Understanding the effect of decentralisation on health services

Regmi, Krishna; Naidoo, Jennie; Greer, Alan; Pilkington, Paul

doi:10.1108/14777261011064986

Cited by 32 publications

(36 citation statements)

References 45 publications

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“…Inadequate access to information, as well as services, is a major barrier for young people in the uptake of sexual and reproductive health services [58, 59]. A knowledge to practice gap had been reported in some occupational groups; educated welders were more aware of hazards and more likely to use personal protective equipment [60], and migrant workers, who lack knowledge of diseases were more likely to be engaged in unsafe sex and be exposed to HIV [61], mostly due to low perceived vulnerability [62].…”

Section: Resultsmentioning

confidence: 99%

“…Notwithstanding education, the impact of inadequate income, pervasive inequitable cultural practices and poor quality of care, can make decision making about health extremely challenging. While the level of education attained is deemed important [30, 32, 33, 36, 38, 51–54], a lack in knowledge also exists regarding either availability of services, severity of illnesses and/or vulnerability to diseases [48–50, 56–58, 60–62]. Healthcare practices in households have deep roots in cultural beliefs and gender roles [19] thus a strong education system is required to advance this area.…”

Section: Discussionmentioning

confidence: 99%

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The potential of health literacy to address the health related UN sustainable development goal 3 (SDG3) in Nepal: a rapid review

Budhathoki

Pokharel

Good

et al. 2017

BMC Health Serv Res

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BackgroundHealth literacy has been linked to health outcomes across population groups around the world. Nepal, a low income country, experiences the double burden of highly prevalent communicable as well as non-communicable diseases. The World Health Organization (WHO) has positioned health literacy as a key mechanism to meet the health-related Sustainable Development Goal (SDG3). However, there is little known about the status of health literacy in developing countries such as Nepal. This paper aims to review the potential of health literacy to address SDG3 in Nepal.MethodsA rapid review was conducted using the knowledge to action evidence summary approach. Articles included in the review were those reporting on barriers to health care engagements in Nepal published in English language between January 2000 and December 2015.ResultsBarriers for healthcare engagement included knowledge and education as strong factors, followed by culture, gender roles, quality of service and cost of services. These barriers influence the Nepalese community to access and engage with services, and make and enact healthcare decisions, not only at the individual level but at the family level. These factors are directly linked to health literacy. Health literacy is a pivotal determinant of understanding, accessing and using health information and health services, it is important that the health literacy needs of the people be addressed.ConclusionLocally identified and developed health literacy interventions may provide opportunities for systematic improvements in health to address impediments to healthcare in Nepal. Further research on health literacy and implementation of health literacy interventions may help reduce inequalities and increase the responsiveness of health systems which could potentially facilitate Nepal to meet the sustainable development goals. While there is currently little in place for health literacy to impact on the SDG3, this paper generates insights into health literacy’s potential role.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The potential of health literacy to address the health related UN sustainable development goal 3 (SDG3) in Nepal: a rapid review

Budhathoki

Pokharel

Good

et al. 2017

BMC Health Serv Res

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“…Žemesniųjų valdymo lygių valdžios organai, turėdami tam tikrą autonomiją (veikimo laisvę), visų pirma atskaitingi ne valstybės valdymo subjektams, bet vietos ar regiono rinkėjams (Baltušnikienė, 2009, p. 81). Politikai, decentralizacijos procese yra atskaitingi piliečiams už savo veiksmus (Regmi et al, 2010).…”

Section: Politinės Galios Decentralizacijos Proceso įTaka Elektroniniunclassified

Vietos valdžios ir piliečių interakcija socialiniame tinkle „Facebook“: Lietuvos savivaldybių atvejis

Aurylaitė¹

2017

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Globalizacijos laikotarpiu vietos savivaldoje ėmė ryškėti politinės galios decentralizacijos proceso įtaka vietos valdžios ir piliečių politinei komunikacijai. Vykstant politinei decentralizacijai, teritorinių bendruomenių nariams bei jų išrinktiems atstovams perduodama daugiau įtakos priimant politinius sprendimus, tačiau politiniai institutai, nesuteikiantys piliečiams prieinamų būdų įsitraukti į politinių sprendimų priėmimo procesą, paskatina demokratijos deficito įsivyravimą vietos savivaldoje. Straipsnio tikslas yra atskleisti vietos valdžios (savivaldybių) ir piliečių komunikacijos specifiką socialinėse medijose. Atskleidžiant politinės galios decentralizacijos proceso įtaką vietos savivaldai, išskiriama atskaitomybės ir responsyvumo svarba formuojantis Lietuvos informacinei visuomenei. Liberalios demokratijos procedūrinių dimensijų – atskaitomybės ir responsyvumo moksliniai tyrinėjimai padeda atskleisti interesų atstovavimo galimybes priimant politinius sprendimus skaitmeninėje viešojoje erdvėje. Straipsnyje pristatoma 2015–2016 m. atlikta Lietuvos savivaldybių informacijos viešinimo strategijų socialiniame tinkle „Facebook“ kiekybinė turinio analizė. Atliekant tyrimą vertinama interakcija – viešinamos ir vartojamos informacijos santykis, padedantis atskleisti informacijos viešinimo strategijas socialiniame tinkle „Facebook“. Vertinant elektroninio dalyvavimo strategijas daugiausia dėmesio skiriama atskaitomybės ir responsyvumo kriterijams, šiuo būdu siekiama palaikyti subsidiarumo principą socialinėse medijose. Naujųjų medijų logika pasižymi abipuse komunikacija ir informacijos viešinimo operatyvumu, tačiau politinio instituto – savivaldybių skelbiama informacija yra gana formali, orientuota į vienkryptę komunikaciją. Vietos valdžia skatina piliečius įsitraukti į politinio sprendimo procesą tik tuomet, kai organizuotai viešina informaciją socialiniame tinkle „Facebook“.

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“…Management structures and competencies at the district or sub national level are even weaker [10, 13]. Meanwhile, district level managers are significant for the functioning of the health system, especially in settings that have undergone decentralization [14, 15]. To ensure adequate numbers and distribution of health managers, several strategies have been employed, ranging from policy legalization to training programs with varying degrees of implementation and success [16, 17].…”

Section: Introductionmentioning

confidence: 99%

Building a competent health manager at district level: a grounded theory study from Eastern Uganda

Tetui

Hurtig

Ekirpa-Kiracho

et al. 2016

BMC Health Serv Res

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Background: Health systems in low-income countries are often characterized by poor health outcomes. While many reasons have been advanced to explain the persistently poor outcomes, management of the system has been found to play a key role. According to a WHO framework, the management of health systems is central to its ability to deliver needed health services. In this study, we examined how district managers in a rural setting in Uganda perceived existing approaches to strengthening management so as to provide a pragmatic and synergistic model for improving management capacity building. Methods: Twenty-two interviews were conducted with district level administrative and political managers, district level health managers and health facility managers to understand their perceptions and definitions of management and capacity building. Kathy Charmaz's constructive approach to grounded theory informed the data analysis process. Results: An interative, dynamic and complex model with three sub-process of building a competent health manager was developed. A competent manager was understood as one who knew his/her roles, was well informed and was empowered to execute management functions. Professionalizing health managers which was viewed as the foundation, the use of engaging learning approaches as the inside contents and having a supportive work environment the frame of the model were the sub-processes involved in the model. The sub-processes were interconnected although the respondents agreed that having a supportive work environment was more time and effort intensive relative to the other two sub-processes. Conclusions: The model developed in our study makes four central contributions to enhance the WHO framework and the existing literature. First, it emphasizes management capacity building as an iterative, dynamic and complex process rather than a set of characteristics of competent managers. Second, our model suggests the need for professionalization of health managers at different levels of the health system. Third, our model underscores the benefits that could be accrued from the use of engaging learning approaches through prolonged and sustained processes that act in synergy. Lastly, our model postulates that different resource investments and a varied range of stakeholders could be required at each of the sub-processes.

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Understanding the effect of decentralisation on health services

Cited by 32 publications

References 45 publications

The potential of health literacy to address the health related UN sustainable development goal 3 (SDG3) in Nepal: a rapid review

The potential of health literacy to address the health related UN sustainable development goal 3 (SDG3) in Nepal: a rapid review

Vietos valdžios ir piliečių interakcija socialiniame tinkle „Facebook“: Lietuvos savivaldybių atvejis

Building a competent health manager at district level: a grounded theory study from Eastern Uganda

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