scholarly journals Effectiveness of a quality improvement intervention to increase adherence to key practices during female sterilization services in Chhattisgarh and Odisha states of India

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0244088
Author(s):  
Ashish Srivastava ◽  
Geeta Chhibber ◽  
Neeta Bhatnagar ◽  
Angela Nash-Mercado ◽  
Jyoti Samal ◽  
...  
Keyword(s):  
Public Health ◽  
Quality Improvement ◽  
Service Providers ◽  
Health Facilities ◽  
Quality Improvement Intervention ◽  
Female Sterilization ◽  
Public Health Facilities ◽  
Operative Care ◽  
Urine Testing ◽  
The Impact

Background In response to longstanding concerns around the quality of female sterilization services provided at public health facilities in India, the Government of India issued standards and quality assurance guidelines for female sterilization services in 2014. However, implementation remains a challenge. The Maternal and Child Survival Program rolled out a package of competency-based trainings, periodic mentoring, and easy-to-use job aids in parts of five states to increase service providers’ adherence to key practices identified in the guidelines. Methods The study employed a before-and-after quasi-experimental design with a matched comparison arm to examine the effect of the intervention on provider practices in two states: Odisha and Chhattisgarh. Direct observations of female sterilization services were conducted in selected public health facilities, using a checklist of 30 key practices, at two points in time. Changes in adherence to key practices from baseline to endline were compared at 12 intervention and 12 comparison facilities using a difference in difference analysis. Results Several key practices were well-established prior to the intervention, with adherence levels over 90% at baseline, including hemoglobin and urine testing, use of sterile surgical gloves and instruments, and recommended surgical technique. However, adherence to many other practices was extremely low at baseline. The program significantly increased adherence to nine practices, including those related to ascertaining client’s medical eligibility, client-provider interaction, the consent process, and post-operative care. The greatest improvement was observed in the provision of written instructions for clients prior to discharge. At endline, however, adherence remained below 50% for 14 practices. Conclusion Low adherence to key practices at baseline confirmed the need for quality improvement interventions in female sterilization services. While the intervention improved adherence to certain practices around admission and post-operative care, inadequate human resources and infrastructure, among other factors, may have blunted the impact of the intervention.

scholarly journals Infection prevention preparedness and practices for female sterilization services within primary care facilities in Northern India

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Abhishek Kumar ◽  
Abhishek Gautam ◽  
Arnab Dey ◽  
Ruhi Saith ◽  
Uttamacharya ◽  
...  
Keyword(s):  
Public Health ◽  
Infection Prevention ◽  
Uttar Pradesh ◽  
Health Facilities ◽  
Female Sterilization ◽  
Provider Attitudes ◽  
Public Health Facilities ◽  
Northern India ◽  
Provider Adherence ◽  
Facility Readiness

Abstract Background In 2014, 16 women died following female sterilization operations in Bilaspur, a district in central India. In addition to those 16 deaths, 70 women were hospitalized for critical conditions (Sharma, Lancet 384,2014). Although the government of India’s guidelines for female sterilization mandate infection prevention practices, little is known about the extent of infection prevention preparedness and practice during sterilization procedures that are part of the country’s primary health care services. This study assesses facility readiness for infection prevention and adherence to infection prevention practices during female sterilization procedures in rural northern India. Method The data for this study were collected in 2016–2017 as part of a family planning quality of care survey in selected public health facilities in Bihar (n = 100), and public (n = 120) and private health facilities (n = 97) in Uttar Pradesh. Descriptive analysis examined the extent of facility readiness for infection prevention (availability of handwashing facilities, new or sterilized gloves, antiseptic lotion, and equipment for sterilization). Correlation and multivariate statistical methods were used to examine the role of facility readiness and provider behaviors on infection prevention practices during female sterilization. Result Across the three health sectors, 62% of facilities featured all four infection prevention components. Sterilized equipment was lacking in all three health sectors. In facilities with all four components, provider adherence to infection prevention practices occurred in only 68% of female sterilization procedures. In Bihar, 76% of public health facilities evinced all four components of infection prevention, and in those facilities provider’s adherence to infection prevention practices was almost universal. In Uttar Pradesh, where only 55% of public health facilities had all four components, provider adherence to infection prevention practices occurred in only 43% of female sterilization procedures. Conclusion The findings suggest that facility preparedness for infection prevention does play an important role in provider adherence to infection prevention practices. This phenomenon is not universal, however. Not all doctors from facilities prepared for infection prevention adhere to the practices, highlighting the need to change provider attitudes. Unprepared facilities need to procure required equipment and supplies to ensure the universal practice of infection prevention.

scholarly journals Feasibility of delivering integrated COPD-asthma care at primary and secondary level public healthcare facilities in Pakistan: a process evaluation

BJGP Open ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. bjgpopen18X101632 ◽  
Author(s):  
Muhammad Amir Khan ◽  
Muhammad Ahmar Khan ◽  
John D Walley ◽  
Nida Khan ◽  
Faisal Imtiaz Sheikh ◽  
...  
Keyword(s):  
Public Health ◽  
Integrated Care ◽  
Low Income ◽  
Service Providers ◽  
Health Facilities ◽  
Public Healthcare ◽  
Care Providers ◽  
Asthma Care ◽  
Public Health Facilities ◽  
Clinical Records

BackgroundIn Pakistan,the estimated prevalence of chronic obstructive pulmonary disease (COPD) and asthma are 2.1% and 4.3% respectively, and existing care is grossly lacking both in coverage and quality. An integrated approach is recommended for delivering COPD and asthma care at public health facilities.AimTo understand how an integrated care package was experienced by care providers and patients, and to inform modifications prior to scaling up.Design & settingThe mixed-methods study was conducted as part of cluster randomised trials on integrated COPD and asthma care at 30 public health facilities.MethodThe care practices were assessed by analysing the clinical records of n = 451 asthma and n = 313 COPD patients. Semi-structured interviews with service providers and patients were used to understand their care experiences. A framework approach was applied to analyse and interpret qualitative data.ResultsUtilisation of public health facilities for chronic lung conditions was low, mainly because of the non-availability of inhalers. When diagnosed, around two-thirds (69%) of male and more than half (55%) of female patients had severe airway obstruction. The practice of prescribing inhalers differed between intervention and control arms. Patient non-adherence to follow-up visits remained a major treatment challenge (though attrition was lower and slower in the intervention arm). Around half of the male responders who smoked at baseline reported having quit smoking.ConclusionThe integrated care of chronic lung conditions at public health facilities is feasible and leads to improved diagnosis and treatment in a low-income country setting. The authors recommend scaling of the intervention with continued implementation research, especially on improving patient adherence to treatment.

scholarly journals Assessment of cervical cancer services and cervical cancer related knowledge of health service providers in public health facilities in Addis Ababa, Ethiopia

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Firdawek Getahun ◽  
Adamu Addissie ◽  
Shiferaw Negash ◽  
Gebrekiros Gebremichael
Keyword(s):  
Public Health ◽  
Cervical Cancer ◽  
Health Service ◽  
Service Providers ◽  
Addis Ababa ◽  
Health Facilities ◽  
Health Providers ◽  
Public Health Facilities ◽  
Health Service Providers ◽  
Cancer Services

Abstract Objective To assess cervical cancer services and knowledge of health service providers in public health facilities. Result Two of the three hospitals had cervical cancer screening services. One-third of the hospital had cervical cancer diagnosis service punch biopsy and cervical cancer treatment. Majority, 289 (93.5%) of study participants said cervical cancer was a preventable disease. Having multiple sexual partners 257 (83.2%) and post coital bleeding 251 (81.2%), were the most mentioned risk factor and clinical manifestation of cervical cancer respectively. Majority of the participants were aware of the correct time to start screening 291 (70.5%), and only 95 (25.9%) knew the screening intervals. Overall, 165 (53.4%) of health providers scored below the mean knowledge level score. Females had better knowledge about cervical cancer than males (X2 = 8.4, P = 0.003).

scholarly journals SATISFACTION WITH USE OF PUBLIC HEALTH AND PEER LED FACILITIES FOR HIV PREVENTION SERVICES BY KEY POPULATIONS IN NIGERIA

2019 ◽  
Author(s):  
Bartholomew Ochonye ◽  
Morenike Oluwatoyin Folayan ◽  
Adesegun O Fatusi ◽  
Godwin Emmanuel ◽  
Tomi Adepoju ◽  
...  
Keyword(s):  
Public Health ◽  
Hiv Prevention ◽  
Service Providers ◽  
Health Facilities ◽  
Service Access ◽  
Key Populations ◽  
Public Health Facilities ◽  
Prevention Services ◽  
Barriers To Service ◽  
Barriers To Use

Abstract Background: The aim of the study was to identify the proportion of female sex workers, men who have sex with men, and people who inject drugs who had accessed HIV prevention services at public health facilities and peer-led facilities, their level of satisfaction with these services, and perceived barriers and challenges to accessing HIV services from public and peer-led HIV prevention service providers. Methods: A mixed-method approach was used to collect data from key populations in the four states in Nigeria. Quantitative data collected included level of satisfaction with and barriers to use of public and peer-led facilities. In-depth interviews and focus-group discussions were conducted to explore reasons for satisfaction with and barriers to use of services. Descriptive and bivariate analyses were was conducted for quantitative data. Qualitative data were summaried, emerging themes identified, described and quotes reflecting the themes corresponding to interview questions highlighted Results : Nine hundred sixty-seven persons responded to questions on the use of public health or/and peer-led facilities. Two hundred thirty-eight (49.4%) respondents had received HIV and sexual and reproductive health services through public health facilities, and 236 (48.7%) had received the services through peer-led facilities. Significantly more respondents were satisfied with the quality of services provided by peer-led organisations than with public health facilities with respect to service providers listening to respondent’s problems and concerns (p=0.007),privacy and confidentiality (p=0.04) and respect of rights of service recipients (p=0.04). Significantly more respondents using peer-led organisations than those using public health facilities identified no barriers to service access (p=0.003). More respondents using public health facilities than peer-led facilities identified cost of services (p=0.01), confidentiality (p=0.002), waiting time (p<0.01) and staff attitude (p=0.001) as barriers to service access. Thee was no difference in the proportion of respondents willing to discontinue their use of either facilities (p=0.08). Qualitative data revealed that concerns with access of services at the public health facility were due mainly to stigma and the effects of the same-sex prohibition law. Conclusion: Key populations were more satisfied receiving HIV prevention services at peer-led organisations than at public health facilities.

scholarly journals Universal Access to Essential Medicines: An Evaluation of Nepal’s Free Health Care Scheme

2018 ◽  
Vol 16 (1) ◽  
pp. 36-42 ◽  
Author(s):  
Shiva Raj Adhikari ◽  
Achyut Raj Pandey ◽  
Mamata Ghimire ◽  
Arjun Kumar Thapa ◽  
Dinesh Kumar Lamsal
Keyword(s):  
Public Health ◽  
Health Care ◽  
Service Providers ◽  
Universal Access ◽  
Health Facilities ◽  
Essential Medicines ◽  
Public Health Facilities ◽  
Free Health Care ◽  
Access To Essential Medicines ◽  
Expired Medicines

Background: Access to medicine for the poor is recognized to be difficult task and one of the major challenges in achieving universal health coverage, particularly in low-and- middle income countries. In order to ensure the availability of essential medicines free of cost in public health facilities, Nepal has also commenced Free Health Care Services (FHCS). So, this study aims to evaluate availability, expiry, and stock-out duration of essential medicines at front line service providers in Nepal.Methods: Cross-sectional survey was conducted 28 public health facilities, 7 district warehouses, and 14 private pharmacies in 7 districts of Nepal. The survey was conducted during the March and April 2014. Survey tools recommended by the WHO operational package for assessing, monitoring and evaluating country pharmaceutical situations was used with slight modification as per Nepal’s situation.Results: The availability of medicine was found to be 92.44% in this study. The percentage of expired medicines in district warehouse was found to be 8.40. The average stock-out duration in district warehouse was 0.324 days.Conclusions: Although the availability of essential medicines at peripheral health facilities was found to be satisfactory with lesser proportion of expired medicines, a strong monitoring and evaluation of expired and stock medicines are desirable to maintain and improve the access to essential medicines.

scholarly journals Satisfaction with use of public health and peer-led facilities for HIV prevention services by key populations in Nigeria

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bartholomew Ochonye ◽  
Morenike Oluwatoyin Folayan ◽  
Adesegun O. Fatusi ◽  
Godwin Emmanuel ◽  
Oluwatomi Adepoju ◽  
...  
Keyword(s):  
Public Health ◽  
Hiv Prevention ◽  
Service Providers ◽  
Health Facilities ◽  
Service Access ◽  
Key Populations ◽  
Public Health Facilities ◽  
Prevention Services ◽  
Barriers To Service ◽  
Barriers To Use

Abstract Background The aim of the study was to identify the proportion of female sex workers, men who have sex with men, and people who inject drugs who had accessed HIV prevention services at public health facilities and peer-led facilities, their level of satisfaction with these services, and perceived barriers and challenges to accessing HIV services from public and peer-led HIV prevention service providers. Methods A mixed-method approach was used to collect data from key populations in the four states in Nigeria. Quantitative data collected included level of satisfaction with and barriers to use of public and peer-led facilities. In-depth interviews and focus-group discussions were conducted to explore reasons for satisfaction with and barriers to use of services. Descriptive and bivariate analyses were was conducted for quantitative data. Qualitative data were summaried, emerging themes identified, described and quotes reflecting the themes corresponding to interview questions highlighted. Results Nine hundred sixty-seven persons responded to questions on the use of public health or/and peer-led facilities. Two hundred thirty-eight (49.4%) respondents had received HIV and sexual and reproductive health services through public health facilities, and 236 (48.7%) had received the services through peer-led facilities. Significantly more respondents were satisfied with the quality of services provided by peer-led organisations than with public health facilities with respect to service providers listening to respondent’s problems and concerns (p = 0.007),privacy and confidentiality (p = 0.04) and respect of rights of service recipients (p = 0.04). Significantly more respondents using peer-led organisations than those using public health facilities identified no barriers to service access (p = 0.003). More respondents using public health facilities than peer-led facilities identified cost of services (p = 0.01), confidentiality (p = 0.002), waiting time (p < 0.01) and staff attitude (p = 0.001) as barriers to service access. Thee was no difference in the proportion of respondents willing to discontinue their use of either facilities (p = 0.08). Qualitative data revealed that concerns with access of services at the public health facility were due mainly to stigma and the effects of the same-sex prohibition law. Conclusion Key populations were more satisfied receiving HIV prevention services at peer-led organisations than at public health facilities.

scholarly journals Protecting the poor? Impact of the national health equity fund on utilization of government health services in Cambodia, 2006-2013

2019 ◽  
Vol 4 (6) ◽  
pp. e001679 ◽  
Author(s):  
Peter Leslie Annear ◽  
John Tayu Lee ◽  
Keovathanak Khim ◽  
Por Ir ◽  
Ellen Moscoe ◽  
...  
Keyword(s):  
Public Health ◽  
Health Equity ◽  
Health Facilities ◽  
National Study ◽  
First Year ◽  
Equity Fund ◽  
Public Health Facilities ◽  
Level Change ◽  
The Poor ◽  
The Impact

IntroductionCambodia’s health equity fund (HEF) is the country’s most significant social security scheme, covering the poorest one-fifth of the national population. During the last two decades, the HEF system was scaled up from an initial two health districts to national coverage of public health facilities. This is the first national study to examine the impact of the HEF on the utilisation of public health facilities.MethodsWe first investigated the level of national HEF population coverage and health service use made by HEF eligible members using an administrative HEF operational dataset. Second, through multilevel interrupted time series analysis of routine monthly utilisation statistics during 2006–2013, we evaluated the impact of the HEF on hospital and health centre utilisation.ResultsThe proportion of HEF beneficiaries using hospital services in a given year (4.6%) appeared to exceed rates in the general population (3.3%). The introduction of the HEF was associated with: a significant level change in the monthly number of consultations at HCs followed by a gradual slope increase in time trend and a significant level change in the monthly number of deliveries. Overall, this was equivalent to a 15.6% net increase in number of consultations and 5.3% in deliveries in the first year. At RHs: a significant level change in the number of RH inpatient cases, followed by a sustained slope increase; a significant slope increase in the number of outpatient consultations and in the overall number of newborn deliveries. Overall, this was equivalent to a 47.9% net increase in inpatient cases, 24.1% in outpatient cases and 31.4% in deliveries in the first year.ConclusionThe implementation of the HEF scheme was associated with increased utilisation of primary and secondary care services by the poor.

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