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Waitzberg R, Pfundstein I, Maresso A, Rechel B, van Ginneken E, Quentin W. Health system description and assessment: a scoping review of templates for systematic analyses. Health Res Policy Syst 2024; 22:82. [PMID: 38992666 PMCID: PMC11238392 DOI: 10.1186/s12961-024-01166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/23/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Understanding and comparing health systems is key for cross-country learning and health system strengthening. Templates help to develop standardised and coherent descriptions and assessments of health systems, which then allow meaningful analyses and comparisons. Our scoping review aims to provide an overview of existing templates, their content and the way data is presented. MAIN BODY Based on the WHO building blocks framework, we defined templates as having (1) an overall framework, (2) a list of indicators or topics, and (3) instructions for authors, while covering (4) the design of the health system, (5) an assessment of health system performance, and (6) should cover the entire health system. We conducted a scoping review of grey literature published between 2000 and 2023 to identify templates. The content of the identified templates was screened, analyzed and compared. We found 12 documents that met our inclusion criteria. The building block `health financing´ is covered in all 12 templates; and many templates cover ´service delivery´ and ´health workforce'. Health system performance is frequently assessed with regard to 'access and coverage', 'quality and safety', and 'financial protection'. Most templates do not cover 'responsiveness' and 'efficiency'. Seven templates combine quantitative and qualitative data, three are mostly quantitative, and two are primarily qualitative. Templates cover data and information that is mostly relevant for specific groups of countries, e.g. a particular geographical region, or for high or for low and middle-income countries (LMICs). Templates for LMICs rely more on survey-based indicators than administrative data. CONCLUSIONS This is the first scoping review of templates for standardized descriptions of health systems and assessments of their performance. The implications are that (1) templates can help analyze health systems across countries while accounting for context; (2) template-guided analyses of health systems could underpin national health policies, strategies, and plans; (3) organizations developing templates could learn from approaches of other templates; and (4) more research is needed on how to improve templates to better achieve their goals. Our findings provide an overview and help identify the most important aspects and topics to look at when comparing and analyzing health systems, and how data are commonly presented. The templates were created by organizations with different agendas and target audiences, and with different end products in mind. Comprehensive health systems analyses and comparisons require production of quantitative indicators and complementing them with qualitative information to build a holistic picture. CLINICAL TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ruth Waitzberg
- Department of Health Care Management, Faculty of Economics and Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany.
| | - Isabel Pfundstein
- Department of Health Care Management, Faculty of Economics and Management, Technische Universität Berlin, Berlin, Germany
| | - Anna Maresso
- European Observatory on Health Systems and Policies, Berlin, Germany
| | - Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Department of Health Care Management, Technische Universität Berlin, Strasse Des 17. Juni 135, 10623, Berlin, Germany
| | - Wilm Quentin
- Planetary & Public Health, University of Bayreuth, Bayreuth, Germany
- German West-African Centre for Global Health and Pandemic Prevention, Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
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Zhong L, Lopez D, Pei S, Gao J. Healthcare system resilience and adaptability to pandemic disruptions in the United States. Nat Med 2024:10.1038/s41591-024-03103-6. [PMID: 38956198 DOI: 10.1038/s41591-024-03103-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/31/2024] [Indexed: 07/04/2024]
Abstract
Understanding healthcare system resilience has become paramount, particularly in the wake of the COVID-19 pandemic, which imposed unprecedented burdens on healthcare services and severely impacted public health. Resilience is defined as the system's ability to absorb, recover from and adapt to disruptions; however, despite extensive studies on this subject, we still lack empirical evidence and mathematical tools to quantify its adaptability (the ability of the system to adjust to and learn from disruptions). By analyzing millions of patients' electronic medical records across US states, we find that the COVID-19 pandemic caused two successive waves of disruptions within the healthcare systems, enabling natural experiment analysis of the adaptive capacity of each system to adapt to past disruptions. We generalized the quantification framework and found that the US healthcare systems exhibit substantial adaptability (ρ = 0.58) but only a moderate level of resilience (r = 0.70). When considering system responses across racial groups, Black and Hispanic groups were more severely impacted by pandemic disruptions than white and Asian groups. Physician abundance was the key characteristic for determining healthcare system resilience. Our results offer vital guidance in designing resilient and sustainable healthcare systems to prepare for future waves of disruptions akin to COVID-19 pandemics.
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Affiliation(s)
- Lu Zhong
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, NY, USA
- Network Science and Technology Center, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Dimitri Lopez
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, NY, USA
| | - Sen Pei
- Department of Environmental Health Sciences, Columbia University, New York City, NY, USA
| | - Jianxi Gao
- Department of Computer Science, Rensselaer Polytechnic Institute, Troy, NY, USA.
- Network Science and Technology Center, Rensselaer Polytechnic Institute, Troy, NY, USA.
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Trang DTH, Ha BTT, Vui LT, Chi NTQ, Thi LM, Duong DTT, Hung DT, Cronin de Chavez A, Manzano A, Lakin K, Kane S, Mirzoev T. Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam. Health Policy Plan 2024; 39:541-551. [PMID: 38597872 PMCID: PMC11145914 DOI: 10.1093/heapol/czae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
The prevalence of common perinatal mental disorders in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps have been identified at all levels. This paper explores constraints to the integration of maternal and mental health services at the primary healthcare level and the implications for the health system's responsiveness to the needs and expectations of pregnant women with mental health conditions in Vietnam. As part of the RESPONSE project, a three-phase realist evaluation study, we present Phase 1 findings, which employed systematic and scoping literature reviews and qualitative data collection (focus groups and interviews) with key health system actors in Bac Giang province, Vietnam, to understand the barriers to maternal mental healthcare provision, utilization and integration strategies. A four-level framing of the barriers to integrating perinatal mental health services in Vietnam was used in reporting findings, which comprised individual, sociocultural, organizational and structural levels. At the sociocultural and structural levels, these barriers included cultural beliefs about the holistic notion of physical and mental health, stigma towards mental health, biomedical approach to healthcare services, absence of comprehensive mental health policy and a lack of mental health workforce. At the organizational level, there was an absence of clinical guidelines on the integration of mental health in routine antenatal visits, a shortage of staff and poor health facilities. Finally, at the provider level, a lack of knowledge and training on mental health was identified. The integration of mental health into routine antenatal visits at the primary care level has the potential help to reduce stigma towards mental health and improve health system responsiveness by providing services closer to the local level, offering prompt attention, better choice of services and better communication while ensuring privacy and confidentiality of services. This can improve the demand for mental health services and help reduce the delay of care-seeking.
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Affiliation(s)
- Do Thi Hanh Trang
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Bui Thi Thu Ha
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Le Thi Vui
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | | | - Le Minh Thi
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Doan Thi Thuy Duong
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Dang The Hung
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Anna Cronin de Chavez
- Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Kimberly Lakin
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Sumit Kane
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Tolib Mirzoev
- Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
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Khanpoor H, Amerzadeh M, Alizadeh A, Khosravizadeh O, Rafiei S. Developing a responsive model to societal needs in medical education. BMC MEDICAL EDUCATION 2024; 24:370. [PMID: 38575947 PMCID: PMC10996077 DOI: 10.1186/s12909-024-05355-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Responsiveness is relevant in the context of treatment and the provision of medical services. However, if we delve deeper into the subject, we must establish and develop responsiveness within the medical sciences education system. This study aims to identify the dimensions that significantly impact responsiveness in the medical education system based on a comprehensive review and expert opinions in healthcare. METHODS The present research is descriptive-analytical in terms of its objective and follows a mixed-method approach. This study was conducted in three stages. Initially, we utilized relevant keywords related to education in databases, such as Web of Science, Scopus, ScienceDirect, OVID, CINHAL, EBSCO, Google Scholar, Iranmedex, SID, and Irandoc. Subsequently, in the expert panel session stage, the factors influencing responsiveness were identified in the comprehensive review stage, and with this thematic background, they were conceptualized. Finally, the Confirmatory Factor Analysis (CFA) technique was employed to coherently examine the relationships between variables and present the final model. RESULTS We obtained 32 articles from the comprehensive review of studies. Four components in planning, implementation, monitoring and evaluation, and intersectoral cooperation were identified based on expert panel opinions. Based on the standardized coefficients, the components of research-based educational planning, community-oriented education evaluation indicators, and utilization of modern educational methods are statistically significant. CONCLUSION The establishment and development of responsiveness in the medical sciences education system involve training specialized and responsive human resources through innovative educational methods that have sufficient familiarity with the multidimensional concepts of health and how to achieve them. This approach allows for practical and responsible steps toward training competent and committed physicians in line with the needs of society. On the other hand, responsiveness in the medical sciences education system can be improved by enhancing research-based educational planning and developing community-oriented evaluation indicators that can assess the number of revised educational programs based on societal needs. Therefore, understanding the critical elements in revising medical education programs, which play the most significant role in addressing societal needs and responding to changing disease patterns and new health priorities, is both a necessity and an important priority.
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Affiliation(s)
- Hooman Khanpoor
- Student Research Committee, School of Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mohammad Amerzadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non- Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Ahad Alizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non- Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Omid Khosravizadeh
- Social Determinants of Health Research Center, Research Institute for Prevention of Non- Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Sima Rafiei
- Social Determinants of Health Research Center, Research Institute for Prevention of Non- Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
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Aaltonen K, Vaalavuo M. Financial burden of medicines in five Northern European countries: A decommodification perspective. Soc Sci Med 2024; 347:116799. [PMID: 38518482 DOI: 10.1016/j.socscimed.2024.116799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 02/12/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
Affordable access to healthcare including medicines is a key social policy goal in Europe. However, it has rarely been addressed in comparative social policy research. Although the concept of decommodification has already been used in the context of healthcare and sickness benefits, we argue that the scope of such studies should be expanded to medicines to understand how welfare states protect their citizens from market forces in case of illness. We examine and compare the relationship between income, other characteristics, and subjective financial burden of medicines (FBM) across five countries with universal health systems pursuing egalitarian aims (Denmark, Finland, the Netherlands, Norway and Sweden). Analyses using 2017 EU-SILC microdata and linear probability models showed large differences in the level of FBM across countries, with the highest income quintile in Finland reporting FBM more frequently than the lowest income quintile in Denmark. Finland differed from the rest by increasing probability of FBM with age. In other countries, middle-aged adults tended to be the most affected, and older adults were well-protected. The association between income and FBM was strongest in the Netherlands; however, the higher probability of FBM was skewed towards the lower quintiles in all countries. FBM and financial burden of medical care were strongly associated although FBM tended to be more common. Unmet needs for medical examination were rare and lacked sensitivity in capturing manifestations of market risk. Decommodification literature has focused healthcare services as proxy of access; nevertheless, our study shows that further functions, and broader outcomes should be examined to capture market risk. Our evidence further highlights that important differences can be found even in countries with relatively similar health policy aims. The cost of medicines should be considered in comparative studies of health and welfare states.
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Affiliation(s)
- Katri Aaltonen
- INVEST Research Flagship Centre, University of Turku, Finland; Kela Research, Social Insurance Institution of Finland, Finland.
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Adlbrecht L, Karrer M, Helfenberger N, Ziegler E, Zeller A. Facilitators and barriers to implementing a specialized care unit for persons with cognitive impairment in an acute geriatric hospital: a process evaluation. BMC Geriatr 2024; 24:29. [PMID: 38184542 PMCID: PMC10771665 DOI: 10.1186/s12877-023-04612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 12/17/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Implementing dementia care interventions in an acute hospital poses multiple challenges. To understand factors influencing the implementation, in-depth knowledge about specific facilitators and barriers is necessary. The aim of this study was to identify facilitators and barriers to implementing an interprofessional, multicomponent intervention of a specialized unit for persons with cognitive impairment in an acute geriatric hospital. METHODS We conducted a process evaluation as part of a participatory action research study. For data collection, semi-structured individual interviews with fifteen professionals involved in the implementation of the specialized unit. We further conducted two focus groups with twelve professionals working on other units of the geriatric hospital. We performed a qualitative content analysis following Kuckartz's content-structuring analysis scheme. RESULTS We identified the following barriers to implementing the specialized unit: uncontrollable contextual changes (e.g., COVID-19 pandemic), staff turnover in key functions, high fluctuation in the nursing team, traditional work culture, entrenched structures, inflexible and efficiency-oriented processes, monoprofessional attitude, neglect of project-related communication, and fragmentation of interprofessional cooperation. An established culture of interprofessionalism, an interprofessionally composed project group, cooperation with a research partner, as well as the project groups' motivation and competence of managing change facilitated the implementation. CONCLUSIONS The implementation faced numerous barriers that can be described using the key constructs of the i-PARIHS framework: context, recipients, innovation, and facilitation. Overcoming these barriers requires an organizational development approach, extended project duration and increased process orientation. Furthermore, strategically planned, precise and ongoing communication towards all persons involved seems crucial. Differences between the work cultures of the professions involved deserve particular attention with regard to project-related roles and processes.
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Affiliation(s)
- Laura Adlbrecht
- Competence Center Dementia Care, Department of Health, Institute of Applied Nursing Sciences, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000, St.Gallen, Switzerland.
| | - Melanie Karrer
- University of Applied Sciences for Health Professions Upper Austria, Semmelweisstraße 34/D, Linz, 4020, Austria
| | - Nicole Helfenberger
- Geriatrische Klinik St. Gallen AG, Rorschacher Strasse 94, St. Gallen, 9000, Switzerland
| | - Eva Ziegler
- Geriatrische Klinik St. Gallen AG, Rorschacher Strasse 94, St. Gallen, 9000, Switzerland
| | - Adelheid Zeller
- Competence Center Dementia Care, Department of Health, Institute of Applied Nursing Sciences, Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000, St.Gallen, Switzerland
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Nila S, Dutta E, Prakash SS, Korula S, Oommen AM. Patient and caregiver perspectives of select non-communicable diseases in India: A scoping review. PLoS One 2024; 19:e0296643. [PMID: 38180969 PMCID: PMC10769076 DOI: 10.1371/journal.pone.0296643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Patient-reported measures of encounters in healthcare settings and consideration of their preferences could provide valuable inputs to improve healthcare quality. Although there are increasing reports of user experiences regarding health care in India in recent times, there is a lack of evidence from Indian healthcare settings on the care provided for patients with chronic diseases. METHODS We selected diabetes mellitus and cancer as representatives of two common conditions requiring different care pathways. We conducted a scoping review of studies reporting experiences or preferences of patients/caregivers for these conditions, in PubMed, Global Index Medicus and grey literature, from the year 2000 onwards. Both published and emergent themes were derived from the data and summarised as a narrative synthesis. RESULTS Of 95 included studies (49 diabetes, 46 cancer), 73% (65) were exclusively quantitative surveys, 79% included only patients (75), and 59.5% (44) were conducted in government centres. Studies were concentrated in a few states in India, with the underrepresentation of vulnerable population groups and representative studies. There was a lack of standardised tools and comprehensive approaches for assessing experiences and preferences of patients and caregivers, concerning diabetes and cancers in India. The commonest type of care assessed was therapeutic (74), with 14 cancer studies on diagnosis and nine on palliative care. Repeated visits to crowded centres, drug refill issues, unavailability of specific services in government facilities, and expensive private care characterised diabetes care, while cancer care involved delayed diagnosis and treatment, communication, and pain management issues. CONCLUSIONS There is a need for robust approaches and standardised tools to measure responsiveness of the healthcare system to patient needs, across geographical and population subgroups in India. Health system reforms are needed to improve access to high-quality care for treatment and palliation of cancer and management of chronic diseases such as diabetes.
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Affiliation(s)
- Sindhu Nila
- KEM Hospital Research Centre, Rasta Peth, Savitribai Phule Pune University, Ganeshkhind, Pune, Maharashtra, India
| | - Eliza Dutta
- Indian Institute of Public Health, Shillong, Pasteur Hills, Lawmali, Shillong, Meghalaya, India
| | - S. S. Prakash
- Department of Biochemistry, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Sophy Korula
- Department of Paediatrics, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Anu Mary Oommen
- Department of Community Health, Christian Medical College Vellore, Vellore, Tamil Nadu, India
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Lakin K, Ha DT, Mirzoev T, Ha BTT, Agyepong IA, Kane S. "We can't expect much": Childbearing women's 'horizon of expectations' of the health system in rural Vietnam. Health Place 2024; 85:103166. [PMID: 38101200 DOI: 10.1016/j.healthplace.2023.103166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Kimberly Lakin
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Dinh Thu Ha
- Hanoi University of Public Health, Hanoi, Viet Nam
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
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Tindyebwa T, Ssempala R, Ssennyonjo A, Mayora C, Muhoozi M, Tusabe J, Mukama P, Freddie S. Expectations of clients, insurers, and providers: a qualitative responsiveness assessment among private health insurance sector in Kampala-Uganda. BMC Health Serv Res 2023; 23:1358. [PMID: 38053178 DOI: 10.1186/s12913-023-10386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/27/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND There is less attention to assessing how health services meet the expectations of private health insurance (PHI) actors, clients, insurers, and providers in developing countries. Interdependently, the expectations of each actor are stipulated during contract negotiations (duties, obligations, and privileges) in a PHI arrangement. Complementary service roles performed by each actor significantly contribute to achieving their expectations. This study assessed the role of PHI in meeting the expectations of clients, insurers, and providers in Kampala. Lessons from this study may inform possible reviews and improvements in Uganda's proposed National Health Insurance Scheme (NHIS) to ensure NHIS service responsiveness. METHODS This study employed a qualitative case-study design. Eight (8) focus group discussions (FGDs) with insured clients and nine (9) key informant interviews (KIIs) with insurer and provider liaison officers between October 2020 and February 2021 were conducted. Participants were purposively selected from eligible institutions. Thematic analysis was employed, and findings were presented using themes with corresponding anonymized narratives and quotes. RESULTS Client-Provider, Client-Insurer, and Provider-Insurer expectations were generally not met. Client-provider expectations: Although most facilities were clean with a conducive care environment, clients experienced low service care responsiveness characterized by long waiting times. Both clients and providers received inadequate feedback about services they received and delivered respectively, in addition to prompt care being received by a few clients. For client-insurer expectations, under unclear service packages, clients received low-quality medicines. Lastly, for provider-insurer expectations, delayed payments, selective periodic assessments, and inadequate orientation of clients on insurance plans were most reported. Weak coordination between the client-provider and insurer did not support delivery processes for responsive service. CONCLUSION Health care service responsiveness was generally low. There is a need to commit resources to support the setting up of clearer service package orientation programs, and efficient monitoring and feedback platforms. Uganda's proposed National Health Insurance Act may use these findings to: Inform its design initiatives focusing on operating under realistic expectations, investment in quality improvement systems and coordination, and efficient and accountable client care relationships.
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Affiliation(s)
- Tonny Tindyebwa
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
| | - Richard Ssempala
- Department of Economic Theory and Analysis, School of Economics, Makerere University, Kampala, Uganda
| | - Aloysius Ssennyonjo
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Chrispus Mayora
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Micheal Muhoozi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Joan Tusabe
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Paul Mukama
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Ssengooba Freddie
- Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
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Beks H, Mc Namara KP, Mitchell Mununjali F, Charles Kaurna JA, Versace VL. Responsiveness of a rural Aboriginal community controlled health organisation: A qualitative study. Aust J Rural Health 2023; 31:1214-1228. [PMID: 37800385 DOI: 10.1111/ajr.13048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 09/04/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Responsiveness of health care systems is a global concept defined as the ability of systems to function in a manner that meets the expectations of individuals, and is under-studied. In Australia, Aboriginal Community Controlled Health Organisations (ACCHOs) are valued by Aboriginal and Torres Strait Islander Peoples for the provision of holistic culturally safe primary health care and are well positioned to be responsive to community needs. OBJECTIVE To develop a conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal and Torres Strait Islander Peoples in their service region. DESIGN A qualitative interview study using abductive reasoning was conducted. Interviews conducted with Aboriginal clients, key informants, and ACCHO health personnel from two evaluations undertaken in partnership with a rural ACCHO located in Victoria, Australia, were analysed through an iterative process of identifying key concepts from the data and evidence. Key concepts were used to develop a conceptual framework. FINDINGS Across the two evaluations, 22 participants were involved in data collection and 28 interviews were undertaken. A conceptual framework examining the responsiveness of a rural ACCHO to the health care needs of Aboriginal Peoples within their service region was developed and encompassed three concepts: operating within a complex adaptive system, mechanisms of responsiveness used by the ACCHO, and challenges experienced by the ACCHO when being responsive. DISCUSSION The developed conceptual framework expands on research supporting the value of ACCHOs in providing holistic culturally safe health care to their communities, particularly in rural settings. A key finding is the importance for ACCHOs to meet the health care needs of their community whilst navigating needs in the context of the broader health care system. When dissonance is encountered between external system components and community needs, challenges can be experienced such as adequately resourcing models of service delivery and maintaining the provision of services. CONCLUSION Conceptualising the health care system as a complex adaptive system in which an ACCHO operates and is responsive, highlights the competing demands experienced. Findings expand on mechanisms of responsiveness used at the service-user interface. Future research should examine how the broader health care system can support the role and functions of ACCHOs in being responsive to the health care needs of their communities.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| | - Kevin P Mc Namara
- Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
| | | | | | - Vincent L Versace
- Deakin Rural Health, Deakin University, Warrnambool, Victoria, Australia
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Menold N, Biddle L, von Hermanni H, Kadel J, Bozorgmehr K. Ensuring cross-cultural data comparability by means of anchoring vignettes in heterogeneous refugee samples. BMC Med Res Methodol 2023; 23:213. [PMID: 37759183 PMCID: PMC10536699 DOI: 10.1186/s12874-023-02015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/08/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Configural, metric, and scalar measurement invariance have been indicators of bias-free statistical cross-group comparisons, although they are difficult to verify in the data. Low comparability of translated questionnaires or the different understanding of response formats by respondents might lead to rejection of measurement invariance and point to comparability bias in multi-language surveys. Anchoring vignettes have been proposed as a method to control for the different understanding of response categories by respondents (the latter is referred to as differential item functioning related to response categories or rating scales: RC-DIF). We evaluate the question whether the cross-cultural comparability of data can be assured by means of anchoring vignettes or by considering socio-demographic heterogeneity as an alternative approach. METHODS We used the Health System Responsiveness (HSR) questionnaire and collected survey data in English (n = 183) and Arabic (n = 121) in a random sample of refugees in the third largest German federal state. We conducted multiple-group Confirmatory Factor Analyses (MGCFA) to analyse measurement invariance and compared the results when 1) using rescaled data on the basis of anchoring vignettes (non-parametric approach), 2) including information on RC-DIF from the analyses with anchoring vignettes as covariates (parametric approach) and 3) including socio-demographic covariates. RESULTS For the HSR, every level of measurement invariance between the Arabic and English languages was rejected. Implementing rescaling or modelling on the basis of anchoring vignettes provided superior results over the initial MGCFA analysis, since configural, metric and - for ordered categorical analyses-scalar invariance could not be rejected. A consideration of socio-demographic variables did not show such an improvement. CONCLUSIONS Surveys may consider anchoring vignettes as a method to assess cross-cultural comparability of data, whereas socio-demographic variables cannot be used to improve data comparability as a standalone method. More research on the efficient implementation of anchoring vignettes and further development of methods to incorporate them when modelling measurement invariance is needed.
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Affiliation(s)
- Natalja Menold
- Dept. of Methods in Empirical Social Research, Technische Universität Dresden, Dresden, Germany.
| | - Louise Biddle
- Charité - Universitätsmedizin Berlin, Institute of International Health, Berlin, Germany
| | - Hagen von Hermanni
- Dept. of Methods in Empirical Social Research, Technische Universität Dresden, Dresden, Germany
| | - Jasmin Kadel
- Dept. of Methods in Empirical Social Research, Technische Universität Dresden, Dresden, Germany
| | - Kayvan Bozorgmehr
- University Hospital Heidelberg, Section for Health Equity Studies & Migration, Heidelberg, Germany
- Dept. of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
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Cerf ME. Gearing health systems for universal health coverage. FRONTIERS IN HEALTH SERVICES 2023; 3:1200238. [PMID: 37808893 PMCID: PMC10552266 DOI: 10.3389/frhs.2023.1200238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023]
Abstract
Universal health coverage requires adequate and sustainable resourcing, which includes human capital, finance and infrastructure for its realization and sustainability. Well-functioning health systems enable health service delivery and therefore need to be either adequately or optimally geared-prepared and equipped-for service delivery to advance universal health coverage. Adequately geared health systems have sufficient capacity and capability per resourcing levels whereas optimally geared health systems achieve the best possible capacity and capability per resourcing levels. Adequately or optimally geared health systems help to mitigate health system constraints, challenges and inefficiencies. Effective, efficient, equitable, robust, resilient and responsive health systems are elements for implementing and realizing universal health coverage and are embedded and aligned to a global people-centric health strategy. These elements build, enhance and sustain health systems to advance universal health coverage. Effective and efficient health systems encompass continuous improvement and high performance for providing quality healthcare. Robust and resilient health systems provide a supportive and enabling environment for health service delivery. Responsive and equitable health systems prioritize people and access to healthcare. Efforts should be made to design, construct, re-define, refine and optimize health systems that are effective, efficient, equitable, robust, resilient and responsive to deliver decent quality healthcare for all.
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Affiliation(s)
- Marlon E. Cerf
- Grants, Innovation and Product Development, South African Medical Research Council, Cape Town, South Africa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Cape Town, South Africa
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13
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Chaves ACC, Scherer MDDA, Conill EM. What contributes to Primary Health Care effectiveness? Integrative literature review, 2010-2020. CIENCIA & SAUDE COLETIVA 2023; 28:2537-2551. [PMID: 37672445 DOI: 10.1590/1413-81232023289.15342022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/11/2023] [Indexed: 09/08/2023] Open
Abstract
Primary Health Care (PHC) intends to rearrange services to make it more effective. Nevertheless, effectiveness in PHC is quite a challenge. This study reviews several articles regarding the effectiveness improvements in PHC between 2010 and 2020. Ninety out of 8,369 articles found in PubMed and the Virtual Health Library databases search were selected for thematic analysis using the Atlas.ti® 9.0 software. There were four categories identified: strategies for monitoring and evaluating health services, organizational arrangements, models and technologies applied to PHC. Studies concerning the sensitive conditions indicators were predominant. Institutional assessment programs, PHC as a structuring policy, appropriate workforce, measures to increase access and digital technologies showed positive effects. However, payment for performance is still controversial. The expressive number of Brazilian publications reveals the broad diffusion of PHC in the country and the concern on its performance. These findings reassure well-known aspects, but it also points to the need for a logical model to better define what is intended as effectiveness within primary health care as well as clarify the polysemy that surrounds the concept. We also suggest substituting the term "resolvability", commonly used in Brazil, for "effectiveness".
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14
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Kibet E, Namirimu F, Nakazibwe F, Kyagera AZ, Ayebazibwe D, Omech B. Health System Responsiveness for Persons with HIV and Disability in South Western Uganda. HIV AIDS (Auckl) 2023; 15:445-456. [PMID: 37576866 PMCID: PMC10422993 DOI: 10.2147/hiv.s414288] [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: 04/13/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023] Open
Abstract
Background Inequitable access to Human Immunodeficiency Virus/Acquired Immune Syndrome (HIV/AIDS) Treatment and Care Services (HATCS) for People With Disabilities (PWD) is a hurdle to ending the pandemic by 2030. The aim of this study was to evaluate the Health System's Responsiveness (HSR) and associated factors for PWD attending HATCS at health facilities in South Western Uganda. Methods Between February and April 2022, we enrolled a total of 106 people with disabilities for a quantitative study and 14 key informants from selected primary care HIV clinics. The World Health Organization Multi-country study's disability assessment schedules 2.0 and Health system responsiveness (HSR) questionnaire were adopted to measure the level of disabilities and responsiveness, respectively. The level of HSR was evaluated using descriptive analysis. The association between socio-demographics, level of disabilities and HSR was evaluated through binary and multivariable logistic regression. The qualitative data were collected from 14 key informants using interview guide and analyzed according to thematic areas (deductive approaches). Results Overall, Health system responsiveness (HSR) was at 47.62% being acceptable to people living with HIV and Disabilities in south western Uganda. Across different domains, the best performance was reported in social consideration (68.57%) and autonomy (67.62%). The least performance was registered in dignity (2.83%), confidentiality (2.91%), prompt Attention (17.35%) and Choices (30.48%). Whereas performance in communications (53.92%) and quality of basic amenities (42.27%) were average. There were no socio-demographics or disability variables that were predictive of HATCS responsiveness. PWDs experienced lack of social support, poor communication, stigma and discrimination during the HATCs services. On the other hand, the health-care providers felt frustrated by their inability to communicate effectively with PWDs and meet their need for social support. Conclusion HSR was comparatively low, with dignity, confidentiality, prompt attention, and choice ranking worst. To address the universal and legitimate requirements of PWDs in accessing care, urgent initiatives are required to create awareness among all stakeholders.
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Affiliation(s)
- Emmanuel Kibet
- Faculty of Medicine, Mbarara University of Sciences and Technology, Mbarara City, Uganda
| | - Florence Namirimu
- Faculty of Medicine, Mbarara University of Sciences and Technology, Mbarara City, Uganda
| | - Felista Nakazibwe
- Faculty of Medicine, Mbarara University of Sciences and Technology, Mbarara City, Uganda
| | - Arnold Zironda Kyagera
- Faculty of Medicine, Mbarara University of Sciences and Technology, Mbarara City, Uganda
| | - Disan Ayebazibwe
- Faculty of Medicine, Mbarara University of Sciences and Technology, Mbarara City, Uganda
| | - Bernard Omech
- Department of Health Planning and Management, Lira University, Lira City, Uganda
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15
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Gonzalez-Bautista E, Morsch P, Gonzalez C, Vega E. A short list of high-priority indicators of health system responsiveness for aging: an eDelphi consensus study. Rev Panam Salud Publica 2023; 47:e103. [PMID: 37534053 PMCID: PMC10392236 DOI: 10.26633/rpsp.2023.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/06/2023] [Indexed: 08/04/2023] Open
Abstract
The objective of this article was to provide a consensus-based short list of effective indicators to measure health system responsiveness to the needs of older adults which would be relevant to informing public policy. An e-Delphi study was done with no direct interaction between respondents. Virtual surveys were sent to 141 participants with experience in analysis and monitoring of health indicators, management of health systems, and health care of older adults. A baseline list of 24 previously published indicators was used. The criteria for selection as high priority indicators were: usefulness as a tracer of health system responsiveness and usefulness to inform policy. Consensus was defined as: ≥70% agreement among the participants that the indicator was very high or high priority; plus being benchmarked by ≥50% of respondents as having a higher relative weight than other indicators; plus being in the top 10 in the ranking list. The first round of the process included 38 participants with varied professional backgrounds. Consensus was reached for seven indicators after two rounds. Five indicators were related to distal outcomes (mortality, disability, or healthy life expectancy), one to monitoring functional assessments, and one to poverty levels. Health systems professionals should consider these comprehensive priority indicators in their efforts to provide a better health system for older people.
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Affiliation(s)
- Emmanuel Gonzalez-Bautista
- GerontopoleToulouse University HospitalToulouseFranceGerontopole, Toulouse University Hospital, Toulouse, France.
| | - Patricia Morsch
- Health Systems and ServicesPan American Health OrganizationWashington, D.C.United States of AmericaHealth Systems and Services, Pan American Health Organization, Washington, D.C., United States of America.
| | | | - Enrique Vega
- Health Systems and ServicesPan American Health OrganizationWashington, D.C.United States of AmericaHealth Systems and Services, Pan American Health Organization, Washington, D.C., United States of America.
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Lakin K, Kane S. What can one legitimately expect from a health system? A conceptual analysis and a proposal for research and action. BMJ Glob Health 2023; 8:e012453. [PMID: 37400118 DOI: 10.1136/bmjgh-2023-012453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/10/2023] [Indexed: 07/05/2023] Open
Abstract
In 2007, the WHO proposed the Building Blocks Framework and articulated 'responsiveness' as one of the four goals for health systems. While researchers have studied and measured health systems responsiveness since, several aspects of the concept remain unexamined, including, understanding the notion of 'legitimate expectations'-a notion central to the definition of responsiveness. We begin this analysis by providing a conceptual overview of how 'legitimacy' is understood in key social science disciplines. Drawing on insights from this overview, we examine how 'legitimacy' is understood in the literature on health systems responsiveness and reveal that there is currently little critical engagement with this notion of the 'legitimacy' of expectations. In response, we unpack the concept of 'legitimate' expectations and propose approaches and areas for reflection, research, and action. We conclude that contestation, and ongoing negotiation of entrenched health system processes and norms which establish citizens' 'legitimate' expectations of health systems, is needed-through processes that ensure equitable and wide participation. We also call on researchers, in their capacity as key health policy actors, to trigger and initiate processes and help create equitable spaces for citizens to participate in establishing 'legitimate' expectations of health systems.
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Affiliation(s)
- Kimberly Lakin
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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17
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Gautier L, Di Ruggiero E, Jackson C, Bentayeb N, Blain MJ, Chowdhury F, Gueye STM, Haydary M, Maillet L, Mahmoudi L, Mondal S, Ouffouet Bessiranthy A, Pluye P, Ziam S, Touati N. Learning from intersectoral initiatives to respond to the needs of refugees, asylum seekers, and migrants without status in the context of COVID-19 in Quebec and Ontario: a qualitative multiple case study protocol. Health Res Policy Syst 2023; 21:59. [PMID: 37340475 DOI: 10.1186/s12961-023-00991-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 05/08/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Refugees, asylum seekers, and migrants without status experience precarious living and working conditions that disproportionately expose them to coronavirus disease 2019 (COVID-19). In the two most populous Canadian provinces (Quebec and Ontario), to reduce the vulnerability factors experienced by the most marginalized migrants, the public and community sectors engage in joint coordination efforts called intersectoral collaboration. This collaboration ensures holistic care provisioning, inclusive of psychosocial support, assistance to address food security, and educational and employment assistance. This research project explores how community and public sectors collaborated on intersectoral initiatives during the COVID-19 pandemic to support refugees, asylum seekers, and migrants without status in the cities of Montreal, Sherbrooke, and Toronto, and generates lessons for a sustainable response to the heterogeneous needs of these migrants. METHODS This theory-informed participatory research is co-created with socioculturally diverse research partners (refugees, asylum seekers and migrants without status, employees of community organizations, and employees of public organizations). We will utilize Mirzoev and Kane's framework on health systems' responsiveness to guide the four phases of a qualitative multiple case study (a case being an intersectoral initiative). These phases will include (1) building an inventory of intersectoral initiatives developed during the pandemic, (2) organizing a deliberative workshop with representatives of the study population, community, and public sector respondents to select and validate the intersectoral initiatives, (3) interviews (n = 80) with community and public sector frontline workers and managers, municipal/regional/provincial policymakers, and employees of philanthropic foundations, and (4) focus groups (n = 80) with refugees, asylum seekers, and migrants without status. Qualitative data will be analyzed using thematic analysis. The findings will be used to develop discussion forums to spur cross-learning among service providers. DISCUSSION This research will highlight the experiences of community and public organizations in their ability to offer responsive services for refugees, asylum seekers, and migrants without status in the context of a pandemic. We will draw lessons learnt from the promising practices developed in the context of COVID-19, to improve services beyond times of crisis. Lastly, we will reflect upon our participatory approach-particularly in relation to the engagement of refugees and asylum seekers in the governance of our research.
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Affiliation(s)
- Lara Gautier
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada.
- Centre de recherche en Santé Publique (CReSP), University of Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Canada.
- SHERPA University Institute, CIUSSS West Central Montreal, Montreal, Canada.
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carly Jackson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Naïma Bentayeb
- SHERPA University Institute, CIUSSS West Central Montreal, Montreal, Canada
- École Nationale d'Administration Publique, Montreal, Canada
- McGill University, Montreal, Canada
| | - Marie-Jeanne Blain
- Centre de recherche et de partage des savoirs InterActions, Université de Montréal, Montreal, Canada
| | - Fariha Chowdhury
- School of Rehabilitation Sciences, McMaster University, Hamilton, Canada
| | | | | | - Lara Maillet
- École Nationale d'Administration Publique, Montreal, Canada
| | - Laila Mahmoudi
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada
| | - Shinjini Mondal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Armel Ouffouet Bessiranthy
- School of Public Health, University of Montreal, Suite 3076, 7101 Av du Parc, Montreal, QC, H3N 1X9, Canada
| | | | - Saliha Ziam
- École des Sciences de l'administration, Université TÉLUQ, Montreal, Canada
| | - Nassera Touati
- École Nationale d'Administration Publique, Montreal, Canada
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18
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Bazie F, Speizer IS, Castle S, Boukary K, Maytan-Joneydi A, Calhoun LM, Onadja Y, Guiella G. Community perspectives on family planning service quality among users and non-users: a qualitative study from two cities in Burkina Faso. Reprod Health 2023; 20:75. [PMID: 37198684 PMCID: PMC10189908 DOI: 10.1186/s12978-023-01618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/05/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Most studies that focus on quality of family planning (FP) services collect data from facilities. These studies miss the perspectives of quality from women who do not visit a facility and for whom perceived quality may be a barrier to service utilization. METHODS This qualitative study from two cities in Burkina Faso examines perceived quality of FP services from women who were recruited at the community level to avoid potential biases based on recruiting women at facilities. Twenty focus group discussions were undertaken with varying groups of women of different ages (15-19; 20-24; 25+), marital statuses (unmarried; married), and current modern contraceptive use experiences (current non-users; current users). All focus group discussions were undertaken in the local language and transcribed and translated into French for coding and analysis. RESULTS Women discuss FP service quality in a variety of locations, depending on their age group. Perspectives on service quality for younger women are often informed by others' experiences whereas for the older women, they are formed by their own and others' experiences. Two important aspects of service delivery emerge from the discussions including interactions with providers and selected system-level aspects of service provision. Important components of provider interactions relate to (a) the initial reception from the provider, (b) the quality of counseling received, (c) stigma and bias from providers, and d) privacy and confidentiality. At the health system level, discussions revolved around (a) wait time; (b) stockouts of methods; (c) costs of services/methods; (d) the expectation for tests as part of service provision; and (e) difficulties with method removal. CONCLUSIONS To increase contraceptive use among women, it is crucial to address the components of service quality they identify as related to higher quality services. This means supporting providers to offer services in a more friendly and respectful manner. In addition, it is important to ensure that full information is provided to clients on what to expect during a visit to avoid false expectations that lead to poor perceived quality. These types of client-focused activities can improve perceptions of service quality and ideally support use of FP to meet women's needs.
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Affiliation(s)
- Fiacre Bazie
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Ilene S. Speizer
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC 27516 USA
| | | | - Kindo Boukary
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Amelia Maytan-Joneydi
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC 27516 USA
| | - Lisa M. Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 W. Franklin St., Chapel Hill, NC 27516 USA
| | - Yentema Onadja
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
| | - Georges Guiella
- Institut Supérieur des Sciences de la Population (ISSP), Université Joseph Ki-Zerbo, Ouagadougou, Burkina Faso
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Yevoo LL, Amarteyfio KA, Ansah-Antwi JA, Wallace L, Menka E, Ofori-Ansah G, Nyampong I, Mayeden S, Agyepong IA. The "No bed syndrome" in Ghana - what, how and why? A literature, electronic and print media review. FRONTIERS IN HEALTH SERVICES 2023; 3:1012014. [PMID: 37234197 PMCID: PMC10207332 DOI: 10.3389/frhs.2023.1012014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/03/2023] [Indexed: 05/27/2023]
Abstract
Objectives "No bed syndrome" has become a familiar phrase in Ghana. Yet, there is very little in medical texts or the peer reviewed literature about it. This review aimed to document what the phrase means in the Ghanaian context, how and why it occurs, and potential solutions. Design A qualitative desk review using a thematic synthesis of grey and published literature, print and electronic media content covering the period January 2014 to February 2021. Text was coded line by line to identify themes and sub-themes related to the research questions. Analysis was manual and with Microsoft Excel to sort themes. Setting Ghana. Participants and Intervention Not applicable. Results "No bed syndrome" describes the turning away by hospitals and clinics of people seeking walk in or referral emergency care with the stated reasons "no bed available" or "all beds are full". There are reported cases of people dying while going round multiple hospitals seeking help and being repeatedly turned away because there is "no bed". The situation appears to be most acute in the highly urbanized and densely populated Greater Accra region. It is driven by a complex of factors related to context, health system functions, values, and priorities. The solutions that have been tried are fragmented rather than well-coordinated whole system reform. Discussions and recommendations The "no bed syndrome" describes the challenge of a poorly functioning emergency health care system rather than just the absence of a bed on which to place an emergency case. Many low and middle income countries have similar challenges with their emergency health care systems and this analysis from Ghana is potentially valuable in attracting global attention and thinking about emergency health systems capacity and reform in low and middle income countries. The solution to the "no bed syndrome" in Ghana requires reform of Ghana's emergency healthcare system that takes a whole system and integrated approach. All the components of the health system such as human resource, information systems, financing, equipment tools and supplies, management and leadership need to be examined and addressed together alongside health system values such as accountability, equity or fairness in the formulation, implementation, continuous monitoring and evaluation of policies and programs for system reform to expand and strengthen emergency healthcare system capacity and responsiveness. Despite the temptation to fall back on them as low hanging fruit, piecemeal and ad-hoc solutions cannot solve the problem.
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Affiliation(s)
- Linda Lucy Yevoo
- Research and Development Division, Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana
| | | | | | - Lauren Wallace
- Research and Development Division, Dodowa Health Research Center, Ghana Health Service, Dodowa, Ghana
| | | | - Gifty Ofori-Ansah
- Greater Accra Region, Ningo Prampram District, Ghana Health Service, Accra, Ghana
| | | | - Samuel Mayeden
- Policy, Planning, Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana
| | - Irene Akua Agyepong
- Faculty of Public Health, Ghana College of Physicians and Surgeons (GCPS), Accra, Ghana
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20
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Embleton L, Logie CH, Ngure K, Nelson L, Kimbo L, Ayuku D, Turan JM, Braitstein P. Intersectional Stigma and Implementation of HIV Prevention and Treatment Services for Adolescents Living with and at Risk for HIV: Opportunities for Improvement in the HIV Continuum in Sub-Saharan Africa. AIDS Behav 2023; 27:162-184. [PMID: 35907143 PMCID: PMC10192191 DOI: 10.1007/s10461-022-03793-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/01/2022]
Abstract
Adolescents in sub-Saharan Africa, specifically adolescent girls and young women, young men who have sex with men, transgender persons, persons who use substances, and adolescents experiencing homelessness experience intersectional stigma, have a high incidence of HIV and are less likely to be engaged in HIV prevention and care. We conducted a thematic analysis informed by the Health and Discrimination Framework using a multiple case study design with five case studies in 3 sub-Saharan African countries. Our analysis found commonalities in adolescents' intersectional stigma experiences across cases, despite different contexts. We characterize how intersectional stigma impacts the uptake and implementation of HIV prevention and treatment services along the continuum for adolescents. Findings reveal how intersectional stigma operates across social-ecological levels and worsens HIV-related outcomes for adolescents. We identify opportunities for implementation science research to address stigma-related barriers to the uptake and delivery of HIV services for adolescents in sub-Saharan Africa.
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Affiliation(s)
- Lonnie Embleton
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - LaRon Nelson
- School of Nursing, Yale University, Orange, CT, USA
| | - Liza Kimbo
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David Ayuku
- Department of Behavioural Sciences, Moi University, College of Health Sciences, Eldoret, Kenya
| | - Janet M Turan
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada.
- College of Health Sciences, School of Public Health, Moi University, Eldoret, Kenya.
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
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Ibu JM, Mhlongo EM. Health systems responsiveness towards the Mentor Mother Program for preventing mother-to-child transmission of HIV in military hospitals. Nurs Open 2023; 10:2295-2308. [PMID: 36426988 PMCID: PMC10006667 DOI: 10.1002/nop2.1483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/11/2022] [Accepted: 10/29/2022] [Indexed: 11/27/2022] Open
Abstract
AIM This study explored health systems responsiveness towards the Mentor Mother Program for PMTCT in the Nigeria Department of Defence hospitals. Factors affecting quality service were also highlighted, which gave helpful insights into the strategies employed by stakeholders to ensure that health systems responsiveness was propagated responsibly. DESIGN An exploratory qualitative interview study. METHODS Six semistructured interviews were conducted with six key informants (three doctors and three nurses) and one focus group session with six Mentor Mothers. Open coding of data was done to formulate themes and subthemes. Thematic analysis was adopted for analysis. RESULTS Four themes emerged-Service Quality, Basic Amenities, Patient-oriented Strategies and Factors affecting service Quality. These showcased the nonmedical components of health systems responsiveness and accentuated how well they were utilized to achieve health systems responsiveness.
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Affiliation(s)
- Josephine Moshe Ibu
- School of Nursing and Public HealthUniversity of KwaZulu‐NatalDurbanSouth Africa
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22
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Forouzan AS, Mirabzadeh A, Falahat K, Banazadeh Z, Eftekhari MB. Healthcare System Responsiveness in Covid-19: An Experience from Capital City of I.R of Iran. Int J Prev Med 2023; 14:34. [PMID: 37351045 PMCID: PMC10284203 DOI: 10.4103/ijpvm.ijpvm_14_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 10/27/2022] [Indexed: 06/24/2023] Open
Abstract
Background As a public health emergency, coronavirus disease 2019 (Covid-19) is a threat to our future; therefore, appropriate health system responsiveness (HSR), as an important criterion, is of crucial importance. This study aimed to evaluate the different dimensions of responsiveness of healthcare centers, both public and private, providing COVID-19 services in Tehran. Methods Following a cross-sectional design, this study was conducted in Tehran (the capital city of I.R. Iran) from May to November 2020. Data were collected using the World Health Organization (WHO) questionnaire on responsiveness. Two hundred questionnaires were filled out through face-to-face or phone call interviews in two public and private hospitals (100 in each) providing Covid-19 services. Participants were selected using the convenience sampling technique among all those who received Covid-19 services during the past six months in the city of Tehran. Results The mean age of participants was 45.9 ± 15.9 and 51.5% were female. On an average, 52.6% of the respondents evaluated at least one dimension of responsiveness as appropriate and/or strongly appropriate. Communication obtained the highest score (58.2%), followed by confidentiality (56.5%), dignity (56%), and prompt attention (52%). Meanwhile, autonomy and choice were evaluated as poor (moderate, weak, and strongly weak) by 63.5 and 52.5% of respondents. There was no significant association between the type of healthcare center (i.e., public or private) and responsiveness (p-value = 0.896). However, there was a significant difference between gender (p-value = 0.036) and education level (p-value = 0.014) with responsiveness. According to the respondents, prompt attention and choice were the most and least important dimensions, respectively. Conclusions Evaluation of HSR in the era of COVID-19 not only provides a tool for qualitative assessment of services but also plays an important role in providing feedback to policymakers to adopt effective policies.
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Affiliation(s)
- Ameneh Setareh Forouzan
- Department of social welfare, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Arash Mirabzadeh
- Department of Psychiatric, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Katayoun Falahat
- Department of Research, Undersecretary for Research and Technology, Ministry of Health and Medical Sciences, Tehran, Iran
| | - Zahra Banazadeh
- Department of Research, Iran University of Medical Sciences, Tehran, Iran
| | - Monir Baradaran Eftekhari
- Department of Research, Shahrake Gharb, Undersecretary for Research and Technology, Ministry of Health and Medical Sciences, Tehran, Iran
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Abbas S, Kermode M, Khan MD, Denholm J, Adetunji H, Kane S. What Makes People With Chronic Illnesses Discontinue Treatment? A Practice Theory Informed Analysis of Adherence to Treatment among Patients With Drug-Resistant Tuberculosis in Pakistan. Int J Health Policy Manag 2023; 12:6576. [PMID: 37579474 PMCID: PMC10125133 DOI: 10.34172/ijhpm.2022.6576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/27/2022] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Non-adherence to treatment is a frequently observed phenomenon amongst those on long-term treatment for chronic illnesses. This qualitative study draws upon the tenets of 'practice theory' to reveal what shapes patients' ability to adhere to the demanding treatment for drug-resistant tuberculosis (DR-TB) at three treatment sites in Khyber-Pakhtunkhwa (KP) province of Pakistan. METHODS This qualitative study involved observation of service provision over a period of nine months of stay at, and embedment within the three treatment sites and in-depth interviews with 13 service providers and 22 patients who became non-adherent to their treatment. RESULTS Consistent with the extensive research based on the barriers and facilitator approach, both patients, and providers in our study also talked of patients' doubts about diagnosis and treatment efficacy, side-effects of drugs, economic constraints, unreliable disbursements of monetary incentive, attitude of providers and co-morbidities as reasons for non-adherence to treatment. Applying a practice theory perspective yielded more contextualised insights; inadequate help with patients' physical complaints, unempathetic responses to their queries, and failure to provide essential information, created conditions which hindered the establishment and maintenance of the 'practice' of adhering to treatment. These supply-side gaps created confusion, bred resentment, and exacerbated pre-existing distrust of public health services among patients, and ultimately drove them to disengage with the TB services and stop their treatment. CONCLUSION We argue that the lack of supply-side 'responsiveness' to patient needs beyond the provision of a few material inputs is what is lacking in the existing DR-TB program in Pakistan. We conclude that unless Pakistan's TB program explicitly engages with these supply side, system level gaps, patients will continue to struggle to adhere to their treatments and the TB program will continue to lose patients. Conceptually, we make a case for reimagining the act of adherence (or not) to long-term treatment as a 'Practice.'
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Affiliation(s)
- Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Justin Denholm
- Department of Infectious Diseases, University of Melbourne, Melbourne, VIC, Australia
| | - Hamed Adetunji
- Faculty of Public Health & Health Informatics, Umm Al Qura University, Makkah Almukarramah, Saudi Arabia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Lakin K, Kane S. A critical interpretive synthesis of migrants' experiences of the Australian health system. Int J Equity Health 2023; 22:7. [PMID: 36624465 PMCID: PMC9827657 DOI: 10.1186/s12939-022-01821-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/25/2022] [Indexed: 01/10/2023] Open
Abstract
While the health of and healthcare use by migrants has received significant scholarly and policy attention in Australia, current debates highlight that a critical examination of the theoretical underpinnings of these inquiries and responses is needed. We conducted a systematic review and critical interpretive synthesis (CIS) to critically examine how the policy and scholarly literature conceptualises migrants' interactions with and experiences of the Australian health system. Guided by PRISMA, we searched for literature without imposing any limits. We also searched key State and Federal Government websites for relevant policy documents. Our initially broad inclusion criteria became refined as the CIS progressed. We prioritised the likely relevance and theoretical contribution of the papers to our inquiry over methodological quality. The CIS of 104 papers revealed that the Australian scholarly literature and policy documents consistently homogenise and reduce migrants according to an assumed, (1) cultural identity, (2) linguistic affiliation, and/or (3) broad geographic origin. Based on these three critiques and drawing on the theoretical literature, we propose a synthesising argument on how the Australian literature could better conceptualise migrants' experiences of the Australian health system. We contend that both research and policy should explicitly recognise and engage with the multifaceted and shifting ways that migrants define themselves, generally, and during their encounters with destination country health systems. Engagement with this notion is necessary for also understanding how aspects of migrants' identities are dynamically co-constructed during their interactions with the health system. These understandings have implications for improving the design and implementation of policies and programs directed at improving the responsiveness of Australia's health system to the needs and expectations of migrant communities specifically, and destination countries broadly.
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Affiliation(s)
- Kimberly Lakin
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 2, 32 Lincoln Square, Melbourne, 3010, Australia
| | - Sumit Kane
- Nossal Institute for Global Health, School of Population and Global Health, The University of Melbourne, Level 2, 32 Lincoln Square, Melbourne, 3010, Australia.
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Pesantes MA, Cortez L, Scaramutti C, Portocarrero J, Haghparast-Bidgoli H, Miranda JJ. [Responding to the sexual and reproductive health needs of Venezuelan migrant women in LimaResposta às necessidades de saúde sexual e reprodutiva de migrantes venezuelanas em Lima]. Rev Panam Salud Publica 2023; 47:e69. [PMID: 37089788 PMCID: PMC10115188 DOI: 10.26633/rpsp.2023.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/21/2023] [Indexed: 04/25/2023] Open
Abstract
Objectives To present and analyze the Peruvian health system's response to the sexual and reproductive health needs of Venezuelan women living in the city of Lima, Peru, and to identify some of the reasons underlying this response. Methods Information was collected through semi-structured, in-depth telephone interviews with 30 Venezuelan women, 10 healthcare workers, and two Ministry of Health officials. Results Based on the experiences of Venezuelan women who sought care through these services during 2019-2020 and the perspectives of healthcare personnel and health authorities, we present an analysis of the public health services' capacity and limitations in meeting the sexual and reproductive health needs of this population. Migrant women's testimonies reported a positive experience with a health system that, despite shortcomings, responds to the most common sexual and reproductive health needs. These perspectives parallel the testimonies of healthcare personnel and authorities who emphasized the existence of priority policies for sexual and reproductive health care. Conclusion This study shows how a national priority framework (reducing maternal mortality), accompanied by operational mechanisms for social protection (such as the Comprehensive Health Insurance program), represent complementary instruments that have a positive impact on and extend benefits to migrants, even though this population was not considered when designing these policies.
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Affiliation(s)
- M Amalia Pesantes
- Universidad Peruana Cayetano Heredia Lima Perú Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Leonardo Cortez
- Universidad Peruana Cayetano Heredia Lima Perú Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Carolina Scaramutti
- University of Miami Miami Estados Unidos de América University of Miami, Miami, Estados Unidos de América
| | - Jill Portocarrero
- Universidad Peruana Cayetano Heredia Lima Perú Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - J Jaime Miranda
- Universidad Peruana Cayetano Heredia Lima Perú Universidad Peruana Cayetano Heredia, Lima, Perú
- University of Miami Miami Estados Unidos de América University of Miami, Miami, Estados Unidos de América
- University College London Londres Reino Unido University College London, Londres, Reino Unido
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Farrington N, Dantanus K, Richardson A, Bridges J. Understanding the cultural environment of the outpatient care setting for patients with dementia receiving cancer treatment: A qualitative study. Health Expect 2022; 26:98-107. [PMID: 36382351 PMCID: PMC9854287 DOI: 10.1111/hex.13523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION People with dementia have poorer cancer outcomes than those without dementia, and experience inequalities in access to, and quality of, care. Outpatient environments, where radiotherapy, chemotherapy and immunotherapy cancer treatments typically take place, have largely been excluded from research. This study was conducted to understand provision of treatment and support and experiences of care for people with dementia undergoing cancer treatment in the outpatient setting. MATERIALS AND METHODS Using observation, interviews and document analysis, data were collected to scrutinize the cultural environment of ambulatory care, comprising the physical fabric of the care setting; interactions, behaviours and perceptions of those in the care setting; and the organizational, clinical and interactional processes involved in care delivery. The study was conducted in the outpatient oncology departments of two large teaching hospitals in England between January 2019 and July 2021. RESULTS Data were gathered from a wide range of sources, including 15 h of observation, and interviews with patients (n = 2), caregivers (n = 7) and staff (n = 20). Evidence from this study suggests that the cultural environment of the outpatient care setting reflects and supports the standardized processing of people for cancer treatment. Dementia introduces a wider set of care requirements not catered for by this standardized treatment model and associated processes. Data showed that the needs of patients with dementia could be addressed most effectively when individualized care, as opposed to standardized care, was offered. CONCLUSION There is work to be done in outpatient cancer services to ensure responsiveness to individual patient need. This could be achieved by having an established way (or ways) of eliciting needs, preferences and expectations, a belief that a person's needs and expectations are legitimate and that effort should be made to address them, with the ability to accommodate these needs and expectations. PATIENT OR PUBLIC CONTRIBUTION Patients and caregivers were involved in the study design and development of study materials including the interview topic guide. They also assisted with discussion and clarification of study findings.
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Affiliation(s)
- Naomi Farrington
- Cancer Care, Division BUniversity Hospital Southampton NHSFT and Health Sciences, University of SouthamptonSouthamptonUK
| | - Katherine Dantanus
- Cancer Care, Division BUniversity Hospital Southampton NHSFTSouthamptonUK
| | - Alison Richardson
- Cancer Care, Division BUniversity Hospital Southampton NHSFT and Health Sciences, University of SouthamptonSouthamptonUK
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Haemmerli M, Asante A, Susilo D, Satrya A, Fattah RA, Cheng Q, Kosen S, Novitasari D, Puteri GC, Adawiyah E, Hayen A, Gilson L, Mills A, Tangcharoensathien V, Jan S, Thabrany H, Wiseman V. Using measures of quality of care to assess equity in health care funding for primary care: analysis of Indonesian household data. BMC Health Serv Res 2022; 22:1349. [PMID: 36376946 PMCID: PMC9664775 DOI: 10.1186/s12913-022-08739-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many countries implementing pro-poor reforms to expand subsidized health care, especially for the poor, recognize that high-quality healthcare, and not just access alone, is necessary to meet the Sustainable Development Goals. As the poor are more likely to use low quality health services, measures to improve access to health care need to emphasise quality as the cornerstone to achieving equity goals. Current methods to evaluate health systems financing equity fail to take into account measures of quality. This paper aims to provide a worked example of how to adapt a popular quantitative approach, Benefit Incidence Analysis (BIA), to incorporate a quality weighting into the computation of public subsidies for health care. METHODS We used a dataset consisting of a sample of households surveyed in 10 provinces of Indonesia in early-2018. In parallel, a survey of public health facilities was conducted in the same geographical areas, and information about health facility infrastructure and basic equipment was collected. In each facility, an index of service readiness was computed as a measure of quality. Individuals who reported visiting a primary health care facility in the month before the interview were matched to their chosen facility. Standard BIA and an extended BIA that adjusts for service quality were conducted. RESULTS Quality scores were relatively high across all facilities, with an average of 82%. Scores for basic equipment were highest, with an average score of 99% compared to essential medicines with an average score of 60%. Our findings from the quality-weighted BIA show that the distribution of subsidies for public primary health care facilities became less 'pro-poor' while private clinics became more 'pro-rich' after accounting for quality of care. Overall the distribution of subsidies became significantly pro-rich (CI = 0.037). CONCLUSIONS Routine collection of quality indicators that can be linked to individuals is needed to enable a comprehensive understanding of individuals' pathways of care. From a policy perspective, accounting for quality of care in health financing assessment is crucial in a context where quality of care is a nationwide issue. In such a context, any health financing performance assessment is likely to be biased if quality is not accounted for.
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Affiliation(s)
- Manon Haemmerli
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
| | - Augustine Asante
- School of Population Health, University of New South Wales, Sydney, Australia
| | - Dwidjo Susilo
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Aryana Satrya
- Department of Management, Faculty of Economics, University of Indonesia, Depok, Indonesia
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Rifqi Abdul Fattah
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Qinglu Cheng
- Kirby Institute, University of New South Wales, Sydney, Australia
| | | | - Danty Novitasari
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
| | - Gemala Chairunnisa Puteri
- Centre for Social Security Studies, University of Indonesia, Jakarta, Indonesia
- Centre for Health Economics and Policy Studies, University of Indonesia, Jakarta, Indonesia
| | - Eviati Adawiyah
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Andrew Hayen
- School of Public Health, University of Technology Sydney, Sydney, Australia
| | - Lucy Gilson
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Health Policy and Systems Division, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Anne Mills
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, Australia
| | | | - Virginia Wiseman
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- Kirby Institute, University of New South Wales, Sydney, Australia
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Does Health System Responsiveness Differ between Insured and Uninsured Outpatients in Primary Health Care Facilities in Asagirt District, Ethiopia? A Cross-Sectional Study. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/3857873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background. An effective designation of health facilities improves the facility’s ability to respond to patients’ legitimate expectations. Limited evidence exists regarding the association between health system responsiveness and financial fairness in Sub-Saharan Africa, particularly in Ethiopia. The purpose of the study was, therefore to evaluate the health system responsiveness among insured and uninsured outpatients in primary healthcare facilities and determine the association between health insurance and health system responsiveness among outpatients. Methods. A facility-based cross-sectional study was conducted between March 30 and April 30,2021. The study sampled 423 participants using a systematic random sampling technique, and the data was collected with structured and pretested questionnaires administered by interviewers. Responsiveness was measured using the short version of the World Health Organization’s multicountry responsiveness survey, which has seven dimensions including autonomy, communication, confidentiality, attention, dignity, choice, and amenities. Using quantile regression, a specific association between health insurance and the health system responsiveness index was examined, adjusting for sociodemographic, quality, and satisfaction-related factors. Results. Of a total of 417 outpatients, 70.74% had health insurance. There was no statistical difference in health system responsiveness among insured and uninsured outpatients. Possession of health insurance was not associated with responsiveness (−0.67; 95%CI: −1.59, 0.25). There was a statistically significant negative relationship between age and responsiveness (−1.33; 95% CI: −2.47, −0.19) among 30–39 year olds and (−1.66; 95% CI: −3.02, −0.32) among 40–49 year olds. However, there was a positive statistical association between responsiveness with urban residence (+1.33; 95%CI: 0.37, 2.29), perceived quality of healthcare (+2.96; 95%CI: 1.95, 4.05), and patient satisfaction (3; 95%CI: 1.94, 4.07). Conclusions. There was no difference in the responsiveness of the health system between insured and uninsured outpatients. All domains need further improvement, particularly those more closely related to patients’ concerns, such as waiting time to get service and choices of healthcare providers. Furthermore, health facility administrators and the government should enhance responsive healthcare services in parallel with quality improvement and patient satisfaction, based on feedback from service users for better performance.
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Kohno A, Dahlui M, Koh D, Dhamanti I, Rahman H, Nakayama T. Factors influencing healthcare-seeking behaviour among Muslims from Southeast Asian countries (Indonesia and Malaysia) living in Japan: an exploratory qualitative study. BMJ Open 2022; 12:e058718. [PMID: 36207034 PMCID: PMC9557278 DOI: 10.1136/bmjopen-2021-058718] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/10/2022] Open
Abstract
OBJECTIVES To identify factors influencing healthcare-seeking behaviours and to explore issues with healthcare experiences of Muslims from Southeast Asian countries (Indonesia and Malaysia) living in Japan. DESIGN Qualitative study. SETTING Kansai area of Japan (Kyoto, Osaka, Hyogo and Nara prefectures). PARTICIPANTS Forty-five Muslims in Japan from Southeast Asian countries (Indonesia and Malaysia). METHODS Semistructured interviews were conducted by trained interviewers who are Muslims living in Japan. Interviews were conducted in Indonesian and Malaysian languages and transcribed and translated into English. The data were thematically analysed. RESULTS Four themes were identified: (1) trying to comply with the recommendations of Islam, (2) confusion about healthcare system, (3) improvising an informal support system and (4) language barrier problems. CONCLUSION Muslims in Japan have some issues when obtaining healthcare services mainly because of communication issues besides the conflicts to meet their religious obligations. Education and awareness building for the Muslim patients in Japan as well as Japanese healthcare providers are needed to allow smooth communication between Japanese healthcare providers and Muslim patients in Japan.
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Affiliation(s)
- Ayako Kohno
- Internationalization Promotion Office, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Maznah Dahlui
- Department of Research Development and Innovation, University of Malaya, Kuala Lumpur, Malaysia
| | - David Koh
- SSH School of Public Health, National University of Singapore, Singapore
| | - Inge Dhamanti
- Department of Health Policy and Administration, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Hanif Rahman
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Gadong, Brunei Darussalam
- School of Nursing and Statistics Online Computational Resources, University of Michigan, Ann Arbor, Michigan, USA
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yusefi AR, Davarani ER, Daneshi S, Bastani M, Mehralian G, Bastani P. Responsiveness level and its effect on services quality from the viewpoints of the older adults hospitalized during COVID-19 pandemic. BMC Geriatr 2022; 22:653. [PMID: 35945488 PMCID: PMC9362974 DOI: 10.1186/s12877-022-03344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Aging is a sensitive period of life. Attention to the needs of this stage is considered a social necessity. This study is conducted to investigate the responsiveness level and its effect on service quality from the hospitalized older adults’ viewpoints during the COVID-19 pandemic in the south of Iran. Methods It was a cross-sectional descriptive-analytic study that was conducted on 386 old patients. The study instrument was a standard questionnaire that includes three sections of demographic information, World Health Organization Responsiveness, and SERVQUAL. Data were analyzed applying descriptive and inferential statistics the same as Independent T-test, ANOVA, Pearson correlation, and multiple linear regression. Results The mean levels of responsiveness and service quality were 90.72 ± 9.38 (from 160) and 68.01 ± 8.51 (from 110) respectively. This indicates the average level of these variables from the old patients’ viewpoints. There was a significant positive correlation between responsiveness and service quality (r = 0.585). According to the results of multiple linear regression, the dimensions of communication, dignity, prompt attention, primary facilities, social support, information confidentiality, right to choose, and autonomy were identified as the predictors of service quality. Conclusion The average level of responsiveness and service quality perceived from the old patients’ viewpoints during the COVID-19 pandemic can be considered a necessity for supportive planning among the older adults. Meanwhile, according to the impacts of responsiveness on service quality, educational programs are recommended to promote the level of healthcare providers’ responsiveness.
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Affiliation(s)
- Ali Reza Yusefi
- Department of Public Health, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Esmat Rezabeigi Davarani
- Health in Disasters and Emergencies Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Salman Daneshi
- Department of Public Health, School of Health, Jiroft University of Medical Sciences, Jiroft, Iran
| | - Misagh Bastani
- Shooshtari Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Peivand Bastani
- Faculty of Health and Behavioral Sciences, School of Dentistry, University of Queensland, Brisbane, Australia
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Calhoun LM, Maytan-Joneydi A, Nouhou AM, Benova L, Delvaux T, van den Akker T, Agali BI, Speizer IS. "I Got What I Came for": A Qualitative Exploration into Family Planning Client Satisfaction in Dosso Region, Niger. Open Access J Contracept 2022; 13:95-110. [PMID: 35860625 PMCID: PMC9289954 DOI: 10.2147/oajc.s361895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background Client satisfaction is recognized as an important construct for evaluating health service provision, yet the field of family planning (FP) lacks a standard approach to its measurement. Further, little is known about satisfaction with FP services in Niger, the site of this study. This study aims to understand what features of FP visits were satisfactory or dissatisfactory from a woman’s perspective and reflect on the conceptualization and measurement of satisfaction with FP services. Methods Between February and March 2020, 2720 FP clients (ages 15–49) were interviewed across 45 public health centers in Dosso region, Niger using a structured survey tool. The focus of this paper is on a random sub-sample of 100 clients who were additionally asked four open-ended questions regarding what they liked and disliked about their FP visit. Responses were audio-recorded, translated into French, transcribed, translated into English, coded, and analyzed thematically. Results FP clients described nine key visit attributes related to their satisfaction with the visit: treatment by the provider, content of the counseling, wait time, FP commodity availability, privacy, cleanliness/infrastructure, visit processes and procedures, cost, and opening hours. The reason for FP visit (start, continue, or change method) was an important driver of the dimensions which contributed to satisfaction. Pre-formed expectations about the visit played a critical role in shaping satisfaction, particularly if the client’s pre-visit expectations (or negative expectations) were met or not and if she obtained what she came for. Conclusion This study makes a significant contribution by identifying visit attributes that are important to FP clients in Dosso region, Niger, and highlights that satisfaction with FP services is shaped by more than just what occurs on the day of service. We propose a conceptual framework to understand satisfaction with FP services that can be used for future FP programming in Niger.
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Affiliation(s)
- Lisa M Calhoun
- Carolina Population Center, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Athena Institute, Vrije Universiteit, Amsterdam, Netherlands.,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Amelia Maytan-Joneydi
- Carolina Population Center, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thérèse Delvaux
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Thomas van den Akker
- Athena Institute, Vrije Universiteit, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Ilene S Speizer
- Carolina Population Center, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Maternal and Child Health, Gillings School of Global Public Health, the University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Biddle L, Ziegler S, Baron J, Flory L, Bozorgmehr K. The patient journey of newly arrived asylum seekers and responsiveness of care: A qualitative study in Germany. PLoS One 2022; 17:e0270419. [PMID: 35749409 PMCID: PMC9231813 DOI: 10.1371/journal.pone.0270419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/09/2022] [Indexed: 11/29/2022] Open
Abstract
Background Research on health and healthcare for asylum seekers and refugees (ASR) has focused strongly on accessibility and legal entitlements, with quality of care receiving little attention. This study aimed to assess responsiveness, as non-medical quality of care, in the narratives of ASR patients recently arrived in Germany. Methods 31 ASR with existing medical conditions were recruited in six refugee reception centres and three psychosocial centres. Semi-structured, qualitative interviews were conducted which reconstructed their patient journey after arrival in Germany. Interviews were recorded, transcribed verbatim and evaluated using thematic analysis. Results The experiences of participants throughout the patient journey provided a rich and varied description of the responsiveness of health services. Some dimensions of responsiveness, including respectful treatment, clear communication and trust, resurfaced throughout the narratives. These factors were prominent reasons for positive evaluations of the health system, and negative experiences were reported in their absence. Other dimensions, including cleanliness of facilities, autonomy of decision-making and choice of provider were raised seldomly. Positive experiences in Germany were often set in contrast to negative experiences in the participants’ countries of origin or during transit. Furthermore, many participants evaluated their experience with healthcare services in terms of the perceived technical quality of medical care rather than with reference to responsiveness. Conclusion This qualitative study among ASR analysed patient experiences to better understand responsiveness of care for this population. While our results show high overall satisfaction with health services in Germany, using the lens of responsiveness allowed us to identify particular policy areas where care can be strengthened further. These include in particular the expansion of high-quality interpreting services, provision of professional training to increase the competency of healthcare staff in caring for a diverse patient population, as well as an alignment between healthcare and asylum processes to promote continuity of care.
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Affiliation(s)
- Louise Biddle
- Department of General Practice and Health Service Research, Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Sandra Ziegler
- Department of General Practice and Health Service Research, Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany
| | - Jenny Baron
- Nationwide Working Group of Psychosocial Centres for Refugees and Victims of Torture e.V. (BAfF), Berlin, Germany
| | - Lea Flory
- Nationwide Working Group of Psychosocial Centres for Refugees and Victims of Torture e.V. (BAfF), Berlin, Germany
| | - Kayvan Bozorgmehr
- Department of General Practice and Health Service Research, Section Health Equity Studies & Migration, University Hospital Heidelberg, Heidelberg, Germany
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- * E-mail:
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Hamon JK, Kambanje M, Pryor S, Kaponda AS, Mwale E, Mayhew SH, Webster J, Burchett HED. Integrated Delivery of Family Planning and Childhood Immunisation Services: A Qualitative Study of Factors Influencing Service Responsiveness in Malawi. Health Policy Plan 2022; 37:885-894. [PMID: 35713382 PMCID: PMC9347017 DOI: 10.1093/heapol/czac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 06/10/2022] [Accepted: 06/16/2022] [Indexed: 11/14/2022] Open
Abstract
Evidence from several countries in sub-Saharan Africa suggests that the integration of family planning (FP) with childhood immunization services can help reduce the unmet need for FP among postpartum women without undermining the uptake of immunizations. However, the quality and responsiveness of FP services that are integrated with childhood immunizations remain understudied. A qualitative study was conducted in two districts of Malawi, which examined the factors influencing the responsiveness of FP services that were integrated with childhood immunizations in monthly public outreach clinics. Semi-structured interviews with clients (n = 23) and FP providers (n = 10) and a clinic audit were carried out in six clinics. Hardware (material) and software (relational) factors influencing service responsiveness were identified through thematic and framework analyses of interview transcripts, and clinic characteristics were summarized from the audit data to contextualize the qualitative findings. Overall, 13 factors were found to influence service responsiveness in terms of the ease of access, choice of provider, environment, service continuity, confidentiality, communication, dignity and FP counselling afforded to clients. Among these factors, hardware deficiencies, including the absence of a dedicated building for the provision of FP services and the lack of FP commodities in clinics, were perceived to negatively affect service responsiveness. Crucially, the providers’ use of their agency to alter the delivery of services was found to mitigate the negative effects of some hardware deficits on the ease of access, choice of provider, environment and confidentiality experienced by clients. This study contributes to an emerging recognition that providers can offset the effect of hardware deficiencies when services are integrated if they are afforded sufficient flexibility to make independent decisions. Consideration of software elements in the design and delivery of FP services that are integrated with childhood immunizations is therefore critical to optimize the responsiveness of these services.
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Affiliation(s)
| | | | | | | | | | | | | | - Helen E D Burchett
- Department of Public Health, Environments and Society, LSHTM, London, UK
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Goldberg EM, Bountogo M, Harling G, Baernighausen T, Davies JI, Hirschhorn LR. Older persons experiences of healthcare in rural Burkina Faso: Results of a cross sectional household survey. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000193. [PMID: 36962344 PMCID: PMC10021992 DOI: 10.1371/journal.pgph.0000193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 04/18/2022] [Indexed: 11/19/2022]
Abstract
Ensuring responsive healthcare which meets patient expectations and generates trust is important to increase rates of access and retention. This need is important for aging populations where non-communicable diseases (NCDs) are a growing cause of morbidity and mortality. We performed a cross-sectional household survey including socio-demographic; morbidities; and patient-reported health system utilization, responsiveness, and quality outcomes in individuals 40 and older in northwestern Burkina Faso. We describe results and use exploratory factor analysis to derive a contextually appropriate grouping of health system responsiveness (HSR) variables. We used linear or logistic regression to explore associations between socio-demographics, morbidities, and the grouped-variable, then between these variables and health system quality outcomes. Of 2,639 eligible respondents, 26.8% had least one NCD, 56.3% were frail or pre-frail and 23.9% had a recent healthcare visit, including only 1/3 of those with an NCD. Highest ratings of care experience (excellent/very good) included ease of following instructions (86.1%) and trust in provider skills (81.1%). The HSR grouping with the greatest factor loading included involvement in decision-making, clarity in communication, trust in the provider, and confidence in providers' skills, labelled Shared Understanding and Decision Making (SUDM). In multivariable analysis, higher quality of life (OR 1.02,95%CI 1.01-1.04), frailty (OR 1.47,95%CI 1.00-2.16), and SUDM (OR 1.06,95%CI 1.05-1.09) were associated with greater health system trust and confidence. SUDM was associated with overall positive assessment of the healthcare system (OR 1.02,95%CI 1.01-1.03) and met healthcare needs (OR 1.09,95%CI 1.08-1.11). Younger age and highest wealth quintile were also associated with higher met needs. Recent healthcare access was low for people with existing NCDs, and SUDM was the most consistent factor associated with higher health system quality outcomes. Results highlight the need to increase continuity of care for aging populations with NCDs and explore strengthening SUDM to achieve this goal.
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Affiliation(s)
- Ellen M. Goldberg
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, United States of America
| | | | - Guy Harling
- Institute for Global Health, University College London, London, United Kingdom
| | - Till Baernighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Justine I. Davies
- Institute of Applied Health Research, Birmingham University, Birmingham, United Kingdom
| | - Lisa R. Hirschhorn
- Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Qin L, Chen S, Feng X, Luo B, Chen Y. Patient-Perceived Health System Responsiveness of the Epilepsy Management Project in Rural China during the Period of COVID-19. Healthcare (Basel) 2022; 10:799. [PMID: 35627936 PMCID: PMC9141671 DOI: 10.3390/healthcare10050799] [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: 03/21/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 11/20/2022] Open
Abstract
Health system responsiveness (HSR) measures the experience of health-system users in terms of the non-clinical domains of the health system, which has been regarded as the three major goals of health performance evaluation. Good HSR may promote the use of health services and ultimately the health of patients. However, the HSR has not been measured as the main goal of the Epilepsy Management Project (EMP) in rural China. This study aims to evaluate the levels and distributions of the patient-perceived HSR of the EMP in rural China during the period of COVID-19 and identify its relevant factors so as to provide advice on the improvement of further strategies. Based on the key informant survey (KIS) of responsiveness from the World Health Organization proposal, we conducted a cross-sectional survey of 420 epilepsy patients selected proportional randomly from seven rural areas in the Hunan province of China in 2021. Eight domains of patients-perceived HSR were assessed by face-to-face interview. The overall HSR scored at a fairly “good” level of 8.3 (8.3 out of a maximum of 10.0). During the COVID-19 period, the scores of responsiveness domains were highest at 8.66 to 8.93 in “confidentiality”, “dignity” and “choice of providers”, while lowest at 8.38 to 8.53 in “prompt attention”, “social support” and “basic amenities”. The representative responsiveness equality index (REI) was 0.732, indicating the moderately balanced distributions of responsiveness of the EMP in rural China. Female, old age, and low education were significantly related to the lower HSR scores of rural EMP (p < 0.05). The HSR of EMP in rural China was fairly good. However, measures to improve the patient-perceived HSR are still needed, especially including better service, higher social support, and more comfortable medical environments.
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Affiliation(s)
- Lulu Qin
- Department of Social Medicine and Health Management, School of Medicine, Hunan Normal University, Changsha 410013, China; (L.Q.); (S.C.); (X.F.)
| | - Si Chen
- Department of Social Medicine and Health Management, School of Medicine, Hunan Normal University, Changsha 410013, China; (L.Q.); (S.C.); (X.F.)
| | - Xianglin Feng
- Department of Social Medicine and Health Management, School of Medicine, Hunan Normal University, Changsha 410013, China; (L.Q.); (S.C.); (X.F.)
| | - Bangan Luo
- Department of Mental Health, Brain Hospital of Hunan Province, Changsha 410007, China
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha 410078, China
| | - Yiwei Chen
- Department of Neurology, Xiangya Third Hospital, Central South University, Changsha 410017, China
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36
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Pengpid S, Peltzer K. Health Care Responsiveness by Conventional, Traditional and Complementary Medicine Providers in a National Sample of Middle-Aged and Older Adults in India in 2017–2018. J Multidiscip Healthc 2022; 15:773-782. [PMID: 35422625 PMCID: PMC9005073 DOI: 10.2147/jmdh.s357761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction This study aimed to determine the prevalence and correlates of health care responsiveness by conventional, traditional and complementary medicine providers in middle-aged and older community-dwelling adults from the India Longitudinal Ageing Study in India (LASI) Wave 1 in 2017–2018. Methods The cross-sectional sample included 37,852 participants who received outpatient health care in the past 12 months, of which 33,615 had visited a conventional health facility, 2120 an AYUSH facility, and 2117 a traditional health practitioner (THP). Results The prevalence of poor health care responsiveness was 10.1% overall, and 10.7% for the conventional health facility, 8.3% for AYUSH, and 5.7% for the THP. In adjusted logistic regression analysis using the whole sample, the prevalence of poor health care responsiveness was significantly lower among AYUSH and THP clients than among conventional health care clients. Having higher education, higher socioeconomic status and being a Sikh decreased the odds of poor health care responsiveness, while being a member of a caste, having two or more chronic diseases, functional disability, and visiting the health facility for immunisation increased the odds of poor health care responsiveness. In regard to the AYUSH provider, older age decreased the odds and member of a caste, being a Christian and functional disability increased the odds of poor health care responsiveness, and in terms of the THP, being a Sikh decreased the odds and older age, functional disability and visiting the THP for immunisation and for treatment for injury/accident increased the odds of poor health care responsiveness. Discussion One in ten middle-aged or older adults in India reported poor health care responsiveness, and several sociodemographic and health factors were identified associated with poor health care responsiveness by different service providers.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health Mahidol University, Bangkok, Thailand
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Correspondence: Karl Peltzer, Department of Psychology, University of the Free State, Bloemfontein, South Africa, Email
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Holetzek T, Holmberg C. Representation in participatory health care decision-making: Reflections on an Application-Oriented Model. Health Expect 2022; 25:1444-1452. [PMID: 35340091 PMCID: PMC9327827 DOI: 10.1111/hex.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 01/23/2022] [Accepted: 03/05/2022] [Indexed: 11/29/2022] Open
Abstract
Context The involvement of lay people in health care decision‐making processes is now the norm in many countries. However, one important aspect of participation has not received sufficient attention in the past and remains underexplored: representation. Objective This paper explores the question of how public participation efforts in collective health care decision‐making processes can attempt to aim for legitimate representation so that those individuals or groups not present can be taken into account in the decisions affecting them. This paper argues that to make decisions that effectively address those affected, representation needs to be seen as a relevant part of any participatory setting. To support this argument, the paper outlines the concepts of participation and representation and transfers them to health care contexts. Results A conceptual reflection on responsiveness and the characteristics of representative actors in representative‐participatory settings is introduced, which could provide actors planning to conduct participatory health care projects with tools to reflect on the merits and possible flaws of participatory constellations. Patient or Public Contribution The paper contributes to improving public participation in health care decision‐making.
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Affiliation(s)
- Tim Holetzek
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany.,Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Potsdam, Germany
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Negash WD, Tsehay CT, Yazachew L, Asmamaw DB, Desta DZ, Atnafu A. Health system responsiveness and associated factors among outpatients in primary health care facilities in Ethiopia. BMC Health Serv Res 2022; 22:249. [PMID: 35209882 PMCID: PMC8867670 DOI: 10.1186/s12913-022-07651-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Health system responsiveness is defined as the outcome of designing health facility relationships so that they are familiar and responsive to patients’ universally legitimate expectations. Even though different strategies have been implemented to measure responsiveness, only limited evidence exists in Sub-Saharan Africa. In Ethiopia, information about health system responsiveness among outpatients is limited. Assessing responsiveness could help facilities in improving service delivery based on patient expectations. Objective The study aimed to assess health system responsiveness and associated factors among outpatients in primary health care facilities, Asagirt District, Ethiopia, 2021. Methods Facility-based cross-sectional quantitative study was implemented between March 30 and April 30/2021. A systematic random sampling technique was employed to select 423 participants, and interviewer-administered data were collected using structured and pretested questionnaires. Both bivariable and multivariable logistic regressions were employed to identify factors associated with health system responsiveness. Adjusted Odds Ratio with their corresponding 95% CI was used to declare factors associated with health system responsiveness. A p-value less than 0.05 was used to declare significant statistical variables. Results The overall health system responsiveness performance was 66.2% (95% CI: 61.4—70.7). Confidentiality and dignity were the highest responsive domains. Health system responsiveness was higher among satisfied patients (AOR: 9.9, 95% CI: 5.11–19.46), utilized private clinics (AOR: 8.8, 95% CI: 4.32–18.25), and no transport payment (AOR: 1.7, 95% CI: 1.03–2.92) in the study setting. Conclusion Overall, health system responsiveness performance was higher than a case-specific study in Ethiopia. To improve the health systems responsiveness and potentially fulfil patients’ legitimate expectations, we need to facilitate informed treatment choice, provide reasonable care within a reasonable time frame, and give patients the option of consulting a specialist. Aside from that, enhancing patient satisfaction, using input from service users, Collaboration, and exchanging experiences between public and private facilities will be important interventions to improve HSR performance.
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Affiliation(s)
- Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Chalie Tadie Tsehay
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lake Yazachew
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Dawit Zenamarkos Desta
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Coronado-Vázquez V, Gil-de-Gómez MJ, Rodríguez-Eguizábal E, Oliván-Blázquez B, Gómez-Salgado J, Magallón-Botaya R, Sánchez-Calavera MA. Evaluation of primary care responsiveness by people with mental illness in Spain. BMC Health Serv Res 2022; 22:133. [PMID: 35101052 PMCID: PMC8805273 DOI: 10.1186/s12913-022-07516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/17/2022] [Indexed: 11/14/2022] Open
Abstract
Background The health system responsiveness is a concept developed by the World Health Organization that measures patients’ expectations for the non-medical care they receive. The aim of this study is to assess primary care responsiveness as seen by people with mental illness and to analyse the factors associated with poor responsiveness. Methods Cross-sectional descriptive study on 426 people with mental illness who had attended primary care consultations at least once in the previous 12 months. The responsiveness of the health system was determined through the short questionnaire “Multi-country Survey Study on Health and Health Systems Responsiveness”. Differences in responsiveness by sociodemographic characteristics were compared through the Chi-squared test. Logistic regression identified the factors associated with poor responsiveness. Results Overall responsiveness was measured as good by 77.4% of patients, being this probability higher in the domains: dignity, confidentiality, and communication. The most valued domains by people with mental illness were prompt attention (42.4%), dignity (30.1%), and communication (17%). Only prompt attention scored high importance and poor responsiveness. In patients with an income lower than 900 euros per month and low level of studies, the probability of poor confidentiality responsiveness was multiplied by 3 and 2.7 respectively. Conclusions People with mental illness perceive good responsiveness from primary care in terms of dignity, confidentiality, and communication. Prompt attention, as the domain of greatest importance and worst valuation, should be prioritised through the implementation of organisational measures in health centres to reduce waiting times, especially in urban areas. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07516-2.
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Affiliation(s)
- Valle Coronado-Vázquez
- Aragonese Institute for Health Sciences (IACS), 50009, Zaragoza, Spain.,School of Medicine, Universidad Francisco de Vitoria, 28223, Madrid, Spain.,Illescas Primary Care Health Center, Castilla-La Mancha Health Service, 45200, Toledo, Spain.,Group B21-20R, Health Research Institute of Aragon (IIS), 50009, Zaragoza, Spain.,redIAPP group RD16/0007/0005, Aragonese Primary Care Research Group, 50009, Zaragoza, Spain
| | - María Josefa Gil-de-Gómez
- Aragonese Institute for Health Sciences (IACS), 50009, Zaragoza, Spain.,San Pedro Hospital, La Rioja Health Service, 26006, Logroño, Spain
| | - Eva Rodríguez-Eguizábal
- Aragonese Institute for Health Sciences (IACS), 50009, Zaragoza, Spain.,Puerta de Arnedo Primary Care Health Center, La Rioja Health Service, 26580, Arnedo, Spain
| | - Bárbara Oliván-Blázquez
- Group B21-20R, Health Research Institute of Aragon (IIS), 50009, Zaragoza, Spain.,redIAPP group RD16/0007/0005, Aragonese Primary Care Research Group, 50009, Zaragoza, Spain.,University of Zaragoza, 50009, Zaragoza, Spain
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health. Campus El Carmen, Universidad de Huelva, Av. de 3 de Marzo, 21007, Huelva, Spain. .,Safety and Health Postgraduate Programme, Universidad Espíritu Santo, 092301, Guayaquil, Ecuador.
| | - Rosa Magallón-Botaya
- Group B21-20R, Health Research Institute of Aragon (IIS), 50009, Zaragoza, Spain.,redIAPP group RD16/0007/0005, Aragonese Primary Care Research Group, 50009, Zaragoza, Spain.,University of Zaragoza, 50009, Zaragoza, Spain.,Arrabal Primary Care Health Center, Aragon Health Service, 50009, Zaragoza, Spain
| | - María Antonia Sánchez-Calavera
- Group B21-20R, Health Research Institute of Aragon (IIS), 50009, Zaragoza, Spain.,redIAPP group RD16/0007/0005, Aragonese Primary Care Research Group, 50009, Zaragoza, Spain.,University of Zaragoza, 50009, Zaragoza, Spain.,Fuentes Norte Primary Care Health Center, Aragon Health Service, 50002, Zaragoza, Spain
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Furlanetto DDLC, Santos WD, Scherer MDDA, Cavalcante FV, Oliveira A, Oliveira KHDD, Santos RRD, Leite TA, Poças KC, Santos LMP. Estrutura e responsividade: a Atenção Primária à Saúde está preparada para o enfrentamento da Covid-19? SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-1104202213403p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO A pandemia de Covid-19 reforçou a necessidade de esforços globais para garantir cobertura e acesso universal à saúde, impondo desafios na gestão da Atenção Primária à Saúde (APS). Este estudo objetivou desen- volver e aplicar um instrumento de avaliação da responsividade das Unidades Básicas de Saúde (UBS) diante da Covid-19, baseado na coprodução entre pesquisadores universitários e equipes técnicas da APS. O instrumento, dividido em dois módulos, incluiu identificação; horário de funcionamento; processo de trabalho; estrutura física, equipamentos, mobiliário, suprimentos e Equipamentos de Proteção Individual (EPI); atendimento, exames e acompanhamento de Usuários Sintomáticos Respiratórios (USR); vigilância, integração, comunicação e gestão. Todas as 165 UBS foram convidadas a completar o instrumento. Principais resultados: houve readequação da estrutura física (salas de espera, espaços internos/externos); fornecimento de EPI e de testes Covid-19, busca ativa de USR/suspeitos Covid-19 por telefone/visitas domiciliares, monitoramento de fluxos de transferência de pacientes e telessaúde. Concluindo, as UBS reorganizaram seus serviços para atender necessidades da pandemia. Fornecer informações sobre estrutura e capacidade de resposta das UBS pode subsidiar sistemas de saúde para planejamento e tomada de decisões, em diferentes níveis de gestão, crucial para determinar estratégias para reforçar a responsividade da APS em situações de pandemias e outras calamidades.
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Affiliation(s)
| | - Wallace Dos Santos
- Universidade de Brasília, Brazil; Secretaria de Estado de Saúde do Distrito Federal, Brazil
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Moallef S, DeBeck K, Fairbairn N, Cui Z, Brar R, Wilson D, Johnson C, Milloy MJ, Hayashi K. Inability to contact opioid agonist therapy prescribers during the COVID-19 pandemic in a Canadian setting: a cross-sectional analysis among people on opioid agonist therapy. Addict Sci Clin Pract 2022; 17:73. [PMID: 36522789 PMCID: PMC9751503 DOI: 10.1186/s13722-022-00354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic and consequent public health response may have undermined key responses to the protracted drug poisoning crisis, including reduced access to opioid agonist therapy (OAT) among people with opioid use disorder. Our study objectives were to estimate the prevalence of and identify factors associated with inability to contact OAT prescribers when in need among people on OAT in a Canadian setting during the dual public health crises. METHODS Survey data were collected from three prospective cohort studies of community-recruited people who use drugs between July and November 2020, in Vancouver, Canada. A multivariable logistic regression analysis was used to identify potential factors associated with inability to contact OAT prescribers among patients who accessed OAT in the past 6 months. RESULTS Among 448 respondents who reported accessing OAT in the past 6 months, including 231 (54.9%) men, 85 (19.0%) reported having been unable to contact OAT prescribers when needed, whereas 268 (59.8%) reported being able to talk to their prescriber when needed, and 95 (21.2%) reported that they did not want to talk to their medication prescriber in the previous 6 months. Among those who reported inability to contact prescribers, 45 (53.6%) reported that their overall ability to contact prescribers decreased since the start of the pandemic. In multivariable analyses, factors independently associated with inability to talk to OAT prescribers included: chronic pain (Adjusted Odds Ratio [AOR] = 1.82; 95% Confidence Interval [CI] 1.02, 3.27), moderate to severe symptoms of depression or anxiety (AOR = 4.74; 95% CI 2.30, 9.76), inability to access health/social services (AOR = 2.66; 95% CI 1.41, 5.02), and inability to self-isolate or socially distance most or all of the time (AOR = 2.13; 95% CI 1.10, 4.14). CONCLUSIONS Overall, approximately one fifth of the sample reported inability to contact their OAT prescribers when needed, and those people were more likely to have co-occurring vulnerabilities (i.e., co-morbidities, inability to access health/social services) and higher vulnerability to COVID-19. Interventions are needed to ensure optimal access to OAT and mitigate the deepening health inequities resulting from the COVID-19 pandemic and the escalating drug poisoning crisis.
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Affiliation(s)
- Soroush Moallef
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Kora DeBeck
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494School of Public Policy, Simon Fraser University, Burnaby, BC Canada
| | - Nadia Fairbairn
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Zishan Cui
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Rupinder Brar
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada ,grid.417243.70000 0004 0384 4428Vancouver Coastal Health Authority, Vancouver, BC Canada
| | - Dean Wilson
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada
| | - Cheyenne Johnson
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830School of Nursing, University of British Columbia, Vancouver, BC Canada
| | - M.-J. Milloy
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Kanna Hayashi
- grid.416553.00000 0000 8589 2327British Columbia Centre on Substance Use, St. Paul’s Hospital, 400-1045 Howe Street, Vancouver, BC V6Z 2A9 Canada ,grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
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Furlanetto DDLC, Santos WD, Scherer MDDA, Cavalcante FV, Oliveira A, Oliveira KHDD, Santos RRD, Leite TA, Poças KC, Santos LMP. Structure and responsiveness: are Primary Health Care Units prepared to face COVID-19? SAÚDE EM DEBATE 2022. [DOI: 10.1590/0103-1104202213403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ABSTRACT The COVID-19 pandemic reinforced the need for global efforts to grant universal health coverage and access, which imposes management challenges for Primary Health Care (PHC). This study aimed to develop and apply an instrument to assess the PHC Units’ responsiveness to COVID-19, based on co-production efforts between university researchers and PHC technical teams. The instrument composed of two modules, included identification, operating hours, workforce, work process, structure, equipment, furniture, supplies, Personal Protection Equipment (PPE), Symptomatic Respiratory Patient (SRP) examinations and follow-up, information, surveillance, integration, communication, and management. All the 165 PHC Units in Brasília were invited to complete the instrument. Main results: there was physical structure adaptation (adequate configuration of waiting rooms, internal and external spaces allowing safe distance); provision of PPE and COVID-19 tests; active search for SRP/COVID-19 suspects by phone, mobile or home visits; monitoring flows of patient transfer and telehealth implementation. In conclusion, the PHC Units reorganized their services to meet the demands of the pandemic context. Providing information about structure and responsiveness of PHC Units may subside health systems for planning and decision-making at different levels of management, which is crucial to determine strategies to empower and reinforce PHC responsivity in situations of pandemics and other calamities.
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Affiliation(s)
| | - Wallace Dos Santos
- Universidade de Brasília, Brazil; Secretaria de Estado de Saúde do Distrito Federal, Brazil
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Biddle L, Wenner J, Bozorgmehr K. Inequalities in health system responsiveness among asylum seekers and refugees: A population-based, cross-sectional study in Germany. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000984. [PMID: 36962593 PMCID: PMC10021598 DOI: 10.1371/journal.pgph.0000984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022]
Abstract
Global migration has sparked renewed interest in Universal Health Coverage in high-income countries. However, quality of care has received little attention. This study uses the concept of responsiveness to study quality of care for asylum seekers and refugees (ASR) in Germany and identify inequalities among this group. We report results from a population-based, cross-sectional health monitoring survey in Germany's third-largest federal state using random sampling methods. Established instruments were used to measure responsiveness, health status and socio-demographic factors. Data were weighted and adjusted logistic regression models applied to identify inequalities related to health status, structural and socio-demographic factors. N = 344 survey participants were included in the analysis (response rate 39.2%). Combined responsiveness was 77% (95%CI: 68%; 83%) but varied between domains. Responsiveness was poor for individuals with symptoms of anxiety (OR 0.35, 95%CI 0.13,0.99), longstanding illness (OR:0.42, 95%CI:0.17,1.06) and diminished health-related quality of life (OR:0.24, 95%CI:0.06,0.95). Individuals from Southern Asia (OR: 0.24, 95%CI: 0.07,0.86) and young participants (OR:0.31, 95%CI:0.12,0.82) also reported less responsive care. Unique patterns of explanatory factors were identified within each responsiveness domain. We found important differences in responsiveness related to health, socio-demographic and structural factors, both in combined responsiveness and in individual domains. Inequalities related to health status factors are particularly concerning given the potential implications for equity of access. Future research should explore responsiveness for different sectors, include individuals who have not utilised healthcare and allow for the adjustment of differential expectations of care between population groups.
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Affiliation(s)
- Louise Biddle
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Department of General Practice and Health Services Research, Section for Health Equity Studies and Migration, University Hospital Heidelberg, Heidelberg, Germany
| | - Judith Wenner
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Kayvan Bozorgmehr
- Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, Bielefeld, Germany
- Department of General Practice and Health Services Research, Section for Health Equity Studies and Migration, University Hospital Heidelberg, Heidelberg, Germany
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Lakin K, Kane S. Peoples' expectations of healthcare: A conceptual review and proposed analytical framework. Soc Sci Med 2022; 292:114636. [PMID: 34894457 DOI: 10.1016/j.socscimed.2021.114636] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
Expectations shape how one experiences the healthcare one receives. In this paper we argue that the current conceptualisations of expectations within the healthcare literature have much to gain from the many recent and adjacent conceptual developments in other disciplines. The concept of expectations has been extensively studied across disciplines - we review the key texts on the subject in the business, management, social psychology, and sociology literatures to provide a conceptual overview and propose an integrative analytical framework for better understanding individuals' expectations in healthcare. We argue that peoples' expectations of a care encounter are usefully understood as being shaped by their social locations at particular points of time, which is at the intersection of multiple social structures and relations. Peoples' future expectations of care may also be influenced by the experiences of past and current care encounters, framed again by intersecting social structures and relations at that point in time. We demonstrate how an intersectional, translocational and relational analytical approach can allow researchers and practitioners to consider how peoples' social locations shape their expectations of care, not only within a given social environment, but at certain points in time and over time. We emphasise that, given the mobilities and mixing societies are experiencing globally, such an approach is particularly useful for understanding healthcare-related expectations and experiences of all.
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Affiliation(s)
- Kimberly Lakin
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
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Gaspar A, Miranda JJ. Burden of treatment as a measure of healthcare quality: An innovative approach to addressing global inequities in multimorbidity. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000484. [PMID: 36962213 PMCID: PMC10021660 DOI: 10.1371/journal.pgph.0000484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Andrea Gaspar
- CRONICAS Center for Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J Jaime Miranda
- CRONICAS Center for Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Fitzpatrick KM, Wild TC, Pritchard C, Azimi T, McGee T, Sperber J, Albert L, Montesanti S. Health Systems Responsiveness in Addressing Indigenous Residents' Health and Mental Health Needs Following the 2016 Horse River Wildfire in Northern Alberta, Canada: Perspectives From Health Service Providers. Front Public Health 2021; 9:723613. [PMID: 34957001 PMCID: PMC8704385 DOI: 10.3389/fpubh.2021.723613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/31/2021] [Indexed: 12/03/2022] Open
Abstract
Following the 2016 Horse River Wildfire in northern Alberta, the provincial health authority, the ministry of health, non-profit and charitable organizations, and regional community-based service agencies mobilized to address the growing health and mental health concerns among Indigenous residents and communities through the provision of services and supports. Among the communities and residents that experienced significant devastation and loss were First Nation and Métis residents in the region. Provincial and local funding was allocated to new recovery positions and to support pre-existing health and social programs. The objective of this research was to qualitatively describe the health systems response to the health impacts following the wildfire from the perspective of service providers who were directly responsible for delivering or organizing health and mental wellness services and supports to Indigenous residents. Semi-structured qualitative interviews were conducted with 15 Indigenous and 10 non-Indigenous service providers from the Regional Municipality of Wood Buffalo (RMWB). Interviews were transcribed verbatim and a constant comparative analysis method was used to identify themes. Following service provider interviews, a supplemental document review was completed to provide background and context for the qualitative findings from interviews. The document review allowed for a better understanding of the health systems response at a systems level following the wildfire. Triangulation of semi-structured interviews and organization report documents confirmed our findings. The conceptual framework by Mirzoev and Kane for understanding health systems responsiveness guided our data interpretation. Our findings were divided into three themes (1) service provision in response to Indigenous mental health concerns (2) gaps in Indigenous health-related services post-wildfire and (3) adopting a health equity lens in post-disaster recovery. The knowledge gained from this research can help inform future emergency management and assist policy and decision makers with culturally safe and responsive recovery planning. Future recovery and response efforts should consider identifying and addressing underlying health, mental health, and emotional concerns in order to be more effective in assisting with healing for Indigenous communities following a public health emergency such as a wildfire disaster.
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Affiliation(s)
| | - T Cameron Wild
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Caillie Pritchard
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Tara Azimi
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Tara McGee
- Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, AB, Canada
| | - Jodi Sperber
- Kee Tas Kee Now Tribal Council, Atikameg, AB, Canada
| | | | - Stephanie Montesanti
- School of Public Health, University of Alberta, Edmonton, AB, Canada.,Centre for Healthy Communities, School of Public Health, University of Alberta, Edmonton, AB, Canada
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Akuze J, Annerstedt KS, Benova L, Chipeta E, Dossou JP, Gross MM, Kidanto H, Marchal B, Alvesson HM, Pembe AB, van Damme W, Waiswa P, Hanson C. Action leveraging evidence to reduce perinatal mortality and morbidity (ALERT): study protocol for a stepped-wedge cluster-randomised trial in Benin, Malawi, Tanzania and Uganda. BMC Health Serv Res 2021; 21:1324. [PMID: 34895216 PMCID: PMC8665312 DOI: 10.1186/s12913-021-07155-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 01/01/2023] Open
Abstract
Background Insufficient reductions in maternal and neonatal deaths and stillbirths in the past decade are a deterrence to achieving the Sustainable Development Goal 3. The majority of deaths occur during the intrapartum and immediate postnatal period. Overcoming the knowledge-do-gap to ensure implementation of known evidence-based interventions during this period has the potential to avert at least 2.5 million deaths in mothers and their offspring annually. This paper describes a study protocol for implementing and evaluating a multi-faceted health care system intervention to strengthen the implementation of evidence-based interventions and responsive care during this crucial period. Methods This is a cluster randomised stepped-wedge trial with a nested realist process evaluation across 16 hospitals in Benin, Malawi, Tanzania and Uganda. The ALERT intervention will include four main components: i) end-user participation through narratives of women, families and midwifery providers to ensure co-design of the intervention; ii) competency-based training; iii) quality improvement supported by data from a clinical perinatal e-registry and iv) empowerment and leadership mentoring of maternity unit leaders complemented by district based bi-annual coordination and accountability meetings. The trial’s primary outcome is in-facility perinatal (stillbirths and early neonatal) mortality, in which we expect a 25% reduction. A perinatal e-registry will be implemented to monitor the trial. Our nested realist process evaluation will help to understand what works, for whom, and under which conditions. We will apply a gender lens to explore constraints to the provision of evidence-based care by health workers providing maternity services. An economic evaluation will assess the scalability and cost-effectiveness of ALERT intervention. Discussion There is evidence that each of the ALERT intervention components improves health providers’ practices and has modest to moderate effects. We aim to test if the innovative packaging, including addressing specific health systems constraints in these settings, will have a synergistic effect and produce more considerable perinatal mortality reductions. Trial registration Pan African Clinical Trial Registry (www.pactr.org): PACTR202006793783148. Registered on 17th June 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07155-z.
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Affiliation(s)
- Joseph Akuze
- Centre of Excellence for Maternal Newborn and Child Health, Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda.,Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Effie Chipeta
- College of Medicine, The Centre for Reproductive Health, University of Malawi, Blantyre, Malawi
| | - Jean-Paul Dossou
- Centre de Recherche en Reproduction Humaine et en Démographie (CERRHUD), Cotonou, Benin
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Hussein Kidanto
- Aga Khan University, Medical College, Dar es Salaam, Tanzania
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Wim van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Peter Waiswa
- Centre of Excellence for Maternal Newborn and Child Health, Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala, Uganda
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden.,Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
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Borghi J, Binyaruka P, Mayumana I, Lange S, Somville V, Maestad O. Long-term effects of payment for performance on maternal and child health outcomes: evidence from Tanzania. BMJ Glob Health 2021; 6:e006409. [PMID: 34916272 PMCID: PMC8679076 DOI: 10.1136/bmjgh-2021-006409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The success of payment for performance (P4P) schemes relies on their ability to generate sustainable changes in the behaviour of healthcare providers. This paper examines short-term and longer-term effects of P4P in Tanzania and the reasons for these changes. METHODS We conducted a controlled before and after study and an embedded process evaluation. Three rounds of facility, patient and household survey data (at baseline, after 13 months and at 36 months) measured programme effects in seven intervention districts and four comparison districts. We used linear difference-in-difference regression analysis to determine programme effects, and differential effects over time. Four rounds of qualitative data examined evolution in programme design, implementation and mechanisms of change. RESULTS Programme effects on the rate of institutional deliveries and antimalarial treatment during antenatal care reduced overtime, with stock out rates of antimalarials increasing over time to baseline levels. P4P led to sustained improvements in kindness during deliveries, with a wider set of improvements in patient experience of care in the longer term. A change in programme management and funding delayed incentive payments affecting performance on some indicators. The verification system became more integrated within routine systems over time, reducing the time burden on managers and health workers. Ongoing financial autonomy and supervision sustained motivational effects in those aspects of care giving not reliant on funding. CONCLUSION Our study adds to limited and mixed evidence documenting how P4P effects evolve over time. Our findings highlight the importance of undertaking ongoing assessment of effects over time.
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Affiliation(s)
- Josephine Borghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Binyaruka
- Ifakara Health Institute, Dar es Salaam, Tanzania, United Republic of
- Chr Michelsen Institute, Bergen, Norway
| | - Iddy Mayumana
- Ifakara Health Institute, Ifakara, Morogoro, Tanzania, United Republic of
| | - Siri Lange
- Chr Michelsen Institute, Bergen, Norway
- Department of Health Promotion and Development, University of Bergen, Bergen, Hordaland, Norway
| | - Vincent Somville
- Chr Michelsen Institute, Bergen, Norway
- NHH Norwegian School of Economics, Bergen, Norway
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Biau S, Bonnet E, Dagenais C, De Allegri M, Traoré Z, Ouedraogo AW, Sow A, Dubois-Nguyen K, Ridde V. Using Information and Communication Technologies to Engage Citizens in Health System Governance in Burkina Faso: Protocol for Action Research. JMIR Res Protoc 2021; 10:e28780. [PMID: 34783671 PMCID: PMC8663653 DOI: 10.2196/28780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/10/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Health systems are complex systems involving a vast range of actors. In West Africa, they are often not accessible or responsive. Burkina Faso has widely expressed, in its public health policy, the need to improve both access to quality care and health system responsiveness. There is also a strong wish to give more voice to citizens. To support Burkinabè institutions in achieving these goals, we have developed an action research (AR) protocol. OBJECTIVE This paper presents the protocol that will address citizens' participation in health policies and their empowerment through the expression of opinions, for accountability, as well as the strengthening of the health system using information and communication technologies (ICTs). METHODS Our approach will consist of (1) enabling people to express their opinions on the health system by means of a toll-free (TF) service coupled with an interactive voice server (IVS); (2) building an information base with anonymous and reliable data; and (3) conducting information awareness-raising activities, including knowledge transfer (KT) and advocacy, social integration activities, development of OpenData platforms, and the capitalization and media coverage of governance issues. For this purpose, the AR project will be implemented in Burkina Faso. The design uses a concurrent mixed-methods approach. This AR project will evaluate the acceptability, process, effectiveness, and economic costs of the device's implementation. We will also analyze the potential for the data collected by the device to be used to improve practices. RESULTS Data collection is in progress; the TF number was officially launched on July 1, 2020, and data collection is planned to continue throughout 2021. By using mixed methods, our AR will be approached from a variety of perspectives. Mixed methods will support us in combining the partial insights into sophisticated realities from qualitative inquiries with the data analyses produced by quantitative research. CONCLUSIONS This AR is expected to add knowledge on how to increase the empowerment of the population, especially the most vulnerable, to participate in democratic processes and enjoy and exercise their human rights. This protocol recommends implementing a low-cost, contextually adapted technology, associated with an evidence-based approach and carried out on a significant scale. The originality of this approach lies in the fact that it introduces a real AR dimension with local communities and nongovernmental organizations (NGOs), combined with an integrated strategy of KT and application throughout the project for all stakeholders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/28780.
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Affiliation(s)
- Sandrine Biau
- Unité de santé internationale, Université de Montréal, Montreal, QC, Canada
- AfricaSys Company, Ouagadougou, Burkina Faso
| | - Emmanuel Bonnet
- UMR 215 PRODIG, Institut de recherche pour le développement, Aubervilliers, France
| | | | - Manuela De Allegri
- Heidelberg Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | | | | | - Abdramane Sow
- Health and Development Working Group, Action-Governance-Integration-Strengthening, Ouagadougou, Burkina Faso
| | | | - Valéry Ridde
- Centre Population et Développement, Institut de recherche pour le développement, institut national de la santé et de la recherche médicale, Université de Paris, Paris, France
- Institut de Santé et Développement, Dakar, Senegal
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50
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Health and immigration systems as an ethnographic field: Methodological lessons from examining immigration enforcement and health in the US. Soc Sci Med 2021; 300:114498. [PMID: 34893355 DOI: 10.1016/j.socscimed.2021.114498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/07/2021] [Accepted: 10/18/2021] [Indexed: 11/22/2022]
Abstract
The complexity of health systems and their social, political, and economic contexts has resulted in a call for multidisciplinary research that can appropriately examine the relationships and interactions surrounding health systems. Anthropologists, who have a disciplinary training that emphasizes social structures and human relationships, are well-suited to conduct health systems research. However, there remains a gap in anthropologically-ground methodological approaches for conducting in-depth, qualitative research that simultaneously conceptualizes and maps out a health system and examines connections between health systems and other social structures, such as immigration enforcement systems. Without such methodological approaches, limitations in examining a health system and its constituent elements will persist, and health and social scientists will miss opportunities to identify links between different factors in a health system and outside the system itself. In this article, I use ethnographic research examining the health-related consequences of immigration enforcement laws and police practices in the United States to show how to examine relationships between multiple social systems. In doing so, I provide an example for how to conduct in-depth, qualitative health systems research by merging theoretical frameworks in health sciences and anthropology to demonstrate how medical anthropologists can conceptualize a health system as a social field for ethnographic inquiry. Overall, I argue that such an approach permits anthropologists a way to conduct rigorous health systems research that emphasizes relationships and reveals potentially hidden interactions.
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