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Kuikel BS, Shrestha A, Xu DR, Shahi BB, Bhandari B, Mishra RK, Bhattrai N, Acharya K, Timalsina A, Dangaura NR, Adhikari B, Dhital R, Karmacharya BM. A critical analysis of health system in Nepal; Perspective's based on COVID-19 response. DIALOGUES IN HEALTH 2023; 3:100142. [PMID: 37325802 PMCID: PMC10257514 DOI: 10.1016/j.dialog.2023.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 06/17/2023]
Abstract
Background Nepal moved from a unitary government to a federal system of government in 2015 under its constitution. Nepal is a federal democratic republic governed by three levels of government: a federal, provincial, and local level. The response to COVID-19 in Nepal has been majorly led and controlled by the federal government. All three levels of government are performing their responsibilities; however, they face various challenges in responding to COVID-19. This study aimed to critically analyze Nepal's health system in the context of the COVID-19 response. Methods We conducted semi-structured in-depth interviews by telephone among the policymakers, health workers, and stakeholders at the federal, provincial, and local levels (n = 41) between January to July 2021. The interviews were audio recorded, transcribed into English, and coded using inductive-deductive approaches. Results COVID-19 considerably impacted routine health care, mainly maternity services and immunization. Inadequate financial resources, inadequate human resources, and the lack of ventilators, ICUs, and X-ray services were the significant challenges in tackling and managing COVID-19 effectively. Conclusion The study found that all three levels of government perform their roles and responsibilities and effectively manage the pandemic. The federal and provincial governments focused more on the plans and policy development, while the local government demonstrated greater accountability in implementing those plans and policies. Therefore, all three tiers of government need to coordinate together for preparing and communicating information in times of emergency. Besides, it is imperative to empower local governments to maintain Nepal's federal health system.
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Affiliation(s)
- Bihari Sharan Kuikel
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Archana Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Institute for Implementation Science and Health, Kathmandu, Nepal
- Center of Methods for Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | | | | | | | | | | | | | - Ashish Timalsina
- Family Welfare Division, Department of Health Services, Kathmandu, Nepal
| | - Nripa Raj Dangaura
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | - Rabin Dhital
- Rural Development and Empowerment Center, Nuwakot, Nepal
| | - Biraj Man Karmacharya
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
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Khatri RB, Endalamaw A, Erku D, Wolka E, Nigatu F, Zewdie A, Assefa Y. Preparedness, impacts, and responses of public health emergencies towards health security: qualitative synthesis of evidence. Arch Public Health 2023; 81:208. [PMID: 38037151 PMCID: PMC10687930 DOI: 10.1186/s13690-023-01223-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Natural and human-made public health emergencies (PHEs), such as armed conflicts, floods, and disease outbreaks, influence health systems including interruption of delivery and utilization of health services, and increased health service needs. However, the intensity and types of impacts of these PHEs vary across countries due to several associated factors. This scoping review aimed to synthesise available evidence on PHEs, their preparedness, impacts, and responses. METHODS We conducted a scoping review of published evidence. Studies were identified using search terms related to two concepts: health security and primary health care. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines to select studies. We adapted the review framework of Arksey and O'Malley. Data were analyzed using a thematic analysis approach and explained under three stages of PHEs: preparedness, impacts, and responses. RESULTS A total of 64 studies were included in this review. Health systems of many low- and middle-income countries had inadequate preparedness to absorb the shocks of PHEs, limited surveillance, and monitoring of risks. Health systems have been overburdened with interrupted health services, increased need for health services, poor health resilience, and health inequities. Strategies of response to the impact of PHEs included integrated services such as public health and primary care, communication and partnership across sectors, use of digital tools, multisectoral coordination and actions, system approach to responses, multidisciplinary providers, and planning for resilient health systems. CONCLUSIONS Public health emergencies have high impacts in countries with weak health systems, inadequate preparedness, and inadequate surveillance mechanisms. Better health system preparedness is required to absorb the impact, respond to the consequences, and adapt for future PHEs. Some potential response strategies could be ensuring need-based health services, monitoring and surveillance of post-emergency outbreaks, and multisectoral actions to engage sectors to address the collateral impacts of PHEs. Mitigation strategies for future PHEs could include risk assessment, disaster preparedness, and setting digital alarm systems for monitoring and surveillance.
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Affiliation(s)
- Resham B Khatri
- Health Social Science and Development Research Institute, Kathmandu, Nepal.
- School of Public Health, University of Queensland, Brisbane, Australia.
| | - Aklilu Endalamaw
- School of Public Health, University of Queensland, Brisbane, Australia
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Eskinder Wolka
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Frehiwot Nigatu
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care-Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, University of Queensland, Brisbane, Australia
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Cui C, Lv B, Meng K. Associations Among Organizational Capabilities, Organizational Performance and the Medical Alliance Implementation Effect in Community Health Centers in China: A Moderated Mediation Model. Risk Manag Healthc Policy 2023; 16:1969-1983. [PMID: 37790984 PMCID: PMC10543936 DOI: 10.2147/rmhp.s425782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 09/13/2023] [Indexed: 10/05/2023] Open
Abstract
Purpose Community health centers (CHCs) are an important part of the healthcare system worldwide. Based on the dual process model of organizational capabilities, this study explores the relationship between organizational capabilities and the organizational performance of CHCs, as well as the role played by the medical alliance implementation effect. Methods In this study, whole-group sampling was used to extract CHCs. All 135 CHCs in 8 of 16 districts of Beijing were selected as subjects. The organizational capabilities of the CHCs and the medical alliance implementation effect were evaluated using a questionnaire survey of 1957 managers and 3622 medical staff, respectively. A pathway analysis of the mediating role of the organizational capabilities of CHCs and the moderating role of the medical alliance implementation effect was conducted using Mplus 8.0. Results The development capabilities had a positive impact on basic capabilities (β = 0.878, P < 0.001), and core capabilities (β = 0.952, P < 0.001), but had no direct impact on organizational performance. Basic capabilities positively affected organizational performance (β = 1.163, P < 0.001), and core capabilities negatively affected organizational performance (β =- 0.886, P = 0.004). Both basic capabilities (β =1.022, P < 0.001) and core capabilities (β =- 0.843, P = 0.005) played a mediating role in the relationship between development capabilities and organizational performance. The moderating role of the medical alliance implementation effect was not significant. Conclusion This study found that strengthening the organizational capabilities of CHCs can effectively improve their performance, with the development of basic capabilities being a primary concern. The medical alliance implementation effect has not had a significant impact on organizational performance, and the cooperation between CHCs and high-level hospitals should be further promoted to give full play to the medical alliance's role and improve the organizational performance of CHCs.
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Affiliation(s)
- Chengsen Cui
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
- China Center for Health Development Studies, Peking University, Beijing, People’s Republic of China
| | - Bo Lv
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
| | - Kai Meng
- School of Public Health, Capital Medical University, Beijing, People’s Republic of China
- High Quality Development Research Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Celino SDDM, de Albuquerque Filho NJB, Gomes MDNC, Costa GMC, de Mendonça AEO. Evaluation of primary health care by users during the COVID-19 pandemic: A cross-sectional study. PLoS One 2023; 18:e0292039. [PMID: 37738255 PMCID: PMC10516436 DOI: 10.1371/journal.pone.0292039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 09/12/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE To evaluate the primary health care (PHC) attributes and associated factors during the COVID-19 pandemic using the perspective of users. METHODS This cross-sectional, quantitative study included 422 PHC users from 96 Family Health Teams in a city in Brazil. The assessment used the Primary Care Assessment Tool (PCATool) and a structured questionnaire on the sociodemographic and epidemiological characteristics of users and basic health units (BHU). The Person's chi-square test was used to analyze the association between high overall scores in PCATool and characteristics of users and BHU. Crude and adjusted prevalence ratios (PR) with a 95% confidence interval were also calculated. Poisson regression and Rao Scott's Chi-square test were used to estimate crude PR. RESULTS Most users were aged 30 to 39 years (26.3%), women (75.4%), registered at the BHU for over ten years (59.5%), and had incomplete secondary education (30.6%). The mean of PHC essential attributes and overall scores were low (6.10 ± 0.81 and 5.78 ± 0.77, respectively). "First-contact care-use" received the highest score (9.22 ± 1.62), while "first-contact care-accessibility" received the lowest (2.82 ± 0.90). High overall scores were associated with an average employment time of professionals (doctors and nurses) at the BHU (PR = 1.31; 95% CI 1.17-1.48; p < 0.001) and lower educational level of users (PR = 1.71; 95% CI 1.54-1.90; p < 0.001. CONCLUSION "First-contact care-use" was the best evaluated, while "first-contact care-accessibility" was the worst. High scores were associated with a lower educational level of users and BHU with more experienced professionals.
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Shami E, Gholipour K, Naghibi D, Azami-Aghdash S. The roles and challenges of the primary health care systems in epidemic management: a scoping review. Prim Health Care Res Dev 2023; 24:e55. [PMID: 37705282 PMCID: PMC10539738 DOI: 10.1017/s1463423623000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/21/2023] [Accepted: 08/02/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND AND AIM During the early stage of pandemics, primary health care (PHC) is the first point of contact with the health system for people. This study aimed to find the leading roles and challenges of the PHC system in dealing with the outbreak of infectious diseases. METHODS The current scoping review was conducted in 2022 using the Arkesy and O'Malley framework. A bibliographic search was conducted in PubMed, Web of Science, and Scopus databases. Following a Google Scholar search, a manual search in some journals, reference checks for articles, and a review of organizational reports, websites, and other sources of information were also conducted. Data were analyzed using the content-analysis method. FINDINGS Finally, 65 documents (42 articles and 23 reports, books, and news) were included in the study. Initially, 626 codes were extracted, and 132 final codes were categorized into eight main themes and 44 sub-themes. The main themes for the roles of PHC included: service provision, education and knowledge, surveillance, access, coordination and communication, management and leadership, infrastructure change and rapid preparation, and patient and community management. Regarding the challenges faced by PHC in the epidemic of infectious diseases, 24 key challenges were identified and categorized into four major areas. CONCLUSIONS Based on the results of the present study, there is a need for further studies to formulate and theorize the specific roles of PHC in managing infectious disease epidemics. The results of this study can be utilized by researchers and officials to inform their efforts in addressing this purpose.
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Affiliation(s)
- Elham Shami
- Iranian Center of Excellence in Health Management, Department of Health Services Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Social Determinants of Health Research Center, Department of Health Service Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Deniz Naghibi
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Meshi EB, Nakamura K, Seino K, Alemi S. Equity in water, sanitation, hygiene, and waste management services in healthcare facilities in Tanzania. PUBLIC HEALTH IN PRACTICE 2022; 4:100323. [PMID: 36304419 PMCID: PMC9593710 DOI: 10.1016/j.puhip.2022.100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/03/2022] Open
Abstract
Objectives To determine coverage and the reliability of water, sanitation, hygiene (WASH) and healthcare waste management (HCWM) services in healthcare facilities (HCFs) in Tanzania. Study design Cross-sectional study design. Methods Data of 1066 HCFs in Tanzania from the 2014-15 Tanzania Service Provision Assessment (TSPA) survey were analyzed. The availability of WASH and HCWM services was examined across facility locations, types, and managing authorities. Descriptive statistics, and bivariate and multivariate logistic regression analyses were performed. Results HCFs with improved water sources, with functional improved latrines for patients, and using the incineration method to treat sharps waste before final disposal were 81.2%, 70.6%, and 41.3%, respectively. Among the HCFs with improved water sources and with functional improved latrines for patients, 50.9% and 50.6% respectively experienced water outages. Rural HCFs were less likely to have water sources on-site within 500 m (AOR 0.41; 95%CI 0.24-0.68), and soap, running water or alcohol-based hand rub (AOR 0.54; 95%CI 0.37-0.80). Rural HCFs were 0.25 times less likely to have functioning improved latrines for patients than urban HCFs (p < 0.001). Public HCFs were 0.5 times less likely to have an incineration method for sharps waste treatment than private HCFs (p < 0.001). Conclusion Access inequity in WASH and HCWM was observed in HCFs in rural areas and those under public management. To attain equity and sustainability, investing in improving WASH and HCWM services for both new and renovations projects, must consider the circumstance status of the marginalized society.
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Affiliation(s)
- Eugene Benjamin Meshi
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan,Department of Public Health, School of Nursing and Public Health, The University of Dodoma, P.O. BOX 259, Dodoma, United Republic of Tanzania
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan,Corresponding author.
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
| | - Sharifullah Alemi
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8510, Japan
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Temporal associations between emergency department and telehealth volumes during the COVID-19 pandemic: A time-series analysis from 2 academic medical centers. Am J Emerg Med 2022; 54:238-241. [PMID: 35182918 PMCID: PMC8817426 DOI: 10.1016/j.ajem.2022.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background The COVID-19 pandemic compelled healthcare systems to rapidly adapt to changing healthcare needs as well as identify ways to reduce COVID transmission. The relationship between pandemic-related trends in emergency department (ED) visits and telehealth urgent care visits have not been studied. Methods We performed an interrupted time series analysis to evaluate trends between ED visits and telehealth urgent medical care visits at two urban healthcare system in Colorado. We performed pairwise comparisons between baseline versus each COVID-19 surge and all three surges combined, for both ED and telehealth encounters at each site and used Wilcoxon rank sum test to compare median values. Results During the study period, 595,350 patient encounters occurred. We saw ED visits decline in correlation with rising telehealth visits during each COVID surge. Conclusions During initial COVID surges, ED visits declined while telehealth visits rose in inverse correlation with falling ED visits, suggesting that some patients shifted their preferred location for clinical care. As EDs cope with future staffing during the ongoing COVID pandemic, telehealth represents an opportunity for emergency physicians and a means to align patients desires for virtual care with ED volumes and staffing.
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Galanis P, Kaitelidou D, Prezerakos P, Kotsiopoulos I, Siskou O, Konstantakopoulou O, Hadjichristodoulou C, Tsiodras S. Low seropositivity for SARS-CoV-2 antibodies among healthcare workers after the first COVID-19 pandemic wave in Greece. Public Health 2021; 198:223-229. [PMID: 34482100 PMCID: PMC8324404 DOI: 10.1016/j.puhe.2021.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/19/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022]
Abstract
Objectives To estimate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seropositivity among healthcare workers (HCWs) in Greece and to identify high-risk groups in healthcare facilities. Study design The study design used in this study is a nationwide cross-sectional study. Methods Data were collected from 1 June to 9 July 2020. HCWs in the Greek National Health System were offered a free SARS-CoV-2 IgG antibody test, regardless of symptoms. Results Overall, 379 of 57,418 HCWs (0.66%, 95% confidence interval [CI]: 0.59–0.73) were positive for SARS-CoV-2 antibodies. The adjusted overall seroprevalence was 0.43% (95% CI: 0.35–0.51). We found that HCWs in non-reference hospitals for COVID-19 (odds ratio [OR]: 1.81, 95% CI: 1.23–2.64; P = 0.002) and reference hospitals for COVID-19 (OR: 1.66, 95% CI: 1.06–2.58; P = 0.03) were more likely to be seropositive than HCWs in primary care centres. Regarding professions, nurses (OR: 1.45, 95% CI: 1.07–1.98; P = 0.02), physicians (OR: 1.43, 95% CI: 1.06–1.93; P = 0.02), and administrative, cleaning and security staff (OR: 1.50, 95% CI: 1.09–2.06; P = 0.01) had a statistically higher chance of having a positive serology than laboratory employees. Conclusions The adjusted overall seroprevalence found in this study indicates a very low prevalence of SARS-CoV-2 among HCWs in Greece. This result is in line with the low incidence of COVID-19 during the first wave of the pandemic and is a direct benefit from the early implementation of lockdown.
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Affiliation(s)
- P Galanis
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - D Kaitelidou
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - P Prezerakos
- Department of Nursing, University of Peloponnese, Laboratory of Integrated Health Care, Tripoli, Greece.
| | - I Kotsiopoulos
- General for Health Services, Ministry of Health, Athens, Greece.
| | - O Siskou
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - O Konstantakopoulou
- Faculty of Nursing, Center for Health Services Management and Evaluation, National and Kapodistrian University of Athens, Athens, Greece.
| | - C Hadjichristodoulou
- Laboratory of Hygiene and Epidemiology, Faculty of Medicine, University of Thessaly, Larissa, Greece.
| | - S Tsiodras
- Faculty of Medicine, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece.
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