Provide Quality Health Services Research Articles

Self-Governance by Humanitarian Non-State Actors in Health and Nutrition Relief

In the provision of humanitarian health assistance in a post disaster context, critical concerns such as local ownership, financial and political transparency and humane implementation are central. Given that poor quality or unsuitable health assistance can have grossly negative consequences such as increased morbidity, mortality, and disability, increasingly, humanitarian agencies are recognizing the need for a common set of standards and guiding principles for humanitarian health assistance. This includes consideration of provision of quality health services in addition to other core issues such as cooperation and coordination between various institutions and sectors. The central argument postulated in this paper is that despite the absence of a proper global enforcement mechanism of the obligation to provide quality humanitarian assistance in health and nutrition, emerging self-governing mechanisms, such as the Sphere Humanitarian Charter provides a useful mechanism for self-regulation and action by civil society organizations. Such self-regulatory mechanisms contribute to the development of international customary law with regard to an emerging responsibility to provide effective humanitarian assistance.

Assessing the service quality of Iran military hospitals: Joint Commission International standards and Analytic Hierarchy Process (AHP) technique.

Background:Military hospitals are responsible for preserving, restoring and improving the health of not only armed forces, but also other people. According to the military organizations strategy, which is being a leader and pioneer in all areas, providing quality health services is one of the main goals of the military health care organizations. This study was aimed to evaluate the service quality of selected military hospitals in Iran based on the Joint Commission International (JCI) standards and comparing these hospitals with each other and ranking them using the analytic hierarchy process (AHP) technique in 2013.Materials and Methods:This was a cross-sectional and descriptive study conducted on five military hospitals, selected using the purposive sampling method, in 2013. Required data collected using checklists of accreditation standards and nominal group technique. AHP technique was used for prioritizing. Furthermore, Expert Choice 11.0 was used to analyze the collected data.Results:Among JCI standards, the standards of access to care and continuity of care (weight = 0.122), quality improvement and patient safety (weight = 0.121) and leadership and management (weight = 0.117) had the greatest importance, respectively. Furthermore, in the overall ranking, BGT (weight = 0.369), IHM (0.238), SAU (0.202), IHK (weight = 0.125) and SAB (weight = 0.066) ranked first to fifth, respectively.Conclusion:AHP is an appropriate technique for measuring the overall performance of hospitals and their quality of services. It is a holistic approach that takes all hospital processes into consideration. The results of the present study can be used to improve hospitals performance through identifying areas, which are in need of focus for quality improvement and selecting strategies to improve service quality.

Current Approaches in Cardio-Renal Syndrome

In recent years, burden of cardiac and kidney diseases throughout the world is increasing. Studies show that the coexistence of both diseases contributes to increased mortality, morbidity, and healthcare costs. One of the major challenges facing health systems today is to prevent cardio-renal syndrome and provide quality health services to individuals with cardio-renal syndrome. The “cardio-renal syndrome” is a general term to describe different clinical conditions in which heart and kidney dysfunctions coexist. Although the incidence of cardio-renal syndrome is increasing, the evidences are limited about its pathophysiology and effective management. Severe problems may occur due to the interaction of neurohumoral, hemodynamic, and other less known factors in patients with cardio-renal syndrome. Therefore, the management of cardio-renal syndrome requires a multidisciplinary, mutifaceted and patient-centred approach. The most recent developments on the definition, classification, epidemiology, pathophysiology, and prevention and management strategies of cardio-renal syndrome are discussed in this revie.

A realist synthesis of the effect of social accountability interventions on health service providers’ and policymakers’ responsiveness

BackgroundAccountability has center stage in the current post-Millennium Development Goals (MDG) debate. One of the effective strategies for building equitable health systems and providing quality health services is the strengthening of citizen-driven or social accountability processes. The monitoring of actions and decisions of policymakers and providers by citizens is regarded as a right in itself but also as an alternative to weak administrative accountability mechanisms, in particular in settings with poor governance. The effects of social accountability interventions are often based on assumptions and are difficult to evaluate because of their complex nature and context sensitivity. This study aims to review and assess the available evidence for the effect of social accountability interventions on policymakers’ and providers’ responsiveness in countries with medium to low levels of governance capacity and quality. For policymakers and practitioners engaged in health system strengthening, social accountability initiatives and rights-based approaches to health, the findings of this review may help when reflecting on the assumptions and theories of change behind their policies and interventions.Methods/DesignLittle is known about social accountability interventions, their outcomes and the circumstances under which they produce outcomes for particular groups or issues. In this study, social accountability interventions are conceptualized as complex social interventions for which a realist synthesis is considered the most appropriate method of systematic review. The synthesis is based on a preliminary program theory of social accountability that will be tested through an iterative process of primary study searches, data extraction, analysis and synthesis. Published and non-published (grey) quantitative and qualitative studies in English, French and Spanish will be included. Quality and validity will be enhanced by continuous peer review and team reflection among the reviewers.DiscussionThe authors believe the advantages of a realist synthesis for social accountability lie in the possibility of overcoming disciplinary or paradigmatic boundaries often found in public health and development. In addition, they argue that this approach fills the knowledge gap left by conventional synthesis or evaluation exercises of participatory programs. Finally, the authors describe the practical strategies adopted to address methodological challenges and validity.

Comment: Inter-Island referrals in Solomon Islands: a remote hospital perspective

[Extract] We thank Negin, Martiniuk, Farrell and Dalipanda for their contribution in Rural and Remote Health to the field of inter-island referrals in the Solomon Islands¹. We agree that the provision of quality health services to people in remote areas is central to global efforts to achieve universal access to health care. We note with interest their findings that outline the increasing costs involved in referring patients to the National Referral Hospital (NRH) from the provinces, and the current Ministry of Health and Medical Services (MHMS) under-budgeting for these costs.

Measuring health expenditures and outcomes in saarc region: health is a luxury?

The objective of the study is to investigate the link between health care expenditures (HCE), economic growth and health outcomes (i.e., life expectancy (LE), infant mortality and the share of elderly people) for a panel of South Asian Association for Regional Cooperation (SAARC) countries; namely, Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka; over the period of 1995–2010. The developed panel cointegration technique is employed for analysis of short and long-run relationship between the variables. The results of panel cointegration found that there is a long-run relationship between health expenditures, economic growth and health outcomes in SAARC region. The estimated results indicate that both, LE and share of elderly people in population have a negative relationship related to the HCEs which signifies that HCEs are luxury goods in SAARC countries. The burden of aging population can be lowered by provision of quality health services and utilization of their experience and knowledge in dynamics of economic development forecasting. Furthermore, there is no significant relationship found between infant mortality rate (IMR) and HCEs which implies that HCEs do not provide sufficient benefits to reduce infant mortality. Similarly, HCEs are not enough in generating GDP, lowering IMR and increasing LE in SAARC region. The implementation of appropriate tax reform, stable food prices and trade promotion for low transaction cost medical equipment is required for the SAARC region.

Strengthening health workforce capacity through work-based training

BackgroundAlthough much attention has been given to increasing the number of health workers, less focus has been directed at developing models of training that address real-life workplace needs. Makerere University School of Public Health (MakSPH) with funding support from the Centers for Disease Control and Prevention (CDC) developed an eight-month modular, in-service work-based training program aimed at strengthening the capacity for monitoring and evaluation (M&E) and continuous quality improvement (CQI) in health service delivery.MethodsThis capacity building program, initiated in 2008, is offered to in-service health professionals working in Uganda. The purpose of the training is to strengthen the capacity to provide quality health services through hands-on training that allows for skills building with minimum work disruptions while encouraging greater involvement of other institutional staff to enhance continuity and sustainability. The hands-on training uses practical gaps and challenges at the workplace through a highly participatory process. Trainees work with other staff to design and implement ‘projects’ meant to address work-related priority problems, working closely with mentors. Trainees’ knowledge and skills are enhanced through short courses offered at specific intervals throughout the course.ResultsOverall, 143 trainees were admitted between 2008 and 2011. Of these, 120 (84%) from 66 institutions completed the training successfully. Of the trainees, 37% were Social Scientists, 34% were Medical/Nursing/Clinical Officers, 5.8% were Statisticians, while 23% belonged to other professions. Majority of the trainees (80%) were employed by Non-Government Organizations while 20% worked with the public health sector. Trainees implemented 66 projects which addressed issues such as improving access to health care services; reducing waiting time for patients; strengthening M&E systems; and improving data collection and reporting. The projects implemented aimed to improve trainees’ skills and competencies in M&E and CQI and the design of the projects was such that they could share these skills with other staff, with minimal interruptions of their work.ConclusionsThe modular, work-based training model strengthens the capacity of the health workforce through hands-on, real-life experiences in the work-setting and improves institutional capacity, thereby providing a practical example of health systems strengthening through health workforce capacity building.

Organisation and Working of Health Department in Haryana: A Study

The State Government required efficient and dynamic health organisation at the state level to ensure effective and efficient primary health-care delivery system at all the levels within the state, especially, at the grass root and rural level. In the subsequent paragraphs, the organisational structure of health-care machinery in the state of Haryana is shown. The Health Department, Haryana, is committed to provide quality health services and raise the health status of its people. The health services are being provided through a network of 50 hospitals (including Hospital of Medical College, Rohtak), 86 community health centres, 420 primary health centres, 2,433 sub-centres (SCs), 20 district T.B. centres, 41 dispensaries, Post-Graduate Institute of Medical Education and Research at Rohtak and a Medical College at Agroha (Hisar) and Mullana (Ambala).

Frequency, cost and impact of inter-island referrals in the Solomon Islands

Providing quality health services to people living in remote areas is central to global efforts to achieve universal access to health care. Effective referral systems are especially critical in resource-limited countries where small populations are separated by considerable distances, geographic challenges and the limitations of human resources for health. This study aimed to build an evidence base on inter-island referrals in the Solomon Islands, in particular regarding the number of referrals, reasons for referrals, and cost, to ultimately provide recommendations regarding referral practice effectiveness and efficiency. Data were taken from the referral database collected and maintained by the National Referral Hospital (NRH) in the capital, Honiara. Data included age, sex, ward or department visited, date of travel back to home port, home port and province. Data were available and included for 2008, 6 months of 2009, all of 2010 and 1 month of 2011; a total of 31 months. Travel costs were taken from NRH administrative information and included in the analysis. In addition, 10 qualitative interviews were conducted with clinicians and policy-makers in the tertiary hospital and one provincial hospital to gather information regarding inter-island referrals, their appropriateness and challenges faced. In the Solomon Islands, referrals from outer islands to the NRH are substantial and are gradually increasing over time. The two most populous provinces outside of the capital, Western and Malaita, represented 51% of all referrals in the study period. Of those referred, 21% were less than 15 years of age - even though 40% of the country's population is under 15 - with 30% being young adults of 15-24 years. Orthopaedic conditions comprised the largest number of referrals, with obstetric and gynaecological conditions a close second. The cost of referrals is rapidly increasing and was almost US$350,000 per year for the NRH alone. The amount budgeted for patient travel from the provinces to the NRH was a fraction of what is needed to cover the current number of referrals leading to a substantial budget shortfall. There did not appear to be a clear link between number of doctors in each province and the rate of referrals. Improving the appropriateness of referrals can have a substantial impact on access, quality of care and costs. Improvements in equipment in remote facilities, in human resources for health and in information technology can strengthen the quality of care in outer islands. Reducing the burden on referral facilities will allow them to provide appropriate care to those most in need while building public trust in all layers of the health system.

Current healthcare in Bulgaria: time for predictive diagnostics and preventive medicine

Since 1990 Bulgaria gradually moved from monopolistic to market regulated economy and healthcare. In 2007 the country became member of the European Union and started to adopt EU legislations. However, significant gaps between the average European and Bulgarian level of social, health and economic efficiency remain to be narrowed. The major challenge is the demographic situation, where recent trends give alarming signals. Plans for reformation include transition towards out-patient palliative healthcare centers for the aging population as well as reduction of the costs with new electronic system of health insurance. The favorable location of the country at the Black Sea coast gives opportunities for medical tourism, which can provide quality health service for foreign customers. Finally, national platforms on prevention of major non-communicable diseases, such as obesity, cancer and diabetes, must be established as coordinated actions for the health and wellness of next generations.

Language liaisons

Dallas and the North Texas region of the United States have seen profound demographic shifts that have challenged one regional health care network in its effort to provide quality health services to an increasingly linguistically heterogeneous community. The response to this challenge has included a reconceptualization of the organization’s language policy to create alignment between it and the organization’s mission, considering language policy from both an equity and a quality control perspective. This industry-facing language planning case study looks at how Children’s Medical Center of Dallas has responded to the challenge by explicitly recognizing patients’ linguistic needs, developing its workforce, and creating a language liaison program that bridges the communication gap between doctors and their patients. While governments select language policies and engage in language planning mainly for political purposes, private organizations serving multilingual communications have quality of service as an added incentive to engage in such activities if they are to remain viable.

Military Public Health

Public health is a key contributor to military effectiveness. Successful operations depend on the underlying fitness of personnel and the maintenance of health through effective prevention of, or protection from, harmful environmental exposures and behaviours. Public health practice in the military covers the main domains of health promotion and improvement, health protection and the provision of quality health services. The information resources underpinning this work differ from those available to civilian practitioners, but it is possible to derive population level information from the joint personnel administration system, aggregated pseudo-anonymised military primary care data, deployed hospital, aeromedical evacuation and mental health databases, patient tracking systems and a number of surveillance systems covering, for example, climatic injury and communicable disease. Difficulty in identifying military patients as a sub-set limits the usefulness of many of the national and regional health information sources routinely used in civilian practice. The medical examination of individuals during the selection process screens out declared or detectable major physical and psychological problems and creates a healthy worker effect. However, military personnel are drawn from the civilian population and reflect the health behaviours of the groups from which they are recruited. Poor levels of dental health on entry and higher than average levels of cigarette smoking are present in sections of the military population. Harmful drinking behaviour is common. The prevalence of risk factors is not evenly distributed. The population is heavily skewed towards the under-30 age group, with males the predominant proportion. Nevertheless, sub-groups within the military population, such as females, personnel recruited from overseas and young personnel with low levels of educational attainment, have particular needs that require targeted approaches. An overall defence health strategy directs and supports the work of the chain of command in developing healthy polices and providing a healthpromoting environment as far as is possible. Paradoxes exist in military health promotion. Unlike their civilian counterparts, many among the Armed Forces population undertake high levels of physical activity. The development and maintenance of good physical fitness is essential to prepare all deploying personnel for the demands of operations. But the necessarily robust physical training results in sports injuries and overuse injuries that may require prolonged recovery periods. Surveillance of injuries and modification of training schedules and activities is an ongoing process moving towards an irreducible minimum level of sports and training injury. Individual behaviour is another area with conflicting drivers. The demands of operations may inherently steer the selective recruitment of individuals with tendencies towards risk-taking behaviour, and those who work well in groups, conforming to peer group behaviours. Clearly these qualities need control and direction rather than to be stifled, and the fine line managed by commanders is supported by focussed and pertinent health promotion efforts. …

Allocation of Gastroenterology Training Positions in Ontario: Supply or Demand?

Allocation of Gastroenterology Training Positions in Ontario: Supply or Demand?

Primary health care: back to basics in Madagascar

When the first batch of 1500 young health aides were dispatched in 1980 to Madagascar's villages, it was thought to herald a new era in health care for the island nation off the south-east coast of Africa. The project was the centrepiece of the country's primary health care policy, launched in 1978 with high hopes of meeting the Alma-Ata goal of health for all by 2000. The drive to improve health services was not before time. Despite declaring its independence from France in 1960 and undergoing the Malagasy Socialist Revolution resulting in the Second Republic in 1975, health care in Madagascar remained inadequate, a throwback to colonial times when it served the ruling elite, with its infrastructure and staff concentrated in the towns. In the intervening 30 years, the much-vaunted primary health care initiative has brought mixed results, making strong advances in some areas while failing to deliver in others. On the plus side, Professor Dieudonne Randrianarimanana, the cabinet director of the Madagascar Ministry of Health, Family Planning and Social Protection in the capital Antananarivo, says that the islanders have never been more motivated to look after their health as they are today. The general situation is getting better, says Randrianarimanana. Average life expectancy is 55 years; poliomyelitis is about to be eradicated; the prevalence of leprosy is less than 1 per 10 000; and infant mortality is decreasing (in 2006 the probability of dying in the first year of life was down to 58 deaths per 1000 live births compared with 98 in 1993 and 74 in 2003). The government is aiming for a 100% success rate in preventing and treating malaria, while AIDS is not a major health problem, he says, because HIV prevalence is relatively low compared with the rest of sub-Saharan Africa; an estimated 0.95% of the island's population of 18.6 million are infected. However, Randrianarimanana says Madagascar has failed to achieve the health for all by 2000 target laid down by the Alma-Ata Declaration, and estimates only 60-70% of Madagascar's inhabitants--that is those who live in regions served by roads--have ready access to primary health care. Many people still have to walk 10 kilometres or more to receive treatment, though mobile health centres have been introduced in remote and sparsely populated areas. In an organizational reshuffle in the mid- 1990s, all 1500 original primary health care centres, and others that had come into operation, were reclassified as Basic Health Centres or Centres Sante de Bases (CSBs). In 2004, almost 3000 CSBs throughout the country were listed on the health ministry web site. While the name has changed, the CSBs still operate essentially as primary health care centres. Dr Dieudonne Rasolomahefa, the Director-General of Health at the Ministry of Health, Family Planning and Social Protection, says a level 1 basic health centre (CSBs are classified level 1 or 2 according to the size of population they serve) is now staffed by a nurse rather than a health aide. Rasolomahefa says the nurses and midwives (paramedical workers) receive a higher level of training via the health ministry than the health aides of the past, for whom training programmes ceased in 1982. The health aides continue to work as such until retirement. [ILLUSTRATION OMITTED] Indeed, though the term, primary health care, is not generally used in official quarters these days, the primary health care programme in Madagascar has been reinforced, Rasolomahefa says. The Madagascar Action Plan 2007-2012 (MAP) has become the key policy of the Malagasy state, comprising eight commitments towards a prosperous future. Commitment five outlines the government's strategy on health, family planning and the fight against HIV/AIDS. Under the plan, the government has committed itself to providing quality health services to all; eradicating major diseases; HIV/AIDS control and prevention; implementing a successful family planning strategy; reducing infant, neo-natal and maternal mortality; improving nutrition and food security; and providing safe water and promoting hygienic practices. …

企業外労働衛生機関における産業看護職の雇用と活動の実態

The purposes of this study were to survey the actual conditions of the employment status and activities of occupational health nurses who are employed in Japanese Industrial Health Organizations (IHOs), and to investigate whether the OHNs provide quality health services to employees. We mailed 1,780 questionnaires to nurses who belong to 92 IHOs (members of the National Federation of Industrial Health Organizations). A total of 976 questionnaires were returned (54.8% valid response rate) and 968 questionnaires were considered eligible for analysis. The results showed the following issues: 1) most public health nurses belonged to the department of occupational health service, but they did not have enough experience with industrial hazards or workers safety or health; 2) public health nurses want to participate more directly in care for workers; 3) Public Health Nurses provided health counseling in the charge of their enterprises, but they did not take managerial roles, including place-of-work patrol, attendance to safety, and health committees in their workplaces; 4) they were not satisfied with the present roles demanded by the other staff and their managers; 5) they did not have enough opportunities to attend the job training. Together, the results of this study suggest that the OHNs in IHOs need to have more opportunities to perform their expertise in industrial health & safety and job training in order to provide autonomous health services to the workers.

Uncertainty in Malaria Control in Tanzania: Crossroads and Challenges for Future Interventions

In Tanzania malaria is the leading cause of morbidity and mortality, especially in children under 5 years. The disease ranks number one in both outpatient and inpatient statistics. The socio-economic impact of malaria is so high that it contributes highly to poverty and underdevelopment. Efforts made during the past century to combat and control malaria have not been successful. The prospects of achieving the Abuja declaration targets are uncertain within the remaining period of time. Currently, the Ministry of Health through a 5-year strategic plan advocates four main approaches in the fight against the disease. These include improved case management, vector control using insecticide treated mosquito nets, prevention and control of malaria in pregnancy and epidemic preparedness, prevention and control. However, these strategies face various challenges including inadequate human, financial, and material resources; inefficiency in the healthcare system that is incapable of providing quality health services and access to prompt diagnosis and treatment; lack of an effective disease surveillance system; and an inefficient health education communication mechanism. Tanzania is at the crossroads and is challenged with the need to introduce a new antimalarial treatment regimen and the reintroduction of DDT for indoor residual spray. Unless malaria control strategy adopts an integrated approach its success is far from being realized. This article reviews the current malaria control strategies and its challenges in Tanzania and proposes new strategies.

Assessment of the health status and risk factors of Kham Tibetan pastoralists in the alpine grasslands of the Tibetan plateau

The health status of Tibetan herders in the Sanjiangyuan region of the Tibetan Plateau, in southwest Qinghai Province, is assessed in this paper. The field study was conducted in 2002 in the context of a broader community development and research framework, the ultimate goal of which is to achieve an effective region-specific programme of preventative health care and training for Tibetan pastoralists. Specifically, the authors analysed the impact of a number of potentially health-related environmental and lifestyle risk factors on self-reported health indicators, with a special emphasis on mother and child health. Several health status indicators were used, including a general morbidity index and a measurement of functional incapacity due to illness in the sample households. Maternal and child health findings were alarming with high rates of miscarriage and infant loss, with no traditional midwives to assist in pregnancy and delivery. Preventable childhood illnesses were also common. Other debilitating diseases included hepatitis, tuberculosis, arthritis (gout), gall bladder disease, peptic ulcers and back pain. Finally, binary logistic regression analysis showed a significant link between general morbidity and the time it takes to obtain water. The survey findings, validated by the focus groups, indicate a real need for increased accessibility and quality of health service provision to women and men and effective preventative health strategies.

Health Services Delivery: Reframing Policies for Global Nursing Migration in North America—A Caribbean Perspective

Countries of the Caribbean face critical challenges in nurse migration and health services delivery. They are experiencing two types of migration-country-to-country migration within the Caribbean and migration from the Caribbean to developed countries, including the United States, Canada, and the United Kingdom. Aggressive international recruitment practices in the Caribbean resulted in a dramatic loss of nurses in the region and had an adverse impact on health-services delivery. A Managed Migration Program is being developed with two guiding principles-observing the rights of individual nurses to choose where they want to work and live while balancing individual rights with a country's obligation to provide quality health services to its citizens. It is a multi-country, multi-agency, multi-interventional strategy to increase intake, production, and retention of nurses. Various efforts designed to balance nursing supply and demand are underway, with the goal of providing universal, effective, and quality health care in the Caribbean.

The health system in Nepal—An introduction

We present here a study on the health system in Nepal. Approximately two-thirds of the health problems in Nepal are infectious diseases. Epidemics occur frequently with a high rate of morbidity and mortality and there are occasional outbreaks of infectious diseases of unknown etiology. In addition, the rapid rate of HIV infection in the Indian sub-continent is likely to add a new dimension of opportunistic infections. Until now, the Health System introduced as the General Health Plan in 1956 has been expanded by focusing on primary health care, and a comprehensive network-like Health System has been developed; the most basic unit is a Sub-Health Post or Health Post in each Village Development Committee area. However, the expansion of the Health System has not been matched by an expansion in the domestive resources, workers and supplies, and the available resources are not efficiently distributed. In addition, insufficient resources available for preventive and promotive medicine and the occurrence of non-infectious diseases such as cancer and cardiovascular diseases has been increasing. The Government recently introduced a Health Policy encouraging the private sector to invest in the production of health workers and in providing quality health services. As a result, several private health institutions have been founded and are expected to contribute to the development of the human resources required by Nepal.

Editorial Comments

Assessment and evaluation of education,practice and research of health professionals are necessary in order to provide quality health services to our communities, country and internationally. In this edition most of the articles address assessment or evaluation of education practice or research.
 
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