Policy and evaluation perspectives on traditional health practitioners in national health care systems

After much resistance by physicians and health planners to traditional practitioners, international policy has recently shifted to support their inclusion in modern-sector health care programs. Governments in several dozen countries now utilize midwives in official health and family planning programs but, with only a few exceptions, continue to resist incorporating traditional healers into the national health care system. Bureaucratic and sociological reasons for this are discussed and recommendations are made for more balanced evaluation of the traditional practitioner components that have been developed in national and other health care systems.     

Patients' perspectives on diabetes health care education

Living with Type 2 diabetes requires that patients develop a range of competencies that allow them to take greater control over the treatment of their disease. This requires education that promotes health whilst respecting individuals' self-perceived needs and voluntary choices. Whilst such a concept is not new in the field of diabetes, health professionals are still struggling with how to administer it successfully. This paper presents the findings of a research trial of a theoretically constructed educational intervention. It focuses on the patients' perspectives of what they valued about the intervention which was found to be clinically effective over a short-term period only. Limitations to maintaining effects were associated with a number of factors. The study found that whilst patients can be educated toward greater autonomy, not all health professionals are ready to work in partnership with them. It highlighted the importance of clinical staff not only gaining a better understanding of diabetes management, but also of the theoretical principles underlying patient empowerment. This paper outlines these principles and shows how they were synthesized to produce a framework for informing practice. Patients' views are utilized to provide guidelines for improving the outcomes of patient education.     

Paediatricians' perspectives on global health priorities for newborn care in a developing country: a national survey

ABSTRACT: BACKGROUND: An understanding of the perception of paediatricians as key stakeholders in child healthcare delivery and the degree of congruence with current investment priorities is crucial in accelerating progress towards the attainment of global targets for child survival and overall health in developing countries. This study therefore elicited the views of paediatricians on current global priorities for newborn health in Nigeria as possible guide for policy makers. METHODS: Paediatric consultants and residents in the country were surveyed nationally between February and March 2011 using a questionnaire requiring the ranking of nine prominent and other neonatal conditions based separately on hospital admissions, mortality, morbidity and disability as well as based on all health indices in order of importance or disease burden. Responses were analysed with Friedman test and differences between subgroups of respondents with MannWhitney U test. RESULTS: Valid responses were received from 152 (65.8%) of 231 eligible physicians. Preterm birth/low birthweight ranked highest by all measures except for birth asphyxia which ranked highest for disability. Neonatal jaundice ranked next to sepsis by all measures except for disability and above tetanus except mortality. Preterm birth/low birthweight, birth asphyxia, sepsis, jaundice and meningitis ranked highest by composite measures while jaundice had comparable rating with sepsis. Birth trauma was most frequently cited under other unspecified conditions. There were no significant differences in ranking between consultants and residents except for birth asphyxia in relation to hospital admissions and morbidity as well as sepsis and tetanus in relation to mortality. CONCLUSIONS: Current global priorities for neonatal survival in Nigeria largely accord with paediatricians' views except for neonatal jaundice which is commonly subsumed under miscellaneous neonatal conditions. While the importance of these priority conditions extends beyond mortality thus suggesting the need for a broader conceptualisation of newborn health, paediatricians should be actively engaged in advancing the attainment of global priorities for child survival and health in this population.     

Privacy versus accountability: a health care dilemma

Social work practitioners are obligated both to document their services to clients and to protect information about their clients from unwarranted access and use. In the current environment of social work practice in the health care field, these obligations often conflict. This article describes and offers solutions to the dilemma of privacy versus accountability. If social workers maximize the protection offered by the four principles of privacy: confidentiality, anonymity, client access, and abridgment , they can safeguard personal information while still meeting accountability standards.     

The dilemma of essential drugs in primary health care

This article describes the evolution of essential drug programmes in eastern Africa from national donor assisted programmes to community-based drug programmes. Problems of the transition towards cost recovery are discussed and greater dialogue between government, donors and communities will be required if real community management is to be commenced.     

Stakeholder perspectives towards implementing the national framework on palliative care in Canada

ContextIn 2018 Health Canada developed a national framework and subsequent action plan for palliative care. Collaboration and implementation by stakeholder organizations however continues to take place without coordination. Little is known about their attitudes toward national policy development and motivation to work together.MethodsWe employ a well-known stakeholder analysis framework to identify and understand the attitudes of key stakeholders. Organizations that have contributed to national palliative policy development over the past 25 years were identified and prioritized. In this paper, we survey key stakeholders to understand their attitudes towards collaboration and implementation of the 2018 Framework. A novel method to identify homogeneous stakeholder cohorts was developed.FindingsFifty-four out of 75 key organizations (72%) completed the survey. Organizations genuinely support the Framework. However, three-quarters of organizations were not confident in their abilities to strongly influence national palliative care policies. Barriers to collaboration include differences in governance models and funding arrangements, a lack of resources and divergent priorities. Homogeneous stakeholder cohorts and in-depth analysis of stakeholder characteristics resulted in recommendations to support targeted engagement strategies.ConclusionsImplementation of national palliative care policies requires a large-scale coordinated approach involving all stakeholders. Recommendations are centered on the premise that targeted and tailored stakeholder engagement needs to be coordinated and is superior to a one-size fits all approach.