A mentális betegeket célzó szolgáltatások hatékonyságának fejlesztési lehetőségei két komplex nemzetközi program tükrében

Háttér és célkitűzésekA súlyos mentális betegségek és a betegség során előforduló relapszusok terhei és költségimplikációi egyéni és társadalmi szinten is jelentősek. A mentálhigiénés szolgáltatások elérhetősége és színvonala, a kliensek egészségkimenetele és a hagyományos pszichiátriai és addiktológiai ellátás költségei azonban egyszerre javíthatók innovatív kezelési, szolgáltatásszervezési és finanszírozási technikák együttes használatával. Tanulmányunk célja, hogy áttekintse a pozitív és a közösségi pszichiátriai szemléletmód, az integrált ellátásszervezés és a sikeralapú kifizetés mint innovatív finanszírozási technika alkalmazási lehetőségeit két, súlyos mentális betegek gondozásával és egészségfejlesztésével foglalkozó program bemutatásán keresztül.MódszerA pozitív pszichiátria, közösségi pszichiátria, az integrált ellátásszervezés és az innovatív szolgáltatásfinanszírozás koncepcióival kapcsolatban gyűjtöttünk hazai és nemzetközi szakirodalmat.EredményekA pozitív pszichiátria, a közösségi pszichiátria és az integrált ellátásszervezés tehermentesíthetik a költséges pszichiátriai és addiktológiai fekvőbeteg-ellátást, és elősegíthetik a szolgáltatások színvonalának fejlesztését egy integrált ellátási folyamat részeként. A sikeralapú kifizetés modellje új típusú magánbefektetők megjelenését eredményezi, elősegíti a teljesítménymérés és -értékelés kultúrájának terjedését, és újfajta kockázatmegosztási mechanizmust alkalmaz az interszektoriális együttműködések megvalósításakor.KövetkeztetésekA közösségi pszichiátria, a pozitív pszichiátria, az integrált ellátásszervezés és a sikeralapú kifizetés számos eszközt biztosít a mentális betegeket célzó szolgáltatások fejlesztéséhez, egyúttal elősegítve az interszektoriális együttműködések és a hosszú távú komplex programok kialakítását. A jelen közleményben ismertetett nemzetközi példák elősegíthetik a mentális betegeket célzó hazai programok fejlesztését.Background and ObjectivesThe burden and cost implications of serious mental illness and related relapses affect significantly both the individual and society. Access to and quality of mental health services, along with clients’ health outcomes and the costs of traditional hospital-centered mental health services can be improved by the use of innovative treatment, coordination of service delivery and financing techniques. Our objective is to explore the potential uses of positive psychiatric innovation, community-based psychiatry, integrated service delivery and the “pay for success” financing model, through presenting two mental health programs delivered to clients with serious mental illness.MethodsLiterature related to positive psychiatry, community psychiatry, integrated service delivery and innovative financing have been searched and reviewed.ResultsPositive psychiatry and community-based approaches to mental health care and service can further ease the costs of inpatient care and improve the quality of services as an integrated part of a service process. The “pay for success” model enables new types of private investors, promotes rigorous measurement and assessment of performance and uses an innovative risk-sharing mechanism in the implementation of intersectoral cooperations.ConclusionCommunity psychiatry, positive psychiatry, integrated service delivery and the pay for success model of financing provides various tools to improve mental health services while enabling intersectoral cooperations and long-term, complex programs. Our objective is to support the development of local mental health programs by presenting international examples.

Development of integration indexes to determine the extent of family planning and child immunization services integration in health facilities in urban areas of Nigeria

Background Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods This study utilizes cross-sectional health facility (N = 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N = 1479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

Background Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods This study utilizes cross-sectional health facility (N= 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N= 1,479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Component Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that using more nuanced measures of integration may (a) more accurately reflect true variation in integration within and across health facilities, (b) enable more precise measurement of the determinants or effects of integration, and (c) provide more tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

Background: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. While integration models vary, many studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum. It is thus challenging to ascertain the determinants and effects of integrated service delivery. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services and applies them to analyze the extent of integration across 400 health facilities. Methods: This study utilizes cross-sectional health facility (N= 400; 58% hospitals, 42% primary healthcare centers) and healthcare provider (N= 1,479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Components Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that measuring integration as a binary variable does not (a) reflect the true variation in integration within and across health facilities, (b) enable nuanced measurement of the determinants or effects of integration, or (c) provide tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.

Using a Multisectoral Approach in Tackling Child Sexual Abuse: Lessons from a Zimbabwean Case Study

Child sexual abuse is one of the prevalent social ills that affect children in Zimbabwe. In response to the problem of child sexual abuse and the need to mitigate its adverse effects, Zimbabwe established the Victim Friendly System. The Victim Friendly System is a multisectoral forum made up of social workers, medical doctors, nurses, the police force and role players within the justice system such as magistrates, prosecutors, counsellors, educationists and psychologists. These professionals offer distinctive but complementary interventions to child survivors of child sexual abuse. This paper discusses the merits and lessons gleaned from using the Victim Friendly System as a multisectoral forum to tackle child sexual abuse. In researching this phenomenon, the study adopted a qualitative approach and data were collected from 38 participants and 4 key informants selected using theoretical and purposive sampling respectively. A total of 300 court files of child sexual abuse cases were also reviewed. The findings that emerged from the study show that a multisectoral approach to dealing with child sexual abuse provides the benefit of integrated service delivery. Improved outcomes for victims of sexual abuse as well as streamlined, effective and efficient operations for organisations that form part of the Victim Friendly System were also evident. This notwithstanding, the paper also discusses some areas of concern that could potentially affect how the Victim Friendly System multisectoral arrangement works. The lessons that emerged from the study provide some insights that are useful in informing guidelines for multisectoral arrangements.

Development of Integration Indexes to Determine the Extent of Family Planning and Child Immunization Services Integration in Health Facilities in Urban Areas of Nigeria

Background: Integrating family planning into child immunization services may address unmet need for contraception by offering family planning information and services to postpartum women during routine child immunization visits. However, policies and programs promoting integration are often based on insubstantial or conflicting evidence about its effects on service delivery and health outcomes. Since most studies measure integration as binary (a facility is integrated or not) rather than a multidimensional and varying continuum, it is difficult to understand the determinants and effects of integration. This study creates Facility and Provider Integration Indexes, which measure capacity to support integrated family planning and child immunization services, and applies them to analyze the extent of integration across 400 health facilities. Methods: This study utilizes cross-sectional health facility (N= 400; 49% hospitals, 51% primary healthcare centers) and healthcare provider (N= 1,479) survey data that were collected in six urban areas of Nigeria for the impact evaluation of the Nigerian Urban Reproductive Health Initiative. Principal Components Analysis was used to develop Provider and Facility Integration Indexes that estimate the extent of integration in these health facilities. The Provider Integration Index measures provider skills and practices that support integrated service delivery while the Facility Integration Index measures facility norms that support integrated service delivery. Index scores range from zero (low) to ten (high). Results: Mean Provider Integration Index score is 5.42 (SD 3.10), and mean Facility Integration Index score is 6.22 (SD 2.72). Twenty-three percent of facilities were classified as having low Provider Integration scores, 32% as medium, and 45% as high. Fourteen percent of facilities were classified as having low Facility Integration scores, 38% as medium, and 48% as high. Conclusion: Many facilities in our sample have achieved high levels of integration, while many others have not. Results suggest that measuring integration as a binary variable does not (a) reflect the true variation in integration within and across health facilities, (b) enable nuanced measurement of the determinants or effects of integration, or (c) provide tailored, actionable information about how best to improve integration. Overall, results reinforce the importance of utilizing more nuanced measures of facility-level integration.