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Background The World Health Organization Model List of Essential Medicines (WHO EML) has played a critical role in guiding the country-level selection and financing of medicines for more than 4 decades. It continues to be a relevant evidence-based policy that can support universal health coverage (UHC) and access to essential medicines. The objective of this review was to identify factors affecting adaptation and implementation of WHO EML at the national level. Methods and findings We conducted a qualitative evidence synthesis by searching 10 databases (including CINAHL, Embase, Ovid MEDLINE, Scopus, and Web of Science) through October 2021. Primary qualitative studies focused on country-level implementation of WHO EML were included. The qualitative findings were populated in the Supporting the Use of Research Evidence (SURE) framework, and key themes were identified through an iterative process. We appraised the papers using the Critical Appraisal Skills Programme (CASP) tool and assessed our confidence in the findings using the Grading of Recommendations Assessment, Development and Evaluation working group-Confidence in Evidence from Reviews of Qualitative research (GRADE-CERQual). We screened 1,567 unique citations, reviewed 183 full texts, and included 23 studies, from 30 settings. Non-English studies and experiences and perceptions of stakeholders published in gray literature were not collected. Our findings centered around 3 main ideas pertaining to national adaptation and implementation of WHO EML: (1) the importance of designing institutions, governance, and leadership for national medicines lists (NMLs), particularly the consideration of transparency, coordination capacity, legislative mechanisms, managing regional differences, and clinical guidance; (2) the capacity to manage evidence to inform NML updates, including processes for contextualizing global evidence, utilizing local data and expert knowledge, and assessing budget impact, to which locally relevant cost-effectiveness information plays an important role; and (3) the influence of NML on purchasing and prescribing by altering provider incentives, through linkages to systems for financing and procurement and donor influence. Conclusions This qualitative evidence synthesis underscores the complexity and interdependencies inherent to implementation of WHO EML. To maximize the value of NMLs, greater investments should be made in processes and institutions that are needed to support various stages of the implementation pathway from global norms to adjusting prescribed behavior. Moreover, further research on linkages between NMLs, procurement, and the availability of medicines will provide additional insight into optimal NML implementation. Protocol registry PROSPERO CRD42018104112, Author(s): Elizabeth F. Peacocke 1,*, Sonja L. Myhre 1, Hakan Safaralilo Foss 2, Unni Gopinathan 1 Introduction The World Health Organization Model List of Essential Medicines (WHO EML) offers a [...]

Purpose Engagement in policy is an essential public health service, with state legislatures serving as important arenas for activity on issues affecting children and families. However, a gap in communication often exists between policymakers and public health researchers who have the research knowledge to inform policy issues. We describe one tool for researchers to better leverage public health research to inform state legislative policymaking on issues of relevance to children and families. Description The Oregon Family Impact Seminar (OFIS), adapted from the Policy Institute for Family Impact Seminars, applies a systematic process to bring a synthesis of research findings on public health issues to state legislators using a six-step process: (1) identify candidate topics, (2) recruit legislative champions, (3) select the topic, (4) identify and prepare speakers, (5) host the presentations, and (6) develop and disseminate a research brief as a follow-up contact. Assessment Use of this model in Oregon has produced policy impact; for example, the 2015 presentation, 'Two-Generation Approaches to Reduce Poverty,' prompted ongoing dialogue culminating in a new statute to increase Earned Income Tax Credit for parents with young children. This approach also has strengthened relationships among researchers and legislators, which serves to streamline the OFIS process. Conclusion This model is an effective vehicle for leveraging public health research findings to inform state-level policy. This model also serves to connect researchers with opportunities to engage with policymakers to address significant public health problems, particularly those addressing social, economic, and environmental determinants of health for children and families., Author(s): Emily J. Tomayko [sup.1] , Bethany Godlewski [sup.2] , Sally Bowman [sup.3] , Richard A. Jr. Settersten [sup.2] , Roberta B. Weber [sup.5] , Gloria Krahn [sup.4] Author Affiliations: [...]

ABSTRACT Promulgation of Millennium Development Goals (MDG) in year 2000 gave hope to the world that common interests and challenges such as poverty and hunger, education, gender equality and women [...]

PU23.03 Being a part of the conversation: capacitating youth to participate in HIV prevention conversations using a digital citizen engagement platform in South Africa D. Pillay (1) ; K. Plourde [...]

Information-rich environments in Canada, Australia, and the United Kingdom have been built using record linkage techniques with population-based health insurance systems and longitudinal administrative data. This paper discusses the issues in extending population-based administrative data from health to additional topics more generally connected with well being. The scope of work associated with a multi-faceted American survey, the Panel Study in Income Dynamics (PSID), is compared with that of the administrative data in Manitoba, Canada. Both the PSID and the Manitoba database go back over 30 years, include families, and have good information on residential location. The PSID has emphasized research design to maximize the opportunities associated with expensive primary data collection. Information-rich environments such as that in Manitoba depend on registries and record linkage to increase the range of variables available for analysis. Using new databases on education and income assistance to provide information on the whole Manitoba population has involved linking files while preserving privacy, scaling educational achievement, assessing exposure to a given neighborhood, and measuring family circumstances. Questions being studied concern the role of the socioeconomic gradient and infant health in child development, the comparative influence of family and neighborhood in later well being, and the long-term effects of poverty reduction. Issues of organization of research, gaps in the data, and productivity are discussed. Keywords: Administrative data; Population health; Registry; Policy analysis; Social research; Canada

The article identifies obstacles to implementing effective personalized medical care, and provides solutions to these obstacles. These include changes in the pharmaceutical industry's corporate structure, implementing regulation reform, altering physicians' habits, and establishing performance-based payment.

Health interventions vary substantially in the degree of effort required to implement them. To some extent this is apparent in their financial cost, but the nature and availability of non-financial resources is often of similar importance. In particular, human resource requirements are frequently a major constraint. We propose a conceptual framework for the analysis of interventions according to their degree of technical complexity; this complements the notion of institutional capacity in considering the feasibility of implementing an intervention. Interventions are categorized into four dimensions: characteristics of the basic intervention; characteristics of delivery; requirements on government capacity; and usage characteristics. The analysis of intervention complexity should lead to a better understanding of supply- and demand-side constraints to scaling up, indicate priorities for further research and development, and can point to potential areas for improvement of specific aspects of each intervention to close the gap between the complexity of an intervention and the capacity to implement it. The framework is illustrated using the examples of scaling up condom social marketing programmes, and the DOTS strategy for tuberculosis control in highly resource-constrained countries. The framework could be used as a tool for policy-makers, planners and programme managers when considering the expansion of existing projects or the introduction of new interventions. Intervention complexity thus complements the considerations of burden of disease, cost-effectiveness, affordability and political feasibility in health policy decision-making. Reducing the technical complexity of interventions will be crucial to meeting the health-related Millennium Development Goals. Keywords Health priorities/organization and administration; Delivery of health care/organization and administration; Condoms; Social marketing; Directly observed therapy; Tuberculosis, HIV infections/prevention and control; Multidrug-resistant/prevention and control; Models, Theoretical; Developing countries (source: MeSH, NLM)., Introduction Determining priorities and planning the implementation of health interventions in resource-poor countries is difficult and uncertain, due to lack of dependable evidence, analytical methods for identifying priority options and [...]

Rising health care costs and shrinking state and federal funding for healthcare are causing some to propose a system of health care vouchers. Such systems appear to give recipients greater freedom and convenience to enroll in state-contracted HMOs of their choice and to receive high quality healthcare effectively and efficiently in managed care systems. It appears to be a win-win situation for high quality care and keeping costs in check. But is it a good idea, in the long run? Dale Murray argues that it is not. He offers reasons to believe that these systems do not promote equality or autonomy in health care, after all.

Bangladesh is one of many countries struggling to implement the expanded approach to family planning agreed to at the International Conference on Population and Development (ICPD) (1) in the context [...]

Objectives To quantify the use of self-treatment and to determine the actions taken to manage malaria illness. Methods A cross-sectional study was undertaken in six peasant associations in Butajira district, southern Ethiopia, between January and September 1999. Simple random sampling was used to select a sample of 630 households with malaria cases within the last six months. Findings Overall, 616 (>97%) of the study households acted to manage malaria, including the use of antimalarial drugs at home (112, 17.8%), visiting health services after taking medication at home (294, 46.7%), and taking malaria patients to health care facilities without home treatment (210, 33.3%). Although 406 (64.5%) of the households initiated treatment at home, the use of modern drugs was higher (579, 92%) than that of traditional medicine (51, 8%). Modern drugs used included chloroquine (457, 73.5%) and sulfadoxine-pyrimethamine (377, 60.6%). Malaria control programmes were the main sources of antimalarials. In most cases of malaria, treatment was started (322, 52.3%) or health services visited (175, 34.7%) within two days of the onset of symptoms. Cases of malaria in the lowland areas started treatment and visited health services longer after the onset of malaria than those in the midland areas (adjusted odds ratio, 0.44; 95% confidence interval (CI), 0.30-0.64; and adjusted odds ratio, 0.37; 95% CI, 0.25-0.56, respectively). Similarly, those further than one hour's walk from the nearest health care facility initiated treatment later than those with less than one hour's walk (adjusted odds ratio, 0.62; 95% CI 0.43-0.87). This might be because of inaccessibility to antimalarial drugs and distant health care facilities in the lowland areas; however, statistically insignificant associations were found for sex, age, and religion. Conclusion Self-treatment at home is the major action taken to manage malaria. Efforts should be made to improve the availability of effective antimalarials to communities in rural areas with malaria, particularly through the use of community health workers, mother coordinators, drug sellers, and shop owners. Keywords Malaria, Falciparum/drug therapy; Malaria, Vivax/drug therapy; Antimalarials/administration and dosage/supply and distribution; Self care; Self medication; Patient acceptance of health care; Cross-sectional studies Ethiopia (source: MeSH, NLM). Mots cles Paludisme plasmodium falciparum/chimiotherapie; Paludisme plasmodium vivax/chimiotherapie; Antipaludique/ administration et posologie/ressources et distribution; Autotraitement; Automedication; Acceptation des soins; Etude section efficace; Ethiopie (source: MeSH, INSERM). Palabras clave Paludismo falciparum/quimioterapia; Paludismo vivax/quimioterapia; Antimalaricos/administracion y dosificacion/provision y distribucion; Autocuidado; Automedicacion; Aceptacion de la atencion de salud; Estudios transversales; Etiopia (fuente: DeCS, BIREME)., Introduction Malaria is the most widespread infectious disease and is a major public health problem, particularly in sub-Saharan Africa (1, 2). Studies in some health facilities in Africa showed that [...]

We hypothesize that a human rights framework would be able to analyse central health-related societal issues within important settings like the work place, the family or the health care system. Our study goal was the development and population-based evaluation of a questionnaire for assessment of the perceived human rights status. A questionnaire (HR-14) was developed from the guiding principles of international human rights legislation. For its psychometric evaluation, computer-assisted telephone interviews were conducted in four cities in Europe (Munich, Dresden, Vienna and Bern). Cronbach's alpha for internal consistency was 0.76. Factor analysis supported the concept of human rights as indivisible and interdependent. Extracted factors were consistent with the preliminary settings of family and friend, health care system and community at large, and a supplementary setting workplace. Perceived human rights status was associated with physical function, mental/emotional health, age, study region, general health and employment status. We conclude that it is possible to develop a human rights questionnaire with good psychometric properties. Measurement of the perceived human rights status of populations and population groups may contribute to health policies sensitive to human rights. Keywords: Human rights; Health; Questionnaire; Validity

Three recent surveys from Kenya, the Ivory Coast, and East Java emphasize that anemia is a complex and multifaceted public health problem. A thorough understanding of iron metabolism and its disturbance is central to resolving the problem of anemia but requires intricate analysis. To maximize oxygen-carrying capacity and optimize human function, one must combine issues of sociology, economics, and general health with multiple micronutrient interventions. Key Words: iron deficiency, anemia, iron metabolism, micronutrient interventions

Taiwan reached the World Health Organization (WHO) benchmark of 7% aged 65 and over for defining an aging population only as recently as 1993. With this proportion projected to double to 14% by 2020, Taiwan faces a rapid increase in need for long-term care. This article presents an account of the current service delivery system, which is divided between health and social affairs administrations, with a substantial role also taken by the Veteran Administration, and growing provision of facilities that operate outside the government-registered system. While a basic level of both institutional and community care services has developed, they are not organized into an integrated service system. Problems arising from the divisions and overlaps in responsibility are identified in relation to competition for resources, differences in regulation and eligibility, funding arrangements and misallocation of resources, and divergent views about the philosophical basis of long-term care. Other aspects of services fall under each jurisdiction, but there is also some overlap. A case study of Taiwan's second largest city, Kaohsiung City, reports the outcomes of these divisions as a thin spread of a range of services rather than a coordinated service network. Several planning exercises have been undertaken in recent years to address these problems, and although at an early stage of implementation, the outcomes of these plans are seen as shaping the future directions of long-term care in Taiwan. [Article copies available for a fee from The Haworth Document Delivery Service: 1-800-HAWORTH. E-mail address: KEYWORDS. Taiwan, veterans, service fragmentation, family caregivers, adult day care, respite care, eligibility

The tragic events of September 11th, followed by the recent anthrax incidents, have made us painfully aware of our nation's vulnerability to terrorism, including bioterrorism. Although once considered a remote […]

Information on planned government subsidies to expand health coverage to the uninsured under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 is offered. Additional information on COBRA-LOAN subsidies to offer health coverage to the uninsured is included.

The federal government's plan to expand the access of older people to health coverage by making Medicare accessible at a community-rated premium is discussed. Additional information on pre-Medicare insurance for older people is included.

Evidence-based approaches are prominent on the national and international agendas for health policy and health research. It is unclear what the implications of this approach are for the production and distribution of health in populations, given the notion of multiple determinants in health. It is equally unclear what kind of barriers there are to the adoption of evidence-based approaches in health care practice. This paper sketches some developments in the way in which health policy is informed by the results from health research. It summarises evidence-based approaches in health at three impact levels: intersectoral assessment, national health care policy, and evidence-based medicine in everyday practice. Consensus is growing on the role of broad and specific health determinants, including health care, as well as on priority setting based on the burden of diseases. In spite of methodological constraints, there is a demand for intersectoral assessments, especially in health sector reform. Initiators of policy changes in other sectors may be held responsible for providing the evidence related to health. There are limited possibilities for priority setting at the national health care policy level. Hence, there is a decentralisation of responsibilities for resource use. Health care providers are encouraged to assume agency roles for both patients and society and asked to promote and deliver effective and efficient health care. Governments will have to design a national framework to facilitate their organisation and legal framework to enhance evidence-based health policy. Treatment guidelines supported by evidence on effectiveness and efficiency will be one essential element in this process. With the increasing number of advocates for the enhancement of population health in the policy arenas, evidence-based approaches provide the information and some of the tools to help with priority setting. Keywords: Evidence-based policy; Health determinants; Cost-effectiveness; Guidelines

The purpose of this paper is to stimulate debate on the implications of the new genetics for health policy. Although there are different streams within the social science literature on the new genetics, the primary focus has been on the meaning of genetic testing from the perspective of the individual tested. While essential to understand, it does not add much to the health policy debate. A very different type of information has been produced by the public health and epidemiological literature, focused on screening for genetic disease and concerned with rates of detection, costs and benefits, and evaluation criteria. These data are very important to planning and implementing the type of prenatal screening program already in existence; they do not deal with issues central to the new genetics, such as commercialization, patenting and insurance. The problem is how best these topics should be researched. The final section of the paper suggests that given a phenomenon - the new genetics - which is both multifaceted and very complex, very new and yet with strong historical and cultural roots, we need a matching research agenda. One that breaks out of traditional paradigms separating one method from another and seeks information on the new genetics wherever it may be found. Keywords: New genetics; Health policy; Research

An overview is presented on the emergence of public health in Africa, from the 19th century to the present day. The article focuses on epidemiology, particularly sleeping sickness, smallpox, malaria, and HIV/AIDS.

Microcomparison, or single-component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators' perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available and similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care ratios.

Welfare states in all advanced industrialized countries are under severe financial stress. Many observers argue that in responding to such pressures, governments are converging on a path of marketization and privatization of social risks, which ultimately leads to the unraveling of solidarity. Recent health care reforms in Britain, Germany, and the United States serve as case studies that challenge this argument, Far from converging on a market path, each country has pursued a distinctive reform response combining markets with other policy instruments. Moreover, where state actors lead the way in constructing health care markets, the extent of desolidarity is limited. The structure of each nation's health care system shapes the policy preferences and reform strategies of key actors, and thereby helps explain the distinctiveness of health care reform patterns.

Research indicates that the social construction of health directs the adjudication of health in women's prisons. Topics include the correlation between access to medical care and prisoner behavior, and the failure to address less demonstrable health issues such as psychiatric conditions.

An analysis of patient responses to the out-of-pocket cost of medical care health insurance market reveals that a modification of the Rand experiment methodology would be useful for policy-makers. the method may be used to investigate behavioral responses to price and how responses vary across different populations. Moreover, the technique allows for measurement of central tendency movement and affects of price changes at different levels of distribution.

The relationship between epidemiology and health policy is an area of considerable debate. This article demonstrates the use of epidemiological methods to make health policy formulation more 'policy significant' and 'down to earth'. A case-study of a cholera outbreak in Kaputa district, Zambia is used as an illustration. A closer liaison between epidemiology and social sciences is advocated. Epidemiological data should be supplied as feed back to the study population to facilitate community-based action for health. Key words - epidemiology, health policy, cholera, Zambia

The European Strategy for Health for All by the Year 2000 urged member states to develop a national health policy. In the developmental process of HFA2000 the notion of 'healthy public policy' was conceived in the framework of the WHO Health Promotion Programme. Such 'healthy public policy' - simply referred to as 'health policy' in this article - would take health consequences in all governmental and societal realms into account. Health policy development in The Netherlands was laid down in a 1986 memorandum, 'Nota 2000'. The developmental process of the document is reviewed, and chances for factual implementation analysed. The article concludes with a list of actions to be pursued if health policy is to be successful. Key words - health policy, health promotion, The Netherlands, policy studies

The community-oriented primary care (COPC) model of health care presents a practical means of reintroducing elements of cost containment and humanitarianism to medicine. The current health care system is fragmented and depersonalized. It emphasizes biotechnology and acute hospital care over health status and patient outcome. The three main problems facing the health care system are skyrocketing costs, inadequate access to care and inappropriate or ineffective care. Lawmakers are aware of the public's dissatisfaction with the system and are realizing that true reform will come only with comprehensive revisions in the financing, organization and provision of care. The COPC model requires a primary care practice based in the community, an identifiable population that will receive the services and a process for evaluation. COPC is socially responsive and would control costs., The current high-cost health care delivery system, which places greater emphasis on acute hospital care than on community-based primary and preventive care, is no longer viewed by policymakers, politicians, and the -American public as the ideal model for organizing and providing health care services. Americans want change; however, politicians are responding with a barrage of disjointed finance and cost-containment proposals that fail to address the organization and provision of health care services. Nevertheless, to adequately address problems of cost, access, and quality, reform proposals will need to consider delivery models that create a balance between medical care and health care, between public health and personal health services, and between curative and preventive care. The community-oriented primary care model and the discipline of community and socially responsive medicine is a process for making a health care system more rational, accountable, appropriate, and socially relevant to the public. Consequently, this model, which is now at a pivotal point in its evolution, may serve as a paradigm for reforming the organization and provision of health care services in America. (JAMA. 1993;269:2544-2547)