Health policy and planning
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An informal public-private mix in the health sector has always existed in Uganda, and policymakers, planners and the public in general have taken this for granted. There is now renewed effort to develop a comprehensive policy on the mix, but the policy process has proved to be tortuous and the mix has been interpreted differently by different stakeholders. While significant differences in opinion on the mix still remain, it is becoming clear that the new policy should enable health institutions, whether in the public or the private sector, to play roles in which they have clear comparative advantage over others.
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This paper explores changes to budget allocations for health during the decentralization process in UGANDA: When the districts were given the authority to allot their own budgets, allocations for health were reduced considerably. The rationale for this by district leaders is investigated and analyzed. ⋯ In conclusion, while conditional funding may be a useful short-term step, long-term development requires less conditionalities. Health professionals need to work closely with local leaders and district officials to make health a political priority in order to develop and allocate resources for health at local level.
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Following the disbanding of the Soviet Union in 1991, the government of Kyrgyzstan was unable to maintain the previous level of health services. To revitalize the health services, the Ministry of Health (MOH) first focused on improving their immunization services, including the immunization component of the Health Management Information System (HMIS). Secondly, to increase immunization coverage, the MOH set as a priority the elimination of prescribing false contraindications to immunization. ⋯ After a successful 1-year trial, the MOH implemented the revised HMIS nationally. Not only did the quality of the information system improve, but the new approach provided visible evidence, from facility to national levels, that the MOH was approaching their objective of reducing contraindication rates for DPT immunizations to 5% or less, and that vaccine wastage could be substantially reduced. The project demonstrated that giving health workers the basic epidemiologic skills to monitor their own work measurably improved the quality of the data, and by acquiring the new skills, the workers developed a sense of pride in their work.
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The objective of the paper is to assess the human resource (HR) dimension of the National Health Service (NHS) reforms in the United Kingdom, and to highlight lessons for the health systems of countries undergoing reform or restructuring. Health sector reform in many countries in the 1980s and 1990s has focused on structural change, cost containment, the introduction of market mechanisms and consumer choice. This focus has inevitably challenged the ways that health professionals and other staff are employed and deployed. ⋯ Attempts to alter methods of conducting employee relations and determining pay and conditions of employment have been less successful. However, an overall approach to HR management, which would have been unthinkable in the pre-reform NHS, is now accepted, albeit grudgingly by some, as the way forward. In general, the changes in the NHS HR function can be characterized as a partially successful attempt to adopt private sector HR management techniques to meet the challenges of public sector reform.
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Comparative Study
Public and private hospitals in Bangladesh: service quality and predictors of hospital choice.
This study compares the quality of services provided by public and private hospitals in Bangladesh. The premise of the paper was that the quality of hospital services would be contingent on the incentive structure under which these institutions operate. ⋯ Patient perceptions of service quality and key demographic characteristics were also used to predict choice of public or private hospitals. The model, based on discriminant analysis, demonstrated satisfactory predictive power.