Public Health Facilities Research Articles

Experiences of community engagement for SARS-COV-2 and COVID-19 community surveillance in a rural and urban population in South Western Uganda

Background: We describe lessons learnt from community engagement activities for the successful implementation of a COVID-19 community surveillance study in Kalungu district, south-western Uganda. Methods: One rural and one urban site were selected for COVID-19/SARS-CoV-2 community surveillance in selected households and three public health facilities. COVID-19 pandemic and national COVID-19 protection measures were described and explained in meetings with: district, sub-county/town, village council officials, religious leaders, health workers and Community Advisory Board members. The community surveillance study was introduced to the meeting attendees and minutes captured in English/Luganda (subsequently translated to English). All minutes were manually coded and analysed thematically. Results: The minutes revealed that community members were generally supportive of the COVID-19 surveillance study. Members requested wider communities’ sensitisation about COVID-19 and the survey beyond the selected households. Misinformation and mistrust of Government statements were widespread. People in the community did not understand the `random sample’ selection for the study. Providing appropriate medical care, face masks and honouring appointments for study participants and ensuring that COVID-19 prevention measures were followed during the study improved participation. Conclusion: Successful COVID-19 community surveillance required continuous, active community engagement between the research team, and community stakeholders while maximising previous gains and exploiting existing resources. Keywords: SARS-COV-2; COVID-19; community engagement; surveillance; acceptability; East Africa.

Evaluation of Treatment and Recurrence-Free Survival in Patients with Early HER2-Positive Breast Cancer: Real-Life Data Comparing Public and Private Healthcare

Abstract Introduction The present study was designed to compare the treatment provided in private and public health care facilities for women positive for early breast cancer of the human epidermal growth factor receptor 2 (HER2) subtype, who received anti-HER2 therapy in neoadjuvant or adjuvant settings, with an evaluation of the recurrence-free survival (RFS) and pathological complete response (pCR) rates. Materials and Methods The current is a retrospective study carried out at the Instituto Brasileiro de Controle do Cancer (IBCC Oncologia), in the city of São Paulo, Brazil. We included patients treated between 2015 and 2020. Results The study included 472 medical records of early HER2-positive breast cancer patients treated in the public and private health care systems who received neoadjuvant or adjuvant treatments. The pathological complete response (pCR) was related to a lower recurrence rate and a longer recurrence-free survival (RFS). The results showed no statistically significant difference between the public and private health care systems in terms of RFS. Discussion Although the public health care patients were diagnosed with more advanced diseases than the private health care patients, both presented similar survival rates. In spite of the small number of patients evaluated, the dual HER2 blockade did not improve the clinical outcomes. These findings should be confirmed through studies with a larger number of patients and a longer follow-up period.

Cost-effective analysis of active case finding (ACF) strategy to detect pulmonary tuberculosis (PTB) in selected public health care facilities of the northern state, India

BackgroundIn addition to passive case finding (PCF), active case finding (ACF) strategy under National Tuberculosis Elimination Program is a vital secondary prevention intervention under National Strategic Plan (NSP). The present study was conducted to assess ACF's cost-effectiveness compared to PCF in selected public health facilities for the detection of presumptive TB cases under NTEP. Material and methodsA cross-sectional study was carried out in randomly selected seven public health facilities of a health block of one district of Himachal Pradesh. Bottom-up costing method was used with bootstrapping of results to assess incremental cost-effectiveness ratio (CEAC) and cost-effectiveness acceptability curve (CEAC). ResultsMean cost for ACF and PCF with US$ 3325.8 and 3006.0 respectively to detect all presumptive PTB cases; and US$ 4121.2 and to US$ 3709.0 to confirm all PTB cases. Below WTP threshold (per capita income US$ 2735), WTP 80.3% of simulated ICER values were cost-effective. CEAC showed that saturation was achieved around US$ 300 indicating a likely WTP threshold at which 79.5% of simulated values were cost-effective. For both strategies, One way sensitivity analysis showed the cost is influenced mostly by human resources. ConclusionCurrent study used bottom-up costing method in public health care facilities observed ACF as a cost-effective strategy in reaching out for presumptive PTB. The major cost driver in both strategies is human resource for training, travelling, and administration.

Community-Based Delivery and Administration of Sars-CoV-2 Antigen Rapid Diagnostic Tests: An Operational Research Study in Marketplaces in Malawi and Zambia.

To expand access to testing beyond public health facilities and to strengthen surveillance efforts for COVID-19, community testing using COVID-19 antigen-based rapid diagnostic tests (Ag-RDTs) was identified as a major area of focus in Malawi and Zambia. This research aimed to gather evidence on the feasibility and acceptability of community testing in marketplaces. A cross-sectional study with a mixed-methods design was conducted in marketplaces in Malawi and Zambia to understand operational considerations for the implementation of Ag-RDTs for SARS-CoV-2 in a community setting. Programmatic data were collected prospectively as individuals were tested from June to September 2022. COVID-19 testing was done using Abbott Panbio nasal swab test kits. Semi-qualitative questionnaires were administered to individuals who tested, healthcare workers, and site-based personnel. Data were collected electronically via the SurveyCTO platform and analyzed using STATA. In Malawi, 2,348 participants were tested, and in Zambia, 1,723 people were tested for COVID-19. In Zambia, participants were 46% female, with a median age of 28 years, whereas in Malawi, participants were 69% female, with a median age of 37 years. In Malawi, 78 positive cases were reported (3.3% positivity rate), and in Zambia 10 positive cases were reported (0.5% positivity rate). In Zambia, 99% of 300 participants and in Malawi, 92% of 1,158 testers found the market testing experience and sample collection acceptable. Community testing is a feasible and acceptable intervention to increase testing access in Malawi and Zambia, especially when coupled with community awareness campaigns and mobilization.

The Right to Healthcare Must Include the Right to Ease of Physical Access: Exploring Geography-Health Nexus in GIDA Communities in the Philippines.

Using the United Nations' 'leave no one behind' framework for the achievement of sustainable development goals, this article underscores the key role of geography as one of the core factors why certain people are left behind, deprived, and continue to experience inequality in terms of access to (quality) health care facilities and services. This article specifically examines the consequences of physical inaccessibility to health outcomes and health-seeking behavior in geographically isolated and disadvantaged areas (GIDAs) in the Philippines. This article illustrates that physical accessibility is an ignored aspect of the public health paradigm. For that reason, public health facilities, no matter how critical the facility is to a person's care, are not an immediate option for GIDA residents who seek medical aid. Responsive policy measures are vital to address this seemingly paradigmatic error. Subsidizing transportation costs and allocating funds for road improvements are called for, among other changes. The government must act on the people's right to ease of access as part of fulfilling fundamental health-related state obligations. But for the government to act, it will be crucial for claimants to health rights to proactively demand these changes. The latter is key for the fulfillment of the affected people's right to get easier access to meaningful health care.

A Study of Professionals' Quality of Life among Dentists in Public and Private Healthcare Facilities

A Study of Professionals' Quality of Life among Dentists in Public and Private Healthcare Facilities

Total quality management, supplier quality and operational efficiency in the public health sector in the Upper East Region of Ghana

The purpose of this study was to examine the role that Total Quality Management (TQM) plays in ensuring operational efficiency via supplier quality in public health sector in the Upper East Region. Specifically, the study examined the effect of TQM on supplier quality; effect of TQM on operational efficiency; effect of supplier quality on operational efficiency and finally assessed the mediating role that supplier quality plays in the relationship between TQM and operational efficiency within these health sectors in the Upper East region. Structured questionnaire was utilized to solicit primary data from the study’s respondents. The selection of 174 sampled respondents from the total population of 352 public health facilities were done using a simple random sampling procedure. Also, version 24 of the IBM SPSS software and the SmartPLS model was utilised to process the data. The demographic characteristics of the respondents were analysed with the help of descriptive tools such as means and standard deviation, while inferential statistical tools was employed in testing the cause-and-effect hypothesised relationships between the variables. The findings revealed that total quality management had a positive significant effect on supplier quality. Likewise, the objective two showed that total quality management had a positive statistically significant effect on operational efficiency. The third objective showed that supplier quality had a positive statistically significant effect on operational efficiency, and the fourth research objectives revealed a positive statistically significant mediating effect of supplier quality in the relationship between total quality management and operational efficiency. The study recommended that, management of health facilities within the Upper East region should emphasize on putting measures in place to ensure the improvement of their TQM practices to help set standard that will ensure that suppliers goods and services conform to quality standards

Intra- and inter-facility experiences of coordinating care for patients with lung cancer in KwaZulu-Natal public health facilities: a qualitative study

Aim Despite evidence that effective cancer care coordination has yielded positive results in facilitating and supporting high-quality care, it remains a complex and challenging system to implement. South Africa’s mortality of lung cancer is reported at 13.4%, ranking highest among all cancers. Coordinating the care of cancer patients is complex and can last several months or years, with multiple consultations, rounds of treatment, and follow-up in various settings. With so many health professionals, services, and settings involved, the care of these patients can become fragmented and uncoordinated. This interface between primary and specialty care offers a valuable opportunity to appreciate the challenges of delivering well-coordinated cancer care. Consequently, this paper explores healthcare professionals’ perspectives on coordinating lung cancer care within and between healthcare services. Methods This study was conducted through virtual, telephonic, and face-to-face in-depth interviews with 26 purposively selected participants from primary to tertiary health professionals, using a semi-structured tool and drawing from grounded theory design. Data generation and analysis were conducted iteratively, followed by systematic thematic analysis to organise data, review, and interpret the findings. Findings The overall public health system challenges reported by participants involved service fragmentation, staff shortages, and communication problems. Drivers of lack of care coordination varied widely across healthcare professionals, with interoperability and communication challenges standing out as the most prominent themes. Consequently, better communication, interoperability, and improved care transitions between providers and health systems were proposed. This study provides pertinent information for policymakers and healthcare professionals to develop appropriate strategies for improving cancer care coordination interventions. Conclusions A fundamental change is required to shift the direction of the KwaZulu-Natal public health system towards responsive, patient-centred, comprehensive, and coordinated care. Enabling the primary healthcare level to play a substantial role in care coordination may provide a plausible intervention to circumvent healthcare complexities.

Assessment of the compliance with minimum quality standards by public primary healthcare facilities in Nigeria

Achieving universal health coverage (UHC) and the Sustainable Development Goals (SDG) by 2030 relies on the delivery of quality healthcare services through effective primary healthcare (PHC) systems. This necessitates robust infrastructure, adequately skilled health workers and the availability of essential medicines and commodities. Despite the critical role of minimum standards in benchmarking PHC quality, no global consensus on these standards exists. Nigeria has established minimum standards to enhance healthcare accessibility and quality, including the Revised Ward Health System Strategy (RWHSS) by the National Primary Health Care Development Agency (NPHCDA). This paper outlines the evolution of PHC minimum standards in Nigeria, evaluates compliance with RWHSS standards across all public PHC facilities, and examines the implications for ongoing PHC revitalization efforts. The study used a cross-sectional descriptive design to assess compliance across 25 736 public PHC facilities in Nigeria. Data collection involved a national survey using a standardized assessment tool focussing on infrastructure, staffing, essential medicines and service delivery. Compliance with RWHSS minimum standards was found to be below 50% across all facilities, with median compliance scores of 40.7%. Outreach posts had a median compliance of 32.6%, level 1 facilities 31.5% and level 2+ facilities 50.9%. Key findings revealed major gaps in health infrastructure, human resources and availability of essential medicines and equipment. Compliance varied regionally, with the North-west showing the highest number of facilities but varied performance across standards. The lessons learned underscore the urgent need for targeted interventions and resource allocation to address the identified deficiencies. This study highlights the critical need for regular, comprehensive compliance assessments to guide policy-makers in identifying gaps and strengthening PHC systems in Nigeria. Recommendations include enhancing monitoring mechanisms, improving resource distribution and focussing on infrastructure and human resource development to meet UHC and SDG targets. Addressing these gaps is essential for advancing Nigeria’s healthcare system and ensuring equitable, quality care for all.

Prevalence Estimates of Metabolic Syndrome among the General Population of Central India at Public Health Facilities of Ratlam District, Madhya Pradesh

Prevalence Estimates of Metabolic Syndrome among the General Population of Central India at Public Health Facilities of Ratlam District, Madhya Pradesh

The Healthcare Support Program and Healthcare Utilization of Older Adults in Ethnic Minority Areas in Vietnam

Over the past few decades, Vietnam has experienced a substantial improvement in health outcomes, providing an example of a low-income country that has achieved a major success in public health despite the lack of resources. However, inequalities in access to healthcare services persist among the poor, ethnic minorities, and other vulnerable groups. To address this issue, the Vietnamese government implemented a healthcare support program in ethnic minority areas in 2013. We examine the effects of this program on healthcare utilization among older individuals aged 55-74. Employing a difference-in-differences approach and data from the Vietnam Household Living Standards Survey from 2008-2018, we find that the program has a positive effect on inpatient visits at public health facilities. However, the program has no impact on outpatient visits. Additional analysis reveals that the program increases outpatient visits at commune health stations and inpatient visits at district hospitals. There is also suggestive evidence of a switch from private to public facilities. Our results suggest that providing healthcare resources to disadvantaged areas can increase healthcare utilization of older people, which can, in turn, improve their health outcomes.

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

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

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

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

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

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

The cost-of-illness of multiple sclerosis in Jordan

ABSTRACT Background Multiple Sclerosis (MS) imposes a significant financial burden on health-care systems. This study aims to determine the cost-of-illness (COI) for MS in Jordan, a country where data on the economic impact of MS are scarce. Methods Data were collected for one year, annual COI was estimated using a cross-sectional snowball sampling design. Eligible patients completed a self-reported questionnaire to provide sociodemographic, physician visit, and diagnostic and laboratory test data. Indirect costs were estimated using an adjusted Human Capital Approach. Results This study included 383 patients, (73% females, 61% between 26-45). Eighty % took disease-modifying therapies (DMTs), and 40% had relapses in that year. One-third use non-DMTs and equipment for assistance. The average annual cost per patient was $11,719 (direct costs=$11,252, indirect costs=$467). The total annual cost for all participants was $748,299. The estimated cost of non-DMT, medical tools, diagnostic tests, and hospitalization per patient was $53, 51, 99, and 235 respectively. Conclusion High costs of DMTs state the necessity of resource optimization in Jordan public healthcare facilities. Such findings yield policy-informing actionable insights, suggesting strategic investments in more cost-effective DMTs with potential improvement in accessibility and reduction in the overall economic burden faced by both patients and governments.

Perspectives on hand hygiene in Belizean healthcare facilities during the COVID-19 pandemic: a qualitative evaluation with healthcare workers

ABSTRACT The World Health Organization recommends healthcare workers (HCWs) practice hand hygiene (HH) while providing care. Making alcohol-based hand rub (ABHR) available at points of care is recommended during times of high patient volume, such as the COVID-19 pandemic. In low- and middle-income countries, such as Belize, there may be limited access to HH materials within healthcare facilities. This paper examines the motivators and barriers to HH among HCWs in the 11 largest public healthcare facilities in Belize and HCWs' experiences with an intervention. In 2021, focus group discussions (FGDs) gathered HCWs' HH perceptions and preferences. An intervention was then implemented to increase ABHR access and HH training for HCWs. Post-intervention endpoint FGDs in 2022 documented HCWs' experiences with interventions. Baseline FGDs revealed that self-protection and protection of one's household members from illness were key motivators for HCWs' HH practice. Insufficient time, inadequate access to HH supplies, and gaps in education were barriers to practicing HH. At endpoint, participants appreciated increased access to ABHR and its convenience but did not like ABHR's effect on hands. Experiences with the training were mixed. To improve HCWs' HH practices, HH interventions should be tailored to HCWs' context and learning preferences.

Experiences, acceptability and barriers to calcium supplementation during pregnancy in Dar es Salaam, Tanzania.

Calcium supplementation in pregnancy is recommended in contexts with low dietary calcium intake to reduce the risk of pre-eclampsia and its complications. The World Health Organisation suggested high-dose calcium supplementation (1500-2000 mg/day), divided into three doses and taken at different times from daily iron-folic supplements. We conducted a mixed methods evaluation study to assess experiences, acceptability and barriers to high-dose calcium supplementation from the perspectives of pregnant women and antenatal health care providers at two public health facilities in Dar es Salaam, Tanzania. Descriptive statistics and thematic analysis were used to characterise acceptability, barriers and overall experiences of using high-dose calcium supplementation. Pregnant women in the cohort were aged 19-41 years, with 32.4% being primiparous. The proportion of pregnant women who liked calcium supplements 'a lot' decreased from 50.2% at the first visit to 31.8% at the last antenatal follow-up visit. Adherence was 71.3% (interquartile range: 50.5%, 89.3%), with only 24.0% of the participants taking 90% or more of the required supplements. Although participants expressed positive attitudes towards using calcium supplements, they also voiced concerns about the large size, side effects, the potential to forget and the burden of taking calcium supplements three times per day. Antenatal health care providers also affirmed the high burden of taking calcium supplements in addition to iron-folic acid supplements. Participants expressed the acceptability of using calcium supplements during pregnancy, but adherence to three doses per day posed challenges to pregnant women. Reducing the number of calcium supplement doses per day may improve adherence.

Baseline Survey on Referrals and Healthcare Provider Needs in View for an Electronic Referral System.

The study aimed to evaluate the formats and completeness of the current paper-based referral system and assess user needs for designing an electronic referral system. Conducted in eight public health facilities in Kigali city, the mixed methods approach identified seven different referral letter formats, with the external transfer form averaging 58.8% completeness. Of the 61 elements on this form, 38 were suggested as mandatory and 23 as optional. Focus group discussions confirmed some elements and disputed others. Healthcare providers shared their needs and expectations for the electronic system. The study's outcome provides a clear understanding of the existing referral system and healthcare provider requirements, leading to the design of an electronic referral form.

Role of mixed healthcare providers networks in strengthening primary care systems: a case study of a rural primary care site

IntroductionService delivery networks, also called healthcare providers networks (HCPNs) have been used to address health inequities and promote universal healthcare (UHC). This study described the effect of instituting a mixed...

Health System Structural Factors Associated with Use of Scorecard to Improve RMNCAH Performance Indicators in Public Primary Health Facilities in Kenya

Purpose: Researchers looked into how the structure of the health system affects the use of scorecards to boost reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Kenya's Kwale and Kilifi Counties' public primary health facilities. Specifically, this includes use of the RMNCAH indicators, trainings received on RMNCAH indicators, and factors associated with the utilization of the RMNCAH indicators. Materials and Methods: We conducted a cross-sectional study to gather quantitative data from 119 primary healthcare workers in chosen public primary facilities via one-on-one interviews. We collected data using tablets and the Kobo Collect app. Findings: The findings revealed that 89% of the selected facilities analyzed RMNCAH variables, whereas only 13% used scorecards at the time of the study. The study found that 75% of the facilities that used scorecards did not indicate the specific type of scorecard they received training on. Further research revealed a relationship between scorecard type and utilization (p&lt;0.001, χ2= 2.365), with 84% of facilities analyzing RMNCAH indicators on a monthly basis, focusing on immunization and family planning. However, 63% of healthcare workers rated the health system's structures as either low or poor. Only 11% of facilities had monitoring and evaluation budgets, yet 78% had RMNCAH indicator targets. While most public primary facilities analyze RMNCAH indicators, only a small percentage of these facilities use scorecards due to barriers such as limited training on different types of scorecards, a lack of monitoring and evaluation budget commitments, and poor structural components of the health system Implications to Theory, Practice and Policy: While facilities appreciate the availability of RMNCAH indicators, still the main focus is on immunization and family planning, hence the need for a more comprehensive monitoring of all RMNCAH indicators.