Reversing the trend of weak policy implementation in the Kenyan health sector? – a study of budget allocation and spending of health resources versus set priorities

Background: Since the 2003 United States–British Coalition military invasion, Iraq has been in a state of continuous deterioration at all levels, including the health sector. This study aimed to elicit the viewpoints of the Iraqi people on the current health system, focusing on many provided health services and assessing whether the public prefers the current health system or that was provided before the invasion. Methods: A cross-sectional survey designed to explore the Iraqi people’s opinions on their health system. A self-administered questionnaire using a multi-stage sampling technique was distributed in five geographical regions in Iraq to collect the data from the head of household between 1st October and 31st of December 2019. Multiple logistic regressions were recruited to determine the significant contributing variables in this study. Results: A total of 365 heads of households (response rate: 71.7%) with the mean age of 48.36 + 11.92 years (ranged 35-78) included in the study. Most of the respondents (61.4%) complained of healthcare inaccessibility, 59.7% believed that health resources were not available, 53.7% claimed a deterioration in the quality of care, and 62.2% believed that the political / media position did not contribute to positive changes during the past two decades. Indeed, most respondents (66.0%) believe that the current healthcare system is worse than before. In the multivariate analysis, there was a statistically significant relationship between the characteristics and opinions of the respondents. Young age group (p = 0.003), men (p = < 0.001), unmarried (p = 0.001), high educated (p = < 0.001), rural resident (p = < 0.001), unemployed (p = 0.003), monthly income of less than USD 400 (p = < 0.001), consider themselves to be unhealthy (p = 0.001), and those who think that people are unhappy now than two decades ago (p = 0.012) have a more negative opinion of the health system. Conclusions: Most Iraqis surveyed expressed disappointment from the health system after the 2003 US-led invasion. The current health system is faltering at all levels and does not meet the citizens' basic needs. Health Transformation Program (HTP) has become inevitable to develop an accessible, affordable, high-quality, efficient, and effective health system.

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POLICY IMPLEMENTATION OF A HEALTHY INDONESIA PROGRAM WITH A FAMILY APPROACH IN BANDUNG DISTRICT

Advances in Social Sciences Research Journal ◽

10.14738/assrj.84.9828 ◽

2021 ◽

Vol 8 (3) ◽

pp. 143-155

Author(s):

Uri Zaenuri ◽

Ria Arifianti ◽

Ratna Meisya Dai

Keyword(s):

Policy Implementation ◽

Community Health ◽

Community Health Center ◽

Health Sector ◽

Training Methods ◽

Implementation Model ◽

Family Approach ◽

The Social ◽

Healthy Family ◽

Policy Measures

The purpose of this study was to determine the implementation of the Healthy Indonesia Program with a Family Approach which is indispensable as a determinant of the success of the Bandung Regency Government's performance in the health sector. The Healthy Indonesia Program with a Family Approach is a priority program of the Ministry of Health which is implemented by the Center for Community Health. The implementation of the Healthy Indonesia Program with a Family Approach in Bandung Regency was only carried out in 2017 with program socialization activities at the Health Office and Community Health Center levels. The research method used is descriptive qualitative with the approach of Donald van Meter and Carl van Horn's policy implementation model. The findings from the implementation of the Healthy Indonesia Program with a Family Approach in Bandung Regency have been implemented but have not yet reached the target of total coverage. The Bandung Regency Healthy Family Index is included in the unhealthy assessment (<0.8). So that the success of implementation will be achieved when making improvements from deficiencies, both in terms of standards and policy targets or policy measures and objectives, resources, characteristics of the implementing organization, attitudes of the implementers, communication between organizations and implementing activities, and the social, economic and political environment. Suggestions from this study are to improve the empowerment of family roles and community potential with training methods for community cadres, continue the enumerator recruitment program to assist with home visits and data collection and data input, advocate for budget allocations sourced from regional revenue and expenditure budgets.

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IMPLEMENTASI KEBIJAKAN PELAYANAN KESEHATAN IBU DAN ANAK DI KABUPATEN TAKALAR PROVINSI SULAWESI SELATAN

JPAP Jurnal Penelitian Administrasi Publik ◽

10.30996/jpap.v2i01.700 ◽

2016 ◽

Vol 2 (01) ◽

Author(s):

Halwa Tiah

Keyword(s):

Health Care ◽

Child Health ◽

Policy Implementation ◽

Cultural Values ◽

Health Sector ◽

Situational Factors ◽

Structural Factors ◽

Local Conditions ◽

South Sulawesi ◽

Mother And Child

Takalar district, South Sulawesi has a policy of maternal and child healthby adopting indigenous shaman a major role in the birthing process in theform of Regulation No. 2 of 2010 on the Partnership midwife and healer.Based on the subject matter, the question of the proposed research is howthe implementation of policies on Maternal and Child Health in Takalardistrict, South Sulawesi? How to model Policy Implementation Maternaland Child Health Care according to local conditions in the district of SouthSulawesi Takalar? The method used is descriptive qualitative. The resultsshowed that the results are good policy performance. The success of thepolicy program at the district MCH-KBD Takalar this policy to be a "pilotproject"for other regions. The contents of the policy is a creative solutionbased on local wisdom for facts on the ground people still believe their role.Program planning, implementation and evaluation are participatorystakeholders. Policy context, the views of the Situational factors, KBD is aform of cooperation with the shaman's midwife with the principle of mutualbenefit sipakatau sipakainge upheld by society Takalar. This principle isimplemented by creating the principle of openness, equality, and trust in anattempt to save the mother and baby. This partnership puts birth attendantsand midwives as their role from birth attendant became a partner in caringfor mothers and babies. In terms of structural factors, contextually seen thatthe decentralization policy in the health sector in the district Takalar hasbeen used for the benefit of policy implementation KIA. KBD policy islocal policy is based on local cultural values and fully supported bystakeholders.Keywords: Implementation, health care, mother and child, shaman, Takalar

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Utilization of Military Support in the Response to Hurricane Marilyn: Implications for Future Military-Civilian Cooperation

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00027321 ◽

1999 ◽

Vol 14 (2) ◽

pp. 49-54 ◽

Cited By ~ 2

Author(s):

Michael Weddle ◽

Hugo Prado-Monje

Keyword(s):

Department Of Defense ◽

Disaster Response ◽

Health Sector ◽

Health Resources ◽

The United States ◽

Virgin Islands ◽

Hurricane Andrew ◽

Disaster Assistance ◽

Military Support ◽

Civilian Managers

AbstractIntroduction:The past decade has been a period of evolution for the Federal disaster response system within the United States. Two domestic hurricanes were pivotal events that influenced the methods used for organizing Federal disaster assistance. The lessons of Hurricane Hugo (1989) and Hurricane Andrew (1992) were incorporated into the successful response to Hurricane Marilyn in the U.S. Virgin Islands in 1995. Following each of these storms, the Department of Defense was a major component of the response by the health sector. Despite progress in many areas, lack of clear communication between military and civilian managers and confusion among those requesting Department of Defense health resources may remain as obstacles to rapid response.Methods:This discussion is based on an unpublished case report utilizing interviews with military and civilian managers involved in the Hurricane Marilyn response.Results:The findings suggest that out-of-channel pathways normally utilized in the warning and emergency phase of the response remained operational after more formal civilian-military communication pathways and local assessment capability had been established.Conclusion:It is concluded that delays may be avoided if the system in place was to make all active pathways for the request and validation of military resources visible to the designated Federal managers located within the area of operations.

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Studi Kualitatif Implementasi Kebijakan Eliminasi Malaria di Wilayah Endemis Rendah Kabupaten Pangandaran dan Pandeglang

ASPIRATOR - Journal of Vector-borne Disease Studies ◽

10.22435/asp.v13i1.4683 ◽

2021 ◽

Vol 13 (1) ◽

pp. 55-68

Author(s):

Tri Wahono ◽

Endang Puji Astuti ◽

Andri Ruliansyah ◽

Mara Ipa ◽

Muhammad Umar Riandi

Keyword(s):

Human Resources ◽

Policy Implementation ◽

Malaria Control ◽

Malaria Elimination ◽

Global Fund ◽

Health Sector ◽

Health Programs ◽

The Government ◽

Depth Interviews ◽

Control Implementation

The government targets malaria elimination in Java and Bali by 2023. But until 2020, Pangandaran and Pandeglang Regency haven’t received malaria-free certification. This qualitative study was conducted to provide an overview of Pangandaran and Pandeglang malaria control implementation by comparing it to Activity Indicators based on the Indonesian Minister of Health Decree on malaria elimination. In-depth interviews, using thematically interview guidelines, were conducted to 48 key informants such as policyholders and people in charge of health programs and cross-sectoral at the provincial, district, sub-district, and village levels. Thematic analysis was used in the theme of policy implementation, budget, facilities and infrastructures, human resources, and cross-sector cooperation. The result shows that malaria control is implemented according to the decree, but some activities haven’t been done. The analysis on policy implementation theme shows that both districts have carried out according to the guidelines, with innovation in the form of establishing Posmaldes (village malaria post) in Ujung Kulon National Park in Pandeglang. APBD, APBN, and Global Fund are used as budget sources. Both districts stated that facilities and infrastructures are sufficiently available, but there is a lack in human resources’ quantity and varying degrees of competencies. There is also a lack of cross-sector cooperation because malaria control hasn’t become a priority in those sectors and they are only acting as supports to the health sector. Efforts to control malaria are considered less optimal due to the absence of malaria elimination regulations, varied human resource capabilities, and the limitation in the duties and functions of cross-sectors.

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IMPLEMENTASI KEBIJAKAN JAMINAN KESEHATAN DAERAH DI KABUPATEN PURBALINGGA PROVINSI JAWA TENGAH

Paradigma: Jurnal Masalah Sosial, Politik, dan Kebijakan ◽

10.31315/paradigma.v24i1.5019 ◽

2020 ◽

Vol 24 (1) ◽

pp. 463

Author(s):

Hari Walujo Sedjati

Keyword(s):

Public Health ◽

Health Care ◽

Health Service ◽

Policy Implementation ◽

Health Sector ◽

The Public ◽

Central Java ◽

Health Goals ◽

Efficiency And Effectiveness ◽

The Government

The research aimed to know problems policy health on Purbalingga district; province Central Java. Health planners have been more effective largely because of a policy regionalizing responsibility for the public health pure delivery assurance systems. Several kinds of health service provider’s hospital recommended by government for pure society in Purbalingga district. The Government as certain the efficiency and effectiveness of health services in public actors, these goals and options which frame a actor government Purbalingga district, choice in the health sector, are complicated by agreement over the criteria that determinant which patients are getting too much for pure society to health care. The policy Implementation goals to minimize mortalities and Invalid body for pure society in Purbalingga and policy health goals and standards are reached.

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A Narrative Synthesis Review of Out-of-Pocket Payments for Health Services Under Insurance Regimes: A Policy Implementation Gap Hindering Universal Health Coverage in Sub-Saharan Africa

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2021.38 ◽

2021 ◽

Author(s):

Abigail Nyarko Codjoe Derkyi-Kwarteng ◽

Irene Akua Agyepong ◽

Nana Enyimayew ◽

Lucy Gilson

Keyword(s):

Policy Implementation ◽

Universal Health Coverage ◽

Health Sector ◽

Sub Saharan Africa ◽

Narrative Synthesis ◽

Health Coverage ◽

Implementation Gap ◽

Street Level ◽

Sub Saharan ◽

Universal Health

Background: "Achieve universal health coverage (UHC), including financial risk protection, access to quality essential healthcare services and access to safe, effective, quality and affordable essential medicines and vaccines for all" is the Sustainable Development Goal (SDG) 3.8 target. Although most high-income countries have achieved or are very close to this target, low- and middle-income countries (LMICs) especially those in sub-Saharan Africa (SSA) are still struggling with its achievement. One of the observed challenges in SSA is that even where services are supposed to be "free" at point-of-use because they are covered by a health insurance scheme, out-of-pocket fees are sometimes being made by clients. This represents a policy implementation gap. This study sought to synthesise the known evidence from the published literature on the ‘what’ and ‘why’ of this policy implementation gap in SSA. Methods: The study drew on Lipsky’s street level bureaucracy (SLB) theory, the concept of practical norms, and Taryn Vian’s framework of corruption in the health sector to explore this policy implementation gap through a narrative synthesis review. The data from selected literature were extracted and synthesized iteratively using a thematic content analysis approach. Results: Insured clients paid out-of-pocket for a wide range of services covered by insurance policies. They made formal and informal cash and in-kind payments. The reasons for the payments were complex and multifactorial, potentially explained in many but not all instances, by coping strategies of street level bureaucrats to conflicting health sector policy objectives and resource constraints. In other instances, these payments appeared to be related to structural violence and the ‘corruption complex’ governed by practical norms. Conclusion: A continued top-down approach to health financing reforms and UHC policy is likely to face implementation gaps. It is important to explore bottom-up approaches – recognizing issues related to coping behaviour and practical norms in the face of unrealistic, conflicting policy dictates.

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Health sector reforms and policy implementation in South Africa:

New South African Review 3 ◽

10.18772/22013037359.19 ◽

2018 ◽

pp. 239-260 ◽

Cited By ~ 3

Author(s):

Laetitia Rispel ◽

Julia Moorman

Keyword(s):

South Africa ◽

Policy Implementation ◽

Health Sector ◽

Health Sector Reforms

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Allocation of mental health resources

Psychiatric Ethics ◽

10.1093/med/9780198839262.003.0008 ◽

2021 ◽

pp. 157-182

Author(s):

James E. Sabin ◽

Norman Daniels

Keyword(s):

Mental Health ◽

Resource Allocation ◽

Health Sector ◽

Health Resources ◽

The Public ◽

Allocation Process ◽

Setting Process ◽

Decision Making Processes ◽

Four Levels ◽

Appeals Process

Resource allocation in mental health occurs at four levels. First, within the total allocation a society makes to health care, how much should go to mental health? In most societies, mental health services have been discriminated against. The quest for parity with medical and surgical services reflects the effort to undo this discrimination. In the Oregon priority-setting process, mental health conditions ranked high among community choices. Second, within the mental health sector, which conditions should receive priority? Some priority should be given to those with the most severe impairments, but no principles tell us just how much priority the sickest should receive. Third, within a particular area, such as schizophrenia, how much resource should be devoted to prevention, treatment of acute episodes, or rehabilitation of those with chronic conditions? Finally, in the care of individual patients, how much treatment is ‘enough’? Where and how is the line drawn between interventions regarded as ‘medically necessary’ versus interventions that are desirable but ‘optional’? In the absence of shared principles for making these allocational decisions, societies must establish fair decision-making processes, in which the rationales for policies and decisions are shared with the public, the rationales address meeting population needs in the context of available resources, and a robust appeals process allows patients, families, and clinicians to challenge decisions and policies. Because societies will develop their own distinctive approaches to resource allocation, progress requires looking at the allocation process in an international context.

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Democracy, economic growth and government spending in public health in Southeast Asia

International Journal of Development Issues ◽

10.1108/ijdi-08-2018-0112 ◽

2019 ◽

Vol 18 (1) ◽

pp. 70-87

Author(s):

Thanapan Laiprakobsup

Keyword(s):

Public Health ◽

Southeast Asia ◽

Fixed Effects ◽

Health Sector ◽

Budget Allocation ◽

Ordinary Least Squares ◽

Political Regime ◽

Content Type ◽

The Public ◽

Public Health Sector

Purpose The purpose of this paper is to examine how political regimes and political transition affect government decisions to allocate budgets to the public health sector in Southeast Asia. Design/methodology/approach Ordinary least squares with fixed-effects model is adopted to examine the effect of political regime on public health spending. Findings Examining the allocation of public health budgets in Southeast Asian countries, the paper finds that a democratic government positively leads to an increase in public health budget allocation, while autocratic government negatively affects the allocation of public health budgets. Further, political liberalization contributes to an increase in budget allocation to the public health sector. Originality/value Democratic politics and economic development aim to distribute public resources to social policy, such as policy on public health.

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