Health Facility Managers Research Articles

Influence of Access to Quality Services on Performance of Family Planning Programs in Kuresoi North Sub-County, Nakuru County, Kenya

This study investigated access to quality services influence on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The study was founded on the theory of constraint and adopted a pragmatism paradigm. It applied descriptive research method using mixed method approach to investigate the influence of access to quality services on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The target population in the study was women of reproductive age in 33,482 households distributed in the four Wards of Kuresoi North Sub-County and 19 health management leaders in-charge of all government health facilities offering family planning services in the Sub-County. A sample size of 400 of women of reproductive age and 19 nursing officers in-charge of government health facilities was utilized. The data collection tools used were questionnaire, interview guide, and observation checklist for women of reproductive age and the interview guide for the health facility managers. The research study adopted stratified sampling method. Qualitative data was analyzed according to themes and patterns, and then summarizing the data and linking it to objectives and hypothesis. The study findings exhibited that there was a significant and strong positive individual correlation between access to quality services and performance of family planning program in Kuresoi North Sub-County. The study findings also displayed that there is a significant positive relationship between access to quality services and performance of family planning program in Kuresoi North Sub-County and it predicted the performance of family planning programmes. in Kuresoi North Sub-County.

Influence of Management Competency on Performance of Family Planning Programs in Kuresoi North Sub-County, Nakuru County, Kenya

This study investigated management competency influence on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The study was founded on the theory of constraint and adopted a pragmatism paradigm. It applied descriptive research method using mixed method approach to investigate the influence of management competency on performance of family planning program in Kuresoi North Sub-County, Nakuru County, Kenya. The target population in the study was women of reproductive age in 33,482 households distributed in the four Wards of Kuresoi North Sub-County and 19 health management leaders in-charge of all government health facilities offering family planning services in the Sub-County. A sample size of 400 of women of reproductive age and 19 nursing officers in-charge of government health facilities was utilized. The data collection tools used were questionnaire, interview guide, and observation checklist for women of reproductive age and the interview guide for the health facility managers. The research study adopted stratified sampling method. Qualitative data was analyzed according to themes and patterns and then summarizing the data and linking it to objectives and hypothesis. The study findings indicate that there is moderate management efficiency, exhibited pertaining to family planning in the dispensaries and health centers located in Kuresoi North Sub-County. Further findings exhibited that there was a significant and strong positive individual correlation between management competency and performance of family planning program in Kuresoi North Sub-County. Finally, the study findings also exhibited that there is a significant positive relationship between management competency and performance of family planning program in Kuresoi North Sub-County and it predicted the performance of family planning programmes. in Kuresoi North Sub-County.

Evaluation of Application of Effective Vaccine Management in Wassit Governorate, Iraq

Background: Immunization helps save a life, protect serious illness, and improve quality of life. It is recognized as one of the most cost-effective public health interventions available around the globe. However, the success of this program is heavily dependent on strong immunization supply chain practices. Proper immunization supply chain management ensures availing potent and live vaccines to the community. Objective: To evaluate the application of effective vaccine management in health facilities of Wassit Governorate, Iraq. Subjects and Methods: It was a cross-sectional study involving a multistage sampling. A total of 45 health facilities sites were selected, as follows: one sub-national store (SN), six district store (LD), and thirty eight service point (SP) by using effective vaccine management (EVM) questionnaire, interview, reviewing the records, and observations for the agreed review period. Results: The overall scores of this assessment for all levels (SN, LD, and SP) of the supply chain 66.6% demonstrates a need for more improvement in most areas of the vaccine and supply management system as only two criteria (storage capacity E3 and vaccine management practices E8) exceeds the WHO recommended minimum score of 80%. Performance levels of one criteria (building, equipment E4) were about 72% storage temperature (E2), maintenance(E5) and stock management (E6) were between 61 and 68%, while the vaccine distribution (E7), and information management (E9) were notably very weak with performance in each category less than 60%. Conclusions: The national average percentage at all levels was below the WHO recommended minimum score of 80%. Recommendation: The future vaccine storage capacity must be recalculated and stored to enter any new vaccine, receive large quantities of the influenza vaccine, and replace vaccine refrigerators at the sector level with cold rooms to accommodate current and future increases.

Fire safety management of public buildings: a systematic review of hospital buildings in Asia

PurposeThere is increasing recognition amongst healthcare providers on the necessity to improve fire safety management in healthcare facilities. This is possibly not yet satisfactory because of recent fire incidents in Asia. This paper set out to analyse the literature because of the paucity of systematic reviews on fire safety management of public healthcare facilities and proffer preventive measures.Design/methodology/approachThirty related studies were identified with the support of the Preferred Reporting Items for Systematic reviews and Meta-Analyses via Scopus and Web of Science databases.FindingsInfluencing factors, hindrances to fire safety management and preventive measures for fire-related occurrence in Asian hospital buildings were the three themes that emerged from the reviewed. The factors that influence fire in Asian hospital buildings were categorised into technical, management and legislation factors.Research limitations/implicationsThe recommendations of this paper were based on literature that was systematically reviewed but does not compromise the robustness concerning fire safety management in hospital buildings across Asian countries. Much is needed to be known regarding fire safety in healthcare buildings across Asian countries. This paper recommended exploratory sequential mixed-methods approach as part of the implications for further studies. This will allow in-depth face-to-face interviews and increase the generalisability of future findings concerning fire safety management in hospital buildings across Asian countries to a larger population.Practical implicationsAs part of the practical implications, this paper recommends fire safety management plan as one of the practical possible measures for addressing technical, management and legislation factors. Also recommended is training and fire safety education of healthcare staff in collaboration with safety firefighters to address major issues that may arise from management factors. The government should upgrade the safety technology equipment in healthcare facilities as part of measures to mitigate issues concerning technical and legislation factors. Also, the identified factors are part of the theoretical contributions to the advancement of knowledge and this brings to the front burners new opening.Originality/valueThis is probably the first systematic review paper on fire safety hospital buildings in Asia.

Application of discrete event simulation for performance evaluation in private healthcare: The case of a radiology department

ABSTRACT Radiology departments face tremendous challenges to meet specific service requirements and reach an acceptable level of patients’ satisfaction. This requires dedicated management attention and effective decision-making process. It is of utmost importance for the management to evaluate the effectiveness of the applied strategies in comparison with the proposed strategies for the performance evaluation of resources. The main goal of this study is to evaluate the effectiveness of the applied and proposed management strategies for managing resources in a radiology department of private healthcare facilities. Data were collected regarding the service time and arrival rates. A model is constructed on the Arena simulation software to investigate different strategies of management in a private healthcare facility. The study evidenced that the newly applied strategy is more effective compared to the old one, but there is room for improvement in the services provided to treat all patients on the same day upon arrival with no rescheduled patients. The study demonstrated that the proposed strategy will enable the healthcare facility to treat all patients on the same day upon arrival with no rescheduled patients. In addition to that, the study revealed that the management of private healthcare facilities in Saudi Arabia is more efficient and effective compared to the management of the public healthcare facilities. The study also demonstrated how the Arena simulation software can be utilized to evaluate the effectiveness of the management decision-making process.

Frequency and management of maternal infection in health facilities in 52 countries (GLOSS): a 1-week inception cohort study

SummaryBackgroundMaternal infections are an important cause of maternal mortality and severe maternal morbidity. We report the main findings of the WHO Global Maternal Sepsis Study, which aimed to assess the frequency of maternal infections in health facilities, according to maternal characteristics and outcomes, and coverage of core practices for early identification and management.MethodsWe did a facility-based, prospective, 1-week inception cohort study in 713 health facilities providing obstetric, midwifery, or abortion care, or where women could be admitted because of complications of pregnancy, childbirth, post-partum, or post-abortion, in 52 low-income and middle-income countries (LMICs) and high-income countries (HICs). We obtained data from hospital records for all pregnant or recently pregnant women hospitalised with suspected or confirmed infection. We calculated ratios of infection and infection-related severe maternal outcomes (ie, death or near-miss) per 1000 livebirths and the proportion of intrahospital fatalities across country income groups, as well as the distribution of demographic, obstetric, clinical characteristics and outcomes, and coverage of a set of core practices for identification and management across infection severity groups.FindingsBetween Nov 28, 2017, and Dec 4, 2017, of 2965 women assessed for eligibility, 2850 pregnant or recently pregnant women with suspected or confirmed infection were included. 70·4 (95% CI 67·7–73·1) hospitalised women per 1000 livebirths had a maternal infection, and 10·9 (9·8–12·0) women per 1000 livebirths presented with infection-related (underlying or contributing cause) severe maternal outcomes. Highest ratios were observed in LMICs and the lowest in HICs. The proportion of intrahospital fatalities was 6·8% among women with severe maternal outcomes, with the highest proportion in low-income countries. Infection-related maternal deaths represented more than half of the intrahospital deaths. Around two-thirds (63·9%, n=1821) of the women had a complete set of vital signs recorded, or received antimicrobials the day of suspicion or diagnosis of the infection (70·2%, n=1875), without marked differences across severity groups.InterpretationThe frequency of maternal infections requiring management in health facilities is high. Our results suggest that contribution of direct (obstetric) and indirect (non-obstetric) infections to overall maternal deaths is greater than previously thought. Improvement of early identification is urgently needed, as well as prompt management of women with infections in health facilities by implementing effective evidence-based practices.FundingUNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of Research, Development and Research Training in Human Reproduction, WHO, Merck for Mothers, and United States Agency for International Development.

Short-term effects of air pollution on daily single- and co-morbidity cardiorespiratory outpatient visits

Several studies have noted that the existence of comorbidities lead to an increase in the risk of premature mortality and morbidity. Most of the studies examining the effects of air pollution on comorbidity visits were from Northern American countries, with scarce literature from Asia. This study contributes to existing, yet limited understanding of air pollution-comorbidity by examining the effects of daily air pollutants on outpatient single morbidity and comorbid cardiorespiratory visits in Japan.A total of 1,452,505 outpatient cardiorespiratory visits were recorded among the 21 Japanese cities from 2013 to 2016. Daily outpatient cardiorespiratory visit data were obtained from a health insurance claims database managed by the Japan Medical Data Center Co., Ltd. (JMDC). A time-stratified case crossover analysis coupled with Generalized Additive Mixed Model was used to analyze the association of daily air pollutants (particulate matter 2.5 μm or less in diameter, ozone and nitrogen dioxide) on daily single (respiratory and cardiovascular) and comorbidity health outcomes. We further examined single and cumulative effects for 0–3 and 0–14 lag periods.Ozone, NO2, and PM2.5 were positively associated with cardiorespiratory visits in either shorter or longer lags, with more apparent comorbidity associations with NO2 exposure. A 10-unit increase in NO2, after adjusting for ozone, was associated with a 2.24% (95% CI: 1.34–3.15) and 6.49% (95% CI: 5.00–8.01) increase in comorbidity visit at Lag 0 (of Lag 0–3) and cumulative lag 0–3, respectively. Our results contribute to existing evidence suggesting that short-term and extended exposure to air pollution elicit health risks on cardiovascular, respiratory and comorbid clinic visits. Exposure to NO2, in particular, was associated with increase in the risk of single and comorbidity cardiorespiratory visits. Results can be potentially utilized for both individual health (e.g. risk population health management) and health facility management (e.g. health visit influx determination).

The Effect of Health Service Quality on Health Facility Choice and Health Outcomes in Malawi

We study the impact of health care service quality on health facility choice and health outcomes in Malawi. We use Malawi Demographic and Health Survey (MDHS) 2015 and Malawi Service Provision Assessment (MSPA) 2013-2014 to examine the effect. MSPA provides many useful health care service quality information that has not been examined much in the previous studies. We create health care service quality measures to represent infrastructure quality, medical supplies quality and health facility management quality. We examine the impact of these quality measures on the demand for health services and health outcomes. We find that people who live closer to quality health facilities are more likely to utilize health services such as facility delivery. However, we do not find strong and significant evidences that healthcare quality is associated with positive health outcomes due to the insufficient data and the weak identification strategies.

Provision of Care to Preterm Infants at Resource Limited Health Facilities of Mopani District, South Africa.

Background:Inadequate neonatal facilities in rural areas is one of the challenges affecting the management of preterm infants. In low income countries with limited resources, over 90% of preterm babies die within few days of life.Purpose:The purpose of this study was to describe the challenges encountered by midwives when providing care to preterm infants at resource limited health facilities in Limpopo Province, South Africa.Methods:Qualitative research approach, using exploratory and descriptive design was used. Non-probability purposive sampling was used to select twenty three midwives who had an experience of two or more years in maternity. Data was collected using unstructured individual interviews, which were voice recorded and transcribed and data analysed qualitatively through the open-coding method.Findings:Revealed one theme, preterm condition and expected care; with sub-themes namely; perceived causes of preterm complications and deaths, preterm babies experience several difficulties which need specialised care, the need for constant individualised care and monitoring of preterm infants by midwives, functional relevant equipment needed for care of preterm infants, a need for constant training for midwives regarding care of preterm infants, and importance for a proper structure to house preterm infants which will lead to quality care provision.Conclusion:Preterm babies need simple essential care such as warmth, feeding support, safe oxygen use and prevention of infection. Lack of adequate resources and limited skills from midwives could contribute to morbidity and mortality. Health facility managers need to create opportunities for basic and advanced preterm care to equip the skills of midwives by sending them to special trainings such as Limpopo Initiative Neonatal Care (LINC), Helping Baby Breath (HHB) and Neonatal Intensive Care Unit (NICU). Operational managers should be involved in the identification, procurement and supply of required equipment. Continuous health education should be provided on the mothers about kangaroo mother care (KMC) and measures to prevent infections in the neonatal unit.

Examining purchasing reforms towards universal health coverage by the National Hospital Insurance Fund in Kenya

BackgroundKenya has prioritized the attainment of universal health coverage (UHC) through the expansion of health insurance coverage by the National Hospital Insurance Fund (NHIF). In 2015, the NHIF introduced reforms in premium contribution rates, benefit packages, and provider payment methods. We examined the influence of these reforms on NHIF’s purchasing practices and their implications for strategic purchasing and health system goals of equity, efficiency and quality.MethodsWe conducted an embedded case study with the NHIF as the case and the reforms as embedded units of analysis. We collected data at the national level and in two purposively selected counties through 41 in-depth interviews with health financing stakeholders, facility managers and frontline providers; 4 focus group discussions with 51 NHIF members; and, document reviews. We analysed the data using a Framework approach.ResultsThe new NHIF reforms were characterized by weak purchasing actions. Firstly, the new premium contribution rates were inadequately communicated and unaffordable for certain citizen groups. Secondly, while the new benefit packages were reported to be based on service needs, preferences and values of the population, they were inadequately communicated and unequally distributed across different citizen groups. In addition, the presence of service delivery infrastructure gaps in public healthcare facilities and the pro-urban and pro-private distribution of contracted health facilities compromised delivery of, and access to, these new services. Lastly, the new provider payment methods and rates were considered inadequate, with delayed payments and weak links to financial accountability mechanisms which compromised their ability to incentivize equity, efficiency and quality of healthcare delivery.ConclusionWhile NHIF sought to expand population and service coverage and reduce out-of-pocket payments with the new reforms, weaknesses in the reforms’ design and implementation limited NHIF’s purchasing actions with negative implications for the health system goals of equity, efficiency and quality. For the reforms to accelerate the country’s progress towards UHC, policy makers at the NHIF and, national and county government should make deliberate efforts to align the design and implementation of such reforms with strategic purchasing actions that are aimed at improving health system goals.

Professionalization of the Managerial Capital in the Healthcare Field: a Case of Ukraine

Main challenges, priorities and trends of the national health care are analyzed in the paper. The general concept of managerial capital was defined; its main sources were analyzed. Objective processes of developing a professional management system have been viewed. Within the framework of the forming organization’s management capital the following tasks of healthcare facilities’ management were determined. In the paper it is argues, that the process of managerial capital formation is ongoing in the frameworks of managerial staff’s professionalization. Thus, the main directions and variants of professionalization of managerial staff in healthcare field are proposed. But nevertheless, it is important to emphasize, that professionalization of managerial staff in Ukrainian health care is very complicated process, due to the lack of special training basis for its realization and, especially, understanding of government its necessity. The problem of forming and developing managers of healthcare facilities has been emphasized in the paper. Requirements for modern healthcare professionals have been identified.

Assessment of employee performance management in Tanzania public health facilities

This study assessed how effective employee performance management is in Tanzania public health facilities. Primary data were collected from personnel responsible for human resource management in public health facilities through the use of questionnaires and interviews in Tanzania mainland. It was found that a considerable number of health workers in Tanzania do not understand well how to use the performance management system in place (Open Performance Review Appraisal System-OPRAS). Participatory goal setting was found to be challenging since employees are not given sufficient autonomy to identify and discuss what they are supposed to achieve. Goal implementation has been also affected by the fact that health facilities are allocated with limited resources. The study recommends designing and implementation of capacity building programs to help health workers mastering the use of OPRAS. Supervisors and managers of health facilities should insist participatory goal setting to stir-up motivation and commitment of health workers. The government should increase budget allocated in health facilities to increase employee performance. Keywords: Performance management, Performance appraisal, Health sector, OPRAS, Health systems, Tanzania.

On-site clinical mentoring as a maternal and new-born care quality improvement method: evidence from a nurse cohort study in Nepal

BackgroundWe describe an on-site clinical mentoring program aimed at improving emergency obstetrical and new-born care (EmONC) in Nepal and assess its effectiveness on nurses’ knowledge and skills. In Nepal, both the maternal mortality ratio (MMR, 239/100,000 live births) and the neonatal mortality rate (NMR, 21/1000 live births) were among the highest in the world in 2016, despite impressive progress over recent decades considering the challenging environment.MethodsFrom September 2016 to April 2018, three experienced nurses conducted repeated mentoring visits in 61 comprehensive or basic EmONC centers and birthing centers located in 4 provinces of Nepal. Using updated national training manuals and teaching aids, these clinical mentors assessed and taught 12 core EmONC clinical skills to their nurse-mentees. Clinical mentors worked with management mentors whose goal was to improve the nurses’ working environment. We assessed whether the cohort of nurse-mentees performed better as a group and individually performed better at the end of the program than at baseline using relevant tests (chi-square test, Wilcoxon matched-pairs signed-rank test, and Kruskal-Wallis equality-of-population rank test).ResultsIn total, 308 nurses were assessed, including 96 (31.2%), 77 (25.0%) and 135 (43.8%) who participated in all three, two or only one mentoring session, respectively. In total, 225 (73.0%) worked as auxiliary nurse-midwives (ANMs), while 69 (22.4%) worked as nurses. One hundred and ninety five (63.3%) were trained as skilled birth attendants, of which 45 (23.1%) were nurses, 141 (72.3%) were auxiliaries and 9 (4.6%) had other positions. The proportion of ANMs and nurse-mentees who obtained a knowledge assessment score ≥ 85% increased from 57.8 to 86.1% (p < 0.001). Clinical assessment scores increased significantly for each participant, and therefore for the group. SBA-trained mentees had better knowledge of maternal and new-born care and were better able to perform the 12 core clinical skills throughout the program.ConclusionsOur study suggests that on-site clinical mentoring of nurses coupled with health facility management mentoring can improve nurses’ clinical competences in and performance of maternity and new-born care. Assessing evidence of impact on patient safety would be the next stage in evaluating this promising intervention.

The Effects of Delays in Reimbursement of Claims by National Health Insurance Authority on Financial Management of Health Care Facilities in Brong Ahafo Region of Ghana

The Effects of Delays in Reimbursement of Claims by National Health Insurance Authority on Financial Management of Health Care Facilities in Brong Ahafo Region of Ghana

Legal Certainty of Financial Management in Health Facilities at the Ministry of Defense and Indonesian National Army

Central and regional government hospitals need to be managed by the Public Service Agency. Since the enactment of Law Number 24 of 2011 on the Social Insurance Administration Agency (BPJS), there have been conflicting requirements in the Hospital Financial Management Patterns as a Public Service Agency (BLU) stipulated in Law Number 44 of 2009. The conflict involves the management of health facilities within the Ministry of Defense and the Indonesia National Army (TNI) on the hospital financial management due to the enactment of the BPJS Law. This impacts the income received by the TNI Hospital on offering health services to BPJS participants. How to Cite this Article Pubmed Style Dewi Setyowati, Sutarno. Certainty of Financial Management in Health Facilities at the Ministry of Defense and Indonesian National SRP. 2020; 11(1): 263-267. doi:10.5530/srp.2020.1.33 Web Style Dewi Setyowati, Sutarno. Certainty of Financial Management in Health Facilities at the Ministry of Defense and Indonesian National http://www.sysrevpharm.org/?mno=83789 [Access: March 29, 2021]. doi:10.5530/srp.2020.1.33 AMA (American Medical Association) Style Dewi Setyowati, Sutarno. Certainty of Financial Management in Health Facilities at the Ministry of Defense and Indonesian National SRP. 2020; 11(1): 263-267. doi:10.5530/srp.2020.1.33 Vancouver/ICMJE Style Dewi Setyowati, Sutarno. Certainty of Financial Management in Health Facilities at the Ministry of Defense and Indonesian National SRP. (2020), [cited March 29, 2021]; 11(1): 263-267. doi:10.5530/srp.2020.1.33 Harvard Style Dewi Setyowati, Sutarno (2020) Certainty of Financial Management in Health Facilities at the Ministry of Defense and Indonesian National SRP, 11 (1), 263-267. doi:10.5530/srp.2020.1.33 Turabian Style Dewi Setyowati, Sutarno. 2020. Certainty of Financial Management in Health Facilities at the Ministry of Defense and Indonesian National Systematic Reviews in Pharmacy, 11 (1), 263-267. doi:10.5530/srp.2020.1.33 Chicago Style Dewi Setyowati, Sutarno. Legal Certainty of Financial Management in Health Facilities at the Ministry of Defense and Indonesian National Army. Systematic Reviews in Pharmacy 11 (2020), 263-267. doi:10.5530/srp.2020.1.33 MLA (The Modern Language Association) Style Dewi Setyowati, Sutarno. Legal Certainty of Financial Management in Health Facilities at the Ministry of Defense and Indonesian National Army. Systematic Reviews in Pharmacy 11.1 (2020), 263-267. Print. doi:10.5530/srp.2020.1.33 APA (American Psychological Association) Style Dewi Setyowati, Sutarno (2020) Certainty of Financial Management in Health Facilities at the Ministry of Defense and Indonesian National Systematic Reviews in Pharmacy, 11 (1), 263-267. doi:10.5530/srp.2020.1.33

Radna motivacija i zadovoljstvo poslom zdravstvenih radnika u Vojvodini, Srbija

Introduction/Objective: Employees' job satisfaction represents an integral element of the quality of work in health care institutions and stems from adequate motivation of employees for work. The aim of the study was to examine whether there is a difference in work motivation and job satisfaction among health care professionals in Vojvodina, Serbia. Methods: The study was conducted on a sample of 719 health care professionals, employed in three health centers. A self-administered questionnaire was used for data collection. Student t-test, Spearmen's rank correlation coefficient, ROC analysis and binary logistic regression analysis were used in statistical data analysis. Results: Health professionals were significantly more motivated than satisfied with the following factors of work motivation: achievement of health institution goals, recognition of good performance, good interpersonal relationships, possibilities of promotion and advancement, personal qualities of an immediate manager, monthly income, working conditions, cooperative work atmosphere, secure job, managerial support, availability of up-to-date work equipment, and rewards for exceptional work. Health professionals were significantly less motivated by the factor of work motivation - expert supervision of their work, compared to the degree of its fulfilment/satisfaction provided by their healthcare institutions. Conclusion: Healthcare professionals are more motivated to work than satisfied with the work they do. In order to improve the quality of work in healthcare institution and the provided health care, as well as to increase the satisfaction among the users of health services, it is necessary that management of health care facilities continuously conducts studies on work motivation and job satisfaction.

Prevalence of alcohol dependence syndrome cases with and without delirium during the first phase of lockdown in Telangana

Objectives: To determine the prevalence, association of socio-demographic factors, medical comorbidities with delirium in alcohol dependence syndrome individuals hospitalized during the lockdown period. Design: 667 alcohol-dependent patients attending the institute of mental health, Hyderabad during the 1st phase of lockdown were studied retrospectively with the help of hospital records. Results: Out of 667 samples 266 individuals presented with delirium. There is no significance of sociodemographic factors on delirium except sex. There is a positive correlation between severity of dependence (r=0.26, p=0.000), number of drinks (r=0.271, p=0.000) per day, duration of intake of substance (r=0.137, p=0.000) with delirium. Individuals with medical comorbidity hypertension, both hypertension and diabetes have presented a greater number of delirium cases. Conclusion: Current lockdown scenario is the first time we had faced. We found a greater prevalence of delirium in alcohol dependence cases which is a threat to the health care system. Hence further research in risk factors involving delirium presentation is needed. Stringent rules to control alcohol dependence to avoid a similar situation in the future and effective management of health care facilities are needed. Keywords: Alcohol dependence syndrome, Prevalence, Delirium.

Assessment of cold chain equipments and their management in government health facilities in a District of Delhi: A cross-sectional descriptive study.

Cold chain equipments (CCEs) at health facilities (HFs) are an essential part of the immunization supply chain (ISC). The CCEs in government HFs of Delhi were never assessed using the World Health Organization-United Nations Children's Fund (WHO-UNICEF) Effective Vaccine Management (EVM) tool except that of state vaccine store during National EVM assessment 2013. The objective of the study was to assess the CCEs and their management in government HFs using the WHO-UNICEF EVM tool in a district of Delhi. The assessment was done during December 2017-March 2018 in one randomly selected district of Delhi. Sample size and site selection were done using the WHO EVM site selection tool. A total of 29 HFs were assessed along with District Vaccine Store. Questions on CCEs in EVM tool 1.0.9 were used for data collection. Out of 56 electrical CCEs, 8.9% were nonfunctional, 48.2% were noncompliant with WHO standards, 5.4% were not chlorofluorocarbon free, 4.7% did not have temperature monitoring device, and 18.8% did not have stabilizer. Eighty-six percent of passive containers were compliant with the WHO standards. The storage capacity of electrical vaccine storage equipment was insufficient in 3.4%, passive container capacity in 65.5%, and ice packs preparation and storage capacity in 24.1% of HFs. There was no planned preventive maintenance of CCEs and no standard operating procedures for emergency event management. There was a shortage of vaccine storage, ice packs preparation and storage, and passive container capacity. Many CCEs used in ISC of assessed sites were noncompliant to the WHO standards. There was no PPM of CCEs and no guidelines for emergency event management.

ЖЕНЩИНЫ РУКОВОДИТЕЛИ МЕДИЦИНСКИХ УЧРЕЖДЕНИЙ И ПРОБЛЕМЫ УПРАВЛЕНИЕ СЕКТОРА ЗДРАВООХРАНЕНИЯ В БОЛГАРИИ

This article aims to present women's involvement at the operational management level in the healthcare system, as well as the challenges faced by the management of healthcare facilities. The country is lagging behind European trends in gender equality in the area of authority in the healthcare sector. Female managers of healthcare facilities represent 37%, which is lower than women's involvement in healthcare management in the European countries (41%). There are a number of challenges of systemic nature faced by the management of healthcare structures, generated as a result of regulatory imperfections, financial constraints and staffing deficits. Conclusion: In recent years, Bulgaria has successfully implemented the women’s involvement in management policy, however, there is still much to be done in the healthcare sector. The unresolved problems in the system exacerbate the difficulties before the healthcare management in the country.

Outsourcing in Health Facilities: Challenges in Medical University of Isfahan in Focus.

Introduction:Outsourcing is one of the major strategies for keeping competitive gain in today's highly varying markets, especially in health systems. This study endeavored to identify operational challenges of outsourcing health facilities affiliated to Isfahan University of Medical Sciences in the academic year 2019.Methods:This qualitative study was conducted with content analysis approach. To conduct the interview, key informants were from the managers of health facilities and decision makers of health deputy and managers from private sector were selected through purposive sampling. The saturation point was reached at 12 semi-structured interviewees; this way, data were collected through interviews with experts. A thematic analysis was employed to analyze the transcriptions by MAX QDA10.Results:According to the results of thematic analysis, seven major themes identified as operational challenges of outsourcing health services in health facilities with 40 sub-themes.Conclusions:Outsourcing health services in health facilities needs to be done more scientifically and logically. Decision makers must predict the challenges and apply solutions before outsourcing, supervise, and evaluate the impacts of outsourcing after at least 1 year.