Strengthening health system governance using health facility service charters: a mixed methods assessment of community experiences and perceptions in a district in Kenya

AbstractAdjudicative tribunals are an integral part of health system governance, yet their real-world impact remains largely unknown. Most assessments focus on internal accountability and use anecdotal methodologies; few, studies if any, empirically evaluate their external impact and use these data to test effectiveness, track performance, inform service improvements and ultimately strengthen health systems. Given that such assessments would yield important benefits and have been conducted successfully in similar settings (e.g. specialist courts), their absence is likely attributable to complexity in the health system, methodological difficulties and the legal environment within which tribunals operate. We suggest practical steps for potential evaluators to conduct empirical impact evaluations along with an evaluation matrix template featuring possible target outcomes and corresponding surrogate endpoints, performance indicators and empirical methodologies. Several system-level strategies for supporting such assessments have also been suggested for academics, health system institutions, health planners and research funders. Action is necessary to ensure that policymakers do not continue operating without evidence but can rather pursue data-driven strategies that are more likely to achieve their health system goals in a cost-effective way.

Download Full-text

HCFMUSP: Resilience in Response to the COVID-19 Pandemic

Revista de Administração Contemporânea ◽

10.1590/1982-7849rac2021200245.en ◽

2021 ◽

Vol 25 (spe) ◽

Author(s):

Marcelo Caldeira Pedroso ◽

João Teixeira Pires ◽

Ana Maria Malik ◽

Antonio José Rodrigues Pereira

Keyword(s):

Knowledge Management ◽

Health System ◽

Crisis Management ◽

System Capacity ◽

New Disease ◽

Healthcare Operations ◽

Teaching Case ◽

Health System Governance ◽

Emergency Actions ◽

The Impact

ABSTRACT The teaching case describes a set of emergency actions taken by HCFMUSP to manage the needs brought by the COVID-19 pandemic in Brazil. The case objective considers the issues related to the impact of the pandemic mostly in healthcare operations, emphasizing how to: (a) adapt health system governance in response to a crisis (crisis management); (b) manage the health system capacity, which traditionally is not so resilient; (c) deal with a new disease (knowledge management). Thus, it should allow gathering elements for the management of future crises.

Download Full-text

Community Perception of Health Services in South East Nigeria: A Reflection of Health System Governance in Nigeria

Governing Health Systems ◽

10.4324/9781315230320-21 ◽

2016 ◽

pp. 161-164

Keyword(s):

Health Services ◽

Health System ◽

Community Perception ◽

Health System Governance ◽

Perception Of Health

Download Full-text

Factors influencing diagnosis and treatment initiation for multidrug-resistant/rifampicin-resistant tuberculosis in six sub-Saharan African countries: a mixed-methods systematic review

BMJ Global Health ◽

10.1136/bmjgh-2019-002280 ◽

2020 ◽

Vol 5 (7) ◽

pp. e002280 ◽

Cited By ~ 4

Author(s):

Charity Oga-Omenka ◽

Azhee Tseja-Akinrin ◽

Paulami Sen ◽

Muriel Mac-Seing ◽

Aderonke Agbaje ◽

...

Keyword(s):

Mixed Methods ◽

Health System ◽

Barriers And Facilitators ◽

Diagnosis And Treatment ◽

Drug Resistant ◽

African Countries ◽

Drug Resistant Tuberculosis ◽

Patient Level ◽

Resistant Tuberculosis ◽

Sub Saharan

BackgroundDrug-resistant tuberculosis burdens fragile health systems in sub-Saharan Africa (SSA), complicated by high prevalence of HIV. Several African countries reported large gaps between estimated incidence and diagnosed or treated cases. Our review aimed to identify barriers and facilitators influencing diagnosis and treatment for drug-resistant tuberculosis (DR-TB) in SSA, which is necessary to develop effective strategies to find the missing incident cases and improve quality of care.MethodsUsing an integrative design, we reviewed and narratively synthesised qualitative, quantitative and mixed-methods studies from nine electronic databases: Medline, Global Health, CINAHL, EMBASE, Scopus, Web of Science, International Journal of Tuberculosis and Lung Disease, PubMed and Google Scholar (January 2006 to June 2019).ResultsOf 3181 original studies identified, 55 full texts were screened, and 29 retained. The studies included were from 6 countries, mostly South Africa. Barriers and facilitators to DR-TB care were identified at the health system and patient levels. Predominant health system barriers were laboratory operational issues, provider knowledge and attitudes and information management. Facilitators included GeneXpert MTB/RIF (Xpert) diagnosis and decentralisation of services. At the patient level, predominant barriers were patients being lost to follow-up or dying due to lengthy diagnostic and treatment delays, negative public sector care perceptions, family, work or school commitments and using private sector care. Some patient-level facilitators were HIV positivity and having more symptoms.ConclusionCase detection and treatment for DR -TB in SSA currently relies on individual patients presenting voluntarily to the hospital for care. Specific interventions targeting identified barriers may improve rates and timeliness of detection and treatment.

Download Full-text

Treatment supporters and level of health facility influence completion of sputum smear monitoring among tuberculosis patients in rural Uganda: A mixed-methods study

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2019.12.003 ◽

2020 ◽

Vol 91 ◽

pp. 149-155 ◽

Cited By ~ 2

Author(s):

Jonathan Izudi ◽

Imelda K. Tamwesigire ◽

Francis Bajunirwe

Keyword(s):

Mixed Methods ◽

Health Facility ◽

Mixed Methods Study ◽

Sputum Smear ◽

Tuberculosis Patients

Download Full-text

Assessment of care provision for hypertension at the emergency Department of an Urban Hospital in Mozambique

BMC Health Services Research ◽

10.1186/s12913-019-4820-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Neusa BAY ◽

Edna JUGA ◽

Carlos MACUACUA ◽

José JOÃO ◽

Maria COSTA ◽

...

Keyword(s):

Emergency Department ◽

Risk Stratification ◽

Health System ◽

Health Facility ◽

Essential Medicines ◽

World Health ◽

Diagnostic Tools ◽

Clinical Protocols ◽

Double Burden ◽

Related Factors

Abstract Background Management of hypertension in Mozambique is poor, and rates of control are amongst the lowest in the world. Health system related factors contribute at least partially to this situation, particularly in settings where there is scarcity of resources to address the double burden of infectious and non-communicable diseases. This study aimed to assess the management of hypertension in an emergency department (ED). Methods During a pragmatic and prospective 30-day snapshot study (with 24 h surveillance) and random profiling of one-in-five presentations to the ED of Hospital Geral de Mavalane, Maputo, we assessed patient’s flow and care, as well as health facility’s infrastructure and resources through direct observation. Reports from pharmacy and laboratory stocks were used to assess availability of diagnostics and medicines needed for hypertension management. Results The 1911 hypertensive patients included in the study had several stops during their journey inside the health facility and followed a non-standardized care flow. No clinical protocols or algorithms for risk stratification of hypertension were available. Stock-outs of basic diagnostic tools for risk stratification and medicines were registered. The availability of medicines was 28% on average. Conclusions Critical gaps in health facility readiness to address arterial hypertension seen in ED were uncovered, including lack of clinical protocols, insufficient availability of diagnostics and essential medicines, as well as low affordability of the families to guaranty continuum of care. Innovative financing mechanisms are needed to support the health system to address hypertension.

Download Full-text