Private Facilities Research Articles

Status of infection prevention and control in Cameroon healthcare facilities: lessons learned from the WHO COVID-19 scorecard tool under the hierarchy of control model

BackgroundInfection prevention and control (IPC) helps prevent disease transmission in healthcare facilities. There is a dearth of information on the implementation of IPC during the COVID-19 outbreak in Cameroon using the recommended WHO COVID-19 IPC scorecard tool. The present study assessed healthcare facilities’ compliance to IPC by continuous assessments, with an evaluation of the tool using the hierarchy of control theory. MethodsThis cross-sectional study was conducted in the 10 administrative regions of Cameroon by evaluating healthcare facilities prioritized by the Ministry of Public Health as high-risk facilities between March 2020 and November 2023. Comparisons were made regarding the facilities’ ownership, level and status. Results2,188 assessments from 1,358 healthcare facilities were collected. The median IPC scores at each evaluation were between the intermediate and advanced level, with a bias linked with decreasing selection of facilities. However, only 172 (13%) healthcare facilities achieved advanced IPC score (≥75%). Higher IPC scores were found in hospitals (p<0.001) and in private facilities (p=0.02). Predictors of good IPC compliance were hospital (OR=3.7, CI: 1.4-9.8) and private facility (OR=2.3, CI: 1.6-3.3). The tool met the five domains of the hierarchy of control model. ConclusionRepeated IPC assessments using recommended tools contribute to a better compliance of IPC by healthcare facilities in resources constrained settings.

Costs and resource distribution of direct services for HIV in Uganda

ObjectiveIn high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of...

Patient’s willingness to pay for improved community health insurance in Tanzania

Globally, achieving universal health coverage remains significant challenge. Health insurance coverage in low- and middle-income countries is still low with only a few African countries managed to reach 50% coverage. This study aimed to investigate the factors influencing patients’ willingness to pay (WTP) for medication and various versions of the improved Community Health Insurance Fund (iCHF) in Tanzania. A facility-based cross-sectional study was conducted in all hospitals, health centres, and eight randomly sampled dispensaries, sampling participant from the queue, one out of every three patient based on their order of entry into consultation room, and interviewed 1,748 patients in Kilombero and Same districts in Tanzania. We used multi-stage Contingent Valuation Methods exploring data collected during client exit interviews. We employed a random utility model and estimated WTP through an ordered logit model. The independent variables were; patient’s gender, age, marital status, education, employment status, Non-Communicable Disease (NCD) status, health insurance status, and the type of healthcare facility level. Our findings revealed that most patients exhibited a WTP of an amount equivalent to the current iCHF premiums and would also be willing to pay for an augmented iCHF premium inclusive of additional medication coverage. Upon adjusting for demographic characteristics, we observed that patients enrolled in an insurance program or benefiting from user fee waivers demonstrated a lower WTP for medication, while those with non-communicable diseases (NCDs) and seeking care in private facilities exhibited a higher WTP. Furthermore, patients with a secondary education level or above generally displayed higher WTP for premiums. Conversely, patients enrolled in private insurance and availing user fee waivers, along with those accessing care in public facilities, demonstrated a lowered WTP for iCHF premiums. These results highlight the need for targeted interventions to address systemic deficiencies and improve access to medicines. Our conclusions is that policies considering NCD status, education levels and income status are important when designing health insurance schemes for the informal sector in Tanzania, with the goal of increasing uptake of CHF.

Navigating delayed diagnoses, self-neglect, and lost livelihoods: a qualitative exploration of fisherfolk’s health perspectives and management of non-communicable diseases in Kerala, India

IntroductionNon-Communicable Diseases (NCDs) place a significant burden on India's healthcare system, accounting for approximately 62% of all deaths in the country in 2017. The southern Indian state - Kerala - has some of the highest rates of NCDs. Within the state, the fisherfolk community has a high prevalence of risk factors such as tobacco use and alcohol consumption. Working in the fisheries industry demands physical exertion, night shifts alongside extended periods of time at sea (for seafaring fisherfolk). Evidence is scant on how these conditions relate to the health-seeking experiences of fisherfolk, particularly in the context of NCDs. We conducted a qualitative study in two districts of Kerala to fill this gap.MethodsIn-depth individual and small group interviews– as per participant preference – with male and female fishing community members living with NCDs were conducted between October 2022 and February 2023 in two districts of Kerala. Interviews were conducted to explore community members’ experiences with health-seeking for NCDs. Transliterated English transcripts were coded using ATLAS.ti software and analysed using thematic analysis with inductive generation of codes, with indexing against Levesque, Harris, and Russell’s 2013 access to healthcare framework.ResultsThirty-three interviews with 42 participants were conducted. We found that NCDs were usually diagnosed late- either when admitted/consulted for other illnesses or when the symptoms became unbearable. Health-seeking patterns differed between seafaring and inland fishing subgroups, who were sampled from two districts in the state. Seafaring fisherfolk preferred public facilities for regular checkups and medicines while in-land fisherfolk relied on private facilities, although it was considered expensive. Ability to seek care was impacted by the working hours of the health centre which did not suit their working hours. Health constaints and related expenses also impacted their financial status and occupation, with some opting for less strenuous jobs.ConclusionThis study highlights the NCD-related health-seeking experiences of the fisherfolk community in Kerala, India. Fisherfolk reported self neglect, delayed diagnosis, cost and livelihood constraints owing to the onset of NCDs, even as dual practice and medicine access in the public sector were appreciated. Overall, larger studies and policymaking processes should consider in depth the experiences faced by particular economic groups like fisherfolk, who may face unique health and care-seeking challenges.

Ethical and legal aspects of the abortion dispute in Italy in 2020-2023

The main goal of the article is to analyze the key elements of the current dispute over worldviews and politics in Italy concerning the ethical and legal aspects of various forms of abortion. The country on the Tiber River was one of the states around the world that widely liberalized abortion laws during the COVID-19 pandemic. In August 2020, the Italian Ministry of Health decided that pharmacological abortion – performed with the medical preparation RU-486 – should not be practiced at hospital gynaecology-obstetrics wards, but at day hospital facilities, with no requirement of hospitalization for women performing this type of abortion. Limited access to medical services in public and private healthcare facilities led to the practice of pharmacological abortion shifting largely from hospitals and clinics to pharmacies, private apartments, and homes. In 2021, pharmacological abortion in Italy accounted for 48.3% of all abortions performed under the current abortion law. In the face of the trivialization of the termination of pregnancy, Italian pro-life circles have taken a variety of measures to protect preborn life. One such initiative was the “Beating Heart” campaign, which looked at the possibility of showing the unborn child and its beating heart to the woman seeking an abortion. The analyses carried out in the article show that in the age of the Internet and the global village, it is not so much the legal norms that are increasingly important, but human free will and the awakening of people’s moral sensitivity by developing appropriate bioethical awareness at the societal level. In this context, the various initiatives currently implemented in Italy by pro-life circles to achieve these goals are of great significance. In addition, the abortion debate in Italy supplies a number of arguments for the need to extend the conscience clause to pharmacy personnel.

Assessment of the readiness of health facilities in urban areas to deliver geriatric-friendly care services: a cross-sectional study in Kampala City, Uganda

BackgroundWith the global rise in the elderly population, ensuring geriatric-friendly healthcare services is paramount. This study aimed to assess the current readiness of health facilities in Kampala City, Uganda, to provide geriatric-friendly care services.MethodsWe conducted a cross-sectional study in 35 health facilities (HF) including Private for-profit (PFP), Private not-for-profit, and public (government-run) facilities at different levels i.e., Health Centre III, Health Centre IV, and Hospitals, within Kampala City, Uganda. Data was collected using a self-administered health facility assessment tool. Facilities scoring 80–100 were classified as fully ready to offer geriatric-friendly care, 51–79 indicated moderate readiness, and 0–50 indicated low readiness.ResultsThe overall readiness index (RI) across all facilities was low, 44.09 (SD ± 14.18). The National Referral Hospital (NRH), PFPs, and HFs in Kampala Central had the highest RI of 55.34. 47.63 and 51.09 respectively. The low readiness of HF to provide geriatric-friendly care was due to the low scores in leadership and governance (13.49), financing (19.29), human resource (42.66), and Health Management Information System (47.99) WHO building blocks. HCIVs had a higher readiness index than the other HF levels (Coefficient: 17.40, 95% CI: 4.16 to 30.64, p = 0.012). HFs in Kawempe had a significantly lower RI than those in Makindye and Kampala Central (Coefficient: -13.80, 95% CI: -24.48 to -3.11, p = 0.013).ConclusionThe findings of our study indicate that public and private health facilities in Kampala City are not ready enough to provide geriatric-friendly care services.

Trends in medicine utilisation in public and private healthcare facilities before and during COVID-19: a nationwide analysis of medicine procurement and sales data, 2018-2022.

There was a fluctuation in medication demand and supply during COVID-19 pandemic. This study aimed to assess the trend of drug utilisation in Malaysia in 2018-2022 and evaluate the impact of COVID-19 on drug utilisation rates. We conducted a repeated cross-sectional study of pharmaceutical sales data from public and private sectors in Malaysia from 2018 to 2022. Drug utilisation rates for the period after the onset of COVID-19 (2020-2022) was compared with the earlier period (2018-2019). Interrupted time-series regression analyses evaluated level and slope changes compared to pre-COVID-19 pandemic level for quarterly rates of drugs utilisation in public and private sectors. There was an immediate reduction in the utilisation rates for all drugs after COVID-19 in public (-20.4%; p = 0.043) and private sectors (-22.4%; p = 0.003). In both sectors, significant level changes were observed for anti-infectives, musculoskeletal, neurological, respiratory, and sensory organs preparations following COVID-19 pandemic, followed by a sustained increase in trend from 2020 to 2022. Public sector had a 22.2% reduction in the utilisation of cardiovascular drugs (p = 0.002), particularly for renin-angiotensin system (RAS) agents (-47.4%, p = 0.019). Private sector had large changes for anti-infectives (-53.6%, p < 0.001) and neurological drugs (-51.4%, p < 0.001), driven by an immediate level reduction in antibacterials (-54.2%, p < 0.001) and cough and cold preparations (-59.2%, p < 0.001). Classes with agents used for COVID-19 treatment, such as systemic corticosteroids, antibiotics, and antivirals had an increasing trend between April 2020 and December 2022, although some slope changes were not statistically significant. A significant reduction in the overall drug utilisation rates was observed in the public and private sectors in Malaysia as an immediate impact of the COVID-19 pandemic in 2020. The impacts varied by therapeutic class and health sector. This finding provides an understanding of the changing patterns of drug utilisation that were affected by disease outbreaks for future planning of pandemic preparedness.

COVID-19 vaccine wastage in private and public healthcare facilities in KwaZulu-Natal, South Africa.

In KwaZulu-Natal (KZN), South Africa, COVID-19 vaccinations commenced in May 2021. This study investigated the extent and reasons for COVID-19 vaccine (C19V) wastage in KZN and strategies undertaken to mitigate loss. This two-phase multicenter study was conducted at private and public healthcare facilities from May 2021 to July 2022. KZN reported 2% Pfizer and 1% Janssen C19V wasted, mainly due to expiry. C19V waste-minimization strategies reported by 100% public and private sector vaccination leads included cold chain monitoring, designated trained staff and the use of stock-management systems. The WHO's risk-mitigation factors should be implemented continuously to minimize vaccine wastage.

The nexus between poverty and maternal healthcare utilization with a focus on antenatal care visits and choice of place of birth in Somaliland.

Poverty poses a significant barrier to accessing healthcare globally, particularly in relation to antenatal care (ANC) visits and the use of childbirth facilities, both of which are crucial for women's health and fetal well-being. In Somaliland, only 47% of pregnant women attend healthcare facilities for ANC, with a mere 33% receiving care from skilled birth attendants. Despite this, no previous studies have examined the relationship between poverty and maternal healthcare utilization in Somaliland. This study aims to investigate the effect of poverty on maternal healthcare utilization with focus on ANC visits and the choice of place of birth in Somaliland. Utilizing data from the 2020 Somaliland Demographic Health Survey, a cross-sectional study design was employed, analyzing a nationally representative sample. The sample size used in this study was 3,183 women of reproductive age. Descriptive analysis, negative binomial regression, and multinomial logistic regression were conducted using Stata version 18.0. Diagnostic tests, including Chi-square - 2log likelihood statistic, Akaike Information Criterion, and Bayesian Information Criterion, were employed to evaluate model fit. Poverty, as indicated by wealth quintile, was associated with reduced ANC visits (adjusted incidence rate ratio (aIRR) = 0.884, 95% CI: 0.791-0.987) among women in poorer households compared to those in richer households. Women in Togdheer, Sool, and Sanaag regions had lower ANC visit rates compared to Maroodi Jeex region (aIRR = 0.803, 95% CI: 0.687-0.939; aIRR = 0.710, 95% CI: 0.601-0.839; aIRR = 0.654, 95% CI: 0.558-0.768, respectively). Women from poorer households had lower probabilities of opting for public health facilities (adjusted relative risk ratio (aRRR) = 0.457, 95% CI: 0.352-0.593) and private health facilities (aRRR = 0.195, 95% CI: 0.111-0.341) over home births compared to women in richer households. Women in Togdheer, Sool, and Sanaag regions had lower probabilities of choosing public (aRRR range: 0.331-0.175) and private (aRRR range: 0.350-0.084) health facilities for delivery over home births compared to women in Maroodi Jeex region. Poverty significantly impedes maternal healthcare utilization, contributing to lower ANC attendance and preference for home births over public or private health facility births. Addressing these disparities requires initiatives to eliminate financial barriers, such as user fees, and enhance equitable access through community-based health insurance and improved healthcare infrastructure.

Literacy And Health Awareness Among Tribal Women In North Coastal Districts Of Andhra Pradesh

Tribal women are mostly illiterate and Socially and economically back word. A significant percentage of indigenous tribal women continue to employ home remedies and seek out traditional medicine practitioners/healers. If they are not healed, they seek treatment at private facilities. Inaccessibility, lack of facilities, personnel and their behavior, inconvenient visiting hours, and sickness state were highlighted as barriers to health seeking behavior among Indian tribes while visiting hospitals. Personal problems such as fear of losing daily earnings, cultural beliefs, cost, illiteracy, and unacceptability are also present. Over the years, the lack of maternal health awareness has caused several health concerns, including anemia, neural tube defects , tetanus infection, immunodeficiency syndrome, and even perinatal deaths. Poverty, illiteracy, meagre living conditions, lack of personal hygiene and poor health-seeking behaviour are known to be highly prevalent among these tribes. Further, early age at marriage, consanguinity, high parity and other behavioural factors among women in these tribal communities make them susceptible to sexually transmitted infections (STIs).

The effect of health facility ownership on perceived healthcare quality: evidence from Ghana

Whether private healthcare providers should be encouraged over public providers remains unclear. On the one hand, because private providers are profit-driven, they are more motivated to compete for demand by enhancing quality if demand is elastic. However, because they are more motivated to maximize revenue, they may sacrifice quality to maximize profit. A crucial factor in determining whether private providers should be encouraged is the extent to which their quality exceeds or falls short of that of the public provider. This study, therefore, investigates whether the public and private differ in providing quality healthcare services using the 2014 Ghana Demographic and Health Survey. Our measure of healthcare quality is based on patient satisfaction level with nine healthcare services (cleanliness, waiting time, comfort and safety, consultation time, privacy, listening, explanation, treatment advice and confidentiality) provided by public and private healthcare facilities. We applied an instrumental variable approach to account for endogeneity issues related to the patient’s choice of healthcare provider. We find that private facility users have a higher probability of being very satisfied with “waiting time”, “consultation time”, “listening”, “cleanliness”, “comfort and safety”, “confidentiality”, and “privacy” than public users, thus suggesting that private facilities provide better service than public. We thus recommend encouraging the private sector to enter the healthcare market. We also find that failing to account for endogeneity in provider choice when estimating the effect of healthcare facility ownership on healthcare service quality underestimates the effects.

Integration of IPC/WASH critical conditions into quality of care and quality improvement tools and processes: Bangladesh case study

Unsafe patient care in hospitals, especially in low- and middle-income countries, is often caused by poor infection prevention and control (IPC) practices; insufficient support for water, sanitation, and hygiene (WASH); and inadequate waste management. We looked at the intersection of IPC, WASH, and the global initiative of improving health care quality, specifically around maternal and newborn care in Bangladesh health facilities. We identified 8 primary quality improvement and IPC/WASH policy and guideline documents in Bangladesh and analyzed their incorporation of 30 subconditions under 5 critical conditions: water; sanitation; hygiene; waste management/cleaning; and IPC supplies, guidelines, training, surveillance, and monitoring. To determine how Bangladesh health care workers implemented the policies, we interviewed 33 informants from 16 public and private facilities and the national level. Bangladesh’s 8 primary guidance documents covered 55% of the 30 subconditions. Interviews showed that Bangladesh health facility staff generally rely on eight tools related to quality improvement (five); IPC (two); and supportive supervision (one) plus a robust supervision mechanism. The stakeholders identified a lack of human resources and environmental hygiene infrastructure and supplies as the main gaps in providing IPC/WASH services. We concluded that the Bangladesh government had produced substantial guidance on using quality improvement methods to improve health services. Our recommendations can help identify strategies to better integrate IPC/WASH in resources including standardizing guidelines and tools within one toolkit. Strategizing with stakeholders working on initiatives such as universal health coverage and patient safety to integrate IPC/WASH into quality improvement documents is a mutually reinforcing approach.

Mental health problems in Somalia after decades of humanitarian crises: a qualitative exploration of perceptions and experiences

BackgroundHumanitarian crises increase the risk of mental health problems. Somalia has been affected by conflict, insecurity, and economic turmoil for over three decades, as well as climatic shocks. However, 80–90% of Somalis who have mental health problems do not have access to good-quality, and affordable mental health care. To develop an evidence-based, effective, equitable, and humane programme for mental health, we need to have a holistic understanding of mental health problems and care in relation to people’s perceptions, experiences, and behaviour related to mental health.MethodsWe undertook a qualitative study to explore Somalis’ perceptions and experiences of mental health problems. We conducted three key informant interviews, two in-depth interviews, nine focus group discussions, 12 observations in private and public health facilities and more than 12 informal discussions. We used case vignettes translated into Somali during our discussion. We also studied three cases with experience of mental health problems to understand care-seeking behaviour and the experiences with services available.ResultsSomalia has been moving from a traditional pastoral nomadic lifestyle to a settled one. A strong informal support system exists in the community within clans or family relations. Armed conflict often among clans, natural disasters, and khat use are the three main factors affecting mental health. The prevalence of mental problems is likely greater than is evident. It is perceived that about 95% of people suffering from mental illness remain outside of appropriate care. Few people seek care for mental health problems because they are not aware of it and because it is highly stigmatized and neglected. Those who do seek care usually go to traditional healers because of culture and cost. Resources for mental health care are grossly inadequate with a limited and often poorly trained workforce. At least two levels of barrier to mental health care exist, at the individual/family level (e.g. poor awareness of mental health and stigma) and service provider level (e.g. lack of staff and limited ability to diagnose, treat, or refer persons with mental health problems and stigma). No tool or evidence-based programme is available to address these barriers.ConclusionA qualitative data-driven mental health programme that addresses all these issues is needed with more trained mental health professionals. Given the stigma about mental health problems, there is also a need for a tool to raise awareness about mental health and the importance of mental health care among both the public and health workers.

Investigating dynamics, etiology, pathology, and therapeutic interventions of Caligus clemensi and Vibrio alginolyticus co-infection in farmed marine fish

This study investigated a disease outbreak characterized by caligid copepod infestations and subsequent secondary bacterial infections in European seabass (Dicentrarchus labrax) and flathead grey mullet (Mugil cephalus) cultivated at a private facility in the Deeba Triangle region of Egypt. Moribund fish displayed brown spots on the skin, tongue, and gills, along with lethargy and excess mucus. The fish suffered severe infections, exhibiting external hemorrhages, ulcers, and ascites. The fish had pale, enlarged livers with hemorrhaging. Comprehensive parasitological, bacteriological, molecular, immunity and histopathological analyses were conducted to identify the etiological agents and pathological changes. Caligid copepod infestation was observed in wet mounts from the buccal and branchial cavities of all examined fish, and the caligids were identified as Caligus clemensi through COI gene sequencing and phylogenetic analysis. Vibrio alginolyticus was confirmed as a secondary bacterial infection through biochemical tests, recA gene sequencing, and phylogenetic analyses. Antibiotic susceptibility testing revealed resistance to β-lactams, aminoglycosides, and trimethoprim-sulfamethoxazole in V. alginolyticus isolates. Upregulation of the inflammatory marker IL-1β in gill and skin tissues indicated a robust cell-mediated immune response against the pathogens. Histopathological examination revealed severe tissue damage, hyperplasia, hemorrhage, and congestion in the gills, along with hepatocellular degeneration and steatosis in the liver, providing initial insights into this outbreak. A comprehensive therapeutic regimen was implemented, comprising prolonged hydrogen peroxide immersion baths, followed by the application of the nature-identical plant-based compound Lice-less and probiotic Sanolife Pro-W supplementation. This integrated approach effectively eliminated C. clemensi infestations, controlled secondary bacterial infections, and restored fish health, reducing morbidity and mortality rates to minimal levels.

Fertility services for gay men: A website content analysis of US fertility clinics and sperm banks.

Fertility preservation and subsequent third-party reproduction represents a principal pathway by which gay and bisexual cisgender men may have biologically related children. Previous studies of a similar design have commented on the availability of fertility services for sexually and gender diverse communities, but none have investigated access to the aforementioned services for this specific population. To assess the availability of fertility preservation and third-party reproduction services for gay and bisexual cisgender men across US fertility clinics and sperm banks. A content analysis was performed on a sample of fertility clinic and sperm bank websites compiled from three online sources. Sample construction and analysis were completed in 2023. Each website was systematically examined by two separate coders with a third coder deciding any discrepancies. Website coding followed a pre-constructed standardized questionnaire. Logistic regression analysis was used to identify statistically significant differences. A total of 675 clinic and sperm bank websites (136 academic and 539 private) were analyzed. Five hundred and two (74.4%) offered third-party reproduction and 326 (48.3%) offered fertility preservation for gay and bisexual cisgender men. Furthermore, 248 websites (36.7%) featured some form of disqualifying language either directly communicating or implying exclusion of gay and bisexual cisgender men from these services. Private facilities were more likely to offer third-party reproduction (odds ratio [OR]=1.88, p<0.01) but less likely to offer fertility preservation (OR=0.68, p<0.05) compared with academic affiliated facilities. Lastly, states in the highest Human Rights Campaign Equality Index tier were significantly more likely to offer third-party reproduction (OR=2.50, p<0.01) than the lowest tier. These findings demonstrate great variability in access to fertility preservation and third-party reproduction services. Geography and ambiguity in facility-specific policies represent persistent barriers to family building for gay and bisexual cisgender men.

Ebola disease outbreak caused by the Sudan virus in Uganda, 2022: a descriptive epidemiological study

Uganda has had seven Ebola disease outbreaks, between 2000 and 2022. On Sept 20, 2022, the Ministry of Health declared a Sudan virus disease outbreak in Mubende District, Central Uganda. We describe the epidemiological characteristics and transmission dynamics. For this descriptive study, cases were classified as suspected, probable, or confirmed using Ministry of Health case definitions. We investigated all reported cases to obtain data on case-patient demographics, exposures, and signs and symptoms, and identified transmission chains. We conducted a descriptive epidemiological study and also calculated basic reproduction number (Ro) estimates. Between Aug 8 and Nov 27, 2022, 164 cases (142 confirmed, 22 probable) were identified from nine (6%) of 146 districts. The median age was 29 years (IQR 20-38), 95 (58%) of 164 patients were male, and 77 (47%) patients died. Symptom onsets ranged from Aug 8 to Nov 27, 2022. The case fatality rate was highest in children younger than 10 years (17 [74%] of 23 patients). Fever (135 [84%] of 160 patients), vomiting (93 [58%] patients), weakness (89 [56%] patients), and diarrhoea (81 [51%] patients) were the most common symptoms; bleeding was uncommon (21 [13%] patients). Before outbreak identification, most case-patients (26 [60%] of 43 patients) sought care at private health facilities. The median incubation was 6 days (IQR 5-8), and median time from onset to death was 10 days (7-23). Most early cases represented health-care-associated transmission (43 [26%] of 164 patients); most later cases represented household transmission (109 [66%]). Overall Ro was 1·25. Despite delayed detection, the 2022 Sudan virus disease outbreak was rapidly controlled, possibly thanks to a low Ro. Children (aged <10 years) were at the highest risk of death, highlighting the need for targeted interventions to improve their outcomes during Ebola disease outbreaks. Initial care-seeking occurred at facilities outside the government system, showing a need to ensure that private and public facilities receive training to identify possible Ebola disease cases during an outbreak. Health-care-associated transmission in private health facilities drove the early outbreak, suggesting gaps in infection prevention and control. None.

Solid health care waste management practice in Ethiopia, a convergent mixed method study

IntroductionHealthcare waste is any waste generated by healthcare facilities that is considered potentially hazardous to health. Solid healthcare waste is categorized into infectious and non-infectious wastes. Infectious waste is material suspected of containing pathogens and potentially causing disease. Non-infectious waste includes wastes that have not been in contact with infectious agents, hazardous chemicals, or radioactive substances, similar to household waste, i.e. plastic, papers and leftover foods.This study aimed to investigate solid healthcare waste management practices and develop guidelines to improve solid healthcare waste management practices in Ethiopia. The setting was all health facilities found in Hossaena town.MethodA mixed-method study design was used. For the qualitative phase of this study, eight FGDs were conducted from 4 government health facilities, one FGD from each private health facility (which is 37 in number), and forty-five FGDs were conducted. Four FGDs were executed with cleaners; another four were only health care providers because using homogeneous groups promotes discussion. The remaining 37 FGDs in private health facilities were mixed from health professionals and cleaners because of the number of workers in the private facilities. For the quantitative phase, all health facilities and health facility workers who have direct contact with healthcare waste management practice participated in this study. Both qualitative and quantitative study participants were taken from the health facilities found in Hossaena town.ResultSeventeen (3.1%) health facility workers have hand washing facilities. Three hundred ninety-two (72.6%) of the participants agree on the availability of one or more personal protective equipment (PPE) in the facility ‘‘the reason for the absence of some of the PPEs, like boots and goggles, and the shortage of disposable gloves owes to cost inflation from time to time and sometimes absent from the market’’. The observational finding shows that colour-coded waste bins are available in 23 (9.6%) rooms. 90% of the sharp containers were reusable, and 100% of the waste storage bins were plastic buckets that were easily cleanable. In 40 (97.56%) health facilities, infectious wastes were collected daily from the waste generation areas to the final disposal points. Two hundred seventy-one (50.2%) of the respondents were satisfied or agreed that satisfactory procedures are available in case of an accident. Only 220 (40.8%) respondents were vaccinated for the Hepatitis B virus.ConclusionHand washing facilities, personal protective equipment and preventive vaccinations are not readily available for health workers. Solid waste segregation practices are poor and showed that solid waste management practices (SWMP) are below the acceptable level.

The impact of digital interventions on health insurance coverage for reproductive, maternal, newborn and child health services utilization in Kakamega, Kenya: a cluster randomized controlled trial.

The National Hospital Insurance Fund (NHIF) of Kenya was upgraded to improve access to healthcare for impoverished households, expand universal health coverage, and boost the uptake of essential reproductive, maternal, newborn and child health (RMNCH) services. However, premiums may be unaffordable for the poorest households. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) programme targets low-income women and their households to improve their access to and utilization of quality healthcare, including RMNCH services, by providing subsidized, mobile phone-based NHIF coverage in combination with enhanced, digital training of community health volunteers and upgrading of health facilities. This study evaluated whether expanded NHIF coverage increased the accessibility and utilization of quality basic RMNCH services in areas where i-PUSH was implemented using a longitudinal cluster randomized controlled trial in Kakamega, Kenya. A total of 24 pair-matched villages were randomly assigned either to the treatment or the control group. Within each village, 10 eligible households (i.e. with a woman aged 15-49 years who was either pregnant or with a child <4 years old) were randomly selected. The study applied a difference-in-difference methodology based on a pooled cross-sectional analysis of baseline, midline and endline data, with robustness checks based on balanced panels and Analysis of Covariance methods. The analysis sample included 346 women, of whom 248 had had a live birth in the 3 years prior to any of the surveys, and 424 children aged 0-59 months. Improved NHIF coverage did not have a statistically significant impact on any of the RMNCH outcome indicators at midline nor endline. Uptake of RMNCH services, however, improved substantially in both control and treatment areas at endline compared to baseline. For instance, significant increases were observed in the number of antenatal care visits from baseline to midline (mean = 2.62-2.92, P < 0.01) and delivery with a skilled birth attendant from baseline to midline (mean = 0.91-0.97, P < 0.01). Expanded NHIF coverage, providing enhanced access to RMNCH services of unlimited duration at both public and private facilities, did not result in an increased uptake of care, in a context where access to basic public RMNCH services was already widespread. However, the positive overall trend in RMNCH utilization indicators, in a period of constrained access due to the COVID-19 pandemic, suggests that the other components of the i-PUSH programme may have been beneficial. Further research is needed to better understand how the provision of insurance, enhanced community health volunteer training and improved healthcare quality interact to ensure pregnant women and young children can make full use of the continuum of care.

The quality of routine data for measuring facility-based maternal mortality in public and private health facilities in Kampala City, Uganda

BackgroundRoutine health facility data are an important source of health information in resource-limited settings. Regular quality assessments are necessary to improve the reliability of routine data for different purposes, including estimating facility-based maternal mortality. This study aimed to assess the quality of routine data on deliveries, livebirths and maternal deaths in Kampala City, Uganda.MethodsWe reviewed routine health facility data from the district health information system (DHIS2) for 2016 to 2021. This time period included an upgrade of DHIS2, resulting in two datasets (2016–2019 and 2020–2021) that were managed separately. We analysed data for all facilities that reported at least one delivery in any of the six years, and for a subset of facilities designated to provide emergency obstetric care (EmOC). We adapted the World Health Organization data quality review framework to assess completeness and internal consistency of the three data elements, using 2019 and 2021 as reference years. Primary data were collected to verify reporting accuracy in four purposively selected EmOC facilities. Data were disaggregated by facility level and ownership.ResultsWe included 255 facilities from 2016 to 2019 and 247 from 2020 to 2021; of which 30% were EmOC facilities. The overall completeness of data for deliveries and livebirths ranged between 53% and 55%, while it was < 2% for maternal deaths (98% of monthly values were zero). Among EmOC facilities, completeness was higher for deliveries and livebirths at 80%; and was < 6% for maternal deaths. For the whole sample, the prevalence of outliers for all three data elements was < 2%. Inconsistencies over time were mostly observed for maternal deaths, with the highest difference of 96% occurring in 2021.ConclusionsRoutine data from childbirth facilities in Kampala were generally suboptimal, but the quality was better in EmOC facilities. Given likely underreporting of maternal deaths, further efforts to verify and count all facility-related maternal deaths are essential to accurately estimate facility-based maternal mortality. Data reliability could be enhanced by improving reporting practices in EmOC facilities and streamlining reporting processes in private-for-profit facilities. Further qualitative studies should identify critical points where data are compromised, and data quality assessments should consider service delivery standards.

Healthcare-seeking behavior and out-of-pocket payments in Erbil, Kurdistan Region of Iraq

BackgroundUnderstanding healthcare-seeking behavior and examining health expenditures can help determine possible barriers to accessing healthcare and direct more effective and inclusive healthcare systems. This study aimed to evaluate healthcare-seeking behavior and out-of-pocket healthcare expenditure in a sample of the population in Erbil, Iraq.MethodsWe conducted this cross-sectional study in Erbil, Kurdistan Region of Iraq, from October to December 2023. A convenience sample of 414 adults completed a self-administered online survey. The following data were collected: recent illness, sociodemographic characteristics, type of healthcare received, and cost of healthcare.ResultsThe most common health conditions reported were communicable diseases (16.3%), musculoskeletal problems (13.1%), and noncommunicable diseases (12.7%). Approximately 85% of patients with health conditions requiring care sought healthcare; most visited private clinics (46.3%) and private hospitals (18.6%). The median total out-of-pocket healthcare expenditure in US dollars was 117.3 (interquartile range (IQR) = 45.6–410.0). The median total cost was much greater for participants who first visited a private health facility (USD 135.5, IQR = 57.3-405.6) than those who first visited a public facility (USD 76.8, IQR = 16.1-459.7). Participants ≥ 60 years spent significantly more than those < 14 years (USD 332, 95% CI = 211–453, p < 0.001). Evermarried participants spent significantly more than unmarried (USD 97, 95% CI = 1 to 192, p = 0.047). Health expenditures were significantly greater for noncommunicable diseases than infectious diseases (USD 232, 95% CI = 96–368, p = 0.001). After adjusting for covariates, age ≥ 60 years was independently associated with higher spending (USD 305, 95% CI = 153–457, p < 0.001).ConclusionsMost participants sought care from formal health services, preferring the private sector. Seeking care from private facilities incurred significantly higher costs than seeking care from public ones, which suggests potential barriers to accessing healthcare, particularly affordability. The findings underscore the importance of evaluating existing healthcare policies to enhance effectiveness and identify areas for improvement. This study can help policymakers and healthcare providers design effective interventions, allocate resources efficiently, and improve healthcare delivery.