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Kruk ME, Sabwa S, Lewis TP, Aniebo I, Arsenault C, Carai S, Garcia PJ, Garcia-Elorrio E, Fink G, Kassa M, Mohan S, Moshabela M, Oh J, Pate MA, Nzinga J. Population assessment of health system performance in 16 countries. Bull World Health Organ 2024; 102:486-497B. [PMID: 38933481 PMCID: PMC11197641 DOI: 10.2471/blt.23.291184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 06/28/2024] Open
Abstract
Objective To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income. Methods We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality. Findings In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators. Conclusion Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments.
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Affiliation(s)
- Margaret E Kruk
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Shalom Sabwa
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Todd P Lewis
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Ifeyinwa Aniebo
- Ministry of Health and Social Welfare of Nigeria, Abuja, Nigeria
| | - Catherine Arsenault
- Milken Institute School of Public Health, George Washington University, WashingtonDC, USA
| | - Susanne Carai
- WHO Office on Quality of Care and Patient Safety, Athens, Greece
| | | | | | - Günther Fink
- University of Basel and Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | - Mosa Moshabela
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, Republic of Korea
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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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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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Oluoch D, Molyneux S, Boga M, Maluni J, Murila F, Jones C, Ziebland S, English M, Hinton L. Not just surveys and indicators: narratives capture what really matters for health system strengthening. Lancet Glob Health 2023; 11:e1459-e1463. [PMID: 37591592 DOI: 10.1016/s2214-109x(23)00281-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 08/19/2023]
Abstract
Health system strengthening remains elusive and challenging. Health systems in many countries in sub-Saharan Africa are frequently characterised as weak, with inadequate management and accountability mechanisms, and poor human and financial resources. Putting patients and staff at the heart of health systems is an essential step towards strengthening them. As one of the three pillars of quality in health care, understanding patient experiences is key to moving towards people-centred care. Yet patient experiences are not a singular concept. Patient narratives can convey individual experiences of illness and health care, which complement and augment epidemiological and public health evidence. These narratives, gathered with rigorous, interview-based research and shared with digital tools (audio and video), can generate persuasive evidence. This evidence has important potential for influencing policy and practice, and for supporting people-centred care, but has not been tested systematically in low-income countries. In the Kenyan context of newborn health, work under way is generating evidence to show the transformative potential of patient narratives.
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Affiliation(s)
| | | | | | | | - Florence Murila
- Department of Paediatrics and Child Health, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | | | - Sue Ziebland
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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Girma G, Tamire A, Edessa GJ, Dechasa M, Tefasa OK, Negash A, Dereje J, Masrie A, Shawel S, Mandefro M, Abraham G. Process Evaluation of Health System Responsiveness Level and Associated Factors Among Mothers Gave Birth at Obstetric Ward in a Tertiary Hospital, Southwest of Ethiopia: Mixed Study Methods. J Multidiscip Healthc 2023; 16:2291-2308. [PMID: 37601330 PMCID: PMC10439284 DOI: 10.2147/jmdh.s397735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Abstract
Background The term responsiveness emerged during the World Health Organization (WHO) report in 2000 as new and essential goals of the health systems to meet the needs of people to their expectations from different services being given in healthcare systems. Obstetric violence and childbirth mistreatment are global problems, but the worst obstetric violence usually occurs in underdeveloped countries. Thus, the main objective of this study was to evaluate the responsiveness of obstetric service at Jimma University Medical Center. Methods A single-case study design with quantitative and qualitative data collection was employed. Availability with 17 indicators and health system responsiveness with 24 indicators were used. Consecutive sampling technique was used to select the clients and qualitative data were collected from key informants. SPSS version 25 was used for the analysis of quantitative data, whereas thematic analysis was conducted for qualitative data. A multiple linear regression model was fitted after all assumptions were checked and fit to ensure the relation of the dependent variable with independent variables. Results The overall evaluation was 75.6% and judged good. The resource availability and health system responsiveness were 85.5% and 69.7%, which were judged very good and fair, respectively. A stethoscope and thermometer were not available, while 40% glucose, dexamethasone, and intravenous fluid were the most frequently stocked-out supplies. Dignity (72.1%), confidentiality (71.4%), and prompt attention (70%) were the top three good scores for the health system's responsiveness. Health system responsiveness significantly associated with the following: Not attending formal education, attending college and above, place of delivery (health center), mode of delivery (cesarean section), and being merchant. Conclusion & Recommendation The health system responsiveness of delivery service in study setting was good. All stakeholders should work for improving the health system's responsiveness in delivery service.
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Affiliation(s)
- Gezu Girma
- Department of Health Research, International Center for AIDS Care and Treatment Program (ICAP), Finfine, Ethiopia
| | - Aklilu Tamire
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Harari, Ethiopia
| | - Gebeyehu Jeldu Edessa
- Department of Health Policy and Management, Public Health Faculty, Institute of Health Jimma University, Jimma, Oromia, Ethiopia
| | - Mesay Dechasa
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Obsan Kassa Tefasa
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Harari, Ethiopia
| | - Abraham Negash
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Jerman Dereje
- Department of Psychiatry, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Awoke Masrie
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Harari, Ethiopia
| | - Samrawit Shawel
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Harari, Ethiopia
| | - Miheret Mandefro
- School of Public Health, College of Health and Medical Science, Haramaya University, Harar, Harari, Ethiopia
| | - Gelila Abraham
- Department of Health Policy and Management, Public Health Faculty, Institute of Health Jimma University, Jimma, Oromia, Ethiopia
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Sejie GA, Mahomed OH. Potential facilitators and inhibitors to the implementation and sustainability of the community-based tuberculosis care interventions. A case study from Moshupa, Botswana. PLoS One 2023; 18:e0290010. [PMID: 37561753 PMCID: PMC10414663 DOI: 10.1371/journal.pone.0290010] [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: 12/07/2022] [Accepted: 07/31/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Eliminating Tuberculosis is one of the targets of Sustainable Development Goal Three. Decentralizing TB care beyond health facilities by leveraging community involvement is crucial for safeguarding effective tuberculosis care. In this study, we explored potential facilitators and inhibitors of the implementation and sustainability of community-based interventions for the prevention and treatment of TB in the Moshupa district, Botswana. METHODS This study adopted a qualitative approach using a collective case design. An interpretive paradigm based on relativist ontology and subjectivist epistemology along with abductive research logic was used. The study enrolled treatment supporters of tuberculosis patients diagnosed with drug-susceptible tuberculosis between January 2019 and December 2019 in Moshupa Village for semi-structured interviews, Health care professionals for in-depth interviews, and e community leaders for focus group discussions. Clinic-based observations in Mma-Seetsele clinic were also conducted to corroborate the participants' views. The data collected was analyzed using the NVivo version 12 software package, and statements of the participants were presented as quotes to substantiate the issues discussed. RESULTS This study highlighted effective partnerships between health services and external stakeholders, community empowerment, and the availability of policies and standard operating procedures as facilitators of community TB implementation and sustainability. However, Insufficient funding, low service provider training, policies not embracing age and educational eligibility for treatment supporters, shortage of equipment, medicines, and supplies, inadequate transport availability and incentives to meet clients' basic needs, paper-based systems, inadequate supervision, incomplete data reporting, and low service quality affected the Community TB program efficacy and sustainability in Moshupa. We also found that there was low service provider motivation and retention and that clients had low trust in treatment supporters. CONCLUSION The findings of this study imply that the operational effectiveness of the community TB care approach to disease elimination is compromised; therefore, initiatives addressing the key components, including the availability of resources, governance arrangements and supportive systems for community health workers, are required for successful community TB implementation and sustainability.
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Affiliation(s)
- Gabalape Arnold Sejie
- Discipline of Public Health Medicine, University of KwaZulu, Natal, Durban, South Africa
- Department of Health Promotion and Education, Boitekanelo College, Gaborone, Botswana
| | - Ozayr H. Mahomed
- Discipline of Public Health Medicine, University of KwaZulu, Natal, Durban, South Africa
- Dasman Diabetes Institute, Kuwait City, Kuwait
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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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Tremblay D, Beaupère S, Biaudet J, Castel P, Fervers B, Galvez C, Sontag P, Usher S, Wilhelmy C. Resilience at Work among Healthcare Professionals in Oncology during and beyond the Pandemic: Report from A Deliberative Multi-Stakeholder Reflexive Symposium. Curr Oncol 2023; 30:6986-6995. [PMID: 37504366 PMCID: PMC10377963 DOI: 10.3390/curroncol30070506] [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: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
The chronic distress faced by healthcare professionals (HCPs) in oncology was exacerbated by the COVID-19 pandemic, heightening the need to improve their resilience. The Entretiens Jacques Cartier symposium provided an opportunity for participants from France and Quebec to share perspectives on resilience at work and discuss interventions at individual and organizational levels to support HCP health and well-being. Fifty-eight stakeholders were invited to the symposium, including HCPs, government decision-makers, researchers, and patient representatives. The symposium began with presentations on the nature of professional resilience at work in oncology and promising interventions developed in France and Quebec. Participants were then engaged in deliberation on how evidence and experiential knowledge could contribute to workplace strategies to strengthen resilience. Small-group reflexive sessions using the photovoice method, and an intersectoral roundtable, elicited the expression and deliberation of multiple perspectives on the nature and building blocks of resilience. Four main themes emerged from the discussions: (1) that resilience remains a muddy concept and can be associated pejoratively with "happycracy"; (2) that resilience must contend with bounded autonomy and captors; (3) that it relies on a sense of coherence at work; and (4) that patients play a role in improving HCP resilience. Stakeholders from healthcare systems in different countries view resilience at work as a means of equipping teams to handle chronic and punctual stresses in cancer care. The symposium emphasized the importance of better defining what resilience at work means and pursuing explorations of multicomponent interventions to support oncology HCPs and the patients they care for. The themes raised by participants at the symposium suggest pathways for furthering this exploration.
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Affiliation(s)
- Dominique Tremblay
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC J4K 0A8, Canada
- Centre de Recherche Charles-Le Moyne, Longueuil, QC J4K 0A8, Canada
| | | | - Julien Biaudet
- Cancéropôle Lyon Auvergne Rhône-Alpes, 69007 Lyon, France
| | - Patrick Castel
- Sciences Po, Centre de Sociologie des Organisations (CSO), CNRS, 75007 Paris, France
| | - Béatrice Fervers
- Département Prévention Cancer Environnement, Centre Léon Bérard, 69008 Lyon, France
| | | | | | - Susan Usher
- Commissaire à la Santé et au Bien-Être, Quebec, QC G1S 2L2, Canada
| | - Catherine Wilhelmy
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada
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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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Pai M, Yellapurkar S, Shodhan Shetty A. Infodemic in Public health a reemerging public health threat: a scoping review. F1000Res 2023; 12:632. [PMID: 37663199 PMCID: PMC10474339 DOI: 10.12688/f1000research.130687.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 09/05/2023] Open
Abstract
BACKGROUND Infodemic is a neologism of 'information' and 'epidemic' coined in the year 2003. Evidence mapping is a technique to appraise the literature which enables the extent of research activity in a specific area to be discovered. The main objective of this evidence synthesis presents the outcomes of an evidence map that was directed to know the extent of Infodemics and its effects on public health. Methods: The following methods were used to construct this evidence synthesis: Phase I. Construct a Broad Question Referring to the Field of Analysis. Phase II; Defining Key Variables to Be Mapped, identifying the characters of each variable and Outline Inclusion and Exclusion Criteria for the variables. Phase III: Literature search. Phase IV: Screening and Charting the Appropriate Evidence within the Synthesis. Results: Authors identified 55 records through database searching, after screening for duplicates, 53 records screened at title/abstract level of which, 16 records were removed because of lack of complete article or articles were not in English. 37 articles were eligible for full text screening, 37 full-text articles were than assessed for eligibility and only 22 articles were included as per inclusion criteria with an interrater Outcome Kappa value: 0.91. The strength of agreement was considered to be 'excellent'. Conclusions: This synthesis focused majorly on the gaps in the research focused on infodemic. The two main gaps identified were lack of systematically conducted research and poor digital health literacy. As infodemic is a new phenomenon with respect to the COVID-19 pandemic it was an eye opener at different levels of public health, furthermore this evidence map points out areas for further research on the impact of infodemic.
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Affiliation(s)
- Mithun Pai
- PUBLIC HEALTH DENTISTRY, MANIPAL COLLEGE OF DENTAL SCIENCES, MANIPAL ACADEMY OF HIGHER EDUCATION (MAHE) MANIPAL, MANGALORE, KARNATAKA, 575001, India
| | - Shweta Yellapurkar
- ORAL PATHOLOGY AND MICROBIOLOGY, MANIPAL COLLEGE OF DENTAL SCIENCES, MANIPAL ACADEMY OF HIGHER EDUCATION (MAHE) MANIPAL, MANGALORE, KARNATAKA, 575001, India
| | - Aishwarya Shodhan Shetty
- PUBLIC HEALTH DENTISTRY, MANIPAL COLLEGE OF DENTAL SCIENCES, MANIPAL ACADEMY OF HIGHER EDUCATION (MAHE) MANIPAL, MANGALORE, KARNATAKA, 575001, India
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Akter K, Kuddus A, Jeny T, Nahar T, Shaha S, Ahmed N, King C, Pires M, Haghparast-Bidgoli H, Azad K, Fottrell E, Morrison J. Stakeholder perceptions on scaling-up community-led interventions for prevention and control of non-communicable diseases in Bangladesh: a qualitative study. BMC Public Health 2023; 23:719. [PMID: 37081438 PMCID: PMC10116471 DOI: 10.1186/s12889-023-15551-9] [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: 12/14/2022] [Accepted: 03/28/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Engaging communities is an important component of multisectoral action to address the growing burden of non-communicable diseases (NCDs) in low- and middle-income countries. We conducted research with non-communicable disease stakeholders in Bangladesh to understand how a community-led intervention which was shown to reduce the incidence of type 2 diabetes in rural Bangladesh could be scaled-up. METHODS We purposively sampled any actor who could have an interest in the intervention, or that could affect or be affected by the intervention. We interviewed central level stakeholders from donor agencies, national health policy levels, public, non-governmental, and research sectors to identify scale-up mechanisms. We interviewed community health workers, policy makers, and non-governmental stakeholders, to explore the feasibility and acceptability of implementing the suggested mechanisms. We discussed scale-up options in focus groups with community members who had attended a community-led intervention. We iteratively developed our data collection tools based on our analysis and re-interviewed some participants. We analysed the data deductively using a stakeholder analysis framework, and inductively from codes identified in the data. RESULTS Despite interest in addressing NCDs, there was a lack of a clear community engagement strategy at the government level, and most interventions have been implemented by non-governmental organisations. Many felt the Ministry of Health and Family Welfare should lead on community engagement, and NCD screening and referral has been added to the responsibilities of community health workers and health volunteers. Yet there remains a focus on reproductive health and NCD diagnosis and referral instead of prevention at the community level. There is potential to engage health volunteers in community-led interventions, but their present focus on engaging women for reproductive health does not fit with community needs for NCD prevention. CONCLUSIONS Research highlighted the need for a preventative community engagement strategy to address NCDs, and the potential to utilise existing cadres to scale-up community-led interventions. It will be important to work with key stakeholders to address gender issues and ensure flexibility and responsiveness to community concerns. We indicate areas for further implementation research to develop scaled-up models of community-led interventions to address NCDs.
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Affiliation(s)
- Kohenour Akter
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Abdul Kuddus
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Tasnova Jeny
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Tasmin Nahar
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Sanjit Shaha
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Naveed Ahmed
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Carina King
- Karolinska Institutet, K9 Global Folkhälsa, K9 GPH Stålsby Lundborg Alfvén, Stockholm, 171 77, Sweden
| | - Malini Pires
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | | | - Kishwar Azad
- Diabetic Association of Bangladesh - Centre for Health Research and Implementation (BADAS-CHRI), BIRDEM, Ramna, Dhaka, 1000, Bangladesh
| | - Edward Fottrell
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Joanna Morrison
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK.
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Zhou W, Xiao S, Xie G, Ouyang F, Luo B. A comparison of patient-reported quality between inpatient services for mental and physical health: A tertiary-hospital-based survey in China. Front Psychiatry 2023; 14:1090892. [PMID: 36846224 PMCID: PMC9949676 DOI: 10.3389/fpsyt.2023.1090892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 01/11/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND It is widely acknowledged that quality of mental health services is routinely worse than physical health services across countries. However, studies separately investigating mental health services often report high-level satisfaction, even comparing with physical health services. Therefore, this study aimed to compare patient-reported quality between inpatient services for mental and physical health in China. METHODS An inpatient survey was conducted among service users of mental and physical health services. Patient-reported quality was measured by the responsiveness performance questionnaire after patient discharge and based on patients' multiple experiences of hospitalization in the past 3 years. Chi-square tests were performed to compare the two patient groups' ratings on inpatient services for mental and physical health, and multivariate logistic regression was performed to adjust covariates in the group comparison. RESULTS Inpatient services for mental health were rated better than those for physical health on "treating with respect" (AOR = 3.083, 95% CI = 1.102-8.629) and "choosing a healthcare provider" (AOR = 2.441, 95% CI = 1.263-4.717). However, mental health services had poorer ratings on "asking patient's opinions" (AOR = 0.485, 95% CI = 0.259-0.910). For other responsiveness items, no significant difference was detected between the two types of inpatient services. CONCLUSION Mental health inpatient services provided by China's tertiary hospitals could perform as well as physical health inpatient services in most aspects and even better perform regarding dignity and choice of healthcare providers. However, neglecting patients' voices is more severe in inpatient services for mental health.
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Affiliation(s)
- Wei Zhou
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, Hunan, China
| | - Shuiyuan Xiao
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Guanqing Xie
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Feiyun Ouyang
- Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Bihua Luo
- Clinical Nursing Teaching and Research Section, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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13
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Kesale AM, Mahonge C, Muhanga M. Effects of decentralization on the functionality of health facility governing committees in lower and middle-income countries: a systematic literature review. Glob Health Action 2022; 15:2074662. [PMID: 35960165 PMCID: PMC9377249 DOI: 10.1080/16549716.2022.2074662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/02/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health facility governing committees (HFGCs) were established by lower and middle-income countries (LMICs) to facilitate community participation at the primary facility level to improve health system performance. However, empirical evidence on their effects under decentralization reform on the functionality of HFGCs is scant and inconclusive. OBJECTIVE This article reviews the effects of decentralization on the functionality of HFGCs in LMICs. METHODS A systematic literature review was conducted using various search engines to obtain a total number of 24 relevant articles from 14 countries published between 2000 and 2020. Inclusion criteria include studies must be on community health committees, carried out under decentralization, HFGCs operating at the individual facility, effects of HFGCs on health performance or health outcomes and peer-reviewed empirical studies conducted in LMICs. RESULTS The study has found varied functionality of HFGCs under a decentralization context. The study has found many HFGCs to have very low functionality, while a few HFGCs in other LMICs countries are performing very well. The context and decentralization type, members' awareness of their roles, membership allowance and availability of resource to the facility in which HFGCs operate to produce the desired outcomes play a significant role in facilitating/limiting them to effectively carry out the devolved duties and responsibilities. CONCLUSION Fiscal decentralization has largely been seen as important in making health committees more autonomous, even though it does not guarantee the performance of HFGCs.
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Affiliation(s)
- Anosisye M Kesale
- Department of Local Government Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania
| | - Christopher Mahonge
- Department of Policy Planning and Management, College of Social Sciences and Humanities, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Mikidadi Muhanga
- Department of Development Studies, College of Social Sciences and Humanities, Sokoine University of Agriculture, Morogoro, Tanzania
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14
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Zhou W, Xiao S, Feng C, Yu Y, Wang D, Hu C, Liu X. Measuring the quality of mental health services from the patient perspective in China: psychometric evaluation of the Chinese version of the World Health Organization responsiveness performance questionnaire. Glob Health Action 2022; 15:2035503. [PMID: 35289731 PMCID: PMC8928838 DOI: 10.1080/16549716.2022.2035503] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Despite the large population of patients with mental disorders and the rapid development of mental health services in China, there are few evaluations of Chinese mental health services from the patient perspective. Relevant instruments with robust psychometric properties are lacking. Objective This study aimed to translate, adapt and validate the WHO responsiveness performance questionnaire for measuring the quality of hospital mental health services among Chinese patients. Methods The adaption of the translated questionnaire incorporated experts’ and patients’ opinions. For psychometric testing, 193 outpatients and 168 inpatients completed outpatient and inpatient modules, respectively. Results The adapted questionnaire adhered to the WHO framework of responsiveness domains, and just four items had some wording changes. Item missing rates were below 6%. Both the outpatient and inpatient modules had acceptable internal reliability (Cronbach’s α = 0.837 and 0.730) and most domains had desirable average inter-item correlation coefficients. The confirmatory factor analysis indicated an acceptable model fit for the inpatient module, while some goodness-of-fit indices for the outpatient module were a little outside of the recommended ranges. Except for ‘talking privately’ from the domain of confidentiality (both outpatient and inpatient modules) and ‘waiting time’ from the domain of prompt attention (the inpatient module), factor loadings of all other items were above 0.5. Conclusions The Chinese version of the responsiveness performance questionnaire has acceptable feasibility, reliability, and validity in general and it can be used to measure, assess and improve the quality of mental health services in China.
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Affiliation(s)
- Wei Zhou
- Research Center for Public Health and Social Security, School of Public Administration, Hunan University, Changsha, China
| | - Shuiyuan Xiao
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Caixia Feng
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Teaching Department, Liuzhou People's Hospital, Liu Zhou, China
| | - Yu Yu
- Division of Prevention and Community Research & the Consultation Center, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dan Wang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
| | - Cheng Hu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China.,Department of Public Health, Zhuzhou Central Hospital, Zhuzhou Central Hospital, Zhuzhou, China
| | - Xiang Liu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, China
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15
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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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16
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Adelabu A, Akinyemi O, Adebayo A, Oladokun B. Assessment of the level and distribution of health system responsiveness in Oyo State, Nigeria. BMC Health Serv Res 2022; 22:905. [PMID: 35831823 PMCID: PMC9281151 DOI: 10.1186/s12913-022-08276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Health systems need to be evaluated to ascertain if they are meeting their objectives. There is an increased interest in health system responsiveness (HSR) as a means to appraise health systems. This becomes vital as we put people at the centre of integrated health systems and put a premium on their rights and perspectives. Thus, this study assessed the levels, distribution and factors associated with HSR in Oyo State. Methods The study was a cross-sectional study with 717 adults, who had used an out-patient health facility in the preceding 12 months, interviewed using a semi-structured, interviewer-administered questionnaire. HSR was measured on a multi-domain and multi-item (7 domains and 20 items) 5-point Likert scale that was developed by the WHO to measure HSR globally. Summary scores were computed for level, distribution and the most important domains of HSR. Determinants of poor HSR were determined using binomial logistic regression. The level of statistical significance was set at 5%. Results The overall level of HSR was 47%. The highest-rated domains were confidentiality (72%), dignity (64%) and choice (60%), while the least rated were prompt attention (43%) and communication (52%). The overall distribution of HSR was 0.228 (range of 0 to 1) with the domains of prompt attention (0.595) and choice (0.506) being the most unequally distributed. The most important domains were communication, prompt attention and dignity. The least important domains were choice and confidentiality. The factors associated with poor HSR (overall) were no formal education, (OR = 2.81; 95% CI: 1.35–5.86), primary education as the highest level of education (OR = 2.19; 95% CI: 1.28–3.75), poor socioeconomic class (OR = 1.86; 95% CI: 1.23–2.80), using a government-owned facility (OR = 1.56; 95% CI: 1.11–2.19) and not using the usual health facility (OR = 1.69; 95% CI: 1.13–2.53). Conclusions The overall level of HSR in Oyo State was low with the domains of prompt attention, communication and autonomy being the least rated domains. Therefore, concerted efforts should be targeted at improving HSR as this will improve wellbeing, health system utilization, and the overall health system. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08276-9.
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Affiliation(s)
| | - Oluwaseun Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodeji Adebayo
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Blessing Oladokun
- Department of Mathematics and Statistics, East Tennessee State University, Tennessee, USA
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17
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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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18
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Trivedi M, Saxena A, Shroff Z, Sharma M. Experiences and challenges in accessing hospitalization in a government-funded health insurance scheme: Evidence from early implementation of Pradhan Mantri Jan Aarogya Yojana (PM-JAY) in India. PLoS One 2022; 17:e0266798. [PMID: 35552557 PMCID: PMC9098065 DOI: 10.1371/journal.pone.0266798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/29/2022] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Government-sponsored health insurance schemes can play an important role in improving the reach of healthcare services. Launched in 2018 in India, Pradhan Mantri Jan Aarogya Yojana (PM-JAY) is one of the world's largest government-sponsored health insurance schemes. The objective of this study is to understand beneficiaries' experience of availing healthcare services at the empaneled hospitals in PM-JAY. This study examines the responsiveness of PM-JAY by measuring the prompt attention in service delivery, and access to information by the beneficiaries; financial burden experienced by the beneficiaries; and beneficiary's satisfaction with the experience of hospitalization under PMJAY and its determinants. METHODS The study was conducted during March-August 2019. Data were obtained through a survey conducted with 200 PM-JAY beneficiaries (or their caregivers) in the Indian states of Gujarat and Madhya Pradesh. The study population comprised of patients who received healthcare services at 14 study hospitals in April 2019. Prompt attention was measured in the form of a) effectiveness of helpdesk, and b) time taken at different stages of hospitalization and discharge events. Access to information by the beneficiaries was measured using the frequency and purpose of text messages and phone calls from the scheme authorities to the beneficiaries. The financial burden was measured in terms of the incidence and magnitude of out-of-pocket payments made by the beneficiaries separate from the cashless payment provided to hospitals by PMJAY. Beneficiaries' satisfaction was measured on a five-point Likert scale. RESULTS Socio-economically weaker sections of the society are availing healthcare services under PM-JAY. In Gujarat, the majority of the beneficiaries were made aware of the scheme by the government official channels. In Madhya Pradesh, the majority of the beneficiaries got to know about the scheme from informal sources. For most of the elements of prompt attention, access to information, and beneficiaries' satisfaction, hospitals in Gujarat performed significantly better than the hospitals in Madhya Pradesh. Similarly, for most of the elements of prompt attention, access to information, and beneficiaries' satisfaction, public hospitals performed significantly better than private hospitals. Incidence and magnitude of out-of-pocket payments were significantly higher in Madhya Pradesh as compared to Gujarat, and in private hospitals as compared to the public hospitals. CONCLUSION There is a need to focus on Information, Education, and Communication (IEC) activities for PM-JAY, especially in Madhya Pradesh. Capacity-building efforts need to be prioritized for private hospitals as compared to public hospitals, and for Madhya Pradesh as compared to Gujarat. There is a need to focus on enhancing the responsiveness of the scheme, and timely exchange of information with beneficiaries. There is also an urgent need for measures aimed at reducing the out-of-pocket payments made by the beneficiaries.
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Affiliation(s)
- Mayur Trivedi
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
- * E-mail:
| | - Anurag Saxena
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | | | - Manas Sharma
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
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19
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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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20
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Effects of Hospital Decentralization Processes on Patients’ Satisfaction: Evidence from Two Public Romanian Hospitals across Two Decades. SUSTAINABILITY 2022. [DOI: 10.3390/su14084818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient satisfaction represents an essential indicator in assessing healthcare quality, as it is an extensive source of information regarding the healthcare provider’s ability to meet patients’ expectations and is a key predictor of patients’ behavioral approaches. The purpose of this study is to evaluate the degree of satisfaction of patients who have been admitted for inpatient hospitalization in two public hospitals located in the North-West of Romania, during two different periods of administration/management of healthcare services, in the context of an ongoing decentralization process of public healthcare services (initiated in 2010). An exploratory study was conducted in the period of April–December 2021, based on a patient satisfaction survey, through which the quality of in-hospital services was evaluated at present and up until 2010, by the hospitalized patients in both periods. In total, 208 survey responses were validated and analyzed. The chi-square test and t-test were used for statistical processing. The results of the survey revealed that the percentage of patients that evaluated the inpatient experience as excellent was significantly higher during the period when hospitals were administered by local authorities than during the period of centralized administration (68.27% vs. 28.37%; p < 0.001), both in medical care as well as in hospital hotel services (71.63 vs. 29.81%), respectively (56.25 vs. 27.40; p < 0.001). The results obtained from this survey indicate that the decentralization of hospital units has had a positive effect on the quality of inpatient medical services and highlight the need for formulating and finalizing a policy aimed at developing and enhancing medical services.
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21
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Gonzalez-Bautista E, Morsch P, Mathur M, Bós ÂJG, Hommes C, Vega E. Assessing health system responsiveness to the needs of older people. Rev Panam Salud Publica 2021; 45:e127. [PMID: 34621304 PMCID: PMC8489740 DOI: 10.26633/rpsp.2021.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/14/2021] [Indexed: 01/21/2023] Open
Abstract
Objective To identify key indicators that will allow empirical measurement of a health system's responsiveness to older people. Methods We conducted a series of consultations with experts to develop a relevant list of indicators. Concept mapping was used to devise the list, including the steps of preparation, brainstorming and structuring. Additionally, four countries were used as national case studies to test the feasibility of measuring health system responsiveness with readily available national-level data (Barbados, Brazil, Chile, and Mexico). Results Our study resulted in a list of 25 indicators scored with high usefulness for informing public policy, 10 of which were also categorized as being of high availability. National case studies were useful to assess the feasibility of measuring health system responsiveness in different settings. Conclusions Responsiveness can be comprehensively assessed by (i) approaching the intrinsic features of the system via its inputs, outputs, and outcomes, and (ii) measuring the impact of the system on meeting the needs of older people in terms of their health, financial protection, and expectations. Further consensus is needed to develop a list of core indicators that could be used as a baseline for measuring a health system's responsiveness to the needs of older people.
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Affiliation(s)
- Emmanuel Gonzalez-Bautista
- Pan American Health Organization/World Health Organization Washington D.C. United States of America Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Patricia Morsch
- Pan American Health Organization/World Health Organization Washington D.C. United States of America Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Mallika Mathur
- Pan American Health Organization/World Health Organization Washington D.C. United States of America Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Ângelo José Gonçalves Bós
- Pontifical Catholic University of Rio Grande do Sul Porto Alegre Brazil Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Carolina Hommes
- Pan American Health Organization/World Health Organization Washington D.C. United States of America Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
| | - Enrique Vega
- Pan American Health Organization/World Health Organization Washington D.C. United States of America Pan American Health Organization/World Health Organization, Washington, D.C., United States of America
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