Sustainability of health benefits: Challenges faced by councils health management teams in sustaining comprehensive emergency care services after project phase out. The case of Rufiji, Kilombero and Ulanga districts

Background: Attention to the sustainability of health intervention programs is increasing not only in developing countries but also in developed countries together with international development agencies. However, consensus on operational definitions of sustainability and determinants of sustainability is still at an early stage. While much progress has been made in the development of successful interventions to promote health, too few interventions achieve long term sustainability. Implementation of EMPOWER project in collaboration with World Lung Foundation (WLF) have increased accessibility of comprehensive emergency obstetric care (CEmOC) by upgrading health centers which were formerly not providing CEmOC services in the three rural districts in Tanzania. Although the WHO standards of CEmOC coverage in the project districts was above the requirement, but accessing these health facilities which provides CEmOC was so difficult due to various factors like geographical (mountains, rivers, seasonal roads), locations of these health facilities (like in one district the it was located at a corner of the district), unreliable referral system and poor functionality of these health facilities especially in terms of emergency preparedness etc. all these factors lead to less/poor accessibility to CEmOC. The upgraded facilities include Kibiti in Rufiji district, Mlimba in Kilombero district, Mwaya and Mtimbira in Ulanga district. Objective: To explore challenges of sustaining upgraded health centers and impact on service utilization after project phase out among rural communities in Tanzania.Methods: Purposeful criterion-based selection of the upgraded health centers (those providing CEmOC) was used in the three districts two years after project phase-out. Secondary data analysis of the quantitative data which was collected during and after the project was done. The following services were assessed; total number of facility deliveries, average number of cesarean section (CS), ante natal care (ANC) attendance, post natal care (PNC) attendance, family planning (FP) use and partograph to monitor the progress of labor. Qualitative data involved key informant interviews of council health management teams (CHMT) and facility in charges.Monitoring data, evaluation and observation of various CEmOC and MNCH related indicators were also done. Four upgraded health centers (Mwaya, Mtimbira, Mlimba and Kibiti) were used as case studies to generate learning reported in this paper.Results: Two years post project, the utilization of most of the services like number of deliveries and CS performed better and were maintained in upgraded health centers which receive regular assistance (Mwaya and Mlimba) than Kibiti health center which received minimal support. Health workers remained committed to sustain the practices promoted in the interventionsdespite of the noted challenges.Conclusions: Benefits of introduced health innovations such as upgrading of health centers for CEmOC can only be sustained if a sustainability strategies are integrated at early stages of project design and carried forward in routine district health planning processes.

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Adherence to malaria rapid diagnostic test results and a qualitative study on Health Workers perception about the test in Agona East District of Ghana

10.21203/rs.3.rs-118883/v1 ◽

2020 ◽

Author(s):

Selina Ansah-Koi

Keyword(s):

Diagnostic Test ◽

Rapid Diagnostic Test ◽

Health Workers ◽

Health Planning ◽

National Level ◽

Health Facilities ◽

Health Centers ◽

Quantitative Aspect ◽

Test Results ◽

Negative Test

Abstract Background Ghana has adopted the policy of diagnostically testing for malaria before treatment. The Rapid Diagnostic Test (RDT) is used to diagnose malaria especially in lower health facilities like Health Centers (HC) and Community-based Health Planning Services (CHPS) Compounds without microscopy. Studies have shown that clinicians do not always adhere to negative malaria test results of the RDT and prescribe anti-malarials. Methods Quantitative aspect focused on how malaria is diagnosed and adherence to negative rapid diagnostic test results using the consulting room register and patients’ folder of six health facilities within the period of July to September 2015. In-depth interviews using purposive sampling was conducted for 14 health workers at Health Centers and CHPS compounds to find out their perceptions about malaria RDT and reasons for adherence or non-adherence to test results.Results Of the six health facilities in the Agona East District, 3.87% (14/362) were presumptively diagnosed with malaria whiles 96.10% (348/362) were diagnosed with malaria using RDT.For those tested with RDT, 15.25% tested negative and 84.75% tested positive. Of those who tested negative, 20.75% were given anti-malarials and 79.25% did not receive anti-malarials. Health workers perceived the Malaria RDT kit as easy to use and also as making work easier. Testing is done mainly because it is a policy. Conclusion The malaria testing rate in the Agona East District is higher than that at the National level. Health Centers compared to CHPS compounds are likely to treat for malaria in cases of a negative test result. There is also high adherence to negative test results. Health workers perceive the RDT as a useful tool which has made malaria diagnosis easy.

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An assessment of mental health programs at community health centers in north Minahasa, Indonesia

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20214556 ◽

2021 ◽

Vol 8 (12) ◽

pp. 5707

Author(s):

Jessica Gloria Mogi ◽

Gustaaf A. E. Ratag

Keyword(s):

Mental Health ◽

Community Health ◽

Community Health Centers ◽

Supported Employment ◽

Health Workers ◽

Health Facilities ◽

Health Centers ◽

Healthcare Facilities ◽

Family Approach ◽

Mental Health Programs

Background: The Indonesian government recognizes the importance of mental health issues as indicated by the inclusion of such issues as indicators in the national program, the Healthy Indonesian Program with Family Approach (PIS-PK). This program is enforced in community health centers (puskesmas) in every regency in the country. However, the continually increasing number of mental disorder cases and the intense stigmatization of people with these disorders indicate the need to re-evaluate the capacity and delivery of designated centers’ mental health programs.Methods: This community survey involved interviewing the program directors of four community health centers in north Minahasa using the WHO-AIMS 2.2 questionnaire.Results: Very little effort has been made to improve mental health facilities and programs. Examples of aspects of health facilities that are lacking include training for health workers, the provision of psychotropic drugs, and supported employment or occupational rehabilitation.Conclusions: Community health centers are primary healthcare facilities for society. Therefore, mental health services should be implemented as one of their main programs.

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PENGEMBANGAN MEDIA INFORMASI UNTUK PELAYANAN PENDAFTARAN PASIEN DI BPM RIKA HARDI, S.ST

LOGISTA - Jurnal Ilmiah Pengabdian kepada Masyarakat ◽

10.25077/logista.4.1.123-128.2020 ◽

2020 ◽

Vol 4 (1) ◽

pp. 123

Author(s):

Rahmi Septia Sari

Keyword(s):

Health Facility ◽

Information Needs ◽

Health Workers ◽

Health Management ◽

Community Health Services ◽

Health Care Facilities ◽

Health Facilities ◽

Media Planning ◽

Information Media ◽

The Government

Fasilitas kesehatan merupakan pelayanan yang sangat penting bagi masyarakat. Pelayanan kesehatan adalah tulang punggung fasilitas kesehatan di Indonesia. Fasilitas kesehatan bisa dimiliki oleh Pemerintah, Pemerintah Daerah atau swasta. Tenaga kesehatan terdiri dari beragam profesi seperti tenaga dokter, bidan, perawat, apoteker, ahli gizi, tenaga perekam medis, tenaga manajemen kesehatan maupun tenaga non kesehatan. Pasien yang datang ke fasilitas kesehatan pun memiliki beragam jenis penyakit mulai dari penyakit menular sampai penyakit degeneratif. Oleh karena itu, dalam hal ini dilakukan penyusun alur dan prosedur pendaftaran pasien sehingga pelayanan berlangsung baik. Salah satu kriteria penilaian akreditasi pada suatu fasilitas kesehatan adalah tersedianya informasi tentang alur prosedur pendaftaran pelayanan saat pasien mendaftar di loket pendaftaran. Kejelasan informasi yang diterima pasien akan memberikan rasa puas terhadap pasien. Kesan pertama di loket pendaftaran akan membentuk persepsi pasien terhadap keseluruhan pelayanan di fasilitas kesehatan. Tujuan kegiatan ini menyediakan media informasi untuk edukasi pasien saat mendaftar tentang alur dan prosedur pelayanan di loket pendaftaran. Metode yang lakukan adalah observasi ke fasilitas pelayanan kesehatan, identifikasi dan analisis kebutuhan media informasi, perencangan media informasi, ujicoba media, sosialisasi, dan evaluasi. Hasil yang diperoleh tersedianya media informasi dalam bentuk banner tentang alur prosedur pelayanan di fasilitas kesehatan. Kata Kunci: Media, Alur prosedur pendaftaran, Bidan praktek mandiri ABTRACT Health facilities are very important services for the community. Health services are the backbone of health facilities in Indonesia. Health facilities can be owned by the Government, Local Government or private. Health workers consist of various professions such as doctors, midwives, nurses, pharmacists, nutritionists, medical record workers, health management personnel and non-health workers. Patients who come to health facilities also have a variety of diseases ranging from infectious diseases to degenerative diseases. Therefore, here I am trying to develop a flow and procedure for patient registration. One of the criteria for evaluating accreditation at a health facility is the availability of information about the flow of the procedure for registering services when patients register at the registration counter. Clarity of information received by the patient will give satisfaction to the patient. First impressions at the registration window will shape the patient's perception of the overall service in the health facility. The purpose of this activity is to provide information media for patient education when registering the flow and procedure of service at the registration counter. The method used is observation to health care facilities, identification and analysis of media information needs, information media planning, media testing, outreach, and evaluation. The results obtained are the availability of information media in the form of banners about the flow of service procedures in health facilities. Keywords: Media, Registration procedure flow, Midwife independent practice

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Penerapan Face Shield Bagi Tenaga Medis Untuk Menangani Pasien Covid-19 di Kota Batu Jawa Timur

ABIDUMASY Jurnal Pengabdian kepada Masyarakat ◽

10.33752/abidumasy.v2i1.1318 ◽

2021 ◽

Vol 2 (1) ◽

pp. 1-6

Author(s):

Mochamad Arif Irfai1 ◽

Muchlis Arif ◽

Nova Kristiana ◽

I Made Arsana4

Keyword(s):

Community Health ◽

Community Health Centers ◽

Health Workers ◽

Medical Personnel ◽

Health Facilities ◽

Health Centers ◽

Referral Hospitals ◽

The Government ◽

Activity Questionnaires ◽

Helmet Design

The purpose of this activity is to assist the government in providing and distributing face shields for medical personnel at referral hospitals to treat covid-19 patients. At first we analyzed the problems with partners (hospitals and community health centers). The results of the analysis show that hospitals and health centers lack a helmet-face shield for medical personnel to treat covid-19 patients. Based on the results of discussions and requests from the partner. Then the design is carried out to manufacture a helmet-face shield. There are 2 PPE made, The first type is only a face shield and the second type is obtained a helmet design that is equipped with a face shield or can be called a helmet-face shield. At the end of the activity, questionnaires were distributed to respondents consisting of doctors, nurses and other medical personnel. Respondents were selected randomly in health facilities in Batu, East Java. The response from medical personnel has generally been positive. This can be seen from the questionnaires distributed to respondents. More than 90% of the results of the questionnaire stated that helmet-face shield and face shield products could be accepted by health workers.

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Barriers and Facilitators of Access to Maternal, Newborn and Child Health Services During the First Wave of COVID-19 Pandemic in Nigeria: Findings From a Qualitative Study

10.21203/rs.3.rs-398162/v1 ◽

2021 ◽

Author(s):

Godwin Otuodichinma Akaba ◽

Osasuyi Dirisu ◽

Kehinde S Okunade ◽

Eseoghene Adams ◽

Jane Ohioghame ◽

...

Keyword(s):

Public Health ◽

Child Health ◽

Qualitative Study ◽

Health Workers ◽

Health Facilities ◽

Health Centers ◽

Barriers And Facilitators ◽

Immunization Service ◽

Newborn And Child Health ◽

And Child Health

Abstract BackgroundUnderstanding how COVID-19 has shaped access to maternal. newborn and child health (MNCH) services in Nigeria and the contextual factors attributable to these changes is crucial towards development of policies and interventions that will assist the country in maintaining focus towards sustaining the little gains it has made over the past few years towards improving MNCH despite the COVID -19 pandemic.The objective of the study was to explore the barriers and facilitators of access to MNCH services during the first wave of COVID-19 pandemic in Nigeria.MethodsA qualitative study was conducted among different stakeholder groups in 18 public health facilities in Nigeria between May and July,2020. In-depth interviews were conducted among 54 study participants (service users, service providers and policymakers,) selected from across the three tiers of public health service delivery system in Nigeria (primary health centers, secondary health centers and tertiary health centers). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses.ResultsBarriers to accessing MNCH services during the first wave of Covid-19 pandemic in Nigeria include fear of contracting COVID-19 infection at health facilities, transportation difficulties, movement restriction, stigmatization of sick persons, lack of personal protective equipment (PPE) /medical commodities, long waiting times at hospitals, shortage of manpower, lack of preparedness by health workers, and prioritization of essential services. Enablers to access include the COVID-19 non-pharmacological measures instituted at the health facilities, community sensitization on healthcare access during the pandemic, and alternative strategies for administering immunization service at the clinics.Conclusion Access to MNCH services was negatively affected by the COVID-19 pandemic particularly due to challenges resulting from restrictions in movements and the health systems inability to provide enabling conditions for sustained utilization of MNCH services. There is need for national health managers and policy makers to institute measures that will allow unhindered access to MNCH services during future pandemics. This may include provision of socio-economic safety nets for women, provision of PPEs, use of e-health platforms for consultations, and incentives for health workers.

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Utilization of Routine Health Information from Health Management Information System and Associated Factors Among Health Workers at Health Centers in Oromia Special Zone, Ethiopia: A Multilevel Analysis

Risk Management and Healthcare Policy ◽

10.2147/rmhp.s285604 ◽

2021 ◽

Vol Volume 14 ◽

pp. 1189-1198

Author(s):

Mohammed Ahmed Seid ◽

Negalign Berhanu Bayou ◽

Fanos Yeshanew Ayele ◽

Aregash Abebayehu Zerga

Keyword(s):

Information System ◽

Health Information ◽

Management Information System ◽

Associated Factors ◽

Health Workers ◽

Health Management ◽

Health Centers ◽

Health Management Information System ◽

Management Information ◽

Special Zone

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PENINGKATAN KUNJUNGAN IBU HAMIL DI PUSKESMAS SEBAGAI EFEK DIGUNAKANNYA ULTRASOUND PADA PEMERIKSAAN KEHAMILAN

Jurnal Kesehatan Reproduksi ◽

10.22435/kespro.v10i2.2586 ◽

2020 ◽

Vol 10 (2) ◽

pp. 141-152

Author(s):

Ingan Tarigan ◽

Tita Rosita ◽

Tin Afifah ◽

Soewarta Kosen

Keyword(s):

Antenatal Care ◽

Health Workers ◽

Community Health Center ◽

Total Sample ◽

Mortality Rates ◽

Pregnancy Complication ◽

Health Facilities ◽

Health Centers ◽

Ultrasound Device ◽

The Government

Abstract Background: Maternal and neonatal mortality rates are still a problem in Indonesia. Various efforts have been made, such as training and placing midwives in villages, increasing the number of deliveries performed in health facilities. There is a consensus that an important intervention is to provide appropriate health facilities managed by trained health workers who assist in childbirth, including midwives and doctors. One of the means of infrastructure that needs to be considered available at the community health center (puskesmas) is an ultrasound device to detect pregnancy complications. Objective: The purpose of this study was to determine the effect of the use of ultrasound devices to increase antenatal care (ANC) to health centers. Method: the study design was a quasi-experiment conducted at 20 puskesmas in Bogor district. Analyses was conducted in descriptive, the total sample participating in the study was 4,049 cases, but only 3,314 cases were analysed. Result: The results of the study prove that the availability of USG at the puskesmas increases ANC visits to the puskesmas. The availability of ultrasound and the use of ultrasound affect the number of ANC visits to health facilities, especially to puskesmas. As an attraction for screening and ANC during pregnancy, the government needs to provide an ultrasound device at puskesmas. Key words: Ultrasoundgraphic, antenatal care, Puskesmas, midwives, pregnancy complication Abstrak Latar belakang: Angka kematian ibu dan neonatal masih merupakan masalah di Indonesia. Berbagai upaya telah dilakukan, seperti melatih dan menempatkan bidan di desa, meningkatkan jumlah persalinan yang dilakukan di fasilitas kesehatan. Ada konsensus yang menyatakan bahwa intervensi yang penting dilakukan adalah memberikan fasilitas kesehatan yang layak dikelola oleh tenaga kesehatan terlatih yang menolong persalinan, antara lain bidan dan dokter. Salah satu sarana prasarana yang perlu dipertimbangkan tersedia di puskesmas adalah alat ultrasound untuk mendeteksi komplikasi kehamilan. Tujuan: mengetahui pengaruh penggunaan alat USG terhadap peningkatan antenatal care (ANC) ke puskesmas. Metode: disain penelitian adalah quasi eksperimen yang dilakukan pada 20 puskesmas di kabupaten Bogor. Analisis dilakukan secara deskriptif, total sampel yang berpatisipasi dalam penelitian 4.049 kasus, namun yang di analisis hanya 3.314 kasus. Hasil: Ketersedian USG di puskesmas meningkatkan kunjungan ANC ke puskesmas. Ketersediaan USG dan penggunaan USG mempengaruhi jumlah kunjungan ANC ke fasilitas kesehatan, khususnya ke puskesmas. Sebagai daya Tarik untuk melakukanskrining dan ANC pada saat kehamilan, maka pemerintah perlu menyediakan alat USG di puskesmas. Kata kunci: Ultrasound, Antenatal Care, Puskesmas, Bidan, Komplikasi Kehamilan

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Assessment of COVID-19 Infection Prevention and Control Capabilities in 39 Haitian Hospitals

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.129 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s66-s66

Author(s):

Afeke Kambui ◽

Mentor Lucien ◽

Catherine Emilien ◽

Francois Staco ◽

Ymeline Pateau St Vil ◽

...

Keyword(s):

International Development ◽

Prevention And Control ◽

Infection Prevention ◽

Health Workers ◽

Humanitarian Assistance ◽

Health Facilities ◽

Management Systems ◽

Infection Prevention And Control ◽

Agency For International Development ◽

And Control

Background: Infection prevention and control (IPC) is key (1) to keeping health workers and patients safe from contracting infections during care, (2) to enabling continuity of essential health services, and (3) to pandemic preparedness and response. Frontline health workers are at 3-fold increased risk for COVID-19 (Lancet 2020) and account for 6% of COVID-19 hospitalizations (CDC 2020). With the support of the US Agency for International Development Bureau of Humanitarian Assistance (USAID/BHA) and collaboration of the Haitian Ministry of Health (MSPP), MSH’s Rapid Support to COVID-19 Response in Haiti project (RSCR Haiti) developed an instrument to assess select public hospitals and identify IPC gaps that informed COVID-19 response and system strengthening measures for increasing patient and provider safety. Methods: The IPC tool contains 13 IPC domains and 80 questions, for a total of 600 points. It was developed based on the World Health Organization IPC Assessment Framework for Health Facilities (2018) and US Centers for Disease Control Facility Readiness Assessment for COVID-19 (2020). In total, 39 health facilities chosen by the MSPP across all 10 departments of Haiti were evaluated in October 2020. Data were analyzed in Microsoft Excel by category, site, and IPC capabilities then classified as inadequate, basic, intermediate or advanced. Results: IPC capabilities scored as inadequate in 18% and basic in 67% of hospitals (Graph 1). No institution was advanced. Among health facilities, IPC programs existed in only 18%; IPC guidelines or procedures were present in 38%; staff were trained regularly in 12%; and healthcare-associated infection surveillance was performed in 19%. Systems for COVID-19 triage existed in 56%; 39% had IPC commodity management systems; 45% provided COVID-19 training; 26% practiced monitoring of staff and patients for COVID-19; 36% had protocols for an influx of COVID-19 cases; and 72% practiced risk communication (Table 1). Conclusions: No health facility was sufficiently equipped to implement adequate COVID-19 IPC measures, and all needed strengthening, even in the highest-scoring IPC areas. Through RSCR Haiti, MSH and MSPP were able to identify and address priorities in hospitals: establishing hospital IPC programs; training staff; monitoring health workers and patients; and implementing guidance, triage, and commodity-management systems. This study demonstrates that it is possible to do a quick yet thorough assessment to rapidly identify IPC needs and opportunities, using the results to rapidly build response capacity. Haiti’s experience of integrating locally contextualized global IPC tools to inform systemic COVID-19 response measures can benefit other experts globally.Funding: United States Agency for International Development Bureau of Humanitarian Assistance (USAID/BHA)Disclosures: None

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Analisis Karakteristik dan Persepsi Pengguna Pelayanan Terhadap Pemanfaatan Puskesmas Sebagai Gatekeeper di Dua Puskesmas Kota Bekasi Tahun 2016

Jurnal Ekonomi Kesehatan Indonesia ◽

10.7454/jurnal-eki.v2i1.1957 ◽

2017 ◽

Vol 2 (1) ◽

Author(s):

Fitria Kusumawati Wulandari ◽

Anhari Achadi

Keyword(s):

Health Care ◽

Primary Health Care ◽

Managed Care ◽

Health Workers ◽

Health Facilities ◽

Health Centers ◽

Dominant Factor ◽

Cross Sectional ◽

Purposive Sampling ◽

Primary Health

AbstrakKonsep pelayanan kesehatan primer pada era Jaminan Kesehatan Nasional (JKN) dikembangkan dengan penguatan pelayanan primer sebagai gatekeeper dengan konsep managed care. Pada konsep managed care, suksesnya sistem gatekeeper salah satunya dinilai dari angka kunjungan dan angka rujukan ke Fasilitas Kesehatan Tingkat Lanjutan (FKTL). Penelitian ini bertujuan untuk mengetahui karakteristik dan persepsi pengguna pelayanan terhadap pemanfaatan Puskesmas sebagai gatekeeper di dua puskesmas Kota Bekasi. Penelitian ini menggunakan desain cross sectional dan pengumpulan data melalui pengisian kuesioner oleh 208 pasien peserta JKN di dua puskesmas Kota Bekasi dengan metode pengambilan sampel secara stratified purposive sampling. Hasil penelitian menunjukkan pekerjaan (nilai p=0,018), persepsi terhadap sikap petugas kesehatan (nilai p=0,000), dan lama berobat (nilai p=0,048) berhubungan dengan pemanfaatan puskesmas sebagai gatekeeper. Persepsi terhadap sikap petugas kesehatan merupakan faktor dominan yang mempengaruhi pemanfaatan Puskesmas sebagai gatekeeper (r=0.720). Penerapan konsep gatekeeper dengan baik dapat meningkatkan pemanfaatan Puskesmas dan menekan angka rujukan ke FKTL. AbstractThe concept of primary health care in the era of National Health Insurance (JKN) is developed by strengthening primary health care as a gatekeeper with the concept of managed care. In this concept of managed care, one og the success story of the gatekeeper system is assessed by the visit and referral rates to the Higher Level of Health Facilities (ALHF/Fasilitas Kesehatan Tingkat Lanjut). This study aimed to determine the characteristics and perception of service users towards utilization of public health centers (PHC/Puskesmas) as gatekeeper in two PHC in City of Bekasi. This study used cross-sectional design and data collection by filling up questionnaires by 208 patients of JKN members in two health centers in Bekasi with stratified purposive sampling methods. The results showed that job(p=0.018), perceptions of the health workers’ attitudes (p=0.000), and treatment duration (p=0.048) were related to the utilization of PHC as a gatekeeper. Perceptions of the health workers’ attitude was the dominant factor affecting the utilization of PHC as a gatekeeper (r=0.720). The health workers’ attitude affected the repeated utilization services in PHC and its utilization as a gatekeeper, especially for continuum care. The proper application of gatekeeper concept should be able to increase the utilization of PHC and reduce the number of referrals to the Advanced Level of Health Facilities (ALHF).

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