Applying ethical theories to the Iranian health system governance: a critical empirical assessment

The policies of health systems are inspired by ethical priorities. A critical review of policies can reveal the ethical theories/justice schools behind them. This study aimed to identify the ethical theory(ies) underpinning the Iranian health system governance over the past 50 years. This was a qualitative study conducted in two stages during 2019. First, we identified and constructed the key concepts and distinctive notions of prominent ethical theories/justice schools. Then, we spotted and selected 24 strategic laws and policy documents in the Iranian health system governance during the past 50 years and analyzed their content to surmise their underlying ethical theory. The results showed that the dominant theory affecting the policies of the Iranian health system governance over the past 50 years was egalitarian liberalism and then objective utilitarianism and relativist communitarianism. Retrospective empirical application of ethical theories to health system governance is methodologically doable, and this application reveals the mood or priorities of the politics. Also, highlighting the underpinning ethical theories of health system governance as well as the gap between ambitions versus realization are insightful and may prospectively empower and strengthen egalitarianism

Institutionalizing Leadership Management and Governance for Health System Strengthening in Emerging Economies: Evidence from the Partnership for Health System Strengthening in Africa (PHSSA)Programme

Health systems in an emerging economy, specifically Sub-Saharan Africa (SSA) are characterized as fragile with low implementation of Universal Health Coverage. While acknowledging that the cause of the inadequacy in emerging economies is multi-factorial, other arguments are that the root cause is inadequate political and technical leadership. Evidence reveals that visionary, imaginative, decisive, responsible, and responsive leadership is insufficient to persuade all stakeholders in low-income nations in Sub-Saharan Africa to work together to attain the constructive goal of universal coverage. On the contrary, other academics suggest that successful leadership would establish a clear national vision for universal coverage and a commitment to achieving that objective over time. These contrasting observations motivated an interrogation of the link between health system governance and Universal Health Coverage in an emerging economy taking evidence from the PHSSA programme. Through a meta-analysis of the existing literature as well as analysis of the findings from the programme, the paper explores experiences, critical success factors and recommendations for improvement of UHC through institutionalizing health system governance in an emerging economy. The research provides evidence that the governance linkages in health systems and the outcomes they produce are contingent rather than assured, due to the variety and complexity inherent in the health system governance paradigm. The situation-specific setting of a country's health system determines what can be accomplished through health governance strategy design and implementation efforts. The paper recommends a need to create a conducive environment for adoption of health systems programmes by contextualizing health governance with regard to the larger set of governance institutions that surround it. A competency framework should also be adopted in recruitment of competent health managers. The study also recommends a need for the countries in seeking to institutionalize health system governance to develop and support an organizational structure and context that sustains leadership practices through advocacy, create an enabling environment for health systems leadership, management and governance through the development of ethics and other competences specific to universal health care situations as well as provide proper financial support system so that institutionalization of leadership, management and governance can have maximum impact on the effectiveness and efficiency of health systems. There is also a need to institutionalize short courses, seminars and conferences in health leadership, management, and governance so as to entrench participatory leadership in health systems.

Perspectives on the current state of Nigeria’s emergency care system among participants of an emergency medicine symposium: a qualitative appraisal

IntroductionEmergency care systems provide timely and relevant care to the acutely ill and injured. Published commentaries have characterised deficiencies in the Nigerian emergency care system and offered potential solutions but have not included the perspectives of the Nigerian public. A more inclusive approach that includes feedback from the public may help improve the Nigerian emergency care system through better understanding of the needs, values and expectations of the community.MethodsParticipants of an emergency medicine symposium participated in focus group discussions that were randomly divided into small groups led by two trained facilitators. These facilitators asked open-ended, semistructured questions to lead discussions in the English language. Participant responses were audio-recorded and transcribed verbatim into transcripts. Two independent investigators employed conventional content analysis to code the transcripts until thematic saturation was achieved.ResultsThree descriptive themes emerged characterising the current state of Nigeria’s emergency care system as it relates to prehospital care delivery, hospital care delivery and health system governance: rudimentary, vulnerable and disconnected. At the prehospital level, concepts revolved around emergency recognition and response, ambulance and frontline providers, and cultural norms. At the hospital level, concepts centred around the health workforce, clinical competency, hospital capacity and the burden of financial hardship. At the health system level, concepts concentrated on healthcare access and healthcare financing. Opportunities for emergency care system improvement at each component level were identified and explored.ConclusionsThe participants in this study identified shortcomings and opportunities to improve prehospital care, hospital care and health system governance. The results of this study may help healthcare professionals, policy makers and community leaders identify gaps in the emergency care system and offer solutions in harmony with the needs, values and expectations of the community. If successful, these community-informed interventions may serve as a model to improve emergency care systems throughout Africa.

HCFMUSP: Resilience in Response to the COVID-19 Pandemic

ABSTRACT The teaching case describes a set of emergency actions taken by HCFMUSP to manage the needs brought by the COVID-19 pandemic in Brazil. The case objective considers the issues related to the impact of the pandemic mostly in healthcare operations, emphasizing how to: (a) adapt health system governance in response to a crisis (crisis management); (b) manage the health system capacity, which traditionally is not so resilient; (c) deal with a new disease (knowledge management). Thus, it should allow gathering elements for the management of future crises.

HCFMUSP: Resiliência como Resposta à Pandemia de COVID-19

ABSTRACT The teaching case describes a set of emergency actions taken by HCFMUSP to manage the needs brought by the COVID-19 pandemic in Brazil. The case objective considers the issues related to the impact of the pandemic mostly in healthcare operations, emphasizing how to: (a) adapt health system governance in response to a crisis (crisis management); (b) manage the health system capacity, which traditionally is not so resilient; (c) deal with a new disease (knowledge management). Thus, it should allow gathering elements for the management of future crises.

Health system governance in strengthening International Health Regulations (IHR) compliance in Myanmar

The International Health Regulations 2005 (IHR) is a legally binding framework which requires 196 WHO Member States to take actions to prevent, protect against, control and provide public health response to the international spread of disease. Improving IHR compliance provides grounds for better health system strengthening, which is key to moving countries closer towards Universal Health Coverage. Multisectoral, collaborative working within and across sectors is fundamental to improving IHR (2005) compliance, and for that, governance is the best lever of the health system. This paper highlights the importance of the relationship between governance and IHR in the context of Sustainable Development Goals (SDGs) which follow the fundamental principle of interdependence; SDGs interlink with one another. We consider governance (SDG 16) and how it influences the IHR capacity of SDG 3 (health and well-being for all at all ages). This paper considers the successes of the Myanmar Ministry of Health and Sports thus far in improving IHR compliance and highlights that an even greater focus on health system governance would lead to more sustainable outcomes. Nurturing an institutional culture with enforced rules, which are conducive for improved accountability through inclusive participation would further improve Myanmar IHR strengthening efforts. Without those principles of good governance, the developed IHR capacities cannot be sustained or owned by Myanmar people. This has now become even more urgent given the current COVID-19 pandemic.