scholarly journals Measuring Governance: Developing a Novel Metric for Assessing Whether Policy Environments are Conducive for the Development and Implementation of Nutrition Interventions in Nepal

2020 ◽  
Author(s):  
Grace Namirembe ◽  
Robin Shrestha ◽  
Patrick Webb ◽  
Robert Houser ◽  
Dale Davis ◽  
...  
Keyword(s):  
National Level ◽  
Health Sector ◽  
Leadership Capacity ◽  
World Health ◽  
Government Officials ◽  
Or Education ◽  
Policy Environments ◽  
Nutrition Policies ◽  
Nationally Representative

Background: The Nutrition Governance Index (NGI) defines a first standardized approach to quantifying the ‘quality of governance’ in relation to national plans of action to accelerate improvements in nutrition. It was created in response to growing demand for evidence-based measures that reveal opportunities and challenges as nutrition-related policies on paper are translated into outcomes on the ground. Numerous past efforts to measure ‘governance,’ most notably World Health Organization’s (WHO’s) NGI and the separate Hunger and Nutrition Commitment Index (HANCI), both of which lack granularity below the national level and each of which fails to capture pinch points related to necessary cross-sectoral actions. This paper addresses such caveats by introducing an innovative metric to assess self-reported practices of, and perceptions held by, administration officials tasked with implementing government policy at the sub-national level. The paper discusses the development of this metric, its methodology, and explores its application in the context of Nepal. Methods: Conducted as part of a nationally representative longitudinal survey across 21 of Nepal’s 75 districts, the substudy on which this paper is based used data from 520 government and non-government officials at different geographic and administrative tiers of authority. Using robust statistical techniques, structured questionnaire data were condensed into a score using a scale from 0 to 100. Results: Six domains were identified through the analysis: Understanding Nutrition and related responsibilities; Collaboration; Financial Resources; Nutrition Leadership, Capacity, and Support. About half of all health sector representatives achieved a high score (>3 on 5-point scale) compared to representatives in other sectors of government activity (such as agriculture or education) (χ2=12.99, P<.003). The health sector also showed the most improvement in mean NGI score over a two-year follow-up period. Conclusion: This paper shows that self-reported perceptions and behaviors of those responsible for policy implementation can be usefully quantified. The NGI can be used to assess countries’ readiness for the application of nutrition policies.

Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study

2021 ◽  
Vol 33 (2) ◽  
Author(s):  
Yubraj Acharya ◽  
Nigel James ◽  
Rita Thapa ◽  
Saman Naz ◽  
Rishav Shrestha ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Antenatal Care ◽  
Quality Care ◽  
National Level ◽  
Poor Quality ◽  
Public Hospitals ◽  
World Health ◽  
Outcome Variable

Abstract Background Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients’ socio-economic gradient. Methods We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users’ characteristics. In the qualitative component, we synthesized users’ and providers’ narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews. Results Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced. Conclusion The quality of ANC in Nepal’s primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.

Violence and Health

2018 ◽  
Author(s):  
Maria Cecília de Souza Minayo ◽  
Saul Franco
Keyword(s):  
Health Sector ◽  
Well Being ◽  
Gender Violence ◽  
World Health ◽  
Mental Trauma ◽  
Policies And Programs ◽  
Definition Of ◽  
Health Organization ◽  
Forms Of Violence

Violence is a problem that accompanies the trajectory of humanity, but it presents itself in different ways in each society and throughout its historical development. Despite having different meanings according to the field of knowledge from which it is addressed and the institutions that tackle it, there are some common elements in the definition of this phenomenon. It is acknowledged as the intentional use of force and power by individuals, groups, classes, or countries to impose themselves on others, causing harm and limiting or denying rights. Its most frequent and visible forms include homicides, suicides, war, and terrorism, but violence is also articulated and manifested in less visible forms, such as gender violence, domestic violence, and enforced disappearances. Although attention to the consequences of different forms of violence has always been part of health services, its formal and global inclusion in health sector policies and guidelines is very recent. It was only in 1996 that the World Health Organization acknowledged it as a priority in the health programs of all countries. Violence affects individual and collective health; causes deaths, injuries, and physical and mental trauma; decreases the quality of life; and impairs the well-being of people, communities, and nations. At the same time, violence poses problems for health researchers trying to understand the complexity of its causes, its dynamics, and the different ways of dealing with it. It also poses serious challenges to health systems and services for the care of victims and perpetrators and the formulation of interdisciplinary, multi-professional, inter-sectoral, and socially articulated confrontation and prevention policies and programs.

scholarly journals Epidemiology of measles cases, vaccine effectiveness, and performance towards measles elimination in The Gambia

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258961
Author(s):  
Alieu Sowe ◽  
Mbye Njie ◽  
Dawda Sowe ◽  
Sidat Fofana ◽  
Lamin Ceesay ◽  
...  
Keyword(s):  
National Level ◽  
Vaccine Effectiveness ◽  
Vaccination Status ◽  
The Gambia ◽  
World Health ◽  
Regional Office ◽  
Measles Elimination ◽  
River Region ◽  
Campaign Coverage

Introduction In 2011, member states of the World Health Organization (WHO) Africa Regional Office (AFRO) resolved to eliminate Measles by 2020. Our study aims to assess The Gambia’s progress towards the set AFRO measles elimination target and highlight surveillance and immunisation gaps to better inform future measles prevention strategies. Material and methods A retrospective review of measles surveillance data for the period 2011–2019, was extracted from The Gambia case-based measles surveillance database. WHO—UNICEF national coverage estimates were used for estimating national level MCV coverage. Measles post campaign coverage survey coverage estimates were used to estimate national measles campaign coverage. Results One hundred and twenty-five of the 863 reported suspected cases were laboratory confirmed as measles cases. More than half (53.6%) of the confirmed cases have unknown vaccination status, 24% of cases were vaccinated, 52.8% of cases occurred among males, and 72.8% cases were among urban residents. The incidence of measles cases per million population was lowest (0) in 2011–2012 and highest in 2015 and 2016 (31 and 23 respectively). The indicator for surveillance sensitivity was met in all years except in 2016 and 2019. Children aged 5–9 years (Incidence Rate Ratio—IRR = 0.6) and residents of Central River region (IRR = 0.21) had lower measles risk whilst unvaccinated (Adjusted IRR = 5.95) and those with unknown vaccination status (IRR 2.21) had higher measles risk. Vaccine effectiveness was 89.5%. Conclusion The Gambia’s quest to attain measles elimination status by 2020 has registered significant success but it is unlikely that all target indicators will be met. Vaccination has been very effective in preventing cases. There is variation in measles risk by health region, and it will be important to take it into account when designing prevention and control strategies. The quality of case investigations should be improved to enhance the quality of surveillance for decision making.

A Qualidade na Educação Pública Infantil Brasileira: um Estudo de Caso em uma Cidade do Vale do Paraíba Paulista

2018 ◽  
Vol 19 (4) ◽  
pp. 410
Author(s):  
Pétala Gonçalves Lacerda ◽  
Edna Maria Querido de Oliveira Chamon ◽  
Nilsen Aparecida Vieira Marcondes
Keyword(s):  
Early Childhood ◽  
Public Education ◽  
Early Childhood Education ◽  
Basic Education ◽  
Local Level ◽  
National Level ◽  
Or Education ◽  
Basic Study ◽  
Childhood Education

Considera-se relevante a reflexão sobre a qualidade da Educação Infantil brasileira, porque se constata que a ampliação da oferta na faixa etária, de zero a cinco anos, aconteceu em detrimento da atenção às condições de funcionamento das instituições infantis. Referenciada como uma das etapas da Educação Básica, a Educação Infantil não esteve entre as prioridades educacionais durante praticamente todo o século XX. Somente a partir de 1990 se intensificaram os debates sobre o assunto e, assim, a educação da primeira infância passou a fazer parte das políticas públicas educacionais. Diante disso, objetiva-se com este estudo básico, qualitativo e descritivo, caracterizado como estudo de caso, refletir sobre a qualidade na educação pública infantil brasileira em âmbito municipal. Conclui-se, portanto que a qualidade na educação pública infantil brasileira poderá se estabelecer em âmbito nacional por meio de Políticas Educacionais Municipais, ou seja, em cada Rede Municipal ou Sistema de Ensino que, ao se fortalecer desenvolverá a educação como um todo. Palavras-chave: Educação Pública Infantil. Experiência Municipal. Vale do Paraíba Paulista. AbstractIt is considered relevant reflection on the quality of Brazilian early childhood education because it turns out that the expansion of supply in the age group from zero to five years, took place at the expense of attention to the working conditions of children's institutions. Referenced as one of the stages of basic education, early childhood education was not among educational priorities during the entire twentieth century. Only since 1990 discussions have been intensified on the subject, and so the early childhood education became part of the public educational policies. Therefore, the objective of this basic study, qualitative and descriptive, characterized as a case study, is reflect on the quality of Brazilian children's public education at the local level. It follows therefore that the quality of Brazilian children's public education may be provided at the national level through Municipal Educational Policy, that is in each municipal network or education system that, upon strengthening will develop education as a whole. Keywords:  Children’s Public Education. Municipal Experience. Paulista Paraíba Valley. 

Association between quality of life and team achievement among wheelchair basketball players – a survey study

2015 ◽  
Vol 14 (2) ◽  
Author(s):  
Roy Eilat ◽  
Barak Hazor ◽  
Eli Carmeli
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
National Level ◽  
World Health ◽  
Survey Study ◽  
Wheelchair Basketball ◽  
Basketball Players ◽  
World Health Organization Quality ◽  
Significant Difference

Abstract: Wheelchair basketball, a popular sport that allows for the inclusion of different levels of disability, has been played since 1946. It became a Paralympics sport in 1988. The aim of the study was to examine the association between quality of life (QOL) and achievement among wheelchair basketball players on a national level.Seven German players and 11 Israeli players participated in the study. The 36-Item Short Form Health Survey and the the World Health Organization Quality of Life questionnaires were used to measure QOL, and a sociodemographic questionnaire was used for individual athletic lifestyles.: Due to low compliance by several countries, only Germany and Israel were surveyed. There was no significant difference in the QOL scores between Israeli and German players. Israeli players were, on average, older than German players and had higher incomes. German players dedicated more time to the sport than Israeli players.QOL and team achievement were influenced by hours of practice and younger age, which were related to physical ability requirements for athletic performance. QOL was not contingent on income level or achievement.

scholarly journals Towards patient-centred care in Ghana: health system responsiveness, self-rated health and experiential quality in a nationally representative survey

2020 ◽  
Vol 9 (2) ◽  
pp. e000886 ◽  
Author(s):  
Hannah L Ratcliffe ◽  
Griffith Bell ◽  
Koku Awoonor-Williams ◽  
Asaf Bitton ◽  
June-Ho Kim ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Patient Experience ◽  
Patient Reported Outcomes ◽  
World Health ◽  
Self Rated Health ◽  
Experience Of Care ◽  
Essential Components ◽  
Patient Reported ◽  
Nationally Representative

IntroductionPerson-centredness, including patient experience and satisfaction, is a foundational element of quality of care. Evidence indicates that poor experience and satisfaction are drivers of underutilisation of healthcare services, which in turn is a major driver of avoidable mortality. However, there is limited information about patient experience of care at the population level, particularly in low-income and middle-income countries.MethodsA multistage cluster sample design was used to obtain a nationally representative sample of women of reproductive age in Ghana. Women were interviewed in their homes regarding their demographic characteristics, recent care-seeking characteristics, satisfaction with care, patient-reported outcomes, and—using questions from the World Health Survey Responsiveness Module—the seven domains of responsiveness of outpatient care to assess patient experience. Using Poisson regression with log link, we assessed the relationship between responsiveness and satisfaction, as well as patient-reported outcomes.ResultsWomen who reported more responsive care were more likely to be more educated, have good access to care and have received care at a private facility. Controlling for respondent and visit characteristics, women who reported the highest responsiveness levels were significantly more likely to report that care was excellent at meeting their needs (prevalence ratio (PR)=13.0), excellent quality of care (PR=20.8), being very likely to recommend the facility to others (PR=1.4), excellent self-rated health (PR=4.0) and excellent self-rated mental health (PR=5.1) as women who reported the lowest responsiveness levels.DiscussionThese findings support the emerging global consensus that responsiveness and patient experience of care are not luxuries but essential components of high-performing health systems, and highlight the need for more nuanced and systematic measurement of these areas to inform priority setting and improvement efforts.

scholarly journals ACCREDITATION AND HEALTH CARE QUALITY ASSURANCE IN PAKISTAN: A DESK REVIEW

1970 ◽  
Vol 7 (3) ◽  
pp. 174-179 ◽  
Author(s):  
Fauziah Rabbani ◽  
Imran Naeem Abbasi
Keyword(s):  
Health Care ◽  
Quality Assurance ◽  
Quality Of Care ◽  
National Health ◽  
Health Sector ◽  
World Health ◽  
Private Health Sector ◽  
Regulatory Bodies ◽  
Quality In Healthcare

Background: Pakistan has a well-established healthcare system with 70% healthcare needs catered by private health sector. The latter's unregulated and unchecked expansion has resulted in quackery and compromised quality of care. This situation analysis provides a snapshot of health system's quality assurance and accreditation processes. Methods: Two validated questionnaires from World health Organization gauged the current state of health care accreditation and quality of care initiatives in Pakistan. Information was obtained from peer reviewed articles, grey literature, policy documents on government websites and newspapers. Results: Pakistan has a number of regulatory bodies responsible for ensuring quality in healthcare through accreditation and defined standards. National Institute of Health issues updated clinical quality guidelines pertaining to disease epidemics. A national quality policy was also formulated in 2004. However, implementing and ensuring accreditation has been challenging. Though statutory bodies are in place for registering different cadres of healthcare professionals, policies and mechanisms regarding licensure of healthcare establishments are missing. Emergence of national health vision 2012-2020, provincial health sector strategies and healthcare commission acts have focused on regulation of private health sector and accreditation of healthcare establishments. Despite presence of regulatory bodies, there are implementation gaps. Conclusion: This paper highlights some important gaps regarding accreditation and quality in healthcare. Quality assurance should be incorporated into national health policies, programs and strategies. National health policy should include explicit laws concerning quality Indicators and standards for quality in health care. Need to regulate private health sector and ensuring quality in overall healthcare is more than ever.

scholarly journals Measuring Governance: Developing a Novel Metric for Assessing the Translation of Policies into Action in Nepal

2019 ◽  
Author(s):  
Grace Namirembe ◽  
Robin Shrestha ◽  
Robert Houser ◽  
Shibani Ghosh ◽  
Kedar Baral ◽  
...  
Keyword(s):  
Goodness Of Fit ◽  
Agricultural Sector ◽  
National Level ◽  
Health Sector ◽  
Fit Indices ◽  
Ecological Zones ◽  
Governance Indicator ◽  
Nationally Representative ◽  
Validity Tests ◽  
Policy And Science

Abstract Background The Nutrition Governance Indicator (NGI) defines a first standardized approach to quantifying the ‘quality of governance’ in relation to national plans of action to accelerate improvements in nutrition. It was created in response to growing demand for evidence-based measures that reveal opportunities and challenges as nutrition-related policies on paper are translated into outcomes on the ground. Past efforts to measure ‘governance’, most notably the WHO’s Nutrition Governance Indicator and Hunger and Nutrition Commitment Index (HANCI) lack granularity below the national level, and failure to capture pinch points relating to necessary cross-sectoral actions. The NGI addresses these caveats. This paper introduces the approach that underpins the NGI, discusses its methodology and demonstrates its application in the context of Nepal. Methods The NGI was developed using principal components analysis techniques. The resulting score was standardized to a more intuitive scale ranging from 0 to 100, and categorized into quintiles. Cronbach’s alpha was used to test for reliability in addition to testing for goodness of fit using confirmatory factor analysis methods. The data used to derive the index were obtained from 520 participants in the Policy and Science for Health, Agriculture and Nutrition (PoSHAN) study, a prospective and nationally representative longitudinal survey conducted across 21 districts and three agro-ecological zones of Nepal. Results The NGI passed validity tests with the exception of two fit indices. Two of the six domains passed the reliability test (Understanding nutrition and Collaboration), the Financial resources domain marginally passed at 0.70 criteria of Nunally, while the remaining domains need re-assessment to improve their reliability. The Nepal Health sector showed the most improvement in mean NGI score over a two-year period followed by the Agricultural sector. About half of all health sector representatives were more likely to have a high score compared to other sectors (OR 0.52, 95% CI 0.36 – 0.74). Conclusion Using two panels of data collected in Nepal, this paper has shown that policy-to-action translation can be quantified and applied to sub-national institutions. These findings underscore the practical utility of the index and its importance to the nutrition policy realm.

scholarly journals Measuring the Overall Burden of Early Childhood Malnutrition in Ghana: A Comparison of Estimates from Multiple Data Sources

2020 ◽  
Author(s):  
John Paul Kuwornu ◽  
Jonathan Amoyaw ◽  
Taru Manyanga ◽  
Elizabeth J. Cooper ◽  
Elvis Donkoh ◽  
...  
Keyword(s):  
National Level ◽  
Composite Index ◽  
Primary Objective ◽  
Data Sources ◽  
World Health ◽  
Demographic And Health Surveys ◽  
Growth Standards ◽  
Childhood Malnutrition ◽  
Nationally Representative ◽  
Health Organization

Background: Childhood malnutrition contributes to nearly half (45%) of all deaths among children under 5 globally. The United Nations’ Sustainable Development Goals (SDGs) aims to end all forms of malnutrition by 2030; however, measuring progress towards these goals is challenging, particularly in countries with emerging economies where nationally-representative data are limited. The primary objective of this study was to estimate the overall burden of childhood malnutrition in Ghana at national and regional levels using 3 data sources. Methods: Using data from the long-standing Ghana Demographic and Health Surveys (GDHS), Ghana Multiple Indicator Cluster Survey (GMICS), and the emerging Ghana Socioeconomic Panel Survey (GSPS), we compared the prevalence of malnutrition using the extended composite index of anthropometric failure (eCIAF) for the period 2008- 2011. This study included data for children aged 6-59 months and calculated all anthropometric z-scores based on the World Health Organization (WHO) Growth Standards. We tested for differences in malnutrition subtypes using two-group configural frequency analysis (CFA). Results: Of the 10 281 children (6532 from GMICS, 2141 from GDHS and 1608 from GSPS) included in the study, the only demographic difference observed was the children included in the GSPS were slightly older than those included in the GDHS and GMICS (median age of 36 vs 30 vs 33 months, P<.001). Based on the eCIAF, the overall prevalence of malnutrition at the national level was higher among children in the GSPS (57.3%, 95% CI: 53.9%–60.6%), followed by the GDHS (39.7%, 95% CI: 37.0%–42.5%), and then those in the GMICS (31.2%, 95% CI: 29.3%–33.1%). The two-group CFA showed that the 3 data sources also estimated different prevalence rates for most of the malnutrition subtypes included in the eCIAF. Conclusion: Depending on the data source adopted, our estimates of eCIAF showed that between one-third and half of all Ghanaian children aged 6-59 months had at least one form of malnutrition over the period 2008-2011. These eCIAF estimates should complement the commonly reported measures such as stunting and wasting when interpreting the severity of malnutrition in the country to inform policy decisions.

Fortification of Staple Cereal Flours with Iron and other Micronutrients: Cost Implications of following World Health Organization—Endorsed Recommendations

2012 ◽  
Vol 33 (4_suppl3) ◽  
pp. S336-S343 ◽  
Author(s):  
J. Aaron Grant ◽  
Arnaud Laillou ◽  
Julian Wolfson ◽  
Regina Moench-Pfanner
Keyword(s):  
World Health Organization ◽  
National Level ◽  
World Health ◽  
Electrolytic Iron ◽  
Delivery Vehicles ◽  
Health Organization ◽  
Cost Implications ◽  
The Cost ◽  
Lower Income Countries

Background Wheat and maize flours are widely used delivery vehicles for mass fortification. In lower-income countries, most, if not all, national-level cereal flour fortification programs routinely fortify with iron; however, cofortification with other micronutrients is common. Little information is available on the cost implications programs face when considering current fortification practices versus what the World Health Organization (WHO) interim consensus statement recommends. Objective The objectives of the present paper are to provide information on the costs of adding different chemical forms of iron and/or other micronutrients to premix formulations, and to discuss some of the issues that should be considered regarding which micronutrients to include in the premix. Methods Nine countries in Latin America, Africa, and Asia (three countries per region) that currently cofortify with multiple micronutrients including iron were selected based on low (< 75 g/day), medium (75 to 149 g/day), and high (≥ 150 g/day) mean population flour consumption levels. Premix costs per metric ton of flour produced were estimated for improving iron formulations and for following WHO recommendations for other micronutrients. Results For the selected programs to maintain current premix formulations and improve iron compounds, premix costs would increase by between 155% and 343% when the iron compound was switched from electrolytic iron to sodium iron ethylenediaminetetraacetate (NaFeEDTA), by 6% to 50% when it was switched from electrolytic iron to ferrous sulfate, and by 4% to 13 when iron addition rates were adjusted without switching the compound. To meet WHO recommendations for other micronutrients, premix costs would increase the most when the amounts of vitamins B12 and A were increased. Conclusions For programs that currently cofortify with iron and additional micronutrients, the quality of the iron fortificant should not be overlooked simply to be able to afford to add more micronutrients to the premix. Micronutrients should be selected according to population needs, costs, and potential beneficial synergistic reactions the added micronutrients may have.

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