Health Facility Managers Research Articles

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 concerning 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 HIV. However, within some communities, claims of faith or miraculous healing of HIV and 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 (PCLH). Twenty Pentecostal pastors from two informal settlements in Cape Town, South Africa, were purposefully selected. 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 to the Atlas-ti 2023 software program for thematic data analysis. Since our study was guided by the relational community health system (CHS) 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 the associated 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 (CHCs) and health facility management committees (HFMCs), in settings where complex interaction within the belief systems, practices, and norms of some stakeholders can influence people's health-seeking behaviours such as adhering 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.

HIV and hepatitis B virus co-infection in Mozambique: Policy review and health professionals' knowledge and practices.

Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infection is a public health problem affecting 2.7 million worldwide. In Mozambique, the prevalence of this co-infection is 9.1%, calling for specific policies on prevention, diagnosis and adequate management in health facilities caring for HIV patients. This study aimed to review the existing policies and to assess the knowledge and practices of health professionals about HIV/HBV co-infection. A document and literature review to describe the existing policies and guidelines on HIV/HBV co-infection in Mozambique was performed. Key informants were contacted to clarify or add information. Health Professionals who care for HIV-positive patients in four health centers in Maputo City, the capital of Mozambique, responded to a questionnaire on knowledge and practices about this co-infection. Qualitative analysis was done to identify main themes using content analysis. Descriptive statistics of socio-demographic, knowledge and practice variables was presented using the SPSS Program version 20 and bivariate analysis was applied to describe the association between variables. Twenty-one policy documents were found, and five key informants were interviewed. Fifty-two participants answered the questionnaire. Only one policy document explicitly referred to HIV/HBV co-infection treatment. Most Health Professionals (96%) were aware of HIV/HBV co-infection. Although the only existing policy is on the treatment, few (33%) referenced antiretroviral formulations containing Tenofovir and Lamivudine. Only 29% of Health Professionals reported screening HIV patients for HBV and 21% practiced HIV/HBV co-infection counselling. No statistically significant differences were found when relating the socio-demographic variables with knowledge and practices. Policy documents relating to prevention, diagnosis and clinical management of HIV/HBV co-infection were rare or absent. Health Professionals had little knowledge about HIV/HBV co-infection. Defining adequate policies and training of Health Professionals may help increase awareness, increase counselling of patients for disease prevention, diagnosis and proper management of HIV/HBV co-infected patients.

Determinants of translating routine health information system data into action in Mozambique: a qualitative study

IntroductionRoutine health information systems (RHISs) are an essential source of data to inform decisions and actions around health facility performance, but RHIS data use is often limited in low and...

Obstacles to vaccination coverage for children aged 12 to 59 months in the Mangobo health zone from 2016 to 2019 in Kisangani (DR Congo)

Introduction: Vaccination saves lives and is one of the greatest medical successes in the history of humanity. It saves around three million lives every year worldwide. Specifically, the study aims to determine the obstacles to immunization coverage of children aged 12 to 59 months in the Mangobo Health Zone and to identify the gaps between the administrative immunization coverage of the Health Zone and the coverage of household surveys. Methods: Using a retrospective descriptive approach based on documentary analysis and interviews, we selected a sample of 150 children aged 12 to 59 months living in the Mangobo Health Zone between 2016 and 2019. Results: Adverse events (45.3%) and vaccine stock-outs in the health areas (30.7%) were found to be the main obstacles to child immunization in the Mangobo Health Zone. The differences between administrative vaccination coverage and household survey vaccination coverage are very significant: for the VAA 64.07% and the VAR 62.07%. Conclusion: In order to optimize immunization coverage, it is essential to implement an effective policy for the management of health facilities by the Central Office of the Health Zone and to set up an effective monitoring mechanism with the aim of producing reliable epidemiological data.

Leveraging community health workers for COVID-19 response in Democratic Republic of Congo, Nigeria, Senegal, and Uganda: roles, barriers, and facilitators

BackgroundThe Corona Virus Disease 2019 (COVID-19) pandemic overwhelmed health systems and disrupted the delivery of health services globally. Community Health Workers (CHWs) play a critical role in linking communities to health systems, supporting the prevention and control of diseases in many low- and middle-income countries. However, their roles, barriers, and facilitators in the response and control of the COVID-19 pandemic have not been well documented. We described the roles of CHWs in the COVID-19 response, including the barriers and facilitators.MethodsA cross-sectional study design was used to assess the COVID-19 response in the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. This involved 110 key informant interviews with policymakers, health facility managers, district health managers, and CHWs to understand the role of CHWs in the COVID 19 response, selected purposively. The total sample size was based on information saturation in each of the countries. A document review on the COVID-19 response was also conducted. We searched Google, Google Scholar, and PubMed for published and grey literature. Data from the selected documents were extracted into a Google master matrix in MS Excel and analyzed thematically.ResultsIn COVID-19 Control, CHWs supported community-based surveillance, contact tracing, risk communication, community mobilization, and home-based care. To support the continuity of other non-COVID-19 services, the CHWs conducted community mobilization, sensitizations, outreaches, referrals, and patient follow-ups. CHWs were challenged by movement restrictions, especially in the initial stages of the lockdown, inadequate PPE, increased workload, low allowances, and motivation. CHW were facilitated by trainings, the development of guidelines, development partners’ support/funding, and the provision of personal protective equipment (PPE) and tools.ConclusionCHWs supported both the COVID-19 control and continuity of non-COVID-19 health care during the COVID-19 pandemic. CHWs are a critical resource that must be adequately supported to build resilient health systems.