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.

Aligning Multiple Knowledge Perspectives in a Health Services System

2005 ◽  
pp. 207-221
Author(s):  
Tanya Castleman ◽  
Paul Swatman ◽  
Danielle Fowler
Keyword(s):  
Health Services ◽  
Service Delivery ◽  
Tacit Knowledge ◽  
Feasibility Study ◽  
Social Service ◽  
Organisational Structure ◽  
Major Barrier ◽  
Fine Grained ◽  
Service Data ◽  
The Web

This chapter reports the results of a feasibility study into electronic collection of service data at “point of delivery” for disability programs. The investigation revealed that while the proposed system would have produced more fine-grained data, it would not have improved any actor’s knowledge of service delivery. The study illustrated the importance of context in the transition from data to knowledge; the diffused and fragmented organisational structure of social service administration was shown to be a major barrier to effective building and sharing of knowledge. There was some value in the collection of detailed service data but this would have damaged the web of relationships which underpinned the system of service delivery and on which the smooth functioning of that system depended. The study recommended an approach to managing the informal and tacit knowledge distributed among many stakeholders, which was not especially technologically advanced but which supported, in a highly situated manner, the various stakeholders in this multi-organisational context.

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.

The Impact of Social Mobilization on Health Service Delivery and Health Outcomes

2018 ◽  
Author(s):  
Xavier Giné ◽  
Salma Khalid ◽  
Mansuri Ghazala
Keyword(s):  
Health Services ◽  
Service Delivery ◽  
Health Outcomes ◽  
Health Workers ◽  
Health Service Delivery ◽  
Health Providers ◽  
Child Health Outcomes ◽  
Rural Pakistan ◽  
Post Natal Care ◽  
The Impact

This chapter uses a randomized community development programme in rural Pakistan to assess the impact of citizen engagement on public service delivery and maternal and child health outcomes. The programme had a strong emphasis on organizing women, who also identified health services as a development priority at baseline. At midline, we find that the mobilization effort alone had a significant impact on the performance of village-based health providers. We detect economically large improvements in pregnancy and well-baby visits by female health workers, as well as increased utilization of pre- and post-natal care by pregnant women. In contrast, the quality of supra-village health services did not improve, underscoring the importance of community enforcement and monitoring capacity for improving service delivery.

Immunotherapy in Pancreatic Cancer

2020 ◽  
Vol 04 (04) ◽  
pp. 351-357
Author(s):  
Bassel F. El-Rayes ◽  
Mehmet Akce
Keyword(s):  
Pancreatic Cancer ◽  
Single Agent ◽  
Standard Of Care ◽  
Ongoing Research ◽  
Modest Improvement ◽  
Major Barrier ◽  
Dismal Prognosis ◽  
Rigorous Research ◽  
Tumor Mutational Burden ◽  
Immunosuppressive Tumor Microenvironment

AbstractPancreatic cancer has a dismal prognosis and is projected to be the second most common cause of cancer-related mortality by 2030. Although modest improvement in survival with current conventional cytotoxic chemotherapy-based regimens, 5-year overall survival is still 9%. Despite becoming standard of care in several malignancies, single agent or dual check point inhibitor therapy is not effective in pancreatic cancer except in subgroup of patients with high microsatellite instability or high tumor mutational burden. Profoundly immunosuppressive tumor microenvironment of pancreatic cancer is a major barrier for success of immunotherapy. Rigorous research efforts are underway to explore immune-based combination therapy with chemotherapy, radiation therapy, stroma-modifying agents, vaccines, and targeted therapies. This article aims to provide a review of the ongoing research in pancreatic cancer immunotherapy.

scholarly journals Health literacy and health outcomes in China’s floating population: mediating effects of health service

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hai-YanYu ◽  
Wei-Ling Wu ◽  
Lin-Wei Yu ◽  
Lei Wu
Keyword(s):  
Health Literacy ◽  
Health Service ◽  
Health Services ◽  
Health Outcomes ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Mediating Effect ◽  
Floating Population ◽  
Equation Modeling ◽  
Mediating Effects

Abstract Background The floating population in China consists primarily of internal immigrants and represents a typical health vulnerable group. Poor health literacy has recently become an obstacle in the accessibility and utilization of health services for the vulnerable population, leading to adverse health outcomes. This study aimed to examine whether health literacy affected health outcomes in China’s floating population and whether health service utilization had a mediating effect between health literacy and health outcomes. Method The current study utilized a cross-sectional stratified, multistage, proportional to scale (PPS) study in Zhejiang Province, China, in November and December 2019. In total, 657 valid self-reported questionnaires were recovered and used for data collection. Questionnaires included questions regarding sociodemographic characteristics, health literacy, health outcomes, and health service utilization. Confirmatory factor analysis was used to test questionnaire validity; descriptive statistics were used to understand the demographic characteristics of the floating population; and structural equation modeling was used to determine whether health service utilization mediated health literacy and health outcomes. Results We report positive correlations between health literacy, health service utilization, and health outcomes. Mediation analysis demonstrated that health service utilization had partial mediating effects between health literacy and health outcomes. In the relationship between health literacy and health outcomes, the indirect effects of health service utilization accounted for 6.6–8.7% of the total effects. Conclusion Complete health literacy, through health care literacy and health promotion literacy, affects the mobile population’s initiative to use health services, which, in turn, affects health outcomes. Thus, improving the health literacy of the floating population will help to improve health outcomes. Furthermore, health service providers should enhance the diversity of health service supply to ensure that the floating population has the external resources to improve personal health literacy.

scholarly journals The experiences and strategies of parents’ of adults with anorexia nervosa or bulimia nervosa: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jannike Karlstad ◽  
Cathrine Fredriksen Moe ◽  
Mari Wattum ◽  
Berit Støre Brinchmann
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Qualitative Study ◽  
Health Services ◽  
Bulimia Nervosa ◽  
Professional Support ◽  
Adult Daughters ◽  
Main Concern ◽  
The Core ◽  
Core Category

Abstract Background Caring for an individual with an eating disorder involves guilt, distress and many extra burdens and unmet needs. This qualitative study explored the experiences of parents with adult daughters suffering from anorexia nervosa or bulimia nervosa and the strategies they adopted. A subsidiary aim of the study was to explore the relationship between the caregivers’ perceived need for professional support and the support they reported receiving in practice from the health services. Methods Semi-structured interviews were conducted with 11 mothers and fathers from across Norway. Data collection, coding and analysis was conducted using the principles of constructivist grounded theory in an iterative process. The main concern shared by participants was identified by this process and their “solution” to the main concern then formed the content of the core category. Results ″Wearing all the hats″ emerged as the core category, indicating that the parents have to fulfil several roles to compensate the lack of help from health services. The three subcategories: “adapting to the illness”, “struggling for understanding and help” and “continuing to stay strong” described how the participants handled their situation as parents of adult daughters with eating disorders. Conclusions In daily life, the parents of adults with eating disorders have to attend to a wide range of caregiver tasks to help their ill daughters. This study suggests that the health services that treat adults with eating disorders should be coordinated, with a professional carer in charge. The parents need easy access to information about the illness and its treatment. They also need professional support for themselves in a demanding situation.

scholarly journals A National Accessibility Audit of Primary Health Care Facilities in Brazil—Are People with Disabilities Being Denied Their Right to Health?

2021 ◽  
Vol 18 (6) ◽  
pp. 2953
Author(s):  
Alexandro Pinto ◽  
Luciana Sepúlveda Köpcke ◽  
Renata David ◽  
Hannah Kuper
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
People With Disabilities ◽  
Health Care Facilities ◽  
Internal Space ◽  
Major Barrier ◽  
Healthcare Facilities ◽  
Primary Health ◽  
Care Facilities ◽  
Primary Health Care Facilities

Poor accessibility of healthcare facilities is a major barrier for people with disabilities when seeking care. Yet, accessibility is rarely routinely audited. This study reports findings from the first national assessment of the accessibility of primary health care facilities, undertaken in Brazil. A national accessibility audit was conducted by trained staff of all 38,812 primary healthcare facilities in Brazil in 2012, using a 22-item structured questionnaire. An overall accessibility score was created (22 items), and three sub-scales: external accessibility (eight items), internal accessibility (eight items), information accessibility (six items). The main finding is that the overall accessibility score of primary care facilities in Brazil was low (mean of 22, standard deviation (SD) of 0.21, on a 0–100 scale). Accessibility of different aspects of the healthcare facilities was also low, including external space (mean = 31.0, SD = 2.0), internal space (18.9, 1.9) and accessibility features for people with other visual or hearing impairments (6.3, SD = 1.0). Scores were consistently better in the least poor regions of Brazil and in facilities in larger municipality size (indicating more urban areas). In conclusion, large-scale accessibility audits are feasible to undertake. Poor accessibility means that people with disabilities will experience difficulties in accessing healthcare, and this is a violation of their rights according to international and Brazilian laws.

scholarly journals Factors supporting retention of health and wellbeing staff in Aboriginal health services: a strength-based case study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Sara Deroy ◽  
Heike Schütze
Keyword(s):  
Health Service ◽  
Health Services ◽  
Aboriginal Health ◽  
Social Accountability ◽  
Cultural Safety ◽  
Staff Retention ◽  
Professional Advancement ◽  
Aboriginal Community ◽  
Health And Wellbeing

Abstract Background Aboriginal Community Controlled Health Services are fundamental to improving the health and welfare of Aboriginal peoples. A key element that contributes to the effectiveness of these services are Aboriginal health and wellbeing staff. However, Aboriginal health and wellbeing staff often suffer high rates of stress and burnout. Current literature focuses on proposed strategies to increase staff retention in Aboriginal Health Services, yet, there is limited information available showcasing what has actually worked. Method This was an intrinsic strengths-based case study of one regional Aboriginal Community Controlled Health Service. Semi-structured research yarning interviews were conducted with past and present staff employed in health and wellbeing roles to highlight the factors that staff felt contributed to their retention. Results Ten interviews were conducted between February and April 2018. Six key themes emerged: social accountability, teamwork and collaboration, cultural safety, supervision, professional advancement, and recognition. We add to the literature by identifying the importance of bi-directional communication, and showing that social accountability, teamwork and collaboration, cultural safety, supervision, professional advancement, and recognition continue to be important factors that contribute to health and wellbeing staff retention in Aboriginal Health Services. Conclusion This exemplar Aboriginal Health Service may provide insights into future strategies to improve staff retention in other health services.

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