Stewardship in health policy and its relevance to Pakistan

Since the concept of stewardship in health care first appeared in World Health Report 2000 there has been very limited discussion in the academia about its implications. In the present paper we revisit this concept and review the literature that has been written about it. We have particularly focused on the role of stewardship in health policy of Pakistan. We also highlight the improvement that stewardship can bring about in the health policy of Pakistan and the possible constraints that might be faced during its implementation phase. The literature available is on the concept of stewardship in health policy. The search was done through the database of PubMed with key words including; stewardship, health policy, governance, and role of state. A total of 22 articles were shortlisted and included in the review. The concept of stewardship has a lot of potential to reinterpret and reinvigorate the role of the state in Public Health of nations across the globe, including Pakistan

Scope of Policy Issues in eHealth: Results From a Structured Literature Review

Background: eHealth is widely used as a tool for improving health care delivery and information. However, distinct policies and strategies are required for its proper implementation and integration at national and international levels. Objective: To determine the scope of policy issues faced by individuals, institutions, or governments in implementing eHealth programs. Methods: We conducted a structured review of both peer-reviewed and gray literature from 1998-2008. A Medline search for peer-reviewed articles found 40 papers focusing on different aspects of eHealth policy. In addition, a Google search found 20 national-and international-level policy papers and documents. We reviewed these articles to extract policy issues and solutions described at different levels of care. Results: The literature search found 99 policy issues related to eHealth. We grouped these issues under the following themes: (1) networked care, (2) interjurisdictional practice, (3) diffusion of eHealth/digital divide, (4) eHealth integration with existing systems, (5) response to new initiatives, (6) goal-setting for eHealth policy, (7) evaluation and research, (8) investment, and (9) ethics in eHealth. Conclusions: We provide a list of policy issues that should be understood and addressed by policy makers at global, jurisdictional, and institutional levels, to facilitate smooth and reliable planning of eHealth programs

Development of the school health education program from the perspective of comprehensive school health model: An example at a higher secondary school of Karachi, Pakistan

Objectives: To assess need for school health program, common health issues, knowledge and attitude towards health, perceived needs of students, teachers and parents. Thereafter apply Comprehensive School Health Model in a higher secondary school of Karachi; and gather outcome of the program through anecdotal evidences from stakeholders.Methods: Baseline assessment was conducted through focus group discussions and individual views from through interactive activities from 250 students; focus group discussions with 35 teachers and administered questionnaires to 16 parents. We thematically analyzed the data. Based on the thematic analysis, assigned school health nurse developed and implemented health education curriculum. We gathered anecdotal evidence from stakeholders to gauge success of the program.Results: The responses of students were more inclined towards physical aspects of health, and those of parents on issues related to mental and social development. Teachers emphasized broad and important aspects of counseling on psychosocial problems of students. After implementation of the curriculum, there were developments like establishment of a cafeteria committee to ensure healthy food availability and extended counseling facilities to help students cope with daily life stressors.Conclusions: The program was successful in terms of executing health promoting initiatives for school children. The framework can act as a reference for other schools in developing countries that share similar needs and want to administer and direct the concept of school health promotion for their students

Healing the schism: medicine and public health in Pakistan.

Background: The relationship between medicine and public health has a long and complex co-evolution. In developing countries where the health needs are greatest and resources are few, this relationship is of critical importance. Development of medicine and public health at the Aga Khan University: This paper provides a case study of the development of the relationship between medical and public health at the Aga Khan University (AKU), a leading educational institution in Pakistan, which was founded with a vision of reuniting medicine and public health. Rapid growth and development have led to successful medicine and public health programs, but have fallen short in creating the synergies needed to address the population health problems of the country.The way forward: In a twenty-five year history of strong growth and development, the AKU has recreated the schism that marked US institutional development in the 20th century, despite strategic consideration to address population health in the design of the University. We recommend the creation of public health schools that focus on leadership to renew an emphasis on unifying health concepts and actions following successful examples to bring medicine and public health together

Quit Smoking for Life-Social Marketing Strategy for Youth: A Case for Pakistan

Smoking is the single most avoidable risk factor for cancers. Majority of smokers know about this fact but it is difficult for them to give it up mainly in the face of widespread smoking advertisements by the tobacco industries. To reduce the prevalence of smoking and its associated cancers, immediate actions are required by public health authorities. Social marketing is an effective strategy to promote healthy attitudes and influence people to make real, sustained health behavior change by transiting through different stages which include precontemplation, contemplation, preparation, action, and maintenance. Social marketing can influence smokers to voluntarily accept, reject, modify, or abandon their smoking behavior. In Pakistan, the smoking prevalence has been increasing, necessitating effective measures. The trend of its usage has been going upwards and, according to the World Health Organization, in Pakistan, the usage of cigarette smoking is increased by 30% compared to 1998 figures. The Pakistan Pediatrics Association has estimated 1,000 to 1,200 school-going children between the ages of 6 and 16 years take up smoking every day. In Pakistan, ex-smokers in the low socioeconomic group reported spending 25% of the total household income on this habit. This paper focuses on the antismoking social marketing strategy in Pakistan with an aim to reduce smoking prevalence, especially among the youth

How we developed a bioethics theme in an undergraduate medical curriculum

The 5-year undergraduate medical curriculum at Aga Khan University integrates basic sciences with clinical and community health sciences. Multimodal strategies of teaching and learning, with an emphasis on problem-based learning, are utilized to equip students with knowledge, skills, behaviours, attitudes and values necessary for a high-calibre medical graduate. Bioethics teaching was introduced in the medical curriculum in 1988 and has since undergone several changes. In 2009, a multidisciplinary voluntary group began review of undergraduate bioethics teaching and invested over 350 man-hours in curricular revision. This involved formulating terminal objectives, delineating specific objectives and identifying instructional methodologies and assessment strategies appropriate for the contents of each objective. Innovative strategies were specially devised to work within the time constraints of the existing medical curriculum and importantly, to increase student interest and engagement. The new bioethics curriculum is designed to be comprehensive and robust, and strives to develop graduates who, in addition to being technically skilled and competent, are well-versed in the history and philosophy of ethics and bioethics and are ethical in their thinking and practice, especially in the context of a developing country like Pakistan where health indicators are among the worst in the region, and clinical practices are not effectively regulated to ensure quality of care

Deliberate self-harm: characteristics of patients presenting to a tertiary care hospital in Karachi, Pakistan.

Introduction: Previous deliberate self-harm (DSH) is the strongest predictor of suicide. Although several studies exist in other countries, characteristics of DSH have not been well-studied in Pakistan. AimS: To identify characteristics of deliberate self-harm in a hospital population, building on previous work carried out on this subject at this center. Methods: 284 cases admitted to the Aga Khan University Hospital, Karachi, between January 1997 and August 2003 were studied by analyzing medical records. Information was collected regarding demographics, family history, personal history, suicidal ideation, current stressors, the act of DSH and its management. Results: The most common age group was 21-25 years of age. The majority were females (60.3%). 95.1% of Patients used self-poisoning as a method of deliberate self-harm. 47.3% used benzodiazepines for self-poisoning. Precipitating factors included conflict with family, marital problems, chronic illnesses, and unemployment. Comorbid psychiatric disorders were present in 76.4% Patients. DISCUSSION: Despite the difference in socio-cultural background of our Patients, many of our results were found to be consistent with Western data. Our findings suggest that problem-solving therapy, stress management and improved mental health care may be effective interventions in preventing DSH. Prescription of medications should be regulated. Further studies are suggested at the community level