scholarly journals Health services utilisation and responsiveness profiles in Iran: a provincial household study

2019 ◽  
Vol 7 (1) ◽  
pp. e000007 ◽  
Author(s):  
Mostafa Farahbakhsh ◽  
Homayoun Sadeghi Bazargani ◽  
Mohammad Saadati ◽  
Jafar Sadegh Tabrizi ◽  
Mina Golestani ◽  
...  
Keyword(s):  
Health Services ◽  
Health System ◽  
Health Resources ◽  
Cross Sectional ◽  
The Public ◽  
Significant Difference ◽  
System Responsiveness ◽  
Health System Responsiveness ◽  
East Azerbaijan ◽  
Barriers To Health

ObjectiveThe aim of this study was to describe health services utilisation and responsiveness in East Azerbaijan province, Iran.DesignA cross-sectional household study as part of a larger research on primary healthcare system.SettingWe carried out the study in East Azerbaijan Province, northwest Iran from July to September 2015.ParticipantsA total of 1318 households were included.ResultsMost of the participating households had social security health insurance. Heart failure or hypertension care, general outpatient care and arthritis care were the most used services. High services cost and inadequate medicine and medical equipment were introduced to be the main barriers to health services utilisation in Tabriz and province representative sample (PRS), respectively. Health system responsiveness mean score (the maximum is 100) was 33.71±16.15 (95% CI 32.45 to 34.97) in Tabriz and 32.02±14.3 (95% CI 30.9 to 33.13) in PRS, which showed significant difference (p≤0.02).ConclusionsDifferences in the utilisation and responsiveness of health services and distribution of health resources were observed between Tabriz and PRS. Evidently, health system responsiveness in both Tabriz and PRS was at low level. The results demonstrate the need for changing resource distribution policies and employing reactive health policies to response the public health.

scholarly journals Mapping the Multiple Health System Responsiveness Mechanisms in One Local Health System: A Scoping Review of the Western Cape Provincial Health System of South Africa

2021 ◽  
Author(s):  
Tammy Sutherns ◽  
Jill Olivier
Keyword(s):  
Health System ◽  
Scoping Review ◽  
Grey Literature ◽  
Secondary Analysis ◽  
Local Health ◽  
Western Cape ◽  
Cross Sectional ◽  
Middle Income ◽  
System Responsiveness ◽  
Health System Responsiveness

Background: Despite governments striving for responsive health systems and the implementation of mechanisms to foster better citizen feedback and strengthen accountability and stewardship, these mechanisms do not always function in effective, equitable, or efficient ways. There is also limited evidence that maps the diverse array of responsiveness mechanisms coherently across a particular health system, especially in low- and middle-income country (LMIC) contexts. Methods: This scoping review presents a cross-sectional ‘map’ of types of health system responsiveness mechanisms; the regulatory environment; and evidence available about these; and assesses what is known about their functionality in a particular local South African health system; the Western Cape (WC) province. Multiple forms of indexed and grey literature were synthesized to provide a contextualized understanding of current ‘formal’ responsiveness mechanisms mandated in national and provincial policies and guidelines (n = 379). Various forms of secondary analysis were applied across quantitative and qualitative data, including thematic and time-series analyses. An expert checking process was conducted, with three local field experts, as a final step to check the veracity of the analytics and conclusions made. Results: National, provincial and district policies make provision for health system responsiveness, including varied mechanisms intended to foster public feedback. However, while some are shown to be functioning and effective, there are major barriers faced by all, such as resource and capacity constraints, and a lack of clarity about roles and responsibilities. Most mechanisms exist in isolation, failing to feed into an overarching strategy for improved responsiveness. Conclusion: The lack of synergy between mechanisms or analysis of varied forms of feedback is a missed opportunity. Decision-makers are unable to see trends or gaps in the flow of feedback, check whether all voices are heard or fully understand whether/how systemic response occurs. Urgent health system work lies in the research of macro ‘whole’ systems responsiveness (levels, development, trends).

scholarly journals Health system responsiveness to refugees: a population-based, cross-sectional study in Germany

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Biddle ◽  
J Wenner ◽  
K Bozorgmehr
Keyword(s):  
Health Status ◽  
Supportive Care ◽  
Health System ◽  
Population Based ◽  
Poor Health ◽  
Poor Health Status ◽  
Cross Sectional ◽  
Care Environment ◽  
System Responsiveness ◽  
Health System Responsiveness

Abstract Background Responsiveness, a critical component of health system performance, has received little attention in the context of international migration. Yet the concept provides a unique lens to study the system's ability to meet the legitimate expectations of its users. This study aims to identify predictors of responsiveness for asylum seekers and refugees (ASR) in Germany. Methods A population-based, cross-sectional health monitoring survey was conducted in Germany's third-largest federal state using random sampling at the level of all 1938 accommodation centers. Established instruments were used to measure responsiveness, health status, and socio-demographic factors. Data were weighted for sampling design and calibrated using asylum statistics. Adjusted logistic regression models were applied to identify predictors of responsiveness related to health status, structural, and socio-demographic variables. Results Of 560 respondents (response rate: 42%), 344 provided data on responsiveness. Combined weighted scores for responsiveness were 75% (CI: 69%-82%), with large variations between domains ranging from 86% (CI: 80%-90%) for cleanliness and 83% (CI: 76%-89%) for respect domains, to 56% (CI: 48%-63%) for choice and 52% (CI: 46%-59%) for timeliness domains. Overall responsiveness was worse for ASR with poor general health (OR 0.35; CI: 0.14-0.84), chronic illnesses (OR: 0.37; CI: 0.17-0.81), symptoms of depression (OR: 0.37; CI: 0.15-0.90) and anxiety (OR: 0.26; 0.10-0.68), and poor quality of life (OR: 0.18; 0.06-0.60). Socio-demographic and structural factors were not significantly associated with responsiveness. Conclusions There is room for improvement, especially regarding choice of provider and timeliness of care for ASR in Germany. Poor health status is a predictor of responsiveness, indicating that ASR most in need of a supportive care environment are being sold short. There is therefore an inequitable distribution of health system responsiveness among ASR. Key messages There is a large variation in scores across responsiveness domains, with choice of provider and timeliness of the health system being rated as particularly poor by ASR. Responsiveness is worse for individuals with poor health status, indicating that those most in need of a supportive care environment are being sold short.

scholarly journals Non-fatal injuries in rural Burkina Faso amongst older adults, disease burden and health system responsiveness: a cross-sectional household survey

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045621
Author(s):  
John Whitaker ◽  
Guy Harling ◽  
Ali Sie ◽  
Mamadou Bountogo ◽  
Lisa R Hirschhorn ◽  
...  
Keyword(s):  
Health System ◽  
Burkina Faso ◽  
Disease Burden ◽  
Household Survey ◽  
Secondary Outcome ◽  
Cross Sectional ◽  
Patient Reported ◽  
Reported Health ◽  
System Responsiveness ◽  
Health System Responsiveness

ObjectivesThis study aimed to evaluate the epidemiology of injury as well as patient-reported health system responsiveness following injury and how this compares with non-injured patient experience, in older individuals in rural Burkina Faso.DesignCross-sectional household survey. Secondary analysis of the CRSN Heidelberg Ageing Study dataset.SettingRural Burkina Faso.Participants3028 adults, over 40, from multiple ethnic groups, were randomly sampled from the 2015 Nouna Health and Demographic Surveillance Site census.Primary and secondary outcome measuresPrimary outcome was incidence of injury. Secondary outcomes were incidence of injury related disability and patient-reported health system responsiveness following injury.Results7.7% (232/3028) of the population reported injury in the preceding 12 months. In multivariable analyses, younger age, male sex, highest wealth quintile, an abnormal Generalised Anxiety Disorder score and lower Quality of Life score were all associated with injury. The most common mechanism of injury was being struck or hit by an object, 32.8%. In multivariable analysis, only education was significantly negatively associated with odds of disability (OR 0.407, 95% CI 0.17 to 0.997). Across all survey participants, 3.9% (119/3028) reported their most recent care seeking episode was following injury, rather than for another condition. Positive experience and satisfaction with care were reported following injury, with shorter median wait times (10 vs 20 min, p=0.002) and longer consultation times (20 vs 15 min, p=0.002) than care for another reason. Injured patients were also asked to return to health facilities more often than those seeking care for another reason, 81.4% (95% CI 73.1% to 87.9%) vs 54.8% (95% CI 49.9% to 53.6%).ConclusionsInjury is an important disease burden in this older adult rural low-income and middle-income country population. Further research could inform preventative strategies, including safer rural farming methods, explore the association between adverse mental health and injury, and strengthen health system readiness to provide quality care.

Health System Responsiveness and Its Associated Factors Among Outpatients in Primary Health Care Facilities, Asagirt District, NorthShewa Zone, Ethiopia, 2021: Cross Sectional Study Design

2021 ◽  
Author(s):  
Wubshet Debebe Negash ◽  
Chalie Tadie Tsehay ◽  
Lake Yazachew ◽  
Desale Bihonegn Asmamaw ◽  
Dawit Zenamarkos Desta ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Associated Factors ◽  
Health Care Facilities ◽  
Cross Sectional ◽  
Primary Health ◽  
Care Facilities ◽  
System Responsiveness ◽  
Health System Responsiveness ◽  
Primary Health Care Facilities

Abstract Background: Health system responsiveness is defined as the outcome of designing health facility relationships in such a way that they are familiar and respond appropriately to patients’ universally legitimate expectations. Even though different strategies have been implemented to measure responsiveness, only scanty evidence exists in Sub-Saharan Africa. In Ethiopia information about the level of health system responsiveness among outpatients is scant. Assessing responsiveness could help facilities in improving service delivery based on patient expectations. Objective: The study aimed to assess health system responsiveness and associated factors among outpatients in primary health care facilities, Asagirt District, North Shewa Zone, Ethiopia, 2021. Methods: Facility-based cross-sectional quantitative study was implemented between 30th March and April 30/2021. A systematic random sampling technique was employed to select 423 participants, and interviewer-administered data were collected using a structured and pretested questionnaires. Both bivariable and multivariable logistic regressions were employed to identify factors that have an association with health system responsiveness. Adjusted Odds Ratio with their corresponding 95% CI was used to declare factors associated with health system responsiveness. A p-value less than 0.05 was used to declare statistical significance in this study. Results: The overall health system responsiveness was 66.2% (95% CI: 61.4% - 70.7%). Confidentiality and dignity domains were the highest responsiveness score. Health system responsiveness was higher among satisfied outpatients (AOR: 9.9, 95% CI: 5.11-19.46), utilized private clinics (AOR: 8.8, 95% CI: 4.32-18.25), and no transport cost (AOR: 1.7, 95% CI: 1.03-2.92) in the study setting. Conclusion: Overall health system responsiveness was higher as compared to other case-specific study in Ethiopia. The domains of Autonomy, Waiting time, Basic amenities, and Choice were identified as vital areas needing the effort to raise responsiveness of health care service in the District. HSR was higher in private than public healthcare facilities, among satisfied clients and those who didn’t pay for transport on their way to the health facility than their counterparts. Thus, enhancing patient satisfaction, using input from service users, Collaboration, and experience exchange between public and private facilities will be important interventions to improve HSR.

Assessment of COVID-19 Related Misinformation among the Community in Basrah, Iraq

2020 ◽  
Vol 2 (CSI) ◽  
pp. 12-18
Author(s):  
Ali Al-Rubaye ◽  
Dhurgham Abdulwahid ◽  
Aymen Albadran ◽  
Abbas Ejbary ◽  
Laith Alrubaiy
Keyword(s):  
Cross Sectional Study ◽  
Bachelor's Degree ◽  
Public Knowledge ◽  
Age Group ◽  
Cross Sectional ◽  
Educational Levels ◽  
The Public ◽  
First Case ◽  
Significant Difference ◽  
Central District

Background: There has been a rapid rise in cases of COVID-19 infection and its mortality rate since the first case reported in February 2020. This led to the rampant dissemination of misinformation and rumors about the disease among the public. Objectives: To investigate the scale of public misinformation about COVID-19 in Basrah, Iraq. Methods: A cross-sectional study based on a 22-item questionnaire to assess public knowledge and understanding of information related to the COVID-19 infection. Results: A total of 483 individuals completed the questionnaire. The most frequent age group was 26–35 years (28.2%); there were 280 (58%) males and 203 (42%) females. Of the participants, 282 (58.4%) were with an education level below the Bachelor’s degree, 342 (70.8%) were married, and 311 (64%) were living in districts in Basra other than the central district. Overall, 50.8% (11.8/ 22 * 100%) of individuals had the correct information regarding COVID-19. There was a significant association between the level of COVID-19 related misinformation and participants’ educational levels and occupation (p <0.05). However, there was no significant difference found across sex, age group, marital state, and area of residence. Conclusions: Misinformation related to COVID-19 is widely spread and has to be addressed in order to control the pandemic. Keywords: COVID-19, misinformation, knowledge, Iraq

scholarly journals Health system responsiveness: a systematic evidence mapping review of the global literature

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Gadija Khan ◽  
Nancy Kagwanja ◽  
Eleanor Whyle ◽  
Lucy Gilson ◽  
Sassy Molyneux ◽  
...  
Keyword(s):  
Health System ◽  
Grey Literature ◽  
Feedback Loops ◽  
Theoretical Development ◽  
World Health ◽  
Evidence Map ◽  
Evidence Mapping ◽  
Mapping Review ◽  
System Responsiveness ◽  
Health System Responsiveness

Abstract Background The World Health Organisation framed responsiveness, fair financing and equity as intrinsic goals of health systems. However, of the three, responsiveness received significantly less attention. Responsiveness is essential to strengthen systems’ functioning; provide equitable and accountable services; and to protect the rights of citizens. There is an urgency to make systems more responsive, but our understanding of responsiveness is limited. We therefore sought to map existing evidence on health system responsiveness. Methods A mixed method systemized evidence mapping review was conducted. We searched PubMed, EbscoHost, and Google Scholar. Published and grey literature; conceptual and empirical publications; published between 2000 and 2020 and English language texts were included. We screened titles and abstracts of 1119 publications and 870 full texts. Results Six hundred twenty-one publications were included in the review. Evidence mapping shows substantially more publications between 2011 and 2020 (n = 462/621) than earlier periods. Most of the publications were from Europe (n = 139), with more publications relating to High Income Countries (n = 241) than Low-to-Middle Income Countries (n = 217). Most were empirical studies (n = 424/621) utilized quantitative methodologies (n = 232), while qualitative (n = 127) and mixed methods (n = 63) were more rare. Thematic analysis revealed eight primary conceptualizations of ‘health system responsiveness’, which can be fitted into three dominant categorizations: 1) unidirectional user-service interface; 2) responsiveness as feedback loops between users and the health system; and 3) responsiveness as accountability between public and the system. Conclusions This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work. Further agenda-setting and resourcing of bridging work on health system responsiveness is suggested.

scholarly journals Retrospective study of the distribution of doctors in municipalities of extreme poverty in Brazil

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
B L O Luizeti ◽  
E M M Massuda ◽  
L F G Garcia
Keyword(s):  
Public Health ◽  
Health System ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Extreme Poverty ◽  
The Public ◽  
The North ◽  
Unified Health System ◽  
Shortage Of Doctors ◽  
Demographic Distribution

Abstract In view of the national scenario of scarcity of material and human resources in public health in Brazil, the survey verified the demographics of doctors who attend the Unified Health System (SUS) in municipalities of extreme poverty. An observational, analytical and cross-sectional study was carried out, based on secondary quantitative data from the Department of Informatics of the SUS using the TABNET of December 2019. The care networks variable was restricted to infer the number of physicians who attend the SUS in extreme poverty municipalities in Brazil. Municipalities of extreme poverty are those that at least 20% of the population have a household income of up to 145 reais per capita monthly. In Brazil, there are 1526 municipalities in extreme poverty, 27.4% of the country's total municipalities. 14,907 doctors linked to SUS work in this condition, 3.19% of the total of these professionals in Brazil. There is still disproportion between regions: North concentrates 11.2% of the municipalities in extreme poverty and 8.61% of the total number of doctors; Northeast, with 61.33% of these municipalities, for 61.5% of doctors; Southeast, with 15.46% of the municipalities in this condition, has 20.6% of doctors; South concentrates 10.87% of the municipalities under discussion with 5.61% of doctors and the Midwest, with 4.87% of these municipalities, has 3.54% of doctors. Between 2009 and 2018, there was a 39% increase in the number of doctors in these locations, however, for 2019, there was a decrease of 3.89%. The medical demographic distribution in Brazil is uneven, especially in the North. There is also the vulnerability of this population in view of the observed reduction in the number of professionals between 2018 and 2019 in municipalities of extreme poverty, for political reasons. It is evident the need to restructure the health system to guarantee access to health for this population, through the attraction and fixation of doctors in needy regions in Brazil. Key messages Shortage of doctors in extreme poverty municipalities reinforces the health vulnerability of the population in Brazil. The uneven medical demography in Brazil requires restructuring in the public health system.

scholarly journals Evaluation of e-health (Seha) application: a cross-sectional study in Saudi Arabia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abeer Alharbi ◽  
Joharah Alzuwaed ◽  
Hind Qasem
Keyword(s):  
Saudi Arabia ◽  
Health Services ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Advanced Technology ◽  
Sectional Study ◽  
Cross Sectional ◽  
Technical Problems ◽  
Significant Difference ◽  
Ease Of Access

Abstract Background The Ministry of Health in Saudi Arabia is expanding the country’s telemedicine services by using advanced technology in health services. In doing so, an e-health application (app), Seha, was introduced in 2018 that allows individuals to have face-to-face visual medical consultations with their doctors on their smartphones. Objective This study evaluated the effectiveness of the app in improving healthcare delivery by ensuring patient satisfaction with the care given, increasing access to care, and improving efficiency in the healthcare system. Methods A cross-sectional study design was used to assess the perceptions of users of the Seha app and non-users who continued with traditional health services. The data were collected using an online survey via Google Forms between June 2020 and September 2020. Independent t tests and chi-square (χ2) tests were conducted to answer the research questions. Results There was a significant difference between users and non-users in terms of ease of access to health services (t =  − 9.38, p < 0.05), with app users having a higher mean score (4.19 ± 0.91) than non-users (3.41 ± 1.00); satisfaction with health services (t =  − 6.33, p < 0.05), with users having a higher mean score (3.96 ± 0.91) than non-users (3.45 ± 0.94); and efficiency (only one visit needed for treatment) (t =  − 3.20, p < 0.05), with users having a higher mean score (3.71 ± 0.93) than non-users (3.45 ± 0.93). There were significant associations between the use of the Seha app and age (χ2 = 8.79, p < 0.05), gender (χ2 = 22.19, p < 0.05), region (χ2 = 19.74, p < 0.05), and occupation (χ2 = 22.05, p < 0.05). There were significant relationships between the three items (on access, satisfaction, and efficiency) and experiencing technical issues (t = 4.47, t = 8.11, and t = 3.24, respectively, p < 0.05), with users who faced technical problems having significantly lower mean scores for all three items. Conclusion This study provided evidence that the Seha app improved the delivery of healthcare in Saudi Arabia. Users of the app had a better health experience in terms of their perceived ease of access to healthcare services; their satisfaction with healthcare services; and the efficiency of the system, measured by the number of required doctor visits. Other factors that appeared to influence the use of the app included age, gender, usual source of care, and technical difficulties.

Evaluation of health system in Iraq from people's point of view: a comparative study of two different eras

2021 ◽  
Vol 4 (2) ◽  
pp. 380-387
Author(s):  
Saad Ahmed Ali Jadoo ◽  
Adil H. Alhusseiny ◽  
Shukr Mahmood Yaseen ◽  
Mustafa Ali Mustafa Al-Samarrai ◽  
Anmar Shukur Mahmood
Keyword(s):  
Health System ◽  
Health Sector ◽  
Health Resources ◽  
Sampling Technique ◽  
Point Of View ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Current Health ◽  
Multi Stage ◽  
Geographical Regions

Background: Since the 2003 United States–British Coalition military invasion, Iraq has been in a state of continuous deterioration at all levels, including the health sector. This study aimed to elicit the viewpoints of the Iraqi people on the current health system, focusing on many provided health services and assessing whether the public prefers the current health system or that was provided before the invasion. Methods: A cross-sectional survey designed to explore the Iraqi people’s opinions on their health system. A self-administered questionnaire using a multi-stage sampling technique was distributed in five geographical regions in Iraq to collect the data from the head of household between 1st October and 31st of December 2019. Multiple logistic regressions were recruited to determine the significant contributing variables in this study. Results: A total of 365 heads of households (response rate: 71.7%) with the mean age of 48.36 + 11.92 years (ranged 35-78) included in the study. Most of the respondents (61.4%) complained of healthcare inaccessibility, 59.7% believed that health resources were not available, 53.7% claimed a deterioration in the quality of care, and 62.2% believed that the political / media position did not contribute to positive changes during the past two decades. Indeed, most respondents (66.0%) believe that the current healthcare system is worse than before. In the multivariate analysis, there was a statistically significant relationship between the characteristics and opinions of the respondents. Young age group (p = 0.003), men (p = < 0.001), unmarried (p = 0.001), high educated (p = < 0.001), rural resident (p = < 0.001), unemployed (p = 0.003), monthly income of less than USD 400 (p = < 0.001), consider themselves to be unhealthy (p = 0.001),  and those who think that people are unhappy now than two decades ago (p = 0.012) have a more negative opinion of the health system. Conclusions: Most Iraqis surveyed expressed disappointment from the health system after the 2003 US-led invasion. The current health system is faltering at all levels and does not meet the citizens' basic needs. Health Transformation Program (HTP) has become inevitable to develop an accessible, affordable, high-quality, efficient, and effective health system.

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