METHODS: A qualitative study using a case-study approach was conducted between January 2019 and November 2019 in the districts of Gombak and Klang, where the relevant key informants were located. Nineteen interviews were conducted among elite healthcare personnel from different divisions: management, vector, laboratory, inspectorate, health promotion and entomology. Semi-structured interviews were conducted. The sample size was determined through saturation point criteria. Purposive sampling techniques were used to recruit the participants. The interviews were audio recorded, and the transcribed text was analysed with deductive thematic analysis.
RESULTS: Data analysis led to the development of 5 themes and 13 categories. The major principles of governance were embodied in a milieu of predicament, linked to constraints but also opportunities. The constraints resulted from inherent determinants of dengue outbreaks, the serviceability of governing policies and the macro-economics of budget allocation. The opportunities to sustain governance at the local operating level stem from a prevalent supportive internal management system, collaborative efforts among corresponding external government agencies and willingness to innovate and embrace novel technology.
CONCLUSION: Elites are influential, often well-informed personnel tasked with making decisions that can reverberate across an organisation, impacting future plans and strategic policies. Political arrangements at higher levels will reflect in advance the tone of how governance in dengue prevention and control is operationalised by entities and individuals at lower levels of the health system. The prevailing centralised structure in the Malaysian health system will continue to entrench the position of the elite and intertwine it with governance and its predicaments.
STUDY TYPE: Mixed methods.
METHODS: A desk review was conducted relating to HPSR funding, followed by in-depth interviews. Eight countries and areas were selected to represent characteristics of different health systems. Literature reviews included an analysis of available data relating to HPSR funding and national research and development (R&D) budgets, between 2010 and 2019 (inclusive). In-depth interviews were conducted with 23 stakeholders using an approved interview guide, to assess the attitudes of HPSR funding decision makers towards HPSR, determinants for HPSR and health research funding decisions, and proposals to strengthen HPSR funding and output.
RESULTS: There are four main characteristics of HPSR funding in the WPRO: 1) a general absence of studies on HPSR funding and its determinants; 2) no universally accepted understanding of HPSR; 3) an absence of granular health research funding data in general and for HPSR in particular; and 4) HPSR funding is generally perceived to be minimal. In-depth interviews show that HPSR has different interpretations and emphases across WPRO countries, leading to a fragmented landscape where decision makers generally favour biomedical or clinical research. Participants indicate that political involvement increases overall research funding, especially if there is a clear connection between funders, producers and HPSR users. Suggestions from participants to strengthen HPSR include: appropriately using central agencies to generate demand and raise HPSR as a national priority; adopting interdisciplinary HPSR; and building HPSR capacity and organisational structures.
CONCLUSIONS: HPSR in the Western Pacific region is generally not well funded, with biomedical and public health research often perceived as a higher priority. Although funding is a crucial component of the quality, quantity and relevance of HPSR outputs, HPSR practitioners and organisations must also generate demand for HPSR, build capacity for increasing the quantity and quality of HPSR outputs, and build pathways to translate HPSR outputs into real-world policies.
DESIGN: Health efficiency analysis using data envelopment analysis (DEA) and stochastic frontier approach analysis.
SETTING: Health systems in China and ASEAN countries.
METHODS: DEA-Malmquist model and SFA model were used to analyse the health system efficiency among China and ASEAN countries, and the Tobit regression model was employed to analyse the factors affecting the efficiency of health system among these countries.
RESULTS: In 2020, the average technical efficiency, pure technical efficiency and scale efficiency of China and 10 ASEAN countries' health systems were 0.700, 1 and 0.701, respectively. The average total factor productivity (TFP) index of the health systems in 11 countries from 2015 to 2020 was 0.962, with a decrease of 1.4%, among which the average technical efficiency index was 1.016, and the average technical progress efficiency index was 0.947. In the past 6 years, the TFP index of the health system in Malaysia was higher than 1, while the TFP index of other countries was lower than 1. The cost efficiency among China and ASEAN countries was relatively high and stable. The per capita gross domestic product (current US$) and the urban population have significant effects on the efficiency of health systems.
CONCLUSIONS: Health systems inefficiency is existing in China and the majority ASEAN countries. However, the lower/middle-income countries outperformed high-income countries. Technical efficiency is the key to improve the TFP of health systems. It is suggested that China and ASEAN countries should enhance scale efficiency, accelerate technological progress and strengthen regional health cooperation according to their respective situations.