Affordable Health Care Services Research Articles

Potencijal sektora zdravstvenog osiguranja kao ključnog igrača u eri nakon pandemije

Amid the economic crisis and increased global poverty as a result of the COVID-19 pandemic, having a health insurance plan can be a solution for the public to have access to standard and affordable healthcare services without having financial difficulties. In addition, countries whose citizens have health insurance and are fully covered by it are more likely to achieve Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) by 2030. The objective of this paper is to provide perspectives on how health insurance can be a key player in the post-pandemic era. With all the changes in healthcare services due to the pandemic and technological developments, in this paper, we recommend the industry carry out reforms in both the service coverage and their operating model in the post-pandemic era. The reform is necessary not only to ensure public safety but also the sustainability of the sector itself. Specifically, we believe that the health insurance sector in Serbia has the capacity and the infrastructure to become the key player in ensuring the health of the population in the post-COVID-19 pandemic.

Cultivating Innovative Work Behavior of Nurses Through Diversity Climate: The Mediating Role of Job Crafting.

IntroductionInnovative work behavior of nurses is essential to deliver affordable quality healthcare services. Diversity climate and job crafting are a few of the supportive managerial strategies that can be applied to cultivate the innovative capacity of nurses.ObjectiveAim for the current study is to: (a) examine the role of diversity climate in cultivating innovative work behavior of nurses directly; and (b) indirectly through job crafting.MethodsFor this study data was collected through cross-sectional design employing simple random sampling using structured questionnaires from 283 nurses. Data was analyzed using SPSS.Amos.21.ResultsResults revealed the positive influence of diversity climate on innovative work behavior directly (γ = 0.51, p < .001) and indirectly through job crafting (ρ = 0.235, p < .001).ConclusionThe current study revealed that diversity climate significantly influences the innovative work behavior of employees directly and indirectly through Job crafting. Healthcare management can integrate diversity management policies and job crafting techniques in their strategies to foster innovative work behavior of nurses.

Duty without liability: The impact of article 12 of the International Covenant on Economic, Social and Cultural Rights on the right to health care in Nigeria

The right to health care under article 12 of ICESCR is an instrumental right because it bears vital linkages to the realisation of other rights. For the many Nigerians living in poverty, their health may be the only asset on which they can rely for the exercise of other rights, such as the right to work or the right to adequate housing. Conversely, ill-health can be a liability to the many people living in poverty in Nigeria, even more so in the absence of equal access to affordable and essential healthcare services. This article aims to review the implication of article 12 of ICESCR on some of the existing initiatives for achieving the right to health care in Nigeria, especially in respect of human rights law and policy. The article argues that for Nigeria to meet its international obligations under the right to health care, it must commit to adequate funding of healthcare services and engage with regional and international partners to ensure compliance with article 12 of ICESCR. Given that the right to health care presently is not justiciable in Nigeria because of the ouster clause contained in section 6(6)(c) of the Nigerian Constitution, the article calls for an attitudinal change in the judicial perception of economic and social rights that come before the courts. It urges Nigerian courts to adopt the principle of the interdependency and indivisibility of rights, whereby judicial measures to enforce the right are given effect through the formally-enforceable civil and political rights contained in chapter four of the Nigerian Constitution. The Indian Supreme Court is reputable for taking this approach to the interpretation and enforcement of economic and social rights because the enjoyment of civil and political rights is linked to the satisfaction of economic and social rights, such as the right to health care. Finally, because of the importance of health care to a life of dignity, the article calls for Nigerian courts to adopt a progressive and broader approach when dealing with economic and social rights because of the evident connection between, for example, the right to health care and the right to life.

The Burden of Obesity in Nigeria

Background and Aims: Over the years, obesity has become a global health concern. According to the World Health Organization, as at 2016, the world has experienced over four-fold increase in obesity within four decades. This public health crisis has taken its toll in Nigeria with a reported prevalence of 14% as at 2020. This review thus seeks to assess available evidence on the burden of obesity, associated co-morbidities, risk of non-communicable diseases, and available management strategies in Nigeria. Methods: This narrative review was conducted on research articles retrieved without date restriction. The databases assessed were PubMed, Web of Science, Science Direct, and Google Scholar databases, as well as reference lists of relevant articles. The search terms used were “obesity in Nigeria”, “burden of obesity” “obesity co-morbidities”, and “obesity care.” Results: Studies have indicated that sedentary lifestyle, poor nutritional choices as well as genetic alterations are some of the causes of obesity in Nigeria. With the increasing prevalence of obesity, its associated co-morbidities, the current economic situation of the country and low accessibility to affordable healthcare services, it is currently a burden to healthcare professionals and the country at large. Conclusions: There is a need for the Nigerian government to focus more on healthcare development to cater for the increasing population and mitigate obesity occurrence. Moreover, there is a need for national orientation and sensitization on predisposing factors to obesity.

Self-care Experience in Hypertensive Patients

Introduction: Self-care is an important component to control blood pressure in people with hypertension. Low self-care ability will have an impact on increasing the risk of complications. The purpose of this study was to explore the experiences of hypertensive patients in self-care.Methods: The study used a qualitative method with a phenomenological approach. Nine hypertensive patients were taken by purposive sampling technique. The data collection was using semi-structured interviews. Thematically analyzed data based on transcribed interview data.Results: The results of the study obtained six themes related to self-care, namely perceptions of the causes of recurrence, emotional responses, social support, accessibility of health-care services, self-care behavior and barriers of self-care.Conclusions: Self-care in hypertensive patients is influenced by the availability of social support from both family and health workers as well as the affordability of health-care services. The implication of this study is the need to improve a good support system, especially from nurses to be able to minimize the barriers felt by patients so as to improve self-care abilities

An IoMT-Enabled Smart Healthcare Model to Monitor Elderly People Using Machine Learning Technique

The Internet of Medical Things (IoMT) enables digital devices to gather, infer, and broadcast health data via the cloud platform. The phenomenal growth of the IoMT is fueled by many factors, including the widespread and growing availability of wearables and the ever-decreasing cost of sensor-based technology. The cost of related healthcare will rise as the global population of elderly people grows in parallel with an overall life expectancy that demands affordable healthcare services, solutions, and developments. IoMT may bring revolution in the medical sciences in terms of the quality of healthcare of elderly people while entangled with machine learning (ML) algorithms. The effectiveness of the smart healthcare (SHC) model to monitor elderly people was observed by performing tests on IoMT datasets. For evaluation, the precision, recall, fscore, accuracy, and ROC values are computed. The authors also compare the results of the SHC model with different conventional popular ML techniques, e.g., support vector machine (SVM), K-nearest neighbor (KNN), and decision tree (DT), to analyze the effectiveness of the result.

Roles and reimbursement of pharmacists as South Africa transitions towards Universal Health Coverage (UHC): An online survey-based study.

BackgroundThe implementation of Universal Health Coverage in SA has sought to focus on promoting affordable health care services that are accessible to all citizens. In this regard, pharmacists are expected to play a pivotal function in the revitalization of primary health care (PHC) during this transition by the expansion of their practice roles.ObjectivesTo assess the readiness and perceptions of pharmacists to expand their roles in an integrated health care system. To determine the availability and pricing of primary health care services currently provided within a community pharmacy environment and to evaluate suitable reimbursement for the provision of such services by a community pharmacist.MethodsCommunity pharmacists’ across SA were invited to participate in an online survey-based study. The survey consisted of both open- and closed-ended questions. Descriptive statistics for closed-ended questions were generated and analysed using Microsoft Excel® and Survey Monkey®. Responses for the open-ended questions were transcribed, analysed, and reported as emerging themes.ResultsSix hundred and sixty-four pharmacists’ responded to the online survey. Seventy-five percent of pharmacists’ reported that with appropriate training, a transition into a more patient-centered role might be beneficial in the re-engineering of the PHC system. However, in order to adopt these new roles, appropriate reimbursement structures are required. The current fee levied by pharmacists in community pharmacies that offered these PHC services was found to be lower to that recommended by the South African Pharmacy Council; this disparity is primarily due to a lack of information and policy standardisation. Therefore, in order to ensure that fees levied are fair, comprehensive service package guidelines are required.ConclusionsThis study provides baseline data for policy makers on pharmacists’ readiness to transition into expanded roles. Furthermore, it can be used as a foundation to establish appropriate reimbursement frameworks for pharmacists providing PHC services.

Conflict driven displacement and child health: Evidence based on mother's nationality from Jordan Population and Family Health Survey.

Armed conflicts result in greater vulnerability and socioeconomic inequality of populations besides risking their health and well-being. Conflict intensifies the health needs and risks the life and well-being of individuals at large through displacement. Therefore, our study aims to apprise the interventions to which children under-five living in Jordan are especially at risk for acute respiratory infections, diarrhea, and fever in the conflict circumstances. Secondary data analysis is used in the present study. We used a weighted sample of around 9650 children from Jordan Population and Family Health Survey (JPFHS), 2017-18. Bivariate analysis including prevalence rates were used to examine the distribution of socio-demographic characteristics of children. The study has also used multinomial logistic regression model, in order to evaluate the variations in the probability of nationality of under-five children living in Jordan. "Syrian nationalist" children have a higher relative risk of ARI (RRR = 1.19, [1.08, 1.32]), and "Other-nationalist" children have two times greater risk of ARI compared to "Jordanian children." The relative risk of diarrhea is lower among "Syrian nationalist" and "Other-nationalist" children compared to "Jordanian children." Children belong "Other-nationalist" are found to be less relative risk of fever (RRR = 0.9, [0.80, 1.01]) than "Jordanian children." Our study concludes that conflict-driven displacement has an immediate effect on child health through access, availability, and affordability of health care services, resulting in more significant health care risks. However, sufficient investment is required to address such adversities that affect the health care system due to uneven demand as experienced by the Jordanian health care system. Thus, collaborative efforts through global partners can play a significant role in the countries facing the challenges of managing these health care emergencies.

Role of Health Insurance in Child Health Care Utilization in Misungwi District, Tanzania

Background Health insurance is one of the health financing methods aiming at bringing equity in health care by providing access of quality and affordable health care services to all groups of the population. In Tanzania, children are mainly covered as dependents with no well- established insurance programmes that target children. The burden of out of pocket payments for health care and hence low health care utilization for the uninsured is significant. Study Objective To assess the role of health insurance on health service utilization among children in Misungwi District. Methods A multi-stage cluster sampling was used and interview administered questionnaire with both closed and open ended questions was used to gather primary data on insurance coverage patterns, health care utilization and facility pretences in Misungwi. The sample size used was 227. Analysis was done using statistic computer software SPSS version 20 and data was interpreted and presented based on objectives. Results Health Insurance coverage among children was found to be low with overall coverage being 16.7%. Health insurance status of the child was found to influence health care seeking behaviour of parents and hence health care utilization of the child. Out of pocket payments burden to parents of the uninsured children was evident with 13.6% reporting to borrow money from relatives. Conclusion In this study, it was found that health insurance coverage is low and the child’s health insurance coverage influence the health care seeking behaviour with high cost burden to uninsured children. The need for health insurance coverage is importance for improvement of health service utilization and thus worth further studies.

Prevalence and determinants of self-medication with antibiotics among general population in Afghanistan

ABSTRACT Objective Self-medication with antibiotics (SMA) is a common cause of antibiotic resistance, a major public health problem. This research aimed to identify the prevalence of SMA and explore reasons for practicing SMA among people living in Kabul, Afghanistan. Methods A community-based cross-sectional study was conducted from May to November 2017 in 12 community pharmacies operating across Kabul, Afghanistan. Multivariable logistic regression was conducted to identify the factors associated with the use of SMA. Results Out of 385 participants, 282 (73.2%) practiced SMA during the last year. Overall, 241 (62.6%) were ‘very concerned’ about the use of SMA, and 156 (40.5%) highlighted it is bad to practice SMA. The top three antibiotics used for self-medication were penicillin (ATC class: J01C), metronidazole (ATC: P01AB01), and ceftriaxone (ATC: J01DD04). Economic problems, lack of time to visit doctors, and ease of use were cited as the main reasons for practicing SMA. Furthermore, female participants were less likely to practice SMA compared to male counterparts. Conclusion While efforts should be directed to enforce strict drug regulations system and awareness programs, priority should be given to provide accessible, affordable, and quality health care services to increase citizen’s compliance to appropriate drug prescriptions.

Edge Intelligence for Empowering IoT-Based Healthcare Systems

The demand for real-time, affordable, and efficient smart healthcare services is increasing exponentially due to the technological revolution and burst of population. To meet the increasing demands on this critical infrastructure, there is a need for intelligent methods to cope with the existing related challenges. In this regard, edge computing technology can reduce latency and energy consumption by moving processes closer to the data sources in comparison to the traditional centralized cloud and IoT-based healthcare systems. In addition, by bringing automated insights into the smart healthcare systems, artificial intelligence (AI) provides the possibility of detecting and predicting high-risk diseases in advance, decreasing medical costs for patients, and offering efficient treatments. The objective of this article is to highlight the benefits of the adoption of the edge intelligent technology, along with the use of AI in smart healthcare systems. Moreover, a novel smart healthcare model is proposed to boost the utilization of AI and edge technology in smart healthcare systems. Additionally, we discuss potential challenges and future research directions arising when integrating these different technologies.

Cost of Illness of Epilepsy and Associated Factors in Patients Attending Adult Outpatient Department of University of Gondar Referral Hospital, Northwest Ethiopia.

BackgroundEpilepsy has significant economic implications on health care needs, premature death, and lost work productivity. Therefore, this study aimed to assess the cost of illness of epilepsy and its associated factors in the Outpatient Department of University of Gondar Referral Hospital, Northwest Ethiopia.MethodsWe conducted an institution-based cross-sectional study from March 2018 to April 2018. A total of 442 adult epileptic patients were selected from the chronic follow-up clinic using a systematic sampling technique. We fitted binary logistic regression to identify the associated factors, and significant variables in the multivariable logistic regression analysis were determined using P-value <0.05 and 95% CI.ResultsThe study revealed that the mean total cost illness of epilepsy per patient per year was US$ 166±61.6, and 30.3% of patients incurred high cost. Age (AOR = 1.06; 95% CI: 1.03, 1.09), sex (AOR = 3.66; 95% CI: 1.94, 6.89), educational (AOR = 0.15; 95% CI: 0.005, 0.047), polytherapy (AOR = 4.66; 95% CI: 2.29, 9.46), seizure frequency (AOR = 4.48; 95% CI: 1.56, 12.8), place where AEDs were bought (AOR = 6.23; 95% CI: 2.7, 14.03) and disease duration (AOR = 0.11; 95% CI: 0.05, 0.25) were predictors of the cost of illness of epilepsy.ConclusionThe total annual cost of illness of epilepsy was high, taking into account the per capita income of the individuals. The age, sex, and educational status of the patients, and the number of AED, seizure frequency, places where patients buy drugs, and disease duration were factors significantly associated with the cost of illness of epilepsy. Hence, creating an alternative source of income, socio-economic support, and affordable health care service for patients, especially for female and elderly patients, and strengthening and equipping nearby clinics, increasing drug availability in governmental pharmacies.

The Role of Medical Camps in Ensuring Equity in Accessing Health Care Services in Kenya

This study was carried out to help improve the management and organization of the medical camps in Kenya by the various key stakeholders thus enabling the medical camps achieve the overall goal of enabling access of quality affordable health care services to the disadvantaged and marginalized population in Kenya in acknowledgement that equity in the accessing and provision of health care services is an underlying principle intertwined in the human rights principles. Everyone irrespective of their social and economic status are entitled to a standard of health that is enjoyed by majority of the advantaged populations within a society and deliberate multi-disciplinary efforts need to be taken to ensure access of quality affordable health care services for all. Medical camps organized by public sector, private and Non-governmental organizations are initiatives aimed at achieving the goal of availing high standard of health to especially the vulnerable and disadvantaged populations in a community. This study sought to establish the role of medical camps in ensuring equity in accessing health care services in Kenya. The study targeted 500 patients who attended a medical camp, mounted by Embu County Government, one of the 47 county governments in Kenya, in Karaba, Mbeere South Sub-County on 1 st of November 2019. A total of 50 respondents were sampled which was 10% of the total population as it was not possible to involve all the patients due to time and cost constraints. A convenience sampling technique was employed where the study relied on information provided by willing respondents. The data was collected using a structured interview schedule comprising of both closed and open-ended questions. The data was analysed using factor analysis by use of SPSS software. Descriptive statistics in form of frequencies and percentages were used. The findings revealed that there was 100% response rate where majority of the respondents were female. It was notable that majority of those who attended the medical camp were vulnerable persons most of them with primary level of education, unemployed and earning a meagre monthly income of estimated US$ 139. The findings established that the medical camp was well planned and organized. The location was convenient to majority of the respondents; it was easy to locate and navigate through and majority resided within 5 kilometres of the venue. The majority of the respondents were to a great extent satisfied with services offered, level of professionalism and friendliness of the health professionals, proximity of the medical camp; hygiene and as well as free services. The study therefore concluded that to a great extent medical camps ensure equity in accessing health care services among the disadvantaged populations and recommended that such medical camps be organized on a regular basis. The study also recommended that consideration be given to build the capacity of local health staff to enable them offer follow up services after medical camps are offer. Expanding and equipping health facilities should also be a priority given that not all services could be offered during medical camps such as complicated major surgeries.

Does engagement with frontline health workers improve maternal and child healthcare utilisation and outcomes in India?

BackgroundPoor Maternal and Child Health (MCH) outcomes pose challenges to India’s ability to attain Goal-3 of the Sustainable Development Goals (SDGs). The government of India strengthened the existing network of frontline health workers (FHWs), under its National Rural Health Mission in 2005 and subsequent National Urban Health Mission in 2013 as a strategy to mitigate the shortage of skilled health workers and to provide affordable healthcare services. However, there is a lack of robust national-level empirical analysis on the role of maternal engagement with FHWs in influencing the level of maternal and child health care utilisation and child health outcomes in India.MethodsUsing data from the nationally representative Indian National Family Health Survey (NFHS) 2015–2016, this paper aims to investigate the intensity of engagement of FHWs with married women of child-bearing age (15–49 years), its influence on utilisation of maternal and child healthcare services, and child health outcomes. Our empirical analyses use multivariate regression analyses, focusing on five maternal and child health indicators: antenatal care visits (ANC) (4 or > 4 times), institutional delivery, full-immunisation of children, postnatal care (PNC) (within 2 days of delivery), and child survival.ResultsOur analysis finds that maternal engagement with FHWs is statistically significant and a positive predictor of maternal and child health care utilisation, and child survival. Further, the level of engagement with FHWs is particularly important for women from economically poor households. Our robustness checks across sub-samples of women who delivered only in public health institutions and those from rural areas provides an additional confidence in our main results.ConclusionsFrom a policy perspective, our findings highlight that strengthening the network of FHWs in the areas where they are in shortage which can help in further improving the utilisation of maternal and child healthcare services, and health outcomes. Also, the role of FHWs in the government health system needs to be enhanced by improving skills, working environment, and greater financial incentives.

Stabilizing and Strengthening the Affordable Care Act: Opportunities for a New Administration.

For the past decade, the Affordable Care Act (ACA) has successfully reduced uninsurance and improved access to and affordability of health care services for millions of Americans. But the law was weakened when the Trump administration shortened the open enrollment period in the federal Marketplace, reduced outreach and enrollment funding, and revised the public charge rule, among other actions. The Biden administration will have the chance to reverse some of these changes and further strengthen the law to improve health care access and affordability. In this article, the author explores options for expanding access to affordable coverage and care for those who do not qualify for Medicaid or marketplace financial assistance and further discusses opportunities for increasing enrollment among those who are already eligible. The author also examines opportunities for expanding access to specific services, including reproductive health care, among those with insurance. Any attempts to modify or build on the ACA will likely be complicated by the ongoing coronavirus pandemic as well as slim Democratic majorities in the House and Senate, but regulatory solutions will likely be easier to achieve than those that require changes to federal law or state policy.

CPS-based manufacturing workcell for the production of hybrid medical devices

Cyber-physical system (CPS) can increase efficiency and lower costs in manufacturing operations. CPS and related technologies can help medical device manufacturers to meet the rising demands for quality and affordable healthcare products and services. In this paper, a novel architecture for CPS-based manufacturing workcell systems was proposed. Its contribution is to provide quality inspection and operator guidance in manual assembly systems, specifically for the production of hybrid medical devices. The proposed system involves the integration of enabling technologies including Machine Vision (MV), Internet-of-things (IoT) and Augmented Reality. The group illustrated and evaluated the implementation of two CPS prototypes based on the proposed architecture on the fabrication of a specific hybrid medical device, verifying their effectiveness as guidance tools for operators. The two prototypes, CPS-1 and CPS-2 differ in their MV subsystems by having non-deep learning and deep learning-based image processing methods respectively. Experimental results illustrate that, when exposed to various changing conditions, the Regional Convolutional Neural Network (R-CNN) of CPS-2, on average, has outperformed the non-deep learning image processing method of CPS-1 by 42.3% and 8.5%, in terms of accuracy and precision respectively. Hence, this presents evidence on the usefulness of R-CNN-based MV system to increase the flexibility and adaptability of the CPS in terms of object monitoring and reporting.

Security as a Solution: An Intrusion Detection System Using a Neural Network for IoT Enabled Healthcare Ecosystem

Aim/Purpose: The primary purpose of this study is to provide a cost-effective and artificial intelligence enabled security solution for IoT enabled healthcare ecosystem. It helps to implement, improve, and add new attributes to healthcare services. The paper aims to develop a method based on an artificial neural network technique to predict suspicious devices based on bandwidth usage. Background: COVID has made it mandatory to make medical services available online to every remote place. However, services in the healthcare ecosystem require fast, uninterrupted facilities while securing the data flowing through them. The solution in this paper addresses both the security and uninterrupted services issue. This paper proposes a neural network based solution to detect and disable suspicious devices without interrupting critical and life-saving services. Methodology: This paper is an advancement on our previous research, where we performed manual knowledge-based intrusion detection. In this research, all the experiments were executed in the healthcare domain. The mobility pattern of the devices was divided into six parts, and each one is assigned a dedicated slice. The security module regularly monitored all the clients connected to slices, and machine learning was used to detect and disable the problematic or suspicious devices. We have used MATLAB’s neural network to train the dataset and automatically detect and disable suspicious devices. The different network architectures and different training algorithms (Levenberg–Marquardt and Bayesian Framework) in MATLAB software have attempted to achieve more precise values with different properties. Five iterations of training were executed and compared to get the best result of R=99971. We configured the application to handle the four most applicable use cases. We also performed an experimental application simulation for the assessment and validation of predictions. Contribution: This paper provides a security solution for the IoT enabled healthcare system. The architectures discussed suggest an end-to-end solution on the sliced network. Efficient use of artificial neural networks detects and block suspicious devices. Moreover, the solution can be modified, configured and deployed in many other ecosystems like home automation. Findings: This simulation is a subset of the more extensive simulation previously performed on the sliced network to enhance its security. This paper trained the data using a neural network to make the application intelligent and robust. This enhancement helps detect suspicious devices and isolate them before any harm is caused on the network. The solution works both for an intrusion detection and prevention system by detecting and blocking them from using network resources. The result concludes that using multiple hidden layers and a non-linear transfer function, logsig improved the learning and results. Recommendations for Practitioners: Everything from offices, schools, colleges, and e-consultation is currently happening remotely. It has caused extensive pressure on the network where the data flowing through it has increased multifold. Therefore, it becomes our joint responsibility to provide a cost-effective and sustainable security solution for IoT enabled healthcare services. Practitioners can efficiently use this affordable solution compared to the expensive security options available in the commercial market and deploy it over a sliced network. The solution can be implemented by NGOs and federal governments to provide secure and affordable healthcare monitoring services to patients in remote locations. Recommendation for Researchers: Research can take this solution to the next level by integrating artificial intelligence into all the modules. They can augment this solution by making it compatible with the federal government’s data privacy laws. Authentication and encryption modules can be integrated to enhance it further. Impact on Society: COVID has given massive exposure to the healthcare sector since last year. With everything online, data security and privacy is the next most significant concern. This research can be of great support to those working for the security of health care services. This paper provides “Security as a Solution”, which can enhance the security of an otherwise less secure ecosystem. The healthcare use cases discussed in this paper address the most common security issues in the IoT enabled healthcare ecosystem. Future Research: We can enhance this application by including data privacy modules like authentication and authorisation, data encryption and help to abide by the federal privacy laws. In addition, machine learning and artificial intelligence can be extended to other modules of this application. Moreover, this experiment can be easily applicable to many other domains like e-homes, e-offices and many others. For example, e-homes can have devices like kitchen equipment, rooms, dining, cars, bicycles, and smartwatches. Therefore, one can use this application to monitor these devices and detect any suspicious activity.

Insights from national survey on household expenditure for primary healthcare services availed through informal healthcare providers.

Introduction:Ensuring accessible and affordable primary healthcare services of optimal quality is a core component of universal health coverage (UHC). Though a substantial percentage of population avail healthcare services from informal healthcare providers (IHPs) in rural India, the information regarding the extent of out-of-pocket (OOP) expenditure during such encounters is limited.Method:The study analyzed publicly available data of 75th National Sample Survey (NSS) to understand the household expenditure pattern on availing service from IHPs. OOP expenditure for services availed from IHPs were extracted from main data sets and analyzed for both out-patient care and hospitalization. The OOP was summarized across the five wealth quintiles based on monthly per capita expenditure (MPCE) and disease groupings derived from the ailments recorded during the survey.Results:In total, 721 households accessed IHPs as part of out-patient consultation for infectious disease (67%). Households from rural areas (78%), households belonging to backward groups (75%), households from the poorest quintile and women (52%) access the services of IHPs. The median OOP for all services was INR 240 (IQR 120–600) and more than 90% of total OOP is accounted for medical expenditure.Conclusion:The programs need to define healthcare packages to engage IHPs to increase the reach and reduce OOP expenditure on households.

Grassroots sexual and reproductive rights interventions on sexual risk behavior among female sex workers in Nigeria

Introduction: Sexual reproductive health and rights (SRHR) involve access to accurate information, rights-based quality, safe, effective, affordable, and acceptable health-care services at all levels that cover the sexual and reproductive needs of the individual and community irrespective of social, sex, gender, and other differences. Objective: This study aims at assessing the grassroots interventions on the knowledge of rights, access, and uptake of sexual reproductive health (SRH) services among female sex workers (FSWs) in Benue State, Nigeria. Materials and Methods: This cross-sectional survey is a randomized cluster sampling among FSWs in Benue State, Nigeria. A structured questionnaire was used to collect data from the respondents, and the data collected were analyzed using IBM-SPSS Corp., Armonk, NY, version 25.0. The statistical significance level was set at P 0.05). Virtually all respondents (96.0%) used any contraceptive methods in the intervention period compared with 68.6% at the baseline (P < 0.001). The intervention respondents were 11.84 (95% CI: 4.98–28.16; P < 0.0001) times more likely to use any contraceptive method than their baseline counterparts. The intervention respondents were 2.22 (95% CI: 1.51–3.27; P < 0.0001) times more likely to use emergency contraceptives than their baseline counterparts. Conclusion: This study showed the positive outcomes of grassroots interventions involving FSWs in Benue State, Nigeria. Such interventions should be extended to other key populations in Nigeria.

Status and effects of health workforce related factors on implementation of universal health care in Nakuru West Sub County, Nakuru, Kenya

Background: Globally, due to low health care coverage, there have been continued efforts to ensure that there is increased accessibility to quality, affordable and equitable universal health care (UHC) services in most parts of developing countries, such as within Nakuru county in Kenya.Methods: The study focused on determining health workforce gaps in health care facilities that affect the implementation of UHC in Nakuru West Sub County. Cross-sectional study design was applied, data was collected using structured questionnaires, analyzed using statistical package for social sciences 23rd version and presented in charts for ease comparison.Results: The findings of this study indicated that there was shortage of HWCs. This implies that the staffing in the facilities located in Nakuru West Sub-County is inadequate for the implementation of the Kenyan government UHC and it was evident that the mostly affected sections were the nursing, public health officer (PHO), pharmacy, clinical officers and laboratory in that order. Most alarmingly, majority of the HCWs (58.2%) were not being appreciated for good work, despite the fact that they play a key role in the implementation of UHC.Conclusions: It is therefore imperative for the county government which is the arm of the Kenyan government to ensure that they recruit adequate health care workers in all cadres to serve the continuously rising population and HCWs should have adequate level of education, acceptable training skills and be well- motivated.