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Rashid S, Mahmood H, Asma Iftikhar A, komal N, Butt Z, Mumtaz H, Shellah D. Availability and readiness of primary healthcare facilities for the management of non-communicable diseases in different districts of Punjab, Pakistan. Front Public Health 2023; 11:1037946. [PMID: 36969638 PMCID: PMC10036340 DOI: 10.3389/fpubh.2023.1037946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/08/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionNon-communicable diseases (NCDs) and their effects are rising quickly. NCDs such as cardiovascular illnesses, diabetes, cancer, and chronic lung diseases cause 60% of global deaths; of which, 80% occur in developing countries. In established health systems, primary healthcare handles most of the NCD care.MethodologyThis is a mixed-method study conducted to analyze the health service availability and readiness toward NCDs using the SARA tool. It included 25 basic health units (BHUs) of Punjab, which were selected through random sampling. Quantitative data were collected using the SARA tools, while qualitative data were collected through in-depth interviews with healthcare providers working at the BHUs.ResultsThere was a problem of load shedding of both electricity and water in 52% of the BHUs, which leads to the poor availability of healthcare services. Only eight (32%) out of 25 BHUs provide the diagnosis or management of NCDs. The service availability was the highest for diabetes mellitus (72%), followed by cardiovascular disease (52%) and then chronic respiratory disease (40%). No services were available for cancer at the BHU level.ConclusionThis study raises issues and questions about the primary healthcare system in Punjab in two areas: first, the overall performance system, and second, the readiness of basic healthcare institutions to treat NCDs. The data show that there are many persisting primary healthcare (PHC) deficiencies. The study found a major training and resource deficit (guidelines and promotional materials). Therefore, it is important to include NCD prevention and control training in district training activities. NCDs are underrecognized in primary healthcare (PHC).
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Affiliation(s)
- Sadaf Rashid
- Department of Public Health, National University of Medical Sciences (NUMS), Rawalpindi, Punjab, Pakistan
| | - Humaira Mahmood
- Department of Public Health, National University of Medical Sciences (NUMS), Rawalpindi, Punjab, Pakistan
| | - Asma Asma Iftikhar
- Department of Public Health, National University of Medical Sciences (NUMS), Rawalpindi, Punjab, Pakistan
| | - Nimrah komal
- Department of Public Health, National University of Medical Sciences (NUMS), Rawalpindi, Punjab, Pakistan
| | - Zikria Butt
- Department of Public Health, National University of Medical Sciences (NUMS), Rawalpindi, Punjab, Pakistan
| | - Hassan Mumtaz
- Department of Public Health, Health Services Academy, Islamabad, Islamabad, Pakistan
- *Correspondence: Hassan Mumtaz
| | - Duha Shellah
- Department of Medicine & Health Sciences, An-Najah National University, Nablus, Palestine
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Kabir A, Karim MN, Billah B. The capacity of primary healthcare facilities in Bangladesh to prevent and control non-communicable diseases. BMC PRIMARY CARE 2023; 24:60. [PMID: 36864391 PMCID: PMC9979470 DOI: 10.1186/s12875-023-02016-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND The rapid rise of non-communicable diseases (NCDs) has become a significant public health concern in Bangladesh. This study assesses the readiness of primary healthcare facilities to manage the following NCDs: diabetes mellitus (DM), cervical cancer, chronic respiratory diseases (CRIs), and cardiovascular diseases (CVDs). METHODS A cross-sectional survey was conducted between May 2021 and October 2021 among 126 public and private primary healthcare facilities (nine Upazila health complexes (UHCs), 36 union-level facilities (ULFs), 53 community clinics (CCs), and 28 private hospitals/clinics). The NCD-specific service readiness was assessed using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) reference manual. The facilities' readiness was assessed using the following four domains: guidelines and staff, basic equipment, diagnostic facility, and essential medicine. The mean readiness index (RI) score for each domain was calculated. Facilities with RI scores of above 70% were considered 'ready' to manage NCDs. RESULTS The general services availability ranged between 47% for CCs and 83% for UHCs and the guidelines and staff accessibility were the highest for DM in the UHCs (72%); however, cervical cancer services were unavailable in the ULFs and CCs. The availability of basic equipment was the highest for cervical cancer (100%) in the UHCs and the lowest for DM (24%) in the ULFs. The essential medicine for CRI was 100% in both UHCs and ULFs compared to 25% in private facilities. The diagnostic capacity for CVD and essential medicine for cervical cancer was unavailable at all levels of public and private healthcare facilities. The overall mean RI for each of the four NCDs was below the cut-off value of 70%, with the highest (65%) for CRI in UHCs but unavailable for cervical cancer in CCs. CONCLUSION All levels of primary healthcare facilities are currently not ready to manage NCDs. The notable deficits were the shortage of trained staff and guidelines, diagnostic facilities, and essential medicine. This study recommends increasing service availability to address the rising burden of NCDs at primary healthcare levels in Bangladesh.
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Affiliation(s)
- Ashraful Kabir
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Socioeconomic disparities in diabetes prevalence and management among the adult population in Bangladesh. PLoS One 2022; 17:e0279228. [PMID: 36538534 PMCID: PMC9767371 DOI: 10.1371/journal.pone.0279228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 12/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diabetes, one of the major metabolic disorders, is rising in Bangladesh. Studies indicate there is inequality in prevalence and care-seeking behavior, which requires further exploration to understand the socioeconomic disparities in the pathophysiology of diabetes. This study examined the latest nationally representative estimates of diabetes prevalence, awareness, and management among adults aged 18 years and above in Bangladesh and its association with socioeconomic status in 2017-18. METHODS We used the 2017-18 Bangladesh Demographic and Health Survey data. Diabetic status of 12,092 adults aged 18 years and above was measured in the survey using fasting plasma glucose levels. We applied multivariate logistic regressions to examine the role of socioeconomic status on diabetes prevalence, awareness, and management, after controlling for relevant covariates. RESULTS Overall, 10% of adults had diabetes in Bangladesh in 2017-18, with the highest prevalence of 16% in the age group 55-64 years. Our analyses found statistically significant disparities by socioeconomic status in the prevalence of diabetes as well as the person's awareness of his/her diabetic condition. However, the effect of socioeconomic status on receiving anti-diabetic medication only approached significance (p = 0.07), and we found no significant association between socioeconomic status and control of diabetes. CONCLUSIONS We expect to see an 'accumulation' of the number of people with diabetes to continue in the coming years. The rising prevalence of diabetes is only the tip of an iceberg; a large number of people with uncontrolled diabetes and a lack of awareness of their condition will lead to increased morbidity and mortality, and that could be the real threat. Immediate measures to increase screening coverage and exploration of poor control of diabetes are required to mitigate the situation.
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Sapkota BP, Baral KP, Berger U, Parhofer KG, Rehfuess EA. Health sector readiness for the prevention and control of non-communicable diseases: A multi-method qualitative assessment in Nepal. PLoS One 2022; 17:e0272361. [PMID: 36178897 PMCID: PMC9524672 DOI: 10.1371/journal.pone.0272361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/19/2022] [Indexed: 11/25/2022] Open
Abstract
In Nepal, deaths attributable to NCDs have increased in recent years. Although NCDs constitute a major public health problem, how best to address this has not received much attention. The objective of this study was to assess the readiness of the Nepalese health sector for the prevention and control of NCDs and their risk factors. The study followed a multi-method qualitative approach, using a review of policy documents, focus group discussions (FGDs), and in-depth interviews (IDIs) conducted between August and December 2020. The policy review was performed across four policy categories. FGDs were undertaken with different cadres of health workers and IDIs with policy makers, program managers and service providers. We performed content analysis using the WHO health system building blocks framework as the main categories. Policy documents were concerned with the growing NCD burden, but neglect the control of risk factors. FGDs and IDIs reveal significant perceived weaknesses in each of the six building blocks. According to study participants, existing services were focused on curative rather than preventive interventions. Poor retention of all health workers in rural locations, and of skilled health workers in urban locations led to the health workers across all levels being overburdened. Inadequate quantity and quality of health commodities for NCDs emerged as an important logistics issue. Monitoring and reporting for NCDs and their risk factors was found to be largely absent. Program decisions regarding NCDs did not use the available evidence. The limited budget dedicated to NCDs is being allocated to curative services. The engagement of non-health sectors with the prevention and control of NCDs remained largely neglected. There is a need to redirect health sector priorities towards NCD risk factors, notably to promote healthy diets and physical activity and to limit tobacco and alcohol consumption, at policy as well as community levels.
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Affiliation(s)
- Bhim Prasad Sapkota
- CIH Center for International Health, LMU Munich, Munich, Germany
- Teaching & Training Unit, Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU Munich, Munich, Germany
- * E-mail: ,
| | | | - Ursula Berger
- Institute of Medical Information Processing Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Klaus G. Parhofer
- Medical Department-4, University Hospital, LMU Munich, Munich, Germany
| | - Eva A. Rehfuess
- Institute of Medical Information Processing Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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Oluwole EO, Adeniran A, Chieme CF, Ojo OY, Akinyinka MR, Ilesanmi MM, Olujobi BA, Bakare OQ. Maternal and child health service readiness among primary health care facilities in Ekiti, Nigeria. Afr J Prim Health Care Fam Med 2022; 14:e1-e7. [PMID: 36073122 PMCID: PMC9453109 DOI: 10.4102/phcfm.v14i1.3535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/10/2022] [Accepted: 06/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background The availability of adequate infrastructure, diagnostic medical equipment, medicines and commodities and well-trained medical personnel are essential for the effective delivery of health care services. Aim This study assessed maternal and child health (MCH) services’ specific readiness by type and location of the health facility and compared the readiness between urban and rural primary health care (PHC) facilities in Ekiti State, Nigeria. Setting The study was conducted amongst the heads (officers in charge) of PHC facilities in Ekiti State, Nigeria between August 2020 and October 2020. Methods A descriptive cross-sectional study in which all PHC facilities were conducted and data were collected with the aid of the Service Availability and Readiness Assessment (SARA) tool using the KoboCollect app. Data were cleaned and coded on Microsoft Excel 2016 and exported to Stata SE 12 for analysis. The level of significance was set at p < 0.05. Results Overall, the MCH readiness score amongst PHC facilities was 47% (0.47 ± 0.18). About half (52%) of the facilities had necessary and relevant equipment. Health facilities located in urban areas had more medicines and commodities compared with those of rural areas (0.51 ± 0.16 vs 0.45 ± 0.17, p < 0.05). Primary health care facilities in Ekiti North I had an overall higher service readiness score (0.63 ± 0.19) compared with other federal constituencies (p < 0.001). Conclusion The overall MCH-specific service readiness in Ekiti State was relatively low. Strategies to address the identified gaps for a smooth journey towards the achievement of Universal Health Coverage (UHC) are recommended.
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Affiliation(s)
- Esther O Oluwole
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Surulere.
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Gupta A, Gitanjali T, Christina S, Janani L, Jamsheer MKM, Akoijam BS. Preparedness of healthcare facilities of manipur in the management of noncommunicable diseases: A cross-sectional study. Indian J Public Health 2022; 66:245-250. [PMID: 36149099 DOI: 10.4103/ijph.ijph_29_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background India is experiencing a rapid health transition with a rising burden of noncommunicable diseases (NCDs), causing significant morbidity and mortality. Cost-effective interventions for comprehensive NCD management can only be designed after assessing the readiness of various health facilities. Objectives This study aimed to assess the preparedness of healthcare facilities of Manipur in the management of NCDs and to assess the knowledge of doctors regarding NCDs. Methods A cross-sectional study was conducted in 21 public healthcare facilities in seven districts of Manipur during October 2021. Readiness of these facilities was assessed through observation and interview of doctors and nurses using a checklist adapted from the WHO Package of Essential NCDs. Knowledge of 153 doctors was also assessed using a self-administered, structured questionnaire. Data were entered in SPSS-26 and expressed using descriptive statistics. Results General readiness index of primary health centers (PHCs), community health centers (CHCs), district hospitals (DHs), and tertiary care centers (TCCs) was 47%, 66.3%, 73.2%, and 70%, respectively. CHCs were ready in the domains of patient care services (80%), human resources (75%), and advocacy (91.7%). DHs and TCCs were ready in terms of patient care services, human resources, record maintenance, referral system, and advocacy. PHCs were not ready in any of the nine domains. Majority of the doctors (88%) had inadequate knowledge regarding NCDs. Conclusion PHCs and CHCs were not adequately prepared, but DHs and TCCs were ready to manage NCDs. More than four-fifth of the doctors had inadequate knowledge. Strengthening PHCs and CHCs and training of healthcare workers are needed for integrated NCD management.
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Affiliation(s)
- Avantika Gupta
- Senior Resident, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Takhellambam Gitanjali
- Post Graduate Trainee, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Soubam Christina
- Senior Resident, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - L Janani
- Senior Resident, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - M K Mohammed Jamsheer
- Post Graduate Trainee, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
| | - Brogen Singh Akoijam
- Professor and Head, Professor, Department of Community Medicine, Regional Institute of Medical Sciences, Imphal, Manipur, India
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Kabir A, Karim MN, Islam RM, Romero L, Billah B. Health system readiness for non-communicable diseases at the primary care level: a systematic review. BMJ Open 2022; 12:e060387. [PMID: 35140165 PMCID: PMC8830230 DOI: 10.1136/bmjopen-2021-060387] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To synthesise evidence on the primary healthcare system's readiness for preventing and managing non-communicable diseases (NCDs). DESIGN Systematic review. DATA SOURCES Ovid MEDLINE, EMBASE, CINAHL, PsycINFO and Scopus were searched from 1 January 1984 to 30 July 2021, with hand-searching references and expert advice. ELIGIBILITY CRITERIA Any English-language health research with evidence of readiness/preparedness of the health system at the primary healthcare level in the context of four major NCDs: diabetes mellitus, cancer, chronic respiratory diseases (CRDs) and cardiovascular diseases (CVDs). DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data and assessed the bias. The full-text selected articles were then assessed using the Mixed Methods Appraisal Tool. Health system readiness was descriptively and thematically synthesised in line with the health system dynamics framework. RESULTS Out of 7843 records, 23 papers were included in this review (15 quantitative, 3 qualitative and 5 mixed-method studies). The findings showed that existing literature predominantly examined health system readiness from the supply-side perspective as embedded in the WHO's health system framework. However, at the primary healthcare level, these components are insufficiently prepared for NCDs. Among NCDs, higher levels of readiness were reported for diabetes mellitus and hypertension in comparison to CRDs (asthma, chronic obstructive pulmonary disease), CVDs and cancer. There has been a dearth of research on the demand-side perspective, which is an essential component of a health system and must be addressed in the future research. CONCLUSION The supply-side components at the primary healthcare level are inadequately ready to address the growing NCD burden. Improving supply-side factors, with a particular focus on CRDs, CVDs and cancer, and improving understanding of the demand-side components of the health system's readiness, may help to prevent and manage NCDs at the primary healthcare level.
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Affiliation(s)
- Ashraful Kabir
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Md Nazmul Karim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rakibul M Islam
- Women's Health Research Program, Monash University, Melbourne, Victoria, Australia
| | - Lorena Romero
- The Ian Potter Library, Ground Floor, AMREP Building, The Alfred, Melbourne, Victoria, Australia
| | - Baki Billah
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Kabir A, Karim MN, Billah B. Primary healthcare system readiness to prevent and manage non-communicable diseases in Bangladesh: a mixed-method study protocol. BMJ Open 2021; 11:e051961. [PMID: 34493524 PMCID: PMC8424828 DOI: 10.1136/bmjopen-2021-051961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION The burden of non-communicable diseases (NCDs) is rapidly increasing in Bangladesh. Currently, it contributes to 67% of annual deaths, and accounts for approximately 64% of the disease burden. Since 70% of the Bangladeshi population residing in the rural area rely on the primary healthcare system, assessment of its capacity is crucial for guiding public health decisions to prevent and manage NCDs. This protocol is designed to recognise and assess the Bangladeshi health system's readiness for NCDs at the primary level. METHODS AND ANALYSIS The study will use a mixed-method design. Numerical data will be collected using households and health facilities surveys, while qualitative data will be collected by interviewing healthcare providers, policy planners, health administrators and community members. The WHO's Service Availability and Readiness Assessment (SARA) methodology and Package of Essential Non-communicable (PEN) Disease Interventions for Primary Healthcare reference manuals will be used to assess the readiness of the primary healthcare facilities for NCD services. Furthermore, Health System Dynamics Framework will be used to examine health system factors. Using the supportive items outlined in the WHO PEN package, and indicators proposed in WHO SARA methodology, a composite score will be created to analyse facility-level data. Two independent samples t-test, analysis of variance and χ2 test methods will be used for bivariate analysis, and multiple regression analysis will be used for multivariable analysis. Complementarily, the thematic analysis approach will be used to analyse qualitative data. ETHICS AND DISSEMINATION The project has been approved by the Monash University Human Research Ethics Committee (Project ID: 27112), and Bangladesh Medical Research Council (Ref: BMRC/NREC/2019-2022/270). The research findings will be shared through research articles, conference proceedings or in other scientific media. The reports or publications will not have any information that can be used to identify any of the study participants.
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Affiliation(s)
- Ashraful Kabir
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Md Nazmul Karim
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Baki Billah
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Krishnan A, Mathur P, Kulothungan V, Salve HR, Leburu S, Amarchand R, Nongkynrih B, Chaturvedi HK, Ganeshkumar P, K S VU, Laxmaiah A, Boruah M, Kumar S, Patro BK, Raghav PR, Rajkumar P, Sarma PS, Sharma R, Tambe M, Arlappa N, Mahanta TG, Bhuyan PJ, Joshi RP, Pakhare AP, Galhotra A, Kumar D, Behera BK, Topno RK, Gupta MK, Rustagi N, Trivedi AV, Thankappan KR, Gupta S, Garg S, Shelke SC. Preparedness of primary and secondary health facilities in India to address major noncommunicable diseases: results of a National Noncommunicable Disease Monitoring Survey (NNMS). BMC Health Serv Res 2021; 21:757. [PMID: 34332569 PMCID: PMC8325187 DOI: 10.1186/s12913-021-06530-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 05/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The monitoring framework for evaluating health system response to noncommunicable diseases (NCDs) include indicators to assess availability of affordable basic technologies and essential medicines to treat them in both public and private primary care facilities. The Government of India launched the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS) in 2010 to strengthen health systems. We assessed availability of trained human resources, essential medicines and technologies for diabetes, cardiovascular and chronic respiratory diseases as one of the components of the National Noncommunicable Disease Monitoring Survey (NNMS - 2017-18). METHODS NNMS was a cross-sectional survey. Health facility survey component covered three public [Primary health centre (PHC), Community health centre (CHC) and District hospital (DH)] and one private primary in each of the 600 primary sampling units (PSUs) selected by stratified multistage random sampling to be nationally representative. Survey teams interviewed medical officers, laboratory technicians, and pharmacists using an adapted World Health Organization (WHO) - Service Availability and Readiness Assessment (SARA) tool on handhelds with Open Data Kit (ODK) technology. List of essential medicines and technology was according to WHO - Package of Essential Medicines and Technologies for NCDs (PEN) and NPCDCS guidelines for primary and secondary facilities, respectively. Availability was defined as reported to be generally available within facility premises. RESULTS Total of 537 public and 512 private primary facilities, 386 CHCs and 334 DHs across India were covered. NPCDCS was being implemented in 72.8% of CHCs and 86.8% of DHs. All essential technologies and medicines available to manage three NCDs in primary care varied between 1.1% (95% CI; 0.3-3.3) in rural public to 9.0% (95% CI; 6.2-13.0) in urban private facilities. In NPCDCS implementing districts, 0.4% of CHCs and 14.5% of the DHs were fully equipped. DHs were well staffed, CHCs had deficits in physiotherapist and specialist positions, whereas PHCs reported shortage of nurse-midwives and health assistants. Training under NPCDCS was uniformly poor across all facilities. CONCLUSION Both private and public primary care facilities and public secondary facilities are currently not adequately prepared to comprehensively address the burden of NCDs in India.
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Affiliation(s)
- Anand Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Mathur
- Indian Council Medical Research - National Centre for Disease Informatics and Research, Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India.
| | - Vaitheeswaran Kulothungan
- Indian Council Medical Research - National Centre for Disease Informatics and Research, Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Harshal Ramesh Salve
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sravya Leburu
- Indian Council Medical Research - National Centre for Disease Informatics and Research, Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Ritvik Amarchand
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Baridalyne Nongkynrih
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | - P Ganeshkumar
- Indian Council Medical Research - National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Vinay Urs K S
- Indian Council Medical Research - National Centre for Disease Informatics and Research, Nirmal Bhawan-ICMR Complex (II Floor), Poojanahalli, Kannamangala Post, Bengaluru, Karnataka, 562 110, India
| | - Avula Laxmaiah
- Division of Public Health Nutrition, Indian Council Medical Research - National Institute of Nutrition, Hyderabad, Telangana, India
| | - Manjit Boruah
- Department of Community Medicine, Assam Medical College, Dibrugarh, Assam, India
| | - Sanjeev Kumar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Binod Kumar Patro
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Pankaja Ravi Raghav
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prabu Rajkumar
- Indian Council Medical Research - National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - P Sankara Sarma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Rinku Sharma
- Centre for Noncommunicable Diseases, National Centre for Disease Control, Directorate General of Health Services, New Delhi, India
| | - Muralidhar Tambe
- Department of Community Medicine, B J Govt. Medical College, Pune, Maharashtra, India
| | - N Arlappa
- Division of Public Health Nutrition, Indian Council Medical Research - National Institute of Nutrition, Hyderabad, Telangana, India
| | - Tulika Goswami Mahanta
- Department of Community Medicine / Prevention & Social Medicine, Tezpur Medical College, Tezpur, Assam, India
| | - Pranab Jyoti Bhuyan
- Regional Director Office, Ministry of Health and Family Welfare, Guwahati, Assam, India
| | - Rajnish P Joshi
- Department of General Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhijit P Pakhare
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Abhiruchi Galhotra
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chattisgarh, India
| | - Dewesh Kumar
- Department of Preventive and Social Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Binod Kumar Behera
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhubaneshwar, Odisha, India
| | - Roshan K Topno
- Department of Epidemiology, Indian Council Medical Research - Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
| | - Manoj Kumar Gupta
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Neeti Rustagi
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Atulkumar V Trivedi
- Department of Community Medicine, Government Medical College, Bhavnagar, Gujarat, India
| | - K R Thankappan
- Department of Public Health and Community Medicine, Central University Kerala, Kasaragod, Kerala, India
| | - Sonia Gupta
- Centre for Noncommunicable Diseases, National Centre for Disease Control, Directorate General of Health Services, New Delhi, India
| | - Suneela Garg
- Department of Community Medicine, Maulana Azad Medical College and Associated Hospitals, New Delhi, India
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Rakhshanda S, Dalal K, Chowdhury HA, Mayaboti CA, Paromita P, Rahman AKMF, Hussain AHME, Mashreky SR. Assessing service availability and readiness to manage cervical cancer in Bangladesh. BMC Cancer 2021; 21:670. [PMID: 34090361 PMCID: PMC8180145 DOI: 10.1186/s12885-021-08387-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The second most common cancer among females in Bangladesh is cervical cancer. The national strategy for cervical cancer needs monitoring to ensure that patients have access to care. In order to provide accurate information to policymakers in Bangladesh and other low and middle income countries, it is vital to assess current service availability and readiness to manage cervical cancer at health facilities in Bangladesh. METHODS An interviewer-administered questionnaire adapted from the World Health Organization Service Availability and Readiness Assessment Standard Tool was used to collect cross-sectional data from health administrators of 323 health facilities in Bangladesh. Services provided were categorized into domains and service readiness was determined by mean readiness index (RI) scores. Data analysis was conducted using STATA version 13. RESULTS There were seven tertiary and specialized hospitals, 118 secondary level health facilities, 124 primary level health facilities, and 74 NGO/private hospitals included in the study. Twenty-six per cent of the health facilities provided services to cancer patients. Among the 34 tracer items used to assess cancer management capacity of health facilities, four cervical cancer-specific tracer items were used to determine service readiness for cervical cancer. On average, tertiary and specialized hospitals surpassed the readiness index cutoff of 70% with adequate staff and training (100%), equipment (100%), and diagnostic facilities (85.7%), indicating that they were ready to manage cervical cancer. The mean RI scores for the rest of the health facilities were below the cutoff value, meaning that they were not prepared to provide adequate cervical cancer services. CONCLUSION The health facilities in Bangladesh (except for some tertiary hospitals) lack readiness in cervical cancer management in terms of guidelines on diagnosis and treatment, training of staff, and shortage of equipment. Given that cervical cancer accounts for more than one-fourth of all female cancers in Bangladesh, management of cervical cancer needs to be available at all levels of health facilities, with primary level facilities focusing on early diagnosis. It is recommended that appropriate standard operating procedures on cervical cancer be developed for each level of health facilities to contribute towards attaining sustainable developmental goals.
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Affiliation(s)
- Shagoofa Rakhshanda
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | - Koustuv Dalal
- School of Health Sciences, Mid Sweden University, Sundsvall, Sweden. .,School of Medicine and Health Care, al-Farabi Kazakh National University, Almaty, Kazakhstan.
| | | | | | - Progga Paromita
- Kirtipasha Health and Family Welfare Centre, Jhalokathi Sadar Upazilla, Bangladesh
| | - A K M Fazlur Rahman
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.,Department of Epidemiology, Bangladesh University of Health Science (BUHS), Dhaka, Bangladesh
| | | | - Saidur Rahman Mashreky
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh.,Department of Non-communicable Diseases, Bangladesh University of Health Science (BUHS), Dhaka, Bangladesh
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Bintabara D, Shayo FK. Disparities in availability of services and prediction of the readiness of primary healthcare to manage diabetes in Tanzania. Prim Care Diabetes 2021; 15:365-371. [PMID: 33262058 DOI: 10.1016/j.pcd.2020.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burdens of Non-communicable Diseases have overstretched health systems in developing countries. The study explores disparities in the availability of services and predicts the readiness of primary healthcare facilities to manage diabetes in Tanzania. METHODS The study analyzed data from the 2014-2015 Tanzania Service Provision Assessment Survey. A total of 1142 primary healthcare facilities were included in this analysis. The Negative binomial regression models were fitted to predict each of selected independent variable that is associated with the readiness of primary healthcare to manage diabetes. RESULTS The overall availability of services was significantly different across the type of facility and managing authority. In an adjusted model, the following were the predictors for a significant increase in readiness to manage diabetes: health center [β = 0.470], private facilities [β = 0.252], the performance of management meetings [β = 0.446], having source of fund other than government [β = 0.193,], and presence of medical doctors [β = 0.677]. CONCLUSION The robust primary care systems to manage diabetes could be achieved by improving the readiness of primary healthcare facilities through optimizing the availability of diagnostic tools, basic medicines, medical doctors, and early release of a government fund to publicly-owned facilities.
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Affiliation(s)
| | - Festo K Shayo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.
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12
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Yusuf SS, Acharya K, Ahmed R, Ahmed A. Understanding general health service readiness and its correlates in the health facilities of Bangladesh: evidence from the Bangladesh Health Facility Survey 2017. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01522-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Paromita P, Chowdhury HA, Mayaboti CA, Rakhshanda S, Rahman AKMF, Karim MR, Mashreky SR. Assessing service availability and readiness to manage Chronic Respiratory Diseases (CRDs) in Bangladesh. PLoS One 2021; 16:e0247700. [PMID: 33661982 PMCID: PMC7932138 DOI: 10.1371/journal.pone.0247700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Chronic Respiratory Diseases (CRDs) are some of the most prevailing non-communicable diseases (NCDs) worldwide and cause three times higher morbidity and mortality in low- and middle-income countries (LMIC) than in developed nations. In Bangladesh, there is a dearth of data about the quality of CRD management in health facilities. This study aims to describe CRD service availability and readiness at all tiers of health facilities using the World Health Organization's (WHO) Service Availability and Readiness Assessment (SARA) tool. METHODS A cross-sectional study was conducted from December 2017 to June 2018 in a total of 262 health facilities in Bangladesh using the WHO SARA Standard Tool. Surveys were conducted with facility management personnel by trained data collectors using REDCap software. Descriptive statistics for the availability of CRD services were calculated. Composite scores for facility readiness (Readiness Index 'RI') were created which included four domains: staff and guideline, basic equipment, diagnostic capacity, and essential medicines. RI was calculated for each domain as the mean score of items expressed as a percentage. Indices were compared to a cutoff of70% which means that a facility index above 70% is considered 'ready' to manage CRDs at that level. Data analysis was conducted using SPSS Vr 21.0. RESULTS It was found, tertiary hospitals were the only hospitals that surpassed the readiness index cutoff of 70%, indicating that they had adequate capacity and were ready to manage CRDs (RI 78.3%). The mean readiness scores for the other hospital tiers in descending order were District Hospitals (DH): 40.6%, Upazila Health Complexes (UHC): 33.3% and Private NGOs: 39.5%). CONCLUSION Only tertiary care hospitals, constituting 3.1% of sampled health facilities, were found ready to manage CRD. Inadequate and unequal supplies of medicine as well as a lack of trained staff, guidelines on the diagnosis and treatment of CRDs, equipment, and diagnostic facilities contributed to low readiness index scores in all other tiers of health facilities.
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Affiliation(s)
- Progga Paromita
- Kirtipasha Union Health and Family Welfare Centre, Jhalokathi Sadar Upazila, Barishal, Bangladesh
| | | | | | - Shagoofa Rakhshanda
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | | | - Md. Rizwanul Karim
- Department of Non Communicable Disease Control, Directorate General of Health and Services, Dhaka, Bangladesh
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14
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Bintabara D, Ngajilo D. Readiness of health facilities for the outpatient management of non-communicable diseases in a low-resource setting: an example from a facility-based cross-sectional survey in Tanzania. BMJ Open 2020; 10:e040908. [PMID: 33177143 PMCID: PMC7661355 DOI: 10.1136/bmjopen-2020-040908] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/30/2020] [Accepted: 09/23/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This study assessed the readiness of health facilities to provide outpatient management of non-communicable diseases using a nationally representative sample of health facilities from Tanzania as an example of a low-resource country. DESIGN Facility-based cross-sectional survey. SETTING This study analysed data collected from public and private-owned dispensaries/clinics, health centres and hospitals during the 2014-2015 Tanzania Service Provision Assessment survey. PRIMARY OUTCOME MEASURES Three outcome variables are included in this study, namely readiness of facilities to provide outpatient management for diabetes, hypertension and chronic respiratory diseases. These were composite variables measured based on availability of indicators identified in the WHO-Service Availability and Readiness Assessment manual. These indicators were grouped into three domains, viz staff training and guidelines, basic diagnostic equipment and basic medicines. Readiness was measured by assessing the presence of required indicators in each of these domains. RESULTS Out of 1188 health facilities assessed, 52.1%, 64.8% and 60.9% reported providing services related to diabetes, hypertension and chronic respiratory diseases, respectively. A few facilities reported having treatment guidelines (33.2%) or staff trained to provide non-communicable disease services (10.4%). The availability of basic diagnostic equipment and medicines for these diseases was significantly lower in public lower level facilities than in their private counterparts (p<0.05). Facilities located in urban settings as well as higher level (health centre and hospitals) and publicly owned facilities were significantly associated with increased service readiness index for providing outpatient management of non-communicable diseases. CONCLUSION A fair distribution of resources through the 'push' system of refresher training, treatment guidelines, medicines and diagnostic equipment from higher authorities or other agencies may be one way of strengthening the readiness of lower level and public facilities to cope with the increasing burden of non-communicable diseases in low-resource countries such as Tanzania.
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Affiliation(s)
- Deogratius Bintabara
- Department of Community Medicine, School of Medicine, The University of Dodoma, Dodoma, Tanzania
| | - Dorothy Ngajilo
- Ministry of Health, Community Development, Gender Elderly and Children, Dodoma, Tanzania
- Occupational Medicine Division/Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Ssensamba JT, Mukuru M, Nakafeero M, Ssenyonga R, Kiwanuka SN. Health systems readiness to provide geriatric friendly care services in Uganda: a cross-sectional study. BMC Geriatr 2019; 19:256. [PMID: 31533635 PMCID: PMC6749715 DOI: 10.1186/s12877-019-1272-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background As ageing emerges as the next public health threat in Africa, there is a paucity of information on how prepared its health systems are to provide geriatric friendly care services. In this study, we explored the readiness of Uganda’s public health system to offer geriatric friendly care services in Southern Central Uganda. Methods Four districts with the highest proportion of old persons in Southern Central Uganda were purposively selected, and a cross-section of 18 randomly selected health facilities (HFs) were visited and assessed for availability of critical items deemed important for provision of geriatric friendly services; as derived from World Health Organization’s Age-friendly primary health care centres toolkit. Data was collected using an adapted health facility geriatric assessment tool, entered into Epi-data software and analysed using STATA version 14. Kruskal-Wallis and Dunn’s post hoc tests were conducted to determine any associations between readiness, health facility level, and district. Results The overall readiness index was 16.92 (SD ±4.19) (range 10.8–26.6). This differed across districts; Lwengo 17.91 (SD ±3.15), Rakai 17.63 (SD ±4.55), Bukomansimbi 16.51 (SD ±7.18), Kalungu 13.74 (SD ±2.56) and facility levels; Hospitals 26.62, Health centers four (HCIV) 20.05 and Health centers three (HCIII) 14.80. Low readiness was due to poor scores concerning; leadership (0%), financing (0%), human resources (1.7%) and health management information systems (HMIS) (11.8%) WHO building blocks. Higher-level HFs were statistically significantly friendlier than lower-level HFs (p = 0.015). The difference in readiness between HCIIIs and HCIVs was 2.39 (p = 0.025). Conclusion There is a low readiness for public health facilities to provide geriatric friendly care services in Uganda. This is due to gaps in all of the health system building blocks. There is a need for health system reforms in Uganda to adequately cater for service provision for older adults if the 2020 global healthy ageing goal is to be met.
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Affiliation(s)
- Jude Thaddeus Ssensamba
- Makerere University College of Health Sciences, School of Public Health, Department of Health Policy and Planning, Kampala, Uganda. .,Center for Innovations in Health Africa, Plot 1-3 School Road Namuwongo, P.O. Box 220, Kampala, Uganda.
| | - Moses Mukuru
- Makerere University College of Health Sciences, School of Public Health, Department of Health Policy and Planning, Kampala, Uganda
| | - Mary Nakafeero
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Ronald Ssenyonga
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Suzanne N Kiwanuka
- Makerere University College of Health Sciences, School of Public Health, Department of Health Policy and Planning, Kampala, Uganda
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Jigjidsuren A, Byambaa T, Altangerel E, Batbaatar S, Saw YM, Kariya T, Yamamoto E, Hamajima N. Free and universal access to primary healthcare in Mongolia: the service availability and readiness assessment. BMC Health Serv Res 2019; 19:129. [PMID: 30786897 PMCID: PMC6381625 DOI: 10.1186/s12913-019-3932-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/28/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The government of Mongolia mandates free access to primary healthcare (PHC) for its citizens. However, no evidence is available on the physical presence of PHC services within health facilities. Thus, the present study assessed the capacity of health facilities to provide basic services, at minimum standards, using a World Health Organization (WHO) standardized assessment tool. METHODS The service availability and readiness assessment (SARA) tool was used, which comprised a set of indicators for defining whether a health facility meets the required conditions for providing basic or specific services. The study examined all 146 health facilities in Chingeltei and Khan-Uul districts of Ulaanbaatar city, including private and public hospitals, family health centers (FHCs), outpatient clinics, and sanatoriums. The assessment questionnaire was modified to the country context, and data were collected through interviews and direct observations. Data were analyzed using SPSS 21.0, and relevant nonparametric tests were used to compare median parameters. RESULTS A general service readiness index, or the capacity of health facilities to provide basic services at minimum standards, was 44.1% overall and 36.3, 61.5, and 62.4% for private clinics, FHCs, and hospitals, respectively. Major deficiencies were found in diagnostic capacity, supply of essential medicines, and availability of basic equipment; the mean scores for general service readiness was 13.9, 14.5 and 47.2%, respectively. Availability of selected PHC services was 19.8%. FHCs were evaluated as best capable (69.5%) to provide PHC among all health facilities reviewed (p < 0.001). Contribution of private clinics and sanatoriums to PHC service provisions were minimal (4.1 and 0.5%, respectively). Service-specific readiness among FHCs for family planning services was 44.0%, routine immunization was 83.6%, antenatal care was 56.5%, preventive and curative care for children was 44.5%, adolescent health services was 74.2%, tuberculosis services was 53.4%, HIV and STI services was 52.2%, and non-communicable disease services was 51.7%. CONCLUSIONS Universal access to PHC is stipulated throughout various policies in Mongolia; however, the present results revealed that availability of PHC services within health facilities is very low. FHCs contribute most to providing PHC, but readiness is mostly hampered by a lack of diagnostic capacity and essential medicines.
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Affiliation(s)
- Altantuya Jigjidsuren
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Asian Development Bank, Mongolia Resident Mission, Ulaanbaatar, Mongolia
| | | | | | | | - Yu Mon Saw
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Tetsuyoshi Kariya
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
- Nagoya University Asian Satellite Campuses Institute, Nagoya, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 Japan
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