A document by Ayotunde Giwa. Click on the document to view its contents.

The practice of healthcare management is essential for the efficient operation of health services, encompassing leadership, management, and direction within healthcare organisations. ‘Health management’ extends beyond healthcare management by integrating principles of public health and health policy. As health management is commonly practised but not cohesively recognised, the European Health Management Association (EHMA) conducted this study to develop a cohesive definition of health management. Developed through a qualitative methodology comprising focus group discussions and validation through quantitative expert interviews, this study proposed a holistic definition of health management, incorporating social, environmental and economic determinants of health, cross-sector collaboration, and the ‘One Health’ approach. The publication of this unified definition has important implications for professional training, policy development, and health outcomes. It provides a standardised framework for curricula, informs precise policy formulation, and promotes sustainable, efficient, and equitable healthcare delivery.

....

Background: Health planning is essential for effective public health interventions and optimal resource utilisation. The Portuguese General Directorate of Health has a long history of developing health plans and programmes, for communicable and noncommunicable diseases, and their determinants. This study aimed to review the current 24 programmes and assess the adequacy of their structure and content. Methods: A document analysis was conducted using a programme assessment matrix developed by the research group. Two independent researchers evaluated each programme, scoring items as ”absent,” ”present,” or ”not applicable.” A quantitative analysis was employed to analyse compliance scores between priority and non-priority programmes and across the year of publication. Results: Of the 24 existing programmes, 16 complied with at least 75% of the predefined items. Priority programmes had an 83% global compliance score, surpassing non-priority programmes (with 33% of compliance). While the healthy eating programme achieved 100% compliance, the programme on sexual and reproductive scored the lowest (19%). The item least commonly present was “updated time scope”, in only 21% of the programmes. Most recently published programmes were more likely to have a higher compliance score (Β = 0.76, 95% CI: [0.46, 1.05]). Not all programmes were publicly available in the same digital location. Conclusions: There was heterogeneity in the 24 health promotion programmes in terms of structure, content, timeliness, and accessibility. A standardised structure could enhance their quality and ease their interpretation and dissemination.

Over the past two decades, patient-centered care has gained global prominence, emphasizing collaboration among patients, families, caregivers, and healthcare professionals to improve healthcare delivery. Recognizing the foundational role of patient participation in enhancing clinical outcomes, healthcare organizations increasingly integrate patient inputs and resources into their management strategies. Patient and Family Advisory Councils (PFACs) represent a primary form of collective patient engagement at the organizational level. PFACs actively engage in all levels of the hospital system to enhance quality improvement and meet the demands of patients. Despite PFACs’ recognized importance, empirical evidence regarding their roles as strategic resources and impact on hospital performance remains unexplored. Incorporating patient engagement into SRBV, this study addresses how comprehensive strategic resources are associated with a hospital’s quality of care and patient satisfaction outcomes. Utilizing hospital-level data from 2018 to 2020, a cross-sectional time-series ordered logit analysis examines the quality of care and satisfaction models. The findings reveal that patient engagement, physical resources, and human capital are positively associated with hospital quality of care and patient satisfaction. In contrast, a social resource – a minority population – is negatively associated with hospital outcomes. This study contributes theoretical and practical implications. It synthesizes patient engagement into the SRBV approach and provides consistent empirical evidence. In addition, it suggests evidence for practitioners to develop and manage patient engagement as a strategic resource.

The migration of health workers remains one of the most pressing challenges facing many countries in the global South. This short communication seeks to reignite debate on the effectiveness of the 2010 WHO Global Code of Practice as a tool for managing the migration of health workers from the South. While the WHO Code of Practice was effective in reducing the migration of health workers from countries such as Zimbabwe during its first five years of its implementation, demand for health workers in the UK after Brexit and the COVID-19 pandemic has accelerated the rate of migration of health workers from countries facing critical shortages. Clearly, new solutions are needed that strike a balance between the right of the health workers in the South to migrate and the right of citizens in the region to a stable supply of health workers.

Background. Patient engagement is seen as a fundamental strategy for achieving quality patient-centred care, especially in community-based primary healthcare (OMS2023, Haesebaert et al. 2018). Despite growing interest in patient engagement in Sub-Saharan Africa, few patient engagement initiatives have been identified, and those often are limited to lower-levels of engagement, in participation in health research or in health system improvement (Gogovor et al. 2023). With the aim of giving a voice to under-represented community groups in healthcare governance, the ASSK project supported the implementation of primary health services user committees in the Democratic Republic of the Congo (DRC), designed to enable the representation of two user groups with specific unmet sexual and reproductive health (SRH) needs: women and adolescents. Aims and Methods. Using a mixed-method case study design combining quantitative secondary data (DHIS2) and qualitative data from two research World Cafés (WC1:Women user committees (WUC) n=55; WC2: Adolescents user committee (AUC) n=63)(Schield et al. 2022), this paper looks at the implementation facilitators and barriers, and at the results of this initiative. Results. Women and adolescent members of the user committees highlighted that their participation resulted in increased knowledge of SRH and their related rights, as well as in their “soft skills” such as communication and leadership. In addition, participants reported greater transparency and accountability on the part of the community primary health centers (e.g. by displaying fees for procedures to counter over-billing). Ultimately, WUC and AUC were associated with improved health practices in the community such as increased use of sexual and reproductive health services, including adolescent family planning and assisted childbirth (15-49 years old). Conclusions. Patient user committees for specific marginalized or under-represented groups appear to be an effective way of improving the quality of primary health care services. Further research is needed to better understand how to maximize its potential.

Purpose: Near real-time patient experience feedback (NRTPEF) can enable patient-centric quality improvement. We 1) assess the utility, feasibility, and acceptability of implementing a new NRTPEF, perceived by patients and providers; and 2) understand how the NRTPEF became embedded into routine provider practices. Materials and Methods: Mixed methods process evaluation of the 8-month implementation of an innovative NRTPEF in an inpatient rehabilitation unit, using interviews and focus groups with all the service-unit leaders and interviews with a randomized sample of patients. Beyond descriptive statistics and content analysis, the Normalization Process Theory (NPT) informed a framework analysis. Results: Patients and service-unit leaders perceived high utility in the NRTPEF (median: 9 for both; 0-10 scale) and qualitative comments emphasized the value of providing/obtaining timely feedback. The system was found feasible and acceptable for patients (median: 9.5), but with an improvement margin for providers (median: 7.3). Suggestions include strengthening the data-relay format. Even in the pilot form, providers found the NRTPEF became embedded into practice (median 10; average: 8.6). The NPT-informed analysis shows how providers saw differential value, engaged with, and used the patient feedback into reconfigured practices. Conclusion: An innovative NRTPEF was found useful, feasible and acceptable, but with refinement opportunities before scale-up.

Abstract Background: Health workforce supply is critical to ensuring the delivery of essential healthcare, and may be enhanced via mechanisms which alter the scopes of practice of health professions. The aim of this paper is to study the collective perspectives of allied health decision-makers on factors which influence their development and implementation of advanced and extended scope of practice initiatives, and the timing/catalyst and application of their decision-making. Methods: A grounded-theory, qualitative study of the experiences of allied health directors and senior managers across two Australian jurisdictions. Results: Twenty allied health decision-makers met study eligibility criteria. Data coding of interview transcripts identified 14 factors specific to scope of practice change, spanning rational (n=8) and non-rational (n=6) decision-making approaches. Leadership, Governance, Organisational need, Resourcing, Knowledge & Skills – clinical, Supporting resources, Knowledge & skills – change and Sustainability were identified as being rational and enabling in and of themselves, with Leadership seen as being most influential. Comparatively, the non-rational factors of Socio-economic & political environment, Perceived patient need, Organisational environment, Change culture & appetite, Perceived professional territorialism and Actual professional territorialism were more varied, and primarily influenced the timing/catalyst and application of decision-making. Conclusion : Allied health decision-makers hold a complex, systems-level understanding of scope of practice change. Whilst rational decision criteria were predominant and seen to enable scope change, non-rational influences reflected greater variation in decision timing/catalyst and application, thus emphasising the human dimensions of decision-making. Further research is required to better understand how decision-makers integrate and weight decision-making factors to inform the development of structured decision tools.

Background: International oral health policy directions led by the World Health Organization call for the inclusion of oral health within universal health coverage. The aim of this study is to perform a budget impact analysis of a policy option for a more cost-efficient oral health workforce skill-mix (dentists and oral health therapists) to provide public oral healthcare in Victoria, Australia. Methods: Two hypothetical standard care pathways were developed. A dynamic population Markov model was generated in TreeAge software, with a time horizon of six years. Two scenarios were modelled to determine: 1) base-case scenario: the threshold the dentist workforce could reduce per year, while achieving the same service delivery outputs, and 2) alternative scenario: the potential cost-savings for utilising an optimally cost-efficient oral health workforce skill-mix. Results: The threshold analysis showed a minimum reduction of 13% of the dentist workforce being replaced with oral health therapists can occur without having any impact on the same service delivery outputs. Under the alternative scenario, the potential cost-savings would be AUD$1,425,037 (SD 58,954). Conclusions: Governments and policy-decision makers should consider strategies in training, attracting, and retaining oral health therapists to achieve an optimally cost-efficient oral health workforce skill-mix when delivering public oral healthcare.

A document by Danielle L. Sarno. Click on the document to view its contents.

The global health workforce crisis, simmering for decades, was brought to a rolling boil by the COVID-19 Pandemic in 2020. With scarce literature, evidence, or best practices to draw from, countries around the world moved to flex their workforces to meet acute challenges of the pandemic, facing demands related to patient volume, patient acuity, and worker vulnerability and absenteeism. One early hypothesis suggested that the acute, short-term pandemic phase would be followed by several waves of resource demands extending over the longer term. However, as the acute phase of the pandemic abated, temporary workforce policies expired and others were repealed with a view of returning to “normal”. The workforce needs of subsequent phases of pandemic effects were largely ignored despite our new equilibrium resting nowhere near our pre-COVID baseline. In this paper, we describe Canada’s early pandemic workforce response. We report the results of an environmental scan of the early workforce strategies adopted in Canada during the first COVID wave of the COVID 19 pandemic. Within a three-part framework for supporting a sustainable health workforce, we describe 470 strategies and policies that aimed to increase the numbers and flexibility of health workers in Canada, and to maximise their continued availability to work. These strategies targeted all types of health workers and roles, enabling changes to the places health work is done, the way in which care is delivered, and the mechanisms by which it is regulated. Telehealth strategies and virtual care were the most prevalent, followed by role expansion, licensure flexibility, mental health supports for workers, and return to practice of retirees. We explore the degree to which these short-term, acute response strategies might be adapted or extended to support the evolving workforce’s long-term needs.

There is a gap between healthcare workforce research and decision-making in policy and practice. This matters more than ever given the urgent staffing crisis, with shortfalls of key workers and increasing service pressures. As a national research network, we held the first ever UK forum on health and care workforce research and evidence in March 2023 which aimed to bridge this gap. We brought together clinical and system leaders, policymakers and regulators with workforce researchers. Fifteen sessions convened by leading experts combined knowledge exchange with deliberative dialogue over two days. Topics ranged from workforce analytics, forecasting, international migration to interprofessional working. In these small groups, important knowledge gaps were identified, where existing research had not reached decision-makers. Managers were not aware of accepted high quality evidence in areas like the relationship between registered nurse staffing levels and patient outcomes. Participants also identified important gaps in research, both topic area and study design. More work is needed to engage new disciplines, from labour economics and occupational health to academic human resources. Mobilising knowledge across disciplines will strengthen the quality and range of research as well as identifying relevant and novel interventions. Discussion at the forum highlighted a number of national and local workforce initiatives which had been implemented at pace, from virtual wards to e-rostering and apprentice levies, without a good evidence base or concurrent evaluation. The pandemic had accelerated many changes, including important shifts in skill mix and new roles with little learning from other countries and systems. Existing evaluations were often small-scale or focused on individual, rather than organisational, solutions in areas such as staff wellbeing. The paper provides a summary of an emerging UK workforce research agenda developed at the forum meeting, together with actions to build workforce research capacity and increase reach of findings into policy and practice.

As the Universal Health Insurance Plan (RAMU) is being implemented in Mali, community-based health insurance (CBHI) — one of the pillars— must innovate to meet the challenge of universal health coverage. An experimental CBHI was tested in central Mali between 2017 and 2021. This innovative CBHI professionalizes and organizes risk sharing on a larger scale, moving from municipalities to circles (department). A mixed-method study was carried out to assess the acceptability of this innovation among elected representatives of CBHI offices. In April 2021, 118 questionnaires were administered, followed by 43 qualitative interviews from the same sample in October 2021. Sekhon el al. (2017) seven dimensions of acceptability was used as the conceptual model. More than half of individuals (58%) reported above-average acceptability. Elected officials feel well supported in their activities by the Technical Union of Malian Mutuality (UTM), the umbrella organization of CBHI. They show some confidence in their ability to perform their duties effectively despite varying levels of commitment that often fall short of expectations and needs, which they justify by their volunteer status. Elected officials note that the system is very effective despite the nonoptimal conditions linked to the prevailing insecurity. Professionalization appears to be an unavoidable condition for the performance of the innovation, as well as the new community assembly. However, elected officials are concerned about the sustainability. The UTM will play an important role in continuing its support and fulfilling its functions as a delegated management organization within the framework of the RAMU.

This Perspective argues that the NHS in the UK is facing a critical ‘tipping point’ which means that its very survival is at stake. The article considers the political responses to this crisis - (briefly) from the Conservative government; (briefly) from the ‘anti-NHS’ Right in politics; (briefly) from the ‘centre’ in politics in the form of the Tony Blair Institute for Global Change; and (in depth) from the left-of-centre, the Labour Party. Labour is likely to form the next government, which is why its approach (in terms of both political strategy and the substance of health policy) is considered in depth. It is argued that Labour’s approach, derived from an understandable desire by leader Sir Keir Starmer to disown its ‘unelectable’ recent past, is currently inadequate for the task of putting the NHS on a secure footing for the future.

Background. Attention to the healthcare workforce has increased, yet comprehensive information on migrant healthcare workers is missing. This study focuses on migrant healthcare workers’ experiences and mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective and equitable healthcare workforce policy. Material and methods. Romanian physicians working in Germany during the COVID-19 pandemic served as an empirical case study. We applied a qualitative explorative approach; interviews (n=21) were collected from mid of September to early November 2022 and content analysis was performed. Results and discussion. Migrant physicians showed strong resilience during the COVID-19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well-integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Health policy must establish systematic monitoring of the migrant healthcare workforce including actor-centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence-based circular migration policy.

Background. Discharge against medical advice (DAMA) is used in healthcare facilities in a situation where patients refuse care or decide to leave the hospital before the treating physician recommends discharge. Previous studies have found DAMA to be prevalent among patients with various chronic conditions. The study had four objectives. The study aimed to investigate: 1) the prevalence of DAMA during COVID-19 (2020-2021) among Jordanian patients with chronic diseases, 2) the association between DAMA and sociodemographic and clinical characteristics of patients with chronic diseases, 3) the predictors of DAMA, and 4) the reasons behind DAMA at the patient, hospital, and environmental levels. Methods. A descriptive cross-sectional correlational design was used in the study. A convenience sampling approach was used to collect data from 1576 patients with chronic diseases from 3 private hospitals. Results. The study found that the prevalence rate of DAMA was 33.3%. There was a significant association between the sociodemographic and clinical characteristics of patients with chronic diseases and DAMA. Health insurance found to be the strongest predictor of DAMA. Finally, the study found that patient, hospital, and environmental- related factors had a low impact on DAMA. Conclusions: DAMA is prevalent among patients with chronic diseases in Jordan during COVID-19 pandemic. The current study’s findings can serve as an empirical basis for planning and implementing DAMA prevention programs and/or establishing or revising policies for the target population.

This article is a rejoinder to the rebuttal letter authored by Jair Bolsonaro’s former Minister of Health and Secretary of Primary Care to our initial article, “From Bolsonaro to Lula: The opportunity to rebuild universal healthcare in Brazil during the government transition,” published in the International Journal of Health Planning and Management. We aim to refute the claims that we consider unsubstantiated and disconnected from reality, while reiterating the risks posed by authoritarian and antidemocratic far-right governments, such as Bolsonarism in Brazil, to the sustainability and resilience of universal health systems. This political threat is gaining momentum across several countries worldwide, thereby endangering the Democratic Rule of Law, institutions, and social policies. Furthermore, we emphasize the significant actions implemented during the first 100 days of President Lula’s government, which align with the priorities established during the governmental transition process and strengthen the prospects of reconstructing and fortifying the Brazilian universal health system.