Private Sector Health Facilities Research Articles

Leveraging COVID-19 Vaccine Safety Monitoring in Ethiopia and Pakistan to Enhance System-Wide Safety Surveillance.

The rapid development, introduction, and global uptake of COVID-19 vaccines required countries to have strong pharmacovigilance systems in place to monitor and address adverse events following immunization (AEFIs). These systems provide timely data on vaccine safety that support decisions about the potential risks of vaccine adverse events relative to the benefit of disease prevention. In Ethiopia, the monitoring system was limited by the lack of data being submitted through its passive surveillance system, delays in investigating serious adverse events and conducting causality assessments, and the lack of reporting to the World Health Organization (WHO) global database, VigiBase. In Pakistan, the pharmacovigilance system lacked reporting requirements and guidance documentation, regulatory policies were insufficient, and staff lacked the capacity to evaluate AEFI reports. Several interventions were implemented in both countries to improve pharmacovigilance systems and processes necessary to collect, analyze, and report AEFIs from health care facilities to the national level and facilitate the use of global and national electronic reporting tools. In addition, Pakistan improved the regulatory policy environment and engaged vaccine manufacturers and private sector health facilities in AEFI reporting for the first time in the country. Outcomes include an increased number of COVID-19 vaccine-related AEFIs reported and causality assessments completed, which means that potential safety issues were being analyzed more quickly, comprehensively, and accurately. The number of AEFI reports submitted to VigiBase by Pakistan's regulatory authority more than quintupled from approximately 5,000/quarter in 2021 to 28,555/quarter in 2022. In Ethiopia, by October 2022, 44,000 AEFI reports had been received, and 40 causality assessments completed. In both countries, timely AEFI data review and analysis led to prompt recommendations and regulatory actions, highlighting the far-reaching implications of strengthening the country-level pharmacovigilance systems. These strengthened systems are now in place for use with all vaccines.

Use of Objective Structured Clinical Examination (OSCE) in a hybrid digital / in-person training for hormonal IUD in Nigeria: findings and applications of the approach.

Background: The hormonal intrauterine device, a long-acting reversible contraceptive method, is being introduced to pilot sites in the private and public sector in Nigeria by the Nigerian Federal Ministry of Health since 2019. To inform training of health care providers, a study was conducted on a hybrid digital and in-person training which utilized Objective Structured Clinical Examination (OSCE) to assess competency of provider trainees. This study represents one of few documented experiences using OSCE to assess the effectiveness of a digital training. Methods: From September - October 2021, in Enugu, Kano and Oyo states of Nigeria, 62 health care providers from public and private sector health facilities were trained in hormonal IUD service provision using a hybrid digital / in-person training approach. Providers, who were skilled in provision of copper IUD, underwent a didactic component using digital modules, followed by an in-person practicum, and finally supervised service provision in the provider trainee's workplace. Skills were assessed using OSCE during the one-day practicum. Results: Use of the OSCE to assess skills provided valuable information to study team. The performance of provider trainees was high (average 94% correct completion of steps in the OSCE). Conclusions: OSCE was used as a research methodology as part of this pilot study; to date, OSCE has not been integrated into the training approach to be scaled up by FMOH. Uniformly high performance of provider trainees was seen on the OSCE, unsurprising since provider trainees were experienced in providing copper IUD. If and when training is rolled out to providers inexperienced with copper IUD, OSCE may have a more important role to assess skills before service provision. The role of OSCE in design of hybrid digital / in-person training approaches should be further explored in rollout of hormonal IUD and other contraceptive technologies.

Identifying predictive factors and developing evidence-based guidelines for promoting respectful maternal and newborn care: a mixed method multiphase study design

Background: Mistreatment of women during pregnancy and childbirth by healthcare workers is a common issue in both private and public sector health facilities in India. Improving the quality of maternity care in these sectors is crucial for promoting institutional births and ensuring positive birth experiences. This study aims to develop guidelines for respectful maternity care (RMC) in India through a multiphase quantitative and qualitative study. Methods: The study will utilize a mixed methods multiphase design, which involves collecting, analyzing, and integrating both quantitative and qualitative data. This approach follows the principles of pragmatism paradigm, where the integration of different approaches enhances understanding. The quantitative data will be used to expand and explain the qualitative data collected in the first phase. The integration of both types of data will contribute to the development of new RMC guidelines. Conclusions: This study is the first of its kind in India to develop comprehensive RMC guidelines based on a multiphase study. By exploring the experiences of Indian women regarding disrespect and abuse (D&A) during childbirth and its determinants, the study will provide valuable insights for guideline development. The integration of quantitative and qualitative approaches in the mixed method design will address potential limitations and provide a more comprehensive understanding of the subject.

Abortion beyond 13 weeks in Argentina: healthcare seeking experiences during self-managed abortion accompanied by the Socorristas en Red

BackgroundIn Argentina, a group of feminist activists, the Socorristas en Red, provide information and accompaniment to people seeking abortions, including beyond 13 weeks gestation. Recently-released WHO guidelines for abortion care acknowledge that abortion trajectories vary and people may seek services and support from a range of settings in the process of an abortion. It follows, therefore, that people who self manage abortions beyond 13 weeks with the support of accompaniment groups may interact with health professionals in the public and/or private sector. Understanding the reasons for and experiences with these interactions can help to inform best practice.MethodsIn 2016, we conducted 23 exploratory interviews among women who self managed abortions beyond 13 weeks gestation accompanied by Socorristas, to understand healthcare-seeking decisions and experiences. We used narrative inquiry as an interview technique and coded interviews using first a holistic coding and, second, a content analysis technique to identify emergent themes in the text and subsequently identify themes relevant to study aims.ResultsWe found that many participants had disclosed their abortion intentions to health professionals prior to their abortions. Some were provided with emotional support and referrals to the Socorristas, while others were admonished and warned of serious health consequences. Most participants sought post-abortion care in public or private-sector health facilities; for fear of legal repercussions, many participants did not share that they had used abortion medications with post-abortion care providers. During care seeking, some participants reported poor treatment, in several cases because they were suspected of inducing abortion, while others reported supportive care from health professionals who had previously-established relationships with the Socorristas.ConclusionsThis study illuminates the important role that supportive health professionals can play to ensure that, regardless of the trajectory of an abortion, people feel comfortable accessing clinical services during their abortion process, even in restrictive settings. Feminist activists can help build bridges with the medical system to ensure that providers who interact with people seeking abortion-related services are empathic, understand their legal rights, and provide supportive care.

Opportunities to Strengthen the National Disaster Medical System: The Military-Civilian NDMS Interoperability Study.

The definitive care component of the National Disaster Medical System (NDMS) may not be able to effectively manage tens of thousands of casualties resulting from a catastrophic disaster incident or overseas conflict. To address this potential national security threat, Congress authorized the US Secretary of Defense to conduct the NDMS Pilot Program to improve the interoperability, special capabilities, and patient capacity of the NDMS. The pilot's first phase was the Military-Civilian NDMS Interoperability Study, designed to identify broad themes to direct further NDMS research. Researchers conducted a series of facilitated discussions with 49 key NDMS federal and civilian (private sector) stakeholders to identify and assess weaknesses and opportunities for improving the NDMS. After qualitative analysis, 6 critical themes emerged: (1) coordination, collaboration, and communication between federal and private sector NDMS partners; (2) funding and incentives for improved surge capacity and preparedness for NDMS partners; (3) staffing capacity and competencies for government and private NDMS partners; (4) surge capacity, especially at private sector healthcare facilities; (5) training, education, and exercises and knowledge sharing between federal and private sector NDMS partners; and (6) metrics, benchmarks, and modeling for NDMS partners to track their NDMS-related capabilities and performance. These findings provide a roadmap for federal-level changes and additional operations research to strengthen the NDMS definitive care system, particularly in the areas of policy and legislation, operational coordination, and funding.

Reaching 95-95-95 targets: The role of private sector health facilities in closing the HIV detection gap-Kisumu Kenya, 2018.

HIV testing efficiency could be improved by focusing on high yield populations and identifying types of health facilities where people with undiagnosed HIV infection are more likely to attend. A retrospective cohort analysis of data collected during an integrated TB/HIV active case-finding intervention in Western Kenya. Data were analyzed from health facilities' registers on individuals who reported TB-suggestive symptoms between 1 July and 31 December 2018 and who had an HIV test result within one month following symptom screening. We used logistic regression with general estimating equations adjusting for sub-county level data to identify health facility-level predictors of new HIV diagnoses. Of 11,376 adults with presumptive TB identified in 143 health facilities, 1038 (9%) tested HIV positive. The median HIV positivity per health facility was 6% (IQR = 2-15%). Patients with TB symptoms were over three times as likely to have a new HIV diagnosis in private not-for-profit facilities compared to those in government facilities (adjusted odds ratio (aOR) 3.40; 95% CI = 1.96-5.90). Patients tested in hospitals were over two times as likely to have a new HIV diagnosis as those tested in smaller facilities (i.e., health centers and dispensaries) (aOR 2.26; 95% CI = 1.60-3.21). Individuals with presumptive TB who attended larger health facilities and private not-for-profit facilities had a higher likelihood of being newly diagnosed with HIV. Strengthening HIV services at these facilities and outreach to populations that use them could help to close the HIV diagnosis gap.

STATUS OF FIRE SAFETY IN HEALTHCARE FACILITIES IN INDIA

Healthcare infrastructure in India is undergoing transformation in techno-physical aspects adding to an unprecedented rate of accessibility and affordability of healthcare facility to the masses. However, healthcare infrastructure in India is not up-to-date on global fire safety norms, and has seen several incidences of fire with causalities and loss of facility for running services. This paper draws on secondary data to establish the key fire risk scenarios in both public and private sector healthcare facilities. This study also derives the probability of occurrence of fire events in hospital critical and non-critical areas, based on statistical analysis of secondary data. This study is intended to inform the key stakeholders involved in healthcare infrastructure development to take informed decisions on fire risk prevention in both new and existing hospitals across India.

Consumer choice of health facility among the lowest socioeconomic group in newly established demand-side health-financing scheme in Pakistan.

The Social Health Protection Initiative (SHPI) was introduced initially in Pakistan in Khyber Pakhtunkhwa Province. The initiative aimed to provide the lowest socioeconomic group of the population with in-patient healthcare services, which otherwise would be financially hard to obtain. It is one of the flagship projects of the Provincial Government to contribute towards the United Nations Sustainable Development Goals and universal health coverage. To assess consumer choice of health facility and its determinants for public versus private sector health facilities by people enrolled in SHPI. We used secondary data of availed health services from February 2016 to September 2017 under SHPI. A proxy outcome variable, visit to health facility, was used to determine consumer choice between public and private sector health facilities. The treatment group (health services received by beneficiaries) was used as an independent variable controlled for age groups, cost groups, and geographic location of health facilities. All statistical analyses were performed by SPSS version 20. Most beneficiaries chose private over public health facilities (90.25%). The adjusted odds of visiting a public sector health facility for surgical and obstetrics/gynaecological services were 0.12 [95% confidence interval (CI): 0.10-0.16] and 0.11 (95% CI: 0.09-0.14) respectively, when compared to medical services. SHPI beneficiaries have lesser odds of visiting a public hospital over a private one. The choice may be affected by factors such as age of the beneficiary, cost of health services, and geographic location of health facilities.

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% & 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 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.

Leveraging a matrix of stakeholders to facilitate access to chemotherapy for women's cancers in the Democratic Republic of the Congo.

BackgroundCancer incidence is increasing worldwide. Over the next 20 years, the growing proportion of cases in low- and middle-income countries (LMICs) will account for an estimated 70% of all cancers diagnosed. The vast majority of cancer patients in LMICs will require chemotherapy, due to the advanced stage of their disease at the time of initial presentation. Unfortunately, the availability of cancer drugs in these environments is sparse, resulting in premature death and years of life lost. In an effort to lay a foundation for women’s cancer control in the Democratic Republic of the Congo (DRC), we implemented a programme which combined workforce development, infrastructure creation and cancer drug access. This manuscript reports on our experience with the latter.MethodsA private sector healthcare facility was selected as the programme implementation site. Workforce capacity was developed through a south–south partnership with an African national cancer centre. Cancer drugs were procured through a global cancer medicine access initiative.ResultsA new chemotherapy infusion unit was successfully established at the Biamba Marie Mutombo Hospital in Kinshasa, DRC. A team of Congolese healthcare providers was trained at the Cancer Disease Hospital in Zambia to safely and effectively administer chemotherapy for breast and cervical cancer. Over 100 breast and cervical cancer patients have been treated with 337 courses of chemotherapy, without any serious adverse events.ConclusionCommon barriers to cancer drug access and its administration can be eliminated using regional educational resources to build oncologic workforce capacity, private sector healthcare facilities for infrastructure support and pharmaceutical consortiums to procure low-cost cancer medicines. By leveraging a matrix of global, regional and local stakeholders, the prevailing status quo of very limited access to chemotherapy for women’s cancers was creatively disrupted in DRC, Africa’s largest fragile, conflict and violence-affected country.

Facilitators and barriers to participation of the private sector health facilities in health insurance & government-led schemes in India

BackgroundIn India, policymakers are in an opined that expansion of public-funded health insurance is the key to achieve Universal Health Coverage (UHC). Despite untapped potential to be part of such government-run public-funded health scheme, many private service providers are reluctant to join in such scheme due to various reasons. This paper aims to evaluate facilitators, barriers and perception to participation of the private sector health facilities in Health Insurance & government-led schemes. MethodsPresent study was conducted in 83 private hospitals of Vadodara city. Sampling frame was formed & with the use of random number table, 83 hospitals were selected randomly. Data collection was done in pre tested, pre formed questionnaire & respondents were the medical superintendent or the person in-charge of the hospital. ResultsIn the present study 30% & 26% of hospitals were enrolled for cashless private health insurance facility & government health schemes respectively. Social service, competition and increase clientele were the common reason sought for enrolment in government health schemes. Low & delayed reimbursement, bribe to clear payment, limited services covered, administrative issues were the common problems identified for non-enrolment. There was an association between a number of beds in the hospital & enrolment to government health scheme (p < 0.05). Availability of cashless private health insurance facility (p < 0.01) and satisfied with the current TPA model of health insurance (p < 0.05) were also found statistically significant. ConclusionTimely & rational increase in remuneration, expanding the scope of services and use of appropriate technology for ease in administration is the need of an hour to engage vast service providers under the ambit of public-funded health insurance.

Health Related Quality of Life among Blood Cancer Patients in Pakistan: A Cross Sectional Survey.

The importance of health-related quality of life and its determinants including physical, emotional, and functional domains has long been recognized among blood cancer patients in the developed world but this concept is still in infancy in developing countries, including Pakistan. The objective of the study was to assess health related quality of life among blood cancer patients. A descriptive cross-sectional study design was used. A pre-validated questionnaire that is EORTC-QLQ-C30 was self-administered to a sample of 400 blood cancer patients selected using convenience sampling technique. After data collection, data was cleaned, coded, and entered in SPSS. Descriptive statistics comprising of frequency and percentages were calculated. Non-parametric tests Kruskal Wallis and Mann Whitney tests (P ≤ .05) were performed to find out the differences among different variables. The results highlighted that lowest scores for EORTC-QLQ-C30 were observed in the domain of emotional functioning (3.38, ±35.790), followed by cognitive function (4.56, ±30.368) whereas highest scores were observed in the domain of physical functioning (40.92, ±35.484). Significant difference (P ≤ .05) was observed among different domains of health-related quality of life of blood cancer patients treated in different sectors, provinces, setting, gender, and with different comorbidities. The present study concluded that blood cancer patients had poor health related quality of life in Pakistan. Emotional functioning and cognitive function were the most compromised health related quality of life domains among blood cancer patients. Females having blood cancer, those patients treated in private sector healthcare facilities, patients residing in tribal and rural setting had relatively better health related quality of life. No appropriate psychosocial care program for the blood cancer patients are available in Pakistan.

Levels and dimensions of client satisfaction with the treatment of recent maternal, newborn and child health related illnesses by frontline health workers in rural Nigeria.

Little is documented about levels of client satisfaction with maternal, newborn and child health services at primary health care (PHC) facilities in Nigeria, besides unsubstantiated anecdotes. This study examined different aspects of client satisfaction at primary healthcare level in Nigeria. Quantitative data were collected using personal digital assistants to capture responses from 1548 households in Bauchi and Cross River States. Descriptive statistics were used to summarize study results as frequency tables and percentages. Majority of the study respondents utilized government health facilities for treatment, however some clients used private sector health facilities. Women, newborns and under-fives were treated for a variety of illnesses and disease conditions. Treatment outcomes and levels of satisfaction did not appear to differ by cadre of healthcare provider. Respondents' level of satisfaction with healthcare services at primary healthcare level in Nigeria appear to reflect their modest quality of care expectations, especially in poor PHC rural settings.

Impact of National Drug Pricing Policy 2018 on access to medicines in Lahore division, Pakistan: a pre-post survey study using WHO/HAI methodology

ObjectiveTo evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability.DesignTwo cross-sectional surveys were undertaken before and after...

Assessment of Variation in Cesarean Delivery Rates Between Public and Private Health Facilities in India From 2005 to 2016

The rates of cesarean deliveries have more than doubled in India, from 8% of deliveries in 2005 to 17% of deliveries in 2016. The World Health Organization recommends that cesarean deliveries should not exceed 10% to 15% of all deliveries in any country. An understanding of the association of private and public facilities with the increase in cesarean delivery rates in India is needed. To assess the association of public vs private sector health care facilities with cesarean delivery rates in India and to estimate the potential cost savings if private sector facilities followed World Health Organization recommendation for cesarean deliveries. This cross-sectional study used institutional delivery data from the representative National Family Health Survey (NFHS) in India, including data from the NFHS-1 (1992-1993), the NFHS-3 (2005-2006), and the NFHS-4 (2015-2016). The NFHS-3 and NFHS-4 provided data on 22 647 deliveries and 195 366 deliveries, respectively. The NHFS-4 was the first survey to provide data on out-of-pocket expenditures for delivery by facility type, allowing for a comparison of cesarean deliveries and costs between public and private facilities. The primary sample comprised all pregnant women who delivered infants in public and private institutional facilities in India and who were included the NFHS-3 and the NFHS-4; data on pregnant women who were included in the NFHS-1 were used for comparison. The study's findings were analyzed through geographic mapping, data tabulation, funnel plots, multivariate logistic regression analyses, and potential cost-savings scenario analyses. Data were analyzed from June to December 2019. The main outcome was the rate of cesarean deliveries by facility type (public vs private) and by participant socioeconomic, demographic, and health characteristics. Secondary outcomes were the potential number of avoidable cesarean deliveries and the potential cost savings if private sector facilities followed the World Health Organization recommendations for cesarean deliveries. In the NFHS-3, 22 610 total births occurred at institutional facilities. Of those, 2178 births (15.2%) were cesarean deliveries in public facilities, and 3200 births (27.9%) were cesarean deliveries in private facilities. Of 195 366 total institutional births in the NFHS-4, 15 165 births (11.9%) were cesarean deliveries in public facilities, and 20 506 births (40.9%) were cesarean deliveries in private facilities. The cesarean delivery rate in public health facilities increased from 7.2% in the NFHS-1 to 11.9% in the NFHS-4, whereas in private health facilities, the rate increased from 12.3% to 40.9% during the same period. A substantial increase was found in cesarean delivery rates between the NFHS-3 (2005-2006) and the NFHS-4 (2015-2016), with 22 states exceeding the World Health Organization's upper threshold of 15% in the NFHS-4. The odds ratio for cesarean deliveries in private facilities compared with public facilities increased from 1.62 (95% CI, 1.49-1.76) in the NFHS-3 to 4.17 (95% CI, 4.04-4.30) in the NFHS-4. The number of avoidable cesarean deliveries would have been 1.83 million, with a potential cost savings of $320.60 million, if private sector facilities in India had followed the 15% threshold for cesarean delivery rates recommended by the World Health Organization. In this study, private sector health facilities were associated with a substantial increase in cesarean deliveries in India. Further research is needed to assess the factors underlying the increase in cesarean deliveries in private sector facilities.

Healthcare for non-Covid-19 liver disease patients during the Covid-19 pandemic in Bangladesh: Current trend and future implications.

Healthcare for non-Covid-19 liver disease patients during the Covid-19 pandemic in Bangladesh: Current trend and future implications.

Quality of maternity care provided by private sector healthcare facilities in three states of India: a situational analysis

BackgroundBetter quality of care around the time of childbirth can significantly improve maternal and newborn survival. In countries like India, where the private sector contributes to a considerable proportion of institutional deliveries, it is important to assess the quality of maternity care offered by private sector healthcare facilities. This study seeks to fill that information gap by analysing baseline assessments conducted for the Manyata program, which aims to improve the quality of maternity care at private facilities.MethodsAn observation checklist based on 16 clinical standards endorsed by the Federation of Obstetric and Gynaecological Societies of India (FOGSI) was used to assess 201 private sector healthcare facilities in Maharashtra, Jharkhand, and Uttar Pradesh. Data on facility characteristics came from profiles completed when facilities enrolled in Manyata. Differences in the mean number of standards met were analysed by facility characteristics and the availability of essential supplies.ResultsAround half (47.1%) of all nursing staff engaged in maternity care services at these private healthcare facilities were under qualified. The mean number of clinical standards met by facilities was 3.2 (SD 2.4). Facilities with a monthly delivery load between 20 and 50 met a significantly higher number of standards, as did facilities that had more than 70% of essential supplies available. Both these factors were also significant in a multiple linear regression analysis.ConclusionsThe overall quality of maternity care in private healthcare facilities is poor in all three states, especially for clinical standards related to management of complications.

Diagnose-Specific Antibiotic Prescribing Patterns at Otorhinolaryngology Inpatient Departments of Two Private Sector Healthcare Facilities in Central India: A Five-Year Observational Study.

Antibiotics are over-prescribed in low-and-middle-income countries, where the infection rate is high. The global paucity of standard treatment guidelines and reliable diagnose-specific prescription data from high-infection risk departments such as the otorhinolaryngology (ENT: ears, nose and throat) is a barrier to rationalize antibiotic use and combat antibiotic resistance. The study was conducted to present diagnose-specific antibiotic prescribing patterns of five years at ENT inpatient departments of two private-sector Indian hospitals. Data of all consecutive inpatients (n = 3527) were collected but analyzed for the inpatients aged >15 years (n = 2909) using the World Health Organization’s methodologies. Patient records were divided into four diagnoses groups: surgical, non-surgical, chronic suppurative otitis media (CSOM), and others. Of 2909 inpatients, 51% had surgical diagnoses. An average of 83% of patients in the clean surgery group and more than 75% in the viral and non-infectious groups were prescribed antibiotics. CSOM was the most common diagnosis (31%), where 90% of inpatients were prescribed antibiotics. Overall, third-generation cephalosporins and fluoroquinolones were most commonly prescribed. This study highlights the inappropriate prescribing of antibiotics to patients of clean surgeries, viral infections, and non-infectious groups. The single-prophylactic dose of antibiotic for clean-contaminated surgeries was replaced by the prolonged empirical prescribing. The use of microbiology investigations was insignificant.

Public and Private Sector Health Facilities: Who Possesses National Health Guidelines?

Background: Health guidelines help in ensuring uniformity in quality of care for clients, yet little attention has been giving to understanding if health facilities in the public or private sector are more likely to possess national health guidelines. We hypothesize that government health facilities in low and middle income countries are more likely to possess national guidelines as they are required to comply with public regulations, and are closer to organizations that communicate these guidelines. Methods: We use cross-sectional data from the DHS-SPA surveys to understand the relationship between the managing authority of a health facility (public versus private) and if the facility reports the presence of national health guidelines for maternal and child health (MNCH), communicable, and non-communicable diseases. We restrict our sample to several African and South Asian countries. Findings: We find that health facilities managed by a public authority are more likely to possess guidelines for MNCH, and communicable diseases, as compared to privately managed health facilities. In terms of MNCH healthcare guidelines, the odds of reporting the presence of national guidelines for family planning, IMPAC, CEmOC, and PMTCT, are 57%, 42.4%, 72.2%, and 60.2% higher respectively among public health facilities. For communicable disease guidelines, the odds of reporting the presence of national guidelines for malaria, tuberculosis, and STIs are 103%, 121%, and 81% higher respectively among public health facilities. Interpretation: Our findings suggest that inspite of criticisms, public health facilities have comparative strength in possessing guidelines. Our findings imply a need to improve health system regulation. Funding Statement: The authors stated that they did not receive funding for this work. Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Statement: The study uses publicly available, secondary data and so an IRB application was not filed.