Private Health Sector Research Articles

How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.

Healthcare workers’ preparedness and response during COVID-19 pandemic

Background Healthcare workers (HCWs) are most at risk of contracting SARS-CoV-2 and COVID-19 infection. Their preparedness, as a result of provision and access to personal protective equipment (PPE), training programmes and awareness and practices on infection prevention and control measures, is integral for the prevention of infectious disease transmission. Objectives This study was conducted to assess the preparedness and practices of HCWs during COVID-19 first wave outbreak in Brunei Darussalam. Methods A cross-sectional study using a pre-designed and self-administered web-based questionnaire was conducted among HCWs from government and private health sectors ranging from primary to tertiary health facilities in Brunei Darussalam. Data were analysed using descriptive statistics, and chi-square test was used for statistical significance. Results A total of 511 HCWs participated in the study. Nurses (64%) and HCWs based at hospitals (66%) made up the majority of the study participants, with 74% having occupational exposure to COVID-19 cases. More than 99% of HCWs used respiratory PPE, and 94% used gloves. 74% had undergone respirator fit testing and 65% had received PPE awareness session within the last one year. Coverage in training programmes was found to be low among HCWs from private health facilities. Conclusions Majority of HCWs who had received updated training programmes and therefore were better prepared came from government health facilities. HCWs from private health facilities lacked preparedness training programmes and as such, there needs to be improvement to enhance preparedness measures in light of the ongoing COVID-19 pandemic and for future infectious disease outbreaks.

Impact of COVID- 19 on continuity of essential health services in various health care institutions in district Amritsar, Punjab, India

From a point in time where the human race declared itself the master of the universe to this point in time where it is facing an existential threat from the contagion- Covid 19 pandemic has exposed the vulnerability of the human race to a wipeout. The disruption of physical, mental, social, emotional and financial health and health systems is unprecedented. Study the impact of Covid 19 on continuity of essential health services in various health care institutions in district Amritsar, Punjab.: Online survey was conducted through google forms using questionnaire adapted from the World Health Organization-Pulse Survey on Continuity of Essential Health Services during Covid 19 pandemic. Respondents were personnel working at public and Ayushman Bharat empaneled private health care institutions. Response rate was 60% (55 out of 92 health care institutions personnel responded) A highly significant difference was observed between the public and the private health care sector in provision of antenatal care (Mann Whitney U statistic= 78.00, p=.004) and imaging and radio diagnosing services (Mann Whitney U statistic= 48.00, p=.000) while a significant difference was observed in provision of service of institutional delivery (Mann Whitney U statistic= 112.00, p=.046). All the other essential health services were similarly affected in the public and private health sector institutes. Financial difficulties faced during the lockdown was the single most common reason stated for disruption of essential health services. There was a significant difference in level of satisfaction experienced by health care personnel from public and private sector (Mann Whitney U statistic= 94.00, p=.02). Thematic analysis of the data on improving preparedness to minimize disruption in essential health services yielded the themes pertaining to creating a robust public health care infrastructure including use of e-health technology in the district and recruitment of adequate health care man power according to set norms.

Multidisciplinary Effort and Integrative Preparedness: A Lesson for the Foreseen Multivariate COVID-19 Pandemic Flare-Up.

It has been a year and a half since the world suffered the horrific COVID-19 pandemic which has still continued becoming a prominent headache for the whole world. Recently, we are facing the second and third wave of multivariate outbreaks with great intensity of transmission which renders huge disaster. Presently, new strains of the virus are emerging that are predicted to be resistant for the current vaccines and other management approaches. It needs collaborative and coordinated role at professional, facility, regional, and global levels to ameliorate the pandemic by monitoring the existing and emerging variants. This review addressed the multidisciplinary roles in patient screening and detection, emergency management, moderate and critical care, vaccination, complication prevention, comorbidity management, psychological therapy, and digital health care. The inevitable roles of academicians, researchers, private health sectors, policy makers, regulatory bodies, and partners are also discussed.

The effect of psychological contract on employees' organisational citizenship behaviour and the moderator role of five-factor personality traits in this effect

This study examines the relationship between psychological contract, organisational citizenship behaviours, and sub-dimensions of five-factor personality traits (extraversion, agreeableness, openness, conscientiousness, and neuroticism) of employees in the private sector. In addition, it investigated whether the sub-dimensions of personality traits have moderator roles in the relationship between psychological contract and organisational citizenship behaviours. In order to achieve this aim, the number one model proposed by Hayes (2013) was taken as a basis in establishing the model related to the relationships between three variables. Employees in the private sector (accounting, health and information sectors) who carry out their activities in Istanbul, Ankara, Izmir and Mersin constituted the research universe. The convenience sampling method was chosen while identifying the sample due to the Covid 19 pandemic that affected the world. The data used in the study were collected with three scales between January 1-31, 2021. The analysis of the model established in the study was performed with the SPSS package program and the R programming language. The result of the study indicated a significant relationship between the employees' perceptions of the psychological contract, organisational citizenship behaviour and the sub-dimensions of the five-factor personality traits. In addition, it has been determined that the sub-dimension of personality traits, "openness to development", has a moderator role in the relationship between psychological contract and organisational citizenship behaviour. It is also seen that the results are compatible with similar studies in the literature. It is expected that this research will contribute to organisational behaviour and psychology, while the findings can be used as input for other studies in the specified areas.

Geographical variability and factors associated with caesarean section delivery in India: a comparative assessment of Bihar and Tamil Nadu

BackgroundCaesarean section delivery is a major life-saving obstetric surgical intervention for mothers and babies from pregnancy and childbirth related complications. This paper attempts to investigate the geographical variations and correlating factors of caesarean section delivery in India, particularly focusing on the states of Bihar and Tamil Nadu, accounting for one of the lowest and highest prevalence states of caesarean section delivery respectively.MethodsThis study is based on secondary data, collected from the fourth round of the National Family Health Survey (NFHS-4), 2015–16. We utilized 190,898 women aged 15–49 years who had a living child during the past 5 years preceding the survey. In this study, caesarean section delivery was the outcome variable. A variety of demographic, socio-economic, and pregnancy- and delivery-related variables were considered as explanatory variables. Descriptive statistics, bivariate percentage distribution, Pearson’s Chi-square test, and multivariate binary logistic regression models were employed to draw the inferences from data.ResultsOf participants, about 19% of women had undergone caesarean section delivery in the country. The state-wise distribution shows that Telangana (60%) followed by Andhra Pradesh (42%) and Tamil Nadu (36%) represented the topmost states in caesarean delivery, while Bihar (7%), Madhya Pradesh (10%), and Jharkhand (11%) placed at the bottom end. Multivariate logistic models show that the likelihood of caesarean delivery was higher among older women (35–49 years), women with higher levels of education, Muslims, women belonging to the upper quintiles of the household wealth, and those who received antenatal care (ANC), experienced pregnancy loss and delivery complications. Moreover, the odds of caesarean section delivery were remarkably greater for the private health sector than the public health sector in both focused states: Bihar (odds ratio [OR] = 12.84; 95% confidence interval [CI]: 10.90, 15.13) and Tamil Nadu (OR = 2.90; 95% CI: 2.54, 3.31).ConclusionFindings of this study suggest that improvement in female education, providing economic incentives, and spreading awareness through mass media could raise the caesarean section delivery among women whose vaginal delivery could be unsafe for them as well as for their babies. Moreover, providing adequate ANC and well-equipped public healthcare services would facilitate caesarean delivery among needy women.

ROLE OF GENE XPERT AND LIQUID CULTURE IN DIAGNOSIS OF EXTRA PULMONAR TUBERCULOSIS

INTRODUCTION: Extrapulmonary Tuberculosis (EPTB) accounts for 15- 25% of all TB cases. It is more difficult to diagnose than Pulmonary tuberculosis and often requires invasive procedures to obtain tissue and or fluid samples. Histology is time-consuming and establishing a diagnosis of TB with high specificity remains difficult. Tissue smear microscopy after special staining is often negative. Tissue culture often leads to considerable delays compromising patient care and outcomes. AIMS AND OBJECTIVES:1. To diagnose Extra Pulmonary Tuberculosis by Gene Xpert(Xpert MTB/Rif assay or CBNAAT) and Liquid Cultures. 2. To evaluate the Sensitivity and Specificity of Gene Xpert in Extra Pulmonary Tuberculosis in comparison with Liquid Culture MGIT960 system. MATERIALS AND METHODS: This retrospective cross-sectional study was carried out by reviewing all suspected extra pulmonary tuberculosis samples of 430 patients attending OPD at Institute of Respiratory Diseases, Jaipur from April 2020 to March 2021.The extrapulmonary samples (pleural fluid,CSF,pus,BAL,Ascitic fluid,Synovial fluid,Gastric aspirate,Liver aspirate) were subjected to GeneXpert and Liquid culture MGIT960 system. RESULTS: Of the 430 Extra Pulmonary Samples, The Sensitivity and Specificity of CBNAAT was 79.77% and 95.30% respectively in comparison with Liquid Culture. Out of the 430 Samples CBNAAT was Positive in 87 samples of which 71(81.60%) were Rifampicin sensitive and 16(18.39%) were Rifampicin Resistant.Out of the 430 Samples,Liquid cultures was Positive in 89 samples. CONCLUSION: Gene Xpert has a notable advantage of detecting tuberculosis within two hours which is acceptable to all clinicians to institute early treatment.CBNAAT is one of the rapid diagnostic tests available in the country and it should be routinely used under the public and private health sector effectively to detect early tuberculosis in Extra Pulmonary Samples.

Primary healthcare seeking behaviour of low-income patients across the public and private health sectors in South Africa

BackgroundThe proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) in South Africa, envisioning both private sector providers and public sector clinics as independent contracting units to the NHI Fund. In 2017, 16% of the South African population had private medical insurance and predominately utilised private providers. However, it is estimated that up to 28% of the population access private PHC services, with a meaningful segment of the low-income, uninsured population paying for these services out-of-pocket. The study objective was to characterise the health seeking behaviour of low-income, patients accessing PHC services in both the public and private sectors, patient movement between sectors, and factors influencing their facility choice.MethodsWe conducted once-off patient interviews on a random sample of 153 patients at 7 private PHC providers (primarily providing services to the low-income mostly uninsured patient population) and their matched public PHC clinic (7 facilities).ResultsThe majority of participants were economically active (96/153, 63%), 139/153 (91%) did not have health insurance, and 104/153 (68%) earned up to $621/month. A multiple response question found affordability (67%) and convenience (60%) were ranked as the most important reasons for choosing to usually access care at public clinics (48%); whilst convenience (71%) and quality of care (59%) were key reasons for choosing the private sector (32%). There is movement between sectors: 23/76 (30%) of those interviewed at a private facility and 8/77 (10%) of those interviewed at a public facility indicated usually accessing PHC services at a mix of private and public facilities. Results indicate cycling between the private and public sectors with different factors influencing facility choice.ConclusionsIt is imperative to understand the potential impact on where PHC services are accessed once affordability is mitigated through the NHI as this has implications on planning and contracting of services under the NHI.

Organization of the Saudi health system

Using existing data, we reviewed the organizational structure of the Saudi Arabian health system: its demography and history, principal health indicators, organization and management, type and distribution of facilities, financial base, and the impact on it of the Haj. We noted duplication of services, inadequate coordination between some health industry sectors, and the need for a more extensive and rational health centre network with improved information systems and data collection. We also noted scope for a greater role for the private health sector and increased cooperation between it and the public sector to improve health service delivery and population health.

АНАЛИЗ РЕЗУЛЬТАТИВНОСТИ ПРОФИЛАКТИКИ БОЛЕЗНЕЙ ВЕРХНИХ ДЫХАТЕЛЬНЫХ ПУТЕЙ У ДЕТЕЙ В УСЛОВИЯХ ГОСУДАРСТВЕННОГО И ЧАСТНОГО СЕКТОРА ЗДРАВООХРАНЕНИЯ МОСКОВСКОЙ ОБЛАСТИ

The relevance of the research topic is determined by the high prevalence of diseases of the upper respiratory tract in children. The purpose of the study: to assess the effectiveness of the prevention of upper respiratory diseases in children in the public and private health sector. The analysis of morbidity by circulation and primary morbidity of children in the Moscow region and the city of Ramenskoye as a whole and by class "Respiratory diseases" is carried out. The material of the study is based on the analysis of the primary documentation of the children's polyclinic and the private children's medical center in Ramenskoye, Moscow region. Differences between public and private medical organizations were established: the number of episodes of upper respiratory tract diseases in the observation of children in a state medical organization is 1.4 times higher than in a private medical organization (3.8, against 2.8); the duration of episodes of diseases of the upper respiratory tract per 1 observed child per year in a state medical organization is 39.0% higher than in a private medical organization; the average duration (exacerbation) of the case of diseases of the upper respiratory tract in children in the state medical organization is 2 times higher than when observed in a private medical organization, which is associated with the use of modern treatment technologies and an individual approach. When analyzing the preventive work of children's polyclinics, it was revealed that in the context of the region there are significant fluctuations in the volume of visits made for the purpose of rehabilitation. At the same time, the share of those in need of rehabilitation from the number of those examined in the order of planned rehabilitation amounted to 65.7% in the region, in the city of Ramenskoye 65.4%. Satisfaction of this need was noted at the level of 60.6% in the region, in the city of Ramenskoye 72.3%. The results of the study showed the need to study the factors that determine the high incidence of children with diseases of the upper respiratory tract.

The coverage of hepatitis B birth dose vaccination in Nigeria: Does the place of delivery matter?

Hepatitis B birth dose (HepB-BD) vaccination coverage remains suboptimal in Nigeria. While evidence suggests that institutional delivery is associated with the uptake of HepB-BD vaccine, little is known about how the uptake differs by facility ownership (public or private). This study examined the HepB-BD vaccination coverage by place of delivery in Nigeria. This study is a secondary analysis of data on 6143 children aged 12-23 mo obtained from the 2018 Nigeria Demographic and Health Survey. We assessed the association between HepB-BD vaccination and the place of delivery using logistic regression models. About 53% of the children received the HepB-BD vaccine. Approximately 77, 83 and 33% of those delivered at a public health facility, private health facility and at home received the HepB-BD vaccine, respectively. After controlling for child- and maternal-level factors, the odds of receiving HepB-BD vaccine were significantly lower in children delivered at a private health facility (adjusted OR [aOR]=0.77, 95% CI 0.59 to 0.99) or at home (aOR=0.48, 95% CI 0.36 to 0.63). Wealth index and region of residence were significantly associated with the receipt of HepB-BD vaccination in all three places of delivery. Children are less likely to receive the HepB-BD vaccine if they are delivered at a private health facility or at home. There is a need for private health sector engagement for immunization service delivery and innovative community-based interventions to reach the children delivered at home.

Research Letter: Antihypertensive Drugs Market in India: An Insight on Size, Trends, and Prescribing Preferences in the Private Health Sector, 2016-2018.

Background:India has a high burden of hypertension. While the private sector provides 70% of out-patient care in the country, a significant proportion of patients seeking care from the public sector buy drugs from private markets. This study aimed to describe India’s private sector antihypertensive drugs market at the national and state levels over 2016–2018.Methods:Antihypertensive drugs sales in India from 2016–2018 were analysed using a large nationally representative dataset for the private pharmaceuticals market. In addition, data for five states (Punjab, Madhya Pradesh, Kerala, Telangana, and Maharashtra) that were the foci of a large hypertension control program were studied.Results:The Indian hypertension drug market grew at a rate of 6.9% from 2016 to 2018 with a total of 21,066 million pills sales in 2018. Single-pill combinations (SPCs) contributed to 39.1% of total sale volumes. The market comprised of 182 different antihypertensive drugs including 134 SPCs. Total volume of sales covered a maximum of 26% of treatment need for the estimated population with hypertension. Two-drug SPCs had the highest market share (36%), followed by calcium channel blockers (18%), beta-blockers (16%) and angiotensin receptor blockers (14%). Among SPCs, amlodipine+atenolol had highest sales (9.8%). Twenty-five drugs, a mix of single drugs and SPCs, accounted for 80% of total sales. There were large state-to-state variations in sales per capita, preferred therapeutic classes and drugs.Conclusions:Despite the large antihypertensive drugs market, there exists a high unmet need for treatment in India. Inter-state differences in product sales indicate variable treatment practices, underscoring the need for private sector engagement to improve hypertension care practices aligned with national and international guidelines. SPCs contributed to a large share of the private market and inclusion of select antihypertensive SPCs in the national list of essential medications should be considered for the public health system.

Establishing women's cancer services in a fragile, conflict and violence affected ecosystem in Africa

<h3>Objectives:</h3> The majority of the world's poorest women (income <$1.90/day) reside in fragile, conflict and violence affected countries (FCV), like the Democratic) Republic of the Congo (DRC). Health services in these settings have traditionally focused on immediate relief efforts, communicable diseases and malnutrition. Recent data suggests there is need to widen the focus to include cancer, as its incidence and mortality rates are rising, particularly cancers of the breast and cervix. <h3>Methods:</h3> We used a unique matrix of onsite hands-on training seminars by visiting oncologists and nurse specialists from the U.S. and Zambia, professional exchange programs at Zambia's national cancer center, and wise infrastructure investments to train the local workforce and build the required infrastructure for a women's cancer center in a private sector health facility in Kinshasa. <h3>Results:</h3> Congolese health professionals were trained to perform same-day cervical cancer screening and treatment of precancerous cervical lesions; same-day breast cancer diagnostics; surgical treatment of invasive cancers of the breast and cervix; administration of cytotoxic chemotherapy. Breast and cervical cancer clinics and a chemotherapy suite were developed and outfitted with equipment, supplies and office furniture. <h3>Conclusions:</h3> We forged a novel partnership between oncology health professionals from Africa and its Diaspora, international philanthropic organizations, and an African cancer center, to train the workforce and build the infrastructure for a women's cancer center in a private sector health facility in the DRC.

Emerging therapeutic drug monitoring of anti-infective agents in Australian hospitals: Availability, performance and barriers to implementation.

The purpose of the study was to assess the status of emerging therapeutic drug monitoring (TDM) of anti-infective agents in Australian hospitals. A nationwide cross-sectional survey of all Australian hospitals operating in the public and private health sector was conducted between August and September 2019. The survey consisted of questions regarding institutional TDM practice for anti-infective agents and clinical vignettes specific to β-lactam antibiotics. Responses were received from 82 unique institutions, representing all Australian states and territories. All 29 (100%) of principal referral (major) hospitals in Australia participated. Five surveys were partially complete. Only 25% (20/80) of hospitals had TDM testing available on-site for any of the eight emerging TDM candidates considered: β-lactam antibiotics, anti-tuberculous agents, flucytosine, fluoroquinolones, ganciclovir, human immunodeficiency virus (HIV) drugs, linezolid and teicoplanin. A considerable time lag was noted between TDM sampling and reporting of results. With respect to β-lactam antibiotic TDM, variable indications, pharmacodynamic targets and sampling times were identified. The three greatest barriers to local TDM performance were found to be (1) lack of timely assays/results, (2) lack of institutional-wide expertise and/or training and (3) lack of guidelines to inform ordering of TDM and interpretation of results. The majority of respondents favoured establishing national TDM guidelines and increasing access to dose prediction software, at rates of 89% and 96%, respectively. Translating emerging TDM evidence into daily clinical practice is slow. Concerted efforts are required to address the barriers identified and facilitate the implementation of standardised practice.

ИНФОРМАЦИОННАЯ КУЛЬТУРА ПАЦИЕНТОВ, КАК ФАКТОР СВОЕВРЕМЕННОСТИ ОНКОЛОГИЧЕСКОЙ ПОМОЩИ

Information and its quality have always been important conditions for making the right decisions. The issues of methodical assessment of patient awareness, quality of organization and medical information in the public and private health sector remain unresolved. At the same time, there are very few scientific papers devoted to the research of the information culture of cancer patients. The aim of the study is to develop proposals to improve it on the basis of an assessment of the current state of the information culture of cancer patients. Research base: GBUS IWOOD. Time of the study 2020. Methods: sociological, analytical, documentary. The study program included the use of a survey method on a specially developed questionnaire "A map of social and hygienic research of patient information culture", which included 15 questions of a closed type. The unit of observation is a patient of cancer profile. The sample population, formed by random selection, was 400 patients. Based on the analysis of the medical records, patients were divided into groups, depending on the timeliness of seeking medical care for cancer. The t-Student criterion was used to determine the validity of the difference in the comparison groups. Differences between the groups were considered reliable at p&lt;0.05. According to the results of the study, 5 components of the patient information culture have been identified, its important role in ensuring the timeliness of cancer care has been established, the levels and nature of the reduction in assessments of its current condition have been determined, and measures to improve the information culture of cancer patients have been proposed, which can be demanded by practical doctors, management of medical institutions, health authorities in shaping the areas of hygiene education and education of the population. As a result of the implementation of the proposals, positive dynamics of assessments on all components of patient information culture have been achieved.

Did the poor gain from India\u2019s health policy interventions? Evidence from benefit-incidence analysis, 2004\u20132018

BackgroundHealth policy interventions were expected to improve access to health care delivery, provide financial risk protection, besides reducing inequities that underlie geographic and socio-economic variation in population access to health care. This article examines whether health policy interventions and accelerated health investments in India during 2004–2018 could close the gap in inequity in health care utilization and access to public subsidy by different population groups. Did the poor and socio-economically vulnerable population gain from such government initiatives, compared to the rich and affluent sections of society? And whether the intended objective of improving equity between different regions of the country been achieved during the policy initiatives? This article attempts to assess and provide robust evidence in the Indian context.MethodsEmploying Benefit-Incidence Analysis (BIA) framework, this paper advances earlier evidence by highlighting estimates of health care utilization, concentration and government subsidy by broader provider categories (public versus private) and across service levels (outpatient, inpatient, maternal, pre-and post-natal services). We used 2 waves of household surveys conducted by the National Sample Survey Organisation (NSSO) on health and morbidity. The period of analysis was chosen to represent policy interventions spanning 2004 (pre-policy) and 2018 (post-policy era). We present this evidence across three categories of Indian states, namely, high-focus states, high-focus north eastern states and non-focus states. Such categorization facilitates quantification of reform impact of policy level interventions across the three groups.ResultsUtilisation of healthcare services, except outpatient care visits, accelerated significantly in 2018 from 2004. The difference in utilisation rates between poor and rich (between poorest 20% and richest 20%) had significantly declined during the same period. As far as concentration of healthcare is concerned, the Concentrate Index (CI) underlying inpatient care in public sector fell from 0.07 in 2004 to 0.05 in 2018, implying less pro-rich distribution. The CI in relation to pre-natal, institutional delivery and postnatal services in government facilities were pro-poor both in 2004 and 2018 in all 3 groups of states. The distribution of public subsidy underscoring curative services (inpatient and outpatient) remained pro-rich in 2004 but turned less pro-rich in 2018, measured by CIs which declined sharply across all groups of states for both outpatient (from 0.21 in 2004 to 0.16 in 2018) and inpatient (from 0.24 in 2004 to 0.14 in 2018) respectively. The CI for subsidy on prenatal services declined from approximately 0.01 in 2004 to 0.12 in 2018. In respect to post-natal care, similar results were observed, implying the subsidy on prenatal and post-natal services was overwhelmingly received by poor. The CI underscoring subsidy for institutional delivery although remained positive both in 2018 and 2004, but slightly increased from 0.17 in 2004 to 0.28 in 2018.ConclusionsImprovement in infrastructure and service provisioning through NHM route in the public facilities appears to have relatively benefited the poor. Yet they received a relatively smaller health subsidy than the rich when utilising inpatient and outpatient health services. Inequality continues to persist across all healthcare services in private health sector. Although the NHM remained committed to broader expansion of health care services, a singular focus on maternal and child health conditions especially in backward regions of the country has yielded desired results.

MORBIDITY PATTERNS IN UNDERFIVE CHILDREN IN AN URBAN LOW SOCIOECONOMIC COMMUNITY OF GUNTUR CITY IN ANDHRA PRADESH

Background: Retrospective morbidity data helps in prioritizing health conditions according their burden on the child and the family and to plan effective interventions. This study is set to look at the morbidity patterns in in a low area of Guntur city. Methodology: This descriptive study conducted in the service area of the Urban Health Center (UHC) at in Guntur city involved 740 children from 6 randomly selected areas. After taking informed consent, the mothers of the children were subjected to a pretested structured questionnaire on current illnesses, 2 weeks recall of illnesses and illnesses over the last one year. The data is presented in the form of tables and percentages. Significant findings are subjected to tests of significance at 5% Level of Significance. Results: Point prevalence of morbidity was 16.1% among boys and 10.7 % among girls (p value 0.03). Children with morbidity over last two weeks are 12.4% (boys 10.9% &amp;amp; girls 13.9%). Over one year, 52.2% had some illness (Boys 47.2% and Girls 52.8%). The had the maximum illness burden (69.5%) and the infants had the least (31.1%) (p value 0.00000001). Chronic illnesses like asthma, skin conditions etc. were seen in 5% of the children (5.2% male and 4.8% female). 63% of the children were seen in private facilities while 37% were seen in a Govt. health facility. 11.1% of the children were seen only by unqualified practitioners. Discussion: Morbidity in is mainly focused on Acute Respiratory Infections (ARI) and which are the common causes of mortality in this age group. Chronic conditions of childhood may persist into adulthood and can influence both health and academic outcomes. Private sector health facilities including unqualified practitioners are sought after more than Government health facilities. Conclusion: There is an essential need to empower primary caregivers of children especially the mother to recognize early signs of childhood illness and seek appropriate care while also facilitating structural and procedural changes in the public healthcare system.

The prospective directions of development of entrepreneurship in health care of the Russian Federation

The analysis of international data established that the national indicator of population health quality in the Russian Federation is significantly lower than in the EU, the USA and Canada. In this regard, the urgency of enhancement of state policy concerning updating and promoting development of national health care system,involving available resources of the public and private health sectors is obvious. The development of entrepreneurship in health care should be considered as a mean of improving social and economic efficiency of health care system in Russia. The purpose of study was to analyze perspective directions of development of entrepreneurial initiatives in national health care. On the basis of analysis of corresponding normative legal acts and publications, it is demonstrated that in national health care system prerequisites are establishing to implement new opportunities for patient-oriented entrepreneurial activities associated with development of digital technologies, e-Health, new forms of public-private partnership focused primarily on prevention and rehabilitation of patients.

Tuberculosis Notification

Context: The framework for tuberculosis (TB) notification is one of the components of the World Health Organization's End TB strategy. Notification is essential for estimating the true burden of TB and its control in community which is currently lacking in the private health sector. Aims: The objectives are to identify awareness, willingness, barriers, and preferred methods of TB notification among private practitioners (PPs) in Trichy, South India. Methods: A descriptive cross-sectional study was conducted among 152 doctors working in the private sector and having at least 1 year of clinical experience using nonprobability sampling. A semi-structured, pretested questionnaire was used to obtain details about the general profile, awareness, and willingness regarding TB notification, as well as factors that facilitate and hinder it. Results: Among PPs, 90.7% referred TB cases/suspects to other health facilities and 71.7% were aware that TB notification is mandatory. Only 52.6% and 38.2% were ready to provide the patients' Aadhaar number and bank account details respectively during notification. The most common barriers for notification were: not being aware about the notification procedure (50.7%), lack of time (32.2%), process being tedious (29.6%) and difficulties in getting information from patients (25.7%). Mobile SMS/App/call (74.3%) were preferred by PPs over notification through online (32.2%) and government health staff (26.3%). Conclusions: Although three-fourth of the practitioners were aware and willing to notify TB, more than half of them were not aware about the notification procedure. Improving the awareness on the techniques for notification could motivate PPs to notify TB.

The role of the public and private health sectors on factors associated with early essential newborn care practices among institutional deliveries in Ghana

BackgroundEarly essential newborn care is one of the important interventions developed by the World Health Organization to reduce morbidities and mortalities in neonates. This study investigated the role of the public and private sector health facilities on factors associated with early essential newborn care practices following institutional delivery in Ghana.MethodsWe used data from the 2017/2018 multiple indicator cluster survey for our analysis. A total of 2749 mothers aged 15–49 years were included in the study. Logistic regression analysis was used to assess the factors associated with early essential newborn care in both public and private health sectors.ResultsThe prevalence of good early essential newborn care in the public sector health facilities was 26.4 % (95 % CI: 23.55, 29.30) whiles that of the private sector health facilities was 19.9 % (95 % CI: 13.55, 26.30). Mothers who had a Caesarean section in the public sector health facilities had 67 % lower odds of early essential newborn care compared to mothers who had a vaginal delivery [adjusted prevalence odds ratios (aPOR) = 0.33, 95 % CI: 0.20, 0.53]. Mothers without a health insurance in the public sector health facilities had 26 % lower odds of early essential newborn care compared to mothers with a health insurance (aPOR = 0.74, 95 % CI: 0.56, 0.97). However, these associations were not observed in the private sector health facilities.ConclusionsThe findings suggest that the prevalence of good early essential newborn care in the public sector health facilities was higher than that reported in the private sector health facilities. Child health programs on early essential newborn care needs to be prioritized in the private healthcare sector. The Government of Ghana may also need to increase the coverage of the national health insurance scheme for women in reproductive age.