Goal Of Coverage Research Articles

The public-private partnership (PPP) initiative in healthcare system: as the pathways to achieve the SDGs in Nepal

Globally, financing healthcare is one of the biggest challenges and it becomes a life or death issue in poor countries. Nepal is strongly committed to universal health coverage and Sustainable Development Goals. Existing public health services are inadequate to cater to the growing demands of quality health care and Public Private Partnership (PPP) evolved as newer arrangement for robust healthcare system, improved healthcare quality and enhance cost-effectiveness. Nepal has successfully utilized the PPP model in multiple sectors, however there is limited experience in healthcare. Strengthening PPP models in healthcare could be the pathway for Nepal toward SDG’s and UHC achievement.

Nursing Faculty Development in Pakistan; Teaching and Learning Competencies

Human health resource is the core component of any health system. Pakistan’s health system faces a critical shortage of qualified healthcare professionals such as physicians, dentists, nurses, pharmacists and allied healthcare workers1. Pakistan has one of the fastest growing populations and is ranked as the fifth largest population in the globe2. The health system of Pakistan is confronted with the challenge to cater to the unmet healthcare needs of this rapidly growing human population. The health system of Pakistan is facing multiple challenges and among these, one of the key challenges is the production of quality human resource for health. Pakistan has recently focused much on uplifting the standards of medical schools; to produce competent physicians, however, uplifting and streamlining nursing education still remains a big challenge. Currently, there are approximately 90,000 nurses registered with Pakistan nursing council3. In 2018, the Ministry of National Health Services, Regulation and Coordination made a thorough assessment of the existing human health resource and as per the report published Pakistan needs 0.8 million nurses by the year 20304. There is also an imbalance in the current workforce with more physicians onboard as compared to nurses in the system. Pakistan is thus confronted to upscale the production of nurses to meet Universal Health Coverage goal by year 2030 as well as to maintain the minimum standards of nursing workforce development. To uplift the standards of nursing education, Pakistan has embarked on graduate nursing education as entry into practice qualification from the year 2018 and onwards. This has shifted nursing education pre-dominantly from associate diploma regulated by nursing examination boards to baccalaureate degree program run by the universities. Maintaining standards in the production of quality nursing workforce is a big challenge for Ministry of National Health Services, Regulation and Coordination and Pakistan Nursing Council. Pakistan has though shifted onto a baccalaureate degree program in nursing its faculty is not fully prepared in modern day educational pedagogies, assessment methods, curriculum development and evaluation, educational psychology and educational leadership and management5. There is an acute need to train nursing faculty in basic teaching competencies for effectively teaching at BS nursing level. Such trainings shall be mandatory for everyone who aspires to teach in nursing colleges. The Pakistan nursing council shall make such trainings mandatory for all nursing faculty who is involved in teaching to nursing students.

Unmet healthcare needs among middle-aged and older adults in China.

Unmet healthcare needs have increasingly been recognised as an indicator of equity of healthcare access and utilisation, having the potential to capture frailty of health and social protection systems. This study aimed to estimate the prevalence of unmet healthcare needs and its correlates among middle-aged and older adults in China. This study is based on analyses of the China Health and Retirement Longitudinal Study carried out in 2011 among Chinese adults aged 45years and above. Multivariable logistic regression models were conducted to examine associated factors, stratified by rural or urban residence. Reasons for having unmet needs for inpatient and outpatient services were also analysed. Among 14,774 participants, the prevalence of unmet healthcare needs was 13.0% (95% confidence interval 12.3-13.8%) and was higher in rural areas. The most prevalent reasons for unmet need for inpatient and outpatient care were 'not enough money' and 'illness is not serious, don't need treatment', respectively. The respondents who were unmarried, employed, had poor self-reported health, needed help with activities of daily living, reported lower life satisfaction, multiple chronic conditions and depressive symptoms had increased odds of unmet healthcare needs. This study suggests that unmet healthcare needs are more concentrated among people living with multiple health conditions and mental health problems in China. If universal health coverage goals and sustainable development goal 3 are to be met, it is essential that effective mechanisms for addressing unmet healthcare needs are identified.

What will it take to meet UNAIDS targets for preexposure prophylaxis users?

Preexposure prophylaxis (PrEP) is a critical strategy to curb new HIV infections globally. National and global targets have been set for people starting PrEP. However, global PrEP initiations fell short of UNAIDS 2020 targets, and reflection is needed on how we set and meet targets for PrEP use. Recent literature documents challenges to meeting ambitious goals for PrEP coverage in multiple phases of PrEP: PrEP initiations are limited by gaps in the identification of those who might benefit from PrEP. Conversely, getting PrEP to those who need it most is threatened by inaccurate risk perception and HIV and PrEP stigma. Once people are on PrEP, a substantial number discontinue PrEP in the first year (the 'PrEP Cliff'), a finding that is robust across groups of PrEP users (e.g., women, men who have sex with men, transwomen) and across global prevention settings. Further, PrEP inequities - by which we refer to utilization of PrEP in a specific group that is not commensurate with their epidemic risk - threaten the overall population benefit of PrEP because those at highest risk of acquiring HIV are not adequately protected. To realize global goals for PrEP utilization and impact, we must address multiple points of PrEP delivery programs that address not just PrEP starts, but also retention in PrEP and measurement and accountability to PrEP equity. We call for new approaches to better identify PrEP candidates, suggest additional research to address the known and consistent reasons for PrEP discontinuations, and advocate for metrics to measure and be accountable to PrEP equity.

Gynecologic interstitial brachytherapy curriculum using a low-cost phantom with ultrasound workshop and a treatment planning workshop is effective

PURPOSE/OBJECTIVE(S)Standardized simulation training geared towards interstitial brachytherapy (IS BT) for gynecologic malignancies is lacking in radiation oncology resident education. We developed and implemented a curriculum for IS BT training with (1) lecture on equipment, workflow, and guidelines, (2) hands-on ultrasound-guided IS BT workshop, and (3) treatment planning workshop. METHODS AND MATERIALThe cost in materials of each phantom was approximately $66. After a lecture, two alternating workshops were performed. The first session consisted of a hands-on ultrasound-guided IS BT workshop with one resident imaging the phantom with a transabdominal ultrasound probe and the other resident implanting the phantom with needles. A second session consisted of a hands-on treatment planning workshop using BrachyVision and an l-Q spreadsheet with the following objectives: coverage goal, meeting D2cc constraints, and minimizing V200. The primary outcome was improvement in knowledge assessed with Likert-style questions and objective knowledge-based questions (KBQs). RESULTSFour of the seven medical residents that participated in this curriculum had prior IS BT experience. Residents reported significantly improved knowledge regarding gynecologic IS BT equipment and procedure, evaluating gynecologic anatomy using ultrasound, CT simulation, contouring, and plan review (overall median pre-session subjective score 2 (1) −(3) versus post-session score 4 (3) −(4, p < 0.01). Residents demonstrated improvement in answering KBQs correctly from 44% correct at baseline to 88% after completion of the curriculum (p < 0.01). All residents “Agree” and “Strongly Agree” the session was an effective learning experience. CONCLUSIONSResidents participating in phantom training with an ultrasound curriculum and a treatment planning session is effective for improving knowledge and skills in IS BT for radiation oncology residents.

Experiences of seeking healthcare across the border: lessons to inform upstream policies and system developments on cross-border health in East Africa

ObjectivesThis study explored the experiences of accessing care across the border in East Africa.ParticipantsFrom February to June 2018, a cross-sectional study using qualitative and quantitative methods was conducted among 279...

Institutionalizing Leadership Management and Governance for Health System Strengthening in Emerging Economies: Evidence from the Partnership for Health System Strengthening in Africa (PHSSA)Programme

Health systems in an emerging economy, specifically Sub-Saharan Africa (SSA) are characterized as fragile with low implementation of Universal Health Coverage. While acknowledging that the cause of the inadequacy in emerging economies is multi-factorial, other arguments are that the root cause is inadequate political and technical leadership. Evidence reveals that visionary, imaginative, decisive, responsible, and responsive leadership is insufficient to persuade all stakeholders in low-income nations in Sub-Saharan Africa to work together to attain the constructive goal of universal coverage. On the contrary, other academics suggest that successful leadership would establish a clear national vision for universal coverage and a commitment to achieving that objective over time. These contrasting observations motivated an interrogation of the link between health system governance and Universal Health Coverage in an emerging economy taking evidence from the PHSSA programme. Through a meta-analysis of the existing literature as well as analysis of the findings from the programme, the paper explores experiences, critical success factors and recommendations for improvement of UHC through institutionalizing health system governance in an emerging economy. The research provides evidence that the governance linkages in health systems and the outcomes they produce are contingent rather than assured, due to the variety and complexity inherent in the health system governance paradigm. The situation-specific setting of a country's health system determines what can be accomplished through health governance strategy design and implementation efforts. The paper recommends a need to create a conducive environment for adoption of health systems programmes by contextualizing health governance with regard to the larger set of governance institutions that surround it. A competency framework should also be adopted in recruitment of competent health managers. The study also recommends a need for the countries in seeking to institutionalize health system governance to develop and support an organizational structure and context that sustains leadership practices through advocacy, create an enabling environment for health systems leadership, management and governance through the development of ethics and other competences specific to universal health care situations as well as provide proper financial support system so that institutionalization of leadership, management and governance can have maximum impact on the effectiveness and efficiency of health systems. There is also a need to institutionalize short courses, seminars and conferences in health leadership, management, and governance so as to entrench participatory leadership in health systems.

Disparities in healthcare access and utilization and human papillomavirus (HPV) vaccine initiation in the United States

ABSTRACT Currently in the United States, Human Papillomavirus (HPV) vaccination coverage among eligible individuals is lower compared to coverage goals of 80% set by the HealthyPeople 2030 initiative. In this study, we used the National Health and Nutrition Examination Survey (NHANES) 2015–2016 and 2017–2018 datasets to determine the association between HPV vaccine initiation among individuals of ages 9 to 26 years and their patterns of healthcare access and utilization. In particular, we examined the following healthcare characteristics: 1) having a routine place of healthcare, 2) having health insurance coverage, 3) frequency of healthcare visits per year, and 4) type of routine place of healthcare (outpatient primary care vs. ED, etc.). We fit independent multivariable logistic regression models for each NHANES dataset and controlled for sociodemographic characteristics and interactions with healthcare access and utilization characteristics. Our findings suggest that HPV vaccine initiation is positively associated with having a routine place of healthcare (2015–2016: aOR 1.92, 95% CI 1.25–2.95; 2017–2018: aOR 1.99, 95% CI 1.07–3.68). Relatedly, HPV vaccine initiation is negatively associated with never having received healthcare in the past year (2015–2016: aOR 0.61, 95% CI 0.41–0.90; 2017–2018: aOR 0.45, 95% CI 0.27–0.75). The results of this study suggest that interventions to promote HPV vaccination should include strategies that promote access to and utilization of routine health care services. Our findings are particularly salient in light of the drop in HPV vaccine initiation and healthcare access and utilization among adolescents during the COVID-19 pandemic.

Effect of mobile application user interface improvements on minimum expected home visit coverage by community health workers in Mali: a randomised controlled trial

BackgroundProactive community case management (ProCCM) has shown promise to advance goals of universal health coverage (UHC). ProCCM community health workers (CHWs) face operational challenges when pursuing their goal of visiting...

Integrated and People-centred Hospital toward Universal Health Coverage in WHO- European Countries.

Background: Ensuring integrated people-centred health services (IPCHS) that offer universal access, social equity, and financial protection within a primary health care method is important toward universal health coverage and health sustainable development goals. Hospitals are part of this ambitious agenda. The purpose is to review the health system and to list and summarize hospital interventions. Methods: Document review. As part of our review, we selected health systems reports for conceptualizing IPCHS frameworks at the country level as well as those focusing on the hospital sector. Our research team collected and analyzed data including governance, financing, human resource, provision service, and reforms based on the health system report of 14 countries. Results: The review showed 26 challenges, most of which were in Eastern European countries, with 48 interventions in 3 themes and 13 subthemes. Conclusion: Due to the paradigm shift, there is a need for change. However, a much better positive view is needed to determine the role of hospitals in the service delivery system. The IPCHS framework provides guidance for countries in setting priorities, and formulating, implementing, and evaluating national policy/strategic plans for their hospital sector. Although the vision and interventions should be adapted to local context, different policy instruments may be needed to specifically tackle the most pressing local issues. Recognizing differences in countries’ contexts will help to develop realistic and applicable solutions.

Disparities in end-of-life outcomes among advanced cancer patients in Sri Lanka: Results from the APPROACH study.

A Universal Health Coverage goal is to provide access to affordable palliative care to reduce disparities in end-of-life (EOL) outcomes. To assess progress toward this goal in Sri Lanka, our primary aim was to systematically assess differences in patients' physical, psychological, social and spiritual outcomes, and their perceived quality of care by their socioeconomic status (SES). As part of the multi-country APPROACH (Asian Patient Perspectives Regarding Oncology Awareness, Care and Health) study, we surveyed 199 patients with a stage IV solid malignant tumor and aged >21 years from the largest government cancer hospital in Sri Lanka. We assessed their physical (physical and functional well-being, symptom burden), psychological (anxiety, depression, emotional well-being), social (social well-being), and spiritual outcomes and perceived quality of care (physician communication, nursing care, and coordination/responsiveness). Low SES patients reported significantly lower physical and functional well-being, emotional well-being, spiritual well-being including meaning/peace and faith; and significantly higher symptom burden, anxiety and depressive symptoms compared with patients from high SES (p < 0.05 for all outcomes). Results have implications regarding reducing barriers in access to appropriate palliative care and EOL care services to stage IV cancer patients from low SES in Sri Lanka.

Proton and Photon Dosimetry of Carbon Fiber-PEEK Implants for Paraspinal Stereotactic Body Radiation Therapy

<h3>Purpose/Objective(s)</h3> Carbon fiber composite (CFR-PEEK) implants have been shown to improve image quality in volumetric imaging compared with titanium (Ti). We perform a dosimetric comparison of proton and photon SBRT plans with Ti and CFR-PEEK implants for paraspinal SBRT treatments. <h3>Materials/Methods</h3> CT scans of a spine phantom embedded with CFR-PEEK and Ti implants were obtained. PTV and OAR contours for a 24 Gy single fraction plan were generated with d_max spinal cord < 14 Gy. Nine-field IMRT photon plans were optimized on both scans. Three-field pencil beam scanning (PBS) plans using multi-field optimization (MFO) were generated. Robust evaluation for 2 mm setup, ± 3.5% range and ± 10% material density override uncertainties were performed. To evaluate the MR image quality of the carbon fiber implants, an implant set was placed in a water phantom. Spine MRI imaging sequences were acquired at 1.5T and 3T and associated artifacts were evaluated. <h3>Results</h3> Target V95 coverage statistics for all plans are shown in Table 1. Photon plans with CFR-PEEK vs. Ti implants were not significantly different. Target coverage goals and OAR constraints were met. When the CFR-PEEK optimized photon plan was recalculated on Ti CT, PTV V100% was reduced by 12.4%, demonstrating the dose perturbation induced by Ti implants. The MFO proton plans for both implant scenarios had lower coverage than the IMRT plans due to the sharper gradients on the IMRT plans. The PBS plan for CFR-PEEK had slightly better coverage than for Ti. Cord-constraint-free proton plans were generated to investigate how the cord constraint impacted the proton plan. Without the constraint, PTV V95% was 99.0% for CFR-PEEK and 94.9% for Ti plans. The increased coverage for CFR-PEEK plan suggests that the potential advantage of CFR-PEEK is masked by the tight cord constraints. In robustness analysis, no clear benefit was shown for range and setup uncertainties. However, advantage in target coverage robustness was seen under material density perturbation analysis. Specifically, the perturbed PTV V95% ranged from 88.7% to 88.4%. In contrast, for Ti plan, PTV V95% varied from 86.5% to 82.3% in perturbed scenarios. In MRI studies, no metal signal loss image artifacts were observed around the CFR-PEEK screws at either field strengths. Minor signal pile-up artifacts of < 5 mm can be seen on one side of the screw in high field 3 T studies but were negligible in 1.5 T studies. <h3>Conclusion</h3> For paraspinal SBRT, utilizing CFR-PEEK compared to Ti implants do not significantly affect plan quality for both PBS and IMRT. Proton plans are more robust for material composition uncertainties only. The largest advantage of CFR-PEEK vs. Ti will be in MR image quality improvements, which can translate to more accurate target delineations and improved follow-up image quality.

Tangential VMAT vs. 3D-Conformal Radiotherapy for Left-Sided Whole Breast and Regional Lymph Node Irradiation

<h3>Purpose/Objective(s)</h3> Whole breast and regional nodal irradiation presents a challenge in balancing the need for target coverage with avoidance of normal tissues. The novel technique termed tangential VMAT (tVMAT) utilizes beam angles tangential to the curvature of the chest wall without beams entering perpendicular to the chest wall in the direction of thoracic organs. In this study tVMAT was compared to standard 3D-conformal radiotherapy (3DCRT) in a dosimetric analysis. To our knowledge this is the first study to assess tVMAT in left-sided breast cancer patients requiring regional nodal irradiation. <h3>Materials/Methods</h3> Ten patients with left-sided breast cancer previously treated with adjuvant RT to the breast, axillary, and supraclavicular nodal regions were selected for this study. For each patient two plans were created: 1) a standard dual-isocenter three-field 3DCRT plan (two tangents and a supraclavicular field) using field-in-field dose modulation and 2) a tVMAT plan. Each tVMAT plan utilized a single isocenter for two partial arcs with angles selected to keep the central axis of the beams tangential to the curvature of the chest wall at all points. The prescription for both techniques was 5000 cGy in 25 fractions to the breast, axillary levels I-III, and supraclavicular target volumes with a goal coverage of 95% of the breast and nodal target volumes receiving at least 95% of the prescription dose. Normal tissue dose constraints were adapted from NSABP B51. Plans were created using a treatment planning system and differences in mean values for dosimetric endpoints were assessed for statistical significance using a Student's t-test (α = 0.05). <h3>Results</h3> Compared to 3DCRT plans, tVMAT provided more uniform coverage to the breast and regional lymph nodes (mean conformity index was 1.38 for tVMAT versus 2.42 for 3DCRT, <i>P</i> < 0.01) and the max point dose for tVMAT was lower on average (112.8% for tVMAT versus 121.5% for 3DCRT, <i>P</i> < 0.001). Both plans met the breast target coverage goals, however coverage to the lymph nodes was superior for tVMAT (mean coverage to 95% of the axillary plus supraclavicular target volumes was ≥ 99.0% of the prescribed dose for tVMAT versus ≥ 94.8% for 3DCRT, <i>P</i> < 0.001). Cold spots within the breast and nodal target volumes were on average lower for 3DCRT (952 cGy for 3DCRT versus 2760 cGy for tVMAT, <i>P</i> < 0.001). OAR sparing was improved with tVMAT, with a lower average V20_Gy for the left lung (16.5% for tVMAT versus 24.6% for 3DCRT, <i>P</i> < 0.01), and lower mean heart dose (168 cGy for tVMAT versus 200 cGy for 3DCRT, <i>P</i> = 0.03). <h3>Conclusion</h3> Tangential VMAT is a promising technique for the treatment of intact breast and regional lymph nodes and may provide better target coverage and OAR sparing compared to conventional 3D-conformal techniques. The use of a single isocenter for tVMAT could yield a simplified setup and more accurate treatment delivery, ideally with the use of deep inspiration breath hold or respiratory gating.

Gynecologic Interstitial Brachytherapy Curriculum Using a Low-Cost Phantom With Ultrasound Workshop and a Treatment Planning Workshop is Feasible and Effective

<h3>Purpose/Objective(s)</h3> There is no standard simulation training geared towards interstitial brachytherapy (IS BT) for gynecologic malignancies. Most residents perform few IS cases during residency. However, IS BT is an integral part of care for locally advanced gynecologic malignancies. We developed and implemented a workshop curriculum for IS BT with: 1) lecture on equipment, workflow, and guidelines, 2) hands-on ultrasound-guided IS BT workshop, and 3) treatment planning workshop. <h3>Materials/Methods</h3> The cost of each gynecologic phantom was approximately $70; phantoms were composed of an acrylic vase cube, rigid PETG tubes, modeling clay, agar, glass microspheres, a custom molded cervix/uterus structure, and a water-filled condom to mimic the bladder. A hands-on ultrasound-guided IS BT workshop was performed with residents in two small groups, where they imaged the gynecologic phantom using a transabdominal ultrasound probe. Participants alternated roles of sonographer or brachytherapist, implanting the phantom using custom stainless-steel needles machined in-house. A second workshop with hands-on treatment planning was performed in planning software using a L-Q spreadsheet with the following objectives: coverage goal of D90, meeting D2cc constraints of bladder and rectum, and minimizing V200 to qualitatively involve a small volume. All residents filled out a pre- and post-survey with subjective (4 demographics; 12 Likert-style) and objective knowledge-based (13) questions about GYN IS-BT. Paired subjective data were compared with the Wilcoxon signed ranks test. Paired objective data were compared with the McNemar's test of paired proportions. All statistical analysis was performed with a 2-sided <i>P</i>-value at the 0.05 significance level. <h3>Results</h3> Four residents had prior IS BT experience. After the workshop, residents reported significantly improved comfort with skills and knowledge regarding GYN IS BT equipment and procedure, evaluating GYN anatomy using ultrasound, and CT Simulation, contouring, and plan review (median pre-session Likert score 2 [1-3] vs post session 3 [3-4], <i>P</i> < 0.05). The overall rate of percent correct items assessing objective radiation oncology knowledge at baseline was 44%, Following completion of the curriculum, the overall percent correct items was 88% (<i>P</i> < 0.0001). All residents "Agree" (2/7) and "Strongly Agree" (5/7) the session was an effective learning experience. Qualitative feedback primarily asked for more time with treatment planning and educational content beforehand. <h3>Conclusion</h3> Residents participating in phantom training with an ultrasound curriculum and a treatment planning session is both feasible and effective. Similar strategies should be considered to enhance and standardize radiation oncology education initiatives for gynecologic IS BT training.

Health Insurance Coverage of Migrant Workers in China

Migrant workers are an important component of China's labor market, playing a vital role in economic development and social stability. In the face of significant health risks related to their work, migrant workers remain largely under-represented in China’s health insurance system despite their eligibility to participate in several programs. To achieve China’s goal of universal healthcare coverage, migrant workers are targeting populations. The objective of this paper is to understand the factors associated with migrant workers’ participation in health insurance programs. This analysis draws from a survey of 3,342 migrant workers that was conducted by China Agricultural University in 2013. A multinomial logit model was performed to identify the determinants of migrant workers’ health insurance participation. Our findings suggest that the highest rates of un-insurance were observed for females, the elderly, those with lower levels of education, income, or lower self-reported health status, and migrant workers in the construction industry. They are the most vulnerable populations and susceptible to various health and occupational hazards. Besides the high enrollment rates of migrant workers in the New Rural Cooperative Medical Scheme, the scheme’s lack of portability needs a complete “Inter-province” balancing reimbursement networking platform to be built. Furthermore, establishing a multi-level medical security system that is accessible and affordable may serve the goal of improving health insurance participation among migrant workers.

Mapping levels of COVID-19 vaccine hesitancy worldwide: preliminary results of a systematic review

Abstract Background Several factors can determine the success of a vaccination campaign, regardless of the availability of an effective and safe vaccine. Among these, vaccine hesitancy (VH) has long represented one of the main barriers to achieving vaccination coverage goals in many countries. The aim of this systematic review was to summarize the global levels of COVID-19 VH and to identify their determinants. Methods A systematic review of the literature was carried out following the PRISMA guideline and searching on PubMed, Web of Science, Scopus and PsycINFO for observational studies published up to April 2021 in English or Italian language. Levels of hesitancy and data on determinants, according to the SAGE working group matrix of determinants, were extracted. The systematic review protocol was registered on Prospero (ID: CRD42021235328). Results Of the 5447 articles initially retrieved, 89 were included in the qualitative synthesis. The included studies investigated COVID-19 VH on 1.954.331 individuals from 68 different countries (North America 19; South America 23; Africa 3; Asia 18; Europe 55; Oceania 4) between March 2020 and January 2021. Rates of hesitancy, before to the worldwide availability of vaccinations (82 studies), ranged from 84.6% (Cameroon, May-August 2020) to 10.37% (China, March-June 2020). Studies carried out on January 2021 (N = 7) showed rates ranging from 42.8% (Turkey) to 5.3% (UK). A subgroup analysis of data referring to healthcare workers showed the highest hesitancy rates in Honk Kong (60%) and Turkey (26.6%), before and after vaccine availability, respectively. Conclusions Preliminary results confirm the wide variability of VH across the world. The ongoing quantitative synthesis on prevalence of VH and the analysis on determinants will allow to update intervention strategies to address VH, both in general population and healthcare workers, orienting public health policies. Key messages Vaccine Hesitancy continues to be one of the greatest threats to global health and, in the long term, one of the potential barriers to the success of the global COVID-19 vaccination campaign. Identifying and synthesizing the specific determinants of COVID-19 vaccine hesitancy is essential to guide intervention strategies to promote vaccine confidence and, finally, vaccine acceptance.

Using the workload indicators of staffing need method to determine the staffing requirements for primary healthcare service delivery in Nigeria

Background Weak health governance mechanisms and inequitable distribution of health investments exist in Nigeria, and this is negatively affecting the health system, and health workforce availability and performance. This is evident at the primary level of care and necessitates the need to ensure that staffing levels are informed by workloads. Methods This study applied the workload indicators of staffing need (WISN) method to determine the staffing requirements for nurses, midwives, community health officers (CHO), community health extension workers (CHEWS), and junior community health extension workers (JCHEWS). It was conducted in 11 purposefully selected primary-level health facilities in two local government areas in Cross River State, Nigeria. Results Eighteen health service activities were identified for the primary level of care across the life course. Whilst nurses, midwives, CHO and CHEWS perform all the activities, the JCHEWS performed 10 of these functions. The staffing requirement findings for the facilities in Calabar Municipal indicated that there were staffing shortages for nurses and midwives in 4 of the 5 sampled facilities, three facilities had sufficient or excess numbers of CHO/CHEWS, and 4 facilities had sufficient or excess numbers of JCHEWS. In Calabar South local government area, the calculated requirement showed a cumulative shortage of 5 nurses/midwives and 26 CHO/CHEW, and appropriate staffing of JCHEWS in 4 facilities. Conclusions The results of this study illustrate the staffing needs of nurses, midwives, CHO, CHEWS and JCHEWS in the sampled facilities and indicate the need for using evidence for staffing decisions. This is pertinent considering it ultimately contribute to improvements in service delivery and health indices. The evidence from the application of the WISN tool and the scale-up of its application has the potential of contributing to the achievement of national goals as well as universal health coverage and sustainable development goals.

Academic service-learning nursing partnerships in the Americas: a scoping review

BackgroundAcademic service-learning nursing partnerships (ASLNPs) integrate instruction, reflection, and scholarship with tailored service through enriched learning experiences that teach civic responsibility and strengthen communities, while meeting academic nursing outcomes. Objective: This scoping review aimed to identify, appraise, and synthesize evidence of community focused ASLNPs that promote primary health care throughout the Americas region.MethodsA systematic search of PubMed, CINAHL, Scopus, Google Scholar, and LILACS English-language databases was performed in accordance with PRISMA guidelines. Full-text articles published since 2010 were reviewed using an inductive thematic approach stemming from the “Advancing Healthcare Transformation: a New Era for Academic Nursing Report” and the Pan American Health Organization “Strategic Directions for Nursing.”ResultsA total of 51 articles were included with the vast majority 47 (92.1 %) representing North America. Structured, established relationships between an academic nursing institution or program and one or more community serving entities resulted in high levels of effectiveness and innovation across settings. Five themes emerged: (a) sustaining educational standards and processes - improving academic outcomes (25.5 %), (b) strengthening capacity for collaborative practice and interprofessional education (13.7 %), (c) preparing nurses of the future (11.8 %), (d) enhancing community services and outcomes (21.6 %), and (e) conceptualizing or implementing innovative academic nursing partnerships (27.4 %). A synthesis of conceptual frameworks and models revealed six focus areas: communities/populations (26.2 %), nursing (26.2 %), pedagogy (19 %), targeted outreach (14.3 %), interprofessional collaboration (11.9 %), and health determinants (9.5 %). A proliferation in US articles, triggered by nursing policy publications, was confirmed.ConclusionsASLNPs serve as mechanisms for nurses and faculty to develop and lead change across a wide variety of community settings and healthcare systems, develop scholarship, as well as for students to apply the knowledge and skills learned. Given the lack of geographically broad evidence, successes and challenges across U.S. partnerships should be viewed cautiously. Nevertheless, ASLNPs can play a critical role towards meeting the goal of universal health access and coverage through partnering with the education sector. Further investigation of grey literature as well as Spanish and Portuguese language literature from Latin American and Caribbean countries is highly recommended.

Vaccination status of medical students and faculty members

Objectives: To analyze the student's and professor's vaccinal situation of a medical course. Methods: It is a transversal and quantitative research, done in 2019, which aimed to identify if preconized vaccines of Programa Nacional de Imunização (PNI) were administered or not. The data was obtained through a questionnaire applied to professors and students from the 1st to the 12th period, under CAAE 08246918.1.0000.5237. Posteriorly, it was done an inferential and comparative analysis with literature and vaccinal data from previous research done in 2014, at the same institution, that evaluated vaccination for hepatitis B, dT, varicella, influenza, and HPV. Results: Despite the rise in vaccination of students from 2014 to 2019, most of PNI coverage goals were not reached in 2019. As a result, it is necessary to maintain the incentives for vaccination in the health sector since the sample is constituted of a high-risk group of infectious contagious diseases. Conclusion: The implementation of an action plan for the exigence of the updated vaccinal chart as a prerequisite for registration of medical students must be considered. It is expected that it would reinforce the relevance of vaccination for diseases that are preventable through immunization.

CORR Insights®: Musculoskeletal Urgent Care Centers Restrict Access for Patients with Medicaid Insurance Based on Policy and Location.

CORR Insights®: Musculoskeletal Urgent Care Centers Restrict Access for Patients with Medicaid Insurance Based on Policy and Location.