Health policy and planning
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Global efforts to address alcohol harm have significantly increased since the mid-1990 s. By 2010, the World Health Organization (WHO) had adopted the non-binding Global Strategy to Reduce the Harmful Use of Alcohol. This study investigates the role of a global health network, anchored by the Global Alcohol Policy Alliance (GAPA), which has used scientific evidence on harm and effective interventions to advocate for greater global public health efforts to reduce alcohol harm. ⋯ The analysis reveals a need to transform the network into a formal coalition of regional and national organizations that represent a broader variety of constituents, including the medical community, consumer groups and development-focused non-governmental organizations. Considering the growing harm of alcohol abuse in LMICs and the availability of proven and cost-effective public health interventions, alcohol control represents an excellent 'buy' for donors interested in addressing non-communicable diseases. Alcohol control has broad beneficial effects for human development, including promoting road safety and reducing domestic violence and health care costs across a wide variety of illnesses caused by alcohol consumption.
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Advocacy, policy, research and intervention efforts against childhood pneumonia have lagged behind other health issues, including malaria, measles and tuberculosis. Accelerating progress on the issue began in 2008, following decades of efforts by individuals and organizations to address the leading cause of childhood mortality and establish a global health network. This article traces the history of this network's formation and evolution to identify lessons for other global health issues. ⋯ Frustrated with lack of progress on the issue, actors began forming a network and shared identity that included a broad spectrum of those whose interests overlap with pneumonia. As the network coalesced and expanded, its members coordinated and collaborated on conducting and sharing research on severity and tractability, crafting comprehensive strategies and conducting advocacy. These network activities exerted indirect influence leading to increased attention, funding, policies and some implementation.
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In 2002, Thailand achieved universal health coverage through the introduction of the Universal Coverage Scheme (UCS). However, people with citizenship problems, so-called 'stateless people', were left uninsured. Consequently, the 'Health Insurance for People with Citizenship Problems' (HIS-PCP) policy was adopted in 2010 with features emulating the UCS. ⋯ Guidelines concerning budgeting and scope of service provision should be fine-tuned. In the long run, the nationality verification process for stateless people should be expedited. The MOPH should develop clear and practical guidelines to assist health personnel to support patients to resolve their citizenship problems.
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Transparency interventions, such as public reporting, have emerged as a potential policy approach to improving the performance of health care providers in resource-constrained settings. We report on results from focus groups and key informant interviews in rural areas of two Tajik provinces, Soghd and Khatlon, with regards to three important initial considerations for developing a report card initiative for primary health care in this setting: selecting indicators for the report card, collecting data, and working with existing institutions and stakeholders. ⋯ Participants indicated a preference for arms-length collection of sensitive feedback on local providers. Because citizens and local institutions have close and important relations with their local health care providers, there may be scope for a trusted external actor, such as a non-governmental organization, to facilitate the report card process.
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There are different reimbursement rates by the various insurance schemes in Thailand, which include the Universal Coverage scheme (UCS), civil servant medical benefit scheme (CSMBS) and social security scheme (SSS). Hence, there are concerns about inequitable care standards. Harmonization of the rates of emergency medical services has been started since April 2012. ⋯ Payment mechanism alone is inadequate to ensure equitable distribution of health outcomes in provision of emergency medical care by private providers in urban settings across the country. A secondary finding was that patients accessing hospital services directly showed better improvement or lower in-hospital mortality compared with access through formal pre-hospital means (P < 0.001). Plausible explanations have been discussed with policy implications and recommendations for further studies.