The role of National Immunization Technical Advisory Groups (NITAG) in strengthening health system governance: Lessons from three middle-income countries—Argentina,Jordan, and South Africa (2017–2018)

IntroductionToward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance.MethodsIn 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC).ResultsDocument review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation.ConclusionsSystematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.     

农村教师艾滋病防治知识、态度、行为和效能调查分析

目的了解农村教师艾滋病防治知识、态度、行为和效能情况,为开展艾滋病防治的信息、教育、沟通(IEC)技能训练提供科学依据。方法对1200名农村教师进行《艾滋病防治问卷》调查。结果农村教师艾滋病防治知识比较欠缺,相关态度和行为有待改善,艾滋病防治上的自我效能感亟待提高。结论对农村教师开展艾滋病防治知识的健康教育十分必要。     

浙江省农村卫生技术人员岗位培训需求调查

[目的]了解农村基层卫生工作人员的基本状况,分析其知识结构,掌握农村卫技人员对岗位培训的需求,为有关部门制订农村卫技人员的培训政策与计划提供参考。[方法]随机调查浙江省农村基层卫技人员,采用Access建立数据库、SPSS10.0进行统计处理。[结果]农村卫技人员中本科学历仅占2.8%,大专学历占28.8%,中专学历占43.4%,其余为无正规学历者;职称结构中,主治及以上占11.8%,医师占29.6%,医士占37.0%,其余为卫生员和无职称人员;83.9%的人在从医后参加过1年以上专业培训;86%的人愿意参加继续医学教育。[结论]浙江省农村卫技人员学历低,工作年限长,知识老化,期望得到继续医学教育以取得更高学历,更新医学知识,提高实际业务水平。     

农村外来务工人员的健康现状及相关知信行调查分析

目的了解农村外来务工人员的健康现状,评价其知信行水平,找出该人群的健康隐患以及采取有针对性的健康促进策略。方法采用二阶段随机抽样的方法,抽取192名15岁以上的外来务工人员进行问卷调查,问卷由宁波市健康教育所自行设计。结果外来务工人员以青壮年为主,且流出地集中,基本生活条件较差。知识得分的中位数为45.0分,不合格率为69.3%,优秀率仅为5.7%。高血压危险因素的知晓率只有7.3%,艾滋病的3个主要的传播途径的知晓率为46.4%。外来人员的吸烟率为23.6%,其中男性吸烟率为46.3%。6.8%的人经常喝生水,血压测量率和体检率都较低。结论外来务工人员预防和保健知识掌握情况较差,整体卫生意识淡薄,需要进行针对性的健康教育,并应制定有利于健康的相关公共政策。     

农村卫生适宜技术推广示范研究中的模式、机制及其作用的探讨

目的：为我国的农村卫生适宜技术的推广提供实践经验和理论依据，探索适合我国目前国情（尤其是对于西部农村地区）的卫生适宜技术推广的最佳模式与机制。方法：在重庆市两个农村卫生适宜技术示范县开展卫生适宜技术推广示范工作。结果：在2005和2006年分别采用了不同的卫生适宜技术推广模式，获得了不同的效果；适宜技术在一定程度上缓解了农民看病难、看病贵的状况，获得了卫生工作者和人民群众广泛的欢迎和好评。结论：对于我国西部农村地区的卫生适宜技术推广工作，最佳的模式是“政府主导＋市场导向”的综合模式；适合的机制是以协调联动、社会动员、适当经济补偿、约束与激励并用四项为主的多项机制协同作用；项目研究的全过程必须由具备科研能力的高等院校和科研院所主持参与才能成功地总结经验。     

Health workforce planning in Europe: Creating learning country clusters

In this article, the different dimensions and determinants of health workforce planning (HWF) are investigated to improve context-sensitivity and mutual learning among groups of countries with similar HWF characteristics. A novel approach to scoring countries according to their HFW characteristics and type of planning is introduced using data collected in 2012 by a large European Union project involving 35 European countries (the ‘Matrix Study’ [8]). HWF planning is measured in terms of three major dimensions: (1) data infrastructure to monitor the capacities and dynamics of health workforces, (2) the institutions involved in defining and implementing labour market regulations, and (3) the availability of models to estimate supply–demand gaps and to forecast imbalances. The result shows that the three dimensions of HWF planning are weakly interrelated, indicating that countries invest in HWF in different ways. Determinant analysis shows that countries with larger health labour markets, National Healthcare Service (NHS), mobility, and strong primary health care score higher on HWF planning dimensions than others. Consequently, the results suggest that clustering countries with similar conditions in terms of HWF planning is a way forward towards mutual and contextual learning.     

Health related outcomes among people with type 2 diabetes by country of birth: Result from the 45 and Up Study

Background

Ethnic variation in the occurrence of type 2 diabetes, complications, mortality, and health behaviours has been reported. The current research examined patterns of health-related outcomes by country of birth in people with diabetes aged 45 years and over in New South Wales, Australia.

Obtaining reliable intraoral digital scans for an implant-supported complete-arch prosthesis: A dental technique

This article describes a technique for obtaining an accurate complete-arch digital scan for an edentulous patient. To achieve this, an auxiliary polymeric device that simulates a denture is designed, fabricated, and placed in the mouth. This device, having the geometry of a typical dental arch, facilitates the digitalization of the edentulous complete arch. This is because the change in radius of the curvature (change of geometry) enables the scanner to perform a more accurate alignment. Initially, the necessary location of the implants is acquired, and then the soft tissue is added. This technique can achieve accurate complete-arch digital scans. Distances between implants are closer to the gold standard when using this auxiliary geometry piece than those obtained without using it.     

Rehabilitation of cerebral palsy in a developing country: the need for comprehensive assessment

Records of 100 children with cerebral palsy from rural India attending a cerebral palsy clinic were analysed to determine the frequency of associated handicaps and to evaluate whether appropriate intervention had been instituted for these handicaps. All the children underwent speech, hearing, psychological, ophthalmologic, neurological, physical, functional and orthopaedic evaluations on their visit to the clinic. History was elicited from the parents of the patients to identify which of the disabilities were recognized either by them or their primary care physician, and whether any intervention had been instituted. The mean age of the patients was 6.9 years. Eighty-two per cent of the children had one or more disabilities apart from locomotor disabilities, visual defects being the commonest (54%). Fifty-four per cent of the children had more than one associated disability. Although 43% of the patients had been referred by a primary care physician, one or more associated disabilities had not been recognized and epilepsy was the only associated problem that had been treated prior to the evaluation. The study emphasizes the need for comprehensive evaluation of all children with cerebral palsy to enable proper rehabilitation.     

农村合作医疗体系建设研究综合考察

总结了国内对农村合作医疗的主要研究观点,分别从农村合作医疗制度风险、政府作用、社会功能、管理方式等方面分析了农村合作医疗中存在的问题与经验。