Health system intervention: back of the envelope to statewide transformation of occupational health care delivery

The occupational health nurse helps promote the workers' health as well as coordinate their health benefits. New options in health care delivery impact on these benefits and are an important field of study for the occupational health nurse. The trend toward cost containment is examined in light of changing health care delivery systems. HMOs, IPAs and PPOs are compared and contrasted with emphasis on their cost-saving features. Important variables are included for employees to consider when selecting a plan.

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The Military Health System: A Community of Solutions for Medical Education, Health Care Delivery, and Public Health

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2013.03.120192 ◽

2013 ◽

Vol 26 (3) ◽

pp. 264-270 ◽

Cited By ~ 1

Author(s):

R. P. Lennon ◽

A. Saguil ◽

D. A. Seehusen ◽

B. V. Reamy ◽

M. B. Stephens

Keyword(s):

Public Health ◽

Health Care ◽

Medical Education ◽

Health System ◽

Health Care Delivery ◽

Care Delivery ◽

Military Health System ◽

Military Health ◽

System A ◽

The Military

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The engine or the caboose: health policy in developing countries

Revista de Saúde Pública ◽

10.1590/s0034-89101990000600012 ◽

1990 ◽

Vol 24 (6) ◽

pp. 523-527

Author(s):

Raymond L. Goldsteen ◽

Julio Cesar R. Pereira ◽

Karen Goldsteen

Keyword(s):

Health Care ◽

Developing Countries ◽

Health Policy ◽

Health System ◽

Health Care Delivery ◽

Care Delivery ◽

Private Health Care ◽

Public And Private ◽

Tiered System ◽

Effectiveness And Efficiency

A discussion of health policy in developing countries is presented. It argues that developing countries must adopt a progressive approach to health policy which rejects the two-tiered system of public and private health care. However, it also points out that ideology is not sufficient to maintain support. A progressive health system must utilize administrative and social and behavioral sciences to achieve effectiveness and efficiency in health care delivery. It cannot ignore these goals any more than a private health care system can.

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Equity analysis of health system accessibility from perspective of people with disability

International Journal of Health Governance ◽

10.1108/ijhg-11-2018-0067 ◽

2019 ◽

Vol 24 (4) ◽

pp. 298-309

Author(s):

Hussain Zandam ◽

Muhamad Hanafiah Juni

Keyword(s):

Health Care ◽

Health System ◽

Health Care Delivery ◽

Access To Health Care ◽

Care Delivery ◽

Physical Disabilities ◽

People With Disabilities ◽

Cross Sectional Survey ◽

Content Type ◽

Access To Health

Purpose Self-evaluated access and accessibility has been found to be associated with healthcare seeking and quality of life. Studies have shown that, however, a vast majority of individuals with disability living in poor countries have limited access to healthcare influenced by several barriers. The purpose of this paper is to compare the perception of general accessibility of health care services and its association with access barriers and other contextual factors between people with physical disabilities and counterparts without disability. Design/methodology/approach This study is a cross sectional survey involving 213 individuals with physical disabilities and 213 counterparts without disability sampled using a multi-stage method. Data were collected using a structured questionnaire with sections on socioeconomic and living conditions, education, health, employment and access to health care. Data analysis involved using χ2 for proportions and T-test and multiple regressions (stepwise) method to determine significant factors that influence perception on accessibility. Findings The study finds that people with disabilities fared worse in various socioeconomic factors such as education, employment, income and assets possession. People with disabilities also experience more dimensional barriers and reported poor health system accessibility. The difference in accessibility continued after adjusting for other variables, implying that there are more inherent factors that explain the perception of access for people with disabilities. Practical implications Governments should ensure equitable access to health care delivery for people with disabilities through equitable health policies and services that are responsive to the needs of people with disabilities and promote the creation of enabling environment to enhance participation in health care delivery. Originality/value The authors confirm that the paper has neither been submitted to peer review, nor is in the process of peer reviewing or accepted for publishing in another journal. The author(s) confirms that the research in this work is original, and that all the data given in the paper are real and authentic. If necessary, the paper can be recalled, and errors corrected. The undersigned authors transfer the copyright for this work to the International Journal of Health Governance. The authors are free of any personal or business association that could represent a conflict of interest regarding the paper submitted, and the authors have respected the research ethics principles.

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Current Status and Future Directions of mHealth Interventions for Health System Strengthening in India: Systematic Review (Preprint)

10.2196/preprints.11440 ◽

2018 ◽

Cited By ~ 1

Author(s):

Abhinav Bassi ◽

Oommen John ◽

Devarsetty Praveen ◽

Pallab K Maulik ◽

Rajmohan Panda ◽

...

Keyword(s):

Health Care ◽

Service Delivery ◽

Health System ◽

Health Systems ◽

Health Care Delivery ◽

Care Delivery ◽

Health Systems Strengthening ◽

Noncommunicable Disease ◽

Health Initiatives

BACKGROUND With the exponential increase in mobile phone users in India, a large number of public health initiatives are leveraging information technology and mobile devices for health care delivery. Given the considerable financial and human resources being invested in these initiatives, it is important to ascertain their role in strengthening health care systems. OBJECTIVE We undertook this review to identify the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. The review classifies these initiatives based on the disease areas, geographical distribution, and target users and assesses the quality of the available literature. METHODS A search of the literature was done to identify mHealth or telemedicine articles published between January 1997 and June 2017 from India. The electronic bibliographic databases and registries searched included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization health system building block framework was used to categorize the published initiatives as per their role in the health system. Quality assessment of the selected articles was done using the Cochrane risk of bias assessment and National Institutes of Health, US tools. RESULTS The combined search strategies yielded 2150 citations out of which 318 articles were included (primary research articles=125; reviews and system architectural, case studies, and opinion articles=193). A sharp increase was seen after 2012, driven primarily by noncommunicable disease–focused articles. Majority of the primary studies had their sites in the south Indian states, with no published articles from Jammu and Kashmir and north-eastern parts of India. Service delivery was the primary focus of 57.6% (72/125) of the selected articles. A majority of these articles had their focus on 1 (36.0%, 45/125) or 2 (45.6%, 57/125) domains of health system, most frequently service delivery and health workforce. Initiatives commonly used client education as a tool for improving the health system. More than 91.2% (114/125) of the studies, which lacked a sample size justification, had used convenience sampling. Methodological rigor of the selected trials (n=11) was assessed to be poor as majority of the studies had a high risk for bias in at least 2 categories. CONCLUSIONS In conclusion, mHealth initiatives are being increasingly tested to improve health care delivery in India. Our review highlights the poor quality of the current evidence base and an urgent need for focused research aimed at generating high-quality evidence on the efficacy, user acceptability, and cost-effectiveness of mHealth interventions aimed toward health systems strengthening. A pragmatic approach would be to include an implementation research component into the existing and proposed digital health initiatives to support the generation of evidence for health systems strengthening on strategically important outcomes.

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Crossing borders: the PACK experience of spreading a complex health system intervention across low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2018-001088 ◽

2018 ◽

Vol 3 (Suppl 5) ◽

pp. e001088 ◽

Cited By ~ 11

Author(s):

Ruth Cornick ◽

Camilla Wattrus ◽

Tracy Eastman ◽

Christy Joy Ras ◽

Ajibola Awotiwon ◽

...

Keyword(s):

Primary Care ◽

Health System ◽

Low Income ◽

Resource Constraints ◽

Care Delivery ◽

Middle Income ◽

System Intervention ◽

Learning Health System ◽

Primary Care Delivery ◽

Health System Intervention

Developing a health system intervention that helps to improve primary care in a low-income and middle-income country (LMIC) is a considerable challenge; finding ways to spread that intervention to other LMICs is another. The Practical Approach to Care Kit (PACK) programme is a complex health system intervention that has been developed and adopted as policy in South Africa to improve and standardise primary care delivery. We have successfully spread PACK to several other LMICs, including Botswana, Brazil, Nigeria and Ethiopia. This paper describes our experiences of localising and implementing PACK in these countries, and our evolving mentorship model of localisation that entails our unit providing mentorship support to an in-country team to ensure that the programme is tailored to local resource constraints, burden of disease and on-the-ground realities. The iterative nature of the model’s development meant that with each country experience, we could refine both the mentorship package and the programme itself with lessons from one country applied to the next—a ‘learning health system’ with global reach. While not yet formally evaluated, we appear to have created a feasible model for taking our health system intervention across more borders.

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