scholarly journals Measuring oxygen access: lessons from health facility assessments in Lagos, Nigeria

2021 ◽  
Vol 6 (8) ◽  
pp. e006069
Author(s):  
Hamish R Graham ◽  
Omotayo E Olojede ◽  
Ayobami A Bakare ◽  
Agnese Iuliano ◽  
Oyaniyi Olatunde ◽  
...  
Keyword(s):  
Health Facility ◽  
Point Of Care ◽  
Assessment Tools ◽  
Operating Theatre ◽  
Facility Assessment ◽  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres ◽  
The Cost

The COVID-19 pandemic has highlighted global oxygen system deficiencies and revealed gaps in how we understand and measure ‘oxygen access’. We present a case study on oxygen access from 58 health facilities in Lagos state, Nigeria. We found large differences in oxygen access between facilities (primary vs secondary, government vs private) and describe three key domains to consider when measuring oxygen access: availability, cost, use. Of 58 facilities surveyed, 8 (14%) of facilities had a functional pulse oximeter. Oximeters (N=27) were typically located in outpatient clinics (12/27, 44%), paediatric ward (6/27, 22%) or operating theatre (4/27, 15%). 34/58 (59%) facilities had a functional source of oxygen available on the day of inspection, of which 31 (91%) facilities had it available in a single ward area, typically the operating theatre or maternity ward. Oxygen services were free to patients at primary health centres, when available, but expensive in hospitals and private facilities, with the median cost for 2 days oxygen 13 000 (US$36) and 27 500 (US$77) Naira, respectively. We obtained limited data on the cost of oxygen services to facilities. Pulse oximetry use was low in secondary care facilities (32%, 21/65 patients had SpO2 documented) and negligible in private facilities (2%, 3/177) and primary health centres (<1%, 2/608). We were unable to determine the proportion of hypoxaemic patients who received oxygen therapy with available data. However, triangulation of existing data suggested that no facilities were equipped to meet minimum oxygen demands. We highlight the importance of a multifaceted approach to measuring oxygen access that assesses access at the point-of-care and ideally at the patient-level. We propose standard metrics to report oxygen access and describe how these can be integrated into routine health information systems and existing health facility assessment tools.

scholarly journals Measuring Oxygen Access: lessons from health facility assessments in Nigeria

2021 ◽  
Author(s):  
Hamish R Graham ◽  
Omotayo E Olojede ◽  
Ayobami A Bakare ◽  
Agnese Iuliano ◽  
Oyaniyi Olatunde ◽  
...  
Keyword(s):  
Health Facility ◽  
Pulse Oximeter ◽  
Point Of Care ◽  
Assessment Tools ◽  
Operating Theatre ◽  
List Type ◽  
Functional Requirements ◽  
Blood Oxygen Level ◽  
Facility Assessment ◽  
Primary Health Centres

ABSTRACTThe COVID-19 pandemic has highlighted global oxygen system deficiencies and revealed gaps in how we understand and measure “oxygen access”. We present a case study on oxygen access from 58 health facilities in Lagos state, Nigeria. We found large differences in oxygen access between facilities (primary vs secondary, government vs private) and describe four key domains to consider when measuring oxygen access.Use8/58 (14%) of facilities had a functional pulse oximeter for detecting hypoxaemia (low blood oxygen level) and guiding oxygen care. Oximeters were typically located in outpatient clinics (12/27, 44%), paediatric ward (6/27, 22%), or operating theatre (4/27, 15%), not suitable for children, and infrequently used.Availability34/58 (59%) facilities had a functional source of oxygen available on the day of inspection, of which 31 (91%) facilities had it available in a single ward area, typically the operating theatre or maternity ward.CostOxygen was free to patients at primary health centres, when available, but expensive in hospitals and private facilities, with the median cost for 2 days oxygen 13000 ($36 USD) and 27500 ($77 USD) naira, respectively.Patient accessNo facilities were adequately equipped to meet minimum oxygen demands for patients. We were unable to determine the proportion of hypoxaemic patients who received oxygen therapy with available data.We highlight the importance of a multi-faceted approach to measuring oxygen access that assesses access at the point-of-care, and ideally at the patient-level. We propose standard metrics to report oxygen access and describe how these can be integrated into routine health information systems and existing health facility assessment tools.SUMMARY BOXOxygen access is poorly understood and the most commonly used metrics (e.g. presence of an oxygen source) do not correlate well with actual access to patients.Pulse oximetry use is a critical indicator for the quality of oxygen services and may be a reasonable reflection of oxygen coverage to patients with hypoxaemia.Oxygen, and pulse oximeter, availability must be assessed at the point-of-care in all major service delivery areas, as intra-facility oxygen distribution is highly inequitable.Minimum functional requirements for oxygen sources must be assessed, as many oxygen concentrators and cylinders may be present without being in working order.

What Causes Medicine Shortages in Primary Health Centres?

2015 ◽  
Vol 17 (1) ◽  
pp. 86-97 ◽  
Author(s):  
Shweta Raut-Marathe ◽  
Nilangi Sardeshpande ◽  
Deepali Yakkundi
Keyword(s):  
Primary Health ◽  
Primary Health Centres ◽  
Health Centres

scholarly journals Improving quality of care during childbirth in primary health centres: a stepped-wedge cluster-randomised trial in India

2018 ◽  
Vol 3 (5) ◽  
pp. e000907 ◽  
Author(s):  
Ramesh Agarwal ◽  
Deepak Chawla ◽  
Minakshi Sharma ◽  
Shyama Nagaranjan ◽  
Suresh K Dalpath ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Management Strategy ◽  
Randomised Trial ◽  
Cluster Randomised Trial ◽  
Stepped Wedge ◽  
Primary Health ◽  
Cluster Randomised ◽  
Primary Health Centres ◽  
Health Centres

BackgroundLow/middle-income countries need a large-scale improvement in the quality of care (QoC) around the time of childbirth in order to reduce high maternal, fetal and neonatal mortality. However, there is a paucity of scalable models.MethodsWe conducted a stepped-wedge cluster-randomised trial in 15 primary health centres (PHC) of the state of Haryana in India to test the effectiveness of a multipronged quality management strategy comprising capacity building of providers, periodic assessments of the PHCs to identify quality gaps and undertaking improvement activities for closure of the gaps. The 21-month duration of the study was divided into seven periods (steps) of 3  months each. Starting from the second period, a set of randomly selected three PHCs (cluster) crossed over to the intervention arm for rest of the period of the study. The primary outcomes included the number of women approaching the PHCs for childbirth and 12 directly observed essential practices related to the childbirth. Outcomes were adjusted with random effect for cluster (PHC) and fixed effect for ‘months of intervention’.ResultsThe intervention strategy led to increase in the number of women approaching PHCs for childbirth (26 vs 21 women per PHC-month, adjusted incidence rate ratio: 1.22; 95% CI 1.17 to 1.28). Of the 12 practices, 6 improved modestly, 2 remained near universal during both intervention and control periods, 3 did not change and 1 worsened. There was no evidence of change in mortality with a majority of deaths occurring either during referral transport or at the referral facilities.ConclusionA multipronged quality management strategy enhanced utilisation of services and modestly improved key practices around the time of childbirth in PHCs in India.Trial registration numberCTRI/2016/05/006963.

scholarly journals Quality of Health Assistants in primary Health centres in Rural Maharashtra, India

2013 ◽  
Vol 6 ◽  
pp. HSI.S11226
Author(s):  
Enakshi Ganguly ◽  
Bishan S. Garg
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Primary Health Care System ◽  
Job Descriptions ◽  
Continuous Training ◽  
Primary Health ◽  
Primary Health Centres ◽  
Quality Assurance Mechanism ◽  
Health Centres

Introduction Health assistants are important functionaries of the primary health care system in India. Their role is supervision of field-based services among other things. A quality assurance mechanism for these health assistants is lacking. The present study was undertaken with the objectives of developing a tool to assess the quality of health assistants in primary health centres (PHCs) and to assess their quality using this tool. Methodology Health assistants from three PHCs in the Wardha district of India were observed for a year using a tool developed from primary health care management Aavancement program modules. Data was collected by direct observation, interview, and review of records for quality of activities. Results Staff strength of health assistants was 87.5%. None of the health assistants were clear about their job descriptions. A supervisory schedule for providing supportive supervision to auxiliary nurse midwives (ANMs) was absent; most field activities pertaining to maternal and child health received poor focus. Monthly meetings lacked a clear agenda, and comments on quality improvement of services provided by the ANMs were missing. Conclusion Continuous training with sensitization on quality issues is required to improve the unsatisfactory quality.

scholarly journals What do non-ophthalmic health professionals know about retinoblastoma: a survey in Saudi Arabia

2019 ◽  
Vol 7 (2) ◽  
pp. 457
Author(s):  
Dora H. AlHarkan ◽  
Malak A. Almuzneef ◽  
Norah M Alhammad ◽  
Nora A. Alyousif ◽  
Lina A. Alyousif ◽  
...  
Keyword(s):  
Health Professionals ◽  
Male Gender ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
General Hospitals ◽  
Primary Health ◽  
Primary Health Centres ◽  
Gender Education ◽  
Health Centres ◽  
Level Of Knowledge

Background: The aim of the study is to estimate the level of knowledge about retinoblastoma (Rb) and its determinants among non-ophthalmic health professionals of Qassim region of Saudi Arabia.Methods: This cross-sectional survey was held in 2016 in primary health centres (PHC) and general hospitals in the study area. In addition to demography like age, gender, education, place of work, participants replied to five questions related to Rb with close-ended questions to respond. They were matched to the expert group's answers to estimate the level of knowledge.Results: One hundred and fifty-two non-ophthalmic doctors participated in the survey. The excellent grade of knowledge of Rb was in 66 [43.3% (95% confidence interval 35.5-51.3)] of participants. Very poor level of knowledge was noted in 13 [8.6% (95% CI 4.1-13.0)] participants. Male gender (P = 0.02) and physician category (P = 0.02) were significantly associated with the excellent grade of Rb related knowledge. The participant’s response by type of questions varied significantly (P<0.001).Conclusions: More than half of the non-ophthalmic health professionals had less than desired knowledge about Rb. Health education about Rb to health professionals could be gender sensitive and based on the type of profession. Increasing the awareness about retinoblastoma among non-ophthalmic health professional is important.

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