Health sector reform, including structural and process changes such as the incorporation of feasi... more Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
Tropical Medicine & International Health, May 1, 2006
Objective To rank health problems contributing most to the burden of disease in Zimbabwe using Di... more Objective To rank health problems contributing most to the burden of disease in Zimbabwe using Disability-Adjusted Life Years as the population health measure. Methods The required epidemiological information for this exercise was derived from a variety of sources. Population size and total number of deaths by age and sex for the year 1997 were taken from an inter-censal survey. The cause of death pattern was determined based on the Vital Registration System, which was adjusted for underreporting of HIV and reallocation of ill-defined causes. Non-fatal disease figures were estimated based on local disease registers, surveys and routine health service data supplemented by estimates from epidemiological studies from other settings if no Zimbabwean sources were available. Disease and public health experts were consulted about the identification of the best possible sources of information, the quality of these sources and the data adjustments made. Findings HIV infection emerged from the information collected as the single most serious public health problem in Zimbabwe responsible for 49% of the total disease burden. A quarter of the total burden of disease was attributed to morbidity rather than premature mortality. The share of the disease burden was marginally higher in females (50.4%) compared to males. Conclusion Using to a large extent local sources of information, it was possible to develop plausible estimates of the size and the relative significance of the major health problems in Zimbabwe. The disease pattern of Zimbabwe varied substantially from regional estimates for sub-Saharan Africa justifying the need for countries to develop their own burden of disease estimates.
The Journal of Applied Behavioral Science, Mar 1, 2006
Health sector reform, including structural and process changes such as the incorporation of feasi... more Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
International Journal of Medical Informatics, Jun 1, 2007
"big bang" introduction of electronic packages, devices and software applications may be an obsta... more "big bang" introduction of electronic packages, devices and software applications may be an obstacle framing and anchoring local HCO to external settings, "modern" and universal models. Thus, a uniform step-by-step implementation of hospital-based health information system is desirable.
Global concerns about poverty, epidemics and new emergent diseases urges rich countries to improv... more Global concerns about poverty, epidemics and new emergent diseases urges rich countries to improve their development assistance, aid effectiveness, investments in health systems, including the health information systems. Governments of low income countries have embarked since about a decade ago on various health sector reforms that have led to often contradictory but most often not so successful outcomes. Formally, governments of rich and poor countries share the same goal: to increase coordination and harmonization of relationships on aid, debt relief, trade, poverty reduction program and health systems support. Mozambique, one of the poorest countries in the world and also one of the largest recipient of loans, grants, and technical support, has gone through multiple phases of reforms involving different kinds of partnership with donor countries, and have experienced different degrees of successes, unfulfilled promises, unsuccessful coordination attempts and duplications of interv...
Objective To rank health problems contributing most to the burden of disease in Zimbabwe using Di... more Objective To rank health problems contributing most to the burden of disease in Zimbabwe using Disability-Adjusted Life Years as the population health measure. Methods The required epidemiological information for this exercise was derived from a variety of sources. Population size and total number of deaths by age and sex for the year 1997 were taken from an inter-censal survey. The cause of death pattern was determined based on the Vital Registration System, which was adjusted for underreporting of HIV and reallocation of ill-defined causes. Non-fatal disease figures were estimated based on local disease registers, surveys and routine health service data supplemented by estimates from epidemiological studies from other settings if no Zimbabwean sources were available. Disease and public health experts were consulted about the identification of the best possible sources of information, the quality of these sources and the data adjustments made. Findings HIV infection emerged from the information collected as the single most serious public health problem in Zimbabwe responsible for 49% of the total disease burden. A quarter of the total burden of disease was attributed to morbidity rather than premature mortality. The share of the disease burden was marginally higher in females (50.4%) compared to males. Conclusion Using to a large extent local sources of information, it was possible to develop plausible estimates of the size and the relative significance of the major health problems in Zimbabwe. The disease pattern of Zimbabwe varied substantially from regional estimates for sub-Saharan Africa justifying the need for countries to develop their own burden of disease estimates.
International Journal of Medical Informatics, 2007
"big bang" introduction of electronic packages, devices and software applications may be an obsta... more "big bang" introduction of electronic packages, devices and software applications may be an obstacle framing and anchoring local HCO to external settings, "modern" and universal models. Thus, a uniform step-by-step implementation of hospital-based health information system is desirable.
Health sector reform, including structural and process changes such as the incorporation of feasi... more Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
Health sector reform, including structural and process changes such as the incorporation of feasi... more Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
Health sector reform, including structural and process changes such as the incorporation of feasi... more Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
Health sector reform, including structural and process changes such as the incorporation of feasi... more Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
Tropical Medicine & International Health, May 1, 2006
Objective To rank health problems contributing most to the burden of disease in Zimbabwe using Di... more Objective To rank health problems contributing most to the burden of disease in Zimbabwe using Disability-Adjusted Life Years as the population health measure. Methods The required epidemiological information for this exercise was derived from a variety of sources. Population size and total number of deaths by age and sex for the year 1997 were taken from an inter-censal survey. The cause of death pattern was determined based on the Vital Registration System, which was adjusted for underreporting of HIV and reallocation of ill-defined causes. Non-fatal disease figures were estimated based on local disease registers, surveys and routine health service data supplemented by estimates from epidemiological studies from other settings if no Zimbabwean sources were available. Disease and public health experts were consulted about the identification of the best possible sources of information, the quality of these sources and the data adjustments made. Findings HIV infection emerged from the information collected as the single most serious public health problem in Zimbabwe responsible for 49% of the total disease burden. A quarter of the total burden of disease was attributed to morbidity rather than premature mortality. The share of the disease burden was marginally higher in females (50.4%) compared to males. Conclusion Using to a large extent local sources of information, it was possible to develop plausible estimates of the size and the relative significance of the major health problems in Zimbabwe. The disease pattern of Zimbabwe varied substantially from regional estimates for sub-Saharan Africa justifying the need for countries to develop their own burden of disease estimates.
The Journal of Applied Behavioral Science, Mar 1, 2006
Health sector reform, including structural and process changes such as the incorporation of feasi... more Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
International Journal of Medical Informatics, Jun 1, 2007
"big bang" introduction of electronic packages, devices and software applications may be an obsta... more "big bang" introduction of electronic packages, devices and software applications may be an obstacle framing and anchoring local HCO to external settings, "modern" and universal models. Thus, a uniform step-by-step implementation of hospital-based health information system is desirable.
Global concerns about poverty, epidemics and new emergent diseases urges rich countries to improv... more Global concerns about poverty, epidemics and new emergent diseases urges rich countries to improve their development assistance, aid effectiveness, investments in health systems, including the health information systems. Governments of low income countries have embarked since about a decade ago on various health sector reforms that have led to often contradictory but most often not so successful outcomes. Formally, governments of rich and poor countries share the same goal: to increase coordination and harmonization of relationships on aid, debt relief, trade, poverty reduction program and health systems support. Mozambique, one of the poorest countries in the world and also one of the largest recipient of loans, grants, and technical support, has gone through multiple phases of reforms involving different kinds of partnership with donor countries, and have experienced different degrees of successes, unfulfilled promises, unsuccessful coordination attempts and duplications of interv...
Objective To rank health problems contributing most to the burden of disease in Zimbabwe using Di... more Objective To rank health problems contributing most to the burden of disease in Zimbabwe using Disability-Adjusted Life Years as the population health measure. Methods The required epidemiological information for this exercise was derived from a variety of sources. Population size and total number of deaths by age and sex for the year 1997 were taken from an inter-censal survey. The cause of death pattern was determined based on the Vital Registration System, which was adjusted for underreporting of HIV and reallocation of ill-defined causes. Non-fatal disease figures were estimated based on local disease registers, surveys and routine health service data supplemented by estimates from epidemiological studies from other settings if no Zimbabwean sources were available. Disease and public health experts were consulted about the identification of the best possible sources of information, the quality of these sources and the data adjustments made. Findings HIV infection emerged from the information collected as the single most serious public health problem in Zimbabwe responsible for 49% of the total disease burden. A quarter of the total burden of disease was attributed to morbidity rather than premature mortality. The share of the disease burden was marginally higher in females (50.4%) compared to males. Conclusion Using to a large extent local sources of information, it was possible to develop plausible estimates of the size and the relative significance of the major health problems in Zimbabwe. The disease pattern of Zimbabwe varied substantially from regional estimates for sub-Saharan Africa justifying the need for countries to develop their own burden of disease estimates.
International Journal of Medical Informatics, 2007
"big bang" introduction of electronic packages, devices and software applications may be an obsta... more "big bang" introduction of electronic packages, devices and software applications may be an obstacle framing and anchoring local HCO to external settings, "modern" and universal models. Thus, a uniform step-by-step implementation of hospital-based health information system is desirable.
Health sector reform, including structural and process changes such as the incorporation of feasi... more Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
Health sector reform, including structural and process changes such as the incorporation of feasi... more Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
Health sector reform, including structural and process changes such as the incorporation of feasi... more Health sector reform, including structural and process changes such as the incorporation of feasible information and communication technologies, is a priority in many least developed countries. However, such changes have not been particularly effective, the reasons for which will be explored in this article. Particular attention will be paid to attempts to integrate information systems in HIV/AIDS program in Mozambique. The article draws on new institutional theory to argue that the focus of this program on formal rules (i.e., Sector Wide Approach policy and national plans), which deemphasize the informal constraints at the point of service delivery (i.e., priority given to health care over reporting), has resulted in limited change. Furthermore, the limited overlap between the formal and informal domains raises the need for enhancing incentives and enforcement as key mechanisms through which more effective change can be enabled in the future.
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Papers by Bruno Piotti