Improve Health Services Research Articles

The impact of devolution on local health systems: Evidence from Greater Manchester, England

Devolution and decentralisation policies involving health and other government sectors have been promoted with a view to improve efficiency and equity in local service provision. Evaluations of these reforms have focused on specific health or care measures, but little is known about their full impact on local health systems. We evaluated the impact of devolution in Greater Manchester (England) on multiple outcomes using a whole system approach.We estimated the impact of devolution until February 2020 on 98 measures of health system performance, using the generalised synthetic control method and adjusting for multiple hypothesis testing. We selected measures from existing monitoring frameworks to populate the WHO Health System Performance Assessment framework. The included measures captured information on health system functions, intermediatory objectives, final goals, and social determinants of health. We identified which indicators were targeted in response to devolution from an analysis of 170 health policy intervention documents.Life expectancy (0.233 years, S.E. 0.012) and healthy life expectancy (0.603 years, S.E. 0.391) increased more in GM than in the estimated synthetic control group following devolution. These increases were driven by improvements in public health, primary care, hospital, and adult social care services as well as factors associated with social determinants of health, including a reduction in alcohol-related admissions (−110.1 admission per 100,000, S.E. 9.07). In contrast, the impact on outpatient, mental health, maternity, and dental services was mixed.Devolution was associated with improved population health, driven by improvements in health services and wider social determinants of health. These changes occurred despite limited devolved powers over health service resources suggesting that other mechanisms played an important role, including the allocation of sustainability and transformation funding and the alignment of decision-making across health, social care, and wider public services in the region.

"Closed books": restrictions to primary healthcare access in Aotearoa New Zealand-reporting results from a survey across general practices.

In Aotearoa New Zealand, primary care is organised by enrolling patients with a primary care provider. However, the benefits of this arrangement are frustrated when providers "close their books" due to insufficient capacity for new patients. We investigated the extent, evolution and impact of this situation on health access and equity in access to primary healthcare. We distributed a survey for general practice personnel in 2022, yielding 227 valid responses. We examined responses across respondents' practice characteristics, including practice size, rural-urban setting, average co-payments, region and ethnic composition of the catchment population. Most general practices are selectively enrolling their patients. In 2022, only 28% of respondents freely enrolled new people. Since 2019, most respondents (79%) had "closed books" or limited enrolments at some point. The situation worsened between 2019 and 2022, compromising equal opportunity and access in healthcare. Restricted enrolment poses a widespread barrier to health access and equity, and it worsened since the beginning of the COVID-19 pandemic. Addressing closed books and limited enrolments in general practice could significantly improve health services' access and equity. The study aims to inform ongoing health reforms.

Accreditation in Hospital Health Based on the Competence Profile of Institutional Quality Management

Health accreditation is based on ensuring the level of quality in care, structural and process care, thus defining the reflection of the performance of a continuous improvement of population health services. The present context aims to highlight the responsibilities regarding management conduct within the accreditation scenario, with an analytical and reflective view of the established information. The basis was based on scientific productions related to the theme with an active and retrospective search of the last ten years, the databases that permeate the composition are concise and coherent, using the discourse of the authors to construct the proposal. In general, caution was expressed regarding operational health services related to continuous accreditation and the qualification of the demand for assistance and strategic clinical performance, the health system being a complex enabled to the growing population adaptation with tools of breadth and integration of care, with potential for quality efficiency to reach its executions.

Advancing healthcare: integrating telemedicine with baby incubators at puskesmas dampit to ensure seamless health services

Puskesmas in Malang Regency do not yet have facilities for monitoring LBW in real time via android either by health workers at the health centre or the patient's family. Puskesmas Dampit serves communities spread across several villages with a coverage area spread across several villages. This is an obstacle for families to get access to monitor the patient's progress, because the patient is in the NICU or ICU room. Another thing is that there is no training for users in the use of telemedicine-based Baby Incubator equipment. The role of users and families of patients is very important to keep the equipment in good condition. However, operating trainings based on new technology for users have never been conducted. Efforts to solve the above problems are to carry out counselling and assistance in the use of baby incubator equipment to users including nurses, midwives and other non-health worker users, so as to increase the knowledge of officers or users which in turn will have an impact on increasing the productivity of officers or users and improving the quality of service at the health centre. The purpose of this Community Service is to increase the role and participation of Poltekkes Kemenkes Surabaya in improving the degree of public health in the Puskesmas Dampit area, Malang Regency. The results of community service through the application of telemedicine-based Baby Incubator at Puskesmas Dampit are increased knowledge and skills regarding telemedicine-based baby incubator equipment. This will improve health services, especially for babies who need intensive care. The implementation of this technology provides significant benefits, including increased accessibility of health services, speed of response to patient health conditions, family involvement in care, and efficient use of resources. Assistance to Puskesmas personnel and patient families in the form of training, monitoring and evaluation of the use of appropriate technology in the form of Telemedicine-based baby incubator utilization.

Mapping stakeholders to maximise the impact of research on health inequalities for people with learning disabilities: The development of a framework for the Making Positive Moves study

AbstractBackgroundPeople with learning disabilities experience health and social inequalities, and research that could improve health services may not be implemented in real‐life settings. Building stakeholder networks that can share and implement research findings may address this. This paper presents a framework for building a stakeholder network that maximises the likelihood of research recommendations being implemented in practice. This was developed as part of the ‘Making Positive Moves’ (MPM) study, which explores the experiences of people with learning disabilities following discharge from a residential stay within a hospital inpatient setting.MethodsWe reviewed the literature on existing theoretical frameworks to support the development of a model for dissemination of the MPM findings. Stakeholder categories were identified through consultation with the MPM researchers, experts by experience and the steering group and a hub and spoke model to represent all stakeholder categories was created. These categories include person moving; family of the person moving; specialist schools; social care; care providers; regulators; third sector organisations; policy organisations; academic community; and NHS professionals. After establishing the categories, we consulted with people with learning disabilities and other stakeholders and conducted online searches to create a stakeholder database. Through information gathering and direct contact with stakeholders, we assessed levels of interest, power and engagement to determine which stakeholders to prioritise in our dissemination activities. The Stakeholder Wheel was created to present the data captured within the database and engagement profiles in an illustrative way.FindingsWe use two stakeholder sub‐categories, user‐led organisations and care providers, to demonstrate the methodological approach. The examples illustrate how a scoring system helped us to identify high‐priority stakeholders who we then contacted to collaborate within developing our dissemination strategy to maximise the impact of the MPM research findings.ConclusionsWe developed a framework to map stakeholders for the MPM study and enable targeted dissemination to increase the impact of the research. This approach has the potential to reduce health inequalities among people with learning disabilities by increasing the awareness of and ability to implement evidence‐based recommendations in real‐life settings. The stakeholder mapping framework could be applied to research projects associated with learning disabilities to bridge the gap between research and practice and reduce health inequalities.

Construction Management in the New Building Project for the Haji Medan General Hospital

Improving health services is one of the priorities in North Sumatra Province, a province that is currently carrying out a lot of development, one of which is the construction of hospitals which are used to meet the health needs of the people in North Sumatra. The development process carried out is a form of service improvement. This study was carried out to analyze the development management of RSU Haji Medan which was carried out by PT. KSO Adhi-Penta. Good construction management needs to be implemented to ensure that work can be completed according to the implementation schedule. The problem formulation in this research discusses three research focuses, namely: 1) Supervision of project management at RSU Haji Medan, 2) Arrangement of human and material resources, 3) Arrangement of scheduling of RSU Haji Medan project activities. The analytical method in this research was carried out using the and Build principle. The Design and Build method provides opportunities to increase time and cost efficiency. The results of this research are: 1) Construction supervision management ensures that all construction activities take place in accordance with the plans, specifications and standards that have been set. 2) Human resources (HR) and material factors cannot be separated because they will have an impact on the quality and running of the business activities carried out. Not only that, the quality of human resources and materials will provide maximum results. 3) PT. KSO Adhi-Penta's target for completion and implementation was successful in achieving the progress that had been determined step by step in accordance with the plan, this indicates that in the construction of RSU Haji Medan, the contractor or developer was successful in implementing management principles well.

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.

Comparative Analysis Of Service Quality On Patient Satisfaction Levels In Government And Private Hospitals In Medan City In 2022

This study compares service quality to patient satisfaction in government and private hospitals in Medan City in 2022. This study used a survey method using a questionnaire as a data collection instrument. The research respondents were patients who used government and private hospital services. The data collected includes service quality dimensions, such as tangibles, reliability, responsiveness, assurance, and empathy. In addition, the data also consists of the level of patient satisfaction with the services provided by the hospital. Comparative analysis of service quality and patient satisfaction levels was carried out using appropriate statistical techniques, such as testing the difference between two groups of hospitals (government vs. private) using appropriate statistical tests. The results of this analysis will provide an understanding of the differences in service quality between government and private hospitals, as well as the related level of patient satisfaction. This research is expected to contribute to the development and improvement of health services in hospitals, especially in the city of Medan. The results of this study can also be input for hospital management to improve service quality and patient satisfaction. Thus, hospitals can provide better services and meet patient expectations to enhance the reputation and competitiveness of both government and private hospitals in Medan City. Especially in the city of Medan. The results of this study can also be input for hospital management to improve service quality and patient satisfaction. Thus, hospitals can provide better services and meet patient expectations to enhance the reputation and competitiveness of both government and private hospitals in Medan City. Especially in the city of Medan. The results of this study can also be input for hospital management to improve service quality and patient satisfaction. Thus, hospitals can provide better services and meet patient expectations to enhance the reputation and competitiveness of both government and private hospitals in Medan City.

Young people’s experiences of being involved in quality improvement of youth mental health services

BackgroundThere is a worldwide concern regarding young people’s mental health and the complexities of designing mental health services to meet these challenges. By integrating user knowledge in the design of mental health services, the services will be better suited to meet the distinctive requirements of youth, as well as uphold their entitlement to participate and influence. This study delves into the viewpoints of young people with experience from mental health services, exploring their perceived advantages and challenges related to their involvement in the enhancement of mental health services’ quality.MethodsA qualitative study with in-depth interviews and thematic analysis were conducted. Ten young, experienced users participated in the study.ResultsYouth user involvement in quality improvement of mental health services yielded notable benefits experienced as fostering personal recovery. Simultaneously, this involvement entailed challenging responsibilities. The participants experienced challenges associated with navigating their memories and expressing concern for their peers. The success of user involvement was closely associated with open-minded cooperative healthcare professionals, facilitation within the services, and provision of support for the young participants.ConclusionsThis study elucidates perceived benefits and challenges related to user involvement at an organizational level. It identifies pivotal conditions to success and underscores the value of incorporating user experience in the improvement of services, not only to create services tailored to the needs of youth but also to instill a positive self-identity and empower those participating. Recognizing the value of experienced users in quality improvement of the services will promote development of youth-friendly services.

‘Look up from the waiting list and see the bigger picture’: a qualitative analysis of clinical specialist physiotherapist perspectives on low back pain care in Ireland

IntroductionHealthcare systems are struggling to deliver high-quality low back pain (LBP) care. In 2012 specialist physiotherapist-led musculoskeletal (MSK) triage services were introduced in Irish hospitals to expedite patient care and alleviate pressure on elective orthopaedic/ rheumatology consultant clinics. Specialist physiotherapists have expertise to inform health service improvement and reform, but their perspectives of LBP healthcare delivery have received scant attention. ObjectivesTo explore specialist physiotherapists’ perspectives on LBP care in Ireland, the barriers and facilitators to quality LBP care and the development of MSK interface services in primary care settings. DesignCross-sectional observational study using an anonymous electronic survey with thematic framework analysis of response data from open-ended questions. ParticipantsThirty-four clinical specialist physiotherapists in Irish MSK triage services. ResultsThematic analysis resulted in six overarching themes, grouped into two categories. One category pertained to LBP healthcare in Ireland with the following three themes: 1) Inadequate health services for patients with LBP; 2) Need for defined LBP clinical pathways; 3) Need for a multisectoral approach to spine health. Themes in the second category, pertaining to the development of community-based MSK interface services, were: 4) Concern regarding isolation from secondary care services; 5) Unrealistic expectations of MSK triage; 6) Improved communication and collaboration with primary care services. ConclusionSpecialist physiotherapists have concerns regarding LBP health services and persistence of a biomedical, secondary care-led approach. They advocate for investment in primary care multi-disciplinary teams, enhanced integration across primary and secondary care, development of a national clinical pathway and a multisectoral approach. Contribution of paper•This study captures, for the first time, the perspectives of specialist physiotherapists on LBP healthcare delivery enabling a better understanding of the ‘on-the-ground’ issues in delivering quality LBP healthcare.•Opportunities for LBP healthcare service improvement are identified at micro, meso and macro health system levels.•The findings can be used to inform the development and implementation of a new national LBP clinical pathway and community-based MSK triage clinics.

Explaining the Characteristics of Nursing Managers in Transformational Management: A Qualitative Study

Background: Transformational management (TM) focuses on the characteristics and behaviors required for a manager to empower and motivate team members. Nursing managers and leaders who practice TM mostly demonstrate varying degrees of transformational characteristics. Objectives: This study aimed to explain the characteristics of nursing managers in TM. Methods: In this study, we used the qualitative content analysis method. Twenty-two nursing managers were selected through purposive sampling within April 2022 to September 2023. Semi-structured interviews were used to collect the data. Data analysis followed the technique recommended by Graneheim and Lundman (2020). All interview sessions were recorded, transcribed in a Word file, and subsequently entered and analyzed in MAXQDA (2020). Results: After analyzing the data and extracting 423 open codes, seven subcategories and three final categories emerged regarding the characteristics required for nursing managers in TM. The identified characteristics in this study include the creation of a transformational culture, an ethics-oriented approach, and institutionalization of changes. Conclusions: By identifying and applying the characteristics essential to TM, nursing managers can initiate valuable changes. This, in turn, leads to transformation within their management style, the nursing profession, and the improvement of health services.

Assessing the relationship between coverage of essential health services and poverty levels in low- and middle-income countries.

Universal health coverage (UHC) aims to provide essential health services and financial protection to all. This study aimed to assess the relationship between the service coverage aspect of universal health coverage and poverty in low- and middle-income countries (LMICs). Using country-level data from 96 LMICs from 1990 to 2017, we employed fixed-effects and random-effects regressions to investigate the association of eight service coverage indicators (inpatient admissions; antenatal care; skilled birth attendance; full immunization; cervical and breast cancer screening rates; diarrhoea and acute respiratory infection treatment rates) with poverty headcount ratios and gaps at the $1.90, $3.20 and $5.50 poverty lines. Missing data were imputed using within-country linear interpolation or extrapolation. One-unit increases in seven service indicators (breast cancer screening being the only one with no significant associations) were associated with reduced poverty headcounts by 2.54, 2.46 and 1.81 percentage points at the $1.90, $3.20 and $5.50 lines, respectively. The corresponding reductions in poverty gaps were 0.99 ($1.90), 1.83 ($3.20) and 1.89 ($5.50) percentage points. Apart from cervical cancer screening, which was only significant in one poverty headcount model ($5.50 line), all other service indicators were significant in either the poverty headcount or gap models at both $1.90 and $3.20 poverty lines. In LMICs, higher service coverage rates are associated with lower incidence and intensity of poverty. Further research is warranted to identify the causal pathways and specific circumstances in which improved health services in LMICs might help to reduce poverty.

Kesiapan Klinik Melaksanakan Promosi Kesehatan Berbasis Media Digital Dalam Upaya Peningkatan Layanan Kesehatan

The rapid development of technology and information affects various sectors. In this case, one of them is the health sector. By maximizing the use of digital media to communicate, provide education and to facilitate the delivery of information in order to realize widespread improvements in health services. Health Promotion plays an important role in the process of community empowerment through activities that inform, influence and help the community to play an active role in encouraging behavior change and improving health towards optimal levels of health. The aim of this research is to analyze the readiness of clinics to implement digital media-based health promotion with an approach DOQIT (Doctor's Office Quality-Information Technology). This research method uses a quantitative descriptive research type design with a cross sectional approach. The samples taken were employees of the Fastabiq Sehat Pati clinic who were involved in digital media-based health promotion. The sampling technique for this research used a total sampling of 15 officers. The type of data used by researchers is primary data with questionnaires. The tool used for data collection is a questionnaire which is a modification of the DOQ-IT (Doctor's Office Quality-Information Technology) questionnaire. The analysis method used is a descriptive analysis method of frequencies, percentages, graphs and tables.

Perineal Wound Treatment with Wound Healing Process on Knowledge of Post Partum Mothers at the Bissappu Bantaeng Community Health Center

Maternal Mortality Rate is an important indicator in assessing health status. Maternal Mortality can be used in monitoring deaths related to pregnancy. This indicator is influenced by general health status, education and services during pregnancy and childbirth. The sensitivity of MMR to improvements in health services makes it an indicator of the success of health sector development. Cases of maternal death include deaths of pregnant women, giving birth and postpartum women. Perineal tears generally occur in the midline and can become extensive if the fetal head is born too early, the angle of the pubic arch is smaller than normal, the fetal head passes through the pelvic inlet with a size that is larger than the circumferential suboccipitobregmatica. A perineal wound is an injury to the urogenital diaphragm and leftator ani muscle, which occurs during normal delivery, or delivery with an instrument, and can occur without injury to the skin of the perineum or vagina, so it is not visible from the outside. The aim is to prove the relationship between post partum mothers' knowledge about perineal wound care and the wound healing process. This research method is an analytical survey with a cross sectional approach, the research population is all 32 post partum mothers at the Bissappu Community Health Center. The sampling technique in this research was carried out using a total population technique. The results of the study found that of the 32 respondents, the majority of respondents' knowledge about perineal wound care was sufficient, namely 15 people (46.9%) and the minority had good knowledge, namely 8 people (25%), normal wound healing, namely 12 people (37.5%) and the fast minority, namely 9 people (28.1%). Chi-Square test results (person Chi-Square) with a p value of 0.00 < α=0.05 where H0 is rejected and Ha is accepted. The conclusion is that there is a significant relationship between maternal knowledge about perineal wound care and the wound healing process.

Receptivity of referral letters and partner notification practices for sexually transmitted infections among a population of men who have sex with men in South Africa: A qualitative study

Although an effective public health strategy to control transmission of sexually transmitted infection (STI) and promote linkage to care exists, little is known about the receptivity of patient referral letters and partner notification (PN) among men who have sex with men (MSM). A qualitative study was conducted involving MSM enrolled in a clinical trial. Individual exit interviews were done with purposefully sampled participants (n = 23) at month 12 from baseline. The study was conducted at a research institute located in a poorly resourced community in Gauteng Province, South Africa. The themes that emerged from the data during thematic content analysis were reaction to STI diagnosis on receiving a referral letter, receptivity of the referral letter and partner notification, STI treatment and usefulness of a referral letter, experiences of accessing healthcare services, nurses’ attitudes towards the MSM, and the MSM’s recommendations for improving health services. The findings suggest that the MSM were receptive to referral letters, which they believed allowed for earlier and easier access to treatment and provided the opportunity to embrace safer sexual practices. Nevertheless, many felt it was challenging to inform their sexual partners due to some being in casual or multiple sexual relationships. Some reported experiencing discrimination from nurses while seeking treatment. This study anticipated that it would be of importance to policymakers when designing and implementing policies on patient referral letters and partner notifications.

The health service perspective on determinants of success in allied health student research project collaborations: a qualitative study guided by the Consolidated Framework for Implementation Research

BackgroundA research culture in health care organisations is associated with improved healthcare performance. Allied health (AH) students undertake research training as part of their professional degree qualifications. This may include participation in research projects, sometimes undertaken in association with health services. Co-supervision of these projects by health service staff provides research capacity building opportunities and staff-centred outcomes for the individuals involved, as well as improvements in clinical knowledge and practice within the local area. Also, publications from these projects contribute to the wider evidence base. Identification of barriers and facilitators to engagement in, and conduct of, these projects may optimise systems for improved health service outcomes.MethodsThis formative evaluation used the Consolidated Framework for Implementation Research (CFIR) to guide analysis of qualitative data obtained from semi-structured interviews with health service-employed allied health professionals, including clinicians and research fellows, who had supervised students on clinical-related research placements within the previous five years.ResultsEleven AH clinicians described 18 collaborative projects with 24 students from five AH disciplines across four universities. Three health service-employed AH research fellows described their involvement in these and other student research projects. Twenty key determinant constructs were identified and mapped across all five CFIR domains. Facilitators included health service cosmopolitanism, project adaptability and implementation climate (compatibility). Health service-employed research fellows provided readiness for implementation and a facilitator for project execution. The main barriers identified were cost to staff in workload and personal time and aspects related to project complexity. Differing student characteristics affected the relative advantage of collaborative projects in positive and negative manners.ConclusionsThis study describes the facilitators and barriers to the conduct of collaborative AH student research projects. Addressing these determinants when establishing each new project may enable health services to optimise communication, role delineation and project success, and thus ultimately, healthcare performance and patient care.

Rheumatoid Arthritis Care Experiences of Black People Living in Canada: A Qualitative Study to Inform Health Service Improvements.

To understand experiences related to rheumatoid arthritis (RA) care and propose service-level strategies to reduce and mitigate inequities for Black people living in Canada. Purposive and respondent driven sampling was used to recruit participants for qualitative interviews to explore population factors relevant to RA care and challenges and facilitators for access to health care services, medications, and enacting preferred treatment plans. Thematic analysis was conducted using the Braun and Clarke method with inductive and deductive coding and critical race theory guiding analysis. Six women and two men with RA, and two women health care professionals, expressed how their racial identity contributed to their understanding of RA, preferences for treatment, and outcome goals. Health care access was influenced by financial limitations and racism, by exclusion, and discrimination, and also by cultural norms in seeking health care and awareness about RA within the Black community. Participants experienced health system fragmentation and were not connected to ancillary supports. Treatment decision-making was influenced by the legacy of oppression and medical experimentation on Black people and the predominance of biomedical approaches emphasized by health care providers. Holistic and cultural approaches, provided in safe, trauma-informed care environments, with flexibility in service models, are desired. Partnerships between arthritis care services and Black community organizations are proposed to promote community awareness and knowledge about arthritis and provide support mechanisms for patients within their community. Our study highlights unique considerations based on race and ethnicity and provides suggestions for arthritis care to mitigate inequities for Black people living with arthritis.

Public health nurses’ experiences following up children with overweight and obesity according to national guidelines. A qualitative study

ABSTRACT Purpose This study aimed to develop knowledge of how the follow-up regarding overweight and obesity among children in primary school is experienced by the PHN and how the guidelines may be used to improve health services in this follow-up. Methods We analysed semi-structured interviews of 9 PHNs using qualitative content analysis. Results Two themes emerged: Following up with children with overweight and obesity is an important but challenging duty; The PHNs call for clearer guidelines. Following five sub-themes: PHNs strive to adhere to the guidelines, show compassion in the follow-up, have difficulty handling parents’ feelings and reactions, feel alone with the responsibility, and have suggestions for clearer guidelines. Conclusions PHNs call for enough resources to communicate the results of the child’s weight in a sufficient form. PHNs and families should establish common goals. The PHN should avoid one-way communication but meet the parents’ concerns and needs. This requires the PHN to focus on building a secure relation to the child and the families, as described by Peplau. Guidelines must include instructions and tools on how to communicate and meet the family’s concerns. Political action and increased funding could strengthen the follow-up and thereby prevent more obesity among children, which can be a predictor of poorer health outcomes later in life.

Kanker Leher Rahim (Cancer Cervix) Sebagai Pembunuh Wanita Terbanyak Di Negara Berkembang

Worldwide, cervical cancer is twelfth most common (Edward, 2010) and the fifth most deadly cancer in women (Globocan, 2002). It affects about 16 per 100,000 women per year and kills about 9 per 100,000 per year (WHO, 2006). Approximately80% of cervical cancers occur in developing countries (Kent, 2010). Worldwide, in2008, it was estimated that there were 473,000 cases of cervical cancer, and 253,500 deaths per year (NCC, 2008).Cervical cancer is the leading cause of cancer death in most developing countries (Edianto, 2006). Counted as many as 510,000 new cases occur each years and lasts more than 288,000 deaths from the disease worldwide. Low incidence of this disease in women aged under 25 years old, but the incidence increases in women aged35 to 40 years and reached a maximum at the age of the 50's. Meanwhile, the incidence of cervical cancer it self continues to increase from about 25 per 100,000 in 1988 to around 32 per 100,000 in 1992 (Edianto, 2006).In 2005, the number of women aged 15-64 years in Indonesia is 65 million and the prevalence of cervical cancer is 50 per 100,000 women. This means the number of patients with cervical cancer is approximately 32 500 patients. Patients with stage I as much as 7% or 2275, stage Ib-IIa by 28% or 9100, and a stage IIB-IV by 65% or 21125 patients (Rasjidi, 2007). This data showed that cancer cervix detected mostly on late stages, so it commonly called silent diseases.The uterine cervix is the lowest portion of a woman's uterus (womb). Most of the uterus lies in the pelvis, but part of the cervix is located in the vagina, where it connects the uterus with the vagina.Cancer of the cervix occurs when the cells of the cervix change in a way that leads to abnormal growth and invasion of other tissues or organs of the body. Like all cancers, cancer of the cervix is much more likely to be cured if it is detected early and treated immediately. One of the key features of cervical cancer is its slow progression from normal cervical tissue, to precancerous (or dysplastic) changes in the tissue, toinvasive cancer. The slow progression through numerous precancerous changes is very important because it provides opportunities for prevention and early detection and treatment.Invasive cancer means that the cancer affects the deeper tissues of the cervixand may have spread to other parts of the body. This spread is called metastasis. Cervical cancers don't always spread, but those that do most often spread to the lungs, the liver, the bladder, the vagina, and/or the rectum. Invasive cancer this way could caused death.This literature review is intended to improve the understanding of cervical cancer that is expected to impact on improving health services in particular increased levels of knowledge about cervical cancer and its prevention at an early stage to reduce the incidence of cervical cancer and the death because of it, especially in Indonesia.

Does Public Financial Management Save Life? Evidence from a Quantitative Review of PFM and Health Outcomes in Sub-Saharan African Countries

ABSTRACT Public financial management (PFM) theory suggests that improvements in the allocation, execution, and monitoring of public funds can result in improved sectoral outcomes, including in health. However, the existing literature on the relationship between PFM quality and health outcomes provides limited empirical documentation and insufficient explanation of the mechanics of that relationship. This paper contributes to the literature by estimating the correlation between PFM quality and health outcomes from a sample of sub-Saharan African countries over the period 2005–2018, using a pooled ordinary least squares (OLS) estimator. The analysis uses Public Expenditure and Financial Accountability (PEFA) scores as proxies for PFM quality. The findings indicate that countries with high-quality PFM tended to have the lowest maternal, under-five and noncommunicable diseases (NCDs) mortality. Among the standard PFM dimensions, the one associated with the higher correlation with maternal and under-five mortality was “predictability and control in budget execution.” Better PFM quality was significantly associated with a drop in maternal and under-five mortality in countries which allocated a higher proportion of their budget to the health sector. In countries allocating a lower proportion of their budget to health, the correlations between PFM quality and the three mortality indicators were not significant. The negative correlations between PFM quality and maternal and under-five mortality were significant only in countries with more effective governance. These findings support an emphasis on strengthening PFM as a means of improving health service provision and health outcomes.