scholarly journals Predictors of patients’ choice of hospitals under universal health coverage: a case study of the Nicaraguan capital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ida G. Monfared ◽  
Jonathan Garcia ◽  
Sebastian Vollmer
Keyword(s):  
Low Income ◽  
Healthcare Providers ◽  
Multinomial Logit Model ◽  
Healthcare Facility ◽  
Quality Of Healthcare ◽  
Public Hospitals ◽  
Relative Risk Ratio ◽  
Health Coverage ◽  
Quality Healthcare ◽  
Clear Cut

Abstract Background This study looks at the factors that can shape patients’ choice of healthcare providers. Understanding this process can help with making high quality healthcare more accessible for all. We focus on distance, patient’s health status, (perceived) quality of healthcare facility, and referrals to investigate how these factors compete in shaping patients’ choice of hospitals. Methods This study was carried out in Managua, the capital of Nicaragua. Utilizing an exit-survey, patients were interviewed across five public hospitals in 2017 and then six in 2019 when a new highly-equipped hospital was added to the system. We used a multinomial logit model to investigate patients’ preference of a specific hospital over the rest within each wave. Results Our results show that being referred to a hospital is the strongest predictor and in some cases, it can increase the relative risk ratio of choosing a facility by a factor of 49 (p < 0.01; 95% CI: 27.39–87.17). For the remaining factors, the hierarchy of importance was less clear-cut yet all these factors remained significantly important at various levels. Conclusions Overall, our results highlight the importance of referral systems in making quality healthcare more equitable. Moreover, with distance also being a key predictor and in the absence of an organized referral system, those with low-income would either be further deprived by having to settle with locally available healthcare (regardless of its quality) or face high amounts of out-of-pocket expenditure when seeking help from the private sector.

IMPROVING THE SERVICE QUALITY OF HEALTHCARE IN GHANA: The Role of Locum Nursing

2013 ◽  
Vol 03 (12) ◽  
pp. 01-14
Author(s):  
Keelson, Solomon A. ◽  
Ann Dodor
Keyword(s):  
Service Quality ◽  
Healthcare Delivery ◽  
Sampling Technique ◽  
Research Problem ◽  
Quality Of Healthcare ◽  
Public Hospitals ◽  
Nurse Shortage ◽  
Quality Healthcare ◽  
Hospital Administrators

The study was purposed to consider how encouraging use of locum nursing could aid in managing nurse shortage in the country and consequently improve the service quality of healthcare in Ghana. To be able to address the research problem and achieve the objectives, thirty public hospitals and thirty private hospitals were selected from the three major cities in Ghana to provide data for the study. Also, 250 locum nurses were sampled for information. Nursing Supervisors or Hospital Administrators from the selected hospitals were use as informant for the study. The paper adopted a survey approach, where incidental sampling technique was used to select the hospitals, and the snowball together with incidental sampling methods were used for selecting locum nurses for the study. Mean and standard deviation were the data analysis method used. The findings confirmed that locum practice in Ghana is relatively low. Similarly, the paper also suggested that locum contribute to addressing the issue of nurse shortage in Ghana. At the same time locum nursing was found to contribute to quality healthcare delivery in the country. Appropriate policy directions were recommended.

scholarly journals Factors necessary for effective corporate waqf management for Malaysian public healthcare

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Raja Aishah binti Raja Adnan ◽  
Mahazan Abdul Mutalib ◽  
Muhammad Ridhwan Ab Aziz
Keyword(s):  
Government Expenditure ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Profit Sharing ◽  
Public Hospitals ◽  
Public Healthcare ◽  
Content Type ◽  
Quality Healthcare ◽  
Partnership Model ◽  
Healthcare Model

PurposeThis research paper aims to determine the factors needed to propose a platform where waqf (Islamic endowment) organizations can collaborate with government public hospitals to develop corporate waqf hospitals. Consequently, the elements of governance and sustainability are included in the management of corporate waqf hospitals thereby leading to the corporatization of public hospitals.Design/methodology/approachThis study adopts the qualitative research methodology and undertakes content analysis of data collected from journal articles, magazines and official websites. Data analysis involves open coding with NVivo 12.FindingsGeneral findings from the literature review have shown that architectural and engineering fundamentals were essential factors in the success of past waqf hospitals of the era between 8th and 14th centuries. In that era, the decentralized waqf-based hospitals employed the mutawalli (the trustee/manager of the waqf assets) to govern the administration of the hospitals. Present corporate waqf hospitals can exploit the elements identified from past waqf-based hospitals and additionally adopt the private-public partnership model in the form of a muḍārabah (profit-sharing contract) agreement to design a sustainable waqf governance model for Malaysian public healthcare services.Research limitations/implicationsThe proposed platform is designed for a corporate waqf model developed in collaboration between Malaysian waqf institutions and public healthcare services. It abides by both the Malaysian fatwa (Islamic rulings) on waqf and the laws of the Malaysian Government.Practical implicationsThere is potential for developing the Malaysian corporate waqf-governance healthcare model which will enable the hospital to provide better quality healthcare to more patients through upgrading the quality of equipment used in hospitals and/or better facilities at equal or lower costs. Consequently, this will not only improve waqf management and distribution but also result in reduction of government expenditure.Social implicationsThis research promotes the concept of a corporate waqf hospital which will provide innumerable beneficial healthcare services in terms of improved healthcare quality at affordable costs to the general public and at no cost to the poor and the underprivileged.Originality/valueAlthough waqf has played an important role as a vehicle for Islamic financing in the society for centuries, a model of collaboration or partnership of waqf with public healthcare services has yet to be explored and developed. With proper corporate governance and well-managed sustainability in a corporate waqf model, this newly developed partnership between waqf institutions and public healthcare providers can be a first step in many more interesting collaborative arrangements that can be established between waqf institutions and public services in the future.

scholarly journals Diabetes registry and service in Nigerian suburban areas: experience at a secondary healthcare facility

2019 ◽  
Vol 7 (1) ◽  
pp. 189
Author(s):  
Chinedu O. Obodo ◽  
Eunice O. Igumbor ◽  
Otovwe Agofure ◽  
Fortunatus D. Gbeinbo ◽  
Henzy Ocheli ◽  
...  
Keyword(s):  
Medical Records ◽  
Healthcare Facility ◽  
Public Hospitals ◽  
Initial Development ◽  
Quality Healthcare ◽  
Diabetes Registry ◽  
Disease Epidemiology ◽  
Community Needs ◽  
Professional Development Training ◽  
Data Documentation

Background: Disease registries help to provide quality healthcare, including chronic care. As part of ongoing bringing research in diabetes to global environments and systems 2 project in Delta State, Nigeria; a preliminary concern is completeness of clinical assessments and data collection that would enable patients’ follow-up. The aim of this piece of work is to investigate if data collected for local diabetes registry is complete and sufficient to provide better understanding of the disease epidemiology and treatment follow-up.Methods: This was a purposive medical records audit at public secondary level hospital that followed initial development of diabetes register at the Catholic Hospital, Abbi with 44 pieces of clinical and demographic information. At the public hospitals, 93 patients’ medical records were audited and the data were entered into the register and evaluated, descriptively.Results: The results show that about 52% of the 44 itemized information were collected, of which completeness of data/documentation was as low as 3% in some items. Blood pressure assessment was done on 70% of patients and 16% of patients had diabetes complications. Lifestyle regimen monitoring was not documented. Neither incidence nor morbidity and mortality rate could be definitively ascertained.Conclusions: Quality of clinical data documentation was poor. This study contributes a measure of community needs assessment for professional development training on diabetes.

scholarly journals Perceptions of Good-Quality Antenatal Care and Birthing Services among Postpartum Women in Nepal

2021 ◽  
Vol 18 (13) ◽  
pp. 6876
Author(s):  
Sushma Rajbanshi ◽  
Mohd Noor Norhayati ◽  
Nik Hussain Nik Hazlina
Keyword(s):  
Quality Of Care ◽  
Low Socioeconomic Status ◽  
Healthcare Providers ◽  
Healthcare Facility ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Interpersonal Behavior ◽  
Postpartum Women ◽  
Health Seeking

Patient complaints and dissatisfaction should be taken seriously and used as an opportunity to provide acceptable services. Mounting evidence shows that the perception of the quality of healthcare services impacts health-seeking behaviors. This study explores the perceptions of good-quality antenatal and birthing services among postpartum women. A qualitative study using phenomenological inquiry was conducted in the Morang district, Nepal. The study participants were postpartum women with at least one high-risk factor who refused the referral hospital’s birth advice. A total of 14 women were purposively selected and interviewed in-depth. NVivo 12 Plus software was used for systematic coding, and thematic analysis was performed manually. Three themes emerged: (i) women’s opinions and satisfactory factors of health services, (ii) expectations of the health facility and staff, and (iii) a lack of suggestions to improve the quality of care. Women did not have many expectations from the healthcare facility or the healthcare providers and could not express what good quality of care meant for them. Women from low socioeconomic status and marginalized ethnicities lack knowledge of their basic reproductive rights. These women judge the quality of care in terms of staff interpersonal behavior and personal experiences. Women will not demand quality services if they lack an understanding of their basic health rights.

scholarly journals From the Editor's desk

2016 ◽  
Vol 209 (1) ◽  
pp. 92-92
Author(s):  
Kamaldeep Bhui
Keyword(s):  
Low Income ◽  
Chronic Illnesses ◽  
Low Income Countries ◽  
Health Coverage ◽  
Public And Private ◽  
Quality Healthcare ◽  
Article Type ◽  
Comprehensive Health ◽  
The Uk ◽  
Lower Income Countries

Trials, tribulations, mind and mechanism Cost and innovationUK investment in health (public and private) is falling, from 8% in 2009, to 6.6% by 2021.1 Current expectations of the NHS, to provide comprehensive, modernised, and scientifically founded care have risen alongside greater needs of a growing population living with chronic illnesses. In fact, global efforts to improve health are challenged by similar issues, and most people around the globe are neither seeing nor do they expect comprehensive health coverage. Many countries still do not have appropriate policy and legislation. The current strains on health provision in the UK and other higher-income countries demand actions that perhaps would only have been previously been considered for lower-income countries where, by comparison, there is grossly insufficient investment (see editorial by Sashidharan et al, pp. ); so task shifting and community development innovations from low-income countries are proposed as alternatives to high-quality healthcare in high-income countries. The job of government has become to contain and offset costs to the state by seeking a range of alternative providers, and by driving down the costs of existing provision.

Knowledge and Communication of the National Core Standards Tool

2018 ◽  
Vol 20 (2) ◽  
Author(s):  
Winnie Thembisile Maphumulo ◽  
Busisiwe Bhengu
Keyword(s):  
Pearson Correlation ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Sampling Technique ◽  
Quality Of Healthcare ◽  
Survey Study ◽  
Public Healthcare ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Professional Nurses

The National Department of Health in South Africa has introduced the National Core Standards (NCS) tool to improve the quality of healthcare delivery in all public healthcare institutions. Knowledge of the NCS tool is essential among healthcare providers. This study investigated the level of knowledge on NCS and how the NCS tool was communicated among professional nurses. This was a cross-sectional survey study. Purposive sampling technique was used to select hospitals that only offered tertiary services in KwaZulu-Natal. Six strata of departments were selected using simple stratified sampling. The population of professional nurses in the selected hospitals was 3 050. Systematic random sampling was used to recruit 543 participants. The collected data were analysed using SPSS version 25. The study showed that only 16 (3.7%) respondents had knowledge about NCS, using McDonald’s standard of learning outcome measured criteria regarding the NCS tool. The Pearson correlation coefficient between the communication and knowledge was r = 0.055. The results revealed that although the communication scores for the respondents were high their knowledge scores remained low. This study concluded that there is a lack of knowledge regarding the NCS tool and therefore healthcare institutions need to commit themselves to the training of professional nurses regarding the NCS tool. The findings suggest that healthcare institutions implement the allocation of incentives for nurses that attend the workshops for NCS.

scholarly journals Experiences and impact of international medical volunteering: a multi-country mixed methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041599 ◽  
Author(s):  
Mary McCauley ◽  
Joanna Raven ◽  
Nynke van den Broek
Keyword(s):  
Low Income ◽  
Online Survey ◽  
Positive Impact ◽  
Healthcare Providers ◽  
International Medical ◽  
Middle Income ◽  
Use Of Resources ◽  
The Uk ◽  
Medical Volunteers ◽  
The Impact

ObjectiveTo assess the experience and impact of medical volunteers who facilitated training workshops for healthcare providers in maternal and newborn emergency care in 13 countries.SettingsBangladesh, Ghana, India, Kenya, Malawi, Namibia, Nigeria, Pakistan, Sierra Leone, South Africa, Tanzania, UK and Zimbabwe.ParticipantsMedical volunteers from the UK (n=162) and from low-income and middle-income countries (LMIC) (n=138).Outcome measuresExpectations, experience, views, personal and professional impact of the experience of volunteering on medical volunteers based in the UK and in LMIC.ResultsUK-based medical volunteers (n=38) were interviewed using focus group discussions (n=12) and key informant interviews (n=26). 262 volunteers (UK-based n=124 (47.3%), and LMIC-based n=138 (52.7%)) responded to the online survey (62% response rate), covering 506 volunteering episodes. UK-based medical volunteers were motivated by altruism, and perceived volunteering as a valuable opportunity to develop their skills in leadership, teaching and communication, skills reported to be transferable to their home workplace. Medical volunteers based in the UK and in LMIC (n=244) reported increased confidence (98%, n=239); improved teamwork (95%, n=232); strengthened leadership skills (90%, n=220); and reported that volunteering had a positive impact for the host country (96%, n=234) and healthcare providers trained (99%, n=241); formed sustainable partnerships (97%, n=237); promoted multidisciplinary team working (98%, n=239); and was a good use of resources (98%, n=239). Medical volunteers based in LMIC reported higher satisfaction scores than those from the UK with regards to impact on personal and professional development.ConclusionHealthcare providers from the UK and LMIC are highly motivated to volunteer to increase local healthcare providers’ knowledge and skills in low-resource settings. Further research is necessary to understand the experiences of local partners and communities regarding how the impact of international medical volunteering can be mutually beneficial and sustainable with measurable outcomes.

scholarly journals Improving Tanzanian childbirth service quality

2018 ◽  
Vol 31 (3) ◽  
pp. 190-202 ◽  
Author(s):  
Jennie Jaribu ◽  
Suzanne Penfold ◽  
Cathy Green ◽  
Fatuma Manzi ◽  
Joanna Schellenberg
Keyword(s):  
Health Facility ◽  
Low Income ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Rural District ◽  
Local Data ◽  
Content Type ◽  
Primary Health ◽  
Primary Health Facilities ◽  
Childbirth Care

Purpose The purpose of this paper is to describe a quality improvement (QI) intervention in primary health facilities providing childbirth care in rural Southern Tanzania. Design/methodology/approach A QI collaborative model involving district managers and health facility staff was piloted for 6 months in 4 health facilities in Mtwara Rural district and implemented for 18 months in 23 primary health facilities in Ruangwa district. The model brings together healthcare providers from different health facilities in interactive workshops by: applying QI methods to generate and test change ideas in their own facilities; using local data to monitor improvement and decision making; and health facility supervision visits by project and district mentors. The topics for improving childbirth were deliveries and partographs. Findings Median monthly deliveries increased in 4 months from 38 (IQR 37-40) to 65 (IQR 53-71) in Mtwara Rural district, and in 17 months in Ruangwa district from 110 (IQR 103-125) to 161 (IQR 148-174). In Ruangwa health facilities, the women for whom partographs were used to monitor labour progress increased from 10 to 57 per cent in 17 months. Research limitations/implications The time for QI innovation, testing and implementation phases was limited, and the study only looked at trends. The outcomes were limited to process rather than health outcome measures. Originality/value Healthcare providers became confident in the QI method through engagement, generating and testing their own change ideas, and observing improvements. The findings suggest that implementing a QI initiative is feasible in rural, low-income settings.

scholarly journals Evaluating medical education regulation changes in Brazil: workforce impact

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Alexandre Medeiros Figueiredo ◽  
Danette Waller McKinley ◽  
Adriano Massuda ◽  
George Dantas Azevedo
Keyword(s):  
Medical Education ◽  
Public Schools ◽  
Low Income ◽  
School Enrollment ◽  
Health Coverage ◽  
Continuous Assessment ◽  
Middle Income ◽  
Unified Health System ◽  
Medical Undergraduate ◽  
The Impact

Abstract Background Shortages and inequitable distribution of physicians is an obstacle to move towards Universal Health Coverage, especially in low-income and middle-income countries. In Brazil, expansion of medical school enrollment, curricula changes and recruitment programs were established to increase the number of physicians in underserved areas. This study seeks to analyze the impact of these measures in reduce inequities in access to medical education and physicians’ distribution. Methods This is an observational study that analyzes changes in the number of undergraduate medical places and number of physicians per inhabitants in different areas in Brazil between the years 2010 and 2018. Data regarding the number of undergraduate medical places, number and the practice location of physicians were obtained in public databases. Municipalities with less than 20,000 inhabitants were considered underserved areas. Data regarding access to antenatal visits were analyzed as a proxy for impact in access to healthcare. Results From 2010 to 2018, 19,519 new medical undergraduate places were created which represents an increase of 120.2%. The increase in the number of physicians engaged in the workforce throughout the period was 113,702 physicians, 74,771 of these physicians in the Unified Health System. The greatest increase in the physicians per 1000 inhabitants ratio in the municipalities with the smallest population, the lowest Gross Domestic Product per capita and in those located in the states with the lowest concentration of physicians occurred in the 2013–2015 period. Increase in physician supply improved access to antenatal care. Conclusions There was an expansion in the number of undergraduate medical places and medical workforce in all groups of municipalities assessed in Brazil. Medical undergraduate places expansion in the federal public schools was more efficient to reduce regional inequities in access to medical education than private sector expansion. The recruitment component of More Doctors for Brazil Program demonstrated effectiveness to increase the number of physicians in underserved areas. Our results indicate the importance of public policies to face inequities in access to medical education and physician shortages and the necessity of continuous assessment during the period of implementation, especially in the context of political and economic changes.

scholarly journals Exploring patient-provider interactions and the health system’s responsiveness to street-connected children and youth in Kenya: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Embleton Lonnie ◽  
Shah Pooja ◽  
Gayapersad Allison ◽  
Kiptui Reuben ◽  
Ayuku David ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Health System ◽  
Health Systems ◽  
Cultural Context ◽  
Healthcare Providers ◽  
Children And Youth ◽  
Economic Factors ◽  
Health Coverage ◽  
Socially Constructed ◽  
Prompt Attention

Abstract Background In Kenya, street-connected children and youth (SCY) have poor health outcomes and die prematurely due to preventable causes. This suggests they are not accessing or receiving adequately responsive healthcare to prevent morbidity and mortality. We sought to gain insight into the health systems responsiveness to SCY in Kenya through an in-depth exploration of SCY’s and healthcare provider’s reflections on their interactions with each other. Methods This qualitative study was conducted across 5 counties in western Kenya between May 2017 and September 2018 using multiple methods to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY in Kenya. The present analysis focuses on a subset of data from focus group discussions and in-depth interviews concerning the delivery of healthcare to SCY, interactions between SCY and providers, and SCY’s experiences in the health system. We conducted a thematic analysis situated in a conceptual framework for health systems responsiveness. Results Through three themes, context, negative patient-provider interactions, and positive patient-provider interactions, we identified factors that shape health systems responsiveness to SCY in Kenya. Economic factors influenced and limited SCY’s interactions with the health system and shaped their experiences of dignity, quality of basic amenities, choice of provider, and prompt attention. The stigmatization and discrimination of SCY, a sociological process shaped by the social-cultural context in Kenya, resulted in experiences of indignity and a lack of prompt attention when interacting with the health system. Patient-provider interactions were highly influenced by healthcare providers’ adverse personal emotions and attitudes towards SCY, resulting in negative interactions and a lack of health systems responsiveness. Conclusions This study suggests that the health system in Kenya is inadequately responsive to SCY. Increasing public health expenditures and expanding universal health coverage may begin to address economic factors, such as the inability to pay for care, which influence SCY’s experiences of choice of provider, prompt attention, and dignity. The deeply embedded adverse emotional responses expressed by providers about SCY, associated with the socially constructed stigmatization of this population, need to be addressed to improve patient-provider interactions.

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