Artículos de revistas
URI permanente para esta colecciónhttps://hdl.handle.net/20.500.12640/4067
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Ítem Acceso Abierto Telemedicine in Peru: origin, implementation, pandemic escalation, and prospects in the new normal(Oxford University Press, 2024-01-12) Rees, Gareth H.For many countries telemedicine was speedily adopted as a result of the COVID-19 pandemic, though for some countries telemedicine may have been implemented in a context of limited regulations or few plans or strategies to scale quickly. This article recounts how telemedicine was developed in Peru as a measure to support the country's Universal Health Coverage and service access to rural and locations with low workforce numbers and its deployment. From a range of data, we find that Peru's development of telehealth began before the pandemic, which by 2020 was sufficient to be able to foster a rapid and wider deployment and while the telemedicine service volumes quickly grew from the pandemic onset, these numbers then begin to reduce suggesting that telemedicine was considered more as a pandemic emergency measure rather than a change to the mix of health provision. From these data we offer two lessons, (i) that Peru's preparedness in terms of telemedicine policy and regulation were helpful to rapidly expand telemedicine at a time of necessity and (ii) that due to this investment and with a better understanding, Peru now has a short-run window of opportunity for the Peruvian Government to continue its regulatory development and investment to further deploy telemedicine services as a UHC improvement measure and to better align the health system to the country’s health needs.Ítem Acceso Abierto Health workforce governance and professions: a re-analysis of New Zealand’s primary care workforce policy actors(BioMed Central, 2023-05-07) Rees, Gareth H.Background: This article contributes to the health workforce planning literature by exploring the dynamics of health professions in New Zealand’s Primary Care sector and deriving broad lessons for an international audience. Professions tend influence health policy and governance decisions and practices to retain their place, status and influence. Therefore, understanding their power dynamics and the positions that they have on workforce policies and issues assists workforce governance or health system reform plans. Methods: Using the infrequently reported health workforce policy tool, actor analysis, a reanalysis of previously collected data is undertaken using an actor-based framework for the study of professionalism. Two models were developed, (1) the framework’s original four-actor model and (2) a five-actor model for the comparison of the Medical and Nurse professions. Existing workforce actor data were reclassified, formatted, and entered into actor analysis software to reveal the professions’ relative power, inter-relationships and strategic workforce issue positions. Results: In the four-actor model, the Organised user actor is found to be most influential, while the others are found to be dependent. In the five-actor model, the Medical and Nurse professions are individually more influential than their combined position in the four-actor model. Practicing professionals and Organised user actors have strong converging inter-relationships over workforce issues in both models, though in the five-actor model, the Nurse profession has weaker coherency than the Medical profession. The Medical and Nurse professions are found to be in opposition over the workforce issues labelled divisive. Conclusions: These results reflect the professions’ potential to influence New Zealand’s Primary Care sector, indicating their power and influence over a range of policy and reform measures. As such, the four lessons that are derived from the case indicate to policy makers that they should be aware of situational contexts and actor power, take care when encountering divisive issues and try to achieve broad-based support for proposed policies.Ítem Acceso Abierto Are sustainable health workforces possible?: issues and a possible remedy(MDPI, 2023-02-15) Rees, Gareth H.; James, Rosemary; Samadashvili, Levan; Scotter, CrisThe 2020–2022 period of the global COVID-19 pandemic exposed the fact that many countries health systems had inadequate health workforce availability. This is despite sustainable health workforces being critical to health service and healthcare delivery, an acknowledgement that drove the significant investment and focus on health workforce development over the previous two decades. As such, this review article discusses health workforce governance and planning, notes its weaknesses, and identifies some of the barriers to the implementation of health workforce policy making and planning and the achievement of sustainable health workforces. Important is the recognition that health workforce planning is long-term in nature, while health workforce decision-making processes are dominated by political processes that have much shorter time frames. The article concludes by offering the approach of backcasting to overcome this dichotomy.Ítem Acceso Abierto Addressing sustainable rural development with shared value: a Peruvian model from the cacao industry(MDPI, 2021-07-19) Borda, Armando; Morales, Oswaldo; Teegen, Hildy; Rees, Gareth H.; Gonzalez-Perez, Maria AlejandraHere we present a model aimed at contributing to the literature around sustainable supply chains by examining a novel redesign initiative of the chocolate supply chain within the Peruvian cacao (cocoa) industry. Using the Creating Shared Value (CSV) framework, we apply the case study method in examining the Peruvian Cacao Alliance’s experience in redesigning both the stages and relationships within its supply of cacao to the world. Data were collected from both primary and secondary sources and analyzed after coding from categories defined in the literature on CSV. The case demonstrates the opportunity to successfully participate in the supply chains of globally recognized, consumer-facing chocolate brands while simultaneously obtaining social, economic and environmental benefits for the rural communities that supply cacao. While addressing both social and business gains remains fairly important for supply chain members, there are several implementation challenges that need to be considered to achieve the goals of CSV strategies in a sustained way. By analyzing the experience of this particular cacao value chain, we are able to offer practical insight on how to more effectively implement the creating shared value approach, thereby illuminating that it is possible for value generated through such supply chains to be more equitably shared. As such, we provide a valuable initial step in better understanding how the CSV concept applies in practice by identifying its boundary conditions for achieving improved cacao supply chain practices and relationships.Ítem Acceso Abierto Rethinking workforce planning for integrated care: using scenario analysis to facilitate policy development(BioMed Central, 2020-05-15) Rees, Gareth H.; Crampton, Peter; Gauld, Robin; MacDonell, StephenBackground: A goal of health workforce planning is to have the most appropriate workforce available to meet prevailing needs. However, this is a difficult task when considering integrated care, as future workforces may require different numbers, roles and skill mixes than those at present. With this uncertainty and large variations in what constitutes integrated care, current health workforce policy and planning processes are poorly placed to respond. In order to address this issue, we present a scenario-based workforce planning approach. Methods: We propose a novel mixed methods design, incorporating content analysis, scenario methods and scenario analysis through the use of a policy Delphi. The design prescribes that data be gathered from workforce documents and studies that are used to develop scenarios, which are then assessed by a panel of suitably qualified people. Assessment consists of evaluating scenario desirability, feasibility and validity and includes a process for indicating policy development opportunities. Results: We confirmed our method using data from New Zealand’s Older Persons Health sector and its workforce. Three scenarios resulted, one that reflects a normative direction and two alternatives that reflect key sector workforce drivers and trends. One of these, based on alternative assumptions, was found to be more desirable by the policy Delphi panel. The panel also found a number of favourable policy proposals. Conclusions: The method shows that through applying techniques that have been developed to accommodate uncertainty, health workforce planning can benefit when confronting issues associated with integrated care. The method contributes to overcoming significant weaknesses of present health workforce planning approaches by identifying a wider range of plausible futures and thematic kernels for policy development. The use of scenarios provides a means to contemplate future situations and provides opportunities for policy rehearsal and reflection.Ítem Acceso Abierto The implications of COVID-19 for health workforce planning and policy: the case of Peru(Wiley, 2021-02-19) Rees, Gareth H.; Peralta Quispe, Felipe; Scotter, CrisLike many countries Peru is confronting uncertainties due to the COVID-19 pandemic and its consequences. This is having impacts not only on health systems but also on the planning and preparation of its workforces. In this case article we summarise the progress Peru has been making to improve its workforce capacity and planning and review how Peru has coped with the stresses put on its health system arising from the pandemic. By recounting the responses that the Ministry of Health made through mobilising existing capabilities, additional workers and collaboration with health science faculties and health professional colleges, the article identifies that a longer-term planning perspective based on skills that services require is something that Peru may consider to compliment the health workforce investments that are already being made. As such, this case provides an example for workforce planners and policy makers to contemplate when considering health workforce planning in post-COVID uncertainty.Ítem Acceso Abierto The evolution of New Zealand's health workforce policy and planning system: a study of workforce governance and health reform(BioMed Central, 2019-07-05) Rees, Gareth H.Introduction: While considerable attention has been given to improving health workforce planning practice, few articles focus on the relationship between health workforce governance and health reform. By outlining a sequence of health reforms, we reveal how New Zealand’s health workforce governance and practices came under pressure, leading to a rethink and the introduction of innovative approaches and initiatives. Case description: New Zealand’s health system was quite stable up to the late 1980s, after which 30 years of structural and system reform was undertaken. This had the effect of replacing the centralised medically led health workforce policy and planning system with a market-driven and short-run employer-led planning approach. The increasing pressures and inconsistencies this approach produced ultimately led to the re-centralisation of some governance functions and brought with it a new vision of how to better prepare for future health needs. While significant gain has been made implementing this new vision, issues remain for achieving more effective innovation diffusion and improved integrated care orientations. Discussion and evaluation: The case reveals that there was a failure to consider the health workforce in almost all of the reforms. Health and workforce policy became increasingly disconnected at the central and regional levels, leading to fragmentation, duplication and widening gaps. New Zealand’s more recent workforce policy and planning approach has adopted new tools and techniques to overcome these weaknesses that have implications for the workforce and service delivery, workforce governance and planning methodologies. However, further strengthening of workforce governance is required to embed the changes in policy and planning and to improve organisational capabilities to diffuse innovation and respond to evolving roles and team-based models of care. Conclusion: The case reveals that disconnecting the workforce from reform policy leads to a range of debilitating effects. By addressing how it approaches workforce planning and policy, New Zealand is now better placed to plan for a future of integrated and team-based health care. The case provides cues for other countries considering reform agendas, the most important being to include and consider the health workforce in health reform processes.Ítem Acceso Abierto The impact of culture on the management of subsidiary organizations: the case of Viettel in Peru(Universidad EAFIT, 2020-12-16) Rees, Gareth H.; Morales Tristán, Oswaldo; Alosilla Cruzado, Gladys; Guizado Vásquez, Sandra; Laos Raffo, Bárbara; López Melgar, OrlandoAs south-south investments increase so do the issues experienced by investing companies. One of these is the impact of culture. This article analyzes the effects of the subsidiary country culture on an investing firm’s organizational culture and the managerial practices used to address them. Data is gathered from cultural databases, a company-wide survey and semi structured interviews. Descriptive statistics are used to reveal country and organizational culture differences, with content analysis to expose management responses. There is a clear difference between the firm’s Vietnamese and Peruvian workers, with the company’s practices more amenable to the Vietnamese employees. Recognition of this has resulted in a number of initiatives to reduce its impact. The study’s results offer suggestions that may be valued by other foreign companies interested in operating in Peru and may be especially relevant to Southeast Asia and Asian companies interested in investing in or looking to start operations in Latin America.
