Standardization and strengthening the functionality of hospital management boards in central hospitals: Evidence of a developing economy

Zimbabwe’s public hospitals have been criticised for the declining standard of health service delivery for the past three decades with fingers pointed towards the hospital governance system. In response to the criticism, the government of Zimbabwe, through the Ministry of Health, has begun the process of making structural changes to the entire hospital governance system (Moyo, 2016; Sikipa, Osifo-Dawodu, Kokwaro, & Rice, 2019). The aim of the study is to examine the processes of appointing hospital management board (HMB) members in central hospitals of Zimbabwe. The study sought to explore the standardization, strengthening, and performance of HMBs in central hospitals of Zimbabwe with a focus on six central hospitals which include Harare, Chitungwiza, Parirenyatwa Group of Hospitals, United Bulawayo Hospitals (UBH), Mpilo, and Ingutsheni. The study employed a mixed-method design using the questionnaire and interviews to collect data. The target population included 66 board members. The census approach was used meaning that all members of the population formed the sample size. The study revealed that 67% of hospitals had functional HMBs with a quorum despite lacking a clear policy to evaluate their performance. The gaps identified required policy review to strengthen the appointment and performance of HMBs

COVID-19 and inequities in the Americas: lessons learned and implications for essential health services

The COVID-19 pandemic has exacerbated social, economic, and health-related disparities, which disproportionately affect persons living in conditions of vulnerability. Such populations include ethnic groups who face discrimination and experience barriers to accessing comprehensive health care. The COVID-19 pandemic has exposed these health disparities, and disruptions of essential health services have further widened the gaps in access to health care. Noncommunicable diseases are more prevalent among groups most impacted by poor social determinants of health and have been associated with an increased likelihood of severe COVID-19 disease and higher mortality. Disruptions in the provision of essential health services for noncommunicable diseases, mental health, communicable diseases such as HIV, tuberculosis, and malaria, and maternal and child health services (including sexual and reproductive health), are projected to also increase poor health outcomes. Other challenges have been an increased frequency of interpersonal violence and food insecurity. Countries in the Americas have responded to the disruptions caused by the pandemic by means of health service delivery through telemedicine and other digital solutions and stepping up social service support interventions. As vaccinations for COVID-19 create the opportunity to overcome the pandemic, countries must strengthen primary health care and essential health services with a view to ensuring equity, if the region is to achieve universal health coverage in fulfillment of the Sustainable Development Goals.

Factors Influencing the Implementation of Foreign Innovations in Organization and Management of Health Service Delivery in China: A Systematic Review

Background: China has been encouraged to learn from international innovations in the organization and management of health service delivery to achieve the national health reform objectives. However, the success and effectiveness of implementing innovations is affected by the interactions of innovations with the Chinese context. Our aim is to synthesize evidence on factors influencing the implementation of non-Chinese innovations in organization and management of health service delivery in mainland China.Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched seven databases for peer-reviewed articles published between 2009 and 2020. Data were analyzed and combined to generate a list of factors influencing the implementation of foreign innovations in China. The factors were classified in the categories context, system, organization, innovation, users, resources, and implementation process.Results: The 110 studies meeting the inclusion criteria revealed 33 factors. Most supported by evidence is the factor integration in organizational policies, followed by the factors motivation & incentives and human resources. Some factors (e.g., governmental policies & regulations) were mentioned in multiple studies with little or no evidence.Conclusion: Evidence on factors influencing the implementation of foreign innovations in organization and management of health service delivery is scarce and of limited quality. Although many factors identified in this review have also been reported in reviews primarily considering Western literature, this review suggests that extrinsic motivation, financial incentives, governmental and organizational policies & regulations are more important while decentralization was found to be less important in China compare to Western countries. In addition, introducing innovations in rural China seems more challenging than in urban China, because of a lack of human resources and the more traditional rural culture.

Studi Kasus Kehamilan Dengan Risiko Tinggi

Maternal mortality rate (MMR) and infant mortality rate (IMR) are determinants and benchmarks for the success of health service delivery. In 2019 Indonesia's Maternal Mortality Rate (MMR) is still high, at 305 per 100,000 live births. The purpose of this case study is to provide midwifery care during pregnancy to high-risk mothers aged over 35 years and mild anemia to minimize complications that will occur. The method of this case study is to provide midwifery care to pregnant women with high risk in the form of exposure to the subject of one client who experiences a high risk of pregnancy who will be given care during pregnancy. The results of this case study are given care to reduce the complaints felt by the client and carry out early detection to reduce the occurrence of complications. The conclusion of this case study is midwifery care for Ny. N during pregnancy in Pekalongan has been carried out on high-risk patients aged more than 35 years and mild anemia according to the needs and authority of the midwife so that it does not cause any complications. For this reason, midwives need to provide care as a form of early detection to reduce the incidence of complicationsKey Word: Maternity care, pregnant, high risk AbstrakAngka kematian ibu (AKI) dan angka kematian bayi (AKB) menjadi penentu dan tolak ukur keberhasilan penyelenggaraan pelayanan kesehatan. Pada tahun 2019 Angka Kematian Ibu (AKI) Indonesia masih tetap tinggi, yaitu 305 per 100.000 kelahiran hidup. Tujuan dari studi kasus ini adalah memberikan asuhan kebidanan selama masa kehamilan pada ibu dengan risiko tinggi usia diatas 35 tahun dan anemia ringan untuk meminimalkan komplikasi yang akan terjadi. Metode studi kasus ini adalah dengan pemberian asuhan kebidanan pada ibu hamil dengan risiko tinggi berupa pemaparan dengan subyek satu klien yang mengalami risiko tinggi dalam kehamilanya yang akan diberikan asuhan selama masa kehamilan. Hasil studi kasus ini diberikan asuhan untuk mengurangi keluhan yang dirasakan klien serta melakukan deteksi dini untuk mengurangi terjadinya komplikasi. Simpulan studi kasus ini adalah asuhan kebidanan pada Ny. N selama masa kehamilan Pekalongan sudah dilakukan pada pasien yang mengalami risiko tinggi usia lebih dari 35 tahun dan anemia ringan sesuai kebutuhan dan kewenangan bidan sehingga tidak menimbulkan komplikasi apapun. Untuk itu bidan perlu melakukan asuhan sebagai bentuk deteksi dini untuk mengurangi timbulnya komplikasiKata kunci: asuhan kebidanan, ibu hamil, risiko tinggi

Exploring the Basis for the Increasing Medical Negligence Claims in South Africa

Litigation arising from medical negligence have continued to witness an incremental trajectory in the contemporary South African medical jurisprudence. As the number of claims continue to rise, so also does the financial expense in the form of cost of litigation on the part of the litigants and damages paid by the healthcare personnel and government agencies in successful cases. Such expense, however, palls into oblivion when compared with the reputational damage attendant such negligent conducts on the parts of both the healthcare personnel and the healthcare institutions. On the positive side, however, is that the growing instances of such claims have brought to the fore the need to interrogate the reasons and seek solutions with a view to attaining a more efficient health service delivery system in the country.

Multi-Stakeholder Partnerships (MSPs) for Health Service Delivery in Ethiopia

The past few decades have witnessed the integration of non-state actors in public service delivery. Partnerships as a form of governance involves state and non-state actors in public policy formulation and implementation. The widespread poverty and severe health problems in Ethiopia demand for an increasing role of a wide range of actors outside of the state. In the past few years, the Ethiopian government has been actively seeking collaborative arrangements for health service delivery that are aimed at ensuring access to basic and quality health service delivery. The paper will focus on studying MSPs for health service delivery as a form of governance, hence we focus on the internal dynamics of the MSPs for health service delivery and provide an understanding of state and non-state interaction in these governance networks. The case analysis is based on a specific MSP for helath service delivery at local level.

The Accountability of Health Facility Governing Committees and its Associated Factors in Selected Primary Health Facilities Implementing Direct Health Facility Financing in Tanzania

Users Committees such as Health Facility Governing Committees (HFGCs) are one of the popular mechanisms used to represent communities and civil societies in holding service providers into account. This study embarked on assessing the status of accountability of HFGCs under the DHFF context in Tanzania as experienced by the supply side (HFGCs members). A cross-sectional design was employed in collecting both qualitative and quantitative data at one point in time in 32 selected health facilities. A closed-ended questionnaire, in-depth interview and FGDs were employed to collect data. Data were analyzed through descriptive statistics and Multiple logistics regression, and thematic analyses. The study found high accountability of HFGCs by 78%. specifically, HFGCs have high accountability in mobilizing the community to join community health funds 99.71%, receiving medicines and medical commodities 88.57% and timely health services 84.29%. It was reviled that the accountability of the health facility governance committee was significantly associated with the health planning aspect (p=0.0048) and financial management aspect (p=0.0045). This study concluded that the fiscal decentralization context empowers HFGCs to be accountable in accomplishing their responsibilities hence improving health service delivery in developing countries. This study recommends more efforts to be directed in supporting HFGCs addressing challenges of managing health facilities works and mobilization of resources from other stakeholders.

Zooming in and Out: A Holistic Framework for Research on Maternal, Late Fetal, and Newborn Survival and Health

Research is needed to understand why some countries succeed in greater improvements maternal, late fetal and newborn health and reducing mortality than others. Pathways towards these health outcomes operate at many levels, making it difficult to understand which factors contribute most to these health improvements. Conceptual frameworks provide a cognitive means of rendering order to these factors, and how they interrelate to positively influence maternal, late fetal and newborn health. We developed a conceptual framework by integrating theories and frameworks from different disciplines to encapsulate the range of factors that explain reductions in maternal, late fetal and newborn mortality and improvements in health. We developed our framework iteratively, combining our interdisciplinary research team’s knowledge, experience, and review of the literature. We present a framework that includes health policy and systems levers (or intentional actions that policy makers can implement) to improve maternal, late fetal and newborn health; service delivery and coverage of interventions across the continuum of care, and epidemiological and behavioural risk factors. The framework also considers the role of context in influencing for whom and where health and non-health efforts have the most impact, to recognise ‘the causes of the causes’ at play at the individual/household, community, national and transnational levels. Our framework holistically reflects the range of interrelated factors influencing improved maternal, late fetal and newborn health and survival. The framework lends itself to studying how different factors work together to influence these outcomes using an array of methods. Such research should inform future efforts to improve maternal, late fetal and newborn health and survival in different contexts. By re-orienting research in this way, we hope to equip policymakers and practitioners alike with the insight necessary to make the world a safer and fairer place for mothers and their babies.