Childhood Immunisation Coverage during the COVID-19 Epidemic in Italy

The COVID-19 pandemic has affected national healthcare systems worldwide, with around 282 million cumulative confirmed cases reported in over 220 countries and territories as of the end of 2021. The Italian National Health System was heavily affected, with detrimental impacts on preventive service delivery. Routine vaccination services were disrupted across the country during the first months of the pandemic, and both access to and demand for vaccines have decreased during the pandemic. In many cases, parents preferred to postpone scheduled appointments for routine paediatric vaccinations because of stay-at-home orders or fear of COVID-19 infection when accessing care. The objective of the current study was to assess the routine childhood vaccine coverage (VC) rates during the COVID-19 epidemic in Italy. We compared 2020 and 2019 VC by age group and vaccine type. The Italian Ministry of Health collected anonymised and aggregated immunisation national data through the local health authorities (LHAs). Results were considered statistically significant at a two-tailed p-value ≤ 0.05. VC rates for mandatory vaccinations decreased in 2020 compared to 2019 (range of VC rate decrease: −1% to −2.7%), while chicken pox increased (+2.2%) in 7-year-old children. Recommended vaccinations were moderately affected (range of VC rate decrease in 2020 vs. 2019: −1.4% to −8.5%), with the exception of anti-HPV in males, Men ACWY, and anti-rotavirus vaccination (VC increase 2020 vs. 2019: +1.8%, +4.7% and +9.4%, respectively). In the COVID-19 era, the implementation of coherent, transparent, and effective communication campaigns and educational programs on safe childhood vaccinations, together with the increase in the number of healthcare staff employed, is essential to support strategies to reinforce vaccination confidence and behaviour, thus avoiding health threats due to VPD during and beyond COVID-19 times.

RELATIONSHIP OF LEADER SUPPORT WITH EMPLOYEE WORK ACHIEVEMENT AT SEI SUKA DISTRICT PUSKESMAS SEI SUKA BATU BARA DISTRICT 2019

Background: The national health system is essentially an order that reflects the efforts of the Indonesian people to increase their ability to achieve health status. Puskesmas is a leading health service organization unit that provides comprehensive and integrated health services to the community. Human resource management is a planning, organizing, coordinating, implementing, and supervising the procurement, development, provision of remuneration, integration, maintenance, and separation of workers in order to achieve organizational goals. One way to improve resource management is leadership support for outstanding employees. Purpose: This study aims to determine the relationship between leadership support and employee performance at the Sei Suka Health Center, Sei Suka District, Batu Bara Regency in 2019. Method: This research was conducted cross sectional with data collection method (questionnaire). Each group with an age range of 20-30 years, 31-40, 41-50, 51-60 was given a questionnaire to fill out. Determination of the relationship between leadership support and employee performance can be seen from the results obtained after filling out the questionnaire, then the data is analyzed using the chi-square test. Results: The results obtained that the most respondents in the category of good leadership support as many as 16 people (48.5%) had poor work performance and the least was good leadership support 2 people (6.1%) had good work performance after being tested with the chi test square can be seen that the value of Significancy p value = 0.003 (P <0.005) which shows that the relationship between leadership support and employee performance is significant. Conclusion: there is a significant relationship between leadership support and employee performance.

A strategic reflection for the management and implementation of CAR-T therapy in Spain: an expert consensus paper

CAR-T cell therapy represents a therapeutic revolution in the prognosis and treatment of patients with certain types of hematological cancer. However, they also pose new challenges in the healthcare, regulatory and financial fields. The aim of the RET-A project was to undertake a strategic reflection on the management of CAR-T therapies within the Spanish National Health System, to agree on recommendations that will help to better deal with the new context introduced by these cell therapies in the present and in the future. This think tank involved 40 key agents and opinion leaders. The experts identified three great challenges for implementing advanced therapies in Spain: therapeutic individualisation, with a multidisciplinary approach; acceleration of access times, by minimizing bureaucracy; and increase in the number of centers qualified to manage the CAR-T therapies in the NHS. The experts agreed on the ideal criteria for designating those qualified centers. They also agreed on a comprehensive CAR-T care pathway with the timings and roles which would ideally be involved in each part of the process.

The practice of integrated healthcare and the experiences of people in Ghana’s Ashanti region

Background The Ghanaian government has implemented interventions that integrate traditional medicine (TM) into its national health system in response to the high prevalence of TM use. However, empirical evidence of the experiences of service users and the practice of integrated health in Ghana is scanty. Therefore, this study explored the experiences of people with TM integration into the formal health system in Ashanti region using an adapted TM integration framework. Methods A sequential explanatory mixed methods study design comprising survey administration and in-depth interviews for data collection was utilised to address the research objective. Framework analysis was used in analysing the qualitative data and for triangulation of results. Results Participants were aware of licensing and training of TM practitioners in a science-based university in Ghana. However, knowledge of the existence of TM units in selected hospitals in the region was minimal. Integration knowledge was largely influenced by sex, marital status, household size and residential status, where males and urban dwellers were more familiar with the process than females and rural dwellers. Low patronage of integrated health services in the region was attributable to weak cross referrals. However, service users who had engaged with the integrated system recounted a satisfactory outcome. Conclusion Service users’ unfamiliarity with the presence of integrated facilities in Ghana could be an impediment to the practice of integrated healthcare. Sensitisation of the public about the practice of an integrated system could refine the Ghanaian integrated system. Regular evaluation of patient satisfaction and outcome measures might also serve as an effective strategy for improving health services delivery since evaluation is becoming an important component of health service design and implementation. There is the need for future studies to focus on exploring the perceptions and experiences of health practitioners and hospital administrators regarding the practice of integrated health in Ghana.

The Impact of Contracting on the Portuguese National Health System

All treatments, materials, instruments, exams, vaccines, tests, hospitalizations, surgeries, human resources, investigations, medicines, autopsies, among many other services provided by the National Health System (SNS). Therefore, funding is required, and the external services and supplies to which the SNS must constantly update its technologies and the necessary and continuous training and essential maintenance and cleaning expenses. Moreover, health financing has been a matter of great concern, both nationally and internationally, as health expenditures are growing faster than economic growth. Over the years, efficiency in resource allocation has always been a desirable objective, but one that is not easy to achieve. The truth is that there is much waste in allocating resources. Thereby, this study analyzes the impact of the contractualization process to which Portugal has adhered, which is most similar to a privatization model; that is, we sought to understand whether the contractualization of the SNS has a favorable effect on the economic level. However, after the entire process and development of the work, it is concluded that the contracting had a negligible impact. The repercussion that it had on the economic performance of Portuguese Hospitals was in a negative sense. In the statistical analyses it was used tests of differences between averages, to check the behavior of the economic performance of hospitals towards the contracting process. It was taken data of reports and accounts from a sample of fifteen Portuguese Hospitals S.A. that went through this contracting process from 2003 to 2017, in order to calculate the four indicators, such as: Return On Assets (ROA); Return On Equity (ROE); Economic Value Added (EVA) and the Market Value Added (MVA). For each of these indicators, were analyzed and compared the resulted effects between the period of two years before and two years after the contracting process. From the obtained results, we can conclude that contracting process had little impact on the economic performance of Portuguese Hospitals and the resulting impact was not favorable.

Clinical Presentation of the SARS-CoV-2 Virus Infection and Predictive Validity of the PCR Test in Primary Health Care Worker Patients of the Spanish National Health System

Background: Despite the impact that the SARS-CoV-2 virus infection has presented in Spain, data on the diagnostic capacity of the symptoms associated with this infection are limited, especially among patients with mild symptoms and who are detected in the primary care field (PC). The objective of the present study was to know the associated symptoms and their predictive criterial validity in SARS-CoV-2 infection among professionals working in PC. Methods: A cross-sectional, multicenter study was carried out in the Spanish National Health System, through an epidemiological survey directed to patients who underwent the PCR test for SARS-CoV-2 in the PC setting. Results: A total of 1612 patients participated, of which 86.6% were PC healthcare professionals, and of these, 67.4% family doctors. Hyposmia, with a sensitivity of 42.69% (95% CI: 37.30–48.08) and a specificity of 95.91% (95% CI: 94.78–97.03), and ageusia with a sensitivity of 39.47% (34.15–44.80) and a specificity of 95.20% (93.98–96.41) were the symptoms with the highest criteria validity indexes. Conclusions: This study identifies the specific symptoms of loss of smell or taste as the most frequently associated with SARS-CoV-2 infection, essential in the detection of COVID-19 given its high frequency and predictive capacity.

Analysis of financial resources for public health in Brazilian capitals: a time trend ecological study

This study aimed to analyze part of the financial resources used to fund public health actions in the 26-Brazilian capitals, from 2008 to 2018. This is a time-trend ecological study involving revenue and expenditure indicators provided by the Information System on Public Budget for Health (SIOPS). The values were deflated based on the Extended National Consumer Price Index of 2018 in Brazil to allow the comparison over the years. The mean annual variation of health investments, in Brazilian Reais (BRL) was assessed using linear regressions. Pearson’s correlation coefficients were estimated between federal revenues and expenditures with the capitals’ resources. All capitals presented statistically significant positive correlations for the origin of the budget resource invested in health. The lowest coefficient was found in the capital city of Macapá (Amapá State) (r = 0.860) and the highest, in Fortaleza (Ceará State) (r = 0.997). Belo Horizonte (Minas Gerais State) was the capital with the highest annual increase in federal transfers (about BRL 67.91 per year) and Teresina (Piauí State) presented the highest annual increase in health expenditures among the capitals (about BRL 55.42 per year). We found a increase in the transfers of the Brazilian Unified National Health System (SUS) and municipal resources in almost all capitals, but there are still inequalities in the distribution of financial resources among Brazilian capitals from different regions. Health funding is affected by the municipalization of SUS and it is not the single factor affecting the access and quality of health services.

Digital Healthcare Strategy

This goal of this chapter is to introduce digital strategies for healthcare. The chapter begins with an analysis of key indicators of public health and the healthcare sector. Next, the chapter presents key principles for healthcare, focusing on the constitution of the national health system. A case study focusing on Poland is then presented. After this, the chapter puts forth a digital strategy for the national health system. This is followed by an analysis of several health systems: the patient information system, the clinic information system, the pharmacy information, and the hospital information system. Next, the use of big data for healthcare is considered. The chapter concludes by putting forth a model for the national health information system and by discussing important trends in the development of digital health.