Health Facility Managers Research Articles

Examining patient choice and provider competition under the National Health Insurance Fund outpatient cover in Kenya: does it enhance access and quality of care?

BackgroundWhile patient choice and provider competition are predicted to influence provider behaviour for enhancing access and quality of care, evidence on provider perceptions and response to patient choice and provider competition is largely missing in low-resource settings such as Kenya. We examined provider and purchaser perceptions about whether patient choice and provider competition influenced provider behaviour and enhanced access and quality of outpatient care in Kenya.MethodsWe conducted a qualitative study to explore this across two purposefully selected counties. We conducted 15 in-depth interviews (IDIs) with health facility managers and National Health Insurance Fund (NHIF) staff across the two counties. We examined these across five areas summarised as either local market conditions or patient feedback following the Vengberg framework.ResultsNHIF members’ choice of outpatient facilities compelled private and faith-based providers to compete for members while public providers did not view choice as a way of spurring competition. Besides, all providers did not receive any information regarding the exit of NHIF members from their facilities. Providers felt that that information would be crucial for their planning, especially in enhancing service accessibility and quality of care. Most providers ensured the availability of drugs, provided a wider range of services and leveraged on marketing to attract and retain NHIF members. Finally, providers highlighted their redesign of service delivery to meet NHIF members’ needs whilst enhancing the quality-of-care aspects such as waiting time and having qualified health workers.ConclusionThere is a need for NHIF to share NHIF members’ exit information with providers to support their service delivery arrangements in response to NHIF members’ needs. Besides, this study contributes evidence on patient choice and provider competition and their influence on access and quality of care from a low-resource setting country which is crucial as NHIF transitioned to the Social Health Authority.

Emotional Intelligence and Professional Satisfaction: Insights for the Management of  Diagnostic and Therapeutic Technologists in Madeira

The management of health facilities is complex and challenging. It´s needed a harmonization between management and leadership, results and care provided. Leadership effectiveness is increasingly associated with emotional skills, capable of positively influencing the organizational culture, climate and performance of teams.  Professional Satisfaction (PS) emerges as a crucial indicator of the organizational environment that can impact an organization's results. This research explored the relationship between Emotional Intelligence (EI) and PS  and whether the EI and PS vary according to their sociodemographic and professional characteristics in Diagnostic and Therapeutic Technologists (DTT) in the Autonomous Region of Madeira (ARM). Using questionnaires, we sought to ascertain whether there is a correlation between EI and PS. Corroborating other data founded in the literature, it was not possible to establish a statistically positive correlation between these two variables. This study contributed to a better understanding of EI and PS in the DTT in the ARM, highlighting the importance of research in this region and group of health professionals.

Supporting Nursing Staff During Crises: Impact of Organisational Support Measures and Resources in Job Satisfaction in German Nursing Homes.

The COVID-19 pandemic placed an immense burden on nursing home staff, significantly increasing their workload. How the impact of these challenges on job satisfaction is mitigated by personal and social resources, along with organisational support measures initiated by nursing homes, is investigated in this study. In 2021, a cross-sectional survey was conducted among nursing home staff in Rhineland-Palatinate (n = 373). The questionnaire contained parts of standardised instruments (parts of the Copenhagen Psychosocial Questionnaire (COPSOQ), Brief Resilience Scale) and self-developed questions related to support measures such as training, psychological support and work organisation changes. The association of these support measures, as well as personal and social resources (e.g., resilience, social support, sense of community), with job satisfaction was explored. Descriptive, bivariate and regression analyses were conducted. While various support measures were offered to the nursing home staff, significant gaps remained. Training on hygiene and COVID-19 care was beneficial but not universally available. Similarly, psychological, pastoral and palliative support was lacking for a large portion of nursing home staff. Surprisingly, in the regression analysis, frequent information updates from supervisors were found to be negatively correlated with job satisfaction (p = 0.002). However, some personal and social resources (resilience (p = 0.002), social support (p = 0.001), sense of community at work (p ≤ 0.001), commitment to the workplace (p = 0.019), recognition by management (p ≤ 0.001)), and various support measures (training programmes (p = 0.005), changes in work organisation (p = 0.008), technical measures (p = 0.025)) were positively correlated with job satisfaction. This study highlights that despite the implementation of various support measures for nursing home staff during the COVID-19 pandemic, significant gaps remained. Notably, a substantial portion of staff members lacked access to crucial support services such as psychological, pastoral and palliative care. Furthermore, healthcare facility managers should prioritise the following support measures, especially during crises: comprehensive training, including resilience training; flexible working arrangements; and recognition for nursing staff. Ultimately, healthcare organisations should aim to create a supportive work environment that fosters a sense of community and belonging among their nursing workforce.

Integration of family planning into the primary health care in Ethiopia: results from national assessment

BackgroundFamily planning (FP) is part of Ethiopia’s essential health service package. However, integrating FP into other health care services is a relatively new concept. Integrated service can minimize missed opportunities and allow health workers to provide FP services and Reproductive, Maternal, Newborn, Child, Adolescent, and Nutrition (RMNCAH-N) services simultaneously. Thus, the objective of this study was to assess the levels of FP integration into maternal and child health (MCH) services at primary health care service delivery units in Ethiopia.MethodsThis was a facility-based cross-sectional study conducted from July to October 2022. We conducted a nationally representative survey of primary health care (PHC) facilities selected from seven regions and two-city administrations in Ethiopia to assess the current level of FP integration across four service delivery units (antenatal care unit, postnatal care unit, post-abortion care unit, and immunization unit) of the facilities. We collected data from selected health facilities through interview with health facility managers, healthcare providers in the selected service units, clients seeking health services, and extraction of data from facility records. We employed descriptive analysis, and categorized the degree of FP integration according to the FP information and services provided in the selected service delivery units.ResultsThis national FP integration survey included 122 health facilities (39 primary hospitals, 42 health centers, and 41 health posts) from seven regions and two city administrations. The study found a huge discrepancy regarding FP counselling given at ANC, PNC, PAC, and immunization service delivery units as reported by health care providers and clients. The proportion of PNC and immunization clients who received FP counselling was higher at health post compared to hospitals and health centers. Moreover, the proportion of PAC clients who received FP information was higher in primary hospitals compared to health centers.ConclusionData from facility records and provider interviews showed significant FP integration within ANC, PNC, and immunization units of PHC facilities. However, client exit interviews indicated low FP counselling integration. Facility records revealed few PNC and PAC clients received contraceptives in the past year. The study found high FP counselling and provision of at least one short- or long-acting contraceptive at PNC and PAC units. No facility offered contraceptives at immunization units, indicating missed FP integration opportunities.

Global Perspectives on Healthcare Waste Management and Bibliographic Mapping during the Crises of COVID-19

The lack of proper waste management of health care facilities can have a significant negative health impact on the global population. This study provides a critical view on the current state of the existing healthcare waste management practices used in healthcare facilities around the world during the Coronavirus disease 2019 (COVID-19) pandemic outbreak. The increasing amount of COVID-related healthcare waste was analyzed and classified to provide justification for the urgent need to develop waste management standards that ensure safe containment and diversion of hazardous and non-hazardous wastes through recycling, reuse and repurposing. The waste handling, treatment, and disposal management of healthcare waste from various COVID-infected locations such as homes, quarantine centers, camps, and hospitals have been reviewed. A total of 100 documents on COVID-19 related healthcare waste were published on the Web of Science database over the 2020-2022 period. Innovative solutions for effective waste treatment and disposal, related government policies and regulations, and literature survey supported by VOSviewer-aided detailed bibliographic analysis are presented and critically discussed. Thus, the present research output advocates for a paradigm shift towards circular economy principles in healthcare waste management, emphasizing waste reduction, recycling, and recovery, and encourages global cooperation to develop resilient, crisis-responsive waste management systems.

Common open source WebGIS platform for spatial and non-spatial data to enhance health services in Sri Lanka

This study explores the transformative potential and current limitations of Geographic Information Systems (GIS) in the context of Sri Lanka's health sector and broader development initiatives. Despite the global GIS market's expected growth to billions by 2025, driven by its adoption in infrastructure, urban planning, and the integration with emerging technologies, its application in critical areas such as public health, disaster management, and citizen services remains underutilized. This underutilization stems from a lack of ground-level information, limited knowledge of GIS capabilities, restricted access to essential geospatial data, and the high cost of GIS software. This paper discusses the significant hurdles in obtaining updated and comprehensive citizen, household, and health-related information, which impedes effective planning and decision-making within the health sector of Sri Lanka. It further examines the initiatives by the Ministry of Health, supported by the Asian Development Bank, to implement a GIS-based Health Mapping System focused on infrastructure and inventory management of health facilities, yet lacking in integrating critical citizen data for demand analysis of health services. The study underscores the necessity for a comprehensive "Geographical Citizen Information System for the Health Sector in Sri Lanka" akin to those in developed countries, to host, process, and analyze spatial and non-spatial information for enhanced policymaking and development planning. Through an analysis of current challenges and the exploration of potential solutions, this paper advocates for an integrated approach to harness the full capabilities of GIS technologies, thereby enabling more informed and effective governance in Sri Lanka’s Health sector.

The Development of Operational Model Integrating Digital Technologies into Public Mental Healthcare Services in Nigeria

The availability and utilization of digital technologies can leverage the challenges of the sharp-depleting workforce due to the consistent migration of healthcare professionals (HCPs), the alarming ratio of the number of patients to HCPs, discretional use of digital technologies among HCPs in providing effective therapeutic interventions and mental healthcare services. This study aimed to develop an operational model that integrates digital technologies in mental healthcare service delivery for public facilities in Nigeria. The practice-oriented theory guides the development of the model. A qualitative method assessed the digital technologies used during the COVID-19 pandemic. A non-probability, purposive sampling technique that employed the snowball method was used in selecting the sixteen (16) HCPs from four (4) neuropsychiatric hospitals in South-West Nigeria. Thematic analysis was conducted on qualitative data. Findings from the qualitative analysis revealed several challenges in providing adequate and efficient services in public mental healthcare facilities in Nigeria, such as human resource challenges, brain drain, lack of infrastructure, and strains on HCPs. Findings from this study indicated that digital technologies are sparingly utilized in public mental healthcare service delivery due to a lack of policy and framework. HCPs perceive digital technologies to be beneficial to themselves and their clients. The highlighted benefits to patients are reduced stigmatization levels, decreased financial burden, enhanced accessibility to therapists, strengthened adherence, mitigated relapse incidences and improved intervention. The transition from the traditional/conventional space of mental healthcare service delivery to digital space requires a collaborative approach with Computer scientists (software developers, database administrators), Data scientists, investors, stakeholders and mental HCPs. The proposed model serves as a contemporary framework that the Government, policymakers in the Ministry of Health and management of mental health facilities in Nigeria can adopt, providing the needed awareness of the benefit of technological intervention.

УПРАВЛІННЯ ЛЮДСЬКИМИ РЕСУРСАМИ ЗАКЛАДІВ ОХОРОНИ ЗДОРОВ’Я

Introduction. Significant changes in the functioning of the health care sector determined the transition to a new management system, which is reflected in the management of health care facilities in general and in the management of human resources in particular. The modern development of high technologies leads to the transformation of work and the structure and quality of human resources. The requirements for the professional and qualification level of employees, work discipline, experience, individual characteristics and soft skills, the ability to master new knowledge and acquire new skills are increasing. Therefore, the role and place of a person in the organization is growing and there is a need to change approaches to human resource management. The purpose of the article: substantiation of the theoretical and methodological provisions of human resource management of health care institutions Results. Based on the generalization of domestic and foreign works, the definition of human resources of the organization as a determining factor and the driving force of its development, which combines personal, business, professional qualities, the totality of which, with their continuous development, ensures strategic competitive advantages of the organization, has been clarified. The author's vision of the grouping of requirements for employees of health care institutions based on the competence approach, which takes into account such groups of criteria as basic (the same for all employees within a certain category), professional and general competencies (which can differ significantly even within the same category of employees) is substantiated ). The essence of human resources management as a set of methods, approaches, technologies for creating the necessary conditions and motivation of the organization's employees for the formation, development and realization of personal, business, and professional potential for achieving the goals of the organization, ensuring its competitiveness on the one hand, and the interests of employees on the other is specified. The methodological basis of human resources management has been improved based on the symbiosis of elements of basic concepts and models that determine the fundamental principles, criteria and approaches that take into account modern changes in the environment of organizations, the nature of work, requirements for employees and their positioning as a subject of the management process. The methodological aspects of human resources management have been developed, namely, criteria (competitiveness of human resources, human potential, efficiency of its use, optimal staffing), approaches (complex , institutional, structural-functional, functional, systemic, synergistic), which maximally take into account the specifics of the functioning of organizations. A conceptual model of human resources management has been developed, the main difference of which is the orientation to the person in all its manifestations and the creation of conditions for the development and realization of the personal, business, and professional potential of employees to achieve their own goals and the goals of the organization's development, ensuring its competitiveness. Conclusions. Human resources of the organization are the driving force of its development. They include personal, business, professional qualities. Human resources management consists in creating the necessary conditions and motivating the organization's employees to form, develop, and realize their personal, business, and professional potential to achieve the organization's goals, ensure its competitiveness on the one hand, and the interests of employees on the other.

Determinants of health-seeking behaviour in rural district of Jasikan, Ghana: a cross-sectional study

BackgroundThe Ghana Health Service aims to ensure the health of all Ghanaians. Understanding the factors that influence people’s health-seeking behaviour will help the Ghana Health Service evaluate and enact policies that will enable it to achieve set targets. This research aimed to determine the factors that influence the health-seeking behaviour of the residents of Jasikan District and ascertain the importance of the well-being clinic in this context.MethodsThe study design was a community-based cross-sectional study using a mixed method of data collection. A stratified sample of 295 respondents from the five [5] sub-districts of the target population was obtained. Cramer’s V statistic was used to assess the effect size and significance of the association between categorical variables. Further, multiple binary logistic regression was used to determine significant predictors of health-seeking behaviour. Health seeking behaviour was categorised as appropriate or inappropriate. The health seeking behaviour of participants was considered appropriate if they sought health care at public health facilities, private health facilities, and licensed Pharmacies/OTCMS and inappropriate when participants sough care at traditional/faith healers, engaging in self-medication, and not taking action during an illness episode.ResultsThe mean age of participants in the study was 37.49 ± 15.74 years. Females comprised the majority of study respondents (160; 56.3%). When they fell ill, 61% of respondents chose formal public health institutions as the first port of call. A significant proportion of respondents (245; 83%) preferred appropriate health-seeking behaviour, with age (p = 0.045) and health insurance status (p < 0.01) significantly influencing where respondents sought care. More than half of respondents indicated that affordable service (59.9%), readily available drugs (54.5%), and good services (52.0%) are key characteristics of respondents’ preference for service in healthcare. The educational level significantly correlated with service characteristics when people seek health care (p = 0.035). The severity of illness (9; 28.1%), perception of a facility as the best place (7; 21.9%), well-trained staff (4; 12.5%), and professionalism (3; 9.4%) influenced respondents’ choice of health care. More than half (78%) of respondents agreed with the need for a well-being clinic in a hospital. The binary logistic regression indicates that religion is a significant predictor the appropriateness of participants’ health seeking behaviour, but the overall model could not improve the overall prediction rate of the constant model.ConclusionThe health-seeking behaviour of the people of Jasikan is good. The participants’ sex, good service, affordability, and availability of medicines are critical service characteristics that influence the choice of healthcare providers. Managers of health facilities should consider these characteristics to remain competitive and drive positive health-seeking behaviour in the community. Facilities are encouraged to set up a functional well-being clinic and open it to the public.

Transforming leaders to transform hospitals. Cultivating ethical leadership for compassionate healthcare

The importance of compassionate care has been widely acknowledged in the literature as a crucial component for enhancing patient care, improving clinical outcomes, and reducing burnout, compassion fatigue, malpractice, and healthcare costs (Watts et al., 2023). However, many healthcare systems continue to struggle with effectively implementing and sustaining compassionate care practices due to the burden of administration, limitations in resources, and a focus on efficiency and profitability. The purpose of this paper is to advocate for the necessity of (re) “humanizing” the healthcare environment, which is urgently needed today to counteract the trend of eroding the value or essence of care practices by refocusing on the patient and their family. Specifically, this paper will argue that to reverse this trend, it is crucial to transform the education of healthcare facility leaders and managers at all levels. It is vital to provide them with guidelines and training that is not only technical but also ethical, with a focus on character education. This approach would enable them to recognize the right values and effectively address complex situations from a moral perspective. Providing leaders with the opportunity to flourish through dedicated programs can positively transform our hospitals and healthcare facilities. Such programs are essential for creating a balanced healthcare environment where efficiency and compassionate care coexist, leading to improved care outcomes, reduced costs, and enhanced well-being for professionals.

Artificial intelligence in healthcare facilities asset information management: mixed review

Healthcare facilities are pivotal in ensuring continuous access to services, particularly for individuals with complex health conditions. Effective asset information management (AIM) in these facilities through artificial intelligence (AI) can enhance operational efficiency. The exploratory bibliometric and systematic review assesses the status and trends of AI applications in AIM within healthcare facilities. The findings reveal a significant gap between research findings and practical implementation, highlighting the need for further integration and real-world usage of AI-powered solutions in healthcare facilities settings. This study identified notable gaps, including the need for research on utilising AI to enhance asset management in healthcare, including maintenance scheduling and procurement processes. Involving stakeholders, such as healthcare professionals, facility managers, and patients, in effective facility management using AI requires further investigation. Research is needed to evaluate the economic benefits and develop robust ethical guidelines for responsible AI implementation. Notably, previous research has given limited attention to AI for healthcare AIM, with emerging trends focusing more on AI and infrastructure than the ‘asset’ aspect. Implementing AI-powered solutions tailored to the unique needs of healthcare facilities and evaluating cost-effectiveness will lead to improved asset management practices, enhanced decision-making processes, and, ultimately, more efficient and effective healthcare operations.

Pay for a free service, access to cesarean section in the slums of Dakar

BackgroundIn sub-Saharan Africa, equitable access to cesarean section remains a major challenge for reducing maternal and neonatal mortality, particularly among disadvantaged populations. This situation is further exacerbated in slums, where women face significant financial barriers to accessing expensive healthcare services, such as cesarean. Within this context, this paper aims to study access to emergency cesarean services among women living in the slums of Dakar, considering the free cesarean policy implemented in Senegal since 2005.MethodQuantitative data were collected using a cross-sectional retrospective approach, from 18 health facility managers and 260 women living in slums in Dakar who had undergone cesarean delivery between July and December 2022. The surveys aimed to collect socio-demographic data on women and the costs they paid to have a cesarean section, as well as on the application of the policy of free caesarean sections by public health facilities. The data were processed using Stata.ResultsThe results indicated that poor women residing in Dakar slums do have access to emergency cesarean section services in public health facilities. However, a significant portion of these women come from impoverished households and lack higher education, making them more vulnerable to financial constraints when seeking a C-section. Despite cesarean sections being performed primarily based on medical necessity, regardless of the woman's economic status, ethnicity, or educational background, women often find themselves having to pay substantial amounts to undergo the procedure. This is particularly concerning, as cesarean sections are intended to be entirely free in public health facilities in Senegal. Health facility managers attribute this financial burden to the State, which recurrently delays reimbursements for cesarean sections, forcing them to charge women higher prices for the procedure.ConclusionA more rigorous enforcement of the policy for free cesarean section could greatly enhance access to this obstetric practice for women living in the slums of Dakar.

Evaluation of the feasibility, acceptability, and impact of Group Antenatal Care at the health post level on continuation in antenatal care and facility based delivery in Ethiopia using a cluster randomized stepped-wedge design: Study protocol

Background Adequate antenatal care (ANC) and facility-based delivery are linked to improved maternal and neonatal outcomes. Adequate antenatal care attendance and facility birth rates are increasing in Ethiopia but remain well below national goals and global recommendations. Group ANC (G-ANC), when implemented at higher level facilities, is associated with improved quality and experience of ANC, and increased ANC retention and facility-based delivery. The objectives of the study are to assess the feasibility, acceptability, and impact of G-ANC implemented at lower-level facilities (health posts) on ANC continuation and facility-based delivery. Methods G-ANC will first be piloted in five purposively selected health posts. The study will then use a stepped-wedge design in 36 health posts under six health centers, with randomization of the order of the start of the intervention done at the health center level (clusters). The design will include three time periods: first is a six-month control period with no G-ANC implementation, followed by another six months period where G-ANC will be introduced in half (n=18) of the study health posts, then final six months where G-ANC will be implemented in the remaining 18 health posts. Quantitative and qualitative data collection approaches will be used. The study has “pause and reflect” points designed to iterate on the intervention before rolling out to the next set of sites. Qualitative research will be conducted using in-depth interviews with pregnant women, health care workers, facility managers, and regional health managers. 770 women will be enrolled across all phases. Conclusions The study will inform decision makers locally and globally on whether G-ANC is a feasible service delivery model at the health post level. Effectiveness of G-ANC at increasing ANC retention and facility-based delivery will be reported, as well as its acceptability to pregnant women and Health Extension Workers. Registration NCT05054491, ClinicalTrials.gov (September 23rd 2021).

Total quality management, supplier quality and operational efficiency in the public health sector in the Upper East Region of Ghana

The purpose of this study was to examine the role that Total Quality Management (TQM) plays in ensuring operational efficiency via supplier quality in public health sector in the Upper East Region. Specifically, the study examined the effect of TQM on supplier quality; effect of TQM on operational efficiency; effect of supplier quality on operational efficiency and finally assessed the mediating role that supplier quality plays in the relationship between TQM and operational efficiency within these health sectors in the Upper East region. Structured questionnaire was utilized to solicit primary data from the study’s respondents. The selection of 174 sampled respondents from the total population of 352 public health facilities were done using a simple random sampling procedure. Also, version 24 of the IBM SPSS software and the SmartPLS model was utilised to process the data. The demographic characteristics of the respondents were analysed with the help of descriptive tools such as means and standard deviation, while inferential statistical tools was employed in testing the cause-and-effect hypothesised relationships between the variables. The findings revealed that total quality management had a positive significant effect on supplier quality. Likewise, the objective two showed that total quality management had a positive statistically significant effect on operational efficiency. The third objective showed that supplier quality had a positive statistically significant effect on operational efficiency, and the fourth research objectives revealed a positive statistically significant mediating effect of supplier quality in the relationship between total quality management and operational efficiency. The study recommended that, management of health facilities within the Upper East region should emphasize on putting measures in place to ensure the improvement of their TQM practices to help set standard that will ensure that suppliers goods and services conform to quality standards

Technical efficiency of ghanaian health facilities before and during the COVID-19 pandemic

PurposeUnderstanding the technical efficiency of health facilities is essential for an optimal allocation of scarce resources to primary health sectors. The COVID-19 pandemic may have further undermined levels of efficiency in low-resource settings. This study takes advantage of 2019 and 2020 data on characteristics of health facilities, health services inputs and output to examine the levels and changes in efficiency of Ghanaian health facilities. The current study by using a panel dataset contributes to existing evidence, which is mostly based on pre-COVID-19 and single-period data.MethodsThe analysis is based on a panel dataset including 151 Ghanaian health facilities. Data Envelopement Analysis (DEA) technique was used to estimate the level and changes in efficiency of health facilities across two years..ResultsThe results show a net increase of 26% in inputs, influenced mostly by increases in temporary non-clinical staff (131%) and attrition of temporary clinical staff and permanent non-clinical staff, 40% and 54% respectively. There was also a net reduction in output of 34%, driven by a reduction in in-patient days (37%), immunization (11%), outpatients visits and laboratory test of 9%. Nowithstanding the COVID-19 pandemic, the results indicate that 59 (39%) of sampled health facilities in 2020 were efficient, compared to 48 (32%) in 2019. The results also indicate that smaller-sized health facilities were less likely to be efficient compared to relatively bigger health facilities.ConclusionBased on the findings, it will be essential to examine factors that accounted for efficiency improvements in some health facilities, to enable health facilities lagging behind to learn from those on the efficiency frontier. In addition, the findings emphasise the need for CHAG to work with health facility managers to optimise inputs allocation through a redistribution of staff. Most importantly, the findings are suggestive of the resilience of CHAG health facilities in responding to a health shock such as the COVID-19 pandemic.

The Nexus between Environmental Factors and Behaviour Change in the Upper East Region of Ghana: The Mediating Role of Marketing Strategies

This study aimed to explore the mediating role of marketing strategies in the relationship between environmental factors and behavior change in healthcare utilisation. A cross-sectional survey design was conducted using a random sampling technique to select 474 healthcare workers from six Health Directorates across Municipalities and Districts in the Upper East Region of Ghana. The target population from which the sample size was determined was 1980. The theories that guided this study were the Health Belief Model and the Theory of Planned Planned Behaviour. A structured questionnaire was designed using a five-point Likert scale and administered to the respondents. The data was collected over three months from February to April. A Structural Equation Model (SEM) with AMOS was employed to analyse the data. Findings revealed that marketing strategies mediate the relationship between environmental factors and behaviour change. The predicted hypotheses were found to be positive and significant. The study highlights the importance of marketing strategies in disseminating health-related information, which influences positive behaviour change toward healthcare utilisation. The study found that marketing strategies play a crucial role in disseminating health information and promoting behaviour change. The mediating role of marketing strategies in the relationship between environmental factors and behaviour change was established. All hypotheses were confirmed, demonstrating the key role of marketing strategies in improving health outcomes through behaviour modification. It is recommended that healthcare facility managers consider incorporating marketing strategies into their strategic plans to optimise outcomes.

Beliefs of Pentecostal pastors on the use of antiretroviral treatment among Pentecostal Christians living with HIV in a suburb of Cape Town-South Africa: a community health systems lens.

The global public health community accepts antiretroviral therapy (ART) for controlling and managing human immunodeficiency virus (HIV). However, within some communities, claims of faith or miraculous healing of HIV and acquired immunodeficiency syndrome (AIDS) by Pentecostal pastors continue to spark controversies. This paper reports on an exploratory qualitative study to explore the beliefs held by Pentecostal pastors regarding the use of ART among Pentecostal Christians who are living with HIV. Twenty (20) purposively selected Pentecostal pastors from two informal settlements in Cape Town, South Africa, participated in the study. Open-ended, semi-structured, in-depth individual interviews were conducted on their religious beliefs concerning ART adherence. Interviews were conducted in English, audiotaped and transcribed verbatim before being imported into the Atlas.ti 2023 software program for thematic data analysis. Since our study was guided by the relational community health system model a hybrid deductive-inductive thematic analysis was used. Two contrasting themes about the influence of the religious beliefs of Pentecostal pastors were identified. The first theme and its associated subthemes highlight the lack of basic HIV and ART knowledge among pastors. Consequently, these pastors tend to nudge their Christians to rely more on faith and spiritual healing at the expense of adherence to ART. The second theme and its related sub-themes suggest that some pastors possess some basic HIV knowledge and understand the role of ART and how it works. This group of pastors advise their congregants to use ART and other healthcare services in tandem with spiritual rituals, faith and prayers. Our findings highlight the need for functional community-based structures, such as community health committees and health facility management committees, in settings where complex interaction within the belief systems, practices and norms of some stakeholders can influence people's health-seeking behaviours such as adherence to chronic medications like ART.

The impact of the nurse practice environment, workload, and professional support on job outcomes and standards of care at primary health care clinics in South Africa: A structural equation model approach

BackgroundThere is substantial evidence on the associations between a positive nurse practice environment and improved nurse and patient outcomes, as well as the factors that mediate these associations, in high-income countries and in hospital settings. The knowledge gaps in African and primary health care settings motivated this empirical study. ObjectiveThe objective of this study was to examine the impact of the dimensions of the nurse practice environment, specifically human resource management, foundations for nursing care, and participation in clinic affairs, on job outcomes and standards of care. DesignA cross-sectional study was conducted between November 2021 and June 2022. Setting180 primary health care clinics in two South African provinces of Gauteng and North West. Participants665 nurses of all categories. MethodsA causal model was developed with pathways between the nurse practice environment dimensions and the outcomes of job satisfaction, intention to leave, and standards of care. A set of standardised instruments was used to measure the study variables. Using structural equation modelling, workload and professional support were tested as potential mediators between the nurse practice environment and the outcome variables. ResultsThe nurses scored the domain of foundations for nursing care 71.2 out of 100 on average, indicating high agreement, while the mean scores for nurses’ participation in clinic affairs and human resources management were lower at 68.0 and 61.7 respectively. Although nurses expressed moderate satisfaction with professional support (67.7), they were less satisfied with their workload (52.2). The mean score of overall job satisfaction was moderate (58.9), with 53.8 % of the nurses reporting that they intended leaving the clinic where they were working. Thirty-six percent intended leaving the nursing profession, indicating low intention to stay. The final mediation model was judged to fit the data adequately based on goodness-of-fit indices, confirming that workload and professional support had a mediating role between the nurse practice environment dimensions of interest and both nurses’ job outcomes and standards of care. ConclusionsWe have highlighted the value of supportive practice environments, effective workload management, and enhanced professional support in improving nurses’ job outcomes and satisfaction with standards of care. Improving nurses’ practice environments at primary health care level may have a wide-ranging impact on the performance of the health system. Therefore, primary health care facility managers should ensure that workload is distributed equitably, professional support for nurses is enhanced, and the overall work environment is improved.

Electrical Safety in Public Healthcare Facilities and Medical Devices Management

In hospitals, electrical hazards pose a serious risk that needs to be continuously assessed and improved. Medical surveillance systems and workplace assessments are frequently disregarded, and workers do not follow workplace instructions on safety precautions. The events are linked to a lack of understanding about the significance of electrical dangers and workplace safety and public health. Ignoring these evaluations could have negative effects on one's health, the quality of one's work, handicap, and impairment. The perspective of occupational safety and health on electrical dangers in hospital settings is described in this paper. Additional preventive actions were suggested in order to provide a list of workable and realistic actions that would create a safer and healthier workplace.

Suggested solutions to barriers in accessing healthcare by persons with disability in Uganda: a qualitative study

BackgroundThere are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possible solutions and recommendations to address the existing barriers to access to healthcare for persons with disabilities in rural Uganda.MethodsWe conducted 27 semi-structured interviews with individuals with various disabilities in rural Luuka district, Eastern Uganda, between September and November 2022. The participants included individuals with visual impairment (n = 5), physical impairment (n = 5), hearing impairment (n = 6), multiple impairments (n = 5), intellectual/cognitive impairment (n = 5), and albinism (n = 1). Interviews were recorded, transcribed verbatim, and thematically analysed. We categorized the solutions using the Missing Billion disability-inclusive health systems framework.ResultsOur findings, framed within the health systems framework, revealed several critical themes. On the demand side, suggested solutions emphasized advocacy and sensitization for persons with disabilities, their communities, and caregivers about healthcare needs. Socio-economic empowerment and community-based health services were also highlighted as essential. On the supply side, participants stressed the importance of training healthcare workers on disability, facilitating dialogue and experience-sharing sessions, and employing health workers with disabilities. Additional recommendations included improving accessibility and reasonable accommodation, organizing inclusive services like special clinic days and outreaches, ensuring representation in health facility management, and establishing comprehensive rehabilitation services with affordable assistive devices.ConclusionThe multifaceted solutions proposed by persons with disabilities highlight the complex challenges they face in accessing healthcare services and highlight the necessity for comprehensive, sustainable interventions. The call to action for policymakers and healthcare providers is to prioritise the incorporation of disability-inclusive practices and explore multi-dimensional approaches that foster a more inclusive healthcare environment that adequately meets the needs of persons with disabilities.