scholarly journals Cost of managing atonic postpartum haemorrhage with uterine balloon tamponade devices in public health settings of Maharashtra, India: an economic microcosting study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042389
Author(s):  
Siddesh Sitaram Shetty ◽  
Kusum Venkobrao Moray ◽  
Himanshu Chaurasia ◽  
Beena Nitin Joshi
Keyword(s):  
Public Health ◽  
Health System ◽  
Annual Cost ◽  
Postpartum Haemorrhage ◽  
Public Health System ◽  
Health Facilities ◽  
Health Management Information System ◽  
Public Health Facilities ◽  
Balloon Tamponade ◽  
Uterine Balloon Tamponade

ObjectivePostpartum haemorrhage (PPH) is the worldwide leading cause of preventable maternal mortality. India offers free treatment for pregnancy and related complications in its public health facilities. Management with uterine balloon tamponade (UBT) is recommended for refractory atonic PPH cases. As part of health technology assessment to determine the most cost-effective UBT device, this study estimated costs of atonic PPH management with condom-UBT, Every Second Matters (ESM) UBT and Bakri balloon UBT in public health system of Maharashtra, India.DesignHealth system cost was estimated using primary economic microcosting, data from Health Management Information System and published literature for event probabilities.SettingsFour public health facilities from the state of Maharashtra, India representing primary, secondary and tertiary level care were chosen for primary costing.Outcome measuresUnit, package and annual cost of atonic PPH management with three UBT devices were measured. This included cost of medical treatment, UBT intervention and PPH related surgeries undertaken in public health system of Maharashtra for year 2017–2018.ResultsMedical management of atonic PPH cost the health system US$37 (95% CI 29 to 45) per case, increasing to US$44 (95% CI 36 to 53) with condom-UBT and surgical interventions for uncontrolled cases. Similar cost was estimated for ESM-UBT. Bakri-UBT reported a higher cost of US$59 (95% CI 46 to 73) per case. Overall annual cost of managing 27 915 atonic PPH cases with condom-UBT intervention in Maharashtra was US$1 226 610 (95% CI 870 250 to 1 581 596).ConclusionsAtonic PPH management in public health facilities of Maharashtra with condom-UBT, ESM-UBT or Bakri-UBT accounts to 3.8%, 3.8% or 5.2% of the state’s annual spending on reproductive and child health services. These findings can guide policy-makers to include PPH complication management in publicly financed health schemes. Economic evaluation studies can use this evidence to determine cost effectiveness of UBT in Indian settings.

scholarly journals Health system actors’ perspectives of prescribing practices in public health facilities in Eswatini: A Qualitative Study

PLoS ONE ◽  
2020 ◽  
Vol 15 (7) ◽  
pp. e0235513 ◽  
Author(s):  
Nondumiso B. Q. Ncube ◽  
Lucia Knight ◽  
Hazel Anne Bradley ◽  
Helen Schneider ◽  
Richard Laing
Keyword(s):  
Public Health ◽  
Qualitative Study ◽  
Health System ◽  
Health Facilities ◽  
Prescribing Practices ◽  
Public Health Facilities

scholarly journals Cost-effectiveness of uterine balloon tamponade devices in managing atonic post-partum hemorrhage at public health facilities in India

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256271
Author(s):  
Beena Nitin Joshi ◽  
Siddesh Sitaram Shetty ◽  
Kusum Venkobrao Moray ◽  
Oshima Sachin ◽  
Himanshu Chaurasia
Keyword(s):  
Public Health ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cost Saving ◽  
Incremental Cost ◽  
Post Partum ◽  
Public Health Facilities ◽  
Post Partum Hemorrhage ◽  
Balloon Tamponade ◽  
Uterine Balloon Tamponade

Objective Post-partum hemorrhage (PPH) is the leading direct cause of maternal mortality in India. Uterine balloon tamponade (UBT) is recommended for atonic PPH cases not responding to uterotonics. This study assessed cost-effectiveness of three UBT devices used in Indian public health settings. Methods A decision tree model was built to assess cost-effectiveness of Bakri-UBT and low-cost ESM-UBT alternatives as compared to the recommended standard of care i.e. condom-UBT intervention. A hypothetical annual cohort of women eligible for UBT intervention after experiencing atonic PPH in Indian public health facilities were evaluated for associated costs and outcomes over life-time horizon using a disaggregated societal perspective. Costs by undertaking primary costing and clinical parameters from published literature were used. Incremental cost per Disability Adjusted Life Years (DALY) averted, number of surgeries and maternal deaths with the interventions were estimated. An India specific willingness to pay threshold of INR 24,211 (USD 375) was used to evaluate cost-effectiveness. Detailed sensitivity analysis and expected value of information analysis was undertaken. Results ESM-UBT at base-case Incremental Cost-Effectiveness Ratio (ICER) of INR -2,412 (USD 37) per DALY averted is a cost-saving intervention i.e. is less expensive and more effective as compared to condom-UBT. Probabilistic sensitivity analysis however shows an error probability of 0.36, indicating a degree of uncertainty around model results. Bakri-UBT at an ICER value of INR -126,219 (USD -1,957) per DALY averted incurs higher incremental societal costs and is less effective as compared to condom-UBT. Hence, Bakri-UBT is not cost-effective. Conclusion For atonic PPH management in India, condom-UBT offers better value as compared to Bakri-UBT. Given the limited clinical effectiveness evidence and uncertainty in sensitivity analysis, cost-saving result for ESM-UBT must be considered with caution. Future research may focus on generating high quality comparative clinical evidence for UBT devices to facilitate policy decision making.

scholarly journals Integration of HIV-Sexual Reproductive Health Services for Young People and the Barriers at Public Health Facilities in Mbarara Municipality, Southwestern Uganda: A Qualitative Assessment

2019 ◽  
Vol 2019 ◽  
pp. 1-11 ◽  
Author(s):  
Cecilia Akatukwasa ◽  
Francis Bajunirwe ◽  
Simpson Nuwamanya ◽  
Noel Kansime ◽  
Emmanuel Aheebwe ◽  
...  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Young People ◽  
Reproductive Health ◽  
Health System ◽  
Health Facilities ◽  
Qualitative Assessment ◽  
Care Providers ◽  
Public Health Facilities ◽  
Southwestern Uganda

Background. Sexual and Reproductive Health (SRH) and HIV risk behaviors for young people are intertwined. This rationalizes the need for integration of HIV and SRH services within the health care system, especially in countries with high HIV burden. In this study, we explored the current status of HIV-SRH integration for young people and barriers of integration from different stakeholders at public health facilities in Mbarara Municipality, southwestern Uganda. Methods. We conducted an exploratory qualitative study at public health facilities in Mbarara district of southwestern Uganda. Data were collected among young people (n=48), health care providers (n=63), and key informants (n=11). We used in-depth interviews and focus group discussions to collect the data. Coding and analysis of qualitative data were done using Atlas.ti. Results. Overall there was no differentiation of HIV-SRH services between adults and young people. Integration of HIV-SRH services was reported at all facility levels; however, there was poor differentiation of services for the young persons and adults. Integrated HIV and SRH services for young people were acknowledged to improve access to information and risk perception, improve continuity of care, and reduce cost of services and would also lead to improved client-health worker relationships. The potential barriers to achieving HIV-SRH integration included individual provider characteristics like lack of training and attitudes, generic health system challenges like low staffing levels, poor infrastructure with lack of space and privacy to deliver these services. At the policy level vertical programing and unclear policies and guidelines were identified as challenges. Conclusion. Our study shows integration of HIV and SRH services exists in general but services for adults and young people are blended or poorly differentiated. Significant health system barriers need to be overcome to achieve differentiation of the services for young people and adults.

scholarly journals Utilization of Routine Health Management Information and Associated Factors among Health Professionals Workingat Public Health Facilities of Hadiya Zone Southern Ethiopia

2019 ◽  
Author(s):  
Animut Addis Feleke ◽  
Takele Tigro Olbamo ◽  
Binyam Taddesse ◽  
Yibeltal Siraneh
Keyword(s):  
Public Health ◽  
Information System ◽  
Health Professionals ◽  
Confidence Level ◽  
Health Management ◽  
Health Facilities ◽  
Southern Ethiopia ◽  
Health Management Information System ◽  
Management Information ◽  
Public Health Facilities

Abstract Background Health management information system is a system that used for routine data collection, analysis and utilization in health system. However, limited study done on routine health management information at individual health professionals level. Hence, the objective of this study was to assess utilization of routine health management information and associated factors among health professionals working at public health facilities of Hadiya Zone Southern Ethiopia. Methods A facility based cross-sectional survey was conducted among health professionals working at public health facilities of Hadia Zone from March 15-30, 2018. Using single population proportion formulae, 477participants were randomly selected. Data were collected by self-administered questioner. The data were entered in to Epi data version 3.1 and exported to SPSS version 23 for statistical analysis. Both bivariate (at P<0.25) and multi variable logistics regressions (at P<0.05) were used to identify predictors of utilization. Finally, the findings were presented using graphs, tables, narratives and descriptive numerical summary. Results The finding of this study revealed that utilization of health management information system among health workers was 54.9%. Knowledge [AOR=1.576, 95%CI (1.012, 2.454)], confidence level [AOR=1.873, 95%CI(1.264,2.776)], participation on data aggregation [AOR=2.289, 95% CI (1.293,4.05­)], register their daily data [AOR=2.529, 95% CI(1.023, 6.251)], and complexity of formats [AOR=1.971, 95%CI(1.29,3.011)] were found to be significantly associated with utilization of health information system at 95%confidence level. Conclusion and recommendations The overall health information utilization among health workers was low relative to other literature. Having good knowledge, high confidence level, participation on data aggregation, registering their daily data were independent predictors of information utilization. Therefore, stakeholders at each level should improve capacity of health care providers like providing training and regular mentorship related with information use.

India as a Pioneer of Innovation

2018 ◽  
Keyword(s):  
Public Health ◽  
Health System ◽  
Informal Economy ◽  
Urban Poor ◽  
Public Health System ◽  
Low Cost ◽  
Social Enterprises ◽  
Specific Context ◽  
Innovation Project ◽  
Context Specific

What does innovation mean to and in India? What are the predominant areas of innovation for India, and under what situations do they succeed or fail? This book addresses these all-important questions arising within diverse Indian contexts: informal economy, low-cost settings, large business groups, entertainment and copyright-based industries, an evolving pharma sector, a poorly organized and appallingly underfunded public health system, social enterprises for the urban poor, and innovations for the millions. It explores the issues that promote and those that hinder the country’s rise as an innovation leader. The book’s balanced perspective on India’s promises and failings makes it a valuable addition for those who believe that India’s future banks heavily on its ability to leapfrog using innovation, as well as those sceptical of the Indian state’s belief in the potential of private enterprise and innovation. It also provides critical insights on innovation in general, the most important of which being the highly context-specific, context-driven character of the innovation project.

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.

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