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The union cabinet approved the National Health Policy (NHP) 2017 on 15 March 2017. After its initial draft stage, seeking opinions from different stakeholders for nearly 34 months, the NHP 2017 came to the public domain with its final version. The main objective of this version of the NHP is to implement the proposed National Health Assurance Plan, which has been one of the agendas of the National Democratic Alliance (NDA) government for the healthcare of the people. The main objective of this article is to critically appraise and discuss the scopes and limitations in accomplishing the targets set in the policy document. A critique of the targets has also been discussed, considering the historical evidence and experiences of achieving the same. In the end, suggestions and recommendations have also been suggested for improving the health system regarding NHP 2017. The article critically analyses NHP 2017 based on secondary and grey literature. Evidence from secondary literature has been juxtaposed to compare and contrast the difficulty in implementing the policy. Literature is obtained from electronically accessible search and indexing portals, such as Google, Google Scholar, Web of Sciences, Embase, PubMed, and PubMed Central by using the keywords like health policy, impact of health policy, human resources in health, health care information technology, hospitals, pharmaceuticals and medical devices, health insurance and public health. Considering the implementation challenges of the previous two NHPs, the current NHP 2017 should be relevant to the grassroots level nuances and should address not only the healthcare needs but also the human development indicators. [ABSTRACT FROM AUTHOR]

Abstract Background Non-Communicable diseases (NCD) are the main contributors to mortality and burden of disease. There is no infrastructure in Europe that could provide health information (HI) on Public Health monitoring and Health Systems Performance (HSP) for research and evidence-informed decision-making. Moreover, there was no EU and European Economic Area Member States (EU/EEA MSs) general consensus, on developing this initiative and guarantee its sustainability. The aim of this study is to analyze the integration of technical and political views made by the Joint Action on Health Information (InfAct; Information for Action) and the results obtained from those activities, in terms of advice and national and institutional support to develop an integrated and sustainable European Distributed Infrastructure on Population Health (DIPoH) for research and evidence-informed policy-making. Methods InfAct established two main boards, the Technical Dialogues (TDs) and the Assembly of Members (AoM), to provide a platform for discussion with EU/EEA MSs to establish a sustainable infrastructure for HI: 1) The TDs were composed by national technical experts (NTE) with the aim to discuss and provide feedback about scientific aspects, feasibility and EU-added value of the infrastructure proposed by InfAct. 2) The AoM gathered country representatives from Ministries of Health and Research at the highest political level, with the aim of providing policy-oriented advice for the future political acceptance, support, implementation, and development of InfAct’s outcomes including DIPoH. The documentation provided for the meetings consisted in Fact-Sheets, where the main results, new methods and proposals were clearly exposed for discussion and assessment; altogether with more extended information of the DIPoH. The documentation was provided to national representatives within one more before each TD and AoM meeting. The Agenda and methodological approaches for each TD and AoM meeting consisted in the presentations of the InfAct outcomes extending the information provided in the Fact-Sheets; followed by a non-structured interaction, exchange of information, discussion and suggestions by the MSs representatives. The outcomes of the non-structured discussions were collected in Minutes of the TD and AoM meetings, and the final version was obtained with the consensus of all participants. Additionally, structured letters of political support were provided to the AoM representatives, for them to consider providing their MS written support for DIPoH. Results NTE, within the TDs, considered that DIPoH was useful for technical mutual learning and cooperation among and within countries; although they considered that the technical feasibility to uptake InfAct deliverables at the national and EU level was complex. The AoM focused on political support, resources, and expected MSs returns. The AoM representatives agreed in the interest of setting up an integrated and sustainable HI infrastructure and they considered DIPoH to be well-articulated and defined; although, some of them, expressed some barriers for providing DIPoH political support. The AoM representatives stated that the AoM is the most suitable way to inform EU MSs/ACs about future advances of DIPoH. Both boards provided valuable feedback to develop this infrastructure. Eleven countries and sixteen institutions supported the proposal, either by letters of political support or by signing the Memorandum of Understandings (MoU) and three countries, additionally, provided expression of financial commitment, for DIPoH to be added to the ESFRI 2021 roadmap. Conclusions TDs and AoM were key forums to develop, advise, advocate and provide support for a sustainable European research infrastructure for Population Health.

Abstract Background System dynamics (SD) modelling can inform policy decisions under Thailand's Universal Health Coverage. We report on this thinking approach to Thailand's strategic health workforce planning for the next 20 years (2018–2037). Methods A series of group model building (GMB) sessions involving 110 participants from multi-sectors of Thailand's health systems was conducted in 2017 and 2018. We facilitated policymakers, administrators, practitioners and other stakeholders to co-create a causal loop diagram (CLD) representing a shared understanding of why the health workforce's demands and supplies in Thailand were mismatched. A stock and flow diagram (SFD) was also co-created for testing the consequences of policy options by simulation modelling. Results The simulation modelling found hospital utilisation created a vicious cycle of constantly increasing demands for hospital care and a constant shortage of healthcare providers. Moreover, hospital care was not designed for effectively dealing with the future demands of ageing populations and prevalent chronic illness. Hence, shifting emphasis to professions that can provide primary care, intermediate care, long-term care, palliative care, and end-of-life care can be more effective. Conclusions Our SD modelling confirmed that shifting the care models to address the changing health demands can be a high-leverage policy of health workforce planning, although very difficult to implement in the short term. of health workforce planning, although very difficult to implement in the short term.

Background: Non-Communicable diseases (NCD) are the main contributors to mortality and burden of disease. There is no infrastructure in Europe that could provide health information (HI) on Public Health monitoring and Health Systems Performance (HSP) for research and evidence-informed decision-making. Moreover, there was no EU and European Economic Area Member States (EU/EEA MSs) general consensus, on developing this initiative and guarantee its sustainability. The aim of this study is to analyze the integration of technical and political views made by the Joint Action on Health Information (InfAct; Information for Action) and the results obtained from those activities, in terms of advice and national and institutional support to develop an integrated and sustainable European Distributed Infrastructure on Population Health (DIPoH) for research and evidence-informed policy-making.Methods: InfAct established two main boards, the Technical Dialogues (TDs) and the Assembly of Members (AoM), to provide a platform for discussion with EU/EEA MSs to establish a sustainable infrastructure for HI: 1) The TDs were composed by national technical experts (NTE) with the aim to discuss and provide feedback about scientific aspects, feasibility and EU-added value of the infrastructure proposed by InfAct. 2) The AoM gathered country representatives from Ministries of Health and Research at the highest political level, with the aim of providing policy-oriented advice for the future political acceptance, support, implementation, and development of InfAct's outcomes including DIPoH. The documentation provided for the meetings consisted in Fact-Sheets, where the main results, new methods and proposals were clearly exposed for discussion and assessment; altogether with more extended information of the DIPoH. The documentation was provided to national representatives within one more before each TD and AoM meeting. The Agenda and methodological approaches for each TD and AoM meeting consisted in the presentations of the InfAct outcomes extending the information provided in the Fact-Sheets; followed by a non-structured interaction, exchange of information, discussion and suggestions by the MSs representatives. The outcomes of the non-structured discussions were collected in Minutes of the TD and AoM meetings, and the final version was obtained with the consensus of all participants. Additionally, structured letters of political support were provided to the AoM representatives, for them to consider providing their MS written support for DIPoH.Results: NTE, within the TDs, considered that DIPoH was useful for technical mutual learning and cooperation among and within countries; although they considered that the technical feasibility to uptake InfAct deliverables at the national and EU level was complex. The AoM focused on political support, resources, and expected MSs returns. The AoM representatives agreed in the interest of setting up an integrated and sustainable HI infrastructure and they considered DIPoH to be well-articulated and defined; although, some of them, expressed some barriers for providing DIPoH political support. The AoM representatives stated that the AoM is the most suitable way to inform EU MSs/ACs about future advances of DIPoH. Both boards provided valuable feedback to develop this infrastructure. Eleven countries and sixteen institutions supported the proposal, either by letters of political support or by signing the Memorandum of Understandings (MoU) and three countries, additionally, provided expression of financial commitment, for DIPoH to be added to the ESFRI 2021 roadmap.Conclusions: TDs and AoM were key forums to develop, advise, advocate and provide support for a sustainable European research infrastructure for Population Health. [ABSTRACT FROM AUTHOR]

Introduction: The provision of health care services in Kenya was devolved from the national government to the counties in 2013. Evidence suggests that health system performance in Kenya remains poor. The main issue is poor leadership resulting in poor health system performance. However, most training in Kenya focuses on “leaders” (individual) development as opposed to “leadership” training (development of groups from an organization). The purpose of that study was to explore the impact of leadership training on health system performance in selected counties in Kenya.Methods: A quasi-experimental time-series design was employed. Pretest, posttest control-group design was utilized to find out whether the leadership development program positively contributed to the improvement of health system performance indicators compared with the non-trained managers. Questionnaires were administered to 31 trained health managers from the public, private for-profit, and private not-for-profit health institutions within the same counties.Results: The pretest and posttest means for all the six health system (HS) pillar indicators of the treatment group were higher than those of the control group. The regression method to estimate the DID structural model used to calculate the “fact” and “counterfactual” revealed that training had a positive impact on the intended outcome on the service delivery, information, leadership and governance, human resources, finance, and medical products with impact value ≥1 (57.2).Conclusion: The study findings support both hypotheses that trained health care management teams had a significant difference in the implementation status of priority projects and, hence, had a significant impact on health system performance indicators compared with non-trained managers.

Background: System dynamics (SD) modelling can inform policy decisions under Thailand's Universal Health Coverage. We report on this thinking approach to Thailand's strategic health workforce planning for the next 20 years (2018-2037).Methods: A series of group model building (GMB) sessions involving 110 participants from multi-sectors of Thailand's health systems was conducted in 2017 and 2018. We facilitated policymakers, administrators, practitioners and other stakeholders to co-create a causal loop diagram (CLD) representing a shared understanding of why the health workforce's demands and supplies in Thailand were mismatched. A stock and flow diagram (SFD) was also co-created for testing the consequences of policy options by simulation modelling.Results: The simulation modelling found hospital utilisation created a vicious cycle of constantly increasing demands for hospital care and a constant shortage of healthcare providers. Moreover, hospital care was not designed for effectively dealing with the future demands of ageing populations and prevalent chronic illness. Hence, shifting emphasis to professions that can provide primary care, intermediate care, long-term care, palliative care, and end-of-life care can be more effective.Conclusions: Our SD modelling confirmed that shifting the care models to address the changing health demands can be a high-leverage policy of health workforce planning, although very difficult to implement in the short term. of health workforce planning, although very difficult to implement in the short term. [ABSTRACT FROM AUTHOR]

Aims: Critical appraisal of secondary data made available by the OECD for the time frame 2000-2011. Methods: Comparison of trends and variation of amputations in people with diabetes across OECD countries. Generalized estimating equations to test the statistical significance of the annual change adjusting for major potential confounders. Results: A total of 26 OECD countries contributed to the OECD data collection for at least 1 year in the reference time frame, showing a decline in rates of over 40 %, from a mean of 13.2 (median 9.4, range 5.1-28.1) to 7.8 amputations per 100,000 in the general population (9.9, 1.0-18.4). The multivariate model showed an average decrease equal to −0.27 per 100,000 per year ( p = 0.015), adjusted by structural characteristics of health systems, showing lower amputation rates for health systems financed by public taxation (−4.55 per 100,000 compared to insurance based, p = 0.002) and non-ICD coding mechanisms (−7.04 per 100,000 compared to ICD-derived, p = 0.001). Twelve-year decrease was stronger among insurance-based financing systems (tax based: −0.16 per 100,000, p = 0.064; insurance based: −0.36 per 100,000; p = 0.046). Conclusions: In OECD countries, amputation rates in diabetes continuously decreased over 12 years. Still, in 2011, one amputation every 7 min could be directly attributed to diabetes. Although interesting, these results should be taken with extreme caution, until common definitions are improved and data quality issues, e.g., a different ability in capturing diabetes diagnoses, are fully resolved. [ABSTRACT FROM AUTHOR]

Background: Efficacious interventions to prevent mother-to-child HIV transmission (PMTCT) have not translated well into effective programs. Previous studies of systems engineering applications to PMTCT lacked comparison groups or randomization. Methods: Thirty-six health facilities in Côte d'Ivoire, Kenya, and Mozambique were randomized to usual care or a systems engineering intervention, stratified by country and volume. The intervention guided facility staff to iteratively identify and then rectify barriers to PMTCT implementation. Registry data quantified coverage of HIV testing during first antenatal care visit, antiretrovirals (ARVs) for HIV-positive pregnant women, and screening HIV-exposed infants (HEI) for HIV by 6-8 weeks. We compared the change between baseline (January 2013-January 2014) and postintervention (January 2015-March 2015) periods using t-tests. All analyses were intent-to-treat. Results: ARV coverage increased 3-fold [+13.3% points (95% CI: 0.5 to 26.0) in intervention vs. +4.1 (212.6 to 20.7) in control facilities] and HEI screening increased 17-fold [+11.6 (22.6 to 25.7) in intervention vs. +0.7 (212.9 to 14.4) in control facilities]. In prespecified subgroup analyses, ARV coverage increased significantly in Kenya [+20.9 (-3.1 to 44.9) in intervention vs. -21.2 (-52.7 to 10.4) in controls; P = 0.02]. HEI screening increased significantly in Mozambique [+23.1 (10.3 to 35.8) in intervention vs. +3.7 (213.1 to 20.6) in controls; P = 0.04]. HIV testing did not differ significantly between arms. Conclusions: In this first randomized trial of systems engineering to improve PMTCT, we saw substantially larger improvements in ARV coverage and HEI screening in intervention facilities compared with controls, which were significant in prespecified subgroups. Systems engineering could strengthen PMTCT service delivery and protect infants from HIV. [ABSTRACT FROM AUTHOR]

Telehealth pilot projects and trial implementations are numerous but are often not fully evaluated, preventing construction of a sound evidence base and so limiting their adoption. We describe the need for a generic Telehealth project evaluation framework, within which evaluation is undertaken based on existing health systems performance indicators, using appropriately chosen measures. We provide two case studies explaining how this approach could be applied, in Australian and Canadian settings. It is argued that this framework type of approach to evaluation offers better potential for incorporating the learnings from resultant evaluations into business decisions by "learning organisations", through alignment with organisational performance considerations. [ABSTRACT FROM AUTHOR]

Background: Previous studies show that health systems governance influences health system performance and health outcomes. However, there are few examples of how to implement and monitor good governing practices in fragile and conflict affected environments. Good governance has the potential to make the health system people-centered. More research is needed on implementing a people-centered governance approach in these environments. Case description: We piloted an intervention that placed a people-centred health systems governance approach in the hands of multi-stakeholder committees that govern provincial and district health systems. We report the results of this intervention from three provinces and eleven districts in Afghanistan over a six month period. This mixed-methods exploratory case study uses analysis of governance self-assessment scores, health management information system data on health system performance, and focus group discussions. The outcomes of interest are governance scores and health system performance indicators. We document the application of a people-centred health systems governance conceptual model based on applying four effective governing practices: cultivating accountability, engaging with stakeholders, setting a shared strategic direction, and stewarding resources responsibly. We present a participatory approach where health system leaders identify and act on opportunities for making themselves and their health systems more accountable and responsive to the needs of the communities they serve. Discussion and evaluation: We found that health systems governance can be improved in fragile and conflict affected environments, and that consistent application of the effective governing practices is key to improving governance. Intervention was associated with a 20% increase in antenatal care visit rate in pilot provinces. Focus group discussions showed improvements across the four governing practices, including: establishment of new sub-committees that oversee financial transparency and governance, collaboration with diverse stakeholders, sharper focus on community health needs, more frequent presentation of service delivery data, and increased use of data for decision making. Conclusions: Our findings have implications for policy and practice within and beyond Afghanistan. Governance is central to making health systems responsive to the needs of people who access and provide services. We provide a practical approach to improving health systems governance in fragile and conflict affected environments. [ABSTRACT FROM AUTHOR]

Anniversaries offer the opportunity to revisit events that have been enriched by the passage of time. They help to balance disagreements, create new consensuses and re-launch promising discussions. The decennial of the World Health Report 2000 (WHR 2000) may be such an auspicious occasion (WHO 2000). There are two aspects of the WHR 2000 that are worth considering: the context and the content. The key event regarding the context of the report was the election in 1998 of a new Director General for the World Health Organization (WHO), which took place in the midst of a leadership crisis. For the first time in the history of this organization, a former head of government, Gro Harlem Brundtland, was elected to the top position. In this role she had the vision to firmly place health at the centre of the development agenda, the ability to reposition WHO in the global health arena, the skill to transform an agency mostly focused on providing technical assistance to developing countries into an institution relevant to the entire world, and the commitment to promote evidence-based health policy. This last pledge was expressed in the creation of a new Cluster on Evidence and Information for Policy, a unit explicitly charged with developing a scientific foundation for decision making and undoubtedly one of the most important initiatives during Brundtland's tenure. [ABSTRACT FROM AUTHOR]

Introduction: The provision of health care services in Kenya was devolved from the national government to the counties in 2013. Evidence suggests that health system performance in Kenya remains poor. The main issue is poor leadership resulting in poor health system performance. However, most training in Kenya focuses on "leaders" (individual) development as opposed to "leadership" training (development of groups from an organization). The purpose of that study was to explore the impact of leadership training on health system performance in selected counties in Kenya. Methods: A quasi-experimental time-series design was employed. Pretest, posttest control-group design was utilized to find out whether the leadership development program positively contributed to the improvement of health system performance indicators compared with the non-trained managers. Questionnaires were administered to 31 trained health managers from the public, private for-profit, and private not-for-profit health institutions within the same counties. Results: The pretest and posttest means for all the six health system (HS) pillar indicators of the treatment group were higher than those of the control group. The regression method to estimate the DID structural model used to calculate the "fact" and "counterfactual" revealed that training had a positive impact on the intended outcome on the service delivery, information, leadership and governance, human resources, finance, and medical products with impact value ≥1 (57.2). Conclusion: The study findings support both hypotheses that trained health care management teams had a significant difference in the implementation status of priority projects and, hence, had a significant impact on health system performance indicators compared with non-trained managers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Chelagat, Rice, Onyango and Kokwaro.)

Abstract -In reviewing national health systems assessments (HSAs), we identify four primary rationales for doing HSAs: (i) to motivate health systems reform, (ii) to promote harmonization and alignment across actors in the health system, (iii) to help translate health systems reforms into meaningful ways to track performance, and (iv) to facilitate learning through cross-country comparisons. We propose a set of principles to guide HSAs. These include that the HSA should be relevant , addressing the purpose for which it was designed; trustworthy in terms of being of high quality, rigorous and credible in the eyes of stakeholders; and coherent, considering the health system as a meaningful whole with linkages across system components. Given diverse rationales for undertaking HSAs, there is no one standardized framework to guide them. Frameworks and tools should be selected to reflect proposed use, and careful thought should be given to stakeholder engagement and developing local capacity for HSAs.