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Health Policy Plan 2019 Feb 14. Epub 2019 Feb 14.

Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA, USA.

Financial barriers cause many women in low- and middle-income countries to deliver outside of a health facility, contributing to maternal and neonatal mortality. Savings accrued during pregnancy can increase access to safe delivery services. We investigated the relationship between household saving during pregnancy and facility delivery. Read More

Health Policy Plan 2019 Feb 8. Epub 2019 Feb 8.

Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.

Several tools have been developed to collect information on health facility preparedness to provide sexual violence response services; however, little guidance exists on how this information can be used to better understand which functions a facility can perform. Our study therefore aims to propose a set of signal functions that provide a framework for monitoring the availability of clinical sexual violence services. To illustrate the potential insights that can be gained from using our proposed signal functions, we used the framework to analyse data from a health facility census conducted in Central Province, Zambia. Read More

Health Policy Plan 2019 Feb 7. Epub 2019 Feb 7.

GroundWork, Hintergass 1, Fläsch, Switzerland.

There are important lessons learned from the 2014-16 Ebola virus disease outbreak in West Africa. However, there has not been a systematic documentation of nutrition lessons specifically. Therefore, this study sought to generate multiple stakeholder perspectives for understanding the nutrition challenges faced during the Ebola virus disease outbreak, as well as for consensus building around improved response strategies. Read More

Health Policy Plan 2019 Jan 30. Epub 2019 Jan 30.

Department of Asian and Policy Studies, The Education University of Hong Kong, Hong Kong.

The rapid diffusion of medical technologies is widely recognized as a key driver of healthcare cost escalation. The excessive duplication of technologies gives rise to the so-called medical arms race. Conventional wisdom tends to explain this phenomenon by external reimbursement mechanisms and hospitals' competitive strategies, but has largely neglected the role played by health regulations that may also affect hospitals' technology adoption decisions. Read More

Health Policy Plan 2019 Jan 29. Epub 2019 Jan 29.

Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Nashville, TN, USA.

Despite numerous international and national efforts, only 12 countries in the World Health Organization's African Region met the Millennium Development Goal #4 (MDG#4) to reduce under-five mortality by two-thirds by 2015. Given the variability across sub-Saharan Africa, a four-country study was undertaken to examine barriers and facilitators of child survival prior to 2015. Liberia and Zambia were chosen to represent countries making substantial progress towards MDG#4, while Kenya and Zimbabwe represented countries making less progress. Read More

Health Policy Plan 2019 Jan 25. Epub 2019 Jan 25.

Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, Switzerland.

In Tanzania, the health financing system is extremely fragmented with strategies in place to supplement funds provided from the central level. One of these strategies is the Community Health Fund (CHF), a voluntary health insurance scheme for the informal rural sector. As its implementation has been challenging, we investigated different CHF implementation practices and how these practices and the wider health financing context affect CHF implementation and potentially enrolment. Read More

Health Policy Plan 2019 Jan 25. Epub 2019 Jan 25.

Department of Emergency Medicine, University of Colorado School of Medicine, Denver, CO, USA.

Since the adoption of the Sustainable Development Goals in 2015, innovation in global healthcare delivery has been recognized as a vital avenue for strengthening health systems and overcoming present implementation bottlenecks. In the recent rapid development of the science of global health-care delivery, emergency care-a critical element of the health system-has been widely overlooked. Emergency care plays a vital role in the health system through providing immediately responsive care and serving as one of the main entry points for those with symptomatic disease. Read More

Health Policy Plan 2019 Jan 18. Epub 2019 Jan 18.

Director, CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Armendáriz 497, 2do piso, Miraflores, Lima 18, Perú.

The use of community health workers (CHWs) has been explored as a viable option to provide home health education, counselling and basic health care, notwithstanding their challenges in training and retention. In this manuscript, we review the evidence and discuss how the digitalization affects the CHWs programmes for tackling non-communicable diseases (NCDs) in low- and middle-income countries (LMICs). We conducted a review of literature covering two databases: PubMED and Embase. Read More

Health Policy Plan 2019 Jan 21. Epub 2019 Jan 21.

School of Public Administration, The University of New Mexico, Social Sciences Building, Room 3008, MSC05-3100, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.

Civil society actors have substantially increased their participation in global and national health policymaking processes since the 1970s. Civil society roles in shaping such significant global health milestones as the Doha Declaration on Intellectual Property Rights, the Framework Convention on Tobacco Control and the recently adopted United Nations Sustainable Development Goals are well documented, but knowledge of civil society actor influence on health policy processes in low- and middle-income countries remains fragmented. This study analyses 24 peer-reviewed research articles published between 2007 and 2016 to identify factors affecting civil society influence in the pre-implementation stages of the policy process. Read More

Health Policy Plan 2019 Jan 9. Epub 2019 Jan 9.

Africa Centre for HIV/AIDS Management, Stellenbosch University, Stellenbosch, South Africa.

Efforts to improve the effectiveness of global health aid rarely take full account of the micro-politics of policy change and implementation. South Africa's HIV/AIDS epidemic is a case in point, where the US President's Emergency Plan for AIDS Relief (PEPFAR) has provided essential support to the national AIDS response. With changing political context, PEPFAR has shifted focus several times-most recently reversing the policy of 'transition' out of direct aid to a policy of re-investing in front-line services in priority districts to improve aid effectiveness. Read More

Health Policy Plan 2019 Jan 8. Epub 2019 Jan 8.

The Johns Hopkins Center for Health Security, 621 East Pratt Street, Suite 210, Baltimore, MD 21202, USA.

The 2014-16 West Africa Ebola epidemic was a watershed moment for global health. The outbreak galvanized global action around strengthening infectious disease prevention, detection and response capabilities. We examined the nascent landscape of international programmes, initiatives and institutions established in the aftermath of the 2014-16 Ebola outbreak with the aim of assessing their progress to date to illustrate the current state of the world's global health security architecture. Read More

Health Policy Plan 2019 Jan 3. Epub 2019 Jan 3.

Health Policy Plan 2018 Dec 24. Epub 2018 Dec 24.

London School of Hygiene and Tropical Medicine, London, UK.

A number of primary studies and systematic reviews focused on the contribution of community health workers (CHWs) in the delivery of essential health services. In many countries, a cadre of informal health workers also provide services on a volunteer basis [community health volunteers (CHV)], but there has been no synthesis of studies investigating their role and potential contribution across a range of health conditions; most existing studies are narrowly focused on a single condition. As this cadre grows in importance, there is a need to examine the evidence on whether and how CHVs can improve access to and use of essential health services in low- and middle-income countries (LMICs). Read More

Health Policy Plan 2018 Dec 26. Epub 2018 Dec 26.

Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.

Community health workers (CHWs) play a critical role in health promotion, but their workload is often oriented around a single disease. Renewed interest in expansion of multipurpose CHWs to cover an integrated package of services must contend with the debate over how effectively CHWs can perform an increased range of tasks. In this study, we examine whether an existing cadre of HIV-focused paid volunteer CHWs in Iringa, Tanzania, can take on new maternal, newborn and child health (MNCH) promotion tasks without adversely affecting their HIV role. Read More

Health Policy Plan 2018 Dec 14. Epub 2018 Dec 14.

Bureau for Asia/Technical Services, US Agency for International Development, 1300 Pennsylvania Avenue, Washington, USA.

The burgeoning literature on resilient health systems in low- and middle-income countries (LMICs) provides limited insights into the practice of resilience-building. To address this operational shortcoming, we explore the potential of health ministries to become 'learning organizations' to help foster resilience. We adopted a multi-stage, iterative methodology comprising multiple purposive literature searches, the selection and application of a conceptual framework from the 'learning organizations' literature, and expert opinion to expand on the framework with illustrative examples from LMICs. Read More

Health Policy Plan 2018 Dec 12. Epub 2018 Dec 12.

Institute of Social Research, National Autonomous University of Mexico, Mexico City, Mexico.

This study aimed to describe the foundations for quality of care (QoC) in the Mexican public health sector and identify barriers to quality evaluation and improvement from the perspective of the QoC leaders of the main public health sector institutions: Ministry of Health (MoH), the Mexican Institute of Social Security (IMSS) and the Institute of Social Security of State Workers (ISSSTE). We administered a semi-structured online questionnaire that gathered information on foundations (governance, health workforce, platforms, tools and population), evaluation and improvement activities for QoC; 320 leaders from MoH, IMSS and ISSSTE participated. We used thematic content and descriptive analyses to analyse the data. Read More

Health Policy Plan 2018 Dec 13. Epub 2018 Dec 13.

World Health Organization, Regional Office for the Eastern Mediterranean, Monazamet El Seha El Alamia Street, Extension of Abdel Razak El Sanhouri Street, P.O. Box 7608, Nasr City 11371, Cairo, Egypt.

The excessive use of resources, inefficiency and poor service quality in public hospitals has led developing countries to create reforms in public hospital governance, including autonomization. Hospital autonomy refers to the delegation of administrative rights to the hospital management team. The purpose of the present research is to review different aspects of hospital autonomy reforms in developing countries, such as incentives, preparations, obstacles and facilitators to change prior to implementation, impacts on achieving Universal Health Coverage (UHC) goals, challenges, outcomes and implications for implementation. Read More

Health Policy Plan 2018 Dec 7. Epub 2018 Dec 7.

Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, Tehran, Iran.

Health equity has become a progressively popular research topic in recent years. Therefore, this study was made to identify the contributions made by socioeconomic determinants in order to quantify their roles to healthcare utilization inequity and to show their status especially after the recent reform in Iran, i.e. Read More

Health Policy Plan 2018 Dec 10. Epub 2018 Dec 10.

Department of Reproductive Health and Research, World Health Organisation, 20, Avenue Appia - 1211 Geneva, Switzerland.

Estimation of maternal mortality ratio (MMR) in humanitarian settings ('settings of conflict, displacement and natural disaster') is challenging, particularly where communities have dissolved and geographical areas are inaccessible. During humanitarian events, the reproduction of maternal mortality figures by the media is common, and are often based on inaccurate reports. In light of such uncertainties and challenges, the aim of this article was to review and appraise the methodology and data collection tools used to measure MMR in humanitarian settings. Read More

Health Policy Plan 2018 Dec 4. Epub 2018 Dec 4.

Health Policy Plan 2018 Nov;33(9):1037-1046

Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.

This paper studies the effect on hospital service prices of a health system reform that allows managed selective contracting and regulation as a means for efficiency and price competition. Cross-sectional data about prices and market structure were analysed from a pool of 20 markets which includes 15 million Colombians. A multilevel regression method comparing three different market settings was performed. Read More

Health Policy Plan 2018 Nov 6. Epub 2018 Nov 6.

Royal College of Surgeons in Ireland, Lower Mercer Street, Dublin 2, Ireland.

The lack of access to quality-assured surgery in rural parts of sub-Saharan Africa, where the numbers of trained health workers are often insufficient, presents challenges for national governments. The case for investing in scaling up surgical systems in low-resource settings is 3-fold: the potential beneficial impact on a large proportion of the global burden of disease; better access for rural populations who have the greatest unmet need; and the economic case. The economic losses from untreated surgical conditions far exceed any expenditure that would be required to scale up surgical care. Read More

Health Policy Plan 2018 Nov;33(9):1026-1036

Department of Global Health and Development, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, UK.

The impact of payment-for-performance (P4P) schemes in the health sector has been documented, but there has been little attention to the distributional effects of P4P across health facilities. We examined the distribution of P4P payouts over time and assessed whether increased service coverage due to P4P differed across facilities in Tanzania. We used two service outcomes that improved due to P4P [facility-based deliveries and provision of antimalarials during antenatal care (ANC)], to also assess whether incentive design matters for performance inequalities. Read More

Health Policy Plan 2018 Nov;33(9):1018-1025

Department of Global Health and Population, Harvard University, T. H. Chan School of Public Health, 655 Huntington Ave., Boston, MA, USA.

Similar to many other countries, Chile is facing the challenges of rapid ageing and the increase in long-term care (LTC) needs for this population. Implementation of LTC systems has been the response to these challenges in other countries, however, Chile still lacks a strategy for addressing LTC needs. This article advocates for the implementation of a LTC system in Chile, demonstrating that this could be an effective and efficient response to cope with the current and future challenges faced by the country. Read More

Health Policy Plan 2018 Nov;33(9):1009-1017

National Institute of Public Health, Phnom Penh, Cambodia.

Unnecessary injections increase the risk of blood-borne infections as well as pose an avoidable financial burden on patients. Perceptions in rural Cambodia that medical drug injections provide the best quality medical care have resulted in a large proportion of the population seeking injections across medical conditions. As private providers have a higher propensity to offer injections, patients pursue more expensive care contributing to a greater financial burden. Read More

Health Policy Plan 2018 Oct;33(8):957-965

Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.

The Association of Southeast Asian Nations (ASEAN) Economic Community (AEC) was inaugurated in December 2015 with the primary aim of achieving a strong and prosperous community through accelerating economic integration. The notion of a single market, underpinned by the free flow of trade in services and skilled labour, is integral to the spirit of the AEC. To facilitate the intra-regional mobility of health professionals, Mutual Recognition Arrangements (MRAs) were signed, for nursing in 2006 and for medicine and dentistry in 2009, and now sit within the AEC objectives. Read More

Health Policy Plan 2018 Oct;33(8):898-905

Department of Health Policy and Management, Seoul National University College of Medicine and Institute of Health Policy and Management Seoul National University Medical Research Center, Seoul, Korea.

Although many public hospital physicians in Vietnam offer private service on the side, little is known about the magnitude and nature of the phenomenon so-called dual practice, let alone the dynamics between the public and private health sectors. This study investigates how and to what degree public hospital physicians engage in private practice. It also examines the commitment of dual practitioners to the public sector. Read More

Health Policy Plan 2018 Oct;33(8):948-956

Heidelberg Institute of Global Health (HIGH), Medical Faculty and University Hospital, University of Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, Germany.

User fee reduction and removal policies have been the object of extensive research, but little rigorous evidence exists on their sustained effects in relation to use of delivery care services, and no evidence exists on the effects of partial reduction compared with full removal of user fees. We aimed to fill these knowledge gaps by assessing sustained effects of both partial reduction and complete removal of user fees on utilization of facility-based delivery. Our study took place in four districts in the Sahel region of Burkina Faso, where the national user fee reduction policy (SONU) launched in 2007 (lowering fees at point of use by 80%) co-existed with a user fee removal pilot launched in 2008. Read More

Health Policy Plan 2018 Nov;33(9):999-1008

Department of Health Economics and Outcomes Research, Regeneron Pharmaceuticals, Tarrytown, NY, USA.

In Africa, about 33 000 cases of obstetric fistula occur each year. Women with fistula experience debilitating incontinence of urine and/or faeces and are often socially ostracized. Worldwide, Uganda ranks third among countries with the highest burden of obstetric fistula. Read More

Health Policy Plan 2018 Nov;33(9):975-987

Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolf Street, Baltimore, MA, USA.

Health policy and systems research (HPSR) is vital to guiding global institutions, funders, policymakers, activists and implementers in developing and enacting strategies to achieve the Sustainable Development Goals. We undertook a multi-stage participatory process to identify priority research questions relevant to improving accountability within health systems. We conducted interviews (n = 54) and focus group discussions (n = 2) with policymakers from international and national bodies (ministries of health, other government agencies and technical support institutions) across the WHO regions. Read More

Health Policy Plan 2018 Nov;33(9):988-998

Options Consultancy Services, 3 Lower Thames Street, London, UK.

Supportive supervision is an important element of community health worker (CHW) programmes and is believed to improve CHW motivation and performance. A group supervision intervention, which included training and mentorship of supervisors, was implemented in Ethiopia, Kenya, Malawi and Mozambique. In three of the countries, this was combined with individual and/or peer supervision. Read More

Health Policy Plan 2018 Nov;33(9):1047-1054

The George Institute for Global Health, University of New South Wales, Missenden Rd, Sydney, Australia.

Chronic kidney disease (CKD) is a significant and growing driver of the global non-communicable diseases (NCD) burden, responsible for 1.2 million deaths in 2016. While previous research has estimated the out-of-pocket costs of CKD treatment and resulting levels of catastrophic health expenditures, less is known about the impact of such costs on access to, and maintenance of, care. Read More

Health Policy Plan 2018 Oct;33(8):937-947

Department of Endocrinology, Institute of Geriatric Medicine, Liyuan Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.

Based on the high prevalence and undiagnosed rate of diabetes mellitus in China in recent years, the aim of this work was to evaluate the availability, price and affordability of pharmacotherapy for diabetes in public hospitals in Hubei province, China. In 2016, a cross-sectional survey was conducted using World Health Organization/Health Action International (WHO/HAI) methodology. Information on the availability and prices of 20 antidiabetic drugs was collected from 34 public hospitals representing three levels of care. Read More

Health Policy Plan 2018 Oct;33(8):920-927

School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.

Maternal and child mortality rates remain unacceptably high globally, particularly in sub-Saharan Africa. A popular approach to counter these high rates is interventions delivered using mobile phones (mHealth). However, few mHealth interventions have been implemented nationwide and there has been little evaluation of their effectiveness, particularly at scale. Read More

Health Policy Plan 2018 Oct;33(8):928-936

Centre for Development and the Environment (SUM), University of Oslo, Postboks 1116, Blindern, Oslo, Norway.

The growth of global public-private partnerships for health has opened up new spaces for civil society participation in global health governance. Such participation is often justified by the claim that civil society organizations, because of their independence and links to communities, can help address democratic deficits in global-level decision-making processes. This article examines the notion of 'civil society engagement' within major public-private partnerships for health, where civil society is often said to play a particularly important role in mediating between public and private spheres. Read More

Health Policy Plan 2018 Oct;33(8):906-919

Department of Health Care Management, Faculty of Law and Economics, University of Greifswald, Greifswald, Germany.

Since the end of its internal conflict in 1998, Cambodia has experienced tremendous developments in the social, economic and health sectors, with the government embarking on substantial reforms in health financing. Health equity funds that have improved access to public health services for poor people have gradually been extended to the entire country. Using the World Health Organization's methods for the analysis of healthcare expenditure and household survey data from the 2004, 2009 and 2014 Cambodian Socio-Economic Survey, we assessed trends in reported illness, utilization of healthcare services and associated financial burden on households. Read More

Health Policy Plan 2018 Sep;33(7):801-810

Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.

Health system strengthening (HSS) has often been undertaken by global health actors working through vertical programmes. However, experience has shown the challenges of this approach, and the need to recognize health systems as open complex adaptive systems-which in turn has implications for the design and implementation approach of more 'horizontal' HSS interventions. From 2009 to 2016, the Doris Duke Charitable Foundation supported the African Health Initiative, establishing Population Health Implementation and Training partnerships in five African countries (Ghana, Mozambique, Rwanda, Tanzania and Zambia). Read More

Health Policy Plan 2018 Oct;33(8):888-897

National School of Nursing and Obstetrics, National Autonomous University of México, México City, México.

We assess technical efficiency (TE) level for Mexican Ministry of Health (MoH) primary care units. Assessment was focused on the production of adequate maternal health services defined as the coverage level of women who received timely and frequent antenatal care, and institutional and medical care during childbirth. We conducted a longitudinal analysis of administrative and socio-demographic information concerning 233 health jurisdictions for the period 2008-15. Read More

Health Policy Plan 2018 Oct;33(8):966-973

Department of Economics, University of Pretoria, Private Bag X20, Hatfield, Republic of South Africa.

We present a revised method for estimating equivalence scales. Such scales are used to adjust household welfare to account for the size of the household, and are used extensively in the application of the World Health Organization's (WHO) methodology for the evaluation of catastrophic health payments. Applications of the WHO method are underpinned by early estimates that do not control for household income, and, therefore, are likely to overstate equivalence. Read More

Health Policy Plan 2018 Sep;33(7):870-876

School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

The Government of India launched a nationwide programme to save and educate the girl child, Beti Bachao Beti Padhao (B3P), by stringent prohibition of sex-selective abortion, enforcement of Preconception and Prenatal Diagnostic Technique (PC-PNDT) and Medical Termination of Pregnancy (MTP) Acts, and social mobilization. We undertook this study to assess the effectiveness of intervention in Haryana state to improve sex ratio at birth (SRB). The monthly data on SRB (represented as girls per 1000 boys) were collected from civil registration system for the entire state of Haryana to evaluate the impact of B3P programme. Read More

Health Policy Plan 2018 Sep;33(7):861-869

Department of Economics, University of Manitoba, Winnipeg, Canada.

Ghana introduced a social health insurance scheme in 2003. One of its motivations was to protect consumers against adverse health shocks. Financing for the programme comes from a 2. Read More

Health Policy Plan 2018 Oct;33(8):879-887

Institute of Leadership, Royal College of Surgeons in Ireland, Dublin, Ireland.

Traditional leaders play a prominent role at the community level in Malawi, yet limited research has been undertaken on their role in relation to policy implementation. This article seeks to analyse the role of traditional leaders in implementing national maternal, newborn and child health (MNCH) policy and programmes at the community level. We consider whether the role of the chief embodies a top-down (utilitarian) or bottom-up (empowerment) approach to MNCH policy implementation. Read More

Health Policy Plan 2018 Jul;33(suppl_2):ii5-ii15

University of the Western Cape, Robert Sobukwe Road, Bellville, South Africa.

Maternal mortality remains high in Eastern Cape Province, South Africa, despite over 90% of pregnant women utilizing maternal health services. A recent survey showed wide variation in performance among districts in the province. Heterogeneity was also found at the district level, where maternal health outcomes varied considerably among district hospitals. Read More

Health Policy Plan 2018 Jul;33(suppl_2):ii65-ii74

Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa and.

Strong management and leadership competencies have been identified as critical in enhancing health system performance. While the need for strong health system leadership has been raised, an important undertaking for health policy and systems researchers is to generate lessons about how to support leadership development (LD), particularly within the crisis-prone, resource poor contexts that are characteristic of Low- and Middle-Income health systems. As part of the broader DIALHS (District Innovation and Action Learning for Health Systems Development) collaboration, this article reflects on 5 years of action learning and engagement around leadership and LD within primary healthcare (PHC) services. Read More

Health Policy Plan 2018 Jul;33(suppl_2):ii50-ii64

Division of Health Policy and Systems, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa.

The Oliver Tambo Fellowship Programme is convened by the School of Public Health and Family Medicine, University of Cape Town, South Africa. It is a health leadership training programme with a post-graduate Diploma at its core, supplemented by management seminars, mentorship and alumni networking. An external evaluation was conducted in 2015 for the period since 2008. Read More

Health Policy Plan 2018 Jul;33(suppl_2):ii27-ii34

Health Services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, 197 Lenana Place, Nairobi, Kenya.

Clinical leadership is recognized as a crucial element in health system strengthening and health policy globally yet it has received relatively little attention in low and middle income countries (LMICs). Moreover, analyses of clinical leadership tend to focus on senior-level individual leaders, overlooking a wider constellation of middle-level leaders delivering health care in practice in a way affected by their health care context. Using the theoretical lens of 'distributed leadership', this article examines how middle-level leadership is practised and affected by context in Kenyan county hospitals, providing insights relevant to health care in other LMICs. Read More

Health Policy Plan 2018 Jul;33(suppl_2):ii1-ii4

Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, South Africa.

This editorial provides an overview of the six papers included in this special supplement on health leadership in Africa. Together the papers provide evidence of leadership in public hospital settings and of initiatives to strengthen leadership development. On the one hand, they demonstrate both that current leadership practices often impact negatively on staff motivation and patient care, and that contextual factors underpin poor leadership. Read More

Health Policy Plan 2018 Jul;33(suppl_2):ii35-ii49

School of Public Health and Family Medicine, Anzio Road, Observatory, Cape Town, South Africa.

Leadership capacity needs development and nurturing at all levels for strong health systems governance and improved outcomes. The Doctor of Public Health (DrPH) is a professional, interdisciplinary terminal degree focused on strategic leadership capacity building. The concept is not new and there are several programmes globally-but none within Africa, despite its urgent need for strong strategic leadership in health. Read More

Health Policy Plan 2018 Jul;33(suppl_2):ii16-ii26

Rural Development Sociology Group, Wageningen University, 6700 EW Wageningen, The Netherlands.

Hospital managers' power to exercise effective leadership in daily management can affect quality of care directly as well as through effects on frontline workers' motivation. This paper explores the influence of contextual factors on hospital managers' leadership styles and the motivation of frontline workers providing maternal and new born care in two public district hospitals in Ghana. It draws on data from an ethnographic study that involved participant observation, conversations and in-depth interviews conducted over 20 months, with frontline health workers and managers. Read More

Health Policy Plan 2018 Sep;33(7):840-852

Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, USA.

Regulation is essential to health systems and is central to advancing equity-oriented policy objectives in health. Regulating new medical specialties is an emerging, yet underexplored, aspect of health sector governance in low- and middle-income countries (LMICs), such as India. Limited research exists regarding how regulatory institutions in India decide what specialties should be formally recognized and how training programmes for these specialties should be organized. Read More