Large scale healthcare interventions to deal with healthcare issues

Healthcare has always been one of the most important matters for each country and the priority point of most national security policies. It is also true that each healthcare system is a unique complex of regulations and guidelines and varies significantly from country to country.


Any system, even more to be recognized as an effective one, can be developed based on continuous learning, years of field experiments, personal and overall professional experience, and expertise. Nevertheless, there is always a chance for a mistake, even if the system is built by and comprised of the most experienced professionals.


Given that any system is inherently bureaucratic, we can only assume how slow and complicated the mechanisms of modification and changes might be (and they really are – the healthcare sector is no exception).


Nobody is surprised nowadays facing the instances of delays in matters of life and death in hospitals, primary and even emergency care departments. Arising from economic and social factors, these imperfections desire prompt answers, and interventions, which should be ‘large scale’ to deal with systematic problems. According to WHO (2016), “Scaling up is defined as “deliberate efforts to increase the impact of successfully tested health innovations so as to benefit more people and to foster policy and programme development on a lasting basis. Other definitions refer to many efforts to increase the impact, and take into account that scaling up does not only refer to larger groups or populations”.


Landefeld, C.S. et al. (2008) stated that “Large scale healthcare interventions aim to influence clinical evaluation, treatment, or care of a large group of people. Some interventions are coercive….Other…use explicit incentives, whereas other initiatives … are voluntary”.      

However, it is questionable whether any massive forceful interventions (that often prevail) performed by separate official organizations will resolve existing complex problems or cause new. Very often such initiatives depend on immediate circumstances (e.g., Centers for Disease Control and Prevention (CDC) website (2009) provides that “Recommendations for use of antiviral medications may change as data on antiviral effectiveness, clinical spectrum of illness, adverse events from antiviral use, or resistance among circulating viruses become available”) or are aimed at prospective issues. In both cases there seem to be no 100 % evidence-based answers available, besides, it is a heavy responsibility to decide for a large group of people, especially in cases when compromise and experiment may substitute evidence (even well-intentioned).


According to Guralnik, J.M. et al. in Gallin, J.I. (2007, p.207), “More often, there is evidence of both benefit and harm, and the key question is whether the risks outweigh the benefits. It is essential to proceed with any global decisions only if responsibility for well-being of each single precious human life can be assumed without doubts.



  1. Centers for Disease Control and Prevention (2009) Updated Interim Recommendations for the Use of Antiviral Medications in the Treatment and Prevention of Influenza for the 2009-2010 Season. Available online:
  2. Guralnik, J.M. & Maniolio, T.A. (2007) ‘Design and conduct of observational studies and clinical trials’. In: Gallin, J.I. & Ognibene, F.P. Principles and practice of clinical research. 2nd ed. Amsterdam: Elsevier, p.207.
  3. Landefeld CS, Shojania KG, Auerbach AD (2008). Should we use large scale healthcare interventions without clear evidence that benefits outweigh costs and harms? No. BMJ 2008;336:1277.
  4. World Health Organization (WHO, 2016) Available online:

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