Donor coordination to support universal health coverage in Malawi

Development assistance is a major source of financing for health in least developed countries. However, persistent aid fragmentation has led to inefficiencies and health inequities and constrained progress towards Universal Health Coverage (UHC). Malawi is a case study for this global challenge, with 55% of total health expenditure funded by donors and fragmentation across 166 financing sources and 265 implementing partners. This often leads to poor coordination and misalignment between government priorities and donor projects. To address these challenges, the Malawi Ministry of Health (MoH) has developed and implemented an architecture of aid coordination tools and processes. Using a case study approach, we documented the iterative development, implementation and institutionalization of these tools, which was led by the MoH with technical assistance from the Clinton Health Access Initiative. We reviewed the grey literature, including relevant policy documents, planning tools and databases of government/partner funding commitments, and drew upon the authors' experiences in designing, implementing and scaling up these tools. Overall, the iterative use and revision of these tools by the Government of Malawi across the national and subnational levels, including integration with the government's public financial management system, was critical to successful uptake. The tools are used to inform government and partner resource allocation decisions, assess financing and gaps for national and district plans and inform donor grant applications. As Malawi has launched the Health Sector Strategic Plan 2023-2030, these tools are being adapted for the 'One Plan, One Budget and One Report' approach. However, while the tools are an incremental mechanism to strengthen aid alignment, success has been constrained by the larger context of power imbalances and misaligned incentives between the donor community and the Government of Malawi. Reform of the aid architecture is therefore critical to ensure that these tools achieve maximum impact in Malawi's journey towards UHC.

ASHP and ASHP Foundation Pharmacy Forecast 2024: Strategic Planning Guidance for Pharmacy Departments in Hospitals and Health Systems

Purpose: The 2024 ASHP Pharmacy Forecast identifies and contextualizes emerging issues and trends that will influence healthcare, health systems, and the pharmacy profession and provides recommendations to inform long-term strategic planning that should prompt action by pharmacists and health-system leaders. Methods: Drawing on the “wisdom of crowds” concept, a survey was constructed with 6 general themes, each with 6 to 9 focused statements and a seventh theme on preparedness (58 survey items in total). The size of and representation within the survey panel were intended to capture opinions from a wide range of pharmacy leaders. The survey instructed panelists to consider the likelihood of the events/scenarios described in the statements occurring in the next 5 years as being likely, somewhat likely, somewhat unlikely, or very unlikely. Then, survey panelists assessed the preparedness (from very unprepared to very prepared) for 12 of the statements. Results: The 6 survey themes identified were Urgent Public Health Priorities, Responding to the Mental Health Crisis, Achieving Care Equity, New Disease Paradigms and Treatment Innovations, Workforce: Focus on Culture for the Future, and Artificial Intelligence: Can Ethics and Regulators Catch Up? The survey was completed by 250 respondents, yielding an 88% response rate. Analysis of survey results was provided by chapter authors along with strategic recommendations to guide actions for each theme. Conclusion: The focus of the Pharmacy Forecast is on large-scale, long-term trends that will influence healthcare and the pharmacy profession over months and years and not on day-to-day situational dynamics. The report provides insight to stimulate thinking and discussion and provides a starting point to proactively position leaders, their teams, and departments for potential future events and trends.

AI-Enabled Medical Education: Threads of Change, Promising Futures, and Risky Realities Across Four Potential Future Worlds

BACKGROUND

The rapid trajectory of artificial intelligence (AI) development and advancement is quickly outpacing society's ability to determine its future role. As AI continues to transform various aspects of our lives, one critical question arises for medical education: what will be the nature of education, teaching, and learning in a future world where the acquisition, retention, and application of knowledge in the traditional sense are fundamentally altered by AI?

OBJECTIVE

The purpose of this perspective is to plan for the intersection of health care and medical education in the future.

METHODS

We used GPT-4 and scenario-based strategic planning techniques to craft 4 hypothetical future worlds influenced by AI's integration into health care and medical education. This method, used by organizations such as Shell and the Accreditation Council for Graduate Medical Education, assesses readiness for alternative futures and effectively manages uncertainty, risk, and opportunity. The detailed scenarios provide insights into potential environments the medical profession may face and lay the foundation for hypothesis generation and idea-building regarding responsible AI implementation.

RESULTS

The following 4 worlds were created using OpenAI's GPT model: AI Harmony, AI conflict, The world of Ecological Balance, and Existential Risk. Risks include disinformation and misinformation, loss of privacy, widening inequity, erosion of human autonomy, and ethical dilemmas. Benefits involve improved efficiency, personalized interventions, enhanced collaboration, early detection, and accelerated research.

CONCLUSIONS

To ensure responsible AI use, the authors suggest focusing on 3 key areas: developing a robust ethical framework, fostering interdisciplinary collaboration, and investing in education and training. A strong ethical framework emphasizes patient safety, privacy, and autonomy while promoting equity and inclusivity. Interdisciplinary collaboration encourages cooperation among various experts in developing and implementing AI technologies, ensuring that they address the complex needs and challenges in health care and medical education. Investing in education and training prepares professionals and trainees with necessary skills and knowledge to effectively use and critically evaluate AI technologies. The integration of AI in health care and medical education presents a critical juncture between transformative advancements and significant risks. By working together to address both immediate and long-term risks and consequences, we can ensure that AI integration leads to a more equitable, sustainable, and prosperous future for both health care and medical education. As we engage with AI technologies, our collective actions will ultimately determine the state of the future of health care and medical education to harness AI's power while ensuring the safety and well-being of humanity.

An assessment of primary health care costs and resource requirements in Kaduna and Kano, Nigeria

Introduction

The availability of quality primary health care (PHC) services in Nigeria is limited. The PHC system faces significant challenges and the improvement and expansion of PHC services is constrained by low government spending on health, especially on PHC. Out-of-pocket (OOP) expenditures dominate health spending in Nigeria and the reliance on OOP payments leads to financial burdens on the poorest and most vulnerable populations. To address these challenges, the Nigerian government has implemented several legislative and policy reforms, including the National Health Insurance Authority (NHIA) Act enacted in 2022 to make health insurance mandatory for all Nigerian citizens and residents. Our study aimed to determine the costs of providing PHC services at public health facilities in Kaduna and Kano, Nigeria. We compared the actual PHC service delivery costs to the normative costs of delivering the Minimum Service Package (MSP) in the two states.

Methods

We collected primary data from 50 health facilities (25 per state), including PHC facilities-health posts, health clinics, health centers-and general hospitals. Data on facility-level recurrent costs were collected retrospectively for 2019 to estimate economic costs from the provider's perspective. Statewide actual costs were estimated by extrapolating the PHC cost estimates at sampled health facilities, while normative costs were derived using standard treatment protocols (STPs) and the populations requiring PHC services in each state.

Results

We found that average actual PHC costs per capita at PHC facilities-where most PHC services should be provided according to government guidelines-ranged from US$ 18.9 to US$ 28 in Kaduna and US$ 15.9 to US$ 20.4 in Kano, depending on the estimation methods used. When also considering the costs of PHC services provided at general hospitals-where approximately a third of PHC services are delivered in both states-the actual per capita costs of PHC services ranged from US$ 20 to US$ 30.6 in Kaduna and US$ 17.8 to US$ 22 in Kano. All estimates of actual PHC costs per capita were markedly lower than the normative per capita costs of delivering quality PHC services to all those who need them, projected at US$ 44.9 in Kaduna and US$ 49.5 in Kano.

Discussion

Bridging this resource gap would require significant increases in expenditures on PHC in both states. These results can provide useful information for ongoing discussions on the implementation of the NHIA Act including the refinement of provider payment strategies to ensure that PHC providers are remunerated fairly and that they are incentivized to provide quality PHC services.

Instant habits versus flexible tenacity: Do implementation intentions accelerate habit formation?

Implementation intentions (strategic "if-then" plans) have been shown to support behaviour change. This may be achieved by mentally forming stimulus-response associations, thereby promoting habit formation. Does this deliberate attempt to instal "strategic automaticity" only offer advantages, or does it also come at the cost of reduced flexibility that characterises learnt habits? To investigate this, we tested healthy, young participants on a computerised instrumental learning task. Critically, we introduced implementation intentions ("if I see stimulus X, then I will respond") versus goal intentions ("for outcome Z, I will respond)" during instrumental acquisition, and subsequently assessed behavioural flexibility in an outcome-revaluation test. In Experiment 1, we conducted a between-subjects manipulation of strategic planning, and in Experiment 2, a within-subject manipulation. We hypothesised that implementation intentions would lead to strong stimulus-response associations and consequently impair performance when the signalled outcome value changed and therefore required a different response, while benefitting performance when the outcome value (and required response) remained the same. We found that implementation intentions supported instrumental learning, but impaired test performance overall (most robustly in Experiment 2), irrespective of whether the signalled outcome value had changed. We argue that this general detrimental effect of implementation intentions on test performance is likely a consequence of their negative effect on stimulus-outcome learning. Our findings warrant caution when applying if-then plans to situations where the agent does not already possess perfect knowledge of behavioural contingencies.While implementation intentions may support efficient and fast behavioural execution, this may come at the expense of behavioural flexibility.

Strategic concept paper for Bioeconomy in Slovenia: from a patchwork of good practices to an integrated, sustainable and robust bioeconomy system

While Slovenia has significant bioeconomy potential, it remains underutilized, facing challenges in primary bioeconomy sectors, their integration along value chains, uptake of industrial innovation, and institutional coordination. This paper aims to support the unlocking of Slovenia's bioeconomy potential, and foster sustainable and integrated development of its value chains. It provides the evidence base of the composition, volumes and current utilization of the available biomass streams from agriculture, forestry and aquatic systems. It discusses the potential uses of these resources and highlights the need for improved logistics and scalability. Additionally, the structure and performance of bioeconomy-related industries in Slovenia are examined, emphasizing the importance of firm consolidation and integration for successful bioeconomy development. It emphasizes the importance of sector-specific transformation pathways, from primary production to expanding hybrid sectors. The exchange between policymakers and stakeholders is encouraged to recognize synergies, accelerate cooperation, and improve economic performance while closing material and energy loops. The document also reviews the supporting environment for bioeconomy development and proposes steps for improved coordination and strategic planning.

Addressing Structural Racism Using a Whole-Scale Planning Process in a Single Academic Center

Purpose

The murder of George Floyd in 2020 prompted a national demand for cultural transformation to confront the systemic racism prevalent in the country. Academic medical centers were not exempt from this urgent call. This article evaluates the efficacy of a strategic process in fostering cultural transformation within an academic medical system.

Methods

A whole-scale strategic planning process was implemented over 13 months, involving multiple working groups representing key stakeholders from each entity across the system, an anonymous survey, a communication plan, and a balanced scorecard to monitor progress. More than 5500 voices, 160 recommendations, 122 data gathering sessions, and town hall meetings contributed to the creation and implementation of vital action items and a strategic framework. The Diversity Engagement Survey (DES) was administered 18 months following the process launch.

Results

Of the 45,554 employees, students, faculty, and trainees, 96.5% completed unconscious bias education within the fiscal year and 76% of action items, termed "Just Do Its," were completed. Mission, vision, values, and strategic priorities were crafted to serve as a framework for intermediate and long-term actions. The DES revealed improvement in the "respect" attribute of an inclusive culture, and 64% of respondents confirmed that action for cultural transformation is addressing racism both within and outside of the institution.

Conclusion

Implementing a shared purpose, engaging multiple working groups representing key stakeholders, and empowerment of stakeholders to implement changes, in conjunction with the development of a strategic framework addressing structural racism, resulted in the completion of vital action items to initiate cultural change.

International cooperation for nursing human resource development in Lao PDR: Investing in nursing leadership

Strengthening nursing leadership in health systems has been identified as a priority for achieving Universal Health Coverage (UHC). We aimed to analyse the characteristics of Japanese technical assistance projects for nursing human resource development in Lao People's Democratic Republic (Lao PDR) and suggest directions for future assistance. An upgrading program, as part of human resource development, was initiated in the 1990s; it has contributed to the development of nursing leaders. Moreover, technical assistance from development partners has had synergistic effects by consistently promoting the involvement of nursing leaders in administration, education, and clinical practice to establish a functional regulatory system. In resource-limited settings, the application of both edge-pulling (leadership development) and bottom-up (quality improvement of the mass population) strategies are required. From a long-term perspective, development partners should continue to invest in increasing the number and quality of nursing leaders by upgrading the courses and leadership training programs, starting from the younger generation.

How well do policymakers address stigma surrounding substance use disorders: lessons from a qualitative review of Scottish Alcohol and Drug Partnerships' strategic plans

Background

Stigma is a significant barrier to the successful implementation of public health policies which aim to reduce harm from substance use disorders. Despite attention being given to stigma in the literature for at least a decade, evidence on what works to reduce it is limited and inconclusive. Without clear guidance, policymakers could be limited in their ability to develop evidence-informed strategies for reducing stigma. In response to a steep incline in drug-related deaths in Scotland since 1996, the Scottish Government has committed to tackling stigma in national drug policy. Scotland's 31 Alcohol and Drug Partnerships are responsible for developing local strategies that aim to tackle harm from substance use disorders. This qualitative review explored how well these strategies respond to stigma and identified approaches mentioned that could have implicit implications for tackling stigma.

Methods

The strategic plans of Alcohol and Drug Partnerships across Scotland were identified and thematically analysed to identify key themes relating to stigma. Content of strategic plans was initially coded under a coding scheme of four broad categories: content that explicitly mentioned stigma; identity, status and power; deservedness of support; and attribution of responsibility for SUDs.

Results

Twenty-four strategic plans were identified and analysed, with four themes emerging: (1) limited clarity and consistency on how stigma will be directly tackled by ADPs; (2) recognition of the positive contribution that people with substance use disorders can make towards decisions about treatment and support; (3) diversion of people with substance use disorders away from the criminal justice system towards quality support underpinned by human rights; and (4) recognition of the complex determinants of substance use disorders and that everyone has a role to play.

Conclusion

Alcohol and Drug Partnerships acknowledged the importance of tackling stigma in their strategic plans but provide limited clarity on how this will be done. This review calls for the inclusion of more evidence-informed strategies for tackling stigma within the Scottish local policymaking context. This requires academic, policymaking and lived experience communities to collaborate to test and evaluate innovative responses to tackling in stigma to strengthen understanding of what works in which contexts.

A utilization distribution for the global population of Cape Vultures (Gyps coprotheres) to guide wind energy development

The rapid development of wind energy in southern Africa represents an additional threat to the already fragile populations of African vultures. The distribution of the vulnerable Cape Vulture Gyps coprotheres overlaps considerably with wind energy development areas in South Africa, creating conflicts that can hinder both vulture conservation and sustainable energy development. To help address this conflict and aid in the safe placement of wind energy facilities, we map the utilization distribution (UD) of this species across its distributional range. Using tracking data from 68 Cape Vultures collected over the last 20 years, we develop a spatially explicit habitat use model to estimate the expected UDs around known colonies. Scaling the UDs by the number of vultures expected to use each of the colonies, we estimate the Cape Vulture population utilization distribution (PUD) and determine its exposure to wind farm impacts. To complement our results, we model the probability of a vulture flying within the rotor sweep area of a wind turbine throughout the species range and use this to identify areas that are particularly prone to collisions. Overall, our estimated PUD correlates well with reporting rates of the species from the Southern African Bird Atlas Project, currently used to assess potential overlap between Cape Vultures and wind energy developments, but it adds important benefits, such as providing a spatial gradient of activity estimates over the entire species range. We illustrate the application of our maps by analyzing the exposure of Cape Vultures in the Renewable Energy Development Zones (REDZs) in South Africa. This application is a scalable procedure that can be applied at different planning phases, from strategic, nationwide planning to project-level assessments.

Crossing the chasm: strategies for digital transformation in clinical laboratories

Total testing process in a clinical laboratory is designed to produce useful information for patients and clinicians. The changing landscape of healthcare industry forces clinical laboratory leaders to meet the needs of their stakeholders, maximize operational efficiency and improve overall quality of patient care at the same time. The increasing number of data produced force healthcare services industry to digital transformation. Digital transformation is a process of change which includes finding solutions to novel and unmet requirements of an industry by integrating information, computing, communication and connectivity technologies to minimize the number of low-value tasks and focus on high-value tasks. As the process of digital transformation includes not only the modernization of IT infrastructure but also a paradigm shift in perception of value creation and delivery to improve the quality and cost-effectiveness of laboratory operations in the long run, financial, managerial, and educational issues have been blocking the widespread implementation. Clinical laboratories are at the crossroads on the road to the future. Laboratories that fail to align themselves with data-driven practices will risk losing a competitive advantage. In this review, strategies for a successful digital transformation will be overviewed in the context of clinical laboratory settings.

Using Collective Impact to Develop a Community-Led Initiative for Improving Black Infant Mortality

The United States has one of the highest infant mortality rates among developed countries. When stratified by race, disparities are more evident: Black infant mortality rates are 2.5 times higher than non-Hispanic white infants. Structural, systemic racism is a contributing cause for these racial disparities. Multisector collaborations focused on a common agenda, often referred to as collective impact, have been used for infant mortality reduction interventions. In addition, community-based participatory approaches have been applied to incorporate those with lived experience related to adverse pregnancy outcomes. This article critically describes the transition of an infant mortality collective impact initiative from being led by a multisector organizational group to being community led over a 5-year period, 2015-2020. A 34-member community leaders group was developed and determined four priorities and corresponding strategies for the initiative. Findings show that community participatory approaches are a way to address racial equity for public health initiatives.

COVID-19 Scientific Publications From the Centers for Disease Control and Prevention, January 2020-January 2022

OBJECTIVE

High-quality scientific evidence underpins public health decision making. The Centers for Disease Control and Prevention (CDC) agency provides scientific data, including during public health emergencies. To understand CDC's contributions to COVID-19 science, we conducted a bibliometric evaluation of publications authored by CDC scientists from January 20, 2020, through January 20, 2022, by using a quality improvement approach (SQUIRE 2.0).

METHODS

We catalogued COVID-19 articles with ≥1 CDC-affiliated author published in a scientific journal and indexed in the World Health Organization's COVID-19 database. We identified priority topic areas from the agency's COVID-19 Public Health Science Agenda by using keyword scripts in EndNote and then assessed the impact of the published articles by using Scopus and Altmetric.

RESULTS

During the first 2 years of the agency's pandemic response, CDC authors contributed to 1044 unique COVID-19 scientific publications in 208 journals. Publication topics included testing (n = 853, 82%); prevention strategies (n = 658, 63%); natural history, transmission, breakthrough infections, and reinfections (n = 587, 56%); vaccines (n = 567, 54%); health equity (n = 308, 30%); variants (n = 232, 22%); and post-COVID-19 conditions (n = 44, 4%). Publications were cited 40 427 times and received 81 921 news reports and 1 058 893 social media impressions. As the pandemic evolved, CDC adapted to address new scientific questions, including vaccine effectiveness, safety, and access; viral variants, including Delta and Omicron; and health equity.

CONCLUSION

The agency's COVID-19 Public Health Science Agenda helped guide impactful scientific activities. CDC continues to evaluate COVID-19 priority topic areas and contribute to development of new scientific work. CDC is committed to monitoring emerging issues and addressing gaps in evidence needed to improve health.

Using a Community-Informed Translational Model to Prioritize Translational Benefits in Youth Concussion Return-to-Learn Programs

BACKGROUND

The Translational Science Benefit Model (TSBM) was developed to broadly capture systematic measures of health and societal benefits from scientific research, beyond traditional outcome measures. We aimed to develop a systematic process for the application of the TSBM and to then provide an example of a novel application of the TSBM to an ongoing Return-to-Learn (RTL) after youth concussion project involving partnerships with community stakeholders.

METHODS

We invited investigators, project advisory board, and participants of the RTL project to participate in a modified Delphi process. We first generated a list of potential translational benefits using the indicators of the TSBM as guideposts. We then prioritized the benefits on an adapted Eisenhower matrix.

RESULTS

We invited 35 concussion care or research experts to participate, yielding 20 ranked translational benefits. Six of these recommendations were ranked high priority, six were regarded as investments, and eight were ranked as either low yield or low priority.

DISCUSSION

This study found that activities such as education and training of stakeholders, development of policy and consensus statements, and innovation in dissemination, were perceived as higher priority than other activities. Our approach using a modified Delphi process and incorporating the TSBM can be replicated to generate and prioritize potential benefits to society from research studies.

Fifteen essential science advances needed for effective restoration of the world's forest landscapes

There has never been a more pressing and opportune time for science and practice to collaborate towards restoration of the world's forests. Multiple uncertainties remain for achieving successful, long-term forest landscape restoration (FLR). In this article, we use expert knowledge and literature review to identify knowledge gaps that need closing to advance restoration practice, as an introduction to a landmark theme issue on FLR and the UN Decade on Ecosystem Restoration. Aligned with an Adaptive Management Cycle for FLR, we identify 15 essential science advances required to facilitate FLR success for nature and people. They highlight that the greatest science challenges lie in the conceptualization, planning and assessment stages of restoration, which require an evidence base for why, where and how to restore, at realistic scales. FLR and underlying sciences are complex, requiring spatially explicit approaches across disciplines and sectors, considering multiple objectives, drivers and trade-offs critical for decision-making and financing. The developing tropics are a priority region, where scientists must work with stakeholders across the Adaptive Management Cycle. Clearly communicated scientific evidence for action at the outset of restoration planning will enable donors, decision makers and implementers to develop informed objectives, realistic targets and processes for accountability. This article paves the way for 19 further articles in this theme issue, with author contributions from across the world. This article is part of the theme issue 'Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration'.

Evolution of health sector strategic planning in Tanzania: What have we learnt and how can we improve?

Progressive realization of Universal Health Coverage is inevitable given resource constraints. The incremental approach must be reflected in health sector strategic plans which serve as roadmaps. Using a matrix based on the health systems building blocks to extract data, we reviewed three successive sector strategies to assess priority issues addressed. We undertook a thematic synthesis to draw lessons and conclusion reported in this paper. Our review shows good practice as well as areas desiring attention if health sector strategic plans are to serve the intended purpose. Although all strategies were aligned to global and national development aspirations, were developed in a participatory manner they did not reflect the required incremental approach. The challenges to be addressed and the priorities remained largely the same over a 15-year period. The strategies and key results areas to be implemented in the different strategies were numerous with funding gaps. Improving the utility of strategic plans requires improving both the process and content. Implied in this approach is the need for prioritised and affordable strategic plans that reflect incremental efforts to attaining long term targets coupled with strong trend analysis and monitoring. Additionally, we advocate for strategic plan with a longer timeframe perhaps 10 years with adjustments at regular intervals.

Hospital managers' participation in operational planning: insights from a recent study in the Greek National Health System

BACKGROUND

The performance of the public hospitals of the National Health System (NHS) of Greece, as reflected in their financial and operational results, is related to their strategic planning and the factors that influence the accomplishment of their objectives.

METHOD

The organizational performance of NHS hospitals was assessed by analyzing their operational and financial data for the period 2010-2020 (recorded by the "BI-Health" system of the Ministry of Health). Based on internationally accepted factors that influence the successful implementation of strategic planning and the achievement of its objectives, a structured questionnaire consisting of 11 demographic and 93 (on a scale of 1 to 7) factor-related questions was developed and addressed to 56 managers and senior executives. Their response was analyzed using descriptive statistical methods and inference, and "significant" factors were extracted using Principal Components Analysis.

RESULTS

Hospitals reduced their expenditure from 2010 to 2015 by 34.6 %, while the number of inpatients increased by 5.9 %. However, expenditure increased by 41.2 % in the period 2016-2020, while concurrently, inpatients rose by 14.7 %. Outpatient and emergency department visits remained almost stable (6.5 and 4.8 million/year, respectively), during 2010-2015, while increased by 14.5 % till 2020. The average length of stay decreased from 4.1 in 2010 to 3.8 in 2015 and 3.4 in 2020. The survey data showed that NHS hospitals' strategic plan is well "documented", but its "actual implementation" is moderate; The "achievement of the objectives" related to clinical work, quality improvement of services, human resources development, financial strategy, asset strategy, digital strategy, communication and engagement strategy, and research might be good; chief executive officers, nurses, laboratory physicians, and administrators receive a positive grade of participation while the Board of Directors, physicians, employee representatives and the School of Medicine/University receive a moderate grade. The factors: "elements of strategic planning" (33.6 %), "evaluation of services and staff" (20.5 %), "employees' commitment and involvement" (20.1 %), and "operational outcomes and performance" (8.9 %), as derived from the principal component analysis, had the highest impact on achieving their financial and operational objectives, as assessed by the views of the managers of the 35 NHS hospitals.

CONCLUSION

The NHS hospitals increased their efficiency from 2010 to 2020 but failed to maintain control over their expenditure. Through their clinical managers and other employees' representatives, chief executive officers and the Board of Directors need to improve planning formulation, staff involvement and utilization, financial performance, and outcomes as their primary commitment among health policy and management sectors in the Greek NHS. HIPPOKRATIA 2022, 26 (3):91-97.

Strategic planning for addiction programs within academic medical centers: Examples from the Yale Program in Addiction Medicine

Background Addiction programs at academic medical centers must navigate complex, multidisciplinary environments as they work to advance the field and improve substance use treatment access and outcomes. Programs can employ strategic planning processes to identify goals and strategies for success. Methods: The Yale Program in Addiction Medicine began a series of strategic planning activities in February 2020 with the primary aims of (1) conducting a point-in-time needs assessment for the Program and (2) identifying goals for Program improvement and expansion. Drawing upon a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis framework and the Delphi method for group decision-making, these strategic planning activities were implemented in four steps involving multimodal engagement and iterative feedback amongst Program faculty and selected stakeholders. Results: Primary deliverables included four overarching programmatic goals, associated action items, strategies for success, a proposed implementation timeline, and a revised Mission, Vision, and Values statement for the Program. Conclusion: Methodologic considerations and environmental factors offer insight into the strengths, limitations, and adaptive potential of this approach as well as others described in the literature. Key outputs highlight the benefits and timeliness of strategic planning for addiction programs, as heightened interest and investment in substance use treatment, prevention, and harm reduction paves the way for opportunity and innovation.

Successful implementation of a pediatric pharmacy team-level strategic plan during the COVID-19 pandemic

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Modeling COVID-19 Impacts and Response Strategies in the Construction Industry: PLS-SEM Approach

Policymakers are developing response strategies to reduce the impacts of COVID-19. However, developing response strategies without considering their relationships with the impacts of COVID-19 is ineffective. This study aims to model the causal relationships between COVID-19 impacts and response strategies in the construction industry, using Malaysia as a case study. To achieve this, a systematic literature review and semi-structured interviews with forty industry professionals were conducted, yielding 12 impacts and 22 response strategies. The impacts and strategies were inserted into a survey, and 107 valid responses were received. Exploratory factor analysis (EFA) was conducted to group the impacts and strategies. Then, partial least-squares structural equation modeling (PLS-SEM) was employed to identify the causal relationship between the impacts and strategies. The EFA results indicate that the underlying impacts are project- or material-related, and the underlying strategies are market stability and financial aid, supply chain and project support, and information and legislation. The PLS-SEM results indicate that supply chain and project support are required to address material-related impacts, and market stability and financial aid are required to address project-related impacts. This is the first paper that models the relationships between COVID-19 impacts and response strategies in the construction industry.

Action Beyond Exhibition: Amplifying Photovoice Through Social Action After a Community Health Needs Assessment in Philadelphia

Photovoice is a participatory action research method that was founded on mobilizing communities toward action. However, there is limited research detailing the action stages of photovoice that are meant to follow the initial research. In this article, we describe the action stage of a youth photovoice project conducted at the planning phase of a Community Health Needs Assessment of the Latino community in North Philadelphia. In collaboration with local leaders, we utilized photovoice to prioritize the health needs identified in the assessment. We announced a request for proposals and launched twelve, 1-year, community catalyst grants in the amount of US$50,000 each. While grants were funded and implemented, the participants continued to exhibit their findings in Philadelphia City Hall and engage with city policymakers. We developed a health policy workshop where Philadelphia youth beyond the original photovoice participants could learn advocacy skills and policy research to develop a proposal addressing a priority health need identified through photovoice. This workshop was expanded into a year-round program where participants can be matched with a career mentor, engage in professional development sessions, and continue to refine and advocate for their policy proposal. We found that successful action planning stemmed from setting goals several steps ahead of the current stage of action while enhancing the ability to center community voice in guiding action forward. Photovoice influenced decision-making throughout each of the steps taken toward action. Future research should recognize and describe action planning as a central tenet of photovoice methodologies.

Sound Decision Making in Uncertain Times: Can Systems Modelling Be Useful for Informing Policy and Planning for Suicide Prevention?

The COVID-19 pandemic demonstrated the significant value of systems modelling in supporting proactive and effective public health decision making despite the complexities and uncertainties that characterise an evolving crisis. The same approach is possible in the field of mental health. However, a commonly levelled (but misguided) criticism prevents systems modelling from being more routinely adopted, namely, that the presence of uncertainty around key model input parameters renders a model useless. This study explored whether radically different simulated trajectories of suicide would result in different advice to decision makers regarding the optimal strategy to mitigate the impacts of the pandemic on mental health. Using an existing system dynamics model developed in August 2020 for a regional catchment of Western Australia, four scenarios were simulated to model the possible effect of the COVID-19 pandemic on levels of psychological distress. The scenarios produced a range of projected impacts on suicide deaths, ranging from a relatively small to a dramatic increase. Discordance in the sets of best-performing intervention scenarios across the divergent COVID-mental health trajectories was assessed by comparing differences in projected numbers of suicides between the baseline scenario and each of 286 possible intervention scenarios calculated for two time horizons; 2026 and 2041. The best performing intervention combinations over the period 2021–2041 (i.e., post-suicide attempt assertive aftercare, community support programs to increase community connectedness, and technology enabled care coordination) were highly consistent across all four COVID-19 mental health trajectories, reducing suicide deaths by between 23.9–24.6% against the baseline. However, the ranking of best performing intervention combinations does alter depending on the time horizon under consideration due to non-linear intervention impacts. These findings suggest that systems models can retain value in informing robust decision making despite uncertainty in the trajectories of population mental health outcomes. It is recommended that the time horizon under consideration be sufficiently long to capture the full effects of interventions, and efforts should be made to achieve more timely tracking and access to key population mental health indicators to inform model refinements over time and reduce uncertainty in mental health policy and planning decisions.

An assessment of the Libyan baccalaureate nursing education during political turmoil

Since the Libyan Revolution in 2011, the country's nursing workforce has been struggling. Libyan nursing schools have focused on rebuilding the country's supply of nurses after many emigrated. Wanting to infuse the workforce with more baccalaureate-prepared nurses, Libyan nursing faculty invited nursing and public health representatives from a US-based academic medical institution and a non-governmental medical organization to collaborate with local stakeholders in a country-wide assessment. The purpose of this article is to outline the national programs' strengths and weaknesses and make recommendations for developing a strategy to elevate nursing education to meet international standards. This can serve as a launching point to strengthen Libya's health services provision capacity, particularly during this time of transition when opportunities may become available to move in new directions. The approach and findings may have wider application to other countries who are similarly experiencing civil and political turmoil.

Assessing inclusion of trans people in HIV national strategic plans: a review of 60 high HIV prevalence countries

INTRODUCTION

Trans people are disproportionately impacted by HIV yet have not been adequately prioritized in national HIV responses or policy documents. This review aims to understand the extent of meaningful inclusion of trans people in national strategic plans (NSPs) for HIV/AIDS as an essential step in ensuring that HIV policy aligns with epidemiologic data, and trans-specific programming is funded, implemented and sustained.

METHODS

HIV NSPs from 60 countries, across five global regions, were assessed for the level of inclusion of trans populations between January and March 2021. The most recently available NSP for each country, published after 2011, was obtained through publicly accessible online sources or through researcher networks. Data were manually extracted from NSPs using a framework of indicators focusing on trans inclusion in these five major sections of NSPs: (1) narratives; (2) epidemiological data; (3) monitoring and evaluation (M&E) indicators and targets; (4) activities; and (5) budgets.

RESULTS AND DISCUSSION

Within all reviewed NSPs, 65.0% (39/60) mentioned trans people in at least one of the five key sections but only 8.3% (5/60) included trans people in all five key sections. Trans people were more commonly mentioned in the background/narratives of NSPs (61.7%, 37/60) but less commonly included NSP activities (38.3%, 23/60), in M&E indicators and targets (23.7%, 14/60), in epidemiological data (20.0% 12/60), and in NSP budgets (13.3%, 8/60). Countries in the Asia and Pacific region most frequently included trans people in all five key sections (38%, 5/13), while no countries in Eastern and Southern Africa included trans people in all NSP sections.

CONCLUSIONS

This analysis finds substantial gaps in the inclusion of trans populations in NSPs globally. Results highlight the pressing need for states, technical partners, and international funders to engage with trans communities to improve trans-inclusion in all key sections of NSPs. Trans inclusion in NSPs is an essential step towards reaching the populations most at risk of HIV and ultimately achieving country-level epidemic control.

Impending disaster: rise of the epsilon variant in Pakistan and the way forward

The constantly mutating severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) does not appear to be slowing down any time soon. All countries, particularly developing countries, must adapt and strategically plan their way of life around the pandemic, while doing everything possible to keep the mortality rate and spread of the newly emerging variants as low as possible, in order to avoid a further blow to the economy and way of life. Pakistan is one such developing country that is currently battling the dangerous delta strain of SARS-COV-2 with limited resources and has recently seen the emergence of an equally transmissible and highly infectious epsilon strain. This is a concerning situation considering that Pakistan's already overburdened health system and faltering economy cannot withstand another dangerous SARS-COV-2 variant attack. This article highlights some strategies for the country to fortify its defences to prevent the epsilon variant from spreading before it is too late, and emphasises that while identifying potential immune evasion mechanisms in SARS-COV-2 variants is critical in the fight against COVID-19, it is also critical to develop methods of efficient and cost-effective detection to identify an early outbreak and then vigilantly and systematically plan area lockdowns before any hope of conquering this pandemic is lost.

Topical Issues of Strategic Planning and Audit in Modern Russia

The article analyzes the state of strategic planning and audit in the Russian Federation. There is a low level of implementation of the country's main strategic documents, which is due to the insufficient realism of their goals. In turn, the shortcomings of strategic documents are largely a consequence of the lack of regulatory rulemaking and the closed nature of the procedure for their development. Strategic audit in Russia is still not effective enough, since the practical significance of the recommendations of the Accounts Chamber is not great-the problems it reveals cannot be eliminated at the stage of implementation of strategic documents, and it is actually excluded from participation in their development. Based on the results of the analysis, the authors formulate proposals on the areas of improving the procedures for strategic planning and audit.

A Logic Model Framework for Planning an International Refugee Health Research, Evaluation, and Ethics Committee

Collaborative approaches to supporting the health of refugees and other newcomer populations in their resettlement country are needed to address the complex medical and social challenges they may experience after arrival. Refugee health professionals within the Society of Refugee Healthcare Providers (SRHP)-the largest medical society dedicated to refugee health in North America-have expressed interest in greater research collaborations across SRHP membership and a need for guidance in conducting ethical research on refugee health. This article describes a logic model framework for planning the SRHP Research, Evaluation, and Ethics Committee. A logic model was developed to outline the priorities, inputs, outputs, outcomes, assumptions, external factors, and evaluation plan for the committee. The short-term outcomes include (1) establish professional standards in refugee health research, (2) support evaluation of existing refugee health structures and programs, and (3) establish and disseminate an ethical framework for refugee health research. The SRHP Research, Evaluation, and Ethics Committee found the logic model to be an effective planning tool. The model presented here could support the planning of other research committees aimed at helping to achieve health equity for resettled refugee populations.

Effecting change in academic dentistry through small groups

PURPOSE/OBJECTIVE

The work of faculty, staff, and students is driven by their alignment with an institution's vision and purpose, as set forth in its strategic plan. Any plan that calls for innovative growth must address certain aspects of organizational culture as roadblocks to success and should foster relationship building to achieve long-standing progress. This demonstration project investigates a method for effecting change through a Small Group Initiative (SGI).

METHODS

Representatives from faculty and staff were selected by purposive sampling, placed into eight groups of six, and one member of each group was made a facilitator to participate in or facilitate monthly structured discussion-based meetings for a 1-year time period. Participants read one chapter a month of 12: The Elements of Great Managing, which corresponds to the Gallup Q12 Employee Engagement survey that each participant completed at the beginning and end of the program.

RESULTS

Findings indicate an overall increase in participant levels of employee engagement and increased levels of personal ownership in regard to the strategic plan after participating in the SGI.

CONCLUSIONS

Many other institutional efforts aimed at the advancement of school-wide vision and employee engagement can be cumbersome to implement and require a substantial allocation of resources. The SGI, however, requires minimal resources, limited infringement on regular activity, and minimal direct cost to implement. These factors suggest that the SGI could be tailored to meet specific needs of leadership and may have broad-based applicability across various academic settings.

An approach for improving the quality of country-level TB modelling

Mathematical modelling is increasingly used to inform budgeting and strategic decision-making by national TB programmes. Despite the importance of these decisions, there is currently no mechanism to review and confirm the appropriateness of modelling analyses. We have developed a benchmarking, reporting, and review (BRR) approach and accompanying tools to allow constructive review of country-level TB modelling applications. This approach has been piloted in five modelling applications and the results of this study have been used to revise and finalise the approach. The BRR approach consists of 1) quantitative benchmarks against which model assumptions and results can be compared, 2) standardised reporting templates and review criteria, and 3) a multi-stage review process providing feedback to modellers during the application, as well as a summary evaluation after completion. During the pilot, use of the tools prompted important changes in the approaches taken to modelling. The pilot also identified issues beyond the scope of a review mechanism, such as a lack of empirical evidence and capacity constraints. This approach provides independent evaluation of the appropriateness of modelling decisions during the course of an application, allowing meaningful changes to be made before results are used to inform decision-making. The use of these tools can improve the quality and transparency of country-level TB modelling applications.

Supporting government policies to embed and expand rehabilitation in health systems in Europe: A framework for action

Investment in action is vital to confront the challenges associated with chronic diseases and disability facing European health systems. Although relevant policy responses are being increasingly developed, most of them fail to recognize the role of rehabilitation services in achieving public health and social goals. Comprehensive guidance is thus urgently needed to support rehabilitation policy development and expand access to rehabilitation care to meet population needs effectively. This paper describes a framework to guide policy action for rehabilitation in Europe. The framework was developed in collaboration with the European Academy of Rehabilitation Medicine based on a focused literature review and expert consultations. A review in PubMed and grey literature sources identified 458 references and resulted in 135 relevant documents published between 2006 and 2019. Thematic analysis of extracted information helped summarize the findings and develop the draft policy action framework. This was circulated to a wider group of experts and discussed in three workshops in 2018-2019. The framework was revised according to their feedback. The proposed framework contains 48 options for policy action organized in six domains and twelve subdomains that address several areas of health programming. The proposed framework provides a structure to understand the policy terrain related to rehabilitation in Europe and the measures required for translating aspirational political pronouncements into targeted programmatic action and tangible health and social outcomes.

Emergency preparation and mitigation for COVID-19 response in an integrated pharmacy practice model

Purpose

The purpose of this descriptive report is to share experiences in crisis response planning and risk mitigation at a university health system department of pharmacy with an integrated clinical practice model in the early months of the coronarvirus disease 2019 (COVID-19) pandemic.

Summary

The department of pharmacy’s COVID-19 pandemic response included successful planning and implementation of measures to maintain pharmacy operations and minimize COVID-19 exposure of patients and staff. These measures included ensuring adequate personnel staffing using flexible staffing solutions, ongoing assessment of supply chain integrity, and continuation of integrated clinical pharmacy services 24/7 throughout the initial phase of the COVID-19 pandemic. Information technology (IT) and educational program modifications are also discussed.

Conclusion

This report describes successful crisis planning and risk mitigation in the setting of COVID-19, which was facilitated by the department of pharmacy’s integrated clinical practice model. This model enabled uninterrupted personnel scheduling, supply chain integrity, continued provision of 24/7 integrated clinical services, adaptive use of IT tools, and continuation of educational programs. The experiences described may be instructive to other pharmacy departments in evaluating their response to the COVID-19 pandemic and in planning for similar pandemic or other emergency scenarios.

Kidney transplantation in the time of COVID-19: Dilemmas, experiences, and perspectives

Introduction

Hospital do Rim is a high‐volume kidney transplant (KT) center located in São Paulo, a city with 12.2 million inhabitants. Over the last 18 years, we performed 11 436 KT, 70% of which from deceased donors. To mitigate the effects of reduction in the number of transplants on the waiting list, sequential measures were implemented when COVID‐19 was declared pandemic.

Methods

The first step was to provide SARS‐COV‐2 RT‐PCR testing for all symptomatic employees and patients and the compulsory use of personal protective equipment in the hospital facilities. Living donor KT were postponed, and all deceased donors and recipients were tested before the transplantation. The immunosuppressive protocols were maintained, and telehealth strategies were developed.

Results

Among the 1013 employees, there were 214 cases of COVID‐19, nine required ward hospitalization, and no deaths occurred. In 26%, the probable source of contamination was occupational. From the first patient diagnosed with COVID‐19 in 03/20/2020 till 10/21/2020, 523 deceased KT were performed, a 21% increase compared with 2019, with no confirmed donor‐derived SARS‐CoV‐2 infection. Four patients were transplanted with a positive pretransplant SARS‐CoV‐2 test, but none of them developed the disease. Overall, of 11 875 KT followed in our center, 674 developed COVID‐19. Among the hospitalized, 53% required mechanical ventilation, and 45% required hemodialysis. Their overall mortality rate was 27.5%.

Conclusion

This experience shows the challenges that transplant centers faced as the pandemic unfolded and illustrates the effectiveness of the sequential measures implemented to provide a safe environment for transplantation.

Healthy Eating Policy Strategies in Community Health Improvement Plans: A Cross-Sectional Survey of US Local Health Departments

CONTEXT

Policies (eg, regulations, taxes, and zoning ordinances) can increase opportunities for healthy eating. Community Health Improvement Plans (CHIP) may foster collaboration and local health department (LHD) engagement in policy decision making to improve local food environments. Limited research describes what policies supportive of healthy food environments are included in CHIPs nationally and relationships between LHD characteristics and participation in plans including such policies.

OBJECTIVES

To determine the proportion of US LHDs who participated in development of a CHIP containing healthy eating policy strategies and assess the association between LHD characteristics and inclusion of any healthy eating policy strategy in a CHIP.

DESIGN

A cross-sectional national probability survey.

PARTICIPANTS

Of the 209 US LHDs (serving populations <500 000) (response rate: 30.2%), 176 LHDs with complete data on CHIP status, outcomes, and covariates were eligible for analysis.

MAIN OUTCOME MEASURES

Thirteen healthy eating policy strategies were organized into 3 categories: increasing availability/identification of healthy foods, reducing access to unhealthy foods, and improving school food environments. Strategies and categories were identified from literature and public health recommendations.

RESULTS

In total, 32.2% of LHDs reported inclusion of 1 or more healthy eating policy strategies in a CHIP. The proportion of departments reporting specific strategies ranged from 20.8% for school district policies to 1.1% for sugar-sweetened beverage taxes. Local health departments serving 25 000 to 49 999 residents (odds ratio [OR]: 5.00; 95% confidence interval [CI]: 1.71-14.63), 100 000 to 499 999 residents (OR: 3.66; 95% CI: 1.12-11.95), pursuing national accreditation (OR: 4.46; 95% CI: 1.83-10.83), or accredited (OR: 3.22; 95% CI: 1.08-9.63) were more likely to include 1 or more healthy eating policy strategies in a CHIP than smaller LHDs (<25 000) and LHDs not seeking accreditation, respectively, after adjusting for covariates.

CONCLUSIONS

Few LHDs serving less than 500 000 residents reported CHIPs that included a policy-based approach to improve food environments, indicating room for improvement. Population size served and accreditation may affect LHD policy engagement to enhance local food environments.

Which Social, Economic, and Health Sector Strategies Will Deliver the Greatest Impacts for Youth Mental Health and Suicide Prevention? Protocol for an Advanced, Systems Modelling Approach

Background: Current global challenges are generating extensive social disruption and uncertainty that have the potential to undermine the mental health, wellbeing, and futures of young people. The scale and complexity of challenges call for engagement with systems science-based decision analytic tools that can capture the dynamics and interrelationships between physical, social, economic, and health systems, and support effective national and regional responses. At the outset of the pandemic mental health-related systems models were developed for the Australian context, however, the extent to which findings are generalisable across diverse regions remains unknown. This study aims to explore the context dependency of systems modelling insights. Methods: This study will employ a comparative case study design, applying participatory system dynamics modelling across eight diverse regions of Australia to answer three primary research questions: (i) Will current regional differences in key youth mental health outcomes be exacerbated in forward projections due to the social and economic impacts of COVID-19?; (ii) What combination of social policies and health system strengthening initiatives will deliver the greatest impacts within each region?; (iii) To what extent are optimal strategic responses consistent across the diverse regions? We provide a detailed technical blueprint as a potential springboard for more timely construction and deployment of systems models in international contexts to facilitate a broader examination of the question of generalisability and inform investments in the mental health and wellbeing of young people in the post COVID-19 recovery. Discussion: Computer simulation is known as the third pillar of science (after theory and experiment). Simulation allows researchers and decision makers to move beyond what can be manipulated within the scale, time, and ethical limits of the experimental approach. Such learning when achieved collectively, has the potential to enhance regional self-determination, help move beyond incremental adjustments to the status quo, and catalyze transformational change. This research seeks to advance efforts to establish regional decision support infrastructure and empower communities to effectively respond. In addition, this research seeks to move towards an understanding of the extent to which systems modelling insights may be relevant to the global mental health response by encouraging researchers to use, challenge, and advance the existing work for scientific and societal progress.

Health information technology foresight for Iran: A Delphi study of experts' views to inform future policymaking

BACKGROUND

Policymakers require a systematic approach when planning for information technology needs in healthcare.

OBJECTIVE

The aim of this study was to obtain experts' predictions of future health information technology (HIT) needs until 2025 for Iran in relation to the relative importance of key technologies, expected timeframe of realisation, areas that may be impacted upon and obstacles to achieving these goals.

METHOD

This article presents results from the third phase (a Delphi study) of a larger mixed-method study. Policymakers from the Iranian Ministry of Health and faculty members from different medical universities across the country who were expert in the field of HIT were invited to participate (n = 61).

RESULTS

Participants (39) completed the first-round questionnaire and 24 completed the second. The development of personal health records (n = 32, 82.0%), the development of clinical decision-making systems (n = 30, 76.9%) and the use of business intelligence for collecting and analysing clinical and financial data (n = 32, 82.0%) were predicted to occur after 2025. The healthcare areas predicted to experience the greatest impact from most HITs were facilitating patient-provider communication and improving healthcare quality. Key barriers to achieving HITs were related to weaknesses in planning and limited financial resources for most technologies.

CONCLUSION

By identifying the areas of impact and the barriers to achieving the HIT goals, more accurate planning is possible and resources can be allocated according to priorities.

Impact of trimethylaminuria on daily psychosocial functioning

BACKGROUND

Trimethylaminuria (TMAU) (OMIM #602079) is a rare inherited metabolic condition. TMAU is associated with decreased hepatic trimethylamine N-oxidation, which leads to an excess of the volatile trimethylamine (TMA) instead of substrate conversion to trimethylamine N-oxide (TMAO). TMA is a tertiary amine derived from the enterobacterial metabolism of precursors such as choline and phosphatidylcholine present in the diet, and is also a bacterial metabolite of TMAO, a normal constituent of saltwater fish. When the involved enzyme flavin mono-oxygenase 3 is deficient, TMA builds up and is released in the person's sweat, urine, and breath, giving off a strong body odor. We have recently reported the biochemical and genetic characteristics of 13 Irish adult patients with TMAU attending the main Irish Reference Center. Research on the behavioral and psychosocial aspects of this condition is limited. This study explores the patients' perspectives of living with TMAU in Ireland.

METHODS

A qualitative descriptive phenomenological approach was used. Six adults participated in this study. Data were gathered through semi-structured interviews, which were transcribed and analyzed.

RESULTS

The results suggest that the participants experienced a negative journey to diagnosis. Fear, anxiety, paranoia, and dysfunctional thinking are a constant struggle. Participants reported using avoidant coping mechanisms and strategic planning to navigate daily life.

CONCLUSION

It is considered that the results from this study will inform future interventions with this unique patient cohort.

Patterns of Cross-Sector Collaboration in Local Health Departments: A Cluster Analysis

Local health departments (LHDs) are positioned to act as the community health strategist for their catchment area, which requires cross-sector collaboration. However, little research exists to understand how much and what types of cross-sector collaboration occur and its impact on LHD practice. Data from 490 LHDs who participated in the 2016 National Profile of Local Health Departments survey were analyzed to identify patterns of cross-sector collaboration among LHDs. In the survey, LHDs reported the presence of collaborative activities for each of 22 categories of organizations. Factor analysis was used to identify patterns in the types of organizations with which LHDs collaborate. Then, cluster analysis was conducted to identify patterns in the types of cross-sector collaboration, and cross-sectional analyses examined which LHD characteristics were associated with cluster assignment. LHDs collaborated most with traditional health care-oriented organizations, but less often with organizations focused on upstream determinants of health such as housing. Three distinct clusters represented collaboration patterns in LHDs: coordinators, networkers, and low-collaborators. LHDs who were low-collaborators were more likely to serve smaller populations, be unaccredited, have a smaller workforce, have a White top executive, and have a top executive without a graduate degree. These findings imply that public health practitioners should prioritize building bridges to a variety of organizations and engage in collaboration beyond information sharing. Furthermore, LHDs should prioritize accreditation and workforce development activities for supporting cross-sector collaboration. With these investments, the public health system can better address the social and structural determinants of health and promote health equity.

Water Researchers Do Not Have a Strategic Plan for Gathering Evidence to Inform Water Intake Recommendations to Prevent Chronic Disease

Confusion has persisted for decades in the United States (U.S.) over how much plain water to drink, despite national water intake recommendations which are based on high quality scientific evidence. This editorial summarizes the definition, alignment and coordination of evidence that informs the current U.S. adequate intake (AI) recommendations for water. It highlights gaps in the evidence that perpetuate confusion and opportunity to address the gaps through strategic planning.

Virginia Health Catalyst: A public health perspective frames strategies to ensure oral health is health

The Virginia Oral Health Coalition was created to increase the number of Virginians who access dental services. The organization celebrates its tenth birthday with the expanded focus of ensuring everyone in the state has equitable access to comprehensive health care that includes oral health. It also has a new name - Virginia Health Catalyst. Why does removing 'oral health' from its' name honor dental care more than keeping it?

[The demand for medical technologies during provision of stomatological care to adult population in polyclinic]

The high prevalence of dental diseases, increase of population exactingness to availability and quality of dental medical care predetermine the development of relevant management decisions. The purpose of study was to define the priorities of demand of medical technologies in dental polyclinic. The evaluation of importance of the technologies implemented in case of particular dental diseases was given based on analysis of 37.3 thousand visits of adult population to dental polyclinic and implementation of more than 200 thousand dental manipulations. The 13 groups of technologies applied were established. The calculation of the coefficient of relative importance and its integrated evaluation was carried out. It is established that most of implemented technologies in dental polyclinic were targeted to treatment of caries of teeth and other defects of tissues of tooth that made 37.4% of all dental medical care provided and also pulpitis (20.9%), periodontitis and periapiсal pathology (25.1%). The most demanded technologies are treatment of caries, restoration of crown of tooth, all-diagnostic procedures, anesthesia, survey and consultation. The preventive manipulations consisted 69.2% of all important for patient technologies. The established quantitative importance of dental technologies defines perspective of their demand and main positions of dental polyclinic in development of corresponding strategy.

Systems modelling and simulation to inform strategic decision making for suicide prevention in rural New South Wales (Australia)

BACKGROUND

The need to understand and respond to the unique characteristics and drivers of suicidal behaviour in rural areas has been enabled through the Australian Government's 2015 mental health reforms facilitating a move to an evidence-based, regional approach to suicide prevention. However, a key challenge has been the complex decision-making environment and lack of appropriate tools to facilitate the use of evidence, data and expert knowledge in a way that can inform contextually appropriate strategies that will deliver the greatest impact. This paper reports the co-development of an advanced decision support tool that enables regional decision makers to explore the likely impacts of their decisions before implementing them in the real world.

METHODS

A system dynamics model for the rural and remote population catchment of Western New South Wales was developed. The model was based on defined pathways to mental health care and suicidal behaviour and reproduced historic trends in the incidence of attempted suicide (self-harm hospitalisations) and suicide deaths in the region. A series of intervention scenarios were investigated to forecast their impact on suicidal behaviour over a 10-year period.

RESULTS

Post-suicide attempt assertive aftercare was forecast to deliver the greatest impact, reducing the numbers of self-harm hospitalisations and suicide deaths by 5.65% (95% interval, 4.87-6.42%) and 5.45% (4.68-6.22%), respectively. Reductions were also projected for community support programs (self-harm hospitalisations: 2.83%, 95% interval 2.23-3.46%; suicide deaths: 4.38%, 95% interval 3.78-5.00%). Some scenarios produced unintuitive impacts or effect sizes that were significantly lower than what has been anticipated under the traditional evidence-based approach to suicide prevention and provide an opportunity for learning.

CONCLUSION

Systems modelling and simulation offers significant potential for regional decision makers to better understand and respond to the unique characteristics and drivers of suicidal behaviour in their catchments and more effectively allocate limited health resources.

Alternative strategies towards a sustainable municipal solid waste management system: A case study in Cairo

Major cities in transitional and developing countries are facing the ever-growing challenge of managing solid waste in a sustainable manner. While a variety of treatments exist for solid waste, cities are in need of a sustainable integrated municipal solid waste management (MSWM) system. Such a system is meant to assist them in selecting and investing in an appropriate combination of treatments for the waste they generate, depending on the composition and quantity of this waste. This study presents a systems analysis of the MSWM in Cairo. A constrained non-linear mathematical model is developed to represent an underlying model of a MSWM system, with six waste material flows (cardboard and paper, plastics, metals, glass, organic material, and others). The developed model depicts combinations of five treatment alternatives (composting, anaerobic digestion, mechanical biological treatment, incineration, and landfilling). The treatment methods and their capacity are determined by the model, indicating possible optimal design solutions and recommendations. Starting with an evaluation of the status quo of the MSWM system in Cairo, the paper proposes a staged strategy, involving investigating improvements to the current mixed-waste management system, then exploring the possibility of introducing at-source waste sorting. The environmental and economic implications of different scenarios are analyzed and compared. A material flow analysis, including input data uncertainties, is also conducted by applying substance flow analysis. This analysis shows the difference between the status quo and the proposed improved solutions for diverting waste from landfills and, thus, decreasing carbon dioxide emissions.

Health Literacy Initiatives and Lessons Learned within Public Health Agencies

Located in the northeastern part of the United States, New York State is extremely diverse - from the perspectives of culture, history, language, geography, economy, to name a few. Spreading across approximately 55,000 miles and taking into consideration the diversity of health needs across the state, the New York State Department of Health (NYS DOH) is dedicated to improving the health of all New Yorkers. This is evident in a Prevention Agenda which is New York State's health improvement plan, the blueprint for state and local actions to improve the health and well-being of all New Yorkers, and to promote health equity in all populations who experience disparities [1]. In addition, strategies for successful partnerships include long standing relationships with local health departments, community health centers, hospital systems, community-based organizations, individuals and groups who rely on the State Department of Health for quality services to achieve health equity and eliminate health disparities. This report provides an overview of previous, current, and forthcoming health literacy activities spearheaded by the New York State Department of Health Office of Minority Health and Health Disparities Prevention that support the importance of effective communication and health literacy across the Department.