Improving health service delivery organisational performance in health systems: a taxonomy of strategy areas and conceptual framework for strategy selection

Introduction The importance of integrated, people-centered health systems has been recognized as a central component of achieving Universal Health Coverage. Integration has also been highlighted as a critical element for building resilient health systems that can stand the shock of health emergencies. However, there is dearth of research and systematic synthesis of evidence on the synergistic relationship between integrated health services and pandemic preparedness in low- and low-middle income countries (LMICs). Thus, the authors are organizing a scoping review aiming to explore application of integrated health service delivery approaches during the emerging COVID-19 pandemic in LMICs. Methods and analysis This scoping review adheres to the six steps for scoping reviews from Arksey and OMalley (2005). Peer reviewed scientific literature will be systematically assembled utilizing a standardized and replicable search strategy from seven electronic databases, including PubMed, Embase, Scopus, Web of Science, CINAHL Plus, the World Health Organization Global Research Database on COVID-19, and LitCovid. Initially, the title and abstract of the collected literature, published in English from December 2019 to June 2020, will be screened for inclusion which will be followed by a full text review by two independent reviewers. Data will be charted using a data extraction form and reported in narrative format with accompanying data matrices. Ethics and dissemination No ethical approval is required for the review. The study will be conducted from June to December 2020. Results from this study will provide a snapshot of the evidence currently being generated related to integrated health service delivery in response to the COVID-19 pandemic. The findings will be developed into reports and a peer-reviewed articles and will assist policy makers in making pragmatic and evidence-based decisions for current and future pandemic response.

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Evidence of integrated health service delivery during COVID-19 in low and lower-middle-income countries: protocol for a scoping review

BMJ Open ◽

10.1136/bmjopen-2020-042872 ◽

2021 ◽

Vol 11 (5) ◽

pp. e042872

Author(s):

Rachel Neill ◽

Md Zabir Hasan ◽

Priyanka Das ◽

Vasuki Venugopal ◽

Nishant Jain ◽

...

Keyword(s):

Health Service ◽

Service Delivery ◽

Health Systems ◽

Scoping Review ◽

Health Service Delivery ◽

Data Matrix ◽

Research Database ◽

Middle Income ◽

Middle Income Countries ◽

Integrated Health

IntroductionThe importance of integrated, people-centred health systems has been recognised as a central component of Universal Health Coverage. Integration has also been highlighted as a critical element for building resilient health systems that can withstand the shock of health emergencies. However, there is a dearth of research and systematic synthesis of evidence on the synergistic relationship between integrated health services and pandemic preparedness, response, and recovery in low-income and lower-middle-income countries (LMICs). Thus, the authors are organising a scoping review aiming to explore the application of integrated health service delivery approaches during the emerging COVID-19 pandemic in LMICs.Methods and analysisThis scoping review adheres to the six steps for scoping reviews from Arksey and O’Malley. Peer-reviewed scientific literature will be systematically assembled using a standardised and replicable search strategy from seven electronic databases, including PubMed, Embase, Scopus, Web of Science, CINAHL Plus, the WHO’s Global Research Database on COVID-19 and LitCovid. Initially, the title and abstract of the collected literature, published in English from December 2019 to June 2020, will be screened for inclusion which will be followed by a full-text review by two independent reviewers. Data will be charted using a data extraction form and reported in narrative format with accompanying data matrix.Ethics and disseminationNo ethical approval is required for the review. The study will be conducted from June 2020 to May 2021. Results from this scoping review will provide a snapshot of the evidence currently being generated related to integrated health service delivery in response to the COVID-19 pandemic in LMICs. The findings will be developed into reports and a peer-reviewed article and will assist policy-makers in making pragmatic and evidence-based decisions for current and future pandemic responses.

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Gender disparity in the physicians in public sector in Bangladesh: a mixed-method exploratory study

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.526 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

I Tuly ◽

D Bhattacharyya ◽

S Shafique ◽

S h Hossain ◽

I Anwar

Keyword(s):

Public Sector ◽

Health Service ◽

Service Delivery ◽

Health Systems ◽

Mixed Method ◽

Exploratory Study ◽

Health Service Delivery ◽

Female Physicians ◽

District Health ◽

The Public

Abstract Background Gender equality is needed in health service delivery systems to support universal health coverage (UHC). Women are reluctant to visit male doctors for medical problems. However, number of female doctors is inadequate in many low and middle income countries (LMICs) which is a challenge for establishing gender-sensitive health system. We explored the production and distribution of female physicians in the public sector in Bangladesh to support policy for actions. Methodology This is a mixed-method exploratory study using documentary review; Key Informant Interviews and secondary data analysis. Multiple stakeholder consultations and a policy dialogue were organized to validate the study findings. Results An increasing trend of female medical students was observed since 2011 in admission. In 2018, out of total 5528 students enrolled, 54% were female whereas 46% were male. However, fewer female doctors were enrolled in the public service compared to their male peers. The male-female ratio was almost 2:1 in the public sector. Out of 471 sub-district health managers, 52 were female; out of 64 district health mangers only one was female; and out of 8 Division Directors only one was female. Female doctors reported to face practical problems in rural settings with regard to housing, safety and security. There is no provision of deploying married couples at the same or nearby health facilities. All these compelled female doctors to quit rural posting or even the government service. Moreover, female physicians prefer certain specialties such as obstetrics and gynaecology, medicine and certain basic subjects which may create more gender imbalance in service delivery system. Conclusions In adequate number of female physicians in public sector and their retention in rural areas is a major concern for the health systems in Bangladesh. Policy attention is needed to take necessary steps to make gender-responsive health systems to improve health service to achieve UHC. Key messages Poor presence of female physicians in deployed doctors in public sector in Bangladesh creates problems in health service delivery and is becoming a major concern for the health systems in Bangladesh. Policy needs to take remedial measures to make women-friendly working environment in the public sector hospitals in Bangladesh to provide health service delivery for all leaving no one behind.

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