Browsing by Author "Marstein, Egil"

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    The corporatization of global health: The impact of neoliberalism
    (Jacobs Verlag, 2018-06-14) Marstein, Egil; Babich, Suzanne M.; Department of Health Policy and Management, School of Public Health
    Concomitant with the emergence of a neoliberal precept for global health is the decline in support for publicly funded programs working to alleviate health disparities in poor countries. An unequivocal faith in the privatization and marketization of public health services is evident in current day national policy reforms. Commodification of health services is perceived as a cure-all. Privatization of global health initiatives contrasts with the past institutional paradigm. Corporate and philanthropic power trumps intergovernmental governance. The epistemological precept is clear: Global health is best served with mandated private initiatives. Powerful foundations cause critical shifts in the balance of power among stakeholders and become preeminent players in global health policy agenda formation. The ethics of consequentialism have attained current day prominence. This contrasts with the merits and relevancy of de-ontological ethics in which rules and moral duty are central. In this paper, authors make a case for contesting the ethos of effective altruism or venture philanthropy, suggesting that this approach keeps nations and people from recognizing the oppressive nature of neoliberalism as a governing precept for global health.
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    Global health in transition: The coming of neoliberalism
    (Jacobs Verlag, 2018-01-04) Marstein, Egil; Babich, Suzanne M.; Health Policy and Management, School of Public Health
    Global health as a transnational, intergovernmental, value-based initiative led by the World Health Organization (WHO), working toward improving health and achieving equity in health for all people worldwide, has for years yielded to a growing reliance on corporate-led solutions. Private organizations, non-governmental organizations (NGO), religious and other philanthropic and charitable organizations, increasingly serve a dominant role in setting the global health agenda. Short-term success in combating epidemics and in the provision of funding for project-based initiatives appeals to supporters of marketization of health services. For 30 years, a neoliberal paradigm has dominated the international political economy and hence the governance of global health. A utilitarian logic or the ethics of consequentialism have attained prominence under such banners as effective altruism or venture philanthropy. This contrasts with the merits and relevance of deontological ethics in which rules and moral duty are central. This paper seeks to explain how neo-liberalism became a governing precept and paradigm for global health governance. A priority is to unmask terms and precepts serving as ethos or moral character for corporate actions that benefit vested stakeholders.
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    Healthcare-Associated Infections (HAI) in Kazakhstan: Can We Trust Reporting? A Mixed-Methods Study of Institutional Culture, Context and Leadership in Hospitals and State Public Health Agencies
    (2023-11) Aiypkhanova, Ainur; Marstein, Egil; Deryabina, Anna; Babich, Suzanne
    Background. Health care-associated infections (HAI) are among the most common adverse events in health care delivery globally, with up to 7% of patients in high-income countries and up to 15% in low- and middle-income countries acquiring one during their hospital stay [1]. However, HAI rates in Kazakhstan did not exceed a fraction of one percent for decades [2, 3]. While up to 70% of HAI are preventable through effective infection prevention and control (IPC) practices [1], not knowing the real rate reduces the sense of urgency for national and local leaders and delays action to improve patient safety. Such low HAI rates in Kazakhstan led public health leaders to suspect underreporting, prompting a WHO-sponsored pilot point-prevalence survey, which found a 3.2% HAI rate in 2022, 90 times higher than the reported rate of 0.35% for the same year [4]. This study aimed to find out why health care organizations (HCO) are not reporting HAIs to health authorities, and based on the influence of institutional culture, organizational and country context, how public health leaders can best improve HAI surveillance. Methods. This is a mixed-methods study that used triangulation and grounded theory to analyze data collected in 4 stages: 1) desk review of national policies; 2) secondary datasets collected in a national study of 78 hospitals; 3) qualitative primary data collected from 12 key informants (public health leaders); 4) repeated desk review. safety and get involved in IPC. Epidemiologists from public health agencies must become the source of methodological support and have their training needs met as well. While this study generated evidence in support of multiple recommendations, the water of systems change model [9] can help policymakers appreciate the importance of implicit change conditions such as the culture, often ignored in change efforts undertaken in the post-Soviet countries. Conclusions. HAI rate remains abnormally low in Kazakhstan due to the long-lasting effect of the Soviet approach to IPC and the resulting punitive culture and punitive policies that deter providers from reporting. Findings from this study should be used by national, regional and HCO leaders in Kazakhstan and other countries with similar context to prioritize and design system-wide improvements in IPC and HAI surveillance. Recommendations should not be limited to traditional leadership actions such as policy change, more training and introduction of evidence-based protocols and procedures, but also include an implicit change condition – culture change – to create an environment conducive of truthful reporting of adverse events such as HAIs.