Post Pandemic Impact on Planning Of District Hospitals in India

Background: Many European-trained doctors (ETDs) recruited to work in rural district hospitals in South Africa have insufficient generalist competencies for the range of practice required. Africa Health Placements recruits ETDs to work in rural hospitals in Africa. Many of these doctors feel inadequately prepared. The Stellenbosch University Ukwanda Centre for Rural Health is launching a Postgraduate Diploma in Rural Medicine to help prepare doctors for such work.Aim: To determine the competencies gap for ETDs working in rural district hospitals in South Africa to inform the curriculum of the PG Dip (Rural Medicine).Setting: Rural district hospitals in South Africa.Methods: Nine hospitals in the Eastern Cape, KwaZulu-Natal and Mpumalanga were purposefully selected by Africa Health Placements as receiving ETDs. An online survey was developed asking about the most important competencies and weaknesses for ETDs when working rurally. The clinical manager and any ETDs currently working in each hospital were invited to complete the survey.Results: Surveys were completed by 19 ETDs and five clinical managers. The top clinical competencies in relation to 10 specific domains were identified. The results also indicate broader competencies required, specific skills gaps, the strengths that ETDs bring to South Africa and how ETDs prepare themselves for working in this context.Conclusion: This study identifies the important competency gaps among ETDs and provides useful direction for the diploma and other future training initiatives. The diploma faculty must reflect on these findings and ensure the curriculum is aligned with these gaps.

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THE ROLE OF DISTRICT HOSPITALS AND THE ACTION IN INTERNATIONAL MEDICINE NETWORK

Infectious Disease Clinics of North America ◽

10.1016/s0891-5520(20)30668-1 ◽

1995 ◽

Vol 9 (2) ◽

pp. 391-405

Author(s):

C. Andrew Pearson

Keyword(s):

International Medicine ◽

District Hospitals

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Letter to the Editor: Which Surgical Operations Should be Performed in District Hospitals in East, Central and Southern Africa? Results of a Survey of Regional Clinicians

World Journal of Surgery ◽

10.1007/s00268-020-05893-5 ◽

2021 ◽

Author(s):

Priyansh Nathani ◽

Priti Patil ◽

Monali Mohan ◽

Anita Gadgil ◽

Nobhojit Roy

Keyword(s):

Southern Africa ◽

East Central ◽

Letter To The Editor ◽

District Hospitals ◽

Surgical Operations

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Surgical ambulance referrals in sub-Saharan Africa – financial costs and coping strategies at district hospitals in Tanzania, Malawi and Zambia

BMC Health Services Research ◽

10.1186/s12913-021-06709-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Martilord Ifeanyichi ◽

Henk Broekhuizen ◽

Mweene Cheelo ◽

Adinan Juma ◽

Gerald Mwapasa ◽

...

Keyword(s):

Coping Strategies ◽

Surgical Care ◽

Sub Saharan Africa ◽

Financial Reports ◽

Study Approach ◽

Hospital Managers ◽

District Hospitals ◽

Sub Saharan ◽

Microsoft Office ◽

Patient Referrals

Abstract Background An estimated nine out of ten persons in sub-Saharan Africa (SSA) are unable to access timely, safe and affordable surgery. District hospitals (DHs) which are strategically located to provide basic (non-specialist) surgical care for rural populations have in many instances been compromised by resource inadequacies, resulting in unduly frequent patient referrals to specialist hospitals. This study aimed to quantify the financial burdens of surgical ambulance referrals on DHs and explore the coping strategies employed by these facilities in navigating the challenges. Methods We employed a multi-methods descriptive case study approach, across a total of 14 purposively selected DHs; seven, three, and four in Tanzania, Malawi and Zambia, respectively. Three recurrent cost elements were identified: fuel, ambulance maintenance and staff allowances. Qualitative data related to coping mechanisms were obtained through in-depth interviews of hospital managers while quantitative data related to costs of surgical referrals were obtained from existing records (such as referral registers, ward registers, annual financial reports, and other administrative records) and expert estimates. Interview notes were analysed by manual thematic coding while referral statistics and finance data were processed and analysed using Microsoft Office Excel 2016. Results At all but one of the hospitals, respondents reported inadequacies in numbers and functional states of the ambulances: four centres indicated employing non-ambulance vehicles to convey patients occassionally. No statistically significant correlation was found between referral trip distances and total annual numbers of referral trips, but hospital managers reported considering costs in referral practices. For instance, ten of the study hospitals reported combining patients to minimize trip frequencies. The total cost of ambulance use for patient transportation ranged from I$2 k to I$58 k per year. Between 34% and 79% of all patient referrals were surgical, with total costs ranging from I$1 k to I$32 k per year. Conclusion Cost considerations strongly influence referral decisions and practices, indicating a need for increases in budgetary allocations for referral services. High volumes of potentially avoidable surgical referrals provide an economic case – besides equitable access to healthcare – for scaling up surgery capacity at the district level as savings from decreased referrals could be reinvested in referral systems strengthening.

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Implementation of the Moyo fetal heart rate monitor in district hospitals in Bihar, India: a feasibility study

BMJ Open ◽

10.1136/bmjopen-2020-041071 ◽

2021 ◽

Vol 11 (2) ◽

pp. e041071

Author(s):

Hanna Oommen ◽

Kunal Ranjan ◽

Sudha Murugesan ◽

Aboli Gore ◽

Sunil Sonthalia ◽

...

Keyword(s):

Heart Rate ◽

Health System ◽

Fetal Heart Rate ◽

Clinical Training ◽

Fetal Heart ◽

Barriers And Facilitators ◽

Fetal Heart Rate Monitoring ◽

Cultural Challenges ◽

District Hospitals ◽

Bihar State

ObjectivesGlobally, half of all stillbirths occur during birth. Detection of fetal distress with fetal heart rate monitoring (FHRM), followed by appropriate and timely management, might reduce fresh stillbirths and neonatal morbidity. This study aimed to investigate the barriers and facilitators for the implementation of Moyo FHRM use in Bihar state, and secondarily, the feasibility of collecting reliable obstetrical and neonatal outcome data to assess the effect of implementation.SettingCARE Bihar and the hospital management at four district hospitals (DHs) in Bihar state, each with 6500 to 15 000 deliveries a year, agreed to testing the implementation of Moyo FHRM through a process of meetings, training sessions and collecting data. At each hospital, a clinical training expert was trained to train others, while a clinical assessment facilitator collected data.MethodologyObservational notes were taken at all training sessions and meetings. Individual interviews (n=4) were conducted with clinical training experts (CTEs) on training experiences and barriers and facilitators for Moyo FHRM implementation. The CTEs recoded field notes in diaries. Descriptive analyses performed on pre-implementation and post-implementation data (n=521) assessed quality and completeness.ResultsMain barriers to implementation of Moyo FHRM were health system and cultural challenges involving (1) existing practices, (2) insufficient human resources, (3) action delays and (4) cultural and local challenges. Another barrier was insufficient involvement of doctors. Facilitators for implementation were easy use of the Moyo FHRM device and adequate training for staff.Electronic collection of obstetrical data worked well but had substantial missing data.ConclusionHealth system and cultural challenges are a major constraint to Moyo FHRM implementation in low-resource settings. Improvements at all levels of infrastructure, practices and skills will be critical in busy DHs in Bihar. Full-scale implementation needs doctor-led leadership and ownership. Obstetrical data collection for the purpose of scientific analysis needs to be improved.

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Managing pneumonia through facility-based integrated management of childhood management (IMCI) services: an analysis of the service availability and readiness among public health facilities in Bangladesh

BMC Health Services Research ◽

10.1186/s12913-021-06659-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ahmed Ehsanur Rahamn ◽

Shema Mhajabin ◽

David Dockrell ◽

Harish Nair ◽

Shams El Arifeen ◽

...

Keyword(s):

Public Health ◽

Distribution System ◽

Integrated Management ◽

Child Death ◽

Health Facilities ◽

Family Welfare ◽

Service Availability ◽

District Health ◽

Public Health Facilities ◽

District Hospitals

Abstract Background With an estimated 24,000 deaths per year, pneumonia is the single largest cause of death among young children in Bangladesh, accounting for 18% of all under-5 deaths. The Government of Bangladesh adopted the WHO recommended Integrated Management of Childhood Illness (IMCI)-strategy in 1998 for outpatient management of pneumonia, which was scaled-up nationally by 2014. This paper reports the service availability and readiness related to IMCI-based pneumonia management in Bangladesh. We conducted a secondary analysis of the Bangladesh Health Facility Survey-2017, which was conducted with a nationally representative sample including all administrative divisions and types of health facilities. We limited our analysis to District Hospitals (DHs), Maternal and Child Welfare Centres (MCWCs), Upazila (sub-district) Health Complexes (UHCs), and Union Health and Family Welfare Centres (UH&FWCs), which are mandated to provide IMCI services. Readiness was reported based on 10 items identified by national experts as ‘essential’ for pneumonia management. Results More than 90% of DHs and UHCs, and three-fourths of UH&FWCs and MCWCs provide IMCI-based pneumonia management services. Less than two-third of the staff had ever received IMCI-based pneumonia training. Only one-third of the facilities had a functional ARI timer or a watch able to record seconds on the day of the visit. Pulse oximetry was available in 27% of the district hospitals, 18% of the UHCs and none of the UH&FWCs. Although more than 80% of the facilities had amoxicillin syrup or dispersible tablets, only 16% had injectable gentamicin. IMCI service registers were not available in nearly one-third of the facilities and monthly reporting forms were not available in around 10% of the facilities. Only 18% of facilities had a high-readiness (score 8–10), whereas 20% had a low-readiness (score 0–4). The readiness was significantly poorer among rural and lower level facilities (p < 0.001). Seventy-two percent of the UHCs had availability of one of any of the four oxygen sources (oxygen concentrators, filled oxygen cylinder with flowmeter, filled oxygen cylinder without flowmeter, and oxygen distribution system) followed by DHs (66%) and MCWCs (59%). Conclusion There are substantial gaps in the readiness related to IMCI-based pneumonia management in public health facilities in Bangladesh. Since pneumonia remains a major cause of child death nationally, Bangladesh should make a substantial effort in programme planning, implementation and monitoring to address these critical gaps to ensure better provision of essential care for children suffering from pneumonia.

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Effects of terrorist attacks on access to maternal healthcare services: a national longitudinal study in Burkina Faso

BMJ Global Health ◽

10.1136/bmjgh-2020-002879 ◽

2020 ◽

Vol 5 (9) ◽

pp. e002879

Author(s):

Thomas Druetz ◽

Lalique Browne ◽

Frank Bicaba ◽

Matthew Ian Mitchell ◽

Abel Bicaba

Keyword(s):

Antenatal Care ◽

Burkina Faso ◽

Negative Binomial ◽

Terrorist Attack ◽

Healthcare Services ◽

Terrorist Attacks ◽

Cesarean Sections ◽

Maternal Healthcare ◽

District Hospitals ◽

The Impact

IntroductionMost of the literature on terrorist attacks’ health impacts has focused on direct victims rather than on distal consequences in the overall population. There is limited knowledge on how terrorist attacks can be detrimental to access to healthcare services. The objective of this study is to assess the impact of terrorist attacks on the utilisation of maternal healthcare services by examining the case of Burkina Faso.MethodsThis longitudinal quasi-experimental study uses multiple interrupted time series analysis. Utilisation of healthcare services data was extracted from the National Health Information System in Burkina Faso. Data span the period of January 2013–December 2018 and include all public primary healthcare centres and district hospitals. Terrorist attack data were extracted from the Armed Conflict Location and Event Data project. Negative binomial regression models were fitted with fixed effects to isolate the immediate and long-term effects of terrorist attacks on three outcomes (antenatal care visits, of facility deliveries and of cesarean sections).ResultsDuring the next month of an attack, the incidence of assisted deliveries in healthcare facilities is significantly reduced by 3.8% (95% CI 1.3 to 6.3). Multiple attacks have immediate effects more pronounced than single attacks. Longitudinal analysis show that the incremental number of terrorist attacks is associated with a decrease of the three outcomes. For every additional attack in a commune, the incidence of cesarean sections is reduced by 7.7% (95% CI 4.7 to 10.7) while, for assisted deliveries, it is reduced by 2.5% (95% CI 1.9 to 3.1) and, for antenatal care visits, by 1.8% (95% CI 1.2 to 2.5).ConclusionTerrorist attacks constitute a new barrier to access of maternal healthcare in Burkina Faso. The exponential increase in terrorist activities in West Africa is expected to have negative effects on maternal health in the entire region.

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Is over-reporting a problem in mandatory communicable disease reporting? The taiwanese experience on Enterovirus 71

The Journal of Infection in Developing Countries ◽

10.3855/jidc.4623 ◽

2014 ◽

Vol 8 (10) ◽

pp. 1294-1300

Author(s):

Tseng Chu-Chun ◽

Yang Che-Ming

Keyword(s):

Communicable Disease ◽

Enterovirus 71 ◽

Surveillance Systems ◽

Accuracy Rate ◽

Cross Sectional ◽

Systems Methodology ◽

Disease Reporting ◽

Enteroviral Infection ◽

District Hospitals ◽

The Government

Introduction: In Taiwan, severe enteroviral infections must be reported to the government within 24 hours to ensure that severe enterovirus 71 (EV71) infections can be detected early. The objective of this research was to ascertain whether over-reporting is a problem in mandatory disease-reporting systems. Methodology: A multiyear cross-sectional study methodology was applied based on secondary data analyses. Data from the national notifiable communicable disease surveillance system of Taiwan Centers for Disease Control were analyzed to assess the trends and factors influencing reporting accuracy. Results: From July 1999 to December 2008, 2,611 cases of severe enteroviral infection were reported in Taiwan. Among these cases, 1,516 were confirmed to be EV71 cases, and the remaining 1,095 were confirmed to be non-EV71 infections. The overall accuracy rate was 58%. The accuracy rate was 60%–70% higher during epidemics (2000–2002, 2005, and 2008) and high seasons than it was in other seasons. The accuracy rate was highest among medical centers and lowest among district hospitals. Conclusions: The results indicated that reports are more accurate during high seasons and peak years than during other periods. This might be attributable to the adequate level of specific educational programs for professionals when more cases occur, which could facilitate identification. Based on experiences in Taiwan, optimal training can ensure that surveillance systems are not inundated by false-positive reports.

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