Management Of Health Care Services Research Articles

Patients' experiences on accessing health care services for management of hypertension in rural Bangladesh, Pakistan and Sri Lanka: A qualitative study.

Hypertension is the leading risk factor for cardiovascular disease and leading cause of premature death globally. In 2008, approximately 40% of adults were diagnosed with hypertension, with more than 1.5 billion people estimated to be affected globally by 2025. Hypertension disproportionally affects low- and middle-income countries, where the prevalence is higher and where the health systems are more fragile. This qualitative study explored patients’ experiences on the management and control of hypertension in rural Bangladesh, Sri Lanka and Pakistan. We conducted sixty semi-structured interviews, with 20 participants in each country. Hypertensive individuals were recruited based on age, gender and hypertensive status. Overall, patients’ reported symptoms across the three countries were quite similar, although perceptions of hypertension were mixed. The majority of patients reported low knowledge on how to prevent or treat hypertension. The main barriers to accessing health services, as reported by participants, were inadequate services and poor quality of existing facilities, shortage of medicine supplies, busyness of doctors due to high patient load, long travel distance to facilities, and long waiting times once facilities were reached. Patients also mentioned that cost was a barrier to accessing services and adhering to medication. Many patients, when asked for areas of improvement, reported on the importance of the provider-patient relationship and mentioned valuing doctors who spent time with them, provided advice, and could be trusted. However, most patients reported that, especially at primary health care level and in government hospitals, the experience with their doctor did not meet their expectations. Patients in the three countries reported desire for good quality local medical services, the need for access to doctors, medicine and diagnostics and decreased cost for medication and medical services. Patients also described welcoming health care outreach activities near their homes. Areas of improvement could focus on reorienting community health workers’ activities; involving family members in comprehensive counseling for medication adherence; providing appropriate training for health care staff to deliver effective information and services for controlling hypertension to patients; enhancing primary health care and specialist services; improving supplies of hypertensive medication in public facilities; taking into account patients’ cultural and social background when providing services; and facilitating access and treatment to those who are most vulnerable.

Clinical Supervision Training to Increase Nurses’ Work Performance in Hospitals

A common problem often faced by healthcare service management is the difficulty in finding qualified nurses. Training is one of the characteristics of an organization that has a positive impact on increasing professionalism and the work performance of nurses at the hospital. Improving supervision is a method to monitor the quality of services by hospital supervisors. This study attempts to determine the effect of clinical supervision training as one of the organizational characteristics on increasing the work performance of nurses at the hospital. The quasi-experimental study design was used in this study with 68 nurses who were working in a hospital in Banjarmasin. The observation was carried out before and after training. The dependent variable in this study is clinical supervision training, and the independent variable is work performance. Univariate, and bivariate were used in data analysis. There was an effect of clinical supervision training as one of the organizational characteristics on increasing the work performance of nurses at the hospital (p=0.00). Clinical supervision training increased work performance on clinical supervision abilities. Nurse training improved the quality of healthcare services, especially nursing care. © 2019, Indian Journal of Public Health Research and Development. All rights reserved.

Evaluation of Primary Healthcare from the perspective of child caregivers: an integrative review.

To identify the quality evaluation of Primary Healthcare services in the literature from the perspective of child caregivers through applying the PCATool, children's version. An integrative review performed in the MEDLINE, CINAHL, LILACS, BDENF and Web of Science databases. Seventeen (17) articles were selected. All included studies were descriptive (100%) and had evidence level IV (100%). The affiliation degree component (average = 7.72) of the longitudinality attribute, the utilization component (average = 7.14) of the first contact access attribute, and the information system component (average = 6.63) of the coordination attribute presented high average scores (≥6.6), while the other attributes and components obtained low average scores (<6.6). Although management of Primary Healthcare services has consistently applied efforts to improve their performance and quality in providing and delivering care to the population, it has been observed that problems related to the process and structure of these services still persist given that most of the attributes were poorly evaluated.

The origins of canada healthcare system and key principles for its effectiveness

Aim of investigation. This article describes the origins and key principles for Canada’s healthcare system effectiveness. The focus revolves around the general principles of the sphere of medical care; namely, the orderly process of defining health problems, identifying unmet needs and surveying the resources to meet them, establishing priority goals that are realistic and feasible, and projecting administrative action, concerned with the adequacy, efficacy and efficiency of health services in Canada. The author outlines the dominant principle of the Canadian healthcare system; while complying with the international standards, it provides a highlyqualified medical care, furthermore, both high life expectancy and low infant mortality rates testify to this reality. Noteworthy, the bases of social organization and healthcare system in Canada were grounded in late twentieth century. The fact that the Second World War hardly ever devastated both country’s economy and the nation testifies to the public health system, being established in quite favorable conditions. In addition, the demography of Canadian population, being quite stable and favorable, prompted the economy to rapidly develop as well as the government political decisionmaking to push to review its existing healthcare law principles and start reforming it, so that the country can respond better to its health and health system challenges. It should be emphasized that the Medical Care Act (1966), which, along with the Hospital and Diagnostic Services Act (1957), established the basis for Canada’s universal, publicly financed health insurance system, known as Medicare, effectively enshrined private fee-for-service practice as the dominant mode of practice organization and physician payment in Canada. Canadian Healthcare system establishment fell into several stages: the first stage (in early 40’s of the 20th century), the provision of targeted subsidies for special programs of health care and for the construction of hospitals were legally approved, since a growing number of Canadian citizens were able to obtain a level of decent health care through Canadian hospitals. The second step was taken in 1957, the Hospital Insurance and Diagnostic Services Act (HIDS) were passed with all-party approval; it paid approximately half the cost of provincial insurance plans for hospitalbased care, as long as the plans complied with specified national conditions. Medical Care Act of 1966 extended health insurance to cover doctors’ services. While the basic principles of Medicare are determined by federal legislation, responsibility for health under the Constitution falls under provincial jurisdiction. Therefore, there are certain variations in the plan from province to province. It is not surprising that the first breakthrough of the legal framework contributed to the development of hospitals network in the country; at the same time, medical care qualitative indicators were complied with the national requirements. The third stage (1968-1979) covered the adoption of the legislative documents that formed the Canadian system of medical insurance for Medicare and established the allocation of funds for hospital and community-based medical care. In 1984, a Health Care Act was adopted in Canada, which consolidated the basic principles of Medicare. Medical care had always been a centerpiece of Canada’s welfare state program, since it expected the provincial and territorial governments to be responsible for the management, organization and delivery of health care services for their residents. The specifics of the theme predisposed application of comprehensive approach to the research methodologies, among which there should be mentioned such as: structural-functional analysis, which includes the study of functional dependencies of all elements of the social state. Adhering to the problematic principle of presentation of the material, the author used the institutional method, focused on the study of institutes through which the activities of the health protection system are implemented. At the same time a number of such special methods were used as statistical retrospective and prognostic. Scientific novelty: the mutual precondition of socio-economic, demographic, socio- political factors on the process of formation of the Canadian system of medical services was substantiated , the reasons and the4 main stages of the formation of free medicine in Canada were determined, as well as advantages and disadvantages of the modern Canadian health system. Conclusions An important conclusion of this review is that the Canadian healthcare system also has a spectrum of drawbacks that require bridging the gaps. Currently Canada’s healthcare system faces challenges of staff shortage and access to health care. Nonetheless, it should be emphasized that Canada’s Medicare is a source of pride, funded by the state and provides universal health care coverage care to all residents of Canada.

Managing the Patient Evidence Base Through Trauma Cases in Military University Hospital of Albania

The level of management of traumatic health care services in Albania as a service of the Military University Hospital in Emergency Care differs in relation to other university hospitals across the country, mainly due to changes in the public health of the population. The article aims to present the management of traumatic patients at the Military Hospital in Albania, providing examples of the number of cases that have been addressed in the spread of this disease as epidemiology in Albania. The literature review and data statistics will be carried out by using the hospital records that will be used for further research in Albania. In addition, there is a study of international reports on Trauma management issues, trauma care and quality in Trauma. Much of the results consider the necessity of adopting a comprehensive traumatic system, focusing on quality management and improving trauma care to increase survival and reduce complications to the wounded. Urban conditions and public health policies are the most important factors in developing and implementing programs to improve emergency trauma care services. The heterogeneity of the population and its geographical distribution, the complexity of road accidents, are challenging factors for quantitative research on trauma management and the effectiveness of its care. Staff training in all areas, combined with the existence of modern vehicles and equipment, means of communication and timely transfer of the ambulance, contribute to the treatment of patients with urgent trauma, life saving and prevention of all types of disabilities.

Interprofessional education at the meso level: taking the next step in IPE

ABSTRACTThe downstream demand for professionals with competence in Interprofessional Collaboration (IPC) has contributed to the substantial growth in the upstream demand for interprofessional education (IPE). The majority of IPE programs focuses exclusively on direct care practitioners and seldom include those responsible for the administration and management of care. Unfortunately, complex reimbursement mechanisms along with the multiple agencies and departments regulating the delivery, evaluation, and reimbursement of care can result in unintended barriers to IPC and eventually IPE. The Healthcare Services Planning and Management Program (HSPMP) is an innovative model of IPE that was designed to improve system wide collaboration among those responsible for the reimbursement, management and administration of the delivery of care. Although HSPMP was not developed in the US, this innovative model has the potential to develop the systemic integration needed to break down the barriers to the delivery and evaluation of IPE and IPC. The aim of this article is to introduce HSPMP to the US as a model of IPE that could help facilitate better integration of the US health care system and help to reduce some of the consequences resulting from the current fragmented system of care.

Information System of Nationwide Population-Based Cancer Screening in Taiwan

Background: Pap smear screening was the first nation-wide population-based organized screening since 1999 in Taiwan. After that, nationwide screening programs for breast cancer, colorectal cancer, and oral cancer have been launched since 2004. The national online information system was built for the infrastructure, monitoring, delivery, evaluation, and management of health care services in our nationwide screening program. Aim: To develop a comprehensive health information system for cancer screening to assist health professionals in processing screening with quality assurance and evaluation. Methods: A Web-based solution combining data gathering and processing capabilities was developed. Application design in a server was based on the ASP, HTML, DHTML, Java Script, Java Applet technology and SQL-SERVER relational database. Web-based software programs were developed to facilitate the structure, process, and outcome for screening. Individual screening data were transferred to centralized databases via the Internet. The client-users now include 25 health bureaus, 369 health centers and over 6500 clinics or hospitals. Results: The Taiwanese cancer screening system incorporates nationwide breast cancer screening with mammography, colorectal cancer with fecal immunochemical test, oral cancer with visual inspection. The key performance index for screening including screening rate, positive rate, referral rate, positive predictive rate, detection rate, and interval cancer rate were provided in the system. The system allows for the flow of information among different health services and country areas to monitor participants in the whole process screening. It has an alert system to prevent delayed referral for cases in need of diagnosis and treatment. A total of 2.27 million women aged 45-69 years have attended biennial mammography screening program at least once between 2004 and 2014. More than 4.6 million subjects with the exposure of betel quid and/or cigarette have attended the biennial oral cancer screening. Around 3.8 million subjects aged 50-74 years have attended the biennial FIT screening. Information on organized features appertaining to screening, diagnosis, and outcomes after long-term follow up were collected for the systematic evaluation. The proposed health information system for cancer screening is centered on modules that would allow for the computerization, process, update of screen data, and link with other registry data (e.g., population registry, cancer registry, and mortality). Conclusion: A nation-wide information system for breast cancer, colorectal cancer, and oral cancer screening was successfully developed to support health professionals and health decision makers for planning, delivery, management, and evaluation in population-based cancer screening program.

Public health nurse services for maternal-child immigrant healthcare: a literature review

Aim: To examine the impact of the complexity of regulations and restrictive policies on the accessibility of healthcare services for immigrants, particularly maternal and child healthcare. Public health nurses can facilitate management of healthcare services for immigrants in the community by preventing mortality and morbidity among the immigrant population. This literature review was used to identify the challenges faced by public health nurses in providing maternal-child immigrant healthcare. Design: A literature review. Methods: Relevant healthcare databases including PubMed, CINAHL, Scopus, and Google Scholar were searched using the following combination of search terms: public health nurses, maternal care, child care, and immigrants. Results: Six articles were included in the review. Immigrants (undocumented immigrant families in particular) have limited access to public healthcare services, due to factors such as: socio-demographics; language barriers; cultural differences; the status of unregistered families; psychological distress; and problems with health insurance. Public health nurses deliver health education, maternal and postnatal check-ups, and vaccination through community and/or home-based service programs. The role of immigrant health volunteers is facilitated by the partnership between public health nurses and the immigrant population in providing comprehensive maternal and child healthcare in the community. Conclusion: There are barriers that currently impact on the development of public health nurses' provision of maternal and child healthcare services to immigrants. Strategies that can be implemented to improve public health nurse competencies in maternal and child healthcare of immigrants include bicultural or bilingual training, and cultural competencies in visit programs.

Healthcare Data Utilization for the Betterment of Mankind - An Overview of Big Data Concept in Healthcare

Health Information plays a vital role in the healthcare delivery system. When Informatics is applied to the field of healthcare for the better management of healthcare and patient outcome is called as ‘Medical Informatics’. The aim of modern health care system is to provide optimal health care through the meaningful use of medical informatics which has led to a greater demand for more elaborate and widespread data. In this context, the term big data evolved in health care setting. Big data is the data which constitutes of three ‘V’ viz. Volume, Velocity and Variety. However, utilization of big data requires good healthcare service management system, proper planning, and expertise in the analysis. This article is intended to highlight the importance of big data in medical informatics for better healthcare delivery and to examine some opportunities, applications and challenges. In this article, we discuss the applications of big data in healthcare, an overview of the techniques and tools in big data analysis and challenges in the application of big data in healthcare. The article is also intended to highlight on the importance of the proper use of data for delivering better health care.

The roles of doctors, nurses, and industrial hygienists in the healthcare management services in Korea: a comparison of the opinions of specialized health management institutions and entrusted enterprises

BackgroundThis study aimed to identify the difference of perception about the role of appointing health officers by comparing and analyzing the response of entrustment workplace (EW) and specialized health management institution (SI). This is considered an important aspect of an institutional assessment to improve the quality of health management services.MethodsA survey questionnaire was mailed to 122 SIs and 319 EWs nationwide. The questionnaire survey was about the general characteristics of SIs and EWs and main occupations for each evaluation item. In total, 81 SIs (66.4%) and 30 EWs responded to the questionnaire. A logistic regression analysis was performed to compare the opinions of SI and EW.ResultsBased on the analysis, the items showing statistically significant differences were as follows. Doctors’ main tasks survey: “Guidance on their wearing personal protective equipment (PPE)” (OR: 4.58), “Guidance of improvement of work environment (WE)” (OR: 3.33), etc.; Nurses’ main tasks survey: “Guidance on their wearing PPE” (OR: 3.86), “Guidance for programs on health process in confined space (CS)” (OR: 0.36), “Guidance on the hearing conservation program (HCP)” (OR: 0.28), etc.; Industrial hygienist (IH)‘s main tasks survey: “Guidance of work through inspection (WTI)” (OR: 0.15), “Guidance on the improvement of WE” (OR: 0.32), “Management confirmation of substances used by process and Material Safety Data Sheet (MSDS)” (OR: 0.08), “Guidance on posting or keeping of MSDS and warning signs” (OR: 0.03), “Prevention of dust-induced medical problems” (OR: 0.28), “Guidance for programs of health process in CS” (OR: 0.39), etc.ConclusionsIt is necessary to educate the EWs to recognize the need for physicians to perform tasks, such as wearing a PPE, and instruction to improve WE. As for nurses’ tasks, such as education about the CS and the noise work, educating the nurses of the SI is regarded necessary as the demand of the EWs is considered. With respect to the unique tasks of IH, such as WE management and instructions for wearing PPE, among several other tasks of IH, training should be provided for improved IH recognition.

Managing the Patient Evidence Base Through Trauma Cases in Military University Hospital of Albania.

The level of management of traumatic health care services in Albania as a service of the Military University Hospital in Emergency Care differs in relation to other university hospitals across the country, mainly due to changes in the public health of the population. The article aims to present the management of traumatic patients at the Military Hospital in Albania, providing examples of the number of cases that have been addressed in the spread of this disease as epidemiology in Albania. The literature review and data statistics will be carried out by using the hospital records that will be used for further research in Albania. In addition, there is a study of international reports on Trauma management issues, trauma care and quality in Trauma. Much of the results consider the necessity of adopting a comprehensive traumatic system, focusing on quality management and improving trauma care to increase survival and reduce complications to the wounded. Urban conditions and public health policies are the most important factors in developing and implementing programs to improve emergency trauma care services. The heterogeneity of the population and its geographical distribution, the complexity of road accidents, are challenging factors for quantitative research on trauma management and the effectiveness of its care. Staff training in all areas, combined with the existence of modern vehicles and equipment, means of communication and timely transfer of the ambulance, contribute to the treatment of patients with urgent trauma, life saving and prevention of all types of disabilities.

Predicting cross-cultural intentions to engage in physical activity

PurposeThis research identifies cross-cultural differences between perception and behavioral intentions of Western and South Asian consumers to engage in physical activity. The theory of planned behavior is applied. It aims to provide insights to healthcare marketers and managers to address the problems of being overweight and obese in South Asia.Design/methodology/approachPath analysis was used to conduct this research. Two online questionnaires were used to collect data from South Asian and North American respondents. Cross-cultural differences were identified based on results from structural equation models.FindingsPath analysis shows that the theory of planned behavior effectively predicted the behavioral intentions of North American and South Asian respondents. South Asians are more strongly influenced by subjective norms and perceived behavioral control in their intentions to engage in physical activity. On the other hand, North Americans are more strongly influenced by their attitudes.Practical implicationsA consistent campaign to increase awareness about the risks of being overweight and obese will be necessary in South Asian countries to address this problem. Healthcare marketers need to emphasize marketing messages that lead to positive attitudes toward a healthy lifestyle in society and form public opinion such that it increases the role of social norms.Originality/valueThe research establishes the utility of the theory of planned behavior for South Asian populations. It identifies cross-cultural differences in terms of how behavioral intentions to engage in physical activity are formed in North American and South Asian populations. The findings are relevant to healthcare service managers and marketers in South Asia.

A Contemporary Study on Occupational Stress among Nurses in Mumbai

&lt;p&gt;In history of health care service management literature, various perspectives of Finance, Operations &amp;amp; Marketing have been addressed so well, however very little research was carried out from the view point of Human Resources. This research is an endeavor to address this small gap. Further, about health Care Service management, generally attention is more on various links of the customer, facilities, inputs and their interrelation and interaction. But, there are various environmental factors such as facilities and law and order climate supporting &amp;amp; within which the professionals operate. This can make or mar their performance especially with reference to logistics aspects. This research is an attempt to look at human aspects of the entities in the environment of the health care services.&lt;/p&gt;

A Doctor's Name as a Brand: A Nationwide Survey on Registered Clinic Names in Taiwan.

In countries where the private clinics of physicians can be freely named, registering a clinic with a physician’s name is one way to make patients familiar with the physician. No previous study had investigated how clinics make use of this method of personal branding. Therefore, the current study analyzed 10,847 private physician Western medicine clinics in Taiwan. Of those clinics, 31.0% (n = 3363) were named with a physician’s full name, 8.9% (n = 960) with a surname, and 8.1% (n = 884) with a given name. The proportion of clinics registered with a physician’s name was lower in rural areas (37.3%) than in urban (48.5%) and suburban areas (49.2%), respectively. Among clinics with only one kind of specialist, a physician’s name was used most frequently in clinics of obstetrics and gynecology (64.9%), otorhinolaryngology (64.1%), and dermatology (63.4%). In Taiwan, fewer than half of clinics used a physician’s name as a brand. The sociocultural or strategic factors and real benefits of doing so could be further studied in the future for a better understanding of healthcare services management.

IT applications in healthcare management: a survey.

Healthcare management is currently undergoing substantial changes, and reshaping our perception of the medical field. One spectrum is that of the considerable changes that we see in surgical machines and equipment, and the way the procedures are performed. Computing power, Internet and associated technologies are transforming surgical operations into model based procedures. The other spectrum is the management side of healthcare, which is equally critical to the medical profession. In particular, recent advances in the field of Information Technology (IT) is assisting in better management of health appointments and record management. With the proliferation of IT and management, data is now playing a vital role in diagnostics, drug administration and management of healthcare services. With the advancement in data processing, large amounts of medical data collected by medical centres and providers, can now be mined and analysed to assist in planning and making appropriate decisions. In this article, we shall provide an overview of the role of IT that have been reshaping the healthcare management, hospital, health profession and industry.

Assessing the Relative Performance of Nurses Using Data Envelopment Analysis Matrix (DEAM).

Assessing employee performance is one of the most important issue in healthcare management services. Because of their direct relationship with patients, nurses are also the most influential hospital staff who play a vital role in providing healthcare services. In this paper, a novel Data Envelopment Analysis Matrix (DEAM) approach is proposed for assessing the performance of nurses based on relative efficiency. The proposed model consists of five input variables (including type of employment, work experience, training hours, working hours and overtime hours) and eight output variables (the outputs are amount of hours each nurse spend on each of the eight activities including documentation, medical instructions, wound care and patient drainage, laboratory sampling, assessment and control care, follow-up and counseling and para-clinical measures, attendance during visiting and discharge suction) have been tested on 30 nurses from the heart department of a hospital in Iran. After determining the relative efficiency of each nurse based on the DEA model, the nurses' performance were evaluated in a DEAM format. As results the nurses were divided into four groups; superstars, potential stars, those who are needed to be trained effectively and question marks. Finally, based on the proposed approach, we have drawn some recommendations to policy makers in order to improve and maintain the performance of each of these groups. The proposed approach provides a practical framework for hospital managers so that they can assess the relative efficiency of nurses, plan and take steps to improve the quality of healthcare delivery.

The Perception of Professional Nurses About the Introduction of the National Health Insurance (NHI) in a Private Hospital in Gauteng, South Africa

Introduction:Based on concerns raised by professional nurses working in a private hospital that hinge on financial implication of the NHI, the state of public health sector and implications of the NHI to the South African health system prompted the need to determine their perceptions on the introduction of the NHI in a private hospital in Gauteng province, South Africa.Methods:A qualitative, exploratory and descriptive design using a semi-structured individual interview schedule was conducted. Coding and thematic analysis of data were done. The sample was purposive, consisting of 18 professional nurses from a private hospital in Gauteng, South Africa.Results:Findings indicated that they acknowledge the principles of the NHI such as a right to access healthcare, equity, affordability, efficiency, effectiveness and appropriateness. However, there were concerns on the Department of Health’s ability to ensure adequate human resources, sufficient equipment, safe infrastructure, meeting the national core standards which are still hampered by challenges experienced in public hospitals. Participants indicated that the government is not ready for the implementation of the NHI, based on the perceived non-transparency on outcomes from NHI pilot sites.Conclusion:General views concerning funding challenges, based on perceived mismanagement of funds and irregular expenditure as well as poor communication with all stakeholders involved in the implementation of the NHI were raised. The NHI is not only about financing, it involves service delivery, management and governance of health care services. There is a gap in information available to healthcare workers concerning the implementation of the NHI in South Africa.

E-service usage and satisfaction in Botswana

PurposeThe purpose of this paper is to establish the level of usage of e-services (websites and e-mail) by Botswana Public Officers Medical Aid Scheme (BPOMAS) and PULA Medical Aid (PULA) customers; the level of satisfaction; perceived value; and benefits derived from the website and e-mail services.Design/methodology/approachIn total, 200 BPOMAS members and 100 PULA members were sampled. Systematic sampling technique was used to select the participants. A questionnaire mainly guided by the E-S-QUAL and E-RecS-QUAL scales was designed to gain an in-depth understanding of customers’ perceptions and experiences of e-service quality.FindingsIt was established that there is a positive and significant relationship between the usage of e-services and benefits derived from e-services and between the usage of e-services and satisfaction. In addition, a nexus of relationship was observed between perceived value of the e-services and satisfaction.Research limitations/implicationsThe management of healthcare services in Botswana needs to understand customers’ value perceptions of e-services and e-service quality in order to establish where to make the most of their efforts.Practical implicationsThe managers of healthcare insurance providers should consider stepping up e-service usage and satisfaction levels, supported by client-centred training programmes, to assist clinicians deliver care to the expectation of patients.Originality/valueThere is an acute lack of research in the Botswana context, particularly into the link between e-service usage and satisfaction in the health insurance industry. This paper contributes to the extant literature by elucidating the nexus of relationship between e-service usage and satisfaction in Botswana.

Child mortality in South Africa: Fewer deaths, but better data are needed

South Africa is committed to reducing under-5 mortality rates in line with the Sustainable Development Goal (SDG) targets. Policymakers and healthcare service managers require accurate and complete data on the number and causes of child deaths to plan and monitor healthcare service delivery and health outcomes. This study aimed to review nationally representative data on under-5 mortality and the cause of deaths among children under 5 years of age. We also reviewed systems that are currently used for generating these data. Child mortality has declined substantially in the past decade. Under-5 mortality in 2015 is estimated at 37 - 40 deaths per 1 000 live births, with an estimated infant mortality rate of 27 - 33 deaths per 1 000 live births. Approximately one-third of under-5 deaths occur during the newborn period, while diarrhoea, pneumonia and HIV infection remain the most important causes of death outside of the newborn period. The proportion of deaths owing to non-natural causes, congenital disorders and non-communicable diseases has increased. However, many discrepancies in data collected through different systems are noted, especially at the sub-national level. There is a need to improve the completeness and accuracy of existing data systems and to strengthen reconciliation and triangulation of data.

Conceptualization of Management of Healthcare Services

Conceptualization of Management of Healthcare Services