This paper aims to analyze Uganda's institutional capacity and readiness to advance its healthcare system. It will do a historical review of institutional development and the current environment to identify strengths and weaknesses. It will compare Uganda's healthcare system to higher-ranked systems and other African countries that have seen improvements. This comparative analysis will summarize clues about Uganda's existing institutional capacity and what it needs to adopt robust healthcare services for its growing population. Understanding a country's institutions can help predict its development and reforms needed to improve health outcomes.
Budget Behavior and Corruption: An Manifestation of Political Economy in Indo...AJHSSR Journal
The purpose of this study is to describe the behavior as one form of political economy in
Indonesia. The study further analyzes the potential for budgetary behavior associated with corruption. The
analysis basically focuses on analytical descriptive analysis. Using such methods, it can provide information
about the relationship between political economy, budgetary behavior, and relations with corruption in
Indonesia. The conclusion of the study is that the Indonesian economy is strongly influenced by political
circumstances and forces. With the curr
Monitoring progress towards universal health coverage at country and global l...The Rockefeller Foundation
A movement towards universal health coverage (UHC) – ensuring that everyone who needs health services is able to get them, without undue financial hardship – has been growing across the globe (1). This has led to a sharp increase in the demand for expertise, evidence and measures of progress and a push to make UHC one of the goals of the post-2015 development agenda (2). This paper proposes a framework for tracking country and global progress towards UHC; its aim is to inform and guide these discussions and assessment of both aggregate and equitable coverage of essential health services as well as financial protection. Monitoring progress towards these two components of UHC will be complementary and critical to achieving desirable health outcome goals, such as ending preventable deaths and promoting healthy life expectancy and also reducing poverty and protecting household incomes.
This paper was written jointly by the World Health Organization (WHO) and The World Bank Group on the basis of consultations and discussions with country representatives, technical experts and global health and development partners (3). A draft of this paper was posted online and circulated widely for consultation between December 2013 and February 2014. Nearly 70 submissions were received from countries, development partners, civil society, academics and other interested stakeholders. The feedback was synthesized and reviewed at a meeting of country and global experts in Bellagio, Italy, in March 2014 (4). The paper was modified to reflect the views emerging from these consultations.
Protection Of Women’s Economic, Social Rights Linked To Healthier PopulationsΔρ. Γιώργος K. Κασάπης
A study in the BMJ Open journal found that protecting women’s rights leads to faster development and better health outcomes for men and women in both developing and developed countries. The study, based on data from 162 countries between 2004 and 2010, found that vaccination rates, reproductive health, death rates, life expectancy, and disease prevention rates were consistently better than average in countries where women’s rights were highly respected.
For the poor in urban slums, the majority of the programs targeting community health are often to combat communicable diseases or do not prioritize NCD related outcomes.
Budget Behavior and Corruption: An Manifestation of Political Economy in Indo...AJHSSR Journal
The purpose of this study is to describe the behavior as one form of political economy in
Indonesia. The study further analyzes the potential for budgetary behavior associated with corruption. The
analysis basically focuses on analytical descriptive analysis. Using such methods, it can provide information
about the relationship between political economy, budgetary behavior, and relations with corruption in
Indonesia. The conclusion of the study is that the Indonesian economy is strongly influenced by political
circumstances and forces. With the curr
Monitoring progress towards universal health coverage at country and global l...The Rockefeller Foundation
A movement towards universal health coverage (UHC) – ensuring that everyone who needs health services is able to get them, without undue financial hardship – has been growing across the globe (1). This has led to a sharp increase in the demand for expertise, evidence and measures of progress and a push to make UHC one of the goals of the post-2015 development agenda (2). This paper proposes a framework for tracking country and global progress towards UHC; its aim is to inform and guide these discussions and assessment of both aggregate and equitable coverage of essential health services as well as financial protection. Monitoring progress towards these two components of UHC will be complementary and critical to achieving desirable health outcome goals, such as ending preventable deaths and promoting healthy life expectancy and also reducing poverty and protecting household incomes.
This paper was written jointly by the World Health Organization (WHO) and The World Bank Group on the basis of consultations and discussions with country representatives, technical experts and global health and development partners (3). A draft of this paper was posted online and circulated widely for consultation between December 2013 and February 2014. Nearly 70 submissions were received from countries, development partners, civil society, academics and other interested stakeholders. The feedback was synthesized and reviewed at a meeting of country and global experts in Bellagio, Italy, in March 2014 (4). The paper was modified to reflect the views emerging from these consultations.
Protection Of Women’s Economic, Social Rights Linked To Healthier PopulationsΔρ. Γιώργος K. Κασάπης
A study in the BMJ Open journal found that protecting women’s rights leads to faster development and better health outcomes for men and women in both developing and developed countries. The study, based on data from 162 countries between 2004 and 2010, found that vaccination rates, reproductive health, death rates, life expectancy, and disease prevention rates were consistently better than average in countries where women’s rights were highly respected.
For the poor in urban slums, the majority of the programs targeting community health are often to combat communicable diseases or do not prioritize NCD related outcomes.
Income inequalities in health presentationPrashanth N S
Presentation on socio-economic inequalities in health in India made at the National Seminar on Health Equity Evidence and Priorities for Research in India conducted by the Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum in 2015
Corporate Governance in Local Governments of the Public Sector for Sustainabl...ijtsrd
Corporate governance in the public sector, particularly, in local governments is crucial to quality service delivery, citizen participation and sustainable development. Using Integrative Review approach, the study sought to review literature on corporate governance in local governments of the public sector. The results, according to the frame of the study based on selected literature revealed that most studies focused on one rather than two or more countries, there appeared to be less quantitative studies than qualitative studies, there seemed to be more reviews on the subject than empirical studies. The study confirms that public sector corporate governance as a concept is receiving some attention in both practice and literature. Isaac Jerry Kwabena Asare | Yusheng Kong "Corporate Governance in Local Governments of the Public Sector for Sustainable Development: An Integrated Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-6 , October 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33504.pdf Paper Url: https://www.ijtsrd.com/management/public-sector-management/33504/corporate-governance-in-local-governments-of-the-public-sector-for-sustainable-development-an-integrated-review/isaac-jerry-kwabena-asare
The state in global health (focus on LICs/MICs)Albert Domingo
A report/presentation on the changing dynamics of the power of the state viz. external actors in formulating health policy, particularly in low income countries and middle income countries.
The role of gender in enhancing the development agendaJack Onyisi Abebe
Gender and development is important because it focuses on connections between gender and development initiatives and feminists’ perspectives, and deals with issues such as health and education, decision making and leadership, peace building, violence against women and economic empowerment. Development cannot be realized without the very significant component of gender. Countries the world over have proved that exclusion of women in development has rendered their development efforts futile.
A new health and development paradigm post-2015: grounded in human rightsLisa Hallgarten
Marge Berer, Editor of RHM, presentation at meeting
Divided we stand? Universal health coverage and the unfinished agenda of the health MDGs
Institute of Tropical Medicine, Antwerp February 11th 2014
Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECDEyesWideOpen2008
A WHO study that proves that Social Health Insurance healthcare systems DO NOT WORK.
It increases costs, have no positive effect on national health, and even has negative effects on employment and some areas of health.
This study is to focus attention on the extent to which the health care needs of
adolescents and young adults are being planned for and addressed as New York implements the Patient
Protection and Affordable Care Act (ACA)
Breakthrough Advocacy for Breakthrough ResearchCTSciNet .org
Meeting: Physician-Scientist Career Development Meeting, New York Academy of Sciences, November 3-5, 2010
Presentation: Breakthrough Advocacy for Breakthrough Research
Speaker: Mary Woolley, President and CEO, Research!America
View online with audio at http://community.sciencecareers.org/ctscinet/groups/sessions/2010/12/breakthrough-advocacy-for-breakthrough-research.php
Well being and economic growth: a case study of Costa Rican development by Da...Danika Tynes, Ph.D.
This exploration is pursued through the application of happiness research, which has demonstrated the mis-alignment of economic growth and happiness to explore the fundamental research question: ‘Are we measuring the wrong thing?’ And, specifically reviews whether the prevailing MDG indicators are useful predictors of progress and development. It is considered whether a shift toward focus on self-growth can replace economic growth as the fundamental institutional push and better facilitate achievement of the desired state of equilibrium in the world.
Understanding Linkages between Governance and Health: Concepts and EvidenceHFG Project
There is a lack of evidence and understanding of the dynamics of interventions and contexts in which improved health system governance can contribute to improved health outcomes. As donors and governments increase their emphasis on improving the accountability and transparency of health systems, there is an ever increasing need for this evidence. Governance interventions could then more effectively contribute to measurable improvements in health
outcomes such as reduction in maternal or child mortality, or increased coverage of HIV/AIDS treatment.
On September 14, 2016 the USAID Health Finance and Governance Project (HFG) supported the USAID Office of Health Systems (OHS) and WHO to co-sponsor a workshop to launch a major initiative to marshal the evidence of how health governance contributes to health system performance and ultimately health outcomes. The marshaling of evidence activity will culminate in a high level international event in June 2017 to share knowledge and foster dialogue between donors, researchers, health governance practitioners, and policy makers.
The event brings together important USAID and WHO initiatives to elevate the importance of health governance. The HFG workshop included 35 health and governance professionals from across USAID (OHS, the Center of Excellence for Democracy, Rights and Governance, and the Bureau for Economic Growth, Education and Environment), the WHO, World Bank, academic partners, and implementing partners to launch the marshaling the evidence effort.
Income inequalities in health presentationPrashanth N S
Presentation on socio-economic inequalities in health in India made at the National Seminar on Health Equity Evidence and Priorities for Research in India conducted by the Sree Chitra Tirunal Institute for Medical Sciences & Technology (SCTIMST), Trivandrum in 2015
Corporate Governance in Local Governments of the Public Sector for Sustainabl...ijtsrd
Corporate governance in the public sector, particularly, in local governments is crucial to quality service delivery, citizen participation and sustainable development. Using Integrative Review approach, the study sought to review literature on corporate governance in local governments of the public sector. The results, according to the frame of the study based on selected literature revealed that most studies focused on one rather than two or more countries, there appeared to be less quantitative studies than qualitative studies, there seemed to be more reviews on the subject than empirical studies. The study confirms that public sector corporate governance as a concept is receiving some attention in both practice and literature. Isaac Jerry Kwabena Asare | Yusheng Kong "Corporate Governance in Local Governments of the Public Sector for Sustainable Development: An Integrated Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-6 , October 2020, URL: https://www.ijtsrd.com/papers/ijtsrd33504.pdf Paper Url: https://www.ijtsrd.com/management/public-sector-management/33504/corporate-governance-in-local-governments-of-the-public-sector-for-sustainable-development-an-integrated-review/isaac-jerry-kwabena-asare
The state in global health (focus on LICs/MICs)Albert Domingo
A report/presentation on the changing dynamics of the power of the state viz. external actors in formulating health policy, particularly in low income countries and middle income countries.
The role of gender in enhancing the development agendaJack Onyisi Abebe
Gender and development is important because it focuses on connections between gender and development initiatives and feminists’ perspectives, and deals with issues such as health and education, decision making and leadership, peace building, violence against women and economic empowerment. Development cannot be realized without the very significant component of gender. Countries the world over have proved that exclusion of women in development has rendered their development efforts futile.
A new health and development paradigm post-2015: grounded in human rightsLisa Hallgarten
Marge Berer, Editor of RHM, presentation at meeting
Divided we stand? Universal health coverage and the unfinished agenda of the health MDGs
Institute of Tropical Medicine, Antwerp February 11th 2014
Social Health Insurance vs. Tax-Financed Health Systems—Evidence from the OECDEyesWideOpen2008
A WHO study that proves that Social Health Insurance healthcare systems DO NOT WORK.
It increases costs, have no positive effect on national health, and even has negative effects on employment and some areas of health.
This study is to focus attention on the extent to which the health care needs of
adolescents and young adults are being planned for and addressed as New York implements the Patient
Protection and Affordable Care Act (ACA)
Breakthrough Advocacy for Breakthrough ResearchCTSciNet .org
Meeting: Physician-Scientist Career Development Meeting, New York Academy of Sciences, November 3-5, 2010
Presentation: Breakthrough Advocacy for Breakthrough Research
Speaker: Mary Woolley, President and CEO, Research!America
View online with audio at http://community.sciencecareers.org/ctscinet/groups/sessions/2010/12/breakthrough-advocacy-for-breakthrough-research.php
Well being and economic growth: a case study of Costa Rican development by Da...Danika Tynes, Ph.D.
This exploration is pursued through the application of happiness research, which has demonstrated the mis-alignment of economic growth and happiness to explore the fundamental research question: ‘Are we measuring the wrong thing?’ And, specifically reviews whether the prevailing MDG indicators are useful predictors of progress and development. It is considered whether a shift toward focus on self-growth can replace economic growth as the fundamental institutional push and better facilitate achievement of the desired state of equilibrium in the world.
Understanding Linkages between Governance and Health: Concepts and EvidenceHFG Project
There is a lack of evidence and understanding of the dynamics of interventions and contexts in which improved health system governance can contribute to improved health outcomes. As donors and governments increase their emphasis on improving the accountability and transparency of health systems, there is an ever increasing need for this evidence. Governance interventions could then more effectively contribute to measurable improvements in health
outcomes such as reduction in maternal or child mortality, or increased coverage of HIV/AIDS treatment.
On September 14, 2016 the USAID Health Finance and Governance Project (HFG) supported the USAID Office of Health Systems (OHS) and WHO to co-sponsor a workshop to launch a major initiative to marshal the evidence of how health governance contributes to health system performance and ultimately health outcomes. The marshaling of evidence activity will culminate in a high level international event in June 2017 to share knowledge and foster dialogue between donors, researchers, health governance practitioners, and policy makers.
The event brings together important USAID and WHO initiatives to elevate the importance of health governance. The HFG workshop included 35 health and governance professionals from across USAID (OHS, the Center of Excellence for Democracy, Rights and Governance, and the Bureau for Economic Growth, Education and Environment), the WHO, World Bank, academic partners, and implementing partners to launch the marshaling the evidence effort.
The Impacts of Health and Education Components of Human Resources Development...iosrjce
IOSR Journal of Economics and Finance (IOSR-JEF) discourages theoretical articles that are limited to axiomatics or that discuss minor variations of familiar models. Similarly, IOSR-JEF has little interest in empirical papers that do not explain the model's theoretical foundations or that exhausts themselves in applying a new or established technique (such as cointegration) to another data set without providing very good reasons why this research is important.
An Analysis of Impact of Human Capital Investment on Demographic Characterist...inventionjournals
The demographic features of the 2011census of India have revealed that India is the second largest country next to China in terms of working age population (25 - 50 years) in the world. It has been known that the country’s economic growth is based on both natural and human resources available in the country. Still, there are more avenues for effective and efficient use of labour-productivity in this age group. It is well conceived by the theory that the human resources are the biggest contributor of economic growth which is augmented by a process of human capital formation. Of late, health and education have been viewed as the two dimensions of human capital which are treated as an indicator of social welfare. The variations in health status of different age groups in market and non-market labour productivities are still prevalent in many developing countries. The low health status persons contribute less to human capital formation than of others (Behrman and Deolalikar, 1988). According to them, “Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity”. Therefore, it cannot be purchased by the consumers in the market as we do for other goods and services in the market. On the other hand, it can be produced by spending time upon health improving activities, as well as, purchasing medical inputs (Grossman M., 1972). Behrman has pointed out that there is an inverse relationship between low health status and human capital formation. Therefore, the economists have focused their attention to study the determinants and impact of health status on economic growth. The present study attempts to analyse the human capital investment and its impact of socio- economic status on human resources (HR) in Chennai district, Tamil Nadu. To aid our research effort, an extensive literature has also been reviewed in an attempt to answer various queries raised. On the basis of the statement of problems, the research questionnaires have been canvassed among the respondents to obtain the information. This study is based on databases obtained both from primary and secondary sources. The information through primary sources has been collected with the help of interview schedule. The secondary data on Human Capital Investment and the Impact of Socio- Economic Status on Human Resources have been collected from various sources in Chennai City. In the health sector, this study focuses its attention to reporting illness, amount spent, days lost. Some of the opted econometric techniques have been used to examine the objectives of the study. Our empirical strategy has applied the following tools of analysis. The statistical tools like OLS, PROBIT and LOGIT techniques are used to analyze the indicator ‘selfreported illnesses. And, ‘Health expenditure’ and ‘number of days lost’ are estimated by OLS and TOBIT techniques, besides by applying correlation, regression analysis.
Health System in India: Opportunities and Challenges for EnhancementsIOSRJBM
One of the basic vitalities of good living is quick access to essential services like health care. But many times it could mean a condition of life and death for an individual who is unable to get the access to these services. Thus an important part of social sector development is incomplete without adequate health care facilities. The quality of human health is the foundation upon which the realization of life goals and objectives of a persona, the community or nation as whole depends. It is both an end and means of development strategy. The relationship between health and development is mutually reinforcing- while health contributes to economic development, economic development, in turn, tends to improve the health status of the population in a country. India as a nation has been growing economically at a rapid pace particularly after the advent of New Economic Policy of 1991. However, this rapid economic development has not been accompanied by social development particularly health sector development. Health sector has been accorded very low priority in terms of allocation of resources. Public expenditure on health is less than 1 per cent of GDP in India. This research paper focuses on the current status of the Indian healthcare industry, the challenges faced plus the comparison of few selected Indian states based on health indicators. Furthermore comparison of India with some developed and developing countries is also employed in order get the clear picture of the health sector. In order to boost the development line, some opportunities in the health care industry are also discussed and necessary policy implications. Regarding in this connection India lags behind in regard of health improvement as compared to U.S.A, Canada, China, and Brazil, but contrary to other developing countries like Pakistan, Bangladesh the scenario is better with life expectancy, Mortality ratios, health care spending speak volumes about the healthcare status. When analyzed through the prism eye, within India there are large disparities amongst states in achieving health outcomes as well. Before liberalization the improvement was at a snail’s pace, but after liberalization the whole picture changed because the key initiatives to improve the current healthcare standard a two prong strategy focusing on the infrastructure needs and the technology solution were implemented, which resulted in the healthy scenario of the healthcare industry. Healthcare sector, a leading weapon as the contributor to GDP (approx.8%) is thus the matter to be deeply looked into, so that golden harvest is reaped.
CHAPTER 7The policy processEileen T. O’GradyThere are tJinElias52
CHAPTER 7
The policy process
Eileen T. O’Grady
“There are three critical ingredients to democratic renewal and progressive change in America: good public policy, grassroots organizing and electoral politics.”
Paul Wellstone
Nurses can more strategically and effectively influence policy if they have a clear understanding of the policymaking process. Conceptual models can help to organize and interpret information by depicting complex ideas in a simplified form; to this end, political scientists have developed a number of conceptual models to explain the highly dynamic process of policymaking. This chapter reviews two of these conceptual models.
Health policy and politics
Health policy encompasses the political, economic, social, cultural, and social determinants of individuals and populations and attempts to address the broader issues in health and health care (see Box 7.1 for policy definitions). A clear understanding of the points of influence to shape policy is essential and includes framing the problem itself. For example, if nurses working in a nurse-managed clinic are troubled by staff shortages or long patient waits, they may be inclined to see themselves as the solution by working longer hours and seeing more patients. Defining and framing the problem is the first step in the policy process and involves assessing its history, patterns of impact, resource allocation, and community needs. Broadening and framing the problem to influence or educate stakeholders at the local, state, or federal level could include advocating for better access or funding for nursing workforce development (see Box 7.1).
BOX 7.1
Policy Definitions
Policy is authoritative decision making related to choices about goals and priorities of the policymaking body. In general, policies are constructed as a set of regulations (public policy), practice standards (workplace), governance mandates (organizations), ethical behavior (research), and ordinances (communities) that direct individuals, groups, organizations, and systems toward the desired behaviors and goals.
Health policy is the authoritative decisions made in the legislative, judicial, and executive branches of government that are intended to direct or influence the actions, behaviors, and decisions of others (Longest, 2016).
Policy analysis is the investigation of an issue including the background, purpose, content, and effects of various options within a policy context and their relevant social, economic, and political factors (Dye, 2016).
The next step is to bring the problem to the attention of those who have the power to implement a solution. Other key factors to consider include generating public interest, the availability of viable policy solutions, the likelihood that the policy will serve most of the people at risk in a fair and equitable fashion, and consideration of the organizational, community, societal, and political viability of the policy solution.
Public interest is a fascinating dynamic ...
Running head SOCIAL WELLBEING IN THE NETHERLANDS .docxtodd521
Running head: SOCIAL WELLBEING IN THE NETHERLANDS 1
SOCIAL WELLBEING IN THE NETHERLANDS 2Social Wellbeing in the Netherlands
Introduction
Social wellbeing is an end state in which basic human needs are met and people are able to coexist peacefully in communities with opportunities for advancement (USIP, 2013). This is showcased by access to basic needs and services including water, food, shelter and health services (USIP, 2013). The basic needs must be met but belonging is also important. In general, humans are social individuals who want a basic set of standards to create a sense of social wellbeing. There is a strive for connection and this connection including value systems, traditions and even beliefs. When a population is content and feels as though their needs are met they become more sustainable in their social development. Social wellbeing plays a crucial role in sustainability. This paper will analyze the social wellbeing of the Netherlands, identify opportunities for policy enactment, and consider the environmental aspects of social wellbeing and social quality in the country.
The Netherlands and Social Wellbeing
The Netherlands Institute for Social Research is a government agency which conducts research into the social aspects of all areas of government policy. The Netherlands Institute of Social Research was founded in 1973 after politicians began taking an increased interest in the population and their welfare (Netherlands Institute of Social Research, 2020). The main fields studied are health, welfare, social security, the labor market and education, with a particular focus on the interfaces between these fields (Netherlands Institute of Social Research, 2020). Further, the organization itself was designed to create a picture of the social and cultural wellbeing of the Netherlands. Goals of the organization include the ability to contribute to policy changes and evaluation of how one can achieve a desired solution- for the good of the people (Netherlands Institute of Social Research, 2020).
The reports created by this organization are used by the government, academics and civil servants. Advice is provided on legal obligations and civil duties of the government. The goal is doing what is best for the wellbeing of the people. Members of the Netherlands Institute of Social Research are scientists, social geographers, legal specialists, and those who specialize in the economy (Netherlands Institute of Social Research, 2020). Feedback of all kinds is provided by the people of the Netherlands and used in the development of policy and bettering the wellbeing of the population. Books are published yearly that offer the people of the Netherlands, as well as other countries, the opportunity to better understand the social wellbeing of the population. Further, the survey and study results are used to better understand policy, changes, and how to further improve the wellbeing of the peop.
Running head SOCIAL WELLBEING IN THE NETHERLANDS .docxjeanettehully
Running head: SOCIAL WELLBEING IN THE NETHERLANDS 1
SOCIAL WELLBEING IN THE NETHERLANDS 2Social Wellbeing in the Netherlands
Introduction
Social wellbeing is an end state in which basic human needs are met and people are able to coexist peacefully in communities with opportunities for advancement (USIP, 2013). This is showcased by access to basic needs and services including water, food, shelter and health services (USIP, 2013). The basic needs must be met but belonging is also important. In general, humans are social individuals who want a basic set of standards to create a sense of social wellbeing. There is a strive for connection and this connection including value systems, traditions and even beliefs. When a population is content and feels as though their needs are met they become more sustainable in their social development. Social wellbeing plays a crucial role in sustainability. This paper will analyze the social wellbeing of the Netherlands, identify opportunities for policy enactment, and consider the environmental aspects of social wellbeing and social quality in the country.
The Netherlands and Social Wellbeing
The Netherlands Institute for Social Research is a government agency which conducts research into the social aspects of all areas of government policy. The Netherlands Institute of Social Research was founded in 1973 after politicians began taking an increased interest in the population and their welfare (Netherlands Institute of Social Research, 2020). The main fields studied are health, welfare, social security, the labor market and education, with a particular focus on the interfaces between these fields (Netherlands Institute of Social Research, 2020). Further, the organization itself was designed to create a picture of the social and cultural wellbeing of the Netherlands. Goals of the organization include the ability to contribute to policy changes and evaluation of how one can achieve a desired solution- for the good of the people (Netherlands Institute of Social Research, 2020).
The reports created by this organization are used by the government, academics and civil servants. Advice is provided on legal obligations and civil duties of the government. The goal is doing what is best for the wellbeing of the people. Members of the Netherlands Institute of Social Research are scientists, social geographers, legal specialists, and those who specialize in the economy (Netherlands Institute of Social Research, 2020). Feedback of all kinds is provided by the people of the Netherlands and used in the development of policy and bettering the wellbeing of the population. Books are published yearly that offer the people of the Netherlands, as well as other countries, the opportunity to better understand the social wellbeing of the population. Further, the survey and study results are used to better understand policy, changes, and how to further improve the wellbeing of the people. Appr ...
Understanding the Dynamics of Successful Health System Strengthening Interven...HFG Project
Evidence is scarce, scattered, and not widely disseminated on how interventions to strengthen health system performance contribute to sustained improvements in health status, particularly toward ending preventable child and maternal deaths and fostering an AIDS-free generation. Without this evidence, decision-makers lack a sound basis for investing scarce health funds in health system strengthening (HSS) interventions in an environment of competing investment options. This evidence gap impedes support for HSS from numerous stakeholders, both within and outside of USAID. This study will help address this evidence gap by exploring the dynamics of successful HSS interventions in low-income countries. The study seeks to address four key questions:
How were a range of successful HSS interventions implemented in different countries?
What factors facilitated and constrained the successful implementation and documented outcomes of the interventions?
What were important factors about implementation that emerged across the different cases?
What are the implications of this study for implementing future HSS interventions?
The study will comprise three main activities:
Six qualitative, retrospective case studies of successful USAID-supported HSS interventions to explore what factors contributed to successful implementation
Qualitative cross-case analysis to identify patterns of policy processes, circumstances, relationships, and characteristics that may be associated with successful HSS reforms
Develop and propose a set of strategic recommendations for introducing and sustaining HSS reforms in low-income countries
A realist synthesis to develop an explanatory model of how policy instruments...Araz Taeihagh
Abstract
Background
Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes.
Methods
A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories.
Findings
From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types.
Conclusions
This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes.
Healthcare is a major part of every country's development platform. By healthcare we are in fact protecting the most important driver of development. Healthcare systems are primarily safe guarding the development core engine and are the best means of sustainable development.
Similar to Independent study -danika tynes--the road for the healthcare system in uganda (20)
The Diffusion of Telehealth: System-Level Conditions for Successful Adoption ...Danika Tynes, Ph.D.
Telehealth is a promising advancement in health care, though there are certain conditions under which telehealth has a greater chance of success. This research sought to further the understanding of what conditions compel the success of telehealth adoption at the systems level applying Diffusion of Innovations (DoI) theory. System-level indicators were selected to represent four components of DoI theory (relative advantage, compatibility, complexity, and observability) and regressed on 5 types of Telehealth (Teleradiology, Teledermatology, Telepathology, Telepsychology, and Remote Monitoring) using multiple logistic regression.
Analyses included data from 84 states leveraging data from the World Health Organization, World Bank, ICT Index, and HDI Index. The analyses supported relative advantage and compatibility as the strongest influencers of telehealth adoption. These findings help to quantitatively clarify the factors influencing the adoption of innovation and advance the ability to make recommendations on the viability of state telehealth adoption. In addition, results indicate when DoI theory is most applicable to the understanding of telehealth diffusion. Ultimately, this research may contribute to more focused allocation of scarce health care resources through consideration of existing state conditions available to foster innovation.
Danika Tynes
Date of Award
Summer 2019
Degree Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
School
Social Science and Global Studies
Committee Chair
Dr. Robert Pauly
Committee Chair School
Social Science and Global Studies
Committee Member 2
Dr. Edward Sayre
Committee Member 2 School
Social Science and Global Studies
Committee Member 3
Dr. Joseph J. St. Marie
Committee Member 3 School
Social Science and Global Studies
Committee Member 4
Dr. Hadise F. Tavana
Committee Member 4 School
Social Science and Global Studies
ORCID ID
0000-0003-0979-0734
Copyright
Tynes, 2019
Recommended Citation
Tynes, Danika, "The Diffusion of Telehealth: System-Level Conditions for Successful Adoption" (2019). Dissertations. 1675.
https://aquila.usm.edu/dissertations/1675
In his book Cross Cultural Analysis, Minikov (2013) states, “The relationship between theory and empiricism and the question of which of the two should come first are important issues. Different perspectives have resulted in disagreement, confusion…” (p. 72). Explain the two, or more, sides to the argument of how to study culture and then take a stand on which should come first by giving examples and evidence to support your claim while refuting the other approach.
The Effects of ‘Quasi-Institutions’ on International Security by Danika TynesDanika Tynes, Ph.D.
The Effects of ‘Quasi-Institutions’ on International Security by Danika Tynes. Neoliberal institutionalism purports that humans and states are rational actors, that there is a natural goodness of actors, and that cooperation is ultimately achievable (Keohane, 1998). Institutions, in this view, are an effective mechanism through which cooperation is attained and agreements are reinforced. This international relations theory would accordingly suggest that institutions have a positive effect on international development and sustainable growth. Recent attention has focused on how institutions can help to address threats to international security (ibid). For significant threats to international security and stability posed by weak and failed states including increased crime, terrorism, epidemic disease, energy insecurity, and regional instability (Burchill et al., 2009), institutions are playing an important role. While mounting research on the impact of the World Health Organization (WHO), the United Nations (UN), the North Atlantic Treaty Organization (NATO), and others has supported the institutionalist claims, there are also less well-defined organizations that are playing a role in international development, termed here as “quasi-institutions.” This paper seeks to answer: Do quasi-institutions (i.e., multi-national corporations, non-governmental organizations, and non-profit organizations) that function without any centralized oversight or governance help or hurt the progress of international security aims? Potential policy options for managing or harnessing those impacts will also be explored.
Model of Health: Are Islamic Approaches to Healthcare Viable for the Develope...Danika Tynes, Ph.D.
Model of Health: Are Islamic Approaches to Healthcare Viable for the Developed World? by Danika Tynes. In the West, perceptions of Islam are molded by popular discourse, media assumptions, and Western-oriented scholarly inquiry (Heyneman, 2004). Among those portrayals, discussion primarily revolves around “us vs. them,” “good Muslims vs. bad Muslims,” civilizational identities, geopolitics, and political Islam, with a close eye on current events in Egypt, Syria, Yemen, and other majority Muslim states (ibid; Huntington, 1999). Across the board, Islam is assumed to be characteristic of underdevelopment and almost synonymous with lack of modernity with little to no contribution to the modern world or how it is shaped (Esposito, 1999). However, just as modernity cannot be ignored by developing countries, the influence of the globalization of Islam cannot be shut out. In spite of these prevailing considerations of Muslim countries, this paper contends that the United States (i.e., a component and influencer of Western civilization) may be adopting several core Islamic principles in its healthcare reform and may do well to better understand the cultural characteristics that underlie the natural state of health that is a way of being in the Muslim communities that continue to grow. Herein, health policies of Muslim countries will be compared to those of the United States (U.S.).
Nations are more similar in their focus on healthcare than any other function of government and the inclusion of morality in policy is more likely to appear in healthcare than any other realm (Carpenter, 2012). Islam purports that one’s health is a significant priority and it is one’s obligation to treat the body well, such as to eliminate parasites from pork in the diet, eschew liquor to maintain awareness of divine action at all times, or take proper medications when the need arises (Heyneman, 2004). Key messages delivered through Islam, such as the focus on preventive care over curative care, ambulatory care over hospitalization, and public care organizations over private ones are premises that are newly being adopted in major legislation in the United States (ibid). Islam’s attention to the connectedness between policy and religion as displayed in its guidance for healthcare, may provide some insights into the current transformations in global healthcare. This paper will review Islam’s religious references and guidance to achieving better health, document health policies enacted within Muslim countries, and compare such polices to those being implemented in the United States (U.S.). The research will seek to unfold whether commonalities exist and a framework can be started based on central tenets that could lend to a global healthcare structure that is not polarized by civilizational differences. Using case studies and longitudinal data on key healthcare indicators, this research will explore commonalities and divergences in health in the U.S. and in Arab nations.
A workshop hosted by the South African Journal of Science aimed at postgraduate students and early career researchers with little or no experience in writing and publishing journal articles.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Independent study -danika tynes--the road for the healthcare system in uganda
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The Road for the Healthcare System in Uganda
This paper aims to ascertain the intersection point between economic, political and socio-
cultural factors in predicting the institutional readiness for advancing the healthcare system in
Uganda. To address the research question of whether Uganda as a state has or will have the
institutional capacity to significantly reduce morbidity indicator gaps, a historical review will
analyze the development of institutions as well as the current state environment that lend to
institutional strength and weaknesses pertaining to the healthcare delivery system. The question
of why some states develop and others do not continues to evade researchers (Olson, 1982; Sen,
1999). Robust bodies of literature focus on political development, democratization, institutional
capacity, imperialism, military strength, natural resource wealth, religion, cultural propensities,
and other factors. None independently address the foremost question, which begs to understand if
it is the right question. It is argued that institutional development is the mechanism through which
development occurs and, using this logic, it should serve to reason that understanding first why
institutions are strong or weak or lend to desired development outcomes can serve to predict the
development of a state. Therefore, this inquiry will look to the Ugandan healthcare system not to
determine why it may or may not be strong, but to better understand the institutional structures as
a predictor of system development. This will be accomplished through comparative analysis with
countries ranked higher as healthcare systems and also other African countries that have seen
improvements over time in their respective healthcare systems. This exploratory comparative
analysis aims to summarize some clues as to what institutional capacity Uganda has or needs to
adopt in order to provide more robust healthcare services for its growing population. Key questions
will include: What is the impact of institutions on healthcare development? Is Uganda
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institutionally ready for healthcare reform? What would help Uganda to be in the position to make
sweeping reforms that would yield high impact on morbidity indicators? What states in Africa
have made successful reforms? Are they applicable to Uganda as best practices? How are quality
healthcare systems structured that contrast with Uganda?
There have been attempts to make investments in Ugandan healthcare though indicators of
health remain poor (Chandler et al., 2013). Uganda is not presently on target with Millennium
Development Goals (MDGs) for health (ibid). It has been suggested that Uganda, despite its
investments in healthcare, has faced barriers to quality care, primarily owing to externally-defined
or socio-cultural priorities. This paper seeks to add to the literature by delving into institutional
misalignments that may contribute to why Ugandan healthcare may not be keeping pace with
desired objectives. For the purposes of this research, healthcare system will be defined as “all
activities whose primary purpose is to promote, restore, or maintain health” (Kamwesiga, 2011).
Inputs to Development
A persistent question across relevant disciplines in examination of international
development is ‘why do some countries develop and others do not’ (Harrison & Huntington, 2001;
Minkov, 2012; Moore, 2012)? This is an important question because of the downstream impacts
of underdevelopment; more glaringly so in the wake of globalization. For example, mineral wealth
in developing Africa may be a more significant export and income opportunity to contribute to the
“Low-income countries do not have to wait to become wealthy to become
healthier, however. Experience has shown that, even in the absence of income
growth, using existing knowledge and technologies can reduce deaths and
illnesses even in the poorest countries. These health improvements, in turn,
will help countries achieve their development goals”
(Laxminaryayan & Ashford, 2008).
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physical and economic wellness of the populations therein but for the limits imposed by
underdevelopment such as corruption, conflict, and deep inequality. Having more people living
in countries with infrastructure that can contribute to a more peaceful and progressive whole is the
current institutional push. Answering the question as to why some develop and others do not has
been explored from economic, political and cultural perspectives, the latter of which has been
largely ignored in the inquiry, only to shine a bright light on the failures of economic and political
theories in providing a comprehensive explanation.
The level of political development, or progress towards a stable political order, is
contingent upon the relationship between active political participants in societies and the political
institutions (Huntington, 2006). Level of institutionalization, or the “process by which
organizations and procedures acquire value and stability,” can be measured based on “adaptability,
complexity, autonomy, and coherence of organizations and procedures” (ibid). Operationalizing
the criteria for these elements can serve as a foundation for comparative political development.
For example, in the United States, Congress serves as an institution with low transaction costs such
that stable legislation becomes possible (Hall & Taylor, 1996), whereas in Uganda, it has been
exceedingly difficult to build stable institutions due to many of the desired elements of
institutionalization such as lack of coherence. Huntington’s gap hypothesis proposes that social
mobilization resulting from advances such as in education, urbanization and modernization, in turn
influence people’s values and expections while economic development impacts economic output
and capabilities. The gap between social expectation and economic reality is what leads to political
instability (i.e., lack of development) because politics becomes the mechanism by which the gap
can be closed. If political institutions are not strong enough to accommodate the mobilization being
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driven by the gap, then the result is political instability. That politcial instability has numerous
impacts such as to institutional capacity to develop adequate healthcare systems.
Neoliberal institutionalism purports that humans and states are rational actors, that there is
a natural goodness of actors, and that cooperation is ultimately achievable (Keohane, 1998).
Institutions, in this view, are an effective mechanism through which cooperation is attained and
agreements are reinforced. This international relations theory would accordingly suggest that
institutions have a positive effect on international development and sustainable growth not only
for political stability, crime, and security but also for disease, wellness, and health of nations
(Burchill et al., 2009).
Institutional Assessment
The influence of institutions has important direct relationships with healthcare systems because
institutions set agendas and derive how efforts are spent, especially when concerning those who
are disadvantaged (Bjornskov, Drener & Fischer, 2010). Institutions can be defined as “rules of
the game” (North, 1990). To think about development as a ‘game’ is crude, but the simplification
provides context for how there are rules which are followed to focus attention on the desired course
of action. As such, the quality of institutions is a major concern and whether they are steering
populations toward a better future, given that they are rooted in specific ideologies, values, and
preferences (Duffield, 2007). Joseph Stiglitz, an economist awarded the Nobel prize said it well:
“What you measure affects what you do. If you don’t measure the right thing, you don’t do the
right thing” (Forgeard et al., 2011). Institutions set the policy agenda and set it to hopefully achieve
progress. Defining what “progress” means is therefore key to obtaining the objective of greater
welfare of nations. Of the values that remain at the forefront, is the focus on economic growth as
5. 5 | P a g e
a primary institutions push (Easterlin, 1974). However, scholars are questioning if those values are
misaligned with the true aims of global progress (Booroah, 2006). In public policy concerns, most
everyone would claim to be interested in human well-being (Bates, 2004).
Institutions can be both formal and informal, the former being state-led and the latter
functions of society (Lau, 2005). Institutions are important when observing the course of
development because “countries with better institutions, more secure property rights, and less
distortionary policies will invest more in physical and human capital and will use the factors more
efficiently to achieve a greater level of income” (Acemoglu, Johnson and Robinson, 2001). It has
been observed that strong institutions that do invest in human capital have direct impacts on rates
of infant and maternal mortality in addition to factors such as literacy, population growth rates,
legal stability, GDP growth and other variables that can impact the health of nations (Lau, 2005).
For Uganda, assessing the current state of institutional strength and capacity to support change in
healthcare is fundamental to understanding barriers to progress.
Institutional capacity-building is an effort espoused by development institutions (USAID,
2000). Strengthening of institutions is an activity undertaken with the aim of bolstering
administrative management, service provision effectiveness, building upon institutional culture,
and enhancing sustainability. The measurement of institutional capacity is important because it
helps to establish a baseline and set targets for organizational improvement. In Africa, the
discourse on strengthening health systems has only recently become a driver of agenda-setting.
Mbacke (2013) argues that this discourse was solidified in 2004 as a result of the Mexico Statement
on Health Research that put forth a call to action in global health and cooperation from all global
governments to commit resources to creating sustainable health systems to the benefit of the
international community as a whole. It was argued, that only through this push could Millennium
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Development Goals be viably reached since any weaknesses in national health systems would
create negative downstream impacts for all global health initiatives.
A USAID instructional publication (2000) focused on measurement of institutional
capacity identified that a barrier to successful change is lack of institutional capacity to achieve
and reinforce desired results. Strong institutions are most effectively able to realize programmatic
objectives that are sustainable. USAID utilizes certain capacity-building techniques that include
technical assistance, advisory council, long-term consultation, and provision of tools to support
sustainable development. This survey of applicable techniques proposes that sustainability is most
appropriately had through expansion of institutional capacity and efforts and resources are best
spent in this regard.
Uganda: A Background
Uganda, under Britain’s rule until 1962, is currently an independent state on the African continent
(CIA Factbook, 2014). Subsequent to independence, Uganda succumbed to two dictatorial
regimes under Idi Amin (1971-1979) and Milton Obote (1980-1985), with the current leader,
Yoweri Museveni in place since 1986, which extends relative stability (ibid). Uganda, population
36 million, is land-locked, with Sudan to the North, Kenya to the East, Rwanda and Tanzania to
the South, and the Democratic Republic of the Congo to the West. A variety of ethnic groups are
represented in Uganda: Baganda 16.9%, Banyankole 9.5%, Basoga 8.4%, Bakiga 6.9%, Iteso
6.4%, Langi 6.1%, Acholi 4.7%, Bagisu 4.6%, Lugbara 4.2%, Bunyoro 2.7%, other 29.6%. A
variety of religions are also represented: Roman Catholic 41.9%, Protestant 42% (Anglican 35.9%,
Pentecostal 4.6%, Seventh-Day Adventist 1.5%), Muslim 12.1%, other 3.1%, none 0.9%. Only
4.5% of Ugandans are over 55 years of age, with nearly half of the Ugandan population being
7. 7 | P a g e
under the age of 14 lending to a median age of 15.5 years. Population growth is high at 3.24%
making Uganda among the fastest growing populations in the world. Healthcare indicators show
maternal mortality of 310 deaths of 100,000 live births; infant mortality of 69 deaths per 1,000 live
births; life expectancy at birth is 55 years old; total fertility rate of 6 children on average to every
woman; a contraceptive prevalence rate of 30%; .12 physicians per 1,000 people; .5 hospital beds
per 1,000 people; sanitation facilities are accessible by 34% of the people; HIV/AIDS prevalence
is 7.2% (ibid).
Healthcare in Uganda
Uganda maintains a decentralized healthcare system since 1999 wherein local governments are
responsible for the provision of healthcare for their respective local populations (Ndaruhutse,
2013). Prior to decentralization, local healthcare facilities were funded by Uganda’s Ministry of
Health (ibid). This decentralized model was implemented with the goals of improving efficiencies
and effectiveness, promoting community and local-level ownership and responsibility, as well as
more readily allocating goods and services at the local levels. A main benefit observed of this
model is that it has opened up free market opportunities for private and public healthcare services.
However, the same challenges that existed in the former centralized model were simply transferred
to the local levels and exacerbated. Thus, decentralization can be argued to have moved Ugandan
healthcare into a weaker institutional position since consistency in approach, commonality of
goals, and governance cannot be centrally observed or tracked (Wooding, Nagaddya, Nakaggwa,
2012). In addition to decentralization, Uganda has also taken additional measures towards other
health sector reforms. These include eliminating user fees, establishing government partnerships
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with private healthcare organizations and providers, and promoting public hospital autonomy and
bottom-up planning practices (Kamwesiga, 2011).
The decentralized structure of the Ugandan healthcare system makes interstate cooperation
both a viable approach and simultaneously challenging one due to alignment issues that may arise
(Ndaruhutse, 2013). A growing middle class in Uganda is investing in private healthcare as they
aim to consume more quality care than that which is provided publicly. Those who cannot afford
this option remain under the provision of the government (EIU, 2011). Interestingly, a study to
observe the impact of Uganda’s abolishment of health system user fees found that the cost of care
did not impact the quality of care but did impact the perceptions of the quality of care; whereas
patients felt that free care was lower quality (Nabyonga-Orem et al., 2008).
The Ugandan healthcare system is structured somewhat hierarchically (Kamwesiga, 2011).
One level is the “village health teams.” This is the level of first contact in rural areas and is
supported by volunteers that have no medical training or carry medicine, but they mobilize on
bicycle and can refer patients to health clinics when there is a need. Another level of the system
is called a “health centre II.” Each Ugandan parish is expected to have a health centre II facility
that has the capacity to service several thousand people for common diseases like malaria or other
health challenges (e.g., antenatal care) on an outpatient basis staffed by a nurse. “Health centre
III” level facilities are allocated to sub-counties and staff approximately 18 personnel with an on-
site laboratory. The “health center IV” is a district-level hospital serving an entire county that can
admit on an in-patient basis as well as have a doctor on staff and capacity for emergency
operations. Across Uganda there are 10 “regional referral hospitals” that also extend specialty
services including mental health and dentistry. Lastly, there are “national referral and teaching
9. 9 | P a g e
hospitals” where the most complex of cases can be seen and attendee to by the most well-trained
of medical professionals (ibid).
Communicable diseases such as malaria, HIV/AIDS and tuberculosis have been ravaging
healthcare challenges in Uganda. Today, these have become compounded by rapid rate increases
in chronic diseases such as diabetes and heart disease (EIU, 2011). Heart disease and obesity, in
fact, are on a projector to outpace communicable diseases by 2030 (ibid). This double-threat to the
population’s health lends to an overwhelming disease burden for an already insufficient healthcare
infrastructure. “Healthcare delivery infrastructure is insufficient; skilled healthcare workers and
crucial medicines are in short supply; and poor procurement and distribution systems are leading
to unequal access to treatment” (EIU, 2011, pp. 4). The current state of Uganda’s healthcare
system with the double-threat of disease, the rapidly growing population with very low life
expectancy, and an ineffective healthcare infrastructure draws a bleak current state picture.
According to the World Bank (2014), Uganda has demonstrated a slight decline in spending on
healthcare as a percentage of GDP between 2009 (2.1%) and 2012 (1.9%). Uganda remains one
of the worst healthcare systems in the world (Kelly, 2009). Fifty-one percent of people do not
access public healthcare facilities, 38% of healthcare positions are filled by qualified professionals,
and of those, 70% of doctors and 40% of nurses provide care only in urban areas, thus limiting
service to only 12% of Ugandans (ibid).
A study was conducted to assess the institutional capacity within Uganda in regard to
parasite-based malaria in Ugandan lower level health facilities (Kyabayinze et al., 2012). It was
determined that the health facilities were primarily unequipped to address malaria, a leading cause
of death. This type of targeted assessment is helpful for determining the precise interventions
needed in order to realize the desired outcome of reducing malaria deaths that have impact on
10. 10 | P a g e
MDGs. Analyses found that only 24% of lower level health facilities had the requisite equipment
on-site to treat parasite-based malaria (ibid). This finding helps to quantify what is needed to those
the gap in a targeted manner and what type of institutional strengthening can occur to realize a
shift in the delivery of care. It may well serve to focus early on institution-building as it pertains
to the healthcare delivery system in Uganda.
Case: Saving Mothers, Giving Life
A great deal of Uganda’s healthcare infrastructure relies upon non-governmental organizations
(NGOs) and donor organizations (Kruk et al., 2014). On the one hand, these groups have been
hugely impactful in targeted areas. Kruk et al. (2014) conducted an assessment of the efforts of a
program called Saving Mothers, Giving Life (SMGL) to ascertain the benefits of these types of
interventions. Findings showed that within service delivery, SMGL was able to increase the
capacity of hospitals to be equipped to provide better maternal care. For example, solar lamps were
implemented to reduce power outage barriers. Conversely, the lofty and aggressive goals specific
to maternal care shifted resources and took attention away from other health conditions. This
resulted in huge numbers of new obstetric patients, crowded healthcare facilities, and
unpreparedness of healthcare workers.
From a human resources perspective, the program was also able to fund additional doctors
and nurses to increase access points for care. However, the program demanded an intensive off-
site training schedule so staff shortages occurred at healthcare facilities as a result. In addition,
the existing staff and newly hired staff experienced tension between them such that retention of
staff at the close of the program fell into question. Financially, the program was able to lobby for
increased wages for participating doctors and accordingly a bill was passed toward this aim. This
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reduced the previous wage gap for doctors who were unwilling to travel to rural areas. This
approach, while closing financial and access gaps, was specific only to the SMGL program, which
questions whether the solution is scalable to other interventions and, if replicated, wouldn’t place
a significant burden on the Ugandan government as well as challenge the decentralized healthcare
system structure.
Another benefit found was in the raised awareness and focus on maternal health and the
prioritization on the healthcare agenda that was reinforced by state institutions. Because this was
an outside agency program, however, lack of ownership became a threat to sustainability. In
addition, different districts implemented the program in different ways which undermines a
consistency of approach to lend to a sustainable model. The SMGL program further realized
positive changes in purchasing and supply management training so benefits were realized in the
supply chain and the prevention of ‘stock-outs.’ This supply chain, however, relied upon donor
funding again raising sustainability questions. Lastly, the SMGL program implemented upgrades
to communications, medical records management and healthcare information technology to
facilitate patient care tracking over time. Unfortunately, since few personnel were trained and able
to use these systems, wait times increased within the health facilities.
This review of a large-scale national intervention aimed at rapid improvement
demonstrates that positive changes may occur but are often, and in this case always, accompanied
by negative impacts. A ‘big bang’ approach to implementation to receive quick results may not
only elude achieving desired sustainable outcomes, but undermine future worthy attempts if the
value of the implementation does not outweigh the risks such as financial investment, human time,
and institutional involvement.
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Healthcare system comparisons
Uganda is 149 of 191 ranked healthcare systems (Tandon et al., 2000). While many African
countries fall to the bottom of this list (i.e, > 95), some African countries do rank in the top 50th
percentile to include: Morocco (29th
), Tunisia (52nd
), Senegal (59th
), Egypt (63rd
) and Algeria (81st
)
(ibid). The Brookings Institute’s “Weak States Index” (Patrick & Rice, 2008) unsurprisingly finds
that, taking into account economic, political, security and social welfare indicators, the same trends
apply: most African countries rank the weakest, Uganda included. This demonstrates that health
and effective health institutions are at the core of not just the health of populations, but of nations
as well.
Among the United Nation’s Millennium Development Goals, is the charge to reduce child
mortality rates (United Nations, 2000). This is not an arbitrary goal in that the World Health
Organization has identified child mortality as a leading indicator of the overall development of
countries and the health of their populations (World Health Organization, 2012). Child mortality
has decreased by 35% globally from 1990 to 2010, with an average annual decrease for all
countries of 2.2%, whereas the least progress has been noted in developing countries (UNCF,
2011). Policy interventions targeted at women’s health, increasing access to healthcare services,
and enforcing the accountability of health systems have been cited as the underlying reasons for
the reduction in child mortality rates (UNCF, 2011).
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Graph 1. Health Systems Rankings (lower 50th
percentile) Child Mortality Comparison
In Graph 1 above, Ugandan child mortality trends are compared to those observed for the
5 African countries (Algeria, Egypt, Senegal, Tunisia, and Morocco) who ranked in the top 50th
percentile of the healthcare systems ranking (Tandon et al., 2000). In Graph 2, below, Ugandan
child mortality trends are compared to African countries whose healthcare systems rank in the top
50th
percentile but still are ranked higher than Uganda overall. It is interesting to observe that in
both graphs, Uganda started out the highest or nearly highest for child mortality but in Graph 2
comes to fall in the middle of the group in 2012.
0
20
40
60
80
100
120
140
160
180
200
1990 2000 2012
African Countries in Lower 50th Percentile of Health System Rankings Compared to Uganda
Infant Mortality Under 5 per 1,000 births 1990-2012
Algeria Egypt Senegal Tunisia Morocco Uganda
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Graph 2. Health Systems Rankings (upper 50th
percentile) Child Mortality Comparison
Table 1. % Change Child Mortality 1990-2012
0
50
100
150
200
250
1990 2000 2012
African Countries in Upper 50th Percentile of Health System Rankings in Advance of Uganda
Infant Mortality Under 5 per 1,000 births 1990-2012
Benin Burkina Faso Burundi Cape Verde Cote d'Ivoire Gabon
Gambia Ghana Guyana Kenya Sudan Uganda
Country
% Change
1990-2012
Egypt -75%
Tunisia -69%
Cape Verde -64%
Uganda -61%
Morocco -61%
Algeria -60%
Senegal -58%
Gambia -57%
Benin -50%
Burkina Faso -49%
Ghana -44%
Sudan -43%
Burundi -36%
Gabon -33%
Cote d'Ivoire -29%
Kenya -26%
Guyana -23%
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The findings in the graphs above prompted an analysis of the change over time for child mortality
across all African countries with healthcare systems that ranked higher than Uganda. In Table 1
the percent change in child mortality is calculated for the years 1990-2012. With the exception of
Cape Verde, Uganda has outpaced all of the other lower 50th
percentile healthcare systems in
reducing child mortality to keep pace with those healthcare systems ranking in the highest 50th
percentile. This appears to be good progress over time, and while the absolute rate of child
mortality (i.e., 69 per 1,000 live births) remains high, additional focus in this area could realize
real gains in the coming years and facilitate meeting MDG aims.
African country health system advances
Ghana has been successful in reducing maternal mortality from 500 deaths per 100,000 live births
to 350 deaths per 100,000 live births within a four-year period from 2004-2008 (EIU, 2011).
Ghana achieved this major shift by making the delivery of babies a free service for all mothers.
This result demonstrates that many want care and will access it when cost is not a barrier. As such,
models that are moving towards privatization and increased costs to populations will likely
negatively impact a healthcare system’s progress and outcomes, particularly in developing
countries. On the other hand, the study also revealed that many did not choose to seek out medical
care for child birth despite it being free (ibid). It appears that, culturally, a barrier can be those
unwilling to access healthcare or lacking knowledge to understand the benefits.
The Institute for Healthcare Improvement (IHI) in South Africa published a white paper
(2012) to articulate their recommendations for health systems improvement based upon the lessons
learned of their interventions. Recommendations include: 1) Implement training programs to
embed knowledge within societal groupings; 2) Provide tools and resources to make change easier
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(i.e., make it easier to exhibit desired behaviors); 3) Conduct small tests of change rather than take
on full-scale interventions. For example, in South Africa, the IHI has limited its scope to
improving hospital safety and improving care for HIVpatients. Targeted interventions are
significantly more achievable than undertaking an entire healthcare system overhaul (ibid); 4)
Maintain data that tracks progress of interventions over time; 5) Start with evidence-based
interventions as ‘low-hanging fruit’ and help to mitigate risk to intervention success; 6) Create
support networks for patients with similar health challenges such as in the instance of chronic
disease clubs; 7) Keep innovation periods short and reinforce with metrics for desired behavior
changes.
A study of South Africa’s public healthcare reforms reviewed their lessons learned
pertaining to the HIV/AIDS pandemic (Knijn & Slabbert, 2012). A hybrid public/private model
did not work well in post-apartheid Africa. Leveraging NGO’s and donor funding to address
HIV/AIDS has been critical to applying antiretroviral treatment. But, this donor aid is not
sustainable given the heavy burden of HIV/AIDS. The South African government is working to
use the public healthcare system to address population care needs in cooperation with NGOs,
though the obstacles observed in this hybrid model include: 1) governance integration; 2) priorities
and timelines are difficult to reconcile; 3) the public system is at a disadvantage without NGOs
especially in rural areas (ibid). Transitioning from NGO support to public healthcare presents and
immense challenge.
Best Practices
Healthcare reform has become a global challenge that even developed nations are
encountering. While all states do not share the same political, economic and social profiles and
17. 17 | P a g e
thus cannot address their health system structures the same way, best practice review can offer a
helpful launch for where to begin addressing an overwhelming undertaking. One commonly
agreed upon best practice, for example is that a primary healthcare approach is highly
recommended as a positive first step in health system strengthening, particularly as it relates to
meeting MDGs (Mback, 2013). In addition, Kruk et al. (2014) argue that having high, broad
healthcare goals rather than incremental goals will over time threaten the sustainability of health
system changes, thus small and targeted changes are preferred. Also, widely promoted is that
country-level interventions combined with community-level buy-in and ownership facilitate better
coordination and opportunities to achieve desired outcomes (WHO, 2010).
The Economist Intelligence Unit (2011) conducted a broad study on the state of Africa’s
healthcare systems. In general, this environmental scan yielded several recommendations for
shifting systems most substantively and sustainably through: 1) shifting to preventive care in lieu
of curative care; 2) empowering communities to ‘own’ their healthcare and healthcare resources;
3) increasing the role of technology in healthcare (i.e., for mobility); 4) focusing on healthcare
supply chain efficiencies to get the right supplies and equipment to the right locations to facilitate
the right care; 5) shifting from a model that relies on foreign aid to one that sustainably leverages
local resources; and, 6) making healthcare universal so that all Africans may benefit from and
access care.
Another survey of “best buys” in the advancement of global health was conducted by the
Disease Control Priorities Project (DCPP)--an effort of the U.S. National Institutes of Health, the
World Health Organization, the World Bank, and the Bill & Melinda Gates Foundation. This
initiative worked to determine which opportunities existed for developing countries as a ‘low-
hanging fruit,’ or low cost, high impact approaches that could result in massive early benefits in
18. 18 | P a g e
global health (Laxminarayan & Ashford, 2008). DCPP used disability-adjusted life years
(DALYs) as the common metric to assess the cost-effectiveness of various health interventions.
The DALYs measure whether premature death or disability lower individual’s health status. It is
the aversion of death or disability that can be attributed to an intervention that impacts this metric.
The survey found the following top ten recommendations for best health buys for developing
countries: 1) vaccinating children; 2) preventive pediatric care; 3) tobacco taxation (i.e., to
dissuade consumption); 4) HIV/AIDS prevention; 5) maternal and child nutrition; 6) insecticide-
treated bed nets (i.e., malaria prevention); 7) enforcement of traffic laws (i.e., injury prevention);
8) short-course chemotherapy to treat tuberculosis; 9) education for mothers and birth attendants;
and, 10) promotion of aspirin to assist with chronic disease management. All of these suggestions
with the exception of #8 are preventive in nature rather than curative.
To address alignment and resource issues, a community based education (CBE) approach
has been broadly promoted, whereby communities lie at the center of a taxonomy with bi-
directional reinforcement to students, academic institutions and healthcare facilities. The concept
is that students, academic institutions and healthcare facilities are all external factors that are the
external components necessary for a successful healthcare system but their influence is mediated
by the communities being served (Ndaruhutse, 2013). Thus, any effort to strengthen a healthcare
system that ignores the role of community would likely undermine desired institutional impacts.
These best practices all place the community at the core reinforced by targeted directives
for realizing solid primary care infrastructure that focuses on preventive care in key areas focused
on small changes over time rather than sweeping reforms. While Uganda’s policy reform did
attempt to localize healthcare in a bottom-up fashion, a gap may exist in centrally communicated
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objectives with strong institutional leadership, metrics, reinforcement and resources to realize the
desired changes—one country all moving in the same direction.
Singapore Healthcare System
Singapore, also once a British colony and previously considered a developing country, has come
to offer one of the world’s best healthcare systems ranking 6 of 191 (Tandon et al., 2000). Not
only has Singapore succeeded in delivering quality healthcare to its citizens at the level of
healthcare leaders like France, Italy, and Malta (ibid), it has been able to do so inexpensively and
sustainably (Haseltine, 2013).
Primary factors enabling Singapore to, in under 40 years of development, achieve this
status include: 1) political unity; 2) prioritizing economic growth before investing in healthcare;
3) a common goal of collective well-being; and, 4) prioritizing the rights, education and health of
women. In addition, to encounter the question of universal coverage that all countries face, the
Prime Minister of the time, Lee Kuan Yew, reasoned that for individuals to psychologically own
their own health, they should pay something for services, which would also prevent a ‘welfare
state’ mentality (ibid).
Early in the health system development, infrastructure was established to support collective
gains across sectors that touch health such as housing. After independence, Singapore faced a
housing crisis and widespread slum conditions, which fostered poor sanitation and hygiene.
Beginning in 1960, the government build 20,000 housing flats climbing to 55,000 flats by 1965.
Today, nearly 85% of the population of Singapore are inhabitants of these housing flats that are
equipped with exercise areas, clean grounds, and nearby healthy public food centers (ibid). This
infrastructure building was a form of institutional strengthening by ancillary sectors to health. In
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addition, the government invested in increasing access to care by sponsoring education for
healthcare professionals abroad so they could return to Singapore and practice medicine. Other
infrastructure investments included upgrading or building healthcare facilities, and shifting
primary care to outpatient clinic networks and, while public hospitals remained under government
control, they were granted more autonomy to participate in a free market and help to keep costs
low. By 1983, Singapore launched its National Health Care Plan that detailed the long-term
strategic plan for maintaining a quality and affordable healthcare system that was scalable and
sustainable as well as responsive to the growth of its economy and population needs (ibid). At the
core of change was a focus on individual responsibility and supplying the tools and infrastructure
to help citizens to help themselves as part of a collective wellness culture.
According to the United Nation’s Millennium Development Goals data, in 2012, the rate
of child mortality under 5 years in Singapore was 3 per 1,000 live births compared to Uganda’s 69
per 1,000 live births (United Nations, 2014). Differences between how Singapore has approached
the strengthening of its healthcare system and how Uganda is approaching its health system
development are listed in Table 2 below:
Table 2. Healthcare System Differences Between Singapore and Uganda
Singapore Uganda
Public services are allowed autonomy to
contribute to free market economics and help
keep costs low
Decentralized system places autonomy at the
local level
Government intervention is permitted to keep
healthcare quality high and costs low if there
are any observed market shifts
Government subsidies for certain programs are
made available
Patients are required to pay some fee though
healthcare is guaranteed
Healthcare is free to all, though lack of
oversight breeds corruption (i.e., denial of care
for those who cannot pay; Wooding,
Nagaddya, Nakaggwa, 2012).
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Private providers keep pace with costs set by
public hospitals since quality of care is
equivalent
Private providers attract a growing middle
class and may provide more
quality/specialized care than provided by
public services
Strong institutional support and common
messaging across the country
Fragmented institutional messaging
Certainly, Singapore is in a very different economic, political, and socio-cultural position
than Uganda so the comparison between them could seem inappropriate. However, there is always
use in surveying when a country does something well to backwards from there to determine what
tools and methodologies could be leveraged and altered. At the very least, starting with
understanding what thriving healthcare systems do to maintain that position can provide clues for
development. Singapore stands out among healthcare leaders because they have not always
enjoyed their economic status or health prosperity and have in a fairly short period transformed
their healthcare system, lending to the notion that it is possible to achieve given the right set of
factors in alignment. In 1980, Singapore’s GDP per capita was $5,004 in current US dollars.
Comparatively, Uganda’s GDP per capita for the same period was $99 (World Bank, 2014). In
2013, Singapore’s GDP per capita was $55,182 compared to Uganda’s $572 (ibid). While
Singapore saw double the growth in GDP per capita over the 33 year period, Uganda did see
growth. It is worthy to note that if there is any relationship between economic growth and
healthcare system development, progress (as measured by MDGs) is a real possibility in Uganda.
Relationship between Institutional Strength and Healthcare System Strength
To assess the relationship between institutional strength and strength of healthcare systems, both are
represented herein by validated indices, the Global Report 2014 published by the Center for Systemic
Peach (Marshall & Cole, 2014) and the health systems ranking index published by the World Health
Organization (Tandon et al., 2000). The Global Report 2014 is applied to index countries based upon
armed conflict, governance, and societal-system development. This index is being used to proxy for
22. 22 | P a g e
institutional strength since the report reveals the fragility of states and relevant literature suggests that
institutions are key to the development of weak and fragile states (Keohane, 1998). This composite
index is comprised of an effectiveness score and a legitimacy score. The effectiveness score is
calculated from security effectiveness (total residual war), political effectiveness (regime/governance
stability), economic effectiveness (GDP per capita) and social effectiveness (human capital
development). The legitimacy score accounts for security legitimacy (state repression), political
legitimacy (regime/governance inclusion), economic legitimacy (share of export trade in
manufactured goods) and social legitimacy (human capital care). To rank healthcare systems, Tandon
et al. used a composite index made up of 5 factors that were accordingly weighted based upon a WHO
survey where individuals identified how they prioritized the goals of healthcare systems: 1) overall
health (25%); 2) health inequality (25%); 3) responsiveness-level (12.%%); 4) responsiveness-
distribution (12.5%); and, 5) fair-financing (25%). The resulting country rankings are enabled by a
score assigned that aggregates these measures to indicate overall health system performance.
The healthcare system index ranked 191 countries whereas the fragility index ranked 167
countries. Both indexes held measurement for the same 158 countries. Using this combined data set
the scores of healthcare systems were correlated to observe if there was a relationship between
healthcare system strength and institutional strength. The healthcare system index ranked states from
low to high and the fragility index scored from high to low. For example, Uganda ranked 149
(score=.464) on healthcare system, but received a score of 18 (high fragility) on the fragility index.
Therefore, the correlational analysis showed a negative significant relationship between the scores on
these indexes, depicted in Table 3 below:
Fragility Index Effectiveness Score Legitimacy Score
Healthcare
System Score -0.760920865 -0.760176321 -0.65555051
23. 23 | P a g e
This data shows that the relationships between healthcare system strength and overall state
fragility is high (r=-.76) as are the relationships between health system strength and state
effectiveness (r=-.76) and legitimacy (r=-.66). This lends support for the hypothesis that
institutional strength and health system strength are interrelated concepts and, as such, better
understanding these mechanisms should be prioritized. These strong relationships also lend
credibility to using the composite score of overall state fragility solely to look at the ability to
predict healthcare system strength.
Table 4. Regression Fragility Scores on Health System Scores
In regression of state fragility scores on healthcare system scores, the robust model proved
significant at p<.00001 (Adj R2
=.5721; F=209.644; df= 1, 155). Using these indices to represent
the underlying constructs, shows that security, political, economic, and social legitimacy and
effectiveness account for 57% of the variability in health system strength. This finding helps to
add to the literature and reinforce the influence that institutions have on achieving desired
outcomes in health.
Regression Statistics
Multiple R 0.75824
R Square 0.574929
Adjusted R Square 0.572186
Standard Error 0.146168
Observations 157
ANOVA
df SS MS F Significance F
Regression 1 4.479076 4.479076 209.6446 1.3491E-30
Residual 155 3.311589 0.021365
Total 156 7.790666
24. 24 | P a g e
Discussion
This exploratory comparative analysis sought to identify what institutional capacity
Uganda has or could adopt in order to provide more robust healthcare services for its growing
population. Based on the case studies and global index data reviewed, the notion that the role of
institutions is key in developing healthcare systems appears to be a solid direction for future in-
depth analysis. In particular, better understanding what aspects of Uganda’s existing institutions
work well or may serve to be bolstered in measurable, re-enforceable and accountable ways may
add clearer, more targeted direction for development. In addition, ancillary institutions such as
housing, legal, security, economic, or political, can be surveyed for areas where desired healthcare
outcomes can be better achieved if those institutions partner for strategic aims.
Due to the rapid population growth in Uganda, massive healthcare reform has not been
supported in review of best practices, but instead finds for taking a targeted approach that starts
low, tracks progress, validates the desired impacts, institutionalizes the change, and then
disseminates to a broader scale so that all may benefit. Such an approach would limit the risk to
wasting valuable time and resources, both of which are already under strain. It is argued that,
though there is a push towards healthcare system strengthening across Africa, much of that push
is ‘talk’ that lacks the reinforcement of targeted and substantive ‘action’ much of which can be
attributed to the challenge of restructuring healthcare systems being a massive and overwhelming
endeavor (Mbacke, 2013). Owing to the decentralized healthcare system structure, should
individual parishes take on health outcome improvement initiatives, such progress can be tracked
and funneled through the state’s Ministry of Health with central cooperation and information
dissemination to help create a knowledge base accessible to all.
25. 25 | P a g e
In general, it is reviewed that the primary institutional push would do well to focus on
preventive care rather than curative care to begin with. Preventive services, through international
health system survey and best practices, have demonstrated to provide for the greatest lift despite
economic growth of a country. Uganda faces an extremely heavy burden of disease, limited
healthcare personnel, inadequate healthcare infrastructure, and a growing population that is a very
young population, many of which will not survive (if keeping with current trends) to realize an
adulthood to contribute to the healthcare workforce, just be consumers of it. Allocating resources
and efforts where they will be the most valuable can be a working strategy with the broadest reach.
Additional priorities for maturing the healthcare system over time once preventive care services
are institutionally solidified would augment this strategy.
It was also reviewed that the measurement of interventions and their outcomes is the best,
most reliable method for helping a country to determine what works well for their population. In
Uganda, much of the healthcare interventions are made possible through outside aid such as donor
funding or NGOs. For such externally-driven influences, having policies in place to establish
governance can be helpful. For example, mandating that NGOs and donor organizations adhere
to a standard of data gathering would be hugely beneficial for assessing the impacts of targeted
interventions and where some work or others to not from a contextual perspective. Fragmentation
of approaches should be avoided. Institutional strength and common goals across the health system
can facilitate a needed integration that will reduce cost owing to intervention failures and build a
centralized knowledge base to be leveraged in the future.
.
27. 27 | P a g e
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