The International Health Architecture and Its Mission on Available Policies - Coursework Example

Table of Contents 1.0.Introduction 1 2.0.The International Health Architecture and Its Mission on Available Policies 2 3.0.Sustainable Financing for the internationally adopted Policy 5 4.0.The International Policy and Health Related Problems Mismatch 7 5.0.Effects of the challenges on the health policies 8 6.0.Conclusion 8 7.0.References 9 1.0. Introduction As Bauld and Judge (2008) note, health policies have been on increase therefore practices and processes by policy actors have to be streamlined so that there can be clear evidence concerning the effectiveness of such policies (p. 1). However, such effectiveness requires a well thought for health policy implementation procedure. John Last while studying A Brief History of Advances Toward Health (John, 2005) contends that no matter the policy that has been prioritised, the constellation of international health policy still face challenges that if not well structured, could torpedo the already lofty, normally extraordinary goals that countries have set so as to meet health care goals. Studies such as Baker and Fidlert (2006); Callahan (2011) have categorised international challenges on health policy in terms of those brought by money while others have been related with the mismatch between the structure of international health policy itself and the looming priorities of mission (Callahan, 2011; American Nurses Association, 2001). Contemporary scholars such as Hamel and Nairn (2011) have argued that challenges facing international health policy are embedded on planetary environment within which world health practitioners operate. This is to mean that bureaucracies such as political environment are a key challenge to such international policies. World Health Organization (WHO) recognise that international health policies have steadily been hampered by financial crises thus becoming nothing less of built atop a far less ambitious as well as poorly funded set of policies that fall under the rubrics of any other policy (World Health Organization, 2008). This study builds from the researches above to critically assess challenges to international health policy. Theoretical underpinnings and reports gathered from such challenges will help develop comparative analysis on how to asses whether such challenges progress or inhibit policy in health. 2.0. The International Health Architecture and Its Mission on Available Policies Starting with Global Burden of Diseases Study (GBD) 2010 as cited in United Nations (2012), current health trends face a big challenge due to mismatched health architecture and the mission set. Mismatched health architecture and the mission set has been defined by Katz and Fischer (2010) as a situation where the policy set does not reflect common health problems large is facing at the time of implementation of a given health related policy. Global Burden of Diseases Study further shows that there are significant policies that intend to bring drastic changes to global health but with one notable challenge. Beginning from a different perspective but in a related way, the problems and incidences of chronic disease mortality plummeted between 1998 and 2010, there were number of children who perished before the age of five (African Summit on HIV/AIDS, 2001). This was attributed to Affordable Medicines Facility—malaria (AMFm) as an international policy that aimed at financing and facilitating increase in access to cheap and effective malaria treatment as well as delay resistance to the last remaining effective drug. Connecting this point to the international health architecture as a challenge that affects international policy on health, it is worth noting that there has been drastic change in life expectancy and causes of death which now requires radical but new directions in international health policies and efforts. According to Global Fund (2009), there was slightly above 52.8 million deaths as a result of health related complications (maternal, neonatal, communicable and nutritional causes leading). This made international policies makers to draft new strategies to rectify the trend in as much there was already an international health policy to contend with. As a matter of fact, post-2015 Millennium Development Goals has seen the intensification of Universal Health Coverage (UHC) that was aimed at slowing down the statistic as shown above (United Nations 2012). However, international health architecture means that Universal Health Coverage as a policy may not be fully implemented as there are new trends of death that claims more life other than the ones that had been identified in the ‘52.8 million deaths’ agenda. For instance, in 2012, Pariser (2013) reports that diabetes, cardiovascular diseases, cancer and senility were leading health related concerns internationally therefore implementing the newly ratified Universal Health Coverage as a policy had to be stopped so as to take care of the emerging global health architecture. Bauld and Judge (2008) discuss this challenge from the perspective of ‘Practical examples from the Health Action Zones’ (p. 97). Bauld and Judge argue that policies can only be successful if it aims at tackling general health problems faced by what they term as ‘Health Action Zone’. However, if there are instance where there are other emerging health concerns (health architecture) then it will be a challenge to implement a given policy in health. The architecture of international health currently reflects disease-specific silos that aim to finance tuberculosis, HIV/AIDS, maternal health but forgetting critical issues such as malaria (African Summit on HIV/AIDS, 2001). This according Summit has greatly affected the implementation of policies that have been passed. To specify such policies, immediately before the 2010/2011 scandals at the Global Fund, there was a policy that the institution (Global Fund) should be mandated to act as all-health provide but such failed due to fractured and multiplicity of health related issues. Therefore a policy to finance tuberculosis, HIV/AIDS and maternal health was altered so as to take care of the emerging trends in malaria. Contextualising this argument, there was a policy passed by World Health Organization (WHO) and United Nations AIDS Programme (UNAIDS) that aimed at reducing prevalence of HIV/AIDS in West Africa (World Health Organization, 2012). However, due to a new health architecture where Ebola is now claiming more lives in Sierra Leone, Guinea, Nigeria and Liberia, the policy as set by World Health Organization (WHO) and United Nations AIDS Programme has to be affected because attention has to turn to Ebola hit countries and possible strategies of averting the menace before it spreads to other countries (by 5th October 3, 2014 Ebola had claimed 1,421 lives in Liberia alone according to World Health Organization). 3.0. Sustainable Financing for the internationally adopted Policy It is apparent from the reports released by World Health Organization that a number of countries have the will power to adopt international health policy but again the very same countries have highly depended on external support with regard to such policy implementation (World Health Organization, 2012). To some extent, it has been reported that these countries struggle to generate revenues but cannot meet standards set by policy setters. To contextualise this statement, one of the international policies that have been adopted for all countries is that there need to be universal access to healthcare. Arguing from this point, developing countries, especially those that are still lacking extraction industries are unlikely to attain such lofty and self-sustaining goals. Bauld and Judge (2008) argue that Health Action Zones (HAZs) established in 1998 to act as trailblasers in modernising health related issues have struggled due to unsustainable finances. According to Bauld and Judge, it has been tricky for policies set to be fully implemented by Health Action Zones due to financial constraints. While the argument above relates to developing countries, studies such as Woods (2011) have shown that even world economic superpowers face a challenge to effectively deal with international health policies due to inadequate sustainable finances. Basing on latest report released by Lachman (2009) China received approximately $2.2 billion Overseas Development Aid (ODA) in 2005 to facilitate the implementation of health related policies. However, Lachman (2009) further reports that such amount was not enough in implementing the strategic plans China government had thus failing the objectives of the policy. The conclusion that can be made from the analysis Lachman (2009) is that international policies on health policy requires well planned funding and that if it remain dependent on internal revenues then such policies will not be successful. Still on lack of sustainable financing for international policy on health, estimates for United Nations AIDS Programme (UNAIDS) by Oxford Policy Management 2012 shows that financial commitments to health policies and programmes have dropped significantly thus affecting the ability of recipient countries to effect the international policies on the same (National Bureau of Statistics 2013). Bauld and Judge (2008) discuss this challenge in the sub-topic ‘The theory of change approach to evaluation’ (p. 95). In the analysis, the two writers postulate that policies that affect how health related issues can be run depend on the finances delegated in what they term as ‘Comprehensive Community Initiatives’ (p. 95). To be specific, they add that such policies set out how objectives should be attained and how to measure outcomes. However, such are difficult to attain due to lack of proper financing models. What Bauld and Judge aim to explain with regard to the theory of change approach to evaluation is that without proper planning on how the policy will be implemented financially; there is no linkage between the planned activity and the problem that should be solved. In 2007 only 12 governments and about 14 philanthropic organisations donated 53 percent of funding that was aimed at progressing research and Development (R & D) in the line of policies such as tuberculosis, malaria and HIV/AIDS eradication (National Bureau of Statistics, 2013). While there is international policy to eradicate these common diseases, there are other deadly diseases such as pneumonia that have clear policies but fail to get adequate financial fundings. According to United Nations AIDS Programme (UNAIDS) the policy to save lives of HIV/AIDS victim needs $4,090/life (National Bureau of Statistics 2013). Expressing such calculus realistically means that donors should be in forefront especially towards developing countries otherwise $4,090/life will not be attained. 4.0. The International Policy and Health Related Problems Mismatch Though Obamacare is not a policy that this study can be regard as international when it comes to health care, it is a good example that the study finds in attempt to show that one critical challenge to international policy in health is the mismatch between the policy set and the actual problems people face. To underscore Obamacare policy, the main issue is, families or even individuals must have bigger control of health care decisions and dollars that is done through patient-centred and competition-driven system however, Obamacare (Patient Protection and Affordable Care Act) does not reflect this belief because as a policy, it does not augur itself on evidence-based research and specific needs of people. Still on Obamacare, that is exactly the kind of situation where the theory of change approach has much to relate to international health policy. Relating the Obamacare with UNAIDS and reduction of persons death as an international policy, it can be noted that when examined critically, there is reasonably clear and specific statements of approach that were adopted in the strategic as well as the outcomes the policy desired. However, if the policy is compared with the evidence-based situation on the ground (probably in developing countries) there is lack of connectedness between actions, principles and intended outcomes. This is exactly what Bauld and Judge (2008) finds in relationship with their Health Action Zones (HAZs). Additionally, it is clear from study conducted by Pew Research Center (2009) that evidence-based research is not reflected in international policies that have been set. 5.0. Effects of the challenges on the health policies Based on the three challenges reviewed thus far, it is apparent that they negatively affect the progression of health related policies. However, such are embedded on theoretical underpinnings. The first theory that can best suit ways in which the challenges above inhibit the policies is the contextual interaction theory. This theory according to Sade (2007) deals with implementation of policy and at the same time considers policy process on health related issues. Just like Trotter (2011) notes, the point of departure is that policy implementation are coordinated and controlled by actors’ activities. The execution of any other aforementioned policies needs the participation of the actors as either target groups or implementers. Since the theory deals with policy implementation as a multi-actor process, sustainable financing as a challenge that has been identified is directly related with actors who may decide to finance the policy or prioritise on other issues thus inhibiting execution of the identified international policy. Secondly, the output of any policy depends on two critical issues; the challenges identified above and the assessment of the contribution of the policy goals. It can be concluded that the challenges as outlined in the analysis inhibit the progression of the already set international health policies. 6.0. Conclusion This study has reviewed a number of international health policies. Relating the policies to theoretical models that have been reviewed, there is need to find ways of improving the existing challenges. This study has identified three critical challenges that inhibit the progression of the already existing international policies. Additionally the study has identified three major areas that need attention with regard to the challenges; financial equity, the overall costs of care and the quality of care. Sustained improvements in these areas will eliminate problems encountered by the three challenges as well as advancing the main goal of health policy---health itself. 7.0. References African Summit on HIV/AIDS (2001). Tuberculosis and Other Related Infectious Diseases. 2001. Abuja Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases. http://www.un.org/ga/aids/pdf/abuja_declaration.pdf American Nurses Association (ANA). (2001). Code of ethics for nurses with interpretative statements. Silver Spring, MD: Author. Baker MG, Fidlert DP. (2006). Global Public Health Surveillance under New International Health Regulations. Emerg Infect Dis 2006; 12: 7. Bauld, Linda and Judge, Ken, (2008). Chapter 5: Strong Theory, Flexible Methods: Evaluating Complex Community-Based Initiatives. In Green, Judith and Labonte, Ronald (eds), Critical perspectives in public health , (pp.93 - 103). London: Routledge. Callahan, D. (2011). Health care reform: Can a communitarian perspective be salvaged? Theoretical Medicine and Bioethics, 32(5), 351-362. Global Fund. 2009. Debt2Health Overview. http://www.theglobalfund.org/en/innovativefinancing/debt2health/overview/ Hamel, R., and Nairn, T. (2011). The individual mandate: A rancorous moral matter. Health Progress, 92(4), 88-95. Katz R, Fischer J. (2010) The revised international Health Regulations: a framework for global pandemic response. Global Health Governance; 3: 2. Lachman, V.D. (2009). Ethical challenges in healthcare: Developing your moral compass. New York, NY: Springer. Last, John, (2005). A Brief History of Advances Toward Health.. In Gunn, William S.A. et al. (eds), Understanding the global dimensions of health, (pp.3 - 14). New York Springer. Lee K, Collin J. (2005) Global change and health. England: London School of Hygiene and Tropical Medicine. National Bureau of Statistics (2013). 2012 National Population and Housing census. Dar es Salaam, Tanzania: Ministry of Finance. Pariser, D.M. (2013). Ethical considerations in health care reform: Pros and cons of the affordable care act. Clinics in Dermatology, 30(2), 151-155. Pew Research Center (2009). Survey among 2,000 Americans, January 2009. http://online.wsj.com/article/SB10001424052970204683204574354383543314054.html Sade, R.M. (2007). Ethical foundations of health care system reform. Annuals of Thoracic Surgery, 84(5), 1429-1431. Trotter, G. (2011). The moral basis for healthcare reform in the United States. Cambridge Quarterly of Healthcare Ethics, 20(1), 102-107. United Nations. 2012. The Millenium Development Goals Report 2008. http://www.un.org/millenniumgoals/pdf/The%20Millennium%20Development%20Goals%20Report%202008.pdf. Woods M. (2011). The Interview is a Conversation with a Purpose. Palmerston North, New Zealand: School of Health & Social Services, Massey University. World Health Organization (2012). International Health Regulations: Toolkit for implementation in national legislation; Questions and answers, legislative reference and assessment tool and examples of national legislation. Geneva. World Health Organization (2008). Early warning and response to outbreaks and other public health events: a guide. New Delhi: WHO. Read More