Community-based Health Services Research Articles

Community-Based Health Planning and Services (CHPS) concept and access to healthcare delivery in Sefwi Wiawso Municipal, Ghana

BackgroundIn spite of the successes of the community-based health planning and services (CHPS) policy since its inception in the mid-1990s in Ghana, data pertaining to the implementation and use of CHPS facilities in Sefwi Wiawso Municipal is scant. We assessed access to healthcare delivery and factors influencing the use of CHPS in Sefwi Wiawso Municipal.MethodsAn analytical community-based cross-sectional study was conducted in the Sefwi Wiawo Municipal from September to October 2020. Respondents for the study were recruited through multi-stage sampling. Information was collected on their socio-demographic characteristics, knowledge and use of CHPS facilities through interviews using a structured pre-tested questionnaire. Factors influencing the use of CHPS facilities were assessed using univariable and multivariable logistic regression to generate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). P ≤ 0.05 was considered statistically significant.ResultsA total of 483 respondents were recruited for the study. The mean age of the respondents was 43.0 ± 16.3 years, and over 70% were females or married/cohabiting with their partners. Most respondents (88.2%) knew about the CHPS concept and more than half (53.4%) accessed healthcare in the CHPS facilities. Most respondents rated the quality of health services (> 65%) and staff attitude (77.2%) very positively. Significant factors influencing the use of the CHPS facilities were; knowledge of the CHPS concept (AOR 6.57, 95% CI 1.57–27.43; p = 0.01), longer waiting time for a vehicle to the facility, and shorter waiting time at the facility before being provided with care. People who waited for 30–60 min (AOR 2.76, 95% CI 1.08–7.07; p = 0.01) or over an hour (AOR 10.91, 95% CI 3.71–32.06; p = 0.01) before getting a vehicle to the facility, while patients who waited for less than 30 min (AOR 5.74, 95% CI 1.28–25.67; p = 0.03) or 30–60 min (AOR 2.60, 95% CI 0.57–11.78; p = 0.03) at the CHPS facility before receiving care were more likely to access care at the CHPS facilities.ConclusionKnowledge, and use of healthcare services at the CHPS facilities were high in this population. Interventions aimed at reducing waiting time at the CHPS facilities could greatly increase use of healthcare services at these facilities.

‘That is because we are alone’: A relational qualitative study of socio-spatial inequities in maternal and newborn health programme coverage in rural Uttar Pradesh, India

ABSTRACT This qualitative study was conducted in Uttar Pradesh state, India to explore how interrelated socio-economic position and spatial characteristics of four diverse villages may have influenced equity in coverage of community-based maternal and newborn health (MNH) services. We conducted social mapping and three focus group discussions in each village, among women of lower and higher socio-economic position who recently gave birth, and with community health workers (n = 134). Data were analysed in NVivo 11.0 using thematic framework analysis. The extent of socio-economic hierarchies and spatial disparateness within the village, combined with distance to larger centers, together shaped villages’ level of socio-spatial remoteness. Disadvantaged socio-economic groups expressed being more often spatially isolated, with less access to infrastructure, resources or services, which was heightened if the village was physically distant from larger centers. In more socio-spatially remote villages, inequities in coverage of MNH services that disadvantaged lower socio-economic position groups were compounded as these groups more often experienced ASHA vacancies, as well as greater distance to and poorer perceived quality of health services nearest the village. The results inform a conceptual framework of ‘socio-spatial remoteness’ that can guide public health research and programmes to more comprehensively address health inequities within India and beyond.

Psychiatric Residential Treatment Facilities for Child Behavioral Health Services in North Carolina Medicaid

Background Psychiatric residential treatment facilities (PRTFs) are non-hospital inpatient treatment settings for children with severe be­havioral health disorders. PRTFs are a restrictive and costly form of care that can potentially be avoided with community-based behavioral health services. Methods Statewide Medicaid enrollment and claims data for 2015–2022 were used to describe PRTF utilization in North Carolina. We examined annual episodes of care in PRTFs and compared trends before and during the COVID-19 public health emergency. Results From 2015 to 2022, 10,038 children insured by NC Medicaid entered a PRTF across 10,966 episodes of care. In the past five years (2018–2022), care in PRTFs resulted in Medicaid expenditures of over $550 million total, or over $100 million per year. In 2022, 42% of children who entered PRTFs were in foster care and 44% of children were placed in PRTFs outside of North Carolina. Limitations The analysis was limited to data collected for administrative purposes. Conclusions Current trends indicate an ongoing overrepresentation of children in foster care placed in PRTFs and increased out-of-state PRTF placements. Coordinated efforts in future research, policy, and practice are needed to determine the cause of these trends and iden­tify solutions.

How cAN we grow research in community-baseD NHS and SociaL CarE Services (HANDLE)?

Background Community-based NHS and social care services offer a wide range of health and social care services, including General Practice, care homes, hospices, community pharmacies, district and community nursing, and mental health services, which provide care from birth to the end of life. However, despite being fundamental to plans for health and critical social care, community-based NHS health services are poorly understood compared to hospital-based services. A scoping exercise failed to identify any specific research examining the barriers and facilitators of community-based NHS and social care services. Objectives 1) To develop a qualitative framework using semi-structured interviews to explore the perspectives and experiences of the research staff and practitioners. 2) To explore how we can build research on community-based NHS and Social Care services using the perspectives and experiences of the research participants. 3) To make recommendations to clinicians, practitioners, policymakers, and funding organizations on how to build research in community-based NHS and Social Care Services. Methods With reference to the literature and input from the project team and key stakeholders, interviews will be conducted using a semi-structured topic guide. The interview guide will identify barriers and facilitators to researching community-based NHS health and social services. Outcomes The intended outcomes of this study could help in understanding and developing strategies to address workforce needs to increase the capacity and capability of research delivery. Further, to embed a research culture in community-based NHS and social care services by supporting collaborative work between primary, secondary, community, and social care to build research capacity and capability; reach underserved communities and increase local engagement and participation in research; and increase equality, diversity, and inclusion by adding research in community-based NHS and social care services where everyone lives.

When one door closes: a qualitative exploration of women’s experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria

BackgroundCOVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources.MethodsThe study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software.ResultsWomen reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women’s SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies.ConclusionCOVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Pop-up micro clinics for pre-exposure prophylaxis of immunocompromised patients

PurposeHealth care systems aspire to adopt integration strategies shifting the focus from acute care to a broader focus on community-based health and social services. Real-world examples demonstrating effective delivery of integrated care are essential.Design/methodology/approachIn this article, we introduce UHN Connected Care Hub, an innovative model of care comprising an interdisciplinary team designing sustainable, shareable practices across the continuum of care alongside community and health organization partnerships.FindingsWe describe UHN Connected Care Hub’s ability to identify patients from high-risk population and collaborate to delivery timely care, in detailing the real world experience of this model of care in the organization of a centralized system of micro-clinics to administer a therapeutic for pre-exposure prophylaxis against COVID-19 (Tixagevimab/cilgavimab [Evusheld]) in a population of immunocompromised patients.Practical implicationsHaving a centralized system of micro-clinics for care delivery presents opportunities for increased adaptability, patient accessibility, enhanced community partnerships and integratedness. Expansion in the scope of services could also create new opportunities in preventative therapies for optimizing the cost effectiveness and quality of health care provided at the population level.Originality/valueThere is limited evidence on how to efficiently deliver integrated care, particularly to vulnerable and co-morbid patients. We discuss how dynamic organizations with proper infrastructure and a network of healthcare partnerships may allow a more fluid response to rapidly changing policies and procedures and facilitate preparedness for future health care crises or pandemics.

Enhancing Non-Communicable Disease Management in Elderly Families: A Community Outreach Initiative

Non-communicable diseases (NCDs) are a significant public health concern, particularly among elderly families. Limited access to healthcare resources and inadequate disease management exacerbation the impact of NCDs on this vulnerable population. This study aimed to implement a community outreach initiative focused on enhancing non-communicable disease management in elderly families. A comprehensive intervention was designed, including health education workshops, individualized health assessments, and the establishment of support networks. Pre- and post-intervention assessments were conducted to measure changes in knowledge levels, health status, health management practices, health behaviors, and family resilience among elderly families. Following the intervention, there was a substantial improvement in knowledge regarding NCDs and their management. Additionally, participants exhibited enhanced health status and more effective health management practices. Positive changes in health behaviors, such as regular exercise and balanced nutrition, were also observed. Moreover, family resilience significantly increased, strengthening their ability to cope with health challenges. The community outreach initiative demonstrated significant positive outcomes in non-communicable disease management among elderly families. Targeted interventions can play a role in empowering this demographic, improve their health and well-being, and encouraging community-based health services.

Management practices in facilities providing HIV services to key populations in Kenya and Malawi: A descriptive analysis of management in community-based organizations.

HIV services for key populations (KP) at higher risk of HIV infection are often delivered by community-based organizations. To achieve HIV epidemic control, countries need to scale up HIV services for KP. Little is known about the management practices of community-based organizations delivering health services. We explored the management practices and facility characteristics of community-based health facilities providing HIV services to key populations as part of the LINKAGES program in Kenya and Malawi. We collected information on management practices from 45 facilities called drop-in centers (DICs) during US Government FY 2019, adapting the World Management Survey to the HIV community-based health service delivery context. We constructed management domain scores for each facility. We then analyzed the statistical correlations between management domains (performance monitoring, people management, financial management, and community engagement) and facility characteristics (e.g., number of staff, organization maturity, service scale) using ordinary least square models. The lowest mean management domain scores were found for people management in Kenya (38.3) and financial management in Malawi (25.7). The highest mean scores in both countries were for performance monitoring (80.9 in Kenya and 82.2 in Malawi). Within each management domain, there was significant variation across DICs, with the widest ranges in scores (0 to 100) observed for financial management and community involvement. The DIC characteristics we considered explained only a small proportion of the variation in management domain scores across DICs. Community-based health facilities providing HIV services to KP can achieve high levels of management in a context where they receive adequate levels of above-facility support and oversight-even if they deliver complex services, rely heavily on temporary workers and community volunteers, and face significant financial constraints. The variation in scores suggests that some facilities may require more above-facility support and oversight than others.

Experiences of participants in the co-design of a community-based health service for people with high healthcare service use

BackgroundIncorporating perspectives of health consumers, healthcare workers, policy makers and stakeholders through co-design is essential to design services that are fit for purpose. However, the experiences of co-design participants are poorly understood. The aim of this study is to explore the experiences and perceptions of people involved in the co-design of a new service for people with high healthcare service utilisation.MethodsA methodology informed by the principles of grounded theory was used in this qualitative study to evaluate the experiences and perceptions of co-design participants. Participants were healthcare professionals, health managers and leaders and health consumers involved in the co-design of the new service in Tasmania, Australia. Semi-structured interviews were conducted, and data were iteratively and concurrently collected and analysed using constant comparative analysis. Audio/audio-visual recordings of interviews were transcribed verbatim. Transcripts, memos, and an audit trail were coded for experiences and perspectives of participants.ResultsThere were thirteen participants (5 health professionals, 6 health managers and leaders, and 2 health consumers). Codes were collapsed into six sub-themes and six themes. Themes were bureaucracy hinders co-design, importance of consumers and diversity, importance of a common purpose, relationships are integral, participants expectations inform their co-design experience and learning from co-design.ConclusionMost participants reported positive aspects such as having a common purpose, valuing relationships, and having a personal motivation for participating in co-design. However, there were factors which hindered the adaptation of co-design principles and the co-design process. Our research highlights that bureaucracy can hinder co-design, that including people with lived experience is essential and the need to consider various types of diversity when assembling co-design teams. Future co-design projects could use these findings to improve the co-design experience for participants, and ultimately the outcome for communities.

Reducing the equity gap in under-5 mortality through an innovative community health program in Ethiopia: an implementation research study

BackgroundThe Ethiopian government implemented a national community health program, the Health Extension Program (HEP), to provide community-based health services to address persisting access-related barriers to care using health extension workers (HEWs). We used implementation research to understand how Ethiopia leveraged the HEP to widely implement evidence-based interventions (EBIs) known to reduce under-5 mortality (U5M) and address health inequities.MethodsThis study was part of a six-country case study series using implementation research to understand how countries implemented EBIs between 2000–2015. Our mixed-methods research was informed by a hybrid implementation science framework using desk review of published and gray literature, analysis of existing data sources, and 11 key informant interviews. We used implementation of pneumococcal conjugate vaccine (PCV-10) and integrated community case management (iCCM) to illustrate Ethiopia’s ability to rapidly integrate interventions into existing systems at a national level through leveraging the HEP and other implementation strategies and contextual factors which influenced implementation outcomes.ResultsEthiopia implemented numerous EBIs known to address leading causes of U5M, leveraging the HEP as a platform for delivery to successfully introduce and scale new EBIs nationally. By 2014/15, estimated coverage of three doses of PCV-10 was at 76%, with high acceptability (nearly 100%) of vaccines in the community. Between 2000 and 2015, we found evidence of improved care-seeking; coverage of oral rehydration solution for treatment of diarrhea, a service included in iCCM, doubled over this period. HEWs made health services more accessible to rural and pastoralist communities, which account for over 80% of the population, with previously low access, a contextual factor that had been a barrier to high coverage of interventions.ConclusionsLeveraging the HEP as a platform for service delivery allowed Ethiopia to successfully introduce and scale existing and new EBIs nationally, improving feasibility and reach of introduction and scale-up of interventions. Additional efforts are required to reduce the equity gap in coverage of EBIs including PCV-10 and iCCM among pastoralist and rural communities. As other countries continue to work towards reducing U5M, Ethiopia’s experience provides important lessons in effectively delivering key EBIs in the presence of challenging contextual factors.

A scoping review of the residual barriers to skilled birth attendance in Ghana: A conceptual framework and a fish bone analysis.

The achievement of the Sustainable Development Goals (SDGs) targets 3.1, 3.2 and 3.3.1 is strongly dependent on the effective utilization of skilled birth services. Despite advancements made in Skilled Birth Attendance (SBA) in Ghana, there are still instances of unassisted childbirths taking place. The aim of this study was to explore the residual barriers of SBA such as community- and health system-related factors affecting SBA in Ghana and to identify strategies for addressing them. An electronic search was done using PubMed, Popline, Science direct, BioMed Central, Scopus and Google scholar for peer reviewed articles as well as grey articles from other relevant sources, published between 200 and 2022 on community- and health system related factors influencing SBA in Ghana. Out of the 89 articles retrieved for full screening, a total of 52 peer-reviewed articles and 1 grey article were selected for the final review. The study revealed that cultural practices (community factors), low quality of service delivery due to the inappropriate behaviors, lack of competency of skilled birth attendants (SBAs) as well as the inefficient distribution of SBAs contribute to ineffective uptake of SBA (health system factors). Also, indirect costs are associated with the utilization of skilled delivery care even with the existence of 'free' delivery care policy under the national health insurance (policy factor). For Ghana to achieve the SDGs above and improve SBA, it is essential to enhance the quality of skilled delivery care by addressing the attitude and competencies of skilled birth professionals, while plans are put in place to expand and develop the Community-based Health Planning and Services (CHPS) strategy to help address the access barriers to SBA. More so, the 'free' delivery care policy should absorb all the costs associated with skilled delivery for pregnant women as it is intended for.

Viable justice: survivors of sexual and gender-based violence and/or torture amongst South Sudanese refugees living in settlements in Northern Uganda

PurposeThe study aimed to listen to refugee survivors of sexual and gender-based violence (SGBV) and/or torture and explore what justice meant to them in exile. This study argues that what the survivors who participated in this research wanted was “viable justice”. The research was funded by the British Academy and Leverhulme Trust.Design/methodology/approachUsing a survivor-focussed justice lens combined with a trauma-informed approach, narrative interviews were held with 41 women and 20 men refugee survivors living in refugee settlements in Northern Uganda. The researchers also conducted semi-structured interviews with 37 key informants including refugee welfare councils, the UN, civil society, non-government and government organisations. Thematic analysis of the data resulted in the following themes being identified: no hope of formal justice for atrocities that occurred in South Sudan; insecurity; lack of confidence in transitional justice processes in Ugandan refugee settlements; abuse and loss of freedom in refugee settlements; and lack of access to health and justice services in refugee settlements.FindingsThis study argues that what the survivors who participated in this research wanted was “viable justice”. That is justice that is survivor-centred and includes elements of traditional and transitional justice, underpinned by social justice. By including the voices of both men and women survivors of SGBV and/or torture and getting the views of service providers and other stakeholders, this paper offers an alternative form of justice to the internationally accepted types of justice, which offer little relevance or restitution to refugees, particularly where the crime has been committed in a different country and where there is little chance that perpetrators will be prosecuted in a formal court of law.Research limitations/implicationsThe research findings are based on a small sample of South Sudanese refugees living in three refugee settlements in Northern Uganda. Thus, wider conclusions should not be drawn. However, the research does suggest that a “viable justice” approach should be implemented that is gender and culturally sensitive and which could also be trialled in different refugee contexts.Practical implicationsImprovements in refugee survivors’ dignity, resilience and recovery are dependent upon the active engagement of refugees themselves using a “survivor-focussed approach” which combines formal and community-based health services with traditional and transitional justice responses.Social implicationsThe provision of a “viable justice approach” ensures those who have experienced SGBV and/or torture, and their families, feel validated. It will assist them to use their internal, cultural and traditional resilience and agency in the process of recovery.Originality/valueThe research findings are original in that data was collected from men and women survivors of SGBV and/or torture and service providers. The empirical evidence supports this study’s recommendation for an approach that combines both formal and survivor-focussed approaches towards health and viable justice services to meet the needs of refugees living in refugee settlements. This is a response that listens to and responds to the needs of refugee survivors in a way that continues to build their resilience and agency and restores their dignity.

Community engagement approaches for malaria prevention, control and elimination: a scoping review

IntroductionGlobally malaria programmes have adopted approaches to community engagement (ACE) to design and deliver malaria interventions. This scoping review aimed to understand, map, and synthesise intervention activities guided by ACE...

Unsung heroes in Ghana’s healthcare system: the case of community health volunteers and community health management committee

BackgroundIn Ghana, the community-based health planning and services (CHPS) policy highlights the significance of both community health management committees (CHMCs) and community health volunteers (CHVs) in the Ghanaian health system. However, research into their specific effects on health system improvement is scarce. Some research has focussed on the roles of the CHMCs/CHVs in implementing specific targeted health interventions but not on improving the overall health system. Therefore, this research aims to examine the role of the CHMCs and CHVs in improving the Ghanaian health system.MethodsThe study was conducted in three districts in the Ashanti region of Ghana. A total of 35 participants, mainly health service users and health professionals, participated in the study. Data were collected using semi-structured individual in-depth interviews. Participants were selected according to their patient–public engagement or community health activity roles. Data were transcribed and analysed descriptively using NVIVO 12 Plus.ResultsWe found that the effectiveness of CHMCs and CHVs in health systems improvement depends largely on how members are selected. Additionally, working through CHMC and CHVs improves resource availability for community health services, and using them in frontline community health activities improves health outcomes.ConclusionsOverall, we recommend that, for countries with limited healthcare resources such as Ghana, leveraging the significant role of the CHMCs and CHVs is key in complementing government’s efforts to improve resource availability for healthcare services. Community health management committees and CHVs are key in providing basic support to communities with limited healthcare personnel. Thus, there is a need to strengthen their capacities to improve the overall health system.

Religion and Poverty Alleviation in South Sulawesi: Analysis at the Village Level

The influence of religion on poverty reduction has become an exciting study in various countries. Several studies have proven no relationship between religious observance and poverty alleviation. However, on the contrary, other studies have proven that religion affects poverty alleviation. In fact, religion should be able to help overcome poverty. Based on this phenomenon, this study will use raw data of Village Potential (Podes) data issued by BPS in 2018 for South Sulawesi Province, with around 3000 villages. The dependent variable of this study is the number of poor people in each village. Poverty data is taken from the number of poverty certificates issued by the village. This data explains the willingness of people to be considered poor, so that it can show voluntary poverty. Meanwhile, the independent variables include the number of religious places of worship, the number of educational institutions, the number of health institutions, the number of electricity customers, and the number of small-scale industries in the village. This study will use a simple regression method to find the relationship between the variables studied. Even though econometrically many variable relationships are not statistically significant which may be due to the completeness and abnormal distribution of the data, there are interesting variable relationships from this study. The relationship between religion and poverty is negative, indicating that religion can reduce poverty. Community-based health services (posyandu) can also reduce poverty. Markets that show economic aspects will also have an impact on reducing poverty. The same thing is technology proxied with electricity customers will also reduce poverty. Meanwhile, the geographic variable proxied by the distance between the village and the sub-district is not significant and the direction is not as expected.
 Keywords: religion, poverty, South Sulawesi

Self-reported uptake of STI testing services among adolescents and young people aged 15-24 years: Findings from the Yathu Yathu cluster randomized trial in Lusaka, Zambia.

There is little evidence regarding community-based delivery of STI testing and treatment for youth aged 15-24 (AYP) in Zambia. In a cluster-randomised trial, we evaluated whether offering syndromic STI screening through community-based, peer-led sexual and reproductive health services (Yathu Yathu) with referral to a local health facility for testing, increased self-reported testing for STIs (other than HIV) among AYP. Two communities in Lusaka were divided into 10 zones each (20 zones in total); by community, zones were randomly allocated (1:1) to Yathu Yathu or control. Monitoring data were used to describe syndromic STI screening through Yathu Yathu and an endline cross-sectional survey used to evaluate the impact of Yathu Yathu on self-reported ever and recent (last 12 months) STI testing. 10,974 AYP accessed Yathu Yathu; 66.6% (females-67.7%; males-64.7%) were screened for STIs, 6.2% reported any STI symptoms. In the endline survey, 23.3% (n = 350/1501) of AYP who ever had sex ever STI tested; 13.5% (n = 174/1498) who had sex in the last 12 months recently STI tested. By trial arm, there was no difference in self-reported ever or recent STI testing among all AYP. Among men aged 20-24, there was evidence that ever STI testing was higher in the Yathu Yathu compared to control arm (24.1% vs 16.1%; adjPR = 1.67 95%CI = 1.02, 2.74; p = 0.04). Among AYP who ever STI tested, 6.6% (n = 23) reported ever being diagnosed with an STI. Syndromic STI management through community-based, peer-led services showed no impact on self-reported STI testing among AYP. Research on community-based delivery of (near) point-of-care diagnostics is needed. Trial registration number(s): NCT04060420 https://clinicaltrials.gov/ct2/show/NCT04060420; and ISRCTN75609016; https://doi.org/10.1186/ISRCTN75609016.

The Role of Nurses as Alternative Providers of Medical Services in Community-Based Care

The demands on the Irish acute and community-based health services are exponential, increasing the patient flow to the GP practice and/or ED department. Many of the attendances at both are as a result of a deficit in alternative options for the population to attend or because the GP practice and ED department have no alternatives to offer patients. This is also due to the increased acuity and complexity of patients being cared for. This is further compounded by a reduction in the workforce further affecting scheduled care. The nursing workforce has experienced significant impact as a result of the pandemic with many nurses deciding to not remain in the profession and instead reskilling for other professions outside of nursing. Other nurses travel for work abroad for experiences not acquired during the pandemic. Those nurses that have remained in the profession are now retiring and some choosing to do so earlier and returning to work through agencies and other alternatives in a flexible way to acquire a work/life balance. The health systems are increasing work pressures on nurses that lead to increased risk of patient and professional risk that many nurses are not comfortable with. Together these issues are compounded onto an existing health structure that is unable to manage the escalation in population needs, year on year.
 Sláintecare is the current Irish health policy with principles including hospital avoidance and early discharge including patient satisfaction, choice and flow. Nursing policy advocates for the advanced capability and competency from graduate to advanced practice. Whilst much attention is duly associated with advanced practice, the practice of all nurses to the full scope of practice is also advocated. Whilst not funded in the same way as advanced practice, opportunities are available for the profession to develop there mode of service delivery similar to other professionals such as GPs, Dentists, Opticians and Pharmacists. The HSE policy advocates for the contracting of all types of services to meet the healthcare demands, however nurses are normally employed within a public/private service or within agency employment.
 This proposed initiative is the development of a private clinical nursing service that can be delivered in the home to meet the patients’ needs avoiding attendance at the hospital and GP clinic. It differs to the current community nursing service in that it offers universal health coverage. Currently, there is no opportunity for public funding to support reimbursement. As mentioned earlier the PCRS system does not reimburse nurses for clinical work undertaken privately and is an issue that requires further investigation. The cost of this project already demonstrates exponential savings to the health services. It is also attractive to the workforce and offers a quality of life to the patients treated in their own homes.. What is offered is the opportunity for each nurse, who wishes to work independently, to place a plaque on the wall and ‘open for business’. This mode of service delivery is novel, innovative and is an opportunity to discover new ways of practice for nurses

Trends and causes of neonatal mortality from 2010 to 2017 at a Health and Demographic Surveillance site in Northern Ethiopia

ABSTRACT Background Half of global under-five mortalities is neonatal. The highest rates are found in low-income countries such as Ethiopia. Ethiopia has made progress in reducing under-five mortality, but neonatal mortality remains high. Evidence collected continuously at the community level is crucial for understanding the trends and causes of neonatal mortality. Objectives To analyse the trends and causes of neonatal mortality at the Kilte-Awlelo Health and Demographic Surveillance System (KAHDSS) site in Ethiopia from 2010 to 2017. Methods A descriptive study was conducted using data from neonates born between 2010 and 2017 at the KAHDSS site. Data were collected using interviewer-administered questionnaires. Causes of death were examined, and neonatal mortality trends were described using simple linear regression. Results The overall average neonatal mortality rate was 17/1000 live births (LBs). The rate increased from 12 per 1000 LBs in 2010 to 15 per 1000 LBs in 2017. The majority of neonatal deaths occurred during the first week of life, and more than one-half died at home. The leading causes were sepsis, pre-term birth (including respiratory distress), disease related to the perinatal period, birth asphyxia, and neonatal pneumonia. Conclusions The high neonatal mortality in Ethiopia requires urgent attention and action. Sepsis, preterm birth, perinatal diseases, asphyxia, and neonatal pneumonia are the leading causes of death in neonates. Facility- and community-based health services should target the leading causes of neonatal deaths.

Constraints on the functioning of Community-based Health Planning and Services facilities: A qualitative study in the Jirapa Municipality, Ghana.

The declaration of the Alma-Alta on primary health care (PHC) in 1978 enjoined nations to make health care accessible, affordable, and situated within their cultural contexts. The Ghana Community-based Health Planning and Services (CHPS), as a strategy to achieve the goal of PHC, has shown significant successes in communities where it has been implemented. However, a number of challenges continue to affect the effective functioning of CHPS. This study explored the community level and health system constraints on the effective functioning of CHPS in the delivering of PHC services in the Jirapa Municipality. A qualitative approach was implemented. A criterion-based purposive sampling technique was employed to recruit 51 managers and health service providers of CHPS for key informant interviews. The respondents included 25 community health management committee members, 25 health officers in charge of CHPS facilities, and one municipal CHPS coordinator. The interviews were held from September 18 to November 23, 2020. All interviews were face-to-face, audio-recorded and transcribed verbatim. Thematic analysis based on the constant comparative method was employed to analyse the data. The results showed that low community involvement in CHPS activities, disputes over the location and naming of CHPS zones, inadequate understanding of the CHPS concept and religious beliefs were the key community level factors which negatively affected the functioning of CHPS. Also, lack of logistics, financial constraints, poor attitude of health workers and inadequate staff motivation were the health sector constraints on the effective functioning of CHPS. In conclusion, concerted efforts are needed to tackle the community level and health system constraints to improve the overall functioning and effectiveness of the CHPS strategy. We recommend the strengthening of community sensitization, timely disbursement of funding, and provision of infrastructure and supplies to improve upon the effective functioning of CHPS as a strategy for delivery PHC in Ghana.

Promoting research for the fragile Somali health system –

A 3-day conference was held in Garowe from the 30th of January to the 1st of February 2022 under the leadership of the Somali National Institute of Health to strengthen the foundation of health research in the country by promoting strategies for health research capacity building, sharing available evidence for action, and widening research collaborative networks. The conference was also instrumental in concretizing plans for improving the existing Somali Universities’ health research performance. It was jointly organized and supported by the National Institute of Health, the Federal Ministry of Health and Human Services, the Public Health Agency of Sweden, the Somali Swedish Researchers’ Association, and a consortium of Somali and Swedish universities. The Puntland State Ministry of Health hosted the conference. This paper summarizes topics presented at the conference and identifies gaps and opportunities for research capacity strengthening in Somalia, which would generate evidence to inform public health policies. An Organizing Committee for the management and logistics of the conference and a Scientific Committee were established, the latter providing expertise in selecting key research topics and speakers/delegates for the conference. More than 180 participants from academic institutions and the health sector service delivery network attended the conference. Twelve panel presentations and 51 abstracts were delivered, covering health system research priorities. Of the 51 presented abstracts, 35% were on communicable diseases, 26% on reproductive maternal, newborn, child, and adolescent health, 24% were on the health system, and 16% on non-communicable diseases. The conference also highlighted the need to build research capacity to support researchers and institutions to strengthen their research skills, including research methodology, data analysis, interpretation, and scientific writing. Highly relevant findings were presented that had the potential to inform health policy and scale up the community-based health services towards Universal Health Coverage and Sustainable Development Goals.