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‣ AMBIVALENT IMPLICATIONS OF HEALTH CARE INFORMATION SYSTEMS: A STUDY IN THE BRAZILIAN PUBLIC HEALTH CARE SYSTEM

ALBUQUERQUE, Joao Porto de; PRADO, Edmir P. V.; MACHADO, Gabriel Raja
Fonte: FUNDACAO GETULIO VARGAS Publicador: FUNDACAO GETULIO VARGAS
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
67.30535%
This article evaluates social implications of the ""SIGA"" Health Care Information System (HIS) in a public health care organization in the city of Sao Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

‣ Ambivalent implications of health care information systems: a study in the Brazilian public health care system

Albuquerque,João Porto de; Prado,Edmir P. V.; Machado,Gabriel Raja
Fonte: Fundação Getulio Vargas, Escola de Administração de Empresas de S.Paulo Publicador: Fundação Getulio Vargas, Escola de Administração de Empresas de S.Paulo
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2011 Português
Relevância na Pesquisa
67.30535%
This article evaluates social implications of the "SIGA" Health Care Information System (HIS) in a public health care organization in the city of São Paulo. The evaluation was performed by means of an in-depth case study with patients and staff of a public health care organization, using qualitative and quantitative data. On the one hand, the system had consequences perceived as positive such as improved convenience and democratization of specialized treatment for patients and improvements in work organization. On the other hand, negative outcomes were reported, like difficulties faced by employees due to little familiarity with IT and an increase in the time needed to schedule appointments. Results show the ambiguity of the implications of HIS in developing countries, emphasizing the need for a more nuanced view of the evaluation of failures and successes and the importance of social contextual factors.

‣ A cross-case comparative analysis of international security forces’ impacts on health systems in conflict-affected and fragile states

Bourdeaux, Margaret; Kerry, Vanessa; Haggenmiller, Christian; Nickel, Karlheinz
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
67.506064%
Background: Destruction of health systems in fragile and conflict-affected states increases civilian mortality. Despite the size, scope, scale and political influence of international security forces intervening in fragile states, little attention has been paid to array of ways they may impact health systems beyond their effects on short-term humanitarian health aid delivery. Methods: Using case studies we published on international security forces’ impacts on health systems in Haiti, Kosovo, Afghanistan and Libya, we conducted a comparative analysis that examined three questions: What aspects, or building blocks, of health systems did security forces impact across the cases and what was the nature of these impacts? What forums or mechanisms did international security forces use to interact with health system actors? What policies facilitated or hindered security forces from supporting health systems? Results: We found international security forces impacted health system governance, information systems and indigenous health delivery organizations. Positive impacts included bolstering the authority, transparency and capability of health system leadership. Negative impacts included undermining the impartial nature of indigenous health institutions by using health projects to achieve security objectives. Interactions between security and health actors were primarily ad hoc...

‣ Improving district facility readiness: a 12-month evaluation of a data-driven health systems strengthening intervention in rural Rwanda

Iyer, Hari S.; Kamanzi, Emmanuel; Mugunga, Jean Claude; Finnegan, Karen; Uwingabiye, Alice; Shyaka, Edward; Niyonzima, Saleh; Hirschhorn, Lisa R.; Drobac, Peter C.
Fonte: Co-Action Publishing Publicador: Co-Action Publishing
Tipo: Artigo de Revista Científica
Português
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Background: While health systems strengthening (HSS) interventions are recommended by global health policy experts to improve population health in resource-limited settings, few examples exist of evaluations of HSS interventions conducted at the district level. In 2009, a partnership between Partners In Health (PIH), a non-governmental organization, and the Rwandan Ministry of Health (RMOH) was provided funds to implement and evaluate a district-level HSS intervention in two rural districts of Rwanda. Design: The partnership provided limited funds to 14 health centers for targeted systems support in 2010; six others received support prior to the intervention (reference). RMOH health systems norms were mapped across the WHO HSS framework, scored from 0 to 10 and incorporated into a rapid survey assessing 11 domains of facility readiness. Stakeholder meetings allowed partnership leaders to review results, set priorities, and allocate resources. Investments included salary support, infrastructure improvements, medical equipment, and social support for patients. We compared facility domain scores from the start of the intervention to 12 months and tested for correlation between change in score and change in funding allocation to assess equity in our approach. Results: We found significant improvements among intervention facilities from baseline to 12 months across several domains [infrastructure (+4...

‣ How Might India’s Public Health Systems Be Strengthened?

Das Gupta, Monica; Shukla, Rajendra; Somanathan, T.V.; Datta, K.K.
Fonte: Banco Mundial Publicador: Banco Mundial
Português
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The central government s policies, though well-intentioned, have inadvertently de-emphasized environmental health and other preventive public health services in India since the 1950s, when it was decided to amalgamate the medical and public health services and to focus public health services largely on single-issue programs. This paper discusses how successive policy decisions have diminished the Health Ministry s capacity for stewardship of the nation s public health. These decisions have introduced policies and fiscal incentives that have inadvertently enabled states to prioritize medical services and single-issue programs over broader public health services, and diminished the capacity of the public health workforce to deliver public health services. Diseases resulting from poor environmental health conditions continue to impose high costs even among the more affluent, and hinder development. There are many approaches to strengthening the public health system, and the authors suggest one that may require relatively little modification of existing structures and systems. They suggest establishing a focal point in the Health Ministry for public health stewardship...

‣ Clearing the Global Health Fog : A Systematic Review of the Evidence on Integration of Health Systems and Targeted Interventions

Atun, Rifat; de Jongh, Thyra; Secci, Federica V.; Ohiri, Kelechi; Adeyi, Olusoji
Fonte: World Bank Publicador: World Bank
Português
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A longstanding debate on health systems organization relates to benefits of integrating health programs that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes This paper is organized in five chapters. This introduction is followed by the methodology chapter, which includes a brief section on the conceptual framework used to analyze the studies retrieved and the programs presented within these to map the nature and extent of integration into critical health system functions. The results chapter includes: a summary of the outcomes for each study grouped by the disease area or the clinical problem the intervention seeks to address, including the reported success; for each program, analysis and mapping of the nature and extent of integration into critical health system functions; and an analysis of how contextual factors either created opportunities for introducing or integrating a program or influenced the desirability or feasibility of program integration. The discussion chapter provides an overview of the implication of findings for policy makers...

‣ How Can Disease Control Program Contribute to Health System Strengthening in Sub-Saharan Africa : A Concept Note for Engaging in the Global Debates on Health Systems Strengthening

Damme, Wim Van; Pirard, Marjan; Assefa, Yibeltal; Van Olmen, Josefien
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
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Recently, there has been broad consensus in the global health community on the need for health systems strengthening (HSS) to make further progress toward the Millennium Development Goals (MDGs) in Sub-Saharan Africa. However, there is still divergence on how HSS should be framed, what HSS practically entails, and how it should be done. We set out to clarify HSS for managers of disease control programs (DCPs). In September 2000, the United Nations created a new movement in the fight against poverty: 189 countries in the General Assembly expressed their commitment to the Millennium Development Goals (MDGs) in the Millennium Declaration (World Health Organization 2004). The recognition of health as one of the key determinants of human development is translated in three health-related MDGs. MDG 4 and 5 focus respectively on children and women as priority target groups, and MDG 6 focuses on priority diseases (HIV/AIDS, malaria, and other major diseases), representing the bulk of the disease burden in low-income countries. In section two, the author first focuses on how national health systems can be understood...

‣ Information and Communication Technologies for Health Systems Strengthening

Otto, Kate; Shekar, Meera; Herbst, Christopher H.; Mohammed, Rianna
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Trabalho em Andamento
Português
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Information and communication technologies (ICT) for health or eHealth solutions hold great potential for generating systemic efficiencies by strengthening five critical pillars of a health system: human resources for health, supply chain management, health care financing, governance and service delivery, and infrastructure. This report describes the changing landscape of eHealth initiatives through these five pillars, with a geographic focus on Sub-Saharan Africa. This report further details seven criteria, or prerequisites, that must be considered and addressed in order to effectively establish and scale up ICT-based solutions in the health sector. These criteria include infrastructure, data and interoperability standards, local capacity, policy and regulatory environments, an appropriate business model, alignment of partnerships and priorities, and monitoring and evaluation. In order to bring specific examples of these criteria to light, this report concludes with 12 specific case studies of potentially scalable ICT-based health care solutions currently being implemented across the globe at community...

‣ Health Systems in East Asia : What Can Developing Countries Learn from Japan and the Asian Tigers?

Wagstaff, Adam
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
Português
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The health systems of Japan and the Asian Tigers--Hong Kong (China), the Republic of Korea, Singapore, and Taiwan (China)--and the recent reforms to them provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend too on the design features of the system-the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals-rapid cost and price inflation, a race for the best technology, and so on-shows the difficulties of corporatization. Korea's experience with a narrow benefit package shows the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan...

‣ Health Systems Analysis for Better Health System Strengthening

Berman, Peter; Bitran, Ricardo
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Working Paper; Publications & Research
Português
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Health system strengthening and reform are often necessary actions to achieve better outcomes. The World Bank's 2007 strategy for health, nutrition, and population emphasizes the importance of health system strengthening for results. This paper proposes 'health systems analysis' as a distinct methodology that should be developed and practiced in the design of policies and programs for health system strengthening. It identifies key elements of health systems analysis and situates them in a logical framework supported by a wide range of data and methods and a sizable global literature. Health systems analysis includes evidence on health system inputs, processes, and outputs and the analysis of how these combine to produce the outcomes. It considers politics, history, and institutional arrangements. Health systems analysis proposes causes of poor health system performance and suggests how reform policies and strengthening strategies can improve performance. It contributes to implementation and evaluation. Examples from Mexico...

‣ Review of World Bank's Experience with Country-Level Health System Analysis

Bitrán, Ricardo; Gómez, Paulina; Escobar, Liliana; Berman, Peter
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
Português
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The World Bank often carries out in-depth analysis of the conditions and challenges facing different sectors in our client countries as a contribution to developing the analytical and information base for lending, policy dialogue, and more in-depth analytical work. In the health sector, we have identified a substantial body of this type of work focusing on analyzing the performance of health systems, its causes, and potential strategies for performance improvement. The Bank's 2007 Health, Nutrition and Population (HNP) strategy emphasizes the importance of our work on health system strengthening. HSA is often the analytical foundation of this work in countries. This paper reviews a sample of HSAs, 12 major studies carried out since 2000 across all Bank regions. Using the health systems framework of the flagship program on health sector reform and sustainable financing, a comparable synopsis of each study has been prepared in a simple two page chart which traces the analysis from measures of health system performance to its causes and then from policy 'control knobs' to proposals for reform which are intended to improve that performance. Several key questions about the conceptual basis...

‣ Health Management Information Systems for Resource Allocation and Purchasing in Developing Countries

Streveler, Dennis J.; Sherlock, Sheila M.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
Português
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This paper begins with the premise that it is not possible to implement an efficient, modern RAP strategy today without the effective use of information technology. The paper then leads the architect through the functionality of the systems components and environment needed to support RAP, pausing to justify them at each step. The paper can be used as a long-term guide through the systems development process as it is not necessary (and likely not possible) to implement all functions at once. The paper's intended audience is those members of a planning and strategy body, working in conjunction with technical experts, who are charged with designing and implementing a RAP strategy in a developing country.

‣ Restructuring Regional Health Systems In Russia

Marquez, Patricio V.; Lebedeva, Nadezhda
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Brief; Publications & Research
Português
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The delivery of health services in Russia is a federal, regional and municipal responsibility. Reform of the regional health systems, which suffer from over-reliance on curative and inpatient care, deteriorating infrastructure and equipment, and poor quality of services, is a major challenge for the country. From 2003-2008, the World Bank helped strengthen the stewardship capacity of Russia's Federal Ministry of Health and Social Development (MOHSD) and restructure health systems in two pilot regions: the Chuvash Republic and Voronezh oblast. In both regions, hospital bed numbers were reduced while simultaneously increasing service delivery capacity at the primary care, specialized ambulatory, and long-term care facility levels through the introduction of new technologies, clinical protocols, and resource allocation mechanisms that link payments to performance.

‣ Improving Governance and Management of Health Systems : Partnerships and Observatories in Latin America and the Caribbean

Cortez, Rafael; Ferl, Katharina
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Brief; Publications & Research
Português
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67.711304%
Public health observatories proactively investigate health issues to provide robust analytical evidence to policy makers. This type of organization has different characteristics from other public health institutions, such as information-gathering bodies, academic public health departments, or state employed public health practitioners. Governments in Latin America have also begun establishing regional, national, and provincial observatories. Some of the regional observatories provide comparisons of countries in the region in areas such as public health, human resources, food security, and nutrition. Regional and national health observatories have become important tools for governments and health ministries to support national strategic partnerships and to empower civil society, health sector stakeholders, and health sector authorities seeking to develop more effective and efficient health systems. Health observatories are therefore a key instrument for health systems to generate information, data, and intelligence on people's health status and the type and quality of health care delivery. By making all this information available to health providers and policy makers in a timely manner...

‣ Designing and Implementing Health Care Provider Payment Systems : How-To Manuals

Langenbrunner, John C.; Cashin, Cheryl; O’Dougherty, Sheila
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Publications & Research :: Publication; Publications & Research
Português
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This volume grows out of an initiative in the World Bank on resource allocation and purchasing ('RAP'), which started in 2000, and continues to publish articles and books related to strategic purchasing. The initiative emerged from such questions in developing economies as: why do individuals need help in purchasing health services from providers? Is the 'middleman' really necessary? Can people not just buy health services in the same way they would go to the local market to buy bread, milk, or fruit, especially since, throughout most of history that is what most people did? When sick, they contacted local healers directly. Public policy historically was limited largely to protecting the sick against charlatans and was enforced through ethical codes such as the Hippocratic Oath. There was no expensive technology, and most serious conditions led to death. Loss of employment and burial costs were the most expensive parts of illness. With industrialization and the scientific revolution, all this changed. As understanding about the causes, prevention, and treatment of illness expanded, interventions become more complex and expensive. Health care was no longer the exclusive domain of traditional healers. Partly because of the complexities involved...

‣ Health Systems Strengthening Lessons from the Turkish Experience

Chakraborty, Sarbani
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Brief; Publications & Research
Português
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67.48341%
In 2003, the Government of Turkey launched an Health Systems Strengthening (HSS) reform called the 'Health Transformation Program' (HTP). The HTP was designed to address these health system challenges. It was recognized at the outset that without system-wide reforms, significant and sustainable changes in health system performance could not take place. The overall objective of the HTP was to make the health system more effective by improving governance, efficiency, user and provider satisfaction, and long-term sustainability. The main elements of the HTP are: (i) establishment of a single purchaser in the health system; (ii) focusing the Ministry of Health (MoH) on stewardship functions; (iii) making the public sector health services delivery network autonomous; and (iv) strengthening human resources management and information systems in the health system. In its technical focus and paradigm, the HTP represents a classic 'textbook' approach to HSS which many Bank clients are trying to implement.

‣ Toward utilization of data for program management and evaluation: quality assessment of five years of health management information system data in Rwanda

Nisingizwe, Marie Paul; Iyer, Hari S.; Gashayija, Modeste; Hirschhorn, Lisa R.; Amoroso, Cheryl; Wilson, Randy; Rubyutsa, Eric; Gaju, Eric; Basinga, Paulin; Muhire, Andrew; Binagwaho, Agnès; Hedt-Gauthier, Bethany
Fonte: Co-Action Publishing Publicador: Co-Action Publishing
Tipo: Artigo de Revista Científica
Português
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Background: Health data can be useful for effective service delivery, decision making, and evaluating existing programs in order to maintain high quality of healthcare. Studies have shown variability in data quality from national health management information systems (HMISs) in sub-Saharan Africa which threatens utility of these data as a tool to improve health systems. The purpose of this study is to assess the quality of Rwanda's HMIS data over a 5-year period. Methods: The World Health Organization (WHO) data quality report card framework was used to assess the quality of HMIS data captured from 2008 to 2012 and is a census of all 495 publicly funded health facilities in Rwanda. Factors assessed included completeness and internal consistency of 10 indicators selected based on WHO recommendations and priority areas for the Rwanda national health sector. Completeness was measured as percentage of non-missing reports. Consistency was measured as the absence of extreme outliers, internal consistency between related indicators, and consistency of indicators over time. These assessments were done at the district and national level. Results: Nationally, the average monthly district reporting completeness rate was 98% across 10 key indicators from 2008 to 2012. Completeness of indicator data increased over time: 2008...

‣ Oral health information systems - towards measuring progress in oral health promotion and disease prevention

Petersen,Poul Erik; Bourgeois,Denis; Bratthall,Douglas; Ogawa,Hiroshi
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2005 Português
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This article describes the essential components of oral health information systems for the analysis of trends in oral disease and the evaluation of oral health programmes at the country, regional and global levels. Standard methodology for the collection of epidemiological data on oral health has been designed by WHO and used by countries worldwide for the surveillance of oral disease and health. Global, regional and national oral health databanks have highlighted the changing patterns of oral disease which primarily reflect changing risk profiles and the implementation of oral health programmes oriented towards disease prevention and health promotion. The WHO Oral Health Country/Area Profile Programme (CAPP) provides data on oral health from countries, as well as programme experiences and ideas targeted to oral health professionals, policy-makers, health planners, researchers and the general public. WHO has developed global and regional oral health databanks for surveillance, and international projects have designed oral health indicators for use in oral health information systems for assessing the quality of oral health care and surveillance systems. Modern oral health information systems are being developed within the framework of the WHO STEPwise approach to surveillance of noncommunicable...

‣ Information systems for health sector monitoring in Papua New Guinea

Cibulskis,R.E.; Hiawalyer,G.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2002 Português
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This paper describes (i) how a national health information System was designed, tested and implemented in Papua New Guinea, (ii) how the system was integrated with other management information systems, and (iii) how information has been used to support decision-making. It concludes that central coordination of systems design is essential to make sure that information systems are aligned with government priorities and can deliver the information required by managers. While there is often scope for improving the performance of existing information systems, too much emphasis can be placed on revising data collection procedures and creating the perfect information system. Data analysis, even from imperfect systems, can stimulate greater interest in information, which can improve the quality and completeness of reporting and encourage a more methodical approach to planning and monitoring services. Our experience suggests that senior decision-makers and political leaders can play an important role in creating a culture of information use. By demanding health information, using it to formulate policy, and disseminating it through the channels open to them, they can exert greater influence in negotiations with donors and other government departments...

‣ Developing nursing capacity for health systems and services research in Cuba, 2008-2011

Nelcy Martínez,MPH
Fonte: Medical Education Cooperation with Cuba Publicador: Medical Education Cooperation with Cuba
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2012 Português
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INTRODUCTION: Health systems and services research by nursing personnel could inform decisionmaking and nursing care, providing evidence concerning quality of and patient satisfaction. Such studies are rather uncommon in Cuban research institutes, where clinical research predominates. OBJECTIVE: Assess the results of a strategy implemented between 2008 and 2011 to develop nursing capacity for health systems and services research in 14 national research institutes based in Havana. METHODS: The study comprised four stages: description of approaches to health systems and services research by nurses worldwide and in Cuba; analysis of current capacities for such research in Cuba; intervention design and implementation; and evaluation. Various techniques were used including: literature review, bibliometric analysis, questionnaire survey, consultation with experts, focus groups, and workshops for participant orientation and design and followup of research projects. Qualitative information reduction and quantitative information summary methods were used. Initially, 32 nursing managers participated; a further 105 nurses from the institutes were involved in research teams formed during intervention implementation. RESULTS: Of all published nursing research articles retrieved...