Major Health Programs Research Articles

First Field Test of the Novel Integration Mapping Tool for COVID-19 Vaccination Integration into National Immunization Programs and Primary Healthcare-A Case Study from Côte d'Ivoire.

With the containment of the COVID-19 pandemic in Côte d'Ivoire, efforts were made to seamlessly integrate COVID-19 vaccination into the national immunization program. A collaborative initiative involving UNICEF, WHO, GAVI, and partner organizations resulted in the creation of the COVID-19 Vaccine Integration Mapping Tool. This paper presents a case study documenting the field testing of the integration mapping tool and assessing the integration of COVID-19 vaccination within primary healthcare and routine immunization in Côte d'Ivoire. The study aims to describe the pilot process, gather feedback on tool usefulness and challenges, and establish integration priorities through roadmap development. Under the guidance of the Ministry of Health and Universal Coverage Cabinet, a workshop was conducted with participants from major health programs to field test the tool. Data analysis was performed using Excel, and the results were presented through tables, heat maps, and line graphs. The first-of-its-kind field test of the integration mapping tool in Côte d'Ivoire showcased its potential to bring key partners together to discuss the current state of integration, improve transparency about resource allocation, and enhance data management for the incorporation of COVID-19 vaccination into existing immunization systems. The integration of COVID-19 vaccines in Côte d'Ivoire showed a moderate level of progress, with improvement needed in resource allocation, payment systems, targeting of highest-risk groups and vaccine administration. Support should be increased for target population identification, distribution points, quality of care mechanisms, and health personnel training. Health information systems and access to essential medicines were relatively satisfactory. Integration into existing programs, intersectoral collaboration, national health strategy, communication strategy, community participation, and data utilization require improvement. The post-workshop satisfaction survey gave the tool a score of 7 out of 10. Early lessons from Côte d'Ivoire provide guidance on enhancing integration, focusing on data-driven decision-making, collaboration, stakeholder engagement, and effective leadership. The field test of the integration mapping tool (IMT) in Côte d'Ivoire is groundbreaking as it exemplifies the transformative potential of innovative tools in immunization practices. Application of the IMT sets a precedent for seamless COVID-19 vaccination integration worldwide, emphasizing data-driven decision-making, collaboration, timing, and leadership. The success of the pilot exercise in Côte d'Ivoire was attributed to political commitment, well-facilitated workshops, assessments, and the fact that the team in the country had previously developed an initial integration plan.

Effectiveness of Dried Ginger On Dysmenorrhea Associated Symptoms Among Adolescent Girls at A Selected College of a South Indian Town – A Non-Random Pre-Experimental Design Study

Dysmenorrhea influences social, physical, and psychological well-being. Dysmenorrhea causes absenteeism from school, insomnia, nervousness, irritability, depression, and other symptoms. Adolescent girl health promotion is a significant component of the major health programs. Hence a study was planned to assess the effectiveness of dried ginger on dysmenorrhea-associated symptoms among adolescent girls at a selected college, Puducherry. Sixty patients who fit into the diagnosis of dysmenorrhea were selected. Six doses of 500 mg of dried ginger were administered for 48 hours, followed by an assessment of pain scores, and the difference was noted. The fact that there was an association between demographic variables and the intensity of the disease was noted. In the pre-test mean pain score level was 5.2 ±1.2. Whereas in the post-test, after the administration of dried ginger, the mean pain score level was 4.1 ±3.97. The effectiveness was statistically tested by paired t-test (t=1.37), which was found to be highly statistically significant at p < 0.001. There is a significant association between Dysmenorrhea associated symptoms with selected demographic variables like Type of family and dietary pattern. Whereas the other demographic variables are not effective with dysmenorrhea-associated symptoms

How viable is social health insurance for financing health in Zambia? Results from a national willingness to pay survey

In an era of considerable uncertainty about future prospects for development assistance to fund major health programmes in Sub-Saharan Africa, social health insurance is increasingly being considered as an alternative mechanism for increasing financing health. However, empirical support for social health insurance in sub-Saharan Africa remains sparse. The main aim of this study was to examine the viability of increasing health financing through social health insurance in Zambia. The paper uses a large nationally representative household survey to estimate the expected mean and total willingness to pay for social health insurance. The revenue potential of social health insurance for health sector funding is assessed. The results show that despite a high level of public support for social health insurance, with 80% willing to join a social insurance scheme, the estimated mean monthly willingness-to-pay is relatively low at Zambian Kwacha 55 (US$8.8 in 2014 dollars) per household. The evidence presented in this paper suggests that the revenue potential of social health insurance would not be sufficient to fund major improvements in quality of care for insured members, let alone cross-subsidize benefits to non-members.

AWARENESS, IMPLEMENTATION, UTILIZATION ON THE HI- IMPACT 5 PROGRAM IN EASTERN VISAYAS, PHILIPPINES

Background: One of the programs launched by the Department of Health (DOH) was the High Impact Five (HI-5) Program to intensify the implementation of the five major health programs namely infant care, childcare, maternal care, service delivery networks and HIV/ AIDS. Hence, it is important to assess the HI-5 program beneficiaries’ awareness, utilization and satisfaction as well as the program’s extent of implementation. Aim: The study aimed to determine the level of awareness, utilization, implementation, and satisfaction on the HI-5 Program in Eastern Visayas and to determine the relationship between variables. Methods: The study used descriptive correlation research design and survey questionnaires.Key informant interview and records review were used during the data collection process. Results: The study revealed that majority of the respondents were aware of the different HI-5 Program components with high to moderate utilization and satisfaction level on infant care, childcare, maternal care and service delivery networks components. However, the level of awareness, utilization and satisfaction levels were relatively low on the HIV/AIDS component. Likewise, there is a significant relationship found between the respondents’ level of awareness and utilization of the HI-5 program. Conclusion: The results of the study highlight the need to conduct further information dissemination campaign to increase the level of awareness, utilization, satisfaction and improve the extent of implementation on the HI- 5 Program among beneficiaries especially on the HIV / AIDS Component.

Health profile of school dropout children in slums of the municipal corporation area of a city

Background: Though the school health services cater to health needs to an extent, the children who drop out of schools lose on this count. These children never derive the attention for the reason of school dropouts nor are they covered under any major health programs pertaining to their health problems. The objective of the study were to study health profile of the school dropout children aged 7–16 years residing in the slums of municipal corporation area of Nanded city; to study socio-demographic factors of the families of these school dropout children.Methods: It was a community based cross-sectional study carried out in urban slums of Municipal Corporation of the Nanded city in Maharashtra on the children of age group 7 to 16 who dropped out from the school. Total 455 study subjects were studied by using simple random sampling method. A pre-designed and pre-tested questionnaire was used to collect information on socio demographic variables. Thorough clinical examination of each subject was carried out.Results: The mean age of study subjects was 14.2 (±1.9 SD) years. Out of total 455 study subjects, 264 (58%) were boys and 191 (42%) were girls. 11.20% study subjects were having skin infections, 25.71% were having dental caries, 3.29% were having ear impairment, 9.89% were having visual impairment, and 1.31% was having stammering of speech.Conclusions: Anaemia, skin infections, dental caries, visual impairment were major health problems noted in the school dropped out children. Poor socioeconomic status, religion, type of family, more number of children in the family was some sociodemographic factors responsible for school dropout.

Health systems in India.

Health systems and polices have a critical role in determining the manner in which health services are delivered, utilized and affect health outcomes. ‘Health' being a state subject, despite the issuance of the guidelines by the central government, the final prerogative on implementation of the initiatives on newborn care lies with the states. This article briefly describes the public health structure in the country and traces the evolution of the major health programs and initiatives with a particular focus on newborn health.

Monitoring service delivery for universal health coverage: the Service Availability and Readiness Assessment.

To describe the Service Availability and Readiness Assessment (SARA) and the results of its implementation in six countries across three continents. The SARA is a comprehensive approach for assessing and monitoring health service availability and the readiness of facilities to deliver health-care interventions, with a standardized set of indicators that cover all main programmes. Standardized data-collection instruments are used to gather information on a defined set of selected tracer items from public and private health facilities through a facility sample survey or census. Results from assessments in six countries are shown. The results highlight important gaps in service delivery that are obstacles to universal access to health services. Considerable variation was found within and across countries in the distribution of health facility infrastructure and workforce and in the types of services offered. Weaknesses in laboratory diagnostic capacities and gaps in essential medicines and commodities were common across all countries. The SARA fills an important information gap in monitoring health system performance and universal health coverage by providing objective and regular information on all major health programmes that feeds into country planning cycles.

Improving quality and use of data through data-use workshops: Zanzibar, United Republic of Tanzania

In Zanzibar, United Republic of Tanzania, as in many developing countries, health managers lack faith in the national Health Management Information System (HMIS). The establishment of parallel data collection systems generates a vicious cycle: national health data are used little because they are of poor quality, and their relative lack of use, in turn, makes their quality remain poor. An action research approach was applied to strengthen the use of information and improve data quality in Zanzibar. The underlying premise was that encouraging use in small incremental steps could help to break the vicious cycle and improve the HMIS. To test the hypothesis at the national and district levels a project to strengthen the HMIS was established in Zanzibar. The project included quarterly data-use workshops during which district staff assessed their own routine data and critiqued their colleagues' data. The data-use workshops generated inputs that were used by District Health Information Software developers to improve the tool. The HMIS, which initially covered only primary care outpatients and antenatal care, eventually grew to encompass all major health programmes and district and referral hospitals. The workshops directly contributed to improvements in data coverage, data set quality and rationalization, and local use of target indicators. Data-use workshops with active engagement of data users themselves can improve health information systems overall and enhance staff capacity for information use, presentation and analysis for decision-making.

Constraints and obstacles to social health protection in the Maghreb: the cases of Algeria and Morocco

Introduction Economic variables must be taken into account in any attempt to develop social health protection systems. However, such variables should not blind us to the importance of social protection as a civic right and as an effective way to improve the well-being of the population, with a resulting positive effect on the economy. Building or reforming social health protection systems involves a complex combination of political, social and technical factors and strategies. Reforms often call for major changes in resource allocation and in the distribution of power and thus evoke fear and resistance among small but powerful segments of society. This paper briefly describes attempts made by Morocco and Algeria to reform their social health protection systems. Evolution of social health protection systems The measures taken in Morocco to reform social health protection spanned the period from 2002 to 2006. Before 2002, several coexisting optional health insurance schemes covered only 17% of the population. A system of certificates of indigence was operating in parallel and still exists today. Individuals who consider themselves indigent may submit a request to local authorities to receive a certificate granting them access to subsidized hospital care in public facilities. Such a system is universally criticized for being plagued by serious malfunction. (1) In 2002, after several abortive attempts at reform, the Youssoufi government (1997-2002) pushed through a framework law (No. 65-00) on basic medical aimed at phasing in universal coverage for the Moroccan population. This law has two components: compulsory health insurance (Assurance maladie obligatoire, AMO) and medical care (Regime d'assistance medicale, RAMED) for persons in need. While the initial decrees on AMO, which were passed in 2005, only concerned the formal sector, in 2007 the Jettou government (2002-2007) extended coverage to self-employed professionals outside the AMO, through a plan known as Inaya. The RAMED, under pilot-testing in one province, had not yet come into being. With independence in 1962, Algeria inherited a fragmented social protection system with disparities in the population and services covered. Beginning in 1970, the government implemented a series of measures to harmonize and unify social protection schemes. Major health programmes were launched, and the decision to provide public sector health care for free was made in 1974. By 1983 this trend had been consolidated through the unification of social security plans. The nationalization of natural resources, the growth of oil revenues and the launch of a vast movement to industrialize the economy and pay fair salaries to the economically active population provided the foundations for the extension of social protection. This top-down way of building a broadened social protection system and health insurance plan was relatively successful for as long as the central government had substantial financial resources and continued to rapidly develop salaried employment in the public sector. The system covered almost all risks (disease, maternity, disability, death, retirement, work injuries, unemployment, etc.) for more than 85% of the population. In 1988, however, oil revenues slumped, marking the end of the social consensus based on the redistribution of income. This ushered in a protracted and exceptionally violent political, economic and social crisis. Economic constraints for Morocco Despite an annual increase of more than 4% in its per capita gross domestic product over the last decade, Morocco's economic status remains modest, with an annual per capita income still less than 2000 US dollars. Moreover, this economic growth has not significantly reduced the unemployment rate, which is 16% in urban areas, or the poverty level, with 15% of the population being poor and 23% economically vulnerable. …

Health Policy and the Bureaucracy: Politics and Implementation

In the past 50 years, the federal government has undertaken a dramatically expanded role in the health sector of our society. Many of its expanded initiatives have been based on relatively brief laws that set a broad policy direction but require extensive implementation actions by the executive branch or its designee. InHealth Policy and the Bureaucracy, Frank Thompson examines the way the bureaucracy shapes and effects the program by the way it implements the underlying law. Thompson's objective is a worthy one. Historically, the politics of health legislation have received considerable attention; the politics of health policy implementation have received less systematic attention. In his initial chapter, Thompson establishes a reasonable theoretical framework for examining policy implementation. Unfortunately, he then attempts to describe the implementation of eight major health programs consisting of The Hill Burton hospital construction (15 pages), Health Planning and Resources Development (20 pages), Health Maintenance Organizations