This study aims at understanding the performance of primary health care providers and the variables driving this performance using the World Development Report (WDR) 2004 accountability framework. ...The study is primarily based on quantitative surveys at the level of primary health care facilities, health care personnel, and households in their vicinity. These surveys were implemented in four states: Bauchi, Cross River, Kaduna, and Lagos. Despite large Government efforts, the delivery of quality primary health care services remains a challenge in the country. The condition of the infrastructure is poor; many facilities do not have the required equipment or the pharmaceutical products to offer quality care. In addition, household satisfaction with services is low and very few outreach services are provided. The three levels of government, Federal, State, and local governments have some responsibility in the provision of health services. The division of roles and responsibilities between levels, particularly between states and LGs, is complex and not always clear undermining the accountability relationships between citizens, policymakers, and providers. In addition, health personnel salaries are often delayed and are not linked to the provision of services. Clearly defining lines of responsibilities, performance based financing of local governments and providers, and the collection, analysis, and sharing of information are some options that can help to re-align incentives and improve accountability of policymakers and providers. Reinforcing clients power and increasing their demand of services can compensate for weaknesses in the long route of accountability for the delivery of primary health care. The Nigerian Government has long recognized the importance of community participation in the delivery of basic health care services and has thus tried
to involve the communities in the development of PHC along the lines of the Bamako Initiative.
The past three decades have seen enormous changes in the organisation of health care. This book explores the role of knowledge production and technology on these transformations, focusing on the ...market (attempts to embed principles of economic rationality and efficient use of resources in the shaping and delivery of health care), the laboratory (science, experiments and 'evidence' in the management of research, practice and policy) and the forum (the application of deliberative procedures and other forms of public consultation to health care decision making).
Over the period 1987–1991 an inter-disciplinary five-country group developed the EuroQol instrument, a five-dimensional three-level generic measure subsequently termed the ‘EQ-5D’. It was designed to ...measure and value health status. The salient features of its development and its consolidation and expansion are discussed. Initial expansion came, in particular, in the form of new language versions. Their development raised translation and semantic issues, experience with which helped feed into the design of two further instruments, the EQ-5D-5L and the youth version EQ-5D-Y. The expanded usage across clinical programmes, disease and condition areas, population surveys, patient-reported outcomes, and value sets is outlined. Valuation has been of continued relevance for the Group as this has allowed its instruments to be utilised as part of the economic appraisal of health programmes and their incorporation into health technology assessments. The future of the Group is considered in the context of: (1) its scientific strategy, (2) changes in the external environment affecting the demand for EQ-5D, and (3) a variety of issues it is facing in the context of the design of the instrument, its use in health technology assessment, and potential new uses for EQ-5D outside of clinical trials and technology appraisal.
At the turn of the 21st century, several important reports and events designed to raise awareness of health disparities and to describe initial efforts to reduce health disparities took place. The ...Surgeon General's office released several reports that showed dramatic disparities in tobacco use and access to mental health services by race and ethnicity. The first real legislation focused on reducing health disparities was signed into law, creating the National Center for Minority Health and Health Disparities within the NIH. In 2001, the IOM released its landmark report, Crossing the Quality Chasm: A New Health System for the 21st Century , highlighting the importance of a focus on health care quality rather than a focus on only access and cost issues.
Building upon these reports and events, the IOM held a workshop on April 8, 2010, that discussed progress to address health disparities and focused on the success of various federal initiatives to reduce health disparities. How Far Have We Come in Reducing Health Disparities? summarizes the workshop and explains the progress in the field since 2000.
How good is the quality of health care in the United States? Is quality improving? Or is it suffering? While the average person on the street can follow the state of the economy with economic ...indicators, we do not have a tool that allows us to track trends in health care quality. Beginning in 2003, the Agency for Healthcare Research and Quality (AHRQ) will produce an annual report on the national trends in the quality of health care delivery in the United States. AHRQ commissioned the Institute of Medicine (IOM) to help develop a vision for this report that will allow national and state policy makers, providers, consumers, and the public at large to track trends in health care quality. Envisioning the National Health Care Quality Report offers a framework for health care quality, specific examples of the types of measures that should be included in the report, suggestions on the criteria for selecting measures, as well as advice on reaching the intended audiences. Its recommendations could help the national health care quality report to become a mainstay of our nation's effort to improve health care.
As health costs in the U.S. soar past $1.5 trillion, much evidence indicates that the nation does not get good value for its money. It is widely agreed that we could do better by using cost-effective ...analysis (CEA) to help determine which health care services are most worthwhile. American policy makers, however, have largely avoided using CEA, and researchers have devoted little attention to understanding why this is so. By considering the economic, social, legal, and ethical factors that contribute to the situation, and how they can be negotiated in the future, this book offers a unique perspective. It traces the roots of EA in health and medicine, describes its promise for rational resource allocation, and discusses the nature of the opposition to it, using Medicare and the Oregon health plans as examples. In exploring the disconnection between the promise of CEA and the persistent failure of rational intentions, the book seeks to find common ground and practical solutions. It analyzes the prospects for change and presents a roadmap for getting there. It offers pragmatic advice for cost-effectiveness analysts, discussing ways in which they can better translate their research findings into the basis for action. The book also offers advice for policy makers and politicians, including lessons from Europe, Canada, and Australia, and underlines the need for leadership to establish the conditions for change. Available in OSO: http://www.oxschol.com/oso/public/content/publichealthepidemiology/9780195171860/toc.html
PROMOTING PARTNERSHIP FOR HEALTH This book forms part of a series entitled Promoting Partnership for Health publishedin association with the UK Centre for the Advancement of Interprofessional ...Education (CAIPE). The series explores partnership for health from policy, practice and educational perspectives. Whilst strongly advocating the imperative driving collaboration in healthcare, it adopts a pragmatic approach. Far from accepting established ideas and approaches, the series alerts readers to the pitfalls and ways to avoid them. DESCRIPTION Interprofessional Teamwork for Health and Social Care is an invaluable guide for clinicians, academics, managers and policymakers who need to understand, implement and evaluate interprofessional teamwork. It will give them a fuller understanding of how teams function, of the issues relating to the evaluation of teamwork, and of approaches to creating and implementing interventions (e.g. team training, quality improvement initiatives) within health and social care settings. It will also raise awareness of the wide range of theories that can inform interprofessional teamwork. The book is divided into nine chapters. The first 'sets the scene' by outlining some common issues which underpin interprofessional teamwork, while the second discusses current teamwork developments around the globe. Chapter 3 explores a range of team concepts, and Chapter 4 offers a new framework for understanding interprofessional teamwork. The next three chapters discuss how a range of range of social science theories, interventions and evaluation approaches can be employed to advance this field. Chapter 8 presents a synthesis of research into teams the authors have undertaken in Canada, South Africa and the UK, while the final chapter draws together key threads and offers ideas for future of teamwork. The book also provides a range of resources for designing, implementing and evaluating interprofessional teamwork activities.
Against Health Metzl, Jonathan; Kirkland, Anna
11/2010, Volume:
18
eBook
You see someone smoking a cigarette and say,Smoking is bad for your health, when what you mean is, You are a bad person because you smoke. You encounter someone whose body size you deem excessive, ...and say, Obesity is bad for your health, when what you mean is, You are lazy, unsightly, or weak of will. You see a woman bottle-feeding an infant and say,Breastfeeding is better for that child's health, when what you mean is that the woman must be a bad parent. You see the smokers, the overeaters, the bottle-feeders, and affirm your own health in the process. In these and countless other instances, the perception of your own health depends in part on your value judgments about others, and appealing to health allows for a set of moral assumptions to fly stealthily under the radar.Against Health argues that health is a concept, a norm, and a set of bodily practices whose ideological work is often rendered invisible by the assumption that it is a monolithic, universal good. And, that disparities in the incidence and prevalence of disease are closely linked to disparities in income and social support. To be clear, the book's stand against health is not a stand against the authenticity of people's attempts to ward off suffering. Against Health instead claims that individual strivings for health are, in some instances, rendered more difficult by the ways in which health is culturally configured and socially sustained.The book intervenes into current political debates about health in two ways. First, Against Health compellingly unpacks the divergent cultural meanings of health and explores the ideologies involved in its construction. Second, the authors present strategies for moving forward. They ask, what new possibilities and alliances arise? What new forms of activism or coalition can we create? What are our prospects for well-being? In short, what have we got if we ain't got health? Against Health ultimately argues that the conversations doctors, patients, politicians, activists, consumers, and policymakers have about health are enriched by recognizing that, when talking about health, they are not all talking about the same thing. And, that articulating the disparate valences of health can lead to deeper, more productive, and indeed more healthy interactions about our bodies.
Indonesia has made improving the access to health workers, especially in rural areas, and improving the quality of health provider's key priority areas of its next five-year development plan. ...Significant steps and policy changes were taken to improve the distribution of the health workforce, in particular the contracted doctors program and later the contracted midwives program, but few studies have been undertaken to measure the actual impact of these policies and programs. This book is part of the inputs prepared at the request of the government of Indonesia's national development agency, Bappenas, to inform the development of the next national development plan 2010-14. Other inputs include reports on health financing, fiscal space for health, health public expenditure review, and assessments of maternal health and pharmaceuticals. Study findings highlight the importance not only of improving the supply of health care, but also of improving quality, so as to improve health outcomes. Over the period studied, important gains in the determinants of health outcomes have occurred in Indonesia. At the same time, however, the study shows that Indonesia, despite the significant gains, continues to suffer from serious challenges in the number and distribution, and in particular the quality, of its health workers.
Starting with more general issues of healthcare policy and governance in a global perspective and using the lens of national case studies of healthcare reform, this handbook addresses key themes in ...the debates over changing healthcare policy.
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