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Mpirirwe R, Mujugira A, Walusaga H, Ayebare F, Musanje K, Ndugga P, Muhumuza C, Nangendo J, Semitala FC, Kyambadde P, Kalyango J, Kiragga A, Karamagi C, Kamya MR, Armstrong-Hough M, Katahoire AR. Perspectives of female sex workers on HIV pre-exposure prophylaxis delivery in Uganda: A qualitative study. RESEARCH SQUARE 2024:rs.3.rs-4115528. [PMID: 38562811 PMCID: PMC10984088 DOI: 10.21203/rs.3.rs-4115528/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background HIV pre-exposure prophylaxis (PrEP) is underutilized by cisgender female sex workers (FSW) despite its proven effectiveness. This study aimed to understand the experiences of FSW with PrEP services in Uganda to inform HIV programming for this key population. Methods We conducted qualitative interviews with 19 FSW between June and July 2022 at the Most at Risk Populations Initiative clinic, Mulago Hospital, Kampala, to explore experiences with accessing PrEP Indepth interviews explored: (1) descriptions of where and how PrEP was obtained; (2) perspectives on current approaches for accessing PrEP; and (3) individual encounters with PrEP services. Data were analyzed through inductive thematic analysis. Results Three key themes emerged for FSW perspectives on PrEP service delivery. FSW highlighted the positive impact of a welcoming clinic environment, which motivated FSW to initiate PrEP and fostered a sense of connectedness within their community. They also reported feeling accepted, secure, and free from prejudice when accessing PrEP through facility-based services. The second explores the obstacles faced by FSW, such as lengthy wait times at clinics, inadequate provider support, and lack of sensitivity training which hindered their access to PrEP The third sheds light on how HIV-related stigma negatively impacted the delivery of community-based PrEP for FSW. While community-based distribution offered convenience and helped mitigate stigma, clinic-based care provided greater anonymity and was perceived as offering higher-quality care. Overall, FSWs emphasized the critical role of friendly healthcare providers, social support, and non-stigmatizing environments in promoting successful utilization of PrEP. Conclusion The study findings offer insights that can support HIV programs in optimizing PrEP delivery for FSW. Establishing easily accessible drug pick-up locations, prioritizing privacy, addressing and improving health workers' attitudes, and providing regular reminders could enhance PrEP access for FSW and decrease HIV acquisition.
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Link A, Tshimanga M, Cochrane B, Kasprzyk D. High satisfaction among patients at HIV clinics in Harare, Zimbabwe: a time and motion evaluation and patient satisfaction study. Int J Qual Health Care 2023; 35:mzad030. [PMID: 37294882 PMCID: PMC10256183 DOI: 10.1093/intqhc/mzad030] [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: 11/18/2022] [Revised: 03/24/2023] [Accepted: 05/11/2023] [Indexed: 06/11/2023] Open
Abstract
Patient satisfaction is an important component of health and healthcare utilization, which measures the perceived needs and expectations for healthcare services. Patient satisfaction surveys are effective in improving health outcomes by informing health facilities on service and provider gaps and guiding the development of effective action plans and policies for quality improvement within a healthcare organization. Although patient satisfaction and patient flow analyses have been conducted in Zimbabwe, the combination of these two quality improvement measures in the context of Human Immunodeficiency Virus (HIV) clinics has not previously been evaluated. This study assessed and evaluated patient flow and patient satisfaction to enhance care quality and improve HIV service delivery to optimize patient health. We collected time and motion data from HIV patients who attended three purposively selected City of Harare Polyclinics in Harare, Zimbabwe. All patients who sought care at the clinic were given time and motion forms to track their movement and the time spent at each service area. After services were completed, patients were invited to participate in a satisfaction survey regarding their services and care. The average waiting time from clinic arrival to see the provider was 2 hr and 14 min. The areas with the longest waiting time and bottlenecks occurred at registration (49 min) and the HIV clinic waiting area (44 min). Despite these extended times, the overall patient satisfaction for HIV services was high at 72%, with over half (59%) reporting that there was nothing they did not like about their services. Patients were most satisfied with services provided (34%), timely service (27%), and antiretroviral medications (19%). The areas of least satisfaction were related to time delays (24%) and cashier delays (6%). Despite prolonged waiting times, patients' overall satisfaction with their clinic experience remains high. Perceptions of satisfaction are influenced by experience, culture, and context. However, there are still several areas of recommendations to improve service, care, and quality. Specifically, reducing or eliminating service fees, increasing clinic hour times, and having available medication were most cited. Support from the Zimbabwe Ministry of Health and Child Care, City of Harare, and other decision-makers is needed to improve patient satisfaction and address patients' recommendations within the City of Harare Polyclinic organization in accordance with the 2016-20 National Health Strategies for Zimbabwe.
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Affiliation(s)
- Abigail Link
- School of Nursing, University of Washington, Box 357260, Seattle, WA 98195, United States
- Department of Medicine, Division of Infectious Diseases, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, United States
| | - Mufuta Tshimanga
- Department of Community Medicine, University of Zimbabwe, P.O.Box MP167 Mt Pleasant, Harare, Zimbabwe
| | - Barbara Cochrane
- School of Nursing, University of Washington, Box 357260, Seattle, WA 98195, United States
| | - Danuta Kasprzyk
- School of Nursing, University of Washington, Box 357260, Seattle, WA 98195, United States
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Kibirige D, Chamba N, Andia-Biraro I, Kilonzo K, Laizer SN, Sekitoleko I, Kyazze AP, Ninsiima S, Ssekamatte P, Bongomin F, Mrema LE, Olomi W, Mbunda TD, Ntinginya NE, Sabi I, Sharples K, Hill P, Te Brake L, VandeMaat J, vanCrevel R, Critchley JA. Indicators of optimal diabetes care and burden of diabetes complications in Africa: a systematic review and meta-analysis. BMJ Open 2022; 12:e060786. [PMID: 36351737 PMCID: PMC9644326 DOI: 10.1136/bmjopen-2022-060786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Contemporary data on the attainment of optimal diabetes treatment goals and the burden of diabetes complications in adult populations with type 2 diabetes in Africa are lacking. We aimed to document the current status of attainment of three key indicators of optimal diabetes care and the prevalence of five diabetes complications in adult African populations with type 2 diabetes. METHODS We systematically searched Embase, PubMed and the Cochrane library for published studies from January 2000 to December 2020. Included studies reported any information on the proportion of attainment of optimal glycated haemoglobin (HbA1c), blood pressure (BP) and low-density lipoprotein cholesterol (LDLC) goals and/or prevalence of five diabetes complications (diabetic peripheral neuropathy, retinopathy, nephropathy, foot ulcers and peripheral arterial disease). Random effect model meta-analysis was performed to determine the pooled proportion of attainment of the three treatment goals and the prevalence of five diabetes complications. RESULTS In total, 109 studies with a total of 63 890 participants (53.3% being females) were included in the meta-analysis. Most of the studies were conducted in Eastern African countries (n=44, 40.4%). The pooled proportion of attainment of an optimal HbA1c, BP and LDLC goal was 27% (95% CI 24 to 30, I2=94.7%), 38% (95% CI 30 to 46, I2=98.7%) and 42% (95% CI 32 to 52, I2=97.4%), respectively. The pooled prevalence of diabetic peripheral neuropathy, retinopathy, diabetic nephropathy, peripheral arterial disease and foot ulcers was 38% (95% CI 31 to 45, I2=98.2%), 32% (95% CI 28 to 36, I2=98%), 31% (95% CI 22 to 41, I2=99.3%), 19% (95% CI 12 to 25, I2=98.1%) and 11% (95% CI 9 to 14, I2=97.4%), respectively. CONCLUSION Attainment of optimal diabetes treatment goals, especially HbA1c, in adult patients with type 2 diabetes in Africa remains a challenge. Diabetes complications, especially diabetic peripheral neuropathy and retinopathy, are highly prevalent in adult populations with type 2 diabetes in Africa.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Lubaga Hospital, Kampala, Uganda
| | - Nyasatu Chamba
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Irene Andia-Biraro
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Immunomudation and Vaccines, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kajiru Kilonzo
- Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Sweetness Naftal Laizer
- Department of Medicine, Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Isaac Sekitoleko
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Andrew Peter Kyazze
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sandra Ninsiima
- Department of Immunology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Phillip Ssekamatte
- Department of Immunology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Lucy Elauteri Mrema
- Department of Medicine, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
| | - Willyhelmina Olomi
- Department of Medical Statistics, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
| | - Theodora D Mbunda
- Department of Medicine, NIMR-Mbeya Medical Research Programme, Mbeya, Mbeya, Tanzania
| | | | - Issa Sabi
- Department of Paediatrics and Child Health, NIMR-Mbeya Medical Research Programme, Mbeya, Tanzania
| | - Katrina Sharples
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Philip Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Lindsey Te Brake
- Department of Pharmacology, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Josephine VandeMaat
- Department of Medicine, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
| | - Reinout vanCrevel
- Department of Internal Medicine, Radboud University Nijmegen, Nijmegen, Gelderland, The Netherlands
- University of Oxford Centre for Tropical Medicine and Global Health, Oxford, Oxfordshire, UK
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Worku AG, Tilahun HA, Belay H, Mohammedsanni A, Wendrad N, Abate B, Mohammed M, Ahmed M, Wondarad Y, Abebaw M, Denboba W, Mulugeta F, Oumer S, Biru A. Maternal Service Coverage and Its Relationship To Health Information System Performance: A Linked Facility and Population-Based Survey in Ethiopia. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00688. [PMID: 36109058 PMCID: PMC9476483 DOI: 10.9745/ghsp-d-21-00688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
Abstract
Coverage for most maternal services showed promising performance. Improving the health information system performance can further improve maternal service uptake and quality. Background: Studies in Ethiopia show an increasing trend in maternal health service use, such as having at least 4 visits of antenatal care (ANC4+) and skilled birth attendance (SBA). Improving the health information system (HIS) is an intervention that can improve service uptake and quality. We conducted a baseline study to measure current maternal service coverage, HIS performance status, and their relationship. Methods: We conducted a linked health facility-level and population-based survey from September 2020 to October 2020. The study covers all regions of Ethiopia. For the population-based survey, 3,016 mothers were included. Overall, 81 health posts, 71 health centers, and 15 hospitals were selected for the facility survey. A two-stage sampling procedure was applied to select target households. The study used modified Performance of Routine Information System Management tools for the facility survey and a structured questionnaire for the household survey. Multilevel logistic regression was employed to account for clustering and control for likely confounders. Results: Maternal service indicators, ANC4+ visits (54.0%), SBA (75.8%), postnatal care (70.6%), and cesarean delivery (9%) showed good service uptake. All data quality and use indicators showed lower performance compared to the national target of 90%. Maternal education and higher levels of wealth index were significantly and positively associated with all selected maternal service indicators. Longer distance from health facilities was significantly and negatively associated with SBA and the maternal care composite indicator. Among HIS-related indicators, availability of electronic HIS tools was significantly associated with maternal care composite indicator and ANC4+. Conclusions: Maternal service indicators showed promising performance. However, current HIS performance is suboptimal. Both service user and HIS-related factors were associated with maternal service uptake. Conducting similar research outside of the project sites will be helpful to have a wider understanding and better coverage.
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Affiliation(s)
- Abebaw Gebeyehu Worku
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia.
| | - Hibret Alemu Tilahun
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Hiwot Belay
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Afrah Mohammedsanni
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Naod Wendrad
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | - Biruk Abate
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | | | | | | | - Wubshet Denboba
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Frehiwot Mulugeta
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Shemsedin Oumer
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
| | - Amanuel Biru
- JSI Research and Training Institute, Inc., Ethiopia Data Use Partnership, Addis Ababa, Ethiopia
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Mbwogge M, Astbury N, Nkumbe HE, Bunce C, Bascaran C. Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital Using a Mobile Data Collection Kit: Pre-Post Quality Improvement Intervention. JMIRX MED 2022; 3:e34263. [PMID: 37725529 PMCID: PMC10414230 DOI: 10.2196/34263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 04/04/2022] [Accepted: 06/09/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND Waiting time can considerably increase the cost to both the clinic and the patient and be a major predictor of the satisfaction of eye care users. Efficient management of waiting time remains as a challenge in hospitals. Waiting time management will become even more crucial in the postpandemic era. A key consideration when improving waiting time is the involvement of eye care users. This study aimed at improving patient waiting time and satisfaction through the use of Plan-Do-Study-Act (PDSA) quality improvement cycles. OBJECTIVE The objectives of this study were to determine the waiting time and patient satisfaction, measure the association between waiting time and patient satisfaction, and determine the effectiveness of the PDSA model in improving waiting time and satisfaction. METHODS This was a pre-post quality improvement study among patients aged 19 to 80 years, who are consulting with the Magrabi International Council of Ophthalmology Cameroon Eye Institute. We used PDSA cycles to conduct improvement audits of waiting time and satisfaction over 6 weeks. A data collection app known as Open Data Kit (Get ODK Inc) was used for real-time tracking of waiting, service, and idling times at each service point. Participants were also asked whether they were satisfied with the waiting time at the point of exit. Data from 51% (25/49) preintervention participants and 49% (24/49) postintervention participants were analyzed using Stata 14 at .05 significance level. An unpaired 2-tailed t test was used to assess the statistical significance of the observed differences in times before and after the intervention. Logistic regression was used to examine the association between satisfaction and waiting time. RESULTS In total, 49 participants were recruited with mean age of 49 (SD 15.7) years. The preintervention mean waiting, service, and idling times were 450 (SD 96.6), 112 (SD 47), and 338 (SD 98.1) minutes, respectively. There was no significant association between patient waiting time and satisfaction (odds ratio 1, 95% CI 0.99-1; P=.37; χ23=0.4). The use of PDSA led to 15% (66 minutes/450 minutes) improvement in waiting time (t47=2; P=.05) and nonsignificant increase in patient satisfaction from 32% (8/25) to 33% (8/24; z=0.1; P=.92). CONCLUSIONS Use of PDSA led to a borderline statistically significant reduction of 66 minutes in waiting time over 6 weeks and an insignificant improvement in satisfaction, suggesting that quality improvement efforts at the clinic have to be made over a considerable period to be able to produce significant changes. The study provides a good basis for standardizing the cycle (consultation) time at the clinic. We recommend shortening the patient pathway and implementing other measures including a phasic appointment system, automated patient time monitoring, robust ticketing, patient pathway supervision, standard triaging, task shifting, physician consultation planning, patient education, and additional registration staff.
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Affiliation(s)
- Mathew Mbwogge
- International Center for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nicholas Astbury
- International Center for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Catey Bunce
- Research Data & Statistics Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Covadonga Bascaran
- International Center for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Karat AS, McCreesh N, Baisley K, Govender I, Kallon II, Kielmann K, MacGregor H, Vassall A, Yates TA, Grant AD. Estimating waiting times, patient flow, and waiting room occupancy density as part of tuberculosis infection prevention and control research in South African primary health care clinics. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000684. [PMID: 36962412 PMCID: PMC10021248 DOI: 10.1371/journal.pgph.0000684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 06/13/2022] [Indexed: 01/13/2023]
Abstract
Transmission of respiratory pathogens, such as Mycobacterium tuberculosis and severe acute respiratory syndrome coronavirus 2, is more likely during close, prolonged contact and when sharing a poorly ventilated space. Reducing overcrowding of health facilities is a recognised infection prevention and control (IPC) strategy; reliable estimates of waiting times and 'patient flow' would help guide implementation. As part of the Umoya omuhle study, we aimed to estimate clinic visit duration, time spent indoors versus outdoors, and occupancy density of waiting rooms in clinics in KwaZulu-Natal (KZN) and Western Cape (WC), South Africa. We used unique barcodes to track attendees' movements in 11 clinics, multiple imputation to estimate missing arrival and departure times, and mixed-effects linear regression to examine associations with visit duration. 2,903 attendees were included. Median visit duration was 2 hours 36 minutes (interquartile range [IQR] 01:36-3:43). Longer mean visit times were associated with being female (13.5 minutes longer than males; p<0.001) and attending with a baby (18.8 minutes longer than those without; p<0.01), and shorter mean times with later arrival (14.9 minutes shorter per hour after 0700; p<0.001). Overall, attendees spent more of their time indoors (median 95.6% [IQR 46-100]) than outdoors (2.5% [IQR 0-35]). Attendees at clinics with outdoor waiting areas spent a greater proportion (median 13.7% [IQR 1-75]) of their time outdoors. In two clinics in KZN (no appointment system), occupancy densities of ~2.0 persons/m2 were observed in smaller waiting rooms during busy periods. In one clinic in WC (appointment system, larger waiting areas), occupancy density did not exceed 1.0 persons/m2 despite higher overall attendance. In this study, longer waiting times were associated with early arrival, being female, and attending with a young child. Occupancy of waiting rooms varied substantially between rooms and over the clinic day. Light-touch estimation of occupancy density may help guide interventions to improve patient flow.
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Affiliation(s)
- Aaron S Karat
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- The Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Nicky McCreesh
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kathy Baisley
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Indira Govender
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Idriss I Kallon
- Division of Social and Behavioural Sciences, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karina Kielmann
- The Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Hayley MacGregor
- The Institute of Development Studies, University of Sussex, Brighton, United Kingdom
| | - Anna Vassall
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Tom A Yates
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Alison D Grant
- TB Centre, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Africa Health Research Institute, School of Laboratory Medicine & Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Prakash R, Dehury B, Yadav C, Tripathi AB, Sodhi C, Bilal H, Vasanthakumar N, Isac S, Ramesh BM, Blanchard J, Boerma T. Establishing evidence-based decision-making mechanism in a health eco-system and its linkages with health service coverage in 25 high-priority districts of Uttar Pradesh, India. BMC Health Serv Res 2021; 21:196. [PMID: 34511088 PMCID: PMC8436494 DOI: 10.1186/s12913-021-06172-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Achievement of successful health outcomes depends on evidence-based programming and implementation of effective health interventions. Routine Health Management Information System is one of the most valuable data sets to support evidence-based programming, however, evidence on systemic use of routine monitoring data for problem-solving and improving health outcomes remain negligible. We attempt to understand the effects of systematic evidence-based review mechanism on improving health outcomes in Uttar Pradesh, India. Methods Data comes from decision-tracking system and routine health management information system for period Nov-2017 to Mar-2019 covering 6963 health facilities across 25 high-priority districts of the state. Decision-tracking data captured pattern of decisions taken, actions planned and completed, while the latter one provided information on service coverage outcomes over time. Three service coverage indicators, namely, pregnant women receiving 4 or more times ANC and haemoglobin testing during pregnancy, delivered at the health facility, and receive post-partum care within 48 h of delivery were used as outcomes. Univariate and bivariate analyses were conducted. Results Total 412 decisions were taken during the study reference period and a majority were related to ante-natal care services (31%) followed by delivery (16%) and post-natal services (16%). About 21% decisions-taken were focused on improving data quality. By 1 year, 67% of actions planned based on these decisions were completed, 26% were in progress, and the remaining 7% were not completed. We found that, over a year, districts witnessing > 20 percentage-point increase in outcomes were also the districts with significantly higher action completion rates (> 80%) compared to the districts with < 10 percentage-point increase in outcomes having completion of action plans around 50–70%. Conclusions Findings revealed a significantly higher improvement in coverage outcomes among the districts which used routine health management data to conduct monthly review meetings and had high actions completion rates. A data-based review-mechanisms could specifically identify programmatic gaps in service delivery leading to strategic decision making by district authorities to bridge the programmatic gaps. Going forward, establishing systematic evidence-based review platforms can be an important strategy to improve health outcomes and promote the use of routine health monitoring system data in any setting. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06172-2.
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Affiliation(s)
- Ravi Prakash
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada. .,India Health Action Trust (IHAT), Lucknow, India.
| | | | - Charu Yadav
- India Health Action Trust (IHAT), Lucknow, India
| | | | - Chhavi Sodhi
- India Health Action Trust (IHAT), Lucknow, India
| | | | - N Vasanthakumar
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada
| | - Shajy Isac
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada.,India Health Action Trust (IHAT), Lucknow, India
| | - B M Ramesh
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada
| | - James Blanchard
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada
| | - Ties Boerma
- Department of Community Health Sciences, Institute of Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Manitoba, R3E 0T6, Winnipeg, Canada
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Fetene N, Canavan ME, Megentta A, Linnander E, Tan AX, Nadew K, Bradley EH. District-level health management and health system performance. PLoS One 2019; 14:e0210624. [PMID: 30707704 PMCID: PMC6358064 DOI: 10.1371/journal.pone.0210624] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 12/28/2018] [Indexed: 11/21/2022] Open
Abstract
Strengthening district-level management may be an important lever for improving key public health outcomes in low-income settings; however, previous studies have not established the statistical associations between better management and primary healthcare system performance in such settings. To explore this gap, we conducted a cross-sectional study of 36 rural districts and 226 health centers in Ethiopia, a country which has made ambitious investment in expanding access to primary care over the last decade. We employed quantitative measure of management capacity at both the district health office and health center levels and used multiple regression models, accounting for clustering of health centers within districts, to estimate the statistical association between management capacity and a key performance indicator (KPI) summary score based on antenatal care coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. In districts with above median district management capacity, health center management capacity was strongly associated (p < 0.05) with KPI performance. In districts with below median management capacity, health center management capacity was not associated with KPI performance. Having more staff at the district health office was also associated with better KPI performance (p < 0.05) but only in districts with above median management capacity. The results suggest that district-level management may provide an opportunity for improving health system performance in low-income country settings.
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Affiliation(s)
- Netsanet Fetene
- Yale Global Health Leadership Initiative, New Haven, Connecticut, United States of America
| | - Maureen E. Canavan
- Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Abraham Megentta
- Yale Global Health Leadership Initiative, New Haven, Connecticut, United States of America
| | - Erika Linnander
- Yale Global Health Leadership Initiative, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
- * E-mail:
| | - Annabel X. Tan
- Yale Global Health Leadership Initiative, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Kidest Nadew
- Yale Global Health Leadership Initiative, New Haven, Connecticut, United States of America
- Yale School of Public Health, New Haven, Connecticut, United States of America
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