Browsing by Person "Hanson, Kara"

Now showing 1 - 7 of 7

Chapter 6: Human resources and the health sector
(Oxford University Press, 2011-11) McPake, Barbara; Hanson, Kara; Smith, Richard
How to do (or not to do) : designing a discrete choice experiment for application in a low-income country
(2008-12) Mangham, L.; Hanson, Kara; McPake, Barbara
Understanding the preferences of patients and health professionals is useful for health policy and planning. Discrete choice experiments (DCEs) are a quantitative technique for eliciting preferences that can be used in the absence of revealed preference data. The method involves asking individuals to state their preference over hypothetical alternative scenarios, goods or services. Each alternative is described by several attributes and the responses are used to determine whether preferences are significantly influenced by the attributes and also their relative importance. DCEs are widely used in high-income contexts and are increasingly being applied in low- and middle-income countries to consider a range of policy concerns. This paper aims to provide an introduction to DCEs for policy-makers and researchers with little knowledge of the technique. We outline the stages involved in undertaking a DCE, with an emphasis on the design considerations applicable in a low-income setting.
International flow of Zambian nurses
(2009-11) Hamada, Naomi; Maben, Jill; McPake, Barbara; Hanson, Kara
This commentary paper highlights changing patterns of outward migration of Zambian nurses. The aim is to discuss these pattern changes in the light of policy developments in Zambia and in receiving countries. Prior to 2000, South Africa was the most important destination for Zambian registered nurses. In 2000, new destination countries, such as the United Kingdom, became available, resulting in a substantial increase in migration from Zambia. This is attributable to the policy of active recruitment by the United Kingdom's National Health Service and Zambia's policy of offering Voluntary Separation Packages: early retirement lump-sum payments promoted by the government, which nurses used towards migration costs. The dramatic decline in migration to the United Kingdom since 2004 is likely to be due to increased difficulties in obtaining United Kingdom registration and work permits. Despite smaller numbers, enrolled nurses are also leaving Zambia for other destination countries, a significant new development. This paper stresses the need for nurse managers and policy-makers to pay more attention to these wider nurse migration trends in Zambia, and argues that the focus of any migration strategy should be on how to retain a motivated workforce through improving working conditions and policy initiatives to encourage nurses to stay within the public sector.
Managing the public-private mix to achieve universal health coverage
(Elsevier, 2016-06-26) McPake, Barbara; Hanson, Kara
The private sector has a large and growing role in health systems in low-income and middle-income countries. The goal of universal health coverage provides a renewed focus on taking a system perspective in designing policies to manage the private sector. This perspective requires choosing policies that will contribute to the performance of the system as a whole, rather than of any sector individually. Here we draw and extrapolate main messages from the papers in this Series and additional sources to inform policy and research agendas in the context of global and country level efforts to secure universal health coverage in low-income and middle-income countries. Recognising that private providers are highly heterogeneous in terms of their size, objectives, and quality, we explore the types of policy that might respond appropriately to the challenges and opportunities created by four stylised private provider types: the low-quality, underqualified sector that serves poor people in many countries; not-for-profit providers that operate on a range of scales; formally registered small-to-medium private practices; and the corporate commercial hospital sector, which is growing rapidly and about which little is known. 2016 Elsevier Ltd.
Service and population-based exemptions: are these the way forward for equity and efficiency in health financing in low income countries?
(Emerald, 2009) Witter, Sophie; Chernichovsky, Don; Hanson, Kara
The importance of human resources management (HRM) to the success or failure of health systemperformance has, until recently, been generally overlooked. In recent years it has been increasinglyrecognised that getting HR policy and management right has to be at the core of any sustainablesolution to health system performance. In comparison to the evidence base on health care reformrelatedissues of health system finance and appropriate purchaser/provider incentive structures,there is very limited information on the HRM dimension or its impact.Despite the limited, but growing, evidence base on the impact of HRM on organisationalperformance in other sectors, there have been relatively few attempts to assess the implications ofthis evidence for the health sector. This paper examines this broader evidence base on HRM inother sectors and examines some of the underlying issues related to good HRM in the healthsector.The paper considers how human resource management (HRM) has been defined and evaluated inother sectors. Essentially there are two sub-themes: how have HRM interventions been defined?and how have the effects of these interventions been measured in order to identify whichinterventions are most effective? In other words, what is good HRM?The paper argues that it is not only the organisational context that differentiates the health sectorfrom many other sectors, in terms of HRM. Many of the measures of organisational performanceare also unique. Performance in the health sector can be fully assessed only by means of indicatorsthat are sector-specific. These can focus on measures of clinical activity or workload (e.g. staff peroccupied bed, or patient acuity measures), on measures of output (e.g. number of patients treated)or, less frequently, on measures of outcome (e.g. mortality rates or rate of post-surgerycomplications).The paper also stresses the need for a fit between the HRM approach and the organisationalcharacteristics, context and priorities, and for recognition that so-called bundles of linked andcoordinated HRM interventions will be more likely to achieve sustained improvements inorganisational performance than single or uncoordinated interventions.
To retain or remove user fees? : reflections on the current debate in low- and middle-income countries
(Adis International, 2006) James, Chris; Hanson, Kara; McPake, Barbara; Balabanova, D.; Gwatkin, Davidson; Hopwood, Ian; Kirunga, Christina; Knippenberg, Rudolph; Meessen, Bruno; Morris, Saul S.; Preker, Alexander; Souteyrand, Yves; Tibouti, Abdelmajid; Villeneuve, Pascal; Xu, Xu, Ke
Many low- and middle-income countries continue to search for better ways of financing their health systems. Common to many of these systems are problems of inadequate resource mobilisation, as well as inefficient and inequitable use of existing resources. The poor and other vulnerable groups who need healthcare the most are also the most affected by these shortcomings. In particular, these groups have a high reliance on user fees and other out-of-pocket expenditures on health which are both impoverishing and provide a financial barrier to care. It is within this context, and in light of recent policy initiatives on user fee removal, that a debate on the role of user fees in health financing systems has recently returned. This paper provides some reflections on the recent user fees debate, drawing from the evidence presented and subsequent discussions at a recent UNICEF consultation on user fees in the health sector, and relates the debate to the wider issue of access to adequate healthcare. It is argued that, from the wealth of evidence on user fees and other health system reforms, a broad consensus is emerging. First, user fees are an important barrier to accessing health services, especially for poor people. They also negatively impact on adherence to long-term expensive treatments. However, this is offset to some extent by potentially positive impacts on quality. Secondly, user fees are not the only barrier that the poor face. As well as other cost barriers, a number of quality, information and cultural barriers must also be overcome before the poor can access adequate health services. Thirdly, initial evidence on fee abolition in Uganda suggests that this policy has improved access to outpatient services for the poor. For this to be sustainable and effective in reaching the poor, fee removal needs to be part of a broader package of reforms that includes increased budgets to offset lost fee revenue (as was the case in Uganda). Fourthly, implementation matters: if fees are to be abolished, this needs clear communication with a broad stakeholder buy-in, careful monitoring to ensure that official fees are not replaced by informal fees, and appropriate management of the alternative financing mechanisms that are replacing user fees. Fifthly, context is crucial. For instance, immediate fee removal in Cambodia would be inappropriate, given that fees replaced irregular and often high informal fees. In this context, equity funds and eventual expansion of health insurance are perhaps more viable policy options. Conversely, in countries where user fees have had significant adverse effects on access and generated only limited benefits, fee abolition is probably a more attractive policy option. Removing user fees has the potential to improve access to health services, especially for the poor, but it is not appropriate in all contexts. Analysis should move on from broad evaluations of user fees towards exploring how best to dismantle the multiple barriers to access in specific contexts.
Two-tier charging strategies in public hospitals : implications for intra-hospital resource allocation and equity of access to hospital services
(2007) McPake, Barbara; Hanson, Kara; Adam, Christopher
Two-tier charging, the practice of offering separate qualities of service at different prices, is a growing practice in public hospitals internationally. This paper models two-tier charging as a Stackelberg game in which the Ministry of Health leads by setting prices and a representative hospital follows by setting quality levels to maximise surplus in response. Whether or not two-tier charging will secure cross-subsidy from superior to basic service users depends on the own and cross-quality effects of the demand functions for the two services. Under a range of assumptions, the policy will evoke cross-subsidy from basic to superior services.