Coverage Of Health Services Research Articles

Digital health tools and technologies dimensions for equitable access to health, including Universal Health Coverage in developing economies

This study sought to investigate digital health tools and technologies dimensions for equitable access to health, including Universal Health Coverage in developing economies. Universal Health Coverage (UHC) is a promise of accessible and high-quality healthcare, which addresses coverage of essential health services and catastrophic health spending, in line with goal 3 of the United Nations Sustainable Development Goals (SDGs). However, the problem of inequitable access to health, including UHC, continues to plague the entire endeavour, even with notable technological advancements among the population and within the health sector. This study uses a narrative literature review methodology to investigate the dimensions of digital health tools and technologies for equitable access to health, including UHC. The findings from this study identify internet access, availability of internet, availability of a smart device, and device access to digital content as key dimensions for equitable access to health, including UHC in developing economies, and in line with digital health tools and technologies. Considering these dimensions will ensure that developed and deployed interventions are available and accessible to the majority of the population. Ultimately promoting digital health and equitable access to health, as well as ensuring that key dimensions of digital health tools and technologies are not assumed.

Translating restrictive law into practice: An ethnographic exploration of the systemic processing of legally restricted health care access for asylum seekers in Germany

BackgroundAccess to health services for asylum seekers is legally restricted in Germany. The law is subject to interpretation, therefore the chance of receiving care is not equally distributed among asylum seekers. What services are provided to whom is ultimately decided by health professionals and government employees. The respective prioritization processes and criteria are not transparent. We sought to understand how legal restrictions are translated into daily practices and how this affects the health system. We aimed to outline the complex process of cost coverage for health services for asylum seekers and provide insights into common decision-making criteria.MethodsWe conducted an ethnographic exploration of routines in two outpatient clinics in two federal states over the course of three months, doing participant and non-participant observation. Additionally, we interviewed 21 professionals of health care and government organizations, and documented 110 applications for cost coverage of medical services and their outcome. In addition to qualitative data analysis and documentation, we apply a system-theoretical perspective to our findings.ResultsTo perform legal restrictions a cross-sectoral prioritization process of medical services has been implemented, involving health care and government institutions. This changes professional practices, responsibilities and (power) relations. Involved actors find themselves at the intersection of several, oftentimes conflicting priorities, since “doing it right” might be seen differently from a legal, medical, economic, or political perspective. The system-theoretical analysis reveals that while actors have to bring different rationales into workable arrangements this part of the medical system transforms, giving rise to a sub-system that incorporates migration political rationales.ConclusionsHealth care restrictions for asylum seekers are implemented through an organizational linking of care provision and government administration, resulting in a bureaucratization of practice. Power structures at this intersection of health and migration policy, that are uncommon in other parts of the health system are thereby normalized. Outpatient clinics provide low-threshold access to health services, but paradoxically they may unintentionally stabilize health inequities, if prioritization criteria and power dynamics are not made transparent. Health professionals should openly reflect on conflicting rationales. Training, research and professional associations need to empower them to stay true to professional ethical principles and international conventions.

Drivers of universal health coverage in Makueni county, Kenya: Lessons for the Global South

All UN member States committed to realizing universal health coverage (UHC) when they included UHC as Target 3.8 in the Sustainable Development Goals in 2015. However, the global commitment to UHC has not been matched with action on the ground. According to the World Health Organization, about half of the world population lacks full coverage for essential health services. To accelerate progress toward UHC, a close understanding of factors that drive adoption of UHC policies at the national and local levels is essential. The purpose of this study was to investigate the impetus for establishing a sub-national health insurance program in Kenya—the Makueni county government health insurance program (MakueniCare)—which led to increasing the percentage of the county population with health insurance, the majority of whom live in poverty, from 8.8% in 2013 to 91% in 2018. This qualitative case study drew on Kenyan law and policy documents as well as semi-structured interviews with 30 key informants in government and NGOs to understand the drivers that led to the establishment of MakueniCare. Findings revealed that several drivers—namely, global norms, decentralization, democratic competition, and the strategic action of social change-minded leaders—coalesced to influence the adoption of MakueniCare. The study offers timely insights into the factors driving UHC in Makueni, Kenya and lessons for other low- and middle-income countries working toward UHC.

Drug problems and treatment services at the community level: findings from a national sample of key informants in Nigeria

ABSTRACT Aims This study aimed to provide community-level perspectives on substance use, related health and social harms and utilization of treatment for substance use disorders in Nigeria. Methods The study is based on descriptive-qualitative data from semi-structured interviews with a purposive sample of 2,787 key informants (e.g. police officers, health workers) from the 36 states of Nigeria. Results The findings highlight social, economic, legal, academic, occupational and health problems linked to drug consumption. Drug-related problems extended beyond individuals who consume drugs to impact close relations and local communities. Government-funded facilities (e.g. general hospitals, specialist psychiatric facilities) were thought to be more available, accessible and acceptable to people seeking treatment for substance use disorders than other types of facilities (e.g. faith-based facilities, NGO treatment centers). The provision and uptake of services in these facilities are constrained by financial cost and inadequate specialist services for drug use owing to shortage of skilled professionals. Conclusion There exist a need to improve access to substance use disorder treatment through development of skilled manpower, expansion of health service coverage and strengthening of community-based services. Further, prioritizing healthcare services and combating stigma against people who use drugs could contribute to uptake of services.

Informing policy with health labour market analysis to improve availability of family doctors in Tajikistan

BackgroundTajikistan has embarked on health reforms to orient the health system towards primary health care (PHC). The health labour market analysis (HLMA) was initiated by the Ministry of Health with the World Health Organization (WHO) on policy questions related to the PHC workforce team. This article presents the results with focus on family doctors as a critical part of the PHC team, providing lessons for strengthening family medicine and PHC in the European Region and central Asia.MethodsThe HLMA framework was used to guide the analysis. The data for analysis were provided by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. Descriptive means were used to analyse the data. A Technical Working Group guided the process.ResultsThere has been an increase in the number of health workers in the country over the last 7 years. However, there is a huge shortage of family doctors when compared with norms, with decreasing family doctor densities over the last 7 years. Family doctors have the highest vacancy rates among specialists and also constitute the highest proportion of specialists who migrate. There is inequitable distribution of doctors across the regions. Overall number of enrolments and graduates in family medicine are declining. Although salaries in PHC are higher than in hospitals, the overall health workforce salaries are lower than the national average. While there have been efforts to retain and attract doctors to PHC in rural and remote regions, challenges exist. The attraction of doctors to narrow specialties may be leading to undermining PHC and family medicine. While the optimal skill-mix and availability of nurses provide an opportunity to strengthen multi-disciplinary teams at the PHC level, shortages and unequal distribution of doctors are affecting health services coverage and health indicators.ConclusionsApplication of the HLMA framework has helped identify the bottlenecks in the health labour market flows and the possible explanations for them. The policy considerations emerging out of the HLMA have contributed to improving evidence-based planning for retention and recruitment of the PHC workforce, improvements in medical and nursing education, and higher investments in the PHC workforce and particularly in family doctors. Implementation of the Action Plan will require political commitment, financial resources, strong inter-sectoral collaboration, stakeholder management, and cross-country learning of best practices. Through this process, Tajikistan has shown the way forward in implementing the Central Roadmap for health and well-being in Central Asia and the Framework for Action on the Health and Care Workforce in the WHO European Region.

Can "the expanded free maternity services" enable Kenya to achieve universal health coverage by 2030: qualitative study on experiences of mothers and healthcare providers.

Universal health coverage is a global agenda within the sustainable development goals. While nations are attempting to pursue this agenda, the pathways to its realization vary across countries in relation to service, quality, financial accessibility, and equity. Kenya is no exception and has embarked on an initiative, including universal coverage of maternal health services to mitigate maternal morbidity and mortality rates. The implementation of expanded free maternity services, known as the Linda Mama (Taking Care of the Mother) targets pregnant women, newborns, and infants by providing cost-free maternal healthcare services. However, the efficacy of the Linda Mama (LM) initiative remains uncertain. This article therefore explores whether LM could enable Kenya to achieve UHC. This descriptive qualitative study employs in-depth interviews, focus group discussions, informal conversations, and participant observation conducted in Kilifi County, Kenya, with mothers and healthcare providers. The findings suggest that Linda Mama has resulted in increased rates of skilled care births, improved maternal healthcare outcomes, and the introduction of comprehensive maternal and child health training for healthcare professionals, thereby enhancing quality of care. Nonetheless, challenges persist, including discrepancies and shortages in human resources, supplies, and infrastructure and the politicization of healthcare both locally and globally. Despite these challenges, the expanding reach of Linda Mama offers promise for better maternal health. Finally, continuous sensitization efforts are essential to foster trust in Linda Mama and facilitate progress toward universal health coverage in Kenya.

Progress and scenario-based projections of health service availability and coverage towards UHC in the post-conflict and post-pandemic Iraq: a Bayesian hierarchical regression approach

BackgroundTwo decades have passed since the beginning of the Iraq War in 2003. Iraq has long suffered from conflicts and instability, where the people have limited access to healthcare. The...

Ten Year Evaluation of JKN: Strengthening Primary Health Care for National Resilience

This study evaluates the achievements of the National Health Insurance (JKN) over the past ten years, focusing on strengthening primary healthcare for national health system resilience. Launched on January 1, 2014, JKN aims for equitable healthcare access for all Indonesians, with participants reaching over 220 million by 2023. JKN has increased basic health service coverage, including immunization, maternal and child care, and treatment of diseases. Primary healthcare's role is vital in disease prevention, early diagnosis, treatment, and chronic disease management. Case studies highlight successful outreach programs. Challenges include funding deficits, uneven service quality, and lack of medical personnel in remote areas. Recommendations include increased budget allocations, incentive policies, continuous training, integration of services, effective health information systems, and community participation

Public mental health services in Southern China and related health outcomes among individuals living with severe mental illness

Background Although national policies in China are comprehensive and instructive, a wide disparity exists between different cities. The current status of public mental health services by region in China remains unclear. This study aimed to investigate policies related to public mental health services, the contact coverage of public mental health services and outcomes of service users.MethodsA cross-sectional study was carried out in Southern China, between April 2021 and March 2022. Considering the geographical location, socioeconomic development levels, and prevalence of severe mental illness, four cities including Wuhan, Changsha, Guangzhou, and Shenzhen were selected. Relevant service providers were asked to report data on mental health policies and facility-related information, including mental health resources, registration rates of patients, management rates of patients, and medication rates of patients. Eligible patients were invited to report service user-related data, including contact coverage of public mental health services and their outcomes. SPSS 26.0 was used for data analysis.ResultsThe four cities in Southern China have made different efforts to develop public mental health services, primarily focusing on socio-economically disadvantaged individuals. Community health centers in Guangzhou and Shenzhen reported having more professional human resources on mental health and higher mental health budgets for patients. The contact coverage rates of most public mental services were higher than 80%. Patients in Changsha (B = 0.3; 95%CI: 0.1–0.5), Guangzhou (B = 0.2; 95%CI: 0.1–0.3), and Shenzhen (B = 0.3; 95%CI: 0.1–0.4) who received social medical assistance services reported higher levels of medication adherence. Patients in Wuhan (B = -6.5; 95%CI: -12.9--0.1), Guangzhou (B = -2.8; 95%CI: -5.5--0.1), and Shenzhen who received community-based rehabilitation services reported lower levels of disability (B = -2.6; 95%CI: -4.6--0.5).ConclusionsThere have been advances in public mental health services in the four Southern cities. The contact coverage rates of most public mental health services were higher than 80%. Patients’ utilization of public mental services was associated with better health outcomes. To improve the quality of public mental health services, the government should try to engage service users, their family members, and supporters in the design, delivery, operationalization, and evaluation of these public mental health services in the future.

Utilization of allogeneic hematopoietic stem cell transplantation among patients with newly diagnosed acute myeloid leukemia in California: a population-based linked dataset study.

Acute myeloid leukemia (AML) often requires allogeneic hematopoietic cell transplantation (alloHCT) for cure, but historically alloHCT has been strikingly underutilized. Reasons for this remain uncertain at the population level. We examined alloHCT utilization over time and explored associations between demographic/healthcare factors and use of alloHCT by age group (AYA 15-39y, adult 40-64y, older adult 65-79y) using a linked dataset merging the Center for International Blood and Marrow Transplant Research, California Cancer Registry, and California Patient Discharge Database. Eligibility included patients newly diagnosed with AML in California between 2001-2016 who received induction therapy and had no prior HCT. Multivariable Fine-Gray regression analyses were fitted separately across age groups. Among 7,925 patients with AML, alloHCT utilization increased over time across all age groups; however, in the most recent time period studied (2011-2016), utilization within 2 years of diagnosis remained lowest in older adults (13%) relative to adults (41%) and AYAs (49%). Factors statistically significantly associated with lower alloHCT utilization: (1) AYAs: female sex, lower neighborhood socioeconomic status (nSES), uninsured or Indian Health Services (IHS) coverage; (2) adults: older age, male sex, non-Hispanic Black or Asian race and ethnicity, unmarried, lower nSES, uninsured or covered by Medicaid, Medicare, or IHS, higher comorbidity, and living 100+ miles from a transplant center; and (3) older adults: older age, Asian race, and unmarried. In conclusion, using a population-based linked dataset, we demonstrate that utilization of alloHCT among older patients newly diagnosed with AML remains low in California, and factors associated with utilization vary by age group.

Stakeholder Perspectives on the Governance and Accountability of Nigeria's Basic Healthcare Provision Fund.

In recent decades, Nigeria has implemented a number of health financing reforms, yet progress toward Universal Health Coverage (UHC) has remained slow. In particular, the introduction of the Basic Health Care Provision Fund (BHCPF) through the National Health Act of 2014 sought to increase coverage of basic health services in Nigeria. However, recent studies have shown that health financing schemes like the BHCPF in Nigeria are suboptimal and have frequently attributed this to weak accountability and governance of the schemes. However, little is known about accountability and governance of health financing in Nigeria, particularly from the perspective of key actors within the system. This study explores perceptions around governance and accountability through qualitative, in-depth interviews with key BHCPF actors including high-level government officers, academics and Civil Society Organisations. Thematic analysis of the findings reveals broad views among respondents that financial processes are appropriately ring-fenced, and that financial mismanagement is not the most pressing accountability gap. Importantly, respondents report that accountability processes are unclear and weak in subnational service delivery, and cite low utilisation, implicit priority-setting, and poor quality as issues. To accelerate UHC progress, the accountability framework must be redesigned to include greater strategic participation and leadership from subnational governments.

The impact of digital interventions on health insurance coverage for reproductive, maternal, newborn and child health services in Kakamega, Kenya: a cluster randomized controlled trial.

The National Hospital Insurance Fund (NHIF) of Kenya was upgraded to improve access to healthcare for impoverished households, expand universal health coverage (UHC), and boost the uptake of essential reproductive, maternal, newborn and child health (RMNCH) services. However, premiums may be unaffordable for the poorest households. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program targets low-income women and their households to improve their access to and utilization of quality healthcare, including RMNCH services, by providing subsidized, mobile phone-based NHIF coverage in combination with enhanced, digital training of community health volunteers (CHVs) and upgrading of health facilities. This study evaluated whether expanded NHIF coverage increased the accessibility and utilization of quality basic RMNCH services in areas where i-PUSH was implemented using a longitudinal cluster randomized controlled trial in Kakamega, Kenya. A total of 24 pair-matched villages were randomly assigned either to the treatment or the control group. Within each village, 10 eligible households (i.e., with a woman aged 15-49 years who was either pregnant or with a child below 4 years) were randomly selected. The study applied a Difference-in-Difference methodology based on a pooled cross-sectional analysis of baseline, midline and endline data, with robustness checks based on balanced panels and ANCOVA methods. The analysis sample included 346 women, of whom 248 had had a live birth in the 3 years prior to any of the surveys, and 424 children aged 0-59 months. Improved NHIF coverage did not have a statistically significant impact on any of the RMNCH outcome indicators at midline nor endline. Uptake of RMNCH services, however, improved substantially in both control and treatment areas at endline compared to baseline. For instance, significant increases were observed in the number of antenatal care visits from baseline to midline (mean = 2.62 to 2.92) p < 0.01) and delivery with a skilled birth attendant from baseline to midline (mean = 0.91 to 0.97 (p < 0.01). Expanded NHIF coverage, providing enhanced access to RMNCH services of unlimited duration at both public and private facilities, did not result in an increased uptake of care, in a context where access to basic public RMNCH services was already widespread. However, the positive overall trend in RMNCH utilization indicators, in a period of constrained access due to the COVID-19 pandemic, suggests that the other components of the i-PUSH program may have been beneficial. Further research is needed to better understand how the provision of insurance, enhanced CHV training and improved healthcare quality interact to ensure pregnant women and young children can make full use of the continuum of care.

Global, Regional and National Burden of Paediatric Atopic Dermatitis: A Trend and Geographic Inequalities Analysis.

Atopic dermatitis (AD) is a common chronic skin disorder in children. We aimed to investigate trends and regional disparities of burden in paediatric AD at global, regional and national levels, and to explore potential associated factors. Based on data from Global Burden of Disease study 2019, we assessed trends in burden of AD aged <19 years from 1990 to 2019, including prevalent and incident cases, age-standardised prevalence and age-standardised incidence. For potential associated factors, correlations of above trends and indexes of socio-economic status (sociodemographic index, SDI) and health service coverage (universal health coverage index, UHCI) were evaluated. We conducted decomposition analysis to understand the net contribution of population-level factors and their contribution proportions on changes of prevalent and incident cases, including age structure, population change and epidemiological change. Global prevalent and incident cases of paediatric AD increased by about 5.7 and 0.7 million between 1990 and 2019, respectively. Global age-standardised prevalence and incidence decreased by -0.17% (-0.19% to -0.16%) and -0.12% (-0.13% to -0.11%) per year from 1990 to 2019, respectively. Regionally, the highest increase of prevalent and incident cases was in low SDI region (by 96.77% and 84.85%); the highest decrease of age-standardised prevalence and incidence was in high SDI regions (by -0.20% and -0.27% per year). The correlation analyses identified significant negative correlations between trends and SDI and UHCI. Population change was a major driver of case rise; epidemiological change and age structure showed negative impact of case rise. Regional disparities in contribution of three population-level factors were seen, including net contribution direction (positive or negative) and contribution proportion levels. Global paediatric AD case numbers increased, primarily due to population growth. Prevalence and incidence decreased slightly. Geographic inequalities were seen. Developing region-specific strategies targeting potential factors is essential to reduce paediatric AD burden.

Understanding inequalities in the coverage of adolescent sexual and reproductive health services: a qualitative case study of the selected regions of Zambia.

Despite substantial investment in improving healthcare among adolescents in low- and middle-income countries, barriers to access and utilization of services persist, especially to sexual and reproductive health (SRH) services. In response to adolescents' health service needs due to their vulnerability, interventions aimed at improving access and utilization of sexual and reproductive health services have been implemented in specific regions of Zambia. To highlight progress in the access and the overall delivery of services in Zambia, in the wake of a system-level funding mechanism, this paper aims to understand the accessibility, availability, acceptability and quality (AAAQ) of health services provided to young people. In a qualitative case study, 48 discussions- 32 individual interviews with stakeholders and 16 focus group discussions, consisting of 128 male and female adolescents were conducted in six districts from Eastern, Southern and Muchinga provinces of Zambia. Interviews were audio-recorded, recordings transcribed verbatim, and transcripts were analysed using deductive thematic analysis, using the AAAQ framework and Atun's framework on integration, as a guide to reporting the findings. We found that adolescents knew of and had access to common commodities and services- male condoms, health education and HIV counselling and testing. However, availability was affected by access-related barriers such as frequent stock-outs and insufficiently trained healthcare providers. In addition, accessibility was more restricted during the COVID-19 pandemic lockdown and compounded by the low acceptability of SRH service among adolescents across all contexts. This led to the use of alternatives such as herbal medicine and maintained common myths and misconceptions. The overall quality was marred by the lack of dedicated spaces for adolescent health services and the lack of information, education and communication (IEC) materials in some spaces. While it was noted that some services were available for adolescents in all the study sites, numerous barriers inhibited access to these services and had an impact on the quality-of-service provision. With the added restriction to SRH service asses for young people, due to the low acceptability of adolescent SRH service use, the overall integration of adolescent SRH interventions into routine service provision was low and can be improved by targeting contextual barriers and maintaining best practices.

Analysis the Healthy School Campaign in Indonesia: A Health Policy Triangle Approach

The School Health Program policy was initiated by the Indonesian government in 2014. However, by 2021, student health service coverage was still suboptimal. The Healthy Schools Campaign Program was introduced in 2022 as an alternative policy to revitalize the School Health Programme. The study aimed to analyze the Healthy School Campaign Program using the health policy triangle framework, which includes actors, content, process, and context. This research uses qualitative methods with secondary data sourced from electronic document searches. The main actors in this policy involve official government institutions, supported by collaboration with non-government partners. Policy selection is based on situational, structural, cultural and international contextual factors. The program content focuses on physical health, healthy nutrition, and student immunization. The conclusion is that the selection of content is influenced by how actors identify health problems in the early stages of policy preparation. Implementation of this program requires a clear collaboration system as a reference for its implementation in educational units. Teacher and parent involvement is also very important to increase the effectiveness and sustainability of the program.

Fuzzy and spatial analysis of cutaneous leishmaniasis in Pará State, Brazilian Amazon: an ecological and exploratory study.

This study sought to analyze the relationships between cutaneous leishmaniasis and its epidemiological, environmental and socioeconomic conditions, in the 22 microregions of Pará state, Brazil, for the period from 2017 to 2022. In this ecological and exploratory study, the microregions were used as spatial units because they are formed by contiguous municipalities with similar characteristics. The epidemiological, environmental, socioeconomic, and public health policy data employed were obtained from the official information systems at the Ministry of Health, National Institute for Space Research, and Brazilian Institute of Geography and Statistics. A fuzzy system was developed to identify risk factors for the disease, using Python programming language. The results were analyzed with the bivariate Global Moran spatial analysis technique. It was observed that the Altamira microregion had the highest risk percentage for the disease, while Breves had the lowest, with significant differences in the relevance of its conditioning factors, mainly related to land use and cover patterns, in addition to demography and living conditions index, education and public health policies. The fuzzy system associated with the geostatistical technique was satisfactory for identifying areas with health vulnerability gradients related to deforestation, pasture, poverty, illiteracy, and health services coverage, as its conditioning variables. Thus, it was demonstrated that deforestation was the main risk factor for the disease. The system can also be used in environmental and epidemiological surveillance.

School Dropout, Absenteeism and Coverage of Sexual and Reproductive Health Services in South Africa: Are Those Most at Risk Reached?

School attendance or completion is important for adolescents’ development. Adolescents who drop out or are regularly absent from school are at higher risk of adverse sexual and reproductive health (SRH) outcomes. However, there is little evidence evaluating SRH service coverage among adolescents in and out of school. In the context of a large-scale combination HIV and pregnancy prevention intervention funded by the Global Fund, we compared the SRH intervention coverage and SRH risks among adolescent girls who dropped out of school with those who were still in school or who had completed grade 12 in South Africa. Among those still in school, we compared the SRH intervention coverage and SRH risk profiles of those with high versus low or no absenteeism. In 2017 to 2018, we conducted a household survey of adolescent girls aged 15 to 19 years in six of the ten combination intervention districts. Of 2515 participants, 7.6% had dropped out of school. Among the 1864 participants still in school, 10.8% had high absenteeism. Ever having had sex, and condomless sex were more prevalent among dropouts compared with non-dropouts. Dropouts were more likely to access SRH services such as condoms and contraceptives, except the combination prevention intervention services which were more likely to reach those who had not dropped out and were equally likely to reach those in school with high versus low/no absenteeism. Combination SRH prevention programmes can improve the accessibility of SRH services for adolescents in school/who complete school.

A community proactive health management model for family doctors in Shandong, China.

Background Chronic disease management is an essential part of public health management and a fundamental means of slowing down the progression of major diseases. Unlike traditional medical care, proactive health management focuses on the combination of prevention and treatment. Proactive health management can reduce the re-admission rate of patients with chronic diseases, improve long-term prognosis, and effectively reduce the disability and mortality rates of major health events. This study aimed to establish a proactive health management model based on a grid-based medical service team arrangement, and to explore the effect of this model on managing chronic diseases in community health service institutions. Methods A grid-based medical service team was established in Binzhou, Shandong, China, consisting of general practitioners, nurses, public health doctors, health promoters and community grid liaison staff. Each team was responsible for several areas to monitor critical populations within the grid and compile statistics on the health management of these key populations in 2022-2023. Results A total of 2050 patients with coronary artery disease, 4973 patients with hypertension, and 1621 patients with type 2 diabetes were followed up in 2022. Compared with 155,612 resident health records in 2022, the number of records increased by 140.50% in 2023. The number of patients with hypertension under health management in 2023 increased by 50.92%; patients with type 2 diabetes increased by 74.65%; and the number of coronary artery disease increased by 42.00%. After the implementation of grid management, the hospitalisation rate for patients with type 2 diabetes significantly decreased in 2023 (P P >0.05). Conclusion The grid-based community proactive health management model makes full use of the advantages of community resources and improves the pertinence and coverage of community health services. Moreover, it reduces hospitalisation for patients with type 2 diabetes.

Health system performance assessment and reforms, Oman.

To prioritize key areas of action and investment for the next strategic cycle of national development plans (2026-2031) in Oman, we needed a holistic view of the country's health system and its main deficiencies and inefficiencies. Informed by the World Health Organization framework, our team of seven national health ministry staff and two international experts conducted a rapid health system performance assessment. We used already available data to identify system bottlenecks and their potential root causes, verifying our findings with key informant interviews. Oman's 4.9 million population is relatively young (average age 28years) but ageing, with a mounting burden of chronic diseases. While health-care services are free for Omani nationals, more than 1.5 million expatriates rely on out-of-pocket payments for health-care services. Strengthening primary health care, improving the quality of care, providing financial protection, and ensuring that public and private health-care providers operate within the same legal and procedural framework are recognized as key national priorities. Our assessment highlighted the need to extend health service coverage to the whole population, strengthen private health-care sector governance, improve health education, increase financial investment, and expand the country's capacity for data collection and analysis. The assessment framework allowed us to identify areas where information is lacking and use already available data to analyse multiple health outcomes. As well as identifying issues that need to be addressed during the next policy development cycle, our findings have contributed towards the preparation of a more extensive assessment.

Pendampingan Ibu Hamil Sebagai Upaya Meningkatkan Perilaku Kesehatan dan Persalinan di Fasilitas Kesehatan

Low coverage of antenatal care (ANC) and mothers’ delivery conducted not in the health care facilities were two major problems related to maternal health care in of the West Nusa Tenggara Province. The accompaniment to pregnant women could be solution to prevent the risks of pregnancy by increasing the coverage of ANC and directing mother to deliver in health care facilities. This study aims to study the effect of mentoring pregnant women on maternal health behavior during pregnancy until delivery. A quasi-experiment study was conducted in two districts namely East and Central Lombok. Two public health centers ‘Puskesmas’ were selected in each districts. They differed as the intervention and controlled health centers. The criteria for the both health centers were having high number of pregnant women, but low coverage of maternal health services. The control health centers defined as having the closest distance from the intervention one. Study population of this study were all pregnant women in the study area. Sample were selected for those women with the gestational age of 24-26 weeks and willing to be accompanied further or neither not delivery. The total of 130 women were randomly selected from the study population. Results showed the accompaniment of pregnant women was able to increase the score of health behavior as compare to the control group. Pregnant women with accompaniment were 30 times higher chance of better health behavior (OR=30.89; 95%CI=10.72-84.40), and 3 fold prefer to deliver at health facilities (OR=2.89; 95%CI=1.16-7.21). Other positive impact of accompaniment was the obedience of iron pill at least 90 tablets, as well as food supplementation taken. Student accompaniment brought a positive impact to pregnant women on health behavior and delivery in health facility.