Stakeholders Perspectives on the Success Drivers in Ghana's National Health Insurance Scheme - Identifying Policy Translation Issues.

BACKGROUND: Ghana's National Health Insurance Scheme (NHIS), established by an Act of Parliament (Act 650), in 2003 and since replaced by Act 852 of 2012 remains, in African terms, unprecedented in terms of growth and coverage. As a result, the scheme has received praise for its associated legal reforms, clinical audit mechanisms and for serving as a hub for knowledge sharing and learning within the context of South-South cooperation. The scheme continues to shape national health insurance thinking in Africa. While the success, especially in coverage and financial access has been highlighted by many authors, insufficient attention has been paid to critical and context-specific factors. This paper seeks to fill that gap. METHODS: Based on an empirical qualitative case study of stakeholders' views on challenges and success factors in four mutual schemes (district offices) located in two regions of Ghana, the study uses the concept of policy translation to assess whether the Ghana scheme could provide useful lessons to other African and developing countries in their quest to implement social/NHISs. RESULTS: In the study, interviewees referred to both 'hard and soft' elements as driving the "success" of the Ghana scheme. The main 'hard elements' include bureaucratic and legal enforcement capacities; IT; financing; governance, administration and management; regulating membership of the scheme; and service provision and coverage capabilities. The 'soft' elements identified relate to: the background/context of the health insurance scheme; innovative ways of funding the NHIS, the hybrid nature of the Ghana scheme; political will, commitment by government, stakeholders and public cooperation; social structure of Ghana (solidarity); and ownership and participation. CONCLUSION: Other developing countries can expect to translate rather than re-assemble a national health insurance programme in an incomplete and highly modified form over a period of years, amounting to a process best conceived as germination as opposed to emulation. The Ghana experience illustrates that in adopting health financing systems that function well, countries need to customise systems (policy customisation) to suit their socio-economic, political and administrative settings. Home-grown health financing systems that resonate with social values will also need to be found in the process of translation.

Differences in pandemic influenza vaccination policies for pregnant women in Europe.

BACKGROUND: An important component of the policy to deal with the H1N1 pandemic in 2009 was to develop and implement vaccination. Since pregnant women were found to be at particular risk of severe morbidity and mortality, the World Health Organization and the European Centers for Disease Control advised vaccinating pregnant women, regardless of trimester of pregnancy. This study reports a survey of vaccination policies for pregnant women in European countries. METHODS: Questionnaires were sent to European competent authorities of 27 countries via the European Medicines Agency and to leaders of registries of European Surveillance of Congenital Anomalies in 21 countries. RESULTS: Replies were received for 24 out of 32 European countries of which 20 had an official pandemic vaccination policy. These 20 countries all had a policy targeting pregnant women. For two of the four countries without official pandemic vaccination policies, some vaccination of pregnant women took place. In 12 out of 20 countries the policy was to vaccinate only second and third trimester pregnant women and in 8 out of 20 countries the policy was to vaccinate pregnant women regardless of trimester of pregnancy. Seven different vaccines were used for pregnant women, of which four contained adjuvants. Few countries had mechanisms to monitor the number of vaccinations given specifically to pregnant women over time. Vaccination uptake varied. CONCLUSIONS: Differences in pandemic vaccination policy and practice might relate to variation in perception of vaccine efficacy and safety, operational issues related to vaccine manufacturing and procurement, and vaccination campaign systems. Increased monitoring of pandemic influenza vaccine coverage of pregnant women is recommended to enable evaluation of the vaccine safety in pregnancy and pandemic vaccination campaign effectiveness.

Use of card sort methodology in the testing of a clinical leadership competencies model.

The purpose of this paper is to examine the utility of a qualitative 'card sort' research tool - when it is merged with traditional quantitative data gathering methods - to add to our understanding about the nature of competency-based approaches to leadership studies. The study demonstrates how a qualitative technique (card sort) was used for the task of testing a clinical leadership competencies model. All the steps in the card sort methodology are described through its application to the research problem. The paper concludes that card sort has considerable use in adding to the validity of research into the competency approach to leadership. The study reports only one single case. Therefore, the technique must be repeated to secure its validation as a testing technique. The card sort method is proven to be a viable tool to ascertain the individual subjects perceptions regarding competencies. The methodology is described in sufficient detail so as to enable its replication and application by professionals and academic researchers alike. Both groups will find this methodology useful and interesting. The paper seeks to improve upon existing methods for studying leadership competencies. By addressing the limitations of different methods, and also by merging different independent approaches, this project provides an innovative integrated knowledge that can be of significant value.

Leadership competencies in the context of health services.

OBJECTIVES: In a rapidly changing health-care environment, clinicians are increasingly called upon to assume complex leadership responsibilities. The research was undertaken to develop an understanding of the limits to the conceptual and methodological basis of leadership competency modelling in health services context. METHODS: Data were collected from all of the clinicians in a Psychiatric Hospital, Bahrain using a researcher-developed questionnaire. Data were gathered to critically assess the validity of the competency-based approach to leadership on the basis of subjects' capacity to discriminate in terms of importance and accomplishment between the items featured in a research tool containing a comprehensive list of 124 leadership competencies. RESULTS: The results of the analyses indicate a weak identification with the competencies in the sense of revealing low levels of discriminatory sophistication on the part of subjects. CONCLUSION: The study design was limited to participants working in single hospital; therefore, the conclusions made cannot yet be regarded categorically as generalizable. Leadership selection, development and education activities may not achieve their ultimate outcomes due to the subject identification problem associated with the competence approach. It might be necessary to reconsider the efficiency of human resource activities that rely solely on the competency approach. The conceptual basis of leadership competence in health services has been previously neglected. This research casts doubt on competency approaches to leadership if based on subject identification with pre-defined items.

Private medical practitioners and managed care in Malaysia: a survey of knowledge and attitudes held by Federal Territory based doctors.

This paper considers the subject of managed care in Malaysia, providing a questionnaire-based analysis of the position adopted by private medical practitioners. Managed care is now seen as the dominant health care system in the United States, with many other countries around the world including Malaysia beginning to selectively use component parts to tackle particular health care problems. In this survey it was found that three out of four respondents have concerns regarding the implementation of managed care. The survey was used to identify and categorise these concerns. At the same time, three out of four respondents held the opinion that principles of managed care were already a reality or would be in the next 5 years. This group expressed an eagerness to be trained in managed care principles and be given the opportunity to be part of managed care organisations. It is argued that clinicians' knowledge and interest perceptions are an important influence on the implementation of managed care based systems. The survey-based evidence presented in this article is intended as a measure of current understandings and beliefs, in relation to clinical micro-management process associated with managed care.