District Health Services Research Articles

O9 - Keeping Rural Maternity Services a top priority: a case review of transitioning to a midwifery-led model of care

Midwifery-led Continuity of Care (MCoC) models is the gold standard in maternity care. This presentation will outline how a regional district health service in NSW implemented its first MCoC model, ensuring a small rural maternity service did not close. Evaluation of the model proved it is safe, cost-effective and highly valued by women. Case review of a district health service co-design and implementation journey that achieved access to a MCoC model in a regional context. The small rural maternity service previously supported on average 40 women a year to birth under a GP led model. The service was proving unsustainable and at risk of closure. With executive support, a MCoC model was co-designed and implemented in partnership with community, midwifery and obstetric teams. Commencing in 2020, the model successfully commenced whilst enduring the impacts of simultaneously moving to a new hospital build and managing a pandemic response. The implementation of the MCoC model enabled access to care for all women, including those with risk during pregnancy by bringing specialist obstetric care to the local community. This is of particular importance in the region to ensure access to safe care for all women and their families close to home in rural and reginal settings. Compared with the previous service, women who received care from the MCoC model in 2021 had improved outcomes, including higher rate of spontaneous labour, more likely to have a normal birth, a reduced rate of caesarean section, required less medical pain relief and were more likely to breastfeed. Access to the MCoC increased the likelihood of women to access pregnancy care early and ongoing.

ANALISA INSTALASI HIBRID SOLAR CELL UNTUK PUSAT PELAYANAN KESEHATAN

Solar cell can be either semi-conductor devices conductive which can directly convert solar energy into electrical energy forms efficiently. This device is used as a detector of light, but it also can be combined in series or parallel to obtain a price of electric voltage value as central of electrical power producer. The purpose of this plan is to program a solar power plant capable of meeting the electricity needs of the District Health Service Center and compare the economic value if use of solar cells to supply electricity comparison of State Electricity Company. Results show that the plan to set up a solar power plant that could meet the electricity needs of the District Health Service Center by 2200 watt required solar modules Sunpower E19-320W with as many as 70 pieces, Sunny Tower ST42 battery charger as many as 1 piece. While US 2200 48V 464ah batteries (capasity 464 Ah, voltage 48 Volt) are needed as much as 10 pieces (9 pieces strung parallel and 1 piece serial). Battery charging time for 10,18 hours, while the battery operating time 40,46 hours. Inverters are used to convert from DC to AC is Sunny Tower ST 42 as many as 1 piece and phase converter used is Booster D16 as many as 2 pieces. Initial investment cost needed is Rp 2.260.821.500,00. While the total cost of care for 25 years the operating cost is Rp 21.700.616.605,00 , so operating costs solar cell for 25 years is Rp 23.961.438.200,00. As for the cost of electricity for 25 years amounting to Rp. 45.696.969.487,00. So that a comparison between the economic value of the solar energy be compared State Electricity Company with subsidized is 1 : 1.91

Implementing active surveillance for tuberculosis: The experiences of healthcare workers at four sites in two provinces in South Africa.

BackgroundThe high burden of tuberculosis (TB) in South Africa (SA) is associated with uncontrolled transmission in communities and delayed diagnosis of active cases. Active surveillance for TB is provided by community-based services (CBS). Research is required to understand key factors influencing TB screening services in the CBS. This study explored the implementation of active surveillance for TB where community-oriented primary care (COPC) had been successfully implemented to identify these factors.MethodsThis was a qualitative study of four established COPC sites across two provinces in SA where active surveillance for TB is implemented. Semi-structured interviews were conducted with purposively selected healthcare workers in the CBS and citizens in these communities. The recorded interviews were transcribed for data analysis using ATLAS.ti software.ResultsThe factors influencing active surveillance for TB were directly related to the major players in the delivery of CBS. These factors interacted in a complex network influencing implementation of active surveillance for TB. Building effective relationships across stakeholder platforms by community health workers (CHWs) was directly influenced by the training, capacity building afforded these CHWs by the district health services; and acceptability of CBS. Each factor interplayed with others to influence active surveillance for TB.ConclusionCommunity health workers were central to the success of active surveillance for TB. The complex interactions of the social determinants of health and TB transmission in communities required CHWs to develop trusting relationships that responded to these issues that have impact on TB disease and linked clients to healthcare.

Research Ready Grant Program (RRGP) protocol: a model for collaborative multidisciplinary practice–research partnerships

BackgroundLittle attention has been given to the process of implementing or evaluating a structured academic–clinician (university–health service) research capacity-building (RCB) model within healthcare settings. We have developed a model for collaborative multidisciplinary practice–research partnerships called the Research Ready Grant Program (RRGP). The RRGP is informed by Cooke’s (BMC Fam Pract 6:44, 2005) RCB framework and principles. The aim of the study outlined in this protocol is to conduct a process and outcome evaluation of the programme. We will explore how the RRGP's structured mentor model contributes to RCB of clinician-led multidisciplinary research teams. We will identify key factors at the organization, team and individual levels that affect research capacity of health professionals working in one regional health service district. This protocol describes the RRGP design and outlines the methods we will employ to evaluate an RCB programme, the RRGP, delivered in a regional health service in Australia.MethodsThe study will adopt an exploratory concurrent mixed-methods approach designed to evaluate the process of implementing an RCB model across one regional hospital and health service. Both quantitative and qualitative data collection methods over a 12-month period will be implemented. Data triangulation will be applied to capture the complex issues associated with implementing collaborative multidisciplinary practice–research partnerships.DiscussionThe RRGP is an innovative RCB model for clinicians in their workplace. It is expected that the programme will facilitate a culture of collaborative multidisciplinary research and strengthen hospital–university partnerships.

Catchment Area in Health Services: Studies in Kasembon and Pujon Subdistricts, Malang Regency

This study aims to analyze the application of health services in Kasembon and Pujon Districts in Malang Regency based on the catchment area perspective, as well as analyze the challenges of the practice of accessing health services. With the background of service improvement efforts that have been done a lot, but in fact, the accessibility is very difficult or even impossible to change. This study uses a qualitative method with a soft system methodology (SSM) approach. The data processing of the findings is carried out through a comparison of real facts with alternative normative models so that they have the opportunity to generate improvement ideas. The results of the study show that there are still challenges in the form of weak access to health insurance, facilities, and human resources, quality standards of health services, the role of monitoring stakeholders, to patterns of community participation. This then resulted in 3 main points of concern to produce corrective action, namely the evaluation of the health care system, health service practice standards, and the accuracy of the health service program targets. This study recommends a top-down mechanism priority by optimizing the improvement of the quality of health service standards in Kasembon and Pujon by policymakers and bottom-up through a participatory pattern by optimizing local public service agencies (BLUD) through community synergy with various institutions and government at lower levels. for managing access to health services.

Bedside ultrasonography prior to abdominal paracentesis is associated with low complication and high success rate: Experience in a National Health Service District General Hospital in the United Kingdom from 2013 to 2019.

To analyse data from a bedside ultrasound-assisted ascites procedure service in a National Health Service District General Hospital and compare them to results of studies in the medical literature. A retrospective review of audit data collected (January 2013 to December 2019) of the practice of paracentesis in a National Health Service District General hospital. All adult patients referred to the ascites assessment service were included. Bedside ultrasound detected location and volume of ascites, if present. Abdominal wall diameters were determined in order to select the appropriate needle length for procedures. Results and scan images were recorded on a pro-forma. Patients who underwent a procedure were followed up for 7 days, with complications documented. Seven hundred and two scans were performed on 282 patients - 127 (45%) male and 155 (55%) female. In 127 (18%) patients, an intervention was avoided. Five hundred forty-five (78%) patients underwent a procedure: 82 (15%) were diagnostic aspirations and 463 (85%) were therapeutic (large volume) paracentesis. Most scans were performed between 08:00-17:00. Average time from patient assessment to diagnostic aspiration was 4 hours 21 minutes. Complications included three failed procedures (0.6%) and one iatrogenic peritonitis (0.2%), but no bowel perforation, no major haemorrhage or death. It is possible to introduce a bedside ultrasound-assisted ascites procedure service to a National Health Service District General Hospital with a high success and low complication rate.

PELATIHAN OXYTOCIN MASSAGE BAGI PENDAMPING IBU NIFAS

Lack of milk production in the first days after giving birth is caused by a lack of stimulation of the hormone prolactin and the hormone oxytocin. Decreased milk production is caused by decreased stimulation of the hormones prolactin and oxytocin. Efforts that can be made to stimulate an increase in the hormones prolactin and oxytocin include early initiation of breastfeeding, expressing breast milk and performing oxytocin massage, while breast care for postpartum mothers is less effective and efficient in increasing breast milk production. In Indonesia (Kemenkes, 2018) the coverage of infants who were exclusively breastfed in 2018 was 68.74%. In 2018, East Java got 77.51%, and especially in Tuban Regency (Tuban District Health Service data) in the same year it got 73.85%, then in 2019 it increased to 79.6%. However, in 2020 there was a decline to 76.93% of infants who were exclusively breastfed. Based on the data above, it shows that the success of exclusive breastfeeding is still not getting optimal results.Oxytocin massage training has never been carried out in Tegalagung Village, especially for breastfeeding companions such as Posyandu cadres, husbands or families. The method used in this community service activity is the method of lectures, discussions, simulations and demonstrations using leaflets and audio-visual media. The number of postpartum mothers who participated in the training was 20 people.The results of training activities for postpartum women assistants in the village of Tegalagung showed that the results of knowledge analysis showed that overall there was an increase in participants' knowledge after attending the training, meaning that there was an influence on increasing the knowledge of postpartum women assistants after participating in oxytocin massage training. So it was concluded that there was an increase in knowledge between before and after training about oxytocin massage.Recommended that health workers need to consistently and continuously provide training to postpartum mother companions (husband, family or cadres) in order to assist the process of behavioral change in postpartum mothers to exclusively breastfeed and provide care during the postpartum period.

The effect of climatic factors on the number of malaria cases in an inland and a coastal setting from 2011 to 2017 in the equatorial rain forest of Cameroon

BackgroundWeather fluctuation affects the incidence of malaria through a network of causuative pathays. Globally, human activities have ultered weather conditions over time, and consequently the number of malaria cases. This study aimed at determining the influence of humidity, temperature and rainfall on malaria incidence in an inland (Muyuka) and a coastal (Tiko) settings for a period of seven years (2011–2017) as well as predict the number of malaria cases two years after (2018 and 2019).MethodsMalaria data for Muyuka Health District (MHD) and Tiko Health District (THD) were obtained from the Regional Delegation of Public Health and Tiko District Health service respectively. Climate data for MHD was obtained from the Regional Delegation of Transport while that of THD was gotten from Cameroon Development Coorporation. Spearman rank correlation was used to investigate the relationship between number of malaria cases and the weather variables and the simple seasonal model was used to forecast the number of malaria cases for 2018 and 2019.ResultsThe mean monthly rainfall, temperature and relative humidity for MHD were 200.38 mm, 27.050C, 82.35% and THD were 207.36 mm, 27.57 °C and 84.32% respectively, with a total number of malaria cases of 56,745 and 40,160. In MHD, mean yearly humidity strongly correlated negatively with number of malaria cases (r = − 0.811, p = 0.027) but in THD, a moderate negative yearly correlation was observed (r = − 0.595, p = 0.159). In THD, the mean seasonal temperature moderately correlated (r = 0.599, p = 0.024) positively with the number of malaria cases, whereas MHD had a very weak negative correlation (r = − 0.174, p = 0.551). Likewise mean seasonal rainfall in THD moderately correlated (r = − 0.559, p = 0.038) negatively with malaria cases, contrary to MHD which showed a very weak positive correlation (r = 0.425, p = 0.130). The simple seasonal model predicted 6,842 malaria cases in Muyuka, for 2018 and same number for 2019, while 3167 cases were observed in 2018 and 2848 in 2019. Also 6,738 cases of malaria were predicted for MHD in 2018 likewise 2019, but 7327 cases were observed in 2018 and 21,735 cases in 2019.ConclusionHumidity is the principal climatic variable that negatively influences malaria cases in MHD, while higher seasonal temperatures and lower seasonal rain fall significantly increase malaria cases in THD.

Challenges and lessons learned during the planning and early implementation of the RTS,S/AS01E malaria vaccine in three regions of Ghana: a qualitative study

BackgroundIn 2019, the RTS,S/AS01E malaria vaccine was introduced on a pilot basis in six regions of Ghana by the Ministry of Health/Ghana Health Service as part of the WHO-coordinated Malaria Vaccine Implementation Programme (MVIP). This is the first time a malaria vaccination programme has been implemented in any country. This paper describes the challenges faced, and lessons learned, during the planning and early implementation of the RTS,S/AS01E vaccine in three out of the six regions that implemented the programme in Ghana.MethodsTwenty-one in-depth interviews were conducted with regional and district health service managers and frontline health workers three months after the start of MVIP in May 2019. Data were coded using NVivo software version 12 and a coding framework was developed to support thematic analysis to identify the challenges and lessons learned during the RTS,S/AS01E implementation pilot, which were also categorized into the Consolidated Framework for Implementation Research (CFIR).ResultsParticipants reported challenges related to the characteristics of the intervention, such as issues with the vaccine schedule and eligibility criteria, and challenges related to how it was implemented as a pilot programme. Additionally, major challenges were faced due to the spread of rumours leading to vaccine refusals; thus, the outer setting of the CFIR was adapted to accommodate rumours within the community context. Health service managers and frontline health workers also experienced challenges with the process of implementing RTS,S/AS01E, including inadequate sensitization and training, as well as issues with the timeline. They also experienced challenges associated with the features of the systems within which the vaccine was being implemented, including inadequate resources for cold-chain at the health facility level and transportation at the district and health facility levels. This study identified the need for a longer, more intensive and sustained delivery of contextually-appropriate sensitization prior to implementation of a programme such as MVIP.ConclusionsThis study identified 12 main challenges and lessons learned by health service managers and health workers during the planning and early implementation phases of the RTS,S/AS01E pilot introduction in Ghana. These findings are highly relevant to the likely scale-up of RTS,S/AS01E within Ghana and possible implementation in other African countries, as well as to other future introductions of novel vaccines.

Retention of medical officers in the district health services of the Western Cape, South Africa: An exploratory descriptive qualitative study.

BackgroundAn adequate health workforce is an essential building block of effective health systems. In South Africa, medical officers (MOs) are a key component of service delivery in district health services. The Stellenbosch University Family Physician Research Network in the Western Cape identified that retention of MOs was a key issue. The aim of this study was to explore the factors that influence the retention of MOs in public sector district health services in the Western Cape, South Africa.MethodsThis is a descriptive exploratory qualitative study. Medical officers were purposefully selected in terms of districts, facility types, gender, seniority and perceived likelihood of leaving in the next four years. Semi-structured interviews were performed by family physicians, and the qualitative data were analysed using the framework method.ResultsFourteen MOs were interviewed, and four major themes were identified: career intentions; experience of clinical work; experience of the organisation; and personal, family and community issues. Key issues that influenced retention were: ensure that the foundational elements are in place (e.g. adequate salary and good infrastructure), nurture cohesive team dynamics and relationships, have a family physician, continue the shift towards more collaborative and appreciative management styles, create stronger career pathways and opportunities for professional development in the district health services, be open to flexible working hours and overtime, and ensure workload is manageable.ConclusionA number of important factors influencing retention were identified. Leaders and managers of the healthcare services could intervene across these multiple factors to enhance the conditions needed to retain MOs.

Availability of public health facilities and utilization of maternal and child health services in districts of India

ObjectiveThis study aims to address the spatial variation in the availability of public health facilities and utilization of Maternal and Child Health (MCH) services at district level in India. MethodsTwo nationally representative secondary data sources such as the National Family Health Survey 2015-16 and Census of India, 2011 were used to identify districts, which are lagging behind in terms of the availability and utilization of MCH services. Mapping and spatial clustering analyses was performed to identify underperforming districts in India. Further, Ordinary least square and spatial autoregressive models were used to determine the predictor for utilization of MCH services at the district level. ResultsSignificantly, less availability of public health facilities and utilization of MCH services were observed in districts of Jharkhand, Bihar, Uttar Pradesh, Madhya Pradesh, Chhattisgarh, and North-Eastern states as compared to the national average. A shortage of 72,198 (21.9%) doctors and 165,791 (17.5%) paramedical staff found at the country level. After controlling for socio-economic factors, we observed that availability of sub-centre, dispensary, and population hospital bed ratio were significant positive predictors for Antenatal Care (ANC) service utilization whereas, shortage of paramedical staff was a negative predictor for full immunization at district level in India. ConclusionsAdequate availability of health facilities, and human resources are needed in districts, which are underperforming in terms of availability and utilization of MCH services to improve utilization of MCH services.

Disruption in Essential Health Service Delivery: A Qualitative Study on Access to Family Planning Information and Service Utilization During the First Wave of COVID-19 Pandemic in Uganda.

BackgroundCoronavirus disease 2019 (COVID-19) remains a challenge to public health with profound impact on people’s lives. With several mitigation measures implemented to curb the spread of COVID-19, these impacted on access and utilization of general health services including family planning (FP) services. The objective of the study was to understand the extent to which COVID-19 interrupted access and utilization of FP services as well as highlight the challenges faced during the lockdown in Uganda.MethodsA qualitative study was carried out in August and September 2020 across the country. A total of 21 key informant interviews among researchers, policy makers, funding agencies, district family planning focal persons, district health officers and service providers with implementing partners were conducted. These were conducted using face to face (7), phone calls (11) and zoom (3) meetings. All interviews were audio recorded and transcribed verbatim. Transcripts were used to identify and generate codes, sub themes and themes. Analysis was done using the thematic framework analysis and results presented in themes.ResultsFive themes were identified in this study which included; (i) financial and psychosocial needs, (ii) mobility hindrances, (iii) disrupted service delivery, (iv) responsive reproductive health services. The financial and psychosocial needs themes included: household and individual financial constraints, unpredictable future and community acceptance, loss of employment and unemployment, misconceptions and unintended pregnancies; while mobility hindrances included; restricted movement, high transport costs, and difficulty in finding transport.ConclusionResults showed that the pandemic had immediate and significant long-term effects on family planning service accessibility, utilization and delivery. The study recommends implementation of telehealth services, country-wide sensitization on use of long-term contraceptive methods, empowering village health teams and making family planning services mandatory and free to all private facilities in order to lower any disruptions during pandemics.

Research capacity-building for clinicians: understanding how the research facilitator role fosters clinicians\u2019 engagement in the research process

BackgroundThere is evidence reporting more positive outcomes from research capacity-building (RCB) programmes that include a research facilitator role. Further, it has been suggested that research facilitator roles can be a useful strategy in building the research capacity of healthcare clinicians. However, until now, little attention has been applied to identifying the characteristics of the research facilitator role and how this role contributes to clinicians’ engagement with the research process. The aim of this present study is to explore the characteristics required of the research facilitator role in the educational workshop phase of an RCB programme.MethodsThis qualitative study employed an inductive approach and utilized face-to-face interviews to gather data from a purposely selected cohort. Professionally transcribed responses were thematically analysed.ResultsThe role of the research facilitator emerged as comprising two main themes: (1) facilitating the research process and (2) engaging expert clinicians as novice researchers. Pragmatically, analysis of data led to the development of a table outlining the responsibilities, skills and attributes related to each theme. Conceptually, theme 1 encapsulates the research facilitators’ skills and experience and their role as knowledge brokers and cocreators of knowledge. Theme 2 provides insight into the clinician-centric approach the research facilitators utilized to build and foster relationships and support the clinicians through their research journey.ConclusionThis study reports on the characteristics of the research facilitator role in one phase of an RCB programme in one regional health service district in Australia and explains how the role fosters clinicians’ engagement with the research process. Findings from this study will inform the development of future RCB programmes, which is important considering that clinicians’ increased engagement with the research process is vital for developing a sound evidence base to support decision-making in practice and leads to higher levels of skills and greater ability to perform useful research.

Accessing Maternal Health Care in the Midst of the COVID-19 Pandemic: A Study in Two Districts of Assam, India.

BackgroundCOVID-19 pandemic and the subsequent national lockdown in India compelled the health system to focus on COVID-19 management. Information from the field indicated the impact of COVID- 19 on the provision of maternal health services. This research presents users' and providers' perspectives about the effect of the pandemic on maternal health services in select districts of Assam.MethodsThe study was undertaken to understand the status of maternal health service provision and challenges faced by 110 pregnant and recently delivered women, 38 health care providers and 18 Village Health Sanitation and Nutrition Committee members during COVID-19 pandemic. Telephonic interviews were conducted with the users identified through simple random sampling. Healthcare providers and the community members were identified purposively.ResultsMost of the interviewed women reported that they could access the health services, but had to spend out-of-pocket (for certain services) despite accessing the services from government health facilities. Healthcare providers highlighted the lack of transportation facilities and medicine unavailability as challenges in providing routine services. The study revealed high proportion of Caesarian section deliveries (42.6%, n = 32) and stillbirths (10.6%, n = 8).DiscussionThis research hypothesizes the supply-side (health system) factors and demand-side (community-level) factors converged to affect the access to maternal health services. Health system preparedness by ensuring availability of all services at the last mile and strengthening existing community-reliant health services is recommended for uninterrupted good quality and affordable maternal health service provision.

The contribution of family physicians to district health services in South Africa: A national position paper by the South African Academy of Family Physicians.

The purpose of this position paper by the South African Academy of Family Physicians (SAAFPs) is to inform decision making on human resources for health policy in South Africa and the placement of family physicians (FPs) in the district health system. National policies have been marred by misunderstanding of the roles and contribution of FPs; and there is unhelpful variability in how FPs are positioned in the health services between provinces. In the private sector, medical aid schemes have discriminated against FPs by failing to remunerate them as specialists and to recognise their scope of practice.

Fit testing and comfort evaluation of prophylactic dressing use for healthcare workers under N95/P2 respirators in one health service district in Australia

This study evaluated the use of prophylactic dressings (silicone foam, silicone tape, hydrocolloid) under N95/P2 respirators to determine which dressings fit successfully. The aim was to develop a health service protocol for one state in Australia. Data were collected during August and September 2021 as part of the Respiratory Protection Programme on 600 health workers using three types of prophylactic dressings. Five different types of respirators were used. Participant healthcare workers rated comfort on a four-point Likert scale. Successful fit was achieved by 63.6% of the respirator-dressing combinations. The best-performing respirator-dressing combination was the Trident® respirator with dressing Mepilex® Lite silicone foam (90.2% pass rate). High pass rates were found in the Trident® respirator with Mepilex® Border Lite with SofSicure silicone tape (79.1%); the 3M™ 1860 respirator with Mepilex® Border Lite with SofSicure silicone tape (74%); and the BSN orange duckbill respirator with Mepilex® Lite silicone foam (69.8%). The poorest-performing combination was the BYD™ respirator with Mepilex® Border Lite with SofSicure silicone tape (25.9% pass rate). Uncorrected chi-squared tests for association revealed significant associations between dressing type and outcome (P=0.004) and respirator type and outcome (P<0.001). Most respondents (82%) found the dressing combination markedly comfortable. When using prophylactic dressings under N95/P2 respirators, it is necessary to perform a fit test. In this study Trident® respirators had the highest probability of successful fit, while BYD™ respirators had the lowest. Combining Trident® respirators with Mepilex® Lite dressing was optimal. Most participants reported greater comfort with the dressings under the respirators.

Analisis Kinerja Petugas Kesehatan Dalam Penemuan Kasus Baru Stunting Pada Balita Diwilayah Kerja Dinas Kesehatan Kabupaten Ogan Komering Ulu Tahun 2021

Stunting prevention efforts are a priority in stunting prevention to reduce the incidence of stunting and prevent the impact. The role of health workers is no less important in preventing stunting. This study aims to analyze the factors related to the performance of health workers in finding new cases of stunting in Ogan Komering Ulu Regency in 2021. This study is a quantitative study, using a cross sectional design. The sample in this study was a total population of 175 respondents. Bivariate analysis used in this study was chi square and multivariate analysis used multiple logistic regression. The results showed that there was a relationship between training (p value 0.000), workload (p value 0.031), leadership (p value 0.000) and infrastructure (p value 0.012) with the performance of health workers in finding new cases of stunting in children under five in the Work Area. Ogan Komering Ulu District Health Office in 2021. Meanwhile, education (p value 0.450), years of service (p value 0.120), attitudes (p value 0.602) and motivation (p value 0.636) were not related to the performance of health workers in finding new cases of stunting in children under five in the Ogan Komering Uu District Health Office Work Area in 2021. The most dominant variable affecting the performance of health workers in finding new cases of stunting in toddlers in the Ogan Komering Ulu District Health Service Work Area in 2021 is leadership (OR 3,954). Based on the results of the study, it is suggested to the Health Office of Ogan Komering Ulu Regency to further increase training activities for health workers, complete supporting facilities and infrastructure, propose rewards for village midwives and nutrition workers, provide a balanced workload and add officers with different backgrounds. nutrition education.

Impact of COVID-19 on the Use of Emergency Contraceptives in Ghana: An Interrupted Time Series Analysis.

The Coronavirus disease pandemic has disrupted reproductive health services including decline in the use of pre-coital contraceptives. However, evidence of its impact on the use of emergency contraceptives, often, post-coital methods, is limited in the emerging literature, hence this study. Data on total number of emergency contraceptive users from January 2018 to February 2020 (pre-pandemic) and March to December 2020 (during the pandemic) were extracted from the Ghana Health Service District Health Information Management System. Interrupted Time Series analysis was used to estimate the impact of the pandemic on the trend of emergency contraceptive use, adjusting for serial autocorrelation and seasonality. The results showed a gradual upward trend in emergency contraceptive use before the pandemic, increasing at a rate of about 67 (95% CI 37.6–96.8; p = 0.001) users per month. However, the pandemic caused a sudden spike in the use of emergency contraceptives. The pandemic and its related restrictions had an immediate effect on the use of emergency contraceptives, increasing significantly by about 1939 users (95% CI 1096.6–2781.2; p = 0.001) in March 2020. Following March 2020, the number of emergency contraceptive users continued to increase by about 385 users per month (95% CI 272.9–496.4; p = 0.001). The evidence shows that use of emergency contraceptives, often used as post-coital methods for unprotected sex was not negatively impacted by the pandemic. In fact, it is the opposite. Hence, in planning for similar situations attention should be given to the distribution of post-coital contraceptive methods.

Effects of COVID-19 on child health services utilization and delivery in rural Mozambique: a qualitative study.

Little is known about the COVID-19 pandemic-related disruptions in health services and the resilience of the health system response in rural low-resource settings. We conducted a phenomenological qualitative study (October-November 2020) to understand COVID-19-related influences on the utilisation and delivery of child health services in Monapo district, rural Mozambique. We interviewed 36 caregivers with children <2.5 years, 21 health providers, and 4 district health services staff using in-person in-depth interviews. Data were analysed using inductive thematic content analysis. Our findings showed that caregivers, providers, and district health services staff unanimously reported a decrease in child consultations at the start of the pandemic. Administrative data from health facilities confirmed persisting declines in monthly consultations. Respondents explained reductions due to miscommunication about health facility operations, fear of COVID-19, reduced consultation schedules, and reduced household incomes. Providers reported several challenges in delivering services including lack of caregiver compliance with risk mitigation measures, caregivers’ fear of risk mitigation measures, perceived lack of caregiver knowledge about COVID-19, and lack of supplies and protective equipment. All respondents described how COVID-19 had increased food insecurity and food prices, and reduced incomes and livelihoods. These negative economic consequences were perceived as the main reason for reported increases in cases of child malnutrition. Despite reductions, child health service utilisation and delivery has largely continued throughout the COVID-19 pandemic, indicating an adaptive and resilient primary health system response in Monapo district. Our findings highlighted the persistent difficulties providers and caregivers face adhering to COVID-19 prevention and risk mitigation measures. A coordinated multi-sectoral response is needed to address the persistent negative economic impacts of the pandemic for young children and their families in rural areas.

Lessons from studies in South Asia and Sub-Saharan Africa on improvement of basic medical education and related health services

South Asia and Sub-Saharan Africa are facing rapid proliferation of medical schools especially in the private sector stimulated by demand for doctors in the mainly curative private health sector. Accreditation has failed to stem declining standards of basic medical education and its increasing irrelevance to national health care needs. Medical graduates tend to opt for careers in high paying specialties and frequently migrate to Western countries for career progression and a better organized lifestyle. However, some recent developments hold promise for improvement and are potential solutions to the problem: (a) the trend towards decentralization of health systems favours strengthening of district health services that hold the key to serve populations equitably, with district hospitals as hubs for integrating clinical care and Primary Health Care; (b) the trend towards diversification of basic medical education to district health services is potentially beneficial for both as they are interdependent; and (c) the realization that accreditation of health professional education must influence health outcomes through practice provides the impetus to improve related health services. The aim of the present review was to find evidence of successful implementation of these measures in South Asia and Sub-Saharan Africa. Evidence of improvements in performance and health outcomes from decentralization of health systems and strengthening of district health services is forthcoming, although provision and management of human and financial resources are challenging. Similarly, there is growing evidence from Sub-Saharan Africa that improvement of health professional education and quality of health care occurs when experiential learning is based at district level hospitals and its related health services; albeit the evidence is presently limited to externally supported projects. Accreditation based on successful integration of medical education and health services, is the weakest link. Although there is growing pressure for national accreditation agencies to implement global standards of basic medical education, without the context of professional development associated with coordinated improvement in related health services the notion that global standards will improve health care lacks credibility. Eventually, effective convergence of these measures is required if the daunting health challenges in South Asia and Sub-Saharan Africa are to be addressed sustainably.