Social policy in sub-Saharan Africa: a glance in the rear-view mirror

In this article we take a retrospective look at social policy in post-colonial sub-Saharan Africa and account for two distinct phases. The first phase, from 1960 to 1980, is the nationalist phase; the second, framed by the neoliberal policy regime, marked the last two decades of the 20th century. We argue that social policy in the nationalist phase played a transformative role – intrinsic and instrumental. Investment in education and healthcare, rather than social protection, was the key policy instrument. The weaknesses of the period included a growing authoritarianism and failure to transform the inherited colonial political economies. The retrenchment of the public realm under the neoliberal regime led to massive entitlement failure, and the crisis of citizenship and statehood. We argue for a return to a broader vision of social policy, underpinned by the ethos of democratic and socially inclusive development.     

Community Activism in the USA: Catholic Hospital Mergers and Reproductive Access

This article analyzes how grassroots organizing diminishes the potential loss of reproductive services in communities affected by Catholic hospital mergers. The empirical contribution of this study is to highlight changing patterns of pro-choice social movement mobilization and approaches to conflict resolution in the reproductive rights arena. To discover how Catholic hospital mergers threaten access to reproductive services, five case studies based in diverse regional and demographic areas throughout the USA are developed. From the case studies, we analyze which organizational factors most strongly influence the preservation of services. Among the variables which may affect outcomes are: characteristics of the acquiring institution, the type of coalition created to terminate the merger, the failure of pro-life activists to counter-mobilize, incentives for compromise on both sides, and regulatory intervention by government or state action. The study concludes that this new phase of the abortion struggle represents renewed vigor among local pro-choice activists and demonstrates that grassroots coalitions who oppose the curtailment of services often preserve reproductive healthcare options in their communities by creating alliances with professionals and other coalition partners.     

Health and Cultural Determinants of Voluntary HIV Testing and Counseling Among Middle-Aged and Older Latina Women

The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.     

Unaffordable healthcare amid phenomenal growth: the case of healthcare protection in reform China

This article provides an up-to-date assessment of China's reformed urban healthcare system. It illustrates that, in the Chinese case, economic growth does not automatically bring equitable healthcare protection; policy and system designs are also important. The article finds that the reformed urban healthcare system is financially sustainable, but that individual citizens contribute the largest share of healthcare costs, whilst the state is reducing its financial commitment. It also reports the views of two principal stakeholder groups. The survey findings indicate the endorsement of an old ethos for a strong state in healthcare protection. But a substantial minority view is also unveiled, which supports access to healthcare on the basis of insurance contributions. In sum, affordability remains a critical issue for the Chinese despite the fact that they have a new healthcare system and a strong economy.     

Blocking in Healthcare Operations: A New Heuristic and an Application

We consider the problem of optimal capacity allocation in a hospital setting, where patients pass through a set of units, for example intensive care and acute care (AC), or AC and post‐acute care. If the second stage is full, a patient whose service at the first stage is complete is blocked and cannot leave the first stage. We develop a new heuristic for tandem systems to efficiently evaluate the effects of such blocking on system performance and we demonstrate that this heuristic performs well when compared with exact solutions and other approaches presented in the literature. In addition, we show how our tandem heuristic can be used as a building block to model more complex multi‐stage hospital systems with arbitrary patient routing, and we derive insights and actionable capacity strategies for a real hospital system where such blocking occurs between units.     

英国医疗保障制度现状、问题及改革

英国既是世界上首个工业化与福利国家,医疗卫生服务在社会政策框架中占据主导地位,又是最早提供医疗照顾和推进内部市场改革的国家,其卫生制度创新积累了宝贵的历史经验.文章旨在论述、探讨英国医疗保障制度的现状、问题与改革,以期对处于十字路口的中国医疗卫生制度改革创新提供历史借鉴和政策启示.     

How do you measure trust in social institutions and health professionals? A systematic review of the literature (2012–2021)

The importance of measuring trust in health systems has been accentuated due to its correlation with important health outcomes aimed at reducing COVID-19 transmission. A systematic review published almost a decade ago identified gaps in measures including the lack of focus on trust in systems, inconsistency regarding the dimensionality of trust and need for research to strengthen the validity of measures. Given developments in our understandings of trust since its publication, we sought to identify new scales developed, existing ones adapted in response to identified gaps, and agendas for future research. Using the PRISMA approach for systematic reviews, we conducted a search in four databases. A total of 26 articles were assessed. Twelve new scales were identified, while 14 were adapted for different settings and populations. Literature continues to focus on measuring trust in health professionals rather than systems. Various shortcomings were identified, including some articles not mentioning the dimensions included in the scale and suboptimal use of validity and reliability testing and/or reporting. Moreover, a variety of terms were used for dimensions. Future research is needed to address these gaps and consequently, to understand their correlation with health behaviors and outcomes more accurately.     

Parental experiences with changes in maternity care during the Covid-19 pandemic: A mixed-studies systematic review

BackgroundDuring the COVID-19 pandemic, pregnant women were identified as a high-risk and vulnerable group. To reduce risk of transmission, maternity healthcare services were modified to limit exposure but maintain services for pregnant women. However, the change in hospital practice may have compromised quality maternal care standards. Therefore, this review aims to explore parental experiences and views with maternity care received from healthcare institutions during the COVID-19 pandemic.MethodsA mixed studies systematic review was conducted. Six electronic databases (Medline, CINAHL, Embase, PsycInfo, Web of Science, and Maternity and Infant Care) were searched for qualitative, observational, and mixed method studies from the year 2019 to February 2022. Study quality was appraised using the Mixed Methods Appraisal Tool. Quantitative findings were converted to narrative findings. Data was synthesised thematically using a convergent synthesis design.ResultsFifty-eight articles were included. Four themes were generated: (1) Distress associated with COVID-19 regulations (perception of hospital restrictions, confusion with ever changing policies), (2) adaptability with maternity services (prenatal: changes in birth plans, prenatal: altered antenatal appointments, education, and care, intrapartum: medicalization of birth, postpartum: varied views on care received and Breastfeeding woes, postpartum: skin-to-skin contact and mother infant bonding) (3) importance of support persons, and (4) future direction for maternity services.ConclusionsParental experiences highlighted how maternity care during the COVID-19 pandemic did not adhere to WHO standards of quality maternity care. This calls for healthcare institutions to continuously appraise the implementation of restrictive practices that deviate from evidence-based frameworks underpinning quality care.