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This guideline is a result of the project CHANCE, funded by the EU-programme GRUNDTVIG / “Lifelong Learning Programme” conducted from December 2007 to November 2009.
The project focuses on the approach of “CommunityBuilding“, which is beyond counselling and education campaigns designed for the social and environmental circumstances and aims to initiate the build-up of networks and local communities.
The manual is based on the interdisciplinary view of health (holistic according to the WHO), community and social environment (promotion of personal and structural potential).
After the introduction with regard to the subject matter, the manual presents 13 fundamental guidelines and illustrates project examples from the participating countries.
The purpose of this report is to determine whether health maintenance organisations (HMOs) can provide a suitable and viable form of financial health protection and service provision in selected West African countries, supplementary to existing healthcare provision and coverage. Burkina Faso, Côte d’Ivoire, The Gambia, Guinea-Bissau, Liberia and Sierra Leone were chosen as country examples. Chapter 1 provides the context for the health and healthcare situation in West Africa as well as specific country profiles, whilst Chapter 2 describes factors to be considered when establishing an HMO. The range of technical di-mensions of an HMO introduced in this report includes: administration, human resources, financing, accreditation, service availability and readiness, the benefits catalogue, paying providers, drugs and quality management. Each of these dimensions is further discussed in Chapters 3 – 10.
The administration of an HMO consists of nine interconnected fields: management dash-board, quality management, IT department, purchasing and coordination, finance and ac-counting, health plan and benefit package, member management, human resources, and marketing. In Chapter 3, the authors give a more in-depth analysis of the fields of marketing and member management. Recommendations provided in this chapter include the use of different marketing approaches to bridge the gap between communities and the HMO by establishing informative advertising (e.g., via a mobile responsive website, social media, posters, flyers, radio, and recorded information).
Chapter 4 focuses on an HMO’s human resources, particularly in regard to staff recruiting, development and retention. Staff development expands staff competence by increasing employees’ motivation and job satisfaction, which leads to an increase in their performance and productivity, thereby improving staff retention. Furthermore, staff retention is important for ensuring a long-term commitment to the HMO. In conclusion, the success of an HMO is crucially dependent on motivating staff and enabling them to exercise, develop and share their skills.
Chapter 5 covers the financial aspects of an HMO, including dimensions related to its target population, financial barriers, funding resources, management of funds, and specific coun-try challenges. In order to calculate the necessary resources, this chapter make clear that an HMO must consider cost projections for the benefit package, infrastructure development, administration, expansion and a reserve.
To establish an accreditation system, HMOs can interact with stakeholders from different fields and levels of service delivery and administration, as examined in Chapter 6. The polit-ical and social conditions of a country must be considered by the HMO in order to effective-ly implement an accreditation system. Besides this, an HMO can seek to improve the per-formance quality of healthcare by supporting the establishment of an accreditation scheme.
Reliable information on service availability and readiness is necessary for successful health systems management as it allows health services to be tracked in terms of how they have responded to changed inputs and processes. In Chapter 7, the authors analyse the Service Availability and Readiness Assessment (SARA) tool, and recommend its application within the HMO, as it offers a standardised approach to monitoring the supply of services by providing a standard set of tracer indicators.
To implement a health benefit package (HBP), the authors assess existing models, such as the one introduced by Glassman et al. (2017) which specifies ten core elements of an HBP design and helps to enable discussions on the most relevant aspects in designing an HBP for an HMO. Chapter 8 presents a coinsurance scheme within the HBP design which will affect the service utilisation of members as well as utilisation management as one method for cost control. In addition, actuarial calculations are proposed using Sierra Leone as a case example.
Chapter 9 describes the pharmaceutical supply chain required by an HMO. Important steps of the HMO’s medicine supply chain include: selection, quantification and forecasting, pro-curement, storage, and distribution of medical products. Medicines provided by the HMO must be safe, available, accessible, and affordable at all times and for all members. Stock-outs must be avoided, and therefore this chapter recommends employing community-based health workers in order to ensure distribution to patients in rural areas.
Quality management is an important field in an HMO analysed in Chapter 10 of this report. It includes patient safety, efficiency, and patient satisfaction; all factors that must be con-sidered during the implementation of an HMO. The chapter concludes by noting that quality is highly subjective and must therefore be applied to the specific context of an HMO within a specific country.
Finally, Chapters 11 and 12 of the report include implementation challenges of an HMO in West Africa, as well next steps that should be followed. Although similar challenges con-cerning the social, political, or structural environment can be found in most West African countries, direct transfer of elaborated information to other countries and healthcare situa-tions is not always possible. As well as these situational challenges, HMOs encounter dif-ferent questions such as how to balance the scope of available services against the cover-age of diverse geographical areas, engagement of various stakeholders and reflection of respective values, interests and perspectives of local populations.
Limitations of the report include a lack of specificity in general, and the use of many specific country settings, as observations and examples for one HMO dimension may not always be transferable to other regions and healthcare situations. Therefore, this report is not meant to provide concrete conclusions or solutions in regard to the implementation of an HMO in a specific country setting.
In conclusion, this report states that HMOs have the potential to play a substantial role in healthcare system strengthening, provision of quality healthcare services and the preven-tion of financial burden due to ill-health. As a result, an HMO can support West African countries in their role to fulfil their obligation of protecting the health of their citizens. Addi-tionally, the authors strongly believe that an HMO must reflect the cultural, societal and political environment in which it is implemented. Therefore, it is essential that research be conducted prior to its implementation in addition to including the relevant local stakeholders as early as possible in the process.
In our paper we investigate the role of civil society organisations (CSOs) in the provision of services and in forming advocacy coalitions for illegalized migrants in Bern and Vienna. We analyse the variety of CSOs which actively challenge policies of exclusion at the urban level. We examine the political and social practices of CSOs in local welfare arrangements and their organizational structures, the way they build up solidarity relations, networks and alliances, and their relations to municipality and urban authorities. By focusing on varieties of practices and strategies of CSOs, we shed light on civil society’s crucial role concerning the construction of urban infrastructure of solidarity and aim to show how local arrangements for illegalized migrants are co-produced and negotiated by a variety of actors within urban settings.
The aim of this project is to prepare a nutrition guidebook for early childhood active stakeholders that are applicable across Europe and Turkey. The developed nutrition guidebook is the result of two-year collaboration between academics from different professions (nutritionists, home economists, paediatricians, education scientists, health psychologists) across five countries.
Abstract
Over the course of the European Sovereign Debt Crisis members of the euro area have put up significant resources to stabilize the financial situation of a few fellow member states. In Germany, this support is subject to a controversial discussion. One aspect in that is the extent of support provided. Using the financial assistance provided to Greece as an example, this paper sheds some light on the financial burden for Germany in comparison to other member states of the euro area, especially Estonia, Latvia and Lithuania. This implies not only an interesting comparison of strains between large and small economies but also between original and later euro area members.
Keywords: euro area, debt crisis, exposure, Greece, Baltic states, Germany
Good governance and redistribution in health financing : Pro-poor effects and general challenges
(2017)
Good governance has increasingly attained priority in international cooperation and health-system performance. Governance refers to all steering activities by public entities to influence the behaviour and activities of stakeholders involved. In the health sector, governance refers to a wide range of functions related to guidance and rule-making carried out by governments or other public decision-makers. More specifically, governance in the health-financing system applies to two different aspects: in addition to the approaches, strategies and policies determining how financial flows are implemented, managed and supervised according to rules- or outcome-based indicators, health-financing governance encompasses the question of how far resource generation, pooling and allocation are organised in an equitable, fair and sustainable manner. Individual and collective financial sustainability, burden sharing and social coherence or solidarity are essential parts of health-financing governance and depend deeply on societal priorities and values. Fairness of financing, transparent risk pooling and accountable purchasing of health services are intrinsic elements of governance in health financing and critical for achieving universal health coverage. The government is ultimately responsible for implementing an appropriate framework for a transparent, accountable and reliable health-financing system, for ensuring that the intermediate institutions can perform their functions, for executing effective and powerful supervision, and for providing civil society with the means to demand transparency and good financial governance.
Health-financing indicators show the system’s ability to effectively mobilise and allocate resources, implement social protection and pooling schemes, and distribute the financial burden of care equitably. Essentially two groups of indicators exist for assessing governance in the health financing system: rules-based approaches consider the existence of appropriate policies, strategies, and codified approaches for governance; outcome-based indicators measure whether rules and procedures are effectively implemented or enforced and health-financing targets achieved.
We present the first comprehensive and systematic review on the structurally diverse toco-chromanols and -chromenols found in photosynthetic organisms, including marine organisms, and as metabolic intermediates in animals. The focus of this work is on the structural diversity of chromanols and chromenols that result from various side chain modifications. We describe more than 230 structures that derive from a 6-hydroxy-chromanol- and 6-hydroxy-chromenol core, respectively, and comprise di-, sesqui-, mono- and hemiterpenes. We assort the compounds into a structure–activity relationship with special emphasis on anti-inflammatory and anti-carcinogenic activities of the congeners. This review covers the literature published from 1970 to 2017.
- To strengthen its expanding role in global health, the German government is currently preparing a new global health strategy, to be published in 2019.
- As social, political and economic determinants are highly relevant for population health, the German government will need to increase coherence in order to promote its emphasis on creating equal opportunities and reducing inequalities in and between countries.
- For further strengthening its commitment to universal health coverage, for promoting decent work and healthy labour conditions, and for enforcing the right to health, the German government will have to stress the mandatory role of the public sector for global health
The aim of this paper is to examine the causes of food waste and potential prevention strategies from a grocery retail store owner’s perspective. We therefore conducted a case study in a German region through semi-structured expert interviews with grocery retail store owners. From the collected responses, we applied a qualitative content analysis. The results indicated that store owners try to avoid food waste as this incurs a financial loss for them that directly affects them personally, as opposed to store managers of supermarket chains who receive a fixed salary. The main causes of food waste in the grocery retail stores in the region surveyed are expiration dates, spoilage, consumer purchasing behavior, and over-ordering of food products. The most appropriate food waste prevention strategies developed by store owners are those based on store owners’ experience and their own management style, such as the optimization of sales and management strategies, including precise planning, accurate ordering, and timely price reductions on soon-to-be-expiring food products. The redistribution of food surpluses as donations to food banks, employees, and as animal feed further helps to reduce the amount of food waste, but not the financial loss. This study enhances the literature by revealing that grocery retail store owners have the ability and are willing to successfully implement and enforce food prevention strategies in their stores.
Climate change is a global challenge, with estimated mitigation costs ranging from $1.6 to $3.8 trillion per year. As a pioneer in climate action, the European Union has the most exten-sive emissions trading system worldwide (90% of the global value of $759 billion in 2021). In this paper, we review the European Union's climate strategy, emphasizing the EU Emissions Trading System (EU ETS) development, and the role of tropical forest carbon credits for off-setting. We argue that the European Union continues to leave a significant potential of trop-ical forests as natural carbon sinks unattended. In contrast, we reveal that the regulators can learn from the experiences made in the past and the finalization of the rulebook for Article 6 of the Paris Agreement. We present a proposal on changes to the EU ETS regulation by con-verting the European Commission's proposal to increase the linear reduction factor from 2.2% to 4.2% to the eligibility of forest carbon credits, resulting in additional funding poten-tial for forestry projects to increase necessary carbon sinks. Simultaneously, allowing flexibil-ity of investing to a limited extent in neutralization projects mitigates the risk of overstress-ing regulated companies to reach the emission reduction targets.