Retrospective Policy Analysis of Tobacco Prevention and Control in Ethiopia

BACKGROUND: The trend of non-communicable diseases is alarmingly increasing and tobacco consumption and exposure to its smoke have been playing the leading role. Thirty-seven Ethiopians deaths per day are attributable to tobacco. Unless appropriately mitigated, this has social, economic and political impacts. Implementation of the appropriate policy is a good remedy; however, the policy process has never been straight forward and always successful. The involvement of different actors makes policy process complex hence agenda setting, policy formulation, implementation, and evaluations have been full of chaos and even may fail at any of these levels. Thus the aim of this review was retrospectively analyzing tobacco-related policies in Ethiopia that are relevant to control tobacco use and mitigate its impacts.METHODS: Systematically, we searched in pub-med, Scopus, Web of Science and Embase. Additionally, we did hand search on Google scholar and national websites. The terms "tobacco","cigar", "cigarette", "control", "prevention", "policy" and"Ethiopia" were used. Eleven of 128 records met the inclusion criteria and then included. For data analysis, we applied the health policy analysis framework developed by Walt and Gilson.RESULT: Lately, Ethiopia enacted and started to implement tobacco control policies and programs, but its implementation is problematic and consumption rate is increasing.CONCLUSION: Despite the early involvement in tobacco control initiatives and enactment of legal frameworks, Ethiopia's journey and current stand to prevent and control the devastating consequences of tobacco is very limited and unsatisfactory. Therefore, we strongly call for further action, strong involvement of private sector and non-governmental organizations

Influence of organizational culture on provider adherence to the diabetic clinical practice guideline: using the competing values framework in Palestinian Primary Healthcare …

Background Diabetes mellitus (DM) is a serious chronic disease and an important public health issue. This study aimed to identify the predominant culture within the Palestinian Primary Healthcare Centers of the Ministry of Health (PHC-MoH) and the Primary Healthcare Centers of the United Nations Relief and Works Agency for Palestine Refugees (PHC-UNRWA) by using the competing values framework (CVF) and examining its influence on the adherence to the Clinical Practice Guideline (CPG) for DM. Methods A cross-sectional design was employed with a census sample of all the Palestinian family doctors and nurses (n= 323) who work within 71 PHC clinic. A cross-cultural adaptation framework was followed to develop the Arabic version of the CVF questionnaire. Results The overall adherence level to the diabetic guideline was disappointingly suboptimal (51.5%, p< 0.001; 47.3% in the PHC-MoH and 55.5% in

Appraising the methodological quality of the clinical practice guideline for diabetes mellitus using the AGREE II instrument: a methodological evaluation

Objectives To evaluate the methodological quality of the Palestinian Clinical Practice Guideline for Diabetes Mellitus using the Translated Arabic Version of the AGREE II. Design Methodological evaluation. A cross-cultural adaptation framework was followed to translate and develop a standardised Translated Arabic Version of the AGREE II. Setting Palestinian Primary Healthcare Centres. Participants Sixteen appraisers independently evaluated the Clinical Practice Guideline for Diabetes Mellitus using the Translated Arabic Version of the AGREE II. Main outcome measures Methodological quality of diabetic guideline. Results The Translated Arabic Version of the AGREE II showed an acceptable reliability and validity. Internal consistency ranged between 0.67 and 0.88 (Cronbach’s α). Intra-class coefficient among appraisers ranged between 0.56 and 0.88. The quality of this guideline is low. Both domains ‘Scope and

Intersectoral collaboration in the management of non-communicable disease’s risk factors in Iran: stakeholders and social network analysis

Introduction As the major cause of premature death worldwide, noncommunicable diseases (NCDs) are complex and multidimensional, prevention and control of which need global, national, local, and multisectoral collaboration. Governmental stakeholder analysis and social network analysis (SNA) are among the recognized techniques to understand and improve collaboration. Through stakeholder analysis, social network analysis, and identifying the leverage points, we investigated the intersectoral collaboration (ISC) in preventing and controlling NCDs-related risk factors in Iran. Methods This is a mixed-methods study based on semi-structured interviews and reviewing of the legal documents and acts to identify and assess the interest, position, and power of collective decision-making centers on NCDs, followed by the social network analysis of related councils and the risk factors of NCDs. We used Gephi software version 0.9.2 to facilitate SNA. We determined the supreme councils' interest, position, power, and influence on NCDs and related risk factors. The Intervention Level Framework (ILF) and expert opinion were utilized to identify interventions to enhance inter-sectoral collaboration. Results We identified 113 national collective decision-making centers. Five councils had the highest evaluation score for the four criteria (Interest, Position, Power, and Influence), including the Supreme Council for Health and Food Security (SCHFS), Supreme Council for Standards (SCS), Supreme Council for Environmental Protection (SCIP), Supreme Council for Health Insurance (SCHI) and Supreme Council of the Centers of Excellence for Medical Sciences. We calculated degree, in degree, out-degree, weighted out-degree, closeness centrality, betweenness centrality, and Eigenvector centrality for all councils. Supreme Council for Standards and SCHFS have the highest betweenness centrality, showing Node's higher importance in information flow. Interventions to facilitate inter-sectoral collaboration were identified and reported based on Intervention Level Framework's five levels (ILF). ConclusionA variety of stakeholders influences the risk factors of non-communicable diseases. Through an investigation of stakeholders and their social networks, we determined the primary actors for each risk factor. Through the different (levels and types) of interventions identified in this study, the MoHME can leverage the ability of identified stakeholders to improve risk factors management. The proposed interventions for identified stakeholders could facilitate intersectoral collaboration, which is critical for more effective prevention and control of modifiable risk factors for NCDs in Iran. Supreme councils and their members could serve as key hubs for implementing targeted inter-sectoral approaches to address NCDs' risk factors

Participatory evaluation of municipal obesity prevention clubs in Tehran city: Strengths, challenges, and future direction.

Background and aim Community-based initiatives are important for obesity prevention. This study aimed to evaluate the activities of municipal obesity prevention clubs (OBCs) in Tehran, Iran, using a participatory approach. Methods The evaluation team was formed, and the members identified the OBC's strengths, and challenges and provided suggestions for change through a participatory workshop, observation, focus group discussions, reviewing relevant documents (n = 97), and 35 interviews with involved stakeholders. The MAXQDA software was used for data analysis. Results An empowerment training program for volunteers was identified as one of the strengths of OBCs. Despite the obesity prevention efforts of OBCs through public exercise sessions, healthy food festivals, and educational sessions, several challenges were identified that hinder participation in OBCs. These challenges included poor marketing strategies, poor training approaches in participatory planning, insufficient motivational support for volunteers, low perceived recognition of volunteers by the community, volunteers' low food and nutrition literacy, poor educational services in the communities, and limited funding for health promotion activities. Conclusion Weaknesses in all stages of community participation, including information, consultation, collaboration, and empowerment, in OBCs were detected. Facilitating a more enabling environment for informing and involving citizens, expanding neighborhood social capital, and involving health volunteers, academia, and all potential governmental sectors to collaborate for obesity prevention is recommended

Out-of-Pocket and Informal Payment Before and After the Health Transformation Plan in Iran: Evidence from Hospitals Located in Kurdistan, Iran

Background: One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran. Methods: This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples t test. Results: The mean OOP payments before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME), US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO), and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (P<.05). The percentage of informal payments to physicians in hospitals affiliated to MoHME, SSO, and private sector, respectively, were 4.5%, 8.1%, and 12.5% before the HTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no informal payment was reported after the third phase. Conclusion: It seems that the implementation of the HTP has reduced the OOP payments for inpatient services and eradicated informal payments to physician in Kurdistan provinc