Do health policies address the availability, accessibility, acceptability, and quality of human resources for health? Analysis over three decades of National Health Policy of India

Background Human Resources for Health (HRH) are crucial for improving health services coverage and population health outcomes. The World Health Organisation (WHO) promotes countries to formulate holistic policies that focus on four HRH dimensions—availability, accessibility, acceptability, and quality (AAAQ). The status of these dimensions and their incorporation in the National Health Policies of India (NHPIs) are not well known. Methods We created a multilevel framework of strategies and actions directed to improve AAAQ HRH dimensions. HRH-related recommendations of NHPI—1983, 2002, and 2017 were classified according to targeted dimensions and cadres using the framework. We identified the dimensions and cadres focussed by NHPIs using the number of mentions. Furthermore, we introduce a family of dimensionwise deficit indices formulated to assess situational HRH deficiencies for census years (1981, 2001, and 2011) and over-year trends. Finally, we evaluated whether or not the HRH recommendations in NHPIs addressed the deficient cadres and dimensions of the pre-NHPI census years. Results NHPIs focused more on HRH availability and quality compared to accessibility and acceptability. Doctors were prioritized over auxiliary nurses-midwives and pharmacists in terms of total recommendations. AAAQ indices showed deficits in all dimensions for almost all HRH cadres over the years. All deficit indices show a general decreasing trend from 1981 to 2011 except for the accessibility deficit. The recommendations in NHPIs did not correspond to the situational deficits in many instances indicating a policy priority mismatch. Conclusion India needs to incorporate AAAQ dimensions in its policies and monitor their progress. The framework and indices-based approach can help identify the gaps between targeted and needed dimensions and cadres for effective HRH strengthening. At the global level, the application of framework and indices will allow a comparison of the strengths and weaknesses of HRH-related policies of various nations.

A Case Report of Extensively Drug Resistant Typhoid in Karachi, Pakistan: A Major Health Concern to Curb the Outbreak

The disease burden of extensively drug resistant typhoid in developing countries is a major emerging issue that cannot be ignored. Since its emergence from multidrug strains, the majority of typhoid cases in Karachi, Pakistan, have been extensively drug resistant, mostly infecting younger patients. In the study, the authors analysed one such case in an adolescent male and discussed how, by the implementation of national health policies, the spread of these infectious diseases could be prevented and the overall burden on the healthcare system decreased in areas with already limited resources.

“What Do Our Boys Know about Sex?” Preliminary Data of a New Questionnaire for the Evaluation of the Knowledge of Sexuality among Adolescents

Background: The sexual health of young people is an especially important issue for national health policies. Adolescents, in fact, are at elevated risk for adverse sexual and reproductive health outcomes relative to their habits, sexually transmitted infections (STIs), sexual behaviour and teenage pregnancy. The aim of this study was to assess the knowledge about sexuality of students under the age of 18. Moreover, we aimed to explore the influence of sex education on sexual knowledge and behaviour. Methods: The participants were enrolled during a cultural exchange project in September 2019. After completing the questionnaire, all students took part in a sex education course performed by an urologist with expertise in sociology and psychology. The adolescents repeated the same survey in a web form in September 2020, one year after the course. Results: Analyzing the data, sex education lessons helped to improve students’ confidence in approaching all the issues of the questionnaire. Moreover, we observed a significant increase in the role of school as main source of information, while the role of the internet, media and family remained stable. Conclusions: This study encouraged the introduction of school-based sexual education policies, pointing to opportunities for structural early intervention programs.

Priorities and opportunities for palliative and end of life care in United Kingdom health policies: a national documentary analysis

Background Access to high-quality palliative care is inadequate for most people living and dying with serious illness. Policies aimed at optimising delivery of palliative and end of life care are an important mechanism to improve quality of care for the dying. The extent to which palliative care is included in national health policies is unknown. We aimed to identify priorities and opportunities for palliative and end of life care in national health policies in the UK. Methods Documentary analysis consisting of 1) summative content analysis to describe the extent to which palliative and end of life care is referred to and/or prioritised in national health and social care policies, and 2) thematic analysis to explore health policy priorities that are opportunities to widen access to palliative and end of life care for people with serious illness. Relevant national policy documents were identified through web searches of key government and other organisations, and through expert consultation. Documents included were UK-wide or devolved (i.e. England, Scotland, Northern Ireland, Wales), health and social care government strategies published from 2010 onwards. Results Fifteen policy documents were included in the final analysis. Twelve referred to palliative or end of life care, but details about what should improve, or mechanisms to achieve this, were sparse. Policy priorities that are opportunities to widen palliative and end of life care access comprised three inter-related themes: (1) integrated care – conceptualised as reorganisation of services as a way to enable improvement; (2) personalised care – conceptualised as allowing people to shape and manage their own care; and (3) support for unpaid carers – conceptualised as enabling unpaid carers to live a more independent lifestyle and balance caring with their own needs. Conclusions Although information on palliative and end of life care in UK health and social care policies was sparse, improving palliative care may provide an evidence-based approach to achieve the stated policy priorities of integrated care, personalised care, and support for unpaid carers. Aligning existing evidence of the benefits of palliative care with the three priorities identified may be an effective mechanism to both strengthen policy and improve care for people who are dying.

IMPACT ON HEALTH EDUCATION FROM COVID-19 AND CLIMATE CHANGE

World Health Organization (WHO) health policy for Europe “Health 2020” became a stimulus for many countries to renew their national health policies, and it is a guide of actions (WHO, 2013). Long-term studies proved that health is closely linked to socio - economic indicators, among which age plays a major role, and education. Given that there are as many healthy people as possible, it is especially important to form the most important young people attitude to health, to develop a personality who would take care of the health of yourself, your family and those around you. Schools, colleges, and universities are the medium in which a mature generation of future intellectuals are capable and possessed to have a major influence on the development of the state and, with knowledge of the principles of good health, to contribute to and to shape the health policy of the right country, its implementation and at the same time to the population of the country improving health (Misevičienė et al., 2017).

Infective Endocarditis as the Cause of Death: A Populationbased Study in Portugal, from 2002 to 2018

Introduction: Infective endocarditis presents a high rate of morbidity and mortality. Population-based studies addressing mortality caused by infective endocarditis in Portugal are scarce. We aimed to study deaths caused by Infective endocarditis, as well as corresponding demographics and temporal trends.Material and Methods: Retrospective cohort study of all patients whose main cause of death was Infective endocarditis in Portugal from 2002 to 2018. The data was obtained from the national death certificate information system.Results: In Portugal, 3634 people died from infective endocarditis throughout the 17-year study period - infective endocarditis specific mortality rate of 2.1 per 100 000 habitants. Of all deceased, 89% were at least 60 years old, and most were women (55%). Overall, 72% died in a healthcare institution. An annual 9% increase in the incidence death rate from Infective endocarditis was observed, with a significant upward trend during the colder months.Discussion: In Portugal, mortality by infective endocarditis increased, mainly affecting older patients and women, and which can partially be explained by factors such as ageing of the population. The management of older patients with infective endocarditis is challenging as they present a higher number of comorbidities, more valvular heart disease and valve implants, invasive medical procedures and are less likely to undergo cardiac surgery.Conclusion: In addition to data on the evolution of demographics in Portugal, it is crucial to study the incidence of infective endocarditis over time to help explain these findings. The identification of factors that can be used to better model national health policies to improve clinical outcomes of infective endocarditis in Portugal is also required.

The Brain and Causality: How the Brain Becomes an Individual-Level Cause of Illness

How do individual-level explanations become applied to social issues? Neurobiology – the study of the connections between behavior and the cells and structures of the brain – receives substantial public funding and influences social institutions, policy debates, and core aspects of human experience. With respect to mental health, neurobiology has ramifications for the way disorders are defined, diagnosed, and treated, along with how public funding for mental illness is allocated. This article addresses how neurobiologists establish the brain as a cause of mental illness. I analyze 17 months of ethnographic observation at a well-regarded neurobiological research laboratory, as well as observations at professional meetings, to detail three strategies: Linking the Brain to Mental Illness, Explaining Mental Illness with the Brain, and Asserting the Causal Importance of the Brain. These strategies first connect the brain to mental illness, and subsequently establish the causal primacy of the brain relative to alternative explanations (e.g., poverty). I connect findings to medical sociological theories, biological reduction, and emerging national health policies.

Shaping access to health care for refugees at the local level in Germany

Background In Germany, the federal states and even the municipalities have considerable scope for shaping implementation of national health policies for newly arrived refugees, including in the way they organize access to health services. We analysed how gatekeepers can shape access to health care at the local level, exploring access models in six municipalities in the federal state of North Rhine-Westphalia. Methods We assessed the implementation of local access models and the consequences for access for refugees. Our study covered three municipalities with a health care voucher model and three with an electronic health card model. We combined data from official reports and from 21 semi-structured interviews with gatekeepers. Results Our research illustrates how gatekeepers at the local level can shape and facilitate access to health care for refugees, irrespective of the access model chosen. Larger municipalities are more likely to implement an electronic health card model. Gatekeepers report that costs, workload and control are the major aspects underlying the choice of model in municipalities. Access plays only a minor role, although some gatekeepers claim that the electronic health card model can improve access. Conclusions National health policies can support gatekeepers in their role as facilitators, such as through financial incentives or a minimum amount of bureaucracy. They can also allow newly arrived refugees to become members of the statutory health insurance system, which would relieve social welfare offices and general practitioners (GPs) from their role of gatekeepers.

May Measurement Month 2018: an analysis of blood pressure screening results from Sudan

To raise awareness of high blood pressure (BP) levels and associated risk factors among the Sudanese population. A cross-sectional study was conducted in six Sudanese states during the period May–August 2018. The study area included public indoor and outdoor areas, institutes, and service facilities. A questionnaire for collecting the data was employed including demographic data, along with three consecutive BP measurements. Data were collected by trained volunteers. Hypertension (HTN) was defined as a systolic blood pressure ≥140 mmHg or a diastolic blood pressure ≥90 mmHg based on the mean of the second and third measurements, or in those on antihypertensive medication. The current study indicated a high prevalence of HTN (28.2%) among 40 779 participants and a low level of awareness (20.7%) amongst these participants. Of all, 18.2% of hypertensive participants were on medication and of these, 54.6% were controlled. Of all hypertensives, only 9.9% were controlled. Further action needs to be taken by all stakeholders for raising awareness and increasing screening provision of HTN, which are essential for the development of national health policies for control and management of HTN in Sudan.