Levels Of Health Care Delivery System Research Articles

Provision of adolescent and youth-friendly services in public health facilities in Migori County, Kenya

Background: Global and national guidelines on provision of adolescent and youth-friendly services (AYFS) exist. However, the extent to which these services are provided in developing countries, including Kenya, is unknown. Therefore, this study aimed to assess provision of AYFS in public health facilities in Migori County, Kenya. Methods: A cross-sectional study design was employed. The study setting was public health facilities in Migori County. The county has 275 health facilities, of these 159 are government owned/public health facilities. A multistage sampling of 114 public health facilities was done from which 210 healthcare providers (HCPs) were sampled using simple random sampling. Three facility in-charges were purposively selected to represent each of the county's three Levels of healthcare delivery system. Data was collected using structured questionnaires, key informant interviews guide, and Health facility observation checklists. Results: Majority 153 (74%) practiced nursing and 148 (71%) had worked at their current workstation between 1-5 years. Equitable, accessible, acceptable, appropriate, and effective AYFS are provided in the government owned public health facilities. Conclusion: Inadequate AYFS training of healthcare providers and poor implementation of existing policies including weak engagement of young people in AYFS significantly hinder the effective provision of AYFS in public health facilities.

Evaluation of National Patient Safety Implementation Framework in Selected Public Healthcare Facilities of Tamil Nadu: An Operational Research.

The Ministry of Health and Family Welfare has introduced the "National Patient Safety Implementation Framework" to ensure the patient safety at different levels of healthcare delivery system. However, there is limited effort made in evaluating the implementation status of this framework. Hence, we have performed the process evaluation of National Patient Safety Implementation Framework across the public healthcare facilities in Tamil Nadu. This was a facility-level survey conducted by research assistants who visited 18 public health facilities across 6 districts of Tamil Nadu, India, for the purpose of documenting the presence of structural support systems and strategies to promote patient safety. We developed a tool for data collection based on the framework. It comprised a total of 100 indicators under the following domains and subdomains: structural support, systems for reporting, workforce, infection prevention and control, biomedical waste management, sterile supplies, blood safety, injection safety, surgical safety, antimicrobial safety, and COVID-19 safety. Only one facility (subdistrict hospital) belonged to the high-performing category with a score of 79.5 on the implementation of patient safety practices. About 11 facilities (4 medical colleges and 7 Government Hospitals) belonging to medium-performing category. The best-performing medical college had a score of 61.5 for patient safety practices. Six facilities (2 medical colleges, 4 Government Hospitals) belonged to low-performing category in terms of patient safety. The least-performing facilities (both subdistrict hospitals) had scores of 29.5 and 26 for patient safety practices, respectively. Because of COVID-19, there was a positive effect on biomedical waste management and infectious disease safety across all facilities. Most performed poor in the domain with structural systems to support quality and efficiency of healthcare and patient safety. The study concludes that based on the current situation of patient safety practices in public health facilities, it will be difficult to perform full-fledged implementation of patient safety framework by the year 2025.

Evaluation of adolescent/youth.friendly sexual and reproductive health services: A 7-year systematic review from January 2016 to April 2022

Adolescent/youth-friendly sexual and reproductive health services (SRHS) play a vital role in reducing morbidity and mortality associated with adolescent SRH. This review examined studies carried out on adolescent/youth-friendly SRHS with focus on availability, accessibility, utilization as well as perception of health care providers, and adolescents about the services. The study design was systematic review of empirical studies using a well-defined strategy. Online journal was searched comprehensively using Web of Science, Google Scholars databases, PubMed, Medline, and EMBASE. Other sources were identified through the scanning of references of selected sources. The articles selected were between 2016 and 2022 and had qualitative/quantitative and mixed methods. The articles that met the selection criteria were also screened using PRISMA-P guidelines and SPIDER framework for systematic review was further used for inclusion criteria based on the following concepts: sample, phenomenon of interest, design, evaluation and research type. A total number of 32 studies were included in the study and findings were reported based on the five emerging themes. The review showed that majority of the adolescents were not aware of adolescent/youth-friendly SRHS, some health care providers were not also in support of the services which accounted for low utilization of the services among adolescents. The review further showed poor accessibility and nonavailability of AYFSRHS as the only available SRHS were meant for married adults. Therefore, these findings serve as evidence for policy-makers at all the levels of healthcare delivery system to considered all the factors observed in this review and develop strategies that will make adolescent/youth-friendly SRHS available and accessible to adolescents. More so, other stakeholders, especially health care providers must improve their attitude toward provision of adolescent/youth-friendly SRHS.

Morbidity profile and prescription audits using WHO core prescribing indicator in government hospitals of Province 1, Nepal

Background: Periodic assessment of morbidity and drug use at various levels of healthcare delivery system is important to recognize common prevalent morbidities and rationalize the use of medicines. The study was conducted to determine the common morbidities and audit prescription using WHO prescribing indicator in government operated tertiary hospitals of eastern Nepal.
 Methods: A cross-sectional study was carried out in government tertiary hospitals of Province 1, Nepal, from March 2019 to August 2019. For analysis, descriptive statistics were used. Prescribing characteristics were evaluated using recommended guidelines of the World Health Organization (WHO) prescribing indicators.
 Results: Six hundred prescriptions were analyzed. The most prevalent morbidity was endocrine, nutrition & metabolic diseases (21.5%) followed by diseases of the respiratory system (19.8%), circulatory system (17.6%), and digestive system (12.8%). The most frequently encountered individual disease entity were hypertension (18.7%), diabetes (15.5%), acid peptic disorders (14%). A total of 2072 drugs were prescribed with an average of 3.45 (± 1.39) drugs per consultation. About 30.2% of prescriptions encountered contain at least one antibiotics, whereas injectable were prescribed in 1.8%. Only 3.9% of total medicines were prescribed in generic name and 31.7% of drug prescribed were from essential medicine list.
 Conclusion: Among the prescriptions evaluated, diseases of the endocrine, respiratory, cardiovascular, and gastrointestinal systems were the most common morbidities. Polypharmacy was prevalent to some extent whereas prescribing in generic and essential medicine list was poor relative to standard WHO recommendations. However, the overall prescribing of antibiotics and injection were found to be satisfactory.

Development of a framework of intervention strategies for point of care quality improvement at different levels of healthcare delivery system in India: initial lessons

BackgroundInadequate quality of care has been identified as one of the most significant challenges to achieving universal health coverage in low-income and middle-income countries. To address this WHO-SEARO, the point...

Pattern of neonatal morbidity and mortality: A retrospective study in a special newborn care unit, Mumbai

Background: Despite advances in perinatal and neonatal care, neonatal mortality is still high in developing countries, like India. Special neonatal care units (SNCUs) have been set up at different levels of health-care delivery system to provide quality newborn care services to meet this challenge. Aim: This study was undertaken to study morbidity and mortality pattern of neonates admitted at SNCU. Materials and Methods: This retrospective study was conducted in a newly started SNCU in the Western suburbs of Mumbai, India. The study included all babies admitted between 0 and 28 days of life over a period of 1 year. The babies were categorized based on gestational age and birth weight. Results: A total of 531 babies were admitted during the study period, including 125 outborn babies. About 25% of babies were preterm (<37 weeks), and 40% of babies were low birth weight (LBW) including 4.14% very LBW and 2.44% extremely LBW babies. Neonatal jaundice, respiratory distress, prematurity, LBW, suspected sepsis, and perinatal depression were common indications for admission. Only 11 (2.07%) babies required antibiotics. The overall mortality rate was 1.55%, with birth asphyxia being the leading cause of death. Conclusion: Results of this study showed that simple measures for the prevention of morbidity and mortality related to prematurity and sepsis may avoid excessive use of antibiotics and reduce overall morbidity and mortality of neonates admitted in SNCU/neonatal intensive care units.

Review of health-care services for older population in India and possibility of incorporating AYUSH in public health system for geriatric care.

Background:In a developing country like India, which has 10.11% population of >60 years age and a projection of rise of the same by 300% in 2050, health care of elderly is an enormous challenge. The developed world has evolved many models for elderly care, for example, nursing home care, health insurance, etc. Indian Government has also taken multiple measures in this direction by initiating National Policy on Older Persons, 1999, the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, the Old Age Pension Scheme, Rashtriya Vayoshri Yojana 2017, etc. However, there is a necessity that, India must rapidly adapt to the complex health related, social and economic challenges caused by these demographic changes. This may be an opportunity for innovation in the health system by developing a perspective for healthy and active aging, though it is a major challenge. Health care of the older people cannot be achieved unless total health, i.e., physical, social, economic, psychological, and spiritual aspects are addressed.Objective:The objective is to study current policies regarding geriatric health care in India and to propose the possibility to develop a model to provide comprehensive and dedicated health-care services to the older population by integrating conventional and indigenous systems of medicine dwelling in the country.Materials and methods:Electronic search in various scientific journals for research and review articles; electronic along with hand searching of conference proceedings, brochures, government policy documents, press releases, Ayurveda classical texts, etc., regarding geriatric health care in India and model health-care facilities in other countries and regarding of AYUSH systems in geriatric health care in India.Results:There is an urgent need of adaptation and modification in the National Health System to cater the actual requirements of the elderly with plans and strategies dedicated to face their health-related challenges. Adoption of inclusive health-care interventions, can improve health outcomes by making it more acceptable, accessible, and affordable.Conclusion:Integration of AYUSH at various levels of health-care delivery system can potentially contribute to provide unique newer dimensions to the field of geriatric care in India.

Improving efficiency and effectiveness of the telemedicine system between a remote clinic and a super specialty hospital - a case study and its key determining factors

This paper focuses on accessibility of healthcare through telemedicine ICT software implementation and bring process and performance improvements. For achieving efficacy of the hypothesis, this paper studies the key determining factors such as challenges, adoption of technologies and standards, process refinement, reliability, safety and security of the patient records and performance improvements. This pilot study ensures the success of quality healthcare delivery outreach to remote/rural patients through telemedicine in a clinic to hospital (C2H) environment between NLC remote clinic to SRMC super specialty hospital for ensuring the efficacy of the telemedicine system software through ICT. During implementation, delays due to generation and resolution side of the healthcare delivery were identified and suitable policy measures, technology adoption at all levels of healthcare delivery system from both the ends of C2H was advocated.

Improving efficiency and effectiveness of the telemedicine system between a remote clinic and a super specialty hospital - a case study and its key determining factors

This paper focuses on accessibility of healthcare through telemedicine ICT software implementation and bring process and performance improvements. For achieving efficacy of the hypothesis, this paper studies the key determining factors such as challenges, adoption of technologies and standards, process refinement, reliability, safety and security of the patient records and performance improvements. This pilot study ensures the success of quality healthcare delivery outreach to remote/rural patients through telemedicine in a clinic to hospital (C2H) environment between NLC remote clinic to SRMC super specialty hospital for ensuring the efficacy of the telemedicine system software through ICT. During implementation, delays due to generation and resolution side of the healthcare delivery were identified and suitable policy measures, technology adoption at all levels of healthcare delivery system from both the ends of C2H was advocated.

Towards Reforming Health Provider Payment Methods: Evidence from Iran

Background: Equity of access to health and provider payment mechanism in healthcare is a worldwide debated. Healthcare reforms are primarily designed to improve productivity, economic efficiency and quality of care; however, an appropriate reimbursement of healthcare providers for services offered to patients and marinating a robust payment mechanism are not elucidated yet. Objectives: The current study aimed to develop a potential model of provider payment mechanism within and across different levels of healthcare delivery system in Iran. Methods: A three-stage, qualitative approach was carried out in 2013 to complete the study. In the first stage, a range of databases were used to extract evidence-informed literature pertinent to provider payment methods from 1990 to 2015, and to develop an interview guide. A purposive sample of 15 key healthcare executives was then selected to explore the provider payment mechanism in the Iranian healthcare system through semi-structured interviews and focused group discussions. A preliminary model of provider payment was developed, which subsequently scrutinized by using experts’ opinions through Delphi technique. Narrative analysis was used to analyze the data. Results: A hybrid model of provider payment was developed for various levels of healthcare provision. The model suggested the adjusted capitation payment method as the best possible payment method for the first level of healthcare delivery. A combination of diagnosis-related group (DRG) and pay-for-performance methods was proposed for the secondary and tertiary services across the country especially for in-patient care. Fee-for-service (FFS) payment method suited for out-patient services than other methods. Conclusions: No single payment method was emerged as the best predictor to accurately and fairly determine the providers’ payment, and to serve patients’ needs in all situations. A range of payment methods are required to be in place to tackle challenges faced by patients, providers, insurance companies and policy-makers.