Private Facilities Research Articles

Cost analysis of adding hypertension and diabetes management into routine HIV care in Mbarara and Ibanda districts, Uganda.

In 2016, Uganda introduced services for hypertension and diabetes in selected HIV clinics. We evaluated the costs associated with scaling up these services in HIV clinics in Mbarara and Ibanda districts, Uganda. We estimated the annual costs of providing hypertension and diabetes services using an activity-based costing approach from the health system perspective in ten randomly selected HIV clinics in Mbarara and Ibanda districts. Cost inputs included 2023 data on costs of medications, health provider time, salaries, training costs, and monitoring costs. We determined the average annual cost and medication costs for hypertension and diabetes treatment per enrolled adult patient, stratified by type of health facility. The total annual cost of hypertension and diabetes management services in ten selected HIV clinics was estimated to be $413,850 (range: $8,386 - 186,973). The annual average clinic-level cost per enrolled patient was estimated at $14 (range: $7 - 31). Of the total annual cost, the cost of provider time for initial and follow-up visits represented the largest cost component in 5/10 clinics (mean: 37%, range [13-58%]). In 4/10 clinics, the major cost components were the costs of medication, diagnostic tests, and related supplies (mean: 37%, range [10-75%]). The average cost per enrolled adult patient was $11 at public facilities and $21 in private not-for-profit facilities. The average medication cost per patient for hypertension was $24 (range: $7 - 97) annually; $13 at public facilities and $50 at private not-for-profit facilities. For diabetes treatment, the average annual medication cost per patient was estimated at $14 (range: $6 - 35); $11 at public facilities and $22 at private not-for-profit facilities. Adding hypertension and diabetes management to routine HIV care might be feasible based on the estimated annual cost per patient. Hypertension and diabetes treatment was more costly in private not-for-profit facility-based clinics than at public facilities. This variation was primarily driven by higher medication procurement prices at private facilities, revealing a potential area for optimizing costs through improved procurement practices.

Maternal mortality in Panama from 1998 to 2022.

To examine maternal mortality in Panama, analyzing its direct obstetric deaths, indirect obstetric deaths, and contributory conditions. This cohort study used publicly available data from the National Institute of Statistics and Census to present a 25-year retrospective analysis of maternal deaths in the Republic of Panama from 1998 to 2022. Public data were sourced from the National Institute of Statistics and Census website of Panama. Relevant codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD) were used. The maternal mortality ratio (MMR) was defined as the number of maternal deaths per 100 000 live births. Trendline reliability with R 2 was performed to analyze the data. A total of 1 026 maternal deaths occurred in Panama from 1998 through 2022, of which 61.2% were attributed to direct obstetric causes; 23.9%, indirect obstetric causes; 13.6%, contributory conditions; and 1.4% were unknown or undetermined. The average MMR was 60.1. The trendline reliability resulted in R 2 = 0.1 (y = -0.5147x + 1094.7), which is not statistically significant but meets the 2030 Sustainable Development Goals. The specific primary causes of direct obstetric deaths were: 12.9% due to postpartum hemorrhage (ICD O72); 9.2%, eclampsia (ICD O15); 6.7%, puerperal sepsis (ICD O85); and 6.3%, pre-eclampsia (ICD O14). For indirect obstetric deaths, the primary causes were: 14.9% due to other maternal diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O99); and 7.3%, maternal infectious and parasitic diseases classifiable elsewhere but complicating pregnancy, childbirth, and the puerperium (ICD O98). The findings of this study confirmed that there were substantially more direct obstetric causes (61.2%) than indirect obstetric causes (23.9%), contributory causes (13.6%), or unknown/undetermined causes (1.4%) of maternal mortality, despite being highly preventable. Although Panama is right on track to fulfill the target of 70 MMR by 2030, these results highlight the lack of health care access due to the absence of obstetrician-gynecologists per 100 000 population in indigenous comarcas, where 30.8% of the maternal mortalities occur. Furthermore, the health system in Panama is not immune to pandemics and crises. From 1998 to 2022, there were 5 years when the MMR in Panama exceeded 70: 2001, 2002, 2006, 2011, and 2020. These findings also underscore the dichotomy between statistics and health policy. While the trendline reliability was insignificant (R 2 = 0.1), the MMR satisfies requirements for the 2030 Sustainable Development Goals. Future studies should consider factors related to indirect obstetrics and contributory causes of deaths, health care access, COVID-19, cesarean section and natural birth, age, economic income, prenatal and postpartum care, as well as the quality of private and public health facilities in the Americas.

Fatigue, quality of life, and social support in Greek health staff: Public versus private kidney units

Healthcare professionals often experience fatigue and a diminished quality of life due to demanding hours and challenges in balancing work and personal life. Social support plays a critical role in influencing these factors. This study focused on nurses and healthcare workers in the artificial kidney unit, a specialized area requiring significant expertise to operate complex machinery for seriously ill patients. We assessed levels of fatigue, social support, and quality of life among 159 doctors and nurses in public and private facilities across Greece using the Fatigue Assessment Scale, Multidimensional Scale of Perceived Social Support, and General Health Questionnaire-28. Participants reported moderate fatigue (mean = 2.63, standard deviation [SD] = 0.57 for doctors; mean = 2.42, SD = 0.49 for nurses) and moderate-to-high levels of social support (mean = 5.66, SD = 1.35). Factors negatively impacting quality of life, such as physical symptoms, anxiety, social dysfunction, and severe depression, yielded low scores. Notably, fatigue and quality of life differed significantly between public and private sectors (p < 0.05), with public sector professionals reporting higher fatigue levels and lower quality of life. These findings highlight the need for healthcare authorities to address the unique challenges faced by staff in artificial kidney units, particularly in public hospitals, to improve working conditions and overall well-being.

Service Providers' Perceptions of Psychological, Emotional, and Behavioral Issues Among Children and Adolescents During COVID‐19 in South Korea

ABSTRACTVarious emotional and psychological support services for children and adolescents were implemented in South Korea during the COVID‐19 era. However, little is known about the limitations and future directions of current support services from the perspective of service providers. The purpose of this study was to explore service providers' perspectives on emotional and psychological support services for children and adolescents. The present study purposively recruited 11 clinical practitioners providing support services for children and adolescents to conduct semistructured focus group interviews. Thematic analysis identified four major themes: (a) a noticeable increase in problematic behaviors among children and adolescents (e.g., intrinsic and extrinsic problem behaviors); (b) changes in service use patterns (e.g., increased non‐face‐to‐face services); (c) frustrations with inadequate support systems (e.g., the absence of qualified professionals); and (d) identifying future directions (e.g., improving awareness of support services). The findings highlight the necessity of enhancing awareness of how to access services by reducing stigma. The findings also emphasize the need for improved cooperation between public and private facilities, as well as a greater number of skilled professionals to provide high‐quality programs. The practical and political implications are discussed based on the findings.

Palliative Care in the Midst of Adversity: Insights from a Low-Income Country.

The integration of palliative care into conventional healthcare services has demonstrated significant benefits in alleviating serious health-related suffering (SHRS), reducing symptom burden, and lowering healthcare expenditure for patients and families. Despite Lebanon's initial steps towards palliative care development, its integration remains inadequate, particularly due to the country's socio-political and economic challenges. This paper examines the current landscape of palliative care services in Lebanon, including their geographical distribution and care models, while addressing the obstacles impeding their progress. Data on palliative care services were gathered from the presentations of stakeholders at the 2023 National Palliative Care Conference. Currently, three nonprofit organizations provide home-based palliative care primarily for end-of-life patients, while seven hospitals offer palliative care through inpatient consultation teams, three of which have specialized palliative care wards and two outpatient clinics. Hospital-based palliative care services are primarily located in the capital city Beirut and operate within private healthcare facilities. Notably, only home-based services are provided free of charge, while hospital-based care is not reimbursed, thus limiting access to palliative care for only those who can afford it. The political and economic instability, inadequate policies and insufficient reimbursement, shortage of trained expertise and essential medicines like morphine, and inconsistent health education are some of the challenges that Lebanon faces in developing palliative care. A multilevel coordinated response and advocacy are crucial to drive policy reforms, enhance education, promote public awareness, and improve clinical practice ensuring quality and equitable palliative care access to all.

Sociodemographic factors affecting knowledge levels of tuberculosis patients in New Delhi

ABSTRACT Background: Sociodemographic factors can significantly influence the knowledge level of tuberculosis (TB) patients, affecting the overall health outcomes. Due to lack of awareness and the stigma associated with TB, Indian TB elimination efforts are facing challenges. Patients with less information are more likely to experience delays in diagnosis and proper care. Method: A cross-sectional study was conducted in New Delhi across 26 operational National TB Elimination Program districts, involving 200 adult pulmonary TB patients receiving treatment from April to August 2020. A structured questionnaire guided the interviews, followed with bivariate analysis and descriptive statistics used for analysis. Results: Predominantly, residents of semiurban regions accounted for the highest proportion (70.5%), followed by urban areas (20.5%), with rural areas/slums comprising a minority (9%). Notably, a significant majority (94.5%) reported residing in individually owned dwellings, with shared accommodations limited to a minority (5.5%). Sanitary facilities varied, with 77% possessing personal toilets, 18.5% utilizing private facilities, and only 4.5% relying on public toilets. Awareness levels about TB reflected moderate awareness among 56% of participants, good knowledge among 41%, and minimal awareness (poor knowledge) among only 3% of respondents. Conclusion: Age, sex, socioeconomic level, kind of lodgings, malnutrition, and personal cleanliness should all be taken into account for TB treatment adherence. A new set of frameworks should be developed to enhance the living circumstances of high-risk populations and patients who are living in crowded locations since sharing a room or a house in a populated region increases the risk of TB transmission.

Restroom access and health among people experiencing homelessness: A focus on San Diego, CA

ABSTRACT Access to restrooms is vital to personal and public health, particularly among people experiencing homelessness (PEH). This study investigated how restroom access is associated with three domains of self-reported physical health (voiding and defecation-related conditions; skin conditions; and hypertension) among PEH in San Diego, CA. Data from 115 structured interviews with PEH (67.8% male, 40.0% mono-racially White, 57.4% rough sleeping) indicated that 37.4% (n = 43) reported typically using public restroom facilities, 38.3% (n = 44) reported typically using private facilities, and 23.5% (n = 27) reported typically engaging in open defecation. There were moderate to strong associations between urinary, gastrointestinal, and dermatological health conditions and stressors/barriers related to restroom access. The proportion of participants with ≥1 skin-related health conditions who engaged in open defecation was substantially higher (40%) compared to participants who reported no skin-related health conditions who engaged in open defecation (17.9%) (χ2(df = 1,108) = 5.25, p = 0.02). Participants who reported ≥3 voiding or defecation-related health conditions or ≥1 skin-related health conditions reported higher mean restroom-related impediments to health relative to participants without these health conditions. Restricted restroom access may prevent PEH from fulfilling their basic sanitation and hygiene needs, and may exacerbate urinary, gastrointestinal, and skin health conditions.

Association between attitude and menstrual hygiene management practices among adolescent girls with disabilities in selected schools in Wajir County, Kenya

Background: Menstruation is the recurrent peeling of the uterine lining that occurs monthly on girls and women of the reproductive age. Many adolescent girls in African countries have poor knowledge regarding menstruation and this is even worse among menstruating girls with disabilities who are faced with a greater challenge as they require private and specific sanitation facilities. The study focused on establishing the association between attitude and menstrual hygiene management practices among adolescent girls with disabilities in selected schools in Wajir County. Methods: A descriptive cross-sectional design was adopted. Census method was used to select respondents where 101 were interviewed. Pretested questionnaires were used to collect data. All necessary research approvals from relevant institutions were obtained as well as consent and assent sought from respondents and guardians where applicable. Data was managed using SPSS version 22.0 software. Results: Most 88.1% of the respondents did not practice menstrual hygiene management. Further results revealed that 98.9% of those who had negative attitude had not practiced menstrual hygiene management. There was a significant statistical association between nature of attitude and practice of MHM (χ2=11.009, p*=0.029). Conclusions: About 9 out of 10 adolescents with disabilities in Wajir County did not practice menstrual hygiene management. The nature of attitude towards menstrual hygiene management was significantly associated with practice. The study recommended provision of free sanitary pads by relevant stakeholders to all girls who are living with disabilities and provision of enough washrooms to address privacy issues.

A survey of availability and affordability of polypills for primary and secondary prevention of cardiovascular diseases in selected countries

Abstract Background/Introduction The recent inclusion of polypills—fixed-dose combinations of two or more antihypertensive drugs and statin with or without aspirin—in the World Health Organization’s Essential Medicines List (EML) reiterates the potential of this approach to improve global treatment coverage for primary or secondary prevention of cardiovascular diseases (CVDs). Although there exists extensive evidence on efficacy, safety, and acceptability of polypills, there is no research to-date assessing the "real world" availability and affordability of polypills globally. Purpose We conducted a cross-sectional survey of public and private sector facilities in 13 countries from around the world to evaluate the availability and affordability of polypills. Methods In the surveyed countries, we first ascertained whether any polypill was authorized for marketing and/or included in the national EMLs and clinical guidelines. The facility survey employed a modified WHO/Health Action International methodology. In each country, we collected retail and price data for polypills from at least one public sector facility and three private pharmacies using convenience sampling. Polypills were considered unaffordable in a given country if the lowest paid worker spends more than a days’ wage to purchase monthly supply. Results Polypills were approved for marketing in four of the 13 surveyed countries: Spain, India, Mauritius, and Argentina. None of these countries included polypills in national guidelines, formularies, or EMLs. Further, none of the surveyed public pharmacies in any of the four countries stocked any polypills. Among the surveyed private sector facilities, availability ranged from 0% in India (out-of-stock on the survey day but listed for sale) to 100% in Argentina and Spain. In the private sector, we identified seven unique polypill combinations, marketed by eight different companies. Although not in stock, India had a wider range of various combinations (n=5). Many combinations (63%) found in this survey were affordable in the local context, but these were limited to India and Spain. A lowest paid government worker would spend between 0.2 (India)–2.8 (Mauritius) days’ wages to pay the price for one month’s supply of the polypills. Polypills were likely to be affordable in countries that locally manufactured them. Further, two-pill combinations (one antihypertensive and a statin) were stocked by private pharmacies in Argentina, Bangladesh, Cameroon, India, Nepal, and Spain, with affordability ranging from 0.2 (India)–7.1 (Cameroon) days’ wages. Conclusion Low availability and affordability of polypills in both public and private sectors suggest that the implementation and overall uptake of polypills remains poor globally. Context-specific multi-disciplinary health system research is required to understand factors affecting polypill implementation and to design and evaluate appropriate implementation strategies.

Handling client financial insolvency in maternity services: An occurrence, experience and policy gap qualitative analysis among healthcare stakeholders in North-Central Nigeria.

To assess the occurrence of client financial insolvency, experiences of key healthcare stakeholders, and policy gaps on handling the situation during maternity services. A qualitative study was conducted in North-Central Nigeria. Participants were key healthcare stakeholders including healthcare workers from private, primary, secondary, and tertiary facilities, healthcare administrators/facility-heads, program managers and policy makers at local and state government levels through In-depth and Key Informant interviews. Identified themes were occurrence, experiences of stakeholders, and prevention of client financial insolvency. Data were analyzed with the Nvivo statistical package. Participants confirmed the occurrence of client financial insolvency. Clients' inability to pay hospital bills was due to being indigent, awaiting support from relations, or clients who were uncommitted to the payment. Health facilities lack guiding policy documents; potential cases are referred from private to public or from primary to secondary/tertiary facilities. Methods of handling financial insolvency included healthcare worker-related (staff scavenging for needed consumables, fund-raising among facility staff), facility-related (revolving fund, medical social welfare, welfare committee, discharge with re-payment plan, fee-waiver), community-related (ward development committee, religious organizations/philanthropists) interventions, or hospital detention of insolvent clients. Although clients' bills did not increase during detention, many clients did not honor post-discharge re-payment agreements. Participants suggested a client-friendly billing system, early initiation of birth preparedness, partner involvement, and a rapid scale-up of health insurance for pregnant women to curb financial insolvency. Tackling client financial insolvency requires policy documents, support to private facilities, effective debt-recovery mechanisms, and scale up of health insurance for pregnant women.

Assessing the role of the for-profit private healthcare sector in malaria elimination efforts in Bangladesh: a cross-sectional study of challenges and opportunities

BackgroundAmong 13 endemic districts, the Chittagong Hill Tracts bear more than 90% of Bangladesh’s malaria burden. Despite the private sector’s prominence in rural healthcare, its role in malaria management remains underutilized. This study aimed to strategize leveraging the for-profit private sector, such as diagnostic and treatment centers, to bolster national malaria surveillance and control, advancing Bangladesh toward malaria elimination by 2030.MethodsThis mixed-method study commenced with a questionnaire-based cross-sectional survey followed by selected focused group discussions (FGDs) among the participants. Three FGDs were held with the for-profit service providers so that further insights and qualitative viewpoints of them can be utilized in situation analysis. Based on the endemicity and strategic priorities, a comprehensive mapping of private for-profit facilities from the regions comprising 15 sub-districts across 8 chosen districts (7 malaria endemic districts and the rest non-endemic districts) was created. For the non-endemic zone, the sub-districts were selected based on their proximity to an area with high malaria transmission.ResultsAmong the 104 representative participants, majority were male (n = 92, 88.5%), had a diploma in their respective fields (n = 53, 51%) and were involved either in laboratory work (n = 49, 47.1%) or as owners/managers of health centers (n = 41, 39.4%). The selected health facilities were close to the corresponding Upazila Health Complexes (mean distance 2.8 km), but were distantly located from the designated district hospitals (mean distance 48.9 km). The main sources of RDT kits (62.3%) and anti-malarial drugs (63.2%) were local wholesale markets. A large share of the corresponding facilities neither provided malaria treatment services (81.7%) nor worked with the NMEP (93.3%).ConclusionsThis study highlights challenges and recommendations for engaging private for-profit health facilities in Bangladesh’s malaria elimination efforts. The identified challenges include low-quality RDTs, staff shortages, and inadequate capacity building. Recommendations emphasize effective training, stakeholder interaction, and enhanced oversight for successful malaria control efforts.

Exploring the risks of fragmentation in health care markets – An analysis of inpatient care in Georgia

Private providers play an important role in health systems in low-and middle-income countries. In many such contexts, markets are characterized by a high number of relatively small private facilities. The potential risks from highly concentrated healthcare markets are well-researched, and feature in the “Theories of Harm” investigated by competition regulators. However, there is limited evidence on markets that exhibit substantial harms as a result of very low concentration. This paper explores the risks associated with such market fragmentation, drawing on the example of Georgia, which has a largely privatized provider network.We used a mixed-method study design to analyze the inpatient market in Georgia. Market structure was described using administrative data on bed capacity and discharge numbers and geo-location data on travel time between facilities. The implications of the market structure were explored through in-depth interviews (n = 35) with policymakers, healthcare managers, and local experts and an anonymous online survey of similar groups (n = 97).Georgia's inpatient sector is characterized by a high number of small hospitals in terms of bed numbers and inpatient volumes, mitigated to a limited degree by the presence of provider networks. Travel time to the 3rd nearest competitor was extremely short, ranging from 3 to 5 min in big cities to 10 min in small towns and 33 min in remote locations. The fragmented nature of the market, together with inadequate regulatory and purchasing mechanisms, was argued to exacerbate challenges in the availability and competence of clinical staff, while the financial challenges caused by intense competition encouraged wasteful marketing, harmful cost-cutting measures, and demand inducement.We present “Theories of Harm” from market fragmentation, and argue that an effective policy response requires market-shaping activities using regulatory, financing, and purchasing mechanisms to encourage appropriate levels of market consolidation and so enhance quality, efficiency, and effective governance.

Key Predictors of Patient Satisfaction and Loyalty in Saudi Healthcare Facilities: A Cross-Sectional Analysis.

Patient satisfaction and loyalty are essential indicators of healthcare quality, directly impacting patient outcomes and the long-term success of healthcare facilities. Despite the growing importance of patient-centered care in Saudi Arabia, there is limited research exploring the factors that influence patient satisfaction and loyalty, particularly in the Riyadh region. This study aims to identify the key factors influencing patient satisfaction and loyalty among Saudi patients attending public and private healthcare facilities in the Riyadh region. The study focuses on how healthcare service quality, communication, and demographic factors contribute to patient satisfaction and loyalty. A cross-sectional study was conducted with a sample of 350 Saudi patients from 10 healthcare facilities in Riyadh. Data were collected using the Patient Satisfaction Questionnaire (PSQ-18) and the Patient Loyalty Questionnaire (PLQ). Descriptive statistics, Pearson correlation, and multiple linear regression were employed to identify predictors of patient satisfaction and loyalty. Significant predictors of patient satisfaction included general satisfaction (β = 0.48, p < 0.001), communication (β = 0.35, p < 0.001), and the frequency of healthcare visits (β = 0.13, p = 0.011). Private healthcare facilities had higher satisfaction (p < 0.001) and loyalty scores (p < 0.001) compared to public facilities. Patient loyalty was strongly predicted by general satisfaction (β = 0.55, p < 0.001) and communication (β = 0.42, p < 0.001). Communication quality and patient satisfaction are key drivers of patient loyalty in Saudi healthcare facilities. Private facilities outperform public ones in patient satisfaction and loyalty. These findings emphasize the need for healthcare providers to enhance communication and service quality to foster patient loyalty. Tailored approaches to meet the diverse needs of patients, particularly in terms of education and visit frequency, are crucial for improving healthcare outcomes in Saudi Arabia.

Optimising availability and geographical accessibility to emergency obstetric care within a sub-national social health insurance scheme in Nigeria.

Health insurance is a key instrument for a health system on its path to achieving universal health coverage (UHC) and protects individuals from catastrophic health expenditures, especially in health emergencies. However, there are other dimensions to care access beyond financial accessibility. In this study, we assess the geographical accessibility of comprehensive emergency obstetric care (CEmOC) within the Lagos State Health Insurance Scheme. We geocoded functional public and private CEmOC facilities, established facilities registered on the insurance panel as of December 2022, and assembled population distribution for women of childbearing age. We used Google Maps Platform's internal directions application programming interface to obtain driving times to facilities. State- and local government area (LGA)-level median travel time (MTT) and a number of CEmOC facilities reachable within 30 min were obtained for peak travel hours. Across Lagos State, MTT to the nearest public CEmOC was 25 min, reduced to 17 min with private facilities added to the insurance panel. MTT to the nearest public facility in LGAs ranged from 9 min (Lagos Island) to 51 min (Ojo) (median = 25 min). With private facilities added, MTT ranged from 5 min (Agege and Ajeromi-Ifelodun) to 36 min (Ibeju-Lekki) (median = 13 min). On average, no public CEmOC facility was reachable within 30 min of driving for women living in 6 of 20 LGAs. With private facilities included in the scheme, reachable facilities within 30 min remained zero in one LGA (Ibeju-Lekki). Our innovative approach offers policy-relevant evidence to optimise insurance coverage, support efforts in advancing UHC, ensure coverage for CEmOC, and improve health system performance.

Dengue fefer and mixed abortion among pregnant women: findgs of a comparative cross-sectional study

Background: Dengue situation in Bangladesh has escalated over the last few years causing significant mortality and morbidity. Pregnant women are highly vulnerable to dengue infection leading to various grave complications for both mother and foetus including missed abortion. Despite the severity of this condition, few studies have explored the association of dengue fever with missed abortion in Bangladesh. This study aimed to investigate the association between missed abortion and dengue fever. Methods: This comparative cross-sectional study enrolled 35 pregnant women having the history of missed abortion during the gestational age of less than 22 weeks and 35 pregnant women continuing their pregnancy with gestational age of more than 22 weeks receiving ante natal care. Both groups were selected conveniently. The study was conducted in a private facility from February to October, 2023. Data were collected from medical record review and analyzed with appropriate descriptive and analytical statistics. Cases of missed abortion attributed to dengue infection were compared with pregnant women receiving routine antenatal care if their pregnancies continued beyond 22 weeks’ gestation. Other predictive factors for missed abortion were also examined. Results: Dengue infection was detected among 14 (40%) of pregnant women with missed abortion in comparison to 3 (8.6%) pregnant women without missed abortion. Significant (p&lt;0.05) association was found between dengue infection and missed abortion in pregnant women. Conclusion: Special preventive measures should be taken to protect pregnant mother against dengue infection. JOPSOM 2023; 42(1):62-67

Early Lessons From Working With Local Partners to Expand Private-Sector Health Care Networks in Burundi and Mali.

The private health care sector is an important source of service delivery in low- and middle-income countries (LMICs). Yet, the private sector remains fragmented, making it difficult for health system actors to support and ensure the availability of quality health care services. In global health programs, social franchising is one model used to engage and organize the private health care sector. Two social franchise networks, ProFam in West Africa and Tunza in East and Central Africa, provide health care through branded networks of facilities. However, these social franchise networks include a limited number of private health care facilities, and in fragile contexts, like Burundi and Mali, they have faced challenges in integrating with national health systems. The MOMENTUM Private Healthcare Delivery (MPHD) project in Burundi and Mali sought to expand the number of health facilities it engaged beyond the existing ProFam and Tunza networks. The expansion aimed to help improve service quality in more private facilities while advancing localization and reducing fragmentation for improved stewardship by health system actors. MPHD achieved this expansion by removing barriers for private health facilities to join inclusive, nonbranded networks and engaging local partners to build and maintain these networks. We share lessons learned regarding the growing role of local organizations as actors within mixed health systems and provide insights on strengthening stewardship of the increasingly heterogeneous private health care delivery sector in LMICs, particularly in fragile settings.

Satisfaction Amongst Drug-dependent Population with Methadone Maintenance Treatment Services, A Comparison between Public and Private Clinics: Implications for Private Sector Engagement in the Delivery of Methadone Maintenance Programs Across Vietnam.

In Vietnam, the public sector has largely been responsible for delivering methadone maintenance treatment (MMT) services. However, with foreign aid anticipated to decline in the coming years, the involvement of the private sector in delivering MMT services is critical to ensure the continued sustainability of MMT programs across Vietnam. This study aims to evaluate patient satisfaction and identify correlated factors among Vietnamese drug users undergoing MMT in both public and private methadone clinics. A cross-sectional study was conducted in one private and two public methadone facilities in Nam Dinh, a province in the North of Vietnam. A convenience sampling technique was applied to recruit 395 participants. Data was collected through 20-minute face-to-face interviews using a structured questionnaire. Multivariate Tobit regression was utilized to measure associated factors with patient satisfaction. Results showed that patients were highly satisfied with MMT services in both public and private; however, they expected a higher degree of comprehensive care services. Compared with public facilities, the satisfaction level of patients in private facilities was significantly lower in the following aspects: health administration and professional capacity of health workers. However, there were insignificant differences in regard to infrastructure, equipment, and availability of medical services resources, supporting a promising role of the private sector in supporting the expansion of the MMT programs in Vietnam. Integrating MMT with other physical and mental healthcare services, along with strategies for improving administrative procedures and health workers' capacity in private clinics, are critical implications of this study.

Inequalities in the risk and prevention of invasive meningococcal disease in the United States - A systematic literature review.

Vaccination remains the most effective strategy to prevent invasive meningococcal disease (IMD), with MenACWY, MenB and MenABCWY recommended for adolescents/young adults in the United States (US). However, vaccination coverage remains suboptimal, which could be related to population inequalities. To understand the impact of IMD risk, prevention and control inequalities, a global systematic literature review (Medline, Embase, 2012-2022) was conducted on individual, socioeconomic, and environmental inequalities associated with IMD risk, prevention and control in all ages. Studies on IMD risk (n = 15) and prevention (n = 14) inequalities were identified. IMD incidence proportions were higher in Medicaid versus commercially insured populations, and IMD mortality was higher in poorer neighborhoods. White adolescents, adolescents from lower income families, and with lower maternal education were more likely to receive MenB vaccination; while Black and Hispanic adolescents, and adolescents with higher family incomes, were more likely to receive MenACWY vaccination. Meningococcal vaccination was associated with being up-to-date with other vaccinations, having multiple healthcare/well child visits, having a pediatrician as healthcare provider (HCP), and attending private facilities; while being uninsured was associated with lower vaccination. States with a MenACWY vaccination mandate and higher pediatrician-to-children ratios had higher vaccination rates. Important inequalities were due to individual differences, socioeconomic, and environmental factors. IMD prevention is suboptimal, especially among adolescents/young adults. To improve health equity, health policy makers could ameliorate meningococcal vaccination coverage across the US, with simplified and stronger meningococcal vaccine recommendations from public health authorities, and initiatives to enhance parental/patient and HCP knowledge of IMD and vaccine recommendations.

Documenting the Provision of Emergency Contraceptive Pills Through Youth-Serving Delivery Channels: Exploratory Mixed Methods Research on Malawi's Emergency Contraception Strategy.

Emergency contraceptive pills (ECPs) are effective and can be used safely at any age repeatedly within the same cycle. They are often favored by youth yet are underutilized. Private facilities can increase ECP access but present barriers including cost. Identifying effective public-sector ECP distribution models can help ensure equitable access. The Malawi Ministry of Health developed a strategy to improve ECP access in 2020. We documented ECP provision through select public, youth-serving channels recommended by the strategy: general and youth-specific outreach, paid and unpaid community health workers (CHWs), and youth clubs. We conducted this mixed methods study from November 2022-March 2023 in 2 rural districts (Mchinji and Phalombe) implementing the strategy. We conducted qualitative interviews with 10 national stakeholders, 46 providers, and 24 clients aged 15-24 years about ECP service delivery. Additionally, 25 providers collected quantitative tally data about clients seeking ECPs. We analyzed qualitative data using grounded theory and quantitative data descriptively. Stakeholders and providers reported ECP uptake increased in geographies where the strategy was implemented, especially among youth. Providers documented 3,988 client visits for ECPs over 3 months. Of these visits, 26% were from male clients, 36% were from clients aged younger than 20 years, and 64% received ECPs for the first time. Across channels, youth club leaders and unpaid CHWs reported the most client visits per provider and served the youngest clients. However, no ECPs were dispensed during 29% of visits due to stock-outs. While many providers were supportive of youth accessing ECPs, most held unfavorable attitudes toward repeat use. ECP access should be expanded through provision in the studied channels, especially youth clubs and CHWs. However, to meet demand, the supply chain must be strengthened. We recommend addressing providers' attitudes about repeat use to ensure informed method choice.

Evaluation of Treatment and Recurrence-Free Survival in Patients with Early HER2-Positive Breast Cancer: Real-Life Data Comparing Public and Private Healthcare

Abstract Introduction The present study was designed to compare the treatment provided in private and public health care facilities for women positive for early breast cancer of the human epidermal growth factor receptor 2 (HER2) subtype, who received anti-HER2 therapy in neoadjuvant or adjuvant settings, with an evaluation of the recurrence-free survival (RFS) and pathological complete response (pCR) rates. Materials and Methods The current is a retrospective study carried out at the Instituto Brasileiro de Controle do Cancer (IBCC Oncologia), in the city of São Paulo, Brazil. We included patients treated between 2015 and 2020. Results The study included 472 medical records of early HER2-positive breast cancer patients treated in the public and private health care systems who received neoadjuvant or adjuvant treatments. The pathological complete response (pCR) was related to a lower recurrence rate and a longer recurrence-free survival (RFS). The results showed no statistically significant difference between the public and private health care systems in terms of RFS. Discussion Although the public health care patients were diagnosed with more advanced diseases than the private health care patients, both presented similar survival rates. In spite of the small number of patients evaluated, the dual HER2 blockade did not improve the clinical outcomes. These findings should be confirmed through studies with a larger number of patients and a longer follow-up period.