly, the three Nordic countries studied experienced an increase in the purchase of voluntary health insurance and the use of private providers. This introduces several issues for the equality of users and the efficiency of the system. This paper will investigate such trends and address the question: Is the Nordic health system model changing, and what are the consequences for trust, professional regulation and the public interest?

scholarly journals Emerging challenges in the health systems of Kerala, India: qualitative analysis of literature reviews

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Manesh Muraleedharan ◽  
Alaka Omprakash Chandak
Keyword(s):  
Health Care ◽  
Health Economic ◽  
Health System ◽  
Health Systems ◽  
Significant Proportion ◽  
Vital Statistics ◽  
The State ◽  
Future Research ◽  
Health Seeking ◽  
Content Type

PurposeThe substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.Design/methodology/approachA systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.FindingsChronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.Research limitations/implicationsThe present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.Originality/valueGiven the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.

scholarly journals The concept of public health. Types of health systems. Parallel between the Romanian and the Australian health system

2021 ◽  
Vol 68 (1) ◽  
pp. 17-21
Author(s):  
Dorel Dulău ◽  
◽  
Simona Bungău ◽  
Lucia Daina ◽  
Camelia Buhaş ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
Medical Management ◽  
Local Authority ◽  
Public Health System ◽  
Point Of View ◽  
The Public ◽  
Australian Health ◽  
Centralization And Decentralization

Medical management is a field that combines, both in theory and in practice, two somewhat different domains, administration and the medical domain, creating a third area of activity, namely that of medical management. This review is part of a study of health services management, which seeks to find solutions to improve the efficiency of the the management and administration of the medical system, both locally and nationally. In order to be able to study and evaluate, from a scientific point of view, the concepts of centralization and decentralization of the public health system in Romania, it is absolutely pertinent, but also mandatory, to focus on defining the notion of health system. Only later can we approach and research the process of decentralization of health, the political and economic context in which it can be initiated, as well as how to activate and carry it out. Decentralization, as a phenomenon of the transfer of rights and obligations, from the level of the central authority to the level of the local authority, can take various forms. From a theoretical and practical point of view, the forms of decentralization can be studied, evaluated and concluded by emphasizing the strengths and weaknesses. Also important to study are the ways of putting health systems into practice, which from the point of view of the source of funding are divided into state-funded health systems (Semashko, Beveridge and Bismarck) and privately funded health systems.

scholarly journals What Makes Health Systems Resilient? A Qualitative Analysis of The Perspectives of Swiss NGOs

2021 ◽  
Author(s):  
Pauline Yongeun Grimm ◽  
Kaspar Wyss
Keyword(s):  
Global Health ◽  
Health System ◽  
Human Resource Development ◽  
Health Systems ◽  
Knowledge Exchange ◽  
Innovative Solutions ◽  
System Resilience ◽  
State Actors

Abstract Background: Resilience has become relevant than ever before with the advent of increasing and intensifying shocks on the health system and its amplified effects due to globalization. Using the example of non-state actors based in Switzerland, the aim of this study is to explore how and to what extent NGOs with an interest in global health have dealt with unexpected shocks on the health systems of their partner countries and to reflect on the practical implications of resilience for the multiple actors involved. Consequently, this paper analyses the key attributes of resilience that targeted investments may influence, and the different roles key stakeholders may assume to build resilience. Methods: This is a descriptive and exploratory qualitative study analysing the perspectives on health system resilience of Swiss-based NGOs through 20 in-depth interviews. Analysis proceeded using a data-driven thematic analysis closely following the framework method. An analytical framework was developed and applied systematically resulting in a complete framework matrix. The results are categorised into the expected role of the governments, the role of the NGOs, and practical future steps for building health system resilience. Results: The following four key ‘foundations of resilience’ were found to be dominant for unleashing greater resilience attributes regardless of the nature of shocks: ‘realigned relationships,’ ‘foresight,’ ‘motivation,’ and ‘emergency preparedness.’ The attribute to ‘integrate’ was shown to be one of the most crucial characteristics of resilience expected of the national governments from the NGOs, which points to the heightened role of governance. Meanwhile, as a key stakeholder group that is becoming inevitably more powerful in international development cooperation and global health governance, non-state actors namely the NGOs saw themselves in a unique position to facilitate knowledge exchange and to support long-term adaptations of innovative solutions that are increasing in demand. The strongest determinant of resilience in the health system was the degree of investments made for building long-term infrastructures and human resource development which are well-functioning prior to any potential crisis. Conclusions: Health system resilience is a collective endeavour and a result of many stakeholders’ consistent and targeted investments. These investments open up new opportunities to seek innovative solutions and to keep diverse actors in global health accountable. Strong governance, a bi-directional knowledge exchange, and the focus on leveraging science for impact can draw greater potential of resilience in the health systems. Governments and the NGOs have unique points of contribution in this journey towards resilience and may support governments to prioritise investing in the key ‘foundations of resilience’ in order to activate greater attributes of resilience.

Afghan aid flows will resume, bypassing the Taliban

2021 ◽  
Keyword(s):  
Public Sector ◽  
Healthcare Workers ◽  
Economic Impacts ◽  
Female Employment ◽  
Service Members ◽  
Content Type ◽  
The Public ◽  
Security Service ◽  
Wage Payment

Significance The Taliban government has allowed UN agencies to start paying salaries directly to teachers and healthcare workers. It initially stalled on this, but has now conceded for fear of losing legitimacy if it fails to address the looming crisis. Impacts Western concerns about reprisal killings of former security service members will further complicate relations with the Taliban. The public-sector wage payment scheme established by UN agencies may become the norm for many years. Taliban restrictions on female employment will have long-term economic impacts but will fall down the list of Western priority concerns.

Accounting for gaming in the time of plague: COVID-19 in Macau

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Carlos Noronha ◽  
Jieqi Guan ◽  
Sandy Hou In Sio
Keyword(s):  
Critical Event ◽  
Gaming Industry ◽  
Content Type ◽  
The Public ◽  
The Social ◽  
Social Account ◽  
The Government ◽  
The Impact ◽  
Practical Implications

Purpose While the COVID-19 virus has been spreading worldwide, some studies have related the pandemic with various aspects of accounting and therefore emphasized the importance of accounting research in understanding the impact of COVID-19 on society as a whole. Recent studies have looked into such an impact on various industries such as retail and agriculture. The current study aims at applying a sociological framework, sociology of worth (SOW), to the gaming industry in Macau, the largest operator of state-allowed gambling and entertainment in China, which will allow for its development during the COVID-19 pandemic to be charted. Design/methodology/approach The study uses the theory of SOW as a framework and collects data from various sources, such as the government, gaming operators and the public, to create timelines and SOW frameworks to analyze the impact of the virus on the gaming industry and the society as a whole. Findings Detailed content analysis and the creation of different SOW matrices determined that the notion of a “lonely economy” during a time of a critical event may be ameliorated in the long term through compromises of the different worlds and actors of the SOW. Practical implications Though largely theory-based, this study offers a thorough account of the COVID-19 incident for both the government and the gaming industry to reflect on and to consider new ways to fight against degrowth caused by disasters or crises. Social implications The SOW framework divides society into different worlds of different worths. The current study shows how the worths of the different worlds are congruent during normal periods, and how cracks appear between them when a sudden crisis, such as COVID-19, occurs. The article serves as a social account of how these cracks are formed and how could they be resolved through compromise and reconstruction. Originality/value This study is a first attempt to apply SOW to a controversial industry (gaming) while the effects of the COVID-19 pandemic are ongoing. It offers a significant contribution to the social accounting literature through its consideration of the combination of unprecedented factors in a well-timed study that pays close attention to analyses and theoretical elaboration.

Incompatible Images

2009 ◽  
pp. 186-200 ◽  
Author(s):  
Michel J. Sassene
Keyword(s):  
Health System ◽  
Health Systems ◽  
Clinical Evidence ◽  
Asthma Management ◽  
Self Management ◽  
Management Systems ◽  
Use Of Self ◽  
Per Se

This chapter investigates asthmatics’ reasons for not adopting an e-health system for asthma selfmanagement. An understanding of these reasons is particularly relevant, because clinical evidence indicates that, if used, such systems lead to better asthma management. The investigated asthma system is, however, based on a taken-for-granted image of asthmatics as, per se, striving to be symptom-free. This image is incompatible with interviewed asthmatics’ day-to-day performances of their asthma, and renders invisible (a) that their asthma performances emphasize an economy of good passages and of feeling capable, (b) that they achieve the objective of feeling capable in quite different ways, and (c) that feeling capable does not per se equal being symptom-free all the time. To attain long-term use of self-management systems and other patient-centred e-health systems, such systems must acknowledge and link into the manifold performances that comprise users’ ways of living with their disease.

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