Health System Planners Research Articles

Socioeconomic inequality in noncommunicable diseases: Results from a baseline Persian cohort study.

Background: Contrary to health indices advancement during recent years, health inequalities are still a global challenge. This study aimed to determine socioeconomic factors for noncommunicable diseases using concentration indices (CI). Methods: This cross-sectional study was conducted on the baseline data from a cohort study in Fasa (southern Iran). Principle component analysis was used to measure asset index. Moreover, socioeconomic inequalities were calculated by CI. Analysis was done at 95% confidence level using STATA software. Results: A total of 7990 individuals were included in the study. The highest negative CIs were significantly found for epilepsy (-0.334), paramnesia (-0.255), and learning disabilities (-0.063), respectively, and the lowest were significantly found for chronic headaches (-0.046), recurrent headaches (-0.03), infertility (-0.028) and hypertension (-0.057). This index was positive for breast cancer (0.298). Furthermore, it was not Significant for diabetes, thyroid disorders, depression, and chronic lung diseases. Conclusion: The findings showed a significant inequality in the most of the noncommunicable diseases in the region, which are more concentrated among the poorest population. Policymakers in the health system and city planners should consider these results to decrease the burden of noncommunicable diseases in the society by identifying vulnerable subcategories.

How Do Health Systems Address Patient Flow When Services Are Misaligned With Population Needs? A Qualitative Study.

Patient flow through health services is increasingly recognized as a system issue, yet the flow literature has focused overwhelmingly on localized interventions, with limited examination of system-level causes or remedies. Research suggests that intractable flow problems may reflect a basic misalignment between service offerings and population needs, requiring fundamental system redesign. However, little is known about health systems' approaches to population-capacity misalignment, and guidance for system redesign remains underdeveloped. This qualitative study, part of a broader investigation of patient flow in urban Western Canada, explored health-system strategies to address or prevent population-capacity misalignment. We conducted in-depth interviews with a purposive sample of managers in 10 jurisdictions across 4 provinces (N = 300), spanning all healthcare sectors and levels of management. We used the constant comparative method to develop an understanding of relevant strategies and derive principles for system design. All regions showed evidence of pervasive population-capacity misalignment. The most superficial level of response - mutual accommodation (case-by-case problem solving) - was most prevalent; capacity (re)allocation occurred less frequently; population redefinition most rarely. Participants' insights yielded a general principle: Define populations on the basis of clusters of co-occurring need. However, defining such clusters demands a difficult balance between narrowness/rigidity and breadth/flexibility. Deeper analysis suggested a further principle: Populations that can be divided into homogeneous subgroups experiencing similar needs (eg, surgical patients) are best served by narrow/ rigid models; heterogeneous populations featuring diverse constellations of need (eg, frail older adults) require broad/ flexible models. To remedy population-capacity misalignment, health system planners should determine whether clusters of population need are separable vs. fused, select an appropriate service model for each population, allocate sufficient capacity, and only then promote mutual accommodation to address exceptions. Overreliance on case-by-case solutions to systemic problems ensures the persistence of population-capacity misalignment.

Investigating the challenges and barriers of palliative care delivery in Iran and the World: A systematic review study.

Palliative care and terminal patients care centers have an important role in improving the physical and psychological state of the patient and their families and increasing their satisfaction and care providers. A literature search of online databases (PubMed, Scopus, Web of science, Cochrane library, and Google Scholar) was searched from January 1, 2000, to the end of April 2019, by using the appropriate English keywords. Furthermore, IranMedex, Barkat, and Magiran databases were searched for the Persian articles. We used Standards for Reporting Qualitative Research checklist to evaluate the articles quality. From 1328 articles, 166 were reviewed in depth with 13 satisfying our inclusion criteria. The findings of this study revealed a wide range of barriers and challenges to palliative care delivery. The identified barriers were: Cultural, social and organizational barriers, lack of resources, equipment and financing, attitudes and cultures, barriers related to the patient and the patient's family, related barriers providers, time and money, education, communication challenges, policies, insurance problems, safety, and crisis management. The results of the studies showed that there are various barriers and challenges such as economic, cultural, social, organizational, and communication related to palliative care. Given the identified barriers and challenges, it is suggested that to improve the delivery of palliative care, the health system policy-makers and planners consider a resource-appropriate and culturally appropriate framework for palliative care delivery.

Effectiveness of clinical breast examination as a \u2018stand-alone\u2019 screening modality: an overview of systematic reviews

BackgroundThere is uncertainty about the effectiveness of clinical breast examination (CBE) and conflicting recommendations regarding its usefulness as a screening tool for breast cancer. This paper provides an overview of systematic reviews that assessed the effectiveness of CBE as a ‘stand-alone’ screening modality for breast cancer compared to no screening and focused on its value in low- and middle-income countries (LMICs).MethodsWe searched MEDLINE, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews for systematic reviews reporting the effectiveness of CBE published prior to October 29, 2019. The main outcomes assessed were mortality and down staging. The AMSTAR 2 checklist was used to assess the methodological quality of the reviews including risk of bias.ResultsEleven systematic reviews published between 1993 and 2019 were identified. There was no direct evidence that CBE reduced breast cancer mortality. Indirect evidence suggested that a well-performed CBE achieved the same effect as mammography regarding mortality despite its apparently lower sensitivity (40–69% for CBE vs 77–95% for mammography). Greater sensitivity was recorded among younger and Asian women. Moreover, CBE contributed between 17 and 47% of the shift from advanced to early stage cancer.ConclusionsCBE merits attention from health system and service planners in LMICs where a national screening programme based on mammography would be prohibitively expensive. In particular, it is likely that considerable value would be gained from conducting implementation scientific research in countries with large numbers of Asian women and/or where younger women are at higher risk.RegistrationPROSPERO, registration number CRD42019126798.

A model to measure self-assessed proficiency in electronic medical records: Validation using maturity survey data from Canadian community-based physicians

ObjectiveAdoption of electronic medical records (EMRs) does not necessarily translate to proficiency –referred to here as EMR maturity. To realize the full benefit of wide scale EMR adoption, the focus must shift from adoption to advancing mature use. This calls for validated assessment models so that researchers, health system planners and digital health developers can better understand what contributes to maturity among physicians. This research aims to validate a measurement model for self-assessed EMR maturity among community-based physicians. MethodsAs part of an Ontario government-funded EMR adoption program, the EMR Maturity Model for community-based practices was adapted from a hospital-based EMR maturity model. A survey instrument was developed on the foundation of the new model and revised by experts and stakeholders. Content validity, face validity and user acceptance were established before survey administration. Internal consistency and construct validity of the model were tested after survey data were collected. Finally, physicians’ comments collected via the survey were qualitatively analyzed to provide additional insights that can be applied to refinement of the model and survey. ResultsAs of August 1, 2019, 1588 physicians completed the survey. Ordinal alpha tests for reliability and content validity yielded an alpha value of 0.86 across all key measures specifically associated with maturity. Among most of these, there was a pattern of weak to moderate significant (p < .0001) positive Spearman inter-correlations. One factor was extracted for items measuring dimensions of maturity and all factor loadings of the key measures were greater than 0.40. The fit of the one-factor model was moderately adequate. This indicates the model is valid and reliable, with consistency across key measures for measuring one factor: maturity. ConclusionsThis is the first known validated model published in English that measures EMR maturity among community-based physicians. While the model is shown to be valid and reliable statistically and qualitative analysis supports this, there is room for improvement. Both the statistical analysis and portions of the qualitative analysis suggest areas of exploration to strengthen the model and survey. Future efforts will include refining the survey to improve user interface and accrue further data, as the sample to date is insufficient for generalizability.

Barriers and facilitators to implementing evidence-based health innovations in low- and middle-income countries: A systematic literature review

The unsuccessful implementation of health innovations occurs frequently, leading to missed opportunities where improvements could have been made on various aspects of a health system. The purpose of this study is to identify, assess and synthesise the facilitators and barriers to sustainably implementing evidence-based health innovations in a low- and middle-income country (LMIC) context. To identify the LMIC specific facilitators and barriers, a systematic literature review was conducted. 79 studies were analysed, and the implementation barriers and facilitators identified in each study were extracted. The extracted barriers and facilitators were categorised and synthesized into one of seven concepts: context, innovation, relations and networks, institutions, knowledge, actors or resources. There were no substantial variations between the frequency that each concept was identified as a facilitator or barrier to implementation. However, resources, which includes time, human, financial and physical resources, was the most frequently mentioned concept; emphasising the need to focus on the resource situation in LMICs. This study contributes to the growing literature that aims to inform health system planners and evaluators in LMICs on effectively and sustainably implementing evidence-based health innovations.

Digital Health and Professional Identity in Australian Health Libraries: Evidence from the 2018 Australian Health Information Workforce Census

Abstract&#x0D; Objective – This research aimed to examine the characteristics of the current health library professional workforce in Australia. The study also sought to explore the areas of health library competency domains and job functions that may reflect progress toward a specialized digital health information capability.&#x0D; Methods – Health librarians’ responses to the May 2018 Australian Health Information Workforce Census were analysed and compared with results obtained in earlier census counts. The health librarian characteristics were also compared with other health information occupations included in the Census.&#x0D; Results – There were 238 usable health librarian responses. These indicate that the health librarian workforce continues to be a comparatively mature population, with substantial experience, increasing involvement in data- and technology-intensive functions, high levels of professional association membership, and participation in continuing education activities. Notably there are emerging role titles and job functions which point to a greater digital health focus in the changing work realm.&#x0D; Conclusion – The health librarian workforce has adapted its skills, in line with the increased digital emphasis in health information work. However, as with other health information occupational groups, it is possible that health system planners and funders are not aware of librarians’ current functions and skills. This mature workforce may undergo significant attrition and consequent loss of expertise in the next decade. Continued advocacy and strategic planning around these factors with workforce, healthcare quality, and educational organizations will be required.

Factors related to childbearing intentions among women: a cross-sectional study in health centers, Saveh, Iran

BackgroundOne of the most important demographic challenges over the recent three decades in the world has been a significant fall in the fertility rate. This study aimed to investigate factors related to childbearing intentions among a sample of Iranian women.MethodsA cross-sectional study of a sample of Iranian married women attending 8 centers in Saveh was conducted in 2015. A total of 483 married women 15–49 years old participated in this study. A questionnaire was used to collect data about demographics, attitude, subjective norms, marital satisfaction, social support, hopefulness, and behavioral intentions of childbearing.ResultsOverall, 62% of women in the study intended to have children in the next 2 years. The group willing to have children had a higher score on attitude, subjective norms, hopefulness, perceived social support, and marital satisfaction compared to the group unwilling to have children. Also, the regression results revealed that the variables of age, literacy status, employment status, husband literacy, women and husband occupation status, attitude, subjective norms, hopefulness, perceived social support, and marital satisfaction were significant predicting factors for childbearing intention (P < 0.05).Conclusions and recommendationsThe findings highlighted the importance of psychological factors such as marital satisfaction and social support in the childbearing process. Thus, health system planners should pay more attention to these determinants of fertility intention.

Using Google Trends to Predict Pediatric Respiratory Syncytial Virus Encounters at a Major Health Care System.

To assess whether Google search activity predicts lead-time for pediatric respiratory syncytial virus (RSV) encounters within a major health care system. Internet user search and health system encounter database analysis. Pediatric RSV encounter volumes across all clinics and hospitals in the Duke Health system were tabulated from 2005 to 2016. North Carolina Google user search activity for RSV were obtained over the same time period. Time series analysis was used to compare RSV encounters and search activity. Cross-correlation was used to determine the 'lag' time difference between Google user search interest for RSV and observed Pediatric RSV encounter volumes. Google search activity and Pediatric RSV encounter volumes demonstrated strong seasonality with predilection for winter months. Granger Causality testing revealed that North Carolina RSV Google search activity can predict pediatric RSV encounters at our health system (F = 5.72, p < 0.0001). Using cross-correlation, increases in Google search activity provided lead time of 0.21weeks (1.47days) prior to observed increases in Pediatric RSV encounter volumes at our health system. RSV is a common cause of upper airway obstruction in pediatric patients for which pediatric otolaryngologists are consulted. We demonstrate that Google search activity can predict RSV patient interactions with a major health system with a measurable lead-time. The ability to predict when illnesses in a population result in increased health care utilization would be an asset to health system providers, planners and administrators. Prediction of RSV would allow specific care pathways to be developed and resource needs to be anticipated before actual presentation.

Receiving addiction treatment in the US: Do patient demographics, drug of choice, or substance use disorder severity matter?

BackgroundUnderstanding addiction treatment needs and utilization is important to health systems and government to develop policies that effectively address substance use disorders (SUDs) at a population level. This study aims to describe differences in treatment receipt by diagnostic category, drug of choice, and demographic characteristics in an effort to identify potential disparities in receipt of care. MethodsUsing data from the 2017 National Survey on Drug Use and Health, we calculated the proportion of various groups that received treatment and conducted binary logistic regression to determine the association between addiction treatment receipt and SUD severity, drug of choice, and patient demographics. ResultsUsing DSM-5, 16.7 million Americans (age 12 and older) are estimated to have a mild SUD, 5.2 million a moderate SUD, and 4.6 million a severe SUD. The two greatest predictors of treatment receipt are addiction severity and probation status. People with severe opioid use disorder have the greatest probability of treatment receipt with a 55.6% predicted probability of receiving treatment, while people with a mild alcohol use disorder are the least likely to receive treatment with a predicted probability of 1.8% receiving treatment. People with mild alcohol use disorder make up the largest proportion of people identified as needing but not receiving treatment when assuming all people with a diagnosis need treatment. ConclusionsImproving use of existing specialty addiction treatment capacity to address the needs of the 8.5 million Americans with moderate or severe SUD and better use of the general health care system to treat mild or stable SUD may be a better focus for health system planners and government than adding new capacity for specialty treatment.

Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh.

Ensuring access to healthcare in emergency health situations is a persistent concern for health system planners. Emergency services, including critical care units for severe burns and coronary events, are amongst those for which travel time is the most crucial, potentially making a difference between life and death. Although it is generally assumed that access to healthcare is not an issue in densely populated urban areas due to short distances, we prove otherwise by applying improved methods of assessing accessibility to emergency services by the urban poor that take traffic variability into account. Combining unique data on emergency health service locations, traffic flow variability and informal settlements boundaries, we generated time-cost based service areas to assess the extent to which emergency health services are reachable by urban slum dwellers when realistic traffic conditions and their variability in time are considered. Variability in traffic congestion is found to have significant impact on the measurement of timely access to, and availability of, healthcare services for slum populations. While under moderate traffic conditions all slums in Dhaka City are within 60-minutes travel time from an emergency service, in congested traffic conditions only 63% of the city’s slum population is within 60-minutes reach of most emergency services, and only 32% are within 60-minutes reach of a Burn Unit. Moreover, under congested traffic conditions only 12% of slums in Dhaka City Corporation comply with Bangladesh’s policy guidelines that call for access to 1 health service per 50,000 population for most emergency service types, and not a single slum achieved this target for Burn Units. Emergency Obstetric Care (EmOC) and First Aid & Casualty services provide the best coverage, with nearly 100% of the slum population having timely access within 60-minutes in any traffic condition. Ignoring variability in traffic conditions results in a 3-fold overestimation of geographic coverage and masks intra-urban inequities in accessibility to emergency care, by overestimating geographic accessibility in peripheral areas and underestimating the same for central city areas. The evidence provided can help policy makers and urban planners improve health service delivery for the urban poor. We recommend that taking traffic conditions be taken into account in future GIS-based analysis and planning for healthcare service accessibility in urban areas.

Organisation of primary health care in the Asia-Pacific region: developing a prioritised research agenda.

Health system planners in low- and middle-income countries (LMIC) of the Asia-Pacific region seeking to reorient primary health care (PHC) systems to achieve universal health coverage may be hindered by lack of knowledge of what works in their setting. With limited resources for research available, it is important to identify evidence-based strategies for reorganising PHC delivery, determine where relevant evidence gaps exist and prioritise these for future study. This paper describes an approach for doing this using the best available evidence combined with consultation to establish evidence priorities. We first reviewed PHC organisational interventions in Asia-Pacific LMICs and ascertained evidence gaps. The largest gaps related to interventions to promote access to essential medicines, patient management tools, effective health promotion strategies and service planning and accountability. Evidence from Pacific Island countries was particularly scant. We then engaged an expert panel of 22 PHC stakeholders from seven Asia-Pacific LMICs in a Delphi exercise to identify priority questions for future research. Research priorities were: (1) identifying effective PHC service delivery models for chronic diseases; (2) devising sustainable models of disease integration; (3) optimising task shifting; (4) understanding barriers to care continuity; (5) projecting future PHC needs; and (6) designing appropriate PHC service packages. Notably, stakeholder-determined priorities reflected large, context-dependent system issues, while evidence gaps centred on discrete interventions. Future research on the organisation of PHC services in Asia-Pacific LMICs should incorporate codesign principles to engage researchers and national PHC system stakeholders, and innovative methods that build on existing evidence and account for system complexity.

Pregnant Women's Health Literacy Promotion Strategies: A Review

Background: Given the importance maternal health literacy (MHL) level in pregnancy outcome and maternal-child health, Investigating MHL promotion strategies is essential. To this end, the present study aimed to identify and report those interventions that conducted for improving MHL.&#x0D; Methods: A scoping literature search using PubMed, Web of Science, Social Science Research Network, CINAHL, Psych INFO, Magiran, Iran Medex, Iran Doc, SID and Google Scholar. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Eligible studies were identified from English and Persian databases, published between 1990 and 2018. Studies were screened independently by two researchers who performed the data extraction.&#x0D; Results: On the basis of the studies’s intervention technique, 2 major health themes emerged:&#x0D; Group-based interventions (Antenatal classes, Small group teaching, The centering pregnancy model, Web-based discussion forums) and individual -based interventions (Counseling intervention, Web-based educations, The workbook and booklet, Multimedia approaches, Graphics-based tool, A theory-based training program).&#x0D; Conclusion: This review provides insights into existing strategies for MHL promotion. Health policy leaders and health system planners, should support the uptake of these approaches into usual prenatal care.

Using information sources by breast cancer women treated with mastectomy.

BACKGROUND:Awareness of sources of information of mastectomy patients has an important role in accessibility of reliable health information sources, thus, when they get information, they can be effective in the treatment and self-care. The present study aimed to identify the sources of information used by women underwent mastectomy.MATERIALS AND METHODS:The current practical research methodology was qualitative, and research method was conventional qualitative content analysis was performed on 17 patients with breast cancer undergone mastectomy. The sample targeted two hospitals were selected based on criteria of Shaeid Mohammadi and the Persian Gulf and Omid Central chemotherapy in Babdar Abbas. Data were collected by face-to-face semi-structured interviews were conducted in winter 2015. Qualitative content analysis of data was performed at the same time of data collection.RESULTS:Three themes were seemed (medical, interpersonal, and media) sources for explaining the sources of information searching. Subcategories derived from the content of medical (physicians, surgeons, and health workers of health facility centers), interpersonal sources (Family and friends, peers), and media sources (printed, electronic, and Internet).CONCLUSION:Given the importance of information on women underwent mastectomy, and their priority in the use of medical sources, necessitates more attention of health system managers and planners in providing essential information and their accessibility.

Exploring stakeholder's perception about factors affecting on implementation of physiologic birth plan: A qualitative approach

Context: Following the increase in cesarean section rate in Iran, the Ministry of Health and Medical Education has planned a program for the promotion of normal birth. The plan named as “physiologic birth” that is equal with “spontaneous labor.” Aims: This study aims to explain factors affecting the implementation of “physiologic birth plan from stakeholders” view. Setting and Design: In this qualitative study, purposive samples of 21 health-care stakeholders (2 men and 19 women) were interviewed in 2016. The participants included three obstetricians and gynecologists, six midwives, three managers and experts in charge of the plan at the Mazandaran University of Medical Science, and nine women who gave birth under the physiological delivery (Spontaneous Labor) plan. Materials and Methods: Face-to-face semi-structured interviews and one focus group discussion were employed to collect the study data. Statistical Analysis Used: Qualitative content analysis method was used. Results: From the data analysis, the main theme “integrity of designing and implementation” and five subthemes as the influencing factors, namely, The “inadequate resources,” “ambiguity in tasks and roles,” “attention to psychosocial atmosphere,” “considering of the delivery culture,” and “incomprehensive training and updating the plan,” were extracted. Conclusion: This research suggests that the success behind implementing a plan in health-care system including the physiological delivery plan depends on the factors that are requiring should be identified and investigated from the designing stage to the implementation stage and after that. Thus, health system policymakers and planners are required to pay attention to diverse above-mentioned aspects in its designing and implementation.

Low prioritization of latent tuberculosis infection-A systemic barrier to tuberculosis control: A qualitative study in Ontario, Canada.

Eliminating tuberculosis (TB) in low-incidence countries is an important global health priority, and Canada has committed to achieve this goal. The elimination of TB in low-incidence countries requires effective management and treatment of latent tuberculosis infection (LTBI). This study aimed to understand and describe the system-level barriers to LTBI treatment for immigrant populations in the Greater Toronto and Hamilton Area, Ontario, Canada. A qualitative study that used purposive sampling to recruit and interview health system advisors and planners (n=10), providers (n=13), and clients of LTBI health services (n=9). Data were recorded, transcribed verbatim, and analyzed using content analysis. Low prioritization of LTBI was an overarching theme that impacted four dimensions of LTBI care: management, service delivery, health literacy, and health care access. These factors explained, in part, inequities in the system that were linked to variations in health care quality and health care access. While some planners and providers at the local level were attempting to prioritize LTBI care, there was no clear pathway for information sharing. This multiperspective study identified barriers beyond the typical socioeconomic determinants and highlighted important upstream factors that hinder treatment initiation and adherence. Addressing these factors is critical if Canada is to meet the WHO's global call to eradicate TB in all low incidence settings.

Linking surveillance and administrative data to better understand dementia’s impact in Canada

IntroductionCanadian Institute of Health Information and Public Health Agency of Canada combined analytical work for a dementia report. The report linked surveillance and administrative data to support policy makers, health system planners and public in understanding the prevalence of seniors with dementia and their interactions with the health care system.&#x0D; Objectives and ApproachDementia prevalence data from PHAC’s Canadian Chronic Disease Surveillance System was used as a denominator, and data from CIHI’s administrative databases was used as a numerator to calculate the statistics on interactions of seniors with dementia with the healthcare system.&#x0D; Examples of the measures reported by database include:&#x0D; &#x0D; Using DAD: Proportion of seniors with dementia who were hospitalized;&#x0D; Using NACRS: Proportion of seniors with dementia who visited emergency departments;&#x0D; Using CCRS: Proportion of seniors with dementia living in and outside of nursing homes;&#x0D; Using HCRS: Proportion of seniors with dementia living in the community and receiving home care services.&#x0D; &#x0D; ResultsResults for the measures above, as well as rates of patients receiving different services, statistics on where they live, their characteristics, quality of care by sectors, and impacts on caregivers will be presented.&#x0D; One out of 5 seniors with dementia is admitted to hospital every year, and one out of four visited emergency departments at least once. Two out of five seniors with dementia reside in long term care. While in nursing homes, seniors with dementia experience more inappropriate antipsychotic and restraint use compared to seniors without dementia. They are especially susceptible to injury and falls. Once hospitalized, they tend to stay longer waiting for placement and experience greater hospital harm. Caregivers of seniors with dementia experience more distress compared to caregivers of other seniors.&#x0D; Conclusion/ImplicationsThis work illustrates benefits of combining data from different organizations and sectors to help inform policy and fill data gaps. This innovative approach using PHAC’s surveillance and CIHI’s administrative data avoids confusion from varying estimates and duplication of work between organizations, generates new evidence, and reaches a broader audience.

Beyond signal functions in global obstetric care: Using a clinical cascade to measure emergency obstetric readiness.

BackgroundGlobally, the rate of reduction in delivery-associated maternal and perinatal mortality has been slow compared to improvements in post-delivery mortality in children under five. Improving clinical readiness for basic obstetric emergencies is crucial for reducing facility-based maternal deaths. Emergency readiness is commonly assessed using tracers derived from the maternal signal functions model.Objective-methodWe compare emergency readiness using the signal functions model and a novel clinical cascade. The cascades model readiness as the proportion of facilities with resources to identify the emergency (stage 1), treat it (stage 2) and monitor-modify therapy (stage 3). Data were collected from 44 Kenyan clinics as part of an implementation trial.FindingsAlthough most facilities (77.0%) stock maternal signal function tracer drugs, far fewer have resources to practically identify and treat emergencies. In hypertensive emergencies for example, 38.6% of facilities have resources to identify the emergency (Stage 1 readiness, including sphygmomanometer, stethoscope, urine collection device, protein test). 6.8% have the resources to treat the emergency (Stage 2, consumables (IV Kit, fluids), durable goods (IV pole) and drugs (magnesium sulfate and hydralazine). No facilities could monitor or modify therapy (Stage 3). Across five maternal emergencies, the signal functions overestimate readiness by 54.5%. A consistent, step-wise pattern of readiness loss across signal functions and care stage emerged and was profoundly consistent at 33.0%.SignificanceComparing estimates from the maternal signal functions and cascades illustrates four themes. First, signal functions overestimate practical readiness by 55%. Second, the cascade’s intuitive indicators can support cross-sector health system or program planners to more precisely measure and improve emergency care. Third, adding few variables to existing readiness inventories permits step-wise modeling of readiness loss and can inform more precise interventions. Fourth, the novel aggregate readiness loss indicator provides an innovative and intuitive approach for modeling health system emergency readiness. Additional testing in diverse contexts is warranted.

The relationship between job motivation and its dimensions with organizational commitment and its dimensions in midwives of sanitary and therapeutic centers, Arak University of Medical Sciences, 2017.

Introduction and Aim:Human resources with the quality of desirable performance are the most important assets of the organization and increase the probability of success, survival, and progress of the organization. Midwives have a critical role in promoting the health of mothers and infants and survey the relationship between job motivation and organizational commitment can help health system managers and planners to improve the quality of the services provided.Methods:This is a cross-sectional and correlational study; samples of midwives in Arak University of Medical Sciences were selected by stratified sampling with proportional allocation method. The instrument of gathering was demographic information questionnaire, Herzberg's job motivation, and organizational commitment of Allen and Meyer. Data were analyzed by SPSS 16 software and (P < 0.05) were considered significant.Results:There was a significant relationship between job motivation and organizational commitment and their dimensions (r = 0.68, P < 0.001). The highest correlation between job motivation and emotional commitment (r = 0.77), normative commitment (r = 0.62), and continuous commitment (r = 0.55). The most related emotional commitment by way of communication (r = 0.74), continuous commitment to salary and wages (r = 0.54), and normative commitment with the nature of midwifery was r = 0.61.Conclusion:The results show the importance of communication dimensions, salaries, and wages and the nature of job in the commitment of midwives in Markazi Province. More attention from health system administrators to these dimensions can be useful in increasing the motivation and organizational commitment of midwives in this province.

Meeting the complex needs of individuals with rare genetic disorders in South Africa – lessons from tuberous sclerosis complex

Every year, 28 February is Rare Disease Day around the globe. In many high-income countries, significant programmes of research and policy have been developed to understand and meet the needs of individuals who live with rare diseases. In South Africa (SA), rare diseases have unfortunately not reached the awareness of most policy-makers and health system planners. On the one hand, it seems relatively easy to understand why rare diseases have remained ‘rare’ in SA, given the very high burden of other diseases, both communicable and non-communicable. On the other hand, we may be able to learn a lot by studying and treating rare disorders, sometimes with profound clinical consequences.