Service Delivery Points Research Articles

Technological innovation promoters, service quality practices and performance of SACCOs in Kenya

The programmed co-operative enterprises’ innovation initiatives in Kenya have been below their expectations of customers. The majority (60%) of the customers are satisfied by banking and related financial services offered by co-operative enterprises in Kenya. This is below the expectations of what the customers perceive and what is realized at the point of service delivery. This study sought to provide insights into the relationship between technological innovation promoters and performance by empirically testing the direct effect of technological innovation promoters on performance and exploring the moderation effects of service quality practices. The study is anchored on the promoter theory and collective entrepreneurship concept. The study used a self-administered questionnaire to Chief Executive Officers of 158 Savings and Credit Co-operative Societies (SACCOs). Data were analyzed by employing Statistical Software for Social Sciences (SPSS) Version 22 and structural equation modeling using AMOS version 25. The hypotheses were tested using structural equation modeling and hierarchical moderated multiple regression (MMR). Overall, the study found out that, technological innovation promoters have a positive influence on the performance of SACCOs in Kenya, and service quality practices (R2 change) is 0.153. This implied that the moderating effect of service quality practices gained 15.3% variance in the SACCOs above and beyond the variance by technological innovation promoters and performance. This study concludes that an integrative model comprising of technological innovation promoters, service quality practices and performance is a sure way of enhancing collective entrepreneurship and recommends that SACCO management together with their partners should deliberately nurture a customer relationship management culture that will enable them to realize positive performance that has been influenced by service quality practices

A social ecological approach to understanding service utilization barriers among male survivors of sexual violence in three refugee settings: a qualitative exploratory study

BackgroundPost-sexual violence service utilization is often poor in humanitarian settings. Little is known about the service uptake barriers facing male survivors specifically.MethodsTo gain insights into this knowledge gap, we undertook a qualitative exploratory study to better understand the barriers to service utilization among male survivors in three refugee-hosting countries. The study sites and populations included refugees who had travelled the central Mediterranean migration route through Libya living in Rome and Sicily, Italy; Rohingya refugees in Cox’s Bazar, Bangladesh; and refugees from eastern Democratic Republic of the Congo, Somalia, and South Sudan residing in urban areas of Kenya. Methods included document review, 55 semi-structured focus group discussions with 310 refugees, semi-structured key informant interviews with 148 aid workers and human rights experts, and observation of service delivery points. Data were thematically analyzed using NVivo 12.ResultsWe identified eleven key barriers and situated them within a social ecological framework to describe impediments at the policy, community (inter-organizational), organizational, interpersonal, and individual levels. Barriers entailed: 1) restrictions to accessing legal protection, 2) legislative barriers such as the criminalization of same-sex sexual relations, 3) few designated entry points, 4) poor or nonexistent referral systems, 5) lack of community awareness-raising and engagement, 6) limited staff capacity, 7) negative provider attitudes and practices, 8) social stigma, 9) limited knowledge (at the individual level), 10) self-stigma, and 11) low formal help-seeking behaviors.ConclusionThe social ecological framework allowed us to better understand the multifaceted ways that the barriers facing male survivors operate and reinforce one another, and may be useful to inform efforts promoting service uptake. Additional research is warranted in other refugee settings.

Student Centeredness as Innovation

This article explores how a focus on ‘student centeredness’ can lead to ‘innovation’ and how innovation can enhance student centeredness. Putting students at the centre of all considerations can unleash their creative and innovative potential. And recent innovations have made it easier to make students the focal point of service delivery. After a description of what we understand under these two guiding concepts, a case study is presented in which an AI-powered Student Virtual Assistant was developed at York University in Toronto, Canada. All steps of the product creation, including envisioning, designing, prototyping, and evaluating are described, as well as the following steps involving maintenance and expansion.

Towards effective inventory management of health commodities at service delivery points: A case of health personnel in Shamva District, Zimbabwe.

Despite much effort at improving availability of health commodities, stock-outs and expiries are still commonplace at service delivery centres. The success of any inventory management programme relies on the people undertaking it and there seems to be a missing link in the supply chain that could be related to the people tasked with inventory management at service delivery points. The study thus sought to assess whether the personnel’s knowledge, attitude, perceptions and practices are the missing link resulting in stock-outs and expires. The study employed a mixed method approach wherein quantitative and qualitative data collection methods were employed. The data collected sought to explore various aspects of the personnel including the training facility regarding inventory management, personal attitudes and, perceptions and practices towards certain inventory management aspects. Clearly it was found that personnel knowledge levels were very low, attitudes and perceptions veer in the negative whilst practices are not up to standard. This correlated to the availability of drugs and commodities at service delivery points.

Can Administrative Changes Improve Child-Care Subsidy Stability?

This study assesses administrative changes in Massachusetts that shifted the responsibility for child-care subsidy-eligibility reassessments from regional Child Care Resource and Referral agencies to locally contracted child-care providers. The study applies a mixed-methods approach, using (1) state administrative data to examine the association between the administrative changes and children’s stability of subsidy receipt and (2) qualitative methods to illustrate the potential explanatory factors generating observed associations. We find a positive relationship between the administrative changes and subsidy stability overall but also substantial regional variation, which can be explained in part by policy- and organization-level variation identified in our qualitative research. Findings of the study highlight the importance of considering multilevel factors when designing, implementing, and evaluating changes in social service delivery practices and point to the need for a mixed-methods approach to evaluate such changes.

Personal Protective Equipment: Challenges and Strategies to Combat COVID-19 in India: A Narrative Review

The current outbreak of the coronavirus disease (COVID-19) has become a pandemic. All COVID-19-affected countries in the world are implementing containment interventions and trying their best to fight against the disease to halt the further spread of the infection and to reduce mortality. The public health workforce and healthcare staff in clinical settings are playing a crucial role in the early detection of cases, contact tracing and treatment of patients. The availability of personal protective equipment (PPE) and their consistent, proper use by healthcare providers and public health professionals is a crucial factor in combating any infectious disease in a crisis. The requirement of PPE has exponentially increased, as more and more countries are experiencing the COVID-19 pandemic. The rapid spread of the pandemic has created a temporary shortage of PPE in many countries, including India. The lack of PPE has affected the morale of healthcare workers (HCWs) and other frontline warriors in fighting the coronavirus disease, as more than 22,000 health workers in 56 countries have suffered from COVID-19. Some of them have succumbed to it across all countries, including India (WHO). We have reviewed the available literature to understand the challenges in ensuring adequate availability and consistent use of PPE and the strategies for the rational use of PPE in India. Our study reveals that India has responded swiftly to enhance the accessibility of PPE and put in place strategies for the judicious use of PPE to reduce the incidence of the COVID-19 infection to a bare minimum in healthcare settings. In the present article, we report the current status of COVID-19 among HCWs. We have reviewed the challenges and the surge strategies adopted by India to produce or procure good-quality PPE and supply it to all service delivery points in adequate quantities.

Ever and repeat HIV testing rates among male and female clients: Findings from a reproductive health services integration project in South Africa.

HIV testing rates have increased in recent years. Repeat testing is recommended to identify and treat new HIV infections timeously. However, there are limited data on repeat HIV testing, especially in South Africa (SA). To provide data on repeat HIV testing rates in males and females in a district in SA. A sexual and reproductive health (SRH) service integration model was implemented in seven healthcare facilities in eThekwini District, KwaZulu-Natal Province, SA, between 2009 and 2011. HIV testing data were collected from male and female clients attending these facilities, prior to (baseline) and after the implementation (endline) of the 3-year health services integration intervention. There were 230 clients at baseline (195 female, 35 male) and 200 at endline (169 female, 31 male). High ever-tested rates were reported at baseline (females 95.4%, males 74.3%) and endline (females 91.7%, males 87.1%), with large increases in male testing rates over time. In addition, high increases were seen between baseline and endline among those who had tested more than once and more than twice in their lifetime. Increases between baseline and endline testing rates were highest in HIV testing services (HTS) (37.0 - 93.3% for clients who had tested more than once, and 11.1 - 53.3% for those who had tested more than twice). HIV testing and repeat testing increased over time, especially in males and in HTS. Promotion and integration of SRH services are critical to facilitate improved health-seeking behaviour and HIV testing of both male and female clients. They are also important for continued access to HTS at multiple service delivery points.

Investigating the early impact of the Trump Administration's Global Gag Rule on sexual and reproductive health service delivery in Uganda.

BackgroundThe Global Gag Rule (GGR), reinstated by President Trump in January 2017, makes non-U.S. non-governmental organizations ineligible for U.S. foreign assistance if they provide access to or information about abortion. While evidence suggests previous iterations of the GGR negatively impacted sexual and reproductive health outcomes, no studies have quantitatively assessed the impacts of the Trump administration’s GGR.MethodsWe constructed a panel dataset of facilities (76% public) using 2017/2018 Performance Monitoring and Accountability 2020 service delivery point (SDP) surveys in Uganda. Based on information from stakeholder meetings, we classified districts as more or less exposed to the GGR; 45% (N = 34) of study districts were classified as “more exposed”, which corresponded to 145 “more exposed” and 142 “less exposed” health facilities in our sample. We assessed changes in provision of long-acting reversible contraceptives, contraceptive stock-outs, mobile outreach services, engagement with community health workers (CHWs), service integration, and quality of care from 2017 (pre-GGR) to 2018 (post-GGR). Multivariable regression models were estimated, and difference-in-differences impact estimators were determined by calculating predicted probabilities from interaction terms for exposure and survey round.FindingsWe observed no immediate impact of the GGR on the provision of long-acting reversible contraceptives, contraceptive stock-outs, mobile outreach services, service integration, or quality of care. We did observe a significant impact of the policy on the average number of CHWs, with “more exposed” facilities engaging 3.8 fewer CHWs post-GGR (95% CI:-7.31,-0.32).ConclusionsThe reduction in CHWs could reduce contraceptive use and increase unintended pregnancies in Uganda. The lack of other significant findings may not be surprising given the short post-GGR observation window. Rapid organizational responses and stopgap funding from foreign governments may have mitigated any immediate impacts on service delivery in the short term. The true impact may not be felt for many years, as stopgap funding potentially ebbs and service providers adapt to new funding environments.

Small Session Size and Big Vial Size: Operational Research Assessing Open Vial Vaccine Wastage at the Service Delivery Points in the Mandalay Region of Myanmar During 2018.

The World Health Organization (WHO) recommends immunization programmes to monitor vaccine wastage at storage and service delivery points. As there were no vaccine wastage assessments in Myanmar, we aimed to assess the vaccine wastage rates in the Mandalay region. We conducted a cross-sectional descriptive study with the inclusion of all immunization sessions conducted through the twenty randomly selected subcentres in the year 2018. The wastage rates were calculated by aggregating vaccine utilization data from selected subcentres. The vaccine wastage rates for Bacillus Calmette–Guérin (BCG) (54.9%), inactivated polio vaccine (28.3%), and measles-rubella (27.4%) were higher than the WHO indicative rates. The high vaccine wastage rates were seen in lyophilized vaccines (36.9%), vaccines requiring only a single dose per child for complete immunization (39.1%), and those with a large vial size of 20 doses (38.8%). The median session size for BCG (6), measles-rubella (4) and inactivated polio vaccine (2) were lower than their vaccine vial size of 20, 10, and 5 doses, respectively. The wastage was high due to smaller session size and larger vial size, necessitating the disposal of unused doses. Better micro-planning to increase the session size and procuring vaccines with smaller vial sizes needs to be tested as a strategy to reduce vaccine wastage.

Design of Enhanced Dynamic Resource Allocation Framework for Heterogeneous Cloud Environment

Cloud is a heterogeneous environment which is used to provide computing infrastructure as a service to the users. Cloud services are delivered to the users based on the demand received from the cloud service users. The best quality of a business model is to satisfy the product demand on time. Cloud is a business model to enable computing infrastructure everywhere. The cloud resources are scheduled and allocated to the users based on the requirement. Resource allocation in cloud computing environment is suffered by lack of improper monitoring, measurement and on time delivery of resources. This may affect the business growth of cloud service providers. This paper proposes an enhanced dynamic resource allocation framework to allocate resources based on the demands as well as cost of the resources to the users. The demand is forecasted based on the previous request repository. Fastcaster analyzes previous demands on different time and predicts future demands. Resources are prepared and to be in a ready state for allocation. The paper also describes the procedure of the proposed dynamic resource allocation technique for efficient allocation of resources in the cloud. The main focus of this framework is to schedule and allocate the resources which are in demand by the users on time also considered cost of the resources. Framework initiates a new paradigm of a single point of service delivery for all cloud services.

Measures of family planning service quality associated with contraceptive discontinuation: an analysis of Measurement, Learning & Evaluation (MLE) project data from urban Kenya.

Introduction: Several measures to assess family planning service quality (FPQ) exist, yet there is limited evidence on their association with contraceptive discontinuation. Using data from the Measurement, Learning & Evaluation (MLE) Project, this study investigates the association between FPQ and discontinuation-while-in-need without switching in five cities in Kenya. Two measures of FPQ are examined - the Method Information Index (MII) and a comprehensive service delivery point (SDP) assessment rooted in the Bruce Framework for FPQ. Methods: Three models were constructed: two to assess MII reported in household interviews (as an ordinal and binary variable) among 1,033 FP users, and one for facility-level quality domains among 938 FP users who could be linked to a facility type included in the SDP assessment. Cox proportional hazards ratios were estimated where the event of interest was discontinuation-while-in-need without switching. Facility-level FPQ domains were identified using exploratory factor analysis (EFA) using SDP assessment data from 124 facilities. Results: A woman's likelihood of discontinuation-while-in-need was approximately halved whether she was informed of one aspect of MII (HR: 0.45, p < 0.05), or all three (HR: 0.51, p < 0.01) versus receiving no information, when MII was assessed as an ordinal variable. Six facility-level quality domains were identified in EFA. Higher scores in information exchange, privacy, autonomy & dignity and technical competence were associated with a reduced risk of discontinuation-while-in-need (p < 0.05). Conclusions: The MII has potential as an actionable metric for FPQ monitoring at the health facility level. Furthermore, family planning facilities and programs should emphasize information provision and client-centered approaches to care alongside technical competence in the provision of FP care.

Global Social Welfare and Social Policy Debates: Ghana’s Health Insurance Scheme Promotion of the Well-Being of Vulnerable Groups

This article analyses social welfare, social policy with individualist and collectivist theoretical perspectives. It discusses the well-being of vulnerable groups and their access to social services including healthcare in the implementation of the National Health Insurance Scheme (NHIS) in Ghana. The aim is to find out the extent of vulnerable groups enrollment and if their welfare and well-being have improved in the implementation of Ghana’s health insurance scheme. Also, it examines whether NHIS is a pro-poor social intervention program or not. Data sources include census data, documents from health insurance authority, in-depth interviews, focus group discussions, direct observations at social service delivery points. Purposive, cluster and snowball sampling techniques are used to select participants. The sample size is 107 participants with 12 months of intensive data collection in three phases from 2012, 2013 and ended on October 2014. Results show more vulnerable groups are enrolled in NHIS compared with contributors. This suggests people who do not pay annual premiums constituted most health insurance subscribers. Also, the results show health insurance covered 38% of Ghana’s population for the 10 years of implementation of NHIS (2004–2013). Despite the progressive increase in coverage of NHIS, there are still some implementation challenges. The research found certain behaviors, practices, and attitudes of some social service providers as inhibiting subscribers’ enrollment. Future research may focus on social intervention programs for vulnerable groups across states.

Measures of family planning service quality associated with contraceptive discontinuation: an analysis of Measurement, Learning & Evaluation (MLE) project data from urban Kenya

Introduction: Several measures to assess family planning service quality (FPQ) exist, yet there is limited evidence on their association with contraceptive discontinuation. Using data from the Measurement, Learning & Evaluation (MLE) Project, this study investigates the association between FPQ and discontinuation-while-in-need without switching in five cities in Kenya. Two measures of FPQ are examined – the Method Information Index (MII) and a comprehensive service delivery point (SDP) assessment rooted in the Bruce Framework for FPQ. Methods: Three models were constructed: two to assess MII reported in household interviews (as an ordinal and binary variable) among 1,033 FP users, and one for facility-level quality domains among 938 FP users who could be linked to a facility type included in the SDP assessment. Cox proportional hazards ratios were estimated where the event of interest was discontinuation-while-in-need without switching. Facility-level FPQ domains were identified using exploratory factor analysis (EFA) using SDP assessment data from 124 facilities. Results: A woman’s likelihood of discontinuation-while-in-need was approximately halved whether she was informed of one aspect of MII (HR: 0.45, p < 0.05), or all three (HR: 0.51, p < 0.01) versus receiving no information, when MII was assessed as an ordinal variable. Six facility-level quality domains were identified in EFA. Higher scores in information exchange, privacy, autonomy & dignity and technical competence were associated with a reduced risk of discontinuation-while-in-need (p < 0.05). Conclusions: The MII has potential as an actionable metric for FPQ monitoring at the health facility level. Furthermore, family planning facilities and programs should emphasize information provision and client-centered approaches to care alongside technical competence in the provision of FP care.

Applicability of smart phones in identification and transferring the static images of oral mucosal lesions by allied health workers- A feasibility study

Background: Recent years have witnessed an enormous increase in the use of smart phones by almost the entire population. These phones are devices which use satellite communication and computation which can be hand held and used at point of service delivery. Aim: This pilot study aims at training allied health workers in identifying and locating people with oral mucosal lesions using smart phone technology. Methodology: This pilot project was designed and conducted amongst allied health workers in Sullia Taluk of Dakshina Kannada District for identification and transferring the static images of oral mucosal lesions for further diagnosis and follow up. A total of six of the ten PHC’s in Sullia Taluk were selected using simple random sampling method. Allied health workers who met our inclusion criteria were included in this study. Results: Preliminary analysis of the images obtained through smartphones revealed benign lesions in 14 images (7 pairs) potentially- malignant lesions in 34 images (17 pairs) and malignant lesions in 14 images (7 pairs). Conclusion: Health care delivery using Smartphone technology can be used as a promising tool in monitoring, diagnosing of diseases and referral of patients.

&lt;p&gt;Willingness to Join and Pay for Community-Based Health Insurance Among Rural Households of Selected Districts of Jimma Zone, Southwest Ethiopia&lt;/p&gt;

BackgroundGlobally, millions of people suffer and die because they do not have the money to pay for health care. A voluntary health insurance scheme is a prepayment mechanism to overcome the financial hardship of poor households. There is a high demand to determine the enrolment rate and ability to pay before scale-up of the scheme by the government to be sure of its feasibility and sustainability.ObjectiveTo determine willingness to join and pay for a community-based health insurance scheme and associated factors among rural households of selected districts in Jimma Zone, 2018.MethodsA community-based cross-sectional study design was employed in selected districts of Jimma Zone, Ethiopia. Multistage simple random sampling was used to select 422 households. Data were collected using a semi-structured interviewer-administered questionnaire. A double bounded contingent valuation method was applied to elicit households’ willingness to pay for the scheme. Data were entered into Epi-Data 3.1 and analyzed with SPSS V.23. A binary logistic regression model was fitted to determine the presence of statistically significant associations between the dependent and independent variables at p-value <0.05 and AOR values with 95% CI.ResultsOf 422 sampled respondents, 389 participated in this study with a response rate of 92%. Of these, 305 (78%) were willing to join and 274 (90%) of them were willing to pay. The average amount of money the households were willing to pay per household per annum was 228 ETB (8.27 USD), with a range of 100–500 ETB. The older age groups, poor households, and experience of local risk-sharing schemes were found to be determinants for willingness to join the community-based health insurance. Similarly, having a large family size, and low economic and education status of households were significant predictors of willingness to pay for this scheme.ConclusionA high proportion of households were willing to join and pay for the CBHI scheme. The average amount of money they were willing to pay for the scheme was very slightly lower than what is planned by the government. Thus, the government of Ethiopia should strengthen efforts to scale up this scheme in the rural areas of the country specifically to districts not yet enrolled, to reduce direct out-of-pocket payment at service delivery points. This will also contribute to guaranteeing dwellers of rural areas access to quality health services without facing financial hardship, to achieve universal health coverage for all by the end of 2035.

Factors Associated with the Low Completion Rate of Pre-natal Consultations in a Health District in Senegal

Introduction: Maternal-fetal and child morbidity and mortality is still a major public health problem despite all the progress made. It can be reduced significantly by proper monitoring of pregnancy through the 4 recommended pre-natal consultations (PNC). However, PNC completion rates remain low in sub-Saharan Africa. The Koki health district is no exception to this reality with 39% completion rate. The objective of this study is to determine the factors associated with PNC completion by pregnant women in order to make recommendations which aim to reduce maternal and fetal morbidity and mortality in the Koki health district in Senegal. Methodology: A cross-sectional descriptive study was conducted among 603 women who gave birth between 01/01/2017 and 31/12/2017 in the health district's area of responsibility. Two-stage cluster sampling was conducted. The first stage involved the selection of villages through a simple random draw. The second concerned the selection of concessions chosen by the bottle method. The number of clusters per Health Service Delivery Point (HSDP) was based on the number of expected pregnancies. Thus the survey consisted of 30 clusters of 20 women. All women meeting the criteria were selected from the concession. Data entry and analysis was done using Epi Info version 7.2.3.0. Results: The sample consisted of aged 26.15 years old average women, married, predominantly educated (52.75 per cent), and of Wolof ethnic group (66.6 per cent). More than 2/3 of the women (61.63%) were within 5 km of the health facilities. The majority of women (68%) had their own income. Almost all women were satisfied with the reception (97.5%) in the HSDP. Half of the women (50.61%) had their first PNC in the first trimester of pregnancy. The PNC completion rate calculated with prenatal consultation booklet data is 30%. The main factors having a statistically significant relationship with the low PNC completion rate are: age ≥ 30 years, number of pregnancies >3, number of deliveries > 3, distance between home and HSDP ≥ 5 km, PNC high cost perception and lack of own income. Conclusion: The reasons for the low PNC completion rate are related to the obstetrical situation, geographical accessibility, but also the woman's financial situation. Achieving a satisfactory completion rate require not only a greater awareness and empowerment of women, but also accessibility to health facilities.

How did the introduction of mifepristone impact the availability of abortion care in Ottawa? A qualitative study with abortion patients

In 2017, mifepristone and misoprostol became available for early pregnancy termination as the combination pack Mifegymiso® in Ottawa, Ontario, Canada. We conducted 40 semi-structured telephone interviews with Ottawa residents who had abortions before mifepristone’s introduction ( n = 20) and after mifepristone–misoprostol became available ( n = 20) to explore their experiences obtaining care. We audio-recorded and transcribed all interviews and analyzed these data for content and themes using deductive and inductive techniques. Prior to the introduction of mifepristone, our participants reported obtaining abortion care at two facilities and many faced long wait times. Those who had an abortion after mifepristone became available reported obtaining care from a wider array of providers and few waited more than two weeks. However, several mifepristone–misoprostol users reported having to go through a process that involved as many as 10 health service encounters. Both groups reflected positively on their abortion experiences, but some patients who obtained mifepristone–misoprostol outside of an abortion clinic did not feel as well informed as they would have liked. The introduction of mifepristone appears to have expanded the number of service delivery points and reduced wait times for those seeking abortion care in Ottawa. Identifying ways to expand access to medication abortion information and streamline services appears warranted.

Patient satisfaction about services obtained from a teaching hospital, Port Blair: A cross-sectional study.

Background:Periodic evaluation of health services delivered to the community is a part of total quality management of health care delivery system in developing countries.Objective:To assess the level of satisfaction among outdoor patients toward health care services available at teaching hospital, Port Blair.Methodology:The study included exit interview of 500 patients, sampled from 8 service delivery points of the health facility. Predesigned and pretested questionnaire based on PSQ-18 scale developed by Marshall and Hays was used as a study tool. Data entry was done in Microsoft excel sheet and analysis was done using IBM SPSS software version 21.Results:It has been observed that the majority of patients (62%) were from urban area. The highest number (32.40%) of respondents was in the age group of 30–39 years category. Mean satisfaction was the highest for communication (3.94 out of 5), followed by general satisfaction (3.69), technical quality (3.46), time spent with doctor (3.41), interpersonal manner (3.35), and least in accessibility and convenience (2.96).Conclusion:Our study showed a good level of satisfaction of patients with services obtained from the referral center. Among the different domains of measurements of patient satisfaction, only accessibility and convenience score was low. Findings of this study would serve as a baseline data for improving the quality of services and making them more clients centered.

Recent experiences with the Telephone helpline service at the central STD clinic, Colombo.

Introduction: The telephone helplines of the central STD clinic, Colombo provide sexual health information and guidance on STI care and treatment for the general public. However, caller profiles have not been explored or analyzed systematically during the recent past. Objectives: To describe the caller profiles and the content of the calls received to the telephone helpline. Methods: Details on all 215 telephone calls received to helpline during April-July, 2019 were recorded using a data extraction sheet after the verbal consent of the client. Results: Most callers (93%) were males with the median age of 22 years (range 15-65) and well educated (51%). The majority were first-time callers (84%). Reasons for calling included to inquire service delivery points (78%), HIV or HIV testing (62%), HIV symptoms (58%), Pre Exposure Prophylaxis related (11%), STI symptoms (21%) and sexual dysfunctions (12%). Thirty-four (34%) were due to misconceptions related to sexual health and HIV. Most callers (59%) discovered the hotline through internet (n= 126) while almost 10% were linked at a lecture and 6.5% by a peer and the rest as a result of TV programmes or newspaper articles Conclusions: People are using telephone helpline effectively. Therefore, further advertising on helpline through social media and other web sites and expansion of the services to the periphery is recommended. Reasons for less inquiries made by females should be further explored and attended. Timely actions to alleviate misconceptions regarding sexual health and HIV while raising awareness on available services need to be encouraged.

Managing negative word-of-mouth: the interplay between locus of causality and social presence

PurposeThis paper aims to describe the results of four studies that examine the interaction effects between locus of causality and social presence on consumers’ emotional response to a service failure and how they subsequently cope with the negative emotional experiences through support-seeking or vindictive negative word-of-mouth (NWOM).Design/methodology/approachTo evaluate the research hypotheses, one online content analysis study and three experiments were conducted.FindingsThe results of the four studies show that when locus of causality information is not available (Studies 1 and 2), consumers are more likely to engage in support-seeking NWOM when there is social presence (versus no social presence). When a service failure is externally/internally attributed, social presence leads to less/more vindictive NWOM (Studies 3 and 4). The results clarify the underlying affective processes (frustration, anger and embarrassment) that account for the unique interaction effects involving locus of causality and social presence on NWOM.Originality/valueDespite promising progress in both social presence and service failure research, scholarly attempts aiming to draw the theoretical linkages between these two streams are relatively scarce, and it remains unknown regarding whether and how social presence influences NWOM in the event of service failure. Against this backdrop, this research examines the effects of social presence on consumer NWOM in service failure. The authors further contribute to both research streams by testing the effects of an important set of emotions as mediators, as well by exploring the conditions under which a particular emotion is more predictive of its corresponding outcomes. These findings offer important insights that help service managers effectively mitigate customer NWOM at the point of service delivery.