Indian Plural Health System and Resilience: Lessons from COVID-19

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Unnikrishnan Payyappallimana
Keyword(s):  
Health System ◽  
Health Systems ◽  
Local Health ◽  
Potential Core ◽  
The Public ◽  
Integrative Health ◽  
Indian Health ◽  
Indian Context ◽  
Rigorous Research ◽  
History Of

Beginning with a brief recent history of plural health systems in the Indian context, this is a commentary on the idea of resilience from the perspectives of AYUSH and local health traditions (LHTs) as witnessed historically and during the COVID pandemic. By narrating the AYUSH systems’ experiences during COVID-19, in providing health care and in attempts at building rigorous research and evidence, it examines their potential future engagement in the public health scenario in the country. The article contextualizes the potential core functions of plural and integrative health systems for the resilience of the Indian health system.

The regulation of health care in Scandinavia: professionals, the public interest and trust

2018 ◽  
pp. 61-76
Author(s):  
Karsten Vrangbæk
Keyword(s):  
Health Care ◽  
Public Policy ◽  
Health Insurance ◽  
Health System ◽  
Health Systems ◽  
Public Interest ◽  
State Level ◽  
Professional Regulation ◽  
The Public ◽  
Voluntary Health Insurance

Scandinavian health systems have traditionally been portrayed as relatively similar examples of decentralised, public integrated health systems. However, recent decades have seen significant public policy developments in the region that should lead us to modify our understanding. Several dimensions are important for understanding such developments. First, several of the countries have undergone structural reforms creating larger governance units and strengthening the state level capacity to regulate professionals and steer developments at the regional and municipal levels. Secondly, the three Nordic countries studied experienced an increase in the purchase of voluntary health insurance and the use of private providers. This introduces several issues for the equality of users and the efficiency of the system. This paper will investigate such trends and address the question: Is the Nordic health system model changing, and what are the consequences for trust, professional regulation and the public interest?

scholarly journals The concept of public health. Types of health systems. Parallel between the Romanian and the Australian health system

2021 ◽  
Vol 68 (1) ◽  
pp. 17-21
Author(s):  
Dorel Dulău ◽  
◽  
Simona Bungău ◽  
Lucia Daina ◽  
Camelia Buhaş ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
Medical Management ◽  
Local Authority ◽  
Public Health System ◽  
Point Of View ◽  
The Public ◽  
Australian Health ◽  
Centralization And Decentralization

Medical management is a field that combines, both in theory and in practice, two somewhat different domains, administration and the medical domain, creating a third area of activity, namely that of medical management. This review is part of a study of health services management, which seeks to find solutions to improve the efficiency of the the management and administration of the medical system, both locally and nationally. In order to be able to study and evaluate, from a scientific point of view, the concepts of centralization and decentralization of the public health system in Romania, it is absolutely pertinent, but also mandatory, to focus on defining the notion of health system. Only later can we approach and research the process of decentralization of health, the political and economic context in which it can be initiated, as well as how to activate and carry it out. Decentralization, as a phenomenon of the transfer of rights and obligations, from the level of the central authority to the level of the local authority, can take various forms. From a theoretical and practical point of view, the forms of decentralization can be studied, evaluated and concluded by emphasizing the strengths and weaknesses. Also important to study are the ways of putting health systems into practice, which from the point of view of the source of funding are divided into state-funded health systems (Semashko, Beveridge and Bismarck) and privately funded health systems.

Central COVID-19 Coordination Centers in Germany: Description, economic evaluation and systematic review (Preprint)

2021 ◽  
Author(s):  
Nikolas Schopow ◽  
Georg Osterhoff ◽  
Nikolaus von Dercks ◽  
Felix Girrbach ◽  
Christoph Josten ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health System ◽  
University Hospital ◽  
Local Health ◽  
The Public ◽  
Important Benefit ◽  
Economic Analyses ◽  
Management Institutions ◽  
Local Health System ◽  
Regional Hospitals

BACKGROUND During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCC) have been established at several hospitals across Germany with the intention to assist local healthcare professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals, and therefore to prevent the collapse of local health system structures. In addition, they coordinate interhospital transfers of COVID-19 patients and provide or arrange specialized telemedical consultations. OBJECTIVE This study describes the establishment and management of a CCCC at a German university hospital. METHODS We perform economic analyses (cost, cost-effectiveness, use and utility) according to the CHEERS criteria. Additionally, a systematic review was conducted to identify publications on similar institutions worldwide. RESULTS The two months with the highest local incidence (12/2020 and 01/2021) of COVID-19 cases were considered. During this time, 17.3 requests per day were made to CCCC regarding admission or transfer of COVID-19 patients. The majority of requests was made by emergency medical services (56.3%), patients with an average age of 71.8 years were involved and 69.0% of cases had already positive PCR detection. In 59.8% of the concerning patients, further treatment by the general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% of patients were admitted to normal wards and 12.9% were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than €52,000 per month. 90.4% of all patients presented to the hospital were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. CONCLUSIONS Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefit of the CCCC is that it prevents hospitals from being overrun by patients and that it avoids situations in which doctors have to weigh up one patient’s life against another´s.

scholarly journals Qualitative analysis of the coordination of major system change within the Colombian health system in response to COVID-19: study protocol

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Simon Turner ◽  
Natalia Niño
Keyword(s):  
Health Service ◽  
Health Services ◽  
Health System ◽  
Case Studies ◽  
Health Systems ◽  
National Level ◽  
System Change ◽  
Service Planning ◽  
Local Health ◽  
Health Service Planning

Abstract Background Coronavirus (COVID-19) is posing a major and unprecedented challenge to health service planning and delivery across health systems internationally. This nationally funded study is analysing the response of the Colombian health system to the COVID-19 pandemic, drawing on qualitative case studies of three local health systems within the country. The approach will be informed by the concept of ‘major system change’—or coordinated change among a variety of healthcare organizations and other relevant stakeholders— to identify processes that both enable and inhibit adaptation of health services to the challenges presented by COVID-19. The study will collect information on capacity ‘bottlenecks’ as well as successful practices and forms of innovation that have emerged locally, which have the potential for being ‘scaled up’ across Colombia’s health services. Methods/design This qualitative study will be undertaken in two phases. In the first, up to 30 stakeholder interviews will be conducted to ascertain immediate challenges and opportunities for improvement in response to COVID-19 that can be shared in a timely way with health service leaders to inform health service planning. The stakeholders will include planning, provider and intermediary organizations within the health system at the national level. In the second, up to 60 further interviews will be conducted to develop in-depth case studies of three local health systems at the metropolitan area level within Colombia. The interview data will be supplemented with documentary analysis and, where feasible, non-participant observation of planning meetings. Discussion The study’s findings will aid evaluation of the relevance of the concept of major system change in a context of ‘crisis’ decision-making and contribute to international lessons on improving health systems’ capacity to respond to COVID-19 and future pandemics. Study findings will be shared among various stakeholders in the Colombian healthcare system in a formative and timely way in order to inform healthcare planning in response to COVID-19 and future pandemics. Conducting the study at a time of COVID-19 raises a number of practical issues (including physical distancing and pressure on health services) which have been anticipated in the study design and research team’s ways of working.

scholarly journals Rational trust in resilient health systems

2019 ◽  
Vol 34 (7) ◽  
pp. 553-557 ◽  
Author(s):  
Sonja Kristine Kittelsen ◽  
Vincent Charles Keating
Keyword(s):  
Public Health ◽  
Health System ◽  
Health Systems ◽  
The Public ◽  
Public Health Emergencies ◽  
Health Authorities ◽  
Cast Doubt ◽  
Public Health Authorities ◽  
System Resilience ◽  
Relevant Component

AbstractThe 2014–15 Ebola epidemic in West Africa highlighted the significance of trust between the public and public health authorities in the mitigation of health crises. Since the end of the epidemic, there has been a focus amongst scholars and practitioners on building resilient health systems, which many see as an important precondition for successfully combatting future outbreaks. While trust has been acknowledged as a relevant component of health system resilience, we argue for a more sustained theoretical engagement with underlying models of trust in the literature. This article takes a first step in showing the importance of theoretical engagement by focusing on the appeal to rational models of trust in particular in the health system resilience literature, and how currently unconsidered assumptions in this model cast doubt on the effectiveness of strategies to generate trust, and therein resilience, during acute public health emergencies.

scholarly journals Harnessing the potential of tobacco cessation programme amidst COVID-19 pandemic in India

2020 ◽  
Vol 32 (4) ◽  
pp. 740-742
Author(s):  
Garima Bhatt ◽  
Sonu Goel
Keyword(s):  
Supply Chain ◽  
Health Services ◽  
Health Systems ◽  
21St Century ◽  
Tobacco Cessation ◽  
Public Place ◽  
Tobacco Products ◽  
Social Distancing ◽  
The Public ◽  
Indian Health

The COVID-19 pandemic of the 21st Century continues to spread, and tobacco users are at a higher risk of contracting the disease. As a measure to contain its spread, many nations have called for various measures like maintaining social distancing norms, the prohibition of spitting in the public place, partial or complete lockdown, and many more. This shutdown episode has disrupted the entire supply chain in our country, and it is quite natural that tobacco users are also experiencing a scarcity of tobacco products, like others. This adverse situation is an opportune moment for the Indian health systems to target tobacco users to motivate, facilitate, and support the cessation process. Additionally, social distancing can be achieved by utilizing and optimizing our existing health services. In our country, we have dedicated regional & national quitlines and m-Cessation facilities for tobacco users who are willing to quit. These initiatives could reduce the risk of COVID among tobacco users, facilitate the tobacco cessation movement, and provide credence to the advocacy for increasing taxes on tobacco products in the country.

scholarly journals ANMCO POSITION PAPER: The reorganization of cardiology in times of the SARS-CoV-2 pandemic

2021 ◽  
Vol 23 (Supplement_C) ◽  
pp. C154-C163
Author(s):  
Pasquale Caldarola ◽  
Adriano Murrone ◽  
Loris Roncon ◽  
Giuseppe Di Pasquale ◽  
Luigi Tavazzi ◽  
...  
Keyword(s):  
Health System ◽  
Health Systems ◽  
System Organization ◽  
National Health System ◽  
Chronic Phase ◽  
Position Paper ◽  
Healthcare Personnel ◽  
Local Health ◽  
New Models ◽  
Acute Wards

Abstract The COVID-19 pandemic represents an unprecedented event that has brought deep changes in hospital facilities with reshaping of the health system organization, revealing inadequacies of current hospital and local health systems. When the COVID-19 emergency will end, further evaluation of the national health system, new organization of acute wards, and a further evolution of the entire health system will be needed to improve care during the chronic phase of disease. Therefore, new standards for healthcare personnel, more efficient organization of hospital facilities for patients with acute illnesses, improvement of technological approaches, and better integration between hospital and territorial services should be pursued. With experience derived from the COVID-19 pandemic,new models, paradigms, interventional approaches, values and priorities should be suggested and implemented.

scholarly journals The “Sustainability Doctrine” in Donor-Driven Maternal Health Programs in Tanzania

2022 ◽  
pp. 73-91
Author(s):  
Meredith G. Marten
Keyword(s):  
Health System ◽  
Health Systems ◽  
Newborn Care ◽  
Health System Strengthening ◽  
Respectful Maternity Care ◽  
Health Issues ◽  
The Public ◽  
Governmental Organizations ◽  
Non Governmental Organizations ◽  
Sustainable Health

AbstractStrengthening health systems to provide equitable, sustainable health care has been identified as essential for improving maternal and reproductive health. Many donors and non-governmental organizations (NGOs) have contributed to undermining health system strengthening, however, through adhering to what Swidler and Watkins call the “sustainability doctrine,” policies that prioritize time-limited, targeted interventions best suited for short-term funding streams, rather than the long-term needs of local populations. This chapter presents ethnographic data from semi-structured and key informant interviews with 16 policymakers and NGO directors in Dar es Salaam, Tanzania from 2011 to 2012. I illustrate how sustainability doctrine policies were put into practice, and how they have persisted, despite their shortcomings, using examples of donor-prioritized maternal healthcare initiatives in Tanzania rolled-out several years apart: prevention of mother-to-child transmission of HIV (PMTCT) and basic emergency obstetric and newborn care (BEmONC) programs in the late 2000s, and more recent efforts to implement respectful maternity care (RMC) programs. I focus on several issues informants identified as crippling efforts to build strong health systems, particularly the internal brain drain of healthcare workers from the public sector to higher-paying NGO jobs, and the prioritization of types of programs donors believed could be sustained after the funding period ended, specifically trainings and workshops. I describe how despite these issues, international organizations still design and implement less effective programs that often fail to account for local circumstances in their efforts to solve some of the more intractable health issues facing Tanzania today, in particular, the country’s stagnating maternal mortality rate. In this chapter, I argue that practices promoted and implemented under the guise of “sustainability” in policy papers and reports generated by donors paradoxically contribute to health system precarity in Tanzania.

scholarly journals Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia

2020 ◽  
Vol 5 (4) ◽  
pp. e002272 ◽  
Author(s):  
Dell D Saulnier ◽  
Hom Hean ◽  
Dawin Thol ◽  
Por Ir ◽  
Claudia Hanson ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Health System ◽  
Health Systems ◽  
Public Health System ◽  
Health Needs ◽  
Structured Interviews ◽  
The Public ◽  
Pregnancy And Childbirth ◽  
Childbirth Care

IntroductionResilient health systems have the capacity to continue providing health services to meet the community’s diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system’s joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system’s capacity to absorb, adapt or transform as viewed through a framework on health systems resilience.MethodsEight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework.ResultsThe theme ‘Responsible for the status quo’ reflected the community’s responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding.ConclusionsThe community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system’s resilience by creating room for the community to adapt and transform when experiencing floods.

The use of health services by non-resident patients in a border region with mixed health systems

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Pumi Alliana ◽  
F Nampo
Keyword(s):  
Health Services ◽  
Health System ◽  
Health Systems ◽  
Healthcare Services ◽  
Border Region ◽  
Local Health ◽  
High Complexity ◽  
Access To Health Services ◽  
Unified Health System ◽  
International Border

Abstract Background Access to health services in Brazil is universal, comprehensive, and equate, offering free healthcare to anyone, regardless of its country of residence. Cross-border patients may theoretically overload the healthcare services, mainly when the health systems or healthcare quality differ between countries. Sometimes, Brazilian politicians of border areas claim that non-residents overload local health services. Methods We collected data on the medium and high complexity Oncology and Cardiology care provided to in-patients by a reference Brazilian hospital located in the most populous international border of the country. This border is a conurbation that includes the cities of Foz do Iguassu (Brazil), Ciudad del Este (Paraguay), and Puerto Iguazu (Argentina), totaling around 900,000 inhabitants, of which 264,044 live in Foz do Iguassu. In addition to the poor migration control of citizens crossing these borders - especially the border with Paraguay - the Brazilian Unified Health System differs from that of the other two countries for being free of charge, and also for offering better healthcare. Results From January 2014 to December 2018, 107,434 procedures were performed, of which 240 (0.22%) on non-resident patients (Paraguay, [n = 236]; Argentina [n = 4]). Additionally, 238 (0.22%) other procedures were performed on foreign patients who did not declare their city/country of origin (Paraguay [n = 229]; Argentina [n = 8]; Portugal [n = 1]). Conclusions The use of medium and high complexity procedures by the non-residents on the Brazilian side of its most populous international border is low. Non-residents may benefit from medium and high complexity healthcare services of neighboring countries without overloading the health system. Key messages Advocating that non-residents overload medium and high complexity health services in Brazil is dishonest and may segregate people. Efforts should move toward integrating healthcare in border regions.

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