The right staffing mix for inpatient care in rural multi-purpose service health facilities

Antimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) and Joint Medical Stores (JMS) to 442 health facilities from 2017 to 2019. Data were analyzed using the World Health Organization methodology for AMC surveillance. Total quantity of antimicrobials in defined daily dose (DDD) were determined, classified into Access, Watch, Reserve (AWaRe) and AMC density was calculated. There was an increase in total DDDs distributed by NMS in 2019 by 4,166,572 DDD. In 2019, Amoxicillin (27%), Cotrimoxazole (20%), and Metronidazole (12%) were the most supplied antimicrobials by NMS while Doxycycline (10%), Amoxicillin (19%), and Metronidazole (10%) were the most supplied by JMS. The majority of antimicrobials supplied by NMS (81%) and JMS (66%) were from the Access category. Increasing antimicrobial consumption density (DDD per 100 patient days) was observed from national referral to lower-level health facilities. Except for NMS in 2019, total antimicrobials supplied by NMS and JMS remained the same from 2017 to 2019. This serves as a baseline for future assessments and monitoring of stewardship interventions.

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Out-of-Pocket Health Expenditures Among Insured and Uninsured Patients in Vietnam

Asia Pacific Journal of Public Health ◽

10.1177/1010539519833549 ◽

2019 ◽

Vol 31 (3) ◽

pp. 210-218 ◽

Cited By ~ 1

Author(s):

Nguyen Duc Thanh ◽

Bui Thi My Anh ◽

Chu Huyen Xiem ◽

Hoang Van Minh

Keyword(s):

Outpatient Care ◽

Inpatient Care ◽

Health Care Services ◽

Health Facilities ◽

Least Square ◽

Health Centers ◽

Health Coverage ◽

District Health ◽

District Hospitals ◽

Universal Health

Out-of-pocket expenditure/payment (OOP) is one of the indicators measuring the achievement of Universal Health Coverage. This article aimed to compare OOP among the insured and uninsured for their outpatient and inpatient health care services. The data of 6710 individuals using outpatient care and 924 individuals using inpatient care at 78 district hospitals and 246 commune health centers in 6 provinces from the World Bank survey, “The 2015 Vietnam District and Commune Health Facility,” were used for analysis. In the ordinary least square model, the estimated coefficient of the insurance status variable suggested that insurance reduced OOP by 31.1% for outpatient care and 31.5% for inpatient care of the insured as compared with the uninsured ( P <0.001). For outpatient care, insurance reduced OOP more for those enrollees using commune health centers than those using district health facilities, 42.3% and 20.2%, respectively. For inpatient care at district health facilities, insurance reduced OOP by 34.9% as compared with the uninsured ( P <0.001). The study suggested that more active solutions should be created to promote the universal health insurance in Vietnam.

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Kemampuan Klinik Pratama dalam Menangani 195 Diagnosis di Kota Surabaya

Buletin Penelitian Sistem Kesehatan ◽

10.22435/hsr.v24i1.2991 ◽

2021 ◽

Vol 24 (1) ◽

pp. 11-19

Author(s):

Eka Fitria Sari ◽

Faihatul Mukhbitin ◽

Ernawaty Ernawaty

Keyword(s):

Primary Care ◽

Cost Containment ◽

Health Department ◽

Health Facilities ◽

Cross Sectional ◽

Primary Care Clinics ◽

Primary Health ◽

Clinical Diagnoses ◽

The Right ◽

Primary Health Facilities

Head of Surabaya City Health Department Decree No.440/19547/436.3/2016 is based on Indonesian Minister of Health Decree No.HK.02.02/MENKES/514/2015. The regulation explains the need for the management of 195 clinical diagnoses in primary health facilities because it is related to the primary health facilities' capability to handle 195 clinical diagnoses. The RRNS achievement table in January-May 2017 shows that primary care clinics were primary health facilities that occupy the unsafe zone (RRNS>5%) namely 16.68% in Surabaya City. The research objective is to analyze the primary care clinics' capability in Surabaya City to handle the 195 clinical diagnoses. This research used a descriptive cross-sectional design in four primary care clinics with 20 people sampled. The results showed that all clinics had not been able to provide complete services. Clinical doctors had good capabilities in accordance with the Head of Surabaya City Health Department Decree No.440/19547/436.3/2016 but were not supported by the completeness of supply following the Indonesia Minister of Health Decree No.HK.02.02/MENKES/514/2015. In conclusion, only 65 (≤33%) clinical diagnoses can be handled properly with the imbalance between the doctors' capabilities and completeness of supply. This research suggests the regulation makers must also review the primary care clinics' capability to provide supplies and clinics can determine the right cost-containment strategy to handle 195 clinical diagnoses. Abstrak SK Kadinkes Kota Surabaya No.440/19547/436.3/2016 didasari oleh Kepmenkes RI No.HK.02.02/MENKES/514/2015. Peraturan yang menjelaskan tentang kebutuhan penatalaksanaan penanganan 195 diagnosis klinis di FKTP karena berkaitan dengan kemampuan FKTP melakukan penanganan. Tabel pencapaian RRNS bulan Januari-Mei 2017 menunjukkan klinik pratama merupakan jenis FKTP yang paling banyak menempati zona tidak aman (RRNS>5%) yakni 16,68% di Surabaya. Penelitian bertujuan menganalisis kemampuan klinik pratama di Kota Surabaya dalam menangani 195 diagnosis klinis. Penelitian menggunakan desain crosssectional deskriptif di empat klinik pratama dengan sampel 20 orang. Hasil menunjukkan semua klinik yang diteliti belum mampu menyediakan pelayanan secara lengkap. Dokter klinik memiliki kemampuan yang baik sesuai SK Kadinkes Kota Surabaya No.440/19547/436.3/2016 tetapi tidak didukung dengan kelengkapan supply yang dibutuhkan sesuai Kepmenkes RI No.HK.02.02/MENKES/514/2015. Kesimpulannya, diagnosis klinis yang dapat ditangani dengan baik hanya sebanyak 65 (≤33%) dengan hambatan ketidakseimbangan antara kemampuan dokter dan kelengkapan supply. Penelitian ini menyarankan pembuat kebijakan juga meninjau kemampuan klinik dalam menyediakan supply dan klinik dapat menentukan strategi cost containment yang tepat untuk menangani 195 diagnosis klinis.

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Integrating Mental Health and Psychosocial Support Into Health Facilities in Conflict Settings: A Retrospective Review From Six African Countries

Frontiers in Public Health ◽

10.3389/fpubh.2020.591369 ◽

2020 ◽

Vol 8 ◽

Author(s):

Ida Andersen ◽

Rodolfo Rossi ◽

Mamie Nouria Meniko Yabutu ◽

Ives Hubloue

Keyword(s):

Mental Health ◽

Psychological Distress ◽

Psychosocial Support ◽

Health Facilities ◽

Symptoms Of Depression ◽

Conflict Settings ◽

Victims Of Violence ◽

The Right ◽

The Military ◽

Financial Losses

Introduction: The International Committee of the Red Cross runs an increasing number of mental health and psychosocial programmes integrated into health facilities in conflict settings across Africa. This study looks at changes in symptoms of psychological distress and impaired functioning among patients supported through such programmes.Material and Methods: Between January and December 2019, 5,527 victims of violence received mental health and psychosocial support in 29 health facilities in Burundi, Central African Republic, Democratic Republic of the Congo, Mali, Nigeria and South Sudan. Symptoms of psychological distress (IES-R or DASS21) and daily functioning (ICRC scale) were assessed before and after the intervention. Logistical regression models were used to measure associations between these symptoms and the other variables.Results: Factors associated with high distress prior to receiving support included age (peaking at 45–54 years), intervening within three months, rape, caretaker neglect, internal displacement, secondary education level and referral pathway. Anxiety levels in particular were higher among victims of violence committed by unknown civilians, the military or armed groups. Low functioning was associated with divorce, grief and violence committed by the military or armed groups. Following the intervention, the vast majority of patients reported reduced psychological distress (97.25% for IES-R and 99.11% for DASS21) and improved daily functioning (93.58%). A linear trend was found between number of individual sessions and reduction in symptoms of distress. Financial losses were associated with less reduction in symptoms of depression and stress.Discussion: To further address the mental health and psychosocial needs of victims of violence, intervening quickly and increasing the number of individual sessions per patient is crucial. This requires proximity—being in the right place at the right time—which is challenging when working in stable health structures. Symptoms of depression should not be overlooked, and financial losses must be addressed in order to holistically meet the needs of victims of violence.

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Prevalence and causes of visual impairment and blindness among adults with diabetes mellitus aged 40 years and older receiving treatment at government health facilities in the Mopani District, South Africa

African Vision and Eye Health ◽

10.4102/aveh.v73i1.2 ◽

2014 ◽

Vol 73 (1) ◽

Author(s):

R.G. Mabaso ◽

O.A. Oduntan

Keyword(s):

Diabetes Mellitus ◽

South Africa ◽

Visual Impairment ◽

Economic Status ◽

Health Care Facilities ◽

Health Facilities ◽

Cross Sectional ◽

Government Health ◽

The Government ◽

The Right

This article presents part of the findings of a study conducted to assess the prevalence and causes of visual impairment (VI) and blindness among adults with diabetes mellitus (DM) receiving treatment at the government health facilities in the Mopani District, South Africa. This health facility-based cross-sectional study was conducted among 225 Black South African diabetics (161 females and 64 males) aged 40-90 years (mean= 61.50 ± 10.49) years at seven different health care facilities. All the participants were examined for VI using an auto-refractor, pinhole disc, an ophthalmoscope, and a logMAR chart. Visual impairment was defined as visual acuity (VA) of worse than 6/9.5 but better and equal to 3/60, and blindness as VA of worse than 3/60 to no light perception. The prevalence of uncompensated VI and blindness in the right eyes was 70.6 and 3.6%, respectively. In the left eyes, the prevalence was 72 and 3.1% for VI and blindness respectively. The prevalence of blindness remained the same after optical compensation. The leading causes of uncompensated VI and blindness in both eyes were uncorrected refractive error (RE) (49.5%), cataract (24.7%), diabetic retinopathy (3.8%) and glaucoma (2.2%). Following optical compensation, the prevalence of compensated VI and blindness in the right eyes was 41.3 and 3.6%, respectively and in the left eyes, the prevalence was 42.2 and 3.1%, respectively. Uncompensated RE and cataract were the common causes of VI and blindness in this sample. The socio-economic status of this population might have contributed to these findings. These results indicate the need for affordable vision examination and spectacles provision as well as cataract surgery services in this population.

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Healthy choices in New South Wales health facilities for staff and visitors: a policy evaluation

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1143 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

H Trevena ◽

E Munn ◽

L King ◽

M Thomas ◽

L Shepherd ◽

...

Keyword(s):

Policy Evaluation ◽

New South ◽

New South Wales ◽

Evaluation Study ◽

Health Facilities ◽

Local Health ◽

Healthy Weight ◽

Food Outlets ◽

South Wales ◽

The Right

Abstract Issue Obesity and its determinants are risk factors for most leading causes of chronic diseases. In New South Wales (NSW), Australia, 1 in 2 adults and more than 1 in 5 children are above a healthy weight. As a key symbolic part of a suite of health eating policies, the NSW Ministry of Health implemented a Healthy Food and Drink in NSW Health facilities for Staff and Visitors Framework (Framework) across 18 Local Health Districts (LHDs). Many countries are grappling to understand the effectiveness of obesity prevention policies. Description 2: This policy evaluation synthesised evaluation study findings and internal records to assess the effectiveness of the Framework in achieving implementation targets: a) the removal of sugar-sweetened drinks (SSDs) from sale (Dec 2017), b) implementation of 12 food-based practices (Dec 2018). Results The overall implementation package was appropriate for the large, geographically dispersed, decentralised health system (160 health facilities; 927 food outlets;76 retailers) and variable retail arrangements. The Ministry provided LHDs with overall direction, phasing, and monitoring; the LHDs had local leadership, governance, cross-functional support and autonomy to implement in a way to suit them. Accountability and pace of implementation was driven most notably by monitoring and reporting using an electronic tool (PHIMS-N), and a 'network of practice' that was pivotal to problem solving. SSDs were removed from 96% (n = 606) of applicable food outlets; overall average achievement of all practices was high at 82% (22.4 SD). Nine in 10 (92%) consumers support the Framework, and retailers are accepting of its targets. Lessons: This was the right policy at the right time, with well-orchestrated implementation. Annual monitoring and reporting enabled by PHIMS-N is unique in this type of policy implementation and essential for tracking progress, informing decision making, and ensuring accountability. Key messages Implementation of the Framework has resulted in the removal of SSDs from sale, increased availability of healthier foods and decreased unhealthy foods as measured by 12 food-based practices. The Framework is feasible and effective in influencing retail practices in health facilities, has high consumer support for its goals, and overall acceptability and adoption amongst retailers.

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Penentuan Lokasi Fasilitas Kesehatan Strategis Menggunakan Metode Naive Bayes pada RSU Bintang

INFORMAL: Informatics Journal ◽

10.19184/isj.v6i2.23798 ◽

2021 ◽

Vol 6 (2) ◽

pp. 52

Author(s):

Aniek Suryanti Kusuma ◽

Welda Welda ◽

I Komang Juliana

Keyword(s):

Decision Support ◽

Decision Support System ◽

Data Processing ◽

Health Facility ◽

Support System ◽

Naive Bayes ◽

Current System ◽

Naïve Bayes ◽

Health Facilities ◽

The Right

At present the selection of strategic health facility locations is not easy, to determine the right location and in accordance with the needs of patients must use the right calculation. Bintang General Hospital (RSU Bintang) has difficulties in determining the strategic location of new health facilities. The difficulty is due to the absence of data processing from the current system so that in determining the location of strategic health facilities is not based on data that has been analyzed. Based on the problems experienced by RSU Bintang and to assist in making a decision in establishing a strategic health facility location, a study was made to design a decision support system that can perform calculations to determine the location of the most strategic health facility with the title "Decision Support System. Determining the Location of Strategic Health Facilities Using the Naive Bayes Method at RSU Bintang”. Decision support system that is built will have several functions, such as processing patient register data, user data processing, alternative location data processing, criteria data processing, data processing rules, Naive Bayes calculations and managing several reports that can be used as decision support for the RSU Bintang. in determining the location of the most strategic health facilities. In this system, testing has been done by using blackbox testing which gets the test results in accordance with the system design.

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Abstract 233: Diagnostic and Treatment Capacity for Heart Failure in Sub-Saharan Africa: an Analysis of Uganda and Kenya

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.8.suppl_2.233 ◽

2015 ◽

Vol 8 (suppl_2) ◽

Author(s):

Selma Durakovic ◽

Herbert Duber ◽

Gregory Roth

Keyword(s):

Heart Failure ◽

Inpatient Care ◽

Health Facilities ◽

Sub Saharan Africa ◽

Survey Question ◽

Hiv Counseling ◽

Reduced Ejection Fraction ◽

Treat Heart Failure ◽

Nationally Representative ◽

Sub Saharan

Background: There is increasing recognition that heart failure is a significant component of disease burden in Sub-Saharan Africa (SSA) and that better strategies for heart failure management are needed. However, relatively little is known about the capacity to diagnose and treat heart failure in this region. Objectives: In this study, we seek to better understand the health system’s capacity to diagnose and treat heart failure in Uganda and Kenya, in order to inform policy planning and interventions. Methods: We analyzed data from a nationally-representative survey of health facilities in Uganda and Kenya, conducted by the Institute for Health Metrics and Evaluation (IHME) as part of the Access, Bottlenecks, Costs, and Equity (ABCE) project. A structured survey instrument was administered at each facility between 2011 and 2012. In this study we examine the availability of cardiac diagnostic technologies, medications for heart failure, and emergency transportation to an inpatient facility. A package of medications for heart failure with reduced ejection fraction (HFrEF) was defined from local formulary guidelines as including beta-blocker (propranolol or atenolol), ACE inhibitor (captopril or lisinopril), and furosemide. Facility-level data was analyzed by platform type (hospital vs health center), ownership (public vs private), inpatient care availability, and location (urban, semi-urban, or rural). Results: We analyzed 197 health facilities in Uganda and 143 in Kenya after excluding dispensaries, pharmacies, and HIV counseling centers. Among facilities responding to this survey question, functional and staffed ECG was available in 24% of facilitiesin Uganda and 36% of facilities in Kenya. However, this survey question was left unanswered by approximately 70% of the facilities in each country. In regards to treatment capabilities, 37% of Ugandan and 24% of Kenyan facilities reported availability of a basic package of heart failure medications on the day the survey was administered. This was driven predominantly by the low availability of ACE inhibitors, which were available in only 41% of Ugandan and 29% of Kenyan facilities. Of the facilities with medication availability, 26% of Ugandan and 32% of Kenyan facilities had a significant stock out (8+ days) of at least one of the medications in the prior quarter. Of the facilities that did not offer inpatient care, 41% of Ugandan and 66% of Kenyan facilities were prepared for emergency transportation. Conclusion: Few facilities in Uganda and Kenya were prepared to perform necessary tests to diagnose and manage heart failure. Less than half of the facilities in both countries had the medications needed to treat HFrEF. Further investment in cardiac care will be required by these developing health systems if they are to address the growing burden of heart failure.

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Availability and Affordability of Children Essential Medicines in Health Facilities of Southern Nations, Nationalities, And People Region, Ethiopia: Key Determinants for Access.

10.21203/rs.3.rs-115159/v1 ◽

2020 ◽

Author(s):

Tefera Tadesse ◽

Habtamu Abuye L ◽

Gizachew Tilahun

Keyword(s):

Essential Medicine ◽

Health Facilities ◽

Essential Medicines ◽

High Price ◽

Unskilled Worker ◽

Price Ratio ◽

Cross Sectional ◽

The Public ◽

The Right ◽

Medicine Outlets

Abstract Background: Children in resource-limited countries are more likely to die from treatable conditions than those in higher resource settings due to a lack of the right essential medicine at the right time. Globally millions of children die every year from conditions that could be treatable with existing medicines before they reach their fifth birthday. This study aimed in assessing the availability and affordability of essential medicine for children in selected health facilities of southern nations, nationalities, and peoples’ regions (SNNPR), Ethiopia. Method: A medicine outlets-based cross-sectional study was conducted to assess the availability, affordability, and prices of the 30 selected EMs for children in 30 public and 30 private medicine outlets in SNNPR from March 29 to May 5, 2019, applying WHO and Health Action International (HAI) tools. Availability was expressed as the percentage of sampled medicine outlets per sector that the surveyed medicine was found on the day of data collection. The number of daily wages required for the lowest-paid government unskilled worker (LPGW) to buy one standard treatment of an acute condition or treatment for a chronic condition for a month was used to measure affordability and median price ratio for the price of EDs. Results: Availability was varied by sectors, type of medicines, and level of health facilities. The average availability of EMs was 57.67% in the public sector and 53.67% in private sectors. Ceftriaxone, ORS, zink sulfate, and cotrimoxazole were the most widely available medicine types in both sectors. The median price ratios (MPR) for lowest-priced (LP) medicines were 1.26 and 2.24 times higher than their international reference price (IRP) in the public and private sectors respectively. Eighty-two percent of LP medicines in the public and ninety-one percent of LP medicines in the private sectors used in the treatments of prevalent common conditions in the region were unaffordable as they cost a day’s or more wages for the LPGW.Conclusion: Availability, affordability, and price are determinant pre-requisite for EMs access. According to the current work, although fair availability was achieved, the observed high price affected affordability and hence access to EMs.

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Availability and affordability of children essential medicines in health facilities of southern nations, nationalities, and people region, Ethiopia: key determinants for access

BMC Public Health ◽

10.1186/s12889-021-10745-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Tefera Tadesse ◽

Habtamu Abuye ◽

Gizachew Tilahun

Keyword(s):

Essential Medicine ◽

Health Facilities ◽

Essential Medicines ◽

High Price ◽

Unskilled Worker ◽

Price Ratio ◽

Cross Sectional ◽

The Public ◽

The Right ◽

Medicine Outlets

Abstract Background Children in resource-limited countries are more likely to die from treatable conditions than those in higher resource settings due to a lack of the right essential medicine at the right time. Globally millions of children die every year from conditions that could be treatable with existing medicines before they reach their fifth birthday. This study aimed in assessing the availability and affordability of essential medicine for children in selected health facilities of southern nations, nationalities, and peoples’ regions (SNNPR), Ethiopia. Method A medicine outlets-based cross-sectional study was conducted to assess the availability, affordability, and prices of the 30 selected essential medicines (EMs) for children in 30 public and 30 private medicine outlets in SNNPR from March 29 to May 5, 2019, applying WHO and Health Action International (HAI) tools. Availability was expressed as the percentage of sampled medicine outlets per sector that the surveyed medicine was found on the day of data collection. The amount of daily wages required for the lowest-paid government unskilled worker (LPGW) to buy one standard treatment of an acute condition or treatment for a chronic condition for a month was used to measure affordability and median price ratio for the price of EMs. The results Availability varied by sector, type of medication, and level of health facilities. The average availability of EM was 57.67% for the public sector and 53.67% for the private sector. Ceftriaxone, SOR, zinc sulfate, and cotrimoxazole were the most widely available types of medications in the two sectors. The median price ratios (MPR) for the cheapest drugs LP were 1.26 and 2.24 times higher than their International Reference Price (IRP) in the public and private sectors respectively. Eighty-two percent of LP medicines in the public and 91 % of LP medicines in the private sectors used in the treatments of prevalent common conditions in the region were unaffordable as they cost a day’s or more wages for the LPGW. Conclusion Availability, affordability, and price are determinant pre-requisite for EMs access. According to the current work, although fair availability was achieved, the observed high price affected affordability and hence access to EMs.

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