Functioning Of Health Systems Research Articles

An evaluation of the introduction of telehealth for remote antenatal and postnatal contacts in Bangladesh and Lao People's Democratic Republic during the COVID-19 pandemic.

From 2020, COVID-19 spread rapidly around the globe and continues to have a major impact on health system functioning, with a disproportionate impact on low- and middle-income countries (LMIC). Reduced service utilisation and coverage of essential childbirth interventions is likely impacting maternal and newborn morbidity and mortality. Telehealth has been identified as an important tool in the continued provision of essential healthcare services. The aim of this study was to explore the experience and impact of implementing telehealth services for the provision of remote antenatal (ANC) and postnatal (PNC) contacts in regions of Bangladesh and Lao People's Democratic Republic through 100 semi-structured interviews with health service leaders and providers, and childbearing women who organised, provided, or were the recipients of ANC and PNC telehealth during the COVID-19 pandemic response. The findings showed that a sudden pivot from face-to-face to telehealth services posed both health system and provision of care challenges. Health systems lacked funding to support telehealth and the infrastructure needed for service changes; however, some were able to work with key maternal child health departments within Ministries of Health to find the resources to implement the services. Health providers found telehealth beneficial during the pandemic response but identified a lack of training, guidance, and support as a barrier to changing practice. Childbearing women reported being fearful of accessing care at health services due to COVID-19, and whilst they appreciated the telehealth contacts, many continued to prefer face-to-face delivery of ANC and PNC care. Telehealth, however, was a good alternative in a time when face-to-face care was not possible. Considerations for post-pandemic broader implementation or scale-up of telehealth for routine antenatal and postnatal maternity care provision include the need for further research on issues such as accessibility, acceptability, quality of care, and sustainability of service provision.

Measuring Patient Hazard Exposure–The Missing Middle in Disaster Mortality Prevention

Introduction:Interventions that mitigate hazard exposures offer the most efficient means of reducing disaster mortality. However, such interventions require an evidence base that describes the relationship between hazard exposure dynamics and health risk. Medical practitioners have long used patient specific hazard exposure assessments to determine acute and chronic disease risk and align medical treatment and care. This study compared patient-specific hazard exposure data collected from people seeking healthcare during seven different natural hazard disaster events and compared the minimum patient data set standards recommended at the time.Method:Patient data collection forms used by primary and secondary health care providers during emergency health and medical responses to seven natural hazard disasters were reviewed. Data fields relating to potential exposure characteristics were recorded and compared to patient data fields used by health services prior to the disaster event. A literature review of definitions of disaster ‘exposure’ adopted by UN disaster management agencies were compared with the health and medical sector.Results:Only the SARS-CoV-2 disaster consistently assessed and recorded details about patient exposure characteristics. Patient hazard exposure data was typically limited to the time of onset of symptoms and duration relative to hazard impact. Little qualitative or quantitative assessment of the magnitude of exposure to any hazard was included, or patient-environmental data. While variables of hazard and vulnerability were extensively studied, and discussed in scholarly and industry literature, the concept of exposure received comparably little attention.Conclusion:Building an evidence base to correlate hazard and environmental exposure characteristics with patient health effects must be prioritized, especially for cohorts vulnerable from physiological or co-morbid factors. Such advances can be made through simple inclusions in minimum patient dataset recommendations. Understanding hazard-exposure dynamics are vital for advancing emergency health responses toward early intervention and health protection from future hazards that threaten functioning of whole health systems.

Examining the influence of health sector coordination on the efficiency of county health systems in Kenya

BackgroundHealth systems are complex, consisting of multiple interacting structures and actors whose effective coordination is paramount to enhancing health system goals. Health sector coordination is a potential source of inefficiency in the health sector. We examined how the coordination of the health sector affects health system efficiency in Kenya.MethodsWe conducted a qualitative cross-sectional study, collecting data at the national level and in two purposely selected counties in Kenya. We collected data using in-depth interviews (n = 37) with national and county-level respondents, and document reviews. We analyzed the data using a thematic approach.ResultsThe study found that while formal coordination structures exist in the Kenyan health system, duplication, fragmentation, and misalignment of health system functions and actor actions compromise the coordination of the health sector. These challenges were observed in both vertical (coordination within the ministry of health, within the county departments of health, and between the national ministry of health and the county department of health) and horizontal coordination mechanisms (coordination between the ministry of health or the county department of health and non-state partners, and coordination among county governments). These coordination challenges are likely to impact the efficiency of the Kenyan health system by increasing the transaction costs of health system functions. Inadequate coordination also impairs the implementation of health programmes and hence compromises health system performance.ConclusionThe efficiency of the Kenyan health system could be enhanced by strengthening the coordination of the Kenyan health sector. This can be achieved by aligning and harmonizing the intergovernmental and health sector-specific coordination mechanisms, strengthening the implementation of the Kenya health sector coordination framework at the county level, and enhancing donor coordination through common funding arrangements and integrating vertical disease programs with the rest of the health system. The ministry of health and county departments of health should also review internal organizational structures to enhance functional and role clarity of organizational units and staff, respectively. Finally, counties should consider initiating health sector coordination mechanisms between counties to reduce the fragmentation of health system functions across neighboring counties.

Exploring nationwide policy interventions to control COVID-19 from the perspective of the rapid learning health system approach.

The health systems needed to improve their learning capacities during the COVID-19 pandemic. Iran is one of the countries massively struck by the pandemic. This study aimed to explore whether and how the policy interventions made by Iran's policymakers at the national level to control COVID-19, could improve the rapid learning characteristics of the health system. A guide to clarify rapid learning health system (RLHS) characteristics was developed. The guide was used by two independent authors to select the policy interventions that could improve RLHS characteristics, then, to analyze the content of the selected policy interventions. In each stage, results were compared and discussed by all three authors. Final results were presented based on different RLHS characteristics and the potential mechanisms of contribution. Five hundred policy interventions were developed during the first 7 months of the outbreak. Thirty-one policy interventions could potentially improve RLHS characteristics (6.2%). Two characteristics, such as the timely production of research evidence and the appropriate decision support were addressed by selected policy interventions. Policies, that could improve learning capacities, focused on decision-maker groups more than user groups or researcher groups. Most of the developed policy interventions during the first months of the epidemic did not address the learning capacities of the health system. To improve health system functions, improving RLHS characteristics of the health system, especially in patient-centered and data linkage characteristics, is recommended.

Evolution of the Chief Medical Officer Role in Teaching Hospitals and Health Systems.

Clinical physician leaders have become an increasingly important asset to hospitals and hospital systems in a changing healthcare environment. Specifically, the role of the chief medical officer (CMO) has expanded and evolved amid the shift to value-based payment models and sharpened focus on patient safety, quality, community engagement, and equity in healthcare, as well as a global pandemic. In light of these changes, this study examined the transformation of CMOs and similar roles and evaluated the current needs, challenges, and responsibilities of clinical leaders today. The primary data source used in this analysis was a survey fielded to 391 clinical leaders in 290 Association of American Medical Colleges-member hospitals and health systems in 2020. In addition, this study compared responses to the 2020 survey with findings from two prior iterations of the survey from 2005 and 2016. The surveys collected information regarding demographics, compensation, administrative titles, qualifications for the position, and the scope of the role, among other questions. All surveys consisted of multiple-choice, free response, and rating questions. The analysis was conducted using frequency counts and percentage distributions. Thirty percent of eligible clinical leaders responded to the 2020 survey. Twenty-six percent of the clinical leader respondents identified as female. Ninety-one percent of the CMOs were members of the senior management team in their hospital or health system. CMOs reported that they were responsible for five hospitals, on average, with 67% indicating they were responsible for more than 500 physicians. This analysis provides hospital and health systems with insight into the expanding scope and complexity of CMOs as they take on greater leadership responsibilities within their institutions amidst a shifting healthcare landscape. In reflecting on our results, hospital leaders can understand the current needs, barriers, and responsibilities of today's clinical leaders.

Determinants of maternal near-miss event’s among pregnant women attending tertiary care hospital: A case–control study

Background: Women who have survived complications during pregnancy and childbirth have been studied as surrogates of maternal deaths and have been termed as maternal near-miss. Study of such cases is considered a less threatening approach to improve maternal health care by the service providers. With this tool, we will be able to identify the delays. As near-miss occurs much more frequently than maternal deaths, a more reliable quantitative analysis can provide a comprehensive profile of the health system functioning. Near-misses are relatively simpler to analyze and easier to resolve. This knowledge will help in identifying the contributory factors of maternal deaths so that actions can be taken at community and health systems level. Aims and Objectives: The objectives of this study were to determinants of maternal near-miss event’s among pregnant women attending tertiary care hospital. Materials and Methods: This was a case–control study, conducted in the Department of Obstetrics and Gynecology at Government Medical College, Akola from January 2019 to January 2021. One hundred and twenty-five cases and 375 controls were included in the present study using EPI INFO in 2 years. Cases of near-miss events from hospital during study was identified and included in the study. Results: In this study, a total of 500 persons were questioned (125 cases and 375 controls), with a 100% response rate. The average ages of the cases and controls were 26.5 (4.42) and 29 (59.9) years, respectively. Pre-existing medical disorders were substantially linked to maternal near miss (MNM). More over half of the patients (59.2%) and less than a third of the controls (23.21%) had a history of at least one pre-existing medical condition. After adjusting in the multivariate logistic regression model, multigravida, lack of antenatal care, induction of labor, and delays in reaching hospital were positively associated with a MNM. For instance, those mothers who were pregnant for the 2nd–4th times (AOR: 4.94 [95% CI: 1.46–16.8]) and more or equal to 5 times (AOR: 3.84 [95% CI: 1.23–11.91]) were nearly five-fold and four-fold more likely to experience MNM events respectively. Conclusion: The factors that were found to be significant in our study are non-modifiable risk factors for maternal near-miss occurrences. These events can be prevented and mitigated by early detection and proper prenatal care.

Organizing principles of astrocytic nanoarchitecture in the mouse cerebral cortex

Astrocytes are increasingly understood to be important regulators of central nervous system (CNS) function in health and disease; yet, we have little quantitative understanding of their complex architecture. While broad categories of astrocytic structures are known, the discrete building blocks that compose them, along with their geometry and organizing principles, are poorly understood. Quantitative investigation of astrocytic complexity is impeded by the absence of high-resolution datasets and robust computational approaches to analyze these intricate cells. To address this, we produced four ultra-high-resolution datasets of mouse cerebral cortex using serial electron microscopy and developed astrocyte-tailored computer vision methods for accurate structural analysis. We unearthed specific anatomical building blocks, structural motifs, connectivity hubs, and hierarchical organizations of astrocytes. Furthermore, we found that astrocytes interact with discrete clusters of synapses and that astrocytic mitochondria are distributed to lie closer to larger clusters of synapses. Our findings provide a geometrically principled, quantitative understanding of astrocytic nanoarchitecture and point to an unexpected level of complexity in how astrocytes interact with CNS microanatomy.

A call for strengthening the current Libyan national health system by focusing on quality of care: A policy brief

AbstractThe Libyan health system is in a dire state, and after security, strengthening the health system is a top national priority. The initial effort should focus on capacity building using the existing healthcare system as a foundation, and not try to design a new health system that is not appropriate for the situation on the ground. Many new health systems that have been successfully designed and implemented in the last two decades, such as in Taiwan, have built on the experiences and best practices from different countries. These however, were already stable countries that possess the requisite cross‐sector infrastructure to build upon. Libya is different: it not only lacks a robust functioning health system, it lacks many of the infrastructure requirements to carry on most other basic functions. Furthermore, unlike many other countries, Libya is unique in that the financing of healthcare in the long run should not be an issue due to the relatively small population size and potential revenue.Efforts should focus on identifying the strengths and weaknesses of the current national health system and see what needs to be changed to align it along a model of patient‐centered quality care. The current main issue appears to be that of governance and management, which should be redesigned and strengthened to achieve the key strategic objectives of quality and patient safety. For Libya to start to do this, it should try to model an existing single‐payer government model to help improve outcomes.

Enhancing health system’s governance through demographic and health surveys in transitional European countries: The example of Albania

To inform policymakers well, there is a need to promote different types of health examination surveys as additional sources of valuable information which, otherwise, would not be available through routine/administrative statistics. This is especially important for former communist countries of South Eastern Europe including Albania, where the existing health information system (HIS) is weak. Among many efforts to strengthen the HIS in Albania, there is currently a commitment to undertake a second round of a nationwide Demographic and Health Survey (DHS). This survey will involve a nationwide representative sample of about 17,000 private households, where all women aged 15-59 years and their respective partners will be interviewed and examined. Externally, the upcoming Albanian DHS will contribute to the European Union accession requirements regarding provision of standardized and valid health information. Furthermore, the DHS will considerably enhance the core functions of the Albanian health system in line with the WHO recommendations. Internally, the DHS will promote societal participation and responsibility in transitional Albania. Importantly, the forthcoming survey will promote good governance including transparency, accountability and health system responsiveness. Also, the DHS will allow for collection of internationally valid and standardized baseline socio-demographic and health information for: assessment of future national trends; monitoring and evaluation of health programs and interventions; evidencing health disparities and inequities; and cross-national comparisons between Albania and different countries of the European Region. Ultimately, findings of the DHS will enable rational decision-making and evidence-based policy formulation in Albania including appropriate planning, prioritization and sound resource allocation. However, transfer of the information collected and implementation in public health policies and interventional programs is rather challenging for most of the countries, particularly for transitional post-communist countries of South Eastern Europe including Albania.

THE PROLIFERATION OF CORRUPT ACTIVITIES IN PUBLIC HEALTH SYSTEMS DURING THE GLOBAL COVID 19 PANDEMIC

The health-care sector should aim at maintaining and improving the quality of life and individual welfare of each patient, but this is difficult when corruption pervades one or more of the pillars of health-care services such as the structure, organisation, financing, and/or delivery systems. Health systems are particularly susceptible to corruption due to the very large amounts of monetary resources involved, information asymmetries, the large number and wide distribution of actors, system complexity and fragmentation, and the increasingly advanced international supply chain of medicines and medical equipment. Corruption weakens the effective functioning of health systems and usually contributes to their progressive deterioration.

Understanding networks in low-and middle-income countries' health systems: A scoping review.

Networks are an often-employed approach to improve problems of poor service delivery and quality of care in sub-optimally functioning health systems. There are many types of health system networks reported in the literature and despite differences, there are identifiable common characteristics, uses, purposes, and stakeholders. This scoping review systematically searched the literature on networks in health systems to map the different types of networks to develop an understanding of what they are, when and what they are used for, and the purposes they intend to achieve. Peer-reviewed literature was systematically searched from six databases (Medline (Ovid), EMBASE (Ovid), Global Health (Ovid), the Cochrane Library, Web of Science Core Collection, Global Index Medicus's Africa Index Medicus) and grey literature was purposively searched. Data from the selected literature on network definitions, characteristics, stakeholders, uses, and purposes were charted. Drawing on existing frameworks and refining with the selected literature, a five-component framework (form and structure, governance and leadership, mode of functioning, resources, and communication), broadly characterizing a network, is proposed. The framework and mapping of uses, purposes, and stakeholders is a first step towards further understanding what networks are, when and what they are used for, and the purposes they intend to achieve in health systems.

Opportunities and Challenges of Implementing Federal Health System in Nepal at the Time of the COVID-19 Pandemic

Nepal has been practicing the federal system in health since the promulgation of the constitution in 2015. The new three-tier system of one federal, seven provincial and 753 local governments have set up ministries, departments, and health units at each level. Less than four years into this system, the country faced the COVID-19 pandemic. The pandemic created both opportunities and challenges for the federal health system. This study aims to identify those factors from the viewpoint of implementers of the health system. After an extensive literature review, exploratory qualitative research was carried out with twenty public health workers and elected representatives from all the tiers of government, including the federal ministry and governments of Lumbini Province. The data was analyzed using the R package for Qualitative Data Analysis (RQDA). Thematic analysis was performed using the World Health Organization’s six building blocks of the health system as an analytical framework. The participants highlighted many opportunities after federalization in Nepal. The presence of government closer to people helped to make policies and plans as per local needs. Decentralized power to make decisions at the local level made human and financial resources readily available to local governments leading to better service delivery at the time of need. In contrast, the challenges were difficulty transiting into the new system of governance, poor coordination among the different government tiers, and the lack of local expertise to manage and lead the health system during severe constraints posed by the global pandemic of an unprecedented nature. The study showed that the federalization in Nepal has met the goals of devolution of the power structure and better health system management. However, there are specific areas of improvement to ensure a more functional health system.

Twenty-five years of clinical applications using adaptive optics ophthalmoscopy [Invited

Twenty-five years ago, adaptive optics (AO) was combined with fundus photography, thereby initiating a new era in the field of ophthalmic imaging. Since that time, clinical applications of AO ophthalmoscopy to investigate visual system structure and function in both health and disease abound. To date, AO ophthalmoscopy has enabled visualization of most cell types in the retina, offered insight into retinal and systemic disease pathogenesis, and been integrated into clinical trials. This article reviews clinical applications of AO ophthalmoscopy and addresses remaining challenges for AO ophthalmoscopy to become fully integrated into standard ophthalmic care.

Consequences of collagen induced inflammatory arthritis on circadian regulation of the gut microbiome.

The gut microbiota is important for host health and immune system function. Moreover autoimmune diseases, such as rheumatoid arthritis, are associated with significant gut microbiota dysbiosis, although the causes and consequences of this are not fully understood. It has become clear that the composition and metabolic outputs of the microbiome exhibit robust 24 h oscillations, a result of daily variation in timing of food intake as well as rhythmic circadian clock function in the gut. Here, we report that experimental inflammatory arthritis leads to a re-organization of circadian rhythmicity in both the gut and associated microbiome. Mice with collagen induced arthritis exhibited extensive changes in rhythmic gene expression in the colon, and reduced barrier integrity. Re-modeling of the host gut circadian transcriptome was accompanied by significant alteration of the microbiota, including widespread loss of rhythmicity in symbiont species of Lactobacillus, and alteration in circulating microbial derived factors, such as tryptophan metabolites, which are associated with maintenance of barrier function and immune cell populations within the gut. These findings highlight that altered circadian rhythmicity during inflammatory disease contributes to dysregulation of gut integrity and microbiome function.

Strengthening the integration of primary care in pandemic response plans: a qualitative interview study of Canadian family physicians.

As the first point of contact in health care, primary care providers play an integral role in pandemic response. Despite this, primary care has been overlooked in previous pandemic plans, with a lack of emphasis on ways in which the unique characteristics of family practice could be leveraged to create a more effective response. To explore family physicians' perceptions of the integration of primary care in the COVID-19 pandemic response. Descriptive qualitative approach examining family physician roles during the COVID-19 pandemic across four regions in Canada. Semi-structured qualitative interviews were conducted with family physicians and participants were asked about their roles during each pandemic stage, as well as facilitators and barriers they experienced in performing these roles. Interviews were transcribed and a thematic analysis approach was employed to develop a unified coding template across the four regions and identify recurring themes. In total, 68 family physicians completed interviews. Four priorities for integrating primary care in future pandemic planning were identified: 1) improve communication with family physicians; 2) prioritise community-based primary care; 3) leverage the longitudinal relationship between patients and family physicians; and 4) preserve primary care workforce capacity. Across all regions, family physicians felt that primary care was not well incorporated into the COVID-19 pandemic response. Future pandemic plans require greater integration of primary care to ensure the delivery of an effective and coordinated pandemic response. Strengthening pandemic preparedness requires a broader reconsideration and better understanding of the central role of primary care in health system functioning.

Impact of smart health systems on the behavior of older adults under community healthcare.

With the trend of world population aging, a good community health care system will determine whether the elderly can get good medical conditions. How to improve the community health care system can study how the behavior of the elderly affects it. This paper is based on the analysis of the current situation of population aging at home and abroad. On the premise of analyzing the demand and behavior of elderly people seeking medical treatment and the function of community health service institutions. Literature research was conducted to analyze the influencing factors of community health care needs and elderly people's medical seeking behavior at home and abroad. Then the elderly in Tianjin were investigated by issuing questionnaires, and the law of medical treatment behavior of the elderly in Tianjin was calculated. Combined with the results of relevant investigations abroad, the common phenomenon is summarized. Finally, the analysis method of intelligent medical system is proposed, and the design process of system acquisition module and user usage mode are given. The smart medical system can bring great convenience to the elderly and community healthcare. It emphasizes the powerful functions of smart health systems and their future importance for the health care of the elderly.

Strengthening public health systems in China

Strengthening public health systems in China

Strategies to strengthen non-governmental organizations' participation in the Iranian health system.

Non-governmental organizations (NGOs) added a new dimension to intersectoral action for health. Involving the NGOs in health system strengthening could lead to a more efficient, equitable, and better-governed healthcare system. This qualitative study explored effective strategies for NGO participation in the Iranian health system to achieve broader health system goals. We conducted 33 semi-structured interviews with health policymakers and planners, NGO actors at the national and provincial levels, and other key informants. The qualitative data were analyzed through a thematic analysis approach. Trustworthiness in the study was observed at all stages of the study. Four main themes- were identified: empowerment for learning leadership and management skills, creating active participation in policy-making, capacity building for participation, clarifying participation process, falling into 17 sub-themes. Along with the government and health sector policymakers, NGOs may have a significant role in improving health system goals and increasing equity, social responsiveness, financial risk protection, and efficiency. The participation of NGOs in the Iranian health system is a complex process. All elements and dimensions of this process need to be considered when developing a platform for the appropriate participation of NGOs in the health system functions. Evidence-informed strategies for strengthening the participation of NGOs in the health system should be used to utilize NGOs potential to the fullest.

Integrating patient safety education into pharmacy curriculum in Nigeria.

Recognition has been given to patient safety and healthcare quality as central components of a functional health system which has resulted in increased advocacy for elaborate patient safety content in education and training programmes for health professionals. The World Health Organisation's patient safety curriculum is an evidence-based framework that provides a valuable resource for the training of healthcare professionals in enhancing patient safety. Other international organisations have also advocated for the need to restructure healthcare professionals' education to include the concept of patient safety. The ideal time to initiate patient safety education is suggested to be during schooling through curricula that inculcate learning from adverse events. This will prepare pharmacy students as future healthcare professionals who will become better prepared for clinical practice leading to improved healthcare quality and safety.

Influence of Selected Indicators of Healthcare System Functioning Evaluation on the Health Result.

According to the World Health Organization's statistics, 7 of the 10 main causes of death in 2019 were noncommunicable diseases. Health indicators are measures used to evaluate public health system effectiveness and functioning. Monitoring mortality rates from leading causes, life expectancy and other health indicators is essential to address their causes and adapt health systems to react adequately. The aim of this study is to present the dependencies of selected health care indicators and health outcomes. Based on the literature review conducted, selected health indicators, along with healthcare system data, were analyzed using Pearson's r correlation. The analyses included data from the Organization for Economic Cooperation and Development (OECD) presented in statistics and the Health at a Glance 2021 report and data collected as part of the preparation of the Financing Global Health 2020 report by the Institute for Health Metrics and Evaluation. Health system resources are linked to health outcomes. The number of medical consultations, the number of nurses per patient or the level of financing of services under general health insurance are related to life expectancy and deaths due to causes that could have been avoided or treated. Life expectancy is positively correlated with access to general health insurance and public expenditure on healthcare. There is a need for all countries to provide their citizens with broad access to healthcare services.