Poor practice by health care workers has been identified as contributing to high levels of maternal mortality in South Africa. The country is undergoing substantial structural and financial reforms, yet the impact of these on health care workers performance and practice has not been studied. This study, which consisted of an ethnography of two labour wards (one rural and one urban), aimed to lo...

Purpose: School district superintendents say politics is the number one factor limiting their performance, yet research provides limited guidance on navigating the political dynamics of district improvement. State takeovers and district-wide turnaround efforts tend to involve particularly heated and polarized debates. Massachusetts’ 2012 takeover of the Lawrence Public Schools provides a rare c...

AIM To investigate, describe and classify main health policies and reform activities within the healthcare system undertaken over the past twenty years in R. Macedonia. METHODS Desk research was conducted on scientific literature and relevant documentation (in English and Macedonian) about healthcare reforms. Relevant documents available at the Ministry of Health, Health Insurance Fund, World...

In 2001 the World Health Organization ranked the small Central American nation of Costa Rica 36th out of 191 countries for health system performance. Experts hail this as the result of health care reforms which changed the structure of the Costa Rican system and dramatically improved primary health care (PHC). Costa Rica, which has a population of 3.8 million, famously abolished its army in 194...

In recent years, states have looked to reforms in advanced practice nursing scope of practice (SOP) barriers as a potential means to increase access to primary care while reducing costs. Currently, 16 states and the District of Columbia permit advanced practice registered nurses to practice independently of physicians, allowing them to perform functions such as diagnosing and prescribing under ...

How do International Monetary Fund (IMF) policy reforms-so-called 'conditionalities'-affect government health expenditures? We collected archival documents on IMF programmes from 1995 to 2014 to identify the pathways and impact of conditionality on government health spending in 16 West African countries. Based on a qualitative analysis of the data, we find that IMF policy reforms reduce fiscal ...

The district health system in Ghana today is characterized by high resource-uncertainty and narrow decision-space. This article builds a theory-driven historical case study to describe the influence of path-dependent administrative, fiscal and political decentralization processes on development of the district health system and district manager decision-space. Methods included a non-exhaustive ...

decentralisation continues to re-appear in health system reform across the world. evaluation of these reforms reveals how research on decentralisation continues to evolve. in this paper, we examine the theoretical foundations and empirical references which underpin current approaches to studying decentralisation in health systems.

Background In early 1990s, Tanzania like other African countries, adopted health sector reform (HSR). The most strongly held centralisation system that informed the nature of services provision including health was, thus, disintegrated giving rise to decentralisation system. It was within the realm of HSR process, user fees were introduced in the health sector. Along with user fees, various typ...