2,688 research outputs found
Replication Data for: Gender-related self-reported mental health inequalities in primary care in England: Cross-sectional analysis using the GP Patient Survey
No full textThe Stata code replicates the results, figures, and tables of the paper titled "Gender-related self-reported mental health inequalities in primary care in England: Cross-sectional analysis using the GP Patient Survey". The data uses restricted-access data from the GP Patient Survey for England. Further information about the GPPS and dataset is available at https://gp-patient.co.uk or by contacting [email protected]. Information relating to the questionnaires is available at https://gp-patient.co.uk/downloads/2023/qandletter/GPPS_2023_Questionnaire_PUBLIC.pdf
Impact of social accountability monitoring on health facility performance: Evidence from Tanzania
Get PDFSocial accountability programs are increasingly used to improve the performance of public service providers in low‐income settings. Despite their growing popularity, evidence on the effectiveness of social accountability programs remains mixed. In this manuscript, we assess the impact of a social accountability intervention on health facility management exploring quasiexperimental variation in program exposure in Tanzania. We find that the social accountability intervention resulted in a 1.8 SD reduction in drug stockouts relative to the control group, but did not improve facility infrastructure maintenance. The results of this study suggest that social accountability programs may be effective in areas of health service provision that are responsive to changes in provider behavior but may not work in settings where improvements in outcomes are conditional on larger health systems features
A network analysis of patient referrals in two district health systems in Tanzania
Get PDFPatient referral systems are fragile and overlooked components of the health system in Tanzania. Our study aims at exploring patient referral networks in two rural districts in Tanzania, Kilolo and Msalala. Firstly, we ask whether secondary-level facilities act as gatekeepers, mediating referrals from primary- to tertiary-level facilities. Secondly, we explore the facility and network-level determinants of patient referrals focusing on treatment of childhood illnesses and non-communicable diseases. We use data collected across all public health facilities in the districts in 2018. To study gatekeeping, we employ descriptive network analysis tools. To explore the determinants of referrals, we use exponential random graph models. In Kilolo, we find a disproportionate share of patients referred directly to the largest hospital due to geographical proximity. In Msalala, small and specialized secondary-level facilities seem to attract more patients. Overall, the results call for policies to increase referrals to secondary facilities avoiding expensive referrals to hospitals, improving timeliness of care and reducing travel-related financial burden for households
Going operational with health systems governance: supervision and incentives to health workers for increased quality of care in Tanzania
No full textImproving the quality of care is increasingly recognized as a priority of health systems in low- and middle-income countries. Given the labour-intensive nature of healthcare interventions, quality of care largely depends upon the number, training and management of health workers involved in service delivery. Policies available to boost the performance of health workers-and thus the quality of healthcare-include regulation, incentives and supervision-all of which are typically included in quality improvement frameworks and policies. This was the case in Tanzania, where we assessed the role of selected quality improvement policies. To do so, we analysed data from a representative sample of Tanzanian government-managed health facilities, part of the 2014/15 Service Provision Assessment component of the Demographic and Health Survey. We constructed two healthcare quality indicators from data on patient visits: (1) compliance with Integrated Management of Childhood Illness (IMCI) guidelines and (2) patient satisfaction. Using multilevel ordered logistic regression models, we estimated the associations between the outcomes and selected indicators of incentives and supervisory activity at health worker and health facility level. We did not identify any association for the different indicators of top-down supervision at facility and individual level, neither with IMCI compliance nor with patients' satisfaction. Bottom-up supervision, defined as meetings between community and health facility staff, was significantly associated with higher patient satisfaction. Financial incentives in the form of salary top-ups were positively associated with both IMCI compliance and patient satisfaction. Both housing allowances and government-subsidized housing were positively associated with our proxies of quality of care. Good healthcare quality is crucial for promoting health in Tanzania not only through direct outcomes of the process of care but also through increased care-seeking behaviour in the communities. The results of this study highlight the role of community involvement, better salary conditions and housing arrangements for health workers
Data and platform co-ops in smart city citizenship: interview with Igor Calzada
Get PDFIgor Calzada is a senior researcher at universities like Oxford and Cardiff with a focus on urban, regional and technopolitical transformations, considering data issues and social innovation. In November 2020, he launched the book Smart City Citizenship, which proposes another framework at smart cities based on democratic governance and citizenship. Thus, he presents how it is possible to understand and intervene in technopolitical disputes involving algorithms, data, and artificial intelligence based on notions such as digital sovereignty. Among the possibilities, there is the creation of data and platform co-ops based on data and digital commons. For the author, data cooperatives are a subtype of platform cooperatives, in which they focus on business models, while data co-ops share and store data. The book analyzes, among other cases, the Barcelona ecosystem and proposes perspectives for public policies. Currently, Calzada is interested in exploring new models of data governance and artificial intelligence to propose alternative ways to data ecosystems in the European scenario. He defends experimental cities as a reaction to the mainstream idea of the city as a platform, as a reproduction of extractive and panoptic practices through hyperconnectivity. But it will be very difficult in a dangerous context. And he provokes: “how, in the current context, in which we are closed in our homes, can we propose cities with open systems? Other recommendations from the author are an article on platform and data co-ops published in Sustainability journal and a conversation in Spanish about social innovation in smart cities. Read the interview with Igor Calzada: https://digilabour.com.br/2021/01/06/data-and-platform-co-ops-in-smart-city-citizenship-interview-with-igor-calzada
Piano works by Igor Stravinsky
No full textIn my work I thought was right at first a brief outline development work of Igor Stravinsky. I also tried to "map out" the emergence of some major piano works by the author. finally, I added a few notes on the piano interpretive art of Igor Stravinsky
Introduzione a Igor Spanò (a cura di) Il Teatro e la festa. Il tempio, la piazza, la scena
No full textPer tre giorni gli studiosi che sono intervenuti al Convegno hanno riflettuto sul senso e sulle funzioni, sulle pratiche cultuali e rituali, sui luoghi che hanno definito nel corso del tempo i momenti della festa e sulle forme di rappresentazione agonistica (danze, corse, gare, giochi di abilità) o drammatica - di cui erano parte essenziale la musica e il canto - che, spesso intrinsecamente, li accompagnano. L'autore nella sua introduzione esamina le sfumature di significato che racchiude il termine utsava, “festa”, “gioia” in sanscrito.For three days the scholars who spoke at the conference reflected on the meaning and functions, on the cult and ritual practices, on the places that have defined the moments of the celebration over time and on the forms of competitive representation (dances, races, competitions, skill games) or dramatic - of which music and singing were an essential part - which, often intrinsically, accompany them. In his introduction, the author examines the nuances of meaning contained in the term utsava, "feast", "joy" in Sanskrit
Health Reforms In Tanzania: From Self-Reliance To Donor Dependency and Efforts to Return to Self-Reliance
No full textAn Inquiry into Health Systems Governance: the Case of Tanzania
Get PDFOver the last decade, the global movement towards universal health coverage (UHC) gradually shifted its focus. For many low- and middle-income countries (LMICs), the late 1990s and early 2000s have been characterized by strong and long-lasting efforts to eradicate infectious diseases and improve maternal and child health, expanding access to effective healthcare services. Over the following decade, global health institutions started to emphasize the role of health systems governance and the need to address high quality of care across local health systems. Governance has been identified as a building block of all health systems and deemed as conducive of improved social health protection, equity in health and increased quality of healthcare provision. Despite its importance, international institutions and researchers failed to provide a unanimous definition of health systems governance.This dissertation aims to contribute to the debate about health systems governance in LMICs, reflecting on the case of a large sub-Saharan country: Tanzania. The broad goal of this thesis is to distil some operational governance dimensions and assess their role in health services provision in Tanzania. The introductory chapter provides an overview of the role of health systems governance in LMICs, offering a working definition of governance that is used throughout the manuscript. Part I also presents the specific research objectives, outlining the methods applied in the subsequent parts of the dissertation. Part II introduces the reader to the health system and the health policy context in Tanzania, focusing on the governance challenges that characterize this large East African country. Part III looks at the role of incentives to health workers and supervision for the provision of high-quality healthcare. The study is based on a multilevel regression analysis of secondary data on a large sample of Tanzanian public health facilities from the Service Provision Assessment (SPA) survey conducted in 2014/2015. In part IV, the focus switches on the impact evaluation of social accountability initiatives on healthcare provision. The analysis builds on the implementation of a social accountability monitoring program - by the local NGO Sikika - in the Tanzanian region of Dodoma. Using a difference-in-differences approach, the research aims at identifying the effect of the program on two specific outcomes targeted by Sikika: availability of essential medicines and infrastructure maintenance in government-managed health facilities. Part V addresses the design, management and regulation of patient referral systems in settings characterized by strong focus on primary healthcare. The study is based on primary data collected in the two rural districts of Kilolo (Iringa region, Southern Highlands zone) and Msalala (Shinyanga region, Lake zone). The analytical approach builds on previous work in the field of social network analysis, mapping the available data to networks with health facilities representing nodes and patient referrals representing directed edges. The discussion in part VI summarizes the previous results putting them into perspective, outlining a framework where interrelated governance dimensions contribute to UHC goals. The section concludes touching upon the limitations of the proposed approaches and discussing the implications for health policy.The findings can be grouped in four main areas, reflecting the operational governance aspects explored empirically across the manuscript. The first area relates to top-down monitoring and supervision arrangements. The Tanzanian case highlights the ineffectiveness of initiatives meant to monitor the activity of local public healthcare providers spread across vast rural areas. Quality of care at point of service shows no association with the intensity of supervision at facility and individual level. Although measurement errors could prevent effective effect identification, the results cast doubts on the implementation of such arrangements. The second area addresses the role of incentive policies to push health workers towards the provision of high-quality healthcare. Financial and non-financial incentives offered to health workers show positive associations with the two measures of quality of care analysed, namely compliance with guidelines for treatment of sick children and patient satisfaction. Salary top-ups improve the otherwise poor salary conditions faced by health workers in public health facilities across the country. The analysis reveals positive effects on both indicators of quality. Among the non-financial incentives included in the analysis, subsidized housing offered to health workers appears to be positively associated to patient satisfaction. The study suggests an interpretation relating increased satisfaction to closeness between communities of health workers living in the health facility compound. The third area is related to bottom-up supervision and social accountability mechanisms. On the one hand, frequency of meetings between health facility staff and local communities is associated with increased patient satisfaction. The result reinforces the finding on subsidized housing, supporting the idea that closeness between providers and communities improves patient satisfaction. A potential pathway for this influence is the increased accessibility of providers (for example in case of emergencies) and improved ability to address the needs of the community. On the other hand, the social accountability monitoring program implemented in the Dodoma region reveals potentially positive effects on availability of essential medicines. Besides favouring effectiveness and appropriateness of treatments, the reduction of stock-outs in essential medicines contributes to improved patient satisfaction and in turn to positive healthcare seeking behaviour. The study does not detect any impact of social accountability monitoring on infrastructure maintenance, possibly suggesting different impact mechanisms related to the need of district level budgeting and resource allocation. Finally, the fourth area discusses the implications of design and regulation of patient referral systems. The results emphasize the importance of appropriate investments in infrastructure, especially in secondary level facilities (i.e. health centres). The study reveals that in Kilolo district most patient are referred directly to the regional referral hospital in Iringa Town, mainly as a result of geographic closeness and infrastructure availability. Health centres have a little role in terms of mediating referrals between primary and tertiary level facilities. A failure in the gatekeeping system may result in negative consequences in terms of increased financial burden for households required to travel to the crowded hospital words in Iringa Town. The analysis also suggests that a strategic orientation towards quality of care at district level may positively influence the functioning of patient referral systems. In Msalala district, besides higher rates of referrals to health centres, the results are consistent with a virtuous cycle of referrals directed towards smaller and more specialized facilities. Although the study is not designed to detect causal effects, these positive results may be associated to the implementation of a system-wide project aimed at strengthening different components of the health systems.Overall, the dissertation sheds light on the complex interaction between the different health systems governance dimensions analysed. What emerges is a set of mutually connected dimensions that contribute together to the three main goals of UHC: coverage and access, financial protection and the delivery of quality health services. The conclusion offers a number of suggestions to policy makers in relation to the potential outcomes associated to the implementation of different governance tools. On a more general note, the results are consistent with the ongoing efforts to promote systems thinking in health systems research. This dissertation supports the message that health system governance is better addressed with a comprehensive approach rather than with partial policies, unleashing a multiplicative effect of self-reinforcing interactions between different governance functions and tools
DigiTranScope: the governance of digitally-transformed society
Get PDFThis volume presents the key outcomes and research findings of the Digitranscope research project of the European Commission Joint Research Centre. The project set out to explore during the period 2017-2020 the challenges and opportunities that the digital transformation is posing to the governance of society. We focused our attention on the governance of data as a key aspect to understand and shape the governance of society. Data is a key resource in the digital economy, and control over the way it is generated, collected, aggregated, and value is extracted and distributed in society is crucial. We have explored the increasing awareness about the strategic importance of data and emerging governance models to distribute the value generated more equitably in society. These findings have contributed to the new policy orientation in Europe on technological and data sovereignty and the sharing of data for the public interest. The digital transformation, the rise of artificial intelligence and the Internet of Things offer also new opportunities for new forms of policy design, implementation, and assessment providing more personalised support to those who need it and being more participative throughout the policy cycle. The use of digital twins, gaming, simulation, and synthetic data are just at their beginning but promise to change radically the relationships among all the stakeholders in governance of our society
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