Pilot District Research Articles

Permasalahan Pelaksanaan Pelayanan Administrasi Terpadu Kecamatan (Paten) Di Kota Padang

PATEN is a new public management centered in the sub-district to improve the quality and bring the service closer to the community. Since Regulatory of minister Affair number 4 in 2010 was declared. The Implementation of PATEN in Indonesia nowdays reach 15 percent. This research aims to identify the problem of impelementation PATEN in Pilot district projects in Padang in order to provide recommendation for PATEN implementation. This study used descriptive qualitative research through observation, documentation and interview in collecting data. The result showed that there are a number of obstacles in the implementation of PATEN namely the delegation of authority, procedures, human resources, limited facilities and infrastructure. For That, it is amust for the Local Government to handle those problems

Lest we forget, primary health care in Sub-Saharan Africa is nurse led. Is this reflected in the current health systems strengthening undertakings and initiatives?

# Background Primary health care (PHC) in most African countries is nurse led. In South Africa, PHC has a unique history where efforts to provide holistic health care to rural communities began in the early 1940s. There are initiatives to ensure that doctors including General Practitioners (GPs) get to public clinics in South Africa-great initiatives but bearing in mind the current doctor patient ratios and the difficulties to get doctors into rural areas, until we get there, nurses will be and are providing most of PHC services. # Methods We tracked policy implementation aimed at achieving Universal Health Coverage in one pilot district in South Africa from 2011-2015. Qualitative data was collected during three phases 2011-2012 (Contextual mapping), 2013-2014 (Phase 1) and 2015 (Phase 2). A theory of change approach was employed. Semi-structured in-depth interviews were held with participants using a standard interview guide. Participants ranged from provincial, district, sub-district and facility actors involved in policy implementation. # Results Many health systems strengthening activities are being carried out namely; PHC re-engineering package made up of district clinical specialists, school health and ward based teams, referral systems strengthening, management strengthening, and general practitioner (GP) contracting. # Conclusions We found no targeted health systems strengthening initiatives to counteract the challenges faced by PHC nurses which are well documented in literature. What we see currently missing are initiatives directed at the work done by nurses in a PHC setting, to assist them resolve the so well documented challenges they are faced with in their daily work. If PHC is nurse led, we advocate going step by step with the aid of the nursing process and assess what could be done to streamline, strengthen, innovate and support the work a PHC nurse does, guided by systems thinking, hence we propose a Framework for Health Systems Strengthening in a nurse led PHC setting, that takes into account the challenges and the roles of a PHC nurse Figure 1.

Assessment of short/long term electric field strength measurements for a pilot district

Abstract The level of electromagnetic radiation (EMR) exposure increases day by day as natural consequences of technological developments. In recent years, the increasing use of cellular systems has made it necessary to measure and evaluate EMR originating from base stations. In this study, broadband and band selective electric field strength (E) measurements were taken at four different times in order to evaluate the change of short term E in Atakum district of Samsun, Turkey. The measurements were collected from 46 different locations using a SRM 3006 and a PMM 8053 EMR meter in a band from 100 kHz to 3 GHz, and the maximum E (Emax) and the average E (Eavg) were recorded. The highest values have been noticed in these measurements at 9.45 V/m and 17.53 V/m for Eavg and Emax respectively. Apart from these measurements, 24 hour long term E measurements were taken at a location where the highest value was observed and analyzed, to observe the change of Es during a day. At the end of the study, a tentative mathematical model that helps in computing the total E of the medium with 95% accuracy, was obtained.

Leveraging on Cloud Technology for Reporting Maternal and Child Health Services at the Community Level in Ghana

Background and Purpose: The millennium development goals (MDG) have served as a catalyst in galvanizing governments and ministries to refocus their development agenda to meet set MDG targets. Similarly the Ghana Health Service (GHS) recognizes the importance of an efficient health information system (HIS) for generating quality data for monitoring progress towards achieving set targets of the health related MDGs 4, 5 and 6. This paper is therefore about the GHS effort in using electronic health record system called the e-Tracker to support the provision and reporting of primary healthcare in the area of maternal and child health services at the community level. Methods: The research approach was case study of selected facilities in one pilot district. Empirical data was collected using qualitative methods such as participant observations, interviews and supplemented by secondary data sources such as training manuals and other official documents. Philosophically the research was informed by interpretive paradigm through subjective meaning for understanding the sociotechnical complexities of implementing the e-Tracker in the health domain. Actor-Network theory (ANT) was considered as an appropriate theoretical lens to conceptualize and investigate the dynamics of introducing a technological artefact into a social system such as the health domain. Results: Findings were that there was realignment of work practices with resultant reflexive effects (positive and negative) on the working environment as a result of introducing information technology artefact into the health domain. And that the sociotechnical effects are emergent and cannot be determined a priori because of the multiplicities in complexity when the social reacts with the technical. Conclusions: These findings corroborates findings in similar studies in the IS literature in that effects of technological artefacts in complex social-technical system are emergent and cannot be predetermined due to their unpredictability. Furthermore in sociotechnical systems such as the health domain best practice is for the coexistence of electronic and paper systems. Therefore an attempt to completely replace the paper system with the electronic may result in system challenges. Keywords: e-Tracker, Electronic Health Record, Maternal and Child Health

Household satisfaction with a community-based health insurance scheme in Ethiopia.

BackgroundCommunity-based health insurance (CBHI) schemes are an emerging tool for providing financial protection against health-related poverty. In Ethiopia, CBHI is being piloted in 13 districts, but community experience and satisfaction with the scheme have yet to be studied. Therefore, this study aimed to assess the experiences and satisfaction of households enrolled in a pilot CBHI scheme.MethodsA community-based cross-sectional study method was used in one pilot district in South Ethiopia. Data were collected in March and April 2014. 386 households enrolled in the CBHI scheme were sampled by simple random sampling. Data were collected by trained data collectors using a pre-tested structured questionnaire. Descriptive statistics and bivariate and multiple linear regression analyses were performed. P values less than 0.05 and 95 % confidence intervals were used to determine associations between independent and dependent variables.ResultsThe study revealed that overall household satisfaction with CBHI was 91.38 %. Moreover, there was a significant association between health service provision and CBHI members’ satisfaction scores. For instance, household heads that strongly disagreed with laboratory services provision had an average 0.878 decrease in CBHI satisfaction score compared to household heads that strongly agreed. CBHI process- and management-related factors were also significantly associated with satisfaction.ConclusionsSatisfaction with CBHI was high. Age, family size, laboratory services provision, health services provider friendliness, CBHI offices opening times, membership card collection process, and time interval to use of services were significant predictors of satisfaction with CBHI.

Costing of a State-Wide Population Based Cancer Awareness and Early Detection Campaign in a 2.67 Million Population of Punjab State in Northern India.

Punjab state is particularly reporting a rising burden of cancer. A 'door to door cancer awareness and early detection campaign' was therefore launched in the Punjab covering about 2.67 million population, wherein after initial training accredited social health activists (ASHAs) and other health staff conducted a survey for early detection of cancer cases based on a twelve point clinical algorithm. To ascertain unit cost for undertaking a population-based cancer awareness and early detection campaign. Data were collected using bottom-up costing methods. Full economic costs of implementing the campaign from the health system perspective were calculated. Options to meet the likely demand for project activities were further evaluated to examine their worth from the point of view of long-term sustainability. The campaign covered 97% of the state population. A total of 24,659 cases were suspected to have cancer and were referred to health facilities. At the state level, incidence and prevalence of cancer were found to be 90 and 216 per 100,000, respectively. Full economic cost of implementing the campaign in pilot district was USD 117,524. However, the financial cost was approximately USD 6,301. Start-up phase of campaign was more resource intensive (63% of total) than the implementation phase. The economic cost per person contacted and suspected by clinical algorithm was found to be USD 0.20 and USD 40 respectively. Cost per confirmed case under the campaign was 7,043 USD. The campaign was able to screen a reasonably large population. High to high economic cost points towards the fact that the opportunity cost of campaign put a significant burden on health system and other programs. However, generating awareness and early detection strategy adopted in this campaign seems promising in light of fact that organized screening is not in place in India and in many developing countries.

Motivating health workers up to a limit: partial effects of performance-based financing on working environments in Nigeria.

In 2012, the Nigerian government launched performance-based financing (PBF) in three districts providing financial incentives to health workers based on the quantity and quality of service provision. They were given autonomy to use funds for operational costs and performance bonuses. This study aims to understand changes in perceived motivation among health workers with the introduction of PBF in Wamba district, Nigeria. The study used a qualitative research design to compare perceptions of health workers in facilities receiving PBF payments in the pilot district of Wamba to those that were not. In-depth semi-structured interviews (n = 39) were conducted with health workers from PBF and non-PBF facilities along with managers of the PBF project. Framework analysis was used to identify patterns and variations in responses. Facility records were collated and triangulated with qualitative data. Health workers receiving PBF payments reported to be 'awakened' by performance bonuses and improved working environments including routine supportive supervision and availability of essential drugs. They recounted being more punctual, hard working and proud of providing better services to their communities. In comparison, health workers in non-PBF facilities complained about the dearth of basic equipment and lack of motivating strategies. However, health workers from both sets of facilities considered there to be a severe shortage of manpower resulting in excessive workload, fatigue and general dissatisfaction. PBF strategies can succeed in motivating health workers by bringing about a change in incentives and working conditions. However, such programmes need to be aligned with human resource reforms including timely recruitment and appropriate distribution of health workers to prevent burn out and attrition. As people working on the frontline of constrained health systems, health workers are responsive to improved incentives and working conditions, but need more comprehensive support.

‘We can’t help you here’: The discursive erasure of sexual minorities in South African public sexual and reproductive health services

Worldwide, sexual and gender minorities struggle to access sexual and reproductive health (SRH) services. In South Africa, sexual prejudice is entrenched and pervasive in health systems and SRH services do not cater for a diverse range of people. Though health reform is underway, little attention has been given to how sexuality is being addressed in this process, particularly in the National Health Insurance (NHI) scheme currently being piloted. We analyse interview data generated in an NHI pilot district, using discursive methodology, informed by a sexual and reproductive justice standpoint. We show how sexual and gender minorities are discursively in/visibilised in health settings and discuss these findings in relation to the social justice and solidarity aims of health systems reform.

Facility Death Review of Maternal and Neonatal Deaths in Bangladesh.

ObjectivesTo explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh.MethodsThis was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed.ResultsFDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health.DiscussionFDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district levels to forward plan and improve healthcare delivery.

Social inclusion: An effort to end loss-to-treatment follow-up in tuberculosis

Situation analysisPathanamthitta district is implementing Revised National Tuberculosis Control Program as a pilot district since 1993. The district programme was reporting approximately 5% of their diagnosed smear positive patients as never put on treatment (Initial lost to follow up – ILFU) and 5% of the new smear positive [NSP] Pulmonary TB patients as lost to follow up [LFU] during treatment. Attempts based on reengineering of DOTS were not largely successful in bringing down these proportions. InterventionA treatment support group [TSG] is a non-statutory body of socially responsible citizens and volunteers to provide social support to each needy TB patient safeguarding his dignity and confidentiality by ensuring access to information, free and quality services and social welfare programs, empowering the patient for making decision to complete treatment successfully. It is a complete fulfilment of social inclusion standards enumerated by Standards for TB Care in India. Pathanamthitta district started implementing this strategy since 2013. OutcomesAfter intervention, proportion of LFU among NSPTB cases dropped markedly and no LFU were reported among the latest treatment cohorts. Proportion of ILFU keeps similar trend and none were reported among the latest diagnostic cohorts. LessonsSocial support for TB care is feasible under routine program conditions. Addition of standards for social inclusion in STCI is meaningful. Its meaning is translated well by a society empowered with literacy and political sense.

OP0245-PARE Easier Access to Rheumatologist and Early Diagnose

BackgroundIt is well known that diagnose of most of the rheumatic diseases sometimes take several months or couple of years and more. Reasons for that could be quite different –...

Optimization of Distribution Systems: Water Distribution System of Smolensk City Pilot District

Abstract MultiUtility committed to Proteo the analysis of a pilot district of the water distribution network of Smolensk, in order to optimize the network management, the comprehension of the network functioning, finding possible critical scenarios and planning the necessary interventions (e.g. pipes replacement, hydraulic components replacement, leak detection and water losses repair, etc.). Proteo carried out the network analysis using Eraclito, one of the self-produced software, for achieving both hydraulic and technical management of network, simulation, modelling and calibration of technological networks. Starting from the analysis of the network's state of the art, Proteo carried out the analysis of the pilot district.

E-District Portal for District Administration in West Bengal, India: A Survey to Identify Important Factors towards Citizen's Satisfaction

E-District Portal is one of the popular Information and Communication Technology (ICT) initiatives of Government of India to manage district administration in more effective way in place of manual system in West Bengal with the others state of India. Author(s) main objective is to explore different important factors in pilot district of West Bengal those are directly involved with the common citizen's satisfaction and contributing to citizen's behavioral change towards acceptance of e-District project, which could be a lesson learn to take more corrective action to roll out e-District services in future. A well set up questionnaires have been developed over the different related observables and conducted survey among the common citizen's randomly to get their feedback. In this study, quantitative methodology has been adopted to analyze the various observables. The Principal Component method and VARIMAX rotation options of Factor Analysis has been utilized to reduce the set of observables in order to identify key factors. The Kaiser-Meyer-Olkin (KMO) value also has been measured to check the adequacy of the collected dataset for factor analysis.

Characteristics of French people using organised colorectal cancer screening. Analysis of the 2010 French Health, Healthcare and Insurance Survey

ObjectiveTo analyse relationships between socio-demographic characteristics, healthcare access, and behaviour with regard to participation in organised colorectal cancer (CRC) screening. MethodsWe analysed a subset of 2,276 individuals from a cross-sectional population-based survey of French households in 2010. The outcome was participation in CRC screening using multiple logistic regression. The studied variables included socio-demographic characteristics, healthcare access-related variables, and health or perceived health. ResultsAge, living in a pilot district for CRC screening, and having a private additional insurance were associated with participation in CRC screening for both genders. In men, other characteristics were associated: not having 100% coverage for medical fees for a long-term disease, having consulted a medical specialist in the last 12months, and not smoking. In women, other cancer screening behaviours were associated with participation in CRC screening. Results also showed that 81.4% of individuals, who did not have a Hemoccult® test, consulted a GP in the last 12months. ConclusionsDespite efforts made, results confirmed that CRC screening differed among socioeconomic groups. GPs should be encouraged to systematically recommend CRC screening to their patients fitting the criteria of the organised CRC screening programme and further investigation is required to optimise information strategies targeting GPs.

Progress towards malaria elimination in Sabang Municipality, Aceh, Indonesia

BackgroundIndonesia has set 2030 as its deadline for elimination of malaria transmission in the archipelago, with regional deadlines established according to present levels of malaria endemicity and strength of health infrastructure. The Municipality of Sabang which historically had one of the highest levels of malaria in Aceh province aims to achieve elimination by the end of 2013.MethodFrom 2008 to 2010, baseline surveys of malaria interventions, mapping of all confirmed malaria cases, categorization of residual foci of malaria transmission and vector surveys were conducted in Sabang, Aceh, a pilot district for malaria elimination in Indonesia. To inform future elimination efforts, mass screening from the focal areas to measure prevalence of malaria with both microscopy and PCR was conducted. G6PD deficiency prevalence was also measured.ResultDespite its small size, a diverse mixture of potential malaria vectors were documented in Sabang, including Anopheles sundaicus, Anopheles minimus, Anopheles aconitus and Anopheles dirus. Over a two-year span, the number of sub-villages with ongoing malaria transmission reduced from 61 to 43. Coverage of malaria diagnosis and treatment, IRS, and LLINs was over 80%. Screening of 16,229 residents detected 19 positive people, for a point prevalence of 0.12%. Of the 19 positive cases, three symptomatic infections and five asymptomatic infections were detected with microscopy and 11 asymptomatic infections were detected with PCR. Of the 19 cases, seven were infected with Plasmodium falciparum, 11 were infected with Plasmodium vivax, and one subject was infected with both species. Analysis of the 937 blood samples for G6PD deficiency revealed two subjects (0.2%) with deficient G6PD.DiscussionThe interventions carried out by the government of Sabang have dramatically reduced the burden of malaria over the past seven years. The first phase, carried out between 2005 and 2007, included improved malaria diagnosis, introduction of ACT for treatment, and scale-up of coverage of IRS and LLINs. The second phase, from 2008 to 2010, initiated to eliminate the persistent residual transmission of malaria, consisted of development of a malaria database to ensure rapid case reporting and investigation, stratification of malaria foci to guide interventions, and active case detection to hunt symptomatic and asymptomatic malaria carriers.

入港時における操船危険度の評価

The education and training of the third grade pilot started on October, 2008 in Japan, and the third grade pilots were born in 2011. From 2011 to 2012, the pilots had a training period at each pilot district for getting their on-board experience for entering and leaving port as pilots. In the middle of 2012, some of the pilots have started to command ships for entering and leaving port by themselves, but the others, who did not get good results of the evaluation at each pilot association, are continuing the same training. There is not an absolutely evaluation for the risk of ship handling in case of entering port. Today, trainer pilot evaluates the maneuvering of trainees during their ship handling simulator training. They are not absolute evaluations but objective evaluations. In this paper, the authors propose the absolute evaluation method which is much better than the ordinary evaluation by the well experienced pilot for the trainer.

The Linked Response: Lessons Emerging from Integration of HIV and Reproductive Health Services in Cambodia

A qualitative assessment was made of service provider and user perceptions of the quality of integrated reproductive health services established through a pilot intervention in Cambodia. The intervention aimed to promote pregnant women's HIV testing and general utilization of reproductive health facilities as well as improve the follow-up of HIV-positive women and exposed infants through strengthened referral and operational linkages amongst health facilities/services and community-based support interventions for PLHIV. The study was conducted in one operational district where the intervention was piloted and for comparative purposes in a district where integrated services had yet to be implemented. Service providers in the pilot district reported improved collaboration and coordination of services, more effective referral, and the positive impact of improved proximity of HIV testing through integrated local level facilities. Community-based support teams for PLHIV embraced their expanded role, were valued by families receiving their assistance, and were understood to have had an important role in referral, PMTCT follow-up and countering PLHIV stigmatization; findings which underscore the potential role of community support in integrated service provision. Challenges identified included stigmatization of PLHIV by health staff at district hospital level and a lack of confidence amongst non-specialized health staff when managing deliveries by HIV-positive women, partly due to fear of HIV transmission.

Poster #65 FUNCTIONAL IMPAIRMENT: SHOULD IT BE AN OBLIGATE PART OF CLINICAL CRITERIA FOR AN INCREASED RISK OF DEVELOPING PSYCHOSIS?

E-District Portal is one of the popular Information and Communication Technology (ICT) initiatives of Government of India to manage district administration in more effective way in place of manual system in West Bengal with the others state of India. Author(s) main objective is to explore different important factors in pilot district of West Bengal those are directly involved with the common citizen's satisfaction and contributing to citizen's behavioral change towards acceptance of e-District project, which could be a lesson learn to take more corrective action to roll out e-District services in future. A well set up questionnaires have been developed over the different related observables and conducted survey among the common citizen's randomly to get their feedback. In this study, quantitative methodology has been adopted to analyze the various observables. The Principal Component method and VARIMAX rotation options of Factor Analysis has been utilized to reduce the set of observables in order to identify key factors. The Kaiser-Meyer-Olkin (KMO) value also has been measured to check the adequacy of the collected dataset for factor analysis.

Economic Analysis of Leakage in the Bangkok Water Distribution System

Loss of water caused by leakage is a common phenomenon observed in all water distribution systems (WDSs). The volume of leakage around the world is considerably high, and its control is crucial to meet the increasing water demand caused by rapid population growth and urbanization. The most important component of a leakage-control strategy is target setting in terms of economic level of leakage (ELL). The ELL is an economic indication depending on individual network conditions, operating system pressures, demands and their patterns, marginal cost of water, and operating practices. This paper discusses the economic aspects of leakage for a pilot district metered area (DMA) of the WDS of the Metropolitan Waterworks Authority (MWA) in Bangkok, Thailand. The study developed two nomographs for the quick estimation of ELL and active leakage-control cost (ALC) with minimal data analysis. The first nomograph shows the relationship between cost of leakage control, average operating pressure, and level of leakage in the WDS. The second nomograph shows the relationship between ELL, operating-system pressure, and marginal cost of water. The nomographs have been developed based on leakage volume, cost of water, and hydraulic and operational conditions of the WDS. To model different hydraulic and leakage scenarios, the U.S. EPA’s EPANET simulation engine has been used. The research will help utility managers understand different aspects of leakage economics and will lead to better management of their WDSs.

階層分析法とエキスパートシステムを用いた港内操船評価

The education and training of the third grade pilot have been started on October, 2008 in Japan. The third grade pilots were born in 2011. From 2011 to 2012, they had training period at each pilot district for getting their onboard experience for entering and leaving port as pilots. In 2012, some of them started to command ships by themselves, but the others were continued same training, who did not get good results of the evaluation at each pilot association. In this paper, the authors tried to propose how to evaluate difficulty of ship handling for each berth and navigation route from port entrance to berths at Port of Hanshin. For realization of the purpose, we practice questionnaires to a well experienced pilot based on three evaluation criteria which are course control, speed control and distance control. As the result of this study, we calculate the difficulty weight of those berths and navigation routes, and propose method for quantitative evaluation of the difficulty of ship maneuvering at Port of Hanshin. To know the difficulty of berths and navigation routes are useful for the training of fresh pilots after getting pilot licenses, because of their soft landing to professional pilot world. In future, we will consider risk of ship handling in case of entering port using above results. At that time, the difficulties of berths and navigation routes will be fundamental knowledge database for the evaluation system of risk of ship handling.