‘The nurse did not even greet me’: how informed versus non-informed
                        patients evaluate health systems responsiveness in South Africa

Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ experiences of non-clinical dimensions. Results We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers’ explanations of health conditions. Conclusion Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.

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Impact assessment of accreditation in primary and secondary public Healthcare Institutions in the State of Kerala, India

10.1101/2020.05.30.20117432 ◽

2020 ◽

Author(s):

Sindhu Joseph

Keyword(s):

Patient Satisfaction ◽

Primary Healthcare ◽

Positive Impact ◽

Quality Care ◽

Healthcare Delivery ◽

Public Healthcare ◽

Healthcare Facilities ◽

Medical Quality ◽

Quality Dimensions ◽

The Impact

AbstractObjectivesThis study examines the impact of accreditation on the quality of public healthcare delivery in primary and secondary healthcare facilities in Kerala, India.Study DesignA cross-sectional study.SettingKerala State, IndiaParticipantsParticipants are the in-patients (621) who are admitted in medical wards at accredited (312) and non-accredited (309) public healthcare facilities.Main Outcome MeasuresTen constructs used in the study, overarching the quality healthcare delivery, adapting previous studies, SERVQUAL, and Donabedian’s SPO models, are Physical Facility, Admission Services, Patient centeredness, Accessibility of Medical Care, Financial Factors, Professionalism, Staff Services, Medical Quality, Diagnostic Services, and Patient Satisfaction.MethodsThe study employed a positivist approach using a survey questionnaire. The study was conducted from July 2017 to July 2018, using stratified random sampling consists of the four strata; GHs, W&C hospitals, THQHs/THs and CHCs.ResultsAccreditation has a positive impact on patient satisfaction and other quality dimensions, overarching structural and procedural quality in primary healthcare facilities under the public sector in Kerala. Conversely, accreditation has not improved the quality dimensions in secondary healthcare facilities and thereby, the satisfaction of patients.ConclusionsIt cannot be assumed that accreditation is always associated with quality care in primary healthcare facilities. The implementation process must be systematic and must be regularly monitored to make it useful. Mere structural transformation through accreditation alone cannot guarantee patient satisfaction. Secondary healthcare facilities must be transformed into quality care centres through rhetoric action of the authorities concerned through organized efforts.

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COVID-19 Pandemic: An Inhibitor of Universal Health Coverage Programme: A ViewPoint

African Journal of Health, Nursing and Midwifery ◽

10.52589/ajhnm-p2ax15ul ◽

2021 ◽

Vol 4 (5) ◽

pp. 1-13

Author(s):

Helen Idubamo Wankasi

Keyword(s):

Universal Health Coverage ◽

Healthcare Workers ◽

Sustainable Development Goals ◽

Health Coverage ◽

The Sustainable Development ◽

Healthcare Facilities ◽

Effective Governance ◽

Development Goals ◽

Frontline Healthcare Workers ◽

Universal Health

Ever since the re-emergence of Covid-19 as a pandemic, healthcare facilities (human and materials) have been overstressed, evidenced by the rate at which frontline healthcare workers fall sick and die in the course. In some healthcare institutions, the narrative has changed with regards to the number of days to access physicians for treatment, but selected and booked only on specific days and periods, except in extreme emergencies are able to access physicians un-booked. This is inconsistent with the intent of Universal Health Coverage and the Sustainable Development Goals. This paper, therefore, highlighted the objectives, covering a brief overview of COVID-19 and Universal Health Coverage; identified countries developed (Germany 1883) and emerging (South Africa/Nigeria) that have adopted Universal Health Coverage as well described how COVID-19 stands as an inhibitor to the achievement of Universal Health Coverage. At the tail end, recommendations are made on the way forward on the need for effective governance, manpower sourcing and general strengthening of the healthcare system.

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How to Integrate Palliative Care Within Primary Healthcare- Perspectives of People Living With Serious Illnesses, Their Family Caregivers and Primary Healthcare Professionals in Nigeria

10.21203/rs.3.rs-1086435/v1 ◽

2021 ◽

Author(s):

Oladayo A Afolabi ◽

Kennedy Nkhoma ◽

Olaitan Soyannwo ◽

Akinyemi Aje ◽

Adesola Ogunniyi ◽

...

Keyword(s):

Palliative Care ◽

Family Caregivers ◽

Primary Healthcare ◽

Healthcare Providers ◽

Health Coverage ◽

Middle Income ◽

Healthcare Facilities ◽

Care Integration ◽

Qualitative Interview Study ◽

Building Information

Abstract Background Palliative care should be integrated into primary healthcare systems within low- and middle-income countries to achieve Universal Health Coverage goals. We aimed to identify preferences and expectations for primary healthcare support among people living with serious illness and their families in Nigeria, and to determine feasible steps palliative care integration within the health system. Methods Qualitative interview study with 48 participants including people living with serious illnesses (n=21) and their family caregivers (n=15) recruited from specialist clinics at a Teaching hospital in Nigeria; and healthcare providers (n=12) recruited from three primary healthcare facilities in Nigeria. Data were analysed using thematic analysis. Results Three major themes were identified. 1) Balancing patients and families’ expectations and preferences for easily accessible service and opportunities for social interaction and adequate communication with available human resource. 2) Engaging patients requires existing trust and bonds from their current use of primary healthcare and support to develop patients’ agency. 3) Development of healthcare providers is needed to ensure an appropriate clinical response, manage interprofessional trust and ensure clear role delineation. Conclusions Palliative care integration within primary healthcare in Nigeria can be achieved through building information and communication skills of healthcare providers, engaging and empowering patients to exercise their agency in care decisions, and adequately delineating healthcare providers’ roles to ensure staff work within their competencies and training.

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A comparison of the levels of satisfaction with the medical services provided by primary healthcare centers in selected communes in Lubelskie Voivodeship

Polish Journal of Public Health ◽

10.1515/pjph-2016-0002 ◽

2016 ◽

Vol 126 (1) ◽

pp. 8-12

Author(s):

Daria Przybylska ◽

Piotr Przybylski ◽

Bartłomiej Drop ◽

Krzysztof Czarnocki ◽

Wojciech Przybylski ◽

...

Keyword(s):

Family Medicine ◽

Primary Healthcare ◽

The Elderly ◽

Healthcare Services ◽

Medical Services ◽

Public Healthcare ◽

Healthcare Facilities ◽

Primary Type ◽

Primary Healthcare Centers

Abstract Introduction. Family medicine remains the primary type of medical services in Poland and it is supposed to treat both individual patients and the society as a whole. Due to the growing commercialization of the health service, most primary healthcare centers have transformed into non-public healthcare facilities. The public ones (called SPZOZ in Polish) account only for a small fraction of the whole number of primary healthcare facilities. The quality of medical services provided by such facilities, as patients see it, remains one of the key elements determining the development of family medicine centers. Aim. The aim of this paper was to assess patient satisfaction levels regarding the healthcare services they received in two primary healthcare institutions, both of the NZOZ and SPZOZ type, in a small town located close to Lublin. Material and methods. An anonymous survey was filled out by 30 patients of both a public and non-public healthcare center located in Niemce (Niemce Commune, Lublin District). The quality of services was assessed using an original questionnaire in the form of a poll. Results. The results obtained indicate a clear relationship between one’s trust to the physician, diagnosis accuracy and visiting the particular center again, in order to continue the treatment. For older subjects, it was nurses’ kindness and politeness that was the most important. The elderly appreciated the kindness and politeness of the nurses in particular. No significant differences were found between the institutions in respect of the overall perception of satisfaction with services. In terms of infrastructure assessment, the majority of positive feedback was provided for NZOZ. Conclusions. The findings above suggest that it is essential to conduct surveys on a regular basis, in order to check patients’ assessment of the service quality in various institutons.

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Surgery in Brazilian Health Care: funding and physician distribution

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912017002016 ◽

2017 ◽

Vol 44 (2) ◽

pp. 202-207 ◽

Cited By ~ 5

Author(s):

NIVALDO ALONSO ◽

BENJAMIN B. MASSENBURG ◽

RAFAEL GALLI ◽

LUCAS SOBRADO ◽

DARIO BIROLINI

Keyword(s):

Local Population ◽

Surgical Care ◽

National Database ◽

Public Healthcare ◽

Health Coverage ◽

Inequality Index ◽

Public And Private ◽

Healthcare Facilities ◽

The Public ◽

The North

ABSTRACT Objective: to analyze demographic Brazilian medical data from the national public healthcare system (SUS), which provides free universal health coverage for the entire population, and discuss the problems revealed, with particular focus on surgical care. Methods: data was obtained from public healthcare databases including the Medical Demography, the Brazilian Federal Council of Medicine, the Brazilian Institute of Geography and Statistics, and the National Database of Healthcare Establishments. Density and distribution of the medical workforce and healthcare facilities were calculated, and the geographic regions were analyzed using the public private inequality index. Results: Brazil has an average of two physicians for every 1,000 inhabitants, who are unequally distributed throughout the country. There are 22,276 board certified general surgeons in Brazil (11.49 for every 100,000 people). The country currently has 257 medical schools, with 25,159 vacancies for medical students each year, with only around 13,500 vacancies for residency. The public private inequality index is 3.90 for the country, and ranges from 1.63 in the Rio de Janeiro up to 12.06 in Bahia. Conclusions: A significant part of the local population still faces many difficulties in accessing surgical care, particularly in the north and northeast of the country, where there are fewer hospitals and surgeons. Physicians and surgeons are particularly scarce in the public health system nationwide, and better incentives are needed to ensure an equal public and private workforce.

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Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

PLoS ONE ◽

10.1371/journal.pone.0076272 ◽

2013 ◽

Vol 8 (10) ◽

pp. e76272 ◽

Cited By ~ 36

Author(s):

Mareli M. Claassens ◽

Cari van Schalkwyk ◽

Elizabeth du Toit ◽

Eline Roest ◽

Carl J. Lombard ◽

...

Keyword(s):

South Africa ◽

Infection Control ◽

Primary Healthcare ◽

Healthcare Workers ◽

Control Measures ◽

Healthcare Facilities ◽

Infection Control Measures

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Occupational Health Systems across Selected Public Healthcare Facilities in the Philippines

Acta Medica Philippina ◽

10.47895/amp.v48i3.1129 ◽

2014 ◽

Vol 48 (3) ◽

Cited By ~ 1

Author(s):

Paul Michael R. Hernandez ◽

Romeo R. Quizon ◽

Guillano C. Lacsamana ◽

Joanna I. Remaneses

Keyword(s):

Occupational Health ◽

Health Systems ◽

The Philippines ◽

Public Healthcare ◽

Healthcare Facilities

...

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Knowledge, attitudes and practices towards viral haemorrhagic fevers amongst healthcare workers in urban and rural public healthcare facilities in the N’zérékoré Prefecture, Guinea: a cross-sectional study

10.21203/rs.2.17924/v2 ◽

2020 ◽

Author(s):

Manuel Raab ◽

Lisa M. Pfadenhauer ◽

Tamba Jacques Millimouno ◽

Michael Hoelscher ◽

Guenter Froeschl

Keyword(s):

Healthcare Workers ◽

Good Knowledge ◽

Infection Prevention And Control ◽

Public Healthcare ◽

Case Detection ◽

Rural Healthcare ◽

Healthcare Facilities ◽

Attitudes And Practices ◽

Knowledge Attitudes And Practices ◽

Suspect Case

Abstract Introduction: The 2013-2016 Ebola epidemic in West Africa began in Guinea’s Forest region, a region now considered to be at high risk for future epidemics of viral haemorrhagic fevers (VHF). Good knowledge, attitudes and practices towards VHF amongst healthcare workers in such regions are a central pillar of infection prevention and control (IPC). To inform future training in IPC, this study assesses the knowledge, attitudes and practices (KAP) towards VHF amongst healthcare workers in public healthcare facilities in the most populated prefecture in Forest Guinea, and compares results from urban and rural areas. Methods: In June and July 2019, we interviewed 102 healthcare workers in the main urban and rural public healthcare facilities in the N’zérékoré prefecture in Forest Guinea. We used an interviewer-administered questionnaire adapted from validated KAP surveys. Results: The great majority of respondents demonstrated good knowledge and favourable attitudes towards VHF. However, respondents reported some gaps in preventive practices such as VHF suspect case detection. They also reported a shortage of protective medical equipment used in everyday clinical work in both urban and rural healthcare facilities and a lack of training in IPC, especially in rural healthcare facilities. However, whether or not healthcare workers had been trained in IPC did not seem to influence their level of KAP towards VHF. Conclusions: Three years after the end of the Ebola epidemic, our findings suggest that public healthcare facilities in the N’zérékoré prefecture in Forest Guinea still lack essential protective equipment and some practical training in VHF suspect case detection. To minimize the risk of future VHF epidemics and improve management of outbreaks of infectious diseases in the region, current efforts to strengthen the public healthcare system in Guinea should encompass questions of supply and IPC training.

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Transformational improvement in quality care and health systems: the next decade

BMC Medicine ◽

10.1186/s12916-020-01739-y ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Jeffrey Braithwaite ◽

Charles Vincent ◽

Ezequiel Garcia-Elorrio ◽

Yuichi Imanaka ◽

Wendy Nicklin ◽

...

Keyword(s):

Health Systems ◽

Action Plan ◽

Quality Care ◽

The United States ◽

Care Quality ◽

World Health ◽

Main Body ◽

Health Coverage ◽

High Quality ◽

The World

Abstract Background Healthcare is amongst the most complex of human systems. Coordinating activities and integrating newer with older ways of treating patients while delivering high-quality, safe care, is challenging. Three landmark reports in 2018 led by (1) the Lancet Global Health Commission, (2) a coalition of the World Health Organization, the Organisation for Economic Co-operation and Development and the World Bank, and (3) the National Academies of Sciences, Engineering and Medicine of the United States propose that health systems need to tackle care quality, create less harm and provide universal health coverage in all nations, but especially low- and middle-income countries. The objective of this study is to review these reports with the aim of advancing the discussion beyond a conceptual diagnosis of quality gaps into identification of practical opportunities for transforming health systems by 2030. Main body We analysed the reports via text-mining techniques and content analyses to derive their key themes and concepts. Initiatives to make progress include better measurement, using the capacities of information and communications technologies, taking a systems view of change, supporting systems to be constantly improving, creating learning health systems and undergirding progress with effective research and evaluation. Our analysis suggests that the world needs to move from 2018, the year of reports, to the 2020s, the decade of action. We propose three initiatives to support this move: first, developing a blueprint for change, modifiable to each country’s circumstances, to give effect to the reports’ recommendations; second, to make tangible steps to reduce inequities within and across health systems, including redistributing resources to areas of greatest need; and third, learning from what goes right to complement current efforts focused on reducing things going wrong. We provide examples of targeted funding which would have major benefits, reduce inequalities, promote universality and be better at learning from successes as well as failures. Conclusion The reports contain many recommendations, but lack an integrated, implementable, 10-year action plan for the next decade to give effect to their aims to improve care to the most vulnerable, save lives by providing high-quality healthcare and shift to measuring and ensuring better systems- and patient-level outcomes. This article signals what needs to be done to achieve these aims.

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Universal Health Coverage

10.1093/oso/9780197607251.003.0006 ◽

2021 ◽

pp. 134-153

Author(s):

Joia S. Mukherjee

Keyword(s):

Health Systems ◽

Universal Health Coverage ◽

Quality Care ◽

Universal Coverage ◽

Health Coverage ◽

Quality Health Care ◽

The Sustainable Development ◽

Quality Health ◽

The Right ◽

Universal Health

As part of the Sustainable Development Goals the right to health is captured under the rubric of universal health coverage (UHC). That is that all people should have access to the high quality care they need without suffering financial hardship. This chapter explores this seminal topic reviewing the theory of universal coverage and definitions that shape the current conversation about UHC. This chapter also highlights some important steps taken by countries to expand access to quality health care but challenges the rhetoric that financing care through insurance schemes, a common approach to UHC) is sufficient when the inputs into the health systems do not match the disease burden. Finally, the chapter investigates the theory and practice behind a morbidity-based approach to strengthening health systems and achieving UHC.

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