scholarly journals Public healthcare co-payments in Botswana: the dynamics and consequences of policy amnesia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
V Pagiwa ◽  
A Shiell ◽  
S Barraclough
Keyword(s):  
Policy Development ◽  
Institutional Design ◽  
Monitoring And Evaluation ◽  
Public Healthcare ◽  
Healthcare Facilities ◽  
Documentary Analysis ◽  
Corporate Memory ◽  
Local Actors ◽  
The Government ◽  
Enforcement Mechanisms

Abstract Background When policy implementation is not regularly monitored and evaluated, it risks irrelevance to changing conditions and, over time, its original purpose can even be forgotten. In 1975, the government of Botswana instituted co-payments for public healthcare, a policy which has remained largely unaltered since its introduction with the exception of two increases in the fee-level. Therefore, this study aims to critically analyze the institutional design and operation of Botswana's co-payment policy for public healthcare. Methods Using documentary analysis and interviews with 32 key informants, Botswana's longstanding policy requiring a modest co-payment in public healthcare facilities was analysed. Data were analysed thematically in an inductive way. Results The findings revealed the policy was not monitored, rarely evaluated and became both ineffective and inefficient, costing more to administer than was received in revenue. The Ministry of Health and Wellness no longer had a copy of the original policy and there was no corporate memory of its original purpose. Informants were confused about the policy and why it was still in place after four decades. There was absence of requirements for monitoring and evaluation in the original policy. The top-down policy development failed to explain rationale for policy and mobilize popular support leading to civil society ignorant of the policy. Conclusions The consequences of policy amnesia in this study are evident. The lack of timely policy evaluation influenced discretionary powers for administrators applying the co-payment leading to the problems of partiality. Uneconomic financial returns as a result of inflation and poor enforcement mechanisms continued without causing concerns. That might have been undermined by placing emphasis on the role of central actors and ignoring the involvement and significance of the local actors, who are in a much better situation to propose and implement purposeful policies. Key messages Lack of regular policy monitoring and evaluation risks irrelevance to changing conditions, and overtime, the policy’s original purpose is easily forgotten. Requirements for policy monitoring and evaluation need to be explained with the initial policy and enforcement mechanisms put in place.

scholarly journals India’s RMNCH+A Strategy: approach, learnings and limitations

2019 ◽  
Vol 4 (3) ◽  
pp. e001162 ◽  
Author(s):  
Gunjan Taneja ◽  
Vegamadagu Suryanarayana-Rao Sridhar ◽  
Jaya Swarup Mohanty ◽  
Anurag Joshi ◽  
Pranav Bhushan ◽  
...  
Keyword(s):  
Health Planning ◽  
Healthcare Delivery ◽  
Monitoring And Evaluation ◽  
Healthcare Services ◽  
Evaluation Framework ◽  
Public Healthcare ◽  
Healthcare Delivery System ◽  
District Health ◽  
Public Health Challenges ◽  
The Government

Building on the gains of the National Health Mission, India’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Strategy, launched in 2013, was a milestone in the country’s health planning. The strategy recognised the interdependence of RMNCH+A Interventions across the life stages and adopted a comprehensive approach to address inequitable distribution of healthcare services for the vulnerable population groups and in poor-performing geographies of the country. Based on innovative approaches and management reforms, like selection of poor-performing districts, prioritisation of high-impact RMNCH+A healthcare interventions, engagement of development partners and institutionalising a concurrent monitoring system the strategy strived to improve efficiency and effectiveness within the public healthcare delivery system of the country. 184 High Priority Districts were identified across the country on a defined set of indicators for implementation of critical RMNCH+A Interventions and a dedicated institutional framework comprising National and State RMNCH+A Units and District Level Monitors supported by the development partners was established to provide technical support to the state and district health departments. Health facilities based on case load and available services across the High Priority Districts were prioritised for strengthening and were monitored by an RMNCH+A Supportive Supervision mechanism to track progress and generate evidence to facilitate actions for strengthening ongoing interventions. The strategy helped develop an integrated systems-based approach to address public health challenges through a comprehensive framework, defined priorities and robust partnerships with the partner agencies. However, lack of a robust monitoring and evaluation framework and sub-optimal focus on social determinants of health possibly limited its overall impact and ability to sustain improvements. Guided by the learnings and limitations, the Government of India has now designed the ‘Aspirational Districts Program’ to holistically address health challenges in poor-performing districts within the overall sociocultural domain to ensure inclusive and sustained improvements.

scholarly journals A Dynamic Analysis of the Demand for Health Care in Post-Apartheid South Africa

2021 ◽  
Vol 11 (2) ◽  
pp. 484-494
Author(s):  
David Mhlanga
Keyword(s):  
South Africa ◽  
Logit Model ◽  
Healthcare Services ◽  
Public Healthcare ◽  
Probability Models ◽  
Delivery Of Healthcare ◽  
Healthcare Facilities ◽  
The Government ◽  
Public Clinics ◽  
Demand For Health

The study aimed to investigate the drivers of demand for healthcare in South Africa 26 years after democracy. The pattern healthcare demand by households in South Africa is that most households use public healthcare services particularly public clinics compared to private and traditional healthcare facilities. Using conditional probability models, the logit model to be more specific, the results revealed that households head who is unemployed, households who do not have a business, households who were not receiving pension money, had a greater probability of demand for public healthcare institutions. On the other hand, being male, being White, Indian and Coloured, being a property owner and being not a grant beneficiary, reduces the probability of demand for public healthcare facilities in South Africa. As a result, the study recommends more investment in public healthcare but more in public clinics in South Africa due to the high percentage of households using these services. Also, the government must consider investing more in the maintenance and improvement of the welfare of nurses in the country considering the huge role they play in the delivery of healthcare to the citizens.

scholarly journals Assessing the Current States of Logistics Management and Training on Family Planning Services in Nigerian Healthcare Facilities

2021 ◽  
pp. 27-36
Author(s):  
Ali Johnson Onoja ◽  
Felix Olaniyi Sanni ◽  
Simon Peterside Akogu ◽  
Paul Olaiya Abiodun ◽  
Sheila Iye Onoja ◽  
...  
Keyword(s):  
Family Planning ◽  
Service Providers ◽  
Monitoring And Evaluation ◽  
Chi Square ◽  
Healthcare Facilities ◽  
Facility Assessment ◽  
Logistic Management ◽  
Trained Staff ◽  
The Government ◽  
Donor Agencies

Background: Management of Family planning (FP) commodities is a significant problem that is not limited to compromising the quality of FP services but also results in economic burden especially in developing countries.  Some facilities may have ample FP commodities while others have a shortage if FP logistics are managed poorly. Hence, assessing the FP commodities logistic management is relevant to inform decision-makers. Methods: This survey was a cross-section study of 763 public primary and secondary healthcare facilities in Nigeria. The study involved facility assessment and quantitative interview of key personnel in each facility, using a structured questionnaire. The study was conducted from May to July 2019. The data collected were analysed with IBM-SPSS version 25.0. Descriptive statistics were performed, Chi-Square and linear logistics regression were used to establish significant associations; p<0.05 was considered significant. Results: About half (51.4%) of primary and 33.5% of secondary healthcare facilities were not using forms for reporting FP supplies. Also, 23.8% of primary and 18.8% of secondary facilities waited for more than two months before receiving orders. The facilities have an average of 2-3 trained personnel on FP services. FP staff who were trained had their last training over a year ago (primary-31.9%); secondary-37.4%). Secondary facilities were 2.102(95% CI:1.567–2.820) times more likely to use log forms, 1.845(95% CI: 1.076–3.165) times more likely to have cold chains, and 4.785(95% CI: 3.207–7.139) more likely to have trained staff on insertion and removal of implants than primary facilities (p<0.05). Conclusion: We advocate that the government and donor agencies carry out urgent interventions such as regular supply of contraceptives, regular training of FP service providers, provide sufficient manpower, carry out regular monitoring and evaluation of FP services and create awareness on the need to use FP services among grassroots citizens.

scholarly journals Public Health Policy of India and COVID-19: Diagnosis and Prognosis of the Combating Response

2021 ◽  
Vol 13 (6) ◽  
pp. 3415
Author(s):  
Priya Gauttam ◽  
Nitesh Patel ◽  
Bawa Singh ◽  
Jaspal Kaur ◽  
Vijay Kumar Chattu ◽  
...  
Keyword(s):  
Public Health ◽  
Health Policy ◽  
Healthcare System ◽  
Public Health Policy ◽  
Public Healthcare ◽  
Extensive Literature ◽  
Future Health ◽  
Healthcare Facilities ◽  
The Public ◽  
The Government

(1) Background: Society and public policy have been remained interwoven since the inception of the modern state. Public health policy has been one of the important elements of the public administration of the Government of India (GOI). In order to universalize healthcare facilities for all, the GOI has formulated and implemented the national health policy (NHP). The latest NHP (2017) has been focused on the “Health in All” approach. On the other hand, the ongoing pandemic COVID-19 had left critical impacts on India’s health, healthcare system, and human security. The paper’s main focus is to critically examine the existing healthcare facilities and the GOI’s response to combat the COVID-19 apropos the NHP 2017. The paper suggests policy options that can be adopted to prevent the further expansion of the pandemic and prepare the country for future health emergency-like situations. (2) Methods: Extensive literature search was done in various databases, such as Scopus, Web of Science, Medline/PubMed, and google scholar search engines to gather relevant information in the Indian context. (3) Results: Notwithstanding the several combatting steps on a war-footing level, COVID-19 has placed an extra burden over the already overstretched healthcare infrastructure. Consequently, infected cases and deaths have been growing exponentially, making India stand in second place among the top ten COVID-19-infected countries. (4) Conclusions: India needs to expand the public healthcare system and enhance the expenditure as per the set goals in NHP-17 and WHO standards. The private healthcare system has not been proved reliable during the emergency. Only the public health system is suitable for the country wherein the population’s substantial size is rural and poor.

scholarly journals A 5-year assessment of malaria documentation and reporting practices in government healthcare facilities in Lagos, Nigeria

2019 ◽  
Vol 6 (6) ◽  
pp. 2321
Author(s):  
Adeyinka Adeniran ◽  
Kikelomo O. Wright ◽  
Babatunde A. Odugbemi ◽  
Olajide Idris
Keyword(s):  
Local Government ◽  
Health Workers ◽  
The State ◽  
Health Facilities ◽  
Public Healthcare ◽  
Healthcare Facilities ◽  
Reporting Practices ◽  
Lagos State ◽  
The Government ◽  
The Impact

Background: Robust and effective information management systems are critical for successful malaria control and elimination. This study was a follow up study to assess the practices of Lagos State public healthcare facilities with regards to malaria documentations and reporting to the local government authorities (LGAs) in Lagos Nigeria in 2009 and then in 2013.Methods: We conducted a descriptive cross-sectional repeated survey of all 218 functional government-owned health facilities in Lagos State between in years 2009 and 2013 using a structured questionnaire. Approval was obtained from the research ethics committee of the Lagos State Ministry of Health.Results: There was a decrease in the proportion of primary & secondary healthcare facilities that document all cases of malaria seen in the facilities from 97.9% and 95.5% respectively in 2009 to 91.5% and 85.7% in 2013. About 53% of the primary healthcare facilities rendered malaria data to the Local Government Area (LGA) using the IDSR system in 2009 which marginally increase to 62.4% in 2013. Whereas in 2009, 63.6% of secondary healthcare facilities rendered malaria data to the LGA whilst 50% did in 2013. The only Tertiary health facility in the state did not render malaria data to the LGA in 2009 but did in 2013.Conclusions: There was a gradual reduction in malaria documentation by the government healthcare facilities. Therefore, there is need to intensify training among health workers in the government health facilities in the state with continuous monitoring and evaluation of performance to determine the impact. 

THE EFFECTS OF SOCIAL HEALTH INSURANCE ON WOMEN’S HEALTHCARE USE: EVIDENCE FROM INDONESIA

2020 ◽  
pp. 1-24
Author(s):  
SHANIKA SAMARAKOON ◽  
RASYAD A. PARINDURI
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Healthcare Services ◽  
Social Health ◽  
Public Healthcare ◽  
Delivery Care ◽  
Healthcare Use ◽  
Healthcare Facilities ◽  
The Poor ◽  
The Government

To increase the use of healthcare services in Indonesia, the government of Indonesia introduced Askeskin, a subsidized social health insurance for the poor, in 2005. We examine the effects of this social health insurance on women’s healthcare use. Using propensity score matching, we find Askeskin induces women to use public healthcare facilities for birth delivery and antenatal checkup, discourages them from getting help from midwives for birth delivery, and makes them more likely to use contraceptives. The insurance seems to increase delivery care expenditure, however. We do not find evidence that it increases women’s preventive and curative healthcare use.

Design of the Tool (web) EMAeHealth supporting decision-making during pregnancy and postpartum: Collaborative Action Research Study. (Preprint)

2020 ◽  
Author(s):  
Isabel Artieta-Pinedo ◽  
Carmen Paz-Pascual ◽  
Paola Bully ◽  
Maite Espinosa ◽  
Keyword(s):  
Action Research ◽  
Maternal Education ◽  
Monitoring And Evaluation ◽  
Research Process ◽  
Collaborative Action Research ◽  
Public Healthcare ◽  
Self Assessment ◽  
Collaborative Action ◽  
Patient Decision ◽  
Pregnancy And Postpartum

BACKGROUND Background: Despite the benefit it can give women, Maternal Education needs new tools that increase its effectiveness and scope OBJECTIVE To develop a multifunctional, personalized eHealth platform aimed at the self-management of health in relation to maternity METHODS The International Patient Decision Aid Standards (IPDAS) were applied. A website prototype was developed for implementation in the public health system using a collaborative action research process in which experts and patients participate, with qualitative research techniques as well as prioritization and consensus techniques. RESULTS A website is proposed which includes (1) systematically updated information related to clinical practice guidelines, (2) interaction between peers and users/professionals, (3) instruments for self-assessment of health needs as a basis for working on counseling, agreement on actions, help in the search for resources, monitoring and evaluation of results and (4) access for women to their clinical data and the option of sharing them with other health agents. These components, with different access requirements, would be permanently reviewed through iterative cycles depending on the frequency and effectiveness resulting from their use and would be accessible from any digital device CONCLUSIONS This public healthcare website would facilitate use, maintenance and effectiveness to increase quality of care without increasing costs. The participation of professionals and users in the creation of new tools will result in greater satisfaction with their use, with the decisions made, and with the decision process itself.

scholarly journals Migrants’ and Natives’ Attitudes toward Public Healthcare Provision in Denmark, Germany, and the Netherlands

2020 ◽  
Author(s):  
Verena Seibel ◽  
Jeanette A J Renema
Keyword(s):  
The Netherlands ◽  
Welfare States ◽  
Public Healthcare ◽  
Healthcare Provision ◽  
Level Of Satisfaction ◽  
Health Differences ◽  
Socialization Processes ◽  
The Government ◽  
Migrant Groups ◽  
European Welfare States

Abstract Public healthcare is still one of the main pillars of European welfare states, despite the increasing number of migrants, we know little about migrants’ attitudes toward healthcare. We used recent data from the MIFARE survey and compared natives with a variety of nine migrant groups living in Denmark, Germany, and the Netherlands, focusing on migrants’ preferred level of governmental involvement and their satisfaction with public healthcare. We found that, compared to natives, migrants held the government less responsible for providing healthcare while expressing a higher level of satisfaction. Whereas health differences among migrants and natives did not explain this ethnic gap, we found that these ethnic gaps are moderated by socialization processes and knowledge of healthcare rights.

scholarly journals “Just So You Know, It Has Been Hard”: Food Retailers’ Perspectives of Implementing a Food and Nutrition Policy in Public Healthcare Settings

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2053
Author(s):  
Kristy Karying. Law ◽  
Claire Elizabeth. Pulker ◽  
Janelle Diann. Healy ◽  
Christina Mary. Pollard
Keyword(s):  
Nutrition Policy ◽  
Public Healthcare ◽  
Healthcare Facilities ◽  
Voluntary Standards ◽  
Policy Success ◽  
Healthcare Settings ◽  
Food Retailers ◽  
Food And Nutrition ◽  
The Cost ◽  
Public Health Practitioners

Mandated policies to improve food environments in public settings are an important strategy for governments. Most Australian governments have mandated policies or voluntary standards for healthy food procurement in healthcare facilities, however, implementation and compliance are poor. A better understanding of the support required to successfully implement such policies is needed. This research explored food retailers’ experiences in implementing a mandated food and nutrition policy (the Policy) in healthcare settings to identify barriers, enablers, and impacts of compliance. Three 90-min workshops facilitated by two public health practitioners were undertaken with 12 food retailers responsible for operating 44 outlets across four hospitals in Perth, Western Australia. Workshop discussions were transcribed non-verbatim and inductive thematic content was analyzed. Three main themes were identified: (1) food retailers had come to accept their role in implementing the Policy; (2) the Policy made it difficult for food retailers to operate successfully, and; (3) food retailers needed help and support to implement the Policy. Findings indicate the cost of implementation is borne by food retailers. Communications campaigns, centralized databases of classified products, reporting frameworks, recognition of achievements, and dedicated technical expertise would support achieving policy compliance. Feasibility assessments prior to policy implementation are recommended for policy success.

scholarly journals ‘The nurse did not even greet me’: how informed versus non-informed patients evaluate health systems responsiveness in South Africa

2021 ◽  
Vol 6 (4) ◽  
pp. e004360
Author(s):  
Dumisani MacDonald Hompashe ◽  
Ulf-G Gerdtham ◽  
Carmen S Christian ◽  
Anja Smith ◽  
Ronelle Burger
Keyword(s):  
Health Systems ◽  
Primary Healthcare ◽  
Healthcare Workers ◽  
Quality Care ◽  
Public Healthcare ◽  
Health Coverage ◽  
Access To Health Services ◽  
Healthcare Provision ◽  
Healthcare Facilities ◽  
Patients Experience

Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ experiences of non-clinical dimensions. Results We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers’ explanations of health conditions. Conclusion Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.

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