Experiences of private sector quality care amongst mothers, newborns, and children in low- and middle-income countries: a systematic review

Background Experience of care is a pillar of quality care; positive experiences are essential during health care encounters and integral to quality health service delivery. Yet, we lack synthesised knowledge of how private sector delivery of quality care affects experiences of care amongst mothers, newborns, and children. To fill this gap, we conducted a systematic review that examined quantitative, qualitative, and mixed-methods studies on the provision of maternal, newborn, and child health (MNCH) care by private providers in low- and middle-income countries (LMICs). This manuscript focuses on experience of care, including respectful care, and satisfaction with care. Methods Our protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Searches were conducted in eight electronic databases (Cumulative Index to Nursing and Allied Health, EconLit, Excerpta Medica Database, International Bibliography of the Social Sciences, Popline, PubMed, ScienceDirect, and Web of Science) and two websites and supplemented with hand-searches and expert recommendations. For inclusion, studies examining private sector delivery of quality care amongst mothers, newborns, and children in LMICs must have examined maternal, newborn, and/or child morbidity or mortality; quality of care; experience of care; and/or service utilisation. Data were extracted for descriptive statistics and thematic analysis. Results Of the 139 studies included, 45 studies reported data on experience of care. Most studies reporting experience of care were conducted in India, Bangladesh, and Uganda. Experiences of private care amongst mothers, newborns, and children aligned with four components of quality of care: patient-centeredness, timeliness, effectiveness, and equity. Interpersonal relationships with health care workers were essential to experience of care, in particular staff friendliness, positive attitudes, and time spent with health care providers. Experience of care can be a stronger determining factor in MNCH-related decision-making than the quality of services provided. Conclusion Positive experiences of care in private facilities can be linked more broadly to privileges of private care that allow for shorter waiting times and more provider time spent with mothers, newborns, and children. Little is known about experiences of private sector care amongst children. Trial registration This systematic review was registered with the PROSPERO international prospective register of systematic reviews (registration number CRD42019143383).

An economic evaluation of an intervention to increase demand for medical male circumcision among men aged 25–49 years in South Africa

Background Studies estimate that circumcising men between the ages of 20–30 years who have exhibited previous risky sexual behaviour could reduce overall HIV prevalence. Demand creation strategies for medical male circumcision (MMC) targeting men in this age group may significantly impact these prevalence rates. Objectives The objective of this study is to evaluate the cost-effectiveness and cost-benefit of an implementation science, pre-post study designed to increase the uptake of male circumcision for ages 25–49 at a fixed MMC clinic located in Gauteng Province, South Africa. Methods A health care provider perspective was utilised to collect all costs. Costs were compared between the standard care scenario of routine outreach strategies and a full intervention strategy. Cost-effectiveness was measured as cost per mature man enrolled and cost per mature man circumcised. A cost-benefit analysis was employed by using the Bernoulli model to estimate the cases of HIV averted due to medical male circumcision (MMC), and subsequently translated to averted medical costs. Results In the 2015 intervention, the cost of the intervention was $9445 for 722 men. The total HIV treatment costs averted due to the intervention were $542,491 from a public care model and $378,073 from a private care model. The benefit-cost ratio was 57.44 for the public care model and 40.03 for the private care model. The net savings of the intervention were $533,046 or $368,628 - depending on treatment in a public or private setting. Conclusions The intervention was cost-effective compared to similar MMC demand interventions and led to statistically significant cost savings per individual enrolled.

Patients’ Access to Their Psychiatric Notes: Current Policies and Practices in Sweden

Patients’ access to electronic health records (EHRs) is debated worldwide, and access to psychiatry records is even more criticized. There is a nationwide service in Sweden which offers all citizens the opportunity to read their EHR, including clinical notes. This study aims to explore Swedish national and local policy regulations regarding patients’ access to their psychiatric notes and describe to what extent patients currently are offered access to them. The rationale behind the study is that current policies and current practices may differ between the 21 self-governing regions, although there is a national regulation. We gathered web-based information from policy documents and regulations from each region’s website. We also conducted key stakeholder interviews with respondents from the regions and cross-regional private care providers, using a qualitative approach. The results show that 17 of 21 regions share psychiatric notes with patients, where forensic psychiatric care was the most excluded psychiatric care setting. All private care providers reported that they mainly follow the regions’ guidelines. Our findings show that regional differences concerning sharing psychiatric notes persist, despite Swedish regulations and a national policy that stipulates equal care for everyone. The differences, however, appear to have decreased over time, and we report evidence that the regions are moving toward increased transparency for psychiatry patients.

Nanotechnology Based Cosmeceuticals

Nanotechnology manifests the progression within stage of research and development, by increasing the efficacy of the merchandise through delivery of innovative solutions. to beat certain drawbacks associated with the traditional products, application of nanotechnology is escalating within the world of cosmeceuticals. In private care industry, cosmeceuticals are considered the fastest growing segment and thus the use has risen drastically over the years. Nanocosmeceuticals used for skin, hair, nail, and lip care, for conditions like wrinkles, photoaging, hyperpigmentation, dandruff, and hair damage, have inherit widespread use. Novel nanocarriers like nano emulsions, liposomes, microemulsions, niosomes, solid lipid nanoparticles, nanospheres and nanostructured lipid carrier have replaced the usage of conventional delivery system. These novel nanocarriers have advantages of controlled and sustained drug release, enhanced skin penetration, higher stability, high entrapment efficiency and site-specific targeting. However, nanotoxicological researches have indicated concern regarding the impact of increased use of nanoparticles in cosmeceuticals as there are possibilities of nanoparticles to penetrate through skin and cause health hazards. This review on nanotechnology utilized in cosmeceuticals highlights the various novel carriers used for the delivery of cosmeceuticals, marketed formulations, their positive and negative aspects, toxicity, and regulations of nanocosmeceuticals.

Standard Survey Data: Insights Into Private Sector Utilization

Universal Health Coverage in Low- and Middle-Income Countries is increasingly expanding through incorporation of private clinics, pharmacies, and hospitals into an overall health system funded in whole or part through government-managed health insurance. This underscores the importance of policies on health provision which apply across the whole delivery system regardless of ownership status. To advance understanding of private-sector policies, and to facilitate sharing of lessons across countries with similar public-private distributions, we have analyzed data on the source of inpatient and outpatient care from 65 countries. While past studies have conducted similar analysis, ours advances the field in two ways. First, we limit our analysis to data sets from 2010 through 2019, making our study more up-to-date than past studies, while changing health seeking patterns for maternal health since 2010 means that our data set is more representative of overall inpatient care. Second, while past multi-country analysis of public-private ownership have been based on the Demographic Health Surveys, we have added to this data from the Multiple Indicator Cluster Surveys, significantly increasing the countries in our analysis. We have aggregated our analysis by WHO's regions. Outside of the EURO region, where the private sector delivers just 4% of all healthcare services, the private sector remains significant, and in many countries represents more than half of all care. The private sector provides nearly 40% of all healthcare in PAHO, AFRO, and WPRO regions, 57% in SEARO, and 62% in EMRO. While specific countries with two recent surveys show variation in the scale of both inpatient and outpatient private provision, we did not find regional or global trends toward or away from private care within LMICs. Private inpatient care is most important for the wealthy in many countries; public vs. private care varies less, by wealth, for outpatient services.

Are Professionals Rationals? How Organizations and Households Make E-Car Investments

This study attempts to identify the main drivers for e-car investments in households and organizations. We questioned 227 decision makers in households currently considering car purchases, and 101 decision makers in small businesses. The businesses were private care services, because their driving profiles widely fit the capabilities of modern e-cars. The main investment drivers were compared in an integrated action model involving elements of the theory of planned behavior and the norm-activation model, i.e., investment intentions, attitudes, personal (ecological) and social norms, and perceived behavioral control. For each group, different models were calculated in order to investigate the relevance of different types of social norms within the decision process, i.e., injunctive or descriptive norms. As expected, the household and organizational decisions were found to be based on different key factors: the decision makers in households mostly considered personal and descriptive social norms; the organizational decisions were mostly grounded in attitudes and injunctive social norms concerning staff expectations. The results suggest the need for tailored policy measures for each target group.

Influence of socio-economic profile of neighbourhoods on the selection of home care strategies for older dependants

Care strategies for older dependants are determined by not only individuals or network characteristics, but also contextual factors. The objective of this study is to determine whether urban contexts (neighbourhoods) are linked to the use of family care (informal), public services or private care at home (formal). We applied logistic regression analysis to data from the Survey of People in a Situation of Dependence 2018. The sample was composed of 530 older people (55 years old and over) living in two types of socio-economic groups of neighbourhoods in Barcelona, Spain. The type of neighbourhood is relevant in explaining the home care that older dependants receive. In neighbourhoods with a high socio-economic level, dependants are more likely to use private services and less likely to use informal care services and public services, even after controlling for household income, degree of dependency, sex, age and the number of people in the household. Understanding the factors that determine the use of public care services, private care services or family care-giving is important due to the increment in the number of older people in the population. Our results suggest that differences in urban socio-economic contexts determine some inequalities in the use of services even after controlling for socio-economic individual differences. The characteristics of neighbourhoods should be considered to adjust care policies for older dependants.

Travelling intimacies, translation and betrayal in a creative geography

In 2019, we collaborated with German theatre artists to co-create Between Worlds: Outsourcing Dementia Care, an immersive, multi-media piece performed in Newcastle and Berlin. This performance work animated and staged our interviews conducted with the owners of and caregivers working in private care facilities recently built in northern Thailand to provide dementia care for overseas guests from across the Global North. This creation process also drew from interviews we conducted with the family members who had chosen this option for their loved ones with dementia. Incorporating elements of documentary theatre, movement and cinematic projection, Between Worlds was designed to bring audiences into an intimate space, drawing them close to the complexities of the outsourcing of dementia care in order to prompt public conversation and reflection on dementia care in both Thailand and the Global North. Here, we consider the performance of the play and the method that our theatre collaborators used to render transparent the process of translation within performance. We critically assess the outcome to question the possible betrayals implicit in creative and social science work and in the doing of cultural geography.

Geht das stärkere Engagement von Frauen in Pflege und Unterstützung auf ihre geringere Arbeitsmarktbeteiligung zurück? Ein Beitrag zur Gleichstellungsdebatte

Zusammenfassung Frauen leisten nach wie vor mehr private Sorgearbeit als Männer, obwohl ihre Erwerbsbeteiligung in den letzten Jahren deutlich gestiegen ist. In diesem Beitrag untersuchen wir auf Basis des Deutschen Alterssurveys 1996 bis 2017 im Längsschnitt, ob das stärkere Engagement von Frauen in der Übernahme unbezahlter Unterstützung und Pflege für gesundheitlich eingeschränkte Angehörige darauf zurückgeht, dass sie im Vergleich zu Männern nach wie vor seltener, mit geringerem Stundenumfang sowie geringerer beruflicher Qualifikation am Arbeitsmarkt beteiligt sind. Diese Hypothese wird nicht bestätigt, denn bestehende Geschlechterunterschiede in Pflege und Unterstützung können allenfalls partiell durch die geschlechtsspezifische Arbeitsmarktbeteiligung aufgeklärt werden. Abstract: Does Women’s Lower Labor Force Participation Explain their Higher Engagement in Private Care Work? A Contribution to the Debate about Gender Equality Women do still provide more private care work than men, although their participation in employment has increased in the last decades. Using longitudinal data of the German Ageing Survey 1996 to 2017, in this paper, we study, whether women’s greater engagement in unpaid social support and care giving can be attributed to the fact that women compared to men are still less economically active and have a lower occupational qualification. This hypothesis, however, cannot be confirmed, as the gender differences in the private unpaid care work can be explained by gender differences in the labor force participation only to a small amount.