Effects of Results-Based Financing on Patient Satisfaction in Afghanistan

<p>A Results-Based Financing (RBF) program has been implemented in Afghanistan since September 2010 to improve the quality of health care and increase the utilization of maternal and child health services. This PhD study examines the impact of RBF on patient satisfaction and on determinants of patient satisfaction at health facility level in Afghanistan. Determinants of patient satisfaction in the study refer to health provider performance, availability of medicines, vaccines, equipment, and physical appearance of health facilities. I used data collected from a panel of health facilities over a three-year period. The data consist of nearly 3000 patient observations and exit interviews. I included 112 health facilities in my study. These health facilities were part of the 428 health facilities which had been randomly assigned to treatment and control groups prior to the start of RBF in 2010. Financial incentives were distributed among health providers in the treatment facilities through four administration mechanisms: salary-based, task-based, equal-amount, and mixed-method. Follow-up surveys were conducted in 2011 and 2012 in the same 112 facilities, but for new cross-sections of patients and health providers. I analysed a range of patient satisfaction and patient satisfaction determinants measures using a regression-adjusted difference-in-differences estimation model. The results from this study show that after a period of two years, there was an increase of only 8 percentage points in the proportion of patients who were very satisfied with services as a whole. However, the effect was not statistically significant. Similarly, specific aspects of patient satisfaction were not significantly affected by the intervention. Likewise, RBF did not have any significant effect on health provider performance, on availability of medicines, vaccines, and equipment, and on physical appearance of health facilities over a two-year period. I also found no difference in RBF treatment effects by the different incentive administration mechanisms. My study provides evidence which suggests that paying monetary incentives alone may not have the impetus to improve health provider performance to the satisfaction of patients in a post conflict country. In such settings, RBF initiatives need to include both financial and non-financial incentives for health providers in order to achieve the intended objectives of quality of care and patient satisfaction. My study provides pragmatic recommendations aimed at holistic approaches to improving quality and delivery of healthcare in a post conflict setting.</p>

Effects of Results-Based Financing on Patient Satisfaction in Afghanistan

<p>A Results-Based Financing (RBF) program has been implemented in Afghanistan since September 2010 to improve the quality of health care and increase the utilization of maternal and child health services. This PhD study examines the impact of RBF on patient satisfaction and on determinants of patient satisfaction at health facility level in Afghanistan. Determinants of patient satisfaction in the study refer to health provider performance, availability of medicines, vaccines, equipment, and physical appearance of health facilities. I used data collected from a panel of health facilities over a three-year period. The data consist of nearly 3000 patient observations and exit interviews. I included 112 health facilities in my study. These health facilities were part of the 428 health facilities which had been randomly assigned to treatment and control groups prior to the start of RBF in 2010. Financial incentives were distributed among health providers in the treatment facilities through four administration mechanisms: salary-based, task-based, equal-amount, and mixed-method. Follow-up surveys were conducted in 2011 and 2012 in the same 112 facilities, but for new cross-sections of patients and health providers. I analysed a range of patient satisfaction and patient satisfaction determinants measures using a regression-adjusted difference-in-differences estimation model. The results from this study show that after a period of two years, there was an increase of only 8 percentage points in the proportion of patients who were very satisfied with services as a whole. However, the effect was not statistically significant. Similarly, specific aspects of patient satisfaction were not significantly affected by the intervention. Likewise, RBF did not have any significant effect on health provider performance, on availability of medicines, vaccines, and equipment, and on physical appearance of health facilities over a two-year period. I also found no difference in RBF treatment effects by the different incentive administration mechanisms. My study provides evidence which suggests that paying monetary incentives alone may not have the impetus to improve health provider performance to the satisfaction of patients in a post conflict country. In such settings, RBF initiatives need to include both financial and non-financial incentives for health providers in order to achieve the intended objectives of quality of care and patient satisfaction. My study provides pragmatic recommendations aimed at holistic approaches to improving quality and delivery of healthcare in a post conflict setting.</p>

Male Prisoners’ Perspectives of Access to Quality Health Care at a Prison Infirmary in Ghana

This study assessed factors that influence access to quality health care among a prison population nearing its release in Ghana. A structured quantitative questionnaire was administered to 200 inmates using a total population sampling. Gap analysis was performed between inmate expectations and perceptions of health provider factors to determine quality. There was an overall negative gap due to expectations exceeding perceptions. This article recommends that a policy document on the health and welfare of inmates be developed and implemented to improve their access to quality health care.

Psychiatric Health Problems and Health Seeking Behavior of Men Who Have Sex with Men (MSM) in Agra city, Uttar Pradesh

Introduction: Researches had shown that Men who have sex with men (MSM) have higher chances of having psychiatric disorder as compared to heterosexual men. Ongoing homophobia, stigma and discrimination have negative effects on mental health of MSM. Many MSM do not seek care from mental health provider because of fear of discrimination Objectives: This study was carried out to assess psychiatric health problem among MSM and also assess their health seeking behavior. Method: The Snowball sampling technique was used. First participants were recruited through a non-profit peer group. Further participants were subsequently referred by participants from their peer circles. Data obtained from total 52 MSM using pretested questionnaire and General health questionnaire (GHQ-28) was analyzed using MS Excel. Results: Two-fifth (40.38%) of MSM had self-reported psychiatric health problem. While on GHQ, 57.69% of MSM were found to have psychiatric health problem with GHQ score of ≥24. MSM who were completely homosexual and who were victims/doer of violence with sex partners had significantly higher chances of having psychiatric health problem.57.15% MSM sought treatment for their psychiatric problem from an Allopathic doctor. Rest of them either went for a self treatment (28.57%) or not taken any treatment (14.28%). 75% MSM reportedly sought treatment from private health facility. Better facility, cost effectiveness, someone known recommended were most commonly cited reason for preferring a mental health provider. Conclusion: High prevalence of psychiatric health problems was found among MSM who engage in higher-risk sexual behavior. MSM require access to mental health screening services.

EFFECTIVENESS OF PEER EDUCATION IN DECREASING ADOLESCENT PREGNANCY: A LITERATURE REVIEW

Background: Currently, the number of adolescents who have sexual intercourse is increasing and those make a higher risk of medical, psychological, and social implications. This behaviour is obviously leading to an increase the number of adolescence pregnancy. Sex education and counselling in many countries is delivered by health care professionals. In Indonesia, there are some sex education programs delivered by peer educators but their success in reducing adolescence pregnancy is unknown. Objective: The aim of this study was to analyze the effectiveness of a peer reproductive health education program in decreasing unplanned pregnancy in adolescents. Method: This integrative literature review was based on 3 databases which included Google Scholar, Pubmed and SAGE Journal. The inclusion criteria were articles published within the 2012–2018-year range, written in English, and the entire article was available and accessible. Only original articles with experimental design will be included. The quality of the selected articles was defined by using the Olsen-Baisch Scoring critical appraisal tool for integrative review. Result: Peer education builds social support and sense of belonging. The content is not only about unplanned pregnancy but also STI and HIV; responsible decision making; and body image identification. Peer educator can be the role model and have greater opportunities to counter the risk of adolescent pregnancy. Conclusion: Preventing adolescent pregnancy can save the next generation and improve adolescent health. Peer educator as part of health provider connect adolescents with their reproductive health needs. This approach would be beneficial strategy consider by health provider to protect adolescents. Keywords: adolescent, peer educator, pregnancy, sex education

Impact of imprecise household location on effective coverage estimates generated through linking household and health provider data by geographic proximity: a simulation study

Background Geographic proximity is often used to link household and health provider data to estimate effective coverage of health interventions. Existing household surveys often provide displaced data on the central point within household clusters rather than household location. This may introduce error into analyses based on the distance between households and providers. Methods We assessed the effect of imprecise household location on quality-adjusted effective coverage of child curative services estimated by linking sick children to providers based on geographic proximity. We used data on care-seeking for child illness and health provider quality in Southern Province, Zambia. The dataset included the location of respondent households, a census of providers, and data on the exact outlets utilized by sick children included in the study. We displaced the central point of each household cluster point five times. We calculated quality-adjusted coverage by assigning each sick child to a provider’s care based on three measures of geographic proximity (Euclidean distance, travel time, and geographic radius) from the household location, cluster point, and displaced cluster locations. We compared the estimates of quality-adjusted coverage to each other and estimates using each sick child’s true source of care. We performed sensitivity analyses with simulated preferential care-seeking from higher-quality providers and randomly generated provider quality scores. Results Fewer children were linked to their true source of care using cluster locations than household locations. Effective coverage estimates produced using undisplaced or displaced cluster points did not vary significantly from estimates produced using household location data or each sick child’s true source of care. However, the sensitivity analyses simulating greater variability in provider quality showed bias in effective coverage estimates produced with the geographic radius and travel time method using imprecise location data in some scenarios. Conclusions Use of undisplaced or displaced cluster location reduced the proportion of children that linked to their true source of care. In settings with minimal variability in quality within provider categories, the impact on effective coverage estimates is limited. However, use of imprecise household location and choice of geographic linking method can bias estimates in areas with high variability in provider quality or preferential care-seeking.

Behavioral Assessment of productivity and profitability Indicators in Health Provider companies from the Contributory Schemein Colombia

Objetivo: Analizar el comportamiento que han sufrido los indicadores de productividad y rentabilidad financieros en las Empresas Prestadoras de Salud del régimen contributivo en Colombia. Materiales y métodos: Estudio cualitativo, descriptivo propositivo y cuantitativo soportado en un Análisis Discriminante Multivariado (ADM), que permite analizar diferencias significativas durante los periodos 2008 y 2010. Se definen y calculan los indicadores de productividad y rentabilidad financieros analizando las diferencias significativas y medias de los periodos estudiados. Resultados: Se pudo evidenciar y demostrar en el trabajo de investigación que en el análisis de las medias del indicador Utilidad Operacional / Valor agregado (IP2) presentó diferencias significativas. Para el análisis de la función discriminante mejoraron los indicadores Utilidad Bruta / Ingresos Operacionales (MB) y Utilidad Operacional / Valor agregado (IP2) durante los periodos 2008 y 2010 en las Entidades Prestadoras de Salud del régimen contributivo. Conclusiones: Según el trabajo de investigación se pudo concluir por el Análisis Discriminante Multivariado que existe una diferencia significativa en los dos periodos estudiados, el modelo de la función discriminante permite predecir el comportamiento de la población a futuro con un 61,1 % de probabilidad.