In strengthening health systems, the World Health Report 2000 indicates that health system improvement strategies must also cover private (for-profit and non-profit) health care provision and financing if progress towards Universal Health Coverage is to be achieved. Yet very little is known about the financing of non-profit providers in Africa - especially not faith-based health providers, who have often historically remained elusive in terms of financial transparency. This thesis reports on a multiple case study conducted with two non-profit faith-based health providers in Kenya, namely the Africa Inland Church Kijabe Hospital; and Nyumbani-Children of God Relief Institute in Nairobi (Nyumbani) - and situates these within the broader context of health systems financing and public-private partnership in Kenya. Data was collected from multiples sources including: secondary literature; secondary analysis of existing data (such as the Kenya Health Information System); financial data on projects and annual reports; routine facility and service data; previous research on both organizations; archival data; and supplemented by 6 in-depth interviews with key stakeholders. The study reveals a highly complex funding environment for non-profit (and faith-based) health providers in Kenya, which is a result of historic health system configurations, and current funding policy and focus (such as the influx of HIV-related funding). The HIV program in AIC Kijabe Hospital is solely funded by USAID; while Nyumbani is also funded by USAID (70%), but has other private sources. In both cases, funding from various sources is structured differently with varied financial flows and requirements. Faith-based health providers in Kenya are highly dependent on complex donor-funding arrangements, and lack financial resilience as a result. Donors need to better understand the nuance of engagement with such providers.

Context: Partnerships are emerging as critically important vehicles for addressing health in local communities. Coalitions involving local health departments can be viewed as the embodiment of a local public health system. Although it is known that these networks are heavily involved in assessment and community planning activities, limited studies have evaluated whether health coalitions are functioning at an optimal capacity. Objective: This study assesses the extent to which health coalitions met or exceeded expectations for building functional capacity within their respective networks. Design: An evaluative framework was developed focusing on 8 functional characteristics of coalitions previously identified by Erwin and Mills. Twenty-nine indicators were identified that served as "proxy" measures of functional capacity within health coalitions. Setting and Participants: Ninety-three County Health Councils (CoHCs) in Tennessee. Main Outcome Measure(s): Diverse member representation; formal rules, roles, and procedures; open, frequent interpersonal communication; task-focused climate; council leadership; resources; active member participation; and external linkages were assessed to determine the level of functionality of CoHCs. Scores across all CoHCs were analyzed using descriptive statistics such as frequency distributions, measures of central tendency, and measures of variability. Data were analyzed using SAS 9.3. Results: Of 68 CoHCs (73% response rate), the total mean score for the level of functional characteristics was 30.5 (median= 30.5; SD = 6.3; range, 18-44). Of the 8 functional characteristics, CoHCs met or exceeded all indicators associated with council leadership, tasked-focused climate, and external linkages. Lowest scores were for having a written communications plan, written priorities or goals, and opportunities for training. Conclusion: This study advances the research on health coalitions by establishing a process for quantifying the functionality of health coalitions. Future studies will be conducted to examine the association between health coalition functional capacity, local health departments' community health assessment and planning efforts, and changes in community health status.

Auditing in health care has been recommended by many national organisations to improve patient safety and quality of care, despite inconclusive evidence to support its effectiveness. In South Africa, the National Core Standards for health establishments in South Africa (NCS) was published in 2011. The NCS recognises that staff are vital to ensuring that the health system delivers quality health care and therefore require protection against the risk of injury, infection and other occupational hazards, consistent with the South African Occupational Health and Safety act of 1993. The aim of this study was to determine: (a) the compliance of public sector primary healthcare (PHC) facilities with the NCS for occupational health and safety (OHS) and infection prevention and control (IPC), (b) the impact of the audits three years after baseline audits, at follow up self-assessment audits and (c) the reliability of self-assessment audits when compared to external audit results. This dissertation is divided in three parts. Part A is the study protocol which received ethics approval in March 2015. Part B is a structured literature review covering standards for health care, the impact and effectiveness of accreditation/certification/auditing in health care, interrater reliability and factors associated with OHS/IPC compliance. Previous studies have failed to address whether evaluating occupational health and safety or infection prevention and control standards using accreditation/certification in a primary healthcare, low and middle income setting is effective or reliable. Part C is the journal ready manuscript presenting the results of the study in the form of a manuscript for an article for a named peer reviewed journal. This was a cross-sectional study of NCS OHS/IPC audit data, with a longitudinal component, of a sample of public sector PHC facilities in the Western Cape province of South Africa between 2011 and 2015. Baseline PHC facility compliance with OHS/IPC measures was low. There was no significant improvement in compliance after three years. Poor inter-rater reliability indicates a large degree of measurement error. Practical implications of these results are the need to improve reliability of assessments and a process to convert low compliance scores into implemented improvement actions.

The conflict in Northeastern Nigeria has left the region with an increasing death toll of 20,000 and has caused mass displacement of over 2.3 million(1)(2). The impacts of conflict are far reaching and has adverse consequences on the mental health of affected populations(3). Nigeria’s mental health system does not have the structure or resources to accommodate its mental health burden. Translating the emergency response in Northeastern Nigeria into sustained improved mental health care may be useful toward implementation of Nigeria’s mental health policy and nationwide mental health reform. The purpose of this thesis is to analyze how the emergency response in Northeastern Nigeria may be leveraged to contribute toward an improved mental health system. A literature review was conducted in order to review case studies of regions which have strengthened their mental health systems after and during an emergency. Additionally, best practices for mental health systems strengthening were reviewed. Findings show that a strengthened mental health system may be achieved by the government making an early commitment to seizing the emergency response as an opportunity to reach this goal. The emergency response could adopt key strategies such as developing a local workforce and using established tools to guide service provision. Additionally, the investment of key stakeholders and a commitment toward decentralization and scaling up community-based services is recommended. Such an approach may be beneficial toward improved mental health care in Northeastern Nigeria and may be useful to Nigeria as a whole.

Background: With recent emphasis on creating a stronger, more patient-centred, health system in Ontario, there remains no clear definition of a “public health” system, hindering the ability to integrate preventive public health and health care practices. This study aims to describe public health systems and initiate a research agenda for this field. Methods: A critical interpretive synthesis of the literature was conducted using six electronic databases. In addition, data extraction, coding and analysis followed a best-fit framework analysis method. Initial codes were based on two current leading health systems and policy classification schemes: health systems arrangements (based on governance, financial and delivery arrangements) and the 3I+E framework for health policy formulation (institutions, interests, ideas and external factors). New codes were developed as guided by the data. A constant comparative method was used to develop concepts and to further link these into themes. Additional documents were identified to fill conceptual gaps. Results: 5,933 unique documents were identified and 338 documents met the inclusion criteria. 81 documents were purposively sampled for full-text review and 58 of these were included in this study. Nine documents were found to help fill conceptual gaps. Generally, public health systems can be defined using traditional healthcare systems and policy frameworks. There was also a strong emphasis on identifying and standardizing the roles and functions of public health. Partnerships (community and multi-sectoral) are common features within and between components of public health systems. A public health system framework and a model of a population health system were conceptualized. Discussion: Understanding public health systems can help strengthen these systems and further integrate preventive public health and primary care services. Systems are influenced by organizational and contextual factors that need to be explored to improve population health. A research agenda is proposed to move this field forward. / Thesis / Master of Public Health (MPH)

El Perú está negociando el Acuerdo de Asociación Transpacífico, un acuerdo comercial que podría tener serias implicancias para los sistemas de salud de las naciones incluidas. Los capítulos de transparencia y propiedad intelectual son los más controversiales. El primero porque abre la posibilidad a los grupos interesados a objetar las decisiones de las autoridades sanitarias acerca de la incorporación de tecnologías sanitarias al sistema de salud, dándoles mecanismos de arbitraje si sus productos no son incorporados al sistema. El segundo, porque plantea restricciones al ingreso de productos genéricos al ampliar el período de datos de prueba e implementar mecanismos de oposición al registro de los mismos. Adicionalmente, el acuerdo contempla la posibilidad de restringir la regulación del consumo de alcohol, tabaco y alimentos procesados. Se deben crear sistemas de vigilancia del impacto del acuerdo si este se concreta, y generar mecanismos que impidan que los escasos recursos disponibles para la salud se desvíen a financiar tecnología de punta que no necesariamente va a tener un impacto positivo a nivel poblacional. / Peru is negotiating the Transpacific Partnership Agreement, a commercial treaty that could have deleterious implications for the health systems of the included partners. Transparency and Intellectual Property chapters are the most controversial elements. The first mostly because it opens the possibility for groups of interest to refuse decisions being taken by the sanitary authorities concerning the incorporation of health technologies to the public health systems. The second because it poses restrictions to the entrance of generic medical products, widening the period of data exclusivity and implementing mechanisms of opposition to their registry. Other chapters include strategies to block the states from regulating the consumption of alcohol, tobacco and processed foods. We ought to create surveillance systems to evaluate the impact of the agreement if it is signed, and generate mechanisms that prevent the little resources we already have devoted for health to be deviated to top technology that will not necessarily have a positive impact at a population level.

No description available.

acase@tulane.edu

acase@tulane.edu

acase@tulane.edu