Public Community Health Centers Research Articles

Seismic damage and comparison of fragility functions of public and residential buildings damaged by the 2014 Mae Lao (Northern Thailand) earthquake

On 5 May 2014, a 6.1-Mw earthquake struck the Mae Lao region in Thailand and resulted in the evacuation of all public structures in the epicentral area due to varying degrees of structural and nonstructural damage. This study reports the damage sustained by public buildings in the epicentral area based on postseismic surveys and data gathered from the local official database. Using these damage observations, fragility functions are then derived for public buildings, that is, temples and community health centers, and compared with fragility functions developed for residential buildings damaged in the same area. This earthquake provided several important lessons related to nonstructural damage to local community health centers and temples within the epicentral region. The failure of nonstructural components could lead to serious injuries and casualties. This study has also shown that poor seismic performance of local temples could be expected with moderate ground shaking. Findings in this study could be useful for developing appropriate strategies to ensure safety of local communities for moderate earthquakes for similar structures within the Indochina region in the future.

M-health services equipped with public sector community health centers (MH-PS-CHCs), an emerging public-private joint venture in China: adoption from M-health Users’ Perspective

ABSTRACT People with minor medical conditions in China tend to prefer healthcare consultation in the emergency department of tertiary hospitals and avoid public sector community health centers (PS-CHC). The reason behind this is the trust deficit in the quality of medical care at PS-CHC. On the other hand, Chinese m-health companies have a surprising number of registered users and daily healthcare queries. However, the lack of physical check-ups causes a lack of trust in the quality of prescribed treatments for m-health users. One such m-health company entered into a joint venture with a local government body. In this joint venture, the doctors from tertiary hospitals can provide healthcare consultation to m-health users at PS-CHC. This study investigates m-health users’ intention to use m-health services equipped with PS-CHC, an emerging public-private joint venture in China. We extended the technology acceptance model with government support and trust to predict the adoption of such technology-based public-private joint ventures in a better way. The data were collected from 432 m-health users in Hefei and analyzed using Smart-PLS. All eight direct, but only three mediating relationships were to be found significant. This study has implications for researchers, government healthcare authorities, and m-health service providers.

A Qualitative Study to Assess the Perceptions of the Nurses and Accredited Social Health Activists (ASHAs) Regarding the Prevention of Female Feticide in a selected District of Haryana

Objective: The objective of the study was to assess the perceptions of the nurses and Accredited Social Health Activists (ASHAs) regarding the prevention of female feticide. Methods: The study was conducted in Public Health Centres and Community Health centres of Faridabad district, Haryana. An in-depth interview was conducted by using semi-structured interview schedule in order to assess the perceptions of the nurses and ASHA workers regarding the different aspects of female feticide. The recorded data were transformed into verbatim written accounts. Thematic analysis was done and it followed a five-phase process. In phase I, transcripts were read fully without coding the data to gain an overall sense of the views of the study participants. In phase two and three, more detailed transcript review to identify key phrases and words, followed by coding and data reduction was done. In phase four, another researcher individually coded the transcripts and compared those findings to reach a consensus about the explanations. Conclusion: Qualitative analysis of nursing personnel and ASHAs regarding their perception about female feticide provided deeper insights into the problem of female feticide and its consequences in the society. And it reveals that they are sensitized about this pressing issue and are ready to become the channel of communication to the public for the prevention of the female feticide. It is very necessary that the government and NGOs should systematically organize and orient several programmes to tackle this critical social issue

A Qualitative Study to Assess the Perceptions of the Nurses and Accredited Social Health Activists (ASHAs) Regarding the Prevention of Female Feticide in a Selected District of Haryana

Objective: The objective of the study was to assess the perceptions of the nurses and Accredited Social Health Activists (ASHAs) regarding the prevention of female feticide. Methods: The study was conducted in Public Health Centres and Community Health centres of Faridabad district, Haryana. An in-depth interview was conducted by using semi-structured interview schedule in order to assess the perceptions of the nurses and ASHA workers regarding the different aspects of female feticide. The recorded data were transformed into verbatim written accounts. Thematic analysis was done and it followed a five-phase process. In phase I, transcripts were read fully without coding the data to gain an overall sense of the views of the study participants. In phase two and three, more detailed transcript review to identify key phrases and words, followed by coding and data reduction was done. In phase four, another researcher individually coded the transcripts and compared those findings to reach a consensus about the explanations. Conclusion: Qualitative analysis of nursing personnel and ASHAs regarding their perception about female feticide provided deeper insights into the problem of female feticide and its consequences in the society. And it reveals that they are sensitized about this pressing issue and are ready to become the channel of communication to the public for the prevention of the female feticide. It is very necessary that the government and NGOs should systematically organize and orient several programmes to tackle this critical social issue.

Understanding the roles of community health workers in improving perinatal health equity in rural Uttar Pradesh, India: a qualitative study

BackgroundDespite substantial reductions in perinatal deaths (stillbirths and early neonatal deaths), India’s perinatal mortality rates remain high, both nationally and in individual states. Rates are highest among disadvantaged socio-economic groups. To address this, India’s National Health Mission has trained community health workers called Accredited Social Health Activists (ASHAs) to counsel and support women by visiting them at home before and after childbirth. We conducted a qualitative study to explore the roles of ASHAs’ home visits in improving equity in perinatal health between socio-economic position groups in rural Uttar Pradesh (UP), India.MethodsWe conducted social mapping in four villages of two districts in UP, followed by three focus group discussions in each village (12 in total) with ASHAs and women who had recently given birth belonging to ‘higher’ and ‘lower’ socio-economic position groups (n = 134 participants). We analysed the data in NVivo and Dedoose using a thematic framework approach.ResultsHome visits enabled ASHAs to build trusting relationships with women, offer information about health services, schemes and preventive care, and provide practical support for accessing maternity care. This helped many women and families prepare for birth and motivated them to deliver in health facilities. In particular, ASHAs encouraged women who were poorer, less educated or from lower caste groups to give birth in public Community Health Centres (CHCs). However, women who gave birth at CHCs often experienced insufficient emergency obstetric care, mistreatment from staff, indirect costs, lack of medicines, and referrals to higher-level facilities when complications occurred. Referrals often led to delays and higher fees that placed the greatest burden on families who were considered of lower socio-economic position or living in remote areas, and increased their risk of experiencing perinatal loss.ConclusionsThe study found that ASHAs built relationships, counselled and supported many pregnant women of lower socio-economic positions. Ongoing inequities in health facility births and perinatal mortality were perpetuated by overlapping contextual issues beyond the ASHAs’ purview. Supporting ASHAs’ integration with community organisations and health system strategies more broadly is needed to address these issues and optimise pathways between equity in intervention coverage, processes and perinatal health outcomes.

Comparison of the management and control of hypertension by public and private primary care providers in Shenzhen, China

BackgroundThe Chinese government has designated primary care as the cornerstone for addressing the public health challenges posed by hypertension. In urban China, primary care is usually delivered by either publicly- or privately-owned community health centers (CHCs), and whether there CHCs can achieve the same population health objectives remains unknown. This study aimed to compare management and control of hypertension by public versus private primary care providers. MethodsA face-to-face, cross-sectional patient survey was performed on-site at 12 CHCs in Shenzhen, China (3 privately owned and 9 publicly owned). A total of 1046 hypertensive patients were selected via systematic sampling methods and completed the survey. Information regarding primary care management, anti-hypertensive drug treatment and compliance, and blood pressure was recorded. ResultsCompared with hypertensive patients enrolled from private CHCs, those from public CHCs were more likely to be managed by CHCs (84.6% vs. 61.6%; odds ratio [OR] = 2.594, 95% confidence interval [CI]: 1.730–3.891), to take anti-hypertensive drugs (87.5% vs. 66.8%; OR = 3.193, 95%CI: 1.995–5.110), and to adhere to physicians' advice (91.5% vs. 82.5%; OR = 1.930, 95%CI: 1.0002–3.717). However, hypertension control rates did not differ significantly between public and private CHCs (48.3% vs. 37.6%; P > 0.01, tested by multiple logistic regression models). ConclusionsPublic CHCs showed better performance for the management of hypertensive patients compared with private CHCs, although there is room for improvements for both types of CHCs. Initiation of interventions to motivate primary care providers in both public and private CHCs to comply with hypertension management guidelines is recommended.

INDHCI: Indonesian Districts Health Care Information Model

Indonesia as the fourth most populated country in the world has inadequate informaton health care treatment. Moreover, the health index of the population of Indonesia is still relatively low compared to other countries. Medical record for example, no national medical record health information systems integrated which answer challenges to decision making services soon. Provincial health office no have medical record data which doctor need and adequate of information system for decision making to medical action. Indonesian district healthcare information based on raspberry (INDHCI) will be started of Indonesian district and concern in hospitals service healthcare, doctor and patient can communication. Will be built collaboration on district where need to integrate all hospitals healthcare data such as medical record, health facility for hospitals service data medical record collection with public and private community health center and the ministry of health of the Republic of Indonesia. The development will implement current technology such as Near Field Communication or NFC is the development of Bluetooth and RFID in which NFC provides communication technologies using Bluetooth to connect and RFID as a wave to connect to other NFC devices. NFC allows mobile phones to store necessary data safely and reliably. The data can be sent to other phones using NFC or read by an NFC reader. Then data can be save on Data Warehouse. Data can be used as Indonesian district health care information, Indonesian health research by institution and decision Support System by doctor to serve patient any where. The Indonesian district healthcare Information Model will be built in smartphone application, using the Internet of Things (IoT).

The Relationship between self-efficacy in implementing diet with the blood sugar levels in DM patients in the working area of the Bara-baraya community health center at Makassar City.

Background: Self-efficacy in implementing diets in patients with diabetes mellitus focuses on the patient's believeness in being able to do the behaviors that can support the improvement of their illness and the improve the management of his self-care. Low self-efficacy will have an impact on decreasing the self-care of diabetic patients in complying with various factors such as unstable blood sugar levels. Research Objectives: To know the relationship between self-efficacy in the implementation of the diet with blood sugar levels in DM patients in the working area of the Bara-Baraya Public Community Health Center at Makassar city. Research Methods: this research used a cross sectional approach. The sample of this research was 50 diabetic patients. Random sampling technique. The data analysis includes of univariate and bivariate using the chi square test. Research Results: Based on statistical tests, it found that a significant relationship between self-efficacy in the implementation of the diet with blood sugar levels (p value: 0,000). The conclusion: There is a relationship between self-efficacy in the implementation of diet with blood sugar levels in DM patients in the Bara-Baraya Public Community Health Center at Makassar city.

Comparison of health care utilization among users of public and private community health centres in urban China

In China, the government has encouraged the participation of private sector facilities in primary care to improve health care quality. We compare health care utilization patterns among patients who select private versus public community health centres (CHCs) for reimbursed outpatient services. This paper uses data from the Urban Employee Basic Medical Insurance scheme from 2013 to 2016 in one of the largest cities in China. We used a Poisson model and a logistic model to examine outcomes on monthly outpatient visits and the probability of hospitalization, respectively. Compared with being a user of a public CHC, being a user of a private CHC is associated with a 26.2% lower incidence rate of outpatient visits to hospitals [95% confidence interval (CI): 30.1-21.8%] and no difference in rates of visits to CHCs or hospitalization. Among patients with diabetes or hypertension, being a user of a private CHC is associated with a 12.9% lower incidence rate of outpatient visits to CHCs (95% CI: 19.8-5.4%), a 25.6% lower incidence rate of outpatient visits to hospitals (95% CI: 21.4-19.5%) and 22.3% higher odds of hospitalization (95% CI: 3.5-44.7%). Being a user of a private CHC is associated with a reduction in outpatient visits to hospitals, which aligns with the goal of reducing hospital congestion at the outpatient level. For patients with chronic diseases, being a user of a private CHC is associated with a higher probability of hospitalization. More research is needed to understand the reason for this difference.

Managing Close Contacts of COVID-19 Confirmed Cases in Metropolitan Areas in China.

The novel coronavirus (COVID-19) outbreak has rapidly spread across the world. As medical systems continue to develop vaccines and treatments, it is crucial for the public health community to establish nonpharmaceutical interventions (NPIs) that can effectively mitigate the rate of SARS-Coronavirus-2 (SARS-CoV-2) spread across highly populated residential areas, especially among individuals who have close contact with confirmed cases. A community-driven preparedness strategy has been implemented in metropolitan areas in China. The Chinese Center for Disease Control and Prevention (CCDC) has required that all COVID-19 confirmed cases be recorded and documented in a national notifiable disease surveillance system (NDSS). After receiving reports of newly confirmed cases, an epidemiological services team at the CCDC or trained medical professionals at local clinical facilities start a case-contact investigation. A task force performs home visits to infected individuals. Persons under investigation (PUIs) can stay in designated quarantine facilities for 14 days or in special circumstances can be quarantined at home. This community-based approach involved all stakeholders including local public health departments, public safety authorities, neighborhood councils, and community health centers.

Using HIV Surveillance and Clinic Data to Optimize Data to Care Efforts in Community Health Centers in Massachusetts: The Massachusetts Partnerships for Care Project.

We describe Data to Care processes of the Massachusetts Partnerships for Care (MA P4C) project and identify factors associated with engagement, retention, and viral suppression outcomes. The Massachusetts Department of Public Health and participating community health centers generated lists of patients not in care based on a temporal gap in laboratory results, missed clinic visits, and provider concern regarding engagement. The Massachusetts Department of Public Health and community health centers reviewed the lists monthly and identified out-of-care patients in need of linkage or re-engagement. Between October 2015 and June 2017, of 1418 patients potentially out of care, 83 (5.9%) were confirmed to be out of care. Forty-four of those out of care (53%) received services or were re-engaged in care within 90 days, 45 (54%) were retained in care, and 40 (48%) were virally suppressed. The odds of being re-engaged or retained were lower for patients who were 6 months out-of-care (vs. those newly diagnosed). Patients with an AIDS-defining condition had increased odds of retention and viral suppression. The odds of viral suppression were reduced for patients who reported exposure categories other than men who have sex with men and were younger (30-49 years vs. ≥50 years). Although rates of re-engagement, retention, and viral suppression were low, the MA P4C Data to Care procedures provided a means for accurate ascertainment of out-of-care status. Future Data to Care programs should investigate the factors that contribute to disengagement from care.

Free facilities or false promises? The effects of Accredited Social Health Activists' home visits on maternal and newborn health equity in Uttar Pradesh, India: a mixed methods study

Abstract Background The state of Uttar Pradesh has one of the highest neonatal mortality rates in India (45 per 1000 livebirths), with substantially more deaths among the poorest people. To address this, India's National Health Mission has trained community-based incentivised volunteers called Accredited Social Health Activists (ASHAs) to visit all pregnant women at home and support them to deliver their babies in public hospitals or clinics. Contextual processes greatly shape community-based efforts to reduce health inequities, yet few studies have examined these dynamics. We undertook a mixed methods study to understand the extent to which, how, and in what circumstances ASHAs' home visits reduce gaps between socioeconomic groups in institutional delivery rates in Uttar Pradesh, India. Methods We conducted generalised linear modelling using a cross-sectional survey in a representative random sample of women who had given birth within the last 2 months in 25 districts in 2014–15. We conducted qualitative social mapping and focus group discussions in four villages that were more and less remote in two districts, with purposively selected ASHAs, and mothers from higher and lower socioeconomic groups (n=134). We used thematic framework analysis. Sigma Institutional Review Board and University College London Research Ethics Committee provided ethics approval. Findings We included data from 57 778 women. Institutional delivery rates were 7 and 12 percentage points more equal between the highest and lowest caste (RR 1·09 [95% CI 1·04–1·14] vs 1·25 [1·17–1·33]) and education groups (1·29 [1·26 −1·31] vs 1·66 [1·61–1·70]), respectively, in women who received any third trimester home visits from ASHAs compared with no visit. The qualitative data showed that ASHAs' promotion of incentives and free care influenced families of lower socioeconomic position to deliver their babies in public community health centres. However, many of these families lost faith in the facilities when they experienced indirect costs, lack of medicines or transport, and poor treatment, particularly in the remote villages. These issues also led complicated deliveries to be referred to higher-level, often private, hospitals that poor families can ill afford, and wealthier families to opt directly for private care. Interpretation This study provides guidance for adapting implementation strategies within socioeconomic and health system contexts by strategically supporting ASHAs to build relationships with all families, eliminating indirect costs and other accessibility barriers, and strengthening the quality of care at public health facilities where most needed. This would help alleviate families' widespread reliance on emergency and expensive delivery care, and reinforce ASHAs' role in improving maternal and newborn health equity. Funding None.

Expanding Maternal and Neonatal Survival in Indonesia: A program overview

The Expanding Maternal and Neonatal Survival (EMAS) program was implemented from September 2011 to March 2017 to support the Indonesian Ministry of Health to improve the quality of emergency obstetric and newborn care, increase the efficiency and effectiveness of emergency referrals, and increase accountability through local government and civic engagement. EMAS worked in over 400 public and private referral hospitals and community health centers (puskesmas) in six provinces where over 50% of all maternal deaths were occurring. Mentoring was the main method used to improve performance at facilities and within referral systems. The use of data for prospective assessment of indicators of improved quality of care and referral efficiency was strengthened. Case reviews were used to examine contextual factors contributing to maternal deaths in EMAS-target hospitals and external evaluations were used in retrospective assessments of effectiveness of approaches. The vision of sustainability was infused into EMAS approaches from the outset. Collaboration and advocacy with district health offices in EMAS-supported districts enabled self-funding of selected interventions within 23 of 30 EMAS districts and 35 non-EMAS districts. Articles in this Supplement describe outcomes and impact of EMAS approaches over the term of the program.

Various views of the same elephant: crossing perceptions of key actors on an integrated local health network for older adults

Context: In 2004, Quebec’s government lead an important reform of its health and social structure, aiming at improving integration of services. Accordingly, 94 Health and social services centers were created by the mergers of public establishments local community health centers, long term care facilities and acute care hospitals in most cases. Each new organisation was mandated to lead in the implementation of an integrated local health network that ensures the delivery of a comprehensive continuum of care for the population living on their territories. Several stakeholders policy makers, managers, providers, patients and caregivers were involved at different levels in the implementation of the integrated local health networks. Aims: To analyse an integrated local health network for older adults according to multiple perspectives. Methods: This research is part of an international research program “implementing integrated care for older adults with complex health needs” ICOACH where three case studies were carried out in each jurisdiction: Quebec, Ontario and New Zealand. This presentation is based on data collected in Quebec from 96 semi-structured interviews with various key stakeholders such as policy makersn=11; healthcare providers n=28, managers n=33, older adult patients n=14 and caregivers n=10, as well as the analysis of official documents. data was analysed based on the 59 items of the six dimensions of the Rainbow Model of Integrated Care framework to identify convergences and divergences in the perspectives of the major stakeholders. Results: In general, there is a strong convergence in the views of policy makers, managers and providers on several key features of functional, professional and clinical integration. Although they often adhere to the same principles, differences are sometimes observed at the level of implementation. For instance, they all view, the Continuity item as a central element where organizational structures must support service trajectories. However, several providers report that the poor harmonization of the operating rules between the organizations and the lack of knowledge of the various programs create a lack of fluidity. Another example is related to the item centrality of client needs. Policy makers and managers report that services are developed on the needs of patients while provider’s nuances by repeatedly reporting that services are offered according to their availability at the organization. Among the six dimensions, the clinical dimension is the one that is illuminated by all perspectives while the organizational and systemic dimension are more addressed by policy-makers and managers. Adding the perspectives of patients/caregivers reveals a dissonance of the apparent consensus around the clinical dimension. Conclusion: Based on the Rainbow model, we observed discrepancies between the 4 perspectives in analyzing the implementation of integrated local health networks. Policymakers and managers hold very similar perspectives. Providers often converge in the guiding principles with policy makers and managers, but often diverge at the implementation level by reporting several barriers. They are the buffer group whose perspectives sometimes converge with policy-makers and managers, and at other times with patients/caregivers. Regarding patients/caregivers, they mainly focus on t the clinical dimension and their views often diverge from those of decision makers and managers.

Pain Self-Management: Easier Said than Done? Factors Associated with Early Dropout from Pain Self-Management in a Rural Primary Care Population.

To explore whether psychosocial or demographic factors are associated with early dropout from pain self-management in a rural, low-socioeconomic status population. Secondary analysis of retrospective data. Multidisciplinary pain clinic located in an outer regional area of Australia. One hundred eighty-six people attending a public community health center with chronic noncancer pain (mean age 54.9 years; 58.1% women; 81.7% in receipt of government benefit as their primary source of income). Bivariate analysis and logistic regression, with early dropout as the dependent variable and a range of demographic and psychological independent variables. Following bivariate analysis, early dropout was significantly associated (P < 0.05) with male gender, younger age, history of substance use, being a past victim of assault/abuse, receiving unemployment or disability benefit, having literacy difficulties, higher pain catastrophizing score, higher daily opioid dose, and not holding a multifactorial belief about the cause of pain. Logistic regression analysis resulted in three significant predictors of dropout: substance use history (P = 0.002), past victim of assault or abuse (P = 0.029), high pain catastrophising score (P = 0.048); and one of engagement: holding a multifactorial belief about pain cause (P = 0.005). In a rural, low-socioeconomic status population, addressing social stressors related to lifetime adversity may be important to increasing engagement in pain self-management. Lack of attention to these factors may increase health inequity among those most disabled by chronic pain. Further research into dropout and engagement, especially among disadvantaged populations, is recommended.

Evolving Models and Ongoing Challenges for HIV Preexposure Prophylaxis Implementation in the United States.

The use of preexposure prophylaxis (PrEP) for HIV prevention was approved by the Food and Drug Administration in 2012, but delivery to at-risk persons has lagged. This critical review analyzes the current state of PrEP implementation in the United States, by reviewing barriers and innovative solutions to enhance PrEP access and uptake. Clinical care settings, public health programs, and community-based organizations (CBOs). Critical review of recent peer-reviewed literature. More than 100 papers were reviewed. PrEP is currently provided in diverse settings. Care models include sexually transmitted disease clinics, community health centers, CBOs, pharmacies, and private primary care providers (PCPs). Sexually transmitted disease clinics have staff trained in sexual health counseling and are linked to public health programs (eg, partner notification services), whereas PCPs and community health centers may be less comfortable counseling and feel time-constrained in managing PrEP. However, PCPs may be ideal PrEP providers, given their long-term relationships with patients, integrating PrEP into routine care. Collaborations with CBOs can expand PrEP care through adherence support and insurance navigation. Pharmacies can deliver PrEP, given their experience with medication dispensing and counseling, and may be more accessible for some patients, but to address other health concerns, liaisons with PCPs may be needed. PrEP implementation in the United States is moving forward with the development of diverse models of delivery. Optimal scale-up will require learning about the best features of each model and providing choices to consumers that enhance engagement and uptake.

Screening for developmental dysplasia of the hip in a rural health district: An analysis of practice.

To describe hip dysplasia screening practices in a local rural health district. Cross-sectional study of hospital birth records, local physiotherapy records, public community health electronic medical record (Community Health Information Management Enterprise database) and a survey of local clinicians who work with infants and children. Three rural public hospitals and community health centres in a New South Wales health district. Birth records (n=196) from March 2012 to May 2012; attendance at child and family nurse checks (n=788) May 2013-April 2014; 13 cases of managed developmental dysplasia of the hip (DDH) 2012 and local clinicians (n=49). At birth, the majority of infants (91%, 179/196) had documented hip screening. Community health records show this dropped to 75% (587/788) at 1-4weeks and 29% (227/788) at 6-8weeks. A survey of local clinicians (54% response rate; 49/91) revealed most (78%) screen for DDH and less than half (43%) use guidelines. Almost all (97%) clinicians reported screening for DDH at 6-8weeks of age. Only 51% of clinicians reported having specific training for DDH screening and 76% would like further training. The rate of late DDH requiring management in 2012 was 0.87% (7/806) and the rate of late DDH requiring surgery was 0.25% (2/806). DDH screening practices are well established at birth in the rural health district. There is variability in DDH screening practices beyond 8weeks of age. Clinicians report variations in their knowledge and training. Training in DDH screening and hip screening prompts added to the personal health record might improve rates of DDH screening beyond 8weeks of age.

Pattern and severity of multimorbidity among patients attending primary care settings in Odisha, India.

Multimorbidity is increasingly the primary concern of healthcare systems globally with substantial implications for patient outcomes and resource cost. A critical knowledge gap exists as to the magnitude of multimorbidity in primary care practice in low and middle income countries with available information limited to prevalence. In India, primary care forms the bulk of the health care delivery being provided through both public (community health center) and private general practice setting. We undertook a study to identify multimorbidity patterns and relate these patterns to severity among primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire. Multimorbidity patterns (dyad and triad) were identified for 21 chronic conditions, functional limitation was assessed as a proxy measure of severity and the mean severity score for each pattern, was determined after adjusting for age. The leading dyads in younger age group i.e. 18–29 years were acid peptic disease with arthritis/ chronic back ache/tuberculosis /chronic lung disease, while older age groups had more frequent combinations of hypertension + arthritis/ chronic lung disease/vision difficulty, and arthritis + chronic back ache. The triad of acid peptic disease + arthritis + chronic backache was common in men in all age groups. Tuberculosis and lung diseases were associated with significantly higher age-adjusted mean severity score (poorer functional ability). Among men, arthritis, chronic backache, chronic lung disease and vision impairment were observed to have highest severity) whereas women reported higher severity for combinations of hypertension, chronic back ache and arthritis. Given the paucity of studies on multimorbidity patterns in low and middle income countries, future studies should seek to assess the reproducibility of our findings in other populations and settings. Another task is the potential implications of different multimorbidity clusters for designing care protocols, as currently the protocols are disease specific, hardly taking comorbidity into account.

Cost of Delivering Health Care Services in Public Sector Primary and Community Health Centres in North India

BackgroundWith the commitment of the national government to provide universal healthcare at cheap and affordable prices in India, public healthcare services are being strengthened in India. However, there is dearth of cost data for provision of health services through public system like primary & community health centres. In this study, we aim to bridge this gap in evidence by assessing the total annual and per capita cost of delivering the package of health services at PHC and CHC level. Secondly, we determined the per capita cost of delivering specific health services like cost per antenatal care visit, per institutional delivery, per outpatient consultation, per bed-day hospitalization etc.MethodsWe undertook economic costing of fourteen public health facilities (seven PHCs and CHCs each) in three North-Indian states viz., Haryana, Himachal Pradesh and Punjab. Bottom-up costing method was adopted for collection of data on all resources spent on delivery of health services in selected health facilities. Analysis was undertaken using a health system perspective. The joint costs like human resource, capital, and equipment were apportioned as per the time value spent on a particular service. Capital costs were discounted and annualized over the estimated life of the item. Mean annual costs and unit costs were estimated along with their 95% confidence intervals using bootstrap methodology.ResultsThe overall annual cost of delivering services through public sector primary and community health facilities in three states of north India were INR 8.8 million (95% CI: 7,365,630–10,294,065) and INR 26.9 million (95% CI: 22,225,159.3–32,290,099.6), respectively. Human resources accounted for more than 50% of the overall costs at both the level of PHCs and CHCs. Per capita per year costs for provision of complete package of preventive, curative and promotive services at PHC and CHC were INR 170.8 (95% CI: 131.6–208.3) and INR162.1 (95% CI: 112–219.1), respectively.ConclusionThe study estimates can be used for financial planning of scaling up of similar health services in the urban areas under the aegis of National Health Mission. The estimates would be also useful in undertaking equity analysis and full economic evaluations of the health systems.

Different Models of Hospital-Community Health Centre Collaboration in Selected Cities in China: A Cross-Sectional Comparative Study.

Objective: In recent years, in order to provide patients with seamless and integrated healthcare services, some models of collaboration between public hospitals and community health centres have been piloted in some cities in China. The main goals of this study were to assess the nature and characteristics of these collaboration models.Methods: Three cases of three different collaboration models in three Chinese cities were selected to analyse using descriptive statistics, Pearson χ2 and ordinal logistic regression.Results: Results showed that the Direct Management Model in Wuhan exhibited better structure indicators than the other two models. Staff in the Direct Management Model had the highest satisfaction level (77.6%) with respect to patient referral. Communications between hospitals and community health centres and among care providers were generally inadequate. Publicity about hospital–community health centre collaboration was inadequate, resulting in low awareness among patients and even among health professionals.Conclusion: Results can inform health service delivery integration efforts in China and provide crucial information for the assessment of similar collaborations in other countries.