Institutionalizing Information Systems for Universal Health Coverage in Primary Healthcare and the Need for New Forms of Institutional Work

Today, many countries around the world focus on ensuring that all people can access health services of sufficient quality without experiencing financial hardship (i.e., universal health coverage). To measure progress towards this goal, countries need to build robust health information systems. Because countries need to root universal health coverage in primary healthcare, they also needs to sensitively anchor health information systems that support universal health coverage in existing routine health information systems. However, doing so involves significant challenges, which we study via empirically analyzing an Indian state\u27s effort to implement a universal health coverage health information system in primary healthcare. Using a theoretical lens informed by institutional theory, we seek to answer the question: “What is required to develop institutions that support the use of new technologies and associated work processes that universal health coverage entails?”. We identify the contradictions that emerge when new systems clash with existing ones, and we discuss what implications such contradictions have in terms of system design, work processes, and institutions. We contribute to the literature by explaining inherent complexities in universal health coverage health information system design and implementation and providing system design guidelines

Patterns of Public Participation: Opportunity Structures and Mobilization from a Cross-National Perspective

PURPOSE: The paper summarizes data from twelve countries, chosen to exhibit wide variation, on the role and place of public participation in the setting of priorities. It seeks to exhibit cross-national patterns in respect of public participation, linking those differences to institutional features of the countries concerned. DESIGN/METHODOLOGY/APPROACH: The approach is an example of case-orientated qualitative assessment of participation practices. It derives its data from the presentation of country case studies by experts on each system. The country cases are located within the historical development of democracy in each country. FINDINGS: Patterns of participation are widely variable. Participation that is effective through routinized institutional processes appears to be inversely related to contestatory participation that uses political mobilization to challenge the legitimacy of the priority setting process. No system has resolved the conceptual ambiguities that are implicit in the idea of public participation. ORIGINALITY/VALUE: The paper draws on a unique collection of country case studies in participatory practice in prioritization, supplementing existing published sources. In showing that contestatory participation plays an important role in a sub-set of these countries it makes an important contribution to the field because it broadens the debate about public participation in priority setting beyond the use of minipublics and the observation of public representatives on decision-making bodies

Universal Healthcare Coverage and the Future of Healthcare in Kosovo

The aim of this Honors project paper is to identify and analyze policy issues that will affect the health sector in Kosovo once universal health coverage scheme is implemented. More specifically, the study will focus on three pillars of the health sector, namely health institutions, medical personnel and citizens. Besides assessing changes on the pillars of the health sector, this study aims at evaluating the receptiveness of stakeholders to this policy issue, more specifically the citizens’ perspective on the implementation of universal health coverage in Kosovo. This study is based on a combination of qualitative research methods—primary and secondary research. The research methodology is encompassed the coupling of literature review, large-scale survey and semi-structured interviews

Patterns of public participation: opportunity structures and mobilization from a cross-national perspective

Purpose: The paper summarizes data from twelve countries, chosen to exhibit wide variation, on the role and place of public participation in the setting of priorities. It seeks to exhibit cross-national patterns in respect of public participation, linking those differences to institutional features of the countries concerned. Design/methodology/approach: The approach is an example of case-orientated qualitative assessment of participation practices. It derives its data from the presentation of country case studies by experts on each system. The country cases are located within the historical development of democracy in each country. Findings: Patterns of participation are widely variable. Participation that is effective through routinized institutional processes appears to be inversely related to contestatory participation that uses political mobilization to challenge the legitimacy of the priority setting process. No system has resolved the conceptual ambiguities that are implicit in the idea of public participation. Originality/value: The paper draws on a unique collection of country case studies in participatory practice in prioritization, supplementing existing published sources. In showing that contestatory participation plays an important role in a sub-set of these countries it makes an important contribution to the field because it broadens the debate about public participation in priority setting beyond the use of minipublics and the observation of public representatives on decision-making bodies

State Capacity and Non-state Service Provision in Fragile and Conflict-affected States

How can governments effectively engage with non-state providers (NSPs) of basic services where capacity is weak? This paper examines whether and how fragile and conflict affected states can co-ordinate, finance, and set and apply standards for the provision of basic services by NSPs. It explores ways of incrementally engaging the state, beginning with activities that are least likely to do harm to non-state provision. Through the ‘indirect’ roles of setting the policy environment and engaging in policy dialogue, regulating and facilitating, contracting, and entering into mutual and informal agreements with NSPs, the state can in principle assume responsibility for the provision of basic services without necessarily being involved in direct provision. But government capacity to perform these roles is constrained by the state’s weak legitimacy, coverage and competence, lack of basic information about the non-state sector, and lack of basic organisational capacity to form and maintain relationships with NSPs. The experience of the exercise of the indirect roles in fragile settings suggests: * Governments may be more willing to engage with NSPs where there is recognition that government cannot alone deliver all services, where public and private services are not in competition, and where there is evidence that successful collaboration is possible (demonstrated through small-scale pilots). * The extent to which engagements are ‘pro-service’may be influenced by government motives for engagement and the extent to which the providers that are most important to poor people are engaged. * Formal policy dialogue between government and NSPs may be imperfect, unrepresentative and at times unhelpful in fragile settings. Informal dialogue - at the operational level - could more likely be where synergies can be found. * Regulation is more likely to be ‘pro-service’ where it offers incentives for compliance, and where it focuses on standards in terms of outputs and outcomes rather than inputs and entry controls. * Wide scale, performance-based contracting has been successful in delivering services in some cases, but the sustainability of this approach is often questioned. Some successful contractual agreements have a strong informal, relational element and grow out of earlier informal connections. * Informal and mutual agreements can avoid the capacity problems and tensions implicit in formal contracting but may present problems of non-transparency and exclusion of competition. Paradoxically, the need for large-scale approaches and quick co-ordination of services in fragile and conflict-affected settings may require ‘prematurely high’ levels of state-NSP engagement, before the development of the underlying institutional structures that would support them. When considering strategies to support the capacity of government to engagement with NSPs, donors should: * Recognise non-state service provision and adopt the ‘do no harm’ principle: It would be wrong to set the ambition of 'managing ‘ non-state provision in its entirety, and it can be very harmful for low-capacity states to seek to regulate all NSP or to draw it into clumsy contracts. * Beware of generalisation: Non-state provision takes many forms in response to different histories and to political and economic change. The possibilities and case for state engagement have to be assessed not assumed. The particular identities of NGOs and enterprises should be considered. * Recognise that state building can occur through any of the types of engagement with NSPs: Types of engagement should therefore be selected on the basis of their likely effectiveness in improving service delivery. * Begin with less risky/small scale forms of engagement where possible: State interventions that imply a direct controlling role for the state and which impose obligations on NSPs (i.e. contracting and regulation) require greater capacity (on both sides) and present greater risk of harm if performed badly than the roles of policy dialogue and entering into mutual agreements. * Adopt mixed approaches: The choice between forms of engagement does not have to be absolute. Rather than adopting a uniform plan of engagement in a particular country, it may be better to try different approaches in different regions or sectors

The Development of Long-Term Care in Post-Socialist Member States of the EU

Long-term care (LTC) in the new EU member states, which used to belong to the former socialist countries, is not yet a legally separated sector of social security. However, the ageing dynamics are more intensive in these states than in the old EU member states. This paper analyses the process of creating an LTC sector in the context of institutional reforms of social protection systems during the transition period. The authors explain LTC’s position straddling the health and social sectors, the underdevelopment of formal LTC, and the current policies regarding the risk of LTC dependency. The paper is based mainly on the analysis of information provided by country experts in the ANCIEN project

The Processual Ordering of Mental Health Care: The Dramaturgical Styles of Contending Political Factions

The processual ordering branch of symbolic interaction has long recognized the importance of rhetoric and power to the social constitution of reality. However, little systematic effort has been devoted to probing their intertwined effects in the public policy arena. The purpose of this paper is to employ the processual ordering perspective to examine the dramaturgical styles used in shaping public policy -- expressed in terms of the “public administration” and “realpolitik” forms of rhetoric -- among contending political factions as they negotiate mental health public policy. A latent content analysis of the minutes of key U.S. Congressional debates, augmented with secondary archival material from the press is employed. It is concluded that both forms of rhetoric play a role in shaping public mental health policy and that both factions modify their rhetorical form as the debate progresses. Those modifications strengthen the position of one faction while weakening that of the other. Theoretical implications are discussed

Identification of publicly available data sources to inform the conduct of Health Technology Assessment in India

Background: Health technology assessment (HTA) provides a globally-accepted and structured approach to synthesising evidence for cost and clinical effectiveness alongside ethical and equity considerations to inform evidence-based priorities. India is one of the most recent countries to formally commit to institutionalising HTA as an integral component of the heath resource allocation decision-making process. The effective conduct of HTA depends on the availability of reliable data. Methods: We draw from our experience of collecting, synthesizing, and analysing health-related datasets in India and internationally, to highlight the complex requirements for undertaking HTA, and explore the availability of such data in India. We first outlined each of the core data components required for the conduct of HTA, and their availability in India, drawing attention to where data can be accessed, and different ways in which researchers can overcome the challenges of missing or low quality data. Results: We grouped data into the following categories: clinical efficacy; cost; epidemiology; quality of life; service use/consumption; and equity. We identified numerous large local data sources containing epidemiological information. There was a marked absence of other locally-collected data necessary for informing HTA, particularly data relating to cost, service use, and quality of life. Conclusions: The introduction of HTA into the health policy space in India provides an opportunity to comprehensively assess the availability and quality of health data capture across the country. While epidemiological information is routinely collected across India, other data inputs necessary for HTA are not readily available. This poses a significant bottleneck to the efficient generation and deployment of HTA into the health decision space. Overcoming these data gaps by strengthening the routine collection of comprehensive and verifiable health data will have important implications not only for embedding economic analyses into the priority setting process, but for strengthening the health system as a whole

Accelerating learning for pro-poor health markets

CommentaryBackground: Given the rapid evolution of health markets, learning is key to promoting the identification and uptake of health market policies and practices that better serve the needs of the poor. However there are significant challenges to learning about health markets. We discuss the different forms that learning takes, from the development of codified scientific knowledge, through to experience-based learning, all in relationship to health markets. Discussion: Notable challenges to learning in health markets include the difficulty of acquiring data from private health care providers, designing evaluations that capture the complex dynamics present within health markets and developing communities of practice that encompass the diverse actors present within health markets, and building trust and mutual understanding across these groups. The paper proposes experimentation with country-specific market data platforms that can integrate relevant evidence from different data sources, and simultaneously exploring strategies to secure better information on private providers and health markets. Possible approaches to adapting evaluation designs so that they are better able to take account of different and changing contexts as well as producing real time findings are discussed. Finally capturing informal knowledge about health markets is key. Communities of practice that bridge different health market actors can help to share such experience-based knowledge and in so doing, may help to formalize it. More geographically-focused communities of practice are needed, and such communities may be supported by innovation brokers and/or be built around member-based organizations. Summary: Strategic investments in and support to learning about health markets can address some of the challenges experienced to-date, and accelerate learning that supports health markets that serve the poor.DFI

Sustainability of healthcare financing in the Western Balkans : an overview of progress and challenges

This paper explores the major challenges to the sustainability of health sector financing in the countries of the Western Balkans - Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia and the province of Kosovo. It focuses on how the incentives created by the different elements of the healthcare financing system affect the behavior of healthcare providers and individuals, and the resulting inefficiencies in revenue collection and expenditure containment. The paper analyzes patterns of healthcare expenditure, finding that there is some evidence of cost containment, but that current expenditure levels - while similar to that in EU countries as a share of GDP - are low in per capita terms and the fiscal space to increase expenditures is extremely limited. It also examines the key drivers of current healthcare expenditure and the most significant barriers to revenue generation, identifying some key health reforms that countries in the sub-region could consider in order to enhance the efficiency and sustainability of their health systems. Data are drawn from international databases, country institutions, and household surveys.Health Monitoring&Evaluation,Health Economics&Finance,Health Systems Development&Reform,Public Sector Expenditure Analysis&Management,Health Law