Objective: To assess National Health Insurance Fund (NHIF) members’ level of understanding, experiences, and factors influencing their choice of NHIF-contracted outpatient facilities in Kenya. Methods: We conducted a cross-sectional qualitative study with NHIF members in two purposefully selected counties (Nyeri and Makueni counties) in Kenya. We collected data through 15 focus group discussions with NHIF members. Data were analysed using a framework analysis approach. Results: Urban-based NHIF members had a good understanding of the NHIF-contracted outpatient facility selection process and the approaches for choosing and changing providers, unlike their rural counterparts. While NHIF members were required to choose a provider before accessing care, the number of available alternative facilities was perceived to be inadequate. Finally, NHIF members identified seven factors they considered important when choosing an NHIF-contracted outpatient provider. Of these factors, the availability of drugs, distance from the household to the facility and waiting time at the facility until consultation were considered the most important. Conclusion: There is a need for the NHIF to prioritise awareness-raising approaches tailored to rural settings. Further, there is a need for the NHIF to contract more providers to both spur competition among providers and provide alternatives for members to choose from. Besides, NHIF members revealed the important factors they consider when selecting outpatient facilities. Consequently, NHIF should leverage the preferred factors when contracting healthcare providers. Similarly, healthcare providers should enhance the availability of drugs, reduce waiting times whilst improving their staff’s attitudes which would enhance user satisfaction and the quality of care provided.

While the estimate of hospital costs concerns the past, its planning focus on the future. However, many public hospitals in low and middle-income countries don’t have robust accounting health systems to evaluate and project their expenses. In Brazil, public hospitals are funded based on government estimates of available hospital infrastructure, historical expenditures and population needs. However, these pieces of information are not always readily available for all hospitals. To solve this challenge, we propose a flexible simulation-based optimisation algorithm that integrates this dual task: estimating and planning hospital costs. The method was applied to a network of 17 public hospitals in Brazil to produce the estimates. Setting the model parameters for population needs and future hospital infrastructure can be used as a cost-projection tool for divestment, maintenance, or investment. Results show that the method can aid health managers in hospitals’ global budgeting and policymakers in improving fairness in hospitals’ financing.

The conflict in Ukraine, which started when Russia invaded and violated its sovereignty, has led to the country's worst war since the annexation of Crimea in 2014. The war has resulted in a significant number of casualties, displaced millions of people, and damaged the healthcare system, which was already struggling before the conflict. The neurosurgical field, in particular, has been severely affected, with infrastructure and healthcare systems routinely demolished or interrupted in conflict zones, making fundamental medical operations unavailable to victims of armed conflict. As a result, neurosurgeons have been compelled to conduct surgeries outside of their areas of competence, in makeshift settings or under challenging conditions, with limited access to materials and equipment. The war has also severely damaged specialized neurosurgery facilities, causing a severe shortage of crucial supplies and equipment. To address the challenges facing neurosurgery care in Ukraine, it is essential to rebuild and repair the damaged neurosurgical centers and provide them with the necessary equipment and supplies to successfully administer neurosurgical treatments. Training programs for neurosurgeons and other medical specialists must also be organized to manage complex neurosurgical problems under difficult conditions.

Background: Pregnancy complications and adverse birth outcomes are among the major contributors to poor maternal and child health. Mothers in remote communities are at higher risk of adverse birth outcomes due to constraints in access to maternal healthcare services. In Ghana, a community-based primary healthcare program called the Ghana Essential Health Interventions Program (GEHIP) was implemented in a rural region to help strengthen primary healthcare delivery and improve maternal and child healthcare services delivery. This study assessed the effect of this program on adverse birth outcomes. Methods: Secondary household survey data from reproductive-aged women from the GEHIP project were used in this analysis. Difference-in-differences regression and logistic regression were used to examine the effect of GEHIP on adverse birth outcomes and equity in the distribution of adverse birth outcomes using household wealth index and maternal educational attainment as equity measures. The analysis involves the comparison of project baseline and end-line outcomes in intervention and non-intervention districts. Results: The intervention had a significant effect in the reduction of adverse pregnancy outcomes (DiD=-0.043; p-value=0.010). Although disadvantaged groups experience larger reductions in adverse pregnancy outcomes, controlling for covariates, there was no statistically significant equity effect of GEHIP on adverse pregnancy outcomes using either the household wealth index or maternal educational attainment as equity measures. Conclusion: GEHIP’s community-based healthcare program reduced adverse birth outcomes but no effect on relative equity was established. Factoring in approaches for targeting disadvantaged populations in the implementation of community-based health programs is crucial to ensuring equity in health outcomes.

Background: The planning and management of health policy is directly linked to evidence-based research. To obtain the most rigorous results in research it is important to have a representative sample. However, ethnic minorities are often not accounted for in research. Migration, equality, and diversity issues are important priorities which need to be considered by researchers. The aim of this systematic review (SR) is to explore the literature examining the experiences of minority language users in Health and Social Care Research (HSCR). Method: A SR of the literature was conducted. SPIDER framework and Cochrane principles were utilized to conduct the review. Five databases were searched, yielding 5311 papers initially. A SR protocol was developed and published in PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020225114analysis. Results: Following the title and abstract review by two reviewers, 74 papers were included, and a narrative account was provided. Six themes were identified: 1. Disparities in healthcare; 2. Maternal health; 3. Mental health; 4. Methodology in health research; 5. Migrant and minority healthcare; 6. Racial and ethnic gaps in healthcare. Results showed that language barriers (including language proficiency) and cultural barriers still exist in terms of recruitment, possibly effecting the validity of the results. Several papers acknowledged language barriers but did not act to reduce them. Conclusion: Despite research highlighting cultures over the past 40 years, there is a need for this to be acknowledged and embedded in the research process. We propose that future research should include details of languages spoken so readers can understand the sample composition to be able to interpret the results in the best way, recognising the significance of culture and language. If language is not considered as a significant aspect of research, the findings of the research cannot be rigorous and therefore the validity is compromised.

For better serving people's complex needs the subsequent movement to person-centered integrated care, requires inter-organizational cooperation and service provision by domain-overarching networks and alliances. In the development to these networks, it is relevant to explore which accountability approaches are appropriate for local inter-organizational healthcare governance. Therefore, in a scoping review we studied the current state of knowledge and practice of accountability in healthcare in the Netherlands. We found that two of the included 41 studies show characteristics of accountability towards healthcare with characteristics of integration care components, such as integration of services with accompanying accountability arrangements and development of networked accountability. The first studies are found in the literature which report on accountability in integrated care. With this we add to the international discussion about accountability as an aspect of integrated care governance, by providing insight into the current state of art of accountability in Dutch healthcare.

The COVID-19 pandemic has pushed health policy frontstage and exposed the stark differences in government capacities to respond to the crisis. This has created new demands for comparative heath policy to support knowledge creation on a large scale. However, comparative health policy has been ill prepared; studies have focused on health systems and used typologies together with descriptive, quantitative methods. This clouds the view for the multi-level nature of health policy, the diverse actors involved and the many societal facets of governance performance. We argue for health policy as a bottom-up process with diverse interests and suggest researching these processes comparatively to support policy learning. This calls for expanding the methodology of comparative health policy to include approaches that make greater use of explorative, qualitative research. We introduce possible developmental pathways to illustrate what this may look like. Firstly, the Pan-European Commission points to novel transnational and cross-sectoral collaborations, and a coordinated policy response to global challenges like the pandemic. Secondly, feminist networks show how to shift the focus towards social inequalities and the health needs of women and vulnerable populations. Thirdly, researchers demonstrate the value of new knowledge emerging from small-scale bottom-up comparisons based on structured assessment frameworks. Together, these developmental pathways demonstrate the potential to refocus comparative health policy towards greater responsiveness to the societal performance of governments, such as social inequalities created by the COVID-19 pandemic. This also opens opportunities for strengthening the global outlook of comparative health policy.

Is workplace violence against health care workers in Mozambique gender related?

Background: Occupational Therapists are needed for meeting the health, rehabilitation, and occupational needs of the population worldwide, but there is no strategy for strengthening the occupational therapy workforce against a backdrop of an insufficient and inequitable supply worldwide. Objective: To perform a situational assessment of occupational therapy workforce development and research toward informing a global human resources strategy for strengthening the profession. Method: A multi-methods design incorporating SWOT analysis based on scoping review findings, workforce development frameworks, and expert feedback. Results: Strengths included identified workforce research trends, gaps, and findings. Weaknesses included a shortage of workforce research, lack of uniform and readily available workforce datasets, absence of workforce research programs, over-reliance on descriptive and non-experimental research, lack of research on workforce topics (e.g., diversity), and lack of labor market or economic analyses. Opportunities are the availability of guidance and tools for strengthening the health and rehabilitation workforce worldwide, and increased membership from low- and middle-income countries (LMICs) in the international professional federation. Threats include the suboptimal funding of occupational therapy workforce research, the lack of profession-specific data on cross-professional datasets and studies, suboptimal educational capacity in LMICs, lack of universal professional regulation and uniform workforce data collection in many contexts, and a perceived lower priority of this health workforce focused on health and wellbeing rather than medical outcomes. Conclusion: This SWOT analysis identifies strengths and opportunities to be seized and weaknesses and threats to be addressed by development of a strategy for the global strengthening of the occupational therapy workforce.

In recent years, healthcare organizations in North America have undergone major structural changes. As research indicates negative impacts of mergers on patient outcomes and difficulties for the nursing work group in particular, the present paper aims to answer calls for more research about the long-term effects of major organizational change on nursing professionals' well-being and professional practice. We used an exploratory qualitative research design and interviewed 43 nursing professionals in various roles, ranging from clinical nurses, nurse practitioners, to head nurses and nursing advisors. Drawing on the job demands-resources model and the person-environment fit theory, our data analysis suggests that the merger has led to a global structural disempowerment, with negative consequences for the nursing practice environment and nurse retention.