Advantages and disadvantages of channeling Gavi's health system strengthening funds through health partners, a case study.

INTRODUCTION: Following a period of interruption of Gavi's funds for health system strengthening (HSS) in Cameroon and Chad, the two countries reprogramed their HSS grants. To implement the reprogrammed HSS, Chad committed to better management of the funds. Cameroon chose to channel the HSS funds through one of the health partners. This process is new to Gavi's HSS grants, and little is known about its effectiveness or characteristics. We investigated the advantages and disadvantages of this process to inform the global health community about the added value of this solution. MATERIALS AND METHODS: We retrospectively evaluated Gavi's HSS programs in Cameroon and Chad through a mixed methodology. To explore the pros and cons of channeling the funds through a health partner, we triangulated data from document review, key informant interviews (KIIs), field visits, and financial analysis of HSS expenditures in both countries. RESULTS: Data triangulated from multiple sources showed that channeling HSS funds thorugh a health partner in Cameroon allowed compliance with budget, the development of a stronger accounting system at the Ministry of Health (MOH), and a rigid monitoring system. However, this mechanism delayed implementation by six months, accounted for 15% of the total cost, and created a tension around roles between MOH and the health partner. Achievement of program's output indicators was average. In Chad, expenditures complied with budget as well. However, implementation was delayed longer causing a second reprogramming of the funds. While the program had fewer output indicators in Chad, these were minimally achieved. DISCUSSION: To our knowledge, this is the first study of channeling Gavi HSS funds through a health partner. This new process contributed to a higher level of implementation, stronger monitoring, and strengthened accountability in Cameroon. Recipient countries of Gavi HSS grants who lack the financial management capacity can benefit from a similar process.

The health economic burden that acute and chronic wounds impose on an average clinical commissioning group/health board in the UK.

OBJECTIVE: To estimate the patterns of care and related resource use attributable to managing acute and chronic wounds among a catchment population of a typical clinical commissioning group (CCG)/health board and corresponding National Health Service (NHS) costs in the UK. METHOD: This was a sub-analysis of a retrospective cohort analysis of the records of 2000 patients in The Health Improvement Network (THIN) database. Patients' characteristics, wound-related health outcomes and health-care resource use were quantified for an average CCG/health board with a catchment population of 250,000 adults ≥18 years of age, and the corresponding NHS cost of patient management was estimated at 2013/2014 prices. RESULTS: An average CCG/health board was estimated to be managing 11,200 wounds in 2012/2013. Of these, 40% were considered to be acute wounds, 48% chronic and 12% lacking any specific diagnosis. The prevalence of acute, chronic and unspecified wounds was estimated to be growing at the rate of 9%, 12% and 13% per annum respectively. Our analysis indicated that the current rate of wound healing must increase by an average of at least 1% per annum across all wound types in order to slow down the increasing prevalence. Otherwise, an average CCG/health board is predicted to manage ~23,200 wounds per annum by 2019/2020 and is predicted to spend a discounted (the process of determining the present value of a payment that is to be received in the future) £50 million on managing these wounds and associated comorbidities. CONCLUSION: Real-world evidence highlights the substantial burden that acute and chronic wounds impose on an average CCG/health board. Strategies are required to improve the accuracy of diagnosis and healing rates.

Policy dialogues - the "bolts and joints" of policy-making: experiences from Cabo Verde, Chad and Mali.

BACKGROUND: Policy processes that yield good outcomes are inherently complex, requiring interactions of stakeholders in problem identification, generation of political will and selection of practical solutions. To make policy processes rational, policy dialogues are increasingly being used as a policy-making tool. Despite their increasing use for policy-making in Africa, evidence is limited on how they have evolved and are being used on the continent or in low and middle income countries elsewhere. METHODS: This was an exploratory study using qualitative methods. It utilised data related to policy dialogues for three specific policies and strategies to understand the interplay between policy dialogue and policy-making in Cabo Verde, Chad and Mali. The specific methods used to gather data were key informant interviews and document review. Data were analysed inductively and deductively using thematic content analysis. RESULTS: Participation in the policy dialogues was inclusive, and in some instances bottom-up participatory approaches were used. The respondents felt that the execution of the policy dialogues had been seamless, and the few divergent views expressed often were resolved in a unanimous manner. The policies and strategies developed were seen by all stakeholders as relating to priority issues. Other specific process factors that contributed to the success of the dialogues included the use of innovative approaches, good facilitation, availability of resources for the dialogues, good communication, and consideration of the different opinions. Among the barriers were contextual issues, delays in decision-making and conflicting coordination roles and mandates. CONCLUSIONS: Policy dialogues have proved to be an effective tool in health sector management and could be a crucial component of the governance dynamics of the sector. The policy dialogue process needs to be institutionalised for continuity and maintenance of institutional intelligence. Other essential influencing factors include building capacity for coordination and facilitation of policy dialogues, provision of sustainable financing for execution of the dialogues, use of inclusive and bottom-up approaches, and timely provision of reliable evidence. Ensuring continued participation of all the actors necessitates innovation to allow dialogue outside the formal frameworks and spaces that should feed into the formal dialogue processes.

Engaging basic scientists in translational research: identifying opportunities, overcoming obstacles.

This report is based on the Federation of American Societies for Experimental Biology's symposium, "Engaging basic Scientists in Translational Research: Identifying Opportunities, Overcoming Obstacles," held in Chevy Chase, MD, March 24-25, 2011. Meeting participants examined the benefits of engaging basic scientists in translational research, the challenges to their participation in translational research, and the roles that research institutions, funding organizations, professional societies, and scientific publishers can play to address these challenges.

Cancer guideline development in Europe: a survey among ECCO members.

A survey was conducted among European Cancer Organisations by the European CanCer Organisation (ECCO) to evaluate initiatives on cancer guideline development. An electronic questionnaire based on the 'Appraisal of Guidelines Research and Evaluation' (AGREE) instrument was sent to different ECCO members and other Scientific European Organisations involved in cancer care. Between April 2010 and July 2010, 30 European Cancer Organisations (ECOs) were contacted and 21 responded to the questionnaire. Of these, 13 were involved in the production of clinical practice guidelines. The majority of the cancer guidelines were treatment or disease-management related (84.6%). The objectives were appropriate clinical care (76.9%), cost containment (7.7%) or both (23.1%). Almost all organisations developed guidelines for their members but more than half were also aimed at policy makers (53.9%). In 69% of cases, the guidelines were developed according to specific instructions by searches in an electronic data base while in 46.2% there was a manual evaluation of the original articles. Disciplines almost always involved in guideline development groups were the medical and nursing specialities, while in some groups, communication specialists were always involved. Patients, as key stakeholders of the guidelines were involved by eight organisations in their development. The median costs for the development of a cancer guideline were between 25000 and 50,000 euro. This survey shows that many European cancer organisations are producing cancer guidelines. Since their development is both costly and time consuming, a coordinated approach should be encouraged.

La planificación al servicio de proyectos de obra pública / The planning to the service of public work projects

Los fondos públicos destinados a la construcción de obra pública deben ser manejados prudentemente por los funcionados encargados del estado costarricense, con el fin de transformarlos en infraestructra social y económica al servicio del país. Para ello, es necearia una verdadera planificación integral que garantice la funcionalidad de los servicios a brindar, y que considere un sano proceso de factibilidad, diseño y construcción, carente de situaciones que no sean realmente justificables e imprevisibles

Diagnóstico de Salud del Valle de Amateca / Diagnostic of health the Amateca Valley

En este documento tiene el primordial objetivo de medir y analizar la situación de salud según condiciones de vida del Valle de Amarateca y producir información a nivel de los hogares y las personas para la elaboración del Plan Estratégico en Salud que ha de ejecutarse en Amarateca en los próximos tres años. En forma secundaria, se propone generar una base de información para el estudio de las relaciones entre los diferentes aspectos de la salud del Valle

Diagnóstico de Salud del Valle de Amateca / Diagnostic of health the Amateca Valley

En este documento tiene el primordial objetivo de medir y analizar la situación de salud según condiciones de vida del Valle de Amarateca y producir información a nivel de los hogares y las personas para la elaboración del Plan Estratégico en Salud que ha de ejecutarse en Amarateca en los próximos tres años. En forma secundaria, se propone generar una base de información para el estudio de las relaciones entre los diferentes aspectos de la salud del Valle

Mind the gap: transitions in nursing education and care delivery systems.

The relationship between nursing education and nursing practice has been the topic of discussion throughout the history of the profession. The rate of change at the turn of this new century is unfolding more rapidly than ever. In this article the London underground is used as a metaphor to examine transition issues related to nursing education and care delivery. Commuters entering the underground are met with signs and announcements warning travelers to "mind the gap" (the gap is the opening between the train and the platform). The purpose of the underground is to safely transport people from one destination to another. One wrong step and travelers can find themselves in a potentially fatal situation.

[Berlin-Brandenburg-Saxony Rehabilitation Research Group]. / Reha-Forschungsverbund Berlin-Brandenburg-Sachsen (BBS).

The principal subject of the Rehabilitation Research Network of Berlin, Brandenburg and Saxony (BBS) is "the theoretical and practical bases of the organisation and economics of rehabilitation". What is involved is a nation-wide analysis of the rehabilitation system, i.e. obtaining empirical information on the question as to what organisational forms are currently used to carry out rehabilitation and what results are achieved. This empirical stocktaking also includes economic aspects as far as possible. This study is to serve as a basis for developing, testing and implementing steps to rationalise steering mechanisms in the rehabilitation system. The first aspect to be studied is "national steering problems in institutionalised forms of rehabilitation". The focus is on projects on information management and performance and quality management in rehabilitation sciences as well as on the actual work of a number of bodies paying for rehabilitation (Bundesversicherungsanstalt für Angestellte, Landesversicherungsanstalten) as well as rehabilitation facilities (clinics etc.). The two other focuses of the study will examine "rehabilitative adjustment to remedies and technical aids/prostheses" and problems facing "family members in the context of rehabilitation". In studying these two areas, we are particularly interested in examining the interaction between institutionalised aspect of rehabilitation and informal factors both inside and outside the system. The BBS approach is supported by close co-operation with the regional pension insurance institutes (BfA, LVAs) with regard to both the data model and steps being taken. The principal instrument of co-operation is the "Gesellschaft für Rehabilitationswissenschaften e.V." (Society for Rehabilitation Sciences). In Berlin the BBS co-operates with Free University, the Technical University and the Robert Koch Institute and in Saxony with the universities in Dresden and Leipzig. Responsibility for scientific questions in the BBS lies with the Institute for Rehabilitation Sciences of Berlin's Humboldt University.

[Lower Saxony/Bremen Scientific Rehabilitation Research Group]. / Rehabilitationswissenschaftlicher Forschungsverbund Niedersachsen/Bremen (RFNB).

The Network for Rehabilitation Research Niedersachsen/Bremen (RFNB) combines the competencies of different disciplines and regional agents/institutions in the field of rehabilitation, hence creating a network of interdisciplinary rehabilitation research to support the further development of research methodology, to initiate studies whose results can be fed back to practice and be used for education and further qualification. The current research projects of the RFNB are focussing on outcome parameters such as prediction, optimization of interventions and costs in successful rehabilitation.

The National Commission on Nursing Implementation Project.

On May 1, 1991, the National Commission on Nursing Implementation Project officially concluded. Its legacy is one of interdisciplinary collaboration and continuing work to redesign nursing education, practice, and research systems.

O processo de distritalizaçäo da atençäo à saúde no Estado da Bahia / Process of district formation for health care in the state of Bahia

Este trabalho trata do processo de Distritalizaçäo da atençäo à saúde no Estado da Bahia durante o período compreendido entre o início de 87 a meados de 89. Tem como eixo central a implementaçäo das propostas de reorientaçäo da gestäo e da organizaçäo dos serviços de saúde, com base nos princípios da Distritalizaçäo. Trata-se, portanto, de um "estudo de caso" no plano político institucional do setor saúde, especialmente a nível central da Secretaria de Saúde do Estado da Bahia, instituiçäo responsável pela inplantaçäo do SUDS - Sistema Unificado e Descentralizado de Saúde - contexto em que se viabilizou a proposta de Distribuiçäo. As informaçöes trabalhadas foram obtidas a partir da revisäo documental, de entrevistas a dirigentes e técnicas, bem como da observaçäo participante realizada pelo autor no período de 87/88. Os resultados, sistematizados segundo os distintos momentos do processo, de acordo com as variaçöes do quadro político-institucional no período em estudo, säo discutidos tomando-se por referência: a) os antecedentes do processo, tanto no plano Nacional (81-87) marcado pela crise e pela reorientaçäo das políticas de saúde, quanto no plano estadual, com especificidades decorrentes da situaçäo econômica, política e social mais geral e também da configuraçäo da situaçäo de saúde e do Sistema de Saúde, b) o significado estratégio da Distritalizaçäo em relaçäo ao conjunto das medidas de reorientaçäo do Sistema de Saúde contidas no SUDS, tendo em vista a construçäo do sistema único de Saúde, do qual o Distrito Sanitário constitui a base operacional e adminsitrativa. Buscando superar essa visäo "restrita" da Distritalizaçäo realizou-se uma revisäo do processo de definiçäo conceitual no âmbito da América latina, ou seja a revisäo da noçäo de SILOS - Sistemas Locais de Saúde - o que serve de referência para a discussäo mais ampla do Distrito Sanitário enquanto espaço de luta, tática de transformaçäo das práticas de saúde que adquire significado estratégico no processo de Reforma Sanitária Brasileira

Implementing public competition in Swedish county councils: a case study.

Earlier presentations of the theoretical framework for public competition (Saltman and von Otter, 1987) and of the comparative advantage of public competition as against a mixed market model (Saltman and von Otter, 1989a) suggest the importance of concrete arrangements to introduce a public competition approach at the operating level. This paper explores the administrative infra-structure required to implement public competition within the Swedish county-council-based health care system.