Exploring perceptions of community health policy in Kenya and identifying implications for policy change

BACKGROUND:

Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change.

METHODS:

We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before ...

Engaging youth in communities: a framework for promoting adolescent and community health

Health researchers and practitioners increasingly recognise the important role communities play in shaping individual health. Health researchers recognise the role of community factors as causes or determinants of health problems; use community-based methods for understanding complex health issues; and design community-level health solutions. In this commentary, we propose a fourth way to think about the role of communities in individual health by arguing that the community engagement process itself has implications for individual health and strong communities. This topic is especially important during adolescence, a developmental window of opportunity during which individuals need meaningful opportunities to contribute to the world around them.

4th International Conference on Evidence-based Policy in Long-term Care

The 4th International Conference on Evidence-based Policy in Long-term Care will be held from 4th to 7th of September 2016 at the London School of Economics and Political Science, London. Building on the success of the three previous editions, the conference will focus on empirical research with direct relevance to long-term care policy offering an opportunity to debate with international experts policy issues related to the organisation, delivery, funding and regulation of long-term care services.

Some of the main thematic areas to be covered include: care models; case management; economics of long-term care; equity and efficiency; funding systems; health and social care integration; housing and care; institutional dynamics and politics; international comparative analysis; local vs. central policy interactions; personalisation of the care system; policy implications of dementia; service commissioning and regulation; technology and long-term care; unpaid carers; workforce and migrant workers. Abstracts on other relevant LTC policy evaluation topics will ...

How to place citizen's perspective in the centre of public policies.

Placing people in the centre of health system’s design needs to understand what are the people’s perspectives about public policies and what public policies would people prefer. Frequently, public policies aiming to introduce big changes in health systems fail at getting a high acceptance by the citizens.

In this post, published in The Impact Blogs, hosted by the London School of Economics, it is described a framework which aims to align the perspectives of policymakers and citizens, and proposes two mains ways to get to a confluence between these two stakeholders: adjusting the policy frame or trying to influence on citizens’ frame.

The authors of this article applied this framework to a couple of policies, related to support for victims and confidence in the judiciary.

Diversity Conceptual Model for aged care: Person-centred and difference-oriented and connective with a focus on benefit, disadvantage and equity

AIM:

This project aimed to develop a Diversity Conceptual Model to support the aged care sector to identify diversity characteristics and associated benefits and disadvantages in order to consider greater equity in policy and practice.

METHODS:

A multi-method approach was used to develop the Diversity Conceptual Model using a literature review, organisation-wide consultation using a questionnaire, focus groups and interviews with key stakeholders.

RESULTS:

A Diversity Conceptual Model was developed as a visual 'tool', made up of numerous components, with a focus on diversity characteristics that may be creating benefits and disadvantages for a consumer to participate in their health care. Continuous quality improvements and equity are presented as essential overarching components of the Model.

CONCLUSION:

The Diversity Conceptual Model has many potential applications for aged care. The author proposes that its wider adoption would increase confidence, skills and knowledge, enabling the aged care sector to influence greater equity in ...

Developing care for a changing population: Supporting patients with costly, complex needs

Patients with multiple chronic conditions are a challenge for health care organization. In this report, it is offered a review of the most recent evidence regarding new models of care, and they are summarized in 10 points: (I) There are no specific ‘European’ answers to the problem of high cost/complexity, but a growing body of policy-relevant evidence is emerging, (II) Multifaceted interventions seem to work best for complex problems , (III) Identifying who is at risk of complexity is a crucial first step , (IV) The needs of patients identified as ‘complex’ are likely to vary considerably , (V) Good outcomes for complex patients need to be rooted in patient preferences and are likely to include non-medical goals, (VI) Interventions may not reduce high costs, at least in the short term, (VII) Chronic care models may not be fit for purpose for complex patients, (VIII) Although highly relevant, the implications for the ...

Strategies To Empower Communities To Reduce Health Disparities

Community-based participatory research is a promising approach to reducing health disparities. It empowers individuals and communities to become the major players in solving their own health problems. We discuss the use of community-based participatory research and other strategies to enhance empowerment. We also discuss projects from the Centers for Population Health and Health Disparities that have empowered communities to achieve positive health outcomes aimed at reducing disparities. We offer recommendations to policy makers for involving residents in efforts to achieve health equity.

Meet Integrated Care Pioneers in Edinburgh, Manchester and Wrexham!

Study tours offer a unique opportunity to meet integrated care pioneers in their natural environment and to experience and learn about integrated care practices from national and regional innovations. They are designed to support clinicians, managers and policy-makers with an interest and responsibility in the successful adoption of integrated care in policy and practice. Designed to be live case studies, the study visits offer the possibility to discuss regional and country-level strategies with the responsible decision makers, assess the barriers, facilitators and key drivers for integrated care at a regional and local level and reflect upon the transferability of lessons learned in moderated discussions and workshops.

The ICIC17 Three Country Study Tour will visit Scotland, England and Wales and seeks to examine the leadership and management of integrated care in these regions. Sessions will focus on the development of new models and approaches to care for older people with complex ...

Integrated Diabetes Care: A Multidisciplinary Approach

Integrated care is an approach that seeks to improve the quality of care for people with diabetes by ensuring that services are well coordinated around their needs. Healthcare professionals, people with diabetes and the system must be aligned to support improvement both in the delivery of care and in achieving better outcomes for people with diabetes.

Translating the Elements of Health Governance for Integrated Care from Theory to Practice: A Case Study Approach

Against a paucity of evidence, a model describing elements of health governance best suited to achieving integrated care internationally was developed. The aim of this study was to explore how health meso-level organizations used, or planned to use, the governance elements. 

How Do We Evaluate Health in All Policies?; Comment on “Developing a Framework for a Program Theory-Based Approach to Evaluating Policy Processes and Outcomes: Health in All Policies in South Australia”

It is well-established that population health is influenced by a multitude of factors, many of which lie outside the scope of the health sector. In the public health literature it is often assumed that intersectoral engagement with nonhealth sectors will be instrumental in addressing these social determinants of health. Due to the expected desirable outcomes in population health, several countries have introduced Health in All Policies (HiAP). However, whether this systematic, top-down approach to whole-of-government action (which HiAP entails) is efficient in changing government policies remains unclear. A systematic evaluation of HiAP is therefore much needed

Using concept mapping to identify policy options and interventions towards people- centred health care services: a multi stakeholders perspective

People-centred health care (PCC) services are identified by the WHO as important building blocks towards universal health coverage. In 2016 the WHO formulated a comprehensive framework on integrated PCC services based on an international expert consultation. Yet, expert opinions may fail to recognize the needs of all health system stakeholders. Therefore, a consultation method that includes the health workforce and laypersons, can be instrumental to elaborate this framework more in-depth. This research sought to identify participants’ perspectives on policy options and interventions to achieve people-centred health care services from a multi stakeholder perspective.

Multi-Criteria Decision Analysis of Integrated Care Webinar – SELFIE Project

Professionals are increasingly keen to assess the effects of integrated care initiatives and payers and policy makers are keen to ensure that they allocate scarce resources only to services that have proven value for money. When evaluating the added value of complex interventions such as integrated care initiatives, we need to adopt a broad, inclusive method of evaluation and a holistic, person-centered understanding of ‘value’. This is possible with Multi-Criteria Decision Analysis (MCDA). MCDA is a method to improve transparency of decision-making that makes the impact that multiple criteria have on a decision, and their relative importance explicit. It is particularly suited for interventions where multiple, sometimes conflicting, criteria play a role, and the viewpoints of multiple stakeholders about the importance of decision-criteria need to be taken into account. In this webinar prof.dr. Maureen Rutten-van Mölken of the Erasmus School of Health Policy and Management of the Erasmus ...

The development and reform of public health in China from 1949 to 2019

Public health system plays a vital role in the development of health sector in China and protects the health of Chinese people. However, there are few comprehensive reviews and studies focusing on its evolution and reform. It is worthwhile to pay attention to the public health development in China, given that the history and structure of public health system have their own characteristics in China.

The study is a retrospective review of the development public health over seven decades in China. It presents the findings from some national or provincial survey data, interviews with key informants, reviews of relevant published papers and policy contents

Government leadership that supports community-lead integrated care: An analysis of advances and missteps

Integrated care that substantively impacts population health as well as provides quality care requires buy-in, engagement and commitment over time by a plethora of  government and community groups. There is considerable evidence of the complexity of care models that work such that long term commitment is required to truly impact health. These days, beyond work opportunities, most municipal government and community leaders realise that good quality health services are critical to retaining and recruiting residents, especially noteworthy as an issue in rural communities.  How do places manage bottom-up, top-down tensions as politics and control issues intervene across differrent levels of government? What sort of governmental leadership inspires community engagement versus chronic frustration?

Partnership and accountability in the era of integrated care: a tale from England

In England, the 2012 Health and Social Care Act was heralded to be among the most significant changes in policy for the National Health Service (NHS) since its inception in 1948. Yet a key theme of the policy, namely the intensification of competition in service provision, has not fully materialised.
The 2014 Five Year Forward View outlined visions for a more integrated health and care system in England. Subsequent guidance introduced new organisational forms, such as the so-called Sustainability and Transformation Plans and integrated care systems

Are patients ready for integrated person-centered care? A qualitative study of people with epilepsy in Ireland

The National Clinical Programme for Epilepsy (NCPE) in Ireland aims to deliver a holistic model of integrated person-centered care (PCC) that addresses the full spectrum of biomedical and psychosocial needs of people with epilepsy (PwE). However, like all strategic plans, the model encompasses an inherent set of assumptions about the readiness of the environment to implement and sustain the actions required to realize its goals. In this study, through the lens of PwE, the Irish epilepsy care setting was explored to understand its capacity to adopt a new paradigm of integrated PCC.  

Ten lessons for integrated care research and policy - a personal reflection

In January 2019, the University of Birmingham hosted a one-day workshop organised by the Journal of Integrated Care and the Integrated Care Researcher Network. As previous editors of the journal, it was a very proud moment to host such an event, with an audience that felt very much like a “Who’s Who” of the UK integrated care research and policy over at least the last 10 years. With the current editor organising and chairing the event itself, we were privileged to be there solely as participants – and this gave us the opportunity to reflect on the key lessons that we would take away from the workshop (and from all our years writing for and editing the journal, providing advice to government and supporting local integrated care initiatives). These are just personal reflections, but we were struck by how clear and consistent many of the key themes were across different ...

Integrated Health and Social Care in England: Ten Years On

As part of major policy reforms begun in 2010, England introduced a wave of initiatives to encourage more integrated care between health and social care. These built on previous attempts which sought to achieve similar objectives through a focus on better partnership working. This article provides an overview and critical commentary on integrated care policy in England from 2010–2020. The experience of England suggests that greatest progress is made when integrated care focusses on tangible issues and when there is a clear understanding of how success will be measured. 

Values Underpinning Integrated, People-Centred Health Services: Similarities and Differences among Actor Groups Across Europe

In addition to the functional aspects of healthcare integration, an understanding of its normative aspects is needed. This study explores the importance of values underpinning integrated, people-centred health services, and examines similarities and differences among the values prioritised by actors across Europe.

Health and Social Care Reform in Scotland – What Next?

This paper analyses the important enablers, barriers and impacts of country-wide implementation of integrated health and social care in Scotland. It offers insights for other systems seeking to advance similar policy and practice. Landmark legislation was based on a shared vision and narrative about improving outcomes for people and communities. Implementation has involved coordination of multiple policies and interventions for different life stages, care groups, care settings and local context within a dynamic and complex system.

Why Bhutan needs a policy push on person-centred care

Delivering quality healthcare services to people has become a core issue for the Bhutanese healthcare system. There are considerable challenges for healthcare policymakers to recognise and implement an appropriate healthcare model to enhance quality healthcare services in the Bhutanese healthcare system. Actions to improve quality healthcare services in Bhutan requires careful analysis of the healthcare model in the context of the Bhutanese socio-political and healthcare environment. This article provides a brief concept analysis of person-centred care in the context of the Bhutanese socio-political and healthcare environment and describes why it is important to integrate person-centred care into the healthcare system. The article argues that person-centred care is important and relevant to the Bhutanese healthcare system to achieve quality healthcare services and Gross National Happiness.