Improving Patient Race and Ethnicity Data Capture to Address Health Disparities: A Case Study From a Large Urban Health System

Abstract Background Evidence exists about synergies among universal health coverage, health security and health promotion. Uniting these three global agendas has brought success to the country’s health sector. This study aimed to document the efforts Ethiopia has made to apply nationally synergistic approaches uniting these three global health agendas. Our study is part of the Lancet Commission on synergies between these global agendas. Methods We employed a case study design to describe the synergistic process in the Ethiopian health system based on a review of national strategies and policy documents, and key informant interviews with current and former policymakers, and academics. We analyzed the “hardware” (using the World Health Organization’s building blocks) and the “software” (ideas, interests, and power relations) of the Ethiopian health system according to the aforementioned three global agendas. Results Fragmentation of health system primarily manifested as inequities in access to health services, low health workforce and limited capacity to implementation guidelines. Donor driven vertical programs, multiple modalities of health financing, and inadequate multisectoral collaborations were also found to be key features of fragmentation. Several approaches were found to be instrumental in fostering synergies within the global health agenda. These included strong political and technical leadership within the government, transparent coordination, and engagement of stakeholders in the process of priority setting and annual resource mapping. Furthermore, harmonization and alignment of the national strategic plan with international commitments, joint financial arrangements with stakeholders and standing partnership platforms facilitated efforts for synergy. Conclusions Ethiopia has implemented multiple approaches to overcome fragmentation. Such synergistic efforts of the primary global health agendas have made significant contributions to the improvement of the country’s health indicators and may promote sustained functionality of the health system.

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Strategies for Disseminating and Implementing the COVID-19 Vaccines in Rural Areas

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab152 ◽

2021 ◽

Author(s):

Beth Prusaczyk

Keyword(s):

United States ◽

Health Disparities ◽

Urban Health ◽

Rural Areas ◽

The United States ◽

Urban Residents ◽

Rural Residents ◽

Vaccination Programs ◽

Vaccine Information ◽

Roll Out

Abstract The United States has well-documented rural-urban health disparities and it is imperative that these are not exacerbated by an inefficient roll-out of the COVID-19 vaccines to rural areas. In addition to the pre-existing barriers to delivering and receiving healthcare in rural areas, such as high patient:provider ratios and long geographic distances between patients and providers, rural residents are significantly more likely to say they have no intention of receiving a COVID-19 vaccine, compared to urban residents. To overcome these barriers and ensure rural residents receive the vaccine, officials and communities should look to previous research on how to communicate vaccine information and implement successful vaccination programs in rural areas for guidance and concrete strategies to use in their local efforts.

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Who could be One Health Activist at the community level?: A case for India

Human Resources for Health ◽

10.1186/s12960-021-00558-3 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Sandul Yasobant ◽

Walter Bruchhausen ◽

Deepak Saxena ◽

Farjana Zakir Memon ◽

Timo Falkenberg

Keyword(s):

Health System ◽

Work Experience ◽

Financial Incentives ◽

One Health ◽

Health Workers ◽

Structured Interview ◽

Communicable Diseases ◽

Community Level ◽

System Level

Abstract Background Community health workers (CHWs) are the mainstay of the public health system, serving for decades in low-resource countries. Their multi-dimensional work in various health care services, including the prevention of communicable diseases and health promotion of non-communicable diseases, makes CHWs, the frontline workers in their respective communities in India. As India is heading towards the development of One Health (OH), this study attempted to provide an insight into potential OH activists (OHA) at the community level. Thus, this case study in one of India’s western cities, Ahmedabad, targeted identifying OHA by exploring the feasibility and the motivation of CHWs in a local setting. Methods This case study explores two major CHWs, i.e., female (Accredited Social Health Activists/ASHA) health workers (FHWs) and male (multipurpose) health workers (MHWs), on their experience and motivation for becoming an OHA. The data were collected between September 2018 and August 2019 through a mixed design, i.e., quantitative data (cross-sectional structured questionnaire) followed by qualitative data (focus group discussion with a semi-structured interview guide). Results The motivation of the CHWs for liaisoning as OHA was found to be low; however, the FHWs have a higher mean motivation score [40 (36–43)] as compared to MHWs [37 (35–40)] out of a maximum score of 92. Although most CHWs have received zoonoses training or contributed to zoonoses prevention campaigns, their awareness level was found to be different among male and female health workers. Comparing the female and male health workers to act as OHA, higher motivational score, multidisciplinary collaborative work experience, and way for incentive generation documented among the female health workers. Conclusion ASHAs were willing to accept the additional new liaison role of OHAs if measures like financial incentives and improved recognition are provided. Although this study documented various systemic factors at the individual, community, and health system level, which might, directly and indirectly, impact the acceptance level to act as OHA, they need to be accounted for in the policy regime.

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A network of networks

Journal of Health Organization and Management ◽

10.1108/jhom-07-2016-0146 ◽

2017 ◽

Vol 31 (2) ◽

pp. 223-236 ◽

Cited By ~ 3

Author(s):

Rick Iedema ◽

Raj Verma ◽

Sonia Wutzke ◽

Nigel Lyons ◽

Brian McCaughan

Keyword(s):

Health Service ◽

Health System ◽

Network Governance ◽

System Reform ◽

System Transformation ◽

Content Type ◽

Multiple Networks ◽

Network Of Networks

Purpose To further our insight into the role of networks in health system reform, the purpose of this paper is to investigate how one agency, the NSW Agency for Clinical Innovation (ACI), and the multiple networks and enabling resources that it encompasses, govern, manage and extend the potential of networks for healthcare practice improvement. Design/methodology/approach This is a case study investigation which took place over ten months through the first author’s participation in network activities and discussions with the agency’s staff about their main objectives, challenges and achievements, and with selected services around the state of New South Wales to understand the agency’s implementation and large system transformation activities. Findings The paper demonstrates that ACI accommodates multiple networks whose oversight structures, self-organisation and systems change approaches combined in dynamic ways, effectively yield a diversity of network governances. Further, ACI bears out a paradox of “centralised decentralisation”, co-locating agents of innovation with networks of implementation and evaluation expertise. This arrangement strengthens and legitimates the role of the strategic hybrid – the healthcare professional in pursuit of change and improvement, and enhances their influence and impact on the wider system. Research limitations/implications While focussing the case study on one agency only, this study is unique as it highlights inter-network connections. Contributing to the literature on network governance, this paper identifies ACI as a “network of networks” through which resources, expectations and stakeholder dynamics are dynamically and flexibly mediated and enhanced. Practical implications The co-location of and dynamic interaction among clinical networks may create synergies among networks, nurture “strategic hybrids”, and enhance the impact of network activities on health system reform. Social implications Network governance requires more from network members than participation in a single network, as it involves health service professionals and consumers in a multi-network dynamic. This dynamic requires deliberations and collaborations to be flexible, and it increasingly positions members as “strategic hybrids” – people who have moved on from singular taken-as-given stances and identities, towards hybrid positionings and flexible perspectives. Originality/value This paper is novel in that it identifies a critical feature of health service reform and large system transformation: network governance is empowered through the dynamic co-location of and collaboration among healthcare networks, particularly when complemented with “enabler” teams of people specialising in programme implementation and evaluation.

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A closer look at the rural-urban health disparities: Insights from four major diseases in the Commonwealth of Virginia

Social Science & Medicine ◽

10.1016/j.socscimed.2015.07.011 ◽

2015 ◽

Vol 140 ◽

pp. 62-68 ◽

Cited By ~ 14

Author(s):

Di Zeng ◽

Wen You ◽

Bradford Mills ◽

Jeffrey Alwang ◽

Michael Royster ◽

...

Keyword(s):

Health Disparities ◽

Urban Health

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Health system characteristics of quality care delivery: A comparative case study examination of palliative care for cancer patients in four regions in Ontario, Canada

Palliative Medicine ◽

10.1177/0269216311416697 ◽

2011 ◽

Vol 26 (4) ◽

pp. 322-335 ◽

Cited By ~ 17

Author(s):

Jonathan Sussman ◽

Lisa Barbera ◽

Daryl Bainbridge ◽

Doris Howell ◽

Jinghao Yang ◽

...

Keyword(s):

Palliative Care ◽

Health System ◽

Acute Care ◽

Pattern Analysis ◽

Care Delivery ◽

Quality Care ◽

Structural Features ◽

Comparative Case Study ◽

Care Utilization

Background: A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described. Aim: The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths. Design: A comparative case study evaluation was conducted of ‘palliative care’ in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed. Results: 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services. Conclusions: The four palliative care regional ‘systems’ examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems.

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