Human health research and policy development: experience in the Great Lakes region

As a direct outgrowth of industrial and agricultural activities, the quality of the Great Lakes ecosystem has declined significantly because of toxic substances in the water, eutrophication, overfishing, and invasive species that have been introduced into the waterways. Although measures have been adopted to restore the health of the ecosystem, contamination of Great Lakes sport fish continues arising from conditions that still prevail, but on a more limited scale. As a consequence, the Great Lakes states have issued guidelines for the public in the form of health advisories for fish consumption to encourage practices that will minimize exposure to contaminants found in Great Lakes sport fish. Scientific research has strongly influenced many policy decisions, including the development of laws, rules, and guidelines applicable to public health not only in regard to fish advisories but also other issues impacting human health. This paper proposes to outline how policy has been influenced by scientific findings and the far-reaching effect that these decisions have had on the health status of the public in the Great Lakes area and its potential for influencing the nation as a whole and our global neighbors. Within the Great Lakes basin, polychlorinated biphenyls (PCB) and mercury are the subject of the greatest number of fish advisories. Great Lakes-based researchers have studied populations residing in the Great Lakes basin to determine their level of awareness concerning fish consumption health advisories. They found that almost 50% of the residents who consumed Great Lakes sport fish were aware of sport fish consumption advisories. Of those with awareness, almost 60% were males and only about 40% were females. The researchers attributed the greater awareness among males to the health advisory materials that males receive with their fishing licenses and to their contact with fishing-related groups. The lower level of awareness among women regarding fish consumption advisories subsequently prompted the researchers to recommend targeting risk communication programs for female consumers of Great Lakes sport fish, particularly women of reproductive age. The Wisconsin Department of Health and Family Services subsequently followed the recommendation and developed uniform outreach materials for women, minorities, and the general public to be used by the Great Lakes states. The policy change directing educational materials to at-risk groups (e.g., women of reproductive age and minorities) is a direct outgrowth of the finding of low awareness about fish advisories among women who were interviewed.     

Human resource management in post-conflict health systems: review of research and knowledge gaps

In post-conflict settings, severe disruption to health systems invariably leaves populations at high risk of disease and in greater need of health provision than more stable resource-poor countries. The health workforce is often a direct victim of conflict. Effective human resource management (HRM) strategies and policies are critical to addressing the systemic effects of conflict on the health workforce such as flight of human capital, mismatches between skills and service needs, breakdown of pre-service training, and lack of human resource data. This paper reviews published literatures across three functional areas of HRM in post-conflict settings: workforce supply, workforce distribution, and workforce performance. We searched published literatures for articles published in English between 2003 and 2013. The search used context-specific keywords (e.g. post-conflict, reconstruction) in combination with topic-related keywords based on an analytical framework containing the three functional areas of HRM (supply, distribution, and performance) and several corresponding HRM topic areas under these. In addition, the framework includes a number of cross-cutting topics such as leadership and governance, finance, and gender. The literature is growing but still limited. Many publications have focused on health workforce supply issues, including pre-service education and training, pay, and recruitment. Less is known about workforce distribution, especially governance and administrative systems for deployment and incentive policies to redress geographical workforce imbalances. Apart from in-service training, workforce performance is particularly under-researched in the areas of performance-based incentives, management and supervision, work organisation and job design, and performance appraisal. Research is largely on HRM in the early post-conflict period and has relied on secondary data. More primary research is needed across the areas of workforce supply, workforce distribution, and workforce performance. However, this should apply a longer-term focus throughout the different post-conflict phases, while paying attention to key cross-cutting themes such as leadership and governance, gender equity, and task shifting. The research gaps identified should enable future studies to examine how HRM could be used to meet both short and long term objectives for rebuilding health workforces and thereby contribute to achieving more equitable and sustainable health systems outcomes after conflict.     

Human resources for health and decentralization policy in the Brazilian health system

Background

The Brazilian health reform process, following the establishment of the Unified Health System (SUS), has had a strong emphasis on decentralization, with a special focus on financing, management and inter-managerial agreements. Brazil is a federal country and the Ministry of Health (MoH), through the Secretary of Labour Management and Health Education, is responsible for establishing national policy guidelines for health labour management, and also for implementing strategies for the decentralization of management of labour and education in the federal states. This paper assesses whether the process of decentralizing human resources for health (HRH) management and organization to the level of the state and municipal health departments has involved investments in technical, political and financial resources at the national level.

Methods

The research methods used comprise a survey of HRH managers of states and major municipalities (including capitals) and focus groups with these HRH managers - all by geographic region. The results were obtained by combining survey and focus group data, and also through triangulation with the results of previous research.

Results

The results of this evaluation showed the evolution policy, previously restricted to the field of 'personnel administration', now expanded to a conceptual model for health labour management and education-- identifying progress, setbacks, critical issues and challenges for the consolidation of the decentralized model for HRH management. The results showed that 76.3% of the health departments have an HRH unit. It was observed that 63.2% have an HRH information system. However, in most health departments, the HRH unit uses only the payroll and administrative records as data sources. Concerning education in health, 67.6% of the HRH managers mentioned existing cooperation with educational and teaching institutions for training and/or specialization of health workers. Among them, specialization courses account for 61.4% and short courses for 56.1%.

Conclusions

Due to decentralization, the HRH area has been restructured and policies beyond traditional administrative activities have been developed. However, twenty years on from the establishment of the SUS, there remains a low level of institutionalization in the HRH area, despite recent efforts of the MoH.     

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries

Background: Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available.

Objectives: This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC.

Methods: Data were collected during a workshop at the WONCA East Mediterranean Regional Conference in 2017. Academic family physicians (FP) presented their country, using the WONCA framework of 11 PowerPoint slides with queries of the country demographics, main health challenges, and the position of PHC in the health system.

Results: All six countries have improved the health of their populations, but currently face challenges of non-communicable diseases, aging populations and increasing costs. Main concerns were a lack of trained FPs in community settings, underuse of prevention and of equitable access to care. Countries differed in the extent to which this had resulted in coherent policy.

Conclusion: Priorities were (i) advocacy for community-based PHC to policymakers, including the importance of coordination of healthcare at the community level, and UHC to respond to the needs of populations; (ii) collaboration with universities to include PHC as a core component of every medical curriculum; (iii) collaboration with communities to improve public understanding of PHC; (iv) engagement with the private sector to focus on PHC and UHC.     

Channelling Edwin Chadwick: beyond utopian thinking in urban planning policy and health

Health impact assessment is advanced as a formal means to assess the direct and indirect health impacts of urban planning decisions and processes. It is, however, an intrinsically passive policy device. A more comprehensive and practical policy framework or architecture, reminiscent of that devised by Edwin Chadwick and the sanitary reform movement in 19th Century England, will be necessary to reorient the goals and practices of urban planning.     

Priorities for research to take forward the health equity policy agenda

Despite impressive improvements in aggregate indicators of health globally over the past few decades, health inequities between and within countries have persisted, and in many regions and countries are widening. Our recommendations regarding research priorities for health equity are based on an assessment of what information is required to gain an understanding of how to make substantial reductions in health inequities. We recommend that highest priority be given to research in five general areas: (1) global factors and processes that affect health equity and/or constrain what countries can do to address health inequities within their own borders; (2) societal and political structures and relationships that differentially affect people's chances of being healthy within a given society; (3) interrelationships between factors at the individual level and within the social context that increase or decrease the likelihood of achieving and maintaining good health; (4) characteristics of the health care system that influence health equity and (5) effective policy interventions to reduce health inequity in the first four areas.     

Ethical considerations for effective health human resources planning and management

This paper maps out some of the ethical issues associated with effective Health Human Resources (HHR) planning and management. The key HHR topics of ethical recruitment and retention are highlighted drawing upon an ethics framework that emphasizes the principle of transnational justice. The key take-home messages are as follows: (1) ethical recruitment of health workers from other jurisdictions needs to acknowledge the effect their recruitment has on the region, province, or country they leave behind and (2) an ethical approach to HHR management requires more attention be paid to deploying existing domestic HHR to their full scope. This would include but not be limited to non-practising internationally educated health professionals already in Canada.     

Human resources and health work: challenges for a research agenda

This article discusses several key concepts for human resources policy in health in the context of Latin America's regional integration efforts. The article focuses on different concepts of integration to emphasize the analytical distinction between regional and conceptual integration. It also presents labor and human resources concepts before discussing, in the final analysis, the challenges that a common research agenda faces in the context of current health sector reforms in Latin America. The conclusion emphasizes the need to develop a technology and research system capable of supporting the agenda for exchange between MERCOSUR member countries.     

Assistive technology for independent living with dementia: Stylized facts and research gaps

Background

Recent advancement in assistive technologies (AT) have fueled the debate on new, IT-reliant ways of providing cure and care of dementia. Still the impact on practice has been little. With this paper, we want to find out to which extent current studies have discussed the impacts of AT for dementia.

Human resource development: the management, planning and training of health personnel.

The morale of health personnel is fast becoming the major factor affecting both the sustainability and the quality of health care world-wide. Low morale mirrors problems ranging from declining balance of payments allocation to GNP, and a lack of support for the health system from the very top down to the rigid application of national pay, grading and career structures, and the stress of not being able to do the job properly. While many of these and other problems have been voiced again and again in the press and in the academic literature, much of the work on health manpower development has focused on the planning and production of personnel. This has been with the aim of producing specific categories of better-trained health workers with relevant qualifications, resulting in a heavy emphasis on a quantitative output. In this paper it is argued that the management of health personnel, the qualitative aspect of staff development, has been relatively neglected. Unless and until the management of human resource development receives the attention it needs, seeds of discontent, disillusion and dissatisfaction will ultimately lead to national health services losing their competitiveness as employers. The sustainability and quality of health programmes will then be in even greater jeopardy than they are at present. The planning, production and management components of health manpower development have developed haphazardly as verticle activities. A new term such as 'human resource development; the management of health personnel' might help ensure the concept of an integrated process contingent on economic, political, organizational and other important circumstances.     

Integrating public health policy, practice, evaluation, surveillance, and research: the school health action planning and evaluation system

The Canadian Cancer Society and the National Cancer Institute of Canada have charged their Centre for Behavioral Research and Program Evaluation with contributing to the development of the country's systemic capacity to link research, policy, and practice related to population-level interventions. Local data collection and feedback systems are integral to this capacity. Canada's School Health Action Planning and Evaluation System (SHAPES) allows data to be collected from all of a school's students, and these data are used to produce computer-generated school "health profiles." SHAPES is being used for intervention planning, evaluation, surveillance, and research across Canada. Strong demand and multipartner investment suggest that SHAPES is adding value in all of these domains. Such systems can contribute substantially to evidence-informed public health practice, public engagement, participatory action research, and relevant, timely population intervention research.     

Organisation of veterinary public health activities in countries of the Eastern Mediterranean region.

This review covers the organisation of veterinary public health (VPH) activities in countries of the Eastern Mediterranean region, with reference to zoonoses and hazards to man from foods of animal origin. A study of the region shows that no separate VPH units exist within the national Veterinary Services. Although these Services are gradually being upgraded and strengthened, most of their resources are spent in controlling serious contagious animal diseases such as foot and mouth disease, rinderpest and Newcastle disease. Rabies, present in almost every country of the region, is a zoonosis which no Veterinary Service can ignore. Other serious zoonoses affecting the region include echinococcosis, brucellosis, leishmaniasis, anthrax, toxoplasmosis and tuberculosis. Salmonellosis is one of the most serious food-borne zoonoses, while hazards from the increased presence of additives, pesticides, antibiotics and hormones in foods of animal origin are other emerging VPH problems. Many obstacles hamper efficient reorganisation of VPH activities. These include the inherited colonial system of assigning VPH activities to other authorities (health inspectors) rather than to Veterinary Services; the confusion as to which authority should actually be responsible in a given field; the lack of epidemiological studies and knowledge of the real extent of VPH problems; lack of training; inadequately staffed and poorly equipped Veterinary Services; and lack of public awareness. Nonetheless, a few countries have made excellent progress in reorganising VPH activities and in eradicating serious zoonoses. International organisations like the OIE, FAO and WHO can help greatly in establishing efficient VPH programmes.     

离散选择模型在卫生人力政策研究中的应用

卫生技术人员的工作意愿受收入水平、晋升机会等众多因素的影响。研究卫生技术人员的工作意愿,是卫生人力资源研究的重要内容之一。离散选择试验作为国际上新兴的卫生技术人员工作意愿测量方法,可综合研究多种影响因素之间的权衡,对卫生技术人员工作意愿进行定量测量。该方法在卫生领域应用前景广泛,除可用于卫生人力资源研究外,也能广泛应用于医疗保险参保意愿、卫生服务需求等多领域的研究。本文着重介绍了离散选择模型的原理,在卫生技术人员工作意愿测量领域的应用及其优缺点。