Health Center Management Research Articles

Analysis of Basic Immunization Services during the COVID-19 Pandemic at Public Health Centers in Semarang

BACKGROUND: The Corona Virus Disease 2019 (COVID-19) pandemic has affected public health services, including routine immunization services. If this condition continues, the national immunization coverage will decrease, thereby potentially increasing the risk of immunization preventable diseases. AIM: This study aims to determine the coverage of complete basic immunization services in Semarang before (December 2019) and during the pandemic (May 2020) and the factors that affect the coverage of complete basic immunization services. METHODS: This study describes complete basic immunization based on data taken in June-August 2021 at three health centers in Semarang. The data used were the number of visits and the type of immunization obtained from the medical records of the Health Center Management Information System. In addition, in-depth interviews were conducted with the person in charge of the immunization program at the Public Health Center (Puskesmas) to determine the influence factors of the immunization coverage. The data from the interviews were then analyzed thematically. RESULTS: There were 3594 infants who received immunization services, consisting of 2401 before the pandemic and 1193 during the pandemic. The average decrease in the number of basic immunization services was 50.31%. The decrease in the number of basic immunization services occurred in all network public health centers with an average of Puskesmas Genuk (−36.63%), Halmahera (−40%), and Pandanaran (−26.35%). The mother’s fear of COVID-19 contagious, service time and patients restrictions by the PHC, and IPV vaccine stock out have reduced the basic vaccination coverage in all public health centers. CONCLUSION: There was a decline in basic immunization coverage during the pandemic, so it is necessary to fulfill basic immunization needs and service inn

Health management information system (HMIS) data quality and associated factors in Massaguet district, Chad

BackgroundQuality data from Health Management Information Systems (HMIS) are important for tracking the effectiveness of malaria control interventions. However, HMIS data in many resource-limited settings do not currently meet standards set by the World Health Organization (WHO). We aimed to assess HMIS data quality and associated factors in Chad.MethodsA cross-sectional study was conducted in 14 health facilities in Massaguet district. Data on children under 15 years were obtained from the HMIS and from the external patient register covering the period January–December 2018. An additional questionnaire was administered to 16 health centre managers to collect data on contextual variables. Patient registry data were aggregated and compared with the HMIS database at district and health centre level. Completeness and accuracy indicators were calculated as per WHO guidelines. Multivariate logistic regressions were performed on the Verification Factor for attendance, suspected and confirmed malaria cases for three age groups (1 to < 12 months, 1 to < 5 years and 5 to < 15 years) to identify associations between health centre characteristics and data accuracy.ResultsHealth centres achieved a high level of data completeness in HMIS. Malaria data were over-reported in HMIS for children aged under 15 years. There was an association between workload and higher odds of inaccuracy in reporting of attendance among children aged 1 to < 5 years (Odds ratio [OR]: 10.57, 95% CI 2.32–48.19) and 5– < 15 years (OR: 6.64, 95% CI 1.38–32.04). Similar association was found between workload and stock-outs in register books, and inaccuracy in reporting of malaria confirmed cases. Meanwhile, we found that presence of a health technician, and of dedicated staff for data management, were associated with lower inaccuracy in reporting of clinic attendance in children aged under five years.ConclusionData completeness was high while the accuracy was low. Factors associated with data inaccuracy included high workload and the unavailability of required data collection tools. The results suggest that improvement in working conditions for clinic personnel may improve HMIS data quality. Upgrading from paper-based forms to a web-based HMIS may provide a solution for improving data accuracy and its utility for future evaluations of health interventions. Results from this study can inform the Ministry of Health and it partners on the precautions to be taken in the use of HMIS data and inform initiatives for improving its quality.

Obstacles in The Implementation of “Sayang Bunda” E-Health Application

Background: The Sayang Bunda application is an E-Health android application offered by the Semarang City Health Office which provides consultation services to pregnant women and postpartum mothers. E-Health is considered effective as a medium for consulting pregnant women in the city of Semarang. However, based on a preliminary survey to pregnant women, there are pregnant women who do not use and even do not know the application. The purpose of this study was to explore the obstacles in the implementation of the "Sayang Bunda" E-Health Application. Research Methods: This research is a qualitative research where this research is basic and aims to obtain information and data related to the implementation of the Sayang Bunda E-Health application. Data collection techniques use interviews with the health center coordinator midwives and questionnaires with pregnant women and postpartum mothers. The subjects of this study are pregnant women, postpartum mothers, and the managers of community health centers. The study results show that pregnant women and postpartum mothers prefer WhatsApp groups to have consultation related to pregnancy, childbirth, postpartum and newborns since it is easier to do. It is recommended to have policy integration among several parties so that the implementation of the Sayang Bunda E-Health can be carried out optimally. Â Keywords : E -Health, Obstacles, Implementation . Â

«Falta tiempo»: experiencias de médicos gestores de la demanda en la atención primaria de salud chilena

ObjectiveCharacterize the current situation of the demand manager physician (DMP) in primary health care (PHC), from the perceptions of those who fulfill this role, their medical peers and the directors of the family health centers (CESFAMs). DesignQualitative cross-sectional study with a grounded theory approach. SiteFour CESFAMs from the South East Metropolitan Health Service in Santiago, Chile. ParticipantsDemand manager physician, general practitioners and directors of CESFAM. MethodA semi-structured interview and discussion group were used as data collection technique. Open, axial, and selective coding was carried out with the support of the NVivo12 software. ResultsIn practice, DMP performs more functions than those defined for the position by the Ministry of Health, generating the feeling of lack of time to carry out their work, what represents their main barrier at work and reflects the absence of institutional support they receive from their employees. Among these invisible functions are: providing feedback to the medical team, leading clinical meetings, and generating reference protocols. For the good performance of the DMP it is necessary to have technical skills and be recognized by their peers. It was estimated that the family doctor is the most suitable professional for the position. The work of the DMP is limited by institutional factors such as waiting lists, lack of specialists, and poor coordination between levels of care. ConclusionsStandardizing the functions of the DMP is a necessary element for its consolidation and achieving the objectives of maintaining continuity of care in the population.

Evaluation of mass drug administration for schistosomiasis and soil-transmitted helminths in school-aged children in Bankass, Mali

BackgroundIn 2004, Mali implemented mass drug administration (MDA) aimed at controlling schistosomiasis and soil-transmitted helminths. Despite several rounds of MDA, the health district of Bankass reported low coverage (64.8%) for praziquantel and albendazole in 2017, meaning that this district was still facing challenges in accomplishing the targeted 75% coverage. This study aimed to explore the barriers and gaps that hindered MDA implementation in Bankass. MethodsA cross-sectional study was performed. Questionnaires were administrated to all school-aged children in randomly selected villages. Technical directors of community health centers and community drug distributors in the selected villages were included in the interviews. ResultsA total of 2128 children and 52 health workers were interviewed. Coverage rates were 93.51% (1990/2128) for praziquantel and 95.25% (2027/2128) for albendazole. Among the untreated children, 31.63% (31/98) reported being unaware of the campaign and 26.53% (26/98) were unable to reach the distribution points. Most of the health workers suggested increasing incentives. ConclusionThe data showed satisfactory coverage >90%, in contrast with lower rates initially reported by the district health information system. These results raise concerns about the reliability of programmatic data and highlight the importance of population-based surveys for the evaluation of control interventions.

Transmission of SARS-CoV-2 through contact with a SARS-CoV-2-infected individual in the presymptomatic or asymptomatic state in Japan: A case series

Objectives There is little evidence supporting the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from presymptomatic or asymptomatic SARS-CoV-2-infected individuals in Japan, where the incidence of SARS-CoV-2 infection is lower than that in other developed countries. This study aimed to determine whether SARS-CoV-2 transmission can occur from presymptomatic or asymptomatic SARS-CoV-2-infected individuals.Methods We surveyed all directors of Japanese public health centers for index cases and secondary patients who possibly contracted SARS-CoV-2 infection from a presymptomatic or asymptomatic SARS-CoV-2-infected individual who came under their care before June 20, 2020. The professional staff at the centers routinely perform contact tracing of infected persons based on the guidelines of the Infection Control Act. Four authors independently reviewed reports of 9 index cases of SARS-CoV-2-infected individuals with 17 secondary patients from 8 prefectures and examined the cases to determine whether transmission from a SARS-CoV-2-infected individual in the presymptomatic or asymptomatic state occurred.Results We reported 7 index cases with 13 secondary patients. 1) An elderly woman acquired SARS-CoV-2 infection from her sustained asymptomatic granddaughter at home, 2) 4 guests and 1 accompanying child waiting at a hair salon acquired infection from the presymptomatic female hair stylist, 3) 2 inpatients acquired infection from a presymptomatic nurse while providing nursing care in close contact, 4) an elderly couple acquired SARS-CoV-2 infection from their presymptomatic relative who was in the 50s during household care at their home, 5) a man acquired SARS-CoV-2 infection from a presymptomatic adult neighbor in an enclosed space with poor ventilation, 6) a presymptomatic man had transmitted infection to another man at a coffee shop while having a discussion on business, and 7) a man in his 50s acquired SARS-CoV-2 infection from a presymptomatic man during 50 minutes of close contact at their office and in a car. These secondary patients had no other likely routes of infection. The interval between the date of symptom onset in the presymptomatic index case and the secondary patient ranged from 2 to 6 days. The incidence rates at the time these infections occurred in the corresponding prefectures ranged from 0.00 to 6.56 cases/1 million person-days.Conclusion We report the first case of SARS-CoV-2 transmission from a sustained asymptomatic index case in Japan. All secondary patients came into close contact with presymptomatic index cases in areas with poor ventilation.

Impact of COVID-19 prevention measures on health service quality, perceived value and user satisfaction. A structural equation modelling (SEM) approach

ObjectiveTo explain using a structural equation model to patient satisfaction by analysing confidence in preventive measures against COVID-19 as an antecedent of this satisfaction and the effect that these measures have on the antecedents of service quality and perceived value. DesignAn observational cross-sectional study. SiteOnline survey was sent via social networks for recruiting citizens resident in Spain. ParticipantsThe final sample consisted of 149 women and 122 men. The mean age of the participants was 36.73 years, all of whom were health service users. InterventionsNo interventions were conducted in the study. Main measurementsThe study variables for the development of the structural equation model were: confidence in COVID-19 safety protocol, perceived value, quality and user satisfaction. ResultsThe results showed a direct and positive effect of confidence in COVID-19 safety protocol on the quality of services provided, perceived value and user satisfaction. ConclusionsThe study is expected to be of interest to those in charge of designing protective measures against the spread of diseases, health centre managers and marketing professionals interested in the improvement user satisfaction, affected as a result of the current pandemic.

Correlation between the level of knowledge of drug managers and drug management in several primary health centres in Malang regency

&#x0D; Background: Drug management is one of the primary health centre management activities that aims to ensure the continuity and affordability of pharmaceutical preparations. &#x0D; Aim: This study aims to determine the relationship between the level of knowledge of drug managers and drug management in several primary health centres of Malang regency. &#x0D; Method: The study was observational analytic using questionnaire instruments to analyse the level of knowledge of drug managers and three checklists to analyse drug management through three indicators of drug management: (1) conformity of stock to the national formulary, (2) conformity of stock to the disease patterns, and (3) the percentage of expired drugs. &#x0D; Result: There was no significant relationship between the level of knowledge and the first (p = 0.842), second (p = 0.236), and the third indicator (p = 0.361). &#x0D; Conclusion: Not all drug lists in the national formulary are required by each primary health centre. The inventory is adjusted to the consumption and epidemiology.&#x0D;

The Effects of the Pilates Method on Pelvic Floor Injuries during Pregnancy and Childbirth: A Quasi-Experimental Study.

The perineal injuries suffered during childbirth have a great impact on the quality of life of the female population. Evidence suggests that the Pilates method is used by pregnant women to improve the physical and psychological outcomes of pregnancy. The aim of this study was to investigate the influence of the Pilates Method during pregnancy on the incidence and degree of intrapartum perineal trauma. A quasi-experimental study was carried out between November 2018 and December 2019 at different health centers in two health districts. Participants were 72 pregnant women attending the antenatal program, who were assigned to a Pilates group or a control group (48 and 24 pregnant women, respectively). The main outcome measurement was perineal trauma during childbirth. After participating in the Pilates program, the women in the experimental group were significantly less likely to suffer perineal trauma in spontaneous deliveries compared to the women in the control group. After evaluating these results, it is concluded that health center managers should promote the training of midwives in the prevention and treatment of pelvic floor injuries during pregnancy and should consider strategies to enhance adhesion and participation with respect to pelvic floor exercise programs throughout pregnancy by means of Apps and other digital media specifically aimed at this phase.

Evaluation of Drug Use at Pasar Merah Public Health Center in Medan

Evaluation of drug use is one of the clinical pharmacy services at Public Health Center. Evaluation of the drugs use must refer to the indicators of drug use.This study aimed to determine the average number of drugs in each prescription, the percentage of prescribed generic drugs, the percentage of prescribed antibiotics, the percentage of injection, and the percentage of drugs prescribed from the DOEN (List of National Essential Medicines) at Pasar Merah Public Health Center Medan. This research was a retrospective descriptive study carried out by collecting data from the available documents as well as interviews with the head of Medan Pasar Merah Public Health Center and drug management officers.Through the research, it was found that the average number of drugs in each prescription was still high, not in accordance with the prescribed standards, the percentage of generic drugs prescribed was not good, the percentage of prescribed antibiotics was quite high, the percentage of injections prescribed did not meet the percentage indicator of injection prescription, and the percentage of drugs prescribed from the DOEN at Pasar Merah Medan Public Health Center was quite good. This study concludes that the use of drugs in Pasar Merah Medan Public Health Center has not met the indicator of drug use

Conditions and barriers for quality improvement work: a qualitative study of how professionals and health centre managers experience audit and feedback practices in Swedish primary care

BackgroundHigh quality primary care is expected to be the basis of many health care systems. Expectations on primary care are rising as societies age and the burden of chronic disease grows. To stimulate adherence to guidelines and quality improvement, audit and feedback to professionals is often used, but the effects vary. Even with carefully designed audit and feedback practices, barriers related to contextual conditions may prevent quality improvement efforts. The purpose of this study was to explore how professionals and health centre managers in Swedish primary care experience existing forms of audit and feedback, and conditions and barriers for quality improvement, and to explore views on the future use of clinical performance data for quality improvement.MethodsWe used an explorative qualitative design. Focus groups were conducted with health centre managers, physicians and other health professionals at seven health centres. The interviews were audio recorded, transcribed and analysed using qualitative content analysis.ResultsFour different types of audit and feedback that regularly occurred at the health centres were identified. The main part of the audit and feedback was “external”, from the regional purchasers and funders, and from the owners of the health centres. This audit and feedback focused on non-clinical measures such as revenues, utilisation of resources, and the volume of production. The participants in our study did not perceive that existing audit and feedback practices contributed to improved quality in general. This, along with lack of time for quality improvement, lack of autonomy and lack of quality improvement initiatives at the system (macro) level, were considered barriers to quality improvement at the health centres.ConclusionsProfessionals and health centre managers did not experience audit and feedback practices and existing conditions in Swedish primary care as supportive of quality improvement work. From a professional perspective, audit and feedback with a focus on clinical measures, as well as autonomy for professionals, are necessary to create motivation and space for quality improvement work. Such initiatives also need to be supported by quality improvement efforts at the system (macro) level, which favour transformation to a primary care based system.

Modelling the Number of Household Visit to Health Care Centres in Some Nigeria Communities Using Count Data Regression Models

Introduction: The need to model the impact of some demographic indicators on the frequency of household visits to healthcare centres in Nigeria's community is very important for preventing and spreading community diseases. This study aimed to investigate the effect of the patents' age, gender, marital status, type of illness and amount spent on the frequency of visits to community health care centres in Nigeria and to compared Negative Binomial Regression (NBR) and Generalized Poisson Regression (GPR) models to determine the preferred count regression model for the number of household visits to health centres in some communities in Nigeria. Methods: Survey of 132640 households in some Nigeria communities obtained from the 2018/2019 Nigeria Living Standard Survey (NLSS) were extracted from the National Bureau of Statistics (NBS) in collaboration with the World Bank. The Negative Binomial and Generalised Poisson regression models were used to investigate the five demographic variables on the frequency of visit to the community health centres. The performance of the count regression model was assessed using the Chi-square -2log Likelihood Statistic (2logL), Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) selection criteria. Results: Findings from the study showed that the type of illness and amount spent has a significantly positive effect on the number of household members' visits to the community health care centres in Nigeria while age, gender, and marital status was discovered to have a negative effect on the number of household members' visits to the community health care centres in Nigeria. Conclusion: The Nigeria Government, health centre management and community healthcare service providers' need to be aware that the amount spent and the nature of illness determines the level of health care services utilisation in the Nigeria community, hence the need for the drastic reduction in charges to encourage a household visit to the community health centres whenever the need arises.

Perception of Malaria Chemoprevention Interventions in Infants and Children in Eight Sub-Saharan African Countries: An End User Perspective Study.

Preventive chemotherapy interventions have been identified as key tools for malaria prevention and control. Although a large number of publications have reported on the efficacy and safety profile of these interventions, little literature exists on end-user experience. The objective of this study was to provide insights on the perceptions and attitudes towards seasonal malaria chemoprevention (SMC) and intermittent preventive treatment of infants (IPTi) to identify drivers of and barriers to acceptance. A total of 179 in-depth qualitative interviews were conducted with community health workers (CHWs), health center managers, parents of children receiving chemoprevention, and national decision makers across eight countries in sub-Saharan Africa. The transcribed verbatim responses were coded and analyzed using a thematic approach. Findings indicate that, although SMC is largely accepted by end users, coverage remained below 100%. The main causes mentioned were children’s absenteeism, children being sick, parents’ reluctance, and lack of staff. Regarding IPTi, results from participants based in Sierra Leone showed that the intervention was generally accepted and perceived as efficacious. The main challenges were access to water, crushing the tablets, and high staff turnover. SMC and IPTi are perceived as valuable interventions. Our study identified the key elements that need to be considered to facilitate the expansion of these two interventions to different geographies or age groups.

Management Analysis of Pandemic Covid-19 in Kepung, Kediri Districts

Pandemic is a recurring event that causes a global recession and threatens human security. The Covid-19 pandemic in Indonesia is predicted to have very high morbidity and mortality rate. The strategy has been implemented but the case is still high, so it needs to be evaluated of the management factor from task force and community health center. The research method used is descriptive qualitative, with purposive sampling and indeep interview of 16 main informants and 2 triangulation informants. The research results from the input aspect of man and money are sufficient, lack of material becouse of regulations, budgets, stock and information that cause negative stigma and inadequate movement of task force and inadequate mentoring methods due to weak coordination. The planning aspects consider community input (batoom up), fulfillment of guidelines and instructions from the health office or district task force (top down) with a system of changes to the Financial Budget. The conclusion is that the preventive and promotive roles of community health center management and task forces are not maximal in efforts to deal with a pandemic becouse of limited inputs and constraints in organization and implementation.

Evaluasi Sistem Informasi Manajemen Puskesmas (Simpus) (Studi Kasus : Puskesmas Induk Di Wilayah Kabupaten Sukoharjo)

The public health center management information system (SIMPUS) is used to provide services at public health center, from patient registration to medical services. There are some inconsistencies regulations happen, so it is needed evaluation using COBIT 4.1 to evaluate the level of capability (As-Is) and draw conclusion.This research uses primary and secondary data collection methods. This study uses primary and secondary data collection methods. The author conducts an evaluation process using Framework COBIT 4.1 domain Acquire and Implement (AI) process Acquire and Maintain Application Software (AI2), Delivery and Support (DS) process Educate and Train Users (DS7) and Monitor and Evaluate (ME) process Monitor and Evaluate IT Performance (ME1). There are 154 respondents with details of AI2 27 respondents, DS7 100 respondents, and ME1 27 respondents. The AI2 questionnaire has 24 questions, DS7 and ME1 have 18 questions. The maturity level of AI2 is 3.29 and DS7 is 2.59, the value of CO maturity is at matury level 3, which means the condition in which the entire process has been documented and has been communicated, and implemented properly, but there is no evaluation process of the system. The ME1 maturity level of 3.58 at matury level 4 means that the computerized process can be monitored and evaluated properly. Based on the expected level, it is concluded that the average expected ideal value for AI2 and DS7 is at level 4 while ME1 is at level 5.Keywords: The public health center management information system (SIMPUS) is used to provide services at public health center, from patient registration to medical services. There are some inconsistencies regulations happen, so it is needed evaluation using COBIT 4.1 to evaluate the level of capability (As-Is) and draw conclusion.This research uses primary and secondary data collection methods. This study uses primary and secondary data collection methods. The author conducts an evaluation process using Framework COBIT 4.1 domain Acquire and Implement (AI) process Acquire and Maintain Application Software (AI2), Delivery and Support (DS) process Educate and Train Users (DS7) and Monitor and Evaluate (ME) process Monitor and Evaluate IT Performance (ME1). There are 154 respondents with details of AI2 27 respondents, DS7 100 respondents, and ME1 27 respondents. The AI2 questionnaire has 24 questions, DS7 and ME1 have 18 questions. The maturity level of AI2 is 3.29 and DS7 is 2.59, the value of CO maturity is at matury level 3, which means the condition in which the entire process has been documented and has been communicated, and implemented properly, but there is no evaluation process of the system. The ME1 maturity level of 3.58 at matury level 4 means that the computerized process can be monitored and evaluated properly. Based on the expected level, it is concluded that the average expected ideal value for AI2 and DS7 is at level 4 while ME1 is at level 5.Keywords : Puskesmas Management Information System, Framework COBIT 4.1, Maturity Level

Contributing barriers to loss to follow up from antenatal care services in villages around Addis Ababa: a qualitative study

BackgroundProblems during pregnancy, childbirth and postpartum are the major contributors to maternal and perinatal morbidity and mortality. Focused antenatal care is an intervention set to provide basic services for pregnant women, to reduce morbidity and mortality related to pregnancy. In Ethiopia, there is a significant loss to follow up from antenatal care services between the first and fourth visits. The aim of this study is to explore the potential contributing barriers to loss to follow up of pregnant women from antenatal care services in villages around Addis Ababa, the capital city of the country.MethodsA qualitative research method was used, where 20 in-depth interviews (zonal, woreda and health center managers, midwives and health extension workers were the participants) and three focus group discussions (mothers who were lost to follow up, mothers who completed four sessions of antenatal care visits, and community volunteers were the participants) were conducted. A qualitative data analysis software, ATLAS.ti 8, was applied.ResultsInability to deliver essential antenatal care services which occurs primarily due to shortage of the required medical equipment, drugs, and other supplies is a major barrier for sustainable attendance of antenatal care services followed by poor care, respect, and receptiveness of service providers. Lack and cost of transport as well as partners’ approval and support were also claimed to be part of the major barriers. Community culture and pervious maternal experiences as well as maternal sociodemographic factors like maternal age at time of pregnancy and educational status of mothers were also reported as barriers to seeking and completion of antenatal care services.ConclusionsBoth demand and supply side barriers play a significant role in the loss to follow up from antenatal care services. Availing essential antenatal care services, closer to the community by improving the infrastructure, health workforce and supply chain system is recommended.

Mental health and diabetes self-management: assessing stakeholder perspectives from health centers in Northern Mexico

BackgroundPeople living with diabetes have an increased risk of developing mental health issues. Mexico has observed a high prevalence of people living with diabetes suffering from mental health issues, such as anxiety and depression. Self-management programs have demonstrated promise in helping participants address and prevent not only physiological health complications but mental health issues as well. This qualitative study aimed to understand the mental health benefits of a diabetes self-management intervention for health centers in Northern Mexico and opportunities for improvement through assessing stakeholder perspectives.MethodsTrained research staff used a semi-structured questionnaire guide to conduct all interviews and focus groups from February–May 2018. Individual interviews (n = 16) were conducted face-to-face at four health center sites among all health center directors and key staff located throughout the state of Sonora. One focus group (n = 41) was conducted at each of the four health centers among intervention participants. Directed content analysis was used to establish themes by understanding relationships, identifying similar experiences, and determining patterns across datasets.ResultsIn total 57 health center directors, health center staff, and intervention participants were involved in the interviews and focus groups across the four health centers. Overall the analysis identified four themes throughout the data, two were categorized as benefits and two as improvements. The primary themes for participant benefits were an increase in self-efficacy and social support to manage their chronic conditions. These were evident from not only participant perspectives, but health staff observations. Conversely, increased family involvement, and increased mental health integration and services within diabetes care were identified themes for opportunities to improve the intervention to be more inclusive and holistic.ConclusionAll stakeholders observed the benefits for intervention participants and opportunities for more inclusivity of the family and integration as well as an increase in mental health services. The themes identified demonstrated a need to more proactively enhance and utilize diabetes self-management as a means to improve mental health outcomes among people living with diabetes in Mexico. This is an opportunity to employ a more comprehensive approach to diabetes self-management, and integrate mental health services into overall diabetes care.Trial registrationwww.ClinicalTrials.gov, identifier: NCT02804698. Registered on June 17, 2016.

Analysis of health resource allocation efficiency of township hospitals in China

This paper aims to analyze the distribution of health resources in township hospitals in China from 2015 to 2018, and to provide Suggestions for improving the utilization efficiency of health resources in township hospitals by selecting 29 provinces/autonomous regions/municipalities directly under the Central Government (except Beijing and Shanghai) as the research objects. DEA-BCC model and DEA-Malmquist index model were used to analyze the utilization efficiency of health resources allocation in China’s township health centers. Results are In 2018 in the country, 29 provinces, cities and towns and townships, the comprehensive technical efficiency, pure technical efficiency and scale efficiency of mean value of the allocation of health resources is respectively 0.585, 0.751, 0.802, including Tianjin, Jiangsu, Zhejiang, Qinghai, Ningxia and other regions with theirs comprehensive efficiency be 1, DEA, being relatively effective, the comprehensive efficiency of other 24 regions are less than 1, being weak DEA efficient or relatively invalid; From 2015 to 2018, the average total factor productivity index of township health centers in nationwide was 0.979, with an average decrease of 2.1%, the change index of technical efficiency decreased by 1.3%, and the technological progress index decreased by 0.9%. It comes to a conclusion the level of overall resource allocation efficiency of township health centers in China is low with an unbalanced overall resource allocation, and the total factor productivity as a whole shows a downward trend. It is necessary to rationally plan the distribution of health resources in township hospitals, to increase technical input, improve the overall level of medical services, and balance the differences among regions, update the management concept of township health center managers, promote smart medical treatment and fine management, strengthen financial support and policy preference, promote the technological progress of township hospitals, and improve the efficiency of health resources use.

Analisis Tingkat Penerimaan dan Penggunaan Sistem Informasi Manajemen Puskesmas Di Kabupaten Jember

The Health Office (HE) in Jember District has conducted tests the operation of 40% Public Health Center Information System Management (SIMPUS). But from 20 public health centers (PHC), only 80% of the PHC ran it. The HE of Jember targets the end of 2019 SIMPUS will be fully operated in 50 PHC throughout the Jember district. The study aims to analyze the acceptance and use of technology systems in health center management by using the methods of the unified theory of acceptance and use of technology (UTAUT). The study examined variables of performance expectation, effort expectation, social impact, facilitating conditions, behavioral interest, and behavior of SIMPUS users. This study was analytic research. The data analysis technique used path analysis. The result explains the performance expectation is effected to the behavioral interest (t-value: 2,9); effort expectation is effected to the behavioral interest (t-value:1,01); social impact is effected to the behavioral interest (t-value: 9,47); facilitating conditions is effected to the user's behavioral (t-value:4,67); behavioral interest is effected to the user's behavior (t-value:8,54). Important for Health Office to maintain SIMPUS quality as well as to frequent SIMPUS updates in order to increase SIMPUS behavior

EVALUASI PENERAPAN SISTEM INFORMASI MANAJEMEN PUSKESMAS (SIMPUS) DENGAN METODE HOT-FIT DI PUSKESMAS GATAK

Information system evaluation is the process of knowing the extent of the information system. From a preliminary study of researchers in the health center gatak about the number of human resources has been found that the lack of human resources is competent in the it field, not all officers understand the use of the Health Center Management Information System (HCMIS), sometimes an error server causes a breakdown in service processes. The purpose of this study is to evaluate the application of Health Center Management Information System in the health center gatak and know the use of quality services indicator Health Center Management Information System by explaining the compatible systems component that is human, technology and organization. This type of research is a descriptive analytic study with a qualitative approach. Research subject exist six is the head of medical records, one operator polyclinic, Hcmis coordinator, one Hcmis operator, head of the medical center, and one pharmacist. The sample retrieval technique used is purposive sampling. The results of this study, is known to what extent the Health Center Management Information System program is running, to provide input for an evaluation at health center gatak for the front because human, technology, and organization compatibility really does affect information systems. It is hoped that there will be periodic training so that the implementation of Health Center Management Information System use becomes easier.