District health network policy in Iran: the role of ideas, interests, and institutions (3i framework) in a nutshell

Abstract Background District Health Network (DHN), one of Iran’s most successful health reforms, was launched in 1985 to provide primary health care (PHC), in response to health inequities in Iran. The present study aims to use interrelated elements of the 3i framework: ideas (e.g., beliefs and values, culture, knowledge, research evidence and solutions), interests (e.g., civil servants, pressure groups, elected parties, academians and researchers, and policy entrepreneurs), and institutions (e.g., rules, precedents, and organizational, government structures, policy network, and policy legacies) to explain retrospectively how (DHN) policy in Iran, as a developing country, was initiated and formed. Methods A historical narrative approach with a case study perspective was employed to focus on the formation and framing process of DHN. For this purpose, the 3i framework was used as a guideline for data analysis. This study mainly searched and extracted secondary sources, including online news, reports, books, dissertations, and published articles in the scientific databases. Primary interviews as a supplementary source were also carried out to meet cross-validation of the data. Data were analyzed using a deductive and inductive approach. Results According to the 3i framework, the following factors contributed to the formation of DHN policy in Iran: previous national efforts (for instance Rezaieh plan) and international events aiming to provide public health services for peripheral regions; dominant social discourses and values at the beginning of the Iranian revolution such as addressing the needs of disadvantaged and marginalized groups, which were embedded in the goals of DHN policy aiming to provide basic health services for deprived people especially living in rural and remote areas. Besides, the remarkable social cohesion and solidarity among people reinforced by the Iran-Iraq war were among other factors which contributed to the formation of participatory plans such as DHN (ideas). Main policy entrepreneurs including Minister of Health, his public health deputy and two planners of DHN with similar and rich background in the public health field and sharing the same beliefs (interests) which subsequently led to creation of tight-knit policy community network between them (institutions) also accelerated the creation of DHN in Iran to great extent. Political support of parliamentary representatives (interests), and formal laws such as principles of Iran Constitution (institutions) were also influential in passing the DHN in Iran. Conclusions The 3i framework constituents would be insightful in explaining the creation of public health policies. This framework showed that the alignment of laws, structures, and interests of the main actors of the policy with the dominant ideas and beliefs in the society, opened the opportunity to form DHN in Iran.

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Membangun Komunikasi dalam Sinergi Pelayanan Kesehatan di Kabupaten Bandung

KOMUNIKA Jurnal Dakwah dan Komunikasi ◽

10.24090/komunika.v14i1.3033 ◽

2020 ◽

Vol 14 (1) ◽

pp. 17-28

Author(s):

Ditha Prasanti ◽

Ikhsan Fuady ◽

Sri Seti Indriani

Keyword(s):

Public Health ◽

Health Service ◽

Health Services ◽

Active Role ◽

Communication Process ◽

Public Health Services ◽

District Health ◽

The Government ◽

The One ◽

The Village

The "one data" policy driven by the government through the Ministry of Health is believed to be able to innovate and give a new face to health services. Of course, the improvement of health services starts from the smallest and lowest layers, namely Polindes. Starting from this policy and the finding of relatively low public health service problems, the authors see a health service in Polindes, which contributes positively to improving the quality of public health services. The health service is the author's view of the communication perspective through the study of Communication in the Synergy of Public Health Services Polindes (Village Maternity Post) in Tarumajaya Village, Kertasari District, Bandung Regency. The method used in this research is a case study. The results of the study revealed that public health services in Polindes are inseparable from the communication process that exists in the village. The verbal communication process includes positive synergy between the communicator and the communicant. In this case, the communicators are village midwives, village officials, namely the village head and his staff, the sub-district health center, and the active role of the village cadres involved. In contrast, the communicant that was targeted was the community in the village of Tarumajaya. This positive synergy results in a marked increase in public services, namely by providing new facilities in the village, RTK (Birth Waiting Home). Kebijakan “one data” yang dimotori oleh pemerintah melalui Kementerian kesehatan diyakini mampu membuat inovasi dan memberikan wajah baru terhadap layanan kesehatan. Tentunya, perbaikan layanan kesehatan tersebut dimulai dari lapisan terkecil dan terbawah yakni Polindes. Berawal dari kebijakan tersebut dan masih ditemukannya masalah pelayanan kesehatan publik yang relatif rendah, penulis melihat sebuah layanan kesehatan di Polindes, yang memberikan kontribusi positif dalam peningkatan kualitas layanan kesehatan masyarakat. Pelayanan kesahatan tersebut penulis lihat dari perpektif komunikasi melaui penelitian Komunikasi dalam Sinergi Pelayanan Kesehatan Publik Polindes (Pos Bersalin Desa) di Desa Tarumajaya, Kecamatan Kertasari, Kabupaten Bandung ini dilakukan. Metode yang digunakan dalam penelitian ini adalah studi kasus. Hasil penelitian mengungkapkan bahwa pelayanan kesehatan publik di Polindes, tidak terlepas dari adanya proses komunikasi yang terjalin di desa tersebut. Proses komunikasi verbal tersebut meliputi sinergitas positif antara pihak komunikator dan komunikan. Dalam hal ini, komunikator tersebut adalah Bidan Desa, Aparat Desa yakni Kepala Desa beserta staffnya, Puskesmas tingkat kecamatan, serta peran aktif dari para kader desa yang terlibat. Sedangkan komunikan yang menjadi target adalah masyarakat di desa Tarumajaya. Sinergitas positif tersebut menghasilkan peningkatan pelayanan publik yang nyata, yaitu dengan adanya penyediaan fasilitas baru di desa, RTK (Rumah Tunggu Kelahiran).

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How Should We Organise Community Health Services?

Australian Journal of Primary Health ◽

10.1071/py97002 ◽

1997 ◽

Vol 3 (1) ◽

pp. 6 ◽

Cited By ~ 3

Author(s):

Hal Swerissen

Keyword(s):

Public Health ◽

Health Services ◽

Community Health ◽

Community Health Services ◽

Community Services ◽

Health Networks ◽

General Direction ◽

Functional Relations ◽

Community Health Networks ◽

The Creation

This paper reviews the organisation of Victorian community health services in the context of the general direction of reform for the Australian and Victorian health systems. It notes that the emphasis has shifted to a greater focus on improving the efficiency of the relationship between needs, resources, services and outcomes. Within this context, in addition to public health measures, national reforms have advocated the creation of funding and organisational arrangements around three service functions: general care, acute care and co-ordinated care. It is argued that the organisation of community services should be driven by these functional relations, not vice versa. The efficiency of vertical and horizontal integration and the creation of community health networks is considered in relation to transaction costs, organisational scale, transition costs and distributional equity. It is concluded that community health networks offer the most efficient model for the delivery of community based public health and general, acute and co-ordinated care services.

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Epidemiology and Primary Health Care

10.1093/med/9780192848741.003.0001 ◽

2021 ◽

pp. 1-19

Author(s):

J Patrick Vaughan ◽

Cesar Victora ◽

A Mushtaque R Chowdhury

Keyword(s):

Public Health ◽

Health Care ◽

Primary Health Care ◽

Health Services ◽

Systems Approach ◽

Health Planning ◽

District Health ◽

The Sustainable Development ◽

Primary Health ◽

Local Decision Making

This chapter introduces the Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC) and the central role of epidemiological concepts, knowledge, and skills in planning, management, and evaluation of district health systems in support of primary health care. It focuses on interventions to improve the health status of whole populations and shows how epidemiology is essential to support local decision-making for improvements in the population’s health. Health planning is outlined using a systems approach for high-priority health services and public health programmes delivered by district health services and programmes. The differences between interventions for clinical medicine and public health are explained. The systems approach to district planning are also explained.

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Development of Learning and Research Health Districts (LRHD) in the DR Congo: results

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1276 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

A Mwembo -Tambwekoy ◽

F Chenge ◽

B Criel

Keyword(s):

Public Health ◽

Action Research ◽

Health Services ◽

Healthcare Delivery ◽

National Policy ◽

Transformation Process ◽

Local Health ◽

District Health ◽

Organization And Management ◽

National Public Health

Abstract Issue There is great need in DRCongo for adequate training sites where national public health managers and workers can discover what is means to manage complex district healthcare delivery systems in a perspective of PHC and UHC. The development of such LRHD is coherent with the national policy in DRC advocating for demonstration districts. Description of the Problem The RIPSEC has launched three sites called LRHD, two of which are rural and one urban. A specialist in the organization and management of health services, from each of the three schools of public health, supervised the development and monitoring of those LRHDs. The Provincial Supervisor was also involved. Three approaches to solving priority problems have been defined: strengthening leadership at the HD level; transform health services into a learning and research framework. We analyze the transformation process obtained in these HD. Results Transformation processes in the district went through a strengthening of the capacity of the district health teams and via a process of action-research. The results of those LRHD after 4 years were mixed: the leadership of the management teams has improved. A reflexive attitude developed which contributes to more appropriate decision-making,monitoring and evaluation.At least one hospital service and 2 health centers have been transformed according to specific problems,improving the interaction between health structures, in order to quality of care has improved, the results of action research have made it possible to resolve local health problems. RIPSEC support to Provincial Supervisor to develop their working tools to better address their functions and responsibilities. However, the documentation of these changes induced by RIPSEC was not yet systematized. No residential internship could be carried out due to operational constraints. Lessons Mentoring, through its intellectual inputs, has contributed to a dynamic of change in the HD. Key messages The basis of the strategy is the improvement of the leadership of the HD management team,reinforced by mentoring and systematic documentation of complex decisions. This program could be continued to perpetuate these fragile achievements. This experience can be used elsewhere in different contexts. But,the residential internship requires other resources.

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PERENCANAAN SUMBER DAYA MANUSIA KESEHATAN (SDMK) PUSKESMAS DI KABUPATEN JEMBER

BISMA ◽

10.19184/bisma.v13i3.11633 ◽

2019 ◽

Vol 13 (3) ◽

pp. 181

Author(s):

Rizkiy Shofiah ◽

Dewi Prihatini ◽

Sebastiana Viphindrartin

Keyword(s):

Public Health ◽

Health Services ◽

Community Health ◽

Health Center ◽

Planning Process ◽

Community Health Center ◽

Health Centers ◽

Exploratory Research ◽

District Health ◽

Public Health Center

Public health centers are the spearhead in the implementation of health services in Indonesia. Public health centers are the first level facilities that seek promotive and preventive services to achieve health status. The provision of health services must be supported by adequate health personnel to support the functioning of the community health center. In accordance with its function, public health centers must have at least five promotive and preventive personnel, namely laboratory, pharmaceutical, nutrition, public health, and sanitation analysts. The availability of health human resources (HRH) for public health centers, especially laboratory analysts, nutrition, public health, and sanitation, is still not evenly distributed in the Jember district health centers. HRK planning in Jember Regency is still focused on medical personnel. This research is an exploratory research with a qualitative approach that aims to determine the HRH planning process, especially the promotive and preventive public health centers. The informants in this study were the head of the public health center administration as part of staffing and additional informants, namely analysts, nutrition, public health, and sanitation staff. Based on the results of the study, public health centers still need personnel such as analysts, nutrition, and sanitation. The results of interviews with informants indicated that the community health center did not have a special HRH planning team. In the planning process, the community health center only carried out an analysis of the HRH needs and then submitted them to the Health Office which had an important role in the planning process to meet the HRH needs of the community health center. As an executor, the community health center can only accept the applicable policies. Public health centers cannot do their own recruits because of budget constraints. This is one of the obstacles that hinders community health centers in HRH planning. Another obstacle in the planning process is waiting for a decision from the Health Office to meet HRH needs and the use of forecasting methods that are not yet clear. This causes, there is no common perception among policy makers. Keyword: Public health center, HRH planning, preventive and promotive.

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Activity-Based Costing and Inter-District Flows in the New Zealand Public Health Sector

10.26686/wgtn.17008153.v1 ◽

2021 ◽

Author(s):

◽

Matthew Peter van Kesteren

Keyword(s):

Public Health ◽

Health Care ◽

New Zealand ◽

Health Services ◽

Health Care Systems ◽

Health Sector ◽

Activity Based Costing ◽

District Health ◽

Public Health Sector ◽

Social Pressures

<p>Changes in the New Zealand public health sector in recent years, such as heightened political, economic and social pressures to manage and reduce costs while improving the quality of care in conjunction with stringent health care guidelines, have forced district health boards (DHB) nationwide to reassess their approach to health care provision. This has chiefly involved evaluating current practices or institutions; revising health care systems, including locality of treatment; and assessing established accounting systems and mechanisms (or lack thereof) to understand the source of costs and resource consumption. Acknowledging that patient welfare has always held pre-eminence in the New Zealand public health sector, balancing the dual pressures to enhance the utilisation of limited resources and adhere to social pressures to provide sustained high quality health services has been a difficult exercise for DHBs. In recognition of the potential benefits of activity-based costing (ABC), and the fact that the New Zealand public health sector is severely underrepresented in current literature, this multi-site case study examines how sophisticated costing systems (such as ABC), are being used by DHBs. Using an institutional theory framework, this study posits that DHBs will use sophisticated costing systems to (1) improve cost understanding with the goal of managing and reducing their costs; and (2) contribute to more informed National Prices for Inter-District Flows (IDF), the aim of which is to plan and provide services to meet the directives and outcomes outlined by the Ministry of Health. Overall, the findings are compelling and reveal that costing systems are used on three levels to plan and provide health services, including unsophisticated costing systems that are not formally recognised; moderately sophisticated costing systems (such as CostPro) that are formally recognised; and sophisticated costing systems (such as PPM) that are formally recognised. Furthermore, the findings reveal that DHBs with sophisticated costing systems generate event-level information, which directly influences the calculation of National Prices for IDFs. The findings of this exploratory study also indicate a need to examine the nexus between ABC and IDFs in a New Zealand public health sector context further.</p>

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