Health Facility Managers Research Articles

Stakeholder views on continuing professional development for doctors working in public primary care facilities in central Uganda: a qualitative study.

the primary care workforce in the public sector of Uganda is under the district health system. The doctors in this workforce provide leadership and frontline promotive, preventive, curative, rehabilitative, and palliative care. Their numbers are still low and therefore need effective support through continuing professional development (CPD). Part of the support is influenced by stakeholders whose views on CPD in the district health system are important. This study therefore explored the stakeholders' views on the CPD of doctors working in the district health system in central Uganda. a qualitative exploratory study was done, and data was collected using an interview guide through in-depth interviews among ten purposively selected CPD stakeholders influencing different aspects of CPD activities of doctors working in public general hospitals and health center IVs. The interviews were recorded and transcribed verbatim and manually analyzed using deductive thematic analysis. five themes were categorized into; CPD practices, facilitators, benefits, challenges, and suggestions. Each of the themes had subthemes; CPD practices; training, mentorship and apprenticeship, support supervision, and quality improvement projects. Facilitators; internet services, grants, health facility managers, facility-based CPD providers, and regional CPD guidelines. Benefits; motivation, knowledge, teamwork, and renewal of practicing licenses. Challenges; workload, allowances, access, documentation, mindset, quality, structure of public health system, and sustainability. Suggestions; training needs analysis, collaboration, monitoring, e-CPD platforms, CPD resource centers, and individual CPD responsibility. the stakeholders' views are an indication that effective CPD is a collaborative effort from both the primary care doctors and those in the leadership of the health care system.

Drug Supply Chain Management in Public Secondary Health Facilities in Lagos State Nigeria

This study was conducted to analyze the drug supply chain at nineteen selected public secondary health centers (SHC) commonly referred to as General Hospitals, in Lagos State. Data was collected from both primary and secondary sources. The primary data were collected through a well-structured questionnaire while the secondary data were sourced from journals, Lagos State Ministry of Health, Lagos Bureau of Statistics (LBS), National Agency for Food and Drug Administration and Control (NAFDAC), etc. A descriptive statistical method was employed for data analysis using the statistical package for Social Science (SPSS) version 2.0 and ArcGIS 10.8 version. Maps, frequency counts, percentages, and analysis of variance (ANOVA) were also used to test the hypothesis The study contributed to the existing body of knowledge by establishing the Euclidean distance of SHC from Central Medical Store (CMS) Oshodi, the residences within and outside the buffer zone of 2km radius around the SHC in Lagos state and the distribution and accessibility of patients to essential drugs in the study area. Findings confirmed that 79.6% of Pharmacists have received training on supply chain practices. The respondents also said that SHC in Lagos gets about 75% of their drug supplies from Central Medical Store. The result also revealed there is a significant relationship between the number of dispensing outlet and the amount paid for drug by patients. Also, 57.5% of the patients preferred to have their drugs delivered at home and 49.5% were willing to pay extra cost for home delivery. The study suggests strong regulation and strict enforcement of National Drug Distribution Guidelines of 2012 (NDDG) by the regulator. The study concludes that effective supply chain will deliver safe, efficient, and quality drugs to meet the health need of the patients.

Senior Management Succession Challenges for U.S. Healthcare Facility Operations

ABSTRACT Purpose The purpose of this research was to better understand current state of mid- and senior-level healthcare facility managers to explore potential roadblocks to FM succession related to demographics, backgrounds, and perceptions in supporting future research prioritization for healthcare facility executive leadership development. Methodology A survey was designed to collect information on facility managers’ gender, race, age, job level, employer industry, retirement timeframe, educational attainment, and perceptions of their employers’ recruiting and succession planning. The survey was sent electronically in February 2021 to more than 12,400 FM professionals with a 29% response rate. Only information from U.S. respondents working in healthcare facility operations was used in this study. Findings The healthcare industry is struggling to attract and retain senior-level facility managers. The difficulty in finding qualified facility managers to fill senior-level positions does not appear to be related to a lack of interested candidates or pay. Factors impeding recurring facility workforce development and succession to senior healthcare FM roles may be related to low succession planning adoption by healthcare organizations, an aged facility workforce, and limited undergraduate education achievement from traditional candidates. Originality Healthcare organizations may prioritize these factors in addressing ongoing FM workforce attrition and development challenges to ensure a sustainable pipeline of qualified facility managers prepared to successfully navigate the unique expectations of leading the healthcare built environment.

Adherence to quality management practices in faith-based hospitals in Ghana: The perspective of healthcare managers

BackgroundThe sensitive nature of the healthcare sector places much responsibility on health facility managers to ensure strict adherence to quality standards. The aim of this study was to examine the extent to which managers of hospitals affiliated with the Christian Health Association of Ghana (CHAG) adhere to quality management standards and practices. MethodsThis qualitative study employed key informant interviews to explore practices in ten CHAG hospitals in Ghana. We interviewed 36 senior staff across Human Resource, Medical Records, Information Communication and Technology (ICT), and Procurement units. The thematic areas covered in the interviews included adherence to medical records practices, the use of ICTs, procurement practices, and recruitment and retention. All interviews were tape-recorded, transcribed verbatim, and analyzed using thematic content analysis. ResultsStrict adherence to standard hospital management protocols were low as most hospitals selected for this study were found to be in breach of adhering to the four key areas of hospital management practices: medical records, ICT, procurement and human resources. For instance, we found that most hospitals did not have Medical Records Committee as against the WHO standards for managing patient records. Also, most hospitals did not have well-resourced and established procurement units. The study again revealed similar findings for the management of human resource and ICTs in the hospitals. ConclusionsManagers of the CHAG hospitals failed to adhere to guidelines and protocols for managing certain key management areas of their health care facilities. This may have negative implications for quality health care delivery, including irregular supply of goods and services, high attrition rate of critical healthcare personnel, long patient waiting times and an overall poor quality of patient care. Although, hospital managers are confronted with several challenges that impede their efforts to adhere to these management protocols, it is important they put measures in place to address these challenges.

Accountability Mechanisms In Result Based Financing And Their Implementation In Lira District, Northern Uganda

Introduction: Results based financing has been proposed as an innovative reform to enhance systems performance in Uganda. Lira District is one of the districts implementing the national results-based financing (RBF) scheme under the Uganda Reproductive Maternal and Child Health services Improvement Project (URMCHIP). The diversity of relationships among various actors in RBF implementation underscores the need for mechanisms to ensure accountability among them. This was a case study which aimed at exploring the RBF accountability mechanisms, their implementation, and related factors in Lira District. Methodology: The study was a descriptive case study employing qualitative methods. The data collection methods included a) focus group discussions with the health workers from RBF facilities, b) key informant interviews with key actors in the RBF program at the MOH as well as in the district including district managers, health facility in charges, verifiers, members of the health facility management committees, c) document review of RBF documents, annual progress and audit reports. were analyzed thematically guided by a framework that explored the relationships and related accountability arrangements in RBF. Results: Several accountability relationships do exist among actors in RBF program and each relationship has associated accountability mechanisms for example, accountability mechanisms between MOH and the district include MOUs and business plans, while between the district and facilities mechanisms include reporting, data verifications, financial audits while display of results on notice boards, complaint boxes are mechanisms between the facility and the community. Regular support supervision and facility innovations such as meetings complimented RBF-specific designs. Challenges hindering smooth implementation of accountability mechanisms included infrequent financial support to enable regular support supervision/verification visits by Expanded District Health Management Team (EDHMT) and corruption tendencies. Conclusion: Implementation of accountability mechanisms in RBF in Lira is suboptimal due to the various RBF design and implementation challenges. There is need to support the EDHMT and facility managers’ in terms of capacity building and facilitation to do their work. Additionally, efforts need to be undertaken to address delayed disbursement of funds and corruption impeding the implementation of accountability mechanisms in the district.

Scaling up integrated care: a realist evaluation on the role of country-specific policy dialogues and scale-up roadmaps in Belgium, Slovenia, and Cambodia

Background: The ‘SCale-Up of diaBetes and hYpertension care’ (SCUBY) project aims to support the scale-up of integrated care for diabetes and hypertension in Cambodia, Slovenia, and Belgium through the co-creation, implementation, and evaluation of contextualized roadmaps. These roadmaps offer avenues for action and are built on evidence as well as stakeholder engagement in policy dialogues. These two implementation strategies – roadmaps and policy dialogues – are very much intertwined and considered to be key elements for successful stakeholder supported scale-up. Yet, little is known about how, why, and under which conditions a roadmap leads to successful implementation and scale-up of integrated care. Therefore, the resulting research question is: ‘How, why, and under which context conditions does a co-created scale-up roadmap lead to adoption, implementation, and scale-up of integrated care?’.
 Methods: A realist approach is used towards testing the initial programme theory (IPT) in the three countries. The IPT draws on political science theory of the multiple streams model (MSM) adapted by Howlett and includes five streams (problem, solution, politics, process and programme) that can emerge, converge and diverge across all policy stages. To test the IPT, information from different sources was collected. Firstly, qualitative interviews were conducted with the researchers in the SCUBY country teams as well as with key stakeholders (health facility managers, policy makers, civil servants, professional medical and patient associations, NGOs, and implementers). Secondly, a document review of grey literature, meeting reports, and official documents was performed. Finally, a workshop was organised with SCUBY researchers from all country teams to refine the IPT. We used the Intervention-Context-Actors-Mechanism-Outcome (ICAMO) configuration to synthesise information into a configurational map.
 Results: In each country case, the project partner’s mandate was key in the approach to scale-up, the design, and content, leading to different mechanisms, scale-up pathways, and outcomes. In Belgium, the (scientific) solutions stream was dominant with creating common understanding as a key mechanism; in Slovenia, the programme stream became the dominant focus whilst exemplifying good practices of patient empowerment; and in Cambodia, the political stream was dominant yet closely knit together with the solutions stream – with knowledge sharing and credibility as key mechanisms. A finding across all three countries was that a lack of political support can derail or slow down scale-up.
 Discussion: This study extends the knowledge base about the use of co-creation in policy dialogues to build a roadmap for scale-up. The roadmaps illustrate how the MSM theory can be used to theorize the policy process of roadmap and policy dialogues in different contexts, aligning the context-dominant stream with the context-specific scale-up strategy. By testing theories in real cases, the theories can be adapted, refuted and/or reconstructed to elicit a refined theory of how and why a roadmap co-created in policy dialogues for scale-up works.

Innovative Approaches in the Management of Healthcare Organisations

Our study provides a comprehensive view of innovations in the management of healthcare facilities (HCF). It fills the research gap and contributes to discussions on the need to introduce new innovative management tools into the curricula of healthcare managers and professionals. The design of the study is based on answering research questions (RQ) by statistical processing of data from 181 managers of various types of HCF in Slovakia, obtained by questionnaire. We evaluate the use of innovative approaches in the management of healthcare organisations in the application of hard and soft management tools and their relationship to the economic results of these organisations. RQs are aimed at differentiating the application of innovative approaches in management depending on the characteristics of HCF and their managers and depending on the economic results. There is a positive relationship between the use of innovative approaches in management and the economic results of HCF. There are significant differences in the degree of application of innovative approaches between different types of facilities, the leaders in their implementation are university hospitals. The medical education of managers with the additional completed specialised management study has a significant relation to the application of innovative approaches in management.

Modeling the impact of hospital beds and vaccination on the dynamics of an infectious disease

The unprecedented scale and rapidity of dissemination of re-emerging and emerging infectious diseases impose new challenges for regulators and health authorities. To curb the dispersal of such diseases, proper management of healthcare facilities and vaccines are core drivers. In the present work, we assess the unified impact of healthcare facilities and vaccination on the control of an infectious disease by formulating a mathematical model. To formulate the model for any region, we consider four classes of human population; namely, susceptible, infected, hospitalized, and vaccinated. It is assumed that the increment in number of beds in hospitals is continuously made in proportion to the number of infected individuals. To ensure the occurrence of transcritical, saddle–node and Hopf bifurcations, the conditions are derived. The normal form is obtained to show the existence of Bogdanov–Takens bifurcation. To validate the analytically obtained results, we have conducted some numerical simulations. These results will be useful to public health authorities for planning appropriate health care resources and vaccination programs to diminish prevalence of infectious diseases.

Control of Dead Stock and Slow-Moving Drugs in the Pharmacy Installation of the Kendari City Regional General Hospital

Background: Dead stock and slow moving is still one of the main problems in drug management in primary health facilities. Based on the results of initial observations, data was obtained from the Kendari City Hospital which showed that there were 7 drug items with a total number of 2,682 pcs that experienced slow moving and dead stock in 2019-2021. The purpose of this study was to analyze dead stock and slow-moving drugs at the Kendari City Hospital pharmacy installation Methods: This research method is qualitative research using a case study approach, with data analysis using the QSR NVivo 12 application with content analysis techniques. The sample in this study consisted of 6 informants. Results: The results of the study using NVIVO analysis showed the causes of dead stock and slow moving drugsin the pharmaceutical installation of the Kendari City Hospital, namely the pattern of prescribing, planning and control systems. Meanwhile, the control of dead stock and slow-moving drugs in the pharmaceutical installation at Kendari City Hospital consists of storage, hospital policies, communication, control systems, distribution, drug selection and planning. Conclusion: In conclusion, the causes of dead stock and slow moving in Kendari City Hospital are due to prescribing patterns, control systems and planning. As for the control of dead stock and slow-moving drugs in the pharmaceutical installation of the Kendari City Hospital, the ones that have been effective are storage, hospital policies, communication, distribution and selection, while what has not been effective is drug planning and control systems.

Evaluating financial management competency in primary healthcare managers of Kondoa, Iramba, and Sumbawanga District Councils, Tanzania

Background : Examining the financial managerial competency of primary healthcare facility managers is very important. Despite its importance, empirical investigation is limited in this area. To contribute mpirical evidence on this subject this study looked at Tanzania's public primary healthcare facility managers. Materials and Methods : The study was conducted in Kondoa, Iramba and Sumbawanga District Councils in Tanzania. This research adopted a cross-sectional research design. A census sampling strategy was employed to obtain primary data from 102 public primary healthcare facility managers. The Statistical Product and Service Solution (SPSS) Version 25 was used to analyse the data. Results : Findings reveal that slightly more than half (57.85%) of managers were competent whereas (42.15%) of them were less competent in acting on the financial statements. In monitoring financial performance (47.53%) were less competent and (52.47%) were competent. Also, in developing budgets following organisational objectives, (50.97%) were less competent and (49.03%) were competent. Additionally, in managing budgets by organisational objectives, (45.09%) were less competent and (54.91%) were competent. Furthermore, in establishing and maintaining the organisation's insurance contracts and financial relationships, (53.92%) were less competent and (46.08%) were competent. Conclusions : Nearly half of the facility managers in selected Tanzanian District Councils demonstrated competence in financial statement analysis, performance monitoring, budget development, and managing insurance contracts and financial relationships. Recommendations : This study recommends improving the financial managerial competency of facility managers in all areas of financial management roles as a key area of investment in efforts to improve the management of primary healthcare facilities.

When should DIY have a localized healthcare waste management system?

Purpose: The 2018 healthcare waste management crisis catalyzed a critical review of the concerns expressed by the Health Office (dinkes) and healthcare facilities regarding healthcare waste management in the Special Region of Yogyakarta (DIY). Due to this crisis, the Ministry of Health hired Universitas Gadjah Mada (UGM) to look into potential solutions and promote DIY government policy responses. This paper examines the management strategy during crisis times and possible alternative solutions.
 Methods: This paper uses focused group discussions reports involving separate groups of (1) environmental health officials from community health centers, (2) hospitals, (3) environment health officials of district health authorities, and (4) cross-sectoral province officials in the Yogyakarta Special Region. It is part of a project 'A case study of strengthening regional-based medical waste management model', fund from the Environmental Health Directorate, Directorate General of Public Health, Ministry of Health (Project KN 01.03/6.1/0198/2019).
 Result: A simulation of policy options based on health facility managers suggests that a province-based system is the most profitable in the long term for DIY, with several possible options. The national policy roadmap was considered inadequate to respond to DIY's urgent local needs. Furthermore, the series of meetings succeeded in forming an informal forum between health facilities, provincial health offices, and associations of hospital environmental sanitation experts, monitoring medical waste management.
 Conclusion: The 2018 medical waste management crisis led to the formulation of policy response choices tailored to the capacity of DIY. These choices considered the expenditures and legal sanctions faced by healthcare facilities and the economic value of a region-based waste system for local government authorities. This comprehensive approach highlights the importance of local capacity. It needs to shape effective and sustainable medical waste management policies, underscoring the necessity of region-specific strategies in the face of national health crises.

Membership dropout rates and associated factors in a community-based health insurance scheme in southern Ethiopia: a mixed method study

BackgroundDropout from community-based health insurance (CBHI) membership is a common problem in low-income countries, even if its implementation leads to substantial improvement in the utilization of essential health services. Few studies have addressed the factors contributing to dropout rates in southern Ethiopia. Therefore, the purpose of this study was to determine the rate of CBHI dropout in southern Ethiopia as well as any contributing factors.MethodsThis mixed-method cross-sectional study was conducted among 460 randomly selected CBHI-enrolled households at the Arba Minch Health and Demography Surveillance System site from November 1, 2021, to April 30, 2022. The quantitative data were collected by an open data kit (ODK). using an interviewer-based structured questionnaire and analyzed using Statistical Package for the Social Sciences (SPSS) version 25.0. Multivariable logistic regression was applied to identify significant variables. The qualitative data were used to support the quantitative findings and were gathered through in-depth interviews (by the CBHI coordinator and three purposively selected health extension workers) and focus group discussions (in two randomly selected villages). The qualitative data were analyzed using thematic analysis. Finally, triangulation was used to present both the quantitative and qualitative findings.ResultsThis study found that 92 (21.5%) people stopped their community-based health insurance membership. The presence of sick adults [AOR = 0.281, 95% CI (0.136–0.581)], trust of participants in the contracted health facilities [AOR = 0.227, 95% CI (0.121–0.436)], and poor knowledge of the participants [AOR = 5.518, 95% CI (1.526–19.950)] were significant predictors.ConclusionThe magnitude of the dropout rate was high in this study when compared with the national target. The absence of a sick adult, the absence of trust among participants, and the poor knowledge status of the participants were significant predictors. We suggest that the health facility managers, the CBHI coordinating office, and the district health office give priority to implementing a wide range of knowledge improvement activities and a transparent system in public health facilities. Studies with longitudinal research designs are called for at a wide range of national levels to address the limitations of this study.

Structural, Familial, and Psychosocial Factors Affecting Long-Term Antiretroviral Treatment Adherence amongst Adolescents Living with Perinatally Acquired HIV in Limpopo, South Africa.

After more than two decades of the expansion of antiretroviral treatment (ART) in adolescents living with perinatal HIV (APHIV) in sub-Saharan Africa, there is still poorly sustained long-term adherence to ART due to multifactorial factors with the consequence of increased mortality and morbidity. There are little data available on the familial and structural factors which affect sustenance to long-term adherence to ART. A qualitative exploratory design was used to conduct in-depth interviews with 21 APHIV attending HIV care and management in the rural health facilities of Vhembe district in Limpopo Province, South Africa. Transcripts were translated verbatim into English, and data were analyzed using Tesch's eight steps of qualitative data analysis. The sample consisted of APHIV 10-19 years old who were aware of their HIV status, and all had received ART for more than 5 years. They lived in extended, disrupted, grandparent- and child-headed households. They experienced food insecurities due to poverty or orphanhood, as well as living in disrupted households, which deterred them from long-term adherence. In addition, dependency on social support grants to sustain their livelihoods affected long-term adherence. APHIV had challenges with structural factors such as inconsistent clinic attendance, clashes between school activities and clinic appointments, and the lack of transport fare to the clinic, which affected adherence. Although APHIV were on one-pill fixed-dose ART, they were not able to sustain long-term adherence due to various familial, structural, and psychosocial challenges. In addition to institution-based interventions, there is a need for family, community-based, and multi-sectorial interventions to support long-term ART adherence among APHIV.

The Approach of Community-Directed Treatment with Ivermectin in the Participation of Communities in the Fight against Onchocerciasis: The Resignation of Community Distributors

Objective: The aim of this article is to analyze the factors behind the resignation of Community Distributors. Methodology: The qualitative method was used to collect data through individual interviews and focus groups in the health districts of Kouoptamo, Foumbot and Massangam in the West region of Cameroon. Between 2020 and 2022, these interviews were conducted with Beneficiaries, Community Distributors, managers of district health services and health facilities, and also town hall managers. The data collected was analyzed using the content analysis technique and interpreted using Michel Crozier's Systemic Analysis. Results: The methodological procedures used led to a number of results, including the low or non-existent coverage of CDs, the choice of CDs, the lack of community ownership, the discrepancy between actual and official data, and the diversion and sale of medicines, the main consequence of which is the misuse of Mectizan. Furthermore, faced with a lack of support, community distributors are showing a lack of interest in distributing this product and are resigning. To alleviate this problem, health professionals are trying to replace them with health auxiliaries, nurses and trainees, who unfortunately have no knowledge of their area of activity. Conclusion: As the Community Distributor is the key to Ivermectin Treatment under the Community Directive, it is important to review its status on the scale of actors and to consider strategies for its funding in order to revitalize the CDTI strategy for the elimination of onchocerciasis.

Who makes health governance decisions at the local level? A cross sectional study from primary health facilities in Tanzania.

Lower- and middle-income countries have decentralized decision-making at the community level, as well as community governance structures, to encourage community participation in governance processes, particularly in primary healthcare (PHC). In Tanzania, decentralization resulted in the establishment of Health Facility Governing Committees (HFGCs) to encourage community participation in the governance of primary health facilities to improve the quality and responsiveness of health service delivery. Nonetheless, despite the presence of HFGCs, PHC delivery remains ineffective and of poor quality. It is unclear who makes governance decisions at PHC facilities to ensure that services delivered are of expected quality and respond the community's needs, tastes, and preferences. This paper aims to assess the perspectives of members of the HFGC on who make governance decision in the context of fiscal decentralization. A cross-section design was used to collect both quantitative and qualitative data. A four-multistagesampling technique was adopted to selects regions, council, health facilities, and HFGC members. Respondents who participated in structured questionnaire responses were chosen using proportional sampling, whereas those who participated in in-depth interviews and Focus Group Discussions were chosen using purposive selection. The data was analyzed descriptively and thematically. The study revealed that HFGCs members perceive that governance decisions in primary health facilities are primarily made by the health facility management, and later are presented in HFGCs. As such, HFGCs are used a passively used to justify participation in decision that was already made by the management, which contradict with the principal of decentralization that emphasizes community participation on fiscal decisions. Decentralization of PHC facilities does not guarantee the participation of community members in fiscal decision of their respective primary health facilities through HFGCs. HFGC is passively used governance structure to substitute community participation in primary health facilities'fiscal decisions. Enforcement mechanisms are required to facilitate effective community participation.

The impact of COVID-19 on health financing in Kenya.

Sudden shocks to health systems, such as the COVID-19 pandemic may disrupt health system functions. Health system functions may also influence the health system's ability to deliver in the face of sudden shocks such as the COVID-19 pandemic. We examined the impact of COVID-19 on the health financing function in Kenya, and how specific health financing arrangements influenced the health systems capacity to deliver services during the COVID-19 pandemic.We conducted a cross-sectional study in three purposively selected counties in Kenya using a qualitative approach. We collected data using in-depth interviews (n = 56) and relevant document reviews. We interviewed national level health financing stakeholders, county department of health managers, health facility managers and COVID-19 healthcare workers. We analysed data using a framework approach. Purchasing arrangements: COVID-19 services were partially subsidized by the national government, exposing individuals to out-of-pocket costs given the high costs of these services. The National Health Insurance Fund (NHIF) adapted its enhanced scheme's benefit package targeting formal sector groups to include COVID-19 services but did not make any adaptations to its general scheme targeting the less well-off in society. This had potential equity implications. Public Finance Management (PFM) systems: Nationally, PFM processes were adaptable and partly flexible allowing shorter timelines for budget and procurement processes. At county level, PFM systems were partially flexible with some resource reallocation but maintained centralized purchasing arrangements. The flow of funds to counties and health facilities was delayed and the procurement processes were lengthy. Reproductive and child health services: Domestic and donor funds were reallocated towards the pandemic response resulting in postponement of program activities and affected family planning service delivery. Universal Health Coverage (UHC) plans: Prioritization of UHC related activities was negatively impacted due the shift of focus to the pandemic response. Contrarily the strategic investments in the health sector were found to be a beneficial approach in strengthening the health system. Strengthening health systems to improve their resilience to cope with public health emergencies requires substantial investment of financial and non-financial resources. Health financing arrangements are integral in determining the extent of adaptability, flexibility, and responsiveness of health system to COVID-19 and future pandemics.

Maternal satisfaction with intrapartum care and associated factors among mothers who gave birth in public hospitals of the South West Shewa Zone, Ethiopia, 2022.

Maternal satisfaction with intrapartum care is a multidimensional assumption of satisfaction with self and with the physical environment of the delivery ward and quality of care. Maternal satisfaction with intrapartum care affects the selection of birthplace and helps to identify gaps between actual and intended healthcare outcomes. This study aims to assess factors that affect maternal satisfaction with intrapartum care. To assess maternal satisfaction with intrapartum care and associated factors among mothers who gave birth in public hospitals in the South-west Shewa Zone, Ethiopia, 2022. A cross-sectional study approach among 420 mothers was conducted between April 14 and June 14, 2022. Systematic random sampling was used to select mothers for face-to-face interviews every two intervals. Bivariate and multivariable logistic regression analyses were carried out. P-values of <0.25 in association with study variables were transferred to multivariable logistic regression models. An adjusted odds ratio with a 95% confidence interval was computed, and p-values of <0.05 were considered statistically significant in the multivariable model. The results of this study are presented using text, tables, and charts. Data were collected from 420 participants, and 413 mothers completed the interview, giving a response rate of 98.33%. The overall maternal satisfaction with intrapartum care was 245 (59.32%) [95% CI: 55-64]. Mothers who were considered normal during labor and delivery (AOR = 2.57 (95% CI: 1.30-5.07), had a labor duration of 12 h or less (AOR = 1.59 (95% CI: 1.03-2.44), and experienced a waiting time of <15 min (AOR = 2.06 (95% CI: 1.21-3.52) were significantly associated with maternal satisfaction with intrapartum care. More than half of mothers were satisfied with the overall intrapartum care they received. Health facility managers and healthcare providers work together to improve maternal satisfaction with intrapartum care.

The intervening influence of the quality of health-care administrative process on the relationship between facilities management service quality and patients’ health-care experience in Ghana

PurposePatient-centred strategies should be applied in health-care facilities management (HcFM) to guarantee service quality to meet patients’ needs and ensure quality patient health-care experience. This paper aims to examine the intervening influence of the quality of health-care administrative process (QAP) on the association between health-care facilities service quality and patients’ experiences with medical care.Design/methodology/approachA quantitative technique was used for this cross-sectional study in three Ghanaian teaching hospitals. A total of 622 relevant questionnaires were used for the analysis of the study using SEM-PLS.FindingsThe intervening influence of the QAP on the relationship between HcFM service quality (empathy and tangibility) and patients’ health-care experience (PHcE) were reinforced whilst that of reliability, responsiveness and assurance were not reinforced. The association between the QAP and PHcE was also established.Research limitations/implicationsA high-quality health-care workforce (both core and supporting) and quality work environment provided by the FM department and QAP are essential during quality-of-care delivery, to reduce threats to patient safety to achieve exceptional PHcE. The constraint on the study is that information was gathered from only Ghana. Hence, the generalisation of the findings will be a challenge. Thus, in future, it is proposed that a comparative study across a developed country and a developing country can be conducted. Future research can assess the influence of the health-care internal appearance on patients’ satisfaction.Practical implicationsPractically, the administrative system can be improved by reducing patients overall waiting time. Steps must also be taken to reduce the problem of needless administrative tasks and practices to simplify administrative practices and improve patients’ total health-care experience (core health-care delivery and HcFM), as this influence patients’ total health-care experience.Originality/valueTo the best of the authors’ knowledge, this empirical validation is one of the initial studies in service quality and FM to examine how health-care administrative process quality affects the relationship between FM service quality and patients’ experiences with medical care. This framework can be adapted for research in different countries to extend knowledge.

Perceptions and drivers of healthcare provider and drug dispenser practices for the treatment of malaria in pregnancy in the context of multiple first-line therapies in western Kenya: a qualitative study

BackgroundEmergence of Plasmodium falciparum resistance to artemether-lumefantrine in Africa prompted the pilot introduction of multiple first-line therapies (MFT) against malaria in Kenya, potentially exposing women-of-childbearing-age (WOCBAs) to anti-malarials with unknown safety profiles in the first trimester. This qualitative study explored knowledge and perceptions among healthcare providers providing malaria treatment to WOCBAs and pregnant women.MethodsIn-depth interviews were conducted with purposively selected public and private health facility (HF) and drug outlet (DO) providers within and outside the pilot-MFT area. County health managers were interviewed about their knowledge of the national treatment guidelines. Transcripts were coded by content analysis using the World Health Organization health system building blocks (leadership/governance, financing, health workforce, health information systems, access to medicines, and service delivery).ResultsThirty providers (HF:21, DO:9) and three health managers were interviewed. Eighteen providers were from HFs in the pilot-MFT area; the remaining three and all nine DOs were outside the pilot-MFT area. The analysis revealed that providers had not been trained in malaria case management in the previous twelve months. DO providers were unfamiliar with national treatment guidelines in pregnancy and reported having no pregnancy tests. Health managers were unable to supervise DOs due to resource limitations. Providers from HFs and DOs noted poor sensitivity of malaria rapid diagnostic tests (RDTs) and hesitancy among patients who associated malaria-RDTs with HIV testing. Almost all providers reported anti-malarial stock-outs, with quinine most affected. Patient preference was a major factor in prescribing anti-malarials. Providers in HFs and DOs reported preferentially using artemether-lumefantrine in the first trimester due to the side effects and unavailability of quinine.ConclusionKnowledge of malaria case management in drug outlets and health facilities remains poor. Improved regulation of DO providers is warranted. Optimizing treatment of malaria in pregnancy requires training, availability of malaria commodities, and pregnancy tests.

Making health insurance responsive to citizens: the management of members’ complaints by mutual health organisations in Kinshasa, Democratic Republic of Congo

IntroductionIn moving towards universal health coverage, a number of low-income and middle-income countries have adopted community-based health insurance (CBHI) as a means to reduce both the inequity in healthcare access...