Does the perceived healthcare quality provided by full-time government employee doctors in the public system differ from the perceived care quality in their own privately managed facilities in Nigeria?

Objective: Although the differences in the quality levels between the public and private sectors have been identified in literature not much is known about the level of quality differences that exist when full time government employee doctors offer the same clinical services in their own privately managed facilities. The objective of this study was to compare service user perceived quality of care provided by full-time government employee doctors in the public system and in their own privately managed facilities in Nigeria.Methods: A cross-sectional multistage sampling design was used to elicit service user views on process, structure and outcome elements of quality identified in the Donabedian’s care quality model. The software for population surveys in EPI Info 7 was used to calculate the required sample. A total of 407 questionnaires were administered and completed after a pre-test.Results: Respondents reported better health outcomes in private practice than in the public system and a majority would recommend visiting a dual physician’s private practice than the public system where they work full-time. Process aspects of quality, including better rapport with doctors, greater perceived confidentiality, shorter wait times, and absence of bureaucratic impediments were said to be better in privately managed facilities of government doctors. However, respondents said that the public sector was superior in respect of the structure element of quality as reflected in better infrastructure, equipment, and availability of drugs.Conclusions: Despite the relatively lower cost of care in government hospitals the outcome and process elements are still crucial in determining which sector patients prefer. These two elements seem to have influenced patronage for private practices of dual practitioners.

Companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19: a mixed-methods analysis of national and organisational responses and perspectives

ObjectivesTo explore stakeholders’ and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE) COVID-19 UK study.SettingMaternity care provision in England.ParticipantsInterviews were held with 26 national governmental, professional and service-user organisation leads (July–December 2020). Other data included public-facing outputs logged from 25 maternity Trusts (September/October 2020) and data extracted from 78 documents from eight key governmental, professional and service-user organisations that informed national maternity care guidance and policy (February–December 2020).ResultsSix themes emerged: ‘Postcode lottery of care’ highlights variations in companionship and visiting practices between trusts/locations, ‘Confusion and stress around ‘rules’’ relates to a lack of and variable information concerning companionship/visiting, ‘Unintended consequences’ concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, ‘Need for flexibility’ highlights concerns about applying companionship and visiting policies irrespective of need, ‘‘Acceptable’ time for support’ highlights variations in when and if companionship was ‘allowed’ antenatally and intrapartum and ‘Loss of human rights for gain in infection control’ emphasises how a predominant focus on infection control was at a cost to psychological safety and human rights.ConclusionsPolicies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations.

Citizen experts in participatory governance: Democratic and epistemic assets of service user involvement, local knowledge and citizen science

Initiatives that attribute expert status to ‘ordinary citizens’ proliferate in a range of societal realms and are generally celebrated for ‘democratising expertise’. By tapping new sources of knowledge and participation simultaneously, such ‘citizen expertise’ practices seem to provide responses to the contemporary decline of trust in political elites and traditional experts that seriously challenges the legitimacy of democratic policy-making. This study distinguishes between three quintessential types of citizen expertise (‘local knowledge’, ‘service user involvement’ and ‘citizen science’) and, from an integrated perspective, critically discusses the value of citizen expertise for public knowledge production and democratic governance. Drawing on empirical insights and on theories of democracy and of expertise and knowledge, the concepts of expertise and participation are refined and quality conditions of citizen expertise are developed. The study argues that citizen expertise is epistemically particularly valuable when it is based on distinct, non-ubiquitous experiences and on collective, not just individual, insights. It contends that representativeness is key to the democratic legitimacy of citizen experts in the policy context and points to the key role of organised civil society in establishing the required accountability relationships.

The United Kingdom and the Netherlands maternity care responses to COVID-19: a comparative study

Background: The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises. Aim: To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations. Method: A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders. Findings: Both countries had an infection control focus, with less emphasis on the impact of restrictions. Differences included care providers’ fear of contracting COVID-19; the extent to which personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised. Conclusion: We recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women’s and families’ values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.

Passenger satisfaction and decision of repurchasing on rail transportation services

The purpose of the study was to determine and analyze the effect of train rates, comfort and timeliness on passenger satisfaction and the impact of repurchase decision of train transportation services for the Jenggala Train on the Sidoarjo-Mojokerto route, at East Java, Indonesia. The main problem, there are complaints about unsatisfactory service, inaccuracy of departure and arrival time at the station aim. Also, the passenger capacity provided is large, but the volume transport is still minimal and there is no data on passengers who make repeat purchases. The sample are 100 Jenggala train crossing service Sidoarjo-Mojokerto passengers. Method of data analyze used path analysis. The result showed that the changes of rate amount, experience of passenger comfort, and timeliness of train travel had major impact on the decision of repurchase. As a theorithical and practical implication, the improvement of service user facilities at the station and on the train is very important needed to create comfort for users of transportation services train, because the comfort variable has a significant effect dominant in influencing purchasing decisions.

Navigating and Negotiating Health and Social Services in the Context of Homelessness: Resistance and Resilience

In this article, we draw upon a case study exploring social inequality and homelessness in homeless-oriented services in a large health and social services centre in Montreal, Quebec, Canada. We take up professionals’ (working in homelessness services) and service users’ (people experiencing homelessness) (N=12) perspectives exploring slippery notions of empowerment/disempowerment using a stigma, resistance, and resilience lens. We mobilize the concepts of navigation and negotiation to better understand participants’ experiences of stigma and the dialogical tensions in empowerment/disempowerment constructs moving beyond simple worker/service user dichotomies of powerful/powerlessness. We explore the more nuanced ways professionals and people who experience homelessness (often described in passive terms) understand these tensions and the dynamics at play within professional relationships, systems, and structural constraints. We unpack professionals’ “silent practices” in their effort to “empower” service users and resist institutional forged by neoliberal pressures. We make the case that systemic and structural constraints manifested in institutional practices push people experiencing homelessness to adopt strategies of resilience.