Health Services In Countries Research Articles

Barriers to young people’s use of sexual and reproductive health services in Asia-Pacific

Abstract Background Qualitative literature extensively documents young people’s barriers to accessing sexual and reproductive health (SRH) services in Asia-Pacific countries. However, efforts to synthesise this research for practical use in healthcare policy and practice are lacking. This systematic review aims to systematically review and synthesise published qualitative literature focusing on young people’s utilisation of SRH services and understanding common access barriers. Methods We systematically searched five electronic databases from inception until 24 June 2022: MEDLINE, EMBASE, PsycINFO, CINAHL, and Web of Science. Google Scholar and reference lists of all included studies were also searched. We used the Critical Appraisal Skills Programme (CASP) checklist for appraising the quality of included studies and analysed the data using a thematic synthesis approach. Results We included 31 papers reporting the experiences of over 1800 young people from 16 Asia-Pacific countries. Thematic synthesis identified several factors affecting adolescents’ utilisation of SRH services, which were grouped into six descriptive themes: navigating puberty; lack of SRH knowledge; embarrassment and confidentiality concerns; low decision-making autonomy; traditional practices and religious beliefs; and socio-cultural norms. Our overreaching analytical theme highlighted the role of shame as a key emotion hindering young people’s utilisation of SRH services. Conclusions Direct communication about SRH issues is crucial for teenagers. Embarrassment, privacy concerns, and stigma significantly affect their service utilisation decisions. Inclusive interventions for both youth and their communities by addressing socio-cultural factors are essential for optimising service accessibility and guiding evidence-based interventions and policies across diverse cultural contexts. Key messages • Understanding young people’s SRH service barriers in Asia-Pacific countries: Socio-cultural norms are highlighted as crucial for optimising service utilisation among young individuals in this area. • Inclusive interventions and policies are needed for enhanced accessibility.

Documenting Community Health Worker Compensation Schemes and Their Perceived Effectiveness in Seven sub-Saharan African Countries: A Qualitative Study.

Community health worker (CHW) incentives and remuneration are core issues affecting the performance of CHWs and health programs. There is limited documentation on the implementation details of CHW financial compensation schemes used in sub-Saharan African countries, including their mechanisms of delivery and effectiveness. We aimed to document CHW financial compensation schemes and understand CHW, government, and other stakeholder perceptions of their effectiveness. A total of 68 semistructured interviews were conducted with a range of purposefully selected key informants in 7 countries: Benin, Burkina Faso, Ghana, Malawi, Mali, Niger, and Zambia. Thematic analysis of coded interview data was conducted, and relevant country documentation was reviewed, including any documents referenced by key informants, to provide contextual background for qualitative interpretation. Key informants described compensation schemes as effective when payments are regular, distributions are consistent, and amounts are sufficient to support health worker performance and continuity of service delivery. CHW compensation schemes associated with an employed worker status and government payroll mechanisms were most often perceived as effective by stakeholders. Compensation schemes associated with a volunteer status were found to vary widely in their delivery mechanisms (e.g., cash or mobile phone distribution) and were perceived as less effective. Lessons learned in implementing CHW compensation schemes involved the need for government leadership, ministerial coordination, community engagement, partner harmonization, and realistic transitional financing plans. Policymakers should consider these findings in designing compensation schemes for CHWs engaged in routine, continuous health service delivery within the context of their country's health service delivery model. Systematic documentation of the tasks and time commitment of volunteer status CHWs could support more recognition of their health system contributions and better determination of commensurate compensation as recommended by the 2018 World Health Organization Guidelines on Health Policy and System Support to Optimize Community Health Worker Programs.

Organizing visions for data-centric management: how Norwegian policy documents construe the use of data in health organizations

PurposeNorway, like other welfare states, seeks to leverage data to transform its pressured public healthcare system. While managers will be central to doing so, we lack knowledge about how specifically they would do so and what constraints and expectations they operate under. Public sources, like the Norwegian policy documents investigated here, provide important backdrops against which such managerial work emerges. This article therefore aims to analyze how key Norwegian policy documents construe data use in health management.Design/methodology/approachWe analyzed five notable policy documents using a “practice-oriented” framework, considering these as arenas for “organizing visions” (OVs) about managerial use of data in healthcare organizations. This framework considers documents as not just texts that comment on a topic but as discursive tools that formulate, negotiate and shape issues of national importance, such as expectations about data use in health management.FindingsThe OVs we identify anticipate a bold future for health management, where data use is supported through interconnected information systems that provide relevant information on demand. These OVs are similar to discourse on “evidence-based management,” but differ in important ways. Managers are consistently framed as key stakeholders that can benefit from using secondary data, but this requires better data integration across the health system. Despite forward-looking OVs, we find considerable ambiguity regarding the practical, social and epistemic dimensions of data use in health management. Our analysis calls for a reframing, by moving away from the hype of “data-driven” health management toward an empirically-oriented, “data-centric” approach that recognizes the situated and relational nature of managerial work on secondary data.Originality/valueBy exploring OVs in the Norwegian health policy landscape, this study adds to our growing understanding of expectations towards healthcare managers' use of data. Given Norway's highly digitized health system, our analysis has relevance for health services in other countries.

Characterizing models of adolescent and youth-friendly health services in sub-Saharan Africa: a scoping review.

This scoping review provides an up-to-date overview of the evidence on adolescent and youth-friendly health services (AYFHS) in sub-Saharan African countries. We conducted a search of four databases and grey literature sources to identify English language publications from January 1, 2005, to December 14th, 2022. The review synthesized evidence on the models and characteristics of AYFHS, the application of World Health Organization (WHO) standards, and whether AYFHS have improved young people's health outcomes. In total, 77 sources were included in the review, representing 47 AYFHS initiatives spanning 19 countries, and three multi-country reports. Most commonly, AYFHS were delivered in public health facilities and focused on sexual and reproductive health, with limited application of WHO standards. Some evidence suggested that AYFHS increased young people's health service utilization and contraceptives uptake. There is a clear need to strengthen and develop innovative and multi-pronged approaches to delivering and evaluating AYFHS in this region.

Effect of the COVID-19 pandemic on utilization of essential health services in Iran evidence from an interrupted time series analysis

BackgroundThe COVID-19 disrupted the provision of essential health services in numerous countries, potentially leading to outbreaks of deadly diseases. This study aims to investigate the effect of the COVID-19 pandemic on the utilization of essential health services in Iran.MethodsAn analytical cross-sectional study was conducted using interrupted time series (ITS) analysis. Data about five indicators, including 'childhood vaccination, infant care, hypertension screening, diabetes screening, and breast cancer screening,' were obtained from the electronic health record System in two-time intervals: 15 months before (November 2018 to January 2020) and 15 months after (January 2020 to May 2021) the onset of the COVID-19 pandemic. The data were analyzed by utilizing ITS. In addition, a Poisson model was employed due to the usage of count data. The Durbin-Watson (DW) test was used to identify the presence of lag-1 autocorrelation in the time series data. All statistical analysis was performed using R 4.3.1 software, considering a 5% significance level.ResultsThe ITS analysis showed that the COVID-19 pandemic significantly affected the utilization of all essential health services (P < 0.0001). The utilization of hypertension screening (RR = 0.51, p < 0.001), diabetes screening (RR = 0.884, p < 0.001), breast cancer screening (RR = 0.435, p < 0.001), childhood vaccination (IRR = 0.947, p < 0.001), and infant care (RR = 1.666, p < 0.001), exhibited a significant decrease in the short term following the pandemic (P < 0.0001). However, the long-term trend for all service utilization, except breast cancer screening (IRR = 0.952, p < 0.001), demonstrated a significant increase.ConclusionsThe COVID-19 pandemic affected utilization of essential health care in Iran. It is imperative to utilize this evidence to develop policies that will be translated into targeted planning and implementation to sustain provision and utilization of essential health services during public health emergencies. It is also vital to raise awareness and public knowledge regarding the consequences of interruptions in essential health services. In addition, it is important to identify the supply- and demand-side factors contributing to these disruptions.

Exploring refugees' experience of accessing dental health services in host countries: a scoping review.

Refugees often face worse oral health outcomes, such as periodontal diseases and dental caries in host countries due to barriers including language and cultural differences, institutional discrimination, and restricted use of dental health services. This scoping review aims to map and summarise the available studies on refugees' experience of accessing dental health services in the host countries, to identify the main characteristics of the dental health services that refugees access and to explore the barriers and enablers to navigate the dental health service system in their host countries. The Joanna Briggs Institute (JBI) framework was adopted. PubMed, Scopus, Assia, CINAHL and Social Services Abstract were searched. A search strategy was developed using Medical Subject Headings (MeSH) terms and a combination of search operators and syntax used in MEDLINE were adopted for the remaining databases. Data were synthesised using thematic analysis. Fourteen articles were included. Most studies used qualitative methods and Australia seemed to be the country with the highest number of publications surrounding this topic. The included studies showed that refugees frequently encountered substantial obstacles when attempting to access dental services in host countries. Numerous barriers such as language barriers, cultural differences, and lack of health insurance or financial support hindered refugees' ability to access these services. Additionally, many refugees possessed limited knowledge of the dental care system in their new country. As a result of untreated dental problems, refugees suffered from pain and other health complications. This scoping review explored the challenges refugees have experienced in accessing dental health services in host countries, which included the key barriers such as affordability, accessibility, accommodation, availability, awareness, and acceptability. The scarcity of relevant research highlighted the need for a more comprehensive understanding of refugees' experiences accessing dental health services in host countries. Limited data were identified regarding evidence focusing on the characteristics of dental services accessed by refugees in host countries.

Exploring Trauma- and Violence-Informed Pregnancy Care for Karen Women of Refugee Background: A Community-Based Participatory Study.

Women of refugee background experience poorer perinatal outcomes when compared to their local-born counterparts. Women of refugee background have often experienced trauma and are likely to encounter barriers to accessing health services in host countries which can exacerbate their recovery from trauma and contribute to poor health outcomes. Trauma- and violence-informed approaches to care offer opportunities to address barriers to pregnancy care which may, in turn, improve these poor outcomes. Trauma- and violence-informed care is a framework that acknowledges a person's experiences of trauma, recognises its impact and symptoms, and works toward resisting re-traumatisation by integrating knowledge into practice. Despite this, trauma- and violence-informed care in maternity care settings has rarely been explored from the perspectives of women of refugee background. This study aimed to explore trauma- and violence-informed pregnancy care from the perspectives of Karen women of refugee background using Community-Based Participatory Research methods. The lead researcher is a Karen-Australian woman with lived refugee experience. A Community Advisory Group was formed to support the study. Semi-structured interviews were conducted with seven Karen women of refugee background who had recently had a baby in Western metropolitan Melbourne, Australia. The data were analysed using Reflexive Thematic Analysis. Karen women shared what they considered to be important elements of trauma- and violence-informed pregnancy care. Three major elements were identified: (1) care design and accessibility; (2) promoting choice and control; and (3) trauma-informed interpreting. The critical importance of the interpreter-mediated setting was highlighted as women reported that they may not experience trauma- and violence-informed maternity care if they cannot access an interpreter or their relationship with the interpreter is unsafe. This study offers critical insights regarding the elements of trauma- and violence-informed pregnancy care that are important to Karen women of refugee background.

Factors influencing access to and utilization of youth-friendly sexual and reproductive health services in Isiolo County, Kenya

Background: Although there has been momentum in implementing sexual and reproductive health (SRH) services in most countries, young people typically remain underserved by these services despite their demonstrated need. This study aimed to determine the factors influencing access to and utilization of youth-friendly sexual and reproductive health (AYSRH) services in Isiolo County. This study was conducted under the Jhpiego-supported Accelerating Post pregnancy Family Planning Integration into Primary Healthcare (APIP) project that supports Isiolo.&#x0D; Methods: Mixed-methods qualitative and quantitative approach​ was used. Data were collected using the KOBO digital tool. and analysis was performed using NVivo and Stata for qualitative and quantitative data, respectively.&#x0D; Results: The baseline study found that 69% of the APIP-supported facilities offered YFSRHS, with 77% of the facilities conveniently located for ease of access by the youths. 69% of the facilities had AYSRH signages displayed outside the buildings, with 31% displaying the signages inside the building. 31% of the facilities had separate counseling and examination rooms to ensure privacy for the youths as they sought services. 54% of the facilities involved the youth in decision-making during the provision of the YFSRHS. The study also found that 31% of the facilities involved their communities and made them aware of the YFHS provided at the hospitals. &#x0D; Conclusion: Interventions focusing on implementing YFSRHS should aim at addressing challenges affecting quality services in health facilities to offer them according to the youth’s needs.

Towards integrated mental health services in low-income and middle-income countries: organisation of primary healthcare providers – a scoping review protocol

IntroductionMental health conditions constitute a significant percentage of the global burden of disease. A shortfall of mental health specialists and a lack of integration of services in primary care in...

Patient-reported outcome, clinician-reported outcome, and patient satisfaction with treatment by crisis resolution teams: a multicenter pre-post study of outcome and associated factors in Norway

BackgroundCrisis resolution teams (CRTs) have become a part of mental health services in many high-income countries. Many studies have investigated the impact of CRTs on acute admissions to inpatient units, but very few studies have investigated patient-reported and clinician-reported outcomes for CRT service users. Our aims were to study patient-reported and clinician-reported outcomes of CRT treatment, how the outcomes were associated with characteristics of the service user and the treatment, and whether outcomes were different across CRTs.MethodsThe study was a pre-post observational multicenter study of 475 patients receiving treatment from 25 CRTs in urban and rural areas in Norway. There was no control group. Outcomes were change in mental health status reported by service users using CORE-10 and by clinicians using HoNOS. Patient satisfaction was measured using CSQ-8 at the end of the treatment. Components of CRT accessibility and interventions were measured by clinicians reporting details on each session with the service user. CRT model fidelity was measured using the CORE CRT Fidelity Scale version 2. We used paired t-tests to analyze outcomes and linear mixed modeling to analyze associations of the outcomes with the characteristics of service users and the treatment provided. Using independent t-tests, we analyzed differences in outcomes and patient satisfaction between two clusters of CRTs with differences in accessibility.ResultsThe patient-reported outcomes and the clinician-reported outcomes were significantly positive and with a large effect size. Both were significantly positively associated with practical support and medication management and negatively associated with collaboration with mental health inpatient units. Patient satisfaction was high at the end of the treatment. CRTs with higher accessibility had a significantly better clinician-reported outcome, but no significant differences were reported for patient-reported outcomes or patient satisfaction.ConclusionsCRT treatment led to improved symptom status as reported by patients and clinicians, as well as high patient satisfaction. Practical support and medication management were the interventions most strongly associated with positive outcomes. Some of the variations in outcomes were at the team level. Patient- and clinician-reported outcomes should be used more in studies on the effect of treatment provided by crisis resolution teams.

ANALISIS INDEKS KEPUASAN MASYARAKAT TERHADAP PELAYANAN KESEHATAN DI PUSKESMAS KOTA MADIUN

Background. Public satisfaction with public services plays an important role in the stability of a country's health services. Measurement of the Public Satisfaction Index is a reference in evaluating the quality of service between patient expectations and health service performance.Purpose. This study aims to analyze the Community Satisfaction Index for Health services at the Madiun City Health Center.Methods. This study used a crosectional design with quantitative methods, conducted in October 2023 at the Madiun City Health Center with a sample of 64 research subjects using a simple random sampling technique. The research variables were 9 elements of the Community Satisfaction Index, namely the elements of requirements, procedures, time, rates, service products, competence, behavior, handling complaints, and facilities and infrastructure.Result. The results showed that the Community Satisfaction Index was 81.99, with details of the Community Satisfaction Index being good, namely in the elements of requirements (81.3%), procedures (71.9%), time (84.4%), service products (87.5%), competence (81.3%), behavior (71.9%), handling complaints (70.3%), with a very good Community Satisfaction Index in the elements of tariffs (62.5%) and facilities and infrastructure (79.7%).Conclusion. The Public Satisfaction Index is 81.99, with a very good Public Satisfaction Index on the elements of tariffs and facilities and infrastructure. &#x0D;

Towards system redesign: An exploratory analysis of neurodivergent traits in a childhood population referred for autism assessment.

Children's health services in many countries are moving from single condition diagnostic silo assessments to considering neurodevelopment in a more holistic sense. There has been increasing recognition of the importance of clinical overlap and co-occurrence of different neurotypes when assessing neurodivergent children. Using a cross-sectional service evaluation design, we investigated the overlap of neurodivergences in a cohort of children referred for autism assessment, focusing on motor, learning, and attention/activity level domains. We aimed to determine what proportion of children in a cohort referred for an autism assessment showed traits of additional neurodivergences, and what proportion were further investigated. We evaluated anonymised medical records of children aged between two and 17 years referred for autism assessment. We used validated questionnaires to assess for neurodivergent traits. A weighted scoring system was developed to determine traits in each neurodevelopmental domain and a score above the median was considered to indicate a neurodivergent trait. Evidence of further investigations were recorded. We then examined the relationships between autism traits and traits of additional neurodivergence. 114 participants were included for evaluation. 62.3% (n = 71) had completed questionnaires for analysis. Of these, 71.8% (n = 51) scored greater than the median for at least one additional neurotype, indicating the presence of other neurodivergent traits, and 88.7% (n = 64) attracted a diagnosis of autism. Only 26.3% of children with evidence of additional neurotypes were further investigated beyond their autism assessment. Our results demonstrate the extensive overlap between additional neurodivergent traits in a population of children referred with suspected autism and show that only a small proportion were further investigated. The use of standardised questionnaires to uncover additional neurodivergences may have utility in improving the holistic nature of neurodevelopmental assessments.

Attitude towards purchasing consumer items can be extracted from Demographic and health survey India-2019-2020 (NFHS 5)

Background: National Health Surveys have been part of national health services in many countries, but their data are summary com- pilations and commonly used only for describing trends in health and living conditions. Aim: Tostatisticallydisclosenetworksofinteractingvariableswithin National Health Survey data. Sample and methods: We used anthropometric, educational, environ- mental and economic information of people of Sikkim, West Bengal, Telangana, and Gujarat, India, obtained by the Fifth Indian National Family Health Survey (NFHS-5).We applied a new statistical approach labeled as “St. Nicholas House Analysis” (SNHA). SNHA ranks absolute bivariate correlation coef- ficients in descending order according to magnitude. The method creates hierarchic “association chains” of correlation coefficients de- fined by sequences where reversing the start and end point does not alter the ordering of elements. Association chains characterize de- pendence structures within networks of extensively interacting variables. Results: SNHA disclosed fundamental differences in the network of anthropometric, educational, environmental and economic variables of the people of Sikkim, and the people of West Ben- gal, Telangana and Gujarat. Whereas relevant interactions among these variables were largely absent in the people of Sikkim, the variables formed characteristic star-shaped networks with wealth quintile and the possession of motorcycles in a strong central position, in the people of West Bengal, Telangana and Gujarat. Conclusion: Depicting association chains within net- works of extensively interacting variables such as health survey data appears to be a promising statisti- cal tool for disentangling the effects of environmen- tal circumstances, education, and social, economic, political and emotional (SEPE) factors on human growth.

Teamwork in community health committees: a case study in two urban informal settlements

BackgroundCommunity health committees (CHCs) are mechanisms for community participation in decision-making and overseeing health services in several low-and middle-income countries (LMICs). There is little research that examines teamwork and internal team relationships between members of these committees in LMICs. We aimed to assess teamwork and factors that affected teamwork of CHCs in an urban slum setting in Nairobi, Kenya.MethodsUsing a qualitative case-study design, we explored teamwork of two CHCs based in two urban informal settlements in Nairobi. We used semi-structured interviews (n = 16) to explore the factors that influenced teamwork and triangulated responses using three group discussions (n = 14). We assessed the interpersonal and contextual factors that influenced teamwork using a framework for assessing teamwork of teams involved in delivering community health services.ResultsCommittee members perceived the relationships with each other as trusting and respectful. They had regular interaction with each other as friends, neighbors and lay health workers. CHC members looked to the Community Health Assistants (CHAs) as their supervisor and “boss”, despite CHAs being CHC members themselves. The lay-community members in both CHCs expressed different goals for the committee. Some viewed the committee as informal savings group and community-based organization, while others viewed the committee as a structure for supervising Community Health Promoters (CHPs). Some members doubled up as both CHPs and CHC members. Complaints of favoritism arose from CHC members who were not CHPs whenever CHC members who were CHPs received stipends after being assigned health promotion tasks in the community. Underlying factors such as influence by elites, power imbalances and capacity strengthening had an influence on teamwork in CHCs.ConclusionIn the absence of direction and support from the health system, CHCs morph into groups that prioritize the interests of the members. This redirects the teamwork that would have benefited community health services to other common interests of the team. Teamwork can be harnessed by strengthening the capacity of CHC members, CHAs, and health managers in team building and incorporating content on teamwork in the curriculum for training CHCs.

Nurse escorts' perceptions of nurse-led inter-hospital ambulance transfer in the Wheatbelt region of Western Australia: A descriptive survey study.

The Western Australia (WA) Country Health Service (WACHS) requires the ward or emergency department (ED) registered nurse (RN) to assume the responsibility of conducting nurse-led interhospital patient road ambulance transfers, in the absence of an available registered paramedic (RP). The generalist nurse escort with no specialised training is allocated to the patient transport from their rostered shifts when the need arises, and, in some instances, this nurse may not have been in an ambulance before. Patients requiring transfer are usually prioritised over hospital patient care because of the life-threatening nature of these situations and the urgency to get them to tertiary care facilities. This study explored nurses' perceptions about caring for a patient during road ambulance transfer, with an aim of supporting future policy formulation and decision-making to guide nurses' training, induction and ongoing education on interhospital transfers. To examine the perceptions of hospital-employed registered nurses caring for a patient during road ambulance transfer from rural Western Australia. A descriptive survey design included 23 questions to clarify the level of experience and training, the prevalence of clinical deterioration and the confidence to manage patient care. Findings from the surveys indicated that nurses often felt overwhelmed by the responsibility of the patient transfer, unclear guidelines, limited preparation and handover, lack of orientation to the ambulance environment, difficulty escalating care during transfer and no insight into the return to base process. To explore how the RN who normally works within a well-organised and accessible multidisciplinary team manages caring for a patient in an unfamiliar mobile environment, the study was conducted within WACHS in the Wheatbelt Region of WA involving 27 health care sites. Participating nurses were asked several broad questions to explore their perceptions on how well-equipped they are in managing clinical care and deterioration during transfer; what are the challenges that they face while doing so and how confident they are about their knowledge, skill level and scope of clinical practice in supporting patients during interhospital transfer? Wheatbelt nurse escorts were capable, generalist nurses with a demonstrated skill set in managing patient care during transfer when needed. The 'back of the ambulance' was a challenging environment for nurses to engage in the type of care usually provided in the hospital setting, which come with a high level of uncertainty and anxiety for both patient outcome and own well-being.

Using Simulations to Help Public Health Students Overcome Language Barriers for Better Health Outcomes.

Growing migration into Norway has increasingly strained the country's health services. Good communication is essential to ensure quality care. Often, healthcare workers and immigrant clients do not share a common language, and it is known that the conditions and expectations of immigrant clients can be different from the majority population. This study aimed to explore the viability of utilizing simulations as a pedagogical tool for educating public health students in effectively navigating a multicultural environment to promote better health outcomes. This study is a component of an extra-curricular training project that utilized a convergent mixed-methods design. The present study focuses on reporting the qualitative component of the findings. The data collection process encompassed the implementation of a stepwise simulation exercise with case-based clinical scenarios focusing on three lifestyle diseases specifically designed for this study. Method triangulation was achieved by using different methodological approaches in the analysis. Our results show the importance of simulation training for healthcare students when working with clients who do not share the same language. Interactions with clients of different backgrounds must be practiced, and simulations can be used to improve healthcare students' communication skills. The study highlights the need for healthcare education programs to integrate cultural competence simulation training and broaden the scope of medical training to address culturally challenging encounters.

The impact of COVID-19 on mental health service utilisation in England

The COVID-19 pandemic has had a significant impact on population mental health and the need for mental health services in many countries, while also disrupting critical mental health services and capacity, as a response to the pandemic. Mental health providers were asked to reconfigure wards to accommodate patients with COVID-19, thereby reducing capacity to provide mental health services. This is likely to have widened the existing mismatch between demand and supply of mental health care in the English NHS. We quantify the impact of these rapid service reconfigurations on activity levels for mental health providers in England during the first thirteen months (March 2020–March 2021) of the COVID-19 pandemic. We use monthly mental health service utilisation data for a large subset of mental health providers in England from January 1, 2015 to March 31, 2021. We use multivariate regression to estimate the difference between observed and expected utilisation from the start of the pandemic in March 2020. Expected utilisation levels (i.e. the counterfactual) are estimated from trends in utilisation observed during the pre-pandemic period January 1, 2015 to February 31, 2020. We measure utilisation as the monthly number of inpatient admissions, discharges, net admissions (admissions less discharges), length of stay, bed days, number of occupied beds, patients with outpatient appointments, and total outpatient appointments. We also calculate the accumulated difference in utilisation from the start of the pandemic period. There was a sharp reduction in total inpatient admissions and net admissions at the beginning of the pandemic, followed by a return to pre-pandemic levels from September 2020. Shorter inpatient stays are observed over the whole period and bed days and occupied bed counts had not recovered to pre-pandemic levels by March 2021. There is also evidence of greater use of outpatient appointments, potentially as a substitute for inpatient care.

Dampak Implementasi Pembayaran Berbasis Kinerja (Pay-For-Performance) Pada Fasilitas Kesehatan Tingkat Pertama (FKTP) Terhadap Kualitas Layanan Kesehatan Di Berbagai Negara

The pay-for-performance (P4P) mechanism is a strategy in the health sector to increase the availability, quality and utilization of health services. In P4P, incentives are given after achieving a series of agreed outcomes by improving the performance of health workers in health facilities. This literature review was conducted with the aim of knowing the impact of implementing pay-for-performance at primary care (FKTP) on the quality of health services in various countries. The method is carried out by searching several databases, namely Pubmed, Embase, and Proquest with the main intervention being the implementation of pay-for-performance. The results of the review focused on the impact of implementing pay-for-performance at First Level Health Facilities on the quality of health services in various countries. From this study it can be concluded that pay-for-performance has been used in various countries with different numbers and areas (domains) of indicators adapted to the characteristics of primary care in a country. Some of the benefits of implementing pay-for-performance are that it can stimulate quality improvement in clinical care and improve patient experience of the role of general practitioners and the system of care. P4P can improve the process and outcome of cardiovascular treatment. Providing incentives can have an effect on improving the quality of performance in clinical practice. Providing P4P incentives can meet the quality measures of hypertension care recommended by the guidelines. In the United States, the provision of P4P incentives can increase physician compliance to provide hypertension drugs according to guidelines. Providing incentives can also have an impact on improving blood pressure control in hypertensive patients.

The impacts of COVID-19 and its policy response on access and utilization of maternal and child health services in Tanzania: A mixed methods study.

The SARS-Cov-2 virus (COVID-19) has had a global social and economic impact. Despite the growing evidence, its effects on access and delivery of maternal and child health services in low-income countries are still unclear. This cross-sectional case study was conducted in Mjini Magharibi, Chake Chake, and Ilala districts in Tanzania to help fill this gap. The study combined qualitative and quantitative data collection methods, providing an account of the evolution of the pandemic and the associated control measures in Tanzania. We drew from 34 in-depth interviews, 60 semi-structured interviews, and 14 focus group discussions with key informants, patients, and health providers, and complemented the findings with a review of pandemic reports and health facility records. We followed the Standards for Reporting Qualitative Research (SRQR) to provide an account of the findings. Our account of the pandemic shows that there was at times an inconsistent policy response in Tanzania, with diverse control measures adopted at various stages of the epidemic. There was a perception that COVID-19 services were prioritized during the epidemic at the expense of regular ones. There were reports of reorganisation of health facilities, reallocation of staff, rescheduled antenatal and postnatal clinics, and reduced time for health education and child monitoring. Scarcity of essential commodities was reported, such as vaccines, equipment, and medical supplies. Such perceptions were in part supported by the routine utilization evidence in the three districts, showing a lower uptake of antenatal, postnatal, family planning, and immunization services, as well as fewer institutional deliveries. Our findings suggest that, although the policy response in Tanzania was erratic, it was rather fear of the pandemic itself and diversion of resources to control COVID-19, that may have contributed most to lower the utilization of mother and child services. For future emergencies, it will be crucial to ensure the policy response does not weaken the population's demand for services.

Unmet Needs for Cardiac Rehabilitation in Africa: A Perennial Gap in the Management of Individuals with Cardiac Diseases.

Cardiac rehabilitation (CR) is a standard model of care, and an established component of comprehensive care that has been proven to reduce mortality and morbidity in patients with cardiac diseases. International clinical practice guidelines routinely recommend that cardiac patients participate in CR programs for comprehensive secondary prevention. However, there is scant guidance on how to deliver these programs in low-resourced settings. This dearth of clinical practice guidelines may be an indication of low emphasis placed on CR as a component of cardiac health services in low-income countries, especially in Africa. Indeed, CR programs are almost non-existent in Africa despite the unmet need for CR in patients with ischemic heart disease in Africa reported to be about one million. This figure represents the highest unmet need of any World Health Organization region, and is colossal given the projected accelerated increases in incidence of cardiovascular diseases (CVD) in the region. This narrative review explored the availability of CR programs, potential barriers to CR and strategies that can mitigate such barriers in Africa.