scholarly journals Compromised quality of maternal healthcare in a market economy: Medellín, Colombia 2008-2009

2011 ◽  
pp. 294-302 ◽  
Author(s):  
Gloria Molina ◽  
Gilma Vargas ◽  
Alina Shaw
Keyword(s):  
Health Services ◽  
Maternal Care ◽  
Maternal Health Services ◽  
Labor Costs ◽  
Individual Interviews ◽  
The Social ◽  
Municipal Policies ◽  
Obstetric Services ◽  
Health Institutions

Objective: To analyze the quality of the maternal health services in Medellín city, Colombia within the context of the Social Security System in Health from the perspective of the mothers, physicians and nurses involved in the provision of these services. Methodology: A qualitative study was carried out, during which 24 individual interviews were conducted to key doctors and nurses, who work in health institutions that providing maternal care. Also three focus groups with mothers were conducted. The data analysis was carried out using a systematic and carefully coding and categorization process. Findings: In spite of the fact that municipal policies have been put in place to improve maternity care, mother and pregnant women face problems with health services. Findings suggests that the strategies put in place by these health institutions to decrease labor costs, the administrative barriers, the low tariffs of the obstetric services paid by the health insurers within and competitive market, and the focus on getting financial profitability, are aspects that affecting quality of maternal care.

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

scholarly journals Improving maternal health services through social accountability interventions in Nepal:  An analytical review of existing literature

2019 ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Grey Literature ◽  
Maternal Health Services ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background: The persistent equity and quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. The Government of Nepal has emphasized on responsive and accountable maternal health services since 2005, while social accountability interventions have been commenced as a strategical approach. This review is an attempt to critically explore the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute informed policy. Methods: A literature review and desk study were done between December 2018 to May 2019. An adapted framework of social accountability by Lodenstein et al. 2013 was used for critical analysis and synthesis of the existing literature from Nepal and other low- and middle-income countries (LMICs). The literature was searched and extracted from the search engines i.e. google and google scholar using keywords. The searched includes both published and grey literature. Results: The review found different social accountability interventions initiated by the government and external development partners in maternal health services in Nepal. The evidence from Nepal and other LMICs showed that the social accountability interventions improve the quality of maternal health services through improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. The strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions: The evidence show that social accountability interventions have the potential to improve the quality of maternal health services in Nepal. Critical factors of successful outcomes in maternal health services include quality implementation of the interventions. Similarly, continuous effort is needed from policymaker to strengthen monitoring and regulatory mechanism of the health system and decentralization, improve access to the information and establishment of proper channels to capture complaints and feedback from the community to ensure the effectiveness of the interventions for the long run. Furthermore, research is needed to evaluate the impact of the existing social accountability interventions in the reduction of maternal mortality in Nepal.

The technology organization of production in health services: (re)knowing boundaries and embracing perspective

2009 ◽  
Vol 4 (1) ◽  
pp. 385
Author(s):  
Diego Bonfada ◽  
José Rodolfo Lopes de Paiva Cavalcanti ◽  
Dayane Pessoa de Araujo ◽  
Jacileide Guimarães
Keyword(s):  
Health Services ◽  
Medical Model ◽  
Theoretical Discussion ◽  
Health Manpower ◽  
Technological Organization ◽  
Basic Reference ◽  
Recursos Humanos ◽  
Health Institutions ◽  
Organization Of Production

ABSTRACTObjective: to reflect on the current dynamics of health services focusing on the importance of soft technologies such proposal to break with the curative hegemonic medical model. Methods: it was performed a literature review of author considered a basic reference for the theme. From this, was developed a theoretical discussion of the texts consulted with a view to support the discussion of soft technologies and production of health care. Results: we perceived that health services point to a fragmented practice, curative and appreciate the highly complex procedures, expertise and hard technologies and soft-hard to guarantee the quality of care. Conclusion: it is essential that the technological organization of work in health rescue the prioritization of the use of soft technologies to that can move forward in the consolidation of the quality of a health system. In this sense, universities and health institutions must act mutually pointing to the reality transformation. Descriptors: health manpower;, technology; health services. RESUMOObjetivo: refletir sobre a atual dinâmica dos serviços de saúde evidenciando a importância das tecnologias leves como proposta de ruptura com o modelo médico curativista hegemônico. Métodos: foi realizado um levantamento bibliográfico de autores considerados referência básica para o tema. A partir disso, foi desenvolvida uma reflexão teórica dos textos consultados, na perspectiva de subsidiar a discussão sobre as tecnologias leves e a produção do cuidado em saúde. Resultados: percebeu-se que os serviços de saúde apontam para uma prática fragmentadora, curativista e que valoriza os procedimentos de alta complexidade, a especialização e as tecnologias duras e leve-duras como garantia da qualidade da assistência. Conclusão: torna-se imprescindível que a organização tecnológica do trabalho em saúde resgate a priorização do uso das tecnologias leves para que se possa avançar no processo de consolidação de um sistema de saúde de qualidade. Nesse sentido, Universidades e os serviços precisam atuar mutuamente objetivando a transformação da realidade. Descritores: recursos humanos em saúde; tecnologia; serviços de saúde. RESUMENObjetivo: reflexionar sobre la dinámica actual de los servicios de salud se destaca la importancia de las tecnologías blandas propuesta de este tipo para romper con el modelo médico hegemónico de la curativa. Métodos: se realizó una revisión de la literatura de autores considera como una referencia básica para el tema. De esto, hemos desarrollado un análisis teórico de los textos consultados con el fin de apoyar la discusión de las tecnologías blandas y la producción de atención de la salud. Resultados: se observó que los servicios sanitarios apuntan a una práctica trituradora, curativos y de apreciar los procedimientos de alta complejidad, la experiencia y las tecnologías de duro y blando-duro para garantizar la calidad de la atención. Conclusión: es esencial que la organización tecnológica de los trabajos de rescate en la priorización de la salud de la utilización de tecnologías blandas para avanzar en la consolidación de un sistema de atención sanitaria de calidad. En este sentido, las universidades y otros servicios deben actuar encaminadas a cambiar la realidad. Descriptores: recursos humanos en salud; tecnologia; servicios de salud. 

Age Weights for Health Services Derived from the Relative Social Willingness-to-Pay Instrument

2016 ◽  
Vol 37 (3) ◽  
pp. 239-251 ◽  
Author(s):  
Jeff Richardson ◽  
John McKie ◽  
Angelo Iezzi ◽  
Aimee Maxwell
Keyword(s):  
Quality Of Life ◽  
Health Services ◽  
Willingness To Pay ◽  
Physical Health ◽  
Survey Respondent ◽  
Life Saving ◽  
The Social ◽  
Life Improvement ◽  
Social Valuation

The effect of a patient’s age on the social valuation of health services remains controversial, with empirical results varying in magnitude and implying a different age-value profile. This article employs a new methodology to re-examine these questions. Data were obtained from 2 independent Web-based surveys that administered the Relative Social Willingness to Pay instrument. In the first survey, the age of the patient receiving a life-saving service was varied. Patients were left with either poor mental or physical health. In the second survey, patient age was varied for a service that fully cured the patient’s poor mental or physical health. In total, therefore, 4 sets of age weights were obtained: weights for life-extending services with poor physical or mental health outcomes and weights for quality-of-life improvement for patients in poor mental or physical health. Results were consistent. Increasing age was associated in each case with a monotonic decrease in the social valuation of the services. The decrease in value was quantitatively small until age 60 years. By age 80 years, the social value of services had declined by about 50%. The decline commenced at an earlier age in the context of physical health, although the magnitude of the decrement by age 80 years was unrelated to the type of service. With 1 exception, there was little difference in the valuation of services by the age of the survey respondent. Respondents aged >60 years placed a lower, not higher, value on quality-of-life improvement for elderly individuals than other respondents. There was no difference in the valuation of life-extending services.

scholarly journals EVALUATION OF THE LEVEL OF SATISFACTION OF HOSPITALIZED PUERPERAL WOMAN IN A MATERNITY IN THE COUNTRYSIDE OF PARAÍBA

2018 ◽  
Vol 2 (4) ◽  
pp. 140-159
Author(s):  
Maria Cristina Nascimento de Freitas ◽  
Joselito Santos ◽  
Andreia Oliveira Barros Sousa ◽  
Symara Abrantes Albuquerque de Oliveira Cabral ◽  
Maria Nizete Tavares Alves ◽  
...  
Keyword(s):  
Data Collection ◽  
Health Services ◽  
Consumer Satisfaction ◽  
Maternity Hospital ◽  
Descriptive Research ◽  
Puerperal Woman ◽  
Level Of Satisfaction ◽  
Sample Error ◽  
Health Institutions

There is now a growing need for improvement in health services provided in all health institutions. One possible strategy with this aim is to identify factors that may directly interfere with the quality of care and, therefore,  determine the satisfaction of the user of this service . The purpose of this study was to evaluate the level of satisfaction of postpartum women admitted to a maternity ward, taking into account the existing structure and services provided by the institution. This is an exploratory, descriptive research of quantitative nature developed at the Deodato Cartaxo maternity hospital, belonging to the Regional Hospital of Cajazeiras, located in the municipality of Cajazeiras, Paraiba State in Brazil. The population was composed of hospitalized puerperal women and the sample of 100 woman was performed for convenience, systematic of the proportional type with a sample error of 5%. The data collection period was between the months of august and september 2015. The instrument of data collection was SERVQUAL, evaluating its five quality indicators (tangibility, reliability, attendance, safety and empathy). The results were presented in table form with their respective absolute and relative frequencies. Among the indicators studied, reliability, care and security were the ones that generated the most satisfaction among the puerperal woman and tangibility was referred to as an indicator of dissatisfaction among the users. Keywords: Evaluation of health services; consumer satisfaction; maternities.

The Effectiveness of QMS Implementation in Applying of Quality Health Care for Patients in Health Institutions of Kosovo

2016 ◽  
Vol 2 (3) ◽  
pp. 95
Author(s):  
Samir Lleshi
Keyword(s):  
Health Services ◽  
Continuous Improvement ◽  
Health Sector ◽  
Iso 9001 ◽  
Quality Health Care ◽  
Continuous Quality ◽  
Quality Health ◽  
Health Institutions ◽  
Set Up

Continuous improvement of quality in health system is a challenge for many countries, particularly for those which are undergoing difficult period of transition from the system where the quality was not even known, measured or hasn’t consequently been improved in a system where the health service offers are different. In its route toward the European integration in the recent years Kosovo has set up the basis in terms of quality of infrastructure. Even though compared to its neighbors it is still staying behind in terms of quality of legal infrastructure by creating a quality system according to the requirements of EN ISO 9001 standards, while making easier instalment and constant monitoring of the healthcare standards by setting the guidelines for best application practices, particularly in well-known international fields Health sector in Kosovo is one of the most important sectors and has been continually stated as a priority for development of the country, therefore, creating of conditions for a continuous quality improvement, safety of health services and evaluation of such services is a major challenge associated with a patient and citizens to offer more and higher qualitative health services.

scholarly journals Facilitators and barriers to implement the family doctor contracting services in China: findings from a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032444 ◽  
Author(s):  
Shasha Yuan ◽  
Fang Wang ◽  
Xi Li ◽  
Meng Jia ◽  
Miaomiao Tian
Keyword(s):  
Family Doctor ◽  
Family Doctors ◽  
Individual Interviews ◽  
Primary Health ◽  
Quality Of Primary Care ◽  
Outer Setting ◽  
Health Institutions ◽  
Facilitators And Barriers ◽  
Inner Setting

ObjectiveTo identify the facilitators and barriers to implement family doctor contracting services in China by using Consolidated Framework for Implementation Research (CFIR) to shed new light on establishing family doctor systems in developing countries.DesignA qualitative study conducted from June to August 2017 using semistructured interview guides for focus group discussions (FGDs) and individual interviews. CFIR was used to guide data coding, data analysis and reporting of findings.Setting19 primary health institutions in nine provinces purposively selected from the eastern, middle and western areas of China.ParticipantsFrom the nine sampled provinces in China, 62 policy makers from health related departments at the province, city and county/district levels participated in 9 FGDs; 19 leaders of primary health institutions participated in individual interviews; and 48 family doctor team members participated in 15 FGDs.ResultsBased on CFIR constructs, notable facilitators included national reform involving both top-down and bottom-up policy making (Intervention); support from essential public health funds, fiscal subsidies and health insurance (Outer setting); extra performance-based payments for family doctor teams based on evaluation (Inner setting); and positive engagement of health administrators (Process). Notable barriers included a lack of essential matching mechanisms at national level (Intervention); distrust in the quality of primary care, a lack of government subsidies and health insurance reimbursement and performance ceiling policy (Outer setting); the low competency of family doctors and weak influence of evaluations on performance-based salary (Inner setting); and misunderstandings about family doctor contracting services (Process).ConclusionsThe national design with essential features including financing, incentive mechanisms and multidepartment cooperation, was vital for implementing family doctor contracting services in China. More attention should be paid to the quality of primary care and competency of family doctors. All stakeholders must be informed, be involved and participate before and during the process.

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