Improve Health Service Delivery Research Articles

Factors Influencing DPT Immunization Completion among Children: Insights from Nakawa Division, Kampala, Uganda

This study investigates the factors influencing DPT (Diphtheria, Pertussis, Tetanus) immunization completion among children aged 4–23 months in Nakawa Division, Kampala, Uganda. Utilizing a descriptive cross-sectional design with both qualitative and quantitative methodologies, data were collected from 271 participants using researcher-guided questionnaires. The analysis revealed a high DPT immunization completion rate of 94%, meeting WHO targets. Significant factors associated with completion included caretaker age, religion, and attitude toward vaccine safety and acceptability, as well as health service factors like distance to the facility, ANC attendance, convenience of immunization days, and vaccine availability. However, child-related factors such as age, gender, and birth order showed no significant association. These findings underscore the importance of targeted interventions to address caregiver perceptions and improve health service delivery for sustained immunization coverage. Keywords: Diphtheria; Pertussis-Tetanus (Pertussis is commonly known as whooping cough); DPT Immunization; Completion Status; Nakawa Division, Kampala-Uganda.

The use of positive deviance approach to improve health service delivery and quality of care: a scoping review

BackgroundQuality has been a persistent challenge in the healthcare system, particularly in resource-limited settings. As a result, the utilization of innovative approaches is required to help countries in their efforts to enhance the quality of healthcare. The positive deviance (PD) approach is an innovative approach that can be utilized to improve healthcare quality. The approach assumes that solutions to problems are already available within the community and identifying and sharing those solutions can help others to resolve existing issues. Therefore, this scoping review aimed to synthesize the evidence regarding the use of the PD approach in healthcare system service delivery and quality improvement programs.MethodsArticles were retrieved from six international databases. The last date for article search was June 02, 2023, and no date restriction was applied. All articles were assessed for inclusion through a title and/or abstract read. Then, articles that passed the title and abstract review were screened by reading their full texts. In case of duplication, only the full-text published articles were retained. A descriptive mapping and evidence synthesis was done to present data with the guide of the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews checklist and the results are presented in text, table, and figure formats.ResultsA total of 125 articles were included in this scoping review. More than half, 66 (52.8%), of the articles were from the United States, 11(8.8%) from multinational studies, 10 (8%) from Canada, 8 (6.4%) from the United Kingdom and the remaining, 30 (24%) are from other nations around the world. The scoping review indicates that several types of study designs can be applied in utilizing the PD approach for healthcare service and quality improvement programs. However, although validated performance measures are utilized to identify positive deviants (PDs) in many of the articles, some of the selection criteria utilized by authors lack clarity and are subject to potential bias. In addition, several limitations have been mentioned in the articles including issues in operationalizing PD, focus on leaders and senior managers and limited staff involvement, bias, lack of comparison, limited setting, and issues in generalizability/transferability of results from prospects perspective. Nevertheless, the limitations identified are potentially manageable and can be contextually resolved depending on the nature of the study. Furthermore, PD has been successfully employed in healthcare service and quality improvement programs including in increasing surgical care quality, hand hygiene practice, and reducing healthcare-associated infections.ConclusionThe scoping review findings have indicated that healthcare systems have been able to enhance quality, reduce errors, and improve patient outcomes by identifying lessons from those who exhibit exceptional practices and implementing successful strategies in their practice. All the outcomes of PD-based research, however, are dependent on the first step of identifying true PDs. Hence, it is critical that PDs are identified using objective and validated measures of performance as failure to identify true PDs can subsequently lead to failure in identifying best practices for learning and dissemination to other contextually similar settings.

IoT in Healthcare Domain

Abstract: The Internet of Things (IoT) is a system of wireless, interrelated, and connected digital devices that can collect, send, and store data over a network without requiring human-to-human or human-to-computer interaction. Recent advancement in IoT systems has positively impacted the daily activities of humans, from accessing information to the delivery of service in realtime. This has improved healthcare management and services, especially in medical hospitals, for effective and timely access to diagnostic information and treatment of patients. The IoT promises many benefits to streamlining and enhancing health care delivery to proactively predict health issues and diagnose, treat, and monitor patients both in and out of the hospital. Worldwide, government leaders and decision makers are implementing policies to deliver health care services using technology and more so in response to the novel COVID-19 pandemic. It is now becoming increasingly important to understand how established and emerging IoT technologies can support health systems to deliver safe and effective care. The aim of this viewpoint paper is to provide an overview of the current IoT technology in health care, outline how IoT devices are improving health service delivery, and outline how IoT technology can affect and disrupt global health care in the next decade. IoT-based health care has great potential to improve the efficiency of the health system and improve population health.

A framework for evaluating the implementation and maintenance of integration within the youth mental health system.

Given the global burden of disease of youth mental disorders, there remains a need to examine how to improve care for this population. Integrated care has been posited as a potential solution, but there is limited evidence on how best to design, staff, and evaluate different models of integrated care for youth mental health. This oral paper presents the findings of a narrative synthesis of the evidence on integrated models of mental healthcare for young people aged 12 to 25 within PubMed, SCOPUS, and PsycINFO databases. Our literature review aimed to: (1) define and summarise the literature on integrated models of mental healthcare for children and young people, and (2) evaluate the effectiveness of integrated models of youth mental healthcare in enhancing mental health outcomes, quality of life, satisfaction with care, and improving health service delivery in young people aged 12-25 years. To be included in our review, studies were English language peer-reviewed and grey literature from January 2001 – October 2021, which included systematic and/or scoping reviews that assess integrated mental healthcare for children and young people aged 12 to 25 years and studies evaluating models of integrated mental healthcare for children and young people using intervention and comparator groups (included in meta-analysis). To synthesise this literature, we generated intial inductive themes describing components of integrated care shared across the youth mental health system including, collaborative care, person centred care, population and evidence-based care, and governance and financing. We incorporated these themes within a deductive framework adapted from the World Health Organisation health system building blocks. These building blocks include service delivery; workforce; information systems and communication; products and technology; and finance along with the cross-cutting themes of leadership, governance, and policy and values. We then mapped these core components of integrated care onto the six intensity levels of integrated care developed by Heath and colleagues providing an overview of how integrated care can be operationalised in terms of health service building blocks. This framework can form a basis for the development of well-articulated models of youth integrated mental health pathways, assisting services identify what operational changes are needed to best implement and sustain integrated care in their own context. Planned future work involving this framework includes using it to map the integration of primary, secondary, tertiary, public, and private youth mental health services within the Australian health system.

Overcoming the constraints of competitive clientelism? Explaining the success of Ghana's poorest region in reducing maternal mortality.

Maternal mortality remains a health challenge that many developing countries struggle to address. Drawing on 64 key informant interviews, this article shows how Ghana's most impoverished administrative region, the Upper East, emerged as a bureaucratic 'pocket of effectiveness' in reducing maternal mortality in a context where national political settlement dynamics are undermining progress in improving maternal health. At the national level, Ghana's progress in reducing maternal mortality has been disappointing because public investments are disproportionately directed to reforms that contribute to the short-term political survival of ruling elites. Competitive electoral pressures have contributed to greater elite commitment towards health sector investments with visual impact, while weakening elite incentives for dedicating resources to interventions that are necessary for enhancing the quality of health. The relatively better performance of the Upper East Region in reducing maternal mortality has been driven by a hybrid form of accountability that combines top-down pressures from the regional health directorate with horizontal forms of accountability that result in a competitive spirit among health workers. These findings show that even in contexts where resources are limited, the capacity of sub-national leaders in devising local solutions to local problems can lead to improved performance of health systems at the sub-national level. The findings also suggest the need for academic debates to go beyond the binary distinctions regarding the usefulness of top-down versus bottom-up accountability measures and focus on building effective and legitimate forms of accountability that run both top-down and bottom-up when seeking to improve health service delivery.

Assessing the efficient use of the lightwave health information management system for health service delivery in Ghana

BackgroundIn achieving the WHO’s Universal Health Coverage and the Global Developmental Agenda: Sustainable Development Goal 3 and 9, the Ministry of Health launched a nationwide deployment of the lightwave health...

NAUNEHAL; Integrated immunization and MNCH interventions: A quasi-experimental study-Protocol.

Great improvements in the health of newborns, children, and women in Pakistan are needed. A large body of literature has demonstrated that the majority of maternal, newborn, and child deaths are preventable with essential health strategies including immunization, nutrition interventions, and child health interventions. Despite the importance of these interventions for the health of women and children, access to services continues to be a barrier. Furthermore, demand for services also contributes to low coverage of essential health interventions. Given the emerging threat of COVID-19 coupled with already weak maternal and child health, delivering effective and feasible nutrition and immunization services to communities, and increasing demand and uptake of services is a pressing and important need. This quasi-experimental study aims to improve health service delivery and increase uptake. The study included four main intervention strategies including community mobilization, mobile health teams offering MNCH and immunization services, engagement of the private sector, and testing of a comprehensive health, nutrition, growth, and immunization app, Sehat Nishani, for a period of 12 months. The target group of the project were women of reproductive age (15-49 years) and children under-five. The project was implemented in three union councils (UCs) in Pakistan including Kharotabad-1(Quetta District, Balochistan), Bhana Mari (Peshawar District, Khyber Pakhtunkhwa) and Bakhmal Ahmedzai (Lakki Marwat district, Khyber Pakhtunkhwa). Propensity score matching based on size, location, health facilities, and key health indicators of UC was conducted to identify three matched UCs. A household baseline, midline, endline and close-out assessment will be conducted for evaluating coverage of interventions as well as the knowledge, attitude, and practices of the community in the MNCH and COVID-19 context. Descriptive and inferential statistics will be used to test hypotheses. As well, a detailed cost-effectiveness analysis will be conducted to generate costing data for these interventions to effectively inform policymakers and stakeholder on feasibility of the model. Trial registration: NCT05135637.

The impact of the Safe Delivery Application on knowledge and skills managing postpartum haemorrhage in a low resource setting: a cluster randomized controlled trial in West Wollega region, Ethiopia

BackgroundPostpartum haemorrhage is one of the leading causes of maternal mortality in low-income countries. Improving health workers' competencies in obstetric emergencies in low-income settings, has been recognized as an important factor in preventing maternal mortality and morbidity. mHealth interventions in maternal and newborn health care has shown the potential to improve health service delivery. Strong study designs such as randomized controlled trials are missing to estimate the effectiveness of the mHealth interventions.MethodsBetween August 2013 and August 2014, 70 health facilities in West Wollega Region, Ethiopia were included and randomized to intervention or control in a cluster randomized controlled trial. At intervention facilities birth attendants were provided with a smartphone with the SDA installed. Of 176 midwives and “health extension workers,” 130 completed at 12 months follow-up. At baseline and after 6- and 12-months participants were assessed. Knowledge was tested by a Key Feature Questionnaire, skills by an Objective Structured Assessment of Technical Skills in a structured role-play scenario.ResultsBaseline skills scores were low and comparable with a median of 12/100 in the intervention and the control group. After 6 months skills had doubled in the intervention group (adjusted mean difference 29.6; 95% CI 24.2–35.1 compared to 1·8; 95% CI – 2.7 to 6.3 in the control group). At 12 months skills had further improved in the intervention group (adjusted mean difference 13.3; 95% CI 8.3–18.3 compared to 3.1; 95% CI – 1.0 to 7.3 in the control group). Knowledge scores also significantly improved in the intervention group compared to the control (adjusted mean difference after 12 months 8.5; 95% CI 2.0–15.0).ConclusionThe Safe Delivery App more than doubled clinical skills for managing postpartum haemorrhage among birth attendants making it an attractive tool to reduce maternal mortality.Trial registration: Clinicaltrial.gov Identifier NCT01945931. September 5, 2013.

Experiences, barriers, and facilitators of health data use among performance monitoring teams (PMT) of health facilities in Eastern Ethiopia: A qualitative study.

Routine health data is crucial in decision-making and improved health outcomes. Despite the significant investments in improving Ethiopia's Performance Monitoring Team (PMT), there is limited evidence on the involvement, implementation strategies, and facilitators and barriers to data utilization by these teams responding to present and emerging health challenges. Therefore, this study aimed to explore the PMT experiences, facilitators, and barriers to information use in healthcare facilities in Eastern Ethiopia. This study employed a phenomenological study design using the Consolidated Framework for Implementation Research (CFIR) to identify the most relevant constructs, aiming to describe the data use approaches at six facilities in Dire Dawa and Harari regions in July 2021. Key informant interviews were conducted among 18 purposively selected experts using a semi-structured interview guide. Thematic coding analysis was applied using a partially deductive approach informed by previous studies and an inductive technique with the creation of new emerging themes. Data were analyzed thematically using ATLAS.ti. Study participants felt the primary function of PMT was improving health service delivery. This study also revealed that data quality, performance, service quality, and improvement strategies were among the major focus areas of the PMT. Data use by the PMT was affected by poor data quality, absence of accountability, and lack of recognition for outstanding performance. In addition, the engagement of PMT members on multiple committees negatively impacted data use leading to inadequate follow-up of PMT activities, weariness, and insufficient time to complete responsibilities. Performance monitoring teams in the health facilities were established and functioning according to the national standard. However, barriers to operative data use included PMT engagement with multiple committees, poor data quality, lack of accountability, and poor documentation practices. Addressing the potential barriers by leveraging the PMT and existing structures have the potential to improve data use and health service performance.

Predict the priority of end-users’ maintenance requests and the required technical staff through LSTM and Bi-LSTM recurrent neural networks

PurposeThis paper aims to develop predictive methods, based on recurrent neural networks, useful to support facility managers in building maintenance tasks, by collecting information coming from a computerized maintenance management system (CMMS).Design/methodology/approachThis study applies data-driven and text-mining approaches to a CMMS data set comprising more than 14,500 end-users’ requests for corrective maintenance actions, collected over 14 months. Unidirectional long short-term memory (LSTM) and bidirectional LSTM (Bi-LSTM) recurrent neural networks are trained to predict the priority of each maintenance request and the related technical staff assignment. The data set is also used to depict an overview of corrective maintenance needs and related performances and to verify the most relevant elements in the building and how the current facility management (FM) relates to the requests.FindingsThe study shows that LSTM and Bi-LSTM recurrent neural networks can properly recognize the words contained in the requests, thus correctly and automatically assigning the priority and predicting the technical staff to assign for each end-user’s maintenance request. The obtained global accuracy is very high, reaching 93.3% for priority identification and 96.7% for technical staff assignment. Results also show the main critical building elements for maintenance requests and the related intervention timings.Research limitations/implicationsThis work shows that LSTM and Bi-LSTM recurrent neural networks can automate the assignment process of end-users’ maintenance requests if trained with historical CMMS data. Results are promising; however, the trained LSTM and Bi-LSTM RNN can be applied only to different hospitals adopting similar categorization.Practical implicationsThe data-driven and text-mining approaches can be integrated into the CMMS to support corrective maintenance management by facilities management contractors, i.e. to properly and timely identify the actions to be carried out and the technical staff to assign.Social implicationsThe improvement of the maintenance of the health-care system is a key component of improving health service delivery. This work shows how to reduce health-care service interruptions due to maintenance needs through machine learning methods.Originality/valueThis study develops original methods and tools easily integrable into IT workflow systems (i.e. CMMS) in the FM field.

Validation of an Interoperability Framework for Linking mHealth Apps to Electronic Record Systems in Botswana: Expert Survey Study.

Electronic record (eRecord) systems and mobile health (mHealth) apps have documented potential to improve health service delivery, resulting in increased global uptake. However, their interoperability remains a global challenge hindering diagnosis, monitoring of health conditions, and data access irrespective of geographic location. Given the widespread use of mobile devices by patients and health care providers, linking mHealth apps and eRecord systems could result in a comprehensive and seamless data exchange within a health care community. The Botswana National eHealth Strategy recognizes interoperability as an issue and mHealth as a potential solution for some health care needs but is silent on how to make mHealth apps interoperable with existing eRecord systems. A literature review and analysis of existing mHealth interoperability frameworks found none suitable for Botswana. As such, it was critical to conceptualize, design, and develop an mHealth-eRecord Interoperability Framework (mHeRIF) to enhance the interoperability pillar of the Botswana National eHealth Strategy and leverage the full benefits of linking mHealth apps with other health information systems. This study aimed to validate the developed mHeRIF and determine whether it requires further refinement before consideration towards enhancing the National eHealth Strategy. Published framework validation approaches guided the development of a survey administered to 12 purposively selected local and international eHealth experts. In total, 25% (3/12) of the experts were drawn from Botswana, 25% (3/12) were drawn from low- and middle-income countries in sub-Saharan Africa, 25% (3/12) were drawn from low- and middle-income countries outside Africa, and 25% (3/12) were drawn from high-income countries. Quantitative responses were collated in a Microsoft Excel (Microsoft Corp) spreadsheet for descriptive analysis, and the NVivo software (version 11; QSR International) was used to aid the thematic analysis of the qualitative open-ended questions. The analysis of responses showed overall support for the content and format of the proposed mHeRIF. However, some experts' suggestions led to 4 modest revisions of the mHeRIF. Overall, the experts' reviews showed that the mHeRIF could contribute to the National eHealth Strategy by guiding the linking of mHealth apps to existing eRecord systems in Botswana. Similarly, the experts validated an architectural model derived from the mHeRIF in support of the first mobile telemedicine initiative considered for national rollout in Botswana. The mHeRIF helps identify key components to consider before and after linking mHealth apps to eRecord systems and is being considered for use as the foundation of such interoperability in Botswana.

Incorporating mHealth Interventions into Kenya’s Health Infrastructure to Augment Universal Health Coverage, Service Delivery Improvement Approach

mHealth is the use of mobile and wireless devices to improve health outcomes, healthcare services, and health research. An estimated 68% of the world’s population own mobile phones, with Kenya having approximately 80% of mobile phone penetration. This makes it feasible to accelerate the uptake of mHealth interventions to improve health services delivery. While some evidence has shown how various forms of mHealth interventions have been used to transform health services, health outcomes, and health research in Kenya and globally, many remain largely anecdotal or undocumented. This paper examines the various forms of mHealth interventions that have been incorporated into Kenya’s health infrastructure, and their effectiveness in improving health services delivery in Kenya. A systematic review of peer-reviewed articles, policy briefs, and credible materials published on mHealth have shown that mHealth has succeeded in the health infrastructure such as in collecting and transferring health and patient data, remote diagnosis, treatment, and patient follow-up. The paper also examines the barriers around the uptake of mHealth interventions and recommends how these interventions can be integrated into Kenya’s health infrastructure. Even though there is every reason to believe that mHealth can allow limited resource settings to “leapfrog” over more advanced settings in using mobile technologies to improve health services delivery, mHealth is not a panacea. There are limited will and resources to scale up and integrate mHealth into the health infrastructure with attempted integration met with a negative attitude from the strained health workforce who still view mHealth as additional work, among other challenges. Despite the challenges, there may be an opportunity for Kenya’s Government to leverage mobile and wireless devices to improve the delivery of health services to areas that were previously unreachable, thereby fast-tracking its commitment to achieving Universal Health Coverage.

Patients, populations and partnerships: pillars supporting the promotion of health

Patient and population health are influenced by a myriad of factors outside the traditional biomedical model of disease. Health partnerships, based on a collaborative approach and involving both individuals and institutions, provide an important mechanism to improve health service delivery and enhance health outcomes. In order to be successful in delivering health promotion (and therefore improve health itself), the supporting pillars of patients, populations, and relevant and effective partnerships are of fundamental importance in contemporary practice to deliver better health outcomes for our communities.

The Influence of COVID-19 Pandemic on the Health Seeking Behaviors of Adults Living With Chronic Conditions: A View Through the Health Belief Model.

The COVID-19 pandemic resulted in disruption in every facet of life including health service delivery. This has threatened the attainment of global targets to improve health and wellbeing of all persons. In particular, for persons living with chronic diseases, who require consistent monitoring by health professionals and medication to enhance their health, understanding how the pandemic has disruption their access to health care delivery is critical for interventions aimed at improving health service delivery for all as well as preparedness for future pandemic. This study applied the constructs of the Health Belief Model, to explore the influences of the COVID-19 pandemic on the health seeking behaviors of persons living with chronic diseases. The design was exploratory descriptive. Semi-structured interviews were conducted to collect data among persons living with chronic diseases in the Cape Coast Metropolis of Ghana. Thematic analysis, both inductive and deductive, was conducted to unearth the findings. Awareness of increased susceptibility and risk of a more severe episode if they contracted COVID-19 as a result of the existing chronic diseases was identified. Lack of access to health professionals during the peak of the pandemic as well as the fear of contracting the virus while accessing their regular chronic disease clinic was the main barriers identified. Information in the media served as cues to action for adopting preventive health strategies. Behavior modifications; dietary and lifestyle, self-medication and adoption of COVID-19 related precautions were practiced. Susceptibility to contracting COVID-19 contributed to missed adherence to treatment appointment. The health belief model was a useful framework in exploring the health seeking behavior of the adults living with chronic conditions during the COVID-19 in this study setting. Intensifying targeted education for persons living with chronic diseases will contribute to the adoption of positive health seeking behaviors during future pandemic.

Achieving optimal heath data impact in rural African healthcare settings: measures to barriers in Bukomansimbi District, Central Uganda

BackgroundHealth data is one of the most valuable assets in health service delivery yet one of the most underutilized in especially low-income countries. Health data is postulated to improve health service delivery through availing avenues for optimal patient management, facility management, and public health surveillance and management. Advancements in information technology (IT) will further increase the value of data, but will also call for capacity readiness especially in rural health facilities.We aimed to understand the current knowledge, attitudes and practices of health workers towards health data management and utilization.MethodsWe conducted key informant interviews (KII) for health workers and data staff, and focus group discussions (FGD) for the village health teams (VHTs). We used both purposive and convenience sampling to recruit key informants, and convenience sampling to recruit village health teams. Interviews and discussions were audiotaped and transcribed verbatim. We manually generated the codes and we used thematic analysis to identify the themes. We also developed a reflexivity journal.ResultsWe conducted a total of 6 key informant interviews and 3 focus group discussions of 29 participants. Our analysis identified 7 themes: One theme underscored the health workers’ enthusiasm towards an optimal health data management setting. The rest of the six themes resonated around working remedies to the systemic challenges that grapple health data management and utilization at facilities in rural areas. These include: Building human resource capacity; Equipping the facilities; Improved coordination with partners; Improved data quality assurance; Promotion of a pull supply system and Reducing information relay time.ConclusionOur findings reveal a plethora of systematic challenges that have persistently undercut optimal routine health data management and utilization in rural areas and suggest possible working remedies. Health care workers express enthusiasm towards an optimal health management system but this isn’t matched by their technical capacity, facility readiness, systems and policy willingness. There is an urgent need to build rural lower facilities’ capacity in health data management and utilization which will also lay a foundation for exploitation of information technology in health.

Temporal and Regional Trends in Obstructive Sleep Apnea Using Administrative Health Data in Alberta, Canada.

Rationale: Obstructive sleep apnea (OSA) is a common treatable condition with important health and societal consequences. Objectives: We aimed to assess the annual incidence and prevalence of clinically recognized and geographic clustering of OSA in Alberta, Canada, using administrative health data case definitions. Methods: We used two administrative health databases in Alberta to identify ICD-9 and ICD-10 (International Classification of Diseases, Ninth and 10th Revisions, respectively) diagnostic codes for adults and children at least 2 years old diagnosed with OSA between 2003 and 2020. We defined OSA using an algorithm developed and validated in Alberta: at least three claims or one hospitalization within 2 years. We mapped residential postal codes to 70 subregional health authorities (SRHAs). Crude, age group- and sex-specific incidence and prevalence, and age group- and sex-standardized rates were calculated for Alberta and SRHAs. Spatial scan statistics identified clusters of SRHAs in which OSA cases were higher (hot spots) or lower (cold spots) than expected. Results: Between 2003 and 2020, OSA prevalence increased from 0.14% to 4.59%. The annual incidence of OSA increased after 2013. Incidence and prevalence were higher in older adults and children aged 2-11 years compared with 12-17 years. Cluster analysis revealed regional variation in OSA incidence and prevalence over time with no consistent pattern except for cold spots in one large metropolitan center (Calgary). Conclusions: From 2003 to 2020, the incidence and prevalence of clinically recognized OSA increased but varied by geography. Administrative health data can be used to guide interventions aimed at improving health service delivery and the quality of OSA care.

Exploring physicians' experiences under the national health insurance scheme in Southeastern Nigeria.

A number of low-and middle-income countries have implemented National Health Insurance Schemes (NHIS) as part of efforts to increase access to quality healthcare and financial protection from regressive out-of-pocket payments. This study explored physicians' experiences under the Nigerian (NHIS) to identify factors that may influence efficient health care delivery. A convenient sample of 85 physicians residing in South-East Nigeria who had active contracts with the NHIS were surveyed via self-administered questionnaire for this study. Descriptive statistics were used to summarize the data while Kruskal-Wallis tests were used to determine if there were statistically significant associations between physician professional characteristics and their responses to key statements that assessed their experiences and behavior. Also, thematic analysis was used to assess additional qualitative data provided by study participants. Provider experiences were affected by the perceived inadequacy of reimbursement rates, delays in payment and services not covered by the NHIS. Participants' responses to statements on inadequacy of reimbursement was significantly associated with location using Kruskal-Wallis test (χ2 (1)=7.24, p=0.027) while billing patients for services not covered under the NHIS was significantly associated with length of years of practice (χ2 (1)=15.5, p=0.001) and place of employment (χ2 (1)=5.82, p=0.054). Physician experiences and challenges they face under the NHIS program in Nigeria have unintended effects on the delivery of health care services. It is imperative that these issues are addressed to improve health service delivery.

Use of Mobile Health Units for Primary Health Care in Disasters

Background/Introduction:As disasters disrupt health systems and create additional health needs, Mobile Health Units (MHU) are deployed to help cover primary health care (PHC) needs. However, MHUs have been critiqued for being logistically burdensome and poorly adapted to dominating health needs. Guidelines exist, including WHO Classification for Emergency Medical Teams (EMT) Type 1 mobile, but the usefulness of MHUs in disasters has been poorly studied.Objectives:To explore the use of MHUs for PHC in disasters and identify key characteristics as described in the literature.Method/Description:A scoping review was conducted following framework by Arksey and O’Malley using thematic content analysis. Twenty-six bibliographic databases and websites were screened for white and grey literature on the use of MHUs in disasters published from 2000-2021.Results/Outcomes:The search resulted in 24 reviews and operational reports, highlighting nine themes. While MHUs were reported to improve health service delivery, 16 documents highlighted challenges related to logistics, organization, and coordination. Seven publications described cooperation with local authorities and stakeholders to help improve relevancy of care by adapting service provision to health needs. Several studies highlighted the need for a functioning referral system and inclusion of local and culturally sensitive staff.Conclusion:Findings of this study highlight the added value and areas of improvement of MHUs for PHC in disasters. Recommendations of best practices were proposed based on the literature and may guide future deployments. However, there is a paucity of publications, and further data on EMT Type 1 mobile are needed to evaluate MHUs in disasters and improve guidelines.

The quest for accountability of Health Facility Governing Committees implementing Direct Health Facility Financing in Tanzania: A supply-side experience.

User committees, such as Health Facility Governing Committees, are popular platforms for representing communities and civil society in holding service providers accountable. Fiscal decentralization via various arrangements such as Direct Health Facility Financing is thought to strengthen Health Facility Governing Committees in improving accountability in carrying out the devolved tasks and mandates. The purpose of this study was to analyze the status of accountability of Health Facility Governing Committees in Tanzania under the Direct Health Facility Financing setting as perceived by the supply side. In 32 different health institutions, a cross-sectional design was used to collect both qualitative and quantitative data at one point in time. Data was collected through a closed-ended questionnaire, an in-depth interview, and a Focus Group Discussion. Descriptive statistics, multiple logistic regression, and theme analysis were used to analyze the data. According to the findings, Health Facility Governing Committees’ accountability is 78%. Committees have a high level of accountability in terms of encouraging the community to join community health funds (91.71%), receiving medicines and medical commodities (88.57%), and providing timely health services (84.29%). The health facility governance committee’s responsibility was shown to be substantially connected with the health planning component (p = 0.0048) and the financial management aspect (p = 0.0045). This study found that the fiscal decentralization setting permits Committees to be accountable for carrying out their obligations, resulting in improved health service delivery in developing nations.

Maternal and child surveillance in peri-urban communities: Perceptions of women and community health workers from Pakistan.

Community health workers (CHWs) in maternal, newborn, and child health (MNCH) programs play an important role in demographic surveillance activities; however, there is lack of literature regarding the community and CHWs' perceptions about these activities. The purpose of this study was to explore perceptions of married women of reproductive age (MWRA) regarding the role of CHWs involved in maternal and child surveillance and explore facilitators and barriers for CHWs involved in surveillance activities. A qualitative study was conducted in five peri-urban surveillance sites along the coastal belt of Bin Qasim Town, Karachi, Pakistan. In-depth interviews were conducted with 25 randomly selected MWRAs and 15 CHWs. A thematic analysis was performed to explore perceptions, barriers, and facilitators of the study participants about maternal and child surveillance activities. The results showed that MWRAs perceived surveillance CHWs as service providers with regards to standard counselling i.e. importance of antenatal care, nutrition, immunization, and distribution of iron and folic acid tablets to pregnant women, child growth assessment, and referral of sick children to the health facility. Trust in the CHWs was an enabler for MWRAs, whereas lack of incentives was cited as a barrier to share their health data. CHWs perceived themselves as a bridge in liaising community with the primary health care facility. They highlighted an enabling environment such as appreciation, supportive supervision, training, and utilization of digital data collection tools as facilitators for their work. Low health literacy of the communities, lack of provision of incentives by CHWs to the community, and facility-based experiences of the community were reported as barriers. Surveillance CHWs are an integral link between the health facility and MWRAs. Hence an enabling environment may lead to improved health service delivery, translating into meaningful impact for the mother and child.