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Brindley C, Wijemunige N, Dieteren C, Bom J, Engel M, Meessen B, Bonfrer I. Health seeking behaviours and private sector delivery of care for non-communicable diseases in low- and middle-income countries: protocol for a systematic review. BMJ Open 2023; 13:e066213. [PMID: 37620272 PMCID: PMC10450129 DOI: 10.1136/bmjopen-2022-066213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION The burden of non-communicable diseases (NCDs) has increased substantially in low- and middle-income countries (LMICs), and adapting health service delivery models to address this remains a challenge. Many patients with NCD seek private care at different points in their encounters with the health system, but the determinants and outcomes of these choices are insufficiently understood. The proposed systematic review will help inform the governance of mixed health systems towards achieving the goal of universal health coverage. This protocol details our intended methodological and analytical approaches, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). METHODS AND ANALYSIS Following the PRISMA approach, this systematic review will develop a descriptive synthesis of the determinants and outcomes of private healthcare utilisation for NCDs in LMICs. The databases Embase, Medline, Web of Science Core Collection, EconLit, Global Index Medicus and Google Scholar will be searched for relevant studies published in English between period 1 January 2010 and 30 June 2022 with additional searching of reference lists. The study selection process will involve a title-abstract and full-text review, guided by clearly defined inclusion and exclusion criteria. A quality and risk of bias assessment will be done for each study using the Mixed Methods Appraisal Tool. ETHICS AND DISSEMINATION Ethical approval is not required because this review is based on data collected from publicly available materials. The results will be published in a peer-reviewed journal and presented at related scientific events. PROSPERO REGISTRATION NUMBER CRD42022340059.
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Nilmini Wijemunige
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Health Policy, Colombo, Sri Lanka
| | - Charlotte Dieteren
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Judith Bom
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Maarten Engel
- Erasmus Medical Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Igna Bonfrer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Bokolo S, Mabaso S, Kruger W, Mistri P, Schmucker L, Chetty-Makkan C, Pascoe SJS, Buttenheim A, Thirumurthy H, Long L. Applying behavioural economics principles to increase demand for free HIV testing services at private doctor-led clinics in Johannesburg, South Africa: A randomised controlled trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.07.23293635. [PMID: 37609154 PMCID: PMC10441509 DOI: 10.1101/2023.08.07.23293635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Background Expanding free HIV testing service (HTS) access to include private clinics could increase testing rates. A donor funded programme, GP Care Cell, offered free HIV testing at selected private doctor-led clinics but uptake was low. We investigated whether HTS demand creation materials that used behavioural economics principles could increase demand for HIV testing at these clinics. Methods We conducted a randomised controlled trial in Johannesburg, South Africa (January-April 2022) distributing brochures promoting HTS to adults in five private doctor-led clinic catchment areas. Individuals were randomised to receive three brochure types: (1) "Standard of care" (SOC) advertising a free HIV test and ART; (2) "Healthy lifestyle screening" promoted free low-cost health screenings in addition to HTS; and (3) "Recipient of care voucher" leveraged loss aversion and the endowment effect by highlighting the monetary value of free HTS. The primary outcome was presenting at the clinic following exposure to the brochures. Logistic regression compared outcomes between arms. Results Of the 12,129 brochures distributed, 658 were excluded because of errors or duplicates and 11,471 were analysed. About 59% of brochure recipients were male and 50,3% were aged 25-34 years. In total, 448 (3.9%) brochure recipients presented at the private doctor-led clinics of which 50.7% were males. There were no significant differences in clinic presentation between the healthy lifestyle screening and SOC arm (Adjusted Odds Ratio [AOR] 1.02; 95% CI 0.79-1.32), and similarly between the recipient of care voucher and SOC arm (AOR 1.08; 95% CI 0.84-1.39). Individuals were more likely to attend clinics that were centrally located with visible branding for HTS (AOR=5.30; 95% CI: 4.14-6.79). Conclusion Brochures that used behavioural insights did not increase demand for HTS at private doctor-led clinics. However, consistent distribution of the brochures may have potential to increase HIV testing uptake at highly visible private doctor-led clinics.
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Affiliation(s)
- Simamkele Bokolo
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suzanne Mabaso
- Foundation for Professional Development (FPD), Pretoria, South Africa
| | - Wentzel Kruger
- Foundation for Professional Development (FPD), Pretoria, South Africa
| | - Preethi Mistri
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laura Schmucker
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Candice Chetty-Makkan
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sophie J S Pascoe
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia PA, USA
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Suwantika AA, Zakiyah N, Abdulah R, Diantini A. Assessment of childhood immunization services at private healthcare facilities in Indonesia: a case study in a highly-populated city. Front Public Health 2023; 11:1093387. [PMID: 37575096 PMCID: PMC10415032 DOI: 10.3389/fpubh.2023.1093387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction The need to enhance the utilization of the private sector for immunization programs in Indonesia while maintaining the high quality of services provided is evident. This study aimed to rapidly assess immunization services at private healthcare facilities in Indonesia by using Bandung, the most densely populated city, as the reference case. Methods Initially, a situation analysis was conducted by collecting data from selected healthcare facilities (n = 9). Furthermore, a qualitative study was taken into account by developing framework approaches and conducting interviews with different layers, such as mid-level managers at healthcare facilities (n = 9), professional organizations (n = 4), and public stakeholders (n = 7). Results The situation analysis showed that private healthcare facilities had provided sufficient time for essential childhood immunization services with adequate staff. Nevertheless, the number of limited staff the Ministry of Health (MoH) has trained remains a programmatic problem. Furthermore, private healthcare facilities have used the MoH guidelines and additional internal guidelines for immunization services as the primary reference, including in the efforts to provide complete and reliable equipment. Vaccine availability at private healthcare facilities is manageable with an acceptable out-of-stock level. The results of our interviews highlighted three key findings: the lack of coordination across public and private sectors, the need for immunization service delivery improvement at private healthcare facilities, and the urgency to strengthen institutional capacity for advocacy and immunization systems support. Conclusion Even though private healthcare facilities have been shown to make a modest contribution to childhood immunization services in Indonesia, efforts should be made to expand the role of private healthcare facilities in improving the performance of routine immunization programs.
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Affiliation(s)
- Auliya A. Suwantika
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
- Center for Health Technology Assessment, Universitas Padjadjaran, Bandung, Indonesia
| | - Neily Zakiyah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
| | - Ajeng Diantini
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation (PHARCI), Universitas Padjadjaran, Bandung, Indonesia
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Herath T, Perera M, Kasturiratne A. Factors influencing the decision to use state-funded healthy lifestyle centres in a low-income setting: a qualitative study from Sri Lanka. BMJ Open 2023; 13:e067464. [PMID: 37407056 DOI: 10.1136/bmjopen-2022-067464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Healthy lifestyle centres (HLCs) in Sri Lanka provide screening and lifestyle modification services targeting major non-communicable diseases (NCDs). Even though the service is highly accessible and affordable, HLCs are underused by its target population (adults >35 years). We aimed to explore the factors that influence the decision-making process of utilisation of HLCs in Sri Lanka. SETTING Two districts (Gampaha and Kalutara) from the highest populous province (Western) located adjacent to the capital district of Sri Lanka. PARTICIPANTS Nine service providers, 37 HLC clients and 52 community participants were selected using judgemental, convenient and purposive sampling methods. Theoretical sampling method was used to decide the sample size for each category. METHOD A qualitative study design based on constructivist grounded theory was used. Data collected using in-depth interviews and focus group discussions during January to July 2019 and were analysed using the constant comparison method. RESULTS The decision-making process of utilisation of HLCs was found to be a chain of outcomes with three main steps, such as: intention, readiness and utilisation. Awareness of HLCs, positive attitudes on health, intrinsic or extrinsic motivators, positive attitudes on NCDs and screening were internal factors with a positive influence on intention. Readiness was positively influenced by positive characteristics of the HLCs. It was negatively influenced by negative attitudes on staff and services of HLCs and negative past experiences related to services in state healthcare institutions and HLCs, service provider-related barriers and employment-related barriers. Family-related factors, social support and norms influenced both intention and readiness, either positively or negatively. CONCLUSION The decision-making process of utilisation of HLCs links with factors originating from internal, family, service provider and societal levels. Thus, a multifactorial approach that addresses all these levels is needed to improve the utilisation of HLCs in Sri Lanka.
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Affiliation(s)
- Thilini Herath
- Department of Primary Health Care, Faculty of Health-Care Sciences, Eastern University Sri Lanka, Chenkalady, Eastern, Sri Lanka
| | - Manuja Perera
- Department of Public Health, Faculty of Medicine, University of Kelaniya Sri Lanka, Ragama, Western, Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya Sri Lanka, Ragama, Western, Sri Lanka
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Singh VV, Dutta BK, Singhal A, Patra P, Gupta AK, Mani RN. Anxiety, depression, professional fulfilment and burnout: Public and private doctors' differential response to CoVID-19 pandemic. Ind Psychiatry J 2023; 32:431-436. [PMID: 38161485 PMCID: PMC10756606 DOI: 10.4103/ipj.ipj_17_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 11/18/2022] [Indexed: 01/03/2024] Open
Abstract
Introduction Covid-19 pandemic has been a challenge for healthcare system; the doctors in public and private setups are at the center of this challenge. Public and private doctors differ in personality and some occupational aspects. Do these differences reflect in their response to Covid? Aim To study the difference in anxiety, depression, burnout, and professional fulfillment between doctors in public and private setup during Covid-19 second wave and to assess their coping strategies. Methods A cross-sectional Internet-based observational study was conducted using Stanford PFI, GAD-7, PHQ-2, BFI-10, and brief COPE questionnaires. Results A total of 114 public and 37 private doctors participated in the study. Doctors in private were older in age and deferred in personality profile. Significantly, more private doctors screened for anxiety disorder. 62.2% of private and 41.2% public doctors felt professionally fulfilled. Burnout and depression were not significantly different between groups. Active coping, acceptance, and planning coping were significantly more used by private doctors. Conclusion There are differences how doctors in different setups respond to Covid-19, and there is need to understand these factors.
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Affiliation(s)
| | - Bikram K. Dutta
- Department of Psychiatry, Base Hospital Delhi Cantt, Delhi, India
| | - Ankit Singhal
- Department of Psychiatry, Command Hospital (SC), Pune, Maharashtra, India
| | | | | | - Raghu N. Mani
- Department of Psychiatry, Base Hospital Delhi Cantt, Delhi, India
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Negero MG, Sibbritt D, Dawson A. Women's utilisation of quality antenatal care, intrapartum care and postnatal care services in Ethiopia: a population-based study using the demographic and health survey data. BMC Public Health 2023; 23:1174. [PMID: 37337146 DOI: 10.1186/s12889-023-15938-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE This study sought to investigate the level and determinants of receiving quality antenatal care (ANC), intrapartum care, and postnatal care (PNC) services by women in Ethiopia. The quality of care a woman receives during ANC, intrapartum care, and PNC services affects the health of the woman and her child and her likelihood of seeking care in the future. METHODS Data from the nationally representative Ethiopia Mini Demographic and Health Survey 2019 were analysed for 5,527 mothers who gave birth within five years preceding the survey. We defined quality ANC as having: blood pressure measurement, urine and blood tests, informed of danger signs, iron supplementation, and nutritional counselling during ANC services; quality intrapartum care as having: a health facility birth, skilled birth assistance, and a newborn put to the breast within one hour of birth during intrapartum care services; and quality PNC as having: PNC within two days; cord examination; temperature measurement, and counselling on danger signs and breastfeeding of the newborn; and healthcare provider's observation of breastfeeding during PNC services. We used multilevel mixed-effects logistic regression analyses specifying three-level models: a woman/household, a cluster, and an administrative region to determine predictors of each care quality. The analyses employed sampling weights and were adjusted for sampling design. RESULTS Thirty-six percent (n = 1,048), 43% (n = 1,485), and 21% (n = 374) women received quality ANC, intrapartum care and PNC services, respectively. Private healthcare facilities provided higher-quality ANC and PNC but poor-quality intrapartum care, compared to public health facilities. Having four or more ANC visits, commencing ANC during the first trimester, and higher women's education levels and household wealth indices were positive predictors of quality ANC use. Government health posts were less likely to provide quality ANC. Wealthier, urban-residing women with education and four or more ANC contacts were more likely to receive quality intrapartum care. Women who received quality ANC and skilled birth assistance were more likely to receive quality PNC. Teenage mothers were more likely to receive quality intrapartum care, but were less likely to receive quality PNC than mothers aged 20-49. CONCLUSIONS We recommend standardizing the contents of ANC provided in all healthcare facilities; and promoting early and four or more ANC contacts, effectiveness, sensitivity and vigilance of care provided to teenage mothers, and women's education and economic empowerment.
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Affiliation(s)
- Melese Girmaye Negero
- School of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.
| | - David Sibbritt
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Sodhi K, Chanchalani G, Arya M, Shrestha GS, Chandwani JN, Kumar M, Kansal MG, Ashrafuzzaman M, Mudalige AD, Al Tayar A, Mansour B, Saeed HM, Hashmi M, Das M, Al Shirawi NN, Mathias R, Ahmed WO, Sharma A, Agarwal D, Nasa P. Knowledge and awareness of infection control practices among nursing professionals: A cross-sectional survey from South Asia and the Middle East. World J Crit Care Med 2023; 12:176-187. [PMID: 37397590 PMCID: PMC10308336 DOI: 10.5492/wjccm.v12.i3.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/15/2023] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The proficiency of nursing professionals in the infection prevention and control (IPC) practices is a core component of the strategy to mitigate the challenge of healthcare associated infections.
AIM To test knowledge of nurses working in intensive care units (ICU) in South Asia and Middle East countries on IPC practices.
METHODS An online self-assessment questionnaire based on various aspects of IPC practices was conducted among nurses over three weeks.
RESULTS A total of 1333 nurses from 13 countries completed the survey. The average score was 72.8% and 36% of nurses were proficient (mean score > 80%). 43% and 68.3% of respondents were from government and teaching hospitals, respectively. 79.2% of respondents worked in < 25 bedded ICUs and 46.5% in closed ICUs. Statistically, a significant association was found between the knowledge and expertise of nurses, the country’s per-capita income, type of hospitals, accreditation and teaching status of hospitals and type of ICUs. Working in high- and upper-middle-income countries (β = 4.89, 95%CI: 3.55 to 6.22) was positively associated, and the teaching status of the hospital (β = -4.58, 95%CI: -6.81 to -2.36) was negatively associated with the knowledge score among respondents.
CONCLUSION There is considerable variation in knowledge among nurses working in ICU. Factors like income status of countries, public vs private and teaching status of hospitals and experience are independently associated with nurses’ knowledge of IPC practices.
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Affiliation(s)
- Kanwalpreet Sodhi
- Department of Critical Care, Deep Hospital, Ludhiana 141001, Punjab, India
| | - Gunjan Chanchalani
- Critical Care Medicine, Somaiya Hospital and Research Centre, Mumbai 400001, Maharashtra, India
| | - Muktanjali Arya
- Department of Microbiology and Infection Control, Deep Hospital, Ludhiana 141001, India
| | - Gentle S Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu 44600, Nepal
| | - Juhi N Chandwani
- Anaesthesia and Intensive Care Unit, Royal Hospital, Muscat 112, Oman
| | - Manender Kumar
- Department of Cardiac Anaesthesia, Fortis Hospital, Ludhiana 141002, Punjab, India
| | - Monika G Kansal
- Intensive Care Medicine, Ng Teng Fong General Hospital, Singapore 609606, Singapore
| | - Mohammad Ashrafuzzaman
- Intensive Care Unit, Bangabandhu Sheikh Mujib Medical University, Dhaka 1000, Bangladesh
| | - Anushka D Mudalige
- Intensive Care Unit, Colombo North Teaching Hospital, Ragama 11010, Sri Lanka
| | - Ashraf Al Tayar
- Intensive Care Unit and Respiratory Therapy Department, Security Forces Hospital, Damman 34223, Saudi Arabia
| | - Bassam Mansour
- Pulmonary and Critical Care Division, Zahraa Hospital-University Medical Center, Beirut 1007, Lebanon
- Pulmonary Division, Faculty of Medical Sciences, Lebanese University, Beirut 1007, Lebanon
| | - Hasan M Saeed
- Department of Critical Care, Salmaniyah Medical Complex, Manama 323, Bahrain
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi 75530, Pakistan
| | - Mitul Das
- Anaesthesia and Critical Care, Swasti Hospital, Rangia 781354, India
| | - Nehad N Al Shirawi
- Department of Critical Care Medicine, Al Fujairah Hospital, Fujairah 0000, United Arab Emirates
| | - Ranjan Mathias
- Department of Anesthesia and Intensive Care, Hamad Medical Corporation, Doha 974, Qatar
| | - Wagih O Ahmed
- Intensive Care Unit, Sulaiman Al Habib Medical Group, Buraidah 52211, Saudi Arabia
| | - Amandeep Sharma
- Department of Nursing, Deep Hospital, Ludhiana 141001, India
| | - Diptimala Agarwal
- Anesthesia and Intensive Care, Shantived Institute of Medical Sciences, Agra 282007, India
| | - Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
- Internal Medicine, College of Medicine and Health Sciences, Al Ain 15551, Abu Dhabi, United Arab Emirates
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Sodhi K, Chanchalani G, Arya M, Shrestha GS, Chandwani JN, Kumar M, Kansal MG, Ashrafuzzaman M, Mudalige AD, Al Tayar A, Mansour B, Saeed HM, Hashmi M, Das M, Al Shirawi NN, Mathias R, Ahmed WO, Sharma A, Agarwal D, Nasa P. Knowledge and awareness of infection control practices among nursing professionals: A cross-sectional survey from South Asia and the Middle East. World J Crit Care Med 2023; 12:176-187. [DOI: 10.5492/wjccm.v12.i3.176 sodhi k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
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Alghamdi RS, Perra O, Boyle B, Stockdale J. Perceived treatment of respectful maternity care among pregnant women at healthcare facilities in the Kingdom of Saudi Arabia: A cross-sectional study. Midwifery 2023; 123:103714. [PMID: 37229839 DOI: 10.1016/j.midw.2023.103714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 04/13/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Mistreatment of women during childbirth is a global issue and a violation of fundamental human rights. Respectful maternity care has been affirmed as a universal right of childbearing women. However, little is known about the level of respect experienced by women in the Kingdom of Saudi Arabia (KSA); which is undergoing key reforms in the scope of its healthcare provision. We explored the occurrence of respect perceived by women giving birth in the KSA and compared results between national healthcare sectors, as well as with previous international studies. METHOD We conducted a cross-sectional study using an online survey. The online questionnaire included demographic questions, a translation of the internationally validated Mother on Respect index (MORi) scale, which we adapted to investigate KSA women's experiences, and questions to further investigate women's experiences (e.g. respect of privacy). Women who gave birth within five years at a Saudi healthcare facility were recruited through social media using a snowballing approach. RESULTS Overall, 586 participants were recruited, 54% of whom had been cared for in government hospitals, 65% were aged between 25 and 34, and almost 79% had a BSc or higher qualification. Overall, women's perception about respectful maternity care was positive, however, opinions varied between governmental and private sectors. Women cared for in the government sector reported significantly lower levels of respect compared to those cared for in the private sector (β = -.132, p = .001). The results also highlighted an issue of concern: one in five women (21.8%) reported having been physically abused. Our participants perceived their childbirth experiences to be less respectful compared to those in other high-income countries. CONCLUSION Women birthing in the private sector reported a more respectful experience, which may be explained by the private sector being more consumer-focused. Women who gave birth in the KSA perceived their care to be less respectful than women giving birth in Canada and the USA. Beginning to understand what has provoked the occurrences of mistreatment in childbirth worldwide will inevitably contribute to the development of a solution. Respectful maternity care should be focused on providing women-centred care and quality of care which meets the WHO vision for women's and their families' needs being fulfilled and respected.
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Affiliation(s)
- Reem Saeed Alghamdi
- Maternal and Child Health Care Department, College of Nursing, Building 12, King Saud University, 12372, Riyadh, Kingdom of Saudi Arabia.
| | - Oliver Perra
- The Faculty of Medicine, Health, and Life Sciences, School of Nursing & Midwifery, Queen's University, MBC Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom
| | - Breidge Boyle
- The Faculty of Medicine, Health, and Life Sciences, School of Nursing & Midwifery, Queen's University, MBC Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom
| | - Janine Stockdale
- The Faculty of Medicine, Health, and Life Sciences, School of Nursing & Midwifery, Queen's University, MBC Building, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, United Kingdom
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Varela T, Zamorano P, Muñoz P, Rain C, Irazoqui E, Sapag JC, Tellez A. Evaluation of the implementation progress through key performance indicators in a new multimorbidity patient-centered care model in Chile. BMC Health Serv Res 2023; 23:439. [PMID: 37143071 PMCID: PMC10159678 DOI: 10.1186/s12913-023-09412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Complex health interventions involve deep organizational, structural, and cultural changes that challenge health teams and decision-makers. The explosion of chronic diseases has made the multimorbidity approach a global priority. The Centro de Innovación en Salud ANCORA UC implemented a Multimorbidity Patient-Centered Care Model in the Chilean public health system. OBJECTIVE This study aims to evaluate the progress of the implementation of the Multimorbidity Patient-Centered Care Model in seven primary care centers through key performance indicators. METHODS a set of indicators was designed to evaluate change management, operations, installation of new roles, and services and activities of the intervention strategy of the model. Key performance indicators were identified to monitor the implementation progress on minimal components for the model's sustainability. Each item was assigned against an expected minimum score of 67% of progress from the overall score. They were monitored twice in seven primary health centers in 2019 and 2020, which intervened 22,642 patients with the intervention. RESULTS The results showed that six of the seven primary care centers reached the minimum implementation threshold. The main advances were in operational conditions, and those with minor progress in implementation were the clinical services. Population size, organization, coordination of the health care teams, additional training, and decision-makers support were key factors that determined the degree of progress in a complex intervention. CONCLUSION It was possible to measure the progression of the implementation of a complex intervention through key performance indicators delivering relevant information for decision-makers that pursue a successful and faithful implementation. This study provides a valuable tool for the national scale-up of a similar model started in Chile by the Ministry of Health and other countries.
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Affiliation(s)
- Teresita Varela
- Centro de Innovación en Salud ANCORA UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Zamorano
- Centro de Innovación en Salud ANCORA UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Health Technology Assessment Unit, Center of Clinical Research, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Current Address: Diagonal Paraguay, Santiago, 362, Chile.
| | - Paulina Muñoz
- Centro de Innovación en Salud ANCORA UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Rain
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Esteban Irazoqui
- Centro de Innovación en Salud ANCORA UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jaime C Sapag
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Public health, Pontificia Universidad Católica de Chile, Santiago, Chile
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Alvaro Tellez
- Centro de Innovación en Salud ANCORA UC, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Family Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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Kumar A. The Transformation of The Indian Healthcare System. Cureus 2023; 15:e39079. [PMID: 37378105 PMCID: PMC10292032 DOI: 10.7759/cureus.39079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2023] [Indexed: 06/29/2023] Open
Abstract
The Indian healthcare system is a diverse and complex network of public and private sectors that provide a wide range of medical services to India's 1.4 billion inhabitants. Despite undergoing significant changes over the years, the system continues to face multiple challenges. These challenges include inadequate infrastructure, a shortage of healthcare professionals, urban-rural disparities, limited health insurance coverage, insufficient public healthcare funding, and a fragmented healthcare system. India is grappling with a growing burden of non-communicable diseases, which poses a significant challenge to its healthcare system. The Indian government has initiated multiple programs to improve the healthcare system. The National Health Mission improves the availability of medical equipment and supplies. This also promotes community participation and engagement in healthcare decision-making and service delivery. The Ayushman Bharat scheme is a health insurance program that provides coverage of up to INR 5 lakhs per family per year for secondary and tertiary care hospitalization. The Indian healthcare system is also witnessing multiple healthcare innovations, ranging from low-cost medical devices to innovative healthcare delivery models. The country's healthcare regulatory system is evolving to ensure patient safety, promote high-quality care, and control costs. Furthermore, India has emerged as a leading destination for medical tourism due to the relatively low cost of medical procedures, the availability of skilled doctors, and advanced technology. Factors such as cost-effective treatment, advanced technology, a wide range of specialities, alternative medicine, English language proficiency, and ease of travel have contributed to India's growing medical tourism industry. The Indian healthcare system has made significant progress in recent years. The positive transformation of the Indian healthcare system involves a range of changes and initiatives. Despite challenges, the continued investment in healthcare and innovation provides reasons to be optimistic about the future of healthcare in India.
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Affiliation(s)
- Ankit Kumar
- Respiratory Medicine, King George's Medical University, Lucknow, IND
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Ogale YP, Kennedy CE, Nalugoda F, Mpagazi J, Jackson JC, Galiwango R, Ssekubugu R, Kigozi G, Denison JA, Gaydos CA, Kagaayi J, Grabowski MK. Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001626. [PMID: 37126490 PMCID: PMC10150988 DOI: 10.1371/journal.pgph.0001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
Understanding treatment-seeking behavior is critical to the treatment and control of sexually transmitted infections (STIs), yet current data on STI treatment seeking in low-resource settings is rare. This population-based study aimed to describe STI treatment-seeking behavior and identify factors associated with seeking treatment at a clinic among adults with STI-related symptoms in rural Uganda. The STI prevalence study (STIPS) conducted a survey and STI testing among all consenting adults aged 18-49 in two communities in rural south-central Uganda. Of 1,825 participants, 962 individuals self-reported STI symptoms in the past six months; we present descriptive data on treatment seeking and STI prevalence among these individuals. We used multivariable Poisson regressions with robust variance to determine the sociodemographic and symptom-related factors independently associated with seeking STI treatment at a clinic and assessed the association with previous clinic treatment seeking and current STI diagnosis. Forty-three percent of adults who reported STI-related symptoms in the past six months said they did not seek any treatment. Among those who did, 58% sought treatment at a private clinic, 28% at a government clinic, 9% at a pharmacy/drug store, 3% at a traditional healer, 2% at a market/shop, and 5% at another location. Among both males and females, having multiple STI related symptoms was positively associated with clinic treatment seeking (males = PRR: 1.73, 95%CI: 1.36-2.21; females = PR: 1.41, 95%CI: 1.12-1.78). Approximately one-third of males and females who reported previously seeking clinic treatment for their symptoms were diagnosed with a curable STI at the time of the survey. In this setting, nearly half of adults with STI-related symptoms are not seeking clinical care and many who report having sought treatment for recent STI symptoms have curable STIs. Future studies should explore barriers to care-seeking and strategies to improve STI services.
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Affiliation(s)
- Yasmin P. Ogale
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Caitlin E. Kennedy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | | | | | - Jade C. Jackson
- Johns Hopkins School of Medicine, Baltimore, MD, United States of America
| | | | | | | | - Julie A. Denison
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
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63
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Israeli A, Hod K, Mezer E. Characteristics and differences of strabismus surgeries performed in private versus public settings: a national multicenter study. Int Ophthalmol 2023:10.1007/s10792-023-02725-y. [PMID: 37083871 DOI: 10.1007/s10792-023-02725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To investigate and compare the demographics, diagnoses, and surgical procedure types of strabismus repair in public and private hospitals in Israel in order to highlight possible disparities between them. METHODS Retrospective descriptive study included all strabismus surgeries in seven private hospitals, compared with two large public university-affiliated hospitals from June 2016 to June 2021. Electronic medical records were directly retrieved to produce an anonymized database. RESULTS During the study period 2420 operations were performed. Patients who underwent strabismus surgery in public hospitals were older and had shorter procedures (p < 0.001 and p = 0.004, respectively). The median number of operated muscles and the prevalence of bilateral procedures were higher in private hospitals (p < 0.001 and p < 0.001, respectively). Surgery for common strabismus, especially esotropia, was more prevalent in private (p < 0.001), whereas surgery for vertical strabismus, cranial nerve palsies and complex syndromes were performed more often in public hospitals (p < 0.001, p = 0.008, and p < 0.001, respectively). Rectus recession and inferior oblique (IO) anteriorization were more predominant in private hospitals (p = 0.002 and p < 0.001, respectively), while recuts advancement and IO myectomies were more prevalent in public ones (p = 0.001 and p < 0.001, respectively). Reoperations were far more common in public hospitals (27.2% vs 6.2%, p < 0.0001). This was true across most age groups. CONCLUSIONS Candidates for strabismus surgery in private hospitals in Israel are often younger, with more common diagnoses, and are usually referred for simpler procedures.
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Affiliation(s)
- Asaf Israeli
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Keren Hod
- Department of Academy and Research, Assuta Medical Center, Tel-Aviv, Israel
| | - Eedy Mezer
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
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Marson M, Migheli M, Saccone D. Free to die: Economic freedoms and influenza mortality. ECONOMICS AND HUMAN BIOLOGY 2023; 49:101238. [PMID: 36963295 DOI: 10.1016/j.ehb.2023.101238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/18/2023] [Accepted: 03/11/2023] [Indexed: 05/08/2023]
Abstract
Seasonal influenzas are annually responsible for hundreds of thousands of deaths worldwide, often because of insufficient care, which may depend on orientations of economic policy. Yet, the empirical evidence on the relations existing between policies based on different degrees of economic liberalism and flu mortality is still scarce. This paper contributes to filling the gap by proposing an empirical investigation into the effects of various dimensions of liberalism, proxied by the different components of the Fraser Index of Economic Freedom, on deaths from seasonal influenzas in a sample of 38 OECD countries observed from 1970 to 2018. A dynamic panel System-GMM estimator is used to alleviate endogeneity concerns, while alternative models, specifications and subsamples check the robustness of findings. Findings show that: a) not every component of economic freedom has an effect on flu mortality; b) more economic freedom not always means less or more deaths from flu. In particular, stronger protection of property rights and smaller government consumption are associated with higher flu mortality, which is instead lower when people and capital are freer to move. Such results give rise to policy considerations and contribute to inform policymakers about actions that can limit the mortality of a globally widespread disease like flu.
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Affiliation(s)
- Marta Marson
- University of Torino, Department of Economics and Statistics "Cognetti de Martiis", Lungo Dora Siena, 100 I-10153 Torino, TO, Italy; OEET-Turin Centre on Emerging Economies - Collegio Carlo Alberto, piazza Arbarello, 8 I-10122 Torino, TO, Italy; Polytechnic University of Milan, Department of Management, Economics and Industrial Engineering.
| | - Matteo Migheli
- University of Torino, Department of Economics and Statistics "Cognetti de Martiis", Lungo Dora Siena, 100 I-10153 Torino, TO, Italy
| | - Donatella Saccone
- University of Gastronomic Sciences, piazza Vittorio Emanuele II, 9 I-12042 Bra, CN, Italy; OEET-Turin Centre on Emerging Economies - Collegio Carlo Alberto, piazza Arbarello, 8 I-10122 Torino, TO, Italy
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Ghia C, Rambhad G. Implementation of equity and access in Indian healthcare: current scenario and way forward. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2194507. [PMID: 36998432 PMCID: PMC10044314 DOI: 10.1080/20016689.2023.2194507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The Indian healthcare system is evolving towards better healthcare implementation and coverage. However, even today, the health-care system faces several challenges, a few of which are yet to be addressed. The present review is aimed to delineate the past and present healthcare scenarios in India, health-care policies, and other initiatives for achieving universal health coverage (UHC). METHODS A literature search was done on various government databases, websites, and PubMed for obtaining data and statistics on healthcare funding, health insurance schemes, healthcare budget allocations, categories of medical expenses, government policies, and health technology assessment (HTA) in India. RESULTS The available data indicates 37.2% of the total population is covered by any health insurance of which 78% are covered by public insurance companies. Around 30% of the total health expenditure is borne by the public sector, and there is high out-of-pocket (OOP) expenditure on healthcare. DISCUSSION Several new health policies and schemes, an increase in 2021 budget for healthcare by 137%, vaccination drives, augmenting manufacturing of medical devices, special training packages, Artificial Intelligence/Machine Learning (AI/ML)-based standard treatment workflow systems to ensure proper treatment and clinical decision-making have been initiated by the government for improving healthcare funding, equity, and access.
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Affiliation(s)
- Canna Ghia
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, India
| | - Gautam Rambhad
- Medical and Scientific Affairs, Pfizer Limited, Mumbai, India
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Long LC, Girdwood S, Govender K, Meyer-Rath G, Miot J. Cost and outcomes of routine HIV care and treatment: public and private service delivery models covering low-income earners in South Africa. BMC Health Serv Res 2023; 23:240. [PMID: 36906559 PMCID: PMC10007767 DOI: 10.1186/s12913-023-09147-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/03/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND While South Africa's national HIV program is the largest in the world, it has yet to reach the UNAIDS 95-95-95 targets. To reach these targets, the expansion of the HIV treatment program may be accelerated through the use private sector delivery models. This study identified three innovative non-governmental primary health care models (private sector) providing HIV treatment, as well as two government primary health clinics (public sector) that served similar populations. We estimated the resources used, and costs and outcomes of HIV treatment across these models to provide inputs to inform decisions around how these services might best be provided through National Health Insurance (NHI). METHODS A review of potential private sector models for HIV treatment in a primary health care setting was conducted. Models actively offering HIV treatment (i.e. in 2019) were considered for inclusion in the evaluation, subject to data availability and location. These models were augmented by government primary health clinics offering HIV services in similar locations. We conducted a cost-outcomes analysis by collecting patient-level resource usage and treatment outcomes through retrospective medical record reviews and a bottom-up micro-costing from the provider perspective (public or private payer). Patient outcomes were based on whether the patient was still in care at the end of the follow up period and viral load (VL) status, to create the following outcome categories: in care and responding (VL suppressed), in care and not responding (VL unsuppressed), in care (VL unknown) and not in care (LTFU or deceased). Data collection was conducted in 2019 and reflects services provided during the 4 years prior to that (2016-2019). RESULTS Three hundred seventy-six patients were included across the five HIV treatment models. Across the three private sector models there were differences in the costs and outcomes of HIV treatment delivery, two of the models had results similar to the public sector primary health clinics. The nurse-led model appears to have a cost-outcome profile distinct from the others. CONCLUSION The results show that across the private sector models studied the costs and outcomes of HIV treatment delivery vary, yet there were models that provided costs and outcomes similar to those found with public sector delivery. Offering HIV treatment under NHI through private delivery models could therefore be an option to increase access beyond the current public sector capacity.
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Affiliation(s)
- L C Long
- Health Economics and Epidemiology Research Office (HE²RO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
- Department of Global Health, Boston University School of Public Health, Boston, United States.
| | - S Girdwood
- Health Economics and Epidemiology Research Office (HE²RO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - K Govender
- Health Economics and Epidemiology Research Office (HE²RO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - G Meyer-Rath
- Health Economics and Epidemiology Research Office (HE²RO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, United States
| | - J Miot
- Health Economics and Epidemiology Research Office (HE²RO), Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, United States
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Shakhshir M, Alkaiyat A. Healthcare providers' knowledge, attitude, and practice on quality of nutrition care in hospitals from a developing country: a multicenter experience. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:15. [PMID: 36879345 PMCID: PMC9990276 DOI: 10.1186/s41043-023-00355-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Despite the fact that malnutrition can affect both recovery and outcome in acute care patients, little is known about malnutrition in Palestine, and even less is known about the assessment of malnutrition knowledge, attitudes, and practices (M-KAP) toward healthcare providers and nutrition care quality measures in hospitalized patients. Therefore, this study aimed to evaluate the M-KAP of physicians and nurses in routine clinical care and determine the influencing factors. METHODS From April 1 to June 31, 2019, cross-sectional research was performed at governmental (n = 5) and non-governmental (n = 4) hospitals in the North West Bank of Palestine. Data were collected using a structured self-administered questionnaire from physicians and nurses to collect information on knowledge, attitude, and practices related to malnutrition and nutrition care, alongside sociodemographic characteristics. RESULTS A total of 405 physicians and nurses were participated in the study. Only 56% of participants strongly agreed that nutrition was important, only 27% strongly agreed that there should be nutrition screening, only 25% felt food helped with recovery, and around 12% felt nutrition as part of their job. Approximately 70% of participants said they should refer to a dietitian, but only 23% knew how and only 13% knew when. The median knowledge/attitude score was 71, with an IQR ranging from 65.00 to 75.00, and the median practice score was 15.00 with an IQR of 13.00-18.00. The mean knowledge attitude practice score was 85.62 out of 128 with SD (9.50). Respondents who worked in non-governmental hospitals showed higher practice scores (p < 0.05), while staff nurses and ICU workers showed the highest practice score (p < 0.001). Respondents with younger age categories, working in non-governmental hospitals in the ICU as practical and staff nurses, showed the highest KAP score (p < 0.05). Significance positive correlations were found between respondents' knowledge/attitude and practice scores regarding the quality of nutrition care in hospitals (r = 0.384, p value < 0.05). In addition, the result also revealed that almost half of respondents believed that the most important barriers to inadequate intake of food at the bedside are related to food appearance, taste, and aroma of meals served (58.0%). CONCLUSIONS The research revealed that inadequate knowledge was perceived as a barrier to effective nutrition care to the patient. Many beliefs and attitudes do not always translate into practice. Although the M-KAP of physicians and nurses is lower than in some other countries/studies, it highlights a strong need for more nutrition professionals in the hospital and increasing nutrition education to improve nutrition care in hospitals in Palestine. Furthermore, establishing a nutrition task force in hospitals elaborated by dietitians as the unique nutrition care provider will assure to implementation of a standardized nutrition care process.
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Affiliation(s)
- Muna Shakhshir
- Department of Nutrition, An-Najah National University Hospital, Nablus, 44839 Palestine
- Health Division, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
| | - Abdulsalam Alkaiyat
- Health Division, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839 Palestine
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Balqis-Ali NZ, Jailani AS, Fun WH, Jawahir S, Sararaks S, Lee GHY. Effect of supplementary private health insurance on inpatient utilisation: Evidence from Malaysia. Heliyon 2023; 9:e14025. [PMID: 36879958 PMCID: PMC9984852 DOI: 10.1016/j.heliyon.2023.e14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Supplementary private health insurance (PHI) provides better access to healthcare, improves health outcomes, potentially lowers the costs for health systems and supports the social security system. Improperly regulated PHI, however, may aggravate inequity of access towards preferential care and encourage moral hazard among PHI purchasers, altering the health-seeking behaviour, which is often observed through the pattern of health care utilisation. We investigated the effect of PHI ownership on private inpatient care utilisation, its frequency of admission and length of stay by conducting secondary data analysis of the Malaysian National Health Morbidity Survey (NHMS) 2015 data, a nationally representative community health survey. Malaysian adults 18 years of age and above who utilised inpatient healthcare facilities were included. In this cross-sectional study, we addressed the endogeneity effect of health insurance by employing instrumental variable estimation and a two-stage residual inclusion analysis. We found a significant increase in private inpatient utilisation among those who owned PHI compared to those who did not (β = 4.39, p < 0.001). There was no significant difference in the frequency of admission and length of stay. The increase in private inpatient utilisation among PHI owners may reflect the demand for timely care and hospitality provided by the private sector, potentially exacerbating the moral hazard behaviour among PHI owners. Further exploration of this issue could impact future healthcare systems financing designs and PHI regulation.
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Affiliation(s)
- Nur Zahirah Balqis-Ali
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Anis-Syakira Jailani
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Weng Hong Fun
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Sondi Sararaks
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Block B2, No. 1, Jalan Setia Murni U13/52, Seksyen U13 Bandar Setia Alam, 40170 Shah Alam, Selangor Malaysia
| | - Grace H Y Lee
- Department of Economics, School of Business, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500 Subang Jaya, Selangor Malaysia
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Xue Q, Xu DR, Cheng TC, Pan J, Yip W. The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China. Arch Public Health 2023; 81:19. [PMID: 36765426 PMCID: PMC9911958 DOI: 10.1186/s13690-023-01029-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/21/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals. METHODS A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively. RESULTS The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions. CONCLUSION The public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals' performances among different ownership types under China's context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.
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Affiliation(s)
- Qingping Xue
- grid.413856.d0000 0004 1799 3643School of Public Health, Chengdu Medical College, Chengdu, China ,grid.13291.380000 0001 0807 1581Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Dong Roman Xu
- grid.284723.80000 0000 8877 7471Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China ,grid.284723.80000 0000 8877 7471Acacia Lab for Implementation Research, SMU Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | - Terence C. Cheng
- grid.38142.3c000000041936754XHarvard TH Chan School of Public Health, Boston, USA
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. .,School of Public Administration, Sichuan University, Chengdu, China.
| | - Winnie Yip
- grid.38142.3c000000041936754XHarvard TH Chan School of Public Health, Boston, USA
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Arsenault-Lapierre G, Bui TX, Le Berre M, Bergman H, Vedel I. Rural and urban differences in quality of dementia care of persons with dementia and caregivers across all domains: a systematic review. BMC Health Serv Res 2023; 23:102. [PMID: 36721162 PMCID: PMC9887943 DOI: 10.1186/s12913-023-09100-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There are challenges in healthcare service delivery in rural areas, and this may be especially true for persons with dementia, who have higher needs to access to the healthcare system, and may have difficulties to commute easily and safely to these services. There is a growing body of literature regarding geographical disparities, but there is no comprehensive systematic review of geographical differences in persons with dementia across all domains of care quality. Therefore, the objective of this study is to conduct a systematic review of the literature on rural and urban differences in quality of dementia care outcomes of persons with dementia across all quality-of-care domains. METHODS We performed a digital search in Ovid MEDLINE on July 16, 2019, updated on May 3, 2021, for French or English records. We selected studies that reported outcome from at least one domain of quality of dementia care (Access, Integration, Effective Care, Efficient Care, Population Health, Safety, and Patient-Centered) in both rural and urban persons with dementia or caregivers. We used rigorous, systematic methods for screening, selection, data extraction and we analyzed outcomes reported by at least two studies using vote counting and appraised the certainty of evidence. Finally, we explored sources of heterogeneity. RESULTS From the 38 included studies, we found differences in many dementia care domains. Rural persons with dementia had higher mortality rates (Population Health), lower visits to any physicians (Access), more hospitalizations but shorter stays (Integration), higher antipsychotic medications (Safety), lower use of home care services and higher use of nursing home (Patient-Centered Care) compared to urban persons with dementia. CONCLUSIONS This comprehensive portrait of rural-urban differences in dementia care highlights possible geographically based inequities and can be used by researchers and decision makers to guide development of more equitable dementia care policies.
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Affiliation(s)
- Geneviève Arsenault-Lapierre
- Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC, H3S 1Z1, Canada.
| | - Tammy X. Bui
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada
| | - Mélanie Le Berre
- grid.14848.310000 0001 2292 3357Université de Montréal, Institut Universitaire de Gériatrie de Montréal, 4565 Chemin Queen Mary, Montreal, H3W 1W5 Canada
| | - Howard Bergman
- grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
| | - Isabelle Vedel
- grid.414980.00000 0000 9401 2774Lady Davis Institute for Medical Research, Jewish General Hospital, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montréal, QC H3S 1Z1 Canada ,grid.14709.3b0000 0004 1936 8649Department of Family Medicine, McGill University, 5858 Ch. de La Côte-Des-Neiges, Suite 300, Montreal, QC H3S 1Z1 Canada
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van Duijn S, Barsosio HC, Omollo M, Milimo E, Akoth I, Aroka R, de Sanctis T, K'Oloo A, June MJ, Houben N, Wilming C, Otieno K, Kariuki S, Onsongo S, Odhiambo A, Ganda G, Rinke de Wit TF. Public-private partnership to rapidly strengthen and scale COVID-19 response in Western Kenya. Front Public Health 2023; 10:837215. [PMID: 36733283 PMCID: PMC9887331 DOI: 10.3389/fpubh.2022.837215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 12/19/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction In Africa almost half of healthcare services are delivered through private sector providers. These are often underused in national public health responses. To support and accelerate the public sector's COVID-19 response, we facilitated recruitment of additional private sector capacity by initiating a public-private partnership (PPP) in Kisumu County, Kenya. In this manuscript we demonstrate this PPP's performance. Methods COVID-19 diagnostic testing formed the basis for a PPP between Kenyan Medical Research Institute (KEMRI), Department of Health Kisumu County, PharmAccess Foundation, and local faith-based and private healthcare facilities: COVID-Dx. First phase COVID-Dx was implemented from June 01, 2020, to March 31, 2021 in Kisumu County, Kenya. Trained laboratory technologists in participating healthcare facilities collected nasopharyngeal and oropharyngeal samples from patients meeting the Kenyan MoH COVID-19 case definition. Healthcare workers in participating facilities collected patient clinical data using a digitized MoH COVID-19 Case Identification Form. We shared aggregated results from these data via (semi-) live dashboards with all relevant stakeholders through their mobile phones and tablets. Statistical analyses were performed using Stata 16 to inform project processes. Results Nine private facilities participated in the project. A patient trajectory was developed from case identification to result reporting, all steps supported by a semi-real time digital dashboard. A total of 4,324 PCR tests for SARS-CoV-2 were added to the public response, identifying 425 positives, accounting for 16% of all COVID-19 tests performed in the County over the given time-period. Geo-mapped and time-tagged information on incident cases was depicted on Google maps through PowerBI-dashboards and fed back to policymakers for informed rapid decision making. Preferential COVID-19 testing was performed on health workers at risk, with 1,009 tests performed (up to 43% of all County health workforce). Conclusion We demonstrate feasibility of rapidly increasing the public health sector COVID-19 response through coordinated private sector efforts in an African setting. Our PPP intervention in Kisumu, Kenya was based on a joint testing strategy and demonstrated that semi-real time digitalization of patient trajectories can gain significant efficiencies, linking public and private healthcare efforts, increasing transparency, support better quality health services and informing policy makers to target interventions.
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Affiliation(s)
- Shannen van Duijn
- PharmAccess Foundation, Amsterdam Office, Amsterdam, Netherlands,*Correspondence: Shannen van Duijn ✉
| | - Hellen C. Barsosio
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | - Mevis Omollo
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | | | - Isdorah Akoth
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | - Robert Aroka
- PharmAccess Foundation Kenya Office, Kisumu, Kenya
| | | | - Alloys K'Oloo
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | - Micah J. June
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | | | | | - Kephas Otieno
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | - Simon Kariuki
- Kenya Medical Research Institute (KEMRI), Center for Global Health Research (CGHR), Kisumu, Kenya
| | | | - Albert Odhiambo
- Department of Health, Kisumu County Government, Kisumu, Kenya
| | - Gregory Ganda
- Department of Health, Kisumu County Government, Kisumu, Kenya
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Templeman L, Eberhardt J, Ling J. Exploring the health care experiences of women diagnosed with vulvodynia. J Sex Med 2023; 20:97-106. [PMID: 36897241 DOI: 10.1093/jsxmed/qdac023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/06/2022] [Accepted: 10/17/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Although seeking diagnosis and treatment for chronic pain should be straightforward, this is not typically the case for those living with vulvodynia, who often describe it as a battle, frequently involving misdiagnosis, dismissal, and gender-based discrimination. AIM This study explored the health care experiences of women living with vulvodynia in the United Kingdom. METHODS As they are less explored in literature, experiences postdiagnosis and across varying health care settings were specifically considered. Interviews were conducted with 6 women aged 21 to 30 years to explore their experiences when seeking help for vulvodynia. OUTCOMES Through interpretative phenomenological analysis, 5 themes emerged: the impact of diagnosis, patients' perception of health care, self-guidance and lack of direction, gender as a barrier to effective care, and a lack of consideration of psychological factors. RESULTS Women often experienced difficulties before and after diagnosis, and many felt that their pain was dismissed and ignored due to their gender. Pain management was felt to be prioritized by health care professionals over well-being and mental health. CLINICAL IMPLICATIONS There is a need for further exploration of gender-based discrimination experiences among patients with vulvodynia, health care professionals' perceptions of their capabilities in working with such patients, and the impact of improving professionals' training in working with these patients2. STRENGTHS AND LIMITATIONS Health care experiences after diagnosis are rarely examined within literature, with studies predominantly focusing on experiences surrounding diagnosis, intimate relationships, and specific interventions. The present study provides an in-depth exploration of health care experiences through participants' lived experiences and gives insight into an underresearched area. Women with negative experiences of health care may have been more likely to participate than those with positive experiences, which may have resulted in their overrepresentation. Furthermore, participants were predominantly young White heterosexual women, and almost all had comorbidities, further limiting generalizability. CONCLUSION Findings should be used to inform health care professionals' education and training to improve outcomes for those seeking care for vulvodynia.
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Affiliation(s)
- Lauren Templeman
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough TS1 3BA, United Kingdom
| | - Judith Eberhardt
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough TS1 3BA, United Kingdom
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland SR1 3SD, United Kingdom
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Davoudi A, Sajdeya R, Ison R, Hagen J, Rashidi P, Price CC, Tighe PJ. Fairness in the prediction of acute postoperative pain using machine learning models. Front Digit Health 2023; 4:970281. [PMID: 36714611 PMCID: PMC9874861 DOI: 10.3389/fdgth.2022.970281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/24/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Overall performance of machine learning-based prediction models is promising; however, their generalizability and fairness must be vigorously investigated to ensure they perform sufficiently well for all patients. Objective This study aimed to evaluate prediction bias in machine learning models used for predicting acute postoperative pain. Method We conducted a retrospective review of electronic health records for patients undergoing orthopedic surgery from June 1, 2011, to June 30, 2019, at the University of Florida Health system/Shands Hospital. CatBoost machine learning models were trained for predicting the binary outcome of low (≤4) and high pain (>4). Model biases were assessed against seven protected attributes of age, sex, race, area deprivation index (ADI), speaking language, health literacy, and insurance type. Reweighing of protected attributes was investigated for reducing model bias compared with base models. Fairness metrics of equal opportunity, predictive parity, predictive equality, statistical parity, and overall accuracy equality were examined. Results The final dataset included 14,263 patients [age: 60.72 (16.03) years, 53.87% female, 39.13% low acute postoperative pain]. The machine learning model (area under the curve, 0.71) was biased in terms of age, race, ADI, and insurance type, but not in terms of sex, language, and health literacy. Despite promising overall performance in predicting acute postoperative pain, machine learning-based prediction models may be biased with respect to protected attributes. Conclusion These findings show the need to evaluate fairness in machine learning models involved in perioperative pain before they are implemented as clinical decision support tools.
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Affiliation(s)
- Anis Davoudi
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United Sates
| | - Ruba Sajdeya
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States
| | - Ron Ison
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United Sates
| | - Jennifer Hagen
- Department of Orthopedic Surgery, University of Florida College of Medicine, Gainesville, FL, United States
| | - Parisa Rashidi
- Department of Biomedical Engineering, University of Florida Herbert Wertheim College of Engineering, Gainesville, FL, United States
| | - Catherine C. Price
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United Sates
- Department of Clinical and Health Psychology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States
| | - Patrick J. Tighe
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United Sates
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van de Vijver S, Tensen P, Asiki G, Requena-Méndez A, Heidenrijk M, Stronks K, Cobelens F, Bont J, Agyemang C. Digital health for all: How digital health could reduce inequality and increase universal health coverage. Digit Health 2023; 9:20552076231185434. [PMID: 37434727 PMCID: PMC10331232 DOI: 10.1177/20552076231185434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
Digital transformation in health care has a lot of opportunities to improve access and quality of care. However, in reality not all individuals and communities are benefiting equally from these innovations. People in vulnerable conditions, already in need of more care and support, are often not participating in digital health programs. Fortunately, numerous initiatives worldwide are committed to make digital health accessible to all citizens, stimulating the long-cherished global pursuit of universal health coverage. Unfortunately initiatives are not always familiar with each other and miss connection to jointly make a significant positive impact. To reach universal health coverage via digital health it is necessary to facilitate mutual knowledge exchange, both globally and locally, to link initiatives and apply academic knowledge into practice. This will support policymakers, health care providers and other stakeholders to ensure that digital innovations can increase access to care for everyone, leading towards Digital health for all.
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Affiliation(s)
- Steven van de Vijver
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
- Family Medicine Department, OLVG Hospital, Amsterdam, The Netherlands
| | - Paulien Tensen
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Ana Requena-Méndez
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Barcelona Institute for Global Health, ISGlobal, University of Barcelona, Barcelona, Spain
| | - Michiel Heidenrijk
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
- Joep Lange Institute, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Cobelens
- Department of Global Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jettie Bont
- Department of Family Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Evaluation of health managers' opinions about decentralization in health services. North Clin Istanb 2022; 9:646-653. [PMID: 36685629 PMCID: PMC9833387 DOI: 10.14744/nci.2021.59837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/12/2021] [Accepted: 04/04/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE It was aimed to determine the opinions of health-care managers on theimplementation of decentralization in health-care services. METHODS The research is a cross-sectional and descriptive study.Sample of the study included 261 health managers.Research data were collected from health-care managers between June 8 and July 17, 2020, using face-to-face interviews technic by a questionnaire, in an average of 20-25 minutes. The obtained data were transferred to the computer environment and analyzed with the number, percentage, and Chi-square tests. RESULTS About 52.5% of the health managers stated that health-care services should be provided by the public, 63.2% of them stated that health-care services should be a form of empowered decentralization, 41.8% of them stated that decentralization could be successful in Turkiye, 62.6% stated that decentralization would provide flexibility in health-care management, 70.3% of them said that it could find solutions to the problems, and 73.3% of them stated that it will improve employee performance whereas 44.9% of them stated that it would negatively affect providing services in integrity, 67.2% of them stated that it would cause regional inequalities, 73.2% of them said that local factors will intervene in health-care services, and 57.9% reported that it would weaken the central power. CONCLUSION The majority of health-care managers prefer that health-care services are provided by the public health-care service and prefer the empowered decentralization of health-care services. More than half of the health-care managers expressed their positive views such as the fact that decentralization provides flexibility in health-care services, improve the performance, and participation in service along with the negative views such as the fact that decentralization negatively affects the service delivery, causes regional inequalities and intervention of local factors, and weakens the central power.
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Delaney MM, Usmanova G, Nair TS, Neergheen VL, Miller K, Fishman E, Bajpai N, Memon P, Bobanski L, Singh D, Srivastava VK, Divakar H, Pai H, Semrau KEA, Pallipamula SP. Does Quality Certification Work? An Assessment of Manyata, a Childbirth Quality Program in India's Private Sector. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:GHSP-D-22-00093. [PMID: 36562433 PMCID: PMC9771457 DOI: 10.9745/ghsp-d-22-00093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND In India, more than 60% of hospital beds are in private facilities, yet several studies have observed suboptimal quality of care in private facilities. We aimed to understand the role of Manyata, a quality improvement initiative in private facilities focused on mentorship and clinical standards, to improve the knowledge and skills of health care providers, their adherence to key childbirth-related clinical practices, and health outcomes for women and newborns. METHODS We conducted a secondary analysis of Manyata program data collected from 466 private facilities across 3 states (Jharkhand, Maharashtra, and Uttar Pradesh) in India from October 2016 to February 2019. We calculated means and 95% confidence intervals for knowledge and skills assessment, adherence to facility standards was analyzed by calculating the proportion of facilities passing a given quality standard at baseline and endline, and changes in pregnancy outcomes were assessed with autoregression modeling. RESULTS From assessments conducted before and after training among providers in Manyata, we observed a significant increase in average knowledge score (6.3 vs. 13.2 of 20) and skill score (8.0 vs. 34.3 of 40). Overall, a significant increase occurred in adherence to clinical standards between baseline and endline assessments (29% vs. 93%). The standards with the greatest improvements were identification and management of eclampsia/preeclampsia, postpartum hemorrhage, and neonatal resuscitation. There were no significant changes over time in absolute rate of reported complications; however, referral rates from private facilities for preeclampsia and newborn sepsis identification and management declined. CONCLUSION Our analysis indicates private facilities' adherence to quality standards and nurses' childbirth knowledge and practical skills increased during Manyata. Additional efforts are needed to ensure high-quality care during cesarean deliveries at private facilities. Future studies with rigorous design are required to evaluate the impact of this quality improvement initiative in improving pregnancy outcomes.
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Affiliation(s)
- Megan Marx Delaney
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA.,Correspondence to Megan Marx Delaney ()
| | | | | | - Vanessa L. Neergheen
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | - Kate Miller
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | - Eliza Fishman
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Lauren Bobanski
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Hema Divakar
- Manyata Steering Committee, Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Hrishikesh Pai
- Manyata Steering Committee, Federation of Obstetric and Gynaecological Societies of India, Mumbai, India
| | - Katherine E. A. Semrau
- Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital, Boston, MA, USA.,Ariadne Labs, a joint center of the Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital; Department of Medicine, Harvard Medical School; Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
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Ali D, Woldegiorgis AGY, Tilaye M, Yilma Y, Berhane HY, Tewahido D, Abelti G, Neill R, Silla N, Gilliss L, Mandal M. Integrating private health facilities in government-led health systems: a case study of the public-private mix approach in Ethiopia. BMC Health Serv Res 2022; 22:1477. [PMID: 36463163 PMCID: PMC9719643 DOI: 10.1186/s12913-022-08769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Private health care facilities working in partnership with the public health sector is one option to create sustainable health systems and ensure health and well-being for all in low-income countries. As the second-most populous country in Africa with a rapidly growing economy, demand for health services in Ethiopia is increasing and one-quarter of its health facilities are privately owned. The Private Health Sector Program (PHSP), funded by the United States Agency for International Development, implemented a series of public-private partnership in health projects from 2004 to 2020 to address several public health priorities, including tuberculosis, malaria, HIV/AIDS, and family planning. We assessed PHSP's performance in leadership and governance, access to medicines, health management information systems, human resources, service provision, and finance. METHODS The World Health Organization's health systems strengthening framework, which is organized around six health system building blocks, guided the assessment. We conducted 50 key informant interviews and a health facility assessment at 106 private health facilities supported by the PHSP to evaluate its performance. RESULTS All six building blocks were addressed by the program and key informants shared that several policy and strategic changes were conducive to supporting the functioning of private health facilities. The provision of free medicines from the public pharmaceutical logistics system, relaxation of strict regulatory policies that restricted service provision through the private sector, training of private providers, and public-private mix guidelines developed for tuberculosis, malaria, and reproductive, maternal, newborn, child, and adolescent health helped increase the use of services at health facilities. CONCLUSIONS Some challenges and threats to sustainability remain, including fragile partnerships between public and private bodies, resource constraints, mistrust between the public and private sectors, limited incentives for the private sector, and oversight of the quality of services. To continue with gains in the policy environment, service accessibility, and other aspects of the health system, the government and international communities must work collaboratively to address public-private partnerships in health areas that can be strengthened. Future efforts should emphasize a mechanism to ensure that the private sector is capable, incentivized, and supervised to deliver continuous, high-quality and equitable services.
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Affiliation(s)
- Disha Ali
- John Snow, Inc. (JSI), Arlington, VA, USA
| | | | - Mesfin Tilaye
- USAID/Ethiopia, Entoto Street, Addis Ababa, Ethiopia
| | - Yonas Yilma
- Independent Consultant, Addis Ababa, Ethiopia
| | - Hanna Y Berhane
- Addis Continental Institute of Public Health, Ayat, Addis Ababa, Ethiopia
| | - Dagmawit Tewahido
- Addis Continental Institute of Public Health, Ayat, Addis Ababa, Ethiopia
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Disparities in adult critical care resources across Pakistan: findings from a national survey and assessment using a novel scoring system. Crit Care 2022; 26:209. [PMID: 35818054 PMCID: PMC9272593 DOI: 10.1186/s13054-022-04046-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
In response to the COVID-19 pandemic, concerted efforts were made by provincial and federal governments to invest in critical care infrastructure and medical equipment to bridge the gap of resource-limitation in intensive care units (ICUs) across Pakistan. An initial step in creating a plan toward strengthening Pakistan’s baseline critical care capacity was to carry out a needs-assessment within the country to assess gaps and devise strategies for improving the quality of critical care facilities.
Methods
To assess the baseline critical care capacity of Pakistan, we conducted a series of cross-sectional surveys of hospitals providing COVID-19 care across the country. These hospitals were pre-identified by the Health Services Academy (HSA), Pakistan. Surveys were administered via telephonic and on-site interviews and based on a unique checklist for assessing critical care units which was created from the Partners in Health 4S Framework, which is: Space, Staff, Stuff, and Systems. These components were scored, weighted equally, and then ranked into quartiles.
Results
A total of 106 hospitals were surveyed, with the majority being in the public sector (71.7%) and in the metropolitan setting (56.6%). We found infrastructure, staffing, and systems lacking as only 19.8% of hospitals had negative pressure rooms and 44.4% had quarantine facilities for staff. Merely 36.8% of hospitals employed accredited intensivists and 54.8% of hospitals maintained an ideal nurse-to-patient ratio. 31.1% of hospitals did not have a staffing model, while 37.7% of hospitals did not have surge policies. On Chi-square analysis, statistically significant differences (p < 0.05) were noted between public and private sectors along with metropolitan versus rural settings in various elements. Almost all ranks showed significant disparity between public–private and metropolitan–rural settings, with private and metropolitan hospitals having a greater proportion in the 1st rank, while public and rural hospitals had a greater proportion in the lower ranks.
Conclusion
Pakistan has an underdeveloped critical care network with significant inequity between public–private and metropolitan–rural strata. We hope for future resource allocation and capacity development projects for critical care in order to reduce these disparities.
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Poompruek P, Perris A, Whanpuch P, Chandler CIR, Sringernyuang L. Mystifying medicines and maximising profit: Antibiotic distribution in community pharmacies in Thailand. Glob Public Health 2022; 17:3931-3943. [PMID: 35282798 DOI: 10.1080/17441692.2022.2049843] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Thailand's antimicrobial stewardship strategy has focussed on promoting 'rational drug use' in the public sector, to reduce the threat of drug resistance and control healthcare expenditure. The strategy's next ambition is to attend to the private sector, where antibiotics are widely available over the counter without prescription. Using ethnographic and survey data, this paper follows antibiotics through community pharmacies, to explore drug distribution and access, and identify potential challenges for stewardship. We extend the analytical frame beyond 'irrational' dispenser-customer transactions, to explore the logics of practice of a multiplicity of actors in the context of a highly competitive pharmaceutical market. Highlighting the role of the pharmaceutical industry in mystifying medicines, we show how antibiotics are collapsed into a category of 'strong medicines' and requested by customers using 'prescriptions by proxy'. We further examine how Thailand's drug regulation and classificatory systems, historically orientated around access to medicines, enable the proliferation of antibiotics in the context of contemporary efforts to control distribution. Recognising the negotiations involved in dispensing antibiotics in a pluralistic health system, we attempt to reconfigure allocations of responsibility, advocating for stewardship approaches that take into account local ecologies of care, as well as implications for access, equity, and accountability.
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Affiliation(s)
- Panoopat Poompruek
- Department of Community Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
| | - Anna Perris
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Phakha Whanpuch
- Department of Society and Health, Mahidol University, Nakhon Pathom, Thailand
| | - Clare I R Chandler
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Ong SM, Lim MT, Fah Tong S, Kamaliah MN, Groenewegen P, Sivasampu S. Comparative performance of public and private primary care service delivery in Malaysia: An analysis of findings from QUALICOPC. PLoS One 2022; 17:e0276480. [PMID: 36269717 PMCID: PMC9586414 DOI: 10.1371/journal.pone.0276480] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/07/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Primary care services are essential in achieving universal health coverage and Malaysia is looking into public-private partnership to overcome resource constraints. The study aims to compare the performance of primary care service delivery dimensions between public and private sector. METHODS This cross-sectional study used the data from the Malaysian International Quality and Costs of Primary Care (QUALICOPC) study conducted in 2015-2016. The relative performance of each sector in four dimensions was compared using multi-level linear regression by incorporating a dummy variable indicating public sector in the model. RESULTS The public sector was shown to have higher performance in comprehensiveness and coordination, while the private sector was better in continuity. There was no significant difference in accessibility. The public primary care services were better in serving primary care sensitive conditions, better informational continuity, and with better skill-mix and inter- and intra- professional relationship. Meanwhile, the private sector was stronger in referral decision making process, specialist feedback and greater out of hours facilities access. CONCLUSIONS The public and private sectors differ in their strengths, which the government may tap into to strengthen primary care services. Other areas for improvement include seamless care strategies that promote good referral, feedback, and information continuity.
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Affiliation(s)
- Su Miin Ong
- Centre for Clinical Outcomes Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
- * E-mail:
| | - Ming Tsuey Lim
- Centre for Clinical Outcomes Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz UKM, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - M. N. Kamaliah
- Faculty of Medicine, University of Cyberjaya, Cyberjaya, Selangor, Malaysia
| | - Peter Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Departments of Human Geography and Department of Sociology, Utrecht University, Utrecht, The Netherlands
| | - Sheamini Sivasampu
- Centre for Clinical Outcomes Research, Institute for Clinical Research, Shah Alam, Selangor, Malaysia
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Daniels B, Shah D, Kwan AT, Das R, Das V, Puri V, Tipre P, Waghmare U, Gomare M, Keskar P, Das J, Pai M. Tuberculosis diagnosis and management in the public versus private sector: a standardised patients study in Mumbai, India. BMJ Glob Health 2022; 7:e009657. [PMID: 36261230 PMCID: PMC9582305 DOI: 10.1136/bmjgh-2022-009657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are few rigorous studies comparing quality of tuberculosis (TB) care in public versus private sectors. METHODS We used standardised patients (SPs) to measure technical quality and patient experience in a sample of private and public facilities in Mumbai. RESULTS SPs presented a 'classic, suspected TB' scenario and a 'recurrence or drug-resistance' scenario. In the private sector, SPs completed 643 interactions. In the public sector, 164 interactions. Outcomes included indicators of correct management, medication use and client experience. Public providers used microbiological testing (typically, microscopy) more frequently, in 123 of 164 (75%; 95% CI 68% to 81%) vs 223 of 644 interactions (35%; 95% CI 31% to 38%) in the private sector. Private providers were more likely to order chest X-rays, in 556 of 639 interactions (86%; 95% CI 84% to 89%). According to national TB guidelines, we found higher proportions of correct management in the public sector (75% vs 35%; (adjusted) difference 35 percentage points (pp); 95% CI 25 to 46). If X-rays were considered acceptable for the first case but drug-susceptibility testing was required for the second case, the private sector correctly managed a slightly higher proportion of interactions (67% vs 51%; adjusted difference 16 pp; 95% CI 7 to 25). Broad-spectrum antibiotics were used in 76% (95% CI 66% to 84%) of the interactions in public hospitals, and 61% (95% CI 58% to 65%) in private facilities. Costs in the private clinics averaged rupees INR 512 (95% CI 485 to 539); public facilities charged INR 10. Private providers spent more time with patients (4.4 min vs 2.4 min; adjusted difference 2.0 min; 95% CI 1.2 to 2.9) and asked a greater share of relevant questions (29% vs 43%; adjusted difference 13.7 pp; 95% CI 8.2 to 19.3). CONCLUSIONS While the public providers did a better job of adhering to national TB guidelines (especially microbiological testing) and offered less expensive care, private sector providers did better on client experience.
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Affiliation(s)
- Benjamin Daniels
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Daksha Shah
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Ada T Kwan
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Ranendra Das
- Institute for Socio-Economic Research on Development and Democracy, Delhi, India
| | - Veena Das
- Department of Anthropology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Varsha Puri
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Pranita Tipre
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Upalimitra Waghmare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Mangala Gomare
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Padmaja Keskar
- Public Health Department, Municipal Corporation of Greater Mumbai, Mumbai, India
| | - Jishnu Das
- McCourt School of Public Policy, Georgetown University, Washington, District of Columbia, USA
| | - Madhukar Pai
- McGill International TB Centre, McGill University, Montreal, Québec, Canada
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Adepoju VA, Adejumo OA, Adepoju OE, Adeniyi MO, Etuk V, Nzekwe I, Inegbeboh JO, Adelekan A, Oladimeji O. Do private health providers adhere to National Tuberculosis Guideline while assigning treatment outcome? Findings from a lower middle-income country. Front Public Health 2022; 10:924132. [PMID: 36211674 PMCID: PMC9540382 DOI: 10.3389/fpubh.2022.924132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 08/18/2022] [Indexed: 01/24/2023] Open
Abstract
Background Treatment success rate is an important indicator to measure the performance of the National Tuberculosis Program (NTP). There are concerns about the quality of outcome data from private facilities engaged by NTP. Adherence of private providers of tuberculosis care to NTP guideline while assigning treatment outcomes to patients is rarely investigated. We aimed to determine whether Lagos private for-profit (PFP) and private not-for-profit (PNFP) facilities adhere to domestic TB guideline while assigning treatment outcome and the availability of periodic sputum acid-fast bacilli (AFB) results. Method A retrospective review of facility treatment register and treatment cards of TB patients managed between January and December 2016 across 10 private directly observed treatment short-course (DOTS) facilities involved in the public-private mix (PPM) in Lagos, Nigeria. The study took place between January and June 2019. Results Of the 1,566 patients, majority (60.7%) were male, >30 years (50.2%), HIV-negative (88.4%), and attended PNFP (78.5%). The reported treatment success rate (TSR) was 84.2% while the actual TSR was 53.8%. In total, 91.1, 77.6, and 70.3% of patients had sputum acid-fast bacilli (AFB) at 2/3, month 5, and month 6, respectively, while 68.6% had all the three sputum AFB in the register. Healthcare workers (HCWs) were adherent in assigning treatment outcome for 65.6% of TB patients while 34.4% of patients were assigned incorrect treatment outcomes. Most variations between reported and actual treatment outcomes were found with cured (17%) and completed (13.4%). Successful and unsuccessful outcomes were overreported by 30.4% and 4.1%, respectively. DOTS providers in private facilities with available TB guideline (OR 8.33, CI 3.56-19.49, p < 0.0001) and PNFP facility (OR 4.42, CI 1.91-10.3, p = 0.001) were more likely to adhere to National TB Guideline while assigning TB treatment outcome. Conclusion Frontline TB providers in Lagos private hospitals struggled with assigning correct treatment outcome for TB patients based on NTBLCP guideline. Increased access to all the periodic follow-up AFB tests for TB patients on treatment and availability of National TB Guideline for referencing could potentially improve the adherence of private TB service providers while assigning TB treatment outcomes.
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Affiliation(s)
- Victor Abiola Adepoju
- Department of HIV and Infectious Diseases, Jhpiego (an Affiliate of John Hopkins University), Abuja, Nigeria,*Correspondence: Victor Abiola Adepoju ;
| | - Olusola Adedeji Adejumo
- Department of Community Medicine and Primary Health Care, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Oluwatoyin Elizabeth Adepoju
- Department of Adolescent Research, Adolescent Friendly Research Initiative and Care (ADOLFRIC), Ado-Ekiti, Nigeria
| | - Marius Olusola Adeniyi
- Department of Primary Healthcare Services, Ondo State Primary Healthcare Development Agency, Akure, Nigeria
| | - Victoria Etuk
- International Research Center of Excellence (IRCE), Institute of Human Virology of Nigeria, Abuja, Nigeria
| | - Iheoma Nzekwe
- Department of HIV and Infectious Diseases, Jhpiego (an Affiliate of John Hopkins University), Abuja, Nigeria
| | - Jude O. Inegbeboh
- Department of HIV/AIDS, Birnin Kebbi, Kebbi State Children Emergency Fund (UNICEF), Abuja, Nigeria
| | | | - Olanrewaju Oladimeji
- Department of Public Health, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
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Singh M, Yadav K, Goswami S, Parashar M, Gupta E, Verma M, Goel S, Malhotra S. Predictors of adherence to prescribed antihypertensive medications among Hypertensive (15-49 years) in India: A secondary data analysis of National Family Health Survey 4. J Family Med Prim Care 2022; 11:5807-5814. [PMID: 36505527 PMCID: PMC9731078 DOI: 10.4103/jfmpc.jfmpc_164_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/25/2022] [Accepted: 03/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background Adherence to medications is one of the key determinants of therapeutic control of high blood pressure and is seen as a bottleneck in our fight against hypertension control. We have little scientific evidence from India that highlights the determinants of treatment adherence. Aim The purpose of this study was to identify the predictor adherence to the currently prescribed antihypertensive medications. Material and Methods We did a secondary data analysis of the National Family Health Survey, 2015-2016 datasets. As there were no direct variables to measure adherence, this was derived from the responses to the survey question: "currently taking a prescribed hypertensive medication to lower Blood Pressure" among those already diagnosed as hypertensives by the physician. The other sociodemographic and household-level variables were used as independent variables for analysis. Results The level of awareness about their hypertensive status among the 15-49-year-olds who were subjected to blood pressure measurement was 9.34% (70,267/80,3081). Of these, 70,267 participants, 65878 with valid hypertensive individual data were included in the final analysis. Among them, 26.78% are currently adhering to antihypertensive medication. Female gender (adj OR; 95% CI: 1.17 [1.09-1.24]) and non-reserved caste ([OR] 1.24; 95% [CI]: 1.18-1.32) depicted better adherence to the current treatment. The hypertensives who preferred taking treatment from shops or at home or some other place in comparison to health facilities had a significant association with adherence (adj OR: 1.64; 95% CI: [1.43-1.88]). Conclusion The current study reported low adherence to the current antihypertensive medication. Gender, higher age group, obesity, and place of taking the treatment were strongly associated with adherence to treatment.
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Affiliation(s)
- Mitasha Singh
- Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Kartikey Yadav
- Community Medicine, Lady Harding Medical College, New Delhi, India
| | - Shweta Goswami
- Community Medicine, ESIC Medical College and Hospital, Faridabad, Haryana, India
| | - Mamta Parashar
- Community Medicine, Lady Harding Medical College, New Delhi, India
| | - Ekta Gupta
- ICMR, National Institute of Cancer Prevention and Research, Sector 39, Noida, Gautam Budh Nagar, Uttar Pradesh, India
| | - Madhur Verma
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Sonu Goel
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Sonu Goel, Professor of Health Management, Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, India. Adjunct Clinical Associate Professor, Public Health Masters Program School of Medicine and Health Research Institute (HRI), University of Limerick, Ireland. E-mail:
| | - Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Science, New Delhi, India
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Mgopa LR, Ross MW, Lukumay GG, Mushy SE, Mkony E, Massae AF, Mwakawanga DL, Leshabari S, Mohamed I, Trent M, Wadley J, Bonilla ZE, Rosser BRS. Perceptions of Sexual Healthcare Provision in Tanzania: a Key Informant Qualitative Study. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:849-859. [PMID: 36172532 PMCID: PMC9514134 DOI: 10.1007/s13178-021-00607-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Sexual health care services must be standard and unbiased, guided by a structured health care system. There is a scarcity of data on how sexual health care is delivered in Tanzania. METHODS To address this gap, in July 2019 we interviewed eleven key informants: cultural and public health experts, and political, religious, and community leaders, selected from different organizations in Dar es Salaam, Tanzania. Participants were asked for their opinions about clinical practices of health care professionals when providing care to patients, with an emphasis on sexual health. RESULTS Participants' responses were classified into three subcategories: strengths, barriers, and gaps in sexual health care. Availability of services, service delivery to adults, and code of conduct were among the strengths observed in clinical care services. Barriers included the health care provider's attitudes, moral values, and inadequacy in health policies and treatment guidelines. Vulnerable populations including youth were frequently reported to face most challenges when seeking sexual health care services. In terms of gaps, informants emphasized gender equity in sexual health services provision within care settings. CONCLUSION AND IMPLICATION Data indicate that lack of training in sexual health and guidelines for dealing with sexual issues are a barrier to comprehensive health care. These findings can inform the main areas for curriculum developers to focus on, when developing an Afro-centric sexual health curriculum suitable for students in health care professional courses. Moreover, these findings can be useful when developing treatment guidelines and policies that are beneficial to the sexual health wellbeing of individuals.
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Affiliation(s)
- Lucy R. Mgopa
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Michael W. Ross
- Program in Human Sexuality, Department of Family Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gift Gadiel Lukumay
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Stella Emmanuel Mushy
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Ever Mkony
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Agnes F. Massae
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Dorkas L. Mwakawanga
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Sebalda Leshabari
- Department of Community Health Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania
| | - Inari Mohamed
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Maria Trent
- Department of Adolescent and Young Adult Medicine, Johns Hopkins University Schools of Medicine and Public Health, Baltimore, MD, USA
| | - James Wadley
- Department of Counselling and Health Services, Lincoln University, Philadelphia, PA, USA
| | - Zobeida E. Bonilla
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - B. R. Simon Rosser
- Department of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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Mathew N, Rumbidzai C, Fungisai M. Exploring factors enabling the spread of COVID-19: Narratives of health professionals in Harare, Zimbabwe. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2973-e2979. [PMID: 35133044 PMCID: PMC9111785 DOI: 10.1111/hsc.13742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 12/16/2021] [Accepted: 01/20/2022] [Indexed: 06/14/2023]
Abstract
Low- and middle-income countries (LMICs) are affected by an array of health problems ranging from the weak infrastructure health system to the shortage of equipment and qualified personnel in hospitals and other medical facilities. This makes it difficult for health systems in these countries to withstand pandemics like COVID-19 leading to a rapid infection of the population. This research study was set to explore the factors enabling the spread of COVID-19 in the city of Harare. The study utilised an explorative qualitative approach (EQA). The study recruited 40 (N = 40) health professionals who worked for the private sector and the Ministry of Health. One to one semistructured interviews were used to collect data. The data were thematically analysed and presented. Ethical approval was granted by the Joint Research Council of Zimbabwe (JREC). The study found that the shortage of personal protective equipment (PPE), disregard for social distancing, lack of running water, shortage of clinical supplies, overcrowded living houses, selective enforcement of restrictions and corruption were factors that enabled the spread of COVID-19 pandemic in the city of Harare. There is need for more hospitals to be built and fully equipped with the necessary equipment if health delivery and management of people affected by COVID-19 is to be improved. More importantly, the health system needs to be supported by a robust health promotion initiative to enlighten communities on pandemics like COVID-19 and the need to observe utmost hygiene in all spaces.
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Affiliation(s)
| | - Chireshe Rumbidzai
- Department of Nursing and Public HealthKwazulu Natal UniversityDurbanSouth Africa
| | - Mushawa Fungisai
- Department of Health and Social WorkNottingham Trent UniversityNottinghamUK
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A study on Ishikawa’s original basic tools of quality control in healthcare. TQM JOURNAL 2022. [DOI: 10.1108/tqm-06-2022-0187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe main purpose of this study is to investigate Ishikawa’s statement that “95% of problems in processes can be accomplished using the 7 Quality Control (QC) tools” and explore its validity within the health-care sector. The study will analyze the usage of the 7 QC tools in the health-care service sector and the benefits, challenges and critical success factors (CSFs) for the application of the 7 QC tools in this sector.Design/methodology/approachIn order to evaluate Ishikawa’s statement and how valid his statement is for the health-care sector, an online survey instrument was developed, and data collection was performed utilizing a stratified random sampling strategy. The main strata/clusters were formed by health-care professionals working in all aspects of health-care organizations and functions. A total of 168 participants from European health-care facilities responded to the survey.FindingsThe main finding of this study is that 62% of respondents were trained in the 7 QC tools. Only 3% of participants in the health-care sector perceived that the seven tools of QC can solve above 90% of quality problems as originally claimed by Dr Ishikawa. Another relevant finding presented in this paper is that Histograms, Cause and Effect diagrams and check sheets are the most used tools in the health-care sector. The least used tools are Stratification and Scatter diagrams. This paper also revealed that the 7 QC tools proposed by Dr Ishikawa were most used in hospital wards and in administration functions. This work also presents a list of CSFs required for the proper application of the 7 QC tools in healthcare.Research limitations/implicationsThis research was carried out in European health-care facilities – and there is an opportunity to expand the study across global health-care facilities. There is also an opportunity to study the use of the tools and their impact on hospital performance using the Action Research methodology in a health-care organization.Originality/valueTo the best of the authors’ knowledge, this is the very first research within the health-care sector that focused on investigating the usage of all the 7 basic tools and challenging Dr Ishikawa’s statement: “95% of problems in processes can be accomplished using the 7 Quality Control (QC) tools” from his book “What is Quality Control?” The results of this study represent an important first step toward a full understanding of the applicability of these tools in the health-care sector.
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Levana V, Antonio F. Antecedents of Patient Satisfaction in Private Clinical Laboratories toward Patient Loyalty with Switching Cost and Location as Moderating Factors (An Empirical Study from Indonesia). Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Clinical laboratory services are at the forefront to support healthcare services, particularly during the pandemic of COVID-19. The increasing number of private clinical laboratories at present days indicates the increase in patient needs, causing the healthcare service provider to face challenges as people have more options. Therefore fostering patient loyalty (PL) is a crucial success factor for the business growth of clinical laboratories as healthcare providers.
AIM: The purpose of this study is to analyse antecedents of patient satisfaction (PS) in clinical laboratories towards PL with the switching cost (SC) and location (LO) as moderating factors.
METHODS: This study was done as a quantitative survey, and data were obtained by a cross-sectional approach with partial least squares structural equation modeling (PLS-SEM) for the data analysis method. There are 266 respondents eligible as samples, who undergo the phlebotomy process in a private laboratory located within a specific area.
RESULTS: This study demonstrated that all the 9 hypotheses supported with α: 0.05 and p < 0.05, include 6 independent variables named administrative process (AP), information availability (IA), the environment in the phlebotomy room (ER), phlebotomy process (PP), waiting time (WT) and result notification (RN) that influence PS. Patient satisfaction has been shown to have a direct effect on patient loyalty and also mediate the antecedents. Furthermore, SC and LO have demonstrated a significant effect to moderate this relationship.
CONCLUSIONS: Patient satisfaction has been confirmed as the main construct to predict PL whereas the AP is the most important independent variable followed by IA. Clinical laboratory management should pay more attention to these antecedents in order to ensure PS and retain the clinic’s patients. The cost from the patient's perspective should be taken into account since this helps the clinical laboratory keep the patient loyal.
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Liang D, Linda BE, Wang M, Xu Z. Hospital health-care delivery quality evaluation in Ghana: An integrated medical triangular fuzzy MULTIMOORA approach. Inf Sci (N Y) 2022. [DOI: 10.1016/j.ins.2022.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cohidon C, El Hakmaoui F, Senn N. The role of general practitioners in managing the COVID-19 pandemic in a private healthcare system. Fam Pract 2022; 39:586-591. [PMID: 34537836 PMCID: PMC9295602 DOI: 10.1093/fampra/cmab112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The canton of Vaud's public health authorities, in Switzerland, invited general practitioners (GPs) to participate in managing suspected COVID-19 patients and continue caring for their non-COVID-19 patients. However, this course of action was not mandatory. The present study's objective was to describe and understand how involved GPs were in dealing with the COVID-19 pandemic's first wave. METHODS This mixed-methods study combined a retrospective quantitative survey and a qualitative explanatory investigation. All of the canton's GPs were invited to participate in the quantitative survey via an online questionnaire including sections on: specific organization regarding COVID-19 activities and suspected COVID-19 patients, activities relating to non-COVID-19 patients, consequences on the practice's professional staff, and opinions about the public health authorities' pandemic crisis management. The qualitative investigation involved interviews with 10 volunteer GPs. RESULTS The participation rate was 41%. One third of GPs chose not to reorganize their practice for the specific management of suspected COVID-19 patients. The number of weekly activities and interventions decreased by over 50% at 44% of practices, mostly due to a lack of patients. Even in an extraordinary crisis, GPs maintained their choice of whether to become involved, as their private and independent status allowed them to do. However, those who chose to be involved felt frustrated that the public health authorities did not recognize them as major health providers in the management of the pandemic. CONCLUSION This study illustrated the complexity and limitations of a primary care system based completely on private healthcare providers.
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Affiliation(s)
- Christine Cohidon
- Department of Family Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Fatima El Hakmaoui
- Department of Family Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- Department of Family Medicine, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
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Diango K, Yangongo J, Sistenich V, Hodkinson P, Mafuta E, Wallis L. Evaluation of needs and supply of emergency care in Kinshasa, Democratic Republic of Congo: a cross-sectional household survey. BMJ Open 2022; 12:e060036. [PMID: 35820742 PMCID: PMC9277375 DOI: 10.1136/bmjopen-2021-060036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Emergency care can address over half of deaths occurring each year in low-income countries. A baseline evaluation of the specific needs and gaps in the supply of emergency care at community level could help tailor suitable interventions in such settings. This study evaluates access to, utilisation of, and barriers to emergency care in the city of Kinshasa, Democratic Republic of Congo. DESIGN A cross-sectional, community-based household survey. SETTING 12 health zones in Kinshasa, Democratic Republic of Congo. PARTICIPANTS Three-stage randomised cluster sampling was used to identify approximately 100 households in each of the 12 clusters, for a total of 1217 households. The head of each household or an adult representative responded on behalf of the household. Additional 303 respondents randomly selected in the households were interviewed regarding their personal reasons for not accessing emergency care. PRIMARY OUTCOME Availability and utilisation of emergency care services. RESULTS In August 2021, 1217 households encompassing 6560 individuals were surveyed (response rate of 96.2%). Most households were economically disadvantaged (70.0% lived with <US$100 per person per month) and had no health insurance (98.4%) in a country using a fee-for-service healthcare payment system. An emergency visit in the last 12 months was reported in 52.6% of households. Ambulance utilisation was almost non-existent (0.2%) and access to health facilities for emergencies was mostly by walking (60.6% and 56.7% by day and night, respectively). Death in the last 12 months was reported in 12.8% of households, of which 20.6% occurred out-of-hospital with no care received within 24 hours prior to death. Self-medication (71.3%) and the expected high cost of care (19.5%) were the main reasons for unmet emergency care needs. CONCLUSION There is a substantial gap in the supply of emergency care in Kinshasa, with several unmet needs and reasons for poor access identified.
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Affiliation(s)
- Ken Diango
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - John Yangongo
- Ecole de Santé Publique, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Vera Sistenich
- Department of Emergency Medicine, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Hodkinson
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Eric Mafuta
- Ecole de Santé Publique, Université de Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Rethinking Public Private Mix (PPM) Performance in the Tuberculosis Program: How Is Care Seeking Impacting This Model in High TB Burden Countries? Healthcare (Basel) 2022; 10:healthcare10071285. [PMID: 35885812 PMCID: PMC9317713 DOI: 10.3390/healthcare10071285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
In many high TB burden countries with enormous private-sector presence, up to 60–80% of the initial health-seeking behavior occurs in the private sector when people fall sick. Private-sector providers are also perceived to offer poorer-quality health service, and contribute to TB notification gaps and the spread of multidrug-resistant tuberculosis (MDR-TB). Recent efforts have focused on the expansion of TB services among private providers through public–private mix (PPM) initiatives. However, whether such efforts have matched the contribution of the private sector in TB notification, considering its enormous health-seeking volume, is debatable. Here, we argue that evaluating PPM program performance on the basis of the proportion of private-sector health seeking and level of undernotification is an imperfect approach due to differentials in tuberculosis risk profiles and access among patient populations seeking private care when compared with the public sector. We suggest a uniform definition of what constitutes PPM, and the standardization of PPM reporting tools across countries, including the ability to track patients who might initially seek care in the private sector but are ultimately publicly notified. PPM programs continue to gain prominence with rapid urbanization in major global cities. A universal health coverage framework as part of the PPM expansion mandate would go a long way to reduce the catastrophic cost of seeking TB care.
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Martinussen PE, Rydland HT. (I can't get no) satisfaction: A comparative study of healthcare recommodification in Europe, 2010-18. Soc Sci Med 2022; 305:115083. [PMID: 35640446 DOI: 10.1016/j.socscimed.2022.115083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Abstract
European health reforms during the last decades have strengthened patient rights and introduced choice, competition and financial incentives in a sector that has typically been state-directed and centrally controlled. The marketisation of health care has also drawn out profit and introduced private provision. The main argument behind this trend is that market competition will improve service quality and deliver health services more efficiently. Such reforms often fall under the umbrella of New Public Management (NPM), and there is a lack of empirical research on their effects. The purpose of this paper is to investigate the association between healthcare marketisation and health system outcomes across European nations. In order to measure a country's degree of healthcare marketisation we employed indicators of healthcare decommodification. The concept refers to the extent to which an individual's access to healthcare is dependent upon their market position and the extent to which a country's provision of health is independent from the market. These indicators are three measures that assess the financing, provision and coverage of the private sector, and thus reflects the varied role of the market in a health care system: private health care expenditure as amount of GDP, private hospital beds as amount of total hospital bed stock, and public healthcare coverage. As indicator of health system outcome, we employed a measure that has not previously been investigated in the context of healthcare marketisation: satisfaction with health care system. We used multilevel analyses on five waves (2009-2017) of the biannual European Social Survey (ESS), with our final models including more than 120,000 individuals from 21 countries. Our methodological approach allowed us to study both cross-sectional and longitudinal relationships. The strongest substantial associations were between coverage and satisfaction, with high public healthcare coverage being associated with higher satisfaction.
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Affiliation(s)
- Pål E Martinussen
- Department of Sociology and Political Science, Norwegian University of Science and Technology, P.O. Box 8900 Torgarden, N-7491, Trondheim, Norway.
| | - Håvard T Rydland
- NORCE Norwegian Research Centre AS, P.O. Box 22 Nygårdstangen, N-5838, Bergen, Norway.
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93
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Dai B, Larnyo E, Larnyo A, Nutakor JA, Amerley Amarteifio EN, Frimpong Y, Addai-Dansoh S. Predictors of Healthcare Utilization Among Older Adults with Moderate to Severe Cognitive Limitations in Ghana: A Cross-Sectional Analysis of the WHO Study on Global Ageing and Adult Health (SAGE) Wave 1. Curr Alzheimer Res 2022; 19:585-605. [PMID: 36065914 DOI: 10.2174/1567205019666220905153301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/24/2022] [Accepted: 08/09/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND As the number of older adults in Ghana keeps increasing, so does the prevalence of aging-related diseases and conditions that tend to lead to cognitive decline. However, knowledge on the predicting factors of healthcare utilization among older adults with cognitive limitations is still scarce. OBJECTIVE This study examines the predictive factors of healthcare-seeking behavior among older adults with moderate-to-severe cognitive limitations in Ghana. METHODS Based on Andersen's behavioral model of health service utilization, the study analyzed data from 3106 older adults with moderate to severe cognitive limitations in Ghana aged 50+ using Bivariate Probit Regression and the Heckman Selection Model. RESULTS Results showed that individuals who were aged 75+, living in urban settlements, educated, higher income levels and parents who had some level of education, pension benefits, and both mandatory and voluntary health insurance were more likely to seek inpatient care. Enabling resources such as the national health insurance scheme and other types of medical insurance, household income, pension benefits, and predisposition factors like education influenced outpatient and inpatient healthcare consumption for older adults with moderate to severe cognitive limitations but had little influence on the choice of healthcare facility except for health insurance. CONCLUSION Since the healthcare-seeking behavior of older adults with moderate-to-severe cognitive limitations is driven by an amalgamation of several internal and external factors, there is a need for policy change to understand and cautiously incorporate these factors into the decision to improve equitable access to healthcare services for these individuals, as not all sizes fit all in providing quality care for them.
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Affiliation(s)
- Baozhen Dai
- Department of Labor and Social Security, School of Public Health, Southeast University, Nanjing, Jiangsu Province 210009, China
| | - Ebenezer Larnyo
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Abigail Larnyo
- School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Jonathan Aseye Nutakor
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Edwina Naa Amerley Amarteifio
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Yaw Frimpong
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
| | - Stephen Addai-Dansoh
- Department of Health Policy and Management, School of Management, Jiangsu University, Zhenjiang, Jiangsu Province 212013, China
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94
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Doing more with less - How frugal innovations can contribute to improving healthcare systems. Soc Sci Med 2022; 306:115127. [PMID: 35750004 DOI: 10.1016/j.socscimed.2022.115127] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 05/30/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022]
Abstract
The dominance of an innovation discourse laden with cutting edge and expensive technologies, may be preventing us from recognizing alternative and complementary perspectives, which could help cut healthcare costs while improving worldwide access to health services. One such complementary approach is that of frugal innovation. Frugal innovation, as a way to produce efficacious and affordable products using fewer resources to reach the underserved customers, has received increasing attention in the social sciences literature. Although frugal innovation is commonly associated with emerging economies, there is now a rising interest from healthcare providers in developed countries, to find and apply effective, and lower-cost solutions. Nonetheless, knowledge on frugal innovation and its role in healthcare is dispersed across different literatures which hampers researchers and practitioners to access a fuller, and integrated picture of the phenomenon. In this study, by synthesizing extant knowledge, we tackle the fragmentation of the phenomenon. We elucidate on who the actors are, what is being done, how are such innovations being developed, and what the outcomes are, providing a framework that lays out the underlying mechanisms of frugal innovation in healthcare (FIH). The midrange theory that we develop, provides a conceptual framework for researchers to undertake empirical observation and models to guide managerial practices. Furthermore, by providing a more unified perspective of frugal innovation in healthcare, we hope to initiate conversations on the development, adequacy and adoption of these innovations in healthcare services, which could increase affordability and access for the population while maintaining quality.
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95
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Smithers D, Waitzkin H. Universal health coverage as hegemonic health policy in low- and middle-income countries: A mixed-methods analysis. Soc Sci Med 2022; 302:114961. [PMID: 35527089 DOI: 10.1016/j.socscimed.2022.114961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 02/19/2022] [Accepted: 04/02/2022] [Indexed: 11/24/2022]
Abstract
Universal health coverage (UHC) has become an influential global health policy. This study asked whether and to what extent UHC became a "hegemonic" health policy. The article consists of three parts: a historical timeline of UHC's rise, a bibliometric analysis of UHC in the literature, and a qualitative thematic analysis of how UHC is defined and the thematic content of those definitions. The roots of UHC can be traced to policies enacted by international financial institutions (IFIs) such as the World Bank and International Monetary Fund (IMF) during the latter half of the twentieth century. These policies caused the debt of low- and middle-income countries (LMICs) to rise precipitously and led the same IFIs and other institutions like the World Health Organization to become involved in the development and restructuring of health systems. UHC was presented as the leading method for financing development of health systems. As the bibliometric analysis shows, UHC has come to predominate in the literature around health system reforms. The thematic analysis based on a random selection of papers obtained in the bibliometric component of the study shows that often the term is not defined or only poorly defined. There is wide variation in the definitions, with many papers mentioning concepts such as quality, access, and equity without further clarification. Usually, papers define UHC to include tiering of benefits, with discussions of financing that focus on preventing "catastrophic [individual] expenditures" rather than discussing universal budgeting of a national health care system or national health insurance. We conclude that UHC has become hegemonic within global health policy, to the exclusion of discussions about other approaches to the transformation of health systems that are not predominately based on insurance coverage such as Health Care for All system, a system which provides equal services for the entire population.
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Affiliation(s)
- Daniel Smithers
- Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA.
| | - Howard Waitzkin
- University of New Mexico, Department of Sociology and Health Sciences Center, 801 Encino Place NE, Albuquerque, NM 87102, USA.
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96
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Sinjela KM, Simangolwa WMW, Hehman L, Kamanga M, Mwambazi WK, Sundewall J. Exploring for-profit healthcare providers' perceptions of inclusion in the Zambia National Health Insurance Scheme: A qualitative content analysis. PLoS One 2022; 17:e0268940. [PMID: 35622836 PMCID: PMC9140276 DOI: 10.1371/journal.pone.0268940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/08/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In 2019, Zambia introduced the national health insurance (NHI) as a healthcare financing strategy to increase universal access to health care services. The private health sector can complement public sector providers as service providers under the NHI. As such, the NHI Management Authority seeks to accredit for-profit private healthcare facilities in the NHI. Ascertaining factors that influence private-for-profit health providers to participate in the NHI is essential, but the evidence is lacking. In this study, we aimed to explore and characterize perceptions and experiences of for-profit private hospitals, dental clinics, eye clinics, diagnostic centres, and pharmacies regarding their inclusion in the NHI. METHODS We conducted in-depth interviews with owners or management officers of purposively sampled private health care providers in Lusaka, Zambia (n = 22) between May and June 2020. Qualitative content analysis was used to analyse data. RESULTS The findings highlight low awareness of the NHI among providers and a need to understand the NHI. Providers revealed their positions and views on the accreditation process and payment arrangements and stated that their participation would complement the NHI. They also cited conditions to participate in the NHI, highlighted opportunities and challenges of engaging in the NHI, and expressed a need for sustainable ways of governing the scheme. CONCLUSION The assessment of health providers' inclusion in the NHI scheme is multifaceted. The results of this study surfaced factors such as raising awareness on the NHI among providers and how their concerns on aspects such as payments can be considered as inputs to enlighten consensual agreements between the NHI authority and health providers in leveraging the private health sector. Private providers' concerns must be further understood and considered as the NHI strives to include this group as health care providers in the scheme.
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Affiliation(s)
| | | | | | - Mpuma Kamanga
- National Health Insurance Management Authority (NHIMA), Lusaka, Zambia
| | | | - Jesper Sundewall
- Division of Social Medicine and Global Health, Lund University, Malmö, Sweden
- University of KwaZulu-Natal, Durban, South Africa
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97
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Garg S, Tripathi N, Ranjan A, Bebarta KK. How much do government and households spend on an episode of hospitalisation in India? A comparison for public and private hospitals in Chhattisgarh state. HEALTH ECONOMICS REVIEW 2022; 12:27. [PMID: 35522382 PMCID: PMC9078002 DOI: 10.1186/s13561-022-00372-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 04/26/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Improvements in the financing of healthcare services are important for developing countries like India to make progress towards universal health coverage. Inpatient-care contributes to a big share of total health expenditure in India. India has a mixed health-system with a sizeable presence of private hospitals. Existing studies show that out-of-pocket expenditure (OOPE) incurred per hospitalisation in private hospitals was greater than public facilities. But, such comparisons have not taken into account the healthcare spending by government. METHODS For a valid comparison between public and for-profit private providers, this study in Indian state of Chhattisgarh assessed the combined spending by government and households per episode of hospitalisation. The supply-side and demand-side spending from public and private sources was taken into account. The study used two datasets: a) household survey for data on hospital utilisation, OOPE, cash incentives received by patients and claims raised under publicly funded health insurance (PFHI) schemes (n = 903 hospitalisation episodes) b) survey of public facilities to find supply-side government spending per hospitalisation (n = 64 facilities). RESULTS Taking into account all relevant demand and supply side expenditures, the average total spending per day of hospitalisation was INR 2833 for public hospitals and INR 6788 for private hospitals. Adjusted model for logarithmic transformation of OOPE while controlling for variables including case-mix showed that a hospitalisation in private hospitals was significantly more expensive than public hospitals (coefficient = 2.9, p < 0.001). Hospitalisations in private hospitals were more likely to result in a PFHI claim (adjusted-odds-ratio = 1.45, p = 0.02) and involve a greater amount than public hospitals (coefficient = 0.27, p < 0.001). Propensity-score matching models confirmed the above results. Overall, supply-side public spending contributed to 16% of total spending, demand-side spending through PFHI to 16%, cash incentives to 1% and OOPE to 67%. OOPE constituted 31% of total spending per episode in public and 86% in private hospitals. CONCLUSIONS Government and households put together spent substantially more per hospitalisation in private hospitals than public hospitals in Chhattisgarh. This has important implications for the allocative efficiency and the desired public-private provider-mix. Using public resources for purchasing inpatient care services from private providers may not be a suitable strategy for such contexts.
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Affiliation(s)
- Samir Garg
- State Health Resource Centre, Raipur, Chhattisgarh India
| | | | - Alok Ranjan
- Indian Institute of Technology, Jodhpur, India
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98
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Hanson K, Brikci N, Erlangga D, Alebachew A, De Allegri M, Balabanova D, Blecher M, Cashin C, Esperato A, Hipgrave D, Kalisa I, Kurowski C, Meng Q, Morgan D, Mtei G, Nolte E, Onoka C, Powell-Jackson T, Roland M, Sadanandan R, Stenberg K, Vega Morales J, Wang H, Wurie H. The Lancet Global Health Commission on financing primary health care: putting people at the centre. Lancet Glob Health 2022; 10:e715-e772. [PMID: 35390342 PMCID: PMC9005653 DOI: 10.1016/s2214-109x(22)00005-5] [Citation(s) in RCA: 118] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Kara Hanson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Nouria Brikci
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Darius Erlangga
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Abebe Alebachew
- Breakthrough International Consultancy, Addis Ababa, Ethiopia
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, University Hospital and Faculty of Medicine, University of Heidelberg, Heidelberg, Germany
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | - Ina Kalisa
- World Health Organization, Kigali, Rwanda
| | | | - Qingyue Meng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - David Morgan
- Health Division, The Organisation for Economic Co-operation and Development, Paris, France
| | | | - Ellen Nolte
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Chima Onoka
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Timothy Powell-Jackson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Roland
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | | | | | - Hong Wang
- Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Haja Wurie
- College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
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99
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Nirala SK, Kumar P, Naik BN, Pandey S, Singh C, Rao R, Bhardwaj M. Awareness and Readiness To Implement the Pradhan Mantri Jan Arogya Yojana: A Cross-Sectional Study Among Healthcare Workers of a Tertiary Care Hospital in Eastern India. Cureus 2022; 14:e24574. [PMID: 35651396 PMCID: PMC9138266 DOI: 10.7759/cureus.24574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2022] [Indexed: 11/05/2022] Open
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100
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Datta P, Chaudhuri C. Is Profit Motive Infecting Indian Private Health Care Sector? An Analysis of Unincorporated Healthcare Providers. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221088064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Indian healthcare system is dominated by private sector; its importance is growing with implementation of ‘Ayushman Bharat’, flagship programme of Indian government. Though 62% and 75% of inpatient and outpatient cases in India are treated in private sector, the information about the economy of private healthcare providers is very limited. To the author’s best knowledge, this is the first attempt to address the issue with empirical evidence for the private healthcare providers from a nationally representative survey data for India. Private healthcare sector is estimated to provide employment to 2.34 million persons annually and generate gross value added (GVA) of ₹473.3 billion. Treatment cost on an average is much high in private sector as compared to the public sector. But supply-side data show that average annual receipt per annum is six times higher than average operating cost per annum for unincorporated private healthcare providers in India, indicating underlying profit motive. Analysis of factor payments shows that 55% of GVA of unincorporated private hospitals is gross operating surplus (or profit), followed by emoluments paid to employees and workers (42%). These factors potentially cause over-charging in private sector. Context-specific and appropriate regulatory mechanisms are very much needed to ensure quality of services and control medical inflation.
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Affiliation(s)
- Pritam Datta
- National Institute of Public Finance and Policy (NIPFP), New Delhi, Delhi, India
| | - Chetana Chaudhuri
- National Institute of Public Finance and Policy (NIPFP), New Delhi, Delhi, India
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