Papers by Leon Bijlmakers
International journal of health policy and management, Oct 23, 2023
Background: The Disease Control Priorities 3 (DCP3) project provides long-term support to Pakista... more Background: The Disease Control Priorities 3 (DCP3) project provides long-term support to Pakistan in the development and implementation of its universal health coverage essential package of health services (UHC-EPHS). This paper reports on the priority setting process used in the design of the EPHS during the period 2019-2020, employing the framework of evidence-informed deliberative processes (EDPs), a tool for priority setting with the explicit aim of optimising the legitimacy of decision-making in the development of health benefit packages. Methods: We planned the six steps of the framework during two workshops in the Netherlands with participants from all DCP3 Pakistan partners (October 2019 and February 2020), who implemented these at the country level in Pakistan in 2019 and 2020. Following implementation, we conducted a semi-structured online survey to collect the views of participants in the UHC benefit package design about the prioritisation process. Results: The key steps in the EDP framework were the installation of advisory committees (involving more than 150 members in several Technical Working Groups [TWGs] and a National Advisory Committee [NAC]), definition of decision criteria (effectiveness, cost-effectiveness, avoidable burden of disease, equity, financial risk protection, budget impact, socioeconomic impact and feasibility), selection of interventions for evaluation (a total of 170), and assessment and appraisal (across the three dimensions of the UHC cube) of these interventions. Survey respondents were generally positive across several aspects of the priority setting process. Conclusion: Despite several challenges, including a partial disruption because of the COVID-19 pandemic, implementation of the priority setting process may have improved the legitimacy of decision-making by involving stakeholders through participation with deliberation, and being evidence-informed and transparent. Important lessons were learned that can be beneficial for other countries designing their own health benefit package such as on the options and limitations of broad stakeholder involvement.
Cost Effectiveness and Resource Allocation
Background Countries around the world are increasingly rethinking the design of their health bene... more Background Countries around the world are increasingly rethinking the design of their health benefit package to achieve universal health coverage. Countries can periodically revise their packages on the basis of sectoral cost-effectiveness analyses, i.e. by evaluating a broad set of services against a ‘doing nothing’ scenario using a budget constraint. Alternatively, they can use incremental cost-effectiveness analyses, i.e. to evaluate specific services against current practice using a threshold. In addition, countries may employ hybrid approaches which combines elements of sectoral and incremental cost-effectiveness analysis - a country may e.g. not evaluate the comprehensive set of all services but rather relatively small sets of services targeting a certain condition. However, there is little practical guidance for countries as to which kind of approach they should follow. Methods The present study was based on expert consultation. We refined the typology of approaches of cost-e...
Background Surgical perioperative deaths and major complications are important contributors to pr... more Background Surgical perioperative deaths and major complications are important contributors to preventable morbidity, globally and in sub-Saharan Africa. The surgical safety checklist (SSC) was developed by WHO to reduce surgical deaths and complications, through utilizing a team approach and a series of steps to ensure the safe transit of a patient through the surgical operation. This study explored enablers and barriers to the utilization of the Checklist at the University Teaching Hospital (UTH) in Lusaka, Zambia. Methods A qualitative case study was conducted involving members of surgical teams (doctors, anaesthesia providers, nurses and support staff) from the UTH surgical departments. Purposive sampling was used and 16 in-depth interviews were conducted between December 2018 and March 2019. Data were transcribed, organized and analysed using thematic analysis. Results Analysis revealed variability in implementation of the SSC by surgical teams, which stemmed from lack of senio...
BMJ Quality & Safety
BackgroundIn low-income and middle-income countries, an estimated one in three clinical adverse e... more BackgroundIn low-income and middle-income countries, an estimated one in three clinical adverse events happens in non-complex situations and 83% are preventable. Poor quality of care also leads to inefficient use of human, material and financial resources for health. Improving outcomes and mitigating the risk of adverse events require effective monitoring and quality control systems.AimTo assess the state of surgical monitoring and quality control systems at district hospitals (DHs) in Malawi, Tanzania and Zambia.MethodsA mixed-methods cross-sectional study of 75 DHs: Malawi (22), Tanzania (30) and Zambia (23). This included a questionnaire, interviews and visual inspection of operating theatre (OT) registers. Data were collected on monitoring and quality systems for surgical activity, processes and outcomes, as well as perceived barriers.Results53% (n=40/75) of DHs use more than one OT register to record surgical operations. With the exception of standardised printed OT registers i...
... Mary T. Bassett, Leon A. Bijlmakers, & David M. Sanders the main agricultural producers i... more ... Mary T. Bassett, Leon A. Bijlmakers, & David M. Sanders the main agricultural producers in peasant farming areas, shifts away from income based ... with most households finding that one source of income, whether from wages or agriculture, will not generate the cash needed for ...
Africa, 2001
... Page 3. Research Report No 105 Leon A. Biilmakers Mary T. Bassett David M. Sanders Socioecono... more ... Page 3. Research Report No 105 Leon A. Biilmakers Mary T. Bassett David M. Sanders Socioeconomic Stress, Health and Child ... Programme Coordinator and Series Editor: Adebayo Olukoshi Indexing terms Structural adjustment Child health Child nutrition Zimbabwe Language ...
Social Science & Medicine, Dec 1, 1997
In 1991, Zimbabwe embarked on a structural adjustment programme. In the health sector, collection... more In 1991, Zimbabwe embarked on a structural adjustment programme. In the health sector, collection of fees was enforced and fees were later increased. Utilisation subsequently declined. This paper examines the perceptions of both government nurses and health care consumers regarding the impact of adjustment on overall quality of care, including nurse professionalism, the nurse-client relationship and patient satisfaction with care. These issues were explored in a series of focus group discussions held in December 1993, about three years after policy reforms. The discussions suggested many areas of shared concern (fees, drug availability, waiting times), but divergent views regarding the process of care. Nurses were concerned mainly with overwork and patient ingratitude, and failed to recognise nurse behaviour as a major source of patient dissatisfaction. Community women saw nurses as hardened and indifferent, especially in urban areas. These differences are rooted in the perceived class differences between nurses and the communities they serve, but appear to have sharpened during the period of structural adjustment.
African Studies Review, Apr 1, 1998
Promotores prof. dr. A.J. Dietz prof. dr. C.M. Varkevisser Overige leden van de promotiecommissie... more Promotores prof. dr. A.J. Dietz prof. dr. C.M. Varkevisser Overige leden van de promotiecommissie prof dr. J. van der Gaag prof. dr. J.C. Hoorweg dr. B.H. Kinsey prof. dr. J.A. Kusin prof. dr. G.B. Woelk Faculteit der Maatschappij-en Gedragswetenschappen
This report was commissioned and produced under the auspices of the Nordic Africa Institute's pro... more This report was commissioned and produced under the auspices of the Nordic Africa Institute's programme on The Political and Social Context of Structural Adjustment in Sub-Saharan Africa. It is one of a series of reports published on the theme of structural adjustment and socioeconomic change in contemporary Africa.
Background Obstetric complications are difficult to predict and may require referral, expedited b... more Background Obstetric complications are difficult to predict and may require referral, expedited by ambulance use. We conducted a cost-effectiveness analysis comparing ambulance transfers and self-referrals in obstetric emergencies in a predominantly rural setting in Kenya. Methods A retrospective cross-sectional cost-effectiveness analysis using a healthcare system perspective was conducted of parturient women transferred by ambulance to a higher level hospital compared with self-referrals between January to June 2019. Direct costs needed for ambulance, self-referral and clinical care were calculated. Every woman admitted with a pregnancy-related complication was assessed using the adapted sub-Saharan African Maternal Near Miss (MNM) criteria. Each referred woman was categorized as: ‘necessary referral’ meaning that they were managed for either MNM or potentially life-threatening complications (PLTC) and ‘unnecessary referral’ meaning those with no obstetric complications. Increment...
Health Policy and Planning, 2018
Maternal mortality remains high in Eastern Cape Province, South Africa, despite over 90% of pregn... more Maternal mortality remains high in Eastern Cape Province, South Africa, despite over 90% of pregnant women utilizing maternal health services. A recent survey showed wide variation in performance among districts in the province. Heterogeneity was also found at the district level, where maternal health outcomes varied considerably among district hospitals. In ongoing research, leadership emerged as one of the key health systems factors affecting the performance of maternal health services at facility level. This article reports on a subsequent case study undertaken to examine leadership practices and the functioning of maternal health services in two resource-limited hospitals with disparate maternal health outcomes. An exploratory mixed-methods case study was undertaken with the two rural district hospitals as the units of analysis. The hospitals were purposively selected based on their maternal health outcomes: one reported good maternal health outcomes (pseudonym: Chisomo) and the other had poor outcomes (pseudonym: Tinyade). Comparative data were collected through a facility survey, non-participant observation of management and perinatal meetings, record reviews and interviews with hospital leadership, staff and patients to elicit information about leadership practices including supervision, communication and teamwork. Descriptive and thematic data analysis was undertaken. The two hospitals had similar infrastructure and equipment. Hospital managers at Chisomo used their innovation and entrepreneurial skills to improve quality of care, and leadership style was described as supportive, friendly, approachable but 'firm'. They also undertook frequent and supportive supervisory meetings. Each department at Chisomo developed its own action plan and used data to monitor their actions. Good performers were acknowledged in group meetings. Staff in this facility were motivated and patients were happy about the quality of services. The situation was different at Tinyade hospital. Participants described the leadership style of their senior managers as authoritarian. Managers were rarely available in the office and did not hold regular meetings, leading to poor communication across teams and poor coordination to address resource constraints. This demotivated the staff. The differences in leadership style, structures, processes and work culture affected teamwork, managerial supervision and support. The study demonstrates how leadership styles and practices
International Journal of Technology Assessment in Health Care, 2017
The INTEGRATE-HTA project recommends that complexity be taken into account when conducting health... more The INTEGRATE-HTA project recommends that complexity be taken into account when conducting health technology assessments (HTAs) and suggests a five-step process for doing that. This study examines whether the approach suggested by INTEGRATE-HTA could be useful, appropriate, and feasible in the context of low- and middle-income countries (LMIC) given some of the typical challenges that healthcare systems face in those countries. A nonexhaustive literature review was performed on the implementation in low and middle income countries of the five aspects recommended by the INTEGRATE-HTA project, using the following search terms: national health planning, health sector strategy, health sector performance, assessment criteria, health (management) information, complexity, context, stakeholder consultation. HTA is being practiced in LMIC in various ways and through different mechanisms, for example in health sector reviews, even though it is usually not referred to as HTA. It does not necessarily follow the five steps distinguished in the INTEGRATE-HTA model (scoping; defining the initial logic model; providing concepts and methods to identify, collect, and synthesize evidence in relation to various dimensions; extracting and presenting evidence in respect of agreed assessment criteria; providing guidance to draw conclusions and formulate recommendations). The conditions for functional HTA are not always fulfilled in LMICs. At least four aspects would require special attention: (a) the scope and quality of routine health information that can support and be fed into health technology assessments and strategic planning; (b) consensus on health system performance assessment frameworks and their main criteria, in particular the inclusion of social disparities/equity and sustainability;
BMJ Global Health, Aug 1, 2017
Tropical Medicine & International Health, Aug 1, 2006
Health policy, Feb 1, 2020
A deliberative citizens panel was held to obtain insight into criteria considered relevant for he... more A deliberative citizens panel was held to obtain insight into criteria considered relevant for healthcare priority setting in the Netherlands. Our aim was to examine whether and how panel participation influenced participants' views on this topic. Participants (n = 24) deliberated on eight reimbursement cases in September and October, 2017. Using Q methodology, we identified three distinct viewpoints before (T 0) and after (T 1) panel participation. At T 0 , viewpoint 1 emphasised that access to healthcare is a right and that prioritisation should be based solely on patients' needs. Viewpoint 2 acknowledged scarcity of resources and emphasised the importance of treatment-related health gains. Viewpoint 3 focused on helping those in need, favouring younger patients, patients with a family, and treating diseases that heavily burden the families of patients. At T 1 , viewpoint 1 had become less opposed to prioritisation and more considerate of costs. Viewpoint 2 supported out-of-pocket payments more strongly. A new viewpoint 3 emerged that emphasised the importance of cost-effectiveness and that prioritisation should consider patient characteristics, such as their age. Participants' views partly remained stable, specifically regarding equal access and prioritisation based on need and health gains. Notable changes concerned increased support for prioritisation, consideration of costs, and cost-effectiveness. Further research into the effects of deliberative methods is required to better understand how they may contribute to the legitimacy of and public support for allocation decisions in healthcare.
Tropical Medicine & International Health, Sep 3, 2018
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Papers by Leon Bijlmakers