Brandon Dulisse, Chivon H. Fitch, Nathan T. Connealy
This study explores two communityâuniversity collaborations at the University of Tampaâthe Industry Advisory Board (IAB, est. 2021) and the Criminology Institute for Research and Training (CIRT, est. 2023). Grounded in translational criminology, these initiatives bridge researcherâpractitioner divides through collaborative, evidence-based policy and practice. The IAB, with 25+ agencies, enhances curriculum, research, and student preparedness, while CIRT disseminates evidence-based practices via trainings, symposia, and grant-funded studies on issues like cryptocurrency fraud. Findings reveal that translational criminology thrivesâdefined as growth to 25+ agency partners, 20+ annual student internships/jobs, annual training and certification events, and four publicationsâthrough inclusive stakeholder engagement, clear agenda-setting, and continuous evaluation. These partnerships evolve despite challenges like agency turnover, offering a replicable model for sustainable academicâpractitionerâstudent collaborations. Future directions include expanding to 50+ agencies and aligning curricula with practitioner needs to drive impactful reform.
Zahra Niazkhani, Iris Wallenburg, Johanna Hendriks, Rik Wehrens
In the context of increasing healthcare digitalization, hospital-based clinicians are developing and implementing decentralized digital health innovations (DHIs) tailored to their patient and clinical needs. However, achieving financial sustainability remains one of their challenges. We explored clinician innovators' perspectives on these challenges during the implementation and scale-up of their DHIs in a Dutch academic hospital using qualitative methods. Key challenges identified included funding gaps to cover transition costs, misaligned institutional financial incentives and reimbursement structures, short-term logics of funders overshadowing long-term value in DHI financing, and commercialization pressures. Findings provide insights into the financial and operational challenges faced by such context-driven internal innovations, highlighting the need for coordinated project-and institution-level strategies to support sustainable integration into routine care.
Purpose This article explores the main elements of co-participation in health, examining how community engagement can improve health outcomes and health servicesâ overall efficiency. It aims to discuss and identify key features that facilitate co-participation strategies in service delivery and health program implementation. Design/methodology/approach The authors conducted a general literature review to comprehensively explore the role of co-participation in health, drawing on scientific literature and real-world examples to identify key factors that contribute to successful health interventions. A total of 50 published resources were included, and a descriptive analysis was performed, focusing on summarizing existing literature and highlighting key themes and practical strategies. Documents were selected from publications dated between 2004 and 2024. Findings Community participation is presented as a critical factor in improving population health outcomes. The examined initiatives promote the idea that community integration into the design and implementation of health programs increases treatment adherence, users' health perception and improved health outcomes. Several strategies and approaches are presented as key tools to adequately integrate community engagement such as community empowerment, government decentralization and incorporation of technology, among others. Practical implications Coparticipation in health improves health outcomes and promotes greater equity and social justice. Involving citizens in health decision-making contributes to improving the quality of life and well-being of the community. Empowering patientsâ decision-making not only builds oneâs self-agency in health decision-making but also simultaneously facilitates closing the gaps in healthcare service delivery due to large shortages in the health workforce around the world. This has further implications for overall health systemsâ financing, efficiency and sustainability. Social implications This research has social implications as it underscores how community participation is essential for fostering equity, justice and inclusivity within health systems. Originality/value This article offers an innovative perspective on the role of partnership in achieving good health outcomes, highlighting the importance of adapting interventions to local contexts, the need for sustainable financing and the inclusion of a wide range of actions toward participation.
BACKGROUND: The Durban University of Technology (DUT) Faculty of Health Sciences (FHS) in KwaZulu-Natal, South Africa, is embarking on a project to implement a Decentralized Clinical Training Program (DCTP). The DUT FHS DCTP project is being conducted in response to the growing demands of students requiring clinical service placements as part of work-integrated learning. The project is also geared toward responding to existing gaps in current practices related to the implementation of a DCTP, which has mainly been through traditional universities providing training to medical, optometry, occupational therapy, and physiotherapy students. In South Africa, a DCTP is yet to be implemented within the context of a university of technology; it is yet to be implemented within health science faculties that offer undergraduate health science programs in mainstream biomedicine and alternative and complementary disciplines. OBJECTIVE: We aim to design, pilot, and establish an effective DCTP at the DUT FHS in KwaZulu-Natal, South Africa. METHODS: Participatory action research comprising various designs-namely, appreciative inquiry, qualitative case study design, phenomenography, and descriptive qualitative study design-will be used to conduct the study. Data will be collected using individual interviews, focus group discussions, nominal group technique, consensus methodology, and narrative inquiry. Study participants will include various internal and external stakeholders of the DUT, namely, academic staff; students; key informants from universities currently using successfully established DCTPs; academic support staff; staff working in human resources, finance, procurement, and accounting; and experts in other disciplines such as engineering and information systems. Overall, 4 undergraduate health science programs-namely, Radiography, Medical Orthotics and Prosthetics, Clinical Technology, and Emergency Medical Care and Rescue-will be part of the project's pilot phase. Findings from the project's pilot phase will be used to inform scale-up in the other undergraduate programs in the DUT FHS. The project is being implemented as part of the university's strategic objective of devising innovative curricula and pedagogical practices to improve the mastery, skill set, and competence of health science graduates. RESULTS: The study has currently commenced with the situational analysis, consisting of engagement with external stakeholders implementing DCTPs. The data to be generated from the completion of the situational analysis are anticipated to be published in 2024. CONCLUSIONS: This project is envisioned to facilitate collaboration among the universities of technology, traditional universities, Ministry of Health, and private sector for clinical placement of undergraduate health science students in health establishments that are away from the university, thereby exposing them to real-life experiences related to health care. This will facilitate authentic learning experiences that will contribute to improved competencies of graduates in relation to the health needs of society and the multiple realities of the South African health system. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/52243.
While the importance of primary health care (PHC) as a foundation for a strong healthcare system is widely accepted, the policies needed to achieve it remain deeply controversial. Some proponents call for a greater role for market and user choice in expanding and strengthening PHC, whereas others recommend a greater role for the government in directing its development. The objective of this paper is to assess these arguments by comparing the experience of China and Thailand in strengthening PHC. We find that tight government steering of the healthcare system in Thailand has produced better integration and eventually outcomes than the more decentralized and competitive system in China. The Chinese governmentâs massive administrative and fiscal efforts to strengthen PHC have been undermined by systemic barriers in the wider health system, notably fee-for-service and out-of-pocket financing that distort the incentives of healthcare providers. A key conclusion to emerge from the analysis is that central stewardship and steering accompanied by appropriate incentives to promote integration are critical to building effective primary health care.
BACKGROUND The Durban University of Technology (DUT) Faculty of Health Sciences (FHS) in KwaZulu-Natal, South Africa, is embarking on a project to implement a Decentralized Clinical Training Program (DCTP). The DUT FHS DCTP project is being conducted in response to the growing demands of students requiring clinical service placements as part of work-integrated learning. The project is also geared toward responding to existing gaps in current practices related to the implementation of a DCTP, which has mainly been through traditional universities providing training to medical, optometry, occupational therapy, and physiotherapy students. In South Africa, a DCTP is yet to be implemented within the context of a university of technology; it is yet to be implemented within health science faculties that offer undergraduate health science programs in mainstream biomedicine and alternative and complementary disciplines. OBJECTIVE We aim to design, pilot, and establish an effective DCTP at the DUT FHS in KwaZulu-Natal, South Africa. METHODS Participatory action research comprising various designsânamely, appreciative inquiry, qualitative case study design, phenomenography, and descriptive qualitative study designâwill be used to conduct the study. Data will be collected using individual interviews, focus group discussions, nominal group technique, consensus methodology, and narrative inquiry. Study participants will include various internal and external stakeholders of the DUT, namely, academic staff; students; key informants from universities currently using successfully established DCTPs; academic support staff; staff working in human resources, finance, procurement, and accounting; and experts in other disciplines such as engineering and information systems. Overall, 4 undergraduate health science programsânamely, Radiography, Medical Orthotics and Prosthetics, Clinical Technology, and Emergency Medical Care and Rescueâwill be part of the projectâs pilot phase. Findings from the projectâs pilot phase will be used to inform scale-up in the other undergraduate programs in the DUT FHS. The project is being implemented as part of the universityâs strategic objective of devising innovative curricula and pedagogical practices to improve the mastery, skill set, and competence of health science graduates. RESULTS The study has currently commenced with the situational analysis, consisting of engagement with external stakeholders implementing DCTPs. The data to be generated from the completion of the situational analysis are anticipated to be published in 2024. CONCLUSIONS This project is envisioned to facilitate collaboration among the universities of technology, traditional universities, Ministry of Health, and private sector for clinical placement of undergraduate health science students in health establishments that are away from the university, thereby exposing them to real-life experiences related to health care. This will facilitate authentic learning experiences that will contribute to improved competencies of graduates in relation to the health needs of society and the multiple realities of the South African health system. INTERNATIONAL REGISTERED REPORT PRR1-10.2196/52243
Abstract Introduction Chronic diseases form the largest burden of disease in European countries. Redesign of health systems towards chronic integrated care is needed, with more collaboration between first and second line, between medical and social services and support to prevention and self-management. What are the levers for change in such health systems? This study addresses this knowledge gap, through a policy analysis of barriers and facilitators for change towards chronic integrated care. Methods 26 central level stakeholders were selected, based upon their influence in regulation and policy, financing, health care provision and community representation. Semi-structured face-to-face interviews were held covering assessment of past and current policies and implementation, barriers and opportunities for change. Results Reforms have taken place, such as the stimulation of local initiatives for chronic integrated care projects and the set-up of local care councils. Most stakeholders assessed the current Belgium's implementation of integrated care as low, despite a growing awareness for the need for change. A context factor often mentioned to constrain implementation was a state reform which led to a partial decentralization, fragmentation of decision power and a division of healthcare competences between federal and federated levels. Other barriers were the current financing system, the lack of investments in new models of care and the vested interests of providers. Discussion This analysis shows that chronic care reform in Belgium is constrained by partial decentralization of primary health care, and by the financing system and vested interests. It points to the need for coordination of health policy making and implementation. Disentangling the levels of decision-making and the financial leverage at these levels gives insights for change and change management, for the Belgium health system and other countries with a strong decentralized system. Key messages The current Belgiumâs implementation of integrated care was assessed as low, due to different contexts factors such as division of health care competencies between different governmental levels. In a country as Belgium with a strong decentralized health care system coordination of health policy making and implementation is key in order to scale up integrated care for chronic diseases.
Agnes Nanyonjo, Edmound Kertho, James Tibenderana, Karin KĂ€llander
INTRODUCTION: Several countries have adopted integrated community case management (iCCM) as a strategy for improved health service delivery in areas with poor health facility coverage. Early implementation of iCCM is often run by nongovernmental organizations financed by donors through projects. Such projects risk failure to transition into programs run by the local health system upon project closure. Engagement of subnational health authorities such as district health teams (DHTs) is essential for a smooth transition. METHODS: We used a repeated qualitative study design to assess the readiness of and progress made by DHTs in institutionalizing iCCM into the functions of locally decentralized health systems in 9 western Uganda districts. Readiness data were derived from structured group interviews with DHTs before iCCM policy adoption in 2010 and again in 2015. Progressive institutionalization achievements were assessed through key informant interviews with targeted DHT members and local government district planners in the same areas. FINDINGS: In the readiness study, DHTs expressed commitment to institutionalize iCCM into the local health system through the development of district-specific iCCM activity work plans and budgets. The DHTs further suggested that they would implement district-led training, motivation, and supervision of community health workers; procurement of iCCM medicines and supplies; and advocacy activities for inclusion of iCCM indicators into the national health information systems. After iCCM policy adoption, follow-up study data findings showed that iCCM was largely not institutionalized into the local district health system functions. The poor institutionalization was attributed to lack of stewardship on how to transition from externally supported implementation to district-led programming, conflicting guidelines on community distribution of medicines, poor community-level accountability systems, and limited decision-making autonomy at the district level. CONCLUSION: Successful institutionalization of iCCM requires local ownership with increased coordination and cooperation among governmental and nongovernmental actors at both the national and district levels.
Maria Gabriella Melchiorre, Roberta Papa, Sabrina Quattrini, Giovanni Lamura · 5 authors
INTRODUCTION: eHealth applications have the potential to provide new integrated care services to patients with multimorbidity (MM), also supporting multidisciplinary care. The aim of this paper is to explore how widely eHealth tools have been currently adopted in integrated care programs for (older) people with MM in European countries, including benefits and barriers concerning their adoption, according to some basic health system characteristics. MATERIALS AND METHODS: In 2014, in the framework of the ICARE4EU project, expert organizations in 24 European countries identified 101 integrated care programs. Managers of the selected programs completed an online questionnaire on several dimensions, including the use of eHealth. We analyzed data from this questionnaire, in addition to qualitative information from six innovative programs which were studied in depth through case study methodology, according to characteristics of national health systems: a national health model (financing system), overall strength of primary care (PC) (structure/service delivery process), and level of (de)centralization of health system (executive powers in a country). RESULTS: 85 programs (out of 101) adopted at least one eHealth tool, and 42 of these targeted explicitly older people. In most cases, Electronic Health Records (EHRs) were used and some benefits emerged like improved care management and integration, although inadequate funding mechanisms represented a major barrier. The analysis by health system characteristics showed a greater adoption of eHealth applications in decentralized countries, in countries with a National Health Service (NHS) model, and in countries with a strong/medium level of PC development. CONCLUSIONS: Although in the light of some limitations, findings indicate a relation between implementation of care programs using eHealth tools and basic characteristics of health systems, with decentralization of a health system, NHS model, and strong/medium PC having a key role. However adaptations of European health systems seem necessary, in order to provide a more innovative and integrated care.
Ademar Arthur Chioro dos Reis, Ana Paula Menezes SĂłter, Lumena Almeida Castro Furtado, Silvana Souza da Silva Pereira
Decentralization and regionalization are strategic themes for reforms in the health system. This paper analyzes the complex process of health regionalization being developed in Brazil. This paper identifies that the normative framework from the Brazilian National Health System, SUS has made advances with respect to its institutionalization and overcoming the initial centrality involved in municipalization. This has strengthened the development of regionalization and the intergovernmental agreement on health but the evidence points to the need to promote a revision. Based on document analysis, literature review and the views given by the authors involved in management in SUS as well as generating radically different views, the challenges for the construction of a regionalization that is active, is debated. We also discuss: its relations with planning and the dimensioning of service networks, the production of active care networks and shared management spaces, the inter-federative agreements and regional regulations, the capacity to coordinate regional systems and financing and the impact of the political dimension and electoral cycles. Regionalization (and SUS itself) is an open book, therefore ways and possibilities on how to maintain an active form of regionalization can be recommended.
Open access
Health, Nursing, Elderly Care
Interprofessional Education and Collaboration
Health Systems, Economic Evaluations, Quality of Life
BACKGROUND: The concept of decision space holds appeal as an approach to disaggregating the elements that may influence decision-making in decentralized systems. This narrative review aims to explore the functioning of decision space and the factors that influence decision space. METHODS: A narrative review of the literature was conducted with searches of online databases and academic journals including PubMed Central, Emerald, Wiley, Science Direct, JSTOR, and Sage. The articles were included in the review based on the criteria that they provided insight into the functioning of decision space either through the explicit application of or reference to decision space, or implicitly through discussion of decision-making related to organizational capacity or accountability mechanisms. RESULTS: The articles included in the review encompass literature related to decentralisation, management and decision space. The majority of the studies utilise qualitative methodologies to assess accountability mechanisms, organisational capacities such as finance, human resources and management, and the extent of decision space. Of the 138 articles retrieved, 76 articles were included in the final review. CONCLUSION: The literature supports Bossert's conceptualization of decision space as being related to organizational capacities and accountability mechanisms. These functions influence the decision space available within decentralized systems. The exact relationship between decision space and financial and human resource capacities needs to be explored in greater detail to determine the potential influence on system functioning.
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Communities and Human Settlements-Housing & Human Habitats Governance-Governance Indicators Governance-Local Government Governance-National Governance Governance-Politics and Government Health, Nutrition and Population-Health Economics & Finance Health, Nutrition and Population-Health Monitoring & Evaluation Health, Nutrition and Population-Health Systems Development & Reform Public Sector Development-Decentralization Social Development-Social Accountability
<strong>Background</strong> Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakersâ perspective. <strong>Methods</strong> A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. <strong>Results</strong> The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the âinvasionâ of competences among levels of government and high political turnover are also highlighted. <strong>Conclusions</strong> The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved.
The design of the decentralized co-operative governance system, conditioned and \nregulated by the South African constitution is of critical importance for policy design and \nimplementation. The division of powers falls within a unitary form of government. This \nstudy, which is about the processes, mechanisms and modalities of public policies \ndesign and implementation uses the public finance and health sectors, as a case study \nor lens through which policy design and implementation is examined within a \ndecentralized cooperative governance system. The study is per se not about the public \nhealth system, but rather a review and an analysis about how the decentralization and \ncooperative governance nature, practice and dynamic of government system, influences \nand condition the policy processes and practice on finance and health, separately and \ncollectively within the public health system. \nIn its attempt to unbundle the health function, but also reform the public health system, \ncentral and provincial governments have introduced a number of reforms. These reforms \nwere ostensibly driven by different policies and programmes originating either from the \npublic finance or public health sectors with significant consequences for the provinces. \nMoreover, these different policies also outlined structural and functional responsibilities \nand authority among the central and provincial government departments. The \nimplementation of these policies was at times based on different interpretations of policy \ndesign and implementation responsibilities and authority between the central and \nprovincial governments within co-operative governance system. \nThe argument of this study is that despite intentions implicit to public policy, co-operative \ngovernance system is contested at a central government level within the public health \nsystem, as well as between levels of government and the public health and finance \nsectors. This dissertation explores the nature of the relationship between the central and \nprovincial governments by exploring co-operative governance in the health sector on \npolicy and financing processes and mechanisms. The central question is how does \ndecentralized co-operative governance really work in the public health system? \nA case study method was used to conduct this research. Data was collected over a four \nand half year period using a variety of data collection methods, including semi-structured \nin-depth interviews; documents and reports analyses; policy content review and \nanalyses; and revenue and expenditure reviews and analyses. \nThe studyâs findings are: \na) the functional and structural decentralization of policy-making and implementation \nwithin the co-operative governance system contributes to undermining the cooperative \ngovernance relationship between the public finance and health sector and \ncentral and provincial governments; \nb) the central government is using its overriding powers to âimpose co-ordinated \nsolutionsâ to problems within the co-operative governance system, leading to \nsituations where âimposed co-ordinationâ is considered as âco-operative governanceâ; \nc) the theory provides a classical distinction between state control, supervision and \ninterference models. This dissertation shows that, depending on the policy context \nand circumstances, the uniqueness of South Africaâs co-operative governance \nsystem allows the central government to mobilize any of these models to achieve its \npolicy intentions, whether written or unwritten; and \nd) the classical arguments of decentralization, particularly within a devolved system of \nco-operative governance where greater autonomy and authority are given to subnational \ngovernments, are found wanting within the South African governance \nsystem, given both the policy-making and fiscal resource strength of the central \ngovernment relative to the provinces. \nThis dissertation leads me to conclude that the South African practice of co-operative \ngovernance in the health system is actually imposed co-ordination and that provinces \nare de facto administration outposts of central government policies, programmes and \nservice delivery responsibilities. Therefore in reality there is no autonomy and \nindependence of the provinces from the central government as envisaged in the \nConstitution of the Republic of South Africa. In fact, provinces only exist, in terms of their \nconstitutional competencies as far the central government allows it to exist given its \nplenipotentiary powers over both micro and macro matters affecting institutions, fiscus \nand social policies.
This study addresses the interprofessional training of professionals necessary to function in an integrated service delivery system for children and youth at risk. Information was collected in seven OECD member countries on current multidisciplinary training capabilities, including country information and exemplary program descriptions. A number of significant findings were identified from the study regarding national policies, effects of decentralization, organizing mechanisms, training components, implementation strategies and financing. Clear policy implications emerged from the study, including the need to incorporate national policies on training in the policy framework for serving children and youth at risk, encouraging universities to develop curricula relevant to coordinated systems of care for their children and youth, and establishing national mechanisms for supporting and linking local training initiatives.