scholarly journals Assessing the effects of disease-specific programs on health systems: An analysis of the Bangladesh Lymphatic Filariasis Elimination Program’s impacts on health service coverage and catastrophic health expenditure

2021 ◽  
Vol 15 (11) ◽  
pp. e0009894
Author(s):  
Kimberly M. Koporc ◽  
David R. Hotchkiss ◽  
Charles F. Stoecker ◽  
Deborah A. McFarland ◽  
Thomas Carton
Keyword(s):  
Health Service ◽  
Health Services ◽  
Health System ◽  
Lymphatic Filariasis ◽  
Health Systems ◽  
Health Expenditures ◽  
Difference In Differences ◽  
Catastrophic Health Expenditures ◽  
Service Coverage ◽  
Disease Specific

This study presents a methodology for using tracer indicators to measure the effects of disease-specific programs on national health systems. The methodology is then used to analyze the effects of Bangladesh’s Lymphatic Filariasis Elimination Program, a disease-specific program, on the health system. Using difference-in-differences models and secondary data from population-based household surveys, this study compares changes over time in the utilization rates of eight essential health services and incidences of catastrophic health expenditures between individuals and households, respectively, of lymphatic filariasis hyper-endemic districts (treatment districts) and of hypo- and non-endemic districts (control districts). Utilization of all health services increased from year 2000 to year 2014 for the entire population but more so for the population living in treatment districts. However, when the services were analyzed individually, the difference-in-differences between the two populations was insignificant. Disadvantaged populations (i.e., populations that lived in rural areas, belonged to lower wealth quintiles, or did not attend school) were less likely to access essential health services. After five years of program interventions, households in control districts had a lower incidence of catastrophic health expenditures at several thresholds measured using total household expenditures and total non-food expenditures as denominators. Using essential health service coverage rates as outcome measures, the Lymphatic Filariasis Elimination Program cannot be said to have strengthened or weakened the health system. We can also say that there is a positive association between the Lymphatic Filariasis Elimination Program’s interventions and lowered incidence of catastrophic health expenditures.

scholarly journals Qualitative analysis of the coordination of major system change within the Colombian health system in response to COVID-19: study protocol

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Simon Turner ◽  
Natalia Niño
Keyword(s):  
Health Service ◽  
Health Services ◽  
Health System ◽  
Case Studies ◽  
Health Systems ◽  
National Level ◽  
System Change ◽  
Service Planning ◽  
Local Health ◽  
Health Service Planning

Abstract Background Coronavirus (COVID-19) is posing a major and unprecedented challenge to health service planning and delivery across health systems internationally. This nationally funded study is analysing the response of the Colombian health system to the COVID-19 pandemic, drawing on qualitative case studies of three local health systems within the country. The approach will be informed by the concept of ‘major system change’—or coordinated change among a variety of healthcare organizations and other relevant stakeholders— to identify processes that both enable and inhibit adaptation of health services to the challenges presented by COVID-19. The study will collect information on capacity ‘bottlenecks’ as well as successful practices and forms of innovation that have emerged locally, which have the potential for being ‘scaled up’ across Colombia’s health services. Methods/design This qualitative study will be undertaken in two phases. In the first, up to 30 stakeholder interviews will be conducted to ascertain immediate challenges and opportunities for improvement in response to COVID-19 that can be shared in a timely way with health service leaders to inform health service planning. The stakeholders will include planning, provider and intermediary organizations within the health system at the national level. In the second, up to 60 further interviews will be conducted to develop in-depth case studies of three local health systems at the metropolitan area level within Colombia. The interview data will be supplemented with documentary analysis and, where feasible, non-participant observation of planning meetings. Discussion The study’s findings will aid evaluation of the relevance of the concept of major system change in a context of ‘crisis’ decision-making and contribute to international lessons on improving health systems’ capacity to respond to COVID-19 and future pandemics. Study findings will be shared among various stakeholders in the Colombian healthcare system in a formative and timely way in order to inform healthcare planning in response to COVID-19 and future pandemics. Conducting the study at a time of COVID-19 raises a number of practical issues (including physical distancing and pressure on health services) which have been anticipated in the study design and research team’s ways of working.

What is the role of health systems in responding to domestic violence? An evidence review

2017 ◽  
Vol 41 (6) ◽  
pp. 639 ◽  
Author(s):  
Jo Spangaro
Keyword(s):  
Risk Assessment ◽  
Domestic Violence ◽  
Health Service ◽  
Health Services ◽  
Health System ◽  
Health Systems ◽  
Systematic Reviews ◽  
System Level ◽  
Safety Planning ◽  
First Line

Objective The aim of the present study was to review and analyse academic literature and program evaluations to identify promising evidence for health system responses to domestic violence in Australia and internationally. Methods English-language literature published between January 2005 and March 2016 was retrieved from search results using the terms ‘domestic violence’ or ‘intimate partner violence’ in different combinations with other relevant terms, resulting in 1671 documents, of which 59 were systematic reviews. Electronic databases (Medline (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psycinfo, Social work Abstracts, Informit, Violence and Abuse Abstracts, Family Studies Abstracts, Cochrane Library of Systematic Reviews and EMBASE) were searched and narrative analysis undertaken. Results This review details the evidence base for the following interventions by health services responding to domestic violence: first-line responses, routine screening, risk assessment and safety planning, counselling with women, mother–child interventions, responses to perpetrators, child protection notifications, training and system-level responses. Conclusions There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence. What is known about the topic? Domestic violence is a significant problem globally with enormous human, social and economic costs. Although women who have experienced abuse make extensive use of healthcare services, health services have lagged behind the policing, criminal justice and other human service domains in responding to domestic violence. What does this paper add? The present comprehensive review identifies best-practice health system responses to domestic violence. What are the implications for practitioners? Health systems can play a key role in identifying and responding to domestic violence for women who often do not access other services. There is growing evidence for the effectiveness of health service interventions to reduce the extent of harm caused by domestic violence, in particular for specialist counselling, structured risk assessment and safety planning, training for first-line responses and interventions for mothers and children affected by domestic violence.

scholarly journals Qualitative Analysis of the Coordination of Major System Change Within the Colombian Health System in Response to COVID-19: Study Protocol

2020 ◽  
Author(s):  
Simon Turner ◽  
Natalia Niño
Keyword(s):  
Health Service ◽  
Health Services ◽  
Health System ◽  
Case Studies ◽  
Health Systems ◽  
National Level ◽  
System Change ◽  
Service Planning ◽  
Local Health ◽  
Health Service Planning

Abstract Background Coronavirus (COVID-19) is posing a major and unprecedented challenge to health service planning and delivery across health systems internationally. This nationally-funded study is analysing the response of the Colombian health system to the COVID-19 pandemic, drawing on qualitative case studies of three local health systems within the country. The approach will be informed by the concept of 'major system change' - or coordinated change among a variety of healthcare organisations and other relevant stakeholders - in order to identify processes that both enable and inhibit adaptation of health services to the challenges presented by COVID-19. The study will collect information on capacity “bottlenecks” as well as successful practices and forms of innovation that have emerged locally, which have the potential for being 'scaled up' across Colombia's health services. Methods/design This qualitative study will be undertaken in two phases. In the first, up to 30 stakeholder interviews will be conducted to ascertain and share immediate challenges and opportunities for improvement in response to COVID-19 that can be shared in a timely way with health service leaders to inform immediate health service planning. The stakeholders will be selected in order to sample a range of planning, provider and intermediary organizations within the health system at the national level. In the second, up to 60 further interviews will be conducted to develop in-depth case studies of three local health systems at the metropolitan area level within Colombia. The interview data will be supplemented with documentary analysis and, where feasible, non-participant observation of meetings directly related to the planning and implementation of actions responding to COVID-19. The study will also establish mechanisms for providing timely, formative feedback to inform health system planning relating to COVID-19 and future pandemics by ascertaining stakeholders' preferences during the interviews and wider scoping discussions. Discussion The study's findings will aid evaluation of the relevance of the concept of major system change in a context of 'crisis' decision-making and contribute to international lessons on improving health systems' capacity to respond to COVID-19 and future pandemics. Study findings will be shared among various stakeholders in the Colombian healthcare system in a formative and timely way in order to inform healthcare planning in response to COVID-19 and future pandemics. Conducting the study at a time of COVID-19 raises a number of practical issues (including physical distancing and pressure on health services) which have been anticipated in the study design and research team's ways of working.

scholarly journals Changes in Catastrophic Health Expenditures Depending on Health Policies in Turkey

2021 ◽  
Vol 8 ◽  
Author(s):  
Guvenc Kockaya ◽  
Gülpembe Oguzhan ◽  
Zafer Çalşkan
Keyword(s):  
Health Services ◽  
Health Expenditure ◽  
Positive Impact ◽  
Health Expenditures ◽  
Catastrophic Health Expenditure ◽  
Health Policies ◽  
World Health ◽  
Positive Health ◽  
Catastrophic Health Expenditures ◽  
The Impact

Without any financial protection out of pocket health expenses are essential both because their increase causes difficulties in accessing higher quality health services for households and more importantly because it complicates access to most basic health services. As a result of the Health Transformation Program in practice in the Turkish healthcare system since 2003, significant changes have been done in all layers of the health system. Turkish Statistics Institute (TurkStat) publishes the ratio of households that bear catastrophic health expenditures since 2002. According to TurkStat data, the ratio of households with catastrophic expenditure has fallen from 0.81% in 2002 to 0.17% in 2011 with the health transformation project. However, it has started to rise since 2012 and has reached 0.31% in 2014. This study aims to evaluate the expenditure items that may have caused the rise of the ratio of households with catastrophic health expenditures since 2012, which had previously dropped with the Health Transformation Program that has caused fundamental changes in health policies. Methodology and definitions presented in the article named “Distribution of health payments and catastrophic expenditures: Methodology” by Ke Xu published by the World Health Organization in 2005 have been used. Percentages of health expenditure items among the total expenditure of households with positive health expenditure and households with catastrophic health expenditure between 2007 and 2014 have been evaluated using descriptive analysis. Findings have been interpreted in light of the health policies in practice between 2007 and 2014. An overview of the impact of the health policies reveals that medicine expenditures have decreased both for household and public health expenditures. Despite the impact of policies on the pharmaceutical industry was criticized by the industry, the positive impact can be seen by the decrease in the spending on medicine for households spending on health. Hospital service with positive health expenditure is seen to decrease health expenditure. The reasons for the increase in households with catastrophic health expenditure need further research. As a result, the study strives to discuss the possible policy reasons for the observed effects.

Nature and determinants of out-of-pocket health expenditure among older people in a rural Indian community

2012 ◽  
Vol 24 (10) ◽  
pp. 1664-1673 ◽  
Author(s):  
E. M. Brinda ◽  
A. P. Rajkumar ◽  
U. Enemark ◽  
M. Prince ◽  
K. S. Jacob
Keyword(s):  
Health Services ◽  
Older People ◽  
Health Expenditure ◽  
Health Service Utilization ◽  
Care Delivery ◽  
Health Expenditures ◽  
Gastrointestinal Diseases ◽  
Middle Income ◽  
Middle Income Countries ◽  
Catastrophic Health Expenditures

ABSTRACTBackground: Increasing out-of-pocket health expenditure among older people worsens the inequitable access to essential health services in low and middle-income countries (LMIC). We investigated various socioeconomic and health factors associated with out-of-pocket and catastrophic health expenditures among rural older people in India.Methods: We recruited 1,000 participants aged above 65 years from Kaniyambadi block, Vellore, India. We assessed their out-of-pocket health expenditure, health service utilization, socioeconomic profiles, disability, cognition, and health status by standard instruments. We employed appropriate multivariate statistics evaluating these determinants.Results: Male gender, poor sanitation, diabetes, tuberculosis, malaria, respiratory ailments, gastrointestinal diseases, dementia, depression, and disability were associated with higher out-of-pocket expenditures. Illiteracy, tuberculosis, diabetes, and dementia increased the risk for catastrophic health expenditures, while pension schemes protected against it. Income inequalities were associated with inequities on education, disease prevalence, and access to safe water, sanitation, and nutrition.Conclusions: Interactions between determinants of out-of-pocket health expenditure, economic inequality, and inequities on essential health care delivery to older people are complex. We highlight the need for equitable health services and policies, focusing on both medical and social determinants.

Unlocking Trust in Community Health Systems: Lessons from the Lymphatic Filariasis Morbidity Management and Disability Prevention Pilot Project in Luangwa District, Zambia

2021 ◽  
Author(s):  
Joseph M. Zulu ◽  
Patricia Maritim ◽  
Adam Silumbwe ◽  
Hikabasa Halwiindi ◽  
Patricia Mubita ◽  
...  
Keyword(s):  
Focus Group ◽  
Health Services ◽  
Lymphatic Filariasis ◽  
Health Systems ◽  
Disability Prevention ◽  
Focus Group Discussions ◽  
Group Discussions ◽  
Community Health Systems ◽  
Referral Systems ◽  
Depth Interviews

Background: Surgery for hydrocele is commonly promoted as part of morbidity management and disability prevention (MMDP) services for lymphatic filariasis (LF). However, uptake of these surgeries has been suboptimal owing to several community level barriers that have triggered mistrust in such services. This study aimed at documenting mechanisms of unlocking trust in community health systems (CHS) in the context of a LF hydrocele management project that was implemented in Luangwa District, Zambia. Methods: Qualitative data was collected through in-depth interviews and focus group discussions (n=45) in February 2020 in Luangwa District. Thirty-one in-depth interviews were conducted with hydrocele patients, CHWs, health workers, traditional leaders and traditional healers. Two focus group discussions were also conducted with CHWs who had been involved in project implementation with seven participants per group. Data was analyzed using a thematic analysis approach. Results: The use of locally appropriate communication strategies, development of community driven referral systems, working with credible community intermediaries as well as strengthening health systems capacity through providing technical and logistical support enhanced trust in surgery for hydrocele and uptake of the surgeries. Conclusion: Implementation of community led communication and referral systems as well as strengthening health services are vital in unlocking trust in health systems as such mechanisms trigger authentic partnerships, including mutual respect and recognition in the CHS. The mechanisms also enhance confidence in health services among community members.

scholarly journals Applications of Cloud Computing in Health Systems

2016 ◽  
Vol 9 (6) ◽  
pp. 33 ◽  
Author(s):  
Hamid Moghaddasi ◽  
Alireza Tabatabaei Tabrizi
Keyword(s):  
Cloud Computing ◽  
Health Services ◽  
Health System ◽  
Health Systems ◽  
Biological Data ◽  
Quality Analysis ◽  
Medical Decision ◽  
Access To Health Services ◽  
Computing Services ◽  
Cloud Computing Services

INTRODUCTION: Equitable access to health services is one of the health justice criteria. E-health can sometimes be helpful in this regard. This study is aimed to find the use of cloud computing services across health system.METHOD: In the present review article, numerous research papers from different resources, such as MEDLINE, IEEE and Science direct, were studied. Based on the subject, 210 studies were found. After quality analysis of the papers, 78 studies were selected, from which 53 articles were directly related to the applications of cloud computing in health system.FINDINGS: Cloud computing services are widely used in various industries. Therefore, health system takes advantage of the services. Findings indicate that, the applications of cloud computing in health system, including telemedicine, medical imaging, public and personal health, clinical and hospital information systems, medical decision support system, care, secondary use of health data, serve as different types of specialized software used to analyze gene sequences and archive huge biological data. Generally cloud computing services are available in two sectors in any health system as follows: E-health services and Bioinformatics.CONCLUSION: Facilitated access to the E-health services and big data in health systems are the main features of exploiting cloud computing services in health systems. Using cloud computing in health systems not only makes health services more affordable, but also helps nations to achieve health equity.

scholarly journals Examining the incidence of catastrophic health expenditures and its determinants using multilevel logistic regression in Malawi

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248752
Author(s):  
Atupele N. Mulaga ◽  
Mphatso S. Kamndaya ◽  
Salule J. Masangwi
Keyword(s):  
Public Health ◽  
Logistic Regression ◽  
Health Services ◽  
Health Expenditures ◽  
Free Access ◽  
Public Health Services ◽  
Factors Associated ◽  
Out Of Pocket Payments ◽  
Catastrophic Health Expenditures ◽  
Catastrophic Expenditures

Background Despite a free access to public health services policy in most sub-Saharan African countries, households still contribute to total health expenditures through out-of-pocket expenditures. This reliance on out-of-pocket expenditures places households at a risk of catastrophic health expenditures and impoverishment. This study examined the incidence of catastrophic health expenditures, impoverishing effects of out-of-pocket expenditures on households and factors associated with catastrophic expenditures in Malawi. Methods We conducted a secondary analysis of the most recent nationally representative integrated household survey conducted by the National Statistical Office between April 2016 to 2017 in Malawi with a sample size of 12447 households. Catastrophic health expenditures were estimated based on household annual nonfood expenditures and total household annual expenditures. We estimated incidence of catastrophic health expenditures as the proportion of households whose out-of-pocket expenditures exceed 40% threshold level of non-food expenditures and 10% of total annual expenditures. Impoverishing effect of out-of-pocket health expenditures on households was estimated as the difference between poverty head count before and after accounting for household health payments. We used a multilevel binary logistic regression model to assess factors associated with catastrophic health expenditures. Results A total of 167 households (1.37%) incurred catastrophic health expenditures. These households on average spend over 52% of household nonfood expenditures on health care. 1.6% of Malawians are impoverished due to out-of-pocket health expenditures. Visiting a religious health facility (AOR = 2.27,95% CI:1.24–4.15), hospitalization (AOR = 6.03,95% CI:4.08–8.90), larger household size (AOR = 1.20,95% CI:1.24–1.34), higher socioeconomic status (AOR = 2.94,95% CI:1.39–6.19), living in central region (AOR = 3.54,95% CI:1.79–6.97) and rural areas (AOR = 5.13,95% CI:2.14–12.29) increased the odds of incurring catastrophic expenditures. Conclusion The risk of catastrophic health expenditures and impoverishment persists in Malawi. This calls for government to improve the challenges faced by the free public health services and design better prepayment mechanisms to protect more vulnerable groups of the population from the burden of out-of-pocket payments.

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