scholarly journals Our Blind Spots in the Fight Against Health Systems Corruption Comment on "We Need to Talk About Corruption in Health Systems"

2019 ◽  
Vol 9 (1) ◽  
pp. 34-38
Author(s):  
Reinhard Huss
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Health Workers ◽  
Social Systems ◽  
Health Sector ◽  
Low Income Countries ◽  
Financial Flows ◽  
The Sustainable Development ◽  
Systemic Corruption

The health sector often appears prominent in surveys of perceived corruption, because citizens experience the symptoms of systemic corruption most distressingly during their interaction with frontline health workers. However, the underlying drivers of systemic corruption in society may be located in other social systems with the health system demonstrating the symptoms but not the path how to exit the situation. We need to understand the mechanisms of systemic corruption including the role of corrupt national and international leaders, the role of transnational corporations and international financial flows. We require a corruption definition which goes beyond an exclusive focus on the corrupt individual and considers social systems and organisations facilitating corruption. Finally there is an urgent need to address the serious lack of funding and research in the area of systemic corruption, because it undermines the achievement of the Sustainable Development Goals (SDGs) in many low income countries with the most deprived populations.

scholarly journals Health workforce financing in Uganda: challenges and opportunities

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Koutsoumpa ◽  
R Odedo ◽  
A Banda ◽  
M Meurs ◽  
C Hinlopen ◽  
...  
Keyword(s):  
Low Income ◽  
Health Workforce ◽  
Management Practices ◽  
Health Workers ◽  
Human Resources For Health ◽  
Health Sector ◽  
Adverse Outcomes ◽  
Low Income Countries ◽  
Current Status ◽  
Poor Management

Abstract Background For health systems to operate well and improve people's health by leaving no one behind, they need a fit-for-purpose health workforce. Shortage of health workers leads to reduced access to healthcare, health inequities, and adverse outcomes in the population's health. A key challenge in many low-income countries is mobilising the needed investment for health workforce development. This study evaluated the policy environment of the health workforce in Uganda, analysed its current status, and identified financing mechanisms and management practices that affect the country's health resource envelope. Methods The study was conducted in 2018/19. It entailed literature review, key informant interviews and stakeholder consultations for validation of the findings. Results The shortage of health workers is persevering, despite efforts of the Ugandan Government and development partners. The health workforce is not keeping up with the population growth, nor the epidemiologic changes and demographic trends. Paradoxically, there is a large pool of qualified and licensed health professionals, who remain unabsorbed. Notably, even if all of them were absorbed, Uganda would be still far from the international requirements for universal health coverage. The issues are recognized at the policy level, but insufficient funding and poor management are impeding the recruitment and retention of health workers. Domestic resources are insufficient to fund a health system which can offer a minimum healthcare package and most donors are reluctant to contribute to health workers' salaries. Besides, Uganda is lacking a national health insurance scheme, which keeps out-of-pocket spending on health at very high rates. Moreover, increases in external financing have been accompanied by decreases in domestic government financing, despite economic growth. Conclusions The health sector financing is influenced by a complex political economy, which impedes investments in the health workforce. Key messages The problems and gaps of the Ugandan human resources for health are persisting due to the insufficient financial allocation and the poor management of the health workforce and existing funds. The shortage of health workers is a global health issue that goes beyond national borders and the health sector. It is an essential requirement for exercising the universal right to health.

scholarly journals The multiplier role of psychiatrists in low income settings

2014 ◽  
Vol 23 (2) ◽  
pp. 123-127 ◽  
Author(s):  
F. Kigozi ◽  
J. Ssebunnya
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Low Income ◽  
Health Workers ◽  
Developed Countries ◽  
Low Income Countries ◽  
Wide Range

Mental health care is receiving increased attention in low-income countries with the availability of a wide range of effective evidence-based treatments for acute and chronic mental disorders amidst scarce resources. Availability of these treatments and competent human resources enables the use of a variety of interventions at several levels of care for persons with mental illness and makes it feasible to ensure observance of quality in the treatment approaches that go beyond institutionalisation. However, unlike developed countries which are endowed with many and relatively well-paid mental health specialists, low-income countries face a dire shortage of highly trained mental health professionals in addition to several other challenges. In light of this, there is need to re-assess the role of the few available psychiatrists, with a shift to new core tasks such as designing mental health care programmes that can be delivered by non-specialists, building their health system's capacity for delivering care, including supporting front-line health workers through support supervision, raising awareness on mental health and patients’ rights in addition to promoting essential research. This requires a fundamental paradigm shift from the current training for mental health specialists to a public health oriented approach and providing incentives for community engagement.

scholarly journals Enhancing emergency care in low-income countries using mobile technology-based training tools

2016 ◽  
Vol 101 (12) ◽  
pp. 1149-1152 ◽  
Author(s):  
Hilary Edgcombe ◽  
Chris Paton ◽  
Mike English
Keyword(s):  
Mobile Technology ◽  
Current Literature ◽  
Emergency Care ◽  
Low Income ◽  
Health Workers ◽  
Low Income Countries ◽  
Technological Context

In this paper, we discuss the role of mobile technology in developing training tools for health workers, with particular reference to low-income countries (LICs). The global and technological context is outlined, followed by a summary of approaches to using and evaluating mobile technology for learning in healthcare. Finally, recommendations are made for those developing and using such tools, based on current literature and the authors' involvement in the field.

scholarly journals Targeting anticorruption interventions at the front line: developmental governance in health systems

2020 ◽  
Vol 5 (12) ◽  
pp. e003092
Author(s):  
Eleanor Hutchinson ◽  
Nahitun Naher ◽  
Pallavi Roy ◽  
Martin McKee ◽  
Susannah H Mayhew ◽  
...  
Keyword(s):  
Health Systems ◽  
Low Income ◽  
Health Sector ◽  
Theoretical Models ◽  
Health Coverage ◽  
Healthcare Outcomes ◽  
Theoretical Frameworks ◽  
Middle Income ◽  
The Sustainable Development ◽  
Sustainable Solutions

In 2008, Vian reported an increasing interest in understanding how corruption affects healthcare outcomes and asked what could be done to combat corruption in the health sector. Eleven years later, corruption is seen as a heterogeneous mix of activity, extensive and expensive in terms of loss of productivity, increasing inequity and costs, but with few examples of programmes that have successfully tackled corruption in low-income or middle-income countries. The commitment, by multilateral organisations and many governments to the Sustainable Development Goals and Universal Health Coverage has renewed an interest to find ways to tackle corruption within health systems. These efforts must, however, begin with a critical assessment of the existing theoretical models and approaches that have underpinned action in the health sector in the past and an assessment of the potential of innovations from anticorruption work developed in sectors other than health. To that end, this paper maps the key debates and theoretical frameworks that have dominated research on corruption in health. It examines their limitations, the blind spots that they create in terms of the questions asked, and the capacity for research to take account of contextual factors that drive practice. It draws on new work from heterodox economics which seeks to target anticorruption interventions at practices that have high impact and which are politically and economically feasible to address. We consider how such approaches can be adopted into health systems and what new questions need to be addressed by researchers to support the development of sustainable solutions to corruption. We present a short case study from Bangladesh to show how such an approach reveals new perspectives on actors and drivers of corruption practice. We conclude by considering the most important areas for research and policy.

scholarly journals Experiences of care in the context of payment for performance (P4P) in Tanzania

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Victor Chimhutu ◽  
Marit Tjomsland ◽  
Mwifadhi Mrisho
Keyword(s):  
Health Service ◽  
Low Income ◽  
Health Workers ◽  
Qualitative Content Analysis ◽  
Health Sector ◽  
Governing Committee ◽  
Low Income Countries ◽  
Service Users ◽  
Health Coverage ◽  
The Government

Abstract Background Tanzania is one of many low income countries committed to universal health coverage and Sustainable Development Goals. Despite these bold goals, there is growing concern that the country could be off-track in meeting these goals. This prompted the Government of Tanzania to look for ways to improve health outcomes in these goals and this led to the introduction of Payment for Performance (P4P) in the health sector. Since the inception of P4P in Tanzania a number of impact, cost-effective and process evaluations have been published with less attention being paid to the experiences of care in this context of P4P, which we argue is important for policy agenda setting. This study therefore explores these experiences from the perspectives of health workers, service users and community health governing committee members. Methods A qualitative study design was used to elicit experiences of health workers, health service users and health governing committee members in Rufiji district of the Pwani region in Tanzania. The Payment for Performance pilot was introduced in Pwani region in 2011 and data presented in this article is based on this pilot. A total of 31 in-depth interviews with health workers and 9 focus group discussions with health service users and health governing committee members were conducted. Collected data was analysed through qualitative content analysis. Results Study informants reported positive experiences with Payment for Performance and highlighted its potential in improving the availability, accessibility, acceptability and quality of care (AAAQ). However, the study found that persistent barriers for achieving AAAQ still exist in the health system of Tanzania and these contribute to negative experiences of care in the context of P4P. Conclusion Our findings suggest that there are a number of positive aspects of care that can be improved by Payment for Performance. However its targeted nature on specific services means that these improvements cannot be generalized at health facility level. Additionally, health workers can go as far as they can in improving health services but some factors that act as barriers as demonstrated in this study are out of their control even in the context of Payment for Performance. In this regard there is need to exercise caution when implementing such initiatives, despite seemingly positive targeted outcomes.

Presence through absence? Understanding the role of capital in the African Human Rights Action Plan

2020 ◽  
Vol 58 (4) ◽  
pp. 579-600
Author(s):  
Obiora Chinedu Okafor ◽  
Sanaa Ahmed ◽  
Sylvia Bawa ◽  
Ibironke Odumosu-Ayanu
Keyword(s):  
Human Rights ◽  
Low Income ◽  
Action Plan ◽  
Significant Degree ◽  
Universal Declaration ◽  
Low Income Countries ◽  
Significant Extent ◽  
Global Capital ◽  
Market Practices

AbstractThis study examines the African Human Rights Action Plan (AHRAP) through the lens of Upendra Baxi's germinal theory on the emergence in our time of a ‘trade-related, market-friendly human rights’ (TREMF) thesis that is challenging the specific understandings of ‘people-centric’ human rights that are predicated in the letter and spirit of the Universal Declaration of Human Rights (UDH). Baxi contends, instead, that the dominant strands of the contemporary understandings of human rights are – for the most part – designed to protect the interests of global capital. That said, human rights frameworks in low-income countries need to be studied with a view to what they say and don't say about global capital. Despite its attempt to facilitate a progressive realisation of human rights in Africa, the AHRAP does not rise far enough above the TREMF paradigm to re-locate itself within the UDH one. This is due to the AHRAP not adequately theorising and analysing the role of capital in the (non)realisation of human rights in Africa. By allowing trade and market practices to slip to a significant extent beyond its purview, the AHRAP privileges – to a significant degree – the needs/interests of capital over the human rights of ordinary Africans. That is, the victims of the excesses of capital in Africa are reincarnated in the AHRAP document by the fact of their exclusion from it.

Equity and health sector reforms: can low-income countries escape the medical poverty trap?

The Lancet ◽  
2001 ◽  
Vol 358 (9284) ◽  
pp. 833-836 ◽  
Author(s):  
Margaret Whitehead ◽  
Göran Dahlgren ◽  
Timothy Evans
Keyword(s):  
Low Income ◽  
Health Sector ◽  
Low Income Countries ◽  
Poverty Trap ◽  
Health Sector Reforms
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