Opting for a veil of secrecy – The silencing of indigenous health service seekers by healthcare providers in Bomvanaland

Abstract Background Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. Many developing countries have used community scorecard (CSC) to encourage community participation in health. However, the use of CSC in health in Bangladesh has been limited. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics. Methods A pilot study conducted between January’2018-December’2018 explored feasibility and acceptability of CSC using a thematic framework. The tool was implemented in purposively selected three CCs in Chakaria and one CC in Teknaf sub-district of Bangladesh. Qualitative data from 20 Key-Informant Interviews and four Focus Group Discussions with service users, healthcare providers, and government personnel, document reviews and meeting observations were used in analysis. Results The study showed that participants were enthusiastic and willing to take part in the CSC intervention. They perceived CSC to be useful in raising awareness about health in the community and facilitating structured monitoring of CC services. The process facilitated building stronger community ownership, enhancing accountability and stakeholder engagement. The participants identified issues around service provision, set SMART (specific, measurable, attainable, relevant and time-bound) targets and indicators on supplies, operations, logistics, environment, and patient satisfaction through CSC. However, some systematic and operational challenges of implementation were identified including time and resource constraint, understanding and facilitation of CSC, provider-user conflict, political influence, and lack of central level monitoring. Conclusion The findings suggest that CSC is a feasible and acceptable tool to engage community and healthcare providers in monitoring and managing health facilities. For countries with health systems faced with challenges around accountability, quality and coverage, CSC has the potential to improve community level health-service delivery. The findings are intended to inform program implementers, donors and other stakeholders about context, mechanisms, outcomes and challenges of CSC implementation in Bangladesh and other developing countries. However, proper contextualization, institutional capacity building and policy integration will be critical in establishing effectiveness of CSC at scale.

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Resource allocation and health technology assessment in Australia: Views from the local level

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462309090187 ◽

2009 ◽

Vol 25 (02) ◽

pp. 134-140 ◽

Cited By ~ 10

Author(s):

Gisselle Gallego ◽

Kees van Gool ◽

Dianne Kelleher

Keyword(s):

Decision Making ◽

Health Service ◽

Health Technology Assessment ◽

Technology Assessment ◽

Online Survey ◽

Local Level ◽

Healthcare Providers ◽

Health Technology ◽

Health Technologies ◽

Decision Making Processes

Objectives:Several studies have shown that a key determinant of successful health technology assessment (HTA) uptake is a clear, fair, and consistent decision-making process for the approval and introduction of health technologies. The aim of this study was to gauge healthcare providers' and managers' perceptions of local level decision making and determine whether these processes offer a conducive environment for HTA. An Area Health Service (AHS) aimed to use the results of this study to help design a new process of technology assessment and decision making.Methods:An online survey was sent to all health service managers and healthcare providers working in one AHS in Sydney, Australia. Questions related to perceptions of current health technology decisions in participants' own institution/facility and opinions on key criteria for successful decision-making processes.Results:Less than a third of participants agreed with the statements that local decision-making processes were appropriate, easy to understand, evidence-based, fair, or consistently applied. Decisions were reportedly largely influenced by total cost considerations as well as by the central state health departments and the Area executive.Conclusions:Although there are renewed initiatives in HTA in Australia, there is a risk that such investments will not be productive unless policy makers also examine the decision-making contexts within which HTA can successfully be implemented. The results of this survey show that this is especially true at the local level and that any HTA initiative should be accompanied by efforts to improve decision-making processes.

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Medical Device Regulation from a Health Service Provider’s Perspective

Prosthesis ◽

10.3390/prosthesis3030025 ◽

2021 ◽

Vol 3 (3) ◽

pp. 261-266

Author(s):

Man Ting Kwong ◽

David Stell ◽

Emmanuel Akinluyi

Keyword(s):

Health Service ◽

Medical Device ◽

Medical Devices ◽

Clinical Setting ◽

Service Providers ◽

Healthcare Providers ◽

Current Trends ◽

Health Service Providers ◽

The Uk ◽

Medical Device Regulation

Unfamiliarity with medical device regulations can sometimes be a barrier to deploying technology in a clinical setting for researchers and innovators. Health service providers recognise that innovation can happen within smaller organisations, where regulatory support may be limited. This article sets out to increase transparency and outline key considerations on medical device regulations from a UK healthcare provider’s perspective. The framework used by Guy’s and St Thomas’ NHS Foundation Trust (GSTFT) for assessing research devices is presented to give an overview of the routes that R&D medical devices take to enter a clinical setting. Furthermore, current trends on research studies involving medical devices were extracted from the GSTFT internal R&D database and presented as the following categories (i) commercial vs. non-commercial, (ii) assessment type and (iii) software vs. non-software. New medical devices legislation will be introduced within the UK in July 2023. It is anticipated regulating software as a medical device may become more challenging for healthcare providers and device manufacturers alike. It is therefore important for different stakeholders involved to work together to ensure this does not become a barrier to innovation.

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Community-governed health services in Cape York: does the evidence point to a model of service delivery?

Australian Health Review ◽

10.1071/ah080605 ◽

2008 ◽

Vol 32 (4) ◽

pp. 605 ◽

Cited By ~ 3

Author(s):

Leanne L Coombe ◽

Melissa R Haswell-Elkins ◽

Peter S Hill

Keyword(s):

Health Service ◽

Service Delivery ◽

Indigenous Health ◽

Health Service Delivery ◽

Service Delivery Model ◽

Health Service Provider ◽

Community Governance ◽

Delivery Model ◽

Health Council ◽

Cape York

Health service delivery model reforms are currently underway in Cape York in an effort to improve health outcomes for the Aboriginal and Torres Strait Islander communities. These reforms include the transition of the Apunipima Cape York Health Council from an advocacy agency to a community-controlled health service provider. This paper investigates the literature on existing community governance models and communitycontrolled health service delivery models, to guide the choice of the most appropriate model for the Cape York health reforms. The evidence collected suggests a new innovative health service delivery model is emerging that will not only improve Indigenous health status, but may also present a more appropriate model for the health care sector than the existing mainstream health service delivery model provided for other sections of the collective Australian population.

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The Influence Factors That Affect Thailands Management Of Youth Reproductive Health Service

Journal of Diversity Management (JDM) ◽

10.19030/jdm.v3i4.4999 ◽

2008 ◽

Vol 3 (4) ◽

pp. 27-32 ◽

Cited By ~ 1

Author(s):

Sioy Anusornteerakul ◽

Kimaporn Khamanarong ◽

Suranart Khamanarong ◽

Jadsada Thinkhamrop

Keyword(s):

Reproductive Health ◽

Health Service ◽

Healthcare Providers ◽

Influence Factors ◽

Binary Logistic Regression ◽

Healthcare Services ◽

Influential Factors ◽

Reproductive Health Service ◽

The Family ◽

Clear Idea

The management of reproductive health service for youth has become an important issue during the recent year. However, management has no clear idea about the influential factors of concern to. In this paper, we will discuss these influence factors that affect the management of youth reproductive healthcare service. Mixed methods were used for data collection, including qualitative methods that were conducted by in-dept interview and analyzed by binary logistic regression. According to the analysis, we found six factors that affect the management of reproductive health service, including (1) personal expense, (2) communication within the family, (3) fear of parents reactions, (4) the bureaucratic process of healthcare services, (5) the limitation of healthcare services, and (6) healthcare providers. Then, we reduced the six factors into three group factors that we call three systems to explain these important factors that are of concern to management of reproductive health service. These include the personnel system, service system, and the family support system.

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Risks and older adults with atrial fibrillation in rural communities: an integration lens

Journal of Integrated Care ◽

10.1108/jica-03-2016-0012 ◽

2016 ◽

Vol 24 (4) ◽

pp. 188-200 ◽

Cited By ~ 2

Author(s):

Kathy L Rush ◽

Nelly D Oelke ◽

R. Colin Reid ◽

Carol Laberge ◽

Frank Halperin ◽

...

Keyword(s):

Atrial Fibrillation ◽

Older Adults ◽

Rural Communities ◽

Health Service ◽

Healthcare Delivery ◽

Healthcare Providers ◽

Health Service Delivery ◽

Decision Makers ◽

System Level ◽

Content Type

Purpose – Older adults with atrial fibrillation (AF) have put growing demands on a poorly integrated healthcare system. This is of particular concern in rural communities with rapid population aging and few healthcare resources elevating risk of stroke and mortality. The purpose of this paper is to explore healthcare delivery risks for rural older adults with AF. Design/methodology/approach – This qualitative study collected data from AF patients, healthcare providers and decision makers. Ten patients participated in six-month care journeys involving interviews, logs, photos, and chart reviews. In total, 13 different patients and ten healthcare providers participated in focus groups and two decision makers participated in interviews. Findings – Three key health service risks emerged: lack of patient-focussed access and self-management; unplanned care coordination and follow-up across the continuum of care; and ineffective teamwork with variable perspectives among patients, providers, and decision makers. Originality/value – This study extends the understanding of risks to the health system level. Results provide important information for further research aimed at interventions to improve health service delivery and policy change to mitigate risks for this population.

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Personal and Public Involvement in Healthcare Provision

Advances in Healthcare Information Systems and Administration - The NHS and Contemporary Health Challenges From a Multilevel Perspective ◽

10.4018/978-1-7998-3928-6.ch004 ◽

2020 ◽

pp. 89-116

Keyword(s):

Primary Care ◽

Patient Safety ◽

National Health Service ◽

Health Service ◽

Public Involvement ◽

Healthcare Providers ◽

Healthcare Provision ◽

Governance Framework ◽

Levels Of Care ◽

National Healthcare

Personal and public involvement in healthcare provision has become an essential part of the governance framework of the National Health Service (NHS) today. Patient safety, quality, and responsiveness of care are the main priorities of national healthcare providers. Yet in practice, there are significant limitations to the introduction of a true patient- or person-centred approach, which will be described in this chapter. Two case studies have been included to illustrate the challenges to implementing a true person-centred approach in the NHS. The first relates to the Mid-Staffordshire Hospital Trust where hundreds of patients died as a result of sub-standard levels of care. The second focuses on a family's struggle to access a joined-up package of care for a Parkinson's disease sufferer in a primary care setting.

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Healthcare Providers in the English National Health Service

Healthcare Management and Economics ◽

10.4018/978-1-4666-3982-9.ch009 ◽

2013 ◽

pp. 106-123

Author(s):

Pauline Allen ◽

Will Bartlett ◽

Virginie Pérotin ◽

Greenwell Matchaya ◽

Simon Turner ◽

...

Keyword(s):

National Health Service ◽

Health Service ◽

Social Control ◽

National Health ◽

Healthcare Providers ◽

Three Dimensions ◽

Public And Private ◽

Private Providers ◽

English National Health ◽

English National Health Service

In recent years it has been noted that boundaries between public and private providers of many types of welfare have become blurred. This paper uses three dimensions of publicness to analyse this blurring of boundaries in relation to providers of healthcare in England. The authors find that, although most care is still funded and provided by the state, there are significant additional factors in respect of ownership and social control which indicate that many English healthcare providers are better understood as hybrids. Furthermore, the authors raise concerns about the possible deleterious effects of diminishing aspects of publicness on English healthcare. The most important of these is a decrease in accountability.

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Health literacy among pregnant women in a lifestyle intervention trial: protocol for an explorative study on the role of health literacy in the perinatal health service setting

BMJ Open ◽

10.1136/bmjopen-2020-047377 ◽

2021 ◽

Vol 11 (7) ◽

pp. e047377

Author(s):

Farah Nawabi ◽

Adrienne Alayli ◽

Franziska Krebs ◽

Laura Lorenz ◽

Arim Shukri ◽

...

Keyword(s):

Health Literacy ◽

Health Service ◽

Health Outcomes ◽

Pregnant Women ◽

Lifestyle Intervention ◽

Service Use ◽

Healthcare Providers ◽

Health Service Use ◽

Mother And Child

IntroductionPregnancy is a vulnerable period that affects long-term health of pregnant women and their unborn infants. Health literacy plays a crucial role in promoting healthy behaviour and thereby maintaining good health. This study explores the role of health literacy in the GeMuKi (acronym for ‘Gemeinsam Gesund: Vorsorge plus für Mutter und Kind’—Strengthening health promotion: enhanced check-up visits for mother and child) Project. It will assess the ability of the GeMuKi lifestyle intervention to positively affect health literacy levels through active participation in preventive counselling. The study also explores associations between health literacy, health outcomes, health service use and effectiveness of the intervention.Methods and analysisThe GeMuKi trial has a hybrid effectiveness–implementation design and is carried out in routine prenatal health service settings in Germany. Women (n=1860) are recruited by their gynaecologist during routine check-up visits before 12 weeks of gestation. Trained healthcare providers carry out counselling using motivational interviewing techniques to positively affect health literacy and lifestyle-related risk factors. Healthcare providers (gynaecologists and midwives) and women jointly agree on Specific, Measurable, Achievable Reasonable, Time-Bound goals. Women will be invited to fill in questionnaires at two time points (at recruitment and 37th−40th week of gestation) using an app. Health literacy is measured using the German version of the Health Literacy Survey-16 and the Brief Health Literacy Screener. Lifestyle is measured with questions on physical activity, nutrition, alcohol and drug use. Health outcomes of both mother and child, including gestational weight gain (GWG) will be documented at each routine visit. Health service use will be assessed using social health insurance claims data. Data analyses will be conducted using IBM SPSS Statistics, version 26.0. These include descriptive statistics, tests and regression models. A mediation model will be conducted to answer the question whether health behaviour mediates the association between health literacy and GWG.Ethics and disseminationThe study was approved by the University Hospital of Cologne Research Ethics Committee (ID: 18-163) and the State Chamber of Physicians in Baden-Wuerttemberg (ID: B-F-2018-100). Study results will be disseminated through (poster) presentations at conferences, publications in peer-reviewed journals and press releases.Trail registrationGerman Clinical Trials Register (DRKS00013173). Registered pre-results, 3rd of January 2019, https://www.drks.de

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Household number associated with middle ear disease at an urban Indigenous health service: a cross-sectional study

Australian Journal of Primary Health ◽

10.1071/py13009 ◽

2014 ◽

Vol 20 (3) ◽

pp. 285 ◽

Cited By ~ 5

Author(s):

Geoffrey K. P. Spurling ◽

Deborah A. Askew ◽

Philip J. Schluter ◽

Fiona Simpson ◽

Noel E. Hayman

Keyword(s):

Risk Factors ◽

Health Service ◽

Middle Ear ◽

Torres Strait Islander ◽

Indigenous Health ◽

Community Support ◽

Mixed Effects ◽

Cross Sectional ◽

Middle Ear Disease ◽

Torres Strait

Few epidemiological studies of middle ear disease have been conducted in Aboriginal and Torres Strait Islander populations, yet the disease is common and causes hearing impairment and poorer educational outcomes. The objective of this study is to identify factors associated with abnormal middle ear appearance, a proxy for middle ear disease. Aboriginal and Torres Strait Islander children aged 0–14 years receiving a Child Health Check (CHC) at an urban Indigenous Health Service, Brisbane, Australia were recruited from 2007 to 2010. Mixed-effects models were used to explore associations of 10 recognised risk factors with abnormal middle ear appearance at the time of the CHC. Ethical approval and community support for the project were obtained. Four hundred and fifty-three children were included and 54% were male. Participants were Aboriginal (92%), Torres Strait Islander (2%) or both (6%). Abnormal middle ear appearance was observed in 26 (6%) children and was significantly associated with previous ear infection (odds ratio (OR), 8.8; 95% confidence interval (CI), 3.2–24.0) and households with eight or more people (OR, 3.8; 95% CI, 1.1–14.1) in the imputed multivariable mixed-effects model. No significant associations were found for the other recognised risk factors investigated. Overcrowding should continue to be a core focus for communities and policy makers in reducing middle ear disease and its consequences in Aboriginal and Torres Strait Islander peoples.

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