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Bour BK, Sosu EK, Hasford F, Gyekye PK, Achel DG, Faanu A, Amoako JK, Pitcher RD. National inventory of authorized diagnostic imaging equipment in Ghana: data as of September 2020. Pan Afr Med J 2022; 41:301. [PMID: 35855027 PMCID: PMC9250666 DOI: 10.11604/pamj.2022.41.301.30635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/03/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Bright Kwadwo Bour
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
| | - Edem Kwabla Sosu
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Accra, Ghana
| | - Francis Hasford
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Accra, Ghana
- Corresponding author: Francis Hasford, School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana.
| | - Prince Kwabena Gyekye
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiological and Non-Ionizing Radiation Directorate, Nuclear Regulatory Authority, Accra, Ghana
| | - Daniel Gyingiri Achel
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiological and Medical Sciences Research Institute, Ghana Atomic Energy Commission, Accra, Ghana
| | - Augustine Faanu
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiological and Non-Ionizing Radiation Directorate, Nuclear Regulatory Authority, Accra, Ghana
| | - Joseph Kwabena Amoako
- School of Nuclear and Allied Sciences, University of Ghana, Accra, Ghana
- Radiation Protection Institute, Ghana Atomic Energy Commission, Accra, Ghana
| | - Richard Denys Pitcher
- Division of Radiodiagnosis, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Tan CC, Lam CSP, Matchar DB, Zee YK, Wong JEL. Singapore's health-care system: key features, challenges, and shifts. Lancet 2021; 398:1091-1104. [PMID: 34481560 DOI: 10.1016/s0140-6736(21)00252-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 10/16/2020] [Accepted: 01/19/2021] [Indexed: 01/13/2023]
Abstract
Since Singapore became an independent nation in 1965, the development of its health-care system has been underpinned by an emphasis on personal responsibility for health, and active government intervention to ensure access and affordability through targeted subsidies and to reduce unnecessary costs. Singapore is achieving good health outcomes, with a total health expenditure of 4·47% of gross domestic product in 2016. However, the health-care system is contending with increased stress, as reflected in so-called pain points that have led to public concern, including shortages in acute hospital beds and intermediate and long-term care (ILTC) services, and high out-of-pocket payments. The main drivers of these challenges are the rising prevalence of non-communicable diseases and rapid population ageing, limitations in the delivery and organisation of primary care and ILTC, and financial incentives that might inadvertently impede care integration. To address these challenges, Singapore's Ministry of Health implemented a comprehensive set of reforms in 2012 under its Healthcare 2020 Masterplan. These reforms substantially increased the capacity of public hospital beds and ILTC services in the community, expanded subsidies for primary care and long-term care, and introduced a series of financing health-care reforms to strengthen financial protection and coverage. However, it became clear that these measures alone would not address the underlying drivers of system stress in the long term. Instead, the system requires, and is making, much more fundamental changes to its approach. In 2016, the Ministry of Health encapsulated the required shifts in terms of the so-called Three Beyonds-namely, beyond health care to health, beyond hospital to community, and beyond quality to value.
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Affiliation(s)
- Chorh Chuan Tan
- Office for Healthcare Transformation, Ministry of Health, Singapore; Department of Medicine, National University of Singapore, Singapore.
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore; Duke-NUS Cardiovascular Academic Clinical Program, Duke-NUS Medical School, Singapore; Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - David B Matchar
- Health Services and Systems Research, Duke-NUS Medical School, Singapore; Department of Medicine, Duke University, Durham, NC, USA
| | | | - John E L Wong
- Department of Medicine, National University of Singapore, Singapore; Department of Hematology-Medical Oncology, National University Health System, Singapore
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Joseph J, Sankar D. H, Nambiar D. Empanelment of health care facilities under Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB PM-JAY) in India. PLoS One 2021; 16:e0251814. [PMID: 34043664 PMCID: PMC8158976 DOI: 10.1371/journal.pone.0251814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/03/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction India’s Pradhan Mantri Jan Arogya Yojana (PM-JAY) is the world’s largest health assurance scheme providing health cover of 500,000 INR (about USD 6,800) per family per year. It provides financial support for secondary and tertiary care hospitalization expenses to about 500 million of India’s poorest households through various insurance models with care delivered by public and private empanelled providers. This study undertook to describe the provider empanelment of PM-JAY, a key element of its functioning and determinant of its impact. Methods We carried out secondary analysis of cross-sectional administrative program data publicly available in PM-JAY portal for 30 Indian states and 06 UTs. We analysed the state wise distribution, type and sector of empanelled hospitals and services offered through PM-JAY scheme across all the states and UTs. Results We found that out of the total facilities empanelled (N = 20,257) under the scheme in 2020, more than half (N = 11,367, 56%) were in the public sector, while 8,157 (40%) facilities were private for profit, and 733 (4%) were private not for profit entities. State wise distribution of hospitals showed that five states (Karnataka (N = 2,996, 14.9%), Gujarat (N = 2,672, 13.3%), Uttar Pradesh (N = 2,627, 13%), Tamil Nadu (N = 2315, 11.5%) and Rajasthan (N = 2,093 facilities, 10.4%) contributed to more than 60% of empanelled PMJAY facilities: We also observed that 40% of facilities were offering between two and five specialties while 14% of empanelled hospitals provided 21–24 specialties. Conclusion A majority of the hospital empanelled under the scheme are in states with previous experience of implementing publicly funded health insurance schemes, with the exception of Uttar Pradesh. Reasons underlying these patterns of empanelment as well as the impact of empanelment on service access, utilisation, population health and financial risk protection warrant further study. While the inclusion and regulation of the private sector is a goal that may be served by empanelment, the role of public sector remains critical, particularly in underserved areas of India.
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Affiliation(s)
- Jaison Joseph
- The George Institute for Global Health, New Delhi, India
- * E-mail: ,
| | - Hari Sankar D.
- The George Institute for Global Health, New Delhi, India
| | - Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Leman MA, Claramita M, Rahayu GR. Factors influencing healthy role models in medical school to conduct healthy behavior: a qualitative study. Int J Med Educ 2021; 12:1-11. [PMID: 33491661 PMCID: PMC7883803 DOI: 10.5116/ijme.5ff9.9a88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aimed to identify the factors that support or inhibit medical teachers as healthy role models in medical school to conduct healthy behavior. METHODS This qualitative study involved semi-structured in-depth interviews with medical teachers categorized as healthy role models in a medical school from a previous survey. Ten medical teachers were selected using purposive sampling. Three medical teachers were interviewed by direct meetings, and the remaining were phone interviewed, with one interview facilitated by chat using WhatsApp. Transcribed interviews were coded openly. Themes were finalized through discussion and debate to reach a consensus. RESULTS Two themes were identified: perceived facilitators and perceived barriers, which were classified into four categories and 13 subcategories: intrinsic facilitators (motivation, conscious awareness, having physical limitations, knowledge, and economic reasons); extrinsic facilitators (the impact on doing a particular job, feedback, time, and environment); intrinsic barriers (the lack of self-motivation and having physical limitations); and extrinsic barriers (the burden of responsibilities for being medical teachers and environment). CONCLUSIONS Factors that support and inhibit medical teachers as healthy role models in medical school are influenced by intrinsic and extrinsic factors. This result could be used by medical schools to design appropriate interventions to help medical teachers as healthy role models in conducting healthy behavior. More studies are needed to explore other factors that influence medical teachers to conduct healthy behavior. During the COVID-19 pandemic, healthy role models in medical schools are vitally important and significantly contribute to the overall health of a nation.
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Affiliation(s)
- Michael A. Leman
- School of Dentistry, Faculty of Medicine, Universitas Sam Ratulangi, Manado, Indonesia
| | - Mora Claramita
- Department of Medical, Health Professions Education and Bioethics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Gandes R. Rahayu
- Department of Medical, Health Professions Education and Bioethics, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Boro B, Saikia N. A qualitative study of the barriers to utilizing healthcare services among the tribal population in Assam. PLoS One 2020; 15:e0240096. [PMID: 33031431 PMCID: PMC7544062 DOI: 10.1371/journal.pone.0240096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/20/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE We aim to explore the barriers to accessing modern healthcare services in two tribal populations in Assam. METHODS In March 2018, we conducted qualitative research through 60 in-depth interviews with men and women aged 15 to 50 from Bodo and Rabha tribes in Udalguri and Baksa districts of Assam. We interviewed a group of health-service providers from public health facilities to understand the demand-supply balance in those facilities. FINDINGS On the demand side, direct and indirect financial obstacles, distance to health facilities, poor public transportation, perceived negative behavior of hospital staff, and lack of infrastructure were the main barriers to utilizing healthcare facilities. On the supply side, doctors and nurses in government health facilities were overburdened by demand due to a lack of human resources. CONCLUSIONS Our study highlights the barriers to utilizing health facilities; these are not always driven by factors linked to the patient's socio-economic status but also depend significantly on the quality of the health services and other contextual factors. Although the government has made efforts to improve the rural healthcare system through national-level programs, our qualitative study shows that these programs have not been successful in enhancing the rural healthcare system in the study area.
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Affiliation(s)
- Bandita Boro
- Centre for the Study of Regional Development, Jawaharlal Nehru University, Delhi, India
| | - Nandita Saikia
- Centre for the Study of Regional Development, Jawaharlal Nehru University, Delhi, India
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Dubbink JH, Branco TM, Kamara KB, Bangura JS, Wehrens E, Falama AM, Goorhuis A, Jørgensen PB, Sevalie SS, Hanscheid T, Grobusch MP. COVID-19 treatment in sub-Saharan Africa: If the best is not available, the available becomes the best. Travel Med Infect Dis 2020; 37:101878. [PMID: 32927051 PMCID: PMC7485546 DOI: 10.1016/j.tmaid.2020.101878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Jan H Dubbink
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands
| | - Tiago Martins Branco
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Kelfala Bb Kamara
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - James S Bangura
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Erik Wehrens
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands; Capacare, Trondheim, Norway, and Freetown, Sierra Leone
| | - Abdul M Falama
- District Health Medical Team, District Medical Office, Magburaka, Tonkolili District, Sierra Leone
| | - Abraham Goorhuis
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands
| | - Peter B Jørgensen
- Masanga Hospital, Masanga, Tonkolili District, Sierra Leone; Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone
| | - Stephen S Sevalie
- Joint Medical Unit, 34 Military Hospital, Republic of Sierra Leone Armed Forces, Free Town, Sierra Leone; National COVID-19 Emergency Response Team, National Emergency Operations Centre, Free Town, Sierra Leone
| | | | - Martin Peter Grobusch
- Masanga Medical Research Unit (MMRU), Masanga, Tonkolili District, Sierra Leone; Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Location AMC, Meibergdreef 9, 1100 DD Amsterdam, Amsterdam, the Netherlands.
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Endriyas M, Alano A, Mekonnen E, Kawza A, Lemango F. Decentralizing evidence-based decision-making in resource limited setting: A case of SNNP region, Ethiopia. PLoS One 2020; 15:e0236637. [PMID: 32730355 PMCID: PMC7392275 DOI: 10.1371/journal.pone.0236637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 07/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Access to and the use of accurate, valid, reliable, timely, relevant, legible and complete information is vital for safe and reliable healthcare. Though the study area has been implementing standardized Health Management Information System (HMIS), there was a need for information on how well structures were utilizing information and this study was designed to assess HMIS data utilization. METHODS Facility based retrospective study was conducted in Southern Nations Nationalities and People's Region (SNNPR) in April, 2017. We included data from 163 sample facilities. Data use was evaluated by reviewing eight items from performance monitoring system that included activities from problem identification to monitoring of proposed action plans. Each item reviewed was recoded to yes or no and summed to judge overall performance. RESULTS About half (52%) of woredas, 26.2% health centers (HCs), 25% hospitals and 6.2% health posts (HPs) reviewed their performance monthly but only 20% woredas, 6.2% HCs, 1.5% HPs and no hospital prepared action plans after reviewing performance. Summary of 8 items assessed showed that majority of facilities (87.5% hospitals, 81.5% HPs and 70.8% HCs) were poor in data utilization. CONCLUSIONS Only about half of woredas and below one-fifth of health facilities were utilizing HMIS data and a lot to move to catch-up country's information revolution plan. Lower health care systems should be supported in evidence-based decision-making and progress should be monitored routinely quantitatively and/or qualitatively.
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Atif S, Hussain E, Khan JA. Surface urban heat islands in the mega city of Karachi, their spatial distribution and health emergency response infrastructure. J PAK MED ASSOC 2020; 70:705-712. [PMID: 32296219 DOI: 10.5455/jpma.5478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The 2015 heat wave resulted in an estimated over 1200 deaths during the month of June. However, there were no records on the spatial distribution of the effects of this heat wave. An analysis of Moderate Resolution Imaging Spectroradiometer (MODIS) land surface temperature (LST) daily data was conducted to identify regions that experienced above normal temperatures in 2015. An analysis of the monthly averages showed that in general April and May were the warmer months in Karachi, unlike the case in 2015. In addition, the general warm trends were common in the highly industrialised Sindh Industrial Trading Estate (SITE) and Liaquatabad towns, while Gadap, with its mostly barren land, and New Karachi also experience higher temperatures. Coastal towns were naturally cooler and more habitable in the given scenario. A count of the spatial presence of health facilities for the city was also extracted where Gadap and Korangi were poorly served while the more affluent towns of Defence Housing Authority (DHA) and Gulshan-e-Iqbal appeared to be better served.
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Affiliation(s)
- Salman Atif
- Institute of Geographical Information Systems, Islamabad, Pakistan
| | - Ejaz Hussain
- Institute of Geographical Information Systems, Islamabad, Pakistan
| | - Junaid Aziz Khan
- Institute of Geographical Information Systems, Islamabad, Pakistan
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Angrup A, Kanaujia R, Ray P, Biswal M. Healthcare facilities in low- and middle-income countries affected by COVID-19: Time to upgrade basic infection control and prevention practices. Indian J Med Microbiol 2020; 38:139-143. [PMID: 32883925 PMCID: PMC7709605 DOI: 10.4103/ijmm.ijmm_20_125] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/24/2020] [Accepted: 07/22/2020] [Indexed: 01/29/2023]
Abstract
COVID-19 as a pandemic has spanned across all continents. With the increasing numbers in cases worldwide, even the countries with the best of healthcare facilities are reeling under the burden of the disease. Therefore, in countries with limited access to resources and poor healthcare infrastructure, the low and middle-income countries (LMICs), limiting spread becomes even more challenging. Low- and middle-income countries (LMICs) are severely hit by any outbreak and pandemics and face the lack of infrastructure and problem of overcrowding. Health facilities are compromised and almost exhausted at the time of emergency. There is disruption of normal supply chain, and consumables are not in sufficient quantity. In the current situation, rationalized use of available supplies is important. This paper presents the perspective on the basis of current literature on gaps in various infection prevention and control (IPC) strategies that are being followed currently in LMICs and suggestions for bridging these gaps.
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Affiliation(s)
- Archana Angrup
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rimjhim Kanaujia
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pallab Ray
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Beja A, Moreira VHM, Biai A, N'Dumbá A, Neves C, Ferrinho P. [Availability and Readiness Assessment of Facilities with Hospital Admission Capacity in Two Regions of Guinea-Bissau]. ACTA MEDICA PORT 2020; 33:101-108. [PMID: 32035495 DOI: 10.20344/amp.11178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 05/23/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The weaknesses of Guinea-Bissau's health system have long been highlighted. The purpose of this study is to contribute with evidence for decision-making on the reform of the country's healthcare map, by analyzing the availability and readiness of services at the facilities that may become part of a Hospital Complex in Bissau, proposed in the National Health Development Plan. MATERIAL AND METHODS We analyzed 13 public and private facilities with inpatient capacity, located in Bissau and Biombo. Service Availability and Readiness Assessment (SARA) tools were used for data collection, treatment and analysis. RESULTS A comprehensive overview of these facilities has been provided, describing their general capacity to provide care and their readiness to implement it, along with the availability and readiness of specific services: diagnosis, family planning, mother and child health, obstetrics, communicable and non communicable diseases, blood transfusion and surgery. We observed a greater concentration of beds and professionals in the facilities of public sector, the only that provides all the specific services analyzed. Private sector services with agreements to supply the public sector have higher readiness levels and the private sector has the lowest operating capacity. DISCUSSION Findings reflect the lack of equipment, infrastructure and resources, the predominance of the public sector and the growth of the private for-profit and non-profit sectors, as well as inadequacies in planning and regulation. Similarities and differences between our findings and those described in the literature for other African countries are identified. CONCLUSION This study reinforces the relevance of developing integrated and rational responses of health services and provides evidence for this.
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Affiliation(s)
- André Beja
- Global Health and Tropical Medicine/Instituto de Higiene e Medicina Tropical. Universidade NOVA de Lisboa. Lisboa. Portugal
| | | | - Augusta Biai
- Ministério da Saúde Pública. Bissau. Guiné-Bissau
| | - Agostinho N'Dumbá
- Direção Geral de Planeamento e Políticas de Saúde. Ministério da Saúde Pública. Bissau. Guiné-Bissau
| | - Clotilde Neves
- Inspeção Geral da Administração da Saúde. Ministério da Saúde Pública. Bissau. Guiné-Bissau
| | - Paulo Ferrinho
- Global Health and Tropical Medicine/Instituto de Higiene e Medicina Tropical. Universidade NOVA de Lisboa. Lisboa. Portugal
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Ereso BM, Yimer SA, Gradmann C, Sagbakken M. Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study. PLoS One 2020; 15:e0226307. [PMID: 31895932 PMCID: PMC6939902 DOI: 10.1371/journal.pone.0226307] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/22/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ethiopia is one of the countries with a high burden of tuberculosis (TB). Jimma Zone has the lowest TB case notification rate compared to the national and World Health Organization's (WHO) targets. The aim of the present study was to identify barriers, and explore the origin of these barriers in relation to TB case finding. METHODS A qualitative study was conducted by using different data collection methods and sources. Sixty in-depth interviews with TB treatment providers, program managers and TB patients were included. In addition, 42 governmental health facilities were observed for availability of resources. Data obtained from the in-depth interviews were transcribed, coded, categorized and thematized. Atlas.ti version 7.1 software was used for the data coding and categorizing. RESULTS Inadequate resources for TB case finding, such as a shortage of health-care providers, inadequate basic infrastructure, and inadequate diagnostic equipment and supplies, as well as limited access to TB diagnostic services such as an absence of nearby health facilities providing TB diagnostic services and health system delays in the diagnostic process, were identified as barriers for TB case finding. We identified the absence of trained laboratory professionals in 11, the absence of clean water supply in 13 and the electricity in seven health facilities. Furthermore, we found that difficult topography, the absence of proper roads, an inadequate collaboration with other sectors (such as education), a turnover of laboratory professionals, and a low community mobilization, as the origin of some of these barriers. CONCLUSION Inadequate resources for TB case finding, and a limited access to diagnostic services, were major challenges affecting TB case finding. The optimal application of the directly observed treatment short course (Stop TB) strategy is crucial to increase the current low TB case notification rate. Practical strategies need to be designed to attract and retain health professionals in the health system.
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Affiliation(s)
- Berhane Megerssa Ereso
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- Department of Microbiology, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Coalition for Epidemic Preparedness Innovations (CEPI), Oslo, Norway
| | - Christoph Gradmann
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mette Sagbakken
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Tak S, Lim S, Kim H. Estimating the medical capacity required to administer mass prophylaxis: a hypothetical outbreak of smallpox virus infection in Korea. Epidemiol Health 2019; 41:e2019044. [PMID: 31623421 PMCID: PMC6883025 DOI: 10.4178/epih.e2019044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/10/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The aim of this study was to estimate the medical surge capacity required for mass prophylaxis based on a hypothetical outbreak of smallpox. METHODS We performed a simulation using the Bioterrorism and Epidemic Outbreak Response Model and varied some important parameters, such as the number of core medical personnel and the number of dispensing clinics. RESULTS Gaps were identified in the medical surge capacity of the Korean government, especially in the number of medical personnel who could respond to the need for mass prophylaxis against smallpox. CONCLUSIONS The Korean government will need to train 1,000 or more medical personnel for such an event, and will need to prepare many more dispensing centers than are currently available.
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Affiliation(s)
- Sangwoo Tak
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Soomin Lim
- Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Heesu Kim
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Musinguzi G, Wanyenze RK, Ndejjo R, Ssinabulya I, van Marwijk H, Ddumba I, Bastiaens H, Nuwaha F. An implementation science study to enhance cardiovascular disease prevention in Mukono and Buikwe districts in Uganda: a stepped-wedge design. BMC Health Serv Res 2019; 19:253. [PMID: 31023311 PMCID: PMC6482572 DOI: 10.1186/s12913-019-4095-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/12/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Uganda is experiencing a shift in major causes of death with cases of stroke, heart attack, and heart failure reportedly on the rise. In a study in Mukono and Buikwe in Uganda, more than one in four adults were reportedly hypertensive. Moreover, very few (36.5%) reported to have ever had a blood pressure measurement. The rising burden of CVD is compounded by a lack of integrated primary health care for early detection and treatment of people with increased risk. Many people have less access to effective and equitable health care services which respond to their needs. Capacity gaps in human resources, equipment, and drug supply, and laboratory capabilities are evident. Prevention of risk factors for CVD and provision of effective and affordable treatment to those who require it prevent disability and death and improve quality of life. The aim of this study is to improve health profiles for people with intermediate and high risk factors for CVD at the community and health facility levels. The implementation process and effectiveness of interventions will be evaluated. METHODS The overall study is a type 2-hybrid stepped-wedge (SW) design. The design employs mixed methods evaluations with incremental execution and adaptation. Sequential crossover take place from control to intervention until all are exposed. The study will take place in Mukono and Buikwe districts in Uganda, home to more than 1,000,000 people at the community and primary healthcare facility levels. The study evaluation will be guided by; 1) RE-AIM an evaluation framework and 2) the CFIR a determinant framework. The primary outcomes are implementation - acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, coverage, and sustainability. DISCUSSION The study is envisioned to provide important insight into barriers and facilitators of scaling up CVD prevention in a low income context. This project is registered at the ISRCTN Registry with number ISRCTN15848572. The trial was first registered on 03/01/2019.
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Affiliation(s)
- Geofrey Musinguzi
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rawlance Ndejjo
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Harm van Marwijk
- Department of Primary and Interdisciplinary Care, Briton and Sussex University Medical School, Sussex, UK
| | - Isaac Ddumba
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Health, Mukono, District, Uganda
| | - Hilde Bastiaens
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Jigjidsuren A, Byambaa T, Altangerel E, Batbaatar S, Saw YM, Kariya T, Yamamoto E, Hamajima N. Free and universal access to primary healthcare in Mongolia: the service availability and readiness assessment. BMC Health Serv Res 2019; 19:129. [PMID: 30786897 PMCID: PMC6381625 DOI: 10.1186/s12913-019-3932-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/28/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The government of Mongolia mandates free access to primary healthcare (PHC) for its citizens. However, no evidence is available on the physical presence of PHC services within health facilities. Thus, the present study assessed the capacity of health facilities to provide basic services, at minimum standards, using a World Health Organization (WHO) standardized assessment tool. METHODS The service availability and readiness assessment (SARA) tool was used, which comprised a set of indicators for defining whether a health facility meets the required conditions for providing basic or specific services. The study examined all 146 health facilities in Chingeltei and Khan-Uul districts of Ulaanbaatar city, including private and public hospitals, family health centers (FHCs), outpatient clinics, and sanatoriums. The assessment questionnaire was modified to the country context, and data were collected through interviews and direct observations. Data were analyzed using SPSS 21.0, and relevant nonparametric tests were used to compare median parameters. RESULTS A general service readiness index, or the capacity of health facilities to provide basic services at minimum standards, was 44.1% overall and 36.3, 61.5, and 62.4% for private clinics, FHCs, and hospitals, respectively. Major deficiencies were found in diagnostic capacity, supply of essential medicines, and availability of basic equipment; the mean scores for general service readiness was 13.9, 14.5 and 47.2%, respectively. Availability of selected PHC services was 19.8%. FHCs were evaluated as best capable (69.5%) to provide PHC among all health facilities reviewed (p < 0.001). Contribution of private clinics and sanatoriums to PHC service provisions were minimal (4.1 and 0.5%, respectively). Service-specific readiness among FHCs for family planning services was 44.0%, routine immunization was 83.6%, antenatal care was 56.5%, preventive and curative care for children was 44.5%, adolescent health services was 74.2%, tuberculosis services was 53.4%, HIV and STI services was 52.2%, and non-communicable disease services was 51.7%. CONCLUSIONS Universal access to PHC is stipulated throughout various policies in Mongolia; however, the present results revealed that availability of PHC services within health facilities is very low. FHCs contribute most to providing PHC, but readiness is mostly hampered by a lack of diagnostic capacity and essential medicines.
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Affiliation(s)
- Altantuya Jigjidsuren
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Asian Development Bank, Mongolia Resident Mission, Ulaanbaatar, Mongolia
| | | | | | | | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
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Bintabara D, Ernest A, Mpondo B. Health facility service availability and readiness to provide basic emergency obstetric and newborn care in a low-resource setting: evidence from a Tanzania National Survey. BMJ Open 2019; 9:e020608. [PMID: 30782861 PMCID: PMC6398731 DOI: 10.1136/bmjopen-2017-020608] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study used a nationally representative sample from Tanzania as an example of low-resource setting with a high burden of maternal and newborn deaths, to assess the availability and readiness of health facilities to provide basic emergency obstetric and newborn care (BEmONC) and its associated factors. DESIGN Health facility-based cross-sectional survey. SETTING We analysed data for obstetric and newborn care services obtained from the 2014-2015 Tanzania Service Provision Assessment survey, using WHO-Service Availability and Readiness Assessment tool. PRIMARY AND SECONDARY OUTCOME MEASURES Availability of seven signal functions was measured based on the provision of 'parental administration of antibiotic', 'parental administration of oxytocic', 'parental administration of anticonvulsants', 'assisted vaginal delivery', 'manual removal of placenta', 'manual removal of retained products of conception' and 'neonatal resuscitation'. Readiness was a composite variable measured based on the availability of supportive items categorised into three domains: staff training, diagnostic equipment and basic medicines. RESULTS Out of 1188 facilities, 905 (76.2%) were reported to provide obstetric and newborn care services and therefore were included in the analysis of the current study. Overall availability of seven signal functions and average readiness score were consistently higher among hospitals than health centres and dispensaries (p<0.001). Furthermore, the type of facility, performing quality assurance, regular reviewing of maternal and newborn deaths, reviewing clients' opinion and number of delivery beds per facility were significantly associated with readiness to provide BEmONC. CONCLUSION The study findings show disparities in the availability and readiness to provide BEmONC among health facilities in Tanzania. The Tanzanian Ministry of Health should emphasise quality assurance efforts and systematic maternal and newborn death audits. Health leadership should fairly distribute clinical guidelines, essential medicines, equipment and refresher trainings to improve availability and quality BEmONC.
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Affiliation(s)
- Deogratius Bintabara
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, United Republic of Tanzania
| | - Alex Ernest
- Department of Obstetrics and Gynecology, College of Health Sciences, The University of Dodoma, Dodoma, United Republic of Tanzania
| | - Bonaventura Mpondo
- Department of Internal Medicine, College of Health Sciences, The University of Dodoma, Dodoma, United Republic of Tanzania
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Shayo FK, Bintabara D. Are Tanzanian health facilities ready to provide management of chronic respiratory diseases? An analysis of national survey for policy implications. PLoS One 2019; 14:e0210350. [PMID: 30615663 PMCID: PMC6322729 DOI: 10.1371/journal.pone.0210350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/20/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Chronic respiratory diseases in Tanzania are prevalent and a silent burden to the affected population, and healthcare system. We aimed to explore the availability of services and level of health facilities readiness to provide management of chronic respiratory diseases and its associated factors. METHODS The current study is a secondary analysis of the 2014-2015 Tanzania Service Provision Assessment Survey data. Facilities were considered to have a high readiness to provide management of chronic respiratory diseases if they scored at least half (≥50%) of the indicators listed in each of the three domains (staff training and guideline, equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Descriptive, unadjusted and adjusted logistic regression analyses were performed. A P value < 0.05 was taken to indicate statistical significance. RESULTS Out of 723 facilities included in this analysis, approximately one-tenth had a high readiness to provide management of chronic respiratory diseases. Less than 10% of the facilities had at least one staff who received training for management of chronic respiratory diseases. In an adjusted model, privately owned facilities [AOR = 3.3; 95% CI, 1.5-7.5], hospitals [AOR = 11.6; 95% CI, 5.0-27.2], health centres [AOR = 5.0; 95% CI, 2.4-10.7], and performance of routine management meeting [AOR = 3.3; 95% CI, 1.4-7.8] were significantly associated with high readiness to provide management for chronic respiratory diseases. CONCLUSION Majority of Tanzanian health facilities have low readiness to provide management for chronic respiratory diseases. There is a need for the Tanzanian government to increase the availability of diagnostic equipment, medication, and to provide refresher training specifically in the lower-level and public health facilities for better management of chronic respiratory diseases and other non-communicable diseases.
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Affiliation(s)
- Festo K. Shayo
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deogratius Bintabara
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan
- Department of Public Health, College of Health Sciences, The University of Dodoma, Dodoma, Tanzania
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Rosenkrantz AB, Moy L, Fleming MM, Duszak R. Associations of County-level Radiologist and Mammography Facility Supply with Screening Mammography Rates in the United States. Acad Radiol 2018; 25:883-888. [PMID: 29373212 DOI: 10.1016/j.acra.2017.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 01/12/2023]
Abstract
RATIONALE AND OBJECTIVES The present study aims to assess associations of Medicare beneficiary screening mammography rates with local mammography facility and radiologist availability. MATERIALS AND METHODS Mammography screening rates for Medicare fee-for-service beneficiaries were obtained for US counties using the County Health Rankings data set. County-level certified mammography facility counts were obtained from the United States Food and Drug Administration. County-level mammogram-interpreting radiologist and breast imaging subspecialist counts were determined using Centers for Medicare & Medicaid Services fee-for-service claims files. Spearman correlations and multivariable linear regressions were performed using counties' facility and radiologist counts, as well as counts normalized to counties' Medicare fee-for-service beneficiary volume and land area. RESULTS Across 3035 included counties, average screening mammography rates were 60.5% ± 8.2% (range 26%-88%). Correlations between county-level screening rates and total mammography facilities, facilities per 100,000 square mile county area, total mammography-interpreting radiologists, and mammography-interpreting radiologists per 100,000 county-level Medicare beneficiaries were all weak (r = 0.22-0.26). Correlations between county-level screening rates and mammography rates per 100,000 Medicare beneficiaries, total breast imaging subspecialist radiologists, and breast imaging subspecialist radiologists per 100,000 Medicare beneficiaries were all minimal (r = 0.06-0.16). Multivariable analyses overall demonstrated radiologist supply to have a stronger independent effect than facility supply, although effect sizes remained weak for both. CONCLUSION Mammography facility and radiologist supply-side factors are only weakly associated with county-level Medicare beneficiary screening mammography rates, and as such, screening mammography may differ from many other health-care services. Although efforts to enhance facility and radiologist supply may be helpful, initiatives to improve screening mammography rates should focus more on demand-side factors, such as patient education and primary care physician education and access.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, 660 First Ave, 3rd Floor, NYU Langone Medical Center, New York, NY 10016.
| | - Linda Moy
- Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, 660 First Ave, 3rd Floor, NYU Langone Medical Center, New York, NY 10016
| | - Margaret M Fleming
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Yaya S, Bishwajit G, Uthman OA, Amouzou A. Why some women fail to give birth at health facilities: A comparative study between Ethiopia and Nigeria. PLoS One 2018; 13:e0196896. [PMID: 29723253 PMCID: PMC5933759 DOI: 10.1371/journal.pone.0196896] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/20/2018] [Indexed: 11/25/2022] Open
Abstract
Background Obstetric complications and maternal deaths can be prevented through safe delivery process. Facility based delivery significantly reduces maternal mortality by increasing women’s access to skilled personnel attendance. However, in sub-Saharan Africa, most deliveries take place without skilled attendants and outside health facilities. Utilization of facility-based delivery is affected by socio-cultural norms and several other factors including cost, long distance, accessibility and availability of quality services. This study examined country-level variations of the self-reported causes of not choosing to deliver at a health facility. Methods Cross-sectional data on 37,086 community dwelling women aged between 15–49 years were collected from DHS surveys in Ethiopia (n = 13,053) and Nigeria (n = 24,033). Outcome variables were the self-reported causes of not delivering at health facilities which were regressed against selected sociodemographic and community level determinants. In total eight items complaints were identified for non-use of facility delivery: 1) Cost too much 2) Facility not open, 3) Too far/no transport, 4) don’t trust facility/poor service, 5) No female provider, 6) Husband/family didn’t allow, 7) Not necessary, 8) Not customary. Multivariable regression methods were used for measuring the associations. Results In both countries a large proportion of the women mentioned facility delivery as not necessary, 54.9% (52.3–57.9) in Nigeria and 45.4% (42.0–47.5) in Ethiopia. Significant urban-rural variations were observed in the prevalence of the self-reported causes of non-utilisation. Women in the rural areas are more likely to report delivering at health facility as not customary/not necessary and healthy facility too far/no transport. However, urban women were more likely to complain that husband/family did not allow and that the costs were too high. Conclusion Women in the rural were more likely to regard facility delivery as unnecessary and complain about transportation and financial difficulties. In order to achieving the maternal mortality related targets, addressing regional disparities in accessing maternal healthcare services should be regarded as a priority of health promotion programs in Nigeria and Ethiopia.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
- * E-mail:
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Olalekan A. Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Agbessi Amouzou
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States of America
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Abstract
OBJECTIVES To assess the provision of basic emergency obstetric and newborn care (BEmONC), knowledge of high-risk pregnancies and referral capacity at health centres in Southern Ethiopia. DESIGN A facility-based survey, using an abbreviated version of the Averting Maternal Death and Disability needs assessment tool for emergency obstetric and newborn care. Modules included infrastructure, staffing, number of deliveries, maternal and perinatal mortality, BEmONC signal functions, referral capacity and knowledge of risk factors in pregnancy. SETTING Primary healthcare centres providing delivery services in the Eastern Gurage Zone, a predominantly rural area in Southern Ethiopia. PARTICIPANTS All 20 health centres in the study area were selected for the assessment. One was excluded, as no delivery services had been provided in the 12 months prior to the study. RESULTS Three out of 19 health centres met the government's staffing norm. In the 12 months prior to the survey, 10 004 ([Formula: see text]) deliveries were attended to at the health centres, but none had provided all seven BEmONC signal functions in the three months prior to the survey ([Formula: see text]). Eight maternal and 32 perinatal deaths occurred. Most health centres had performed administration of parenteral uterotonics (17/89.5%), manual removal of placenta (17/89.5%) and neonatal resuscitation (17/89.5%), while few had performed assisted vaginal delivery (3/15.8%) or administration of parenteral anticonvulsants (1/5.3%). Reasons mentioned for non-performance were lack of patients with appropriate indications, lack of training and supply problems. Health workers mentioned on average 3.9±1.4 of 11 risk factors for adverse pregnancy outcomes. Five ambulances were available in the zone. CONCLUSION BEmONC provision is not guaranteed to women giving birth in health centres in Southern Ethiopia. Since the government aims to increase facility deliveries, investments in capacity at health centres are urgently needed.
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Affiliation(s)
- Mitchell Windsma
- Faculty of Medical Sciences, Universitair Medisch Centrum Groningen, University of Groningen, Groningen, The Netherlands
| | - Tienke Vermeiden
- Maternity Department, Butajira General Hospital, Butajira, Ethiopia
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Floris Braat
- Maternity Department, Butajira General Hospital, Butajira, Ethiopia
| | | | - Asheber Gaym
- Ethiopia Country Office, UNICEF, Addis Ababa, Ethiopia
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Centre, Leeuwarden, The Netherlands
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
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Bernhardt M. Providing Musculoskeletal Care and Education in Kansas City. Mo Med 2017; 114:267. [PMID: 30228608 PMCID: PMC6140072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Abstract
BACKGROUND Since 2000, the United Nations' Millennium Development Goals, which included a goal to improve maternal health by the end of 2015, has facilitated significant reductions in maternal morbidity and mortality worldwide. However, despite more focused efforts made especially by low- and middle-income countries, targets were largely unmet in sub-Saharan Africa, where women are plagued by many challenges in seeking obstetric care. The aim of this review was to synthesise literature on barriers to obstetric care at health institutions in sub-Saharan Africa. METHODS This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases were electronically searched to identify studies on barriers to health facility-based obstetric care in sub-Saharan Africa, in English, and dated between 2000 and 2015. Combinations of search terms 'obstetric care', 'access', 'barriers', 'developing countries' and 'sub-Saharan Africa' were used to locate articles. Quantitative, qualitative and mixed-methods studies were considered. A narrative synthesis approach was employed to synthesise the evidence and explore relationships between included studies. RESULTS One hundred and sixty articles met the inclusion criteria. Currently, obstetric care access is hindered by several demand- and supply-side barriers. The principal demand-side barriers identified were limited household resources/income, non-availability of means of transportation, indirect transport costs, a lack of information on health care services/providers, issues related to stigma and women's self-esteem/assertiveness, a lack of birth preparation, cultural beliefs/practices and ignorance about required obstetric health services. On the supply-side, the most significant barriers were cost of services, physical distance between health facilities and service users' residence, long waiting times at health facilities, poor staff knowledge and skills, poor referral practices and poor staff interpersonal relationships. CONCLUSION Despite similarities in obstetric care barriers across sub-Saharan Africa, country-specific strategies are required to tackle the challenges mentioned. Governments need to develop strategies to improve healthcare systems and overall socioeconomic status of women, in order to tackle supply- and demand-side access barriers to obstetric care. It is also important that strategies adopted are supported by research evidence appropriate for local conditions. Finally, more research is needed, particularly, with regard to supply-side interventions that may improve the obstetric care experience of pregnant women. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2014 CRD42014015549.
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Affiliation(s)
- Minerva Kyei-Nimakoh
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Mary Carolan-Olah
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
| | - Terence V. McCann
- Disciplines of Nursing and Midwifery, Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001 Australia
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Biswas RK, Kabir E. Influence of distance between residence and health facilities on non-communicable diseases: An assessment over hypertension and diabetes in Bangladesh. PLoS One 2017; 12:e0177027. [PMID: 28545074 PMCID: PMC5436657 DOI: 10.1371/journal.pone.0177027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/20/2017] [Indexed: 01/01/2023] Open
Abstract
Objective This paper reflected on the prevalence of hypertension and diabetes in Bangladesh, which is spreading rapidly in low-income countries. The rationale of constructing more health centers for addressing NCDs was assessed in this paper by determining the relationship between prevalence of NCDs, particularly hypertension and diabetes, and distance to health facilities. Methods From BDHS (Bangladesh Health and Demographic Survey) 2011 data set, 7544 samples were analyzed to demonstrate association between Non-communicable diseases (NCD) and distance from respondents’ home to health facilities like hospitals, community clinics, pharmacies or doctors’ chambers, and community facilities like market, post office or cinema hall. Bivariate analysis was conducted between accessibility to health facilities and prevalence of the diseases. The causal relationship between the spatial effects and the prevalence of the diseases were analyzed by applying Generalized Linear Mixed Model (GLMM) was fitted. Results Fitting linear mixed effect models, we found that hypertension and diabetes react differently with various spatial effects. Distance from home to hospital had significant effect (P < 0.001) on hypertension showing people living further from the facilities or town centers seemed to be less hypertensive, whereas diabetes showed no such affiliation. Conclusion Higher prevalence of diabetes (40.9%) over hypertension (26.5%) in people aging 35 or higher, have appeared to have caused the difference, which concluded that each non-communicable disease should be dealt to its own merit for policy making instead considering as a group of diseases.
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Affiliation(s)
- Raaj Kishore Biswas
- School of Agricultural, Computational and Environmental Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
- * E-mail:
| | - Enamul Kabir
- School of Agricultural, Computational and Environmental Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
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Cramond V, Reid M. In absentia: describing the toll of war on health in Syria. N Z Med J 2017; 130:9-10. [PMID: 28253239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Matthew Reid
- Member of the Board of Directors, Médecins Sans Frontières, Australia
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Shaw D, Guise JM, Shah N, Gemzell-Danielsson K, Joseph KS, Levy B, Wong F, Woodd S, Main EK. Drivers of maternity care in high-income countries: can health systems support woman-centred care? Lancet 2016; 388:2282-2295. [PMID: 27642026 DOI: 10.1016/s0140-6736(16)31527-6] [Citation(s) in RCA: 105] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/24/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
In high-income countries, medical interventions to address the known risks associated with pregnancy and birth have been largely successful and have resulted in very low levels of maternal and neonatal mortality. In this Series paper, we present the main care delivery models, with case studies of the USA and Sweden, and examine the main drivers of these models. Although nearly all births are attended by a skilled birth attendant and are in an institution, practice, cadre, facility size, and place of birth vary widely; for example, births occur in homes, birth centres, midwifery-led birthing units in hospitals, and in high intervention hospital birthing facilities. Not all care is evidenced-based, and some care provision may be harmful. Fear prevails among subsets of women and providers. In some settings, medical liability costs are enormous, human resource shortages are common, and costs of providing care can be very high. New challenges linked to alteration of epidemiology, such as obesity and older age during pregnancy, are also present. Data are often not readily available to inform policy and practice in a timely way and surveillance requires greater attention and investment. Outcomes are not equitable, and disadvantaged segments of the population face access issues and substantially elevated risks. At the same time, examples of excellence and progress exist, from clinical interventions to models of care and practice. Labourists (who provide care for all the facility's women for labour and delivery) are discussed as a potential solution. Quality and safety factors are informed by women's experiences, as well as medical evidence. Progress requires the ability to normalise birth for most women, with integrated services available if complications develop. We also discuss mechanisms to improve quality of care and highlight areas where research can address knowledge gaps with potential for impact. Evaluation of models that provide woman-centred care and the best outcomes without high costs is required to provide an impetus for change.
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Affiliation(s)
- Dorothy Shaw
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; BC Women's Hospital and Health Centre, Vancouver, BC, Canada.
| | - Jeanne-Marie Guise
- Departments of Obstetrics and Gynecology, Medical Informatics and Clinical Epidemiology, Public Health and Preventive Medicine, and Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Neel Shah
- Beth Israel Deaconess Medical Center, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | - Kristina Gemzell-Danielsson
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; The Children's and Women's Hospital of British Columbia, BC, Canada
| | - Barbara Levy
- George Washington University School of Medicine, Washington, DC, USA; Uniformed Services University of the Health Sciences, Washington, DC, USA
| | - Fontayne Wong
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Susannah Woodd
- London School of Hygiene & Tropical Medicine, London, UK
| | - Elliott K Main
- California Maternal Quality Care Collaborative, San Francisco, CA, USA
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Malentacchi F, Mancini I, Brandslund I, Vermeersch P, Schwab M, Marc J, van Schaik RHN, Siest G, Theodorsson E, Pazzagli M, Di Resta C. Is laboratory medicine ready for the era of personalized medicine? A survey addressed to laboratory directors of hospitals/academic schools of medicine in Europe. Drug Metab Pers Ther 2016; 30:121-8. [PMID: 26036226 DOI: 10.1515/dmdi-2015-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/23/2015] [Indexed: 11/15/2022]
Abstract
Developments in "-omics" are creating a paradigm shift in laboratory medicine leading to personalized medicine. This allows the increase in diagnostics and therapeutics focused on individuals rather than populations. In order to investigate whether laboratory medicine is ready to play a key role in the integration of personalized medicine in routine health care and set the state-of-the-art knowledge about personalized medicine and laboratory medicine in Europe, a questionnaire was constructed under the auspices of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) and the European Society of Pharmacogenomics and Personalised Therapy (ESPT). The answers of the participating laboratory medicine professionals indicate that they are aware that personalized medicine can represent a new and promising health model, and that laboratory medicine should play a key role in supporting the implementation of personalized medicine in the clinical setting. Participants think that the current organization of laboratory medicine needs additional/relevant implementations such as (i) new technological facilities in -omics; (ii) additional training for the current personnel focused on the new methodologies; (iii) incorporation in the laboratory of new competencies in data interpretation and counseling; and (iv) cooperation and collaboration among professionals of different disciplines to integrate information according to a personalized medicine approach.
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Lee CI, Bogart A, Hubbard RA, Obadina ET, Hill DA, Haas JS, Tosteson ANA, Alford-Teaster JA, Sprague BL, DeMartini WB, Lehman CD, Onega TL. Advanced Breast Imaging Availability by Screening Facility Characteristics. Acad Radiol 2015; 22:846-52. [PMID: 25851643 PMCID: PMC4465038 DOI: 10.1016/j.acra.2015.02.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the relationship between screening mammography facility characteristics and on-site availability of advanced breast imaging services required for supplemental screening and the diagnostic evaluation of abnormal screening findings. MATERIALS AND METHODS We analyzed data from all active imaging facilities across six regional registries of the National Cancer Institute-funded Breast Cancer Surveillance Consortium offering screening mammography in calendar years 2011-2012 (n = 105). We used generalized estimating equations regression models to identify associations between facility characteristics (eg, academic affiliation, practice type) and availability of on-site advanced breast imaging (eg, ultrasound [US], magnetic resonance imaging [MRI]) and image-guided biopsy services. RESULTS Breast MRI was not available at any nonradiology or breast imaging-only facilities. A combination of breast US, breast MRI, and imaging-guided breast biopsy services was available at 76.0% of multispecialty breast centers compared to 22.2% of full diagnostic radiology practices (P = .0047) and 75.0% of facilities with academic affiliations compared to 29.0% of those without academic affiliations (P = .04). Both supplemental screening breast US and screening breast MRI were available at 28.0% of multispecialty breast centers compared to 4.7% of full diagnostic radiology practices (P < .01) and 25.0% of academic facilities compared to 8.5% of nonacademic facilities (P = .02). CONCLUSIONS Screening facility characteristics are strongly associated with the availability of on-site advanced breast imaging and image-guided biopsy service. Therefore, the type of imaging facility a woman attends for screening may have important implications on her timely access to supplemental screening and diagnostic breast imaging services.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
| | - Andy Bogart
- Group Health Research Institute, Seattle, Washington
| | | | - Eniola T Obadina
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109
| | - Deirdre A Hill
- Department of Internal Medicine, Cancer Research and Treatment Center, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Dana Farber Harvard Cancer Institute, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Anna N A Tosteson
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Jennifer A Alford-Teaster
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Brian L Sprague
- Department of Surgery and Office of Health Promotion Research, University of Vermont, Burlington, Vermont
| | - Wendy B DeMartini
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Constance D Lehman
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109
| | - Tracy L Onega
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
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Verlo AR, Bailey HH, Cook MR. This Is Africa. J Spec Oper Med 2015; 15:114-119. [PMID: 26360366 DOI: 10.55460/bqas-1d1o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
Military deployments will always result in exposure to health hazards other than those from combat operations. The occupational and environmental health and endemic disease health risks are greater to the Special Operations Forces (SOF) deployed to the challenging conditions in Africa than elsewhere in the world. SOF are deployed to locations that lack life support infrastructures that have become standard for most military deployments; instead, they rely on local resources to sustain operations. Particularly, SOF in Africa do not generally have access to advanced diagnostic or monitoring capabilities or to medical treatment in austere locations that lack environmental or public health regulation. The keys to managing potential adverse health effects lie in identifying and documenting the health hazards and exposures, characterizing the associated risks, and communicating the risks to commanders, deployed personnel, and operational planners.
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Murad AA. Using geographical information systems for defining the accessibility to health care facilities in Jeddah City, Saudi Arabia. Geospat Health 2014; 8:S661-S669. [PMID: 25599637 DOI: 10.4081/gh.2014.295] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 06/04/2023]
Abstract
Spatial data play an important role in the planning of health care facilities and their allocation. Today, geographical information systems (GIS) provide useful techniques for capturing, maintaining and analysing health care spatial data; indeed health geoinformatics is an emerging discipline that uses innovative geospatial technology to investigate health issues. The purpose of this paper is to define how GIS can be used for assessing the level of accessibility to health care. The paper identifies the advantages of using GIS in health care planning and covers GIS-based international accessibility with a focus on GIS applications for health care facilities in Jeddah city, Saudi Arabia. A geodatabase that includes location of health services, road networks, health care demand and population districts was created using ArcGIS software. The geodatabase produced is based on collected data and covers issues, such as defining the spatial distribution of health care facilities, evaluating health demand types and modelling health service areas based on analysis of driving-time and straight-line distances.
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Affiliation(s)
- Abdulkader A Murad
- Department of Urban and Regional Planning, Faculty of Environmental Design, King Abdulaziz University, Jeddah.
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[Occupational rate of RI treatment room for therapy of thyroid cancer for patients taking iodine radioisotopes]. Kaku Igaku 2014; 51:387-94. [PMID: 26328279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
BACKGROUND This study focused on the 47 Member States of the World Health Organization (WHO) African Region. The specific objectives were to prepare a synthesis on the situation of health systems' components, to analyse the correlation between the interventions related to the health Millennium Development Goals (MDGs) and some health systems' components and to provide overview of four major thrusts for progress towards universal health coverage (UHC). METHODS The WHO health systems framework and the health-related MDGs were the frame of reference. The data for selected indicators were obtained from the WHO World Health Statistics 2014 and the Global Health Observatory. RESULTS African Region's average densities of physicians, nursing and midwifery personnel, dentistry personnel, pharmaceutical personnel, and psychiatrists of 2.6, 12, 0.5, 0.9 and 0.05 per 10 000 population were about five-fold, two-fold, five-fold, five-fold and six-fold lower than global averages. Fifty-six percent of the reporting countries had fewer than 11 health posts per 100 000 population, 88% had fewer than 11 health centres per 100 000 population, 82% had fewer than one district hospital per 100 000 population, 74% had fewer than 0.2 provincial hospitals per 100 000 population, and 79% had fewer than 0.2 tertiary hospitals per 100 000 population. Some 83% of the countries had less than one MRI per one million people and 95% had fewer than one radiotherapy unit per million population. Forty-six percent of the countries had not adopted the recommendation of the International Taskforce on Innovative Financing to spend at least US$ 44 per person per year on health. Some of these gaps in health system components were found to be correlated to coverage gaps in interventions for maternal health (MDG 5), child health (MDG 4) and HIV/AIDS, TB and malaria (MDG 6). CONCLUSIONS Substantial gaps exist in health systems and access to MDG-related health interventions. It is imperative that countries adopt the 2014 Luanda Commitment on UHC in Africa as their long-term vision and back it with sound policies and plans with clearly engrained road maps for strengthening national health systems and addressing the social determinants of health.
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Affiliation(s)
- Luis Gomes Sambo
- World Health Organization, Regional Office for Africa, B.P. 06, Brazzaville, Congo.
| | - Joses Muthuri Kirigia
- Research, Publications and Library Services Programme, Health Systems and Services Cluster, World Health Organization, Regional Office for Africa, B.P. 06, Brazzaville, Congo.
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Van Lerberghe W, Matthews Z, Achadi E, Ancona C, Campbell J, Channon A, de Bernis L, De Brouwere V, Fauveau V, Fogstad H, Koblinsky M, Liljestrand J, Mechbal A, Murray SF, Rathavay T, Rehr H, Richard F, ten Hoope-Bender P, Turkmani S. Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality. Lancet 2014; 384:1215-25. [PMID: 24965819 DOI: 10.1016/s0140-6736(14)60919-3] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention.
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Affiliation(s)
| | - Zoe Matthews
- Evidence for Action, University of Southampton, Southampton UK
| | - Endang Achadi
- Center for Family Welfare, Faculty of Public Health University of Indonesia, Depok, West Java, Indonesia
| | | | - James Campbell
- Instituto de Cooperación Social Integrare, Barcelona, Spain
| | - Amos Channon
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | | | - Vincent De Brouwere
- Woman & Child Health Research Centre, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | | | - Susan F Murray
- International Development Institute, King's College London, London, UK
| | - Tung Rathavay
- National Reproductive Health Program, Phnom Penh, Cambodia
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De Pietri D, Dietrich P, Mayo P, Carcagno A, de Titto E. [Use of indicators of geographical accessibility to primary health care centers in addressing inequities]. Rev Panam Salud Publica 2013; 34:452-460. [PMID: 24569975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 11/08/2013] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Characterize geographical indicators in relation to their usefulness in measuring regional inequities, identify and describe areas according to their degree of geographical accessibility to primary health care centers (PHCCs), and detect populations at risk from the perspective of access to primary care. METHODS Analysis of spatial accessibility using geographic information systems (GIS) involved three aspects: population without medical coverage, distribution of PHCCs, and the public transportation network connecting them. RESULTS The development of indicators of demand (real, potential, and differential) and analysis of territorial factors affecting population mobility enabled the characterization of PHCCs with regard to their environment, thereby contributing to local and regional analysis and to the detection of different zones according to regional connectivity levels. CONCLUSIONS Indicators developed in a GIS environment were very useful in analyzing accessibility to PHCCs by vulnerable populations. Zoning the region helped identify inequities by differentiating areas of unmet demand and fragmentation of spatial connectivity between PHCCs and public transportation.
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Affiliation(s)
- Diana De Pietri
- Dirección Nacional de Determinantes de la Salud e Investigación, Ministerio de Salud de la Nación, Buenos Aires, Argentina,
| | - Patricia Dietrich
- Centro de Información Metropolitana, Facultad de Arquitectura, Diseño y Urbanismo, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Patricia Mayo
- Centro de Información Metropolitana, Facultad de Arquitectura, Diseño y Urbanismo, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Carcagno
- Centro de Información Metropolitana, Facultad de Arquitectura, Diseño y Urbanismo, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ernesto de Titto
- Dirección Nacional de Determinantes de la Salud e Investigación, Ministerio de Salud de la Nación, Buenos Aires, Argentina,
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Ichiho HM, Robles B, Aitaoto N. An assessment of non-communicable diseases, diabetes, and related risk factors in the commonwealth of the Northern Mariana Islands: a systems perspective. Hawaii J Med Public Health 2013; 72:19-29. [PMID: 23900536 PMCID: PMC3689462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Non-communicable diseases (NCD) have been identified as a health emergency in the US-affiliated Pacific Islands (USAPI).1 This assessment, funded by the National Institutes of Health, was conducted in the Commonwealth of the Northern Mariana Islands (CNMI) and describes the burdens due to NCDs, with an emphasis on diabetes, and assesses the system of service capacity and current activities for service delivery, data collection and reporting as well as identifies the issues that need to be addressed. There has been a 22.7% decline in the population between 2000 and 2010. Findings of medical and health data reveal that the risk factors of lifestyle behaviors lead to overweight and obesity and subsequent NCD. The leading causes of death are heart disease, stroke and cancer. The 2009 BRFSS survey reveals that the prevalence rate for diabetes was 9.8%. Other findings show significant gaps in the system of administrative, clinical, data, and support services to address these NCDs. There is no overall health plan to address NCDs or diabetes, there is little coordination between the medical care and public health staff, and there is no functional data system to identify, register, and track patients with diabetes. Based on the findings, priority issues and problems to be addressed for the administrative system and clinical system are identified.
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Johnston R, Crooks VA. Medical tourism in the Caribbean region: a call to consider environmental health equity. W INDIAN MED J 2013; 62:250-253. [PMID: 24564048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medical tourism, which is the intentional travel by private-paying patients across international borders for medical treatment, is a sector that has been targeted for growth in many Caribbean countries. The international development of this industry has raised a core set of proposed health equity benefits and drawbacks for host countries. These benefits centre on the potential investment in health infrastructure and opportunities for health labour force development while drawbacks focus on the potential for reduced access to healthcare for locals and inefficient use of limited public resources to support the growth of the medical tourism industry. The development of the medical tourism sector in Caribbean countries raises additional health equity questions that have received little attention in existing international debates, specifically in regard to environmental health equity. In this viewpoint, we introduce questions of environmental health equity that clearly emerge in relation to the developing Caribbean medical tourism sector These questions acknowledge that the growth of this sector will have impacts on the social and physical environments, resources, and waste management infrastructure in countries. We contend that in addition to addressing the wider health equity concerns that have been consistently raised in existing debates surrounding the growth of medical tourism, planning for growth in this sector in the Caribbean must take environmental health equity into account in order to ensure that local populations, environments, and ecosystems are not harmed by facilities catering to international patients.
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Affiliation(s)
- R Johnston
- Department of Geography, Simon Fraser University, British Columbia, Canada.
| | - V A Crooks
- Department of Geography, Simon Fraser University, British Columbia, Canada
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Mills A, Ataguba JE, Akazili J, Borghi J, Garshong B, Makawia S, Mtei G, Harris B, Macha J, Meheus F, McIntyre D. Equity in financing and use of health care in Ghana, South Africa, and Tanzania: implications for paths to universal coverage. Lancet 2012; 380:126-33. [PMID: 22591542 DOI: 10.1016/s0140-6736(12)60357-2] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Universal coverage of health care is now receiving substantial worldwide and national attention, but debate continues on the best mix of financing mechanisms, especially to protect people outside the formal employment sector. Crucial issues are the equity implications of different financing mechanisms, and patterns of service use. We report a whole-system analysis--integrating both public and private sectors--of the equity of health-system financing and service use in Ghana, South Africa, and Tanzania. METHODS We used primary and secondary data to calculate the progressivity of each health-care financing mechanism, catastrophic spending on health care, and the distribution of health-care benefits. We collected qualitative data to inform interpretation. FINDINGS Overall health-care financing was progressive in all three countries, as were direct taxes. Indirect taxes were regressive in South Africa but progressive in Ghana and Tanzania. Out-of-pocket payments were regressive in all three countries. Health-insurance contributions by those outside the formal sector were regressive in both Ghana and Tanzania. The overall distribution of service benefits in all three countries favoured richer people, although the burden of illness was greater for lower-income groups. Access to needed, appropriate services was the biggest challenge to universal coverage in all three countries. INTERPRETATION Analyses of the equity of financing and service use provide guidance on which financing mechanisms to expand, and especially raise questions over the appropriate financing mechanism for the health care of people outside the formal sector. Physical and financial barriers to service access must be addressed if universal coverage is to become a reality. FUNDING European Union and International Development Research Centre.
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Affiliation(s)
- Anne Mills
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Abstract
OBJECTIVE To explore the structural barriers faced by families coping with type 1 diabetes mellitus (T1DM) in Ghana, and to provide insight for policy development. METHODS Qualitative study conducted with families with a child with T1DM, receiving care in the greater Accra area. Total of 17 individuals were interviewed using individual and dyadic approaches: 7 youth with T1DM, 9 parents of children with T1DM, and one medical doctor. FINDINGS 5 key barriers emerged from the data: primary care, schools, financial burden, lack of formal support, and access to information. Participants expressed concern over the misdiagnosis of T1DM at primary care facilities, resulting in some of the children going into a diabetic coma before receiving proper care. Children and parents noted discrimination and poor care at school. Financial burden was due to the high costs of medications and appliances needed for proper diabetes management. A lack of formal support was credited by participants to be the result of the lethargy of advocacy groups or resource centers. Finally, there was a lack of readily available and accessible information for children and parents on T1DM. CONCLUSION Awareness of T1DM needs to be increased, by incorporating lessons on recognition into already existing campaigns for type 2 diabetes mellitus (T2DM). Schools need to be more engaged with their responsibility for children with diabetes. Pressuring policy makers and pharmaceutical companies to make diabetes supplies more affordable and accessible could ease the financial burden. Social support networks need to be explored and strengthened. Study into the experiences of youth with T1DM in rural settings and other parts of Ghana, as well as, youth from low socioeconomic backgrounds is necessary.
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Affiliation(s)
- J Kratzer
- UBC Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada.
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Mooney H. BMA warns of "private sector kicking GPs out of their surgeries". BMJ 2012; 344:e1241. [PMID: 22349585 DOI: 10.1136/bmj.e1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Piskunov GZ. [The procedure for the provision of otorhinolaryngological care]. Vestn Otorinolaringol 2012:4-7. [PMID: 23304716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Sterlikov SA, Bogorodskaia EM, Ponomareva EG, Grigor'ev AV. [The material and technical base of fluorographic units of primary health care facilities and its development promises]. Vestn Rentgenol Radiol 2011:43-47. [PMID: 22420211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The goal of the study was to assess the status of equipment and the staff potential in the fluorography and X-ray units of primary health care facilities and to define priorities and the volume of investments for their modernization. Two hundred and seventy-two health care facilities were studied through the use of questionnaires. The data were processed using standard statistical methods, such as calculation of the mean, median, and 95% confidence intervals. Prognosis was made for the idling period of equipment during stagnation of measures to improve the material and technical base of fluorography units. Priorities for modernizing the material and technical base and the staff potential were defined for the fluorography units of primary health care facilities. The volume of investments required for the modernization was estimated.
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Denham SA, Wood LE, Remsberg K. Diabetes care: provider disparities in the US Appalachian region. Rural Remote Health 2010; 10:1320. [PMID: 20509722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION Diabetes is a devastating and growing problem in the USA and throughout the world. Parts of Appalachia, especially the most rural and economically 'distressed' areas of the region, have disproportionately high levels of diabetes incidence and have had long-standing problems in healthcare access. PURPOSE Little is known about the status of public health infrastructures and expertise available to address the diabetes epidemic, whether in Appalachia or elsewhere. This research examines the availability of professional diabetes care in Appalachia, including the economically distressed areas of the region. METHODS A 2006 cross-sectional survey of healthcare providers in the Appalachian Region identified diabetes service needs and availability in Appalachian healthcare facilities. Survey data and socioeconomic data were combined as a means to assess intra-regional variation in service availability. RESULTS Participants perceived that diabetes prevalence was growing in Appalachia and that they were seeing increasing numbers of persons with diabetes. Healthcare facilities in the region rarely employed specialized health professional providers and the expertise concerning diabetes in some clinicians may be limited. CONCLUSION The current and growing diabetes problem in Appalachia underscores the need for appropriate diabetes services and health professionals acquainted with current standards in diabetes care. Such problems in Appalachia have long been identified and linked with insufficient healthcare resources. The identification of ways to assure that local clinicians have current knowledge of diabetes standards of care is warranted.
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Kruk ME, Wladis A, Mbembati N, Ndao-Brumblay SK, Hsia RY, Galukande M, Luboga S, Matovu A, de Miranda H, Ozgediz D, Quiñones AR, Rockers PC, von Schreeb J, Vaz F, Debas HT, Macfarlane SB. Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey. PLoS Med 2010; 7:e1000242. [PMID: 20231869 PMCID: PMC2834706 DOI: 10.1371/journal.pmed.1000242] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 02/04/2010] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. METHODS AND FINDINGS We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US$0.05 to US$0.14 between the eight hospitals. CONCLUSION African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary.
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Affiliation(s)
- Margaret E Kruk
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, United States of America.
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Hammerschlag CA. Sicker and sicker. Caring 2010; 29:46. [PMID: 20465042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Kulic M, Sosevic A, Tahirovic A, Spuzic M, Mujacic V, Cibo M, Dilic M. Primary percutaneous coronary interventions network in Bosnia and Herzegovina--Sarajevo's proposal. Med Arh 2010; 64:284-288. [PMID: 21287954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Reperfusion therapy is the most useful part of the treatment for patients suffering from an acute coronary syndrome. Start time of reperfusion therapy is an important factor which influenced positively on the number of days of hospitalization, and readmission, the risk of reinfarction, as well as both, short and long-term mortality. Today, several models of reperfusion therapy are available: thrombolytic treatment (pre-hospital or in-hospital setting), primary percutaneous coronary intervention (primary PCI or pPCI) or a combination of both. pPCI is preferred, as soon as possible, in centers with experienced teams, especially for patients in shock, or those with contraindicated fibrinolytic therapies. We will compared, very shortly, the daily practices in 4 countries (Czech Republic, Austria, Croatia, Serbia ), where (well) developed primary PCI hospital networks works efficiently for a years, with the current situation in Bosnia and Herzegovina. Our goal is to describe the easiest and quickest way of establishing the primary PCI network in Bosnia and Herzegovina. By combining the efforts of both Entities of Bosnia and Herzegovina will be possible in the forthcoming period, that B&H becomes a participant in the Stent for life initiative.
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Affiliation(s)
- Mehmed Kulic
- Heart Center, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Hercegovina.
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Schleiter KE. Retail medical clinics: increasing access to low cost medical care amongst a developing legal environment. Ann Health Law 2010; 19:527-i. [PMID: 21456398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Retail medical clinics are an innovation in health care with the potential to increase access to low-cost basic health care services while changing the delivery model for routine, non-urgent medical care. However, the few states that attempted to directly regulate retail medical clinics have been met with criticism by the FTC due to the proposed legislations' anticompetitive undertones. The relationship between retail medical clinics and the host stores or pharmacies that house them has the potential to spark fraud and abuse concerns. Retail medical clinics must abide by state-specific regulation on scope of practice of the various mid-level practitioners who work for the clinics, particularly to minimize exposure to litigation and keep within the clinics' intended purpose of a supplement to primary care physician offices. The author concludes that the consumer benefits of cost and convenience, combined with the potential for growth and expanded consumer base from a retailers' perspective, make the legal challenge inherent in running a retail medical clinic well worth the effort.
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Keegan DW. Healthcare "just around the corner": the role of geographic distribution strategies and healthcare costs. J Med Pract Manage 2010; 25:226-228. [PMID: 20222258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Proponents of the healthcare reform agenda continually compare per capita healthcare spending in the United States to other nations and cite this as one of the clear mandates for healthcare reform. The purpose of this article is to draw attention to the cost of geographic distribution strategies adopted by healthcare organizations and the impact this has on per capita healthcare costs. It is important to quantify the cost of such strategies and to weigh their merits, if the intent is to substantially reduce the cost of healthcare in the United States.
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