scholarly journals The impact of delays on maternal and neonatal outcomes in Ugandan public health facilities: the role of absenteeism

2016 ◽  
Vol 31 (9) ◽  
pp. 1152-1161 ◽  
Author(s):  
Louise Ackers ◽  
Elena Ioannou ◽  
James Ackers-Johnson
Keyword(s):  
Public Health ◽  
Health Facilities ◽  
Neonatal Outcomes ◽  
Public Health Facilities ◽  
Maternal And Neonatal Outcomes ◽  
The Impact

scholarly journals Protecting the poor? Impact of the national health equity fund on utilization of government health services in Cambodia, 2006-2013

2019 ◽  
Vol 4 (6) ◽  
pp. e001679 ◽  
Author(s):  
Peter Leslie Annear ◽  
John Tayu Lee ◽  
Keovathanak Khim ◽  
Por Ir ◽  
Ellen Moscoe ◽  
...  
Keyword(s):  
Public Health ◽  
Health Equity ◽  
Health Facilities ◽  
National Study ◽  
First Year ◽  
Equity Fund ◽  
Public Health Facilities ◽  
Level Change ◽  
The Poor ◽  
The Impact

IntroductionCambodia’s health equity fund (HEF) is the country’s most significant social security scheme, covering the poorest one-fifth of the national population. During the last two decades, the HEF system was scaled up from an initial two health districts to national coverage of public health facilities. This is the first national study to examine the impact of the HEF on the utilisation of public health facilities.MethodsWe first investigated the level of national HEF population coverage and health service use made by HEF eligible members using an administrative HEF operational dataset. Second, through multilevel interrupted time series analysis of routine monthly utilisation statistics during 2006–2013, we evaluated the impact of the HEF on hospital and health centre utilisation.ResultsThe proportion of HEF beneficiaries using hospital services in a given year (4.6%) appeared to exceed rates in the general population (3.3%). The introduction of the HEF was associated with: a significant level change in the monthly number of consultations at HCs followed by a gradual slope increase in time trend and a significant level change in the monthly number of deliveries. Overall, this was equivalent to a 15.6% net increase in number of consultations and 5.3% in deliveries in the first year. At RHs: a significant level change in the number of RH inpatient cases, followed by a sustained slope increase; a significant slope increase in the number of outpatient consultations and in the overall number of newborn deliveries. Overall, this was equivalent to a 47.9% net increase in inpatient cases, 24.1% in outpatient cases and 31.4% in deliveries in the first year.ConclusionThe implementation of the HEF scheme was associated with increased utilisation of primary and secondary care services by the poor.

scholarly journals Impact of devolution on the trends of paediatric malaria admissions and mortality in Homa-Bay County, Kenya

2018 ◽  
Vol 3 (1) ◽  
pp. 3-6
Author(s):  
M O Kodhiambo ◽  
B K Amugune ◽  
J O Oyugi
Keyword(s):  
Public Health ◽  
Universal Access ◽  
Healthcare Delivery ◽  
Health Facilities ◽  
Morbidity And Mortality ◽  
Hard Copy ◽  
Public Health Facilities ◽  
Lake Region ◽  
Paediatric Malaria ◽  
The Impact

AbstractBackground: Malaria is a leading cause of paediatric admissions, morbidity and mortality. Malaria burden is endemic in Homa Bay County in the Lake Region in Kenya. Low social-economic status in Homa Bay County enhances malaria transmission, morbidity and mortality. Paediatric malaria admission and mortality have recently increased in the lake region unlike the rest of Kenya. Literature review did not show studies interrogating health policy correlates of this malaria problem in the region. The policy of the recently devolvement of the government system in Kenya was to bring services closer to the people. Devolved government in which the county governments are now responsible for healthcare delivery may have unique challenges that may influence disease morbidity and mortality. Objective: The aim of this study was to investigate the impact of devolution on paediatric malaria admission and mortality trends in public health facilities in Homa Bay County. Methods: This was a retrospective quasi-experimental study in which paediatrics records of 36 months before and 36 months after the devolvement of government were retrieved and analyzed for malaria incidence and deaths. All records of paediatric malaria cases reported in all 164 public health facilities in Homa-Bay County were examined. Data from the sub-County was obtained from the electronic records at the County Hospital. Hard copy data from health facilities in eight sub-Counties was also inspected at the sub-County level. Analysis of the data was accomplished by use of the Interrupted Time Series (ITS). Permission to conduct the study was obtained from the appropriate authorities. Data coding system was used in order to ensure confidentiality. Results: From January 2013, deaths increased gradually until around the 33rd month when it rose abruptly to nearly 800 then declined to levels below 200 in the 34 th month, which was around the time of devolution. This was followed by a period of stability. Admissions had a similar trend. Conclusions: There was a slight raise in paediatric malaria admissions and in the number of deaths due to malaria morbidity in Homa Bay County after the devolvement of government system in Kenya a factor which could be attributed to teething challenges of devolution. More studies are necessary to assess progress towards universal access to good healthcare services post devolution.

scholarly journals Effectiveness of a quality improvement intervention to increase adherence to key practices during female sterilization services in Chhattisgarh and Odisha states of India

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244088
Author(s):  
Ashish Srivastava ◽  
Geeta Chhibber ◽  
Neeta Bhatnagar ◽  
Angela Nash-Mercado ◽  
Jyoti Samal ◽  
...  
Keyword(s):  
Public Health ◽  
Quality Improvement ◽  
Service Providers ◽  
Health Facilities ◽  
Quality Improvement Intervention ◽  
Female Sterilization ◽  
Public Health Facilities ◽  
Operative Care ◽  
Urine Testing ◽  
The Impact

Background In response to longstanding concerns around the quality of female sterilization services provided at public health facilities in India, the Government of India issued standards and quality assurance guidelines for female sterilization services in 2014. However, implementation remains a challenge. The Maternal and Child Survival Program rolled out a package of competency-based trainings, periodic mentoring, and easy-to-use job aids in parts of five states to increase service providers’ adherence to key practices identified in the guidelines. Methods The study employed a before-and-after quasi-experimental design with a matched comparison arm to examine the effect of the intervention on provider practices in two states: Odisha and Chhattisgarh. Direct observations of female sterilization services were conducted in selected public health facilities, using a checklist of 30 key practices, at two points in time. Changes in adherence to key practices from baseline to endline were compared at 12 intervention and 12 comparison facilities using a difference in difference analysis. Results Several key practices were well-established prior to the intervention, with adherence levels over 90% at baseline, including hemoglobin and urine testing, use of sterile surgical gloves and instruments, and recommended surgical technique. However, adherence to many other practices was extremely low at baseline. The program significantly increased adherence to nine practices, including those related to ascertaining client’s medical eligibility, client-provider interaction, the consent process, and post-operative care. The greatest improvement was observed in the provision of written instructions for clients prior to discharge. At endline, however, adherence remained below 50% for 14 practices. Conclusion Low adherence to key practices at baseline confirmed the need for quality improvement interventions in female sterilization services. While the intervention improved adherence to certain practices around admission and post-operative care, inadequate human resources and infrastructure, among other factors, may have blunted the impact of the intervention.

scholarly journals 26.A. Workshop: Assessing the role of policies and actions to address childhood obesity

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Public Health ◽  
Childhood Obesity ◽  
Stakeholder Engagement ◽  
Special Focus ◽  
Policy Options ◽  
Sustainable Solutions ◽  
Relevant Evidence ◽  
Multi Stakeholder ◽  
The Impact

Abstract   Childhood obesity has grown to become one of the most dramatic features of the global obesity epidemic, with long-term consequences. The spread of obesity has been fueled by changes in social norms and living environments that have shaped individual behaviours making them conducive to excessive and imbalanced nutrition, sedentary lifestyles, and ultimately obesity and associated diseases. The STOP project will aim to generate scientifically sound, novel and policy-relevant evidence on the factors that have contributed to the spread of childhood obesity in European countries and on the effects of alternative technological and organisational solutions and policy options available to address the problem. STOP will translate the evidence gathered and generated into indicators and measurements, policy briefs and toolkits and multi-stakeholder frameworks. A special focus of STOP is understanding the stakeholders' networks and drivers of stakeholders' action. STOP will establish new ways for policy-relevant evidence to be generated, made available and used in the design and implementation of effective and sustainable solutions for childhood obesity at the EU, national and local levels. Each of the policy work packages will: Produce evidence syntheses and impact simulations for different policy approaches;Assess selected policy approaches and actions in children cohorts and other relevant settings;Devise policy toolkits and policy guidance to support the adoption and implementation of specific actions by relevant actors;Establish a country-based European accountability and monitoring framework in each policy area. The workshop aims to: Showcase the impact of different policy options evaluated throughout the STOP project;Increase participants' understanding and awareness of the opportunities and challenges associated with the implementation of selected policies;Increase awareness of public health professionals of the importance of overcoming siloes in identifying and implementing public health policies;Increase the understanding of multi-stakeholder engagement. The discussion will explore the role of stakeholders across different policy areas. We will explore the different definitions of “stakeholders” and “multi-stakeholders” engagement. This will also be an opportunity to explore some of the benefits, risks and challenges around stakeholder engagement, and explore what are the different types of stakeholders involved in these policies as well as their roles. The workshop will offer an opportunity to: Inform participants about existing physical activity, regulatory and fiscal policies to address childhood obesity;Inform participants about new, innovative EU-level projects that aim to address childhood obesity;Outline preliminary findings of the STOP project with regards to the effectiveness of the evaluated policies;Identify some of the gaps and limitations of existing policies and discuss some of the steps to ensure successful policy implementation. Key messages Present new evidence on what policy approaches work in addressing key determinants of childhood obesity. Showcase findings on the attitudes of different stakeholders towards obesity policies, and debate the benefits, risks and challenges of multi-stakeholder engagement.

scholarly journals Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e045997
Author(s):  
Abhijit Pakhare ◽  
Ankur Joshi ◽  
Rasha Anwar ◽  
Khushbu Dubey ◽  
Sanjeev Kumar ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Multivariate Analysis ◽  
Urban Slum ◽  
Primary Care Providers ◽  
Health Facilities ◽  
Care Providers ◽  
Community Based ◽  
Public Health Facilities ◽  
Care Facilities

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

scholarly journals Health facility capacity to provide postabortion care in Afghanistan: a cross-sectional study

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Farzana Maruf ◽  
Hannah Tappis ◽  
Enriquito Lu ◽  
Ghutai Sadeq Yaqubi ◽  
Jelle Stekelenburg ◽  
...  
Keyword(s):  
Public Health ◽  
Family Planning ◽  
High Volume ◽  
Health Facilities ◽  
Public Health Facilities ◽  
Care Services ◽  
Vacuum Aspiration ◽  
Postabortion Care ◽  
Products Of Conception ◽  
Family Planning Counseling

Abstract Background Afghanistan has one of the highest burdens of maternal mortality in the world, estimated at 638 deaths per 100,000 live births in 2017. Infections, obstetric hemorrhage, and unsafe abortion are the three leading causes of maternal death. Contraceptive prevalence rate has fluctuated between 10 and 20% since 2006. The 2016 Afghanistan National Maternal and Newborn Health Quality of Care Assessment evaluated facility readiness to provide quality routine and emergency obstetric and newborn care, including postabortion care services. Methods Accessible public health facilities with at least five births per day (n = 77), a nationally representative sample of public health facilities with fewer than five births per day (n = 149), and 20 purposively selected private health facilities were assessed. Assessment components examining postabortion care included a facility inventory and record review tool to verify drug, supply, equipment, and facility record availability, and an interview tool to collect information on skilled birth attendants’ knowledge and perceptions. Results Most facilities had supplies, equipment, and drugs to manage postabortion care, including family planning counseling and services provision. At public facilities, 36% of skilled birth attendants asked to name essential actions to address abortion complications mentioned manual vacuum aspiration (23% at private facilities); fewer than one-quarter mentioned counseling. When asked what information should be given to postabortion clients, 73% described family planning counseling need (70% at private facilities). Nearly all high-volume public health facilities with an average of five or more births per day and less than 5% of low volume public health facilities with an average of 0–4 deliveries per day reported removal of retained products of conception in the past 3 months. Among the 77 high volume facilities assessed, 58 (75%) reported using misoprostol for removal of retained products of conception, 59 (77%) reported using manual vacuum aspiration, and 67 (87%) reported using dilation and curettage. Conclusions This study provides evidence that there is room for improvement in postabortion care services provision in Afghanistan health facilities including post abortion family planning. Access to high-quality postabortion care needs additional investments to improve providers’ knowledge and practice, availability of supplies and equipment.

scholarly journals Managing pneumonia through facility-based integrated management of childhood management (IMCI) services: an analysis of the service availability and readiness among public health facilities in Bangladesh

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ahmed Ehsanur Rahamn ◽  
Shema Mhajabin ◽  
David Dockrell ◽  
Harish Nair ◽  
Shams El Arifeen ◽  
...  
Keyword(s):  
Public Health ◽  
Distribution System ◽  
Integrated Management ◽  
Child Death ◽  
Health Facilities ◽  
Family Welfare ◽  
Service Availability ◽  
District Health ◽  
Public Health Facilities ◽  
District Hospitals

Abstract Background With an estimated 24,000 deaths per year, pneumonia is the single largest cause of death among young children in Bangladesh, accounting for 18% of all under-5 deaths. The Government of Bangladesh adopted the WHO recommended Integrated Management of Childhood Illness (IMCI)-strategy in 1998 for outpatient management of pneumonia, which was scaled-up nationally by 2014. This paper reports the service availability and readiness related to IMCI-based pneumonia management in Bangladesh. We conducted a secondary analysis of the Bangladesh Health Facility Survey-2017, which was conducted with a nationally representative sample including all administrative divisions and types of health facilities. We limited our analysis to District Hospitals (DHs), Maternal and Child Welfare Centres (MCWCs), Upazila (sub-district) Health Complexes (UHCs), and Union Health and Family Welfare Centres (UH&FWCs), which are mandated to provide IMCI services. Readiness was reported based on 10 items identified by national experts as ‘essential’ for pneumonia management. Results More than 90% of DHs and UHCs, and three-fourths of UH&FWCs and MCWCs provide IMCI-based pneumonia management services. Less than two-third of the staff had ever received IMCI-based pneumonia training. Only one-third of the facilities had a functional ARI timer or a watch able to record seconds on the day of the visit. Pulse oximetry was available in 27% of the district hospitals, 18% of the UHCs and none of the UH&FWCs. Although more than 80% of the facilities had amoxicillin syrup or dispersible tablets, only 16% had injectable gentamicin. IMCI service registers were not available in nearly one-third of the facilities and monthly reporting forms were not available in around 10% of the facilities. Only 18% of facilities had a high-readiness (score 8–10), whereas 20% had a low-readiness (score 0–4). The readiness was significantly poorer among rural and lower level facilities (p < 0.001). Seventy-two percent of the UHCs had availability of one of any of the four oxygen sources (oxygen concentrators, filled oxygen cylinder with flowmeter, filled oxygen cylinder without flowmeter, and oxygen distribution system) followed by DHs (66%) and MCWCs (59%). Conclusion There are substantial gaps in the readiness related to IMCI-based pneumonia management in public health facilities in Bangladesh. Since pneumonia remains a major cause of child death nationally, Bangladesh should make a substantial effort in programme planning, implementation and monitoring to address these critical gaps to ensure better provision of essential care for children suffering from pneumonia.

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