scholarly journals Private health care market shaping and changes in inequities in childhood diarrhoea treatment coverage: evidence from the analysis of baseline and endline surveys of an ORS and zinc scale-up program in Nigeria

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tiwadayo Braimoh ◽  
Isaac Danat ◽  
Mohammed Abubakar ◽  
Obinna Ajeroh ◽  
Melinda Stanley ◽  
...  
Keyword(s):  
Health Care ◽  
Scale Up ◽  
Principal Component ◽  
Oral Rehydration Salt ◽  
Health Coverage ◽  
Health Care Market ◽  
Survey Period ◽  
Policy Objective ◽  
Oral Rehydration ◽  
Concentration Indices

Abstract Background Nearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. In this study, we examine changes in the inequities of coverage of ORS and zinc over the intervention period. Methods Baseline and endline household surveys were used to measure ORS and zinc coverage and household assets. Principal component analysis was used to construct wealth quintiles. We used multi-level logistic regression models to estimate predictive coverage of ORS and zinc by wealth and urbanicity at each survey period. Simple measures of disparity and concentration indices and curves were used to evaluate changes in ORS and zinc coverage inequities. Results At baseline, 28% (95% CI: 22–35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52–58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P <  0.001) for the poorest and 17%-points (P <  0.001) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration indices declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35–41%) compared to 29% (95%CI, 25–33%) in the urban. Conclusion The results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.

scholarly journals Private Health Care Market Shaping and Equity in Childhood Diarrhea Treatment: Evidence From Data Analysis of an ORS and Zinc Scale-up Program in Eight States Across Nigeria 

2020 ◽  
Author(s):  
Tiwadayo Braimoh ◽  
Isaac Danat ◽  
Mohammed Abubakar ◽  
Obinna Ajeroh ◽  
Melinda Stanley ◽  
...  
Keyword(s):  
Health Care ◽  
Scale Up ◽  
Geographical Location ◽  
Pairwise Comparison ◽  
Oral Rehydration Salt ◽  
Health Coverage ◽  
Health Care Market ◽  
Cross Sectional ◽  
Policy Objective ◽  
Oral Rehydration

Abstract Background: Nearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. However, it has been argued that initiatives that engage the private sector may worsen inequities due to their profit motive.Methods: Changes in disparities in the coverage of ORS and zinc treatments by socioeconomic strata and geographical location were assessed using data from cross-sectional baseline and endline surveys.Results: At baseline, 28% (95% CI: 22 - 35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52 - 58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P = 0.000) for the poorest and 17%-points (P = 0.000) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration index declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35 - 41%) compared to 29% (95%CI: 25 - 33%) in the urban.Conclusion: The results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.

scholarly journals Utilization of AYUSH in public health care system: a review

2019 ◽  
Vol 6 (6) ◽  
pp. 2730 ◽  
Author(s):  
Chithra Boovaragasamy ◽  
Seetharaman Narayanan
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Health Care Services ◽  
Scale Up ◽  
Public Health Care ◽  
Health Coverage ◽  
Medical Subject Headings ◽  
Care Services ◽  
Mesh Terms ◽  
The Government

India is currently facing shortage of trained health workforce, especially in rural areas. WHO recommends mainstreaming of Complementary & Traditional systems of medicine as an affordable & culturally acceptable way towards achieving Universal Health Coverage (UHC). Despite the Government of India operating AYUSH clinics in PHCs for more than 10 years, we know very little about patients attending these clinics. Exploring the reasons for utilization of AYUSH care is of much value for planning to scale up the integration of AYUSH. The required information on utilization of AYUSH services were obtained through a review of the literature in PubMed databases (including MEDLINE) using the medical subject headings (MeSH) terms: ‘AYUSH’, ‘utilization’, ‘Ayurveda’, ‘Siddha’, ‘Homeopathy’, ‘morbidities’. All such studies which have focussed on profiling of patients who sought care in AYUSH were the individuals who have non–life-threatening chronic diseases or conditions. To improve AYUSH based health care services, it is imperative to understand the acceptability of AYUSH interventions among the general public for the utmost utilization of AYUSH services.

scholarly journals Zinc Supplementation and Recurrent Diarrhea in Children in Primary Health Care

2020 ◽  
Vol 8 (1) ◽  
pp. 74
Author(s):  
Masta Hutasoit
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Zinc Supplementation ◽  
Healing Process ◽  
Oral Rehydration Salt ◽  
The Body ◽  
High Rate ◽  
Oral Rehydration ◽  
Primary Health ◽  
The Relationship

<div class="WordSection1"><p align="center"><strong>ABSTRACT</strong></p><p><strong> </strong></p><p>The high rate of infant morbidity and mortality due to diarrhea is still a focus on children's health. In addition to Oral Rehydration Salt (ORS), zinc is a supplement needed to treat diarrhea. As long as the child has diarrhea, the body will lose zinc, so that additional zinc is needed to accelerate the healing process of diarrhea. Zinc is an important micronutrient in the growth of children and is able to prevent diarrhea 2-3 months after diarrhea. The previous study showed that most mothers do not give zinc to diarrhea children (59.3 %), thus there are still many recurrent diarrhea in children. Objective of study to determine the relationship between zinc supplementation in children with diarrhea and the incidence of recurrent diarrhea at Kasihan Primary Health Care, Bantul. We used descriptive correlational with a retrospective approach. The number of respondents was 47 children under five years (0-59 months) with diarrhea who were taken to primary health care and received zinc therapy. The sampling technique was carried out by purposive sampling. Data collection was performed by filling out the questionnaire by visiting the respondent's house (home visit). The result of the contingency coefficient showed p= 0.013 (p &lt; 0.05) which means that there was a statistically significant relationship between zinc supplementation and the incidence of recurrent diarrhea. The closeness of the relationship between the two variables was indicated by the correlation coefficient value of 0.342 which was in a moderate relationship. There is a correlation between giving zinc supplementation to children with recurrent diarrhea in Primary Health Care</p><p> </p><p><strong><br /></strong></p></div>

Universal Health Coverage

2017 ◽  
Author(s):  
Joia S. Mukherjee
Keyword(s):  
Health Care ◽  
Universal Health Coverage ◽  
Poor Quality ◽  
Theory And Practice ◽  
Health Coverage ◽  
Quality Health Care ◽  
The Sustainable Development ◽  
Quality Health ◽  
The Right ◽  
Universal Health

This chapter explores the seminal topic of Universal Health Coverage (UHC), an objective within the Sustainable Development goals. It reviews the theory and definitions that shape the current conversation on UHC. The movement from selective primary health care to UHC demonstrates a global commitment to the progressive realization of the right to health. However, access to UHC is limited by barriers to care, inadequate provision of care, and poor-quality services. To deliver UHC, it is critical to align inputs in the health system with the burden of disease. Quality of care must also be improved. Steady, sufficient financing is needed to achieve the laudable goal of UHC.This chapter highlights some important steps taken by countries to expand access to quality health care. Finally, the chapter investigates the theory and practice behind a morbidity-based approach to strengthening health systems and achieving UHC.

scholarly journals 20.F. Workshop: Dental care – coverage and access across countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Oral Health ◽  
North America ◽  
Health Systems ◽  
Universal Health Coverage ◽  
Dental Care ◽  
Financial Protection ◽  
Health Coverage ◽  
Universal Health

Abstract Oral health is a central element of general health with significant impact in terms of pain, suffering, impairment of function and reduced quality of life. Although most oral disease can be prevented by health promotion strategies and routine access to primary oral health care, the GBD study 2017 estimated that oral diseases affect over 3.5 billion people worldwide (Watt et al, 2019). Given the importance of oral health and its potential contribution to achieving universal health coverage (UHC), it has received increased attention in public health debates in recent years. However, little is known about the large variations across countries in terms of service delivery, coverage and financing of oral health. There is a lack of international comparison and understanding of who delivers oral health services, how much is devoted to oral health care and who funds the costs for which type of treatment (Eaton et al., 2019). Yet, these aspects are central for understanding the scope for improvement regarding financial protection against costs of dental care and equal access to services in each country. This workshop aims to present the comparative research on dental care coverage in Europe, North America and Australia led by the European Observatory on Health Systems and Policies. Three presentations will look at dental care coverage using different methods and approaches. They will compare how well the population is covered for dental care especially within Europe and North America considering the health systems design and expenditure level on dental care, using the WHO coverage cube as analytical framework. The first presentation shows results of a cross-country Health Systems in Transition (HiT) review on dental care. It provides a comparative review and analysis of financing, coverage and access in 31 European countries, describing the main trends also in the provision of dental care. The second presentation compares dental care coverage in eight jurisdictions (Australia (New South Wales), Canada (Alberta), England, France, Germany, Italy, Sweden, and the United States) with a particular focus on older adults. The third presentation uses a vignette approach to map the extent of coverage of dental services offered by statutory systems (social insurance, compulsory insurance, NHS) in selected countries in Europe and North America. This workshop provides the opportunity of a focussed discussion on coverage of dental care, which is often neglected in the discussion on access to health services and universal health coverage. The objectives of the workshop are to discuss the oral health systems in an international comparative setting and to draw lessons on best practices and coverage design. The World Conference on Public Health is hence a good opportunity for this workshop that contributes to frame the discussion on oral health systems in a global perspective. Key messages There is large degree of variation in the extent to which the costs of dental care are covered by the statutory systems worldwide with implications for oral health outcomes and financial protection. There is a need for a more systematic collection of oral health indicators to make analysis of reliable and comparable oral health data possible.

scholarly journals Maintaining fair and efficient health care during the COVID-19 pandemic: Theoretical context and practical implications

2021 ◽  
Vol 24 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Charalampos Milionis ◽  
Maria Ntzigani ◽  
Stella Olga Milioni ◽  
Ioannis Ilias
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Systems ◽  
Human Life ◽  
Health Coverage ◽  
Maximum Benefit ◽  
Community Health Systems ◽  
Health Care Efficiency ◽  
Universal Health ◽  
Practical Implications

Coronavirus disease 2019 is a respiratory infection that has evolved to a pandemic with an enormous burden both on human life and health care. States throughout the world have pursued strategies to restrict the transmission of the virus in the community. Health systems have a crucial dual role as they are at the frontline of the fight against the pathogen and at the same time they must continue to offer emergency and routine health services. The provision of health care in the context of the COVID-19 pandemic finds certain barriers. The simultaneous protection of both universal health coverage and health care efficiency is a difficult task due to conflicting challenges of these two goals. Key actions need to be decided and implemented in the fields of health policy, operation of health services, and clinical interaction between health personnel and patients, so that health care continues to perform its mission in a sustainable manner. As the scientific community prepares for the widespread production and application of effective protective and therapeutic agents against COVID-19, it is vital for the general population to remain safe and for the health systems to survive. Allocation of resources and priority setting need to be applied fairly and efficiently for the achievement of the maximum benefit.

scholarly journals Implementing Cancer Care in Rwanda: Capacity Building for Treatment and Scale-Up

2021 ◽  
Vol 13 (13) ◽  
pp. 7216
Author(s):  
Paul H. Park ◽  
Cyprien Shyirambere ◽  
Fred Kateera ◽  
Neil Gupta ◽  
Christian Rusangwa ◽  
...  
Keyword(s):  
Capacity Building ◽  
Scale Up ◽  
Implementation Strategies ◽  
Sub Saharan Africa ◽  
Essential Medicines ◽  
Cancer Center ◽  
Health Coverage ◽  
Cancer Centers ◽  
Implementation Approach ◽  
Single Cancer

Background: The majority of countries in sub-Saharan Africa are ill-prepared to address the rising burden of cancer. While some have been able to establish a single cancer referral center, few have been able to scale-up services nationally towards universal health coverage. The literature lacks a step-wise implementation approach for resource-limited countries to move beyond a single-facility implementation strategy and implement a national cancer strategy to expand effective coverage. Methods: We applied an implementation science framework, which describes a four-phase approach: Exploration, Preparation, Implementation, and Sustainment (EPIS). Through this framework, we describe Rwanda’s approach to establish not just a single cancer center, but a national cancer program. Results: By applying EPIS to Rwanda’s implementation approach, we analyzed and identified the implementation strategies and factors, which informed processes of each phase to establish foundational cancer delivery components, including trained staff, diagnostic technology, essential medicines, and medical informatics. These cancer delivery components allowed for the implementation of Rwanda’s first cancer center, while simultaneously serving as the nidus for capacity building of foundational components for future cancer centers. Conclusion: This “progressive scaling” approach ensured that initial investments in the country’s first cancer center was a step toward establishing future cancer centers in the country.

scholarly journals Scaling Up Information Sharing on HIV-Associated Neurocognitive Disorder: Raising Awareness and Knowledge Among Key Stakeholders

SAGE Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 215824402110168
Author(s):  
Renato M. Liboro ◽  
Paul A. Shuper ◽  
Lori E. Ross
Keyword(s):  
Health Care ◽  
Information Sharing ◽  
Service Providers ◽  
Scale Up ◽  
People Living With Hiv ◽  
Neurocognitive Disorder ◽  
Public Health Informatics ◽  
Raising Awareness ◽  
Hiv Associated Neurocognitive Disorder ◽  
Hiv Aids

Although the majority of specialists and researchers in the field of HIV/AIDS are aware and knowledgeable about HIV-associated neurocognitive disorder (HAND) as a condition that affects as much as 50% of people living with HIV/AIDS (PLWH), research has documented that many health care and service providers who work directly with PLWH are either unaware of HAND or believe they do not know enough information about HAND to effectively support their clients experiencing neurocognitive challenges. Based on the findings of a qualitative study that interviewed 33 health care and service providers in HIV/AIDS services to identify and examine their awareness and knowledge on HAND, this article argues for utilizing a combination of Public Health Informatics principles; communication techniques, propagation strategies, and recognized approaches from Implementation and Dissemination Science; and social media and online discussion platforms, in addition to traditional Knowledge Mobilization strategies, to scale up information sharing on HAND among all relevant stakeholders. Increasing information sharing among stakeholders would be an important step to raising awareness and knowledge on HAND, and consequently, improving care, services, and support for PLWH and neurocognitive issues.

Advocacy for a Digital Oral Health That Leaves No One Behind

2021 ◽  
pp. 238008442110266
Author(s):  
N. Giraudeau ◽  
B. Varenne
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Access To Health Care ◽  
Universal Access ◽  
Digital Health ◽  
World Health ◽  
Noncommunicable Diseases ◽  
Central Component ◽  
Health Coverage ◽  
The Impact

During the first wave of the coronavirus disease 2019 (COVID-19) pandemic, the lockdown enforced led to considerable disruption to the activities of dental services, even leading to closures. To mitigate the impact of the lockdowns, systems were quickly put in place in most countries to respond to dental emergencies, giving priority to distance screening, advice to patients by remote means, and treatment of urgent cases while ensuring continuous care. Digital health was widely adopted as a central component of this new approach, leading to new practices and tools, which in turn demonstrated its potential, limitations, and possible excesses. Political leaders must become aware of the universal availability of digital technology and make use of it as an additional, safe means of providing services to the public. In view of the multiple uses of digital technologies in health—health literacy, teaching, prevention, early detection, therapeutics, and public health policies—deployment of a comprehensive program of digital oral health will require the adoption of a multifaceted approach. Digital tools should be designed to reduce, not increase, inequalities in access to health care. It offers an opportunity to improve healthy behavior, lower risk factors common to oral diseases and others noncommunicable diseases, and contribute to reducing oral health inequalities. It can accelerate the implementation of universal health coverage and help achieve the 2030 Sustainable Development Agenda, leaving no one behind. Digital oral health should be one of the pillars of oral health care after COVID-19. Universal access to digital oral health should be promoted globally. The World Health Organization’s mOralHealth program aims to do that. Knowledge Transfer Statement: This position paper could be used by oral health stakeholders to convince their government to implement digital oral health program.

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