scholarly journals Analysis of the Impact of Corruption in the Health System and Some Recommendations Concepts

2021 ◽  
Author(s):  
Budiarsih Budiarsih
Keyword(s):  
Health Services ◽  
Health System ◽  
Health Financing ◽  
Lower Class ◽  
Financing System ◽  
Good System ◽  
The Impact ◽  
Good Vision

Abstract A country that has a good system will be able to provide good services to its people, but in practice the regulations and financing systems experience obstacles. One of the problems faced by a country is fraud which has the potential to become an act of corruption. Corruption by some individuals is very detrimental to the community as recipients of health services. The data shows the purpose of creating a health system that has a good vision and mission, but in practice, it creates misery for the community, especially the middle to a lower class. During the Covid-19 pandemic, corruption in the financing of the health system also increased. Based on the above background, the researcher will focus on the issue of how to analyze the impact of corruption in the Health System and how to conceptualize recommendations to overcome it. Juridical normative and sociological methods are used to study the problems found and at the same time analyzed in the health financing system. The results of the study found that the health financing system has a noble purpose for the benefit of society. However, in its implementation, there are many errors in the system that result in actions and have the potential to become acts of corruption that result in state losses. Recommendations are made to be implemented immediately so that crime stops and society is protected.

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

Looking at the bigger picture: effect of performance-based contracting of district health services on equity of access to maternal health services in Zambia

2019 ◽  
Author(s):  
Collins Chansa ◽  
Mulenga Mary Mukanu ◽  
Chitalu Miriam Chama-Chiliba ◽  
Mpuma Kamanga ◽  
Nicholas Chikwenya ◽  
...  
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Health Expenditure ◽  
Maternal Health Services ◽  
Health Facilities ◽  
District Level ◽  
Health Service Provision ◽  
Equity Of Access ◽  
The Impact

Abstract Zambia has been using output-based approaches for over two decades to finance whole or part of the public health system. Between 1996 and 2006, performance-based contracting (PBC) was implemented countrywide with the Central Board of Health (CBoH) as the provider of health services. This study reviews the association between PBC and equity of access to maternal health services in Zambia between 1996 and 2006. A comprehensive document review was undertaken to evaluate the implementation process, followed by a trend analysis of health expenditure at district level, and a segmented regression analysis of data on antenatal care (ANC) and deliveries at health facilities that was obtained from five demographic and health survey datasets (1992, 1996, 2002, 2007 and 2014). The results show that PBC was anchored by high-level political support, an overarching policy and legal framework, and collective planning and implementation with all key stakeholders. Decentralization of health service provision was also an enabling factor. ANC coverage increased in both the lower and upper wealth quintiles during the PBC era, followed by a declining trend after the PBC era in both quintiles. Further, the percentage of women delivering at health facilities increased during the PBC era, particularly in rural areas and among the poor. The positive trend continued after the PBC era with similar patterns in both lower and upper wealth quintiles. Despite these gains, per capita health expenditure at district level declined during the PBC era, with the situation worsening after the PBC era. The study concludes that a nationwide PBC approach can contribute to improved equity of access to maternal health services and that PBC is a cost-efficient and sustainable policy reform. The study calls for policymakers to comprehensively evaluate the impact of health system reforms before terminating them.

scholarly journals Health system governance following devolution: comparing experiences of decentralisation in Kenya and Indonesia

2018 ◽  
Vol 3 (5) ◽  
pp. e000939 ◽  
Author(s):  
Rosalind McCollum ◽  
Ralalicia Limato ◽  
Lilian Otiso ◽  
Sally Theobald ◽  
Miriam Taegtmeyer
Keyword(s):  
Health Services ◽  
Health System ◽  
Citizen Participation ◽  
Qualitative Data ◽  
Good Governance ◽  
Preventive Health Services ◽  
Power Relationships ◽  
Framework Analysis ◽  
Country Analysis ◽  
The Impact

IntroductionDevolution reforms in Indonesia and Kenya have brought extensive changes to governance structures and mechanisms for financing and delivering healthcare. Community health approaches can contribute towards attaining many of devolution’s objectives, including community participation, responsiveness, accountability and improved equity. We set out to examine governance in two countries at different stages in the devolution journey: Indonesia at 15 years postdevolution and Kenya at 3 years.MethodsWe collected qualitative data across multiple levels of the health system in one district in Indonesia and ten counties in Kenya, through 80 interviews and six focus group discussions (FGD) in Indonesia and 269 interviews and 14 FGDs in Kenya. Qualitative data were digitally recorded, transcribed and coded before thematic framework analysis. Common themes between contexts were identified inductively and deductively, and similarities and differences critically analysed during an inter-country analysis workshop.ResultsFollowing devolution both Indonesia and Kenya experienced similar challenges ensuring good governance for health. Devolution reforms transformed power relationships, increasing responsibilities at subnational levels and introducing opportunities for citizen participation. In both contexts, the impact of these mechanisms has been undermined by insufficiently clear guidance; failure to address pre-existing negative contextual norms and practices varied decision-maker values, limited priority-setting capacity and limited genuine community accountability. As a consequence, priorities in both contexts are too often placed on curative rather than preventive health services.ConclusionWe recommend consideration of increased intersectoral actions that address social determinants of health, challenge negative norms and practices and place emphasis on community-based primary health services.

scholarly journals Measurement and determinants of financial protection in health in Afghanistan

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ilker Dastan ◽  
Asiyeh Abbasi ◽  
Chokri Arfa ◽  
Mir Najmuddin Hashimi ◽  
Said Mohammad Karim Alawi
Keyword(s):  
Logistic Regression ◽  
Health Services ◽  
Health Expenditure ◽  
Health Financing ◽  
Catastrophic Health Expenditure ◽  
Financial Hardship ◽  
High Rate ◽  
Financing System ◽  
Total Consumption ◽  
Female Head

Abstract Background Out of pocket (OOP) payments for health are significant health financing challenges in Afghanistan as it is a source of incurrence of catastrophic health expenditure (CHE) and impoverishment. Measuring and understanding the drivers and impacts of this financial health hardship is an economic and public health priority, particularly in the time of COVID-19. This is the first study that measures the financial hardship and determines associated factors in Afghanistan. Methods Afghanistan Living Conditions Survey data for 2016–2017 was used for this study. We calculated incidence and intensity of catastrophic health expenditure by using different thresholds ranging from 5 to 40% of total and nonfood consumption and subsequent impoverishment due to OOPs. Logistic regression was used to assess the degree to which Afghan households are protected from the catastrophic household expenditure. Results Results revealed that 32% of the population in Afghanistan incurred catastrophic health expenditure (as 10% of total consumption) and when healthcare payments are netted out of household consumption, the Afghan population live in extreme poverty ($1.9 in 2011 PPP), increased from 29 to 36%. Based on our findings from logistic regression in Afghanistan, having an educated head or being employed are protective factors from financial hardship while having a female head, an elderly member, a disabled, or a sick member are the risk factors of facing catastrophic health expenditure. Moreover, the people living in rural/nomadic areas or facing an economic shock are more likely to face catastrophic health expenditure and hence to be impoverished due to direct OOPs on health. Conclusions The high rate of poverty and catastrophic health expenditure in Afghanistan emphasizes the need to strengthen the health financing system. Although Afghanistan has made great efforts to support households against health expenditure burden during the pandemic, households are at higher risk of poverty and financial hardship due to OOPs. Therefore, there is need for more financial and supportive response policies by providing a better and easier access to primary health services, extending to all entitlement to health services particularly in the public sector, eliminating user fees for COVID-19 health services and suspending fees for other essential health services, expanding coverage of income support, and strengthening the overall health financing system.

scholarly journals The Abolition of User Fees in the Jamaican Public Health System: Impact on Access, Care Provided and the Work of the Professional Nurse

2021 ◽  
Author(s):  
◽  
Adella Campbell
Keyword(s):  
Public Health ◽  
Health Care ◽  
Developing Countries ◽  
Health Services ◽  
Health System ◽  
Public Health System ◽  
User Fees ◽  
Professional Nurse ◽  
The Public ◽  
The Impact

<p>The negative impact of user fees on the utilisation of the health services by the poor in developing countries such as Uganda and Jamaica is well documented. Therefore, various governments have been engaged in reforming public health systems to increase access by underserved populations. One such reform is the introduction of free health services. In Jamaica, user fees were abolished in the public health sector in 2007 for children under 18 years and in 2008 free health care was introduced for all users of the public health system. This study evaluated the impact of the 2008 reform on the Jamaican public health system at 1) the national level, 2) the provider level, and 3) the user level. Perspectives were sought on access to care, the care provided, and the work of the professional nurse. Participants were selected from the Ministry of Health (MOH), the four Regional Health Authorities (RHAs), and urban and rural health facilities. Data collection was done during March – August 2010, using a multi-layered mixed methods evaluation approach, incorporating both qualitative and quantitative methods. Methods included individual interviews with key policymakers (eight) at the MOH and the four RHAs, as well as a senior medical officer of health (one) and pharmacists (three); focus groups with representatives of the main practitioners in the health system including nurses (six groups), pharmacists (one group) and doctors (two groups); document reviews of the MOH and RHAs‘ annual reports, and a survey of patients (200). Views on the impact of the abolition of user charges differed across the three levels and among the health authorities, facilities, and perspectives (policymakers, practitioners and users). Patient utilisation of the public health system increased exponentially immediately following the abolition of user fees, then declined, but remained above the pre-policy level. The work of health care providers, especially the professional nurse, was affected in that they had to provide the expected and required services to the patients despite an increase in workload and constraints such as inadequate resources. The research found that, while policymakers were optimistic about the policy, providers had concerns but patients were satisfied with the increased access and the quality care they were now receiving. Users also encountered challenges that constituted barriers to access. In addition to providing further evidence about the abolition of user fees in the public health system, this research provides important new insights into the impact of the nationwide abolition of user fees, as well as the impact of the policy change on the work of the professional nurse. Equally, the findings highlighted the potential benefits, gaps, and failures of the abolition of user fees‘ policy, and will serve as a catalyst to improve the policy process regarding access to health services and the work of the professional nurse. The findings of this research will be valuable in the planning of health-related programmes for the consumers of health care in developing countries. Despite the need for further research in this area, this research has contributed to the body of knowledge regarding user fees and access to health care in developing countries.</p>

scholarly journals The impact of e-health system implementation on UNWRA health services: an observational study

The Lancet ◽  
2021 ◽  
Vol 398 ◽  
pp. S17
Author(s):  
Ghada Ballout ◽  
Najeeb Al-Shorbaji ◽  
Wafaa Zeidan ◽  
Yousef Shahin ◽  
Majed Hababeh ◽  
...  
Keyword(s):  
Health Services ◽  
Observational Study ◽  
Health System ◽  
System Implementation ◽  
The Impact

scholarly journals Technical and scale efficiency of provincial health systems in China: a bootstrapping data envelopment analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e027539 ◽  
Author(s):  
Peipei Chai ◽  
Yuhui Zhang ◽  
Maigeng Zhou ◽  
Shiwei Liu ◽  
Yohannes Kinfu
Keyword(s):  
Health System ◽  
Survival Rates ◽  
Mainland China ◽  
Health Sector ◽  
Health Financing ◽  
Medical Personnel ◽  
Scale Efficiency ◽  
Data Envelopment ◽  
Life Years ◽  
The Impact

ObjectiveWith escalating health expenditures and increasing health needs, improving health system performance has become imperative in China and internationally. The objective of this study is to examine the efficiency of China’s health system and to understand the underlying causes of the variation in efficiency across provinces.SettingA system-wide perspective is adopted, focusing on performance in maternal health, child health and non-communicable diseases (NCDs) in the 31 provinces of mainland China during 2015.MethodsAnalyses were performed using bootstrapping data envelopment technique. Health outcomes were measured by infant survival rates, maternal survival rates and healthy life years calculated only considering NCDs. Health inputs were measured using health expenditure, and density of medical personnel and hospital beds. The model also examined the impact of environmental factors on health system efficiency.ResultsDue to wide-spread scale inefficiency in the country, the average bias-corrected overall technical efficiency (OTE) was 0.8022 (95% CI values ranging from 0.7251 to 0.8492). Socioeconomic status, hospitalisation rate and share of out-of-pocket expenditures were significant determinants of OTE. Nearly 60% of the provinces operated at a decreasing return to scale, meaning that a gain in efficiency could be achieved only through downsizing the scale of operation.ConclusionsGiven the pervasive nature of diminishing returns across provinces, health policy makers must explore the optimum operational scale which is people-centred and focused on prevention, rather than on treatment, of diseases. Moreover, due consideration should be afforded to social determinants of health and health financing arrangements to complement health-sector based reforms and meet the ambitious goals of the Healthy China 2030 Plan.

scholarly journals The Abolition of User Fees in the Jamaican Public Health System: Impact on Access, Care Provided and the Work of the Professional Nurse

2021 ◽  
Author(s):  
◽  
Adella Campbell
Keyword(s):  
Public Health ◽  
Health Care ◽  
Developing Countries ◽  
Health Services ◽  
Health System ◽  
Public Health System ◽  
User Fees ◽  
Professional Nurse ◽  
The Public ◽  
The Impact

<p>The negative impact of user fees on the utilisation of the health services by the poor in developing countries such as Uganda and Jamaica is well documented. Therefore, various governments have been engaged in reforming public health systems to increase access by underserved populations. One such reform is the introduction of free health services. In Jamaica, user fees were abolished in the public health sector in 2007 for children under 18 years and in 2008 free health care was introduced for all users of the public health system. This study evaluated the impact of the 2008 reform on the Jamaican public health system at 1) the national level, 2) the provider level, and 3) the user level. Perspectives were sought on access to care, the care provided, and the work of the professional nurse. Participants were selected from the Ministry of Health (MOH), the four Regional Health Authorities (RHAs), and urban and rural health facilities. Data collection was done during March – August 2010, using a multi-layered mixed methods evaluation approach, incorporating both qualitative and quantitative methods. Methods included individual interviews with key policymakers (eight) at the MOH and the four RHAs, as well as a senior medical officer of health (one) and pharmacists (three); focus groups with representatives of the main practitioners in the health system including nurses (six groups), pharmacists (one group) and doctors (two groups); document reviews of the MOH and RHAs‘ annual reports, and a survey of patients (200). Views on the impact of the abolition of user charges differed across the three levels and among the health authorities, facilities, and perspectives (policymakers, practitioners and users). Patient utilisation of the public health system increased exponentially immediately following the abolition of user fees, then declined, but remained above the pre-policy level. The work of health care providers, especially the professional nurse, was affected in that they had to provide the expected and required services to the patients despite an increase in workload and constraints such as inadequate resources. The research found that, while policymakers were optimistic about the policy, providers had concerns but patients were satisfied with the increased access and the quality care they were now receiving. Users also encountered challenges that constituted barriers to access. In addition to providing further evidence about the abolition of user fees in the public health system, this research provides important new insights into the impact of the nationwide abolition of user fees, as well as the impact of the policy change on the work of the professional nurse. Equally, the findings highlighted the potential benefits, gaps, and failures of the abolition of user fees‘ policy, and will serve as a catalyst to improve the policy process regarding access to health services and the work of the professional nurse. The findings of this research will be valuable in the planning of health-related programmes for the consumers of health care in developing countries. Despite the need for further research in this area, this research has contributed to the body of knowledge regarding user fees and access to health care in developing countries.</p>

scholarly journals The Impact of Contracting on the Portuguese National Health System

2022 ◽  
Vol 19 ◽  
pp. 13-22
Author(s):  
Gualter Couto ◽  
Maria Rocha ◽  
Pedro Pimentel ◽  
Jacinto Garrido Velarde ◽  
Rui Alexandre Castanho
Keyword(s):  
Health System ◽  
National Health ◽  
Economic Performance ◽  
National Health System ◽  
Value Added ◽  
Health Financing ◽  
Favorable Effect ◽  
Continuous Training ◽  
Contracting Process ◽  
The Impact

All treatments, materials, instruments, exams, vaccines, tests, hospitalizations, surgeries, human resources, investigations, medicines, autopsies, among many other services provided by the National Health System (SNS). Therefore, funding is required, and the external services and supplies to which the SNS must constantly update its technologies and the necessary and continuous training and essential maintenance and cleaning expenses. Moreover, health financing has been a matter of great concern, both nationally and internationally, as health expenditures are growing faster than economic growth. Over the years, efficiency in resource allocation has always been a desirable objective, but one that is not easy to achieve. The truth is that there is much waste in allocating resources. Thereby, this study analyzes the impact of the contractualization process to which Portugal has adhered, which is most similar to a privatization model; that is, we sought to understand whether the contractualization of the SNS has a favorable effect on the economic level. However, after the entire process and development of the work, it is concluded that the contracting had a negligible impact. The repercussion that it had on the economic performance of Portuguese Hospitals was in a negative sense. In the statistical analyses it was used tests of differences between averages, to check the behavior of the economic performance of hospitals towards the contracting process. It was taken data of reports and accounts from a sample of fifteen Portuguese Hospitals S.A. that went through this contracting process from 2003 to 2017, in order to calculate the four indicators, such as: Return On Assets (ROA); Return On Equity (ROE); Economic Value Added (EVA) and the Market Value Added (MVA). For each of these indicators, were analyzed and compared the resulted effects between the period of two years before and two years after the contracting process. From the obtained results, we can conclude that contracting process had little impact on the economic performance of Portuguese Hospitals and the resulting impact was not favorable.

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