scholarly journals Impacts of COVID-19 on Provision and Utilization of Health and Nutrition Services in Uttar Pradesh, India: Insights From Phone Surveys and Administrative Data

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 672-672
Author(s):  
Phuong Nguyen ◽  
Shivani Kachwaha ◽  
Anjali Pant ◽  
Lan Mai Tran ◽  
Monika Walia ◽  
...  
Keyword(s):  
Service Delivery ◽  
Performance Management ◽  
Administrative Data ◽  
Service Provision ◽  
Service Providers ◽  
Uttar Pradesh ◽  
Home Visits ◽  
Food Supplementation ◽  
Nutrition Services ◽  
Health And Nutrition

Abstract Objectives The COVID-19 pandemic has significant potential implications for health systems, but little primary evidence is available on effects on health and nutrition services. We aimed to examine changes in service provision and utilization during the pandemic in Uttar Pradesh, India and identify positive adaptations to service delivery. Methods We conducted longitudinal surveys with frontline workers (FLW, n = 313) and mothers of children < 2 years (n = 659) in December 2019 (in-person) and July 2020 (by phone). We also interviewed block-level managers and obtained administrative data. We examined changes in service provision and utilization using Wilcoxon matched-pairs signed-rank tests. Results Compared to pre-pandemic, service provision reduced substantially during lockdown (83–98 percentage points, pp), except for home visits and take-home-rations (∼30%). Most FLWs (68–90%) resumed service provision in July 2020, except for immunization and hot-cooked meals (< 10%). Administrative data showed similar patterns of disruption and resumption. FLW fears, increased workload, inadequate personal protective equipment (PPE), and manpower shortages challenged service delivery. Key adaptations made to provide services included: delivering services to beneficiary homes (∼40–90%), social distancing (80%), using PPE (40–50%), and telephones for communication (∼20%). On the demand side, service utilization also reduced substantially (40–80pp) during the lockdown, but about half of mothers received home visits and food supplementation. Utilization for most services did not improve after the lockdown, bearing challenges of limited travel (30%), non-availability of services (26%), fear of catching virus when leaving the house (22%) or meeting service providers (14%). Conclusions COVID-19 affected the provision and use of health and nutrition services despite efforts at service restoration and adaptations. Strengthening logistics support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute; and Alive & Thrive, led by FHI Solutions.

Barriers to comorbidity service delivery: the complexities of dual diagnosis and the need to agree on terminology and conceptual frameworks

2010 ◽  
Vol 34 (3) ◽  
pp. 262 ◽  
Author(s):  
Rachel Canaway ◽  
Monika Merkes
Keyword(s):  
Mental Health ◽  
Substance Use ◽  
Service Delivery ◽  
Substance Use Disorders ◽  
Service Provision ◽  
Service Providers ◽  
Complex Problem ◽  
Conceptual Frameworks ◽  
Treatment Service ◽  
Variable Nature

This paper draws from a literature review commissioned as part of a larger project evaluating comorbidity treatment service models, which was funded by the Australian Government Department of Health and Ageing as part of the National Comorbidity Initiative. The co-occurrence of mental health and substance use disorders (comorbidity) is a common and complex problem. This paper outlines conceptual and practical complexities and barriers associated with comorbidity treatment service delivery, particularly around the variable nature of comorbidity, and the impacts of the separation of the mental health (MH) and alcohol and other drug (AOD) sectors with their differing institutional cultures, aetiological concepts, philosophical underpinnings, educational requirements, administrative arrangements, and screening and treatment approaches. Issues pertaining to the lack of consistent definitions and conceptual frameworks for comorbidity are discussed, particularly in relation to the reported lack of communication, collaboration, and linkages between the sectors. It is suggested that the adoption of consistent terminology and conceptual frameworks may provide a valuable step towards consistency in service provision and research and could lead to improved capacity to address the many issues relating to comorbidity service provision and treatment efficacy. What is known about the topic?The co-occurrence of mental health and substance use disorders (comorbidity) is a common and complex problem. However, the service system is not sufficiently developed and coordinated to serve clients with comorbid problems well. What does this paper add?This paper summarises the issues pertaining to conceptual and practical complexities and barriers associated with comorbidity treatment service delivery, including the different aetiologies of comorbidity and types and settings of service providers. What are the implications for practitioners?There is a need for practitioners and other stakeholders to agree on consistent terminology and framework(s) relevant to comorbidity to overcome the barriers and complexities that currently limit service delivery and access to treatment.

scholarly journals Assessing Contact, Coverage, and Quality of continuum of care in Uttar Pradesh, India

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Gupta ◽  
K S ◽  
K Yonzon ◽  
P Kumar ◽  
V Choudhry
Keyword(s):  
Service Delivery ◽  
Health System ◽  
Neonatal Mortality ◽  
Service Provision ◽  
Clinical Care ◽  
Uttar Pradesh ◽  
Continuum Of Care ◽  
Multilevel Regression ◽  
The Continuum

Abstract Background Given the high neonatal mortality in LMIC, strategies suggest a continuum of care (COC) as an effective framework to ensure timely and appropriate service provision throughout the MNCH continuum. However, the measurement approaches traditionally focus on assessing continuum of care from the lenses of time-based coverage and missing out on the quality of coverage and service delivery. This paper aims to assess the continuum of care based on these three parameters and the factors affecting its achievement. Methods Multistage sampling design identified live births and stillbirths in the last calendar year (March 2018-February 2019) across the 50 districts of Uttar Pradesh(n = 16646).COC was assessed on three measurements 1) Contact: Any contact with the health system across the continuum, 2)Coverage: Adequate contacts of the health system through outreach services and clinical care, and 3)Quality: receiving adequate services along with these contacts. Further, a multilevel regression model was used to estimate the factors associated with the continuum of care. Results 64% (60.04-67.65) of the women and child received health system contact across the continuum while only 2.1% (1.57-2.78) and 2.8% (2.33-3.44) women and children achieved coverage and quality based COC, respectively. Achievement of COC coverage and COC quality is highly affected by the service delivery platform, with women at outreach platform being more likely to achieve adequate coverage while women at facilities are more likely to achieve quality services across ANC, delivery, and PNC. Conclusions Achievement of both coverage and quality based COC remains low in Uttar Pradesh, India. Even those who achieve contact(s) failed to receive quality services along with these contacts with health systems. Efforts should be focused on building quality service at the outreach and non-outreach platforms across the continuum of care for reducing the risk of neonatal mortality. Key messages Owing to the lack of an integrated approach for service delivery across outreach, clinical care and community care, continuum of care remains broken for most of the mothers and children. For targeting coverage and quality of COC, focus should be on improving the quality of service provision across the outreach platforms which are already in reach of the women.

scholarly journals Employment relationships in Victorian public hospitals: the Kennett years

2000 ◽  
Vol 23 (3) ◽  
pp. 193 ◽  
Author(s):  
Pauline Stanton
Keyword(s):  
Public Health ◽  
Service Delivery ◽  
Service Provision ◽  
Trade Unions ◽  
Service Providers ◽  
Industrial Relations ◽  
Public Hospitals ◽  
Employment Relations ◽  
The Public ◽  
Health Market

From 1992 to 1999, the Kennett government in Victoria moved to competitive market models of service delivery andthe measurement of service provision through casemix funding. Public hospital managers were given greateraccountability for the costs and provision of service delivery and a new range of service providers, many from theprivate sector, entered the public health market. The decentralisation of the industrial relations system led to newdevelopments in bargaining that brought both opportunities and problems. In the Victorian public health system therewas an increasing emphasis on decentralisation in both service provision and employment relations. In this paper Isuggest that there were contradictions in these developments for government, and new challenges and difficulties foremployers, employees and trade unions.

scholarly journals Landscape analysis of nutrition services at Primary Health Care Units (PHCUs) in four districts of Ethiopia

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243240
Author(s):  
Esete Habtemariam Fenta ◽  
Bilal Shikur Endris ◽  
Yalemwork Getenet Mengistu ◽  
Fekadu Elias Sadamo ◽  
Endashaw Hailu Gelan ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Service Provision ◽  
Service Providers ◽  
Two Dimensions ◽  
Health Facilities ◽  
Health Centers ◽  
Nutrition Services ◽  
High Staff Turnover ◽  
Nutrition Service ◽  
Missed Opportunity

Background Good nutrition and healthy growth during the first 1000days have lasting benefit throughout life. For this, equally important is the structural readiness of health facilities. However, structural readiness and nutrition services provision during the first 1000 days in Ethiopia is not well understood. The present study was part of a broader implementation research aimed at developing model nutrition districts by implementing evidence based, high impact and cost-effective package of nutrition interventions through the continuum of care. This study was aimed at assessing structural readiness of health facilities and the extent of nutrition service provision in the implementation districts. Methods This assessment was conducted in four districts of Ethiopia. We used mixed method; a quantitative study followed by qualitative exploration. The quantitative part of the study addressed two-dimensions, structural readiness and process of nutrition service delivery. The first dimension assessed attributes of context in which care is delivered by observing availability of essential logistics. The second dimension assessed the service provision through direct observation of care at different units of health facilities. For these dimensions, we conducted a total of 380 observations in 23 health centers and 33 health posts. The observations were conducted at the Integrated Management of Neonatal and Childhood Illnesses unit, immunization unit, Antenatal care unit and Postnatal care unit. The qualitative part included a total of 60 key informant interviews with key stakeholders and service providers. Result We assessed structural readiness of 56 health facilities. Both quantitative and qualitative findings revealed poor structural readiness and gap in nutrition services provision. Health facilities lack essential logistics which was found to be more prominent at health posts compared to health centers. The process evaluation showed a critical missed opportunity for anthropometric assessment and preventive nutrition counselling at different contact points. This was particularly prominent at immunization unit (where only 16.4% of children had their weight measured and only 16.2% of mothers with children under six month of age were counselled about exclusive breastfeeding). Although 90.4% of pregnant women who came for antenatal care were prescribed iron and folic acid supplementation, only 57.7% were counselled about the benefit and 42.4% were counselled about the side effect. The qualitative findings showed major service provision bottlenecks including non-functionality of the existing district nutrition coordination body and technical committees, training gaps, staff shortage, high staff turnover resulting in work related burden, fatigue and poor motivation among service providers. Conclusion We found a considerable poor structural readiness and gaps in delivering integrated nutrition services with a significant missed opportunity in nutrition screening and counselling. Ensuring availability of logistics and improving access to training might improve delivery of nutrition services. In addition, ensuring adequate human resource might reduce missed opportunity and enable providers to provide a thorough preventive counselling service.

Service Delivery By a Trade Union—Does It Pay?

1990 ◽  
Vol 19 (2) ◽  
pp. 221-234 ◽  
Author(s):  
Uri Yanay
Keyword(s):  
Health Insurance ◽  
Service Delivery ◽  
Service Provision ◽  
Trade Unions ◽  
Service Providers ◽  
Service Systems ◽  
Insurance Scheme ◽  
Non Union ◽  
Comprehensive Health ◽  
Alternative Service

ABSTRACTA changing socio-economic environment and competition have led trade unions to extend their role and become service providers. This paper examines some of the issues of service delivery which arise. Four central implications are discussed: the trade union's need (1) to adapt to the competitive service provider's market, (2) to enlarge its consumer body, (3) to become an employer of workers, and (4) to expand its interests with business establishments and authorities over non-union matters. The paper focuses on the General Federation of Labour in Israel (the Histadrut), and its comprehensive health insurance scheme (Kupat Holim). The scheme is provided to all union members and their families as part of union membership. Nonetheless, alternative service systems seem sufficiently attractive for many union members to consider ‘deserting’ their union. The union depends on its members—consumers—to secure its broad base, universalistic image, source of income and legitimacy. Trying to attract consumers causes the union to bend some of its principles. Ultimately, service provision forces the union to adopt characteristics alien to, and even contradicting, its traditional, militant role as an organiser of labour.

scholarly journals Using Novel Scenario-Based Assessments to Examine Feasibility of Integrating Preventive Nutrition Services Through the Primary Healthcare System in Bangladesh

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 265-265
Author(s):  
Priyanjana Pramanik ◽  
Phuong Nguyen ◽  
Rasmi Avula ◽  
Sk Masum Billah ◽  
Tarana Ferdous ◽  
...  
Keyword(s):  
Service Delivery ◽  
Pregnant Women ◽  
Interpersonal Communication ◽  
Service Providers ◽  
Preventive Services ◽  
Nutrition Intervention ◽  
Primary Health Care System ◽  
Enabling Factors ◽  
Nutrition Services ◽  
Nutrition Service

Abstract Objectives Bangladesh's National Nutrition Services aims to deliver nutrition services to pregnant women and children through the primary health care system. Previous research highlighted gaps in coverage of preventive nutrition intervention delivery through this system but little is known about feasibility of reshaping service delivery to close the gaps. Prior to designing new approaches, we used a novel scenario-based feasibility testing approach to assess potential to strengthen service delivery. Methods We interviewed 32 service providers and 16 policymakers and conducted 4 focus group discussions with potential beneficiaries, asking respondents about the feasibility of four hypothetical scenarios for preventive service delivery: community-based events (CBE) for pregnant women; well-child services integrated into immunization contacts; CBE for well-children and well-child visits at facilities. Transcribed interviews were systematically coded, synthesized and interpreted using a pre-defined framework. Results Opinions on the need for new platforms for preventive services were mixed; some recommended new platforms, but others suggested strengthening existing delivery points. CBE for pregnant women were perceived as feasible, but workforce shortages emerged as a key challenge. Challenges such as equipment portability, upset children, and a fast-moving service environment suggested low feasibility of integrating nutrition into immunization contacts. In contrast, CBE and facility-based well-child visits emerged as feasible options, conditional on having the necessary workforce, structural readiness and budget support. On the demand side, enabling factors include using interpersonal communication and involving community leaders to increase awareness, organizing events at a convenient time and place for both providers and beneficiaries, and incentives for beneficiaries to encourage participation. Conclusions A scenario-based approach is an efficient method to assess potential feasibility options for nutrition service delivery. Introducing preventive nutrition services requires addressing current challenges in the health system, including human resource and logistic gaps, and investing in creating demand for preventive services. Funding Sources Bill & Melinda Gates Foundation, through A&T, managed by FHI 360.

scholarly journals India's 2.42 Million Frontline Health Workers Enable Restoration of Health and Nutrition Service Delivery After Early COVID-19 Lockdowns

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 206-206
Author(s):  
Rasmi Avula ◽  
Phuong Nguyen ◽  
Sattvika Ashok ◽  
Sumati Bajaj ◽  
Shivani Kachwaha ◽  
...  
Keyword(s):  
Service Delivery ◽  
Child Nutrition ◽  
Food Policy ◽  
Health Workers ◽  
Policy Research ◽  
Food Supplementation ◽  
Growth Monitoring ◽  
Health And Nutrition ◽  
Nutrition Service ◽  
T1 And T2

Abstract Objectives Modeling studies have estimated impacts of potential service delivery disruptions due to COVID-19 pandemic on maternal and child nutrition outcomes, but little is known about actual delivery status. We studied disruptions and restorations of health and nutrition services by frontline workers (FLWs) in India during COVID-19. Methods We conducted phone surveys with 5500 FLWs in seven states between August–October 2020, asking about service delivery during April 2020 (T1) and in the August-October period (T2) and analyzed changes between T1 and T2. We also analyzed publicly available administrative data (AD) from 704 districts including the pre-pandemic period (T0) to examine disruptions and restoration of services. Results Phone surveys suggest, in T1, opening of village centers, fixed day events, growth monitoring, and immunization services was <50% in several states. In T2, restorations of center-based services were seen, with increases of >33% in >= 3 states. Food supplementation was least disrupted both in T1 and T2. AD highlights geographic variability both in disruptions in T1 compared to T0 and restorations in T2. FLWs’ adaptations to ensure service provision included home delivery (60 to 96%), ensuring physical distancing (33 to 86%), coordinating with other FLWs (7 to 49%), and using phone (∼2 to 65%). Challenges included personal fears, walking long distances, and beneficiaries’ non-cooperation. Conclusions Services to mothers and children were disrupted during lockdown and restored thereafter. Rapid policy guidance and local adaptations by a strong cadre of FLWs likely enabled service resumption. However, gaps remain, and more research is needed on use of services by clients. Funding Sources Bill & Melinda Gates Foundation through POSHAN, led by International Food Policy Research Institute.

Systems of Oppression in Geriatric Clinical Service Delivery

2021 ◽  
pp. 1-3
Author(s):  
Diane L. Kendall
Keyword(s):  
Higher Education ◽  
Service Delivery ◽  
Clinical Setting ◽  
Service Providers ◽  
Hard Work ◽  
Clinical Service ◽  
Meaningful Change ◽  
Important Work ◽  
Speech Language Pathologists ◽  
Medical Institutions

Purpose The purpose of this article was to extend the concepts of systems of oppression in higher education to the clinical setting where communication and swallowing services are delivered to geriatric persons, and to begin a conversation as to how clinicians can disrupt oppression in their workplace. Conclusions As clinical service providers to geriatric persons, it is imperative to understand systems of oppression to affect meaningful change. As trained speech-language pathologists and audiologists, we hold power and privilege in the medical institutions in which we work and are therefore obligated to do the hard work. Suggestions offered in this article are only the start of this important work.

Sign in / Sign up

Export Citation Format

Share Document