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

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.

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

2020 ◽  
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 ◽  
World Health ◽  
Research Database ◽  
Middle Income ◽  
Middle Income Countries ◽  
Integrated Health

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.

scholarly journals Effect of performance-based financing on health service delivery: a case study from Adamawa state, Nigeria

2020 ◽  
Author(s):  
Ryoko Sato ◽  
Abdullahi Belel
Keyword(s):  
Health Service ◽  
Service Delivery ◽  
Health Management ◽  
Intervention Group ◽  
Investment Project ◽  
Health Service Delivery ◽  
Health Management Information System ◽  
District Health ◽  
Performance Based Financing ◽  
Quasi Experimental

Abstract The Nigeria State Health Investment Project (NSHIP) was implemented in three Nigerian states between 2013 and 2018. Under the NSHIP, some local government areas were randomly assigned to Performance-Based Financing (PBF) intervention while others received decentralized facility financing (DFF) for comparison. This article evaluates the effect of PBF compared with DFF on health service delivery indicators in Adamawa state, under this quasi-experimental design, using the difference-in-differences technique. The analysis used health facility monthly data collected by the Health Management Information System through the District Health Information Software 2 (DHIS2). The PBF intervention group significantly increased the quantity of most of its service delivery indicators, such as antenatal care visits and deliveries by skilled personnel compared with the comparison group (DFF) after the introduction of NSHIP, although the baseline level of service delivery between PBF and DFF health facilities was statistically identical prior to the introduction of the intervention. We also conducted robustness check analysis to confirm the effect of PBF. Overall, we found a significant positive effect of PBF on most service delivery outcomes, except full vaccinations and post-natal care. One important policy implication is that we should carefully use PBF for targeted indicators.

External performance audit in New Zealand public health: a legitimacy perspective

2019 ◽  
Vol 17 (2) ◽  
pp. 145-175
Author(s):  
Nirmala Nath ◽  
Radiah Othman ◽  
Fawzi Laswad
Keyword(s):  
New Zealand ◽  
Health Service ◽  
Service Delivery ◽  
Health Service Delivery ◽  
District Health ◽  
Content Type ◽  
Public Sector Health ◽  
Performance Audit ◽  
Performance Auditing ◽  
Auditor General

Purpose This paper aims to provide insights into how the New Zealand Office of the Auditor-General (NZOAG) legitimised the selection of topics for performance audit in the New Zealand public health sector over a 10-year period, 2003-2013, by fulfilling the key actors’ “taken for granted beliefs” of the dual roles of the NZOAG: its independence and accountability. Design/methodology/approach This paper uses evidence gathered from interviews with representatives of the District Health Boards, the Ministry of Health (including Health Advisory Committee members) and NZOAG staff, along with publically available documentary evidence over a 10-year period. The authors draw on Suchman’s (1995) authority on institutional legitimacy to inform the research findings. Findings The New Zealand Auditors-General (NZAGs) get inputs from various sources such as their own audit teams, parliamentary deliberations, the Ministry of Health, the District Health Boards, media and public concerns and complaints. These sources initiate ideas for performance audits. Subsequently, the NZAGs use the recurring themes and risk assessment criteria while simultaneously consulting with the auditees (the MOH and the DHBs) and other actors, such as health advisory groups, to select topics for such audits. This signals to the key actors, such as the MOH and the DHBs, that the NZOAG is addressing the topics and concerns relevant to the former while discharging its public accountability role. Furthermore, the consultative approach acts as a catalyst, ensuring that the actors involved with public sector health service delivery, specifically the auditees, accept the selected topic. This leads to a lack of resistance to and criticism of the topic; the selection process, therefore, is legitimatised, and credibility is added to the audits. Because of the consultative approach taken by the NZAGs, the actors, including the performance auditors, continue to believe that the Office acts independently from third party influence in selecting their audit topics, elevating the NZAGs’ moral legitimacy with respect to their public accountability role. Research limitations/implications The study’s focus group does not include parliamentary representatives, only representatives from the DHBs, the MOH and the NZOAG; therefore, the conclusions on effective discharge of the NZOAG’s accountability role and Parliamentary acceptance is not conclusive – the NZOAG acts on behalf of the Parliament in discharging its accountability role and the latter is also the formal recipient of the reports. Practical implications The implications for practitioners and policymakers are that the use of a consultative approach to select topics for performance audit in the absence of performance auditing standards ensures auditee readiness and acceptance of such audits. This also promotes mutual benefits and “trust” between the AG and auditees. Such audits can be used to bring about efficacy in health service delivery. Social implications The selected topics for audits will have an impact on citizens’ lifestyles, with improved health services delivery. Originality/value There is a dearth of research on who initiates the ideas for performance auditing and how the Office of the Auditor-General selects topics for such audits. This study adds a new dimension to the existing performance auditing literature. The authors reveal how the NZOAG seeks to legitimise the selection of topics for such audits by consulting with the auditees and other actors associated with public sector health service delivery, while upholding its independent status and making transparent how it discharges its accountability role within the context of performance auditing.

The Politics of Health Devolution in the Philippines: Experiences of Municipalities in a Devolved Set-up

2004 ◽  
Vol 25 (1) ◽  
pp. 25-54
Author(s):  
Maria Ela L. Atienza
Keyword(s):  
Local Government ◽  
Health Service ◽  
Service Delivery ◽  
Health Service Delivery ◽  
The Philippines ◽  
The Public ◽  
Several Variables ◽  
Sociopolitical Context ◽  
Set Up ◽  
Intervening Variables

This paper analyzes the dynamics of health devolution in the Philippines within the context of the 1991 Local Government Code. The paper looks into how the present level of health devolution came about, the reform's impact on the public health system, and the factors involved in improving health service delivery in municipalities under a devolved set up. There are several variables that are tested as possible intervening variables. These are prioritization of health services in resource allocation and management, adequacy of formal health personnel and facilities, and citizens' participation in health service delivery. The sociopolitical context of the local government is also explored. Two case studies are presented to support the arguments of the paper.

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

BMJ Open ◽  
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.

scholarly journals Innovation in Delivering Public Health Service: Practice In Banyuwangi Regency – Indonesia

2020 ◽  
Vol 8 (1) ◽  
pp. 12-21
Author(s):  
Anugerah Yuka Asmara ◽  
Amy Yayuk Sri Rahayu
Keyword(s):  
Public Health ◽  
Public Sector ◽  
Health Service ◽  
Service Delivery ◽  
Public Service ◽  
Public Management ◽  
Public Health Service ◽  
Local Communities ◽  
New Paradigm ◽  
The Public

Objective - The objective of this study is to elaborate that innovation in public sector organizations (PSOs), especially in delivery of public service, is not mostly determined by top management in the public sector. A new paradigm of public management has led to the creation of a new cooperation scheme across actors in forms of co-design, co-production, and collaboration between public service supplier(s) and users. In the public sector, interconnectedness among actors to make innovation in public service delivery is rare. Methodology/Technique – The method of this research is a case study of 3 different health agencies (Puskesmas) in the Regency of Banyuwangi, East Java Province, Indonesia. All three Puskesmas agencies represent 3 different cultures influencing the practice of innovation in public health service delivered by them. Finding - The findings reveals that the practice of innovation in public service delivery within new paradigm of public management by which interconnectedness between public agency and local communities has occured. The findings of this study show that there is strikingly different impact of innovation delivered by the 3 Puskesmas agencies. Novelty - This study contributes to existing literature on public or organizational management that culture values of local communities as target groups cannot be neglected in implementing innovation in PSOs. Type of Paper: Empirical. Keywords: Innovation, Public Service, Health Service, Banyuwangi, Indonesia. Reference to this paper should be made as follows: Asmara, A. Y; Rahayu, A.Y.S. 2020. Innovation in Delivering Public Health Service: Practice in Banyuwangi Regency – Indonesia, Global J. Bus. Soc. Sci. Review, 8(1): 12 – 21. https://doi.org/10.35609/gjbssr.2020.8.1(1) JEL Classification: H80, H89.

scholarly journals Decentralised clinical training in optometry: a developmental strategy for eye health in KwaZulu Natal?

2018 ◽  
Vol 20 ◽  
Author(s):  
Diane van Staden
Keyword(s):  
Public Health ◽  
South Africa ◽  
Public Sector ◽  
Health Service ◽  
Health Services ◽  
Clinical Training ◽  
Health Service Delivery ◽  
The Public ◽  
Eye Health ◽  
Kwazulu Natal

AbstractBackgroundDecentralised clinical training (DCT) in optometry is an emerging concept in South Africa. In 2016, the University of KwaZulu Natal (UKZN) implemented this adaptive model of clinical training for undergraduate health professions. The initiative, which emanated through an agreement between UKZN’s College of Health Sciences and the KwaZulu Natal Department of Health, centres on the placement of undergraduate optometry students within public health facilities for clinical training purposes. Optometry services in South Africa have, however, had a historical bias towards a private sector model of training and a curative practice approach resulting in access barriers for the rural poor and high levels of unmet need. It has further contributed to a general state of underdevelopment of eye health services within the public sector.DiscussionDCT challenges historical undergraduate programme structures and modes of teaching and learning in optometry. It is largely underpinned by a need to strengthen health service delivery through a primary health care-centred, community-based training approach and produce ‘fit-for-purpose’ graduates who have contextually appropriate competencies for effective, local health service delivery. The historical absence of optometry services within the public sector has, however, contributed to limited planning for, and development of eye health services in this sector. This has inadvertently contributed to the burden of avoidable vision impairment in the country. The public health system in South Africa, therefore, faces various developmental challenges which impact eye health services and student clinical training.ConclusionWhile the model is still in a developmental state and resourcing challenges potentially affecting DCT are noted, early experiences of the Discipline of Optometry at the UKZN are that DCT shows promise in terms of its potential contribution towards the development of eye health services within the public health sector from graduate readiness, resource strengthening, access improvement and health service development perspectives.

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