Selling Beautiful Births: The Use of Evidence by Brazil’s Humanised Birth Movement

Maternal health care continues to be excessively medicalised in many national health systems. Global, national, and local level policy initiatives seek to normalise low-risk birth and optimise the use of clinical interventions, informed by strong evidence supporting care that is centred on women’s preferences and needs. Challenges remain in translating evidence into practice in settings where care is primarily clinician-led and hospital-based, such as in Brazil.I conducted an ethnography of the movement for humanised care in childbirth in São Paulo between 2015 and 2018. I draw on interviews and focus groups with movement members (including mothers, doulas, midwives, obstetricians, politicians, programme leads, and researchers), and observations in health facilities implementing humanised protocols, state health council meetings, and key policy fora (including conferences, campaigning events, and social media). Key actors in this movement have been involved in the development and implementation of evidence-based policy programmes to “humanise” childbirth. Scientific evidence is used strategically alongside rights-based language, such as “obstetric violence”, to legitimise moral and ideological aims. When faced with resistance from pro-c-section doctors, movement members make use of other strategies to improve access to quality care, such as stimulating demand for humanised birth in the private health sector. In Brazil, this has led to a greater public awareness of the risks of the excessive medicalisation of birth but can reinforce existing inequalities in access to high-quality maternity care. Lessons might be drawn that have wider relevance in settings where policymakers are trying to reduce iatrogenic harm from unnecessary interventions in childbirth and for supporters of normal birth working to reduce barriers to access to midwifery-led, woman-centred care.

Assessment of Career Development on Employee Performance in Private Health Sector in Isiolo County

Developing employees for future positions enables organizations to develop and place employees in positions compatible with their career interests, needs, and goals. However, most previous studies on career development did not focus on the private sector. It is against these that the study sought to assess the influence of career development on employee performance in the private sector in Isiolo County, Kenya. The study was anchored under social exchange theory: job embeddedness theory and burnout theory of engagement. The study adopted a descriptive survey design that targeted 397 private medical practitioners in Isiolo County. Stratified and basic random sampling methods were used to choose the population sample of 199 respondents. A standard questionnaire was used as a tool for data collection. The validity and reliability of the questionnaire were calculated using test-retest methods on a sample pilot of 20 medical practitioners chosen from private hospitals in Isiolo County. They were not included in the main study and computed using the alpha coefficient of Cronbach and supervisor guidance. The study established an alpha coefficient of 0.831. A mixed-method approach was used to collect both Qualitative and quantitative data Frequencies, means, and standard deviations were given by descriptive analysis. Multiple linear regression analyses were used to base inferential statistics. ANOVA was used as inferential tools to evaluate the relationship between the study variables with the help of IBM Statistical Package for Social Sciences (IBM SPSS) version 24. Descriptive results indicated a majority of the employees strongly agreed that there are coaching and mentorship programs for career development (M=4.50, SD=1.229). However, there were mixed reactions to the existence of a well-established career path planning aligned with personal goals and interests in the organization where most of the employees remained neutral (M = 3.36, SD = 1.215). With a regression analysis established an R squared of 62.1%, the study suggested another study to establish the other factors that contribute 37.9% to employee performance in the private health sector in Isiolo County.

Pattern and Outcome of Paediatric Surgeries: A Private Paediatric Hospital Experience in Southern Nigeria

Aim: This study was undertaken to determine the pattern and outcome of paediatric surgeries in a private hospital in Southern Nigeria. Study Design: A retrospective study Place and Duration of Study: Study was carried out at a private paediatric hospital over a 14-months period from 1st April 2020–31st May 2021. Methodology: Essential information needed were retrieved from the hospital Health Management System and data analysed using SPSS version 23. Results: Of 1289 children admitted during the study period, 105 had surgical interventions (prevalence of 8.1%). Age range was from 8 days to 16 years (median age of 36months) with male predominance. Only 34.3% of the patients were self-paying. The most common surgical conditions were congenital anomalies (28.1%), followed by surgical infections (22.8%) and then urogenital diseases (19.3%). The least common were central nervous system diseases (0.9%). Emergencies accounted for 39.8% of cases done. The commonest surgeries done were circumcision (16.8%), appendicectomy (15.9%) and herniotomy/herniorraphy (14.2%). One child died (mortality rate of 1%). Duration of stay was mostly < 3days (41.7%). Longest duration was seen in those who had Laparotomy and Skin graft. Conclusion: The prevalence of surgical interventions in a paediatric private hospital in Southern Nigeria was high with emergency surgeries constituting 38.9% of all cases. Thus, for reduction in paediatric morbidity and mortality, we advocate the improvement of surgical infrastructure and manpower not only in tertiary but also in the private health sector.

Private sector delivery of maternal and newborn health care in low-income and middle-income countries: a scoping review protocol

IntroductionRecent studies have pointed to the substantial role of private health sector delivery of maternal and newborn health (MNH) care in low-/middle-income countries (LMICs). While this role has been partly documented, an evidence synthesis is missing. To analyse opportunities and challenges of private sector delivery of MNH care as they pertain to the new World Health Organization (WHO) strategy on engaging the private health service delivery sector through governance in mixed health systems, a more granular understanding of the private health sector’s role and extent in MNH delivery is imperative. We developed a scoping review protocol to map and conceptualise interventions that were explicitly designed and implemented by formal private health sector providers to deliver MNH care in mixed health systems.Methods and analysisThis protocol details our intended methodological and analytical approach following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Seven databases (Cumulative Index to Nursing and Allied Health, Excerpta Medica Database, International Bibliography of the Social Sciences, PubMed, ScienceDirect, Web of Science, WHO Institutional Repository for Information Sharing) and two websites will be searched for studies published between 1 January 2002 and 1 June 2021. For inclusion, quantitative and/or qualitative studies in LMICs must report at least one of the following outcomes: maternal morbidity or mortality; newborn morbidity or mortality; experience of care; use of formal private sector care during pregnancy, childbirth, and postpartum; and stillbirth. Analyses will synthesise the evidence base and gaps on private sector MNH service delivery interventions for each of the six governance behaviours.Ethics and disseminationEthical approval is not required. Findings will be used to develop a menu of private sector interventions for MNH care by governance behaviour. This study will be disseminated through a peer-reviewed publication, working groups, webinars and partners.

The scope of childhood cancer in South Africa: A response to ‘Childhood cancers in a section of the South African private health sector – Analysis of medicines claims data’

Childhood cancer is an under resourced medical field that is emerging as a great healthcare concern in low- and middle-income countries such as South Africa. Therefore, reporting data in this field that may inform policymakers should be representative of the subject matter. This article aims to discuss why medicines claims as an indicator for incidence, as per an article published in 2020, is not representative of childhood malignancies in the South African setting. Literature to support the commentary were sourced using Pubmed, Google scholar, and data presented by members of the South African Children’s Cancer Study Group (SACCSG). Private medical aid coverage in South Africa between 2002 and 2018 varied between 15.5% and 18.2%. Of these, 9.5% were children under 18 years and 3.5% were under the age of six. Only 13.5% of children were treated in private paediatric oncology units during 2015. The limitations in the study were the variable medical aid coverage, the disproportionate age representation, and lack of reliable indicators for measurement and calculation of incidence. Utilising one medicines claims database to evaluate the incidence of childhood cancer in South Africa is not representative and cannot inform policy.Contribution: This article highlights the importance of accurate registration of childhood cancer diagnoses, especially when data and conclusions based on these results inform policy. The study highlights the limitations of extrapolating general conclusions based on data representing only a small sector of the childhood cancer landscape in South Africa.

Organization of the Saudi health system

Using existing data, we reviewed the organizational structure of the Saudi Arabian health system: its demography and history, principal health indicators, organization and management, type and distribution of facilities, financial base, and the impact on it of the Haj. We noted duplication of services, inadequate coordination between some health industry sectors, and the need for a more extensive and rational health centre network with improved information systems and data collection. We also noted scope for a greater role for the private health sector and increased cooperation between it and the public sector to improve health service delivery and population health

ANALYSIS OF THE EFFECTIVENESS OF THE PREVENTION OF DISEASES OF THE UPPER RESPIRATORY TRACT IN CHILDREN IN THE PUBLIC AND PRIVATE HEALTH SECTOR OF THE MOSCOW REGION

The relevance of the research topic is determined by the high prevalence of diseases of the upper respiratory tract in children. The purpose of the study: to assess the effectiveness of the prevention of upper respiratory diseases in children in the public and private health sector. The analysis of morbidity by circulation and primary morbidity of children in the Moscow region and the city of Ramenskoye as a whole and by class "Respiratory diseases" is carried out. The material of the study is based on the analysis of the primary documentation of the children's polyclinic and the private children's medical center in Ramenskoye, Moscow region. Differences between public and private medical organizations were established: the number of episodes of upper respiratory tract diseases in the observation of children in a state medical organization is 1.4 times higher than in a private medical organization (3.8, against 2.8); the duration of episodes of diseases of the upper respiratory tract per 1 observed child per year in a state medical organization is 39.0% higher than in a private medical organization; the average duration (exacerbation) of the case of diseases of the upper respiratory tract in children in the state medical organization is 2 times higher than when observed in a private medical organization, which is associated with the use of modern treatment technologies and an individual approach. When analyzing the preventive work of children's polyclinics, it was revealed that in the context of the region there are significant fluctuations in the volume of visits made for the purpose of rehabilitation. At the same time, the share of those in need of rehabilitation from the number of those examined in the order of planned rehabilitation amounted to 65.7% in the region, in the city of Ramenskoye 65.4%. Satisfaction of this need was noted at the level of 60.6% in the region, in the city of Ramenskoye 72.3%. The results of the study showed the need to study the factors that determine the high incidence of children with diseases of the upper respiratory tract.

Institutional capacity of health care institutes for diagnosis and management of common genetic diseases - A study from a north coastal district of Andhra Pradesh

Background: In India, the genetic disease is a disregarded service element in the community health- protection system. This study aims to gauge the accessibility of services for treating genetic disorders and also to evaluate the practices on deterrence and management services in the district health system. Methods: A cross-sectional survey of selected health amenities from 454 medical officers (MO’s), 94 accredited social health activist (ASHAs) workers, 86 multipurpose health assistant-female (MPHA-F), 34 multipurpose health assistant-male (MPHA-M), 14 multipurpose health supervisors-female (MPHS-F), 10 multipurpose health supervisors-male (MPHS-M), 6 multipurpose health extension officer/ community health officer (MPHEO/CHO), 10 public health nurse (PHN), 45 lab technicians (LT’s) working in the government health sector and 254 in the private health sector, 409 nursing staff working in the government health sector and 995 in the private health sector, 15 primary health centers (PHC’s), 4 community health centers (CHC’s), 1 district government hospital (DGH), 3 referral hospitals (RH’s). From the side of private health institutions 25 corporate hospitals (CH’s), 3 medical colleges (MC’s), and 25 diagnostic laboratories (DL’s) were conducted. Results: The findings show that adequate staff was in place at more than 70% of health centers, but none of the staff have obtained any operative training on genetic disease management. The largest part of the DH’s had rudimentary infrastructural and diagnostic facilities. However, the greater part of the CHC’s and PHC’s had inadequate diagnostic facilities related to genetic disease management. Biochemical, molecular, and cytogenetic services were not available at PHC’s and CHC’s. DH’s, RH’s, and all selected medical colleges were found to have offered the basic Biochemical genetics units during the survey. In 24% of CH’s, the basic biochemical units are available and 32% (8 out of 25) of DL’s have the advanced biochemical genetics units by study. Molecular genetics units were found to be available in 28% (7 out of 25) of DL’s during the study. About 6 (24%) diagnostic centers of cytogenetic laboratories were located in the Visakhapatnam district under the private sector. Conclusion: The district health care infrastructure in India has a shortage of basic services to be provided for the genetic disorder. With some policy resolutions and facility strengthening, it is possible to provide advanced services for a genetic disorder in the district health system.

Health literacy and preparedness of health workers in the private health sector towards the COVID-19 pandemic: Need for integration into the nationwide response

The private health sector has the potential to participate in the COVID-19 pandemic response. The study aimed to assess the health literacy, perceptions, practices, willingness to participate and opportunities for engagement of the private health sector in the COVID-19 response. A cross-sectional survey was carried out among health workers in private health facilities in Edo Central and Edo North Senatorial districts of Edo state between May and June 2020. Data were collected using pre-tested questionnaires and analysis carried out using Statistical Package for Social Science (SPSS). Chi-square test of significance and logistic regression were applied at 5% cut off. A total of 153 health workers participated giving a response rate of 75.0%. Eighty-eight (57.5%) respondents had good knowledge of COVID-19 and 80 (52.3%) held negative perceptions towards COVID-19. Ninety-five (62.1%) respondents believed private health facilities had a role to play in the response particularly in the area of suspected case screening (85.4%). Thirty-one (20.3%) respondents indicated their willingness to participate in the COVID-19 response if their facilities were invited to. Sixty-one (39.9%) and 92 (60.1%) respondents respectively held poor and good practices towards COVID- 19 prevention, with practice significantly associated with educational level (χ2 = 14.10, P < 0.01), profession (χ2 = 15.28, P = 0.01). and previous training in infection prevention and control (IPC) (χ2 = 18.16, P < 0.01). The resources available from the private sector to support the response can be harnessed through engagements with medical directors and health workers in the sector to identify areas of collaboration, address identified gaps in knowledge, improve perception and participation.