Health Committees as Vehicles for Democratic Governance in Health Systems: Lessons from Selected Health Unit Management Committees in Uganda

Introduction: For over forty years, community participation has been a central component of a well-functioning health system. Despite its important role there are many difficulties in defining and understanding community participation as part of governance. Through a case study of selected health unit management committees in Uganda, this paper demonstrates that these committees can be structures for community participation and vehicles for democratic governance in health systems that advance health equity. Guided by the theoretical underpinnings of deliberative democracy the paper evaluates the performance of health unit management committees as a mechanism for citizen participation in health systems. Methods: This paper uses a qualitative, case-study methodology. Through an in-depth look at the health unit management committees of Kiboga and Kyankwanzi in Uganda, the study considered these as examples of structures for democratic community participation in health system. The study undertook literature review on the theories of deliberative democracy and human rights principles, and this provided the theoretical underpinnings of the study. Findings: Our findings underscore that community participation in health systems through health unit management committees ought to be grounded in the principles of deliberative democracy. The core of deliberative democracy is considered to be authentic deliberation and consensus decision-making, which can happen in both direct and representative democracies, giving rise to the notions of populist and elitist deliberative democracy, respectively. As such, a balance needs to be struck between the competitive notions of democracy and the public health requirements of inclusive and direct participation of communities in decision making processes on matters that affect their health. Conclusions: Community participation in the health sector in Uganda hinges on health unit management committees at the lower service provision points. These HUMCs are also perceived as vehicles to strengthen health governance through realizing the right to health of the communities. However, these have been established without attention to investing in capacity building needed to enable them to exercise community voice in the health system.

Grey systems in the management of demand for palliative care services in Poland

Background The concept of care for people in a critical or even terminal health condition, who are in the last stage of their life, has become the mission of palliative care facilities. Therefore, the life of a sick patient poses a number of challenges for health care services to make sure that medical services are tailored to the trajectory of the disease, as well as the various needs, preferences and resources of patients and their families. Methods Health systems financed from public funds need to adopt new methods of management to meet the high and arising demand for a long-term care. There are several ways of assessing the demand for long-term care services. The method recommended by the author and presented in more detail in this paper is the one relying on grey systems, which enables the estimation of forecasting models and, finally, actual forecasts of the number of potential future patients. Results GST can be used to make predictions about the future behaviour of the system, which is why this article aims to present the possibility of using the first-order grey model GM (1,1) in predicting the number of patients of palliative care facilities in Poland. The analysis covers the data from 2014 to 2019, whereas the prediction of the number of patients has been additionally formulated for 2020. Conclusions Health systems, particularly publicly funded ones, are characterised by a certain kind of incompleteness and uncertainty of data on the structure and behaviour of its individual components (e.g. potential patients or payers). The present study aims to prove how simple and effective grey systems models are in the decision-making process.

COVID-19 lockdown implementation in Ghana: lessons learned and hurdles to overcome

COVID-19 exacts huge health and economic burdens on the global economy. To minimize spread of the virus, most governments of the wealthiest countries implemented lockdowns—a tough preventive measure. Ghana implemented a partial lockdown of two major cities, then lifted it in few weeks despite rising numbers of cases. This Viewpoint presents perspectives of key stakeholders in the public about lockdown implementation in Ghana. Respondents characterize the lifting of the lockdown as hasty, poorly communicated, and lacking transparency. Most would have preferred a longer lockdown despite the pressures it imposed especially on the urban poor. Participants expressed uncertainty about the health systems' ability to respond to increases in disease transmission and to provide education, engagement, and empowerment needed in communities, but even so would have preferred a longer lockdown. We offer lessons for more effective policy and implementation of lockdowns.