Opening the debate on DALYs (disability-adjusted life years).
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The 1993 World Development Report is proving to be an influential document for the development of the health sector policies in developing countries. One important aspect of the Report concerns its proposals for Disability Adjusted Life Years as a measure of health change and hence effectiveness of interventions. This article comments on the use of such measures in the health policy arena. (+info)
Primary health care in Turkey: a passing fashion?
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The Alma-Ata Declaration has long been regarded as a watershed in the health policy arena. The global goal of the World Health Organization, 'Health for All by the Year 2000' through primary health care, has attracted many countries both in the developed and the developing world and commitments to this end have been made at every level. However, albeit this consensus on the paper, a common and explicit definition of the concept has not been reached yet. This paper aims at discussing various definitions of primary health care that emerged after the Declaration and also presenting a case study from Turkey, a country that advocates primary health care in her recent health policy reform attempts. After setting the conceptual framework for discussion the Turkish case is presented by using research carried out among Turkish policy-makers at different levels of the State apparatus. It has been concluded that application of primary health care principles as defined in the broad definition of the concept requires major changes or rather shake-ups in Turkey. These areas are outlined briefly at the end of the paper. (+info)
Conducting a literature review on the effectiveness of health care interventions.
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The dramatic increase in the volume of research based information means that effective policy makers must be able to conduct and interpret literature reviews. This article sets out the steps that should be followed in doing so. They are: explicitly defining the question; locating relevant literature; assessing the quality of studies and deciding whether they should be included; synthesizing and re-analyzing the results; and presenting them in a clear and concise manner. The article identifies the leading sources of information, including electronic databases and useful Internet addresses and describes briefly how each stage should be conducted, highlighting the strengths and weaknesses of different approaches and the ways in which bias may be introduced. (+info)
Eradicating guinea worm without wells: unrealized hopes of the Water Decade.
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At the start of the United Nations International Drinking Water Supply and Sanitation Decade in the 1980s, guinea worm disease was targeted as the major indicator of the success of the Decade's efforts to promote safe water. By the late 1980s, most of the guinea worm endemic countries in Africa and South Asia had established guinea worm eradication programmes that included water supply as one of their main technical strategies. By surveying the water supply situation in Ifeloju Local Government Area (LGA) in Oyo State, Nigeria, in June 1996, as a case study, it was possible to determine the role that water supply has played in the eradication effort. Although two major agencies, the former Directorate for Food, Roads and Rural Infrastructure and UNICEF, provided hand dug and bore-hole wells respectively in many parts of the LGA, coverage of the smaller farm hamlets has been minor compared to efforts in the larger towns. This is ironic because the farm hamlets served as a reservoir for the disease in the 1980s, such that when the piped water system in the towns broke down, guinea worm was easily reintroduced into the towns. The survey of 188 ever-endemic hamlets with an estimated population of 23,556 found that 74.3% of the people still drink only pond water. Another 11.3% have wells that have become dysfunctional. Only 14.4% of this rural population has access' to functioning wells. Guinea worm was eliminated from 107 of the hamlets mainly by the use of cloth filters and chemical treatment of ponds. While this proves that it is possible to eradicate guinea worm, it fails to leave behind the legacy of reliable, safe water supplies that was the hope of the Water Decade. (+info)
Global health promotion models: enlightenment or entrapment?
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This paper suggests that there is a tendency for health promotion to be located within models that consider health to be a product of a range of forces, with practice itself assumed to comprise a similarly wide range of activities. This paper develops a critique of this tendency that is essentially accommodating, all embracing and 'neutral'. It is argued that this leads to the masking of tensions between the conflicting values contained within the different elements of the models. We suggest that for health promoters, this is neither conceptually appropriate nor practically sensible. These notions are developed in five main stages. We start by defining some of the key concepts in the piece, e.g. the nature of a 'model' and examples of 'global' models. We then examine some of the general reasons why global models are favoured, with respect to the emergence of the UK's strategy for health, The Health of the Nation. The third stage of the discussion identifies and considers, within the British context, professional and governmental factors perceived to have driven this choice. The fourth aspect of the paper will introduce a critique of the use of global modelling. The paper concludes by critically questioning this evolving relationship, and suggests that it will be essentially conservative and unproductive. We end by reviewing the implications for practice and suggesting a useful way forward. (+info)
Understanding the relation between research and clinical policy: a study of clinicians' views.
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OBJECTIVES: To describe the relation between research evidence and local obstetric unit policy for specific areas of care and to explore clinicians' views about the reasons for any discrepancies identified. DESIGN: An independent evaluation of a project undertaken by a district maternity services liaison committee (MSLC) to promote evidence based maternity care in specific areas of care. The evaluation involved a combination of qualitative methodologies including documentary analysis, non-participant observation, semi-structured interviews, and self completed open ended questionnaires. SETTING: One English health district with three obstetric units. MAIN MEASURES: Congruence between unit policies and research evidence in specific areas of care. Views expressed by unit staff concerning the reasons for any discrepancies identified. Consistency between staff views within and between units. Unit attitudes to modification of discrepant policies and details of any subsequent changes made. RESULTS: Of the 12 unit policies considered, seven were consistent with the research evidence. In all cases in which unit policy did not reflect the evidence, provider unit staff thought that the differences were justified. In several cases there were substantive differences of view between staff in different units. No differences of view were expressed between staff in the same unit. There were three different types of concern about the research evidence and the problems of using it as a basis for deciding unit policy. These were: concerns about the adequacy or completeness of the evidence; concerns about the applicability of the evidence in the local setting; and concerns about local capacity to act on the evidence. At the time of the project, none of the units expressed any intention of modifying the policies under discussion. Subsequently, two of them did make changes of this sort. CONCLUSION: The results suggest the need for further research to ascertain what factors may produce such varying assessments of the validity and adequacy of particular sets of research findings as were found between clinicians in this study and to understand what considerations other than views about evidence may affect decisions to alter clinical policy. IMPLICATIONS: When clinicians have clear reasons for not following research evidence, two contrasting responses are possible. One is to take the view that the clinicians are mistaken, and seek to change their attitudes or persuade them to change their behaviour regardless of their views. An alternative response is to accept that the concerns they express may be legitimate and consider how their doubts may be addressed. The challenge is to recognise which response is preferable in any particular situation. (+info)
Revisiting community participation.
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Community participation in health is a complex entity that has been examined extensively in the literature and continues to be of great interest among community health workers. The genesis of the idea and its conceptual development are primarily attributed to large multinational health institutions, particularly the World Health Organization. However, the implementation of community participation is the ultimate responsibility of local health programme initiators. It is therefore at the local level where day to day realities of incorporating community participation into health service delivery are confronted. This paper reviews the value of community participation in health and provides a detailed examination of the challenges facing its implementation and sustainability. In 1978, the World Health Organization placed community participation squarely at the centre of their strategy to achieve Health For All By The Year 2000. As the year 2000 nears, it is time to critically re-examine the notion of community participation and the most pressing challenges to its viability. (+info)
A critical review of priority setting in the health sector: the methodology of the 1993 World Development Report.
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The 1993 World Development Report, Investing in Health, suggests policies to assist governments of developing countries in improving the health of their populations. A new methodology to improve government spending is introduced. Epidemiological and economic analyses from the basis for a global priority setting exercise, leading to a recommended essential public health and clinical services package for low- and middle-income countries. Ministries of Health in many countries have expressed an interest in designing a national package of essential health services, using the methodology. Given the apparent importance attached to the study and its far reaching potential consequences, this article provides an overview of the method, the main issues and problems in estimating the burden of disease as well as the cost-effectiveness of interventions. Strengths and weaknesses in the databases, value judgements and assumptions are identified, leading to a critical analysis of the validity of the priority setting exercise on the global level. (+info)