The National Health Policy for people with disabilities in Brazil: an analysis of the content, context and the performance of social actors

How to strengthen primary health care? An exploratory study on the policy of vertical integration of high-quality medical resources based on symbiosis theory

Background

The Vertical Integration of High-Quality Medical Resources (VI-HQMR) is a strategy of medical resource reallocation. It is the key to strengthen primary health care (PHC) and build an integrated delivery system (IDS). It contributes to the Sustainable Development Goals (SDGs) of universal health coverage (UHC) set out by the World Health Organization (WHO). In order to VI-HQMR, countries around the world have carried out many beneficial explorations. However, our understanding of the importance of clarifying the internal logical from policy perspective in the VI-HQMR is limited. This study aims to develop a theoretical model from the symbiotic perspective to improve the strategy of VI-HQMR.

Methods

Policies related to the VI-HQMR were retrieved for exploratory research. The texts and entries were coded according to the four elements of symbiosis theory, the first-level categories and their variables were mined, and the occurrence frequency was used as the main indicator for thematic clustering.

Results

A total of 609 policies were retrieved, among which 1,072 entries mentioned VI-HQMR. Results showed that the VI-HQMR included 482 symbiotic units, 549 symbiotic models, 383 symbiotic environments and 96 symbiotic interfaces. Secondary and above public hospitals and PHC institutions are the most important symbiotic units. Medical alliances are the most important symbiotic model. The symbiotic environment includes policy, technology and economics. The vertical integration of human resources is the main symbiotic interface.

Conclusion

The VI-HQMR is still in the initial exploration stage. The symbiotic model is changing from parasitism to the commensalism. To achieve the optimal mutualism model, we need to work hard from the symbiotic environment. Health administrative department should coordinate with other relevant departments to introduce special policies to support the VI-HQMR. Through opening the way for promotion, financial incentive, and informationization assistance, improve the enthusiasm of urban hospitals.

Sources of evidence, pathways, and processes to support disability-inclusive decision-making in low- and middle-income countries: A scoping review

Widespread failure to sufficiently account for disability in policies and programming across sectors limits the inclusion of people with disabilities in global health and development strategies. These oversights are especially marked in low- and middle-income countries (LMICs), where 80% of the world's 1.3 billion people with disabilities reside. To bridge disability policy and programming gaps, it is important to first understand how key categories of decision-makers think about disability in their work, including which sources of evidence, processes, and pathways they rely on to make policy and programming decisions about disability, and what influences (aside from evidence) shape their decision-making. To address these issues, we conducted a scoping review of the literature concerning the use of evidence in governmental and non-governmental decision-making around disability-inclusion in LMICs. We systematically searched databases of peer-reviewed literature and used thorough hand searches to gather grey literature. Documents were eligible if they focused on key governmental and non-governmental stakeholders; disability-inclusive or disability-related decision-making in mainstream or targeted planning, policy-making, programming, or evaluations; and were based on data from LMICs. All literature was double screened and extracted according to a standardised extraction sheet by four reviewers, working in pairs. We included 16 papers, with sources of evidence cited being highly variable and encompassing both empirical and experiential evidence, while barriers and facilitators to using evidence varied by evidence source. Outside of evidence, notable influences on decision-making included government legislation, power dynamics and involvement, stakeholder relationships, the local landscape, funding, and attitudes towards disability. This work highlights the barriers to, and enablers of, evidence utilisation in relation to disability, which can be targeted with intervention and advocacy. Moreover, this review suggests that supporting evidence-based decision-making in relation to disability in LMICs necessitates engagement with varied framings of evidence and influences on decision-making outside of evidence.

Ophthalmic rehabilitation in oncology care

Ophthalmic rehabilitation refers to the multidisciplinary approach to restoring, maximizing, and preserving the visual function and quality of life for patients affected by ocular manifestations of cancer or its treatments. Besides its approach to low vision, ophthalmic rehabilitation also encompasses a series of reconstructive interventions to mitigate anatomic deficits that may interplay with visual impairment. A gamut of oncologic conditions may result in ocular disabilities, including primary intraocular tumours, secondary metastases, or adverse effects of systemic therapies such as chemotherapy, radiation, and surgery. Methods of ophthalmic rehabilitation are evolving constantly and involve the prescription of optical aids and adaptive technologies to enhance remaining vision, as well as supportive training and counselling to address psychosocial effects. Although studies in low vision have mostly covered aspects of rehabilitation in inherited and degenerative eye conditions, ophthalmic rehabilitation within the context of cancer carries specificities that have been poorly explored in the literature on ophthalmology and oncology. This review aims to build on the trends of low vision management, ocular oncology treatments, orbital reconstructive surgery, and visual therapy to revise the published rationale behind evaluating and managing patients facing debilitating ocular sequelae as the result of cancer.

Inclusion of people with disabilities in Chilean health policy: a policy analysis

BACKGROUND

Around 18% of the population in Chile has disabilities. Evidence shows that this population has greater healthcare needs, yet they face barriers to accessing healthcare due to health system failures. This paper aims to assess the inclusion of people with disabilities in health policy documents and to explore the perceptions of key national stakeholders regarding the policy context, policy processes, and actors involved.

METHODS

A policy content analysis was conducted of 12 health policy documents using the EquiFrame framework, adapted to assess disability inclusion. Documents were reviewed and rated on their quality of commitment against 21 core concepts of human rights in the framework. Key national stakeholders (n = 15) were interviewed, and data were thematically analysed under the Walt and Gilson Policy Analysis Triangle, using NVivo R1.

RESULTS

Core human rights concepts of disability were mentioned at least once in nearly all health policy documents (92%). However, 50% had poor policy commitments for disability. Across policies, Prevention of health conditions was the main human rights concept reflected, while Privacy of information was the least referenced concept. Participants described a fragmented disability movement and health policy, related to a dominant biomedical model of disability. It appeared that disability was not prioritized in the health policy agenda, due to ineffective mainstreaming of disability by the Government and the limited influence and engagement of civil society in policy processes. Moreover, the limited existing policy framework on disability inclusion is not being implemented effectively. This implementation gap was attributed to lack of financing, leadership, and human resources, coupled with low monitoring of disability inclusion.

CONCLUSIONS

Improvements are needed in both the development and implementation of disability-inclusive health policies in Chile, to support the achievement of the right to healthcare for people with disabilities and ensuring that the health system truly "leaves no one behind".

Building disability-inclusive health systems

Health systems often fail people with disabilities, which might contribute to their shorter life expectancy and poorer health outcomes than people without disabilities. This Review provides an overview of the existing evidence on health inequities faced by people with disabilities and describes existing approaches to making health systems disability inclusive. Our Review documents a broad range of health-care inequities for people with disabilities (eg, lower levels of cancer screening), which probably contribute towards health differentials. We identified 90 good practice examples that illustrate current strategies to reduce inequalities. Implementing such strategies could help to ensure that health systems can expect, accept, and connect people with disabilities worldwide, deliver on their right to health, and achieve health for all.

Understanding China's shifting priorities and priority-setting processes in development assistance for health

Over the past two decades, China has become a distinctive and increasingly important donor of development assistance for health (DAH). However, little is known about what factors influence China's priority-setting for DAH. In this study, we provide an updated analysis of trends in the priorities of Chinese DAH and compare them to comparable trends among OECD Development Assistance Committee (DAC) donors using data from the AidData's Global Chinese Development Finance Dataset (2000-2017, version 2.0) and the Creditor Reporting System (CRS) database (2000-2017). We also analyse Chinese medical aid exports before and after the start of the COVID-19 pandemic using a Chinese Aid Exports Database. We further explore the potential factors influencing China's shifting priority-setting processes by reviewing Chinese official documents following Walt and Gilson's policy analysis framework (context-actors-process-content) and by testing our conjectures empirically. We find that China has become an important DAH donor to most regions if measured using project value, including but not limited to Africa. China has prioritized aid to African and Asian countries as well as to CRS subsectors that are not prioritized by DAC donors, such as medical services and basic health infrastructure. Chinese quarterly medical aid exports almost quintupled after the start of the COVID-19 pandemic. Noticeably, China has allocated more attention to Asia, eye diseases and infectious disease outbreaks over time. In contrast, the priority given to malaria has declined over the same period. Regarding factors affecting priority shifts, the outbreaks of SARS and Ebola, the launch of the Belt and Road Initiative and the COVID-19 pandemic appear to be important milestones in the timeline of Chinese DAH. Unlike stereotypes of China as a 'lone wolf' donor, our analysis suggests multilateral processes are influential in informing and setting Chinese DAH priorities.

[The limited access of People with Disabilities to health services in a northeastern capital]

The access of People with Disabilities (PwD) to specialized care services was analyzed on the basis of the availability-accommodation and adequacy dimensions. This is a case study with a qualitative approach and triangulation of sources based on documentary research, data from the Health Information Systems and semi-structured interviews with managers, health professionals and PwD. There was an expansion of rehabilitation services in Recife, although it was not possible to analyze the production capacity of such services. The findings point to the existence of architectural and urban barriers and insufficient resources in the services studied. Furthermore, there is a long waiting time for specialized care and difficult access to assistive technologies. It was also observed that professionals have low qualifications to meet the needs of PwD and a process of permanent education in different levels of complexity has not been instituted for workers. The conclusion drawn is that the institution of the Municipal Policy of Comprehensive Health Care for the PwD was insufficient to guarantee access to health services with continuity of care, considering the permanence of the fragmentation of the care network, thus violating the right to health of this segment.