scholarly journals Is development aid to strengthen health systems during protracted conflict a useful investment? The case of South Sudan, 2011–2015

2020 ◽  
Vol 5 (4) ◽  
pp. e002093
Author(s):  
Joseph James Valadez ◽  
Sima Berendes ◽  
Jackline Odhiambo ◽  
William Vargas ◽  
Baburam Devkota ◽  
...  
Keyword(s):  
Health Service ◽  
Health System ◽  
Health Workers ◽  
South Sudan ◽  
Well Being ◽  
Development Aid ◽  
Health System Strengthening ◽  
Cross Sectional ◽  
Oral Rehydration ◽  
Service Coverage

IntroductionIs achievement of Sustainable Development Goal (SDG) 16 (building peaceful societies) a precondition for achieving SDG 3 (health and well-being in all societies, including conflict-affected countries)? Do health system investments in conflict-affected countries waste resources or benefit the public’s health? To answer these questions, we examine the maternal, newborn, child and reproductive health (MNCRH) service provision during protracted conflicts and economic shocks in the Republic of South Sudan between 2011 (at independence) and 2015.MethodsWe conducted two national cross-sectional probability surveys in 10 states (2011) and nine states (2015). Trained state-level health workers collected data from households randomly selected using probability proportional to size sampling of villages in each county. County data were weighted by their population sizes to measure state and national MNCRH services coverage. A two-sample, two-sided Z-test of proportions tested for changes in national health service coverage between 2011 (n=11 800) and 2015 (n=10 792).ResultsTwenty-two of 27 national indicator estimates (81.5%) of MNCRH service coverage improved significantly. Examples: malaria prophylaxis in pregnancy increased by 8.6% (p<0.001) to 33.1% (397/1199 mothers, 95% CI ±2.9%), institutional deliveries by 10.5% (p<0.001) to 20% (230/1199 mothers, ±2.6%) and measles vaccination coverage in children aged 12–23 months by 11.2% (p<0.001) to 49.7% (529/1064 children, ±2.3%). The largest increase (17.7%, p<0.001) occurred for mothers treating diarrhoea in children aged 0–59 months with oral rehydration salts to 51.4% (635/1235 children, ±2.9%). Antenatal and postnatal care, and contraceptive prevalence did not change significantly. Child vitamin A supplementation decreased. Despite significant increases, coverage remained low (median of all indicators = 31.3%, SD = 19.7) . Coverage varied considerably by state (mean SD for all indicators and states=11.1%).ConclusionHealth system strengthening is not a uniform process and not necessarily deterred by conflict. Despite the conflict, health system investments were not wasted; health service coverage increased.

scholarly journals Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

2020 ◽  
Vol 5 (1) ◽  
pp. e001937
Author(s):  
Mike English ◽  
David Gathara ◽  
Jacinta Nzinga ◽  
Pratap Kumar ◽  
Fred Were ◽  
...  
Keyword(s):  
Health System ◽  
Low Income ◽  
Health Workers ◽  
Newborn Care ◽  
Well Being ◽  
Public Hospitals ◽  
Urban Setting ◽  
Health System Strengthening ◽  
Research Approach ◽  
Systems Research

There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.

Health System Challenges Affecting Maternal and Neonatal Health Care Service Utilisation in the Wake of Conflict in Torit County, Republic of South Sudan: A Cross Sectional Study 

2020 ◽  
Author(s):  
Pontius Bayo ◽  
Loubna Belaid ◽  
Christina Zarowsky ◽  
Elijo Omoro Tahir ◽  
Emmanuel Ochola ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Workers ◽  
Care Service ◽  
Health Care Service ◽  
South Sudan ◽  
Health Staff ◽  
Local Health ◽  
Service Utilisation ◽  
Cross Sectional

Abstract ObjectivesThis study examines health facility utilization for pregnancy and delivery care and the health system challenges, in the light of renewed conflict in 2016, in Torit County, South Sudan. We collected monthly facility data retrospectively on total Antenatal Care (ANC) visits, institutional deliveries, major obstetric, and neonatal complications treated from January 2015 to December 2016. We compared 2015 data with that of 2016 when conflict re-started. We also conducted a descriptive qualitative study based on key informant interviews and Focus Group Discussions (FGDs) to explore the health system challenges. We used a thematic approach to analyse qualitative data. Results ANC visits declined by 21% between 2015 and 2016. The proportion of expected births that occurred in facilities declined from 23.6% in 2015 to 16.7% in 2016 (p< 0.001) while the proportion of obstetric complications treated in facilities declined from 58.9% in 2015 to 43.9% in 2016 (p<0.001). The low national budget to fund the health system, evacuation of international health staff, flight of local health workers and disruption of drugs and medical supplies are the health system challenges identified. Economic barriers and perceived poor quality of care were the two main obstacles to access of health care services.

scholarly journals Micronutrient powder distribution through Maternal, Neonatal and Child Health Weeks in Nigeria: process evaluation of feasibility and use

2015 ◽  
Vol 19 (10) ◽  
pp. 1882-1892 ◽  
Author(s):  
Eline L Korenromp ◽  
Opeyemi Adeosun ◽  
Femi Adegoke ◽  
Adekunle Akerele ◽  
Catherine Anger ◽  
...  
Keyword(s):  
Child Health ◽  
Health Service ◽  
Child Nutrition ◽  
Health Workers ◽  
Social Mobilization ◽  
Health System Strengthening ◽  
Cross Sectional ◽  
Change Communication ◽  
Service Distribution ◽  
And Child Health

AbstractObjectiveTo determine the feasibility of distributing micronutrient powders (MNP) for home fortification during biannual Maternal, Neonatal and Child Health Week (MNCHW) events, as a strategy to improve young child nutrition.DesignWe evaluated the coverage, delivery, use and adherence of MNP, and associated behaviour change communication (BCC) materials and social mobilization, through cross-sectional surveys of caregivers attending health-service distribution events and health workers involved in MNP distribution, facility-based observations of MNP distribution activities and a repeated survey of caregivers in their homes who received MNP for their child.SettingFour Local Government Areas in Benue State, Nigeria.SubjectsCaregivers of children 6–59 months of age attending health-service distribution events.ResultsThe 8 million MNP delivered in this pilot during three distribution events were estimated to reach about one-third of eligible children in the area at each event. Programme fidelity was limited by shortages of MNP, BCC materials and inadequate social mobilization, with some limitations in health worker training and engagement. MNP use was consistent with the recommended two or three sachets per week among 51–69 % of caregivers surveyed at home.ConclusionsMNP coverage was low, but consistent with that typically achieved with other services delivered through MNCHW in Benue. Among caregivers who received MNP, acceptance and use among targeted children was high. While some weaknesses in knowledge and delivery of MNP by health workers were observed, health system strengthening and more extensive social mobilization would be key to achieving higher coverage with MNP and other health services provided through MNCHW.

The Effect of Counselling Intervention during Antenatal Care on the Knowledge and Attitude about Danger Signs in Pregnancy: A Cross-Sectional Study in Takalar Regency -

2020 ◽  
Vol 10 (2) ◽  
pp. 51-55
Author(s):  
Nurhikmah ◽  
Tahir Abdullah ◽  
Stang ◽  
Suriah ◽  
Andi Imam Arundhana ◽  
...  
Keyword(s):  
Health Service ◽  
Antenatal Care ◽  
Pregnant Women ◽  
Community Health ◽  
Health Workers ◽  
Community Health Service ◽  
Cross Sectional ◽  
Danger Signs ◽  
Knowledge And Attitude ◽  
In Pregnancy

Objective: This study was to examine the effects of counselling delivered during antenatal care on the knowledge and attitudes of pregnant women about danger signs in pregnancy.Methods: This was a pre-experimental design using one group pre- and post-test only. This study was conducted in Takalar, specifically within Sanrobone Community Health Service working area. Takalar is located in South Sulawesi Province Indonesia and this area is coastal with the majority of people working as a fisherman. Participants of this study were pregnant women living in the villages which are included in the working area of Sanrobone Community Health Service.Results: The study shows that counselling improved knowledge and attitude of pregnant women about danger signs in pregnancy (p=0.011 and p=0.025, respectively). The number of pregnant women with good knowledge and positive attitude increased after the intervention (43.8% vs 93.8%, 62.5% vs 93.8%, respectively).Conclusions: In can be concluded that intervention by means of counselling can improve the knowledge and attitude of pregnant women about danger signs in pregnancy. Therefore, it is important to implement the counselling program delivered by health workers in Community Health Service in order to mitigate the risk of maternal mortality.

scholarly journals Prevalence and factors associated with Metabolic Syndrome in elderly users of the Unified Health System

2014 ◽  
Vol 17 (4) ◽  
pp. 805-817 ◽  
Author(s):  
Edna Cunha Vieira ◽  
Maria do Rosário Gondim Peixoto ◽  
Erika Aparecida da Silveira
Keyword(s):  
Metabolic Syndrome ◽  
Health System ◽  
Health Workers ◽  
The Elderly ◽  
World Health ◽  
Fat Percentage ◽  
Cross Sectional ◽  
Factors Associated ◽  
Unified Health System ◽  
The Metabolic Syndrome

OBJECTIVE: To evaluate the prevalence and factors associated with metabolic syndrome in the elderly. METHODS: Cross-sectional study, with 133 individuals randomly selected in the Unified Health System in Goiania, Goiás. The following variables were researched: anthropometric (BMI, waist circumference, fat percentage by Dual X-ray absorptiometry), sociodemographic (gender, age, color, income, marital status and years of schooling), lifestyle (physical activity, smoking and risk alcohol consumption) and food intake (risk and protective foods). The metabolic syndrome was assessed according to harmonized criteria proposed by the World Health Organization (WHO). The combinations were tested by Poisson regression for confounding factors. RESULTS: The prevalence of metabolic syndrome was 58.65% (95%CI 49.8 - 67.1), with 60.5% (95%CI 49.01 - 71.18) for females and 55.7% (95%CI 41.33 - 69.53) for males. Hypertension was the most prevalent component of the syndrome in both men, with 80.8% (95%CI 64.5 - 90.4), and women, with 85.2% (95%CI 75.5 - 92.1). After the multivariate analysis, only the excess of weight measured by body mass index (prevalence ratio = 1.66; p < 0.01) remained associated with the metabolic syndrome. CONCLUSIONS: The prevalence of metabolic syndrome in this sample was high, indicating the need for systematic actions by health workers in the control of risk factors through prevention strategies and comprehensive care to the elderly.

Looking forward to the next 70 years: from a National Ill-Health Service to a National Health System

2018 ◽  
Vol 14 (1) ◽  
pp. 11-14
Author(s):  
David J. Hunter
Keyword(s):  
National Health Service ◽  
Local Government ◽  
Health Service ◽  
Health System ◽  
21St Century ◽  
National Health ◽  
National Health System ◽  
Well Being ◽  
Tipping Point ◽  
Health And Well Being

AbstractAmidst the NHS’s (National Health Service) success lies its major weakness, although one that Klein overlooks in his reflections on the NHS as it approaches 70. The focus on, and investment in, curing ill-health has been at the expense of attending to the public’s overall health and well-being. This preoccupation poses a greater threat to the NHS’s future than privatisation. Despite the weakness having been diagnosed decades ago, redressing the imbalance has proved stubbornly hard to achieve. Rhetoric has not been translated into reality. Yet, we may be on the cusp of a tipping point where in order to ensure a sustainable NHS, and one that is capable of meeting the 21st century challenges facing it, there is a renewed and overdue interest in promoting health and well-being in communities. But for this to succeed, the NHS will need to embrace its bete noire, local government.

scholarly journals Profile of patients with rheumatic diseases undergoing treatment with anti-TNF agents in the Brazilian Public Health System (SUS), Belo Horizonte - MG

2015 ◽  
Vol 51 (3) ◽  
pp. 709-719 ◽  
Author(s):  
Haliton Alves de Oliveira Junior ◽  
Alessandra Maciel Almeida ◽  
Francisco Assis Acurcio ◽  
Jéssica Barreto dos Santos ◽  
Adriana Maria Kakehasi ◽  
...  
Keyword(s):  
Public Health ◽  
Health System ◽  
Rheumatic Diseases ◽  
Public Health System ◽  
Standard Form ◽  
Female Gender ◽  
Well Being ◽  
Cross Sectional ◽  
The Mean ◽  
Belo Horizonte

The aim of this study was to describe the baseline demographic and clinical characteristics as well as the functional status of a prospective cohort of patients with rheumatic diseases assisted by the Brazilian Public Health System (SUS). Data for 302 patients receiving tumor necrosis factor α inhibitors (anti-TNF agents) was collected through a standard form. Among patients, 229 (75.8%) were female and 155 (51.3%) were Caucasian; the mean age was 50.3 ± 12.8 years, and the mean disease duration was 9.9 ± 8.7 years. Among them 214 patients (70.9%) received adalimumab, 72 (23.8%) etanercept, and 16 (5.3%) infliximab. Mean Health Assessment Questionnaire-Disability Index (HAQ-DI) was 1.37 ± 0.67 for all participants. Poor functional response was associated with female gender, married patients and with a score of < 0.6 on the EuroQoL-5 dimensions (EQ-5D). Significant correlation was found between the HAQ-DI values, disease activity and quality of life (QOL). The results obtained in this study contribute to a better understanding of the clinical and demographic characteristics of patients with rheumatic diseases at the beginning of anti-TNF-agent treatment by SUS. Furthermore, our findings are consistent with another Brazilian and foreign cross-sectional investigations. This knowledge can be of great importance for further studies evaluating the effectiveness of biological agents, as well as, to contribute to improve the well-being of the patients with rheumatic diseases.

scholarly journals Assessing Early Access to Care and Child Survival during a Health System Strengthening Intervention in Mali: A Repeated Cross Sectional Survey

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e81304 ◽  
Author(s):  
Ari D. Johnson ◽  
Dana R. Thomson ◽  
Sidney Atwood ◽  
Ian Alley ◽  
Jessica L. Beckerman ◽  
...  
Keyword(s):  
Health System ◽  
Access To Care ◽  
Child Survival ◽  
Health System Strengthening ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Early Access

scholarly journals FAKTOR-FAKTOR YANG MEMPENGARUHI PEMANFAATAN POSBINDU PTM OLEH MASYARAKAT DI WILAYAH KERJA PUSKESMAS MARTAPURA 2

2020 ◽  
Vol 7 (1) ◽  
pp. 1
Author(s):  
Eka Supriyatna ◽  
Endang Pertiwiwati ◽  
Herry Setiawan
Keyword(s):  
Health Service ◽  
Family Support ◽  
Peer Support ◽  
Health Workers ◽  
Communicable Diseases ◽  
Utilization Rate ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Non Communicable Diseases

ABSTRAKPos Pembinaan Terpadu Penyakit Tidak Menular (Posbindu PTM) merupakan usaha pemerintah dalam menanggulangi penyakit tidak menular. Rendahnya angka pemanfaatan Posbindu oleh masyarakat dalam memanfaatkan pelayanan posbindu dilihat dari data kunjungan Posbindu PTM tiga bulan terakhir tahun 2018 untuk kunjungan lama yaitu pada bulan Oktober 365 kunjungan, kemudian bulan November menurun ke angka 348 kunjungan dan pada Bulan Desember mengalami penurunan sebanyak 297 kunjungan. Secara teoritis, seseorang dikatakan memanfaatkan suatu pelayanan kesehatan jika mendatangi pelayanan kesehatan itu teratur dalam tiga bulan terakhir tanpa menyebabkan terganggunya kegiatan harian. Tujuan dari penelitian adalah menjelaskan hubungan faktor-faktor yang mempengaruhi pemanfaatan Posbindu PTM oleh masyarakat di Wilayah Kerja UPT Puskesmas Martapura 2. Penelitian ini menggunakan desain cross sectional dengan teknik purposive sampling pada 85 orang masyarakat di wilayah kerja UPT Puskesmas Martapura 2. Penelitian ini dilaksanakan pada periode Bulan Maret-April tahun 2019. Pada penelitian ini menggunakan Uji chi square analisis menunjukkan nilai p-value <0,05 yaitu pendidikan (p-value= 0,029), pekerjaan (p-value= 0,022) PR= 4,295 (95% CI 1,315-14,036), dukungan keluarga (p-value= 0,001) PR=7,714 (95% CI 2,698-22,057) , dukungan petugas kesehatan (p-value= 0,001) PR= 8,273 (95% CI 2,795-24,488), dukungan kader kesehatan (p-value= 0,001) PR= 7,071 (95% CI 2,227-22,454), dan dukungan teman sebaya (p-value= 0,001) PR= 5,844 (95% CI 2,114-16,151). Hal ini menunjukkan bahwa pendidikan, pekerjaan, dukungan keluarga, dukungan petugas kesehatan, dukungan kader kesehatan dan dukungan teman sebaya memiliki hubungan pada pemanfaatan Posbindu PTM.Kata-kata kunci: posbindu, pemanfaatan, penyakit tidak menularABSTRACTIntegrated Post Training of Non-Communicable Diseases (Posbindu PTM) is a government effort in tackling non-communicable diseases. The low utilization rate of Posbindu by the community in utilizing posbindu services can be seen from the PTM Posbindu visit data for the last three months of 2018 for long visits namely in October 365 visits, then in November it decreased to 348 visits and in December it decreased by 297 visits. Theoretically, a person is said to utilize a health service if attending the health service regularly in the last three months without causing disruption to daily activities. The purpose of this research is to explain the relationship between the factors that influence the utilization of Posbindu PTM by the community in the Work Area of Martapura Public Health Center 2.1,315-14,036), family support (p-value= 0.001) PR= 7,714 (95% CI2,698-22,057), support of health workers (p-value 0.001) PR= 8.273 (95% CI 2,795-24,488), support for health cadres (p-value= 0.001) PR= 7.071 (95% CI 2,227-22,454), and peer support (p-value= 0.001) PR= 5.844 (95% CI2,114-16,151. This shows that education, employment, family support, health worker support, health cadre support and peer support have a relationship to the use of Posbindu PTM.Keywords : posbindu, utilization, non-communicable diseases

scholarly journals Missed opportunities for vaccination among children aged 0–23 months visiting health facilities in a southwest State of Nigeria, December 2019

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0252798
Author(s):  
Akinola Ayoola Fatiregun ◽  
Laura Nic Lochlainn ◽  
Lassané Kaboré ◽  
Modupeola Dosumu ◽  
Elvis Isere ◽  
...  
Keyword(s):  
Health Service ◽  
Health Workers ◽  
Immunization Coverage ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Service Encounter ◽  
Childhood Immunization ◽  
Cross Sectional ◽  
Missed Opportunities ◽  
Attitudes And Practices

Background Despite efforts to improve childhood immunization coverage in Nigeria, coverage has remained below the national acceptable level. In December 2019, we conducted an assessment of Missed Opportunities for Vaccination (MOV) in Ondo State, in Southwest Nigeria. The objectives were to determine the magnitude of, explore the reasons for, as well as possible solutions for reducing MOV in the State. Methods This was a cross-sectional study using a mixed-methods approach. We purposively selected 66 health facilities in three local government authorities, with a non-probabilistic sampling of caregivers of children 0–23 months for exit interviews, and health workers for knowledge, attitudes, and practices (KAP) surveys. Data collection was complemented with focus group discussions and in-depth interviews with caregivers and health workers. The proportion of MOV among children with documented vaccination histories were determined and thematic analysis of the qualitative data was carried out. Results 984 caregivers with children aged 0–23 months were interviewed, of which 869 were eligible for inclusion in our analysis. The prevalence of MOV was 32.8%. MOV occurred among 90.8% of children during non-vaccination visits, and 7.3% during vaccination visits. Vaccine doses recommended later in the immunization series were given in a less timely manner. Among 41.0% of health workers, they reported their vaccination knowledge was insufficient. Additionally, 57.5% were concerned about and feared adverse events following immunization. Caregivers were found to have a low awareness about vaccination, and issues related to the organization of the health system were found to contribute towards MOV. Conclusions One in three children experienced a MOV during a health service encounter. Potential interventions to reduce MOV include training of health workers about immunization policies and practices, improving caregivers’ engagement and screening of vaccination documentation by health workers during every health service encounter.

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