Provision Of Health Care Services Research Articles

Informal–Formal Healthcare Services Delivery Nexus in Nigeria’s Urban Slums: A Reconnaissance Study

Urban slums are human habitats with poor habitation qualities that are vulnerable to infectious diseases and public health crises. Low coverage from formal healthcare services providers created opportunity for informal providers to thrive in urban slums. This study examined the nature of relationship between informal and formal healthcare services providers in urban slums and explored opportunities for strengthening collaborations between them. Reconnaissance research method, a qualitative research approach for exploring under-researched terrains, guided the interview of 104 slum healthcare stakeholders across eight purposively selected slums in Enugu and Onitsha cities, in southeastern-Nigeria. Findings show that informal healthcare service providers are dominant in urban slums, and many of them cooperate and compete with formal providers. Supervision of informal providers in slums is inadequate, and the formal providers report that the informal providers find acceptance, despite their lack of adequate training and professionalism. Authorities governing health systems in slums are encouraged to establish a mechanism to profile informal providers, delineate the scope of services, and bridge the gap through the creation of referral channels. Subsequent studies may explore what character any mechanism created to institutionalize the collaboration toward improving healthcare services delivery should take and what challenges could undermine it.

Provision of oral healthcare services in WHO-EMR countries: a scoping review

Global neglect of oral healthcare services (OHCS) provision, mainly in Low- and Middle-Income Countries, exacerbates the deterioration of health systems and increases global health inequality.ObjectivesThe objective is to explore the profiles of available oral healthcare services in the WHO Eastern Mediterranean Region (EMR) countries.MethodsA systematic literature search was conducted of grey literature and databases (PubMed, Medline, Embase, and the Cochrane Library). Peer-reviewed articles that reviewed and/or evaluated OHCS in WHO-EMR countries were identified. No time or language limitations were applied. Two independent reviewers conducted the screening and data extraction. A third reviewer arbitrated disagreement. The evaluation of the OHCS provision followed the WHO framework for health system performance assessment. The extraction included socio-demographic characteristics of the studied population, OHCS profile, responsiveness, and health insurance coverage.ResultsOne hundred and thirty-seven studies were identified. The studies that met the inclusion criteria were fifteen published between 1987 and 2016. In addition, two reports were published in 2022. The included studies were conducted in Pakistan, Saudi Arabia, Iran, Libya, Egypt, Oman, Syria, Jourdan, Kuwait, and Tunisia. Generally, Ministries of Health are the main providers of OHCS. The provision for national dental care prevention programmes was highly limited. Furthermore, most of these Ministries of Health have struggled to meet their local populations’ dental needs due to limited finances and resources for OHCS.ConclusionsOral and dental diseases are highly prevalent in the WHO-EMR region and the governments of the region face many challenges to meeting the OHCS needs of the population. Therefore, further studies to assess and re-design the OHCS in these countries to adapt dental care prevention into national health programmes are crucial.

Adapting the serious illness conversation guide for unhoused older adults: a rapid qualitative study

BackgroundOlder adults experiencing homelessness (OAEH) age quickly and die earlier than their housed counterparts. Illness-related decisions are best guided by patients’ values, but healthcare and homelessness service providers need support in facilitating these discussions. The Serious Illness Conversation Guide (SICG) is a communication tool to guide discussions but has not yet been adapted for OAEH.MethodsWe aimed to adapt the SICG for use with OAEH by nurses, social workers, and other homelessness service providers. We conducted semi-structured interviews with homelessness service providers and cognitive interviews with OAEH using the SICG. Service providers included nurses, social workers, or others working in homeless settings. OAEH were at least 50 years old and diagnosed with a serious illness. Interviews were conducted and audio recorded in shelters, transitional housing, a hospital, public spaces, and over Zoom. The research team reviewed transcripts, identifying common themes across transcripts and applying analytic notetaking. We summarized transcripts from each participant group, applying rapid qualitative analysis. For OAEH, data that referenced proposed adaptations or feedback about the SICG tool were grouped into two domains: “SICG interpretation” and “SICG feedback”. For providers, we used domains from the Toolkit of Adaptation Approaches: “collaborative working”, “team”, “endorsement”, “materials”, “messages”, and “delivery”. Summaries were grouped into matrices to help visualize themes to inform adaptations. The adapted guide was then reviewed by expert palliative care clinicians for further refinement.ResultsThe final sample included 11 OAEH (45% Black, 61 ± 7 years old) and 10 providers (80% White, 8.9 ± years practice). Adaptation themes included changing words and phrases to (1) increase transparency about the purpose of the conversation, (2) promote OAEH autonomy and empowerment, (3) align with nurses’ and social workers’ scope of practice regarding facilitating diagnostic and prognostic awareness, and (4) be sensitive to the realities of fragmented healthcare. Responses also revealed training and implementation considerations.ConclusionsThe adapted SICG is a promising clinical tool to aid in the delivery of serious illness conversations with OAEH. Future research should use this updated guide for implementation planning. Additional adaptations may be dependent on specific settings where the SICG will be delivered.

A need to integrate healthcare services for HIV and non-communicable diseases: An Indian perspective.

With the decline in HIV mortality, a concomitant increase in morbidity and death not directly related to HIV has been witnessed. Consequently, many countries especially low- and middle-income countries (LMICs) are now facing the dual burden of HIV and non-communicable diseases (NCDs). 2.3 million people living with HIV in India are at a higher risk of developing NCDs due to ageing, which can be attributed to the additional impact of long-standing HIV infection and the side-effects of antiretroviral therapy. This has led to a rise in demand for a combined health system response for managing HIV infection and co-existing NCDs, especially in LMICs such as India. The health and wellness centres (HWCs) envisioned to provide an expanded range of preventive and curative services including that for chronic conditions may act as a window of opportunity for providing egalitarian and accessible primary care services to these individuals. The reasons for integrating HIV and NCD care are epidemiological overlap between these conditions and the similar strategies required for provision of healthcare services.

HIV status and substance use disorder treatment need and utilization among adults in the United States, 2015–2019: Implications for healthcare service provision and integration

IntroductionSubstance use disorders (SUD) are associated with HIV acquisition and care disruptions. Most research focuses on clinical samples; however, we used a nationally representative, community-based sample to estimate SUD treatment need and utilization by HIV status. MethodsWe included participants from the 2015–2019 National Survey on Drug Use and Health aged 18 and older who met past-year DSM-IV SUD criteria (n = 22,166). Participants self-reported whether a healthcare professional ever told them they had HIV or AIDS [i.e., people with HIV (PWH), non-PWH, HIV status unknown]. Outcomes included past-year: 1) any SUD treatment use; 2) any specialty SUD treatment use; and 3) perceived SUD treatment need. Survey weighted multivariable logistic regression models estimated the likelihood of each outcome by HIV status, adjusting for age, sex, race/ethnicity, education, survey year, health insurance status, and household income. ResultsOverall, 0.5 % were PWH and 0.8 % had an HIV unknown status. Any past-year SUD treatment utilization was low across all groups (10.3 % non-PWH, 24.2 % PWH, and 17.3 % HIV status unknown respondents). Specialty SUD treatment utilization was reported by 7.2 % of non-PWH, 17.8 % PWH, and 10.9 % HIV status unknown respondents. Perceived treatment need was reported by 4.9 % of non-PWH, 12.4 % of PWH, and 3.7 % of HIV status unknown respondents. In adjusted models, PWH were more likely than non-PWH to report any past-year SUD treatment utilization (aOR = 2.06; 95 % CI = 1.08–3.94) or past-year specialty SUD treatment utilization (aOR = 2.07; 95 % CI = 1.07–4.01). Among those with a drug use disorder other than cannabis, respondents with HIV-unknown status were less likely than HIV-negative individuals to report past-year perceived treatment need (aOR = 0.39; 95 % CI = 0.20–0.77). ConclusionsDespite high SUD treatment need among PWH, more than three quarters of PWH with SUD reported no past-year treatment. Compared to non-PWH, PWH had higher treatment utilization and higher specialty treatment utilization, but SUD treatment was low across all groups. As SUD is associated with adverse HIV outcomes, our findings highlight the need for the integration of SUD treatment with HIV testing and care. Increasing access to SUD treatment could help reduce negative SUD-related outcomes along the HIV care continuum.

THE EFFECT OF THE PANDEMIC PROCESS ON THE NUMBER OF PATIENT ADMISSIONS, HOSPITALIZATIONS AND REFERRALS IN A SECONDARY EMERGENCY DEPARTMENT

BACKGROUNDS/PURPOSE In December 2019, the respiratory disease caused by a coronavirus group virus, first seen in Wuhan, China, was named "coronavirus disease" (COVID-19). As a result of various decisions taken around the world to keep the disease under control, to provide healthcare services to diseases other than COVID-19, and to protect healthcare personnel from transmission, there have been some disruptions in healthcare service delivery. In this study, the daily number of patients admitted to the emergency department of a second-level district state hospital during the pandemic period, the number of patients hospitalized and the number of patients referred to another hospital were examined. These data were compared with the pre-pandemic and post-pandemic period. METHODS Applications made between January 01, 2019 and December 31, 2022 were examined retrospectively. The hospital where the study was conducted is a second-tier district state hospital serving a district with a total population of 130 thousand, approximately ten kilometers from the provincial center, and was not declared as a pandemic hospital during the pandemic period, but served both covid patients and patient groups presenting with non-covid complaints. Monthly data were collected on the number of patients admitted to the emergency department, the number of hospitalized patients and the number of patients referred to another institution during the four-year period. The effects of the pandemic period on the total number of admissions, referrals and hospitalizations were compared before and after the pandemic. In addition, the effect of the decisions taken by the Ministry of Internal Affairs during the pandemic on the number of patient applications on a monthly basis, and whether this change, if any, has an effect on the number of patient referrals and hospitalizations were investigated. RESULTS Although the number of patients admitted to the emergency department decreased significantly during the pandemic period, the total number of patients hospitalized and referred from the emergency department did not decrease at a similar rate. Within the framework of this information, we can say that among the patients who applied to the hospital, patients who needed to be hospitalized or who needed to be referred to another institution because treatment was not possible under hospital conditions received the necessary health services both during the pandemic period and before and after the pandemic. CONCLUSION Considering the significant decrease in patient admissions seen with the pandemic, it would be appropriate to examine whether the emergency department is used properly by patients outside the above-mentioned group (without hospitalization or referral) in order to ensure effective and quality health services.

Exploring the Lived Experiences and Coping Mechanisms of Unmarried Women with Polycystic Ovary Syndrome (PCOS) in Pakistan

The current research aimed to demonstrate the lived experiences and coping mechanisms of unmarried women suffering from Polycystic Ovary Syndrome (PCOS) in Pakistan, given that it is the most prevalent endocrine disorder. Furthermore, the study also focused on how these women cope with PCOS, based on a phenomenological qualitative research design. The study utilized a qualitative research design comprising in-depth interviews analyzed through thematic analysis to understand the lived experiences of women with PCOS. Moreover, the perceptions regarding the cultural norms, societal expectations, as well as health information sources were also examined. The results revealed a multifaceted web of stigma, misinformation, and desire to be perceived positively by family and community. Additionally, the study outlined the strategies employed by these women to cope with excessive hair growth anxiety, ranging from medications, diet, and exercises, to using natural remedies. It also underscored the importance of familial support including the access to authentic information as it is helpful for these women to optimally self-manage their emotional well-being. The current study provided a better understanding pertaining to specific healthcare issues faced by unmarried women with PCOS in Pakistan. Moreover, it also enhanced the advocacy for the culturally appropriate and societal stigma targeted interventions to encourage the provision of relevant healthcare services. Furthermore, this study may contribute to new policy adjustments and improvements of healthcare services to enhance the PCOS vulnerable members’ conditions through raising awareness.

The effect of outcome-based education on clinical performance and perception of pediatric care of the third-year nursing students in Mongolia.

Mongolian government has set improvement of clinical proficiency of nursing students as one of its priorities. Nursing professionals have the sentinel role in providing healthcare services in rural areas. Outcome-based education (OBE) offers a promising pedagogical approach to actively mentally engage students to strengthen their clinical proficiencies. We implemented a pilot project with the objective of comparing students' clinical performance under OBE with our traditional didactic techniques. The researchers implemented a non-equivalent two-armed quasi-experimental post-test-only' design approach study. The intervention arm (n = 34) received OBE pediatric training, while the control arm (n = 32) received the traditional pedagogical pediatric nursing training. Each arm of the study completed 16 hours of theory, 32 hours of clinical skills practice and 32 hours of seminars in pediatric nursing care. Data were collected using a five-section instrument, Demographic, Competency Inventory, Nursing Students' Satisfaction, Course Experience, and Objective Structured Clinical Examination. Performance and knowledge proficiencies were evaluated by applying the two-sided independent T-test. The distributions of categorical variables were assessed by Fisher's exact test or chi-squared test of significance. The intervention arm had higher mean score value in the competency inventory ([Formula: see text] = 238.70, SD = ± 23.07) compared to the control arm ([Formula: see text] = 222.11, SD = ± 39.94) (P = 0.04); similarly, the mean value for nursing students' satisfaction was higher for the intervention arm ([Formula: see text] = 117.87, SD = ± 15.94) compared to the control group ([Formula: see text] = 109.76, SD = ± 16.94) (P = 0.049). Additionally, the difference in the mean value for course experience questionnaire between the intervention arm ([Formula: see text] = 125.33, SD = ± 19.30) and the control arm ([Formula: see text] = 110.41, SD = ± 11.28) was statistically significant (P = 0.0001). Finally, the intervention arm had a higher mean value ([Formula: see text] = 85.40, SD = ± 6.11) for objective structural clinical examination compared to the control arm ([Formula: see text] = 81.56, SD = ± 7.01) (P = 0.023). OBE pedagogical approach offers promising benefits to improving nursing students' clinical competencies; additionally, the OBE approach seems to increase students' satisfactions with their clinical curriculum.

EXPERIENCES OF COMMUNITY NURSES IN THE DELIVERY OF OBSTETRICS CARE IN RURAL AREAS

This research employed a generic qualitative approach to investigate the experiences of community nurses in the delivery of obstetrics care in rural areas and in addressing the limitations inherent to their respective localities. The research was carried out within the locality of Davao del Norte, with the participation of a total of fourteen community nurses: seven of them were involved in the in-depth interviews, while the remaining seven took part in the focused group discussion. Thematic analysis was employed to analyze the data. The findings of the study indicate that community nurses in rural locations hold diverse experiences regarding obstetrics care. These are lacking medical equipment and resources, and dealing with patients’ irresponsibility and reluctance to avail services. To cope with the limitations, community nurses implemented the following strategies: utilizing supplement intake alternative methods, and offering insights into the importance of prenatal care. Their recommendations to enhance obstetrics care are fostering collaboration for effective healthcare, enhancing community healthcare through education, and securing funds and medical supplies. This research endeavor has the potential to provide valuable insights for healthcare authorities and other relevant stakeholders to improve rural obstetrics care systems. Through the viewpoints of community nurses, it becomes possible to identify aspects of healthcare, design initiatives, and implement programs that can effectively increase the provision of maternal healthcare services in rural areas. KEYWORDS: Obstetrics care, community nurses, rural areas, generic qualitative study, Davao del Norte, Philippines

Purposeful design in health professions’ curriculum development

Background The content and delivery of a health professions' curriculum is often regarded as ‘intuitive’ and ‘self-defining’, based on commonly encountered professional roles, detailed knowledge of human structure, function and pathology, and opportunities to acquire necessary clinical and communication skills. However, a curriculum tends to develop, sometimes in unexpected ways, due to scientific advances, changes in teaching faculty and variations in clinical placement experience. Trends come and go, often without careful scrutiny and evaluation. A common result is curriculum 'creep', where learning may drift away from the original plan. Methods A review of available curriculum models produced several descriptions that appear to be based primarily on professional norms and traditions and not linked strongly to learning theories or expectations of employers and the community. Regulators accept variety in curriculua so long as agreed outcomes are achieved. Unless planned and maintained carefully, a curriculum may not necessarily prepare graduates well for a Results and discussion Health professions curricula are required to produce graduates not only with higher education qualifications but also capable of providing healthcare services needed by regulators, employers and their communities. The design includes curriculum content, curriculum delivery and assessment of learning, topics often listed separately in standards but in fact closely intertwined, ideally demonstrating constructive alignment that sends consistent messages and facilitates achievement of graduate outcomes. Purposeful design is a systematic approach to defining, developing, and assessing learning that produces competent graduates who will maintain currency throughout their careers. Just as with the human body, everything is connected so a change anywhere is likely to have implications for other parts of the curriculum ecosystem. The role of clinical cases, level of integration, balance of assessment tasks, use of technology, on-site or remote delivery, and choice of assessment methods are important considerations in curriculum design. Any changes should be strategic and aligned with vision, mission, and graduate outcomes. This paper provides a framework analogous to the human body that may facilitate purposeful design of health professions curricula.

The establishment and value of peer group clinical supervision: A qualitative study of stakeholders' perspectives.

Explore perspectives of steering group members and external clinical supervision facilitators of developing and establishing peer group clinical supervision. The climate of healthcare is complex which can lead to staff burnout and challenges to practice. Clinical supervision is suggested as an approach to managing and leadership of such complexities. Qualitative descriptive. Focus group interviews with 19 members of the peer group clinical supervision steering groups and individual interviews with five external clinical supervision facilitators from the Western region of Ireland were conducted. Data analysis followed Elo and Kyngäs' content analysis method, involving preparation, organising and reporting, to extract meaning and identify patterns from the qualitative data collected. Developing peer group clinical supervision practice requires, clarity of purpose and function that address the pros and cons of clinical supervision. Organisational leadership is required to support and release staff for peer group clinical supervision and peer group clinical supervisors need to be credible and have a level of expertise in practice. When prepared and supported, the aspects of confidence, leadership, personal development and resilience develop. Peer group clinical supervisors need training and ongoing continual professional development for their role, scope of practice and responsibilities. Sustainability rests on staff awareness and familiarity with the purpose and format of peer group clinical supervision and the regularity of sessions. Peer group clinical supervision is a means of supporting improvement of patient care delivery while in parallel supporting personal and professional development of staff, building resilience in the workplace. This study explored the implementation of peer group clinical supervision for staff across nursing and midwifery disciplines. It found that implementing peer group clinical supervision had a positive impact on staff well-being and morality and on patient care delivery. These findings influence healthcare service providers in implementing peer group clinical supervision in a sustainable way enabling nurses to continue working in complex healthcare environments delivering safe person-centred care. The qualitative reporting guidelines Standards for Reporting Qualitative Research (SRQR) were followed. Patient/public involvement was addressed in this study by staff, managers, planners, directors, leaders and educationalists being involved at all stages of the study (concept, design, analysis and reporting).

Burnout, Intention to Resign and Related Factors among Health Professionals

Aim: The purpose of this study was to put forth the exhaustion state of healthcare professionals providing healthcare services in the city of Bitlis located in eastern Turkey and to compare the states of exhaustion of the healthcare professionals providing pre-hospital, first level and second level services. Additionally, determining the ratio of the intention to resign and the factors affect their intentions are among the aims of this study. Material and Methods: The study's target population comprised of all healthcare professionals working in Bitlis between 01.11.2018-01.01.2019. Age, gender, place of work, duty, marital status, number of children, smoking status, years of experience and whether they intend to resign or not of all participants were asked and Maslach burnout inventory (MBI) were filled after their consent. Data were analyzed with SPSS. P values

Self-efficacy and Perceived Ease of Use as Factors to Determine Medical Personnel Readiness to Use an Information System Technology

This article uses an empirical investigation to evaluate self-efficacy and perceived ease of use as factors that will determine the successful adoption of the health information system in health institutions, using Nigeria as a case study. The health information system is the application of information technology to enable and promote health care services provision, support and delivery. Utilizing the DeLone and McLean model and a construct from the TAM (Technology Acceptance Model), the focus is on self-efficacy and perceived ease of use which are tested with the (intention to) Use to find a correlation, to consider them as determinant factors of the readiness to adopt an information system in the healthcare environment. Results and findings reveal that self-efficacy and perceived ease of use have an effect on the intention to use and actual use of the HIS. Health practitioners should be trained on how to utilize the information system in order to improve their attitudes and perceptions towards it. Doing this will increase their zeal and make it habitual for them to utilize the system, hence better goals will be attained.

Social health organizations: an analysis of the specialties and exams contracted by the State of São Paulo, Brazil.

Social Health Organizations (SHOs) are private entities that receive resources from governments for the management of public healthcare services. With the history of market interest in public health and the high volume of resources transferred to SHOs, one must question if the market logic continues to be inserted in this management model. The understanding of the dynamics of providing healthcare services to the population in the different contracts may help to understand how possible changes in the contracted services may have an influence. This is a descriptive-exploratory study using quantitative and qualitative approaches. Documental research was conducted through the collection of data from management contracts and amendments. The State of São Paulo was chosen because of its economic representativeness and for being the pioneer state in the implementation of SUS services managed by SHO. Medical specialties were included in 184 renegotiations (6.14%) and excluded in 187 (6.24%), whereas non-medical services were included in 26 renegotiations (2.97%) and excluded in 144 (16.44%). Regarding examinations, 101 renegotiations (18.07%) had their goals increased and 60 (10.73%) reduced, while 6 renegotiations (1.07%) included exams and 12 (2.14%) excluded them.

Organizações sociais de saúde: análise sobre as especialidades e exames contratados pelo Estado de São Paulo, Brasil

Abstract Social Health Organizations (SHOs) are private entities that receive resources from governments for the management of public healthcare services. With the history of market interest in public health and the high volume of resources transferred to SHOs, one must question if the market logic continues to be inserted in this management model. The understanding of the dynamics of providing healthcare services to the population in the different contracts may help to understand how possible changes in the contracted services may have an influence. This is a descriptive-exploratory study using quantitative and qualitative approaches. Documental research was conducted through the collection of data from management contracts and amendments. The State of São Paulo was chosen because of its economic representativeness and for being the pioneer state in the implementation of SUS services managed by SHO. Medical specialties were included in 184 renegotiations (6.14%) and excluded in 187 (6.24%), whereas non-medical services were included in 26 renegotiations (2.97%) and excluded in 144 (16.44%). Regarding examinations, 101 renegotiations (18.07%) had their goals increased and 60 (10.73%) reduced, while 6 renegotiations (1.07%) included exams and 12 (2.14%) excluded them.

Interprofessional learning in practice-based settings: AMEE Guide No. 169

The provision of optimum health care services requires collaboration of health care professionals in integrated interprofessional (IP) teams. This guide addresses the practical aspects of establishing and delivering pre-licensure IP programs to prepare graduates of health professional programs to work in teams and wider collaboration, and consequently enhance the quality of health care. The main updated IP frameworks are presented to highlight commonalities that represent the essential competencies and outcomes of programs implementing interprofessional education (IPE). We discuss how these may be adapted to the local context, and present examples of models of implementation to guide the initial steps of establishing similar programs. Examples of pre-licensure IP practice-based learning, such as community-based, simulation-based, student-run and led clinics, and interprofessional training wards, and post-licensure interprofessional learning (IPL), are described. We consider assessment of IPL along the continuum of learning IP. This guide also emphasises the need to tailor faculty development programs for local contexts and consider factors affecting sustainability such as funding and accreditation. We finish with the governance of IP programs and how global IP networks may support interprofessional practice-based learning from development to delivery.

Integrating Syrian refugees into Lebanon’s healthcare system 2011–2022: a mixed-method study

IntroductionThe Lebanese government estimates the number of Syrian refugees to be 1.5 million, representing 25% of the population. Refugee healthcare services have been integrated into the existing Lebanese health system. This study aims to describe the integration of Syrian refugee health services into the Lebanese national health system from 2011 to 2022, amid an ongoing economic crisis since 2019 and the COVID-19 pandemic.MethodsThis paper employs a mixed-methods approach drawing upon different data sources including: 1- document review (policies, legislation, laws, etc.); 2- semi-structured interviews with policymakers, stakeholders, and health workers; 3- focus group discussions with patients from both host and refugee populations; and 4- health systems and care seeking indicators.ResultsAlthough the demand for primary health care increased due to the Syrian refugee crisis, the provision of primary health care services was maintained. The infusion of international funding over time allowed primary health care centers to expand their resources to accommodate increased demand. The oversupply of physicians in Lebanon allowed the system to maintain a relatively high density of physicians even after the massive influx of refugees. The highly privatized, fragmented and expensive healthcare system has impeded Syrian refugees’ access to secondary and tertiary healthcare services. The economic crisis further exacerbated limits on access for both the host and refugee populations and caused tension between the two populations. Our findings showed that the funds are not channeled through the government, fragmentation across multiple financing sources and reliance on international funding. Common medications and vaccines were available in the public system for both refugee and host communities and were reported to be affordable. The economic crisis hindered both communities’ access to medications due to shortages and dramatic price increases.ConclusionIntegrating refugees in national health systems is essential to achieve sustainable development goals, in particular universal health coverage. Although it can strengthen the capacity of national health systems, the integration of refugees in low-resource settings can be challenging due to existing health system arrangements (e.g., heavily privatized care, curative-oriented, high out-of-pocket, fragmentation across multiple financing sources, and system vulnerability to economic shocks).

Transforming mental health care: Telemedicine as a game-changer for low-income communities in the US and Africa

Telemedicine is transforming mental health care, particularly in low-income communities in the US and Africa, where access to traditional mental health services is limited. This review explores how telemedicine is revolutionizing mental health care delivery, addressing barriers to access, and improving health outcomes for underserved populations. In low-income communities, accessing mental health services can be challenging due to factors such as lack of healthcare infrastructure, stigma, and limited financial resources. Telemedicine, which involves providing healthcare services remotely using telecommunications technology, offers a solution to these challenges by enabling patients to receive mental health care from anywhere, including their homes. Telemedicine in mental health care is particularly impactful for low-income communities in the US and Africa, where access to mental health services is often limited. Through telemedicine, individuals can receive timely and convenient mental health care, leading to improved outcomes and reduced healthcare costs. This review highlights the benefits of telemedicine in mental health care, including increased access to care, improved convenience, and reduced stigma. It also discusses the challenges of implementing telemedicine in low-income communities, such as technological barriers and regulatory issues, and proposes strategies to address these challenges. Overall, telemedicine has the potential to revolutionize mental health care delivery in low-income communities in the US and Africa, improving access to care and health outcomes for underserved populations.

Engagement of private healthcare sector in addressing noncommunicable diseases at primary care level in the Eastern Mediterranean Region.

The private healthcare sector is a critical stakeholder in the provision of health care services, including noncommunicable diseases (NCDs), and engagement with the sector is increasingly being advocated in efforts to achieve Universal Health Coverage. This study was conducted to explore the role of the private health sector in delivering NCD-related primary care services in selected countries of the WHO Eastern Mediterranean Region (EMR): Jordan, Oman, Pakistan, Sudan, and the Syrian Arab Republic. We adapted the analytical framework for this study from the "Framework for action to implement the United Nations political declaration on noncommunicable diseases". We conducted a desk review to gather evidence, identify gaps and provide direction for the subsequent stakeholder interviews. Key informant interview respondents were selected using the snowball sampling method. Data from the interviews were analysed using MAXQDA, version 2020. We reviewed 26 documents and interviewed 19 stakeholders in Jordan, Oman, Pakistan, Sudan and the Syrian Arab Republic. Our results indicated increasing advocacy at the regional and national levels to align the private and public health sectors, just as there were efforts to reduce the risk factors for NCDs by implementing tobacco laws, introducing food labelling guidelines, increasing taxes on soft drinks, and promoting the healthy cities approach. NCDs health information systems varied widely among the countries, from being organized and developed to having poor recordkeeping. The private health sector is the predominant provider of care at primary level in most of the EMR countries. Increased collaboration between the public and private sectors is essential for better management of NCDs in the EMR. Governments need to strengthen regulation and defragment the private health sector and harness the sector's strengths as part of efforts to achieve national health targets, NCD goals and Universal Health Coverage.

Unmet rehabilitation needs in the first 6 months post-injury in a trauma centre population with moderate-to-severe traumatic injuries.

To describe the needs for subacute inpatient rehabilitation and community-based healthcare services, rehabilitation, and social support in patients with moderate-to-severe traumatic injury in the first 6 months post-injury. Further, to explore associations between sociodemographic and clinical characteristics and unmet needs. Multicentre prospective cohort study. Of 601 persons (75% males), mean (standard deviation) age 47 (21) years, admitted to trauma centres in 2020 with moderate-to-severe injury, 501 patients responded at the 6-month follow-up and thus were included in the analyses. Sociodemographic and injury-related characteristics were recorded at inclusion. Estimation of needs was assessed with the Rehabilitation Complexity Scale Extended-Trauma and the Needs and Provision Complexity Scale on hospital discharge. Provision of services was recorded 6months post-injury. Multivariable logistic regressions explored associations between baseline variables and unmet inpatient rehabilitation and community-based service needs. In total, 20% exhibited unmet needs for subacute inpatient rehabilitation, compared with 60% for community-based services. Predictors for unmet community-based service needs included residing in less central areas, profound injury severity, severe head injury, and rehabilitation referral before returning home. Inadequate provision of healthcare and rehabilitation services, particularly in the municipalities, resulted in substantial unmet needs in the first 6 months following injury.