Qualitative appraisal of stakeholders’ perspective on diabetes mellitus policy in Jakarta, Indonesia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Bachtiar ◽  
A Edward ◽  
C Candi ◽  
A Sarena
Keyword(s):  
Primary Healthcare ◽  
Health Workers ◽  
Healthcare Providers ◽  
Routine Data ◽  
District Level ◽  
Capital City ◽  
Care Seeking ◽  
Diabetes Screening ◽  
External Threats ◽  
The Government

Abstract Background Diabetes prevalence in Indonesia increased from 6.9% to 8.5% between 2013 and 2017.1 It was the third-leading cause of death in 2017. The government responded by introducing the Health Minimum Service Standard Policy (HMSS) in 2016. This study aims to perform a rapid qualitative appraisal of strategic stakeholders and capture their perspective on policy implementation. Methods We used a qualitative approach by interviewing stakeholders from the Ministry of Health, provincial and district-level governments, and 12 primary healthcare providers in Jakarta. The interview was performed from December 2019 to January 2020. Policy dissemination, implementation, and evaluation were also assessed during the interview. Triangulation was done with direct observation and routine data review at primary healthcare. Results The policy was disseminated from the MoH to state and district-level governments through workshops. It improved the coverage of screening, from 7.13% to 26.92% between 2017 and 2019 in Jakarta. Most stakeholders concerned about the problem with people's awareness and multisectoral collaboration to improve the coverage of diabetes services. PHC managers expressed internal threats (limited health workers, ineffective teamwork, and limited budget) and external threats (poor care-seeking, people's awareness, and commitment from across stakeholders) in implementing the policy. Conclusions Diabetes screening coverage in PHC has increased since the implementation of the policy, but below far from reaching a universal target. The government should collaborate with PHC to address the issues of internal and external threats. Key messages The 'SPM' policy introduced in 2016 has provided guidance for state and district-level government to assist the efforts on improving diabetes screening by PHCs in Indonesia. Coverage for diabetes screening in Jakarta, the capital city of Indonesia, has not reached the target. Further exploration of external and internal threats at PHC level is needed.

scholarly journals Accessible metrics of access: Novel tools to measure immunization coverage in rural sub-Saharan Africa

2019 ◽  
Vol 3 ◽  
pp. 1540
Author(s):  
Ross M. Boyce ◽  
Paul Delamater ◽  
Rabbison Muhindo ◽  
Michael Matte ◽  
Moses Ntaro ◽  
...  
Keyword(s):  
Underserved Populations ◽  
Immunization Coverage ◽  
Routine Data ◽  
District Level ◽  
Sub Saharan Africa ◽  
Care Seeking ◽  
African Countries ◽  
Accurate Analysis ◽  
Routinely Collected Data ◽  
Sub Saharan

Immunization rates in most sub-Saharan African countries fall far below stated targets. Measuring access in resource-limited settings, however, is challenging, especially with the data available at the district level, which is the primary administrative division for most immunization programs. Despite calls to improve routine data collection and use, there remains a lack of structured methods and practical tools to target underserved populations. Herein, we describe a prospective study that aims to develop, pilot, and validate a set of user-friendly tools to identify geographic areas with limited access to immunization services and by extension, low immunization coverage. The approach will leverage routinely-collected data from public health facilities combined with novel methods of household mapping to perform spatial analyses using open-access platforms. In addition, we will triangulate the analyses across datasets representing common reasons for care seeking – namely, visits for vaccination, antenatal care, and malaria – to improve the accuracy of our estimates. The ultimate goal of this project is to equip front-line providers and district level program managers with novel tools that facilitate timely and accurate analysis of routinely-collected data to guide immunization efforts.

Balancing Access with Accuracy for Infant HIV Diagnostics in Tanzania (A)

2017 ◽  
pp. 1-14
Author(s):  
Kara Palamountain ◽  
Sachin Waikar ◽  
Andrea Hanson ◽  
Katherine Nelson
Keyword(s):  
Health Workers ◽  
Point Of Care ◽  
Healthcare Providers ◽  
Medical Diagnostics ◽  
Paper Test ◽  
Global Health Initiative ◽  
Non Profit ◽  
The Government ◽  
Hiv Diagnostics ◽  
Roll Out

The Global Health Initiative (GHI) is a tripartite collaboration among Northwestern University, non-profit donors, and commercial diagnostics companies. GHI attempts to bridge the gap between the market for sophisticated medical diagnostics equipment in wealthy nations and the need for point-of-care diagnostics in resource limited settings. In 2006 GHI narrowed its focus to HIV diagnostics for underserved nations. The case examines the accuracy-access tradeoff related to the roll-out of infant HIV diagnostics in Tanzania. Tanzania has a prevalent HIV/AIDS problem, particularly in children. As of 2007, Tanzania had an estimated 140,000 children infected with HIV. Existing lab-based diagnostic equipment was either inaccurate for use in infants or required highly skilled health workers. Tanzania's limited infrastructure also forced healthcare providers to choose between providing advanced care to a minority of the population and offering minimal care to the majority with poor access. A Kellogg MBA student research team performed more than thirty in-country interviews to collect data on stakeholder perceptions of three infant test concepts: the strip test, the squeeze test, and the filter paper test. Across the three tests, access decreased as accuracy increased---rural labs could not find or afford health workers skilled enough to conduct the test. In general, interviewees closely affiliated with the government preferred accuracy over access. In contrast, private health facilities had to follow fewer regulations and preferred access over accuracy. The case focuses on the decisions facing Kara Palamountain, the executive director of GHI, in her roll-out recommendations for infant HIV tests in Tanzania. It examines key factors of working in a developing country, including the need to operate in the absence of sufficient market research, balance the competing agendas of different stakeholders, and mitigate external risks such as major international funding.This case was written to be used as a teaching case for students unfamiliar with how to approach and analyze a typical business school case. Unlike many cases used in specific classroom settings, this case is intended to be broad enough that any single student will not have a significant advantage because of his or her background. Moreover, the case is designed to guide students' thinking in a certain direction, using open-ended and more focused discussion questions provided at the case's end.

scholarly journals Non-communicable disease (NCD) corners in public sector health facilities in Bangladesh: a qualitative study assessing challenges and opportunities for improving NCD services at the primary healthcare level

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029562 ◽  
Author(s):  
Lal B Rawal ◽  
Kie Kanda ◽  
Tuhin Biswas ◽  
Md. Imtiaz Tanim ◽  
Prakash Poudel ◽  
...  
Keyword(s):  
News Media ◽  
Primary Healthcare ◽  
Communicable Disease ◽  
Qualitative Interviews ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Challenges And Opportunities ◽  
The Government ◽  
Non Communicable Disease ◽  
Management Services

ObjectiveTo explore healthcare providers’ perspective on non-communicable disease (NCD) prevention and management services provided through the NCD corners in Bangladesh and to examine challenges and opportunities for strengthening NCD services delivery at the primary healthcare level.DesignWe used a grounded theory approach involving in-depth qualitative interviews with healthcare providers. We also used a health facility observation checklist to assess the NCD corners’ service readiness. Furthermore, a stakeholder meeting with participants from the government, non-government organisations (NGOs), private sector, universities and news media was conducted.SettingTwelve subdistrict health facilities, locally known as upazila health complex (UHC), across four administrative divisions.ParticipantsParticipants for the in-depth qualitative interviews were health service providers, namely upazila health and family planning officers (n=4), resident medical officers (n=6), medical doctors (n=4) and civil surgeons (n=1). Participants for the stakeholder meeting were health policy makers, health programme managers, researchers, academicians, NGO workers, private health practitioners and news media reporters.ResultsParticipants reported that diabetes, hypertension and chronic obstructive pulmonary disease were the major NCD-related problems. All participants acknowledged the governments’ initiative to establish the NCD corners to support NCD service delivery. Participants thought the NCD corners have contributed substantially to increase NCD awareness, deliver NCD care and provide referral services. However, participants identified challenges including lack of specific guidelines and standard operating procedures; lack of trained human resources; inadequate laboratory facilities, logistics and medications; and poor recording and reporting systems.ConclusionThe initiative taken by the Government of Bangladesh to set up the NCD corners at the primary healthcare level is appreciative. However, the NCD corners are still at nascent stage to provide prevention and management services for common NCDs. These findings need to be taken into consideration while expanding the NCD corners in other UHCs throughout the country.

Balancing Access with Accuracy for Infant HIV Diagnostics in Tanzania (B)

2017 ◽  
pp. 1-4
Author(s):  
Kara Palamountain ◽  
Sachin Waikar ◽  
Andrea Hanson ◽  
Katherine Nelson
Keyword(s):  
Health Workers ◽  
Point Of Care ◽  
Healthcare Providers ◽  
Medical Diagnostics ◽  
Paper Test ◽  
Global Health Initiative ◽  
Non Profit ◽  
The Government ◽  
Hiv Diagnostics ◽  
Roll Out

The Global Health Initiative (GHI) is a tripartite collaboration among Northwestern University, non-profit donors, and commercial diagnostics companies. GHI attempts to bridge the gap between the market for sophisticated medical diagnostics equipment in wealthy nations and the need for point-of-care diagnostics in resource limited settings. In 2006 GHI narrowed its focus to HIV diagnostics for underserved nations. The case examines the accuracy-access tradeoff related to the roll-out of infant HIV diagnostics in Tanzania. Tanzania has a prevalent HIV/AIDS problem, particularly in children. As of 2007, Tanzania had an estimated 140,000 children infected with HIV. Existing lab-based diagnostic equipment was either inaccurate for use in infants or required highly skilled health workers. Tanzania's limited infrastructure also forced healthcare providers to choose between providing advanced care to a minority of the population and offering minimal care to the majority with poor access. A Kellogg MBA student research team performed more than thirty in-country interviews to collect data on stakeholder perceptions of three infant test concepts: the strip test, the squeeze test, and the filter paper test. Across the three tests, access decreased as accuracy increased---rural labs could not find or afford health workers skilled enough to conduct the test. In general, interviewees closely affiliated with the government preferred accuracy over access. In contrast, private health facilities had to follow fewer regulations and preferred access over accuracy. The case focuses on the decisions facing Kara Palamountain, the executive director of GHI, in her roll-out recommendations for infant HIV tests in Tanzania. It examines key factors of working in a developing country, including the need to operate in the absence of sufficient market research, balance the competing agendas of different stakeholders, and mitigate external risks such as major international funding dryThis case was written to be used as a teaching case for students unfamiliar with how to approach and analyze a typical business school case. Unlike many cases used in specific classroom settings, this case is intended to be broad enough that any single student will not have a significant advantage because of his or her background. Moreover, the case is designed to guide students' thinking in a certain direction, using open-ended and more focused discussion questions provided at the case's end.

scholarly journals Effectiveness of various communication strategies for improving childhood pneumonia case management: a community based behavioral open labeled trial in rural Lucknow, Uttar Pradesh, India

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Shally Awasthi ◽  
Divas Kumar ◽  
Neha Mishra ◽  
Monika Agarwal ◽  
Chandra Mani Pandey
Keyword(s):  
Health Workers ◽  
Uttar Pradesh ◽  
Community Acquired Pneumonia ◽  
Health Facilities ◽  
Pictorial Representation ◽  
Care Seeking ◽  
Community Based ◽  
Optimal Care ◽  
Government Health ◽  
The Government

Abstract Background Community acquired pneumonia is responsible for 16% of under 5 mortality in India, probably due to delayed recognition and qualified care seeking. Therefore these deaths could possibly be averted by creating community awareness and promoting care seeking from qualified physicians in the government system. The objective of study was to assess the effectiveness of facility-based and village-based behavior change communication interventions delivered to community using validated information, education and communication materials, along with infrastructural strengthening of health facilities, for change in care seeking from government system for community acquired pneumonia in rural Lucknow, India. Method Community based open labeled behavioral trial in 2 by 2 factorial design was conducted in eight rural blocks of Lucknow, northern India. Trained community health workers conducted Pneumonia Awareness Sessions once a month for the care givers of children using validated information, education and communication materials either at the villages or at government health facilities. Prior infrastructural strengthening of public health facilities was done to provide optimal care to cases. Pre packed pneumonia drug kits were provided which had amoxicillin, paracetamol and an instruction card on their use as well as pictorial representation of danger signs of pneumonia. Results Study lasted from October 2015 to September 2018. Adherence to conduct of facility-based intervention was 93.0% (279/300) and to village-based intervention was 73.4% (7638/10410). In village-based intervention there was 79.3% (p < 0.0001) increase from a baseline of 3.3% (14/420) and facility-based intervention 68.9% (p = 0.02) increase from a baseline of 5.35% (21/392) in cases of possible pneumonia treated at government health facilities. Conclusion Conduct of structured pneumonia awareness session using validated information, education and communication material at village level with infrastructural strengthening resulted in improved qualified care seeking from government facilities for community acquired pneumonia. Trial registration AEARCTR-0003137, retrospectively registered on 10/July/2018.

scholarly journals Feasibility, Acceptability, and Programme Effectiveness of Misoprostol for Prevention of Postpartum Haemorrhage in Rural Bangladesh: A Quasiexperimental Study

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Abdul Quaiyum ◽  
Rukhsana Gazi ◽  
Shahed Hossain ◽  
Andrea Wirtz ◽  
Nirod Chandra Saha
Keyword(s):  
Blood Loss ◽  
Rural Women ◽  
Postpartum Haemorrhage ◽  
Health Workers ◽  
Control Group ◽  
Care Seeking ◽  
Plastic Container ◽  
Sanitary Pads ◽  
The Government ◽  
Programme Effectiveness

We explored the feasibility of distributing misoprostol tablets using two strategies in prevention of postpartum haemorrhage (PPH) among women residing in the Abhoynagar subdistrict of Bangladesh. We conducted a quasiexperimental study with a posttest design and nonequivalent comparison and intervention groups. Paramedics distributed three misoprostol tablets, one delivery mat (Quaiyum’s delivery mat), a packet of five standardized sanitary pads, and one lidded plastic container with detailed counseling on their use. All materials except misoprostol were also provided with counseling sessions to the control group participants. Postpartum blood loss was measured by paramedics using standardized method. This study has demonstrated community acceptability to misoprostol tablets for the prevention of PPH that reduced overall volume of blood loss after childbirth. Likewise, the delivery mat and pad were found to be useful to mothers as tools for assessing the amount of blood loss after delivery and informing care-seeking decisions. Further studies should be undertaken to explore whether government outreach health workers can be trained to effectively distribute misoprostol tablets among rural women of Bangladesh. Such a study should explore and identify the programmatic requirements to integrate this within the existing reproductive health program of the Government of Bangladesh.

scholarly journals Iranian Primary Healthcare providers` Perspectives on Providing Pre-hospital Emergency Services in Primary Levels of Healthcare System: A Qualitative Study

2019 ◽  
Author(s):  
Maryam Eri ◽  
Mohammad Javad Kabir ◽  
Ashrafi Babazadeh Gashti ◽  
Kamal Mirkarimi ◽  
Alireza Heidari ◽  
...  
Keyword(s):  
Healthcare System ◽  
Primary Healthcare ◽  
Emergency Services ◽  
Health Workers ◽  
Healthcare Providers ◽  
Hospital Emergency ◽  
Policy Makers ◽  
Mortality And Morbidity ◽  
North Of Iran ◽  
Golestan Province

Background and purpose: Due to the important role of emergencies and accidents as mainspring of mortality and morbidity, providing emergency services must be taken into account at all levels of health system. The aim of this study was to investigate the perspectives of healthcare providers on providing pre-hospital emergency services and its challenges in primary healthcare (PHC) levels in Golestan Province, northern Iran.Materials and Methods: The researchers conducted 31 interviews totally (n=21 community health workers and n=10 family physicians) using semi-structured and in-depth interviews in Golestan Province, north of Iran in the year 2014. All interviews were digitally recorded and transcribed. The collected data was then analyzed through qualitative content analysis.Results: In total, three categories were identified related to emergency services in the primary healthcare system, including 1) Different status of  providing primary preventive and emergency care in primary healthcare levels, 2) Need to develop the emergency services in health houses, and 3) Challenges of providing appropriate emergency services in the primary levels of healthcare system, such as lack of physical and human resources, weakness in monitoring and education system, inadequate skills, motivation in health team, heavy workload, and insufficient cooperation with other related organizations.Conclusion: The primary levels of healthcare system were not properly serviced in emergencies. They were also faced with numerous challenges that necessitate health policy makers to plan for promoting and providing required services at this level of healthcare system.

Eliminating Hepatitis B from Bangladesh by the Year 2030

2020 ◽  
Vol 38 (3) ◽  
pp. 145-149
Author(s):  
Md Golam Mustafa ◽  
Md Shahinul Alam ◽  
Md Golam Azam ◽  
Md Mahabubul Alam ◽  
Md Saiful Islam ◽  
...  
Keyword(s):  
Hepatitis B ◽  
Health Workers ◽  
Health Sector ◽  
Public Health Problem ◽  
Integrated System ◽  
Hbv Infection ◽  
Diagnosis And Treatment ◽  
Major Public Health Problem ◽  
Medical Institutions ◽  
The Government

Worldwide, hepatitis B virus (HBV) infection is still a major public health problem. Bangladesh having a large burden of HBV infection, should be a major contributor towards it’s elimination by 2030. The country has been making progress in reducing incidence of HBV infection during the past decades. The progresses are mainly due to large vaccination coverage among children and large coverage of timely birthdose vaccine for prevention of mother-to-child transmission of HBV. However, Bangladesh still faces challenges in achieving target of reduction in mortality from HBV. On the basis of targets of the WHO’s Global health sector strategy on viral hepatitis 2016–2021, we highlight priorities for action towards HBV elimination. To attain the target of reduced mortality we propose that, the service coverage targets of diagnosis and treatment should be prioritized along with vaccination. Firstly, improvements are needed in the diagnostic and treatment abilities of medical institutions and health workers. Secondly, the government needs to reduce the costs of health care. Thirdly, better coordination is needed across existing national program and resources to establish an integrated system for prevention, screening, diagnosis and treatment of HBV infection. In this way, we can make progress towards achieving the target of eliminating HBV from Bangladesh by 2030 J Bangladesh Coll Phys Surg 2020; 38(3): 145-149

The Use of Multimedia and its Impact on Bangladeshi EFL Learners at Tertiary Level

2020 ◽  
Vol 4 (2) ◽  
pp. 150
Author(s):  
Farzana Sharmin Pamela Islam
Keyword(s):  
Language Learning ◽  
Academic Writing ◽  
Teaching And Learning ◽  
English Language ◽  
Capital City ◽  
Tertiary Level ◽  
Language Classroom ◽  
The Difference ◽  
The Government ◽  
The Impact

As 21st century is the era of modern technologies with different aspects, it offers us to make the best use of them. After tape recorder and overhead projector (OHP), multimedia has become an important part of language classroom facilities for its unique and effective application in delivering and learning lesson. Although in many parts of Bangladesh, a South Asian developing country, where English enjoys the status of a foreign language, the use of multimedia in teaching and learning is viewed as a matter of luxury. However, nowadays the usefulness and the necessity of it are well recognized by the academics as well as the government. The study aims to focus on the difference between a traditional classroom void of multimedia and multimedia equipped classrooms at university level by explaining how multimedia support the students with enhanced opportunity to interact with diverse texts that give them more in-depth comprehension of the subject. It also focuses on audio-visual advantage of multimedia on the students’ English language learning. The study has followed a qualitative method to get an in-depth understanding of the impact of using multimedia in an English language classroom at tertiary level. For this purpose, the data have been collected from two different sources. Firstly, from students’ written response to  an open ended question as to their comparative experience of learning  lessons with and without multimedia facilities; and secondly, through  observation of English language classes at a private university of Dhaka, the capital city of Bangladesh. The discussion of the study is limited to  the use of multimedia in English language classroom using cartoons, images and music with a view to enhance students’ skills in academic writing, critical analysis of image and critical appreciation of music. For this purpose, cartoons in English language, images from Google and music from You Tube have got focused discussion in this paper.

Boutiques and Prêt-à-porter in Santiago de Chile: A Formula for Women’s Modernity (1967–1973)

2020 ◽  
Author(s):  
Josefina Vidal M ◽  
Macarena García O ◽  
Pedro Álvarez C
Keyword(s):  
Capital City ◽  
Military Dictatorship ◽  
Haute Couture ◽  
Collective Work ◽  
Santiago De Chile ◽  
Salvador Allende ◽  
Consumer Segment ◽  
The Government ◽  
The 1960S ◽  
New Formula

Abstract In the second half of the 1960s, prêt-à-porter (ready-to-wear) fashion was established in Chile. As an alternative to haute couture (high fashion), prêt-à-porter brought an eagerness for modernisation that was reflected in the setting up of a network of women-led boutiques, which developed strongly between 1967 and 1973. This article first examines the precedents that allowed for the creation of a ‘local fashion system’ that promoted collective work around trades such as knitting and dressmaking. It also analyses the arrangement of a circuit of boutiques in the comuna of Providencia, a strategic sector of Santiago de Chile (the capital city) that fostered the dynamics of social gathering. Later, the article describes the profile of the designer-entrepreneurs whose work was attuned to a female consumer segment that aimed to access a new formula of the modernising bourgeoisie. It also reassesses the rise of a movement called Moda Autóctona, which distanced itself from European fashion and was supported by the government during the socialist regime of Salvador Allende. Lastly, it tackles the eventual dismantling of this network of women’s fashion stores as a result of the installation of a military dictatorship in Chile.

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