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Shuftan N, Rajan D. Bottlenecks to child health service delivery – how can Health System Performance Assessment help? Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac129.332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Health System Performance Assessment (HSPA) is an established tool that can help identify issues with the way health systems work to achieve their intended goals, improve transparency and account-ability, and provide stimulus for reform. However, HSPA frameworks tend to be adult-centric and therefore not generally sensitive to child health challenges. Using a new HSPA framework for Universal Health Coverage, we show how child health tracer conditions can be used to pinpoint system under-performance and flag major bottlenecks impeding service delivery overall. Based on the HSPA framework, health system bottlenecks can be traced backwards to explore possible origins (areas to be targeted for improvement) or forwards to understand potential implications for the achievement of health system goals. The following qualitative and quantitative data are used to highlight major bottlenecks to child health service delivery: eight health system-focused child health assessments which show that one of the main bottlenecks is weak primary care coverage of sexual, reproductive, maternal, newborn, child, and adolescent health services, leading to parents bypassing PHC in favour of hospitals; results from WHO missions (e.g. in Romania and Tajikistan) showing that paediatric patients were often admitted to hospitals for treatment, even for conditions that could be safely managed in the outpatient setting; quantitative data on responsiveness, user experience, client satisfaction and people-centredness from publicly available datasets and national datasets obtained in collaboration with WHO Country Offices for national level data, to contextualize the aforementioned findings.
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Affiliation(s)
- N Shuftan
- Department of Healthcare Management, Technische Universitaet Berlin , Berlin, Germany
| | - D Rajan
- Brussels Hub, European Observatory on Health Systems and Policies , Brussels, Belgium
- WHO , Geneva, Switzerland
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Shuftan N. Understanding access to palliative care for cancer patients in Europe: a vignette approach. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Palliative care encompasses all treatment and care options available for people with serious illness, such as incurable, life-threatening cancer. The goal of palliative care is to improve and maintain quality of life for both patients and their families. It focuses on the assessment and management of pain and other symptoms, addressing caregiver needs, and coordination of care. It requires early identification and coordinated treatment of problems in the physical, functional psychological, social or spiritual dimension.
Methods
A palliative care vignette was developed reflecting typical patient characteristics and a recommended patient pathway for advanced lung cancer: chemotherapy to shrink tumors and alleviate symptoms, opioids for pain, benzodiazepines for breathlessness and anxiety, laxatives for constipation due to opioid use, psychosocial assessment followed by psychotherapy and/or antidepressants, and counselling for family carers. Experts in 12 countries were asked to complete a survey on service coverage, cost sharing, physical access (availability) and other barriers to access.
Results
The presentation will report on findings from a cross-country perspective for each of the categories mentioned above (work is currently ongoing). Individual country examples will be used to highlight outliers and draw policy lessons for the future.
Conclusions
Palliative care has received considerable socio-political support in recent years, due primarily to epidemiological developments. Depending on severity, life expectancy and the patients' personal circumstances, it can be delivered in a variety of settings, including private residences, assisted living facilities, acute and long-term care hospitals, hospice residences, correctional facilities, and homeless shelters. As a result, access barriers might be particularly complex to identify and overcome. Cross-country learning can be an important catalyst for future improvements.
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Affiliation(s)
- N Shuftan
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
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