151
|
Jordanian women's experiences and constructions of labour and birth in different settings, over time and across generations: a qualitative study. BMC Pregnancy Childbirth 2020; 20:357. [PMID: 32522158 PMCID: PMC7288400 DOI: 10.1186/s12884-020-03034-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/25/2020] [Indexed: 11/18/2022] Open
Abstract
Background Overwhelmingly, women in Middle Eastern countries experience birth as dehumanising and disrespectful. Women’s stories can be a very powerful way of informing health services about the impact of the care they receive and can promote practice change. The aim of this study is to examine Jordanian women’s experiences and constructions of labour and birth in different settings (home, public and private hospitals in Jordan, and Australian public hospitals), over time and across generations. Method A qualitative interpretive design was used. Data were collected by face-to-face semi-structured interviews with 27 Jordanian women. Of these women, 20 were living in Jordan (12 had given birth in the last five years and eight had birthed over 15 years ago) while seven were living in Australia (with birthing experience in both Jordan and Australia). Interview data were transcribed verbatim and analysed thematically. Results Women’s birth experiences differed across settings and generations and were represented in the four themes: ‘Birth at home: a place of comfort and control’; ‘Public Hospital: you should not have to suffer’; ‘Private Hospital: buying control’ and ‘Australian maternity care: a mixed experience’. In each theme, the concepts: Pain, Privacy, the Personal and to a lesser extent, Purity (cleanliness), were present but experienced in different ways depending on the setting (home, public or private hospital) and the country. Conclusions The findings demonstrate how meanings attributed to labour and birth, particularly the experience of pain, are produced in different settings, providing insights into the institutional management and social context of birth in Jordan and other Middle Eastern countries. In the public hospital environment in Jordan, women had no support and were treated disrespectfully. This was in stark contrast to women birthing at home only one generation before. Change is urgently needed to offer humanised birth in the Jordanian maternity system,
Collapse
|
152
|
Masefield SC, Megaw A, Barlow M, White PCL, Altink H, Grugel J. Repurposing NGO data for better research outcomes: a scoping review of the use and secondary analysis of NGO data in health policy and systems research. Health Res Policy Syst 2020; 18:63. [PMID: 32513183 PMCID: PMC7278191 DOI: 10.1186/s12961-020-00577-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Non-governmental organisations (NGOs) collect and generate vast amounts of potentially rich data, most of which are not used for research purposes. Secondary analysis of NGO data (their use and analysis in a study for which they were not originally collected) presents an important but largely unrealised opportunity to provide new research insights in critical areas, including the evaluation of health policy and programmes. Methods A scoping review of the published literature was performed to identify the extent to which secondary analysis of NGO data has been used in health policy and systems research (HPSR). A tiered analytical approach provided a comprehensive overview and descriptive analyses of the studies that (1) used data produced or collected by or about NGOs; (2) performed secondary analysis of the NGO data (beyond the use of an NGO report as a supporting reference); and (3) analysed NGO-collected clinical data. Results Of the 156 studies that performed secondary analysis of NGO-produced or collected data, 64% (n = 100) used NGO-produced reports (mostly to a limited extent, as a contextual reference or to critique NGO activities) and 8% (n = 13) analysed NGO-collected clinical data. Of these studies, 55% (n = 86) investigated service delivery research topics and 48% (n = 51) were undertaken in developing countries and 17% (n = 27) in both developing and developed countries. NGOs were authors or co-authors of 26% of the studies. NGO-collected clinical data enabled HPSR within marginalised groups (e.g. migrants, people in conflict-affected areas), albeit with some limitations such as inconsistent and missing data. Conclusion We found evidence that NGO-collected and produced data are most commonly perceived as a source of supporting evidence for HPSR and not as primary source data. However, these data can facilitate research in under-researched marginalised groups and in contexts that are hard to reach by academics such as conflict-affected areas. NGO–academic collaboration could help address issues of NGO data quality to facilitate their more widespread use in research. The use of NGO data use could enable relevant and timely research in the areas of programme evaluation and health policy and advocacy to improve health and reduce health inequalities, especially in marginalised groups and developing countries.
Collapse
Affiliation(s)
- Sarah C Masefield
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom. .,Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.
| | - Alice Megaw
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom
| | - Matt Barlow
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Politics, University of York, York, YO10 5DD, United Kingdom
| | - Piran C L White
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Environment and Geography, University of York, York, YO10 5NG, United Kingdom
| | - Henrice Altink
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of History, University of York, York, YO10 5NH, United Kingdom
| | - Jean Grugel
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Politics, University of York, York, YO10 5DD, United Kingdom
| |
Collapse
|
153
|
Lappan SN, Parra-Cardona JR, Carolan M, Weatherspoon L. Risk and Protective Factors Associated with Childhood Obesity in a Sample of Low-Income, Single Female, Parent/Guardian Households: Implications for Family Therapists. FAMILY PROCESS 2020; 59:597-617. [PMID: 30865293 PMCID: PMC10460515 DOI: 10.1111/famp.12440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The United States is in the midst of a childhood obesity epidemic that disproportionately impacts underserved and diverse populations. In this study, in-depth qualitative interviews were conducted with 16 low-income, single, female, parent/guardians of an overweight or obese 3- to 8-year-old from socioeconomically disadvantaged backgrounds. Following the tenets of the thematic analysis approach, interviews focused on identifying risk and protective factors influencing parental and child health behaviors associated with child weight status. Results from the interviews are organized according to the Socioecological Framework to help identify risk and protective factors at various system levels. Findings from this investigation have relevance for family therapists as they can inform clinical and advocacy-focused interventions with disadvantaged families affected by childhood obesity.
Collapse
Affiliation(s)
- Sara N Lappan
- Department of Health Behavior, University of Alabama, Birmingham, AL
| | | | - Marsha Carolan
- Department of Human Development and Family Studies, Michigan State University, East Lansing, MI
| | - Lorraine Weatherspoon
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI
| |
Collapse
|
154
|
Dev M, Kumar D, Patel D. Coordination between hospitals and insurers in developing economies: an interpretive structural modeling approach. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2020. [DOI: 10.1108/ijphm-10-2019-0068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to identify the factors that influence hospitals’ selection by health-care insurers in India and to establish a hierarchical model representing the relationship among different factors and their influence on the entire scenario.
Design/methodology/approach
A survey with a set of questionnaires was conducted with different health-care insurer executives of reputed health insurance companies. The data has been gathered by using a five-point Likert scale. Their opinions were converted into a reachability matrix and an interpretive structural modeling was constructed. The final results obtained were verified by using fuzzy Matriced Impacts Croises-Multiplication Applique and Classement analysis.
Findings
The results suggested three key driving factors, National Accreditation Board for Hospitals & Healthcare Providers accreditation of the hospital, purchasing power of people in the region and national and international recognition of the hospital among the eleven factors selected for the study.
Research limitations/implications
The research mainly focuses on the health insurance benefits provided by privately owned insurance companies and do not comment on any government’s mass health insurance scheme.
Practical implications
With a small proportion of people under the umbrella of health insurance in India, these factors will assist and expedite insurer’s effort to penetrate deep into rural and urban areas enhancing availability and escalating affordability.
Originality/value
This paper presents key factors responsible for better coordination between health-care systems and insurance companies.
Collapse
|
155
|
Nandi S, Schneider H. Using an equity-based framework for evaluating publicly funded health insurance programmes as an instrument of UHC in Chhattisgarh State, India. Health Res Policy Syst 2020; 18:50. [PMID: 32450870 PMCID: PMC7249418 DOI: 10.1186/s12961-020-00555-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 03/27/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Universal health coverage (UHC) has provided the impetus for the introduction of publicly funded health insurance (PFHI) schemes in the mixed health systems of India and many other low- and middle-income countries. There is a need for a holistic understanding of the pathways of impact of PFHI schemes, including their role in promoting equity of access. METHODS This paper applies an equity-oriented evaluation framework to assess the impacts of PFHI schemes in Chhattisgarh State by synthesising literature from various sources and highlighting knowledge gaps. Data were collected from an extensive review of publications on PFHI schemes in Chhattisgarh since 2009, including empirical studies from the first author's PhD and grey literature such as programme evaluation reports, media articles and civil society campaign documents. The framework was constructed using concepts and frameworks from the health policy and systems research literature on UHC, access and health system building blocks, and is underpinned by the values of equity, human rights and the right to health. RESULTS The analysis finds that evidence of equitable enrolment in Chhattisgarh's PFHI scheme may mask many other inequities. Firstly, equitable enrolment does not automatically lead to the acceptability of the scheme for the poor or to equity in utilisation. Utilisation, especially in the private sector, is skewed towards the areas that have the least health and social need. Secondly, related to this, resource allocation patterns under PFHI deepen the 'infrastructure inequality trap', with resources being effectively transferred from tribal and vulnerable to 'better-off' areas and from the public to the private sector. Thirdly, PFHI fails in its fundamental objective of effective financial protection. Technological innovations, such as the biometric smart card and billing systems, have not provided the necessary safeguards nor led to greater accountability. CONCLUSION The study shows that development of PFHI schemes, within the context of wider neoliberal policies promoting private sector provisioning, has negative consequences for health equity and access. More research is needed on key knowledge gaps related to the impact of PFHI schemes on health systems. An over-reliance on and rapid expansion of PFHI schemes in India is unlikely to achieve UHC.
Collapse
Affiliation(s)
- Sulakshana Nandi
- School of Public Health, University of the Western Cape, Bellville, South Africa
- Public Health Resource Network, 29, New Panchsheel Nagar, Raipur, Chhattisgarh 492001 India
| | - Helen Schneider
- School of Public Health, UWC/MRC Health Services to Systems Unit, University of the Western Cape, Bellville, South Africa
| |
Collapse
|
156
|
Haque M, Islam T, Rahman NAA, McKimm J, Abdullah A, Dhingra S. Strengthening Primary Health-Care Services to Help Prevent and Control Long-Term (Chronic) Non-Communicable Diseases in Low- and Middle-Income Countries. Risk Manag Healthc Policy 2020; 13:409-426. [PMID: 32547272 PMCID: PMC7244358 DOI: 10.2147/rmhp.s239074] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 03/24/2020] [Indexed: 12/31/2022] Open
Abstract
The prevalence of long-term (chronic) non-communicable diseases (NCDs) is increasing globally due to an ageing global population, urbanization, changes in lifestyles, and inequitable access to healthcare. Although previously more common in high- and upper-middle-income countries, lower-middle-income countries (LMICs) are more affected, with NCDs in LMICs currently accounting for 85–90% of premature deaths among 30–69 years old. NCDs have both high morbidity and mortality and high treatment costs, not only for the diseases themselves but also for their complications. Primary health care (PHC) services are a vital component in the prevention and control of long-term NCDs, particularly in LMICs, where the health infrastructure and hospital services may be under strain. Drawing from published studies, this review analyses how PHC services can be utilized and strengthened to help prevent and control long-term NCDs in LMICs. The review finds that a PHC service approach, which deals with health in a comprehensive way, including the promotion, prevention, and control of diseases, can be useful in both high and low resource settings. Further, a PHC based approach also provides opportunities for communities to better access appropriate healthcare, which ensures more significant equity, efficiency, effectiveness, safety, and timeliness, empowers service users, and helps healthcare providers to achieve better health outcomes at lower costs. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/33l6gK1RNFo
Collapse
Affiliation(s)
- Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Tariqul Islam
- UChicago Research Bangladesh, Dhaka 1230, Bangladesh
| | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, 25200, Malaysia
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Swansea, Wales SA2 8PP, UK
| | - Adnan Abdullah
- Unit of Occupational Medicine, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia, (National Defence University of Malaysia), Kuala Lumpur 57000, Malaysia
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine Campus, Mount Hope, Trinidad & Tobago
| |
Collapse
|
157
|
Sulibhavi A, Rubin SJ, Park J, Hashemi S, DePietro JD, Noordzij JP. Preventative and management strategies of hypocalcemia after thyroidectomy among surgeons: An international survey study. Am J Otolaryngol 2020; 41:102394. [PMID: 32035653 DOI: 10.1016/j.amjoto.2020.102394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 01/05/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine international surgeon practice patterns for transient postoperative hypocalcemia in patients undergoing total thyroidectomy. METHODS All member surgeons of the American Thyroid Association and the International Association of Thyroid Surgeons were contacted via email to complete a 20-question survey which included both questions about demographic information and preventing and managing postoperative hypocalcemia after thyroidectomy. Univariate analysis was performed to determine whether providers check preoperative vitamin D levels, postoperative calcium trends and/or PTH to assess for postoperative hypocalcemia. RESULTS A total of 332 surgeons responded to the survey with 72.26% in practice for >10 years and 82.18% performing >50 total thyroidectomies per year. 13.29% of surgeon's surveyed reported that they routinely check preoperative vitamin D levels. Surgeon case volume, type of practice (academic vs non-academic practice), and geographic location in the US were significant predictors of whether surgeons check preoperative Vitamin D levels. International surgeons were significantly more likely to check both postoperative serum Ca and PTH compared to US based surgeons (p < .01). There was no significance difference in practice patterns based on whether the surgeon was a General Surgeon or an Otolaryngologist. CONCLUSIONS Using a questionnaire distributed to both General Surgeons and Otolaryngologists, we demonstrated that there is significant variation in practice patterns between surgeons practicing in the United States and surgeons practicing in other countries, and practice often differs from recommended guidelines.
Collapse
|
158
|
Pati S, Swain S, Knottnerus JA, Metsemakers JFM, van den Akker M. Magnitude and determinants of multimorbidity and health care utilization among patients attending public versus private primary care: a cross-sectional study from Odisha, India. Int J Equity Health 2020; 19:57. [PMID: 32349770 PMCID: PMC7191801 DOI: 10.1186/s12939-020-01170-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background Multimorbidity in primary care is a challenge not only for developing countries but also for low and medium income countries (LMIC). Health services in LMIC countries are being provided by both public and private health care providers. However, a critical knowledge gap exists on understanding the true extent of multimorbidity in both types of primary care settings. Methods We undertook a study to identify multimorbidity prevalence and healthcare utilization among both public and private primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire collecting information on 22 chronic diseases, medication use, number of hospitalization and number of outpatient visits. Result The overall prevalence of multimorbidity was 28.3% and nearly one third of patients of public facilities and one fourth from private facilities had multimorbidity. Leading diseases among patients visiting public facilities included acid peptic diseases, arthritis and chronic back pain. No significant difference in reporting of hypertension and diabetes across the facilities was seen. Besides age, predictors of multimorbidity among patients attending public facilities were, females [AOR: 1.6; 95% CI 1.1–1.3] and non-aboriginal groups [AOR: 1.6; 95%CI 1.1–2.3] whereas, in private females [AOR: 1.6; 95%CI 1.1–2.4], better socioeconomic conditions [AOR 1.4; 95% CI 1.0–2.1] and higher educational status [primary school completed [AOR 2.6; 95%CI 1.6–4.2] and secondary schooling and above [AOR 2.0; 95%CI 1.1–3.6] with reference to no education were seen to be the determinants of multimorbidity. Increased number of hospital visits to public facilities were higher among lower educational status patients [IRR: 1.57; 95% CI 1.13–2.18] whereas, among private patients, the mean number of hospital visits was 1.70 times more in higher educational status [IRR: 1.70; 95%CI 1.01–3.69]. The mean number of medicines taken per day was higher among patients attending private hospitals. Conclusion Our findings suggest that, multimorbidity is being more reported in public primary care facilities. The pattern and health care utilization in both types of settings are different. A comprehensive care approach must be designed for private care providers.
Collapse
Affiliation(s)
- Sanghamitra Pati
- Indian Council of Medical Research, Department of Health Research, ICMR Regional Medical Research Centre, Bhubaneswar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India.
| | - Subhashisa Swain
- School of Medicine, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, NG5 1PB, UK
| | - J André Knottnerus
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands
| | - Job F M Metsemakers
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands.,Academic Centre of General Practice / Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| |
Collapse
|
159
|
Palmieri PA, Leyva-Moral JM, Camacho-Rodriguez DE, Granel-Gimenez N, Ford EW, Mathieson KM, Leafman JS. Hospital survey on patient safety culture (HSOPSC): a multi-method approach for target-language instrument translation, adaptation, and validation to improve the equivalence of meaning for cross-cultural research. BMC Nurs 2020; 19:23. [PMID: 32308560 PMCID: PMC7153229 DOI: 10.1186/s12912-020-00419-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 03/31/2020] [Indexed: 12/03/2022] Open
Abstract
Background The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument. Methods This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation. Results The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate). Conclusions The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.
Collapse
Affiliation(s)
- Patrick A Palmieri
- 1Office of the Vice Chancellor for Research, Universidad Norbert Wiener, Av. Arequipa 444, 15046 Lima, Peru.,2College of Graduate Health Studies, A. T. Still University, 800 West Jefferson Street, Kirksville, MO 63501 USA.,3School of Nursing, Walden University, 100 S Washington Ave, Suite 900, Minneapolis, MN 55401 USA.,4EBHC South America: A Joanna Briggs Institute Affiliated Group, Universidad Norbert Wiener, Av. Arequipa 444, Lima, 15046 Lima, Peru
| | - Juan M Leyva-Moral
- 5Departament d'Infermeria, Facultat de Medicina, Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.,Center for Health Sciences Research, Universidad María Auxiliadora, Av. Canto Bello 431, 15408 Lima, Peru.,7EBHC South America: A Joanna Briggs Institute Affiliated Group, Universidad Norbert Wiener, Av. Arequipa 444, 15046 Lima, Peru
| | - Doriam E Camacho-Rodriguez
- 7EBHC South America: A Joanna Briggs Institute Affiliated Group, Universidad Norbert Wiener, Av. Arequipa 444, 15046 Lima, Peru.,8School of Nursing, Universidad Cooperativa de Colombia, Calle 30, Santa Marta, Magdalena Colombia
| | - Nina Granel-Gimenez
- 5Departament d'Infermeria, Facultat de Medicina, Universitat Autonoma de Barcelona, Avda. Can Domenech, Building M. Office M3/211, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Eric W Ford
- 9School of Public Health, University of Alabama at Birmingham, Ryals Public Health Building, 1665 University Blvd., Ryals 310E, Birmingham, AL 35233 USA
| | - Kathleen M Mathieson
- 2College of Graduate Health Studies, A. T. Still University, 800 West Jefferson Street, Kirksville, MO 63501 USA
| | - Joan S Leafman
- 2College of Graduate Health Studies, A. T. Still University, 800 West Jefferson Street, Kirksville, MO 63501 USA
| |
Collapse
|
160
|
Garza G, Hodges-Delgado P, Hoskovec J, Palos G, Wagner C, Zacharias N, Noblin SJ. Exploring experiences and expectations of prenatal health care and genetic counseling/testing in immigrant Latinas. J Genet Couns 2020; 29:530-541. [PMID: 32302061 DOI: 10.1002/jgc4.1261] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 11/11/2022]
Abstract
As the Latino population of the United States continues to increase, the specific needs of Latinos in genetic counseling continue to be unmet. Using culturally tailored genetic counseling responsive to the needs of the patient can assist in building rapport in genetic counseling sessions. We aimed to investigate the relationship between acculturation, prenatal care, genetic testing experiences, and expectations for prenatal care in an immigrant Latino population. A total of 20 Spanish-speaking, pregnant Latinas from various Latin American countries were interviewed after completing a prenatal genetic counseling session. The semi-structured phone interview included questions about the participants' experiences with genetic counseling/testing, prenatal health care in their home country, their current prenatal care in the United States, and information they felt to be important to know during their pregnancy. Although this study showed no statistically significant associations between acculturation, prenatal care, and genetic counseling/testing experiences, six significant content domains were identified as relevant to the participants. Overall, we found that immigrant Latinas desire to know prenatal risk information to help them prepare, relieve guilt, and help make screening/testing/family planning decisions. These Latinas reported the genetic counselor provided confidence, a sense of autonomy, and empowerment, for them to make their own decisions regarding prenatal screening/testing. The participants also spoke about stressors unique to the immigrant population, most notably being away from their older children and other family members. Identifying relevant factors about the lived experience of this population can help genetic counselors better address possible needs, feelings of guilt, and/or isolation and identifying women who could benefit from group-based prenatal care, support groups, or referrals to social work.
Collapse
Affiliation(s)
- Georgiann Garza
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Priscila Hodges-Delgado
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jennifer Hoskovec
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Guadalupe Palos
- Cancer Survivorship Program, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Chelsea Wagner
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nikolaos Zacharias
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sarah J Noblin
- The University of Texas MD Anderson Cancer Center UTHealth Graduate School of Biomedical Sciences, Houston, TX, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
161
|
Ofoli JNT, Ashau-Oladipo T, Hati SS, Ati L, Ede V. Preventive healthcare uptake in private hospitals in Nigeria: a cross-sectional survey (Nisa premier hospital). BMC Health Serv Res 2020; 20:273. [PMID: 32238153 PMCID: PMC7114808 DOI: 10.1186/s12913-020-05117-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/18/2020] [Indexed: 01/13/2023] Open
Abstract
Background Understanding the features of preventive care uptake is critical for assessing the performance and viability of primary care in any healthcare system. There are gaps in previous studies that focused on primary healthcare features, challenges and way forward in Nigeria but were mainly public sector focused and do not characterize the features of preventive care. Since private healthcare sector remains the most accessed and utilized in Nigeria, this study sought to characterize the features of uptake of preventive care to better understand the current preventive healthcare landscape. Method A descriptive cross-sectional study, using survey questionnaire were randomly administered to adult patients attending the Family Medicine Out-Patient Department (OPD) at Nisa Premier Hospital, Jabi Abuja. The study was conducted over a three-month period. (January to June 2017). Data collected were analyzed using SPSS version 23 (IBM SPSS, Chicago, IL, USA). Descriptive statistics in the form of frequency and percentage were used to report the results. Results A total of 381 participants completed the survey. The results revealed that while an over overwhelming majority (> 90%) of participants indicated knowledge of benefits of preventive care, and preferred interventions aimed at preventing a disease before they occur, 48% preferred interventions aimed at reducing disease or injury impact or interventions aimed at ameliorating the impact of ongoing disease or injury with long lasting effect (43%). Unfortunately, less than 40% of respondents would visit the hospital when their health condition is not serious. Important barriers to uptake of preventive care were revealed as cost (45%), distance to the healthcare provider (36%) and lack of health insurance (33%), whereas poor education (19%), social norms (13%) as well as cultural and religious beliefs (10%) towards accessing certain health services appeared to be lesser barriers. Conclusion Although people are aware of the benefits of preventive care, its uptake will greatly be enhanced through improved health insurance coverage, refocusing primary healthcare functions on preventive rather than curative care and instituting policies that mandatorily prescribe uptake for the insured, both at the individual and the insurer’s level.
Collapse
Affiliation(s)
- Joshua N T Ofoli
- Department of Family and Specialty Medicine, Nisa Premier Hospital, Abuja, Nigeria
| | - Timi Ashau-Oladipo
- Department of Family and Specialty Medicine, Nisa Premier Hospital, Abuja, Nigeria
| | - Stephen S Hati
- Research and Development, Nisa Premier Hospital, Abuja, Nigeria.,Center for Research, Institute of Medical Sciences Africa, Abuja, Nigeria
| | - Lile Ati
- Research and Development, Nisa Premier Hospital, Abuja, Nigeria
| | - Victor Ede
- Medical Audit Department, Nisa Premier Hospital, Abuja, Nigeria.
| |
Collapse
|
162
|
Agarwal M, Freychet C, Jain S, Shivpuri A, Singh A, Dinand V, Sawhney S. Factors impacting referral of JIA patients to a tertiary level pediatric rheumatology center in North India: a retrospective cohort study. Pediatr Rheumatol Online J 2020; 18:21. [PMID: 32131855 PMCID: PMC7057446 DOI: 10.1186/s12969-020-0408-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/03/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND JIA studies demonstrate that there is a "window of opportunity" early in the disease course during which appropriate management improves outcomes. No data is available regarding patients' pathway, before first pediatric rheumatology (PR) evaluation in India, a country where health-care costs are self- paid by patients and where a significant shortage of pediatric rheumatologists (PRsts) is known. This study aimed to describe time from onset of symptoms to first PR visit of JIA patients to a tertiary center in India and factors that impact this. METHODS This retrospective study is from data collected at the PR center, Sir Ganga Ram Hospital (SGRH) in New Delhi. JIA patients fulfilling ILAR 2004 criteria and seen at least twice from 1st October 2013 to 30th September 2018 were included. Data collected were: demographic details, history of disease, referral practitioner, clinical and laboratory features, treatments. Mann-Whitney U-test, Chi square and logistic regression were used as appropriate to study factors that determined time to first PR visit. RESULTS Five hundred and twenty patients were included: 396 were diagnosed at this PR center (group A), 124 were previously diagnosed as JIA and managed by non PRsts before first PR visit (group B). Median time from symptom onset to first PR visit was 4.1 months and median distance travelled 119.5 km. Despite ongoing treatment, group B patients had more aggressive disease and resided further away as compared to Group A patients. On univariate analysis, factors that predicted PR visit within 3 months were private patients, short distance to travel, family history of inflammatory disease, history of fever, history of acute uveitis or high ESR. On multivariate analysis all these factors were significant except high ESR and acute uveitis. CONCLUSION Time to first PR assessment at this center was comparable to that seen in western countries. Cost of care and long distance to the center delayed consultation; acuity of complaints and family history of rheumatologic condition hastened referral. Possible solutions to improve referral to PR centers would be to increase the number of PRsts and to improve medical insurance coverage.
Collapse
Affiliation(s)
- Manjari Agarwal
- 0000 0004 1767 8547grid.415985.4Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Caroline Freychet
- Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India. .,HESPER Laboratory, Claude-Bernard University, Lyon, France.
| | - Sumidha Jain
- 0000 0004 1767 8547grid.415985.4Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Abhay Shivpuri
- 0000 0004 1767 8547grid.415985.4Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Anju Singh
- 0000 0004 1767 8547grid.415985.4Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Veronique Dinand
- 0000 0004 1767 8547grid.415985.4Department of Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Sujata Sawhney
- 0000 0004 1767 8547grid.415985.4Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| |
Collapse
|
163
|
Madsbu MA, Salvesen Ø, Carlsen SM, Westin S, Onarheim K, Nygaard ØP, Solberg TK, Gulati S. Surgery for herniated lumbar disc in private vs public hospitals: A pragmatic comparative effectiveness study. Acta Neurochir (Wien) 2020; 162:703-711. [PMID: 31902004 PMCID: PMC7046569 DOI: 10.1007/s00701-019-04195-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/20/2019] [Indexed: 02/01/2023]
Abstract
Background There is limited evidence on the comparative performance of private and public healthcare. Our aim was to compare outcomes following surgery for lumbar disc herniation (LDH) in private versus public hospitals. Methods Data were obtained from the Norwegian registry for spine surgery. Primary outcome was change in Oswestry disability index (ODI) 1 year after surgery. Secondary endpoints were quality of life (EuroQol EQ-5D), back and leg pain, complications, and duration of surgery and hospital stays. Results Among 5221 patients, 1728 in the private group and 3493 in the public group, 3624 (69.4%) completed 1-year follow-up. In the private group, mean improvement in ODI was 28.8 points vs 32.3 points in the public group (mean difference − 3.5, 95% CI − 5.0 to − 1.9; P for equivalence < 0.001). Equivalence was confirmed in a propensity-matched cohort and following mixed linear model analyses. There were differences in mean change between the groups for EQ-5D (mean difference − 0.05, 95% CI − 0.08 to − 0.02; P = 0.002) and back pain (mean difference − 0.2, 95% CI − 0.2, − 0.4 to − 0.004; P = 0.046), but after propensity matching, the groups did not differ. No difference was found between the two groups for leg pain. Complication rates was lower in the private group (4.5% vs 7.2%; P < 0.001), but after propensity matching, there was no difference. Patients operated in private clinics had shorter duration of surgery (48.4 vs 61.8 min) and hospital stay (0.7 vs 2.2 days). Conclusion At 1 year, the effectiveness of surgery for LDH was equivalent in private and public hospitals.
Collapse
Affiliation(s)
- Mattis A. Madsbu
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sven M. Carlsen
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Endocrinology, St Olavs Hospital, Trondheim, Norway
| | - Steinar Westin
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | | | - Øystein P. Nygaard
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - Tore K. Solberg
- The Norwegian National Registry for Spine Surgery, University Hospital of Northern Norway (UNN), Tromsø, Norway
- Department of Neurosurgery, University Hospital of Northern Norway (UNN), Tromsø, Norway
- Institute of Clinical Medicine, The Arctic University of Norway (UIT), Tromsø, Norway
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- National Advisory Unit on Spinal Surgery, St. Olavs University Hospital, Trondheim, Norway
| |
Collapse
|
164
|
Beaussier AL, Demeritt D, Griffiths A, Rothstein H. Steering by their own lights: Why regulators across Europe use different indicators to measure healthcare quality. Health Policy 2020; 124:501-510. [PMID: 32192738 PMCID: PMC7677115 DOI: 10.1016/j.healthpol.2020.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 02/01/2020] [Accepted: 02/24/2020] [Indexed: 01/21/2023]
Abstract
Indicator sets differ in how they define, measure, and assess healthcare quality. National sets shaped by varying governance traditions and healthcare system configuration. Targeting of quality dimensions and hospital activities shaped by system-specific ‘demand-side’ pressures. Measurement styles shaped by ‘supply-side’ constraints on data access and indicator construction. International benchmarking is easier when healthcare systems and governance traditions are similar.
Despite widespread faith that quality indicators are key to healthcare improvement and regulation, surprisingly little is known about what is actually measured in different countries, nor how, nor why. To address that gap, this article compares the official indicator sets--comprising some 1100 quality measures-- used by statutory hospital regulators in England, Germany, France, and the Netherlands. The findings demonstrate that those countries’ regulators strike very different balances in: the dimensions of quality they assess (e.g. between safety, effectiveness, and patient-centredness); the hospital activities they target (e.g. between clinical and non-clinical activities and management); and the ‘Donabedian’ measurement style of their indicators (between structure, process and outcome indicators). We argue that these contrasts reflect: i) how the distinctive problems facing each country’s healthcare system create different ‘demand-side’ pressures on what national indicator sets measure; and ii) how the configuration of national healthcare systems and governance traditions create ‘supply-side’ constraints on the kinds of data that regulators can use for indicator construction. Our analysis suggests fundamental differences in the meaning of quality and its measurement across countries that are likely to impede international efforts to benchmark quality and identify best practice.
Collapse
Affiliation(s)
- Anne-Laure Beaussier
- Centre de Sociologie des Organisations (CSO), Sciences Po-CNRS, 19 Rue Amélie, 75007 Paris, France
| | - David Demeritt
- Department of Geography, King's College London, Strand, London WC2R 2LS, United Kingdom.
| | - Alex Griffiths
- Data Science Directorate, Statica Research, London, SE22 9PN, United Kingdom
| | - Henry Rothstein
- Department of Geography, King's College London, Strand, London WC2R 2LS, United Kingdom
| |
Collapse
|
165
|
Ugwu IA, Itua I. Utilization of Maternity Services and Its Relationship with Postpartum Use of Modern Contraceptives Among Women of Reproductive Age Group in Nigeria. Open Access J Contracept 2020; 11:1-13. [PMID: 32021499 PMCID: PMC6955809 DOI: 10.2147/oajc.s215619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Background Utilization of maternity services (UMS) exposes mothers to family planning (FP) counseling and other FP promotional activities. Uptake of postpartum modern contraceptives (PPMC) reduces both infant and maternal mortalities by reducing unwanted pregnancies and promoting good child spacing. Understanding the relationship between UMS and uptake of PPMC was therefore very important. Purpose To determine the association between UMS and uptake of PPMC among women of the reproductive age group in Nigeria taking into consideration the influence of the place of access to the maternity services. Patients and Methods This study was a descriptive epidemiological study design. Secondary data obtained from the 2013 Nigerian Demographic Health Survey (NDHS) was analyzed to achieve the above aim. The uptake of PPMC was the dependent variable (DV). The independent variables (IDV) selected were the number of antenatal care (ANC) visits, place of access of ANC, place of delivery, timing of postnatal care (PNC) and place of access of PNC. Other control variables include socio-demographic factors. Descriptive statistics, chi-square testing, and logistic regression analyses were conducted to determine the association between the PPMC uptake and the IDV/other control variables. Statistical significance was claimed at p<0.05. Results Utilization of maternity services was associated with higher uptake of PPMC among the women (>/= 4 ANC visits OR = 2.08, 95% CI=1.65–2.62, P<0.001; public facility delivery OR= 1.80, 95% CI= 1.54–2.10, P< 0.001; private facility delivery OR =1.54, 95% CI 1.28–1.85, P< 0.001; PNC OR=1.21, 95% CI= 1.02–1.43, P=0.029). Accessing postnatal care in private health facilities was associated with increased uptake of PPMC (OR= 1.46, 95% CI =1.05–2.02, P= 0.024). The number of children alive, educational attainment, wealth index and having information about FP remained significant predictors of PPMC uptake. Conclusion The utilization of maternity services was positively associated with postpartum use of modern contraceptives among women of reproductive age in Nigeria. There was increased uptake of PPMC among women who utilized maternity service compared to their counterparts who did not. Regarding the place of access, accessing antenatal care as well as delivering in either private or public health facilities was not a significant predictor of PPMC use. However, accessing postnatal care in private facilities was associated with higher uptake of PPMC.
Collapse
Affiliation(s)
- Innocent Anayochukwu Ugwu
- Department of Obstetrics & Gynecology, College of Medicine, Enugu State University of Science & Technology (ESUT) and ESUT Teaching Hospital, Enugu, Nigeria
| | - Imose Itua
- Department of Public Health and Healthcare Management, University of Liverpool/Laureate Online Education, Liverpool, UK
| |
Collapse
|
166
|
Pugliese-Garcia M, Radovich E, Campbell OMR, Hassanein N, Khalil K, Benova L. Childbirth care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys between 1995 and 2014 examining use of care, provider mix and immediate postpartum care content. BMC Pregnancy Childbirth 2020; 20:46. [PMID: 31959149 PMCID: PMC6971907 DOI: 10.1186/s12884-020-2730-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/09/2020] [Indexed: 11/23/2022] Open
Abstract
Background Egypt has achieved important reductions in maternal and neonatal mortality and experienced increases in the proportion of births attended by skilled professionals. However, substandard care has been highlighted as one of the avoidable causes behind persisting maternal deaths. This paper describes changes over time in the use of childbirth care in Egypt, focusing on location and sector of provision (public versus private) and the content of immediate postpartum care. Methods We used five Demographic and Health Surveys conducted in Egypt between 1995 and 2014 to explore national and regional trends in childbirth care. To assess content of care in 2014, we calculated the caesarean section rate and the percentage of women delivering in a facility who reported receiving four components of immediate postpartum care for themselves and their newborn. Results Between 1995 and 2014, the percentage of women delivering in health facilities increased from 35 to 87% and women delivering with a skilled birth attendant from 49 to 92%. The percentage of women delivering in a private facility nearly quadrupled from 16 to 63%. In 2010–2014, fewer than 2% of women delivering in public or private facilities received all four immediate postpartum care components measured. Conclusions Egypt achieved large increases in the percentage of women delivering in facilities and with skilled birth attendants. However, most women and newborns did not receive essential elements of high quality immediate postpartum care. The large shift to private facilities may highlight failures of public providers to meet women’s expectations. Additionally, the content (quality) of childbirth care needs to improve in both sectors. Immediate action is required to understand and address the drivers of poor quality, including insufficient resources, perverse incentives, poor compliance and enforcement of existing standards, and providers’ behaviours moving between private and public sectors. Otherwise, Egypt risks undermining the benefits of high coverage because of substandard quality childbirth care.
Collapse
Affiliation(s)
- Miguel Pugliese-Garcia
- Faculty of Public Health and Policy, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK.
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Oona M R Campbell
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Nevine Hassanein
- Gynuity Health Projects, Egypt team, 220 East 42nd, New York, NY, 10017, USA
| | | | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
167
|
Mburu G, Igbinedion E, Lim SH, Paing AZ, Yi S, Elbe S, Mwai GW. Outcomes of HIV treatment from the private sector in low-income and middle-income countries: a systematic review protocol. BMJ Open 2020; 10:e031844. [PMID: 31919124 PMCID: PMC6955520 DOI: 10.1136/bmjopen-2019-031844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 12/04/2019] [Accepted: 12/18/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Private sector provision of HIV treatment is increasing in low-income and middle-income countries (LMIC). However, there is limited documentation of its outcomes. This protocol reports a proposed systematic review that will synthesise clinical outcomes of private sector HIV treatment in LMIC. METHODS AND ANALYSIS This review will be conducted in accordance with the preferred reporting items for systematic review and meta-analyses protocols. Primary outcomes will include: (1) proportion of eligible patients initiating antiretroviral therapy (ART); (2) proportion of those on ART with <1000 copies/mL; (3) rate of all-cause mortality among ART recipients. Secondary outcomes will include: (1) proportion receiving Pneumocystis jiroveci pneumonia prophylaxis; (2) proportion with >90% ART adherence (based on any measure reported); (3) proportion screened for non-communicable diseases (specifically cervical cancer, diabetes, hypertension and mental ill health); (iv) proportion screened for tuberculosis. A search of five electronic bibliographical databases (Embase, Medline, PsychINFO, Web of Science and CINAHL) and reference lists of included articles will be conducted to identify relevant articles reporting HIV clinical outcomes. Searches will be limited to LMIC. No age, publication date, study-design or language limits will be applied. Authors of relevant studies will be contacted for clarification. Two reviewers will independently screen citations and abstracts, identify full text articles for inclusion, extract data and appraise the quality and bias of included studies. Outcome data will be pooled to generate aggregative proportions of primary and secondary outcomes. Descriptive statistics and a narrative synthesis will be presented. Heterogeneity and sensitivity assessments will be conducted to aid interpretation of results. ETHICS AND DISSEMINATION The results of this review will be disseminated through a peer-reviewed scientific manuscript and at international scientific conferences. Results will inform quality improvement strategies, replication of identified good practices, potential policy changes, and future research. PROSPERO REGISTRATION NUMBER CRD42016040053.
Collapse
Affiliation(s)
- Gitau Mburu
- Centre for Global Health Policy, University of Sussex, Brighton, East Sussex, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Ewemade Igbinedion
- Department of Community Health, Igbinedion University Teaching Hospital, Okada, Nigeria
| | - Sin How Lim
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | | | - Siyan Yi
- Center for Global Health Research, Touro University California, Vallejo, California, USA
- Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore
- Center for Population Health Research, KHANA, Phnom Penh, Cambodia
| | - Stefan Elbe
- Centre for Global Health Policy, University of Sussex, Brighton, East Sussex, UK
| | - Grace W Mwai
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| |
Collapse
|
168
|
de Barros PGM, Li J, Tremblay C, Okada MY, Sznejder H, Furlan V, Vasconcellos R. Cost Modifications during the Early Years of the Use of the National Cardiovascular Data Registry for Quality Improvement. Clinics (Sao Paulo) 2020; 75:e1708. [PMID: 32876109 PMCID: PMC7442399 DOI: 10.6061/clinics/2020/e1708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/08/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Quality improvement (QI) initiatives based on data from international registries have been reported previously; however, there is a lack of information on the impact on the costs of medical care associated with the use of these tools. METHODS Patients admitted due to myocardial infarction (MI), included in the ACTION Registry® and CathPCI Registry®, in a private Brazilian hospital (i.e., the reference hospital) were analyzed. The costs of care of these patients were compared to the costs of MI admissions in nine similar hospitals not included in the same QI program. Regression models were used to analyze the cost change over time between the two groups of hospitals. Readmission rates were compared using logistic regression, adjusting for the same variables as in the cost model. RESULTS Overall, the annual medical cost inflation in Brazil was higher than the annual cost trend in the reference hospital during the period of analysis. Moreover, the annual in-hospital costs indicate that the reference hospital has a statistically significant 6% lower cost trend for patients with acute MI, compared to patients with the same diagnostic code in the comparison hospitals group, in an adjusted analysis (p-value=0.041). Using multivariable analysis, the readmission rates were also found to be significantly lower in the reference hospital than in the comparison hospitals, with an odds ratio of 0.68 (p-value=0.042). CONCLUSION The use of the NCDR® as a benchmark to guide QI programs outside the United States was associated with the positive impact of bending the cost curve to below that of national medical inflation and the comparison hospitals' costs, with a lower incidence of hospital readmission.
Collapse
Affiliation(s)
| | - John Li
- Optum Health LLC, Eden Prairie, Minnesota, US
| | | | | | | | | | | |
Collapse
|
169
|
Tripathi S, Srivastava A, Memon P, Nair TS, Bhamare P, Singh D, Srivastava V. Quality of maternity care provided by private sector healthcare facilities in three states of India: a situational analysis. BMC Health Serv Res 2019; 19:971. [PMID: 31842926 PMCID: PMC6915998 DOI: 10.1186/s12913-019-4782-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 11/26/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Better quality of care around the time of childbirth can significantly improve maternal and newborn survival. In countries like India, where the private sector contributes to a considerable proportion of institutional deliveries, it is important to assess the quality of maternity care offered by private sector healthcare facilities. This study seeks to fill that information gap by analysing baseline assessments conducted for the Manyata program, which aims to improve the quality of maternity care at private facilities. METHODS An observation checklist based on 16 clinical standards endorsed by the Federation of Obstetric and Gynaecological Societies of India (FOGSI) was used to assess 201 private sector healthcare facilities in Maharashtra, Jharkhand, and Uttar Pradesh. Data on facility characteristics came from profiles completed when facilities enrolled in Manyata. Differences in the mean number of standards met were analysed by facility characteristics and the availability of essential supplies. RESULTS Around half (47.1%) of all nursing staff engaged in maternity care services at these private healthcare facilities were under qualified. The mean number of clinical standards met by facilities was 3.2 (SD 2.4). Facilities with a monthly delivery load between 20 and 50 met a significantly higher number of standards, as did facilities that had more than 70% of essential supplies available. Both these factors were also significant in a multiple linear regression analysis. CONCLUSIONS The overall quality of maternity care in private healthcare facilities is poor in all three states, especially for clinical standards related to management of complications.
Collapse
Affiliation(s)
- Sanjay Tripathi
- Jhpiego an affiliate of Johns Hopkins University, Lucknow, Uttar Pradesh India
| | - Ashish Srivastava
- Jhpiego - an affiliate of Johns Hopkins University, Jhpiego, 29, Okhla Phase 3, New Delhi, India
| | - Parvez Memon
- Jhpiego an affiliate of Johns Hopkins University, Lucknow, Uttar Pradesh India
| | - Tapas Sadasivan Nair
- Jhpiego - an affiliate of Johns Hopkins University, Jhpiego, 29, Okhla Phase 3, New Delhi, India
| | - Parag Bhamare
- Jhpiego - an affiliate of Johns Hopkins University, Mumbai, Maharashtra India
| | - Dinesh Singh
- Jhpiego - an affiliate of Johns Hopkins University, Ranchi, Jharkhand India
| | - Vineet Srivastava
- Jhpiego - an affiliate of Johns Hopkins University, Jhpiego, 29, Okhla Phase 3, New Delhi, India
| |
Collapse
|
170
|
Argaw MD, Mavundla TR, Gidebo KD. Management of uncomplicated malaria in private health facilities in North-West Ethiopia: a clinical audit of current practices. BMC Health Serv Res 2019; 19:932. [PMID: 31801533 PMCID: PMC6894146 DOI: 10.1186/s12913-019-4722-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 11/07/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Malaria is one of the leading public health problems in sub-Saharan Africa that contributes to significant patient morbidity and mortality. The aim of the study was to investigate adherence to malaria diagnosis and treatment guidelines by private health sector providers and compare their performance against the public private partnership (PPP) status. METHODS A facility-based retrospective clinical audit was conducted between October 2016 and January 2017 in 11 medium clinics in the West Gojjam zone of the Amhara Region, North-west Ethiopia. Data was extracted from patient medical records using pretested data abstraction forms. Descriptive statistics were employed to present the findings and adherence of health workers against the national and international standards were classified as ideal, acceptable, minor error and major error for both malaria diagnosis and treatment. A chi-square (X2) test was used to test for a statistically significant relationship after the data had been categorized using public private partnership status at P < 0.05. RESULTS One thousand six hundred fifty clinical files were audited. All malaria suspected patients were investigated either with microscopy or rapid diagnostics test (RDT) for parasitological confirmation. The proportion of malaria treated cases was 23.7% (391/1650). Of which 16.6% (274/1650) were uncomplicated, 3.69% (61 /1650) were severe and complicated and the rest 3.39% (56/1650) were clinical diagnosed malaria cases. And the malaria parasite positivity rate was 20.30% (335/1650). All malaria suspected patients were not investigated with ideal malaria diagnosis recommendations; only 19.4% (320/1650) were investigated with acceptable malaria diagnosis (public private partnership (PPP) 19.4%; 176/907; and non-public private partnership (NPPP) 19.38%; 144/743, X2 (1) = 0.0With regards to treatments of malaria cases, the majority 82.9% of Plasmodium vivax cases were managed with ideal recommended treatment (X2 (1) = 0.35, P = 0.55); among Plasmodium falciparum, mixed (Plasmodium falciparum and Plasmodium vivax). CONCLUSION The clinical audit revealed that the majority of malaria patients had received minor error malaria diagnostic services. In addition, only one fifth of malaria patients had received ideal malaria treatment services. To understand the reasons for the low levels of malaria diagnosis and treatment adherence with national guidelines, a qualitative exploratory descriptive study is recommended.
Collapse
Affiliation(s)
- Mesele Damte Argaw
- USAID Transform: Primary Health Care, JSI Research & Training Institute, Inc., P.O. Box 1392, code 1110, Addis Ababa, Ethiopia.
- Department of Health Studies, University of South Africa, Pretoria, South Africa.
| | | | - Kassa Daka Gidebo
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| |
Collapse
|
171
|
Bertelsen C, Choi JS, Jackanich A, Ge M, Sun GH, Chambers T. Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center. Ann Otol Rhinol Laryngol 2019; 129:369-375. [PMID: 31752501 DOI: 10.1177/0003489419887990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). METHODS Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. RESULTS PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. CONCLUSIONS Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. LEVEL OF EVIDENCE 2c.
Collapse
Affiliation(s)
- Caitlin Bertelsen
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Janet S Choi
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Anna Jackanich
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Marshall Ge
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Gordon H Sun
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Tamara Chambers
- USC Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
172
|
Ab Rahman N, Husin M, Dahian K, Mohamad Noh K, Atun R, Sivasampu S. Job satisfaction of public and private primary care physicians in Malaysia: analysis of findings from QUALICO-PC. HUMAN RESOURCES FOR HEALTH 2019; 17:82. [PMID: 31684972 PMCID: PMC6829856 DOI: 10.1186/s12960-019-0410-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Job satisfaction of doctors is an important factor determining quality and performance of a health system. The aim of this study was to assess job satisfaction among doctors of the public and private primary care clinics in Malaysia and evaluate factors that could influence the job satisfaction rating. METHODS This study was part of the Quality and Costs of Primary Care (QUALICOPC) Malaysia, a cross-sectional survey conducted between August 2015 and June 2016 in Malaysia. Data was collected from doctors recruited from public and private primary care clinics using a standardised questionnaire. Comparisons were made between doctors working in public and private clinics, and logistic regression analysis was used to determine factors influencing the likelihood of job satisfaction outcomes. RESULTS A total of 221 doctors from the public and 239 doctors from the private sector completed the questionnaire. Compared to private doctors, a higher proportion of public doctors felt they were being overloaded with the administrative task (59.7% vs 36.0%) and part of the work does not make sense (33.9% vs 18.4%). Only 62.9% of public doctors felt that there was a good balance between effort and reward while a significantly higher proportion (85.8%) of private doctors reported the same. Over 80% of doctors in both sectors indicated continued interest in their job and agreed that being a doctor is a well-respected job. Logistic regression analysis showed public-private sector and practice location (urban-rural) to be significantly associated with work satisfaction outcomes. CONCLUSION A higher proportion of public doctors experienced pressure from administrative tasks and felt that part of their work does not make sense than their colleague in the private sector. At the same time, the majority of private doctors reported positive outcome on effort-and-reward balance compared to only one third of public doctors. The finding suggests that decreasing administrative workload and enhancing work-based supports might be the most effective ways to improve job satisfaction of primary care doctors because these are some of the main aspects of the job that doctors, especially in public clinics, are most unhappy with.
Collapse
Affiliation(s)
- N. Ab Rahman
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Block B4, No. 1, Jalan Setia Murni U13/52, 40170 Shah Alam, Selangor Malaysia
| | - M. Husin
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Block B4, No. 1, Jalan Setia Murni U13/52, 40170 Shah Alam, Selangor Malaysia
| | - K. Dahian
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak Malaysia
| | - K. Mohamad Noh
- Faculty of Medicine, Cyberjaya University College of Medical Sciences, Cyberjaya, Selangor Malaysia
| | - R. Atun
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA United States of America
| | - S. Sivasampu
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Block B4, No. 1, Jalan Setia Murni U13/52, 40170 Shah Alam, Selangor Malaysia
| |
Collapse
|
173
|
Kerai S, Nisar I, Muhammad I, Qaisar S, Feroz K, Raza A, Khalid F, Baloch B, Jehan F. A Community-Based Survey on Health-Care Utilization for Pneumonia in Children in Peri-Urban Slums of Karachi, Pakistan. Am J Trop Med Hyg 2019; 101:1034-1041. [PMID: 31482784 PMCID: PMC6838581 DOI: 10.4269/ajtmh.18-0656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 07/08/2019] [Indexed: 11/13/2022] Open
Abstract
Pneumonia, as defined by WHO, is a syndromic diagnosis characterized by presence of cough or difficult breathing. Presentation to health-care provider depends on timely identification of signs and symptoms by caretakers. We explored patterns of health-care utilization among caretakers of a randomly selected sample of 1,152 children aged 2-59 months, residing in low-income settlements of Karachi, Pakistan. Information on household demographics, occurrence of pneumonia-specific symptoms, care seeking, air quality, and knowledge regarding preventive measures for pneumonia was collected. Predictors of care seeking were estimated using weighted logistic regression. Prevalence of pneumonia with cough and rapid or difficulty in breathing was found to be 40.8% and 37.1% in infants (2-11 months) and children (12-59 months), respectively. Ninety-five percentage of caretakers sought care, 68.5% privately. Odds ratios (ORs) for independent predictors of care-seeking were as follows: younger age of child (infants compared with children), 3.60 (95% CI = 2.65-4.87); caretaker with primary education compared with none, 3.40 (2.46-4.70); vaccine awareness, 1.65 (1.45-1.87); and breastfeeding awareness, 1.32 (1.13-1.53). Presence of symptoms such as fever OR, 1.51 (1.30-1.76); tachypnea, 1.57 (1.35-1.83); chest indrawing, 2.56 (2.05-3.18); persistent vomiting, 1.69 (1.37-2.09); and recurrent illness, 2.57 (2.23-2.97) were also predictive. There is high health-care utilization for pneumonia with the skewed presentation toward private services. Strategies should be focused on making pneumonia care standardized, efficient and affordable, especially in the private sector.
Collapse
Affiliation(s)
- Salima Kerai
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ilyas Muhammad
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sana Qaisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Khalid Feroz
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Azhar Raza
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Faizan Khalid
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Benazir Baloch
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
174
|
Nair R, Luzzi L, Jamieson L, Spencer AJ, Hanna KMB, Do LG. Private Dental Care Benefits Non-Indigenous Children More Than Indigenous Children. JDR Clin Trans Res 2019; 5:244-253. [PMID: 31661646 DOI: 10.1177/2380084419886869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Various arrangements for funding health care facilities can have different levels of performance of care provision on different groups of people. Such differential performance of oral care is not previously known concerning Indigenous communities. OBJECTIVE This study aimed to assess the effect of visiting a public or private dental care facility on the performance of oral care experienced by Indigenous versus non-Indigenous children in Australia. METHODS Data from the National Child Oral Health Survey were used with a representative sample of children from all the states and territories of Australia. The performance of oral care was measured with the Child Oral Care Performance Assessment Scale (COPAS), which contains 37 items from 9 domains (Effective, Appropriate, Efficient, Responsive, Accessible, Safe, Continuous, Capable, and Sustainable) with a score ranging from 0 to 148. Mixed effects models that accounted for stratum and sampling weights were used for the stratified analyses (Indigenous vs. non-Indigenous) that assessed the effect of public versus private care on the COPAS. Relative excess risk due to interaction was calculated to assess effect modification. RESULTS Among the Indigenous children, private care was similar to public care (regression coefficient [RC] = -1.27, 95% CI = -9.5 to 6.97), whereas private care was higher than public care among non-Indigenous children (RC = 4.60, 95% CI = 3.67 to 6.18). This trend was similar among the 9 domains of the COPAS as well, except for Effectiveness, which was similar for private and public facilities among non-Indigenous children (RC = -0.03, 95% CI = -0.29 to 0.23). Based on the continuous COPAS score, effect modification was 4.46 (95% CI = 0.11 to 8.82) on the additive scale and 1.06 (1.01, 1.13) on the multiplicative scale. The relative excess risk due to interaction reported an excess chance of 1.17 (95% CI = 0.01 to 0.33), which was consistent with the stratified analyses and effect modification measured with the continuous score. CONCLUSION Thus, this study found a higher performance of oral care in private care locations among non-Indigenous children versus Indigenous children. KNOWLEDGE TRANSFER STATEMENT The findings caution policy makers and other stakeholders that moving oral care from public to private care facilities can increase the inequity faced by Indigenous children in Australia.
Collapse
Affiliation(s)
- R Nair
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - L Luzzi
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - L Jamieson
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - A J Spencer
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - K M B Hanna
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| | - L G Do
- ARCPOH, Adelaide Dental School, University of Adelaide, Adelaide, Australia
| |
Collapse
|
175
|
Mokienko A. Effects of a reimbursement change and travel times on the delivery of private and public radiology services in Norway: a register-based longitudinal study of Norwegian claims data. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:22. [PMID: 31636513 PMCID: PMC6796397 DOI: 10.1186/s12962-019-0190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The variation in the impact of the 2008 reimbursement change for Norwegian radiology providers, depending on the travel times to private and public providers in different municipalities, was examined. The activity-based fund allocation for radiology providers was reduced from approximately 50% to 40%, which was compensated by an increased basic grant. The hypothesis was that the Norwegian population would be affected by the reimbursement change unevenly depending on their distances to different types of the providers. METHODS The study of the effect of the reimbursement change and travel time difference between private and public radiology providers in Norway (Time_difference) on the number of the services was performed using fixed-effects regressions applied to panel data at the municipality level with monthly observations for the period 2007-2010. RESULTS After the reimbursement change, the number of private services decreased more than the number of public services. Private services declined after 2008, but the absolute value of the effect was smaller as the Time_difference became greater. The number of public services increased as the Time_difference grew. The total number of services decreased until the Time_difference was equal to 40 min and increased for time differences greater than 40 min. CONCLUSIONS The messages for policymakers are as follows. Populations that only had private providers nearby were more affected by the reimbursement change in terms of a reduced number of services. The reimbursement change contributed to the reallocation of patients from private to public providers. The difference between the centralities of municipalities in their consumption patterns was reduced and the difference between different Regional Health Authorities was increased due to the reimbursement change.
Collapse
Affiliation(s)
- Anastasia Mokienko
- Department of Health Management and Health Economics, University of Oslo, P.O. Box 1089, Blindern, 0317 Oslo, Norway
| |
Collapse
|
176
|
Oliveira JC, Almeida-Santos MA, Cunha-Oliveira J, Oliveira LCS, de Carvalho Barreto ID, Clair RemacreMunareto Lima T, Andreline Maia Arcelino L, Andrade Prado LF, Serra Silveira F, Augusto da Silva Nascimento T, Pereira Ferreira EJ, Vasconcelos Barreto R, Vieira Moraes E, Teles de Mendonça J, Sousa ACS, Barreto-Filho JA. Disparities in Access and Mortality of Patients With ST-Segment-Elevation Myocardial Infarction Using the Brazilian Public Healthcare System: VICTIM Register. J Am Heart Assoc 2019; 8:e013057. [PMID: 31581873 PMCID: PMC6818046 DOI: 10.1161/jaha.119.013057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background There is a scarcity of knowledge as to whether rates of myocardial reperfusion use and 30‐day mortality for patients with ST‐segment–elevation myocardial infarction are similar among patients using the Brazilian Public Health System (SUS) and those using the private healthcare system. Methods and Results A total of 707 patients were analyzed using the VICTIM (Via Crucis for the Treatment of Myocardial Infarction) register database; 589 patients from the SUS and 118 from the private network with ST‐segment–elevation myocardial infarction, who attended hospitals with the capacity to perform primary percutaneous coronary intervention (PCI) were investigated. The timeline, rates of use of PCI, and the 30‐day probability of death were investigated, comparing the SUS patients to those in the private system. The mean time between symptom onset and arrival at the PCI hospital was higher for SUS patients compared with users of the private system (25.4±36.5 versus 9.0±21 hours; P<0.001, respectively). Rates of primary PCI were low in both groups, but significantly lower for the SUS patients (45% versus 78%; P<0.001). The 30‐day mortality rate of SUS patients was 11.9% and of private patients was 5.9% (P=0.04). In the fully adjusted model, the odds ratio for 30‐day mortality for the SUS patients was higher (odds ratio, 2.96; 95% CI, 1.15–7.61; P=0.02). Conclusions The delay in reaching a PCI hospital was almost 3 times higher for the SUS patients. Primary PCI was underused in both groups, especially in the SUS patients. The SUS patients were more likely to die during the 30‐day follow‐up.
Collapse
Affiliation(s)
- Jussiely Cunha Oliveira
- Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil.,Tiradentes University Aracaju Sergipe Brazil
| | - Marcos Antonio Almeida-Santos
- Postgraduate Program in Health and Environment Tiradentes University Aracaju Sergipe Brazil.,Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil
| | - Jeferson Cunha-Oliveira
- Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil.,Department of Pharmacy Federal University of Sergipe Lagarto Sergipe Brazil.,Hospital Primavera Aracaju Sergipe Brazil
| | - Laís Costa Souza Oliveira
- Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil.,Hospital Primavera Aracaju Sergipe Brazil
| | | | | | | | | | | | | | - Eduardo José Pereira Ferreira
- Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil.,Surgery Foundation Hospital Aracaju Sergipe Brazil.,Department of Medicine Federal University of Sergipe Lagarto Sergipe Brazil.,Division of Cardiology University Hospital Federal University of Sergipe Aracaju Sergipe Brazil
| | - Rafael Vasconcelos Barreto
- Surgery Foundation Hospital Aracaju Sergipe Brazil.,Emergency Hospital of Sergipe Aracaju Sergipe Brazil
| | | | - José Teles de Mendonça
- Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil.,Heart Hospital Aracaju Sergipe Brazil.,Division of Cardiology University Hospital Federal University of Sergipe Aracaju Sergipe Brazil
| | - Antonio Carlos Sobral Sousa
- Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil.,Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil.,Division of Cardiology University Hospital Federal University of Sergipe Aracaju Sergipe Brazil
| | - José Augusto Barreto-Filho
- Postgraduate Program in Health Sciences Federal University of Sergipe Aracaju Sergipe Brazil.,Clinic and Hospital São Lucas-Rede D'Or São Luiz Aracaju Sergipe Brazil.,Division of Cardiology University Hospital Federal University of Sergipe Aracaju Sergipe Brazil
| | | |
Collapse
|
177
|
Dela Cruz RZ, Ortega-Dela Cruz RA. Management of public healthcare facilities in the Philippines: issues and concerns. ACTA ACUST UNITED AC 2019. [DOI: 10.12968/bjhc.2019.0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Public hospitals are the primary means of healthcare delivery in developing countries. Given the pressing need for efficient health services, it is imperative to know the extent to which a country's public healthcare institutions meet an ever increasing public demand. This study aimed to assess the state of hospital facilities among public health care institutions in a developing country. Methods Descriptive research methods were used, including needs analysis along with management and client satisfaction surveys, in order to analyse information on issues that related to the management of hospital facilities in the Philippines. Various members of the hospital community were selected to assess different aspects of hospital management. Results The results of this study show that most concerns stemmed from the lack of financial resources, materials, equipment and technological innovations; insufficient knowledge, skills and human resources; and problems that related to processes and methodologies. Conclusions Public hospitals are in dire need of facility upkeep to maintain their operations. This has become a more pressing concern because of the very limited resources at the disposal of public hospitals. This study also highlighted the crucial role played by the national government in finding effective and efficient ways to address these issues and concerns to ensure successful delivery of healthcare services in the country.
Collapse
Affiliation(s)
- Ramiro Z Dela Cruz
- Assistant Professor, College of Computer Studies, Pamantasan ng Cabuyao, Cabuyao City, Laguna, Philippines
| | - Ruth A Ortega-Dela Cruz
- Assistant Professor, Institute for Governance and Rural Development, College of Public Affairs and Development, University of the Philippines Los Baños, College, Laguna, Philippines
| |
Collapse
|
178
|
Haque M, Choudhury A, Haque A, Blackwood RA. Understanding mother and child health-seeking behavior in urban Pakistan. Health Care Women Int 2019; 43:549-567. [PMID: 31553268 DOI: 10.1080/07399332.2019.1641503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Pakistan has long held one of the highest rates in the world for mother and child mortality, albeit the leading causes of death are largely preventable. Unlike many other low and middle-income countries (LMIC), however, limited research has been conducted within conflict-ridden LMIC like Pakistan on health-seeking behavior. Even less is known about more developed localities within these nations. Between May and June 2016, a pre-tested cross-sectional pilot study was conducted in Islamabad. Seventy mothers were surveyed, and data were used to run descriptive analyses and generate multivariable regression models to evaluate a mother's desire to solicit medical attention. Mothers had higher self-health seeking behavioral scores if they were more likely to pursue care for their children and vice versa. In situations that potentially warranted medical intervention, they were also 1.84 times more likely to solicit care for their children than for themselves. While most women were inclined to take their children to an established provider for a variety of illnesses, many still faced prominent barriers to accessing healthcare. To improve population health in developing nations like Pakistan, evidence-based methods should be adopted that increase healthcare accessibility, improve health awareness, and prioritize the health status of everyone in the family.
Collapse
Affiliation(s)
- Marina Haque
- Office for Health Equity and Inclusion and the Department for Health Management and Policy, University of Michigan , Ann Arbor , Michigan , USA
| | - Allysha Choudhury
- Department of Epidemiology, Johns Hopkins University , Baltimore , Maryland , USA
| | - Alina Haque
- Ross School of Business, University of Michigan , Ann Arbor , Michigan , USA
| | - Roland Alexander Blackwood
- Office for Health Equity and Inclusion and Division of Pediatric Infectious Diseases , Ann Arbor , Michigan , USA
| |
Collapse
|
179
|
Suy S, Rego S, Bory S, Chhorn S, Phou S, Prien C, Heng S, Wu S, Legido-Quigley H, Hanefeld J, Saphonn V, Khan MS. Invisible medicine sellers and their use of antibiotics: a qualitative study in Cambodia. BMJ Glob Health 2019; 4:e001787. [PMID: 31637030 PMCID: PMC6768357 DOI: 10.1136/bmjgh-2019-001787] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/09/2019] [Accepted: 08/18/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Global attention to antimicrobial resistance has increased interest in tackling the widespread inappropriate dispensing of antibiotics by informal, for-profit healthcare providers (HCPs). We provide new evidence on an understudied group of informal HCPs: invisible medicine sellers (IMS) who operate without any marked facility. We investigated factors that influence community decisions on which HCPs to purchase medicines from, focusing on reasons for using IMS, and compared different HCPs' knowledge of antibiotic use. METHODS We conducted community focus group discussions (FGDs) in seven purposively selected villages representing high and low informal HCPs use in two peri-urban districts in Phnom Penh, Cambodia. Using information from the FGDs to identify HCPs that sell medicines, we interviewed 35 participants: 21 HCPs (including five IMS) and 14 key informants, including government HCPs and village leaders. We adopted an interpretative approach and conducted a thematic analysis. RESULTS Community members typically knew of several formal and informal HCPs selling medicines nearby, and IMS were common, as were doctors that sell medicines covertly. Two factors were most salient in influencing the choice of HCP for medicine purchasing. The first was trust in the effectiveness of medicines provided, judged by the speed of symptomatic relief. This pushed HCPs to provide several medicines, including antibiotics, at the first consultation. The second was the convenience offered by IMS and other informal HCPs: supplying medicines when other facilities are closed, accepting delayed payments, providing incomplete courses of medication and selling human antibiotics for animal use. CONCLUSION This first study focusing on IMS indicates that it is important, but challenging, for public health agencies to engage with them to reduce inappropriate use of antibiotics. Although public health facilities must fill some gaps that informal HCPs are currently addressing, such as access to medicines at night, reducing demand for unnecessary antibiotics is also critical.
Collapse
Affiliation(s)
- Sovanthida Suy
- Department of Public Health, University of Health Sciences, Phnom Penh, Cambodia
| | - Sonia Rego
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sothavireak Bory
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Socheata Phou
- Department of Public Health, University of Health Sciences, Phnom Penh, Cambodia
| | - Chanra Prien
- Faculty of Pharmacy, University of Health Sciences, Phnom Penh, Cambodia
| | | | - Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Helena Legido-Quigley
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Johanna Hanefeld
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Mishal S Khan
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| |
Collapse
|
180
|
Le TA, Le MQT, Dang AD, Dang AK, Nguyen CT, Pham HQ, Vu GT, Hoang CL, Tran TT, Vuong QH, Tran TH, Tran BX, Latkin CA, Ho CSH, Ho RCM. Multi-level predictors of psychological problems among methadone maintenance treatment patients in difference types of settings in Vietnam. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2019; 14:39. [PMID: 31533764 PMCID: PMC6751619 DOI: 10.1186/s13011-019-0223-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/20/2019] [Indexed: 01/17/2023]
Abstract
Background Methadone, a long-acting opioid agonist maintenance treatment (MMT) is used to treat opioid addiction by preventing opioid withdrawal and reducing cravings. However, it is important to note that mental conditions may persist, or even remain undetected while methadone maintenance treatment is ongoing. This study aimed to examine the level of psychological problems among MMT patients at public and private health facilities and identify associated factors. Method From January to September 2018, a cross-sectional study was performed in Nam Dinh province, one of the largest epicenters providing HIV/AIDS surveillance and treatment services in the North of Vietnam. 395 male respondents currently receiving MMT agreed to participate in a face-to-face interview. Depression, Anxiety and Stress Scale-21 (DASS-21) were used to assess psychological problems among patients. Results The percentage of patients suffering from mild to extremely severe anxiety was the highest among psychological problems (18%). 2.8% of participants had mild depressive symptoms and the percentage of those having mild or moderate stress was approximately 4%. In addition, the longer treatment duration, the lower mental health scores regarding three types of psychological problems. Respondents who received MMT services in public health facilities were more likely to have a higher score of all psychological problems. Participants who lived with partners or spouse, having higher monthly family income had a lower likelihood of having severe depression and stress status. Freelancers or blue-collars/farmers had lower score of depression and anxiety compared to people being unemployed. Conclusion This study suggests that among our sample, MMT patients receiving treatment in public health facilities might have higher rate of psychological problems, including depression, anxiety, and stress than that of those in the private health facility. These results highlight the necessity of taking psychological counseling adequately for MMT patients and psychological assessment should be prioritized in the early stage of treatment.
Collapse
Affiliation(s)
- Tuan Anh Le
- National Institute of Hygiene and Epidemiology, Hanoi, 100000, Vietnam.,Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Mai Quynh Thi Le
- National Institute of Hygiene and Epidemiology, Hanoi, 100000, Vietnam
| | - Anh Duc Dang
- National Institute of Hygiene and Epidemiology, Hanoi, 100000, Vietnam
| | - Anh Kim Dang
- Institute for Global Health Innovations, Duy Tan University, Postal address: No. 73 Hoang Cau street, Hanoi, Da Nang, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Postal address: No. 73 Hoang Cau street, Hanoi, Da Nang, Vietnam.
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Postal address: No. 73 Hoang Cau street, Hanoi, Da Nang, Vietnam
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, 700000, Vietnam
| | - Chi Linh Hoang
- Center of Excellence in Behavior Medicine, Nguyen Tat Thanh University, Ho Chi Minh, 700000, Vietnam
| | - Tung Thanh Tran
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, 700000, Vietnam
| | - Quan-Hoang Vuong
- Centre for Interdisciplinary Social Research, Phenikaa University, Yen Nghia, Ha Dong, Hanoi, 100803, Vietnam.,Faculty of Economics and Finance, Phenikaa University, Yen Nghia, Ha Dong, Hanoi, 100803, Vietnam
| | - Tung Hoang Tran
- Institute of Orthopaedic and Trauma Surgery, Vietnam - Germany Hospital, Hanoi, 100000, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, 119074, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavior Medicine, Nguyen Tat Thanh University, Ho Chi Minh, 700000, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore.,Biomedical Global Institute of Healthcare Research & Technology (BIGHEART), National University of Singapore, Singapore, 117599, Singapore
| |
Collapse
|
181
|
Unicomb L, Horng L, Alam MU, Halder AK, Shoab AK, Ghosh PK, Islam MK, Opel A, Luby SP. Health-Care Facility Water, Sanitation, and Health-Care Waste Management Basic Service Levels in Bangladesh: Results from a Nation-Wide Survey. Am J Trop Med Hyg 2019; 99:916-923. [PMID: 30152311 DOI: 10.4269/ajtmh.18-0133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We conducted a nationally representative cross-sectional study of 875 health-care facilities (HCFs) to determine water, sanitation, and health-care waste disposal service levels in Bangladesh for doctors, staff, and patients/caregivers in 2013. We calculated proportions and prevalence ratios to compare urban versus rural and government versus other HCFs. We report World Health Organization (WHO)-defined basic HCF service levels. The most common HCF was nongovernmental private (80%, 698/875), with an average of 25 beds and 12 admissions per day. There was an improved water source inside the HCF for doctors (79%, 95% confidence intervals [CI]: 75, 82), staff (59%, 95% CI: 55, 64), and patients/caregivers (59%, 95% CI: 55, 63). Improved toilets for doctors (81%, 95% CI: 78, 85) and other staff (73%, 95% CI: 70, 77) were more common than for patients/caregivers (54%, 95% CI: 50, 58). Forty-three percentage (434/875) of HCFs had no disposal method for health-care waste. More urban than rural and more government than other HCFs had an improved water source on the premises and improved toilets for staff. WHO-defined basic service levels were detected in > 90% of HCFs for drinking water, among 46-77% for sanitation, and 68% for handwashing at point of care but 26% near toilets. Forty-seven percentage of HCFs attained basic health-care waste management service levels. Patient/caregiver access to water, sanitation, and hygiene facilities is inadequate in many HCFs across Bangladesh. Improving facilities for this group should be an integral part of accreditation.
Collapse
Affiliation(s)
- Leanne Unicomb
- Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Lily Horng
- Stanford University, Stanford, California
| | - Mahbub-Ul Alam
- Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Amal K Halder
- Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abul K Shoab
- Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Probir K Ghosh
- Environmental Interventions Unit, Enteric and Respiratory Infections Program, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | | | | |
Collapse
|
182
|
Guo S, Carvajal-Aguirre L, Victora CG, Barros AJD, Wehrmeister FC, Vidaletti LP, Gupta G, Matin MZ, Rutter P. Equitable coverage? The roles of the private and public sectors in providing maternal, newborn and child health interventions in South Asia. BMJ Glob Health 2019; 4:e001495. [PMID: 31543985 PMCID: PMC6730586 DOI: 10.1136/bmjgh-2019-001495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/17/2019] [Accepted: 05/25/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction The private sector accounts for an important share of health services available in South Asia. It is not known to what extent socioeconomic and urban–rural inequalities in maternal, newborn and child health (MNCH) interventions are being affected by the presence of private providers. Methods Nationally representative surveys carried out from 2009 to 2015 were analysed for seven of the eight countries in South Asia, as data for Sri Lanka were not available. The outcomes studied included antenatal care (four or more visits), institutional delivery, early initiation of breast feeding, postnatal care for babies, and careseeking for diarrhoea and pneumonia. Results were stratified according to quintiles of household wealth and urban–rural residence. Results At regional level, the public sector played a larger role than the private sector in providing antenatal (24.8% vs 15.6% coverage), delivery (51.9% vs 26.8%) and postnatal care (15.7% vs 8.2%), as well as in the early initiation of breast feeding (26.1% vs 11.1%). The reverse was observed in careseeking for diarrhoea (15.0% and 46.2%) and pneumonia (18.2% and 50.5%). In 28 out of 37 possible analyses of coverage by country, socioeconomic inequalities were significantly wider in the private than in the public sector, and in only four cases the reverse pattern was observed. In 20 of the 37 analyses, the public sector was also more likely to be used by the wealthiest women and children. Conclusion The private sector plays a substantial role in delivering MNCH interventions in South Asia but is more inequitable than the public sector.
Collapse
Affiliation(s)
- Sufang Guo
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| | | | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Aluisio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Fernando C Wehrmeister
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.,Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Luis Paulo Vidaletti
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Gagan Gupta
- UNICEF India, United Nations Childrens Fund, New Delhi, India
| | | | - Paul Rutter
- UNICEF Regional Office for South Asia, Kathmandu, Nepal
| |
Collapse
|
183
|
Doctor HV, Radovich E, Benova L. Time trends in facility-based and private-sector childbirth care: analysis of Demographic and Health Surveys from 25 sub-Saharan African countries from 2000 to 2016. J Glob Health 2019; 9:020406. [PMID: 31360446 PMCID: PMC6644920 DOI: 10.7189/jogh.09.020406] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Africa, and sub-Saharan Africa in particular, remains one of the regions with modest improvements to maternal and newborn survival and morbidity. Good quality intrapartum and early postpartum care in a health facility as well as delivery under the supervision of trained personnel is associated with improved maternal and newborn health outcomes and decreased mortality. We describe and contrast recent time trends in the scale and socio-economic inequalities in facility-based and private facility-based childbirth in sub-Saharan Africa. Methods We used Demographic and Health Surveys in two time periods (2000-2007 and 2008-2016) to analyse levels and time trends in facility-based and private facility-based deliveries for all live births in the five-year survey recall period to women aged 15-49. Household wealth quintiles were used for equity analysis. Absolute numbers of births by facility sector were calculated applying UN Population Division crude birth rates to the total country population. Results The percentage of all live births occurring in health facilities varied across countries (5%-85%) in 2000-2007. In 2008-2016, this ranged from 22% to 92%. The lowest percentage of all births occurring in private facilities in 2000-2007 period was in Ethiopia (0.3%) and the highest in the Democratic Republic of Congo at 20.5%. By 2008-2016, this ranged from 0.6% in Niger to 22.3% in Gabon. Overall, the growth in the absolute numbers of births in facilities outpaced the growth in the percentage of births in facilities. The largest increases in absolute numbers of births occurred in public sector facilities in all countries. Overall, the percentage of births occurring in facilities was significantly lower for poorest compared to wealthiest women. As the percentage of facility births increased in all countries over time, the extent of wealth-based differences had reduced between the two time periods in most countries (median risk ratio in 2008-2016 was 2.02). The majority of countries saw a narrowing in both the absolute and relative difference in facility-based deliveries between poorest and wealthiest. Conclusions The growth in facility-based deliveries, which was largely driven by the public sector, calls for increased investments in effective interventions to improve service delivery and quality of life for the mother and newborn. The goal of universal health coverage to provide better quality services can be achieved by deploying interventions that are holistic in managing and regulating the private sector to enhance performance of the health care system in its entirety rather than interventions that only target service delivery in one sector.
Collapse
Affiliation(s)
- Henry Victor Doctor
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Emma Radovich
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Lenka Benova
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| |
Collapse
|
184
|
Begum T, Nababan H, Rahman A, Islam MR, Adams A, Anwar I. Monitoring caesarean births using the Robson ten group classification system: A cross-sectional survey of private for-profit facilities in urban Bangladesh. PLoS One 2019; 14:e0220693. [PMID: 31393926 PMCID: PMC6687131 DOI: 10.1371/journal.pone.0220693] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Globally, Caesarean section (CS) rates are mounting and currently exceed the safe upper limit of 15%. Monitoring CS rates using clinical indications and obstetric sub-group analysis could confirm that women in need have been served. In Bangladesh, the reported CS rate was 31% in 2016, and almost twice that rate in urban settings. Delivering in the private healthcare sector was a strong determinant. This study uses Robson Ten Group Classification System (TGCS) to report CS rates in urban Bangladesh. The clinical causes and determining factors for CS births have also been examined. METHODS This record linkage cross-sectional survey was undertaken in 34 urban for-profit private hospitals having CS facilities during the period June to August 2015. Data were supplied by inpatient case records and operation theatre registers. Descriptive analyses were performed to calculate the relative size of each group; the group-specific CS rate, and group contribution to total CS and overall CS rate. CS indications were grouped into eleven categories using ICD 10 codes. Binary logistic regression was performed to explore the determinants of CS. RESULTS Out of 1307 births, delivery by CS occurred in 1077 (82%). Three obstetric groups contributed the most to overall CS rate: previous CS (24%), preterm (23%) and term elective groups (22%). The major clinical indications for CS were previous CS (35%), prolonged and obstructed labor (15%), fetal distress (11%) and amniotic fluid disorder (11%). Multiple gestation, non-cephalic presentation, previous bad obstetric history were positive predictors while oxytocin used for labour induction and increased parity were negative predictors of CS. CONCLUSIONS As the first ever study in urban private for-profit health facilities in Bangladesh, this study usefully identifies the burden of CS and where to intervene. Engagement of multiple stakeholders including the private sector is crucial in planning effective strategies for safe reduction of CS.
Collapse
Affiliation(s)
- Tahmina Begum
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- The Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Herfina Nababan
- Nossal Institute for Global Health, School of Population and Global Health, the University of Melbourne, Melbourne, Australia
| | - Aminur Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Md Rajibul Islam
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Alayne Adams
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
- Department of International Health, Georgetown University, Washington, United States of America
- James P Grant School of Public Health, Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| |
Collapse
|
185
|
Adams AM, Ahmed R, Shuvo TA, Yusuf SS, Akhter S, Anwar I. Exploratory qualitative study to understand the underlying motivations and strategies of the private for-profit healthcare sector in urban Bangladesh. BMJ Open 2019; 9:e026586. [PMID: 31272974 PMCID: PMC6615794 DOI: 10.1136/bmjopen-2018-026586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 04/17/2019] [Accepted: 05/31/2019] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This paper explores the underlying motivations and strategies of formal small and medium-sized formal private for-profit sector hospitals and clinics in urban Bangladesh and their implications for quality and access. METHODS This exploratory qualitative study was conducted in Dhaka, Sylhet and Khulna City Corporations. Data collection methods included key informant interviews (20) with government and private sector leaders, in-depth interviews (30) with clinic owners, managers and providers and exit interviews (30) with healthcare clients. RESULTS Profit generation is a driving force behind entry into the private healthcare business and the provision of services. However, non-financial motivations are also emphasised such as aspirations to serve the disadvantaged, personal ambition, desire for greater social status, obligations to continue family business and adverse family events.The discussion of private sector motivations and strategies is framed using the Business Policy Model. This model is comprised of three components: products and services, and efforts to make these attractive including patient-friendly discounts and service-packages, and building 'good' doctor-patient relationships; the market environment, cultivated using medical brokers and referral fees to bring in fresh clientele, and receipt of pharmaceutical incentives; and finally, organisational capabilities, in this case overcoming human resource shortages by relying on medical staff from the public sector, consultant specialists, on-call and less experienced doctors in training, unqualified nursing staff and referring complicated cases to public facilities. CONCLUSIONS In the context of low public sector capacity and growing healthcare demands in urban Bangladesh, private for-profit engagement is critical to achieving universal health coverage (UHC). Given the informality of the sector, the nascent state of healthcare financing, and a weak regulatory framework, the process of engagement must be gradual. Further research is needed to explore how engagement in UHC can be enabled while maintaining profitability. Incentives that support private sector efforts to improve quality, affordability and accountability are a first step in building this relationship.
Collapse
Affiliation(s)
- Alayne Mary Adams
- Department of International Health, Georgetown University, Washington, District of Columbia, USA
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Rushdia Ahmed
- BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Tanzir Ahmed Shuvo
- Department of Health Services Policy and Management, University of South Carolina, Columbia, South Carolina, USA
| | | | - Sadika Akhter
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Iqbal Anwar
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| |
Collapse
|
186
|
Hanson C, Singh S, Zamboni K, Tyagi M, Chamarty S, Shukla R, Schellenberg J. Care practices and neonatal survival in 52 neonatal intensive care units in Telangana and Andhra Pradesh, India: A cross-sectional study. PLoS Med 2019; 16:e1002860. [PMID: 31335869 PMCID: PMC6650044 DOI: 10.1371/journal.pmed.1002860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Indian government supports both public- and private-sector provision of hospital care for neonates: neonatal intensive care is offered in public facilities alongside a rising number of private-for-profit providers. However, there are few published reports about mortality levels and care practices in these facilities. We aimed to assess care practices, causes of admission, and outcomes from neonatal intensive care units (NICUs) in public secondary and private tertiary hospitals and both public and private medical colleges enrolled in a quality improvement collaborative in Telangana and Andhra Pradesh-2 Indian states with a respective population of 35 and 50 million. METHODS AND FINDINGS We conducted a cross-sectional study between 30 May and 26 August 2016 as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care. We assessed the availability of staff and services, adherence to evidence-based practices at admission, and case fatality after admission to the NICU using a range of tools, including facility assessment, observations of admission, and abstraction of registers and telephone interviews after discharge. Our analysis is adjusted for clustering and weighted for caseload at the hospital level and presents findings stratified by type and ownership of hospitals. In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians were working in public secondary NICUs per 10 beds. On admission, all neonates admitted to private hospitals had auscultation (100%, 19 of 19 observations) but only 42% (95% confidence interval [CI] 25%-62%, p-value for difference is 0.361) in public secondary hospitals. The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality rates at age 28 days after admission to a NICU were 4% (95% CI 2%-8%), 15% (9%-24%), 4% (2%-8%) and 2% (1%-5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, according to facility registers. Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%-18%) for public secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges. Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was limited due to the small sample size among private facilities. CONCLUSIONS Our findings suggest differences in quality of neonatal intensive care and 28-day survival between the different types of hospitals, although comparison of outcomes is complicated by differences in the case mix and referral practices between hospitals. Uniform reporting of outcomes and risk factors across the private and public sectors is required to assess the benefits for the population of mixed-care provision.
Collapse
Affiliation(s)
- Claudia Hanson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Samiksha Singh
- Public Health Foundation, India, Kavuri Hills, Madhapur, Hyderabad, India
| | - Karen Zamboni
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| | - Mukta Tyagi
- Public Health Foundation, India, Kavuri Hills, Madhapur, Hyderabad, India
| | - Swecha Chamarty
- Public Health Foundation, India, Kavuri Hills, Madhapur, Hyderabad, India
| | - Rajan Shukla
- Public Health Foundation, India, Kavuri Hills, Madhapur, Hyderabad, India
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, England
| |
Collapse
|
187
|
Babu BV, Sharma Y, Kusuma YS, Sivakami M, Lal DK, Marimuthu P, Geddam JB, Khanna A, Agarwal M, Sudhakar G, Sengupta P, Borhade A, Khan Z, Kerketta AS, Brogen A. Patient experiences and health system responsiveness among internal migrants: A nationwide study in 13 Indian cities. J Healthc Qual Res 2019; 34:167-175. [PMID: 31713527 DOI: 10.1016/j.jhqr.2019.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 04/02/2019] [Accepted: 04/26/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To report various components of health system responsiveness among poor internal migrants who availed the government health facilities in 13 Indian cities. MATERIALS AND METHODS Cluster random sampling was used to select 50,806 migrant households, of which 14,263 households avail the government health facility in last six months. In addition, 5072 women, who sought antenatal care and 3946 women who had delivery in government health facility during last six months were also included. Data on different domains of health system responsiveness were collected using an interviewer-administered questionnaire, developed based on the World Health Survey of WHO. RESULTS Of the eight domains of responsiveness, namely, autonomy, communication, confidentiality, dignity, choice, quality of basic facilities, prompt attention and access to family and community, seven domains, except the 'choice', are assessed, and they are moderate. Only about 30% of participants said that doctor discussed on treatment options (autonomy). And 50-60% of participants said positively for questions of clarity of communication. About 59% of participants acknowledged the confidentiality. Not more than 40% of participants said they were treated with dignity, and privacy is respected (dignity). The responses to quality basic amenities, prompt attention and access to family and community domains are fairly satisfactory. CONCLUSIONS This study has implications as many urban poor, including migrants do not utilize the services of public healthcare facilities. Hence, a responsive health system is required. There should be a policy in place to train and orient healthcare workers on some of the domains of health system responsiveness.
Collapse
Affiliation(s)
- B V Babu
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India.
| | - Y Sharma
- Division of Socio-Behavioural & Health Systems Research, Indian Council of Medical Research, New Delhi, India
| | - Y S Kusuma
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - M Sivakami
- Centre for Health and Social Sciences, School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
| | - D K Lal
- International Institute of Health Management Research, New Delhi, India
| | - P Marimuthu
- Department of Biostatistics, National Institute of Mental Health and Neuro-Sciences, Bangalore, India
| | - J B Geddam
- National Institute of Nutrition of Indian Council of Medical Research, Hyderabad, India
| | - A Khanna
- Indian Institute of Health Management Research, Jaipur, India
| | - M Agarwal
- Department of Community Medicine & Public Health, KG Medical University, Lucknow, India
| | - G Sudhakar
- Department of Human Genetics, Andhra University, Visakhapatnam, India
| | - P Sengupta
- Department of Community Medicine, Christian Medical College, Ludhiana, India
| | - A Borhade
- Indian Institute of Public Health, Public Health Foundation of India, Gurgaon, India
| | - Z Khan
- Department of Community Medicine, JN Medical College, Aligarh Muslim University, Aligarh, India
| | - A S Kerketta
- Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
| | - A Brogen
- Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, India
| |
Collapse
|
188
|
Nkwanyana NM, Voce AS, Mnqayi SO, Sartorius B, Schneider H. A health system framework for perinatal care in South African district hospitals: a Delphi technique. BMC Health Serv Res 2019; 19:402. [PMID: 31221153 PMCID: PMC6585044 DOI: 10.1186/s12913-019-4200-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/30/2019] [Indexed: 11/12/2022] Open
Abstract
Background The majority of perinatal deaths occurring in low- and middle- income countries are preventable. South Africa is a middle-income country with consistently high perinatal mortality rates and most factors contributing to preventable deaths are linked to the functioning of the health system. Particularly of concern in South Africa is the high perinatal mortality in district hospitals, where most births occur and where intrapartum care is provided to women of low and intermediate risk. Therefore, it is crucial to strengthen the health system for perinatal care in district hospitals. There is currently no consolidated documented framework outlining contextual health system domains and indicators that are key to providing effective perinatal care in district hospitals. The purpose of this study was to derive key health system domains and indicators necessary to measure the performance of the health system for perinatal care in South African district hospitals. Methods The Delphi technique was used in collecting data from a panel with experts drawn from disciplines connected with the functioning of the health system for perinatal care in South Africa. The study enrolled thirteen experts from whom data on key health system domains and indicators for perinatal care were derived. The project reference group gave guidance to the development of the framework and ascertained its relevance to the South African setting. Results The Facility Based Health System Framework for Perinatal Care comprising domains and indicators necessary to measure health system performance in South African district hospitals was derived from data. The broad structure of the proposed framework aligns with the WHO Health Systems Framework. Each critical building block has detailed domains and indicators that illuminate essential facility-level and programme-specific elements that require attention for strengthening the health system for perinatal care. Conclusion The proposed framework can enable district hospital management teams to identify gaps in the health system for perinatal care, which need to be strengthened in order to alleviate the burden of perinatal deaths in district hospitals.
Collapse
Affiliation(s)
| | - Anna Silvia Voce
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Sthandwa Octavia Mnqayi
- King Cetshwayo Health District Office, KwaZulu-Natal Department of Health, Empangeni, South Africa
| | - Benn Sartorius
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Schneider
- School of Public Health and SAMRC Health Services to Systems Unit, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
189
|
Tweheyo R, Reed C, Campbell S, Davies L, Daker-White G. 'I have no love for such people, because they leave us to suffer': a qualitative study of health workers' responses and institutional adaptations to absenteeism in rural Uganda. BMJ Glob Health 2019; 4:e001376. [PMID: 31263582 PMCID: PMC6570979 DOI: 10.1136/bmjgh-2018-001376] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/16/2019] [Accepted: 04/21/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Achieving positive treatment outcomes and patient safety are critical goals of the healthcare system. However, this is greatly undermined by near universal health workforce absenteeism, especially in public health facilities of rural Uganda. We investigated the coping adaptations and related consequences of health workforce absenteeism in public and private not-for-profit (PNFP) health facilities of rural Uganda. METHODS An empirical qualitative study involving case study methodology for sampling and principles of grounded theory for data collection and analysis. Focus groups and in-depth interviews were used to interview a total of 95 healthcare workers (11 supervisors and 84 frontline workers). The NVivo V.10 QSR software package was used for data management. RESULTS There was tolerance of absenteeism in both the public and PNFP sectors, more so for clinicians and managers. Coping strategies varied according to the type of health facility. A majority of the PNFP participants reported emotion-focused reactions. These included unplanned work overload, stress, resulting anger directed towards coworkers and patients, shortening of consultation times and retaliatory absence. On the other hand, various cadres of public health facility participants reported ineffective problem-solving adaptations. These included altering weekly schedules, differing patient appointments, impeding absence monitoring registers, offering unnecessary patient referrals and rampant unsupervised informal task shifting from clinicians to nurses. CONCLUSION High levels of absenteeism attributed to clinicians and health service managers result in work overload and stress for frontline health workers, and unsupervised informal task shifting of clinical workload to nurses, who are the less clinically skilled. In resource-limited settings, the underlying causes of absenteeism and low staff morale require attention, because when left unattended, the coping responses to absenteeism can be seen to compromise the well-being of the workforce, the quality of healthcare and patients' access to care.
Collapse
Affiliation(s)
- Raymond Tweheyo
- Department of Public Health, Lira University, Lira, Uganda
- Centre for Primary Care, Division of Population Health, The University of Manchester, Manchester, UK
| | - Catherine Reed
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, The University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, Division of Population Health, The University of Manchester, Manchester, UK
| | - Gavin Daker-White
- Centre for Primary Care, Division of Population Health, The University of Manchester, Manchester, UK
| |
Collapse
|
190
|
Mpimbaza A, Nayiga S, Ndeezi G, Rosenthal PJ, Karamagi C, Katahoire A. Understanding the context of delays in seeking appropriate care for children with symptoms of severe malaria in Uganda. PLoS One 2019; 14:e0217262. [PMID: 31166968 PMCID: PMC6550380 DOI: 10.1371/journal.pone.0217262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 05/08/2019] [Indexed: 12/02/2022] Open
Abstract
Introduction A large proportion of children with uncomplicated malaria receive appropriate treatment late, contributing to progression of illness to severe disease. We explored contexts of caregiver delays in seeking appropriate care for children with severe malaria. Methods This qualitative study was conducted at the Children’s Ward of Jinja Hospital, where children with severe malaria were hospitalized. A total of 22in-depth interviews were conducted with caregivers of children hospitalized with severe malaria. Issues explored were formulated based on the Partners for Applied Social Sciences (PASS) model, focusing on facilitators and barriersto caregivers’promptseeking and accessing ofappropriate care. The data were coded deductively using ATLAS.ti (version 7.5). Codes were then grouped into families based on emerging themes. Results Caregivers’ rating of initial symptoms as mild illness lead to delays in response. Use of home initiated interventions with presumably ineffective herbs or medicines was common, leading to further delay. When care was sought outside the home, drug shops were preferred over public health facilities for reasons of convenience. Drug shops often provided sub-optimal care, and thus contributed to delays in access to appropriate care. Public facilities were often a last resort when illness was perceived to be progressing to severe disease. Further delays occurred at health facilities due to inadequate referral systems. Conclusion Communities living in endemic areas need to be sensitized about the significance of fever, even if mild, as an indicator of malaria. Additionally, amidst ongoing efforts at bringing antimalarial treatment services closer to communities, the value of drug shops as providers ofrationalantimalarialtreatment needs to be reviewed.
Collapse
Affiliation(s)
- Arthur Mpimbaza
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Susan Nayiga
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Grace Ndeezi
- Department of Pediatrics & Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Philip J. Rosenthal
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Charles Karamagi
- Department of Pediatrics & Child Health, Makerere University, College of Health Sciences, Kampala, Uganda
- Clinical Epidemiology Unit, Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Anne Katahoire
- Child Health & Development Centre, Makerere University, College of Health Sciences, Kampala, Uganda
| |
Collapse
|
191
|
Dela Cruz RZ, Ortega-Dela Cruz RA. Addressing facility management issues and challenges common among public health care institutions in a developing country. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1616387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Ramiro Z. Dela Cruz
- College of Information Technology and Engineering, Pamantasan ng Cabuyao, Katapatan Homes, Cabuyao City, Philippines
| | - Ruth A. Ortega-Dela Cruz
- Institute for Governance and Rural Development, College of Public Affairs and Development, University of the Philippines Los Baños, Laguna, Philippines
| |
Collapse
|
192
|
Shmueli L, Davidovitch N, Pliskin JS, Hekselman I, Balicer RD, Greenfield G. Reasons, perceived outcomes and characteristics of second-opinion seekers: are there differences in private vs. public settings? BMC Health Serv Res 2019; 19:238. [PMID: 31014323 PMCID: PMC6480844 DOI: 10.1186/s12913-019-4067-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/05/2019] [Indexed: 01/29/2023] Open
Abstract
Background In most countries, patients can get a second opinion (SO) through public or private healthcare systems. There is lack of data on SO utilization in private vs. public settings. We aim to evaluate the characteristics of people seeking SOs in private vs. public settings, to evaluate their reasons for seeking a SO from a private physician and to compare the perceived outcomes of SOs given in a private system vs. a public system. Methods A cross-sectional national telephone survey, using representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, on the same medical concern. We modeled SO utilization in a public system vs. a private system by patient characteristics using a multivariate logistic regression model. Results 214 of 339 respondents who obtained a SO during the study period, did so in a private practice (63.1%). The main reason for seeking a SO from a private physician rather than a physician in the public system was the assumption that private physicians are more professional (45.7%). However, respondents who obtained a private SO were neither more satisfied from the SO (p = 0.45), nor felt improvement in their perceived clinical outcomes after the SO (p = 0.37). Low self-reported income group, immigrants (immigrated to Israel after 1989) and religious people tended to seek SOs from the public system more than others. Conclusions The main reason for seeking a SO from private physicians was the assumption that they are more professional. However, there were no differences in satisfaction from the SO nor perceived clinical improvement. As most of SOs are sought in the private system, patient misconceptions about the private market superiority may lead to ineffective resource usage and increase inequalities in access to SOs. Ways to improve public services should be considered to reduce health inequalities.
Collapse
Affiliation(s)
- Liora Shmueli
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Joseph S Pliskin
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel.,Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Igal Hekselman
- Clalit Mushlam Health Insurance Systems, Clalit Health Services, 1 Ben Gurion, 5120149, Bnei Brak, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, 101 Arlozorov, 62098, Tel-Aviv, Israel
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St. Dunstan's Road, London, W6 8RP, UK.
| |
Collapse
|
193
|
Zhang W, Wu Q. The Relationship Between Public Sector Employment and Population Health: Evidence From the 1980s and Its Contemporary Implications. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 49:555-581. [PMID: 30839247 DOI: 10.1177/0020731419833530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article explores the relationship between public sector employment and population health both theoretically and quantitatively. First, we build a theoretical framework to situate public employment in the literature that explores the link between politics and health. We argue that public employment, as an instrument of pro-redistributive policies in both the labor market and the welfare state, improves equality and ultimately health. Second, based on a cross-country dataset from the 1980s, and by applying regression analysis and outlier identification techniques, we find that population health measured by life expectancy improves with the size of public employment. The association is stronger for countries with lower income and for women. When policymakers contemplate downsizing state enterprises and government functions, they should consider the health effect of public employment.
Collapse
Affiliation(s)
- Wei Zhang
- 1 School of Marxism, Tang Scholar, Tsinghua University, Beijing, China
| | - Qingjun Wu
- 2 Qingjun Wu, School of Labor and Human Resources, Renmin University of China, Beijing, China
| |
Collapse
|
194
|
Angell BJ, Prinja S, Gupt A, Jha V, Jan S. The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and the path to universal health coverage in India: Overcoming the challenges of stewardship and governance. PLoS Med 2019; 16:e1002759. [PMID: 30845199 PMCID: PMC6405049 DOI: 10.1371/journal.pmed.1002759] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In an Essay, Blake Angell and colleagues discuss ambitious reforms planned to expand coverage of the health system in India.
Collapse
Affiliation(s)
- Blake J. Angell
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- * E-mail:
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anadi Gupt
- National Health Mission, Government of Himachal Pradesh, Shimla, Himachal Pradesh, India
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales, New Delhi, India
- University of Oxford, Oxford, United Kingdom
| | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| |
Collapse
|
195
|
Strengthening the community support group to improve maternal and neonatal health seeking behaviors: A cluster-randomized controlled trial in Satkhira District, Bangladesh. PLoS One 2019; 14:e0212847. [PMID: 30817784 PMCID: PMC6394907 DOI: 10.1371/journal.pone.0212847] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 02/08/2019] [Indexed: 11/20/2022] Open
Abstract
Background Although achieved development goals on maternal and child health, in the era of Sustainable Development Goals (SDGs), Bangladesh still needs to promote skilled attendance at birth as well as a continuum of care for mothers and babies. How to implement effective interventions by strengthening the community health system also remains as a crucial policy issue. The objective of the proposed study is to evaluate the impact of a community-based intervention as part of a bilateral development aid project on utilization of maternal and neonatal care provided by skilled providers and qualified facilities. Methods A cluster randomized trial was conducted in Kalaroa Upazila of Satkhira District. Community Clinics (CCs) in the study setting were randomly allocated to either intervention or control. We recruited all eligible women covered by CC catchment areas who gave a birth during the past 12 months of data collection at the baseline and end-line surveys. In the intervention areas, three Community Support Groups (CSGs) were developed in each of the CC areas. The members of CSG were trained to identify pregnant women, educate community people on pregnancy related danger signs, and encourage them for utilization of skilled services in the community and health facilities. The primary outcomes were the utilization of services for antenatal care, delivery, postnatal care and sick newborns. Difference-in-Difference (DID) analysis was performed to identify the changes by the intervention with adjustment of cluster effects by generalized mixed effects regression models. Result The major indicators of the utilization of maternal and neonatal care among pregnant women with different wealth status showed significant improvement after the intervention. The impacts of the intervention were in particular significant among the women of 2nd and 3rd quintiles of household wealth status. The use of CCs increased after the intervention and private hospitals / clinics served as the major health providers. The study also identified increased practices of cesarean section. Conclusion The success of the intervention suggests a potential of the government efforts to strengthen the community support system for promotion of safe motherhood. The intervention helps to identify and remove existing and emerging barriers that lie between women and healthcare providers for safe motherhood and continuum of care. Trial registration UMIN Clinical Trial Registry UMIN000031789.
Collapse
|
196
|
Su D, Chen YC, Gao HX, Li HM, Chang JJ, Jiang D, Hu XM, Lei SH, Tan M, Chen ZF. Effect of integrated urban and rural residents medical insurance on the utilisation of medical services by residents in China: a propensity score matching with difference-in-differences regression approach. BMJ Open 2019; 9:e026408. [PMID: 30782944 PMCID: PMC6377539 DOI: 10.1136/bmjopen-2018-026408] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES In this study, we aim to evaluate the effect of urban and rural resident medical insurance scheme (URRMI) on the utilisation of medical services by urban and rural residents in the four pilot provinces. SETTING AND PARTICIPANTS The sample used in this study is 13 305 individuals, including 2620 in the treatment group and 10 685 in the control group, from the 2011 and 2015 surveys of China Health and Retirement Longitudinal Study. OUTCOME MEASURES Propensity score matching and difference-in-differences regression approach (PSM-DID) is used in the study. First, we match the baseline data by using kernel matching. Then, the average treatment effect of the four outcome variables are analysed by using the DID model. Finally, the robustness of the PSM-DID estimation is tested by simple model and radius matching. RESULTS Kernel matching have improved the overall balance after matching. The URRMI policy has significantly reduced the need-but-not outpatient care and significantly increased outpatient care cost and inpatient care cost for rural residents, with DID value of -0.271, 0.090 and 0.256, respectively. After robustness test, the DID competing results of four outcome variables are consistent. CONCLUSIONS URRMI has a limited effect on the utilisation of medical and health services by all residents, but the effect on rural residents is obvious. The government should establish a unified or income-matching payment standard to prevent, control the use of medical insurance funds and increase its efforts to implement URRMI integration in more regions to improve overall fundraising levels.
Collapse
Affiliation(s)
- Dai Su
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Ying-chun Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Hong-xia Gao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Hao-miao Li
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Jing-jing Chang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Di Jiang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Xiao-mei Hu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Shi-han Lei
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Min Tan
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| | - Zhi-fang Chen
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Research Center for Rural Health Services, Hubei Province Key Research Institute of Humanities and Social Sciences, Wuhan, China
| |
Collapse
|
197
|
Grosse Frie K, Kamaté B, Traoré CB, Coulibaly B, Mallé B, Kantelhardt EJ. Health system organisation and patient pathways: breast care patients' trajectories and medical doctors' practice in Mali. BMC Public Health 2019; 19:204. [PMID: 30777038 PMCID: PMC6379964 DOI: 10.1186/s12889-019-6532-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/11/2019] [Indexed: 02/06/2023] Open
Abstract
Background Information on pathways of women seeking diagnostic services due to breast- related symptoms can help highlight challenges related to the healthcare system in improving early diagnosis of breast cancer. Methods We retrospectively analysed the entire patient pathway, from first symptom recognition via initial healthcare visit up to final diagnosis at the pathology service in Mali. Data from questionnaire-based structured patient interviews (n = 124) were used to calculate time to first healthcare visit (median 91 days) and consecutive time to diagnosis (median 21 days) and to extract information on type of initially visited healthcare facility (community healthcare centre, referral hospital, tertiary hospital, private clinic). Median time to first healthcare visit and time to diagnosis and type of initially-visited healthcare facility were cross-tabulated with patient characteristics. An additional survey among (n = 30) medical doctors in the community healthcare centres and referral hospitals in Bamako was conducted to understand current knowledge and referral practice with respect to female patients with breast-related symptoms. Results Patients who initially visited private clinics had the shortest time to first healthcare visit (median 44 days), but the longest time to diagnosis (median 170 days). Patients visiting community healthcare centres and referral hospitals took longest for a first healthcare visit (median 153 and 206 days, respectively), but the time to diagnosis was shorter (median 95 and 7 days, respectively). The majority of patients (45%) initially visited a tertiary hospital; these patients had shortest total time to diagnosis (median 56 days health seeking and 8 days diagnostic time), but did not follow the recommended pathway for patients in the pyramidal healthcare system in Mali. The doctors’ survey showed lower breast cancer knowledge in the community healthcare centres than in the referral hospitals. However, most doctors felt able to recognise suspected cases of cancer and referred patients directly to a hospital. Conclusions The role of different healthcare facilities in ensuring triage of patients with breast-related symptoms needs to be defined before any early detection initiatives are implemented. Especially at the entry level of the healthcare system, the access and quality of health services need to be strengthened.
Collapse
Affiliation(s)
- Kirstin Grosse Frie
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstraße 8, 06112, Halle (Saale), Germany.
| | - Bakarou Kamaté
- Institute of Pathology, University Hospital Point G, Bamako, Mali
| | | | | | - Brahima Mallé
- Institute of Pathology, University Hospital Point G, Bamako, Mali
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstraße 8, 06112, Halle (Saale), Germany.,Department of Gynecology, University Hospital Halle (Saale), Halle, Germany
| |
Collapse
|
198
|
Renggli S, Mayumana I, Mboya D, Charles C, Mshana C, Kessy F, Glass TR, Pfeiffer C, Schulze A, Aerts A, Lengeler C. Towards improved health service quality in Tanzania: appropriateness of an electronic tool to assess quality of primary healthcare. BMC Health Serv Res 2019; 19:55. [PMID: 30670011 PMCID: PMC6341708 DOI: 10.1186/s12913-019-3908-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/15/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Progress in health service quality is vital to reach the target of Universal Health Coverage. However, in order to improve quality, it must be measured, and the assessment results must be actionable. We analyzed an electronic tool, which was developed to assess and monitor the quality of primary healthcare in Tanzania in the context of routine supportive supervision. The electronic assessment tool focused on areas in which improvements are most effective in order to suit its purpose of routinely steering improvement measures at local level. METHODS Due to the lack of standards regarding how to best measure quality of care, we used a range of different quantitative and qualitative methods to investigate the appropriateness of the quality assessment tool. The quantitative methods included descriptive statistics, linear regression models, and factor analysis; the qualitative methods in-depth interviews and observations. RESULTS Quantitative and qualitative results were overlapping and consistent. Robustness checks confirmed the tool's ability to assign scores to health facilities and revealed the usefulness of grouping indicators into different quality dimensions. Focusing the quality assessment on processes and structural adequacy of healthcare was an appropriate approach for the assessment's intended purpose, and a unique key feature of the electronic assessment tool. The findings underpinned the accuracy of the assessment tool to measure and monitor quality of primary healthcare for the purpose of routinely steering improvement measures at local level. This was true for different level and owner categories of primary healthcare facilities in Tanzania. CONCLUSION The electronic assessment tool demonstrated a feasible option for routine quality measures of primary healthcare in Tanzania. The findings, combined with the more operational results of companion papers, created a solid foundation for an approach that could lastingly improve services for patients attending primary healthcare. However, the results also revealed that the use of the electronic assessment tool outside its intended purpose, for example for performance-based payment schemes, accreditation and other systematic evaluations of healthcare quality, should be considered carefully because of the risk of bias, adverse effects and corruption.
Collapse
Affiliation(s)
- Sabine Renggli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Iddy Mayumana
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Dominick Mboya
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Christopher Charles
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Christopher Mshana
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Flora Kessy
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Tracy R. Glass
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Constanze Pfeiffer
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Christian Lengeler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| |
Collapse
|
199
|
Bhattacharya Chakravarty A, Rangan S, Dholakia Y, Rai S, Kamble S, Raste T, Shah S, Shah S, Mistry N. Such a long journey: What health seeking pathways of patients with drug resistant tuberculosis in Mumbai tell us. PLoS One 2019; 14:e0209924. [PMID: 30653523 PMCID: PMC6336307 DOI: 10.1371/journal.pone.0209924] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 12/13/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The Indian Tuberculosis (TB) Programme currently faces the dual challenges of tackling increasing numbers of drug resistant (DR) TB cases and regulating practices of a pluralistic private sector catering to TB patients. A study of health seeking behaviour of DR-TB patients in such a situation, offers an opportunity to understand the problems patients face while interacting with health systems. METHODOLOGY Forty-six DR-TB patients drawn from 15 high TB burden wards in Mumbai were interviewed using an open ended interview tool. Interviews were audio recorded and transcribed. Pathway schematics developed from analysis of patient records, were linked to transcripts. Open coding was used to analyse these units and themes were derived after collating the codes. RESULTS AND DISCUSSION The paper presents themes interwoven with narratives in the discussions. These include awareness-action gap among patients, role of neighbourhood providers, responsiveness of health systems, the not-such a 'merry go round' that patients go/are made to go on while seeking care, costs of diagnostics and treatment, and how DR-TB is viewed as the 'big TB'. CONCLUSION The recommendations are based on a preventative ethos which is sustainable, compared to interventions with top-down approaches, which get piloted, but fail to sustain impact when scaled up.
Collapse
Affiliation(s)
| | - Sheela Rangan
- The Foundation for Medical Research, Worli, Mumbai, India
| | - Yatin Dholakia
- The Foundation for Medical Research, Worli, Mumbai, India
| | - Sonu Rai
- The Foundation for Medical Research, Worli, Mumbai, India
| | - Swaran Kamble
- The Foundation for Medical Research, Worli, Mumbai, India
| | - Tejaswi Raste
- The Foundation for Medical Research, Worli, Mumbai, India
| | - Sanchi Shah
- The Foundation for Medical Research, Worli, Mumbai, India
| | - Shimoni Shah
- The Foundation for Medical Research, Worli, Mumbai, India
| | - Nerges Mistry
- The Foundation for Medical Research, Worli, Mumbai, India
| |
Collapse
|
200
|
Chakraborty NM, Montagu D, Wanderi J, Oduor C. Who Serves the Poor? An Equity Analysis of Public and Private Providers of Family Planning and Child Health Services in Kenya. Front Public Health 2019; 6:374. [PMID: 30671427 PMCID: PMC6331399 DOI: 10.3389/fpubh.2018.00374] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/11/2018] [Indexed: 11/29/2022] Open
Abstract
Understanding differences in the wealth status of patients can inform planning decisions aimed at providing affordable access to high quality care to all. This study assesses differences in the wealth status of clients of family planning and child health services by health sector. It also describes reason for facility choice, cost of services, and the proportion of additional clients of these services, and assesses if there are any differences by health sector. A cross-sectional survey of 2,173 clients from 96 health facilities in urban areas of 6 counties in Kenya was conducted, stratified by health facility type. The 4 strata were public, faith-based, private for profit, and social franchise. Client wealth was benchmarked to the national and urban population of the 2014 Kenya Demographic and Health Survey (DHS), and assessed using the EquityTool. There were significant differences in the client wealth distribution between facility types, and public sector facilities served a significantly higher proportion of poor clients than other types of facilities. In all three non-public facility types, more than 25% of clients were from the poorest two wealth quintiles, without significant differences between facility types. No facility type stands out as expanding access to health services more than another. Results show that social franchises do better at reaching the poor than earlier studies have indicated, though not as well as faith-based and public facilities. Findings suggest that private providers remain important within the larger health system, more so for family planning than childhood illness management. In urban areas with significant facility choice, this study quantifies differences in client wealth across four health sectors. Incorporating these findings into policy and programmatic interventions can improve equity in access to and use of quality health services.
Collapse
Affiliation(s)
| | - Dominic Montagu
- Metrics for Management, Oakland, CA, United States.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | | | | |
Collapse
|