Health Service Delivery System Research Articles

The influence of hospital services on patient satisfaction in OPDs: evidence from the transition to a digital system in South Punjab, Pakistan

BackgroundPakistani’s health services delivery system has been rarely evaluated regarding patient satisfaction. This study examined the performance of the Pakistani health system from the perspective of doctor services (DS), digital payment system (DPS), nurses’ services (NS), laboratory services (LS), pharmacy services (PHS), registration services (RS), physical services (environmentally and tangible) and doctor-patient communication (DPC) about patient satisfaction. A random sampling technique was adopted for data collection.MethodologyThe Social Science Statistical Package (SPSS), analysis of moment structures (AMOS), and structural equation modeling were used to analyze the data for reliability, validity, correlations, and descriptive findings. The 879 responses were used for study analysis.ResultsThe study revealed that patient satisfaction was found to be significantly affected positively by LS, PHS, DS, NS, and DPS, while DPC, RS, and PF were impacted non-significantly. Consequently, there is a considerable communication gap in the doctor-patient interaction, and Pakistan's healthcare system is confronted with a shortage of physical infrastructure and challenges in the digital system.ConclusionFurthermore, the insufficient emphasis on registration services necessitates immediate action to improve the entire patient experience and satisfaction. Identifying these shortcomings has the potential to result in a healthcare system that is more efficient and focused on the needs of the patients.

Can Nationwide Central Appointment Systems Reduce Waiting Times in Turkish Public Hospitals?

Health service delivery is an important component of a well-functioning health system. To achieve a competitive healthcare system, healthcare should be provided on time to avoid delays that could harm the patient. In this respect, patient wait time is an important indicator of health services delivery performance. Countries develop national or regional booking systems to manage patient wait times and healthcare delivery resources more efficiently. In this study; the effect of a national booking system on outpatient wait times in Turkish public healthcare settings was investigated. This study was conducted using anonymized national outpatient data sets for the year 2016 with permission from the Republic of Turkey Ministry of Health. The data was analyzed after pre-processing and transformation. As a result of the study, patient wait times were calculated, analyzed and evaluated according to province and facility care levels (secondary or tertiary). Results showed that in 2016, only 30.69% of outpatient visits had appointments and that the average waiting time for patients with appointments was 11.18% shorter than for patients without appointments. The results of this study fill a gap in the literature as almost no studies have investigated this issue due to a lack of administrative and clinical data and will provide important evidence for the improvement of health service delivery systems.

Learnings From the Implementation of an Electronic Human Resource Management System for the Health Workforce in Uttar Pradesh, India.

The state of Uttar Pradesh (UP), India, has one of the largest single public health systems globally, serving about 235 million people through more than 30,000 public health facilities with approximately 160,000 health personnel. Yet, the UP health system has a shortfall of public health facilities to meet the population's needs, a shortage of clinical and nonclinical health personnel, inequitable distribution of existing health personnel, and low utilization of public health facilities. A robust and effective electronic human resource management system (eHRMS) that provides real-time information about the lifecycle of all health professionals in UP may aid in improving the health workforce, resulting in better health services and improved health outcomes. The Government of UP rolled out Manav Sampada, a comprehensive eHRMS that complied with global norms and requirements. We describe the implementation of Manav Sampada at scale and elaborate on key learnings and adoption strategies. Manav Sampada was based on key principles of integration and data-sharing with other digital systems, included functional components, a minimum dataset, used a lifecycle-based approach, and a workflow-based system, all of which acted to improve human resource data quality. The eHRMS emerged as a valuable tool for key stakeholders in reviewing worker performance, identifying skill-building needs, and allocating resources for training, leading to improved availability and equity in the distribution of a few critical cadres. The eHRMS in UP is well positioned to become an integral part of the Ayushman Bharat Digital Mission, the backbone of India's integrated digital health infrastructure. Linking eHRMS to a planned beneficiary-centric unitized health service delivery system (capturing information at the individual level rather than the aggregate level) will enable the measurement of service delivery and quality, leading to improved workforce management.

Existence of cholera outbreak, challenges, and way forward on public health interventions to control cholera outbreak in Guraghe Zones, southern Ethiopia, 2023.

In Ethiopia, despite major improvements seen in health service delivery system, the country continues to be significantly affected by cholera outbreaks. Cholera remains a significant public health problem among the vulnerable populations living in many resource-limited settings with poor access to safe and clean water and hygiene practices. Recurring cholera outbreaks are an indication of deprived water and sanitation conditions as well as weak health systems, contributing to the transmission and spread of the cholera infection. To assess the cholera outbreak, its challenges, and the way forward on public health interventions to solve the knowledge and health service delivery gaps related to cholera control in Guraghe Zone, Ethiopia, 2023. Active surveillance of the cholera outbreak was conducted in all kebeles and town administrative of Guraghe zone from 7/8/2023 to 30/10/2023. A total of 224 cholera cases were detected during the active surveillance method. Data obtained from Guraghe zone offices were exported to SPSS version 25 for additional analysis. The case fatality rate, incidence of the cases, and other descriptive variables were presented and described using figures and tables. A total of 224 cholera cases were detected through an active surveillance system. In this study, the case fatality rate of cholera outbreak was 2.6%. To tackle the cholera outbreak, the Guraghe zone health office collaborated with other stakeholders to prepare four cholera treatment centers. The absence of OCV, inaccessible safe water, low latrine coverage, inappropriate utilization of latrines, and absence of cholera laboratory rapid diagnostics test in Guraghe Zone are barriers to tackling the outbreak. Ethiopia National Cholera Plan targeted eradicating cholera by 2030, 222 cholera outbreak occurred in Guraghe Zone, Ethiopia. To minimize and control cholera mortality rate oral cholera vaccinations should be employed in all areas of the region. Sustainable WASH measures should be guaranteed for the use of safe water and good hygiene practices. Early diagnosis and treatment should be initiated appropriately for those who are infected.

Client satisfaction and contributing factors towards sexual and reproductive health services delivery system among youth at Family Guidance Association of north Ethiopia (FGAE) clinics, 2023: mixed method study

BackgroundThe Family Guidance Association of Ethiopia (FGAE) operates as a non-governmental organization dedicated to offering family planning and reproductive health services to the Ethiopian population. The gap in the study regarding client satisfaction and contributing factors towards sexual and reproductive health services for youth at FGAE clinics highlights the need for a comprehensive investigation to fill this void. By conducting a mixed-method study, this research aims to provide a holistic understanding of the factors influencing client satisfaction in the delivery of sexual and reproductive health services to youth at FGAE clinics. The added value of this study lies in its potential to offer valuable insights and recommendations for improving service delivery systems and enhancing client satisfaction levels, ultimately contributing to the overall well-being and health outcomes of youth in North Ethiopia. Therefore study aimed to asses Client Satisfaction and Contributing Factors towards in sexual and reproductive health services delivery system among youth at Family Guidance Association of North Ethiopia (FGAE) Clinics, 2023.MethodThe study was conducted within the clinics of the Family Guidance Association of Ethiopia (FGAE), spanning Dessie, Kombolcha, and Woldia city administrations, involving a participant cohort of 416 clients. Facility-based concurrent type mixed method study design both quantitative and qualitative techniques were applied. Quantitative research employed a simple random sampling technique and conversely, the qualitative study utilized a heterogeneous type of purposive sampling strategy to recruit participants The collected data underwent a rigorous process of entry, cleaning, and coding using Epi-Data 4.6 software, followed by analysis in STATA V17. Descriptive statistics and binary logistic regression were employed to highlight the impact of independent variables on the dependent variable. A more comprehensive examination was provided through multivariable logistic regression. Crude and adjusted odds ratios, along with a 95% confidence interval, were computed, with significance set at a p-value ≤ 0.05.ResultNearly more than half of the clients 194 (47.8%) came to receive family planning services followed by maternal and child health 107 (26.4%). Sixty patients (14.8%) didn’t receive all the services they wanted or came for. Half of the participants 30 (50%) raised the unavailability of the service as a reason for not taking the service followed by not having enough time in the clinic 12 (20%). About 65.52% (60.74-70.00%) of the participants were satisfied with the Sexual and Reproductive Health services provided by the clinics of FGAE in northeast Ethiopia. Clients in the age group of 25–34 (AOR = 2.04; 95%CI: 1.11–3.72). Clients who had primary and secondary education (AOR = 2.49; 95%CI: 1.03–6.02) and (AOR = 3.05; 95%CI: 1.25–7.49) respectively. Clients who responded that physicians show respect (AOR = 5.59; 95%CI: 1.89–16.49). clients who received an explanation about the side effects of the utilized methods and follow-up dates (AOR = 4.59;95%CI:1.68–12.53) and (AOR = 2.89;95%CI:1.53–5.49) respectively.ConclusionThe proportion of client satisfaction with Client Satisfaction in the Services delivery system at Family Guidance Association of Ethiopia (FGAE) Clinics was low as compared to the previous study. Age group 25–34 years, primary and secondary education, showing respect, explaining side-effects and follow-up visits were significant associated factors of client service satisfaction. Enhancing service delivery at Family Guidance Association of Ethiopia (FGAE) Clinics by targeting specific areas identified in the study. Strategies should focus on improving communication regarding side effects, ensuring respectful interactions, and prioritizing follow-up visits, particularly for clients aged 25–34 with primary and secondary education backgrounds.

Neurological Care within the Indian Health Service.

American Indians and Alaska Natives (AI/AN) are the Indigenous peoples of the United States. According to the U.S. Census Bureau, approximately 9.7 million people self-identified as AI/AN (alone or in combination with other races), representing 2.9% of the total U.S. population. These people represent diverse groups of discrete Tribes, each with their language, culture, and geographic home. As part of the conquest and settlement of North America, some Indigenous peoples signed treaties with the U.S. government, surrendering their lands in return for various government commitments, including health care. The Indian Health Service (IHS) was born out of these agreements. The IHS is an agency in the U.S. Department of Health and Human Services under the U.S. Public Health Service. The IHS provides a comprehensive health service delivery system for approximately 2.7 million AI/AN who belong to 574 federally recognized Tribes/nations in 37 states. The aim of this paper is to make recommendations regarding the initiation of sustainable neurology care in marginalized or underserved populations by reviewing 40 years of neurology care provision within the IHS. We will discuss (1) the IHS, (2) neurological care provided within the IHS, including midlevel provider extension of neurology care and traditional medical care, and (3) select neurological diagnoses within AI/AN populations. Marginalized populations, including those in the United States that are rural, remote, or low socioeconomic status, lack access to specialty neurology care. This includes many AI/AN. The IHS has developed novel solutions to promote specialty care, including neurology. Notably, initial IHS investments in full-time neurology providers have led to more robust neurology care, often receiving attention from university programs. This suggests that an initial investment in stable on-site full-time neurology services provides a path to potential sustainable care for marginalized populations.

Dramatic California ballot measure held narrow lead in statewide vote

As MHW was going to press, the final outcome of California's hotly debated Proposition 1 measure to dramatically alter the state's mental health service delivery system remained in doubt. For most of election night on March 5 and into the following morning, the proposal that would earmark more Mental Health Services Act funding for the development of housing was holding a razor‐thin lead.

SNS 기반 모바일 정신건강서비스 플랫폼 이용경험에 관한 현상학적 연구

This study is a phenomenological study on the experience of using a mobile mental health service platform developed and provided by mental health social welfare experts, and was conducted to provide practical policy and practical suggestions for the necessity of a mobile mental health service platform and the use of a professional mobile mental health service platform in Korea's mental health service delivery system. To this study, data were collected from 12 research participants who have been continuously using the platform for more than a year, and the data were analyzed by applying Giorgi's phenomenological perspective to deeply analyze the nature and meaning of the experience of the phenomenon. As a result of the analysis, 7 components and 20 sub-components were derived, and the components were found to struggle in the beginning and despair of the problem, mental health services I used and negative memories, various mental health services experienced in accidental spaces, reasons for continuing to find the mobile mental health service platform, psychological stability and practical change and recovery, limitations of personal mobile mental health service platforms, and partnerships with public mental health services. Based on these analysis results, the conclusions of this study and practical suggestions were presented.

Tingkat Kepuasan Pasien terhadap Pelayanan Rawat Jalan Poli Penyakit Dalam pada Rsup Dr. Sitanala Tangerang

Outpatient services are an integral component of the health service delivery system in hospitals which provides and plays an important role in continuity of patient care and improving service quality. Patients have a level of satisfaction according to their respective standards for the services they have received. Patient satisfaction is a very important and comprehensive part of the quality of health services provided. Patient satisfaction is a level of patient feeling that arises as a result of the performance of the health services they have obtained after the patient compares it with their expectations. The aim of this research was to determine the satisfaction level of internal medicine outpatients available at RSUP Dr. Sitanala Tangerang using 5 dimensions of quality. The research method is quantitative descriptive research using questionnaire survey techniques. This study used a cross sectional approach because the sampling was carried out simultaneously over the same period of time using a non-random sampling method using convenience sampling of patients who came to receive outpatient services at the internal medicine clinic. With the results of the physical evidence (Tangibles) dimension of 90%, the Responsiveness dimension of 87,9%, the reliability dimension of 89,6%, the Assurance dimension of 93%, and the Attention (Emphaty) dimension of 90,8%.

Some California mental health groups remain fearful over state ballot measure

With California voters just over a week away from deciding on a ballot measure that would represent a major transformation of the state's mental health service delivery system, a striking number of mental health advocates remain either lukewarm about the proposal or bitterly opposed.

Combining topic modeling and bibliometric analysis to understand the evolution of technological innovation adoption in the healthcare industry

PurposeThis paper explores the Adoption of Technological Innovation (ATI) in the healthcare industry. It investigates how the literature has evolved, and what are the emerging innovation dimensions in the healthcare industry adoption studies.Design/methodology/approachWe followed a mixed-method approach combining bibliometric methods and topic modeling, with 57 papers being deeply analyzed.FindingsOur results identify three latent topics. The first one is related to the digitalization in healthcare with a specific focus on the COVID-19 pandemic. The second one groups up the word combinations dealing with the research models and their constructs. The third one refers to the healthcare systems/professionals and their resistance to ATI.Research limitations/implicationsThe study’s sample selection focused on scientific journals included in the Academic Journal Guide and in the FT Research Rank. However, the paper identifies trends that offer managerial insights for stakeholders in the healthcare industry.Practical implicationsATI has the potential to revolutionize the health service delivery system and to decentralize services traditionally provided in hospitals or medical centers. All this would contribute to a reduction in waiting lists and the provision of proximity services.Originality/valueThe originality of the paper lies in the combination of two methods: bibliometric analysis and topic modeling. This approach allowed us to understand the ATI evolutions in the healthcare industry.

Characterising the performance measurement and management system in the primary health care systems of Malawi.

Performance Measurement and Management (PMM) systems are levers that support key management functions in health care systems. Just like many low- and middle-income countries (LMICs), Malawi strives to improve performance via evidence-based decision making and a suitable performance culture. This study sought to describe PMM practices at all levels of primary health care (PHC) in Malawi. This study targeted three levels of PHC, namely the district health centres (DHCs), the zones, and the ministry headquarters. This was a qualitative exploratory research study where decision-makers at each level of PHC were engaged using key-informant interviews (KII) and focus group discussions (FGDs). We found that there is a weak link among levels of PHC in supporting PMM practices leading to poor dissemination of priorities and goals. There is also failure to appropriately institute good PMM practices, and the use of performance information was found to be limited among decision-makers. Though PMM is acknowledged to be key in supporting health service delivery systems, Malawi's PHC system has not fully embarked on making this a priority. Some challenges include unsupportive culture and inadequate capacity for PMM.Contribution:This study contributes to the understanding of the PMM processes in Malawi and further highlights the salient challenges in the use of information for performance management. While the presence of policies on PMM is acknowledged, implementation studies that deal with challenges are urgent and imperative.

EFFECT OF COVID-19 PANDEMIC ON OCCUPATIONAL THERAPY PRACTICE AND IMPLEMENTATION OF TELEREHABILITATION INCLUDING HEALTH SECTORS IN AL AHSA CITY

Introduction and Aim: COVID-19 has turned into a worldwide public health emergency involving 223 nations and regions, and it has had a significant impact on public and health service delivery systems [1]. Tele-rehabilitation has developed as a potential strategy for virtually supervising the delivery of a physical, occupational, speech, and other therapies targeted at treating motor, mental, and neuropsychiatric deficiencies caused by sensory and motor impairments [3]. The transition to telerehabilitation offers a wealth of learning opportunities. This viewpoint offers an overview of how a learning health care system (LHS) approach to telerehabilitation research might foster innovation in health care delivery and lead to new scientific findings [4]. Telerehabilitation benefits minimize the need for patients and providers to travel and in-home rehabilitation services can save travel costs and caregiver strain. Patients with mobility issues will appreciate the convenience [5]. The aim of the study was to determine the COVID-19 pandemic effect on occupational therapy practice and use of telerehabilitation in Al-Ahsa. Method: COVID-19 pandemic effect on occupational therapy practice and use of telerehabilitation in Al-Ahsa assessed by the questionnaire. The purpose of the questionnaire to measure the Effect of Covid-19 pandemic on occupational therapy practice and implementation of telerehabilitation including government hospitals, private hospitals, and clinics in ALAHSA city. We shared the link by distributing it through social media. This study was conducted in Al-Ahsa including government hospitals, private hospitals, and clinics. The data collected from SPSS. 20 questions used to assess different aspects of COVID-19 pandemic effect on occupational therapy practice and use of telerehabilitation in Al-Ahsa with five options (Strongly Agree – Agree – Neutral – Disagree – Strongly Disagree. In addition, it is cross-sectional because the study collected data at giving point across the study. Result: There are 108 participants in this study. All of the participants were from Saudi Arabia in Al-Ahsa that met the inclusion criteria in This study. The number of male participants in the research was 85 (78.70%) . Also, the ages of the participants ranged from 16 to 58 and the average age is 30,23. We found that most of the participants agreed that telerehabilitation was effective and had many benefits for patients where the percentage of answers strongly agree and agree in all questions was high. Furthermore, the ages of the participants in the research are all of them from adolescence and adulthood, as the use of electronic technology to conduct therapeutic and rehabilitative sessions is almost non-existent for people in the late adulthood stage. Conclusion: We found that telerehabilitation is effective and benefits both the therapist and the patient. Also, the percentage of use of telerehabilitation by late adult patients was very low. Telerehabilitation had some problems and defects, and we hope that they will be resolved and the remote treatment system will be fully developed.

All eyes will be on California as voters weigh MH transformation

California voters in March will consider a massive transformation of the state's mental health service delivery system, a proposal that would direct more resources to the most seriously ill individuals. While there are many nuanced implications to the two legislative measures that are being combined into Proposition 1 on the March 5 ballot, observers said they think voters likely will be swayed by supporters' aim to reduce highly visible and crisis‐level homelessness in many California communities.

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN PEMANFAATAN LAYANAN BPJS DI RUMAH SAKIT UMUM DAERAH PADANG LAWAS UTARA

Health is a right for every citizen regardless of social, economic, gender, race and religion status. In Declaration of health stated that health is the most basic human right of every human being in the world (Alma, 2017). BPJS Health is a legal entity that is directly responsible to the President for managing health insurance for all Indonesian people (Ministry of Health, 2020). The health service delivery system in the world today can be thought of as a continuum that places the institutional-universal system at one point with residual-selective at another point. The method is quantitative research with using a cross sectional approach. The population is all BPJS participants in the North Padang Lawas regional general hospital. Sampling used the accidental sampling method of 94 people. The results of the research show that there are many factors relating to knowledge, such as; attitudes, distance, availability of facilities and infrastructure, information and health workers with the utilization of BPJS services at the North Padang Lawas Regional General Hospital. The Conclusion is most significantly related to the utilization of BPJS services at the North Padang Lawas regional general hospital is the Attitude factor

Mental health experiences in 2021 for adults with disabilities who are lesbian, gay, bisexual, or transgender.

Examine the prevalence of mental health issues, receipt of mental health treatment, and self-reported unmet need for mental health treatment among U.S. adults with and without disabilities by lesbian, gay, bisexual, or transgender (LGBT) status during the pandemic. Logistic regression and predicted probabilities using nationally representative, cross-sectional, household survey data from the U.S. Census Bureau's weekly Household Pulse Survey conducted during the COVID-19 pandemic (July 21, 2021-October 11, 2021). Controlling for age, educational attainment, employment, health insurance coverage, and race/ethnicity, adults with disabilities, regardless of LGBT status, had statistically significantly increased odds of having mental health issues, receiving mental health treatment, and reporting the unmet need for mental health treatment compared to adults without disabilities who were not LGBT. Adjusted rates of receipt of mental treatment ranged from a low of 9% for persons without disabilities who were not LGBT to 27% for persons with disabilities who were LGBT, a gap of 18 percentage points. An even larger percentage point gap (22 percentage points) was noted in the unmet need for treatment between persons without disabilities who were not LGBT (9%) and persons with disabilities who were LGBT (31%). These results highlight the need for expansions of the mental health service delivery system in the United States as well as a prioritization of accessibility and inclusiveness practices. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Effect of Armed Conflict on Treatment Interruption, Its Outcome and Associated Factors Among Chronic Disease Patients in North East, Amhara, Ethiopia, 2022.

The health services delivery system is debilitated in conflict setting areas due to damage of health facilities and attack on health care providers. Armed conflict is a complex phenomenon which causes a large amount of death and disability worldwide. However, there is lack of information towards treatment interruption among chronic disease patients in conflict areas. Hence, this study was conducted to assess the prevalence of armed conflict induced treatment interruption and its outcome among chronic disease patients. A mixed cross sectional study design was conducted on a total of 399 sample size at North Wollo and Waghimra zone hospitals. To select study participants a consecutive sampling method was used. Multiple logistic regressions were computed to evaluate the association and thematic analysis was used to analyse qualitative data. From the total 399 study participants, 264 (64.6%) study participants interrupted their medication. Treatment interruption is significantly associated with poor service availability and perceived high stress. War has detrimental health effects, both immediate and long term, on populations. Treatment interruptions due to armed conflict were caused by poor health care access, lack of medications and lack of transport and displacement of hospital staff, insecurity and fear. Treatment interruption results in morbidity, mortality, lifelong complications, disability, psychological and economic impact.

A scoping review of maternal and neonatal health services impacted during COVID-19 in Nepal

Background Coronavirus Disease 2019 (COVID-19), a global pandemic, has resulted in millions of deaths worldwide and severely impacted health service delivery systems. Developing countries, including Nepal, faced the risk of health system failure due to limited infrastructures. During the pandemic, Nepal experienced a decline in medical service utilization by pregnant women and a decrease in national child immunization rates. Maternity services and child immunization services had significant consequences, serving as a warning for future pandemics. This article examines the effects of pandemic-induced stay-at-home policies on maternal and child immunization in Nepal. Methods A comprehensive literature search was conducted to identify relevant articles on PubMed, Scopus, and Google Scholar. The search terms employed were “maternal mortality in Nepal during COVID-19”, “maternity service utilisation in Nepal during COVID-19”, and “child immunisation in Nepal during COVID-19”. The search was limited to articles published between 2019 and 2022, research conducted in Nepal, and that included maternal mortality, utilisation of maternity services, and child immunisation in the title of the full text. Results Factors such as the closure of public transportation and service centres and fear of contamination contributed to a decline in antenatal care visits. The disruption of programs aimed at reducing the Maternal Mortality Rate (MMR) and decreased activities of Female Community Health workers in most parts of the country led to an increase in the maternal mortality rate during the stay-at-home policies. Institutional delivery decreased by 52.4% during the stay-at-home policies compared to the period before. The neonatal mortality rate increased from 13 to 40 per 1000 live births during the pandemic stay-at-home policies. Immunization centres were also closed in Nepal during the early stages of stay-at-home policies, with 50% of centres ceasing services. Measles outbreaks were reported in some parts of the country during the pandemic. Conclusions To mitigate future damage, specific guidelines should be established based on regional factors and infrastructure development. Measures such as providing protective equipment and maintaining communication with pregnant women via telephone can help reduce the impact of future pandemics.

Pendokumentasian Asuhan Keperawatan Berbasis Standar Diagnosis Keperawatan Indonesia bagi Motivasi, Beban Kerja, Supervisi, Model Kepemimpinan dan Organisasi, serta Fasilitas Layanan

This study aims to analyze the relationship between documentation of nursing care based on Indonesian nursing diagnosis standards with motivation, workload, supervision, leadership and organizational models, and service facilities. This study uses a correlational analytic research design with cross-sectional. The results showed that 42 respondents (60.9%) had good motivation with good documentation and a p-value of 0.105. Then the workload is good with implementing good documentation as many as 42 respondents (67.7%) and a p-value of 0.001. In good supervision with exemplary documentation implementation, there were 44 respondents (57.1%). And the p-value is 0.605. Furthermore, a good leadership and organizational model with exemplary documentation implementation was 42 respondents (61.8%) and a p-value of 0.062. Good service facilities with good documentation of 33 respondents (58.9%) and a p-value of 0.477. In conclusion, there is a relationship between workload and documentation implementation, and there is no relationship between work motivation, supervision, leadership, organizational models, service facilities, and documentation implementation. Optimal nursing care services will continue to be a demand for healthcare organizations. There is a desire to change the health service delivery system to a decentralized one.
 
 Keywords: Nursing Care, Motivation, Workload, Supervision, Leadership Model and Organization, Service Facility.

Measuring disparities in access to district and referral hospitals in the city of Kigali, Rwanda

The study focused on the identification of theoretical and methodological constructs that can be used to analyse and improve the spatial performance of public health service delivery systems and the development of a corresponding spatial-analysis and GIS-based planning approach using the city of Kigali as a case study. Access to health care as a multi-tiered system was measured by using five dimensions of access, namely geographic accessibility, availability, affordability, acceptability and accommodation. Geo-statistical analysis was performed to measure and evaluate access to the district and referral health care. For geographic access, the travel time for every trip is approximated for the two main modes of transport (walking and public transport). To realistically represent the friction of distance, the street network was categorised into several road classes for which different travel speeds are estimated for each transport mode on the basis of local knowledge. A factor analysis model was used for availability, affordability, acceptability, and accommodation dimensions. Different indicators were evaluated in various units and scales and standardized to see how satisfaction levels varied with each dimension. Based on the type of indicator, for the cost or benefit, the score was zero (0) or one (1). One (1) was considered a positive impact, while zero (0) was considered a negative impact. Summary scores were developed for all indicators by combining more than one indicator into a single value. The created summary score also ranges from 0 to 1, and the higher the score, the better the access attainment. To find areas that need intervention, the comparison of all five indicators and the scores of access for each indicator was made. The dimensions of geographic accessibility and availability appeared to be the most problematic. The district health care dimensions have revealed a low performance level in geographic accessibility (0.64) and a high-performance level in affordability (0.94). The referral health care dimensions have revealed a low performance level of geographic accessibility (0.17) and a high-performance level of acceptability (0.92). Health planners and policy makers will commonly require such a planning method, particularly in the developing world where spatial contexts are highly dynamic as a result of rapid urbanisation.