The price of quality care: Cross‐sectional associations between out‐of‐pocket payments and quality of care in six low‐income countries

2021 ◽  
Author(s):  
Anna Gage ◽  
Amit Aryal ◽  
Jean Paul Joseph ◽  
Jessica Cohen
Keyword(s):  
Quality Of Care ◽  
Low Income ◽  
Quality Care ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Out Of Pocket Payments

scholarly journals Nurses' Viewpoints on the Quality of Care: A Qualitative Study in Timor-Leste

2020 ◽  
Author(s):  
Bernadethe Marheni Luan ◽  
Paulo Lopes ◽  
Domingos Soares
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health System ◽  
Low Income ◽  
Quality Care ◽  
Low Income Countries ◽  
Small Island ◽  
Skill Mix ◽  
Timor Leste

Abstract Background Research on quality of care revealed nurse-to-patient ratio and skill mix served as key elements in quality of care. However, those studies were done in countries where nursing workforce had reasonable proportion of professional nurses with bachelor degrees. Findings of these researches may overlook challenges in health system as well as the nature of nursing service in small island low-income countries that has a huge proportion of auxiliary nurses. Working in under-sourced places, nurses in Timor-Leste might have different viewpoints on what aspect contribute to quality of care. Methods Focus group discussions (FGDs) were done in 2017, in three districts that included staff nurses and senior nurses from three levels of health care facilities: primary, secondary, and tertiary. Data were analyzed using content analysis method. Results Two themes were emerged from the FGDs data: “patients as the center of the service” and “gaps in providing quality of care”. Aside from attributes of quality care such as equality, efficiency, and patient-centeredness in the delivery of care, the first theme also covered the importance of employing nurses’ value system in order to uphold quality of care. The second theme included quality care milieu amplifying distinctive factors facing health system in under-resources places. Problems related with facility infrastructure, equipment and supplies, financing, management, and staffing were narrated. While an inadequacy or a deficiency of these factors implies the country’s struggles to maintain a functioning health care facility, it incapacitated nurses to improve quality of care. Conclusions Compared to nurses in countries with better skill mix, nurses in under-resources places and small island low-income countries face different challenging situations that go beyond nursing realm, forcing nurses to describe quality care uniquely. Findings from this study provide evidence that it is urgent to develop policies of human resources for health (HRH) within the context of the health policies that contributes to professional management of the largest cadre, thus strengthens their ability to improve patient care service.

‘It makes you someone who changes with the times’: health worker and client perspectives on a smartphone-based counselling application deployed in rural Tanzania

2019 ◽  
Vol 34 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kristy Hackett ◽  
Mina Kazemi ◽  
Curtis Lafleur ◽  
Peter Nyella ◽  
Lawelu Godfrey ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Data Management ◽  
Low Income ◽  
Community Intervention ◽  
Health Workers ◽  
Low Income Countries ◽  
Maternal And Newborn Health ◽  
Pregnancy And Childbirth

AbstractMobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients’ perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.

scholarly journals Readiness of public health facilities to provide quality maternal and newborn care across the state of Bihar, India: a cross-sectional study of district hospitals and primary health centres

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028370 ◽  
Author(s):  
Japneet Kaur ◽  
Samuel Richard Piers Franzen ◽  
Tom Newton-Lewis ◽  
Georgina Murphy
Keyword(s):  
Quality Of Care ◽  
Quality Care ◽  
Cross Sectional Study ◽  
Neonatal Care ◽  
Cross Sectional ◽  
Equipment And Supplies ◽  
Primary Health Centres ◽  
District Hospitals ◽  
Provide Quality Care

IntroductionPoor access to quality healthcare is one of the most important reasons of high maternal and neonatal mortality in India, particularly in poorer states like Bihar. India has implemented initiatives to promote institutional maternal deliveries. It is important to ensure that health facilities are adequately equipped and staffed to provide quality care for mothers and newborns.MethodsWe conducted a cross-sectional study of 190 primary health centres (PHCs) and 36 district hospitals (DHs) across all districts in Bihar to assess the readiness of facilities to provide quality maternal and neonatal care. Infrastructure, equipment and supplies and staffing were assessed using the WHO service availability and readiness assessment and Indian public health standard guidelines. Additionally, we used household survey data to assess the quality of care reported by mothers delivering at study facilities.ResultsPHCs and DHs were found to have 61% and 67% of the mandated structural components to provide maternal and neonatal care, on average, respectively. DHs were, on average, slightly better equipped in terms of infrastructure, equipment and supplies by comparison to PHCs. DHs were found to be inadequately prepared to provide neonatal care. Lack of recommended handwashing stations and bins at both DHs and PHCs suggested low levels of hygiene. Only half of the essential drugs were available in both DHs and PHCs. While no association was revealed between structural capacity and patient-reported quality of care, adequacy of staffing was positively associated with the quality of care in DHs.ConclusionExamining all DHs and a representative sample of PHCs in Bihar, this study revealed the gaps in structural components that need to be filled to provide quality care to mothers and newborns. Access to quality care is essential if progress in reducing maternal and neonatal mortality is to be achieved in this high-burden state.

scholarly journals Private sector delivery of quality care for maternal, newborn and child health in low-income and middle-income countries: a mixed-methods systematic review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e033141
Author(s):  
Samantha R Lattof ◽  
Blerta Maliqi
Keyword(s):  
Systematic Review ◽  
Quality Of Care ◽  
Child Health ◽  
Private Sector ◽  
Low Income ◽  
Quality Care ◽  
Middle Income ◽  
Middle Income Countries ◽  
And Child Health

IntroductionTo accelerate progress to reach the sustainable development goals for ending preventable maternal, newborn and child deaths, it is critical that both the public and private health service delivery systems invest in increasing coverage of interventions to sustainably deliver quality care for mothers, newborns and children at scale. Although various approaches have been successful in high-income countries, little is known about how to effectively engage and sustain private sector involvement in delivering quality care in low-income and middle-income countries. Our systematic review will examine private sector implementation of quality care for maternal, newborn and child health (MNCH) and the impact of this care. This protocol details our intended methodological and analytical approaches, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline for protocols.Methods and analysisFollowing the PRISMA approach, this systematic review will include quantitative, qualitative and mixed-methods studies addressing the provision of quality MNCH care by private sector providers. Eight databases (Cumulative Index to Nursing and Allied Health, EconLit, Excerpta Medica Database, International Bibliography of the Social Sciences, Popline, PubMed, ScienceDirect, Web of Science) and two websites will be searched for relevant studies published between 1 January 1995 and 30 June 2019. For inclusion, studies in low-income and middle-income countries must examine at least one of the following critical outcomes: maternal morbidity or mortality, newborn morbidity or mortality, child morbidity or mortality, quality of care, experience of care and service utilisation. Depending on the data, analyses could include meta-analysis, descriptive quantitative statistics, narrative synthesis and thematic synthesis. Quality will be assessed using tools for qualitative and quantitative studies.Ethics and disseminationFormal ethical approval is not required for this research, as the secondary data are not identifiable. Findings from this review will be used to develop models for effective collaboration of the private and public sectors in implementing quality of care for MNCH. In addition to publishing our findings in a peer-reviewed journal, the findings will be shared through the Quality of Care Network, relevant mailing lists, webinars and social media.PROSPERO registration numberCRD42019143383

scholarly journals Importance of Client Orientation Domains in Non-Clinical Quality of Care: A Household Survey in High and Low Income Districts of Mashhad

2015 ◽  
Vol 8 (7) ◽  
pp. 228
Author(s):  
Somayeh Fazaeli ◽  
Mehdi Yousefi ◽  
Seyed Hasan Banikazemi ◽  
Seyed Amir Hossein Ghazizadeh Hashemi ◽  
Ali Khorsand Vakilzadeh ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Low Income ◽  
Household Survey ◽  
World Health ◽  
Clinical Aspects ◽  
Cross Sectional ◽  
Key Indicator ◽  
Health Organization ◽  
Self Assessed Health

<p>Responsiveness introduced by WHO as a key indicator to assess the performance of health systems and measures by common set of domains that are categorized in to two main categories “Respect for persons” and “client orientation”. This study measured importance of client orientation domains in high and low income districts of Mashhad. In this cross-sectional and explanatory study, Sample of 923 households were selected randomly from two high and low income districts of Mashhad. World Health Organization (WHO) questionnaire was used for data collection. Standard frequency analyses and Ordinal logistic regression (OLR) was employed for data analysis. In general, respondents selected quality of basic amenities as the most important domain and access to social support networks was identified as the least important domain. Households in high income area scored higher domains of prompt attentions<strong> </strong>and choice Compared to low income. There was a significant relationship between variables of ages, having member that need to care and self-assessed health with the ranking of client orientation domains.</p><p>Study of households’ view on ranking of non-clinical aspects of quality of care, especially when faced with limited resources, can help to conduct efforts towards subjects that are more important, and lead to improve the health system performance and productivity.</p>

scholarly journals Epidemiology of multimorbidity in conditions of extreme poverty: a population-based study of older adults in rural Burkina Faso

2020 ◽  
Vol 5 (3) ◽  
pp. e002096
Author(s):  
Maria Lisa Odland ◽  
Collin Payne ◽  
Miles D Witham ◽  
Mark J Siedner ◽  
Till Bärnighausen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Burkina Faso ◽  
Physical Performance ◽  
Low Income ◽  
Household Survey ◽  
Population Based ◽  
Low Income Countries ◽  
Cross Sectional ◽  
Management Interventions

IntroductionMultimorbidity is a health issue of increasing importance worldwide, and is likely to become particularly problematic in low-income countries (LICs) as they undergo economic, demographic and epidemiological transitions. Knowledge of the burden and consequences of multimorbidity in LICs is needed to inform appropriate interventions.MethodsA cross-sectional household survey collected data on morbidities and frailty, disability, quality of life and physical performance on individuals aged over 40 years of age living in the Nouna Health and Demographic Surveillance System area in northwestern Burkina Faso. We defined multimorbidity as the occurrence of two or more conditions, and evaluated the prevalence of and whether this was concordant (conditions in the same morbidity domain of communicable, non-communicable diseases (NCDs) or mental health (MH)) or discordant (conditions in different morbidity domains) multimorbidity. Finally, we fitted multivariable regression models to determine associated factors and consequences of multimorbidity.ResultsMultimorbidity was present in 22.8 (95% CI, 21.4 to 24.2) of the study population; it was more common in females, those who are older, single, more educated, and wealthier. We found a similar prevalence of discordant 11.1 (95% CI, 10.1 to 12.2) and concordant multimorbidity 11.7 (95% CI, 10.6 to 12.8). After controlling for age, sex, marital status, education, and wealth, an increasing number of conditions was strongly associated with frailty, disability, low quality of life, and poor physical performance. We found no difference in the association between concordant and discordant multimorbidity and outcomes, however people who were multimorbid with NCDs alone had better outcomes than those with multimorbidity with NCDs and MH disorders or MH multimorbidity alone.ConclusionsMultimorbidity is prevalent in this poor, rural population and is associated with markers of decreased physical performance and quality of life. Preventative and management interventions are needed to ensure that health systems can deal with increasing multimorbidity and its downstream consequences.

scholarly journals The Determinants of Out-of-Pocket Expenditure in IBD Italian Patients. Results from the AMICI Survey

2020 ◽  
Vol 17 (21) ◽  
pp. 8156
Author(s):  
Matteo Ruggeri ◽  
Carlo Drago ◽  
Chiara Cadeddu ◽  
Alessandro Armuzzi ◽  
Salvo Leone ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Low Income ◽  
Inflammatory Bowel Diseases ◽  
Geographical Location ◽  
Poor Quality ◽  
Public Healthcare ◽  
Cross Sectional ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Decision makers are used to consider Out-of-Pocket Expenditure (OOPE) within a health technology assessment framework in order to account for an indicator relying on the level of fairness and on the quality of care of a health system. In this paper, we provide estimates on the determinants of OOPE in Italy by using data coming from an observational cross-sectional study that enrolled a sample of 2526 patients suffering from inflammatory bowel diseases. We explore the association between OOPE and: (1) geographical location; (2) income effects; (3) performances in delivering healthcare. A regression model was used. Individuals’ age were in the range of 18–88 (mean 44 ± 14.55). Forty-six percent were females, 54% were married and 19% held a bachelor degree. Ninety-six percent of respondents declared an OOPE >0 whose mean value was €960 ± €950. Individuals belonging to low-income and low-performance regions were more likely to declare an OOPE >0 (99%). Regression findings suggest that increases in OOPE could be considered as a response from patients aiming to compensate for lacks and inefficiencies in the public healthcare offers. Policymakers should consider increases in OOPE in patients with Inflammatory Bowel Diseases (IBDs) as an indicator of poor quality of care and poor fairness.

The Role of Technology in Supporting the Education of Community Health Workers and their Leaders

2021 ◽  
pp. 11-24
Author(s):  
Raj Panjabi ◽  
Lesley-Anne Long ◽  
Michael Bailey ◽  
Magnus Conteh
Keyword(s):  
Quality Of Care ◽  
Community Health ◽  
Community Health Workers ◽  
Low Income ◽  
Health Workers ◽  
Poor Quality ◽  
Low Income Countries ◽  
Worker Training ◽  
Care Outcomes

Community health workers (CHWs) often represent the first point of contact for many individuals in low-income countries accessing health services. Unfortunately, due to the low quality of care, outcomes for many people are unpredictable. Although the causes for poor quality of care are multifaceted, one obvious cause is that many CHWs are undertrained. Given the scope of the problem and the lack of resources available to solve it, governments and donor organizations are looking at digital technologies to help address problems such as access to services, health worker training, and decision-making. Access to and understanding of educational content can be improved by combining classroom education with distance learning to create a blended learning approach. Furthermore, by integrating the educational experience offered to CHWs through technology with related support services such as data collection, logistics management and AI-based decision support, governments can compensate for the quality of care gap.

Assessment of knowledge and practice of vaccination of dogs against rabies by dog owners in Makurdi, Benue State, Nigeria

2020 ◽  
Vol 1 ◽  
pp. 5
Author(s):  
Audu Onyemocho ◽  
Agwa Moses ◽  
Aboh Kisani ◽  
Omole Namben Victoria ◽  
Anejo-Okopi Joseph
Keyword(s):  
Low Income ◽  
Life Time ◽  
Knowledge Score ◽  
Educational Status ◽  
Low Income Countries ◽  
Bivariate Analysis ◽  
Cross Sectional ◽  
Knowledge And Practice ◽  
Dog Owners ◽  
The Relationship

Objective: Rabies, one of the oldest and fatal infectious diseases known to human race, is transmitted by infected dogs. The global target of zero dog-mediated rabies human deaths has been set for 2030; however, the realization of this goal poses challenges in most low-income countries where rabies is endemic due to weak surveillance. Dogs have been increasingly deployed for domestic uses over the years, especially for security purposes. This study assessed the assessment of knowledge and practice of vaccination of dogs against rabies by dog owners. Materials and Methods: A cross-sectional community-based study was employed to study 400 dog owners in Makurdi metropolis through multistage sampling techniques. Sighting of valid dog vaccination card was used as criteria for current vaccination. Bivariate analysis was carried out to establish the relationship between the respondent knowledge of rabies and dog vaccination with significant value set at P < 0.05. Results: The mean age of the respondents was 31 (Â ± 0.8) years, majority of them had tertiary and secondary education (40.0% and 39.0%, respectively), 26.0% were traders, and 50.0% were married. Overall, 73.0% of the respondents had good knowledge score, 61.0% had seen at least a rabid dog in their life time, and 74.0% have a history of dog vaccination, but evidence of up to date vaccination of dogs by owners was seen in only 18.0% of all the vaccination cards sighted. The relationship between the educational status of the respondents, their knowledge score, and their dog vaccination was statistically significant (P < 0.05). Conclusion: Knowledge of rabies among dog owners in Makurdi was good, but the practice of dog vaccination was poor. Educational status was a good predictor of practice. Awareness campaign on dog vaccination should be strengthened and adequate measures should be put in place at the veterinary hospitals in Makurdi for vaccination of dogs.

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