Strengthening Health System - Evidence from the use of Bi-directional
                        SMS-based Screening and Feedback System to Improve Efficiency and Quality of
                        Disease Surveillance in Vietnam

Subject. This article studies the mechanism of State health regulation and methods of management of efficiency of regional healthcare institutions. Objectives. The article aims to analyze the territorial health system in the context of the urgent need to optimize budget expenditures and address public health problems, as well as develop directions to improve the effectiveness of the regional health system of the Krasnoyarsk Krai. Methods. For the study, we used the method of index numbers and calculation of dynamics indicators using official statistics data. Results. We have developed and now present a system of indicators of regional health efficiency assessment, focused mainly on public health indicators and quality of medical services. We also offer our own version of the Luenberger observer modification adapted to the objectives of the regional health system analysis. Conclusions and Relevance. The article concludes that it is necessary to optimize the regional health system using the parameters of medical and social efficiency of the system. The proposed approach to assessing the effectiveness of regional health system can be used as a mechanism to develop recommendations for the management of the network of medical and prophylactic institutions of the region.

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Access to health care and Informal Patient Payments for health care in Serbia

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.774 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

S Buch Mejsner ◽

S Lavasani Kjær ◽

L Eklund Karlsson

Keyword(s):

Health Care ◽

Health System ◽

Access To Health Care ◽

Health Care Services ◽

Local Population ◽

Civil Servants ◽

Care Providers ◽

Care Services ◽

Access To Health

Abstract Background Evidence often shows that migrants in the European region have poor access to quality health care. Having a large number of migrants seeking towards Europe, crossing through i.e. Serbia, it is crucial to improve migrants' access to health care and ensure equality in service provision Aim To investigate what are the barriers and facilitators of access to health care in Serbia, perceived by migrants, policy makers, health care providers, civil servants and experts working with migrants. Methods six migrants in an asylum center and eight civil servants in the field of migration were conducted. A complementary questionnaire to key civil servants working with migrants (N = 19) is being distributed to complement the data. The qualitative and quantitative data will be analysed through Grounded Theory and Logistic Regression respectively. Results According to preliminary findings, migrants reported that they were able to access the health care services quite easily. Migrants were mostly fully aware of their rights to access these health care services. However, the interviewed civil servants experienced that, despite the majority of migrants in camps were treated fairly, some migrants were treated inappropriately by health care professionals (being addressed inappropriately, poor or lacking treatment). The civil servants believed that local Serbs, from their own experiences, were treated poorer than migrants (I.e. paying Informal Patient Payments, poor quality of and access to health care services). The interviewed migrants were trusting towards the health system, because they felt protected by the official system that guaranteed them services. The final results will be presented at the conference. Conclusions There was a difference in quality of and access to health care services of local Serbs and migrants in the region. Migrants may be protected by the official health care system and thus have access to and do not pay additional fees for health care services. Key messages Despite comprehensive evidence on Informal Patient Payments (IPP) in Serbia, further research is needed to highlight how health system governance and prevailing policies affect IPP in migrants. There may be clear differences in quality of and access to health care services between the local population and migrants in Serbia.

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MoRoNet a network to strengthen the quality of measles and rubella surveillance in Italy

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1336 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

F Magurano ◽

M Baggieri ◽

P Bucci ◽

E D'Ugo ◽

M Sabbatucci ◽

...

Keyword(s):

Disease Surveillance ◽

Specific Work ◽

Vaccine Preventable Disease ◽

Work Plan ◽

Preventable Disease ◽

National Reference ◽

Disease Elimination ◽

National Networks ◽

Country Specific

Abstract Background Measles is a vaccine-preventable infectious disease and it remains one of the leading causes of infant mortality globally. The World Health Organization (WHO) has adopted the goal of eliminating measles and rubella. Detection and control of communicable diseases would not be possible without accurate laboratory results regarding when and where a particular disease circulates. Methods WHO/Europe therefore works with all Member States to steadily improve the quality of the laboratory data in order to determine the Region's progress towards measles and rubella elimination. For this purpose coordinates the European Measles and Rubella Laboratory Network (MR LabNet). National labs in this network undergoes regular external quality assessment through an annual accreditation programme. Results In Italy, a Sub-national Reference Laboratories Network for measles and rubella (MoRoNET) has been developed since March 2017 and currently includes 15 laboratories. MoRoNet was developed following the indications of the MR LabNet. It is accreditate, coordinated and supervised by the National Reference Laboratory. Conclusions Strengthening the role of national laboratories in overseeing the performance of subnational laboratories has become a critical need in order to properly monitor the Region's measles and rubella elimination efforts. MoRoNet permits to Italy to develop a country-specific work plan for establishing national networks and oversight mechanism, including preliminary monitoring and evaluation indicators compliant with MR LabNet standards. This is very significant not only to optimize the participation in national and regional processes to verify disease elimination, but also to strengthen the quality of vaccine-preventable disease surveillance. MoRoNet Group: A Amendola; F Baldanti; MR Capobianchi; M Chironna; MG Cusi; P D'Agaro; P Lanzafame; T Lazzarotto; K Marinelli; A Orsi; E Pagani; G Palù; F Pittaluga, A Sacchi; F Tramuto. Key messages MoRoNet has permitted to Italy to develop a country-specific work plan for establishing national networks and oversight mechanism, compliant with WHO MR LabNet standards. MoRoNet network has permitted to optimize the participation in processes to verify disease elimination, but also to strengthen the quality of vaccine-preventable disease surveillance.

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Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

Public Health Reviews ◽

10.1186/s40985-020-00147-0 ◽

2020 ◽

Vol 41 (1) ◽

Author(s):

Adweeti Nepal ◽

Santa Kumar Dangol ◽

Anke van der Kwaak

Keyword(s):

Maternal Health ◽

Health Services ◽

Health System ◽

Maternal Health Services ◽

Policy Formulation ◽

Social Accountability ◽

The Social ◽

The Government ◽

The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

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Quality in crisis: a systematic review of the quality of health systems in humanitarian settings

Conflict and Health ◽

10.1186/s13031-021-00342-z ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Keely Jordan ◽

Todd P. Lewis ◽

Bayard Roberts

Keyword(s):

Systematic Review ◽

Health System ◽

Health Systems ◽

Point Of Care ◽

System Level ◽

System Quality ◽

High Quality ◽

Humanitarian Settings ◽

Quality Health

Abstract Background There is a growing concern that the quality of health systems in humanitarian crises and the care they provide has received little attention. To help better understand current practice and research on health system quality, this paper aimed to examine the evidence on the quality of health systems in humanitarian settings. Methods This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. The context of interest was populations affected by humanitarian crisis in low- and middle- income countries (LMICs). We included studies where the intervention of interest, health services for populations affected by crisis, was provided by the formal health system. Our outcome of interest was the quality of the health system. We included primary research studies, from a combination of information sources, published in English between January 2000 and January 2019 using quantitative and qualitative methods. We used the High Quality Health Systems Framework to analyze the included studies by quality domain and sub-domain. Results We identified 2285 articles through our search, of which 163 were eligible for full-text review, and 55 articles were eligible for inclusion in our systematic review. Poor diagnosis, inadequate patient referrals, and inappropriate treatment of illness were commonly cited barriers to quality care. There was a strong focus placed on the foundations of a health system with emphasis on the workforce and tools, but a limited focus on the health impacts of health systems. The review also suggests some barriers to high quality health systems that are specific to humanitarian settings such as language barriers for refugees in their host country, discontinued care for migrant populations with chronic conditions, and fears around provider safety. Conclusion The review highlights a large gap in the measurement of quality both at the point of care and at the health system level. There is a need for further work particularly on health system measurement strategies, accountability mechanisms, and patient-centered approaches in humanitarian settings.

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Impact of a Smart-Ring-Based Feedback System on the Quality of Chest Compressions in Adult Cardiac Arrest: A Randomized Preliminary Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105408 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5408

Author(s):

Chiwon Ahn ◽

Seungjae Lee ◽

Jongshill Lee ◽

Jaehoon Oh ◽

Yeongtak Song ◽

...

Keyword(s):

Primary Outcome ◽

Feedback System ◽

Controlled Study ◽

Feedback Group ◽

Compression Depth ◽

System Usability Scale ◽

The Mean ◽

Preliminary Study ◽

The Ideal

This study aimed to assess the effectiveness of a novel chest compression (CC) smart-ring-based feedback system in a manikin simulation. In this randomized, crossover, controlled study, we evaluated the effect of smart-ring CC feedback on cardiopulmonary resuscitation (CPR). The learnability and usability of the tool were evaluated with the System Usability Scale (SUS). Participants were divided into two groups and each performed CCs with and without feedback 2 weeks apart, using different orders. The primary outcome was compression depth; the proportion of accurate-depth (5–6 cm) CCs, CC rate, and the proportion of complete CCs (≤1 cm of residual leaning) were assessed additionally. The feedback group and the non-feedback group showed significant differences in compression depth (52.1 (46.3–54.8) vs. 47.1 (40.5–49.9) mm, p = 0.021). The proportion of accurate-depth CCs was significantly higher in the interventional than in the control condition (88.7 (30.0–99.1) vs. 22.6 (0.0–58.5%), p = 0.033). The mean SUS score was 83.9 ± 8.7 points. The acceptability ranges were ‘acceptable’, and the adjective rating was ‘excellent’. CCs with smart-ring feedback could help achieve the ideal range of depth during CPR. The smart-ring may be a valuable source of CPR feedback.

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Quantifying the Influence of Individual, Community, and Health System Factors on Quality of Life Among Inner-City African Americans With Type 2 Diabetes

The Science of Diabetes Self-Management and Care ◽

10.1177/0145721721996287 ◽

2021 ◽

pp. 014572172199628

Author(s):

Jennifer A. Campbell ◽

Alice Yan ◽

Renee E. Walker ◽

Lance Weinhardt ◽

Yang Wang ◽

...

Keyword(s):

Quality Of Life ◽

Type 2 Diabetes ◽

African Americans ◽

Inner City ◽

Health System ◽

Community Sample ◽

Primary Data ◽

System Factors

Purpose The purpose of this study is to examine the association of individual, community, and health system factors on quality of life among inner-city African Americans with type 2 diabetes. Methods Primary data from a cross-sectional study with a community sample of 241 inner-city African Americans with type 2 diabetes were analyzed. Paper-based surveys were administered in which the SF-12 was used to capture the physical component (PCS) and mental component (MCS) of quality of life. Four regression approaches (sequential, stepwise with backward and forward selection, and all possible subsets regression) were used to examine the influence of individual, community, and health system factors on PCS and MCS after adjusting for relevant covariates using a conceptual framework. Results In fully adjusted models, having less than a high school education and having major depression were associated with lower quality-of-life scores for MCS across all 4 regression approaches. Being employed was positively associated with better quality-of-life scores for PCS across all 4 regression approaches. PCS was higher across all 4 regression approaches for those reporting a history of trauma. At the health systems level, usual source of care was associated with better PCS across 3 regression approaches. Conclusions These results highlight key factors that influence quality of life among inner-city African Americans with type 2 diabetes that could be targets for interventions in this population. However, additional research is needed to understand existing pathways that may be driving many of these relationships.

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Evaluation of Internship Assessment in Medical Colleges of Bangladesh

Bangladesh Journal of Medical Education ◽

10.3329/bjme.v8i1.32243 ◽

2017 ◽

Vol 8 (1) ◽

pp. 14-17

Author(s):

Farhana Noman ◽

AKM Asaduzzaman ◽

Humayun Kabir Talukder ◽

ASM Shamsul Arefin ◽

Shamima Rahman

Keyword(s):

Feedback System ◽

Descriptive Study ◽

Current Status ◽

Cross Sectional ◽

Medical Practitioners ◽

Assessment Feedback ◽

Assessment Techniques ◽

Major Discipline ◽

Medical Colleges

This study aimed to evaluate the current status of the internship assessment in medical colleges of Bangladesh. Internship acts as the pathway from being a medical student to becoming a registered doctor. Hence, a rigorous and robust internship leads to producing better doctor and in turn better healthcare. Thus, proper assessment is necessary to ensure the quality of the future medical practitioners. Unfortunately, no study has been done in Bangladesh related to this context. A cross-sectional descriptive study with pre-tested self-administered questionnaires covering study place and population and factors relevant to intern assessment (assessment after each major discipline completion, assessment techniques, and feedback) was performed. The study was carried out in 8 medical colleges (4 public and 4 non-government; 4 inside Dhaka and 4 outside). 300 completed questionnaires (250 interns, 50 supervisors) were analyzed. All the collected data were analyzed and presented with SPSS v 19.0 software. Results revealed that there was no assessment present after completion of major placement rotation (about 54% interns and 24% teachers). Furthermore, only logbook was signed as the prevailing assessment technique (more than 66% interns and 72% doctors). Moreover, assessment feedback system was not fully functional (48.7% respondent views). Hence, the overall scenario is shabby and poses questions on our future doctors' skill set.Bangladesh Journal of Medical Education Vol.8(1) 2017: 14-17

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