Affordable Health Care Services Research Articles

The Use of Qualitative Methods to Guide the Development of the Border Resilience Scale in a Participatory Research Study.

U.S.-Mexico border residents experience pervasive social and ecological stressors that contribute to a high burden of chronic disease. However, the border region is primarily composed of high-density Mexican-origin neighborhoods, a characteristic that is most commonly health-promoting. Understanding factors that contribute to border stress and resilience is essential to informing the effective design of community-level health promotion strategies. La Vida en La Frontera is a mixed-methods, participatory study designed to understand factors that may contribute to border resilience in San Luis, Arizona. The study's initial qualitative phase included interviews with 30 Mexican-origin adults exploring community perceptions of the border environment, cross-border ties, and health-related concepts. Border residents described the border as a Mexican enclave characterized by individuals with a common language and shared cultural values and perspectives. Positive characteristics related to living in proximity to Mexico included close extended family relationships, access to Mexican food and products, and access to more affordable health care and other services. Based on these findings, we co-designed the 9-item Border Resilience Scale that measures agreement with the psychosocial benefits of these border attributes. Pilot data with 60 residents suggest there are positive sociocultural attributes associated with living in border communities. Further research should test if they mitigate environmental stressors and contribute to a health-promoting environment for residents.

Achieving Universal Health Coverage in Nigeria: Current Challenges and Recommendations

Health is a fundamental human right upon which all other rights are built. Easy access to needed and affordable healthcare service is essential towards achieving Universal Health Coverage (UHC). The achievement of UHC in middle and low-income countries of Africa such as Nigeria has however continued to pose a mirage, hence the need for a thorough re-evaluation and provision of sustainable solutions.
 This article aims at highlighting the current efforts in achieving UHC in Nigeria and the challenges facing its achievement, while proffering recommendations towards solving these challenges. 
 The Nigerian Government has made considerable efforts in promoting UHC; however a lot still needs to be done. Adequate healthcare financing has been found to be essential towards achieving universal health coverage in Nigeria; hence it is imperative that the Nigerian government and allied agencies continually create effective, achievable and sustainable policies and actions towards financing the healthcare sector, especially at the level of primary healthcare.

Assessment of the Impact of Health Maintenance Organizations on Access, Utilization, and Quality of Service among National Health Insurance Authority Enrollees in Kano, Kano State Nigeria

Effort by government in Nigeria to provide effective ways of accessing quality and affordable healthcare service has been contentious with high cost of health care service delivery. The ineffective management of health care funds over the years was observed as key contributor to the rising cost of healthcare services. The need for the establishment of health maintenance organizations (HMOs) whose responsibility as purchasers, was to manage health care services with health facilities providers under the National Health Insurance Authority Scheme (NHIA). However, this research seeks to assess the impact of healthcare purchasers in Kano state Nigeria, as regards knowledge, utilization, and satisfaction of enrollees whose healthcare services they manage. The study utilized analysis of enrollees, HMOs and desk officers under the scheme. Quantitative and qualitative methods using interviewer administered questionnaire and Key stakeholders’ interview was used. Data were recorded in Microsoft Excel 2010 and analyzed using SPSS version 23.0. NVIVO version 12 with verbatim transcription was used for thematic analysis of qualitative data. Chi-square used to test degree of association and Logistic regression utilized to predict factors for the determinants. Results were presented as tables and charts. Statistical significance p-value <0.05 at confidence level of 95% was considered significant. Thus, analysis of the general demographic outcomes showed a significant association between HMOs and enrollees’ level of knowledge, utilization and satisfaction (p<0.05). Conversely, analysis of federal, state and private run facilities separately, revealed varying outcome as regards the three determinants, with the state-run hospitals mostly affected in terms of enrollee’s outcome. Keywords: Desk officers, Health Maintenance Organizations, Knowledge, National Health Insurance Authority, Satisfaction, Utilization.

Trends and risk factors of stillbirth among women of reproductive age in Pakistan: A multivariate decomposition analysis.

Every year, 2 million babies are stillborn in the world. Globally, there has been a decline in the stillbirth rate of 2%. Despite advancements in prenatal care and the implementation of new medical technologies, the incidence of early stillbirths remains unchanged. A slight decrease in the rate of late-term stillbirth has been observed. Pakistan ranked third in South Asia for having the highest stillbirth rate. Compared to its neighbors and other developing nations, Pakistan has shown a lack of progress in reducing maternal and neonatal fatalities. Therefore, the purpose of this study is to use a multivariate decomposition analysis to examine the trends and factors that have contributed to the change in the stillbirth rate over time. To conduct this study, we used a secondary data analysis approach and analyzed data from the Pakistan Demographic and Health Survey (PDHS) of 2012-2013 and 2017-2018). For the analysis, a total sample of 15,068 births in 2017-2018 and 13,558 births in the PDHS from 2012 to 2013 were taken into account. Using the MVDCMP function within STATA version 15 statistical software, a logit-based multivariate decomposition model was fitted to determine the variables that influence the change in stillbirth. The current study used two cross-sectional surveys to identify important risk factors for stillbirths. Over the past 5 years, Pakistan's stillbirth rate has risen from 3.98 to 5.75%. According to the total multivariate decomposition analysis, the change in coefficient (change in the effect of attributes) accounted for 81.17% of the overall change in the proportion of stillbirths. In contrast, the change in endowment was not statistically significant. Changes in maternal education, individual and community-level wealth status, and mode of delivery all significantly impacted the rate of stillbirths over time. Stillbirths increased in Pakistan from 2012 to 2017. Stillbirths are observed more frequently for women residing in Punjab, Sindh, and rural areas. A major concern that is directly related to the prevalence of stillbirths in Pakistan is the lack of accessible, affordable, and high-quality maternal healthcare facilities. Older, overweight, and uneducated women are more likely to have stillbirths than women who deliver vaginally. High parity and short birth intervals also accelerated the rate of stillbirths. An effective remedy to control stillbirths is the provision of accessible and affordable healthcare services. Awareness campaigns for the health education of pregnant women should focus on raising awareness to support better pregnancy outcomes for poor women living in communities with higher education levels. The risk of stillbirth can be reduced by offering free diagnostics for early detection of birth complications in low-resource settings and referring these cases to knowledgeable gynecologists for safe delivery.

Strategies to improve healthcare services for patients with sickle cell disease in Nigeria: The perspectives of stakeholders.

Background: Sickle cell disease (SCD) continues to pose physical and psychosocial burdens to patients, caregivers and health workers. Stakeholder engagement in the processes of policy making and implementation is increasingly becoming the cornerstone of best practices in healthcare. Aim and Objectives: To engage stakeholders with a view to assessing the knowledge of SCD; ascertain the challenges associated with accessibility and affordability of healthcare services; improve the quality of care, and thereby effect behavioral change through increasing attendance and follow-up of patients in the clinics. Methodology: A Stakeholders' Engagement meeting organized by the Sickle Pan Africa Research Consortium Nigeria Network (SPARC-NEt) was attended by patients, caregivers and members of patient support groups, healthcare providers and management/policymakers. The engagement was through PowerPoint presentations, structured questionnaires and an interactive session. The structured questionnaire assessed the knowledge of stakeholders about SCD; the quality of healthcare services; challenges with access and affordability; and SCD-related government policies. Results: Three hundred and twelve stakeholders attended the engagement meeting. Of the 133 that participated in the study, medical workers were the most represented. The majority had good knowledge of what causes SCD (96.2%) and the best place to get help during SCD crisis (98.5%). However, knowledge of the specific preventive measures of SCD and its crisis was not optimal. In terms of the role of community engagement and education, only about one-quarter of the study participants, 34 (25.6%) knew about their positive role in reducing the prevalence of SCD and alleviating SCD crises. Challenges identified include inadequate healthcare personnel and facilities, delay in obtaining laboratory results, long waiting time in the clinic, poor communication, absence of holistic consultation, uncoordinated healthcare services, high cost of care, ignorance, non-prioritization of SCD by government, lack of multisectoral collaboration and partnership with NGOs and international organizations. Strategies proffered to improve healthcare services include, community/stakeholder engagement and health education, sickle cell daycare services, access to a willing and dedicated multidisciplinary workforce, collaboration with support groups and government policies and programs. Conclusion: There is need for regular stakeholder engagement to improve access to healthcare services for SCD patients in Nigeria.

An Assessment of Enrollees' Knowledge and Satisfaction with Delta State Contributory Health Scheme: A Cross- Sectional Survey of Civil Servants in Delta State, Nigeria.

Delta State Contributory Health Scheme (DSCHS) was established to provide quality and affordable healthcare services to all Deltans, irrespective of socioeconomic status and geographical location. This study assessed the knowledge and satisfaction of formal sector enrollees with the Delta State Contributory Health scheme. This was a cross-sectional descriptive study involving 400 public/civil servants enrolled in DSCHS using a multistage sampling technique. Data was collected using an interviewer-administered structured questionnaire and was analyzed using IBM SPSS version 25.0 software. The study revealed that 207 (51.7%) of the respondents were males, while 193 (48.3%) were females. Two hundred and five (51.2%) of the respondents were within the age group of 43 - 52 years, and 353 (88.2%) of the respondents had tertiary education. Overall, 296 (74.0%) of the respondents had good knowledge, and 104 (26.0%) had poor knowledge of DSCHS; while 138 (52.1%) of the respondents were unsatisfied with DSCHS and 127 (47.9%) were satisfied with the scheme. Age (X2 = 19.67; P<0.001), gender (X2 = 8.53; P=0.004), education (X2 = 20.52; P<0.001), marital status (X2 = 14.13; P=0.001), religion (X2 = 13.12; P=0.001) and years of working experience (X2 = 39.66; P<0.001) was significantly associated with knowledge of DSCHS. The factors significantly associated with satisfaction with DSCHS were ethnicity (X2 = 14.39; P=0.013) and years of working experience (X2 = 11.23; P=0.024). The majority of the study participants had good knowledge regarding DSCHS but were unsatisfied with the level of services provided by the scheme. It is therefore recommended that Delta State Contributory Health Commission should review its benefit package and urgently scale up services to improve enrollees' satisfaction with the scheme.

Determinants of commodity management practices in public health facilities in devolved health systems: a case of essential medicines in Makueni County, Kenya

Background: Good health commodities management is an essential component of effective and affordable health care services globally. Curative, preventative and rehabilitative care involve the utlization of medicines and medical supplies. The specific focus of the research was on the impact of: healthcare worker training; policy and institutional framework; healthcare budgetary allocations; and, available infrastructure on effective management of essential medicines in publicly owned health facilities in a devolved system. Methods: The researcher used descriptive cross-sectional research design and a mixed method of qualitative and quantitative data collection techniques in collecting both primary and secondary data. The study adopted a stratified random sampling procedure to choose targeted 50 public health facilities in Makueni County from a population of 162 health facilities. The calculated size of the sample was 96 respondents through stratified sampling technique. The analysed data was presented using tables, charts and narration for qualitative data. Results: The study findings established that health worker training, health budgetary allocations and available infrastructure had significant and positive effect on management practices of essential medicine in Makueni County, Kenya. However, the effect of policy and institutional framework was found to insignificant in predicting the management practices of essential medicines in Makueni County. Conclusions: The study concluded that healthcare sector is a dynamic sector that faces different changes on a daily basis. Health worker training; policies and institutional structures; budget allocation; and infrastructure need to be advanced to meet the expectations in the evolving healthcare sector.

Factors associated with poor self-rated health among chronic kidney disease patients and their health care utilization: Insights from LASI wave-1, 2017-18.

Chronic kidney disease (CKD), associated with other chronic conditions affects the physical, behavioral, and psychological aspects of an individual, leading to poor self-rated health. Hence, we aimed to assess the factors associated with poor self-rated health (SRH) in CKD patients. Additionally, we assessed their health care utilization. This is an observational study consisting of 527 CKD patients from Longitudinal Aging Study in India (LASI), 2017-2018.A descriptive statistic computed prevalence. Regression analysis assessed the association between poor SRH and socio-demographic variables presented as adjusted odds ratio with a confidence interval of 95%. Health care utilization among CKD patients was graphically presented. Around 64% of CKD patients had poor SRH. Aged 75 years and above (AOR=1.8, 95% CI= 0.5-6.8), rural residents (AOR= AOR 1.8, 95% CI =1.0 -3.1) and those with other chronic conditions (AOR=5.1, 95% CI= 2.3-11.0) were associated with poor SRH. Overall 79% of the CKD patients availed health care facility, most (44.8%) of those visit private facility. We observed older adults, females, rural residents, and having other chronic conditions were associated with poor SRH among CKD patients which highlights the need for equitable and strengthened health care system. There is an urgent need to provide accessible, affordable and quality healthcare services for these individuals so as to maintain continuity of care.

Households Health Care Financing Methods: Social Status Differences, Economic Implications and Clinical Outcomes Among Patients Admitted in a Pediatric Emergency Unit of a Tertiary Hospital in South West Nigeria.

Background. The affordability of health care services by households within a country is determined by the health care financing methods used by her citizens. In accordance with World Health Organization (WHO), health services must be delivered equitably and without imposing financial hardship on the citizens. Aim. This study aimed to determine the pattern of households health care financing method and relate it to the social-background, economic implication and clinical outcome of care in pediatric emergency situations. Method: It is a cross-sectional descriptive study. Result. 210 children from different households were recruited. Majority (75.9%) of the children were aged 0 to 5 years, males (61.2%) and belonged to the low socio-economic status (95.7%). The overall median (IQR) cost of care, income and percentage of income spent on care were ₦10 700 (₦7580-₦19 700), ₦ 65000(₦38000-₦110 000) and 17.6% (7.1%-39.7%) respectively. Though 70 (34.8%) of the respondents were aware of health insurance scheme, only 12.8% were enrolled. There were significant differences in the households' health care financing methods with respect to the socioeconomic status (P = .010), paternal level of education (P < .001), maternal occupation (P = .020), paternal occupation (P = .030) and distribution of income (P < .001). Catastrophic spending was experienced by 67.4% of the household, all of whom paid via out-of-pocket payment (OOPP) (P < .001), catastrophic health spending (CHS) was significantly associated with death and discharge against medical advice (DAMA) (P = .023). All cases of mortality and 93% cases of DAMA occurred with paying out of pocket (OOP) (P = .168). Conclusion. health care services were majorly paid for OOP among households in this study and CHS are high among these households. Clinical and financial outcomes were worse when health care services were paid through OOP.

Household’s Ability to Afford Health Insurance Packages in Tanzania

Most developing countries worldwide are striving to provide universal access to quality and affordable health care services. In turn, health insurance has been promoted as one of the ways to ensure universal coverage and financial protection. This study analyzed households’ ability to afford health insurance packages in Tanzania. The study used the recent 2017/18 Household Budget Survey income data collected by the National Bureau of Statistics and premiums for health insurance packages provided by the National Health Insurance Fund. Households were categorized into four quartiles based on their income, ranging from households with the lowest income to those with the highest income. The study adopted the SDGs indicator 3.8.2 which suggests that health spending should not go beyond 10% percent of household income as the threshold to examine household ability to afford the insurance packages. It was found that most of the households with low to moderate incomes, which account for three quarters of all households, are required to spend more than the recommended 10% threshold of their incomes in purchasing health insurance packages. This is unlikely to be affordable, thus, subjecting them to catastrophic health spending. Although most of the households in the fourth quartile spend less than 10% of their incomes on insurance packages, this is a relatively small group accounting for only 25% of the households. Thus, health insurance coverage is likely to remain low, especially among poor households. It is recommended that the government should provide subsidies to health insurance schemes in order to extend coverage to the poor who cannot afford health insurance packages to enhance financial protection and health coverage.

An assessment of the spatial distribution of bulk billing-only GP services in Australia in relation to area-based socio-economic status.

The accessibility to affordable primary healthcare services contributes to population health and health equity. A key aspect to accessibility is the geographical distribution of primary healthcare services. Limited studies have assessed the nationwide spatial distribution of bulk billing-only medical practices or 'no-fee' services. The aim of this study was to provide a nationwide approximation of bulk billing-only services and evaluate the socio-demographic status and population characteristics in relation to the distribution of bulk billing-only GP services. The methodology in this study used Geographic Information System (GIS) technology to map the locations of all bulk bulking-only medical practices collected in mid-2020 and linked this with population data. The population data and practice locations were analysed at the level of Statistical Areas Level 2 (SA2) regions and used the most recent Census data. The study sample included (n =2095) bulk billing-only medical practice locations. The nationwide average Population-to-Practice (PtP) ratio was 1 practice to 8529 people for regions with access to bulk billing-only practice, and 57.4% of the Australian population lives within an SA2 that has access to at least one bulk billing-only medical practices. No significant associations were identified between practice distribution and area socio-economic status. The study identified areas with low access to affordable GP services, with many SA2 regions having no access to bulk billing-only practices. Findings also indicate that there was no association between area socio-economic status and the distribution of bulk billing-only services.

Balancing Technological Advances with User Needs: User-centered Principles for AI-Driven Smart City Healthcare Monitoring

In recent years, the integration of artificial intelligence (AI) technologies has greatly benefited smart city healthcare, meeting the growing demand for affordable, efficient, and real-time healthcare services. Patient monitoring is one area where artificial intelligence has shown great promise. Improved health outcomes have been made possible by the advancement of AI-based monitoring systems, which enable more personalized and continuous patient monitoring. However, to fully maximize the benefits of these systems, a user-centered approach is essential, which prioritizes patients' needs and experiences while ensuring their privacy and autonomy are respected. This study focuses on the application of user-centered design principles in the development and deployment of AI-driven monitoring systems in smart city healthcare. Addressing the challenges and opportunities of AI-driven monitoring systems, the article considers issues such as privacy and security concerns, data accuracy, and user acceptance. Finally, some possible future directions to the challenges are suggested. A user-centered approach to AI monitoring systems is recommended for healthcare providers to enhance patient experience in smart city healthcare.

Assessing the Impact of the National Health Insurance Program (JKN) on Healthcare Access in City Medan

Assessing the Impact of the National Health Insurance Program (JKN) on Healthcare Access in City Medan. This research evaluates the impact of the National Health Insurance Program (JKN) on healthcare access in City Medan, Indonesia. Implemented with the goal of providing equitable and affordable healthcare services to all citizens, JKN has undergone scrutiny to assess its effectiveness in improving healthcare access and outcomes. Employing a mixed-methods approach, this study amalgamates quantitative surveys and qualitative interviews. Stratified sampling was utilized to collect data from diverse socio-economic groups across City Medan. Quantitative surveys focused on healthcare utilization patterns, awareness of JKN benefits, and demographic factors, while qualitative interviews explored nuanced perspectives, barriers to access, and suggestions for improvement. The analysis reveals a notable increase in healthcare utilization and improved accessibility to essential services following JKN implementation. However, disparities in service quality across healthcare facilities persist, coupled with geographical barriers and administrative complexities hindering seamless service provision. Maternal and child health indicators show promise, and preventive healthcare practices are gaining traction, indicating a shift towards proactive health-seeking behaviors. The research underscores the necessity for policy refinements, targeted interventions, technological innovations, community engagement, and efficient resource allocation to strengthen JKN's effectiveness. Strategic recommendations advocate for streamlined administrative processes, service quality enhancements, and geographical outreach to remote communities

The European pharmacy market: the density and its influencing factors

Abstract Community pharmacies deliver high-quality health care and are responsible for medication safety. During the pandemic, accessibility to the nearest pharmacy became more essential to get vaccinated against Covid-19 and to get medical aid. The government’s goal is to ensure nationwide, reachable, and affordable medical health care services by pharmacies. Therefore, the density of community pharmacies matters. Overall, the density of community pharmacies is fluctuating, with slightly decreasing tendencies in some countries. The research question is: upon which conditions depends the variance in the density of community pharmacies in Europe? So far, the literature has shown that changes in the system affect prices and density. However, a European overview of the development of the density of community pharmacies and its triggers is still missing. This research is essential to counteract against decreasing density consulting in a lack of professional health care through pharmacies. I focus on liberal versus regulated market structures, mail-order prescription drug regulation, and third-party ownership consequences. In a panel analysis, the relative influence of the measures is examined across 27 European countries over the last 21 years. The results show that regulated pharmacy markets have over 10.75 pharmacies/100.000 inhabitants more than liberal markets. Further, mail-order prescription drugs decrease the density by -17.98 pharmacies/100.000 inhabitants. Countries allowing third-party ownership have 7.67 pharmacies/100.000 inhabitants more. The results are statistically significant at a 0.001 level. The output of my analysis recommends regulated pharmacy markets, with a ban on mail-order prescription drugs allowing third-party ownership to support nationwide medical health care through community pharmacies. Key messages • Regulated pharmacy markets, with a ban on mail-order of prescription drugs and third-party-ownership have a positive effect on pharmacies density. • The results of my analysis provide the government with measures to improve professional nationwide health care coverage for the population through pharmacies.

The burden of chronic diseases and patients' preference for healthcare services among adult patients suffering from chronic diseases in Bangladesh.

Low- and middle-income countries (LMICs) have a disproportionately high burden of chronic diseases, with inequalities in health care access and quality services. This study aimed to assess patients' preferences for healthcare services for chronic disease management among adult patients in Bangladesh. The present analysis was conducted among 10,385 patients suffering from chronic diseases, drawn from the latest Household Income and Expenditure Survey 2016-2017. We used the multinomial logistic regression to investigate the association of chronic comorbid conditions and healthcare service-related factors with patients' preferences for healthcare services. The top four dimensions of patient preference for healthcare services in order of magnitude were quality of treatment (30.3%), short distance to health facility (27.6%), affordability of health care (21.7%)and availability of doctors (11.0%). Patients with heart disease had a 29% significantly lower preference for healthcare affordability than the quality of healthcare services (relative risk ratio[RRR] = 0.71; 0.56-0.90). Patients who received healthcare services from pharmacies or dispensaries were more likely to prefer a short distance to a health facility (RRR = 6.99; 4.80-9.86) or affordability of healthcare services (RRR = 3.13; 2.25-4.36). Patients with comorbid conditions were more likely to prefer healthcare affordability (RRR = 1.39; 1.15-1.68). In addition, patients who received health care from a public facility had 2.93 times higher preference for the availability of medical doctors (RRR = 2.93; 1.70-5.04) than the quality of treatment in the health facility, when compared with private service providers. Patient preferences for healthcare services in chronic disease management were significantly associated with the type of disease and its magnitude and characteristics of healthcare providers. Therefore, to enhance service provision and equitable distribution and uptake of health services, policymakers and public health practitioners should consider patient preferences in designing national strategic frameworks for chronic disease management. Our research team includes four researchers (co-authors) with chronic diseases who have experience of living or working with people suffering from chronic conditions or diseases.

Baseline Assessment Towards the Implementation of Formal Sector Health Insurance Scheme for Civil Servants in Ogun State of Nigeria

The healthcare financing mechanism of a nation generally determines the access of her people to the needed qualitative and affordable health care services without undergoing any financial hardship, This study is therefore set to determine among other things the preferred mode of service payment for healthcare, as a measure of demand for health insurance, among civil servants in Ogun State of Nigeria. The study adopted a “quantitative methodology” approach, with the use of pretested self-administered questionnaires. The mean age of the respondents was 37.85 years ± standard deviation of 7.51 years. In setting the health insurance premium, majority, 59.3% of the respondents preferred government use percentage of gross salary rather than estimated amount. They suggested around 2.18% of their gross salary as premium and an additional 30.26% of their gross salary as contribution to the premium from their employer. On an average, they were only willing to pay one thousand seven hundred and eighty naira and 32 kobo (N1,780:32) in a month to have themselves, their spouse and 4 dependants covered by an health insurance scheme. The study indicated the predictors of demand for health insurance as being married, having spent 10 years and more in civil service, and perceived importance (value) of health insurance. The latter implies that there is an association between value attached to health insurance and its demand such that those who felt health insurance was important were 6 times more likely to prefer it as method of service payment than those who did not see the importance of health insurance.

Perception of quality of primary health care services in South-West Nigeria: a cross sectional study

Background: Quality of health-care services has grown in importance in both developed and developing countries' health-care systems over the years. This study aims to assess patients’ perception of quality of primary health care services in Osun State in order to improve healthcare outcomesMethods: This study employed the descriptive cross-sectional design to assess patients’ perception of quality of primary health care services in Osun State.Results: A greater proportion of respondents were motivated to utilize primary health care facilities as a result of accessibility to services/good attitude of health service providers compared to availability of services, affordability of health care services and quality of services. Sixty-two percent of 13 items measuring perception of quality of care by health care providers had above average response, only 25% of items measuring perception of quality of health care service delivery had above average response and only 16% of items measuring perception of quality of health facility had more than average responses. Physical accessibility, adequacy of cost and respectfulness of health workers were very important predictors of patient satisfaction with care.Conclusions: Overall quality of care is perceived to be of average quality. It is recommended that strategies be put in place to ensure sustenance of service areas with perceived good quality and continuous improvement of service areas with perceived poor quality especially recruitment of more health workers, provision of adequate medical equipment and improvement of payment arrangements at the facility.

Strengthening Health Systems for Climate Adaptation and Health Security: Key Considerations for Policy and Programming.

Strengthening Health Systems for Climate Adaptation and Health Security: Key Considerations for Policy and Programming.

Translating Planetary Health Principles Into Sustainable Primary Care Services.

Global anthropogenic environmental degradations such as climate change are increasingly recognized as critical public health issues, on which human beings should urgently act in order to preserve sustainable conditions of living on Earth. “Planetary Health” is a breakthrough concept and emerging research field based on the recognition of the interdependent relationships between living organisms—both human and non-human—and their ecosystems. In that regards, there have been numerous calls by healthcare professionals for a greater recognition and adoption of Planetary Health perspective. At the same time, current Western healthcare systems are facing their limits when it comes to providing affordable, equitable and sustainable healthcare services. Furthermore, while hospital-centrism remains the dominant model of Western health systems, primary care and public health continue to be largely undervalued by policy makers. While healthcare services will have to adapt to the sanitary impacts of environmental degradations, they should also ambition to accompany and accelerate the societal transformations required to re-inscribe the functioning of human societies within planetary boundaries. The entire health system requires profound transformations to achieve this, with obviously a key role for public health. But we argue that the first line of care represented by primary care might also have an important role to play, with its holistic, interdisciplinary, and longitudinal approach to patients, strongly grounded in their living environments and communities. This will require however to redefine the roles, activities and organization of primary care actors to better integrate socio-environmental determinants of health, strengthen interprofessional collaborations, including non-medical collaborations and more generally develop new, environmentally-centered models of care. Furthermore, a planetary health perspective translated in primary care will require the strengthening of synergies between institutions and actors in the field of health and sustainability.

Socio-Demographic Variations on Age-Sex Mortality in Namibia: An Analysis of the 2016 Civil Registration and Vital Statistics Data

Mortality studies are important for the effectiveness of subsystem of health services in a country. Before the Coronavirus pandemic outbreak, there has been a gradual decline in the global mortality indicators, which can be linked to the improving economic development and social wellbeing of the global population, especially, in developing regions such as East Asia and the Pacific, Latin America and the Caribbean, Eastern Europe and the Middle East. This decline in mortality and the high fertility in developing countries are the contributing factors to the increase on global population. Apart from the aggregated frequencies of deaths and crude death rates reported in population census reports, little to no attention has been paid to detailed inference mortality analysis with respect to the age-sex variation perspective in Namibia. Thus, this paper used the negative binomial regression modelling technique to perform an inference mortality analysis across all ages and both sexes in the country as well as across regions and marital status using the 2016 Civil Registration Vital systems data from the Ministry of Home Affairs and Immigration. Results showed that there was a significant relationship between mortality and theindividuals' age, sex, marital status and region. In addition, Oshana, Kavango East, Khomas, Hardap and Omaheke regions had high mortality rates, while infants and elderly individuals had a high probability of dying. Furthermore, the study revealed that individuals who were single and aged 15-59 and 5-14 years had less expected death count. Hence, it is recommended that interventions (such as affordable and proper health care and well-being services) targeted at the (most) vulnerable age groups, marital group and regions be made a priority, in order to meet Sustainable Development Goal 3.