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Foondun T, Pottas L, Soer M. Knowledge of and Attitudes Toward Hearing Loss Among Primary Care Physicians in the Public Health Sector of Mauritius. Int Arch Otorhinolaryngol 2024; 28:e188-e195. [PMID: 38618598 PMCID: PMC11008940 DOI: 10.1055/s-0043-1770729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/22/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Primary care physicians are essential first points of contact for patients with hearing loss. Thus, knowledge of hearing loss and related aspects is essential to ensure the optimal management of individuals with suspected hearing loss. Objective This study aimed to determine the knowledge of and attitudes toward hearing loss among primary care physicians in the public health sector in Mauritius. Methods In this cross-sectional descriptive cohort study, 320 primary care physicians completed an online questionnaire adapted from previous questionnaires on knowledge of and attitudes toward hearing loss. Responses were analyzed using descriptive statistics and cross-sectional analyses. Results Primary care physicians showed limited knowledge of hearing loss in areas such as early identification and intervention, professionals responsible for hearing assessments, and hearing tests used for assessing hearing sensitivity. However, the responses also showed positive attitudes toward hearing loss. Significant associations between knowledge of and attitudes toward hearing loss were obtained regarding the type of physician, length of practice, and department posted in. Ear, nose, and throat specialists, as well as pediatricians, demonstrated significantly higher scores for both knowledge of and positive attitudes toward hearing loss. Conclusions The findings highlight a strong need for ongoing medical education to spread awareness about hearing loss among primary care physicians in the public health sector of Mauritius.
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Affiliation(s)
- Taslima Foondun
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Gauteng, South Africa
- Speech Therapy and Audiology Unit, Jawaharlal Nehru Hospital, Mauritius
| | - Lidia Pottas
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Gauteng, South Africa
| | - Maggi Soer
- Department of Speech-Language Pathology and Audiology, Faculty of Humanities, University of Pretoria, Gauteng, South Africa
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Sarkar S, Wangmo S, Flora MS, Uddin SMJ, Sultan M, Grundy J. Assessing public health sector performance in Bangladesh: Implications for health systems strengthening and universal health coverage - A secondary data analysis. Int J Health Plann Manage 2024; 39:164-174. [PMID: 37904303 DOI: 10.1002/hpm.3724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
The Ministry of Health and Family Welfare has established a health systems strengthening initiative for measuring the performance of public sector health facilities in Bangladesh. The objective of the performance management initiative is to establish routine systems for measuring and scoring health facility performance and promote best practices in public health service management. The performance initiative includes a set of assessments conducted across the four tiers of the public health sector. The findings of assessments demonstrate improvements in the quality of health services and a sharp increase in the utilisation of services across all tiers during the period 2017-2019. The performance management initiative has also identified areas for improvement in the supply-side health system readiness, including ensuring an adequate supply of human resources, essential medicines, and functioning medical equipment and technologies. This initiative outlines the need to systematically address the issue of high health workforce vacancy rates through effective human resource planning and management strategies. The reporting of these ongoing health systems successes and challenges through the performance management initiative in Bangladesh provides an opportunity to develop evidence-based policy reforms for strengthening supply-side health systems. The initiative results, particularly in the context of growing public demand for services, also justifies a monitoring and evaluation mechanism focusing on the quality and coverage of frontline health facilities and the development of more integrated health systems. The performance management initiative will facilitate the maintenance of essential health services while addressing emergency health needs and tracking progress towards achieving the Universal Health Coverage goal.
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Affiliation(s)
- Shila Sarkar
- World Health Organization, Country Office, Dhaka, Bangladesh
| | - Sangay Wangmo
- World Health Organization, Country Office, Dhaka, Bangladesh
| | - Meerjady Sabrina Flora
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Shah Md Jashim Uddin
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Murad Sultan
- World Health Organization, Country Office, Dhaka, Bangladesh
| | - John Grundy
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
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Hossain M, Rahaman M, Rahman J. Covid 19 corruption in the public health sector - Emerging evidence from Bangladesh. Health Policy Plan 2023:7181256. [PMID: 37243741 DOI: 10.1093/heapol/czad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 05/29/2023] Open
Abstract
This paper explores the Covid-19-related corruption in Bangladesh. Specifically, we analyse the issue of Covid-19-related corruption in the health sector of Bangladesh. We also explore how denial strategies adapted by government officials have worsened the problem. Using Cohen's (2001) notion of denial strategies, we analyse media reports during the pandemic that highlighted Covid-19-related corruption occurring in the Bangladeshi health sector. Our analyses reveal that the Covid-19 pandemic has given rise to a new wave of corruption, particularly in the procurement of testing kits and personal protective equipment (PPE), as well as the issuance of false COVID-19 certificates. We call for an in-depth investigation of Covid-19-related corruption in Bangladesh and other developing countries that follows similar social, contextual and cultural values via interviews with policymakers and health professionals. Our paper extends the ongoing debate on Covid-19-related corruption and its impacts on the public health sectors.
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Affiliation(s)
- Moazzem Hossain
- Murdoch Business School, Murdoch University, Perth, Australia
| | - Mustafizur Rahaman
- Department of Accounting, Bangladesh University of Business and Technology, Dhaka 1216, Bangladesh
- UQ Business School, The University of Queensland, Brisbane, Australia
| | - Jahidur Rahman
- College of Business and Public Management, Wenzhou-Kean University, China
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Ngene NC, Khaliq OP, Moodley J. Inequality in health care services in urban and rural settings in South Africa. Afr J Reprod Health 2023; 27:87-95. [PMID: 37584924 DOI: 10.29063/ajrh2023/v27i5s.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
In low- and middle-income countries, urban and rural settings are distinct communities with the latter being more likely to have limited resources, particularly in health care services. We assessed the inequality in health care services in urban and rural settings in South Africa, highlighting the disparities between public and private health services, given that the latter are located mainly in urban settings. Rural settings suffer the highest inequality in the availability of drugs and supplies, overcrowding of health care facilities, delays in transporting patients, inadequate emergency medical services, and lack of experienced health care professionals. Rural settings also preferentially have a shortage of various levels of health care services, and increased security threats by criminals. In addition to specific remedies, the overarching key to solving these challenges is socio-economic growth, as well as visionary and compassionate leadership with integrity and accountability, which ensures policy development, implementation, monitoring, and evaluation.
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Affiliation(s)
- Nnabuike C Ngene
- Department of Obstetrics and Gynaecology, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Obstetrics and Gynecology, Leratong Hospital, Krugersdorp, South Africa
| | - Olive P Khaliq
- Department of Paediatrics and Child Heath, School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Jagidesa Moodley
- Women's Health and HIV Research Group, Department of Obstetrics and Gynecology, School of Clinical Medicine, Faculty of Health Sciences, University of Kwa Zulu-Natal, Durban, South Africa
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Louw QA, Conradie T, Xuma-Soyizwapi N, Davis-Ferguson M, White J, Stols M, Masipa A, Mhlabane P, Mdaka L, Manzini C, Kekana I, Schutte M, Rabothata S, Kleinitz P. Rehabilitation Capacity in South Africa-A Situational Analysis. Int J Environ Res Public Health 2023; 20:3579. [PMID: 36834271 PMCID: PMC9961618 DOI: 10.3390/ijerph20043579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Rehabilitation in South Africa (SA) operates independently of major health services and reforms, despite the increasing rehabilitation need. With the introduction of National Health Insurance (NHI), SA is facing another major health reform. Evidence is needed on the current SA rehabilitation situation, regarding shortcomings, opportunities, and priority strategic strengthening actions. We aimed to describe the current rehabilitation capacity in the SA public health sector, which serves the majority and most vulnerable South Africans. A cross-sectional survey was conducted in five provinces, using the World Health Organisation's Template for Rehabilitation Information Collection (TRIC). Participants were purposively selected for their insights and experiences of rehabilitation in specific government departments, health sectors, organisations, and/or services. TRIC responses were analysed descriptively. Participants explained how timely and effective rehabilitation produced long-term health, social, and economic benefits. Positive initiatives were reported for rehabilitation data collection, service design, and innovation. Challenges included inadequacies in human resources, the integration of rehabilitation at primary care, guidelines, and specialised long-term care facilities. The continuity of care across levels of care was sub-optimal due to inefficient referral systems. Promoting and improving rehabilitation nationally requires concerted, innovative, collaborative, and integrated efforts from multiple stakeholders within, and outside, the health system.
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Affiliation(s)
- Quinette A. Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, Western Cape, South Africa
| | - Thandi Conradie
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town 7500, Western Cape, South Africa
| | | | - Megan Davis-Ferguson
- Disabilities and Rehabilitation, Western Cape Department of Health, Cape Town 8000, Western Cape, South Africa
| | - Janine White
- Western Cape Rehabilitation Centre, Western Cape Department of Health, Cape Town 7789, Western Cape, South Africa
| | - Marie Stols
- Therapeutic and Rehabilitation Services, Limpopo Department of Health, Polokwane 0700, Limpopo, South Africa
| | - Andronica Masipa
- Therapeutic and Rehabilitation Services, Limpopo Department of Health, Polokwane 0700, Limpopo, South Africa
| | - Pringle Mhlabane
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Lungisile Mdaka
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Claudina Manzini
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Ivy Kekana
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Marike Schutte
- Rehabilitation and Disability Services, Mpumalanga Department of Health, Nelspruit 1200, Mpumalanga, South Africa
| | - Simon Rabothata
- Rehabilitation Service, Gauteng Department of Health, Pretoria 2001, Gauteng, South Africa
| | - Pauline Kleinitz
- Sensory Functions, Disability and Rehabilitation Unit, Department for Noncommunicable Diseases, World Health Organization, 1211 Geneva 27, Switzerland
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Jafree SR, Momina AU, Malik N, Naqi SA, Fischer F. Challenges in providing surgical procedures during the COVID-19 pandemic: Qualitative study among Operating Department Practitioners in Pakistan. Sci Prog 2021; 104:368504211023282. [PMID: 34152874 PMCID: PMC10454979 DOI: 10.1177/00368504211023282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The surgical theatre is associated with the highest mortality rates since the onslaught of the COVID-19 pandemic. However, Operating Department Practitioners (ODPs) are neglected human resources for health in regards to both professional development and research for patient safety; even though they are key practitioners with respect to infection control during surgeries. Therefore, this study aims to describe challenges faced by ODPs during the pandemic. The secondary aim is to use empirical evidence to inform the public health sector management about both ODP professional development and improvement in surgical procedures, with a specific focus on pandemics. A qualitative study has been conducted. Data collection was based on an interview guide with open-ended questions. Interviews with 39 ODPs in public sector teaching hospitals of Pakistan who have been working during the COVID-19 pandemic were part of the analysis. Content analysis was used to generate themes. Ten themes related to challenges faced by ODPs in delivering services during the pandemic for securing patient safety were identified: (i) Disparity in training for prevention of COVID-19; (ii) Shortcomings in COVID-19 testing; (iii) Supply shortages of personal protective equipment; (iv) Challenges in maintaining physical distance and prevention protocols; (v) Human resource shortages and role burden; (vi) Problems with hospital administration; (vii) Exclusion and hierarchy; (viii) Teamwork limitations and other communication issues; (ix) Error Management; and (x) Anxiety and fear. The public health sector, in Pakistan and other developing regions, needs to invest in the professional development of ODPs and improve resources and structures for surgical procedures, during pandemics and otherwise.
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Affiliation(s)
- Sara Rizvi Jafree
- Department of Sociology, Forman Christian College University, Lahore, Punjab, Pakistan
| | - Ain ul Momina
- Institute of Public Health, King Edward Medical University, Lahore, Pakistan
| | - Nudra Malik
- Department of Applied Psychology, Lahore College for Women University, Lahore, Pakistan
| | - Syed Asghar Naqi
- Department of Surgery, King Edward Medical University, Lahore, Pakistan
| | - Florian Fischer
- Institute of Public Health, Charité– Universitätsmedizin Berlin, Berlin, Germany
- Institute of Gerontological Health Services and Nursing Research, Ravensburg-Weingarten University of Applied Sciences, Weingarten, Germany
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van der Voorn P, Brand N. Mapping a high-level overview of information flows in the Dutch declaration chain for medical specialist health care. Health Info Libr J 2020; 37:329-336. [PMID: 33205566 PMCID: PMC7839736 DOI: 10.1111/hir.12334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
This study is based on Philippe van der Voorn’s master’s dissertation at the Utrecht University, Department of Science, Information and Computing Sciences. The problem identified was a lack of an integrated information chain and clear governance structure for information flow in the Netherlands’ health care sector. The method of Design Science was followed to construct an overview model of the chain, and towards a business process model that is intuitive for both technical and business users. An initial declaration chain was identified in the literature and presented, to be confirmed and elaborated on via eight interviews at seven different organisations in the medical specialist health care sector. Based on these interviews, the draft overview was adjusted and a Business Process Model and Notation model created that indicates the shared understanding of the data elements and activities between the organisations. The contribution of the overview of the declaration chain, in particular, can help medical specialist staff obtain an understanding of the administrative side of their work, and with a clear information infrastructure lead to better working processes and information quality. F.J.
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Affiliation(s)
| | - Nico Brand
- Utrecht University, Utrecht, Netherlands
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Tweheyo R, Reed C, Campbell S, Davies L, Daker-White G. 'I have no love for such people, because they leave us to suffer': a qualitative study of health workers' responses and institutional adaptations to absenteeism in rural Uganda. BMJ Glob Health 2019; 4:e001376. [PMID: 31263582 PMCID: PMC6570979 DOI: 10.1136/bmjgh-2018-001376] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 04/16/2019] [Accepted: 04/21/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Achieving positive treatment outcomes and patient safety are critical goals of the healthcare system. However, this is greatly undermined by near universal health workforce absenteeism, especially in public health facilities of rural Uganda. We investigated the coping adaptations and related consequences of health workforce absenteeism in public and private not-for-profit (PNFP) health facilities of rural Uganda. METHODS An empirical qualitative study involving case study methodology for sampling and principles of grounded theory for data collection and analysis. Focus groups and in-depth interviews were used to interview a total of 95 healthcare workers (11 supervisors and 84 frontline workers). The NVivo V.10 QSR software package was used for data management. RESULTS There was tolerance of absenteeism in both the public and PNFP sectors, more so for clinicians and managers. Coping strategies varied according to the type of health facility. A majority of the PNFP participants reported emotion-focused reactions. These included unplanned work overload, stress, resulting anger directed towards coworkers and patients, shortening of consultation times and retaliatory absence. On the other hand, various cadres of public health facility participants reported ineffective problem-solving adaptations. These included altering weekly schedules, differing patient appointments, impeding absence monitoring registers, offering unnecessary patient referrals and rampant unsupervised informal task shifting from clinicians to nurses. CONCLUSION High levels of absenteeism attributed to clinicians and health service managers result in work overload and stress for frontline health workers, and unsupervised informal task shifting of clinical workload to nurses, who are the less clinically skilled. In resource-limited settings, the underlying causes of absenteeism and low staff morale require attention, because when left unattended, the coping responses to absenteeism can be seen to compromise the well-being of the workforce, the quality of healthcare and patients' access to care.
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Affiliation(s)
- Raymond Tweheyo
- Department of Public Health, Lira University, Lira, Uganda
- Centre for Primary Care, Division of Population Health, The University of Manchester, Manchester, UK
| | - Catherine Reed
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, The University of Manchester, Manchester, UK
| | - Linda Davies
- Centre for Health Economics, Division of Population Health, The University of Manchester, Manchester, UK
| | - Gavin Daker-White
- Centre for Primary Care, Division of Population Health, The University of Manchester, Manchester, UK
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Sukati VN, Moodley VR, Mashige KP. Knowledge and practices of parents about child eye health care in the public sector in Swaziland. Afr J Prim Health Care Fam Med 2018; 10:e1-e13. [PMID: 30456970 PMCID: PMC6244139 DOI: 10.4102/phcfm.v10i1.1808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 07/10/2018] [Accepted: 07/13/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Swaziland, like many other developing countries, lacks appropriate eye health services, particularly for children. AIM To determine the knowledge and practices of parents about child eye health care in the public sector in Swaziland. SETTING The setting for this study was Swaziland. METHODS A descriptive study involving cross-sectional sampling methodology and quantitative analysis was employed with 173 randomly selected parents whose children attended public schools in Swaziland. RESULTS Out of 173 participants, 104 (60.1%) parents reported that they have never taken their children for an eye test and 69 (31.7%) felt that their children's vision was fine. Ninety-seven (53.1%) parents indicated having no knowledge about child eye conditions and no significant association was found between level of education and knowledge of eye conditions affecting children (p = 0.112). Having an immediate family member who wore spectacles increased the likelihood of a child being taken for eye testing (p = 0.001), but decreased the likelihood of being well informed about eye health (p = 0.218). Of those parents who reported taking their children for eye tests, 34 (49.3%) reported that they were given eye drops and 31 (44.9%) stated that their children were prescribed spectacles. Eighty-seven (50.3%) parents accepted the idea of their children wearing spectacles. CONCLUSION The findings of the study suggest the need for parents to be informed about basic child eye health care and the importance of their children having regular eye examinations.
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Rabbanikhah F, Moradi R, Mazaheri E, Shahbazi S, Barzegar L, Karyani AK. Trends of geographic distribution of general practitioners in the public health sector of Iran. J Educ Health Promot 2018; 7:89. [PMID: 30079360 PMCID: PMC6052776 DOI: 10.4103/jehp.jehp_14_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 04/17/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Proper distribution of general practitioners (GPs) is one of the challenges in all health systems. This study aimed to investigate geographical distribution of GPs in public health sector in Iran between 2010 and 2016. METHODS The study is a descriptive-cross-sectional study. The population of provinces was extracted from Iran's National Statistic Center, while information on GPs was gathered from deputy of statistic and information technology in Ministry of Health and Medical Education. Data analysis was carried out using descriptive statistics, Gini coefficient (GC), and by drawing geographical distribution map of GPs. Data analysis was performed by excel 2013, Stata V.14, and Arc GIS software. RESULTS The results of calculating the number of GPs per 100,000 population in Iran showed that, in year 2010, Chaharmahal and Bakhtiari Province had the highest (10.39) and Alborz Province had the lowest (0.66) number of per capita GPs. The highest number of GPs per 100,000 population among Iran's provinces belonged to Chaharmahal and Bakhtiari (8.97), while the lowest belonged to Tehran (0.28) in year 2016. The GC was 0.31 in year 2010 and 0.283 for 2011. The lowest GC belonged to year 2012 (GC = 0.272), while the largest coefficient belonged to year 2016 (0.356). CONCLUSIONS According to the results of this study, the distribution of GPs in public health sector of Iran in between 2010 and 2016 showed inequality. Therefore, along with increasing the number of GPs working in public health sector, it is necessary to pay attention to their distribution. Further studies are needed to investigate inequality of GPs within and between the provinces.
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Affiliation(s)
- Fahimeh Rabbanikhah
- MPH in Management and Health System Reforms, Deputy of General Human Resources Management of Ministry of Health and Medical Education, Tehran, Iran
| | - Reza Moradi
- Department of Management and Health Economic, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Elaheh Mazaheri
- Department of Medical Information Sciences, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Shahbazi
- Department of Management and Health Economic, School of Public Health, Tehran University of Medical Science, Tehran, Iran
| | - Loghman Barzegar
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Kazemi Karyani
- Research Center for Environmental Determinants of Health, School of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Knox M, Stewart A, Richards CL. Six hours of task-oriented training optimizes walking competency post stroke: a randomized controlled trial in the public health-care system of South Africa. Clin Rehabil 2018. [PMID: 29529870 DOI: 10.1177/0269215518763969] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate a minimal dose intervention of six 1-hour sessions of task-oriented circuit gait training including a caregiver over a 12-week period to persons post stroke in the South African public health sector. DESIGN Stratified, single blinded, randomized controlled trial with three intervention groups. PARTICIPANTS Persons post stroke ( n = 144, mean age 50 years, 72 women), mean 9.5 weeks post stroke. INTERVENTIONS Task group ( n = 51)-accompanied by a caregiver; task-oriented circuit gait training (to improve strength, balance, and task performance while standing and walking). Strength group ( n = 45); strength training of lower extremities while sitting and lying. Control group ( n = 48); one 90-minute educational session on stroke management. MEASURES The six-minute walk test (6MinWT) was the primary outcome; the secondary outcomes included comfortable and fast gait speeds, Berg Balance Scale (BBS), and Timed Up and Go (TUG). Particpants evaluated at baseline, post intervention (12 weeks), and at follow-up 12 weeks later. Change scores were compared using generalized repeated measures analysis of variance (ANOVA). RESULTS Task group change scores for all outcomes post intervention and at follow-up were improved compared to the other groups ( P-values between 0.000005 and 0.04). The change scores (mean, 1SD) between baseline and follow-up for the Task, Strength, and Control groups, respectively, were as follows: 6MinWT:119.52 m (81.92), 81.05 m (79.53), and 60.99 m (68.38); comfortable speed 0.35 m/s (0.23), 0.24 m/s (0.22), and 0.19 m/s (0.21); BBS: 9.94 (7.72), 6.93 (6.01), and 5.19 (4.80); and TUG: -14.24 seconds (16.86), -6.49 seconds (9.88), and -5.65 seconds (8.10). CONCLUSION Results support the efficacy of a minimal dose task-oriented circuit training program with caregiver help to enhance locomotor recovery and walking competency in these persons with stroke.
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Affiliation(s)
- Megan Knox
- 1 Department of Physiotherapy, University of the Witwatersrand-Johannesburg, Johannesburg, South Africa
| | - Aimee Stewart
- 1 Department of Physiotherapy, University of the Witwatersrand-Johannesburg, Johannesburg, South Africa
| | - Carol L Richards
- 2 Department of Rehabilitation and Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Université Laval, Quebec City, QC, Canada
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Abstract
Saudi Arabia's Ministry of Health (MOH) use corporate performance improvement methodologies to develop and implement performance improvement initiatives designed to continue building on the Ministry's vision of transforming hospital operations and instituting a culture of quality and performance focused on the "patient first" principle. We evaluated the feasibility of setting up a performance improvement unit (PIU) within the MOH to apply the principles of Lean Six Sigma and to change management methodologies. The MOH collaborated with external consultants to implement PIU initiatives in 4 steps: PIU Setup, PIU Capability Building, High-Impact Project Implementation, and Project Sustainability and Knowledge Transfer. PIU units were setup across the 13 provinces over 90 days. The process included the promotion of knowledge sharing to strengthen the skill set of Saudi health care professionals and develop local performance improvement champions within the MOH who could lead, implement, and sustain future projects. Implementation was a challenge; though, early results from the High-Impact Project Implementation phase were encouraging. However, the sustainability of PIU interventions was poor, with performance improvement processes returning to baseline levels within 9 months. This case study shows that PIU implementation is a feasible approach for improving health care delivery in Saudi Arabia. Poor sustainability despite initial success highlights the need to further improve the engagement, incentivization, and training of team leaders and members to achieve long-term success with the program.
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Gautham M, Spicer N, Subharwal M, Gupta S, Srivastava A, Bhattacharyya S, Avan BI, Schellenberg J. District decision-making for health in low-income settings: a qualitative study in Uttar Pradesh, India, on engaging the private health sector in sharing health-related data. Health Policy Plan 2017; 31 Suppl 2:ii35-ii46. [PMID: 27591205 PMCID: PMC5009220 DOI: 10.1093/heapol/czv117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/24/2022] Open
Abstract
Health information systems are an important planning and monitoring tool for public health services, but may lack information from the private health sector. In this fourth article in a series on district decision-making for health, we assessed the extent of maternal, newborn and child health (MNCH)-related data sharing between the private and public sectors in two districts of Uttar Pradesh, India; analysed barriers to data sharing; and identified key inputs required for data sharing. Between March 2013 and August 2014, we conducted 74 key informant interviews at national, state and district levels. Respondents were stakeholders from national, state and district health departments, professional associations, non-governmental programmes and private commercial health facilities with 3–200 beds. Qualitative data were analysed using a framework based on a priori and emerging themes. Private facilities registered for ultrasounds and abortions submitted standardized records on these services, which is compulsory under Indian laws. Data sharing for other services was weak, but most facilities maintained basic records related to institutional deliveries and newborns. Public health facilities in blocks collected these data from a few private facilities using different methods. The major barriers to data sharing included the public sector’s non-standardized data collection and utilization systems for MNCH and lack of communication and follow up with private facilities. Private facilities feared information disclosure and the additional burden of reporting, but were willing to share data if asked officially, provided the process was simple and they were assured of confidentiality. Unregistered facilities, managed by providers without a biomedical qualification, also conducted institutional deliveries, but were outside any reporting loops. Our findings suggest that even without legislation, the public sector could set up an effective MNCH data sharing strategy with private registered facilities by developing a standardized and simple system with consistent communication and follow up.
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Affiliation(s)
- Meenakshi Gautham
- IDEAS Project, London School of Hygiene and Tropical Medicine, London, UK,
| | - Neil Spicer
- IDEAS Project, London School of Hygiene and Tropical Medicine, London, UK
| | - Manish Subharwal
- Impact Partners in Social Development, Malviya Nagar, New Delhi, India
| | - Sanjay Gupta
- Impact Partners in Social Development, Malviya Nagar, New Delhi, India
| | - Aradhana Srivastava
- Public Health Foundation of India, Vasant Kunj Institutional Area, New Delhi, India
| | | | - Bilal Iqbal Avan
- IDEAS Project, London School of Hygiene and Tropical Medicine, London, UK
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Buttigieg SC, Schuetz M, Bezzina F. Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis. Front Public Health 2016; 4:201. [PMID: 27683658 PMCID: PMC5021691 DOI: 10.3389/fpubh.2016.00201] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 09/01/2016] [Indexed: 11/17/2022] Open
Abstract
The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state’s health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta.
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Affiliation(s)
- Sandra C Buttigieg
- Department of Health Services Management, Faculty of Health Sciences, University of Malta, Msida, Malta; Aston Business School, Aston University, Birmingham, UK; School of Social Policy, College of Social Sciences, University of Birmingham, Birmingham, UK
| | - Marcus Schuetz
- Department of Management, Faculty of Economics, Management & Accountancy, University of Malta, Msida, Malta; Faculty of Business and Economics, Hong Kong University of Science and Technology, Kowloon, Hong Kong
| | - Frank Bezzina
- Department of Management, Faculty of Economics, Management & Accountancy, University of Malta, Msida, Malta; Department of Organization and Management, Faculty of Economics and Business, University of Zagreb, Zagreb, Croatia
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15
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Peltzer K, Phaswana-Mafuya N, Ladzani R. Implementation of the national programme for prevention of mother-to-child transmission of HIV: a rapid assessment in Cacadu district, South Africa. Afr J AIDS Res 2015; 9:95-106. [PMID: 25860417 DOI: 10.2989/16085906.2010.484594] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To conduct a rapid assessment of the prevention-of-mother-to-child-transmission-of-HIV (PMTCT) programme in two of the three local service areas in Cacadu district, Eastern Cape province, South Africa, we designed an exploratory study using a mixed-methods approach. Quantitative and qualitative data on PMTCT programme implementation were collected in 2008 through a structured assessment at the 44 health facilities implementing the programme in the province. This included in-depth interviews with 11 clinic supervisors, 31 clinic programme coordinators, and 8 hospital/maternity staff members in order to examine their perceived problems and suggestions regarding PMTCT programme implementation; an assessment of the clinic registers and recording systems; a meeting with stakeholders; and one feedback meeting with clinic managers, sub-district management and other stakeholders in regard to the results of the rapid assessment. Overall, most of the national criteria for PMTCT programme implementation were fulfilled across the health facilities. However, shortcomings were found relating to health policy, health services delivery and clients' health-seeking behaviour. The findings show the need for a well-functioning health system with adequate and trained staff, a reduced staff workload, proper case recording, an improved patient follow-up system, better support for staff, the empowerment of PMTCT clients, strong leadership, and coordination and collaboration between partners.
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Affiliation(s)
- Karl Peltzer
- a Human Sciences Research Council , Private Bag X41 , Pretoria , 0001 , South Africa
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16
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Gwala-Ngozo J, Taylor M, Aldous C. Understanding the experiences of doctors who undertake elective surgery on HIV/AIDS patients in an area of high incidence in South Africa. Afr J AIDS Res 2015; 9:11-6. [PMID: 25860408 DOI: 10.2989/16085906.2010.484536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study investigates the experiences of doctors who perform elective surgical procedures in an area of South Africa with a high incidence of HIV and AIDS. A qualitative study approach was adopted. Interviews were individually conducted with 15 doctors. The transcribed interviews were read four times, each with a different data-collection purpose, and follow-up interviews were carried out when it was necessary to complete the data set. Surgical doctors from two semi-urban hospitals and one rural hospital in northern KwaZulu-Natal province took part in the study. The analysis of the interviews rendered four areas of concern in the experiences of doctors who perform surgery on HIV/ AIDS patients. These were: personal factors, patient factors, factors relating to the structure of the health system, and factors concerning protocols for the treatment of patients with HIV or AIDS. Although the doctors were altruistic in their approaches to operating on HIV/AIDS patients, they commonly mentioned the increased levels of stress they experience as a result of a multiplicity of issues surrounding the treatment and care of an HIV/AIDS patient specifically. The public health system has not made special arrangements to deal with the increased patient loads in hospitals as a result of the HIV epidemic, and this will have to be addressed as the number of HIV/AIDS patients increases.
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Affiliation(s)
- Jacqueline Gwala-Ngozo
- a Department of Public Health Medicine, Nelson R. Mandela School of Medicine , University of KwaZulu-Natal , 2nd Floor George Campbell Building, Howard College Campus, Science Drive , Durban , 4041 , South Africa
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17
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Reid M, Botma Y. A framework to expand public services to children with biomedical healthcare needs related to HIV in the Free State, South Africa. Afr J AIDS Res 2015; 11:91-8. [PMID: 25859912 DOI: 10.2989/16085906.2012.698054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The study undertook the development of a framework for expanding the public services available to children with biomedical healthcare needs related to HIV in South Africa. The study consisted of various component projects which were depicted as phases. The first phase was a descriptive quantitative analysis of healthcare services for children exposed to or infected by HIV, as rendered by the public health sector in the Free State Province. The second stage was informed by health policy research: a nominal group technique with stakeholders was used to identify strategies for expanding the healthcare services available to these children. The third phase consisted of workshops with stakeholders in order to devise and validate a framework for the expansion. The theory of change logic model served as the theoretical underpinning of the draft framework. Triangulated data from the literature and the preceding two phases of the study provided the empirical foundation. The problem identified was that of fragmented care delivered to children exposed to or infected with HIV, due to the 'over-verticalization' of programmes. A workshop was held during which the desired results, the possible factors that could influence the results, as well as the suggested strategies to expand and integrate the public services available to HIV-affected children were confirmed. Thus the framework was finalised during the validation workshop by the researchers in collaboration with the stakeholders.
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Affiliation(s)
- Marianne Reid
- a 5 Howard Street , Hillsboro , Bloemfontein , 9301 , South Africa
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Alegana VA, Atkinson PM, Wright JA, Kamwi R, Uusiku P, Katokele S, Snow RW, Noor AM. Estimation of malaria incidence in northern Namibia in 2009 using Bayesian conditional-autoregressive spatial-temporal models. Spat Spatiotemporal Epidemiol 2013; 7:25-36. [PMID: 24238079 PMCID: PMC3839406 DOI: 10.1016/j.sste.2013.09.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 08/05/2013] [Accepted: 09/05/2013] [Indexed: 10/29/2022]
Abstract
As malaria transmission declines, it becomes increasingly important to monitor changes in malaria incidence rather than prevalence. Here, a spatio-temporal model was used to identify constituencies with high malaria incidence to guide malaria control. Malaria cases were assembled across all age groups along with several environmental covariates. A Bayesian conditional-autoregressive model was used to model the spatial and temporal variation of incidence after adjusting for test positivity rates and health facility utilisation. Of the 144,744 malaria cases recorded in Namibia in 2009, 134,851 were suspected and 9893 were parasitologically confirmed. The mean annual incidence based on the Bayesian model predictions was 13 cases per 1000 population with the highest incidence predicted for constituencies bordering Angola and Zambia. The smoothed maps of incidence highlight trends in disease incidence. For Namibia, the 2009 maps provide a baseline for monitoring the targets of pre-elimination.
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Affiliation(s)
- Victor A Alegana
- Malaria Public Health Department, KEMRI-Wellcome Trust-University of Oxford Collaborative Programme, P.O. Box 43640, 00100 GPO Nairobi, Kenya; Centre for Geographical Health Research, Geography and Environment, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
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