also available for download as a

ARTICLES

IHF News

IHF General Assembly, November, 11th 2009 in Rio

The General Assembly took place during the Rio Congress. Most of IHF full members were present or represented to vote the new constitution, renew the members of the Governing council, elect the incoming president, and to approve policies and strategies of IHF, as well as the Director General ‘s report 2008-2009.

The IHF Executive committee, formed by Dr Ibrahim, A. Al Abdulhadi, Dr. Jose Carlos de Souza Abrahão, Mr. Gerard Vincent, Dr. Adeleke Pitan and the chief executive, Eric de Roodenbeke, lead the general assembly.

The vote for the new constitution represented a important step for IHF future. Mr. Rene Peters, presented the new IHF Constitution, on behalf of the Working Party led by Mr. Georg Baum. The new Constitution is more robust and modern, providing a clearer definition of IHF’s mission and shared values. The membership conditions are also better defined to provide a fair and equitable platform for a global community of hospitals/healthcare organizations. There is also better regulation of the Governing Council composition, better outlining of responsibilities of the organs and elaboration of the decision-making procedures.

The General Assembly has also been the occasion to welcome the incoming president, Dr. Jose Carlos de Souza Abrahão, President of CNS- National Health Confederation in Brazil. Dr. Abdulhadi became then immediate past president, and Mr. Tom Dolan, CEO of the American College of Healthcare Executives and representative of the American hospital association, was nominated as the designate president. The adoption of the new constitution also allowed extending the term of office for two years of Mr. Gérard Vincent, Secretary General of the French Hospital Association, as immediate past president.

Then, IHF full members elected the new governing council members to replace members ending their term of office: Dr. Carine Boonen (Belgium), Mrs Ellen Hyttsten (Sweden), Dr. Hermansyur Kartowisastro (Indonesia), Mr. Norberto Larroca (Argentina), Dr. Carlos Duenas (Mexico), Mr. Rene Peters (The Netherlands).

New elected governing council members are: Prof. Guy Durant (Belguim), Prof. Carlos Pereira Alves (Portugal), Dr. Erik Kreyberg Normann (Norway), Dr. Juan Carlos Linares (Argentina), Dr. H. Muki Reksoprodjo (Indonesia).

The Director General report was adopted as well as the accounts for 2007 and 2008 and the budget for 2010. The report is covering the evolution of IHF structure and it stresses the importance of communication between the secretariat and members. A detailed description of the management of each of the legal entity sustaining the over all IHF activities is also provided. A portfolio analysis and perspectives for the future are included in the document. The report has been distributed to all members and is available on demand.

IHF Governing Council

Two governing council meetings have been held in Rio, before and after the General Assembly. Discussion concerned among others, the World Hospital Congress, the organization of a second Hospital Leadership Summit and the IHF financial model.

After the success of the first edition in Paris in May 2009 (see eNewsletter from May 2009), council members unanimously agreed to adopt le leadership summit as an IHF flagship event to be held annually. Next edition should be hosted by the American College of Healthcare Executives, in Chicago or Washington, in May or June 2010. Council members agreed that educational activities, namely IHF Congress and Leadership Summit, should be one of the priorities for the coming year. It was also agreed that Governing Council meetings should be held in conjunction with this event.

Another important issue raised was the IHF financial model. Last year, governing council members decided a significant increase of IHF dues. In fact, for more than 20 years small annual increases did not reflect the economic growth of countries, and did not reflect the countries income scale. The limited incomes from membership dues have put at risk IHF financial sustainability.

This year, the governing council decided not to increase the fees for 2010. However, discussions need to follow up on this issue, to decide the financial model to be adopted for the following years. For this reason the former audit committee and the working party set up for the dues have been merged into and audit and finance committee that will prospect on possible sources of revenues for IHF.

An overview of pandemic H1N1 virus preparedness

The International Hospital Federation led a study among its members about H1N1 preparedness, and gathered kind of information available on their websites regarding this pandemic.

The threat of a fall flu season is a challenge the whole world is trying to find a solutions to. While efforts are being done to find vaccine, each and every country have been putting in place National Pandemic Influenza Plan and Pandemic Influenza Preparedness for to limit the effects of a potential pandemic, inform the public about pandemic influenza, explain what the Government and the health services are doing to prepare for a possible pandemic and finally give information on what members of the public need to do if there is a pandemic.
Organizations and associations representing hospitals have been and are still playing key roles ranging from providing advice to guidelines design.

The study has been prepared through an online questionnaire distributed among the members, and visit of their websites.

Results of the study are available on : http://www.ihffih.org/pdf/pandemic_h1n1_preparedness.pdf

36th World Hospital Congress in Rio, 12-14 November, 2009

The 36th World Hospital Congress, which took place in Rio last month, was a joint realization of the International Hospital Federation, CNS – National Health Confederation and Hospitalar. With about 2000 participants from 70 countries, the congress provided a huge opportunity for interaction and sharing of experiences and practices.

For first time in Latin America, the World Hospital Congress highlighted the theme of Healthcare in the knowledge Era. The congress was closed on Friday, the 14th, in presence of Eric de Roodenbeke, CEO of the IHF, José Carlos Abrahao, President of CNS and incoming president of IHF, Waleska Santos, President of Hospitalar Fair and Forum, Carissa Etienne, Assistant Director of the World Health Organizations, and other personalities of the hospital sector in the world.

Some of the remarkable plenary sessions are detailed below. Parallel sessions addressed various other issues, among other, patient safety issues, evidence-based decision making in healthcare, safe and operational hospitals in emergencies and disasters, globalization in healthcare, etc. All the presentations will be soon available on IHF website (www.ihf-fih.org).

In her presentation about future of healthcare technology in the knowledge era, Carissa Etienne (ADG- WHO) stressed the context and challenges of our evolving world, and health services today. She also explained the role of health technology in responding to the needs, in a context of primary health care renewal. In its presentation, Yunkap Kwankam from the International Society for Telemedicine and eHealth (ISfTeH) illustrated the importance of health technologies in healthcare systems. As for sustainable development and hospitals, Boi Ruiz Garcia from the Catalane hospital association highlighted several points like the environmental performances of the health facilities, the impact on patients and workers, the models for environmental strategies, international assessment systems and the concept of “green hospital”.

The large variety of parallel session allowed participants to up their knowledge on most important themes for hospital decision makers. All these sessions provided a flavor of what is done in Latin America as well as in other part of the world. Participants were able to take away some clues to better face the challenges they have at home.

Besides of the sessions, the simultaneous exhibition Medical Devices Expo, organized by Hospitalar and CNS, aimed at stimulating contacts and business. Social events also gave opportunities for the participants to discuss about hospital issues and to exchange about countries experiences.

The next hospital congress will be in Dubai, 29-31 March, 2011 (www.ihfdubai.ae). The motto of the Dubai Congress is Developing ethics in Hospitals and health services and it is formulated under the theme “Shifting Paradigms: Anticipating the ethical challenges of new medical technologies and procedures in a globalizing world”. A Call for speakers and topics is extended with a deadline on March 31st, 2010.

IHF Hospital Association Meeting

As a tradition, IHF organized a meeting for Federal and State Hospital and Health Care Associations’ Directors, Board members and staff in conjunction with the 36th World Hospital Congress, in Rio de Janeiro, Brazil.

The agenda included discussion around WHO activities, namely the Code of Ethical Recruitment, and the role of district hospitals for Primary Health Care revival and how continuum of care is addressed.

In September 2008, WHO invited Member States, health workers, recruiters, employers, academic and research institutions, health professional organizations, relevant sub regional, regional and international organizations, whether governmental or nongovernmental, and all persons concerned with the international recruitment of health personnel to contribute to a web-based public hearings on a draft code of practice on the international recruitment of health personnel.

The draft code was submitted to the WHO Executive Board for consideration at its 124th Session in January 2009. The final draft had been adopted at regional committee level and that discussions remained ongoing with the aim of its presentation for adoption by the Executive Board at its meeting in January 2010.

The objectives of this code are to:
a.establish and promote voluntary principles, standards and practices for the international
recruitment of health personnel;
b.serve as an instrument of reference to help Member States to establish or to improve the legal and institutional framework required for the international recruitment of health personnel and in the formulation and implementation of appropriate measures;
c.provide guidance that may be used where appropriate in the formulation and implementation of bilateral agreements and other international legal instruments, both binding and voluntary; and
d.facilitate and promote international discussion and advance cooperation on matters related to the international recruitment of health personnel.

Certain IHF members acknowledged the limitations of the Code in relation to the European Union Region where there is free movement of persons, but recognized the need for such an instrument within the wider global framework. No participant made comments on the content of the code which seems appropriate. The issue is the condition for application of the code and the risk of exacerbation of tensions if some comply with it while others continue with unethical recruitment practices.

Concerning the role of district hospitals for Primary Health Care revival and how continuum of care is addressed, we can remember that 2008 World Health report was called “Primary Health Care, now more than ever”. The WHO is seeking to strengthen partnership with strategic partners to move from recommendations to action oriented programs. IHF in response has become engaged in various initiatives and members were invited to share country experiences and provide IHF with information.

The rest of the meeting allowed participants to discuss about various topics as the lessons from the healthcare associations facing H1N1, the feedback and future of the Hospital associations Leadership Summit, the IHF World Map Project, available on the website (www.ihf-fih.org).

Infant Food Safety Program: field missions in Peru and Indonesia

The International Hospital Federation with the support of the International Association of Infant Food Manufacturers (IFM), organized two fact finding missions to hospitals/healthcare facilities in Peru and Indonesia, to explore ways to improve infant and child food handling safety. Field work has been realized in cooperation with the local IHF members, FEPAS (Federacion Peruana de Administradores de Salud) and Persi-IHA (Indonesian Hospital Association).

Patient safety is well supported by many initiatives dealing with healthcare. However, in facilities patients are also receiving food, and on this front, very little has been done to ensure that handling is responding to high standards of safety. Although food handling is not the cause of major fatalities, it nevertheless impacts patient outcomes and length of stay in healthcare facilities.

Before attempting to promote changes in food handling, preparation and feeding practices, it is crucial to understand the local and ‘institutional’ beliefs and behaviors governing them. Technical recommendations based strictly on physiological considerations may be unacceptable if they are incompatible with local and institutional perceptions. It is therefore critical to identify effective ways and sustainable programs of institutionalizing interventions within healthcare settings, one possible example being the ‘positive deviance’ concept, which involves building on capabilities of individuals already have rather than ‘compelled’ behavioral change. As much of infection control lies in the hands of healthcare personnel who are in direct contact with the sick patient, they must understand specific guidelines in prevention of infection transmission through isolation and other good healthcare habits. A key element of the mission was to observe, record by way of the survey, interaction and discussions with patients and hospital personnel (clinical, managerial, support services, nursing, housekeeping, catering, laundry, maintenance and decontamination and sterile services staff) infection control, food preparation practices, particularly vis-à-vis essentials such as:
Hand Washing
Hygiene and Uniform
Barriers: Caps, Masks, Gloves
Equipment Safety and environment
Safe Food Handling
Risk Assessment and surveillance
Data collection and analysis
Formula room preparation and hygiene practices
Monitoring and Evaluation

The global objective of the mission is to develop a generic toolkit, which will address issues food handling in the largest theme of infant food safety. This tool will be further disseminated among all IHF members.

The two field missions in Peru and Indonesia have started with the visit of different kind of hospitals (public and private, different size of hospitals) in different locations (in the countries’ capital and surroundings).

After the visits, a workshop was conducted in each country. It brought together representatives of the different professional groups and stakeholders of the hospitals visited as well as representatives of IHF national member organizations. These involved group session work, which were led by facilitators, during which participants were required to present and address a list of priority issues as well as engage in solution-finding exercises. The workshop objectives were for the participants to bring forth solutions and recommendations aimed at improving knowledge and practices in behaviour. These recommendations were presented at follow-up meetings of decision makers of the hospitals/health facilities visited, as well as representatives from the Ministry of Health and/or national public health governing bodies.

Finally, the field missions concluded with a meeting of hospital directors, ministry of health and/or national public health governing bodies, to report the main conclusions discussed during the workshop. As a result the directors and the authorities were sensitized. Ultimately, political and managerial commitment were sought in order to work towards implementation of the recommendations.

Hospital/Clinic/Health Facility Managers TB and MDR-TB Workshop, Mumbai, India

The IHF, through this MDR‐TB and TB training workshop for hospital and health facility Managers in India, provides an overview of the basics of TB control together with the appropriate expertise and necessary resources to make informed decisions about the management of TB patients in their facilities. The workshop was held in Mumbai, India between 5th and 8th October 2009.

The Workshop was supported by International Hospital Federation, Health Development International and Lilly MDR TB Partnership. The Maharashtra State Anti Tuberculosis Association organized the workshop.

From a public health perspective, poorly supervised or incomplete treatment of TB is worse than no treatment at all. The problem, however, cannot be attributed to the lack of an effective treatment, but to a lack of organization. The shortage of trained staff is consistently cited as the main constraint facing TB control. Effective and expert leadership is therefore crucial among the managers of the treatment delivery settings and network.

Regardless of the mode of delivery, management of TB and MDR‐TB depends on the assurance of a steady supply of medicines provided to patients through a reliable network of educated and effectively trained providers. Thus, a well managed TB control programme can only be found within a framework of collaboration among all those healthcare professionals, in such vital fields as medicine, nursing and hospital management, bringing together knowledge and expertise involved in the treatment and care of the disease.
The role of managers is to be active participants of an area‐wide organization of health services that reaches the community and home levels for effective TB and MDR‐TB control. They have to understand the need for continuous and strong support for MDR‐TB and TB control programmes.

The role of managers would therefore be that of facilitators for doctors and nurses to enable them to provide treatment without interruption and to apply actions for monitoring the control programmes, in the absence of which costs and human suffering increase significantly, particularly as a trend in resistance to major anti‐TB drugs emerges.

Learning Objectives of the workshop
Macro level skills development in leadership, strategic and operational planning and budgeting;
Development of guiding practices of hospital/clinic/health facility managers, in order that they may gain the cooperation and commitment of other agencies and their own staff to plan and to organize a successful and sustainable TB and MDR‐TB national control programme;
identify current management/leadership strengths and weaknesses in occupational settings;
Opportunity to share experiences, practices and expertise with national and international TB
health facility managers;

Outcomes:
Better informed health facility managers in leadership, strategic and operational planning and budgeting within settings treating MDR‐TB and TB;
improved management/leadership, strategic and operational planning and budgeting skills;
Better understanding of management/ leadership financial priorities/realities of TB control and care in and between national and international health facilities.

to download PDF click here

WHO round up

Women and health: Today’s evidence, tomorrow’s agenda

Despite progress, societies continue to fail women at key times of their lives. This report has been commissioned to gather a baseline of data about the health of women and girls throughout the life-course, in different parts of the world, and in different groups within countries.

Despite considerable progress in the past decades, societies continue to fail to meet the health care needs of women at key moments of their lives, particularly in their adolescent years and in older age. These are the key findings of the WHO report Women and health: today's evidence tomorrow's agenda.

WHO calls for urgent action both within the health sector and beyond to improve the health and lives of girls and women around the world, from birth to older age.
The report provides the latest and most comprehensive evidence available to date on women's specific needs and health challenges over their entire life-course.

Women provide the bulk of health care, but rarely receive the care they need - Up to 80% of all health care and 90% of care for HIV/AIDS-related illness is provided in the home - almost always by women. Yet more often than not, women go unsupported, unrecognized and unremunerated in this essential role and health care continues to fail to address their specific needs and challenges throughout their lives.

Women live longer than men but these extra years are not always healthy - HIV, pregnancy-related conditions and tuberculosis continue to be major killers of women aged 15 to 45 globally. However, as women age, non-communicable diseases become major causes of death and disability, particularly after the age of 45 years.

Policy change and action is needed within the health sector and beyond - The report seeks to identify key areas for reform, both within and outside the health sector. These include identifying mechanisms to build strong leadership with the full participation of women's organizations, strengthening health systems to better meet women's needs throughout their lives, leveraging changes in public policy to address how social and economic determinants of health adversely impact women, and building a knowledge base that would allow a better tracking of progress.

The report includes the latest global and regional figures on the health and leading causes of death in women from birth, through childhood, adolescence and adulthood, to older age.

To download the report: http://www.who.int/gender/documents/9789241563857/en/index.html

Global Initiative on Health Technology

The 36th World Hospital Congress in Rio hosted as a pre-congress event the 2nd Technical Advisory Group Meeting on Health Technology. The Global Initiative on Healthcare Technologies is a several-step process, in which IHF is involved.

The objective of the meeting was to review and adopt methodology and tools for health technology.

The Rio meeting will be followed by a meeting in Cairo in June 2010 to finalize the tools. As a final step of the process, the selected tools will be implemented in pilot countries.
This meeting presented the outcomes of experts’ previous meetings, during which a special focus had been put on updating and revising existing tools, and developing new ones.

After feedbacks on previous meeting, speakers from different pilot countries from all over the world presented their challenges and strategies. Essential issues concerning health technologies (HT), have been presented and discussed: HT assessment, healthcare infrastructure and technology policies, HT indicators, HT procurement, healthcare equipment donations, corrective and preventive maintenance, computerized maintenance management system, selection and use of laboratory technologies, list of medical devices by healthcare facility or clinical practices, interrelated database, regulation, etc.

Furthermore, tools have been presented for a potential dissemination. The language issue has been underlined and is to be further considered when dealing about dissemination of tools.

IHF confirmed its commitment to participate in the dissemination of the tools, thanks to its solid network of full and associate members.

Finally, working groups have been formed to work further on relevant issues that emerged from the discussions: nomenclature, human resources, the need for assessment, regulation, dissemination of tools, visibility of HT, methods to create and identify HT maintenance centers of excellence, evidence-based HT justification, standardization, patient safety, telemedicine and framework for regulation and policies.

The objective of the Cairo’s meeting will be to review and adapt the Guidelines for the Formulation of National Health Technology Programs.

More documentation will be available on: http://www.who.int/medical_devices/en/

Role of district hospital in Primary Health Care renewal

This meeting took place during the 36th World Hospital Congress, 11-12 November 2009. The first objective of the meeting was to identify gaps to be filled, and therefore content that should be revised, in policy guidance on the place of the hospital within the district, and the place of district in PHC renewal. The second objective was to identify elements on a related work program.

A Cross-Cluster Special Initiative was set up within the Health Systems and Services (HSS) Cluster with the active involvement of EHT (Essential Health Technologies) and HDS (Health Systems Governance and Service Delivery) to clarify the role of the district hospital within the PHC paradigm.

The focus of this Special Initiative is to study how district hospitals can, should, and have been contributing to the reforms of Primary Health Care (PHC), i.e. universal coverage, service delivery, leadership and public policy reforms.

District hospitals play a critical role in providing individuals and families with timely medical and surgical care. Their main role is to offer the health services that can not be provided by health centres thus serving as back up referral care for primary care centres. They play an important role in supporting health care providers at first contact level thereby forging a critical link between the communities they serve and specialized centres. They play a direct role in training and supervision of health care workers, particularly clinical assistants, nurses and other support staff, as well as an in providing continuing medical education. Beyond this, district hospitals often function as coordinating centres for local health information and planning and provide necessary data to national health planners from the district. They serve as logistics centres for drugs and supplies, etc. and often link up with other government and non government actions in health and health related programs, like water and sanitation, education and social services. The range of the district hospital's role is to be elucidated within the framework of this Special Initiative.

The expected outcomes of the meeting were:
A description of the current state of knowledge of policy guidance including the gaps and therefore the needs for revision
A work programme for stakeholders related to filling the gaps and needs

Conventional arguments claim that hospitals consume too large a share of health budgets; however, a distinction must be made here between tertiary care institutions and district hospitals. District hospitals have typically been under-funded and have suffered deficiencies in quality, to which governments should give urgent attention. Primary care systems in low- and middle-income countries, with district hospitals as the crucial component of the district health system supporting health service delivery in the district as a whole, have yet to receive the sustained policy attention and resources that their importance warrants. The challenge facing many countries is not only to invest additional human and financial resources into district hospitals, but also to organize them in such a manner that they serve as first referral units in providing a continuum of care along with primary care units and ensure the delivery of integrated package of services.

Eric de Roodenbeke, Director General of IHF, contributed to the meeting by presenting the needs to identify the gaps in the current situation and how to translate them into action. The definition of district hospital is not always evident and comprehensive, and can change from a country to another.
Translating gaps into actions could mean, among other:
Reconsidering the role and functions of district hospital,
Reconsidering outcome measures,
Developing new planning model for hospitals,
Enhancing linkages with PHC renewal.

From International Organizations

Establishing private health care facilities in developing countries: a guide for medical entrepreneurs

This book, written by Seung-Hee Nah and Egbe Osifo-Dawodu from the World Bank Institute, is a practical guide for medical professionals with little or no business experience who are interested in establishing health care facilities in developing countries. It is an introduction to the kinds of basic research and planning required to identify viable solutions and reduce the risk of failure.

Drawing on resources from across the World Bank Group and elsewhere, this book aims to provide medical entrepreneurs with some of the tools they need to build sustainable health care facilities for their communities. It offers practical “how to” guidance on key issues such as project concept, prefeasibility and feasibility analyses, regulatory and policy environment, investment and financing needs, marketing and pricing principles, facility construction, staffing, and risk management. Aimed principally at the new private entrepreneur, the book may also be useful to managers of public or not-for-profit health care facilities who are also grappling with issues if quality, efficiency, and sustainability in health care.

To buy the book, please visit the website: http://publications.worldbank.org/ecommerce/catalog/product?item_id=6360754

The World Bank annual report now available

The Annual Report, which covers the period from July 1, 2008, to June 30, 2009, has been prepared by the Executive Directors of both the International Bank for Reconstruction and Development (IBRD) and the International Development Association (IDA)—collectively known as the World Bank—in accordance with the respective bylaws of the two institutions.

Robert B. Zoellick, President of IBRD and IDA, and Chairman of the Board of Executive Directors, has submitted this report, together with the accompanying administrative budgets and audited financial statements, to the Board of Governors. Annual reports for the International Finance Corporation (IFC), the Multilateral Investment Guarantee Agency (MIGA), and the International Centre for Settlement of Investment Disputes (ICSID) are published separately.

The three chapters address:
Innovative initiatives to mitigate global crisis and expand ongoing operation.
World bank actions in the field.
Fiscal year summary.

We all know that the global financial and economic crisis is the greatest challenge, and will be for some time to come. The Bank has created new programs, fast-tracked funds from existing initiatives, and made record commitments to aid the most vulnerable during this emergency. At the same time, it has tended to their ongoing, long-term operations in climate change, health, infrastructure, and much more as they support efforts to achieve the Millennium Development Goals.

You’ll also read the inspiring stories of individuals that the World Bank is proud to have assisted, and find multimedia components on the Annual Report Web site that provide more information about the Bank’s work.

Readers are encouraged to provide their feedback on the Annual Report by emailing wbannualreport@worldbank.org

o download the report (several languages available): http://web.worldbank.org/WBSITE/EXTERNAL/EXTABOUTUS/EXTANNREP/EXTAR2009/0,,c

Hospital and Health Services World News

Where Governments cannot or will not deliver: Health Service Provision in Fragile States

Fragile states, defined by DFID as those “where the government cannot or will not deliver its basic functions to the majority of its people, including the poor”, have some of the worst health indicators and the weakest health services. Services are disproportionately under-funded and funding is more volatile than in other developing countries. Providing health care and rebuilding health services in such countries is a complex and painstaking undertaking for national and local governments, civil society organizations and donor agencies.

To help address this challenge, the Health and Fragile States Network was created in October 2007 to foster dialogue and debate; inform and influence policy; and identify, stimulate and conduct research. The Network, together with the IDS Health and Development Information Team and Eldis recently published a Health and Fragile States dossier on the Eldis web platform that describes the difficulties faced by fragile states and the strategies to overcome them. The dossier, funded by DFID, was launched in June 2009 at IDS and the London International Development Centre (LIDC).

The dossier charts two approaches to health service delivery in fragile states:
the humanitarian approach, which focuses on meeting the immediate health needs of a population; and the health systems strengthening approach, which focuses on building the government's capacity as the steward of the health system.

The dossier covers a number of issues, including: what are fragile states? How can the health-related Millennium Development Goals be met in these states? What are the best approaches for delivering health services in fragile states? How can the World Health Organization’s (WHO) six building blocks for health systems strengthening be used as a framework for planning and priority-setting in fragile states? What are the implications of the international aid effectiveness agenda for the building of resilient and responsive states to deliver basic services? 

For more information: http://www.ids.ac.uk/go/news/where-governments-cannot-or-will-not-deliver-health-service-provision-in-fragile-states

Health and fragile State network : http://www.healthandfragilestates.org/

Health and fragile states dossier: http://www.eldis.org/go/topics/dossiers/health-and-fragile-states

Commercialisation of health and capital flows in east and southern Africa: Issues and implications

To understand flows of private capital behind the growth of the for-profit health care sector in SADC, the Regional Network for Equity in Health in east and southern Africa (EQUINET) working through Rhodes University Institute of Social and Economic Research (ISER), Training and Research Support Centre (TARSC), Southern and Eastern African Trade Information and Negotiations Institute (SEATINI) and York University are examining health sector capital flows in East and southern Africa ESA, and commissioned this overview study.

EQUINET, the Regional Network on Equity in Health in Southern Africa, is a network of professionals, civil society members, policy makers, state officials and others within the region who have come together as an equity catalyst, to promote and realize shared values of equity and social justice in health.

While there is much promotion of private capital flows into the health sector in Southern
Africa in reality these flows have been minimal. The study found that the use of term ‘private sector’ in Africa is misleading since for the most part it consisted of informal shops and non-profit organizations; nearly 40% of the ‘private provision’ is just shops selling drugs of unknown quality. If the shops are removed from the data, then the share of services in the private sector falls dramatically, especially for poor people. Data across fifteen sub-Saharan African countries shows that only 3% of the poorest fifth of the population who sought care saw a private doctor (Oxfam, 2009). Usage intensity estimates in Sub-Saharan Africa as a measure of the relative sizes of private and public sector shows that two in ten persons use private, another three in ten use public facilities and five in ten are not able to access health care at all.

However the size alone of the formal for-profit private is not a good indicator of its influence and role in the health system. Despite low FDI, governments continue a policy bias to encourage FDI in health systems. Even if the FDI dries up, internal shifts in the health sector within countries, even those not regarded as good investment options, are very significant as Zimbabwe and Tanzania show. One of the key challenges faced by governments arises from the increased (or anticipated) private sector participation in health services as well as crossborder trade in health services.

To download the document: http://www.equinetafrica.org/bibl/docs/DIS77capflowRUITERS.pdf
And for more information about EQUINET, please visit: http://www.equinetafrica.org/

Monitoring hospital performance for equity: the contribution of doctors with Africa CUAMM to the strengthening of African Health System

This poster show the result of a study lead by F. Monenti, G. Putoto and D. Carraro, from Doctors with Africa CUAMM, Padua, Italy. The objective is to develop and use a managerial statistical tool to monitor hospital performance, in order to address efficiency and equity over time.

To download the poster: http://www.mediciconlafrica.org/upload/download/cuamm_pansuop09.pdf

Hospital at home (HAH) in France,a structured, individual care plan for all patients

This study, lead by A. Afrite, M.Chaleix, Laure Com-Ruellea and H. Valdelièvre, examines the patient profiles and medical treatments administered in 2006 to define the place of HAH in patients’ care pathway in France.

Hospital at home (HAH) delivers coordinated hospital-level care to patients in their home. Through a description of HAH patients’ profiles, the study assesses this alternative hospitalization mode in the overall healthcare supply in France. It uses data provided by the 2006 HAH Medical Information Systems Program (HAH MISP). In addition to individual characteristics, this exhaustive data set describes the major and associated components of medical treatment, as well as patients’ level of dependency and the length of stay. This study was effectuated in partnership with the Ministry of Health Directorate for Research, Studies, Assessment and Statistics, and has been published in Issues in health economics n° 140 - March 2009.

Pdf available on: http://www.irdes.fr/EspaceAnglais/Publications/IrdesPublications/QES140.pdf

Temporal and geographic heterogeneity of the association between socioeconomic position and hospitalization in Italy: an income based indicato

This article has been written by P. Schifano et al., and has been published in the International Journal for Equity in Health, 8:33, September 2009. Its objective is to test the association between the demand for hospital care and a small area indicator based on income in four Italian cities, over a four-year period (1997-2000), in the adult population.

Background
The inverse association between socioeconomic position (SEP) and health has been extensively explored in Italy; however few studies have been carried out on the relationship between income inequalities and health status or health services utilization, particularly at a local level.

Methods
Census Block (median 260 residents) Median per capita Income (CBMI) was computed through record linkage between 1998 national tax and local population registries in the cities of Rome, Turin, Milan and Bologna (total population approximately 5.5 million). CBMI was linked to acute hospital discharges among residents, based on patient's residence.
Age-standardized gender-specific hospitalization rates were computed by CBMI quintiles (first quintile indicating lowest income), overall, and by city and year. Heterogeneity of the association between income level and hospitalization was analyzed through a Poisson model.

Results
We found an inverse association between small area income level and hospitalization rates, which decreased continuously from 153 per 1000 inhabitants in the first quintile to 107 per 1000 inhabitants in the fifth quintile. Income differences in hospitalization were confirmed in each city and year. However, the magnitude of the association and the absolute level of hospitalization rates were quite different in each city and tended to slightly decrease over time in all cities considered, except Bologna.

Conclusion
Our study confirms an inverse association between income level and the use of hospitalization in four Italian cities, using a small area economic indicator, based on population tax data. Further analysis of the association between income and cause-specific hospitalization rates will allow to better understand the capability of the Italian National Health System to compel with socio-economic inequalities in health needs.

Furthermore the SEP indicator we propose can represent a contribution to the improvement of tools for monitoring inequalities in health and in health services utilization.

To download the document: http://www.equityhealthj.com/content/pdf/1475-9276-8-33.pdf

Private sector healthcare in Indonesia

This publication was produced for review by the United States Agency for International Development. It was prepared by Grace Chee and Michael Borowitz (Abt Associates Inc.) and Andrew Barraclough (Management Sciences for Health) for the Health Systems 20/20, PSP-One and Strengthening Pharmaceutical Systems Projects.

As documented in Indonesia’s 2007 Public Expenditure Review, the private sector’s role in the Indonesian health care system has grown dramatically over the past decade. Development partners came to agreement in late 2008 that a review and assessment of the private health care sector in Indonesia would make a significant contribution by identifying key issues and options for discussion. In-depth understanding of key private health care sector issues would provide information that USAID, development partners, and the Government of Indonesia could use to plan future interventions that better engage private sector health providers to achieve health sector goals and objectives.This report presents the consolidated findings from the desk review and the in-country assessment, as well as recommendations for interventions that could strengthen the role private health care providers can play in achieving health sector objectives.

In line with USAID/Indonesia’s current health strategy, the assessment team offers three options for potential programs to strengthen MCH services and control of infectious diseases:

Integrated approach to improve MCH services.
Collaboration with the private sector in TB control.
Support new GFATM recipients to control infectious diseases.

To download the pdf report: http://www.healthsystems2020.org/content/resource/detail/2355/

Lessons from the Chinese Approach to Health System Development

The 8th issue of Institute of Development Study’s journal published a policy brief about Chinese Approach to Health System Development.

China is managing major health system reforms against a background of rapid economic and institutional change. In doing so it is developing a learning approach to transition management and institution-building.

This approach includes testing innovations at local level, encouraging learning from success, and then gradually building institutions that support new ways of doing things. Chinese policymakers and analysts are also developing strategies for drawing on international experience. Analysts from other countries and officials in organisations that support international health need to understand this approach if they are to strengthen mutual learning with their Chinese counterparts.

To download the full report: http://www.ids.ac.uk/go/idspublication/lessons-from-the-chinese-approach-to-health-system-development

International Events

Geneva Health Forum: Globalization, Crisis and Health Systems: Confronting Regional Perspectives, 13-21 April 2010, International Conference Center, Geneva

A joint initiative launched by the Geneva University Hospitals and the Faculty of Medicine of the University of Geneva in partnership with the main international organizations active in health in Geneva and around the world, the Geneva Health Forum and the Global Access to Health Platform bring together the major stakeholders in global access to health - from field workers to policy-makers. The Forum and the Platform together form a developing global network for international and inter-sectoral dialogue, which has the vision of facilitating the strengthening of health systems and basic health services, striving to keep global access to health on the international agenda.

Health systems around the world are facing unprecedented challenges, many related to or exacerbated by globalization. The 2010 edition of the Geneva Health Forum aims to elucidate the global or transboundary issues that directly or indirectly influence health systems. It also aims to provide deeper insight into how health crises impact society as a whole.
As with any crisis -- be it health related, humanitarian, or environmental -- the current economic downturn presents challenges and threats for health systems. It reveals existing weaknesses and disparities, while offering new opportunities to re-examine health systems. Through dynamic confrontation of perspectives, the Geneva Health Forum 2010 aims to identify sustainable responses to crises, which ensure comprehensive primary healthcare, access to medicines, and prevention. It also addresses the power imbalances at the origin of most social inequalities in health.

In short, the following will be addressed and debated:
Crises reveal existing weaknesses and disparities and offer opportunities for health systems to function on new grounds.
Crises can be local, but are increasingly global in their reach, and their impacts on health systems call for critical examination.
Globalization tends to open new health services markets (structure, systems, workforce, insurances, etc.) which can engender reorganization and redistribution of roles within national health systems.
Exploring concrete examples of local and regional responses to crises and impacts of globalization offers a rich source from which innovative local and global approaches can be formulated
New forms of governance that include the numerous new local and global partners in health must be identified.
Information technologies facilitate the dissemination of information to increasingly diversified actors, local and global -- a phenomenon which poses new challenges and opportunities.
For more information, see: www.genevahealthforum.org

The Environmental Health: Global Perspectives and Challenges; Conceive, Design, Deliver. April, 4th and 5th, 2010, Dubai.

Environmental Health is the call of day as with Global Warming, Scarcity of Water and Pollution in every walk of life has evolved potential threats to Humanity .

The 2nd Annual Conference on “ The Environmental Health: Global Perspectives and Challenges” focuses on three streams related to the understanding, conception and implementation of Environmental Health:Conceive, Design, Deliver.

The Conference, organized by Hamdan Bin Mohammed e- University in Dubai, in April 4th & 5th of April 2010, will address these issues in a unique and peculiar manner.

Held under the patronage of His Highness Sheikh Hamdan Bin Mohammed Al Maktoum, Crown Prince of Dubai, and President of Hamdan Bin Mohammed e-University,the conference will address the challenges in e-Health, Environment and Water Resources and will deliver a consortium to appreciate the changes in the healthcare and environmental models, keeping in view the environmental changes’ appreciation and apprehensions globally and in the UAE, in particular, to promote a better quality of life.

The conference provides also networking opportunities, bringing together representatives from Ministry of Health, Ministry of Environment and Water, Senior Healthcare Executives, Environmental Policy Makers, Healthcare Professionals, NGO’s interested in environmental issues, Scholars, Researchers, Water Resource Industry leaders to discuss and address the challenges to the dynamics of innovations in e-Health, Environment and Water Resources.
All participants will share their expertise, experience and be proactive in defining the global issues related to e-Health, Environment and Water Resources.

For more information: http://ehealth.hbmeu.ae/