Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change.
We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before ...
This paper summarizes an assessment of the state of health care integration in Estonia and its driving forces. In the absence of a widely accepted definition, this study defines health care integration as:
i) the delivery of care in the appropriate care setting and
ii) coordination and continuity of care across care settings.
The study focuses on integration issues related to the prevention and treatment of chronic diseases, with particular attention to the role and functioning of primary care and equity issues. The findings of this analysis therefore do not provide a comprehensive assessment of quality within specific care settings (i.e., primary care, acute inpatient care, etc.), nor of overall health system performance. Yet, they constitute one of several inputs that may be relevant for future policy changes.
These study findings are based on a quantitative analysis of health insurance claims data plus stakeholder interviews and focus group discussions ...
Aotearoa/New Zealand (Aotearoa/NZ) and the United States (U.S.) suffer inequities in health outcomes by race/ethnicity and socioeconomic status. This paper compares both countries’ approaches to health equity to inform policy efforts. They developed a conceptual model that highlights how government and private policies influence health equity by impacting the healthcare system (access to care, structure and quality of care, payment of care), and integration of healthcare system with social services
Devolution changes the locus of power within a country from central to sub-national levels. In 2013, Kenya devolved health and other services from central government to 47 new sub-national governments (known as counties). This transition seeks to strengthen democracy and accountability, increase community participation, improve efficiency and reduce inequities. With changing responsibilities and power following devolution reforms, comes the need for priority-setting at the new county level. Priority-setting arises as a consequence of the needs and demand for healthcare resources exceeding the resources available, resulting in the need for some means of choosing between competing demands
The aim of this study was to evaluate access to healthcare from an equity perspective on the way toward Universal Health Coverage in Turkey. In order to The country representative data from 2006 to 2013 Turkey Income and Living Conditions Surveys were analyzed. Private household residents aged fifteen and older were asked for self-reported unmet need for medical care in the past twelve months.
Community health workers (CHWs) are frequently put forward as a remedy for lack of health system capacity, including challenges associated with health service coverage and with low community engagement in the health system, and expected to enhance or embody health system accountability. During a ‘think in’, held in June of 2017, a diverse group of practitioners and researchers discussed the topic of CHWs and their possible roles in a larger “accountability ecosystem.” While CHWs are often conceptualized as cogs in a mechanistic health delivery system, at the end of the day, CHWs are people embedded in families, communities, and the health system. CHWs’ social position and professional role influence how they are treated and trusted by the health sector and by community members, as well as when, where, and how they can exercise agency and promote accountability. To that end, this study put forward several propositions for further conceptual development ...
Significant attention has been directed toward addressing health inequities at the population health and systems levels, yet little progress has been made in identifying approaches to reduce health inequities through clinical care, particularly in a primary health care context. Although the provision of equity?oriented health care (EOHC) is widely assumed to lead to improvements in patients’ health outcomes, little empirical evidence supports this claim. To remedy this, this study tested whether more EOHC predicts more positive patient health outcomes and identified selected mediators of this relationship
Health is driven by the conditions in which people live and work. Immigrant populations face many challenges and disruptions in living conditions during their settlement process, including the loss of regular health services. Establishing a direct relationship with a family physician is an important aspect of the settlement process for immigrant populations
In 2003, Ontario introduced a patient enrolment system as part of health care reforms, aimed at enhancing primary health care services, but it is unclear whether immigrants have benefited from this health care reform. Therefore, this article studied whether this reform changed the extent of immigrants’ enrolment in primary care services in Ontario between 2003 and 2012.
Nepal has made remarkable efforts towards social health protection over the past several years. In 2016, the Government of Nepal introduced a National Health Insurance Program (NHIP) with an aim to ensure equitable and universal access to healthcare by all Nepalese citizens. Following the first year of operation, the scheme has covered 5 percent of its target population. There are wider concerns regarding the capacity of NHIP to achieve adequate population coverage and remain viable. In this context, this study aimed to identify the factors associated with enrolment of households in the NHIP.
Brazil is a populous high/middle-income country, characterized by deep economic and social inequalities. Like most other Latin American nations, Brazil constructed a health system that included, on the one hand, public health programs and, on the other, social insurance healthcare for those working in the formal sector. This study analyzes the political struggles surrounding the implementation of a universal health system from the mid-1980s to the present, and their effects on selected health indicators, focusing on the relevant international and national contexts, political agendas, government orientations and actors.
China piloted a publicly funded Long-term Care Nursing Insurance (LTCNI) with an aim to improve access to long-term care (LTC) for older people in China in 2012. Existing studies showed that the scheme has been successful in meeting some goals, but little is known on how the availability, price and quality of the local care providers affect access to care. This article founded considerable discrepancies in terms of access to services among the LTCNI beneficiaries. The poor are more likely to choose nursing home care with low costs albeit these services may be of poor quality. The demand for home-based services is high, but these services are not distributed according to population needs and are not available in some districts with high concentration of older people.
Dioselina is a 54-year-old divorcée who has no children and lives alone in a large city. She has been unemployed for a year and just started receiving welfare six months ago. As for her health, she has long-term obesity, chronic obstructive pulmonary disease, and diabetes. In recent months, she began to develop foot ulcers because her blood sugar was not being monitored properly, which is attributable in part to difficulty accessing healthcare services and getting medications and lab tests. If she does not receive rapid treatment and more specialized care for the ulcers, they could worsen and require hospitalization.
A growing number of people who seek health care have stories like Dioselina’s. Healthcare systems in Latin America and the Caribbean face significant health challenges affecting all age groups, which cause premature death and take a heavy social and economic toll.
Taking cues from the Declaration of Astana, nations ...
Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC) are the most promising solution for health systems to satisfy the health needs of the population and to address access, efficiency, quality and equity challenges faced by health systems of the world. PHCs essential attributes (people and family centred care, comprehensiveness, continuity, longitudinality) position this approach as one of the key strategies for countries to meet the aspiration of achieving universal health coverage.
Creating care networks has been a common thread running through Latin America and the Caribbean health policy agendas. In terms of actually putting the IHSDN model in action, there is a wide range of interpretations and experiences, with designs, scales, organizational methods, and maturity levels that vary within and between countries.
Health Network in Action, a publication from the Inter-American Development Bank, shares evidence of the progress made in forming and launching IHSDN in Latin ...
The 24th IUHPE World Conference on Health Promotion will provide a unique opportunity to take stock of strategies and actions that can be taken to align policies with health, well-being and equity objectives (e.g. Health in All Policies), and to reinvigorate all sectors of society and all regions of the world concerned with supporting health and well-being. This will be an opportunity for researchers, health practitioners and decision makers and other sectors critical to population health to exchange knowledge and share experiences on progress and challenges in better aligning policies for the promotion of population health equity and well-being.
The theme for the 24th IUHPE world conference in 2022 is Promoting policies for health, well-being and equity.
The framework for countries to achieve an integrated continuum of long-term care identifies key aspects necessary to achieve an integrated continuum of long-term care service provision and to facilitate the integration of long-term services within existing health and social care systems.
The framework will guide countries in assessing system-level components to implement sustainable and equitable long-term care actions. By applying this framework, countries can begin to develop and shape their long-term care systems as part of their universal health coverage programmes and promote investment in long-term care and the health workforce, including carers.
Regional Framework on the Future of Primary Health Care (PHC) was adopted by Member States at the seventy-third session of the Regional Committee for the Western Pacific in 2022. The framework outlines five key attributes of PHC including people and community-centered, continuous, high-quality and equitable, integrated, and innovative. It highlights five strategic areas of actions needed which pivot around models of service delivery, individual and community empowerment, workforce and provider base, financing, enabling and supportive environment to enable this transformation. It calls on critical health system transformation for the future to achieve Universal Health Coverage and Sustainable Development Goals.