• Analysis of human resources for health strategies and policies in 5 countries in Sub-Saharan Africa, in response to GFATM and PEPFAR-funded HIV-activities

      Cailhol, Johann; Craveiro, Isabel; Madede, Tavares; Makoa, Elsie; Mathole, Thubelihle; Parsons, Ann N; Van Leemput, Luc; Biesma, Regien; Brugha, Ruairi; Chilundo, Baltazar; et al. (2013-10-25)
      Abstract Background Global Health Initiatives (GHIs), aiming at reducing the impact of specific diseases such as Human Immunodeficiency Virus (HIV), have flourished since 2000. Amongst these, PEPFAR and GFATM have provided a substantial amount of funding to countries affected by HIV, predominantly for delivery of antiretroviral therapy (ARV) and prevention strategies. Since the need for additional human resources for health (HRH) was not initially considered by GHIs, countries, to allow ARV scale-up, implemented short-term HRH strategies, adapted to GHI-funding conditionality. Such strategies differed from one country to another and slowly evolved to long-term HRH policies. The processes and content of HRH policy shifts in 5 countries in Sub-Saharan Africa were examined. Methods A multi-country study was conducted from 2007 to 2011 in 5 countries (Angola, Burundi, Lesotho, Mozambique and South Africa), to assess the impact of GHIs on the health system, using a mixed methods design. This paper focuses on the impact of GFATM and PEPFAR on HRH policies. Qualitative data consisted of semi-structured interviews undertaken at national and sub-national levels and analysis of secondary data from national reports. Data were analysed in order to extract countries’ responses to HRH challenges posed by implementation of HIV-related activities. Common themes across the 5 countries were selected and compared in light of each country context. Results In all countries successful ARV roll-out was observed, despite HRH shortages. This was a result of mostly short-term emergency response by GHI-funded Non-Governmental Organizations (NGOs) and to a lesser extent by governments, consisting of using and increasing available HRH for HIV tasks. As challenges and limits of short-term HRH strategies were revealed and HIV became a chronic disease, the 5 countries slowly implemented mid to long-term HRH strategies, such as formalisation of pilot initiatives, increase in HRH production and mitigation of internal migration of HRH, sometimes in collaboration with GHIs. Conclusion Sustainable HRH strengthening is a complex process, depending mostly on HRH production and retention factors, these factors being country-specific. GHIs could assist in these strategies, provided that they are flexible enough to incorporate country-specific needs in terms of funding, that they coordinate at global-level and minimise conditionality for countries.
    • Child health policy and practice in times of recession: findings from Ireland

      Hanafin, Sinéad; Coyne, Imelda; 1Visiting Research Fellow, School of Nursing & Midwifery, Trinity College Dublin. 2Professor of Children’s Nursing and Research, School of Nursing & Midwifery,Trinity College Dublin. (Scienpress Ltd, 2015-09)
    • Community care services: an overview

      National Economic and Social Council (NESC) (National Economic and Social Council (NESC), 1987-10)
    • Diageo's 'Stop Out of Control Drinking' Campaign in Ireland: An Analysis.

      Petticrew, Mark; Fitzgerald, Niamh; Durand, Mary Alison; Knai, Cécile; Davoren, Martin; Perry, Ivan (PLoS (Public Library of Science), 2016)
      It has been argued that the alcohol industry uses corporate social responsibility activities to influence policy and undermine public health, and that every opportunity should be taken to scrutinise such activities. This study analyses a controversial Diageo-funded 'responsible drinking' campaign ("Stop out of Control Drinking", or SOOCD) in Ireland. The study aims to identify how the campaign and its advisory board members frame and define (i) alcohol-related harms, and their causes, and (ii) possible solutions.
    • Do primary care professionals agree about progress with implementation of primary care teams: results from a cross sectional study

      Tierney, E.; O’Sullivan, M.; Hickey, L.; Hannigan, A.; May, C.; Cullen, W.; Kennedy, N.; Kineen, L.; MacFarlane, A. (2016-11-22)
      Abstract Background Primary care is the cornerstone of healthcare reform with policies across jurisdictions promoting interdisciplinary team working. The effective implementation of such health policies requires understanding the perspectives of all actors. However, there is a lack of research about health professionals’ views of this process. This study compares Primary Healthcare Professionals’ perceptions of the effectiveness of the Primary Care Strategy and Primary Care Team (PCT) implementation in Ireland. Methods Design and Setting: e-survey of (1) General Practitioners (GPs) associated with a Graduate Medical School (N = 100) and (2) Primary Care Professionals in 3 of 4 Health Service Executive (HSE) regions (N = 2309). After piloting, snowball sampling was used to administer the survey. Descriptive analysis was carried out using SPSS. Ratings across groups were compared using non-parametric tests. Results There were 569 responses. Response rates varied across disciplines (71 % for GPs, 22 % for other Primary Healthcare Professionals (PCPs). Respondents across all disciplines viewed interdisciplinary working as important. Respondents agreed on lack of progress of implementation of formal PCTs (median rating of 2, where 1 is no progress at all and 5 is complete implementation). GPs were more negative about the effectiveness of the Strategy to promote different disciplines to work together (median rating of 2 compared to 3 for clinical therapists and 3.5 for nurses, P = 0.001). Respondents identified resources and GP participation as most important for effective team working. Protected time for meetings and capacity to manage workload for meetings were rated as very important factors for effective team working by GPs, clinical therapists and nurses. A building for co-location of teams was rated as an important factor by nurses and clinical therapists though GPs rated it as less important. Payment to attend meetings and contractual arrangements were considered important factors by GPs but not by nurses or clinical therapists. Conclusion PCPs and GPs agree there is limited PCT implementation. GPs are most negative about this implementation. There is some disagreement about which resources are most important for effective PCT working. These findings provide valuable data for clinicians and policy makers about implementation of interdisciplinary teams in primary care.
    • The efficacy of different models of smoke-free laws in reducing exposure to second-hand smoke: A multi-country comparison

      Ward, Mark; Currie, L; Kabir, Zubair; Clancy, L; TobaccoFree Research Institute, The Digital Depot, Thomas Street, Dublin 8, Ireland (Elsevier, 2013-02-14)
    • Ethical, scientific and legal issues concerning stem cell research: opinion.

      Irish Council for Bioethics (Irish Council for Bioethics (ICB), 2008)
    • Frameworks for self-management support for chronic disease: a cross-country comparative document analysis.

      Mc Carthy, Vera J C; Savage, Eileen; O Connell, Selena; School of Nursing & Midwifery, University College Cork (BMC health services research, 2018-07-25)
      In a number of countries, frameworks have been developed to improve self-management support (SMS) in order to reduce the impact of chronic disease. The frameworks potentially provide direction for system-wide change in the provision of SMS by healthcare systems. Although policy formulation sets a foundation for health service reform, little is currently known about the processes which underpin SMS framework development as well as the respective implementation and evaluation plans.
    • Future Directions in Health Policy: papers of a conference held in Malahide, Co. Dublin, 6th - 7th April, 1984.

      Council for Social Welfare (A Committee of the Catholic Bishops' Conference) (Council for Social Welfare (A Committee of the Catholic Bishops Conference), 1984)
    • General practice, multimorbidity and evidence based policy making: A key challenge

      Murphy, ME; Glynn, L; Murphy, AW; NUI Galway (Irish Medical Journal, 2014)
    • Health and the future of healthcare

      Healy, Sean J.; Reynolds, Brigid (Mercy Ireland. Conference of Major Religious Superiors, Ireland., 1990)
    • Healthcare utilisation among cancer survivors over 50 years of age

      Coughlan, D; Doherty, E; Frick, K; Ward, P; O’Neill, C (Irish Medical Journal, 2016-02)
    • The impact of austerity on the health workforce and the achievement of human resources for health policies in Ireland (2008–2014)

      Williams, Des; Thomas, Steve (2017-09-11)
      Abstract Background The global economic crisis saw recessionary conditions in most EU countries. Ireland’s severe recession produced pro-cyclical health spending cuts. Yet, human resources for health (HRH) are the most critical of inputs into a health system and an important economic driver. The aim of this article is to evaluate how the Irish health system coped with austerity in relation to HRH and whether austerity allowed and/or facilitated the implementation of HRH policy. Methods The authors employed a quantitative longitudinal trend analysis over the period 2008 to 2014 with Health Service Executive (HSE) staff database as the principal source. For the purpose of this study, heath service employment is defined as directly employed whole-time equivalent public service staffing in the HSE and other government agencies. The authors also examined the heath sector pay bill and sought to establish linkages between the main staff database and pay expenditure, as given in the HSE Annual Accounts and Financial Statements (AFS), and key HRH policies. Results The actual cut in total whole-time equivalent (WTE) of directly employed health services human resources over the period 2008 to 2014 was 8027 WTE, a reduction of 7.2% but substantially less than government claims. There was a degree of relative protection for frontline staffing decreasing by 2.9% between 2008 and 2014 and far less than the 18.5% reduction in other staff. Staff exempted from the general moratorium also increased by a combined 12.6%. Counter to stated policy, the decline in staffing of non-acute care was over double than in acute care. Further, the reduction in directly employed staff was to a great extent matched by a marked increase in agency spending. Conclusions The cuts forced substantial HRH reductions and yet there was some success in pursuing policy goals, such as increasing the frontline workforce while reducing support staff and protection of some cadres. Nevertheless, other policies failed such as moving staff away from acute settings and the claimed financial savings were substantially offset by overtime payments and the need to hire more expensive agency workers. There was also substantial demotivation of staff as a consequence of the changes.
    • Indicators of health system coverage and activity in Ireland during the economic crisis 2008-2014 - from 'more with less' to 'less with less'.

      Burke, Sara; Thomas, Steve; Barry, Sarah; Keegan, Conor; Centre for Health Policy and Management, School of Medicine, 3-4 Fosters Place, Trinity College, Dublin 2, Ireland. Electronic address: sarabur@gmail.com. (2014-09)
      A new Irish government came to power in March 2011 with the most radical proposals for health system reform in the history of the state, including improving access to healthcare, free GP care for all by 2015 and the introduction of Universal Health Insurance after 2016. All this was to be achieved amidst the most severe economic crisis experienced by Ireland since the 1930s. The authors assess how well the system coped with a downsizing of resources by an analysis of coverage and health system activity indicators. These show a health system that managed 'to do more with less' from 2008 to 2012. They also demonstrate a system that was 'doing more with less' by transferring the cost of care onto people and by significant resource cuts. From 2013, the indicators show a system that has no choice but 'to do less with less' with diminishing returns from crude cuts. This is evident in declining numbers with free care, of hospital cases and home care hours, alongside increased wait-times and expensive agency staffing. The results suggest a limited window of benefit from austerity beyond which cuts and rationing prevail which is costly, in both human and financial terms.
    • Industrial relations conflict in Irish hospitals: a review of Labour Court cases

      Cowman, Jennifer; Keating, Mary A.; University of Dublin, Trinity College (Emerald Group Publishing Limited, 2013)
    • Mental health reform in Ireland: social workers’ perceptions of progress

      Browne, Frank; Shera, Wes; Health Service Executive, Ballyfermot Primary Care and Mental Health Centre (Irish Association of Social Workers, 2010)