scholarly journals Exploring the Consequences of decentralization: Has privatization of health services been the perceived effect of decentralization in Khartoum Locality, Sudan?

2020 ◽  
Author(s):  
Bandar Noory ◽  
Sara A Hasssanein ◽  
Asma Elsony ◽  
Gunnar Bjune
Keyword(s):  
Health Services ◽  
Health Care Services ◽  
Health Workers ◽  
Qualitative Content Analysis ◽  
Health Sector ◽  
Public Health Services ◽  
Community Members ◽  
Radical Reform ◽  
Care Services ◽  
Study Participants

Abstract Background: The health system of Sudan has experienced several forms of decentralization, as well as, a radical reform. Authority and governance of secondary and tertiary health facilities have been shifted from federal to state levels. Moreover, the provision of health care services have been moved from large federal tertiary level hospitals such as Khartoum Teaching Hospital (KTH) and Jafaar Ibnaouf Hospital (JIH), located in the center of Khartoum, to smaller district secondary hospitals like Ibrahim Malik (IBMH), which is located in the southern part of Khartoum. Exploring stakeholders’ perceptions on this decentralisation implementation and the relevant consequences is vital in building an empirical benchmark for the improvement of health systems. Methods: This study utilizes a qualitative design which is comprised of an in-depth interviews and qualitative content analysis with an inductive approach. The study was conducted between July and December 2015, and aimed at understanding the personal experiences and perceptions of stakeholders towards decentralization enforcement and the implications on public health services, with a particular focus on the Khartoum locality. It involves community members residing in the Khartoum Locality, specifically in catchments area where hospital decentralization was implemented, as well as, affiliated health workers and policymakers. Results: The major finding suggests that the privatization of health services occurs after decentralization. The study participants also highlighted that scrutiny and reduction of budgets allocated to health services led to an instantaneous enforcement of cost recovery user fee. Devolving KTH Khartoum Teaching and Jafaar Ibnaouf Hospitals into peripherals with less capacity is considered to be a plan to outsource services to the private sector. Another theme that was highlighted in hospitals included the profit-making aspect of the governmental sector in the form of drug supplying and profit-making retail. Conclusions: A change in health services after the enforcement of decentralization was illustrated. Moreover, the empowerment of the privatization concept was the prevailing perception among stakeholders. Having in-depth studies and policy analysis in line with the global liberalization and adjustment programs is crucial for any health sector reform in Sudan. Keywords: decentralization, privatization, stakeholders, global liberalization, profit-making.

scholarly journals Perceived risks and barriers to care for international migrants in transit through Mexico

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Larrea ◽  
R Leyva-Flores ◽  
N Guarneros-Soto ◽  
C Infante-Xibille
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Health Personnel ◽  
Health Care Services ◽  
Barriers To Care ◽  
Human Security ◽  
Public Health Services ◽  
Care Services ◽  
In Transit

Abstract Background Mexico has implemented policies seeking to reduce barriers to care for migrants in transit; however, it is estimated that only 3% of migrants use public health services when needed. The main purpose of this study was to identify the barriers to access public health services faced by migrants in transit through Mexico. Methods Under the human security perspective, in 2018, a qualitative study was carried out in Mexican communities with high migrant mobility. 34 semi-structured interviews were conducted with migrants in transit, and personnel from public health services and migrant shelters (NGOs). Values and meanings related to risks, health problems, barriers to care, experiences of health services utilization, and opinions on facilitating elements to diminish these barriers were identified. Results Migrants in transit through Mexico face risks that affect all dimensions of human security. Perceived anti-migratory and discriminative attitudes during the journey were constantly mentioned in the interviews. Barriers to care were found in the four stages of health care access, classified according to the Tanahashi framework, with the majority related to accessibility and acceptability. The following facilitating elements were also identified: political willingness of local government, knowledge and talent management of health personnel, and strategies implemented for adapting local health care services to migrants. Conclusions Social and political conditions in Mexico disrupt any effort to reduce social risks and barriers to care for migrants in transit. Non-governmental actors are key players for facilitating interactions between migrants and local governmental health care institutions. However, the general anti-migratory context negatively affects access to health care and influence the perspectives of migrants, NGOs, and health personnel. Key messages The predominant perceived barriers to care are in counterpoint to local governmental pro-migrant rights perspectives. NGOs are key actors to promote access to public health care services.

scholarly journals Trends in horizontal inequity in access to public health care services by immigrant condition in Spain (2006–2017)

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Jaime Pinilla ◽  
Miguel A. Negrín ◽  
Ignacio Abásolo
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Health Care Services ◽  
Public Health Care ◽  
Specialist Care ◽  
Public Health Services ◽  
Horizontal Inequity ◽  
Latin Americans ◽  
Care Services

Abstract Background The objective of this research is to analyse trends in horizontal inequity in access to public health services by immigration condition in Spain throughout the period 2006–2017. We focus on “economic immigrants” because they are potentially the most vulnerable group amongst immigrants. Methods Based on the National Health Surveys of 2006–07 (N = 29,478), 2011–12 (N = 20,884) and 2016–17 (N = 22,903), hierarchical logistic regressions with random effects in Spain’s autonomous communities are estimated to explain the probability of using publicly-financed health care services by immigrant condition, controlling by health care need and other socioeconomic and demographic variables. Results Our results indicate that there are several horizontal inequities, though they changed throughout the decade studied. Regarding primary care services, the period starts (2006–07) with no global evidence of horizontal inequity in access (although the analysis by continent shows inequity that is detrimental to Eastern Europeans and Asians), giving way to inequity favouring economic immigrants (particularly Latin Americans and Africans) in 2011–12 and 2016–17. An opposite trend happens with specialist care, as the period starts (2006–07) with evidence of inequity that is detrimental to economic immigrants (particularly those from North of Africa) but this inequity disappears with the economic crisis and after it (with the only exception of Eastern Europeans in 2011–12, whose probability to visit a specialist is lower than for natives). Regarding emergency care, our evidence indicates horizontal inequity in access that favours economic immigrants (particularly Latin Americans and North Africans) that remains throughout the period. In general, there is no inequity in hospitalisations, with the exception of 2011–12, where inequity in favour of economic immigrants (particularly those from Latin America) takes place. Conclusions The results obtained here may serve, firstly, to prevent alarm about negative discrimination of economic immigrants in their access to public health services, even after the implementation of the Royal Decree RD Law 16/2012. Conversely, our results suggest that the horizontal inequity in access to specialist care that was found to be detrimental to economic immigrants in 2006–07, disappeared in global terms in 2011–12 and also by continent of origin in 2016–17.

scholarly journals The role of health services in encouraging disclosure of violence against women

2017 ◽  
Vol 56 (4) ◽  
pp. 220-226
Author(s):  
Vesna Leskošek ◽  
Miha Lučovnik ◽  
Lucija Pavše ◽  
Tanja Premru Sršen ◽  
Megie Krajnc ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care Services ◽  
Health Workers ◽  
Care Service ◽  
Health Care Service ◽  
Care Staff ◽  
Health Care Staff ◽  
Care Services

Abstract Introduction The aim of the survey was to assess the differences in disclosure by the type of violence to better plan the role of health services in identifying and disclosing violence. Methods A validated, anonymous screening questionnaire (NorAQ) for the identification of female victims of violence was offered to all postpartum women at a single maternity unit over a three-month period in 2014. Response rate was 80% (1018 respondents). Chi square test was used for statistical analysis (p<0.05 significant). Results There are differences in disclosure by type of violence. Nearly half (41.5%) of violence by health care services was not reported, compared to 33.7% physical, 23.4% psychological, and 32.5% sexual that was reported. The percentage of violence in intimate partnership reported to health care staff is low (9.3% to 20.8%), but almost half of the violence experienced by heath care services (44%) is reported. Intimate partnership violence is more often reported to the physician than to the psychologist or social worker. Violence in health care service is reported also to nurses. Conclusions Disclosure enables various institutions to start with the procedures aimed at protecting victims against violence. Health workers should continuously encourage women to speak about violence rather than asking about it only once. It is also important that such inquiries are made on different levels of health care system and by different health care professions, since there are differences to whom women are willing to disclose violence.

scholarly journals Health Worker Experiences of and Perspectives on Engaging Men in HIV Care: A Qualitative Study in Cape Town, South Africa

2020 ◽  
Vol 19 ◽  
pp. 232595822093569
Author(s):  
Nonzuzo Mbokazi ◽  
Rutendo Madzima ◽  
Natalie Leon ◽  
Mark N Lurie ◽  
Morna Cornell ◽  
...  
Keyword(s):  
Health Services ◽  
Health Care Services ◽  
Health Workers ◽  
Cape Town ◽  
Public Health Care ◽  
Hiv Care ◽  
Care Services ◽  
Engaging Men ◽  
Hiv Cascade ◽  
Competing Priorities

Men generally fare worse than women across the HIV cascade. While we know much about how men perceive the health services, we know little about how health workers (HWs) themselves have experienced engaging with men and what strategies they have used to improve this engagement. We interviewed 12 HWs in public health care services in Cape Town to better understand their experiences and perspectives. Health workers felt there were significant gaps in men’s engagement with HIV care and identified masculine gender norms, the persistent impact of HIV stigma, and the competing priorities of employment as key barriers. They also highlighted a number of health service-related challenges, including a poor perception of the patient–provider relationship, frustration at low service quality, and unrealistic expectations of the health services. Health workers also described several strategies for more effectively engaging men and for making the health services both more male friendly and more people friendly.

scholarly journals Using the location-allocation P-median model for optimising locations for health care centres in the city of Jeddah City, Saudi Arabia

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Abdulkader Murad ◽  
Fazlay Faruque ◽  
Ammar Naji ◽  
Alok Tiwari
Keyword(s):  
Health Care ◽  
Saudi Arabia ◽  
Health Services ◽  
Health Care Services ◽  
Health Sector ◽  
Evidence Base ◽  
Spatial Accessibility ◽  
Location Allocation ◽  
The Road ◽  
Care Services

Considering spatial accessibility of health services is a critical part in the planning and management of health services. There is evidence that poor geographical locations can obstruct prompt basic health care services to some population sections. We developed a location-allocation P-median model for health centres after analysing their sites, demand location of health services and the road network in Jeddah, Saudi Arabia. This model attempts to optimize health care services network and to put forward location recommendations to maximise service coverage. Our model is shown to be useful as it provides a robust evidence base to urban planners and policymakers responsible for making spatial decisions for the development of the health sector. Besides, it follows the paradigm of new urbanism that encourages decentralisation of essential facilities including basic healthcare in cities, where emphasis is on offering all basic services within walkable distances of 15 min. or less.

scholarly journals Narrative Study of Shariah Hospitals in Indonesia: A Review of Islamic Brand Communities Innovation for Health Care

2020 ◽  
Author(s):  
Wahyu Sulistiadi ◽  
Sri Rahayu ◽  
Meita Veruswati ◽  
Al Asyary
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care Services ◽  
Health Workers ◽  
Code Of Conduct ◽  
Hospital Management ◽  
Hospital System ◽  
Narrative Study ◽  
Care Services

The Ministry of Health evaluates hospital management in accordance with the standard of quality of service. The concept of Shariah hospitals offers management services that exceed the standard of quality of hospital care. The study aims to illustrate the concept of Shariah hospitals in Indonesia. We collect related literature from various media via online search with the keywords “Shariah hospitals,” “implementation of Shariah hospitals,” and “application of Shariah hospitals.” Main findings: The study finds that the Shariah hospitals built by the philosophy of Islam are willing to provide the best health-care services to patients. A code of conduct must be fulfilled by the hospital management in Shariah hospitals: (1) general liability, (2) obligations to society and the environment, (3) obligations to patients, (4) obligations to the leaders, staff, and employees, and (4) relationships with related institutions. The foremost challenges include the improvement of health personnel performance and the quality of services in addition to perceptions that are not inclusive of the system of Shariah hospitals. This implementation should run consistently and with the commitment of all parties. Such insight, in turn, can be counted as an input to an approach to health services, particularly in increasing the performance rates, such as hospital. This study is the first to provide new insight into discussion about shariah hospital by presenting its focuses on Islamic approaches in meeting the quality standards of health services in hospitals so as to obtain more value. However, exclusive principles—Islamization, heterogeneity, and the performance of health workers—challenge the implementation of this hospital system.

scholarly journals A Juridical Review on the Enforcement of Criminal Law to the Violations of Tender Conspiracy Practices in the Procurement of Government Goods/Services in Health Sector

2021 ◽  
Vol 04 (12) ◽  
Author(s):  
Retna K. Rachman ◽  
◽  
◽  
Keyword(s):  
Public Health ◽  
Health Services ◽  
Health Care Services ◽  
Health Sector ◽  
Government Procurement ◽  
Market Demand ◽  
Goods And Services ◽  
Care Services ◽  
The Government ◽  
Demand For Health

Due to the demand for health care services that is getting higher, making business actors engaged in the provision of health services/facilities also seek to further improve the services they have to meet market demand. Hospitals and health clinics are increasingly diverse in offering health services to potential consumers. So that people as consumers also have a variety of choices to fulfill their needs for health services. The health sector is one of the programs that has a fairly large budget item at this time, namely the health equipment procurement program. The large budget allocation from the government opens up opportunities to be misused if there is no strict supervision from the stakeholders themselves or from other institutions. The health budget that should be used to build public health is actually used to enrich oneself and others which can result in poor service and quality of public health. Meanwhile, one of the basic problems related to business competition in Indonesia is the process of procurement of government goods/services. In the process of procuring government goods and services, some believe that there are still many practices of conspiracy to determine the winner in a tender. This clearly contradicts the principles and mechanisms that have been regulated in Presidential Regulation No. 12 of 2021 concerning Government Procurement of Goods/Services and Law No. 5 of 1999 concerning Government Procurement. KPPU was formed based on the mandate of Law Number 5 of 1999. The purpose of this paper is to examine the extent to which the limitations and powers of the KPPU are related to the handling of cases of tender conspiracy which have implications for criminal acts.

scholarly journals Quale economia sanitaria per il rispetto della persona?

2005 ◽  
Vol 54 (1) ◽  
Author(s):  
Stefano Zamagni
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Care Services ◽  
Health Sector ◽  
Health Care Expenditures ◽  
Freedom Of Choice ◽  
Industry Sector ◽  
Care Services ◽  
Pros And Cons ◽  
Over Time

Dopo aver descritto le principali ragioni per cui la spesa sanitaria è destinata ad aumentare nel corso del tempo, l’articolo esamina criticamente la nozione di libertà di scelta applicata all’area dei servizi sanitari. La proposta avanzata per superare la crescente distanza tra le risorse e le spese è passare dalla nozione di distretto sanitario a quella di distretto industriale sanitario. Infine, l’articolo esplora il tema del razionamento nei servizi sanitari discutendo i pro e i contro dei maggiori approcci al razionamento presenti nella letteratura e proposti a partire dalla prospettiva del personalismo filosofico. ---------- After describing the main reasons why health care expenditures are doomed to increase over time, the paper critically examines the notion of freedom of choice in the area of health services. The proposal advanced to overcome the growing gap between resources and expenditures is to move from the notion of health sector to that of health industry sector. Finally, the paper considers the notion of rationing in health care services and discusses the pros and cons of the major approaches to rationing so far advanced in the literature from the perspective of philosophical personalism.

scholarly journals Effect of referral for dental service on dental-service utilization by primary school children aged 8 to 11 years in Enugu, Nigeria

2017 ◽  
Vol 15 (2) ◽  
pp. 151 ◽  
Author(s):  
Nneka Kate Onyejaka ◽  
Morenike Oluwatoyin Folayan ◽  
Nkiruka Folaranmi
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Health Services ◽  
Health Care Services ◽  
Oral Health Care ◽  
Dental Service ◽  
Care Services ◽  
Oral Health Services ◽  
Study Participants ◽  
Referral Letters

Aim: To determine how one dental education session and referral of study participants aged 8-11 years would affect utilization of oral-health care services. Methods: This descriptive prospective study recruited 1,406 pupils aged 8-11 years from randomly selected primary schools in Enugu metropolis. All pupils received one oral-health education and referral letters for treatment. Data were collected on the pupils’ socio-demographic profile, family structure, and history of oral-health care utilization in the 12 months preceding the study and within 12 months of receipt of referral letter. The effect of these factors as predictors of past and recent dental service utilization was determined using logistic regression. Results: Only 4.3% of the study participants had ever used oral-health services in the 12 months prior to the study. Within 12 months of issuing the referral letters, 9.0% of pupils used the oral-health services. Children from middle (AOR: 0.46; CI: 0.29-0.73; p=0.001) and low socioeconomic strata (AOR: 0.21; CI: 0.11-0.39; p<0.001) and those living with relatives/guardians (AOR: 0.08, CI: 0.01-0.56; p=0.01) were still less likely to have utilized oral-health services. Conclusions: Referral of children for oral-health care increased the number of children who utilized oral health care services.

scholarly journals Building trust and enhancing localization to improve access to women’s health services in Afghanistan

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F R Rab ◽  
S S Stranges ◽  
A D Thind ◽  
S S Sohani
Keyword(s):  
Health Care ◽  
Health Services ◽  
Vulnerable Populations ◽  
Time Trend ◽  
Health Workers ◽  
Healthcare Services ◽  
Delivery Of Healthcare ◽  
Care Services ◽  
Women And Children ◽  
Delivery Of Health Services

Abstract Background Over 34 million people in Afghanistan have suffered from death and devastation for the last four decades as a result of conflict. Women and children have borne the brunt of this devastation. Afghanistan has some of the poorest health indicators in the world for women and children. In the midst of armed conflict, providing essential healthcare in remote regions in the throws of conflict remains a challenge, which is being addressed the Mobile Health Teams through Afghan Red Crescent (ARCS). To overcome socio-cultural barriers, ARCS MHTs have used local knowledge to hire female staff as part of the MHTs along with their male relatives as part of MHT staff. The present study was conducted to explore the impact of engaging female health workers as part of MHTs in conflict zones within Afghanistan on access, availability and utilization of maternal and child health care. Methods Quantitative descriptive and time-trend analysis were used to evaluate impact of introduction of female health workers. Qualitative data is being analyzed to assess the possibilities and implications of engaging female health workers in the delivery of health services. Results Preliminary results show a 96% increase in uptake of services for expectant mothers over the last four years. Average of 18 thousand services provided each month by MHTs, 70% for women and children. Service delivery for women and children significantly increased over time (p &lt; 0.05) after inclusion of female health workers in MHTs. Delivery of maternity care services showed a more significant increase (p &lt; 0.001). Time trend and qualitative analyses is ongoing. Conclusions Introduction of female health workers significantly improved uptake of health care services for women and children especially in extremely isolated areas controlled by armed groups in Afghanistan. Engaging with local stakeholders is essential for delivery of health services for vulnerable populations in fragile settings like Afghanistan. Key messages Understanding cultural norms results in socially acceptable solutions to barriers in delivery of healthcare services and leads to improvements in access for women and children in fragile settings. Building local partnerships and capacities and using local resources result in safe, efficient and sustainable delivery of healthcare services for vulnerable populations in fragile settings.

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