Aligning policymaking in decentralized health systems: Evaluation of strategies to prevent and control non-communicable diseases in Nigeria

Noncommunicable diseases (NCDs) are leading causes of death globally and in Nigeria they account for 29% of total deaths. Nigeria’s health system is decentralized. Fragmentation in governance in federalised countries with decentralised health systems is a well-recognised challenge to coherent national health policymaking. The policy response to the rising NCD burden therefore requires strategic intent by national and sub-national governments. This study aimed to understand the implementation of NCD policies in Nigeria, the role of decentralisation of those policies, and to consider the implications for achieving national NCD targets. We conducted a policy analysis combined with key informant interviews to determine to what extent NCD policies and strategies align with Nigeria’s decentralised health system; and the structure and process within which implementation occurs across the various tiers of government. Four inter-related findings emerged: NCD national policies are ‘top down’ in focus and lack attention to decentralisation to subnational and frontline care delivery levels of the health system; there are defective coordination mechanisms for NCD programmes which are underpinned by weak regional organisational structures; financing for NCDs are administratively burdensome and fragmented; and frontline NCD service delivery for NCDs are not effectively being integrated with other essential PHC services. Despite considerable progress being made with development of national NCD policies, greater attention on their implementation at subnational levels is needed to achieve more effective service delivery and progress against national NCD targets. We recommend strengthening subnational coordination mechanisms, greater accountability frameworks, increased and more efficient funding, and greater attention to integrated PHC service delivery models. The use of an effective bottom-up approach, with consideration for decentralization, should also be engaged at all stages of policy formulation.

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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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The Implications of Centre-local Relations on Service Delivery in Local Authorities in Zimbabwe: The Case of Chitungwiza

Journal of Public Administration and Governance ◽

10.5296/jpag.v5i2.7751 ◽

2015 ◽

Vol 5 (2) ◽

pp. 149

Author(s):

Tawanda Nyikadzino ◽

Alfred Gwarega Nhema

Keyword(s):

Local Government ◽

Service Delivery ◽

Central Government ◽

Policy Formulation ◽

Sewer Pipes ◽

Key Informant ◽

Strategic Role ◽

And Control ◽

Depth Interviews ◽

Effective Service

The area of centre-local relations in local government is a contemporary and topical debate in Zimbabwe. It was on this background that the research on centre-local relations was undertaken with a view to assessing the implications of service delivery in Chitungwiza Municipality (CM). The views of different authorities on centre-local relations were reviewed to further analyse the implications of centre-local relations on service delivery in municipalities. The study triangulated different data collection methods such as key informant interviews, documentary search, in-depth interviews, observation and survey to obtain detailed data on the state of centre-local relations and its implications on service delivery in CM. The findings of the study revealed that centre-local relations between the Ministry of Local Government and the CM are highly centralised. The parent ministry retains overall powers and control over the municipality. The Minister who is supposed to play a strategic role in policy formulation and implementation is involved in the day to day running of the municipality leaving little room for elected councillors and residents in general to determine their own destiny. It has been established that centre-local relations that are supposed to foster independence and autonomy of the municipality has turned into a master-subordinate relationship that has negatively affected service delivery. The study concluded that hyper-centralised governance relations are hindering effective service delivery in the municipality. This has been evidenced by erratic water supply, potholed roads, poor refuse collection and bursting of sewer pipes. The study recommends that the central government through the Ministry of Local Government must grant the municipality more autonomy as a measure of improving service delivery.

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What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review

International Journal of Health Policy and Management ◽

10.15171/ijhpm.2018.110 ◽

2018 ◽

Vol 8 (2) ◽

pp. 63-75 ◽

Cited By ~ 16

Author(s):

Pascale Lehoux ◽

Federico Roncarolo ◽

Hudson Pacifico Silva ◽

Antoine Boivin ◽

Jean-Louis Denis ◽

...

Keyword(s):

Service Delivery ◽

Human Resources ◽

Health System ◽

Health Systems ◽

Scoping Review ◽

Rural Areas ◽

Distribution Systems ◽

Qualitative Content Analysis ◽

System Level ◽

Responsible Innovation

Background: While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems’ demand for innovations. Methods: We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed. Results: Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored. Conclusion: Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems.

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Stewardship of noncommunicable diseases in Iran: a qualitative study

International Journal of Health Governance ◽

10.1108/ijhg-07-2020-0074 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

Taha Nasiri ◽

Shahram Yazdani ◽

Lida Shams ◽

Amirhossein Takian

Keyword(s):

Qualitative Study ◽

Health System ◽

Prevention And Control ◽

Action Plan ◽

World Health ◽

Research Progress ◽

Noncommunicable Diseases ◽

National Action Plan ◽

Content Type ◽

And Control

PurposeNoncommunicable diseases (NCDs) count for over 80% of premature death worldwide. More than 76% of the total burden of diseases in Iran is devoted to NCDs. In line with the World Health Organization action plan, Iran has developed its national action plan that led to establishment of the National Committee for Prevention and Control of NCDs (INCDC), whose aim is 30% mortality reduction attributed to NCDs by 2030. The stewardship of health system is the cornerstone of performing and sustaining meaningful actions toward prevention and control of NCDs. The literature is tiny on how to materialize the stewardship and governance of health system. The purpose of this article is to report the findings of a national study that aimed to identity functions and subfunctions of stewardship of NCDs and its related risk factors in Iran.Design/methodology/approachThis is a qualitative study. The authors conducted interviews with 18 purposefully selected interviewees until the authors reached saturation. Thematic content analysis was used for analysis and MAXQDA 10 was employed for data management. The difficulty of coordinating with interviewers and health policymakers in the field slowed the process of research progress.FindingsThe authors identified seven themes and categorized them as main functions for appropriate stewardship of NCDs in Iran, including intelligence generation; strategic framework; evidence-based policies/decisions; system design; resource allocation/development; capacity-building and enforcement/alignment; and categorized them as important.Practical implicationsThe seven themes presented as stewardship functions include concepts and practical examples of the experiences and performance of leading countries in the field of NCDs control that can help policymakers and health managers for better descion-making.Originality/valueIran adopted its national action plan in 2015 and WHO selected Iran as a fast-track country in 2017. The study confirmed that to achieve the global targets, appropriate and contextual stewardship for any specific setting is fundamental. Iran needs to improve its stewardship for prevention and control of NCDs and implement its national action plan. Therefore, the functions and policies outlined in this article for the proper performance of NCDs can improve more meaningful practices in this area in Iran and many other countries.

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A Research Agenda for Cancer and Noncommunicable Disease Prevention and Control in India

Journal of Global Oncology ◽

10.1200/jgo.18.48400 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 122s-122s

Author(s):

I. Kataria ◽

M. Siddiqui ◽

L. Squiers ◽

P.K. Dhillon ◽

T. Gillespie ◽

...

Keyword(s):

Risk Factors ◽

Research Agenda ◽

Prevention And Control ◽

Care Delivery ◽

Noncommunicable Disease ◽

Health System Strengthening ◽

Noncommunicable Diseases ◽

Advisory Group ◽

Web Based ◽

And Control

Background: Noncommunicable diseases (NCDs), including cancer, account for approximately 38 million deaths each year, and almost 75% of these deaths occur in low and middle-income countries. NCDs contribute to 60% of total deaths in India, and of concern are the premature deaths, which account for a staggering 48% mortality and can be prevented. Aim: Establish a consensus research agenda for cancer and NCD prevention and control that has the potential to impact polices, programs and health care delivery. Methods: To develop a NCD research agenda for India, we engaged our community collaborative board (CCB), which included NCD-focused global, national- and state-level stakeholders, and our scientific advisory group (SAG), which included global and national NCD experts, in a three-step process using two Web-based surveys and one in-person meeting. First, we used Delphi methodology to generate topics. Eighteen stakeholders from both CCB and SAG responded to the first Web-based survey generating 165 research ideas during the first round. After accounting for clustering and duplication, we had 56 unique research ideas. Second, these ideas were deliberated upon during the in-person meeting where each participant with a set of 10 stickers placed them next to the research priority(ies) that they felt are important for prevention and control of cancer and NCDs in India. This generated 23 research ideas, which were subjected to SWOT analysis in pairs by the stakeholders using Snowcard methodology with SAG and CCB. The stakeholders prioritized the shortlisted topics based on level of effort and potential to impact NCDs in India. Finally, 15 low effort, high impact priority research ideas for various health outcomes across research disciplines were identified based on discussion with the larger group to reach consensus. The second Web-based survey resulted in identification of 5 key priority research ideas by all stakeholders as being the most important. Results: The 5 prioritized research ideas in order of importance are: (1) development of interventions to empower primary physicians and health workers in early diagnosis of NCDs; (2) evaluation of health system strengthening programs for NCD control; (3) feasibility of integrated care models at primary care level to address multimorbid chronic conditions; (4) development of India specific methods and tools for monitoring trends on NCD morbidity, mortality and risk factors; and (5) identification of effective strategies to mobilize individuals toward NCD screening activities. Conclusion: Development of a consensus research agenda for India is a critical gap needed to pursue resources required to address pressing needs in cancer and other NCDs. The rising mortality and morbidity resulting from cancer and NCDs with similar risk factors, warrants the timely implementation of this agenda. This will generate the evidence-base from which new policies and practices can be used to reduce cancer and other NCDs in India.

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The ‘Top 10’ Challenges for Health Technology Assessment: INAHTA Viewpoint

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462319000825 ◽

2019 ◽

Vol 36 (1) ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Brian O'Rourke ◽

Sophie Söderholm Werkö ◽

Tracy Merlin ◽

Li Ying Huang ◽

Tara Schuller

Keyword(s):

Decision Making ◽

Health Technology Assessment ◽

Health System ◽

Health Systems ◽

Technology Assessment ◽

Health Technology ◽

Publicly Funded ◽

Non Profit ◽

The Many ◽

National Governments

The International Network of Agencies for Health Technology Assessment (INAHTA) spans the globe as a network of 50 publicly-funded health technology assessment (HTA) agencies supporting health system decision making for 1.4 billion people in thirty countries. Agency members are non-profit HTA organizations that are part of, or directly support, regional or national governments. Recently, INAHTA surveyed its members to gather perspectives from agency leadership on the most important issues in HTA today. This paper describes the top 10 challenges identified by INAHTA members. Addressing these challenges requires a call for action from INAHTA member agencies and the many other actors involved in the HTA ecosystem. In opening this call for action, INAHTA will lead the way; however, a comprehensive undertaking from all players is needed to effectively address these challenges and to continue to evolve HTA in its role as a strong and effective contributor to health systems.

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Optimizing integrated imaging service delivery by tier in low-resource health systems

Insights into Imaging ◽

10.1186/s13244-021-01073-8 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Kristen DeStigter ◽

Kara-Lee Pool ◽

Abimbola Leslie ◽

Sarwat Hussain ◽

Bien Soo Tan ◽

...

Keyword(s):

Service Delivery ◽

Health System ◽

Low Income ◽

Care Delivery ◽

Scale Up ◽

Health Coverage ◽

Low Resource Settings ◽

Low Resource ◽

Low Middle Income Countries ◽

Budgetary Decisions

AbstractAccess to imaging diagnostics has been shown to result in accurate treatment, management, and optimal outcomes. Particularly in low-income and low-middle-income countries (LICs, LMICs), access is limited due to a lack of adequate resources. To achieve Sustainable Development Goal (SDG) 3, access to imaging services is critical at every tier of the health system. Optimizing imaging services in low-resource settings is best accomplished by prescriptive, integrated, and coordinated tiered service delivery that takes contextual factors into consideration. To our knowledge, this is the first recommendation for optimized, specific imaging care delivery by tier. A model for tier-based essential imaging services informs and guides policymakers as they set priorities and make budgetary decisions. In this paper, we recommend a framework for tiered imaging services essential to reduce the global burden of disease and attain universal health coverage (UHC). A lack of access to basic imaging services, even at the lowest tier of the health system, can no longer be justified by cost. Worldwide, affordable modalities of modern ultrasound and X-ray are becoming an accessible mainstay for the investigation of common conditions such as pregnancy, pneumonia, and fractures, and are safely performed and interpreted by qualified professionals. Finally, given the vast gap in access to imaging resources between LMICs and high-income countries (HICs), a scale-up of tiered imaging services in low-resource settings has the potential to reduce health disparities between, and within countries. As the access to appropriately integrated imaging services improves, UHC may be achieved.

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Health systems strengthening for noncommunicable disease control and healthy aging: integrated actions in Aruba and Curaçao

Revista Panamericana de Salud Pública ◽

10.26633/rpsp.2019.55 ◽

2019 ◽

Vol 43 ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Malhi Cho ◽

Melissa Marchand ◽

Enrique Vega ◽

Reynaldo Holder ◽

Silvana Luciani ◽

...

Keyword(s):

Health System ◽

Health Systems ◽

Healthy Aging ◽

Health Systems Strengthening ◽

Noncommunicable Disease ◽

Noncommunicable Diseases ◽

Term Care ◽

Financing Policy ◽

Care Community ◽

Demographic Transitions

Caribbean countries are experiencing social, epidemiological, and demographic transitions shaped by the growing elderly population and the rise of noncommunicable diseases (NCDs)—now responsible for 78% of all deaths. These circumstances demand rethinking the model of care to improve health outcomes and build more sustainable health systems with new orientations in policy, service delivery, organization, training, technology, and financing. Policy must be aimed towards healthy living, leveraging interventions that ensure healthy aging. The health system must proactively structure interventions to reduce the incidence of new NCD cases and to prevent related complications. Interventions should be focused on optimizing the individual’s capacity, functional ability, and autonomy within adapted environments, as well as with the necessary preventive, long-term care, self-care, community care, and health system support.

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Through service providers’ eyes: health systems factors affecting implementation of tuberculosis control in Enugu State, South-eastern Nigeria

10.21203/rs.2.18500/v2 ◽

2020 ◽

Author(s):

Daniel Chukwuemeka Ogbuabor

Keyword(s):

Service Delivery ◽

Health System ◽

Health Systems ◽

Service Providers ◽

Control Programme ◽

Health Systems Strengthening ◽

Factors Affecting ◽

Tb Control ◽

South Eastern ◽

Enugu State

Abstract Background Well-functioning health systems are essential to achieving global and national tuberculosis (TB) control targets. This study examined health system factors affecting implementation of TB control programme from the perspectives of service providers. Methods The study was conducted in Enugu State, South-eastern Nigeria using qualitative, cross-sectional design involving 23 TB service providers (13 district TB supervisors and 10 facility TB focal persons). Data were collected through in-depth, semi-structured interviews using a health system dynamic framework and analysed thematically. Results Stewardship from National TB Control Programme (NTP) improved governance of TB control, but stewardship from local government was weak. Government spending on TB control was inadequate, whereas donors fund TB control. Poor human resources management practices hindered TB service delivery. TB service providers have poor capacity for data management because changes in recording and reporting tools were not matched with training of service providers. Drugs and other supplies to TB treatment centres were interrupted despite the use of a logistics agency. Poor integration of TB into general health services, weak laboratory capacity, withdrawal of subsidies to community volunteers and patent medicine vendors, poorly funded patient tracking systems, and ineffectual TB/HIV collaboration resulted in weak organisation of TB service delivery. Conclusion Health systems strengthening for TB control service must focus on effective oversight from NTP and local health system; predictable domestic resource mobilisation through budgets and social health insurance; training and incentives to attract and retain TB service providers; effective supply and TB drug management; and improvements in organization of service delivery.

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The Effect of Service Compact (SERVICOM) on Service Delivery in Nnamdi Azikiwe University Teaching Hospital Nnewi, Nigeria

Africa’s Public Service Delivery and Performance Review ◽

10.4102/apsdpr.v2i4.69 ◽

2014 ◽

Vol 2 (4) ◽

pp. 101

Author(s):

Jude Kennedy Emejulu ◽

M. C. Muo ◽

E. E.O. Chukwuemeka

Keyword(s):

Service Delivery ◽

Federal Government ◽

Teaching Hospital ◽

Care Delivery ◽

University Teaching ◽

Care Providers ◽

Face To Face ◽

Service Unit ◽

Service Areas ◽

And Control

This study examined the effect of service compact (Servicom Service delivery) in Nnamdi Azikiwe University Teaching Hospital Nnewi. Questionnaire and face-to-face interviews were used in the collection of data. The hypotheses were tested using descriptive statistics. The study discovered among other things that with the inauguration of the SERVICOM Charter by the Federal Government of Nigeria, the Management of Nnamdi Azikiwe University Teaching Hospital Nnewi identified key areas that required re-evaluation and attention based on the submissions of every service unit and department, after an analysis of the Strengths, Weaknesses, Opportunities and Threats (SWOT) of each of the service areas. A pre-SERVICOM Charter workshop which was supervised by the Federal Government was held in the various institutions nationwide to enable care providers enumerate their current service capacity and identify their impediments. In the light of the foregoing, some of the recommendations proffered are that the SERVICOM Charter project should be sustained and supervision and control of the SERVICOM Charter project should be intensified in order to ensure that the Nigerian factor of service-fatigue would not supervene in care delivery in the near future.

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