Health Research Policy and Systems

Using normalisation process theory (NPT) to explore implementation of the maternal perinatal death surveillance and response (MPDSR) policy in Uganda: a reflection
Walugembe DR, Plamondon K, Kaharuza F, Waiswa P, Wylie L, Wathen N and Kothari A
The implementation of the maternal perinatal death surveillance and response (MPDSR) policy is among the envisaged strategies to reduce the high global burden of maternal and perinatal mortality and morbidity. However, implementation of this policy across various contexts is inconsistent. Theoretically informed approaches to process evaluation can support assessment the implementation of policy interventions such as MPDSR, particularly in understanding what the actors involved actually do. In this article, we reflect on how the normalisation process theory (NPT) was used to explore implementation of the MPDSR policy in Uganda. NPT is a sociological theory concerned with the social organisation of the work (implementation) of making practices routine elements of everyday life (embedding) and of sustaining embedded practices in their social contexts (integration).
Implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana: a mixed methods analysis
Baatiema L, Sanuade OA, Kretchy IA, Okoibhole L, Kushitor SB, Haghparast-Bidgoli H, Awuah RB, Amon S, Mensah SK, Grijalva-Eternod CS, Adjaye-Gbewonyo K, Antwi P, Jennings HM, Arhinful DK, Aikins M, Koram K, Blandford A and Fottrell E
The World Health Organization (WHO) encourages all member states to adopt and implement a package of essential evidence-based interventions called the Best Buys to reduce the burden of non-communicable diseases (NCDs). To date, little is known about the implementation of national policies and interventions for NCD control in the WHO member states in sub-Saharan Africa. Our study aimed to evaluate the implementation of national policies and interventions (WHO Best Buys) for non-communicable disease prevention and control in Ghana.
What are the priorities of consumers and carers regarding measurement for evaluation in mental healthcare? Results from a Q-methodology study
O'Loughlin R, Lambert C, Olsen G, Thwaites K, Saltmarsh K, Anderson J, Devlin N, Hiscock H and Dalziel K
The purpose of this study was to identify and describe common views of people with lived experience of mental health challenges - consumers and carers, families and supporters - of what they consider the most important measures to include in health economic evaluations which assess the incremental value of competing options in mental health care.
Correction: Role and promise of health policy and systems research in integrating rehabilitation into the health systems
Ghafar A, Bachani AM, Hyder AA, Cieza A, Bhangu A, Bussières A, Sanchez-Ramirez DC, Gandhi DBC, Verbunt J, Rasanathan K, Gustafsson L, Côté P, Reebye R, De la Cerna-Luna R, Negrini S, Frontera WR and Kamalakannan S
"All of these things interact, that's why it's such a wicked problem": Stakeholders' perspectives of what hinders low back pain care in Australia and how to improve it
Costa N, Schneider CH, Amorim A, Parambath S and Blyth F
Low-quality care for low back pain (LBP) is pervasive in Australia. Drivers of low-quality care have been identified elsewhere and include misconceptions about LBP, vested interests and limited funding for evidence-based interventions. Yet, the literature that identified such drivers is not specific to the Australian context, and therefore, it is likely to represent only part of the local problem. This study aimed to determine where the most influential drivers of LBP care are in the Australian healthcare system and what could be done to address them.
Real-world data to improve organ and tissue donation policies: lessons learned from the tissue and organ donor epidemiology study
Greenwald MA, Ezzeldin H, Blumberg EA, Whitaker BI and Forshee RA
The transplantation of human organs, and some human tissues, is often the only life-saving therapy available for serious and life-threatening congenital, inherited or acquired diseases. However, it is associated with a risk of transmission of communicable diseases from donor to recipient. It is imperative to understand the characteristics of the donor population (including both potential and actual donors) to inform policies that protect recipient safety. The Tissue and Organ Donor Epidemiology Study (TODES) was a pilot project designed to identify and collect standardized information on deceased persons referred for organ, tissue and/or eye donation, and to estimate (to the extent possible) infectious disease prevalence and incidence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) in this population. TODES is summarized here to shed light on addressable limitations on accessing data needed for transplant recipient safety. Limitations, future research needs and potential pathways to solve the remaining data needs are explored.
Policy impact of the Imperial College COVID-19 Response Team: global perspective and United Kingdom case study
van Elsland SL, O'Hare RM, McCabe R, Laydon DJ, Ferguson NM, Cori A and Christen P
Mathematical models and advanced analytics play an important role in policy decision making and mobilizing action. The Imperial College Coronavirus Disease 2019 (COVID-19) Response Team (ICCRT) provided continuous, timely and robust epidemiological analyses to inform the policy responses of governments and public health agencies around the world. This study aims to quantify the policy impact of ICCRT outputs, and understand which evidence was considered policy-relevant during the COVID-19 pandemic.
The embedded research model: an answer to the research and evaluation needs of community service organizations?
Kavanagh BE, Versace VL and Mc Namara KP
There is an increasing need to provide evidence of outcomes within the community services sector. However, funding challenges, workforce pressures, and the complex social contexts in which community service organizations operate limit their potential for organizational capacity building. This has flow on effects on the ability to conduct impactful and strategic research. The embedded research model (i.e., when a researcher is embedded into a "host" organisation) may aid in building research and evaluation capacity. This may be particularly useful for the purposes of routine outcome monitoring and continuous quality improvement, which may in turn lead to opportunities for local research and evaluation through the embedded research model. Previous research on the embedded research model across various settings has suggested a number of lessons for implementation. However, to date, nil research has focused on community service organizations. Additional considerations need to be made within this context due to resource limitations, ethical issues, and diverse reporting requirements. Such considerations include the need to take a 'slow science' approach to research and evaluation outputs, consideration of the organisation's readiness for change, and the need to report activities in a transparent, thorough, and consistent manner. The endorsement of embedded research in community service organisations may aid in providing evidence of outcomes for clients, and simultaneously, increase the ability for policymakers to evidence-informed decisions on how to improve outcomes for the local population.
Correction: Building Health Policy and Systems Research (HPSR) capacity in India: reflections from the India HPSR fellowship program (2020-2023)
John S, Ramani S, Abbas SM, Kane S, Lall D, Srinivas PN, Nambiar D, Marchal B, Van Belle S, Sadanandan R and Devadasan N
Transition and change: opportunities and challenges of CHW programme reform for community health systems and vertical disease programmes in Liberia
Zawolo G, Nyaaba GN, Nallo G, Kollie K, Thomson R, Raven J, Theobald S and Dean L
Globally, community health worker (CHW) programmes are critical to addressing health worker shortages and have been recognised as critical pillars within the drive towards universal health coverage (UHC). In 2016, the Liberian Ministry of Health launched the National Community Health Services Policy 2016-2021, which included significant CHW programme reform to address ongoing health workforce capacity gaps in the country. However, little consideration was given to the impact of such reforms on ongoing health interventions that rely heavily on the use of CHW cadres. Our study explores how CHW programme reform in Liberia influenced performance of CHWs involved in the delivery of Neglected Tropical Disease (NTD) programmes to elucidate how health systems reform can impact the delivery of routine health interventions and vice versa.
Role and promise of health policy and systems research in integrating rehabilitation into the health systems
Ghaffar A, Bachani AM, Hyder AA, Cieza A, Bhangu A, Bussières A, Sanchez-Ramirez DC, Gandhi DBC, Verbunt J, Rasanathan K, Gustafsson L, Côté P, Reebye R, De la Cerna-Luna R, Negrini S, Frontera WR and Kamalakannan S
Despite recognized need and reasonable demand, health systems and rehabilitation communities keep working in silos, independently with minimal recognition to the issues of those who require rehabilitation services. Consolidated effort by health systems and rehabilitation parties, recognizing the value, power and promise of each other, is a need of the hour to address this growing issue of public health importance. In this paper, the importance and the need for integration of rehabilitation into health system is emphasized. The efforts being made to integrate rehabilitation into health systems and the potential challenges in integration of these efforts were discussed. Finally, the strategies and benefits of integrating rehabilitation in health systems worldwide is proposed. Health policy and systems research (HPSR) brings a number of assets that may assist in addressing the obstacles discussed above to universal coverage of rehabilitation. It seeks to understand and improve how societies organize themselves to achieve collective health goals; considers links between health systems and social determinants of health; and how different actors interact in policy and implementation processes. This multidisciplinary lens is essential for evidence and learning that might overcome the obstacles to the provision of rehabilitation services, including integration into health systems. Health systems around the world can no longer afford to ignore rehabilitation needs of their populations and the World Health Assembly (WHA) resolution marked a global call to this effect. Therefore, national governments and global health community must invest in setting a priority research agenda and promote the integration of rehabilitation into health systems. The context-specific, need-based and policy-relevant knowledge about this must be made available globally, especially in low- and middle-income countries. This could help integrate and implement rehabilitation in health systems of countries worldwide and also help achieve the targets of Rehabilitation 2030, universal health coverage and Sustainable Development Goals.
Why "free maternal healthcare" is not entirely free in Ghana: a qualitative exploration of the role of street-level bureaucratic power
Alatinga KA, Hsu V, Abiiro GA, Kanmiki EW, Gyan EK and Moyer CA
Ghana introduced a free maternal healthcare policy within its National Health Insurance Scheme (NHIS) in 2008 to remove financial barriers to accessing maternal health services. Despite this policy, evidence suggests that women incur substantial out-of-pocket (OOP) payments for maternal health care. This study explores the underlying reasons for these persistent out-of-pocket payments within the context of Ghana's free maternal healthcare policy.
Development and psychometric validation of an age-friendly health system assessment tool in the Iranian context
Karami B, Tajvar M, Ostadtaghizadeh A and Yaseri M
Evaluating health system interventions for elderly care necessitates a context-specific, credible and dependable instrument. This research was dedicated to creating and validating a tool to assess the health system's age-friendliness. The study unfolded in two pivotal stages: the generation of items utilizing a hybrid model and the psychometric appraisal of the tool, encompassing both validity and reliability assessments. From an initial pool of 522 items derived from a systematic scoping review and qualitative analysis, a concise assessment tool emerged, featuring 52 items across 6 domains: governance, information, resources, service delivery, community engagement and outcomes. The 52-item tool offers a straightforward, substantiated and robust means to gauge age-friendliness, pinpoint health system deficiencies and facilitate strategic planning on the basis of its insights.
Understanding healthcare professionals' responses to patient complaints in secondary and tertiary care in the UK: A systematic review and behavioural analysis using the Theoretical Domains Framework
Antonopoulou V, Meyer C, Chadwick P, Gibson B, Sniehotta FF, Vlaev I, Vassova A, Goffe L, Lorencatto F, McKinlay A and Chater AM
The path of a complaint and patient satisfaction with complaint resolution is often dependent on the responses of healthcare professionals (HCPs). It is therefore important to understand the influences shaping HCP behaviour. This systematic review aimed to (1) identify the key actors, behaviours and factors influencing HCPs' responses to complaints, and (2) apply behavioural science frameworks to classify these influences and provide recommendations for more effective complaints handling behaviours.
Future health technology trends, policy, and governance perspective: the Turkish case
Kambur ES and Yıldırım HH
Advanced health technologies that emerge with the development of technology have an impact on health systems. This study aimed to determine the effects of these technologies on Türkiye's health system and present policy recommendations to reshape Türkiye's health system and policies accordingly.
Working in a relational way is everything: Perceptions of power and value in a drug policy-making network
Zakimi N, Bouchard M, Ritter A and Greer A
The development of drug policies has been a major focus for policy-makers across North America in light of the ongoing public health emergency caused by the overdose crisis. In this context, the current study examined stakeholders' experiences and perceptions of power and value in a drug policy-making process in a North American city using qualitative, questionnaire, and social network data.
Navigating the complexity of a collaborative, system-wide public health programme: learning from a longitudinal qualitative evaluation of the ActEarly City Collaboratory
Nixon L, Sheard L, Sheringham J, Creaser A, Iqbal H, Gansallo P, Mansukoski L, Bryant M and Lockyer B
Addressing the upstream social determinants of health (e.g. built environment, education) can reduce the burden of non-communicable diseases. To do so effectively often requires system-wide collaboration. However, collaborating across multiple sectors, organizations and disciplines within a complex system can be challenging. ActEarly was a public health research consortium that aimed to improve child health by building an interdisciplinary, cross-city partnership to develop and/or evaluate upstream interventions, increase research capacity and improve collaboration between researchers, local authorities and communities. This paper explores ActEarly's experiences of navigating complexity to identify mechanisms that supported its implementation and proposes recommendations for future intersectoral and interdisciplinary population health research collaborations.
Bridging the gap: financing health promotion and disease prevention in Indonesia
Fuady A, Anindhita M, Haniifah M, Ahsan A, Sugiharto A, Haya MAN, Pakasi T, Kusuma D, Solikha DA, Ali PB and Widyahening IS
Spending on preventive care in low- and middle-income countries (LMICs), including Indonesia, is much lower than spending on curative care. There has been a pressing need to develop a clear pathway to increase spending on preventive care. This study aimed to assess the current financing landscape for health promotion and disease prevention in Indonesia and, subsequently, to develop a framework and recommendations for future health promotion financing in the country.
Data protection legislation in Africa and pathways for enhancing compliance in big data health research
Munung NS, Staunton C, Mazibuko O, Wall PJ and Wonkam A
The increasing availability of large volumes of personal data from diverse sources such as electronic health records, research programmes, commercial genetic testing, national health surveys and wearable devices presents significant opportunities for advancing public health, disease surveillance, personalized medicine and scientific research and innovation. However, this potential is hampered by a lack of clarity related to the processing and sharing of personal health data, particularly across varying national regulatory frameworks. This often leaves researcher stakeholders uncertain about how to navigate issues around secondary data use, repurposing data for different research objectives and cross-border data sharing.
Topic identification and content analysis of internet medical policies under the background of Healthy China 2030
Wu G, Ning H, Yuan Y, Chen J, Li G, Liu S and Wang Z
This study aims to analyse the content of internet medical policies, grasp the inherent laws of the development of internet medical policies and provide references for improving the policy system.
Essential core competencies for health policy graduates: a multi-method consensus type study
Doshmangir L, Alipouri Sakha M, Mostafavi H, Kabiri N, Ghaffarifar S and Takian A
In light of the multi-faceted challenges confronting health systems worldwide and the imperative to advance towards development goals, the contribution of health policy graduates is of paramount importance, facilitating the attainment of health and well-being objectives. This paper delineates a set of core skills and competencies that are requisite for health policy graduates, with the objective of preparing these graduates for a spectrum of future roles, including both academic and non-academic positions.