scholarly journals Making doctors stay: Rethinking doctor retention policy in a contracted-out primary healthcare setting in urban Bangladesh

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262358
Author(s):  
Farzana Bashar ◽  
Rubana Islam ◽  
Shaan Muberra Khan ◽  
Shahed Hossain ◽  
Adel A. S. Sikder ◽  
...  
Keyword(s):  
Service Delivery ◽  
Primary Healthcare ◽  
Service Provision ◽  
Urban Areas ◽  
Financial Incentives ◽  
Clinical Skills ◽  
Healthcare Services ◽  
Working Environment ◽  
Staff Retention ◽  
Contracting Out

Background “Contracting Out” is a popular strategy to expand coverage and utilization of health services. Bangladesh began contracting out primary healthcare services to NGOs in urban areas through the Urban Primary Health Care Project (UPHCP) in 1998. Over the three phases of this project, retention of trained and skilled human resources, especially doctors, proved to be an intractable challenge. This paper highlights the issues influencing doctor’s retention both in managerial as well as service provision level in the contracted-out setting. Methodology In this qualitative study, 42 Key Informant Interviews were undertaken with individuals involved with UPHCP in various levels including relevant ministries, project personnel representing the City Corporations and municipalities, NGO managers and doctors. Verbatim transcripts were coded in ATLAS.ti and analyzed using the thematic analysis. Document review was done for data triangulation. Results The most cited problem was a low salary structure in contrast to public sector pay scale followed by a dearth of other financial incentives such as performance-based incentives, provident funds and gratuities. Lack of career ladder, for those in both managerial and service delivery roles, was also identified as a factor hindering staff retention. Other disincentives included inadequate opportunities for training to improve clinical skills, ineffective staffing arrangements, security issues during night shifts, abuse from community members in the context of critical patient management, and lack of job security after project completion. Conclusions An adequate, efficient and dedicated health workforce is a pre-requisite for quality service provision and patient utilization of these services. Improved career development opportunities, the provision of salaries and incentives, and a safer working environment are necessary actions to retain and motivate those serving in managerial and service delivery positions in contracting out arrangements.

scholarly journals Contracting out of health services improves service utilization and satisfaction: evidence from rural districts of Pakistan

2020 ◽  
Author(s):  
Imran Naeem Naeem ◽  
Zafar Fatmi
Keyword(s):  
Health Services ◽  
Service Delivery ◽  
Service Utilization ◽  
Main Concern ◽  
Staff Retention ◽  
Modest Improvement ◽  
Major Barrier ◽  
Contracting Out ◽  
Healthcare Facilities ◽  
Rural Districts

Abstract Background Contracting out of health services to non-state providers has been widely used in developing countries including Pakistan. Based on three years’ experience of contracting out primary and secondary health services, this paper presents findings of third party evaluation of health services from two rural districts of Sindh Pakistan. Methods This was a baseline vs end-line cross sectional assessment of thirteen primary and secondary healthcare facilities from two rural districts (Thatta and Sujawal) of Sindh province that were contracted out in 2016 to a national non-governmental organization. Healthcare facilities included: 8 rural health centres, 4 taluka headquarter hospitals and 1 district headquarter hospital. District health information system was used to extract three years (2016 – 2019) data on key performance indicators (KPIs) as agreed in contract. We conducted record review related to human resource and budget and in-depth interviews with health managers. Health facility assessment survey and client satisfaction exit interviews were also conducted. Results KPIs showed significant improvement in service provision from baseline. General outpatient department (OPD) (33%), specialist OPD (91%), accident/emergency consultations (106%), in-patient admissions (≥100%) alongside diagnostic/laboratory service utilization (86%) increased substantially. Facility based deliveries (37%), and major (99%) and minor (172%) surgeries also showed significant increase. Preventive services (maternal tetanus toxoid, child vaccination) showed modest improvement (4-19%) in the district (overall) but slight decline in some healthcare facilities. Slight improvement in specialist workforce care was noticed, however challenges related to staff retention persisted. Adequate supplies and equipment were available except radiology services. Most healthcare facilities were also in need of repair. Delayed and partial release of funds by government was a major barrier. Lack of coordination among different stakeholders delivering healthcare in the district was also noted. Majority of clients (60%) were satisfied with service delivery but unavailability of medicine was their main concern. Conclusions Contracting out has the potential to improve service utilization. Autonomy over budget allocation and utilization, appointment of all cadre of staff, and improved coordination among all stakeholders is required to improve service delivery. Quality of care and the longer term health outcomes need further evaluation.

scholarly journals The role and response of primary healthcare services in the delivery of palliative care in epidemics and pandemics: A rapid review to inform practice and service delivery during the COVID-19 pandemic

2020 ◽  
Vol 34 (9) ◽  
pp. 1182-1192 ◽  
Author(s):  
Sarah Mitchell ◽  
Victoria Maynard ◽  
Victoria Lyons ◽  
Nicholas Jones ◽  
Clare Gardiner
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Service Delivery ◽  
End Of Life ◽  
Primary Healthcare ◽  
End Of Life Care ◽  
Healthcare Services ◽  
Rapid Review ◽  
Life Care ◽  
Care Providers

Background: The increased number of deaths in the community happening as a result of COVID-19 has caused primary healthcare services to change their traditional service delivery in a short timeframe. Services are quickly adapting to new challenges in the practical delivery of end-of-life care to patients in the community including through virtual consultations and in the provision of timely symptom control. Aim: To synthesise existing evidence related to the delivery of palliative and end-of-life care by primary healthcare professionals in epidemics and pandemics. Design: Rapid systematic review using modified systematic review methods, with narrative synthesis of the evidence. Data sources: Searches were carried out in Medline, Embase, PsychINFO, CINAHL and Web of Science on 7th March 2020. Results: Only five studies met the inclusion criteria, highlighting a striking lack of evidence base for the response of primary healthcare services in palliative care during epidemics and pandemics. All were observational studies. Findings were synthesised using a pandemic response framework according to ‘systems’ (community providers feeling disadvantaged in terms of receiving timely information and protocols), ‘space’ (recognised need for more care in the community), ‘staff’ (training needs and resilience) and ‘stuff’ (other aspects of managing care in pandemics including personal protective equipment, cleaning care settings and access to investigations). Conclusions: As the COVID-19 pandemic progresses, there is an urgent need for research to provide increased understanding of the role of primary care and community nursing services in palliative care, alongside hospices and community specialist palliative care providers.

Unit Managers’ Perceptions of Implementation of National Core Standards in Tertiary Hospitals

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Winnie Thembisile Maphumulo ◽  
Busisiwe Bhengu
Keyword(s):  
South Africa ◽  
Human Resources ◽  
Sampling Technique ◽  
Healthcare Services ◽  
Working Environment ◽  
Staff Retention ◽  
Cross Sectional ◽  
Services Delivery ◽  
Kwazulu Natal ◽  
Tertiary Hospitals

Globally, all healthcare systems face challenges in improving the quality of healthcare services delivery. In South Africa, the National Department of Health introduced the National Core Standards (NCS) tool in 2011 as affirmation of what is predicted to deliver decent, safe and high-quality care in healthcare establishments. The study presented in this paper aimed to determine unit managers’ perceptions of the implementation of the NCS in tertiary hospitals in KwaZulu-Natal, South Africa. This was a cross-sectional, descriptive survey. A purposive sampling technique was used to select hospitals offering secondary and tertiary services in KwaZulu-Natal. A census method was used to recruit all unit managers in the study. A census method is an attempt to list all elements or to use every unit in a group and to measure one or more characteristics of those elements. Out of the 169 population of unit managers counted in these hospitals, only 95 participated in the study. The collected data were analysed using SPSS Statistics version 25. The study showed that the participants’ perceptions were positive about the availability of material resources. However, a shortage of human resources in terms of numbers, skills, and skills mix was noted. The results also revealed that the participants’ perceptions of the availability of a positive working environment were negative. This study recommends that the healthcare authorities develop a strategic approach to manage scarce human resources by attracting, sourcing, selecting, training, developing, and retaining healthcare workers. This includes creating a positive working environment to promote staff retention.

scholarly journals Physiotherapy managers’ views of musculoskeletal physiotherapy service provision in Ireland: a qualitative study

2017 ◽  
Vol 19 (01) ◽  
pp. 77-87 ◽  
Author(s):  
Helen P. French ◽  
Rose Galvin
Keyword(s):  
Primary Care ◽  
Service Delivery ◽  
Service Provision ◽  
Urban Areas ◽  
Resource Constraints ◽  
Early Stage ◽  
Future Research ◽  
Structured Interviews ◽  
Physiotherapy Service ◽  
Stage Of Development

Aim Integrated multidisciplinary primary healthcare is still in a relatively early stage of development in Ireland, with significant restructuring occurring in the past decade. Musculoskeletal physiotherapy services traditionally provided in acute hospital settings have been relocated into the primary care setting where the physiotherapist works as part of the multidisciplinary team. This study aimed to explore physiotherapy managers’ experiences of managing musculoskeletal physiotherapy services in primary care to gain an insight into the opportunities and challenges in service delivery, changing roles and ongoing professional development needs of staff. Participants Qualitative design using semi-structured interviews with primary care physiotherapy managers in the Republic of Ireland was employed. Results Five interviews took in a mix of rural and urban areas nationally. The relationship with the GP was an important one in musculoskeletal physiotherapy services in primary care. Physiotherapists were well skilled but opportunities for professional and career development were restricted. Methods of optimising resources in the face of staffing restrictions were identified. Whilst there were many examples of innovations in service delivery, various barriers negatively impacted on optimal service including resource constraints and national strategy. Conclusions A number of factors that impact on musculoskeletal service delivery in primary care from the perspective of physiotherapy managers were identified in this study. Future research should explore the views of other stakeholders to provide a more thorough understanding of the relevant issues affecting musculoskeletal physiotherapy service provision in primary care in Ireland.

scholarly journals NIGERIAN NURSES AND MIDWIVES UNEMPLOYMENT SURVEY

2020 ◽  
Vol 8 (6) ◽  
pp. 92-101
Author(s):  
EGWUENU RN ◽  
G.I. NSHI RN
Keyword(s):  
Nursing Education ◽  
Rural Community ◽  
Primary Healthcare ◽  
Urban Areas ◽  
Community Setting ◽  
Healthcare Services ◽  
Community Settings ◽  
Health Extension Workers ◽  
Mass Migration ◽  
Nurses And Midwives

Background: The quacking controversy that trailed the Nursing & Midwifery Council of Nigeria’s (N&MCN) release of a “License Community Nurse (LCN)” circular (Ref No. N&MCN/SG/RO/CIR/24/VOL.4/152 dated March 3, 2020) which conveyed the intention of the council to lower the existing standard of nursing education for the LCN programme that will take secondary school leavers at least a credit in English and Biology to be admitted into and two years to complete, and inter alia blamed the crude situation and abysmal performance of the Nigerian Primary Healthcare (PHC) system in the community settings on mass migration of Nurses & Midwives to urban areas and to other countries prompted UGONSA to initiate this survey to empirically determine whether there are indeed a shortage of Nurses & Midwives to fill the manpower need of the Nigerian PHC system in the community settings or not, or whether the shortage is as a result of the deliberate age-long policy of attrition and displacement of Nurses & Midwives from the PHC system in the community settings and their replacement with Community Health Extension Workers (CHEWs) [who do not have nursing education, training, skills or the ethical leaning to be responsible and accountable for nursing & midwifery services] by the National Primary Healthcare Development Agency (NPHCDA). Objective: The main aim of the study was to determine if there is a shortage of nurses that could fill the nursing needs of the PHC system in the community settings. The study also sought to compile the list of unemployed and underemployed Nurses & Midwives and to find out if unemployed Nurses & Midwives are willing to work in the community settings if the opportunity to serve the PHC system in the community setting is offered to them by the NPHCDA. The study further sought to determine the ratio of unemployed Nurses & Midwives in relation to the possible number of graduates that can be licensed by the N&MCN in a session. Methods: Using Google forms an online compilation was carried out from March 7 to April 08, 2020, in a descriptive survey of unemployed Nurses & Midwives that could be reached online within the timeline. Names, Phone numbers, State of Residence, Year of Graduation, Qualification(s), and how long they have remained unemployed after graduation were compiled. In addition, two questions were asked about the objective of the study. Analysis of data was done via Google forms statistical tools.   Results: A total of 3317 unemployed Nurses & Midwives responded to the survey. Among these unemployed Nurses & Midwives – 38% holds RN only, 19% holds both RN & RM, 15.4% holds RM only, while 27.6% holds BNSc plus another qualification. For the year they have remained unemployed after graduation 57.1% have spent 0–2 years, 29.9% have been unemployed for 3–5 years, 7% have been unemployed for 6 – 8 years and 6.1% have been unemployed for more than 8 years. To the question, “Do you think there is a shortage of Nurses and Midwives in Nigeria?” – 47.5% said yes, 43.5% said no whereas 9% were undecided (said maybe). Furthermore, the result showed that while 95% of the unemployed Nurses & Midwives are willing to work in the rural community settings, 1% was not willing to work in the rural community settings and 4% were undecided (.i.e. said maybe) on whether they will work in the rural community settings or not. The result also revealed that the 3317 unemployed Nurses & Midwives captured in the survey represents graduates of 66 Nursing & Midwifery schools per session out of a total of 162 schools that are currently accredited by the N&MCN. This represents 41% of the possible number of graduates that can be turned out of the accredited Nursing & Midwifery Schools (excluding Post-basic schools) in a session. Conclusion: Despite the reported migration of Nurses to urban areas and other countries, at least 41% of Nigerian Nurses & Midwives produced in a session remain unemployed and 95% of them are willing to work in the rural community settings if given the opportunity. These unemployed Nurses & Midwives can bridge the Nursing & Midwifery manpower needs in the Primary Healthcare System should the NPHCDA engage their services with a commensurate or higher payment to what their employed counterparts receive in Federal Government-owned establishments and hospitals. There is no current shortage of Nurses that necessitates the lowering of the existing standard of nursing education. Nurses & Midwives are not responsible for the design, implementation, and delivery of healthcare services at the PHC level and therefore are not culpable for the deplorable condition and abysmal performance of the Nigerian PHC System.

scholarly journals Rural and urban differences in patient experience in China: a coarsened exact matching study from the perspective of residents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dantong Zhao ◽  
Zhongliang Zhou ◽  
Chi Shen ◽  
Rashed Nawaz ◽  
Dan Li ◽  
...  
Keyword(s):  
Patient Experience ◽  
Primary Healthcare ◽  
Urban Areas ◽  
Healthcare Services ◽  
Urban Residents ◽  
Exact Matching ◽  
Rural Residents ◽  
Healthcare Resources ◽  
Coarsened Exact Matching ◽  
Rural And Urban

Abstract Background Patient experience is a key measure widely used to evaluate quality of healthcare, yet there is little discussion about it in China using national survey data. This study aimed to explore rural and urban differences in patient experience in China. Methods Data regarding this study were drawn from Chinese General Social Survey (CGSS) 2015, with a sample size of 9604. Patient experience was measured by the evaluation on healthcare services. Coarsened exact matching (CEM) method was used to balance covariates between the rural and urban respondents. Three thousand three hundred seventy-two participants finally comprised the matched cohort, including 1592 rural residents and 1780 urban residents. Rural and urban differences in patient experience were tested by ordinary least-squares regression and ordered logistic regression. Results The mean (SD) score of patient experience for rural and urban residents was 72.35(17.32) and 69.45(17.00), respectively. Urban residents reported worse patient experience than rural counterparts (Crude analysis: Coef. = − 2.897, 95%CI: − 4.434, − 1.361; OR = 0.706, 95%CI: 0.595, 0.838; Multivariate analysis: Coef. = − 3.040, 95%CI: − 4.473, − 1.607; OR = 0.675, 95%CI: 0.569, 0.801). Older (Coef. = 2.029, 95%CI: 0.338, 3.719) and healthier (Coef. = 2.287, 95%CI: 0.729, 3.845; OR = 1.217, 95%CI: 1.008, 1.469) rural residents living in western area (Coef. = 2.098, 95%CI: 0.464, 3.732; OR = 1.276, 95%CI: 1.044, 1.560) with higher social status (Coef. = 1.158, 95%CI: 0.756, 1.561; OR = 1.145, 95%CI: 1.090, 1.204), evaluation on adequacy (Coef. = 7.018, 95%CI: 5.045, 8.992; OR = 2.163, 95%CI: 1.719, 2.721), distribution (Coef. = 4.464, 95%CI: 2.471, 6.456; OR = 1.658, 95%CI: 1.312, 2.096) and accessibility (Coef. = 2.995, 95%CI: 0.963, 5.026; OR = 1.525, 95%CI: 1.217, 1.911) of healthcare resources had better patient experience. In addition, urban peers with lower education (OR = 0.763, 95%CI: 0.625, 0.931) and higher family economic status (Coef. = 2.990, 95%CI: 0.959, 5.021; OR = 1.371, 95%CI: 1.090,1.723) reported better patient experience. Conclusions Differences in patient experience for rural and urban residents were observed in this study. It is necessary to not only encourage residents to form a habit of seeking healthcare services in local primary healthcare institutions first and then go to large hospitals in urban areas when necessary, but also endeavor to reduce the disparity of healthcare resources between rural and urban areas by improving quality and capacity of rural healthcare institutions and primary healthcare system of China.

Determinants of Health-seeking Behaviour in Northeast India

2019 ◽  
Vol 21 (2) ◽  
pp. 234-257 ◽  
Author(s):  
Sapana Ngangbam ◽  
Archana K. Roy
Keyword(s):  
Primary Healthcare ◽  
Urban Areas ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Northeast India ◽  
Sample Survey ◽  
Health Seeking Behaviour ◽  
Health Seeking ◽  
The Cost

India’s northeast region comprises eight states, which, together, is home to 3.8 per cent of the country’s population. The quality of healthcare and manpower availability remains a cause for concern in the region, affecting the overall health-seeking behaviour of the people. This study attempts to understand the determinants of utilization of healthcare services in Northeast India. Healthcare and morbidity data for this study are based on a Northeast India sample from the National Sample Survey Organization’s (NSSO’s) health consumption data (2014). Probit, multinomial and mixed conditional logit models were employed in the study. In Northeast India, uneducated, higher-aged, Schedule Castes/Schedule Tribes (SCs/STs), Muslims, rural people and district people are served less by medical institutions and because of poor road connectivity they either remain untreated or seek care at underequipped primary healthcare services, while their counterparts utilize private facilities mostly for outpatient care and either public hospital or private facilities for inpatient care. There is also a tendency to substitute alternative healthcare when the cost of an inpatient healthcare service rises. To protect the interest of marginalized people and achieve the target of accessible, affordable and quality healthcare, the government needs to strengthen the primary healthcare in rural areas and improve the quality of healthcare in urban areas without increasing the cost of treatment.

scholarly journals Service delivery and coverage in primary healthcare in a community-health project in Ibadan, Nigeria

2014 ◽  
Vol 6 (1) ◽  
Author(s):  
Kabiru K. Salami ◽  
William R. Brieger
Keyword(s):  
Service Delivery ◽  
Antenatal Care ◽  
Community Health ◽  
Primary Healthcare ◽  
First Trimester ◽  
Health Service Delivery ◽  
Healthcare Services ◽  
Steady Increase ◽  
Record Keeping ◽  
Health Project

Background: Standard health-service delivery aimed toward improving maternal and childhealth status remains elusive in Nigeria because of inaccuracies in data documentation leading to a lack of relatively stable evidence.Objectives: Through a community-health project, this study tested the accuracy of record keeping in primary healthcare services in nine clinics run in Ibadan, Nigeria.Methods: A validation exercise was performed through a sample of the 10 most recent names extracted from three registers maintained by each clinic.Results: A review of the register covering a period of four years showed a steady increase in: fully-immunised children, registration for antenatal care during the first trimester of pregnancy, the number of women who attended antenatal care at least three times, the overall number of women who booked for antenatal care and women who delivered in Eniosa Community-Health Project facilities over the four-year period. It was possible to trace 86% of those selected from the antenatal care register, 88.9% of those from the birth register and 81.1%of those from the immunisation register. Four women who should have been included for antenatal care, seven who had delivered (but were not in the register) and 13 who reportedlyreceived immunisation but were not listed were found during the validation exercise.Conclusion: This study concludes that the names appearing in the register are likely to represent valid events, but that the registers did not capture all such events in the community.

scholarly journals The relationship between healthcare service provision models and patient experience

2021 ◽  
Vol 36 (9) ◽  
pp. 1-24
Author(s):  
Sabina De Rosis ◽  
Chiara Barchielli ◽  
Milena Vainieri ◽  
Nicola Bellé
Keyword(s):  
Service Delivery ◽  
Patient Experience ◽  
Service Provision ◽  
Healthcare Service ◽  
Care Delivery ◽  
Healthcare Services ◽  
Content Type ◽  
Team Working ◽  
The Relationship ◽  
Delivery Models

PurposeUser experience is key for measuring and improving the quality of services, especially in high personal and relation-intensive sectors, such as healthcare. However, evidence on whether and how the organizational model of healthcare service delivery can affect the patient experience is at an early stage. This study investigates the relationship between healthcare service provision models and patient experience by focusing on the nursing care delivery.Design/methodology/approach65 nurses' coordinators were involved to map the nursing models adopted in the healthcare organizations of in an Italian region, Tuscany. This dataset was merged with patient experience measures reported by 9,393 individuals discharged by the same organizations and collected through a Patient-Reported Experience Measures Observatory. The authors run a series of logistic regression models to test the relationships among variables.FindingsPatients appreciate those characteristics of care delivery related to a specific professional nurse. Having someone who is in charge of the patient, both the reference nurse and the supervisor, makes a real difference. Purely organizational features, for instance those referring to the team working, do not significantly predict an excellent experience with healthcare services.Research limitations/implicationsDifferent features referring to different nursing models make the difference in producing an excellent user experience with the service.Practical implicationsThese findings can support managers and practitioners in taking decisions on the service delivery models to adopt. Instead of applying monolithic pure models, mixing features of different models into a hybrid one seems more effective in meeting users' expectations.Originality/valueThis is one of the first studies on the relationship between provision models of high-contact and relational-intensive services (the healthcare services) and users' experience. This research contributes to the literature on healthcare service management suggesting to acknowledge the importance of hybridization of features from different, purely theoretical service delivery models, in order to fit with providers' practice and users' expectations.Highlights This is one of the first studies on the relationship between provision models of nursing care and patient experience.Healthcare services' users appreciate service delivery characteristics identified with “be cared by,” or in other words with having a reference nurse.Nursing models' features that relate to the organizations and that providers tend to judge as professionalizing and evolutive, such as team working, appear not key in relation to patient experience.Pure models of service delivery are theoretically useful, but hybrid models can better meet users' expectations.

Governance and Urban Service Delivery in Zimbabwe

2020 ◽  
Vol 42 (1) ◽  
Author(s):  
Sylvester Marumahoko ◽  
Olugbemiga Samuel Afolab ◽  
Yolanda Sadie ◽  
Norman T Nhede
Keyword(s):  
Local Government ◽  
Service Delivery ◽  
Service Provision ◽  
Urban Areas ◽  
Well Being ◽  
Great Expectation ◽  
Constitutional Protection ◽  
Urban Service ◽  
Provision Of Services ◽  
Downward Spiral

It is contended that service delivery is the core function of developmental local government. The provision of services such as waste management, water and health services is closely associated with the well-being of urban dwellers. In the period leading to the adoption of Zimbabwe’s 2013 Constitution, many people supported the devolution of services and functions to local government. It was a major victory when local government was elevated and given constitutional protection. There was great expectation that service delivery would improve in the cities, towns and smaller urban centres. Seven years later, that expectation appears not to have been realised. Instead, indications are that urban service delivery is experiencing a downward spiral. Using open-ended questionnaires, closed-ended questionnaires and the focus group discussions research methods, the article investigates the drivers of inadequate service provision in four urban areas in Zimbabwe. The paper also proffers suggestions for improving service delivery. The results of the study underscore that the causes of insufficient service provision are multi-pronged and not necessarily limited to inefficiency and ineffectiveness on the part of urban councils. In fact, a major recurring finding is that national government policies are big factors contributing towards the decline of urban service delivery.

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