Factors Influenced Healthcare Service Delivery During COVID-19 Pandemic: A Case Study in Cicalengka, Indonesia

Since the enactment of the restriction in 2020, Puskesmas Cicalengka has been faced numerous healthcare delivery problems, which led to the failure of achieving the target of the healthcare program. It is important to identify the factors which caused the healthcare problems to compose a plan for years to come. Identification can be accomplished using a logic model framework consisting of input, process, output, and environment. This study was conducted to identify the input factors that play the roles in healthcare service delivery output in Puskesmas Cicalengka during the COVID-19 pandemic in 2020. This study was conducted as a qualitative study using a case study design. The study was done by analyzing related documents, observing and interviewing staff. Data was collected in March 2021. The result shows that Puskesmas was once closed in April 2020 due to the pandemic. In May 2020, Puskesmas reopened and started to provide healthcare services by following the new regulation from the Ministry of Health. The input factors which affected healthcare delivery in Puskesmas Cicalengka during the pandemic of COVID-19 in 2020 were man, money, material, methods, minutes, and information. Machine was the only factor that did not affect healthcare delivery since it was in good condition. Further research must be completed with quantitative research to reach a comprehensive point of view.

Design of an Ultrasound-Navigated Prostate Cancer Biopsy System for Nationwide Implementation in Senegal

This paper presents the design of NaviPBx, an ultrasound-navigated prostate cancer biopsy system. NaviPBx is designed to support an affordable and sustainable national healthcare program in Senegal. It uses spatiotemporal navigation and multiparametric transrectal ultrasound to guide biopsies. NaviPBx integrates concepts and methods that have been independently validated previously in clinical feasibility studies and deploys them together in a practical prostate cancer biopsy system. NaviPBx is based entirely on free open-source software and will be shared as a free open-source program with no restriction on its use. NaviPBx is set to be deployed and sustained nationwide through the Senegalese Military Health Service. This paper reports on the results of the design process of NaviPBx. Our approach concentrates on “frugal technology”, intended to be affordable for low–middle income (LMIC) countries. Our project promises the wide-scale application of prostate biopsy and will foster time-efficient development and programmatic implementation of ultrasound-guided diagnostic and therapeutic interventions in Senegal and beyond.

Female Community Health Workers and Health System Navigation in a Conflict Zone: The Case of Afghanistan

Afghanistan ranked 171st among 188 countries in the Gender Inequality Index of 2011 and has only 16% of its women participating in the labor force. The country has been mired in violence for decades which has resulted in the destruction of the social infrastructure including the health sector. Recently, Afghanistan has deployed community health workers (CHW) who make up majority of the health workforce in the remote areas of this country. This paper aims to bring the plight of the CHWs to the forefront of discussion and shed light on the challenges they face as they attempt to bring basic healthcare to people living in a conflict zone. The paper discusses the motivations of Afghani women to become CHWs, their status in the community and within the health system, the threatening situations under which they operate, and the challenges they face as working women in a deeply patriarchal society within a conflict zone. The paper argues that female CHWs should be provided proper accreditation for their work, should be allowed and encouraged to progress in their careers, and should be instilled at the heart of healthcare program planning because they have the field experience to make the most effective and community oriented programmatic decisions.

COVID-19 incidence and mortality in non-dialysis chronic kidney disease patients

Many studies reported a higher risk of COVID-19 disease among patients on dialysis or with kidney transplantation, and the poor outcome of COVID-19 in these patients. Patients in conservative management for chronic kidney disease (CKD) have received attention only recently, therefore less is known about how COVID-19 affects this population. The aim of this study was to provide evidence on COVID-19 incidence and mortality in CKD patients followed up in an integrated healthcare program and in the population living in the same catchment area. The study population included CKD patients recruited in the Emilia-Romagna Prevention of Progressive Renal Insufficiency (PIRP) project, followed up in the 4 nephrology units (Ravenna, Forlì, Cesena and Rimini) of the Romagna Local Health Authority (Italy) and alive at 1.01.2020. We estimated the incidence of COVID-19, its related mortality and the excess mortality within this PIRP cohort as of 31.07.2020. COVID-19 incidence in CKD patients was 4.09% (193/4,716 patients), while in the general population it was 0.46% (5,195/1,125,574). The crude mortality rate among CKD patients with COVID-19 was 44.6% (86/193), compared to 4.7% (215/4,523) in CKD patients without COVID-19. The excess mortality of March-April 2020 was +69.8% than the average mortality of March-April 2015–19 in the PIRP cohort. In a cohort mostly including regularly followed up CKD patients, the incidence of COVID-19 among CKD patients was strongly related to the spread of the infection in the community, while its lethality is associated with the underlying kidney condition and comorbidities. COVID-19 related mortality was about ten times higher than that of CKD patients without COVID. For this reason, it is urgent to offer a direct protection to CKD patients by prioritizing their vaccination.

Young Guns and Billionaires

Chapter 2 examines how the Republican Party’s crackup evolved over the course of Barack Obama’s two terms as president. As divided as the GOP may have been after the 2008 presidential election, its major donors were linked in their opposition to Obama. For the first time since McCain-Feingold, the full force of conservative wealth in America was united against healthcare reform and any spending to revive the perilous economy, rescue the auto industry, or provide relief for mortgage holders. The election of the first African American president made it easy for conservative commentators on talk radio and Fox News to call Obama’s healthcare plan “reparations.” This stoked racial resentment and boosted the plans of wealthy industrialists Charles and David Koch to move Republicans further to the right. Their main organization, Americans for Prosperity, raised hundreds of millions of dollars yearly and quietly provided training, infrastructure, and funding for many of the “spontaneous” Tea Party groups that helped restore Republican control of Congress. Donors may not have been willing to give millions of dollars for compromise, but the slash-and-burn tactics of the Tea Party became a catastrophic example of overreach. The 2012 presidential nominee, Mitt Romney, got caught up in a party tilting ever more to the right; he was only given financial support for his campaign against Obama when he renounced his Massachusetts healthcare program—the model for Obamacare—and put Ryan on his ticket.

An Analysis of Literature Reviews in the Context of Healthcare Program Assessment

When conducting an assessment of existing literature, various types of literature reviews can be utilized. More specifically, each type has its advantages, disadvantages, and ideal circumstances in which it should be used. This paper explores the systematic review, scoping review, and rapid review in the context of research that seeks to assess existing health care programs. Evidence suggests that the systematic review is the most rigorous and in-depth, but often takes a significant amount of time to complete. The scoping review is less rigorous and used to identify what is known about a specific topic in the literature. The rapid review is similar in rigour to the systematic review, but takes less time and is often used in situations where data needs to be obtained quickly. In this paper, strengths and weaknesses, alongside examples of each review are given. They are then analyzed to see which would be best to utilize for the topic of assessing existing health care programs. In closing, it is decided that the rapid review is the best method due to its limited time frame and extensive rigour, which is the most beneficial when assessing health care programs.

Ayushman Bharat: Service Adoption Challenges in Universal Healthcare System

The Ayushman Bharat, the universal healthcare scheme in India, faced service adoption challenges after its launch in 2018. It was an enigma for the top management in Ayushman Bharat regarding slower service adoption of a free mass healthcare coverage scheme by the target population. The case focuses on the service adoption challenges from patient and physician perspectives while implementing a universal healthcare system. It provides insights to policymakers, physicians, service operations managers, and healthcare administrators regarding managing the universal healthcare system’s implementation challenges in a developing country context. Research questions/Objective: This study aims to understand service adoption challenges in a universal healthcare system setting. The study explores the following research questions: How is service adoption theory applied in a universal health coverage program? What should be the integrated marketing communication plan to improve the awareness about a universal healthcare program? Links to theory: The study uses service adoption theory. It analyzes service adoption challenges for the universal healthcare system in India called Ayushman Bharat. It also uses literature on the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Phenomenon studied: The case study uses pan India patient and physician data to explore service adoption issues in Ayushman Bharat - a universal healthcare scheme in India. Case context: The primary data collected through the field (hospital) visits and interaction with patients and physicians of Ayushman Bharat form the basis of this case study. Findings: The study emphasizes on performance expectancy, ease in availing of the service, positive social influence, and facilitating conditions for service delivery of Ayushman Bharat. The Ayushman Bharat scheme’s performance expectancy means how being a healthy individual would contribute to better performance at the workplace. The effort expectancy is the level of ease an eligible Ayushman Bharat scheme can avail the service at the empanelled hospital. The social acceptance of the Ayushman Bharat scheme by friends, peers, and people in the vicinity would create a positive social influence. The facilitating conditions in the Ayushman Bharat scheme are the government’s capacity to provide organizational and technological infrastructure to support this universal healthcare program. Discussions: The use of service adoption theory and the UTAUT model to enhance the adoption of the universal healthcare system in India have been discussed in the case study.

Incorporating Portfolio Uncertainty in Decision Rules for Healthcare Resource Allocation

Cost-effectiveness analysis is widely adopted as a means to inform policy and decision makers in setting priorities for healthcare resource allocation. In resource-constrained settings, decision makers are confronted with healthcare resource reallocation decisions, e.g., moving funds from one or more existing healthcare programs to fund new healthcare programs. The decision-making plane (DMP) has been developed as a means to graphically present the results of reallocating available healthcare resources when healthcare program costs and effects are uncertain. Mapping a value function over the DMP allows the analyst to value all possible combinations of net costs and net effects that may result from reallocating available healthcare resources under conditions of uncertainty. In this paper, we extend this approach to include a change in portfolio risk, stemming from a change in the portfolios of funded healthcare programs, as an additional source of uncertainty, and demonstrate how this can be incorporated into the value function over net costs and net effects for a risk-averse decision maker. The methodology presented in this paper is of particular interest to decision makers who are risk averse, as it will help to better incorporate their preferences in the process of deciding how to best allocate scarce healthcare resources.