Public Health Care Delivery System Research Articles

Testing of plant materials in homeopathic medicine manufacturing

Globally, diabetes causes about 1.5 million deaths per year. Data predicts that the current global epidemiological burden of diabetes is increasing alongside its long-term life threatening sequelae and side-effects from synthetic antidiabetic drugs. Challenges in the public healthcare delivery system, inadequate human and financial resources, expensive antidiabetic drugs coupled with their limited availability, efficacy and tolerability, and a higher priority for subventions to the control of communicable diseases such as HIV/AIDS than to drugs for non-communicable conditions especially diabetes have opened new vistas for diabetics to seek complementary and alternative medicines. As a corollary, there is a renewed momentum backed by the World Health Organization to discover newer, cheaper and better antidiabetic agents from medicinal plants. As data on putative antidiabetic properties of plants remain scattered, this review provides a new synthesis of antidiabetic plants from Africa, Central America, Mexico, South Asia, and Iran. In the countries mentioned in this review, numerous plant species decrease blood sugar levels by inhibiting the enzymes α-amylase and α-glucosidase. Other antidiabetic plants restore pancreatic cells, improve insulin secretion and sensitivity, decrease metabolic syndrome in type 2 diabetes patients in addition to exerting antioxidant and hepatoprotective functions. Mechanisms of action are mediated by phytochemical agents including saponins, polyphenols, ellagitannins, triterpenes, and elements such as Mg, P, Ca, K, Mn, Cu, Zn, S, Cr, Co, Ni and V. These plant compounds and elements may be included into new and more efficacious herbal drugs and nutraceuticals to lessen the global burden of diabetes.

Role of surveillance in the strengthening of the public health care delivery system

Role of surveillance in the strengthening of the public health care delivery system

Need for population-based survey to strengthen public health care delivery system: A program manager perspective

Need for population-based survey to strengthen public health care delivery system: A program manager perspective

Burden of non communicable diseases in India: Setting priority for action

Non-communicable diseases (NCDs) are defined as diseases of long duration, and are generally slow in progression. NCDs are the leading cause of death in the world, responsible for 63% deaths worldwide in 2008. NCDs accounts for 53 percent of deaths in India. Based on available evidence cardiovascular diseases (24 percent), chronic respiratory diseases (11 percent), cancer (6 percent) and diabetes (2 percent) are the leading cause of mortality in India. Treatment cost is almost double for NCDs as compared to other conditions and illnesses. Burden of NCDs and resultants mortality is expected to increase unless massive efforts are made to prevent and control NCDs and their risk factors. India could develop a strategy for reducing out of pocket expenditure. Underlying determinants of NCDs mainly exist in non-health sectors, such as agriculture, urban development, education and trade. Inter-sectoral collaboration is therefore essential to create an enabling environment. Government of India had launched various vertical programmes such as National Cancer Control Programmes, National Tobacco Control Programme, National Programme for Prevention and Control of Cancer, Diabetes, CVD and Stroke (NPCDCS) etc. Strong surveillance, monitoring and evaluation system is required for successful implementation of the programmes. Public health facilities should be strengthened for providing services of screening; early diagnosis and treatment within the public health care delivery system. Efforts need to be done on implementing the clinical standards and guidelines developed under the Indian Public Health Standards (IPHS), and integrating NCD training into training curricula of health workforce.

Antimicrobial resistance in India: A review

Antimicrobial resistance is an important concern for the public health authorities at global level. However, in developing countries like India, recent hospital and some community based data showed increase in burden of antimicrobial resistance. Research related to antimicrobial use, determinants and development of antimicrobial resistance, regional variation and interventional strategies according to the existing health care situation in each country is a big challenge. This paper discusses the situational analysis of antimicrobial resistance with respect to its problem, determinants and challenges ahead with strategies required in future to reduce the burden in India. Recent data from Google search, Medline and other sources were collected which was reviewed and analyzed by the authors. Hospital based studies showed higher and varied spectrum of resistance in different regions while there are limited number of community based studies at country level. There exists lacunae in the structure and functioning of public health care delivery system with regard to quantification of the problem and various determining factors related to antimicrobial resistance. There is an urgent need to develop and strengthen antimicrobial policy, standard treatment guidelines, national plan for containment of AMR and research related to public health aspects of AMR at community and hospital level in India.

Knowledge of dental decay and associated factors among pregnant women: a study from rural India.

To assess the knowledge of dental decay among pregnant women and its relationship with sociodemographic characteristics and caries experience in rural India. A cross-sectional study was conducted among 381 pregnant women in southern India. Variables and knowledge of dental decay were recorded using a structured self-administered questionnaire. Dental caries was recorded by a calibrated examiner as per WHO guidelines. The majority of the respondents were under 30 years of age (91.6%), utilised a public health-care delivery system (57.2%), were primigravid (63%), had a pre-universtiy diploma (64.8%) and were in the 3rd trimester (63%). Overall, poor knowledge was expressed by 12% to 37% of the women. The mean (±SD) DT (decayed teeth), MT (missing teeth), FT (filled teeth) and DMFT (decayed, missing and filled teeth) were 3.08 (±2.6), 0.93 (±2.23), 0.39 (±1.14) and 4.4 (±3.56), respectively. There were no significant differences in the responses to the knowledge of caries with respect to age and trimester. Educational status, health-care delivery system and number of pregnancies had a significant association with knowledge of caries. This study highlighted the limited knowledge of dental decay among pregnant, rural, southern Indian women. Preventive programmes for pregnant women should be designed based upon a thorough interview including an informative session on the specific risks during this period, in order to motivate the patient towards oral health and implement the needed prophylactic measures.

A Public-Private Partnership: The New York University-Health and Hospitals Corporation Clinical and Translational Science Institute

The NYU-HHC Clinical and Translational Science Institute (CTSI), directed by Drs. Judith Hochman and Bruce Cronstein, represents a strategic public-private alliance between two of New York's leading institutions in the service of the people of the city. New York University (“NYU”), founded in 1831, is the country's largest private university with 14 schools and over 40,000 students in New York City. The New York City Health and Hospitals Corporation (“HHC”) is the largest public health care delivery system in the United States, overseeing eleven acute-care hospitals, six diagnostic and treatment centers, four long term care centers, one hundred community health centers, a certified home health agency, and a managed care plan for 450,000 enrollees. In 2011, the HHC Emergency Departments alone provided care to more than one million patients. Of the eleven acute care hospitals, eight are included in the NYU-HHC CTSI: Bellevue Hospital Center, Coler-Goldwater Specialty Hospital and Nursing Facility, Coney Island Hospital, Gouverneur Diagnostic and Treatment Center, Kings County Hospital Center, Lincoln Medical and Mental Health Center, Metropolitan Hospital Center and Woodhull Medical and Mental Health Center. The CTSI offers multi-faceted support for clinical and translational research. Our Clinical Research Center is currently housed in a 3,200sf space within Bellevue Hospital but will soon move to a 9,000sf space that was newly renovated to better support the types of research carried out on our unit. The NYU-HHC CTSI has a strong educational component, supporting both degree-granting and certificate programs in Clinical Investigation, Comparative Effectiveness Research and Population Health. In addition, strong and successful programs designed to develop investigative careers by residents, fellows and junior faculty are in place. The Center for Health Informatics and Bioinformatics (CHIBI) offers state of the art informatics support for analysis of large datasets, examining best practices in informatics and examination of the success of analytic software. NYU School of Medicine has been in the forefront of efforts to forge academic-industry alliances with ongoing programs in collaboration with Pfizer and a strong history of developing technologies which have been licensed to Pharma where they were developed into therapies to benefit patients. One of the unique strengths of the NYU-HHC CTSI is our Community Engagement and Population Health Research Core which, in combination with the partnership with NYC Health and Hospitals Corporation, has the ability to promote community-based research in our diverse communities, determine the most pressing areas of research for each of our communities, and promote the well-being of the citizens of our great city.

Inpatient satisfaction: an analysis of Malaysian public hospitals

PurposeThe purpose of this paper is to provide an empirical analysis on inpatient satisfaction in Malaysian public hospitals.Design/methodology/approachA self‐administered questionnaire was the main data collection method. Altogether, 23 hospitals throughout Peninsular Malaysia participated in the survey. Cluster sampling was used in the selection of the respondent hospitals, while convenience sampling was used in administering the survey.FindingsThree factors of inpatient satisfaction were extracted, which were clinical and physical dimensions of service, and additional facilities for patients and family members. Inpatient satisfaction was found to be higher for the clinical dimension than for the physical dimension. Overall, inpatient satisfaction was high, as reflected by the high mean score of the variables, although caution was expressed in interpreting the findings, particularly the low expectations of patients to begin with.Research limitations/implicationsThe research was limited to inpatients of Malaysian public hospitals. A thorough evaluation of the nation's public healthcare delivery system would need to include outpatient services as well.Originality/valueThe paper provides an empirical analysis on inpatient satisfaction in Malaysian public hospitals. This allows policy makers to evaluate the level of public healthcare delivery service in the country and therefore assist in policy decision‐making and implementation.

High Dependency on Quacks – Is There a Gap in the Public Health Care Delivery System? Reflections from a District Located in the Thar Desert (India)

This paper tries to analyse the availability and role of public health care services provided by the public sector in India. In addition, it also explores the reasons behind the high dependency on quacks in the study area. Data was acquired through in-depth interviews of 610 respondents with the help of a structured questionnaire from September to December 2010. Here, an attempt has been made to probe the pattern of utilization of health care services available at public health facilities by the sample respondents. It has been assessed in relation to socio-economic and demographic characteristics of the interviewees which exert significant influence on the utilization of health care facilities. The study finds that the number of CHCs/PHCs/Sub-centres in the study area is not adequate to meet the health needs (medical advice or treatment) of entire the population. The results recommend improving the availability and accessibility of health care facilities in the area under study. Author’s Note Alok Chauhan received an M. Sc. in Geography from the Banaras Hindu University, Varanasi in 2006. He is pursuing a Ph.D. in the Department of Geography at the Banaras Hindu University, Varanasi. His research interests include Population and Family welfare, Health Care Services, Maternal and Child Health.

Comprehensive Health Insurance Scheme (CHIS) in Kerala: Some Issues of Comprehensiveness and Equity

The Comprehensive Health Insurance Scheme (CHIS) was implemented in Kerala from October 2, 2008 on the lines of the Rashtriya Swasthya Bima Yojana (RSBY). While RSBY caters to those Below the Poverty Line, CHIS envisages bringing within the insurance fold a larger population. This paper attempts to discuss how successful the scheme has been in providing comprehensive insurance coverage and also some issues of equity that it brings in its wake. It examines the implementation of CHIS, especially with reference to comprehensiveness and equity. Although CHIS provides financial access to services to the beneficiaries, it does so only to a limited extent. The shortfalls of the scheme with respect to enrolment of beneficiaries, empanelment of service providers, coverage of costs, quality of service delivery, etc., not only undermine access to quality health care but may also lead to the perpetuation of inequality in delivery of health care across regions and providers. Quality of health care can be ensured only when such demand-side financing alternatives are initiated along with supply-side interventions which focus on improving the quality of service. It was assumed that the competition between the public and private sectors for the revenue out of CHIS claims will motivate them to strive for better standards of service. But it is seen that the public sector driven by the revenue-incentive model of CHIS is moving towards the profit-oriented mode of functioning of the private sector. It needs to be seen whether instead of allowing public funds to flow to the private sector comprising of the private hospitals as well as private insurer, more money should be pumped for improving the public health care delivery system.

Leadership development initiatives underlie individual and system performance in a US public healthcare delivery system

PurposeThe purpose of this case study was to gather participants' perceptions of the impact of Memorial Healthcare System's Pillars of Leadership Academy's leadership development programs on an individual, professional and organizational level.Design/methodology/approachThrough a mixture of in‐person and telephone structured interviews, the researchers collected and analyzed qualitative data to explore the experiences of participants from the leadership development programs.FindingsThe major themes that interviewees mentioned as impacts of their participation in the mentoring programs closely parallel the foundations of transformational leadership. This suggests that the goals of the Pillars of Leadership Academy have been successful in developing leaders, which provides the basis for improved organizational as well as individual performance.Practical implicationsDeveloping leaders has been identified as one of the most pressing challenges for the future. Memorial Healthcare System (MHS) demonstrates that theory‐ and competency‐based leadership development programs can contribute to the performance and success of individuals as well as health services organizations.Originality/valueThe success of MHS overall and the contributions of the Pillars of Leadership Academy to the organizational culture and leadership provides a best practice that other organizations can follow regarding the implementation of a success leadership development program.

Awareness and Implementation of the 2000 United States Public Health Service Tobacco Dependence Treatment Guideline in a Public Hospital System

The 2000 United States Public Health Service (USPHS) clinical practice guideline, "Treating Tobacco Use and Dependence," recommends systems interventions to integrate the treatment of tobacco into routine health care. The Tobacco Control Initiative employed a systems approach to integrate evidence-based treatment for tobacco use into patient care practices in Louisiana's safety net health care system. The purpose of this study was to assess changes in awareness and implementation of the USPHS clinical practice guideline. Surveys were administered to a purposive sample of hospital personnel from key departments in the Louisiana State University system of public hospitals in 2003 (n = 24) and 2007 (n = 44). Perceptions of implementation success improved for 50 of 59 distinct survey items. Rasch scaling was used to assess overall (scaled) change and showed substantial improvement from 2003 to 2007 (P < 0.001). Survey items also were grouped into 6 logical key concept sets. Improvement occurred in perceptions for all 6 key concepts; however, not uniformly. Results of the 2003 and 2007 surveys illustrate the potential effectiveness of using a systems approach to integrate the assessment and treatment of tobacco use into routine care practices in a public health care delivery system that serves medically vulnerable populations.

System-wide effects of Global Fund investments in Nepal

Nepal, with a concentrated HIV epidemic and high burden of tuberculosis (TB) and malaria, was perceived to have immensely benefited from grants by the Global Fund to Fight AIDS, Tuberculosis and Malaria in addressing the three diseases, amounting to total approved funding of US$80 million. This paper looks at the interaction and integration of Global Fund-supported programmes and national health systems. A mixed method 'case study' approach based on the Systemic Rapid Assessment Toolkit (SYSRA) was used to systematically analyse across the main health systems functional domains. The Country Coordinating Mechanism has been credited with providing the stewardship in attracting additional resources and providing oversight. The involvement of civil society for delivering key HIV and malaria interventions targeting high-risk groups was perceived to be highly beneficial. TB and malaria services were found to be well integrated into the public health care delivery system, while HIV services targeting at-risk groups were often delivered using parallel structures. Political instability, absence of continuity in leadership and sub-optimal investments in health were together perceived to have led to fragmentation of financing and planning activities, especially in HIV the programme. The demand for timely programmatic and financial reporting for donor-supported programmes has contributed to the creation of parallel monitoring and evaluation structures, with missed opportunities for strengthening and utilizing the national health management information systems.

Experience with Seed Localization for Nonpalpable Breast Lesions in a Public Health Care System

Seed localization uses a radioactive source to identify nonpalpable breast lesions for excision; it is an emerging alternative to wire localization (WL). Previous single health system studies report decreased rates of re-excision and improved patient convenience with this technique. This study is the first to implement this procedure in a public health care delivery system composed of a primarily minority and low-income population. A multidisciplinary team was formed to create a protocol for breast seed localization (BSL) and monitor the results. After 50 seed localizations were successfully completed, a retrospective matched-pair analysis with patients who had undergone WL during the same period was performed. Overall experience with the BSL protocol is reviewed, along with the occurrence of a seed loss. Processes necessary to reactivate the BSL protocol and prevent future losses are delineated. BSL is associated with decreased rates of re-excision and can be successfully implemented in a public health care system. BSL is an attractive alternative to WL in a high-volume, county-based population. It allows increased efficiency in the operating room and has a low rate of complications. Cautionary measures must be taken to ensure proper seed chain of custody to prevent seed loss.

EVIPNet Africa's first series of policy briefs to support evidence-informed policymaking

EVIPNet (Evidence-Informed Policy Network) Africa—a network of World Health Organization (WHO)-sponsored knowledge-translation (KT) platforms in seven sub-Saharan African countries—was launched at a meeting in Brazzaville, Congo, in March 2006 (1;2). EVIPNet Africa can trace its origins to resolutions from both the Ministerial Summit on Health Research (November 2004) and the World Health Assembly (May 2005) (10;11), the spirit of which was re-affirmed at the Global Ministerial Forum on Research for Health (November 2008) (13). The World Health Assembly called for “establishing or strengthening mechanisms to transfer knowledge in support of evidence-based public health and health care delivery systems and evidence-based related policies” (10). EVIPNet Africa can trace its inspiration to a more local development: the preparatory work that led to the establishment of the East African Community–sponsored Regional East African Community Health (REACH) Policy initiative, a KT platform involving Kenya, Tanzania, and Uganda (and more recently Burundi and Rwanda as well). REACH Policy is now part of the EVIPNet Africa family.

Assessing the context of health care utilization in Ecuador: a spatial and multilevel analysis.

BackgroundThere are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services.MethodsThis study is cross-sectional and analyzes data from the 2004 National Demographic and Maternal & Child Health dataset. Provider variables come from the Ecuadorian System of Social Indicators (SIISE). Global Moran's I statistic is used to assess spatial autocorrelation of the provider variables. Multilevel modeling is used for the simultaneous analysis of provision of services at the province-level with use of services at the individual level.ResultsSpatial analysis indicates no significant differences in the density of health care providers among Ecuadorian provinces. After adjusting for various predisposing, enabling, need factors and interaction terms, density of public practice health personnel was positively associated with use of preventive care, particularly among rural households. On the other hand, density of private practice physicians was positively associated with use of curative care, particularly among urban households.ConclusionsThere are significant public/private, urban/rural gaps in provision of services in Ecuador; which in turn affect people's use of services. It is necessary to strengthen the public health care delivery system (which includes addressing distribution of health workers) and national health information systems. These efforts could improve access to health care, and inform the civil society and policymakers on the advances of health care reform.

Congruence in the assessment of service quality between employees and customers: A study of a public health care delivery system

Using social information processing theory, we examined the congruence between employee and customer assessments of organizations' service quality. The setting was a public health care delivery system. Contrary to expectations, employee assessments of service quality were lower than those of their customers. Also unexpectedly, employees with professional training had less congruent assessments than other employees. As expected, employees with longer tenure and those in departments with stronger customer service work climates had more congruent assessments relative to their customers. The results have implications for both management theory and for managers interested in developing customer-centered organizations.

Patient satisfaction at the Muhimbili National Hospital in Dar es Salaam, Tanzania.

Patients are the primary beneficiaries of the services and care that hospitals provide. The Patient Satisfaction study examined the extent to which patients at the Muhimbili National Hospital (MNH) were satisfied with the services and care they received at MNH. This was part of a baseline study that sought to determine the level of performance of the hospital before massive restructuring, reform, and renovations were undertaken. Exit interviews were the main research method used to determine patient satisfaction. Patients were interviewed as they were leaving the OPD clinics, laboratory, X-ray, pharmacy and inpatient wards. The study found that most patients were satisfied with the services and care they received. This high level of satisfaction must be viewed within the context of a hierarchical public health care delivery system, with MNH at the apex. The services and care MNH provides can only be excellent compared to that provided by lower level health facilities. Indeed, patients covered by this study perceived the services provided by MNH as superior, and this was reflected in the high level of satisfaction they reported. Some patients expressed dissatisfaction with specific aspects of the services that they received. They were particularly dissatisfied with long waiting times before receiving services, the high costs of treatment and investigations charged at MNH, poor levels of hygiene in the wards, and negative attitudes of staff towards patients. Although only a small proportion of patients expressed dissatisfaction with these aspects of the services provided, they are significant in that they constitute a call for action by the MNH management to encourage the health personnel to embrace a new staff-patient relationship ethos, in which the patient is a viewed as a customer.

The Swedish cost burden of overweight and obesity – evaluated with the PAR approach and a statistical modelling approach

The rising trend in the prevalence of obesity, which is a major risk factor for a number of diseases notably diabetes and cardiovascular diseases, has become a major public health concern in many countries during the past decades. This development has also led to an increased cost burden on the public health care delivery system that has been documented in many studies. The standard approach taken for estimating the cost burden attributed to a risk factor is the so-called PAR (Population Attributed Risk) approach; an approach that is based on cross-sectional data. In this paper, the methods and findings of two studies that have documented the cost burden attributed to overweight and obesity on the public health care delivery system in Sweden are contrasted: one using the PAR approach and one using a statistical modeling approach based on longitudinal hospital care data for 15 years for 33 000 individuals. The main motivation for this paper is that the study using the PAR approach is only available in the Swedish language. The PAR approach estimated a cost burden of 3 600 million SEK (390 million Euro), equavalent to 1.9% of national health care expenditure, out of which 1 800 million SEK (190 million Euro) were spent on hospital care. The statistical modeling approach estimated the corresponding cost burden for hospital care at 2 100 million SEK (230 million Euro). The statistical modeling approach presents no estimates of the total cost burden attributed to overweight and obesity.

Health System Managerial Staffing Patterns: Public Sector Experience From Pakistan

Poor human resource management and frequent changes in senior management has been associated with low levels of performance in the social sector in less developed countries. A study of administrative data on transfer and posting was conducted on the 54 top provincial offices in the government of Sindh Department of Health over the period of 24 years (1981-2004). There were 689 transfers/postings made in the 54 key offices studied over the 24 year time period. Almost half (48.9%) of these postings lasted no longer than 1 year. The offices affected highest were tertiary/district care hospitals (54 times) and district health offices (37 times) respectively. High rate of frequent transfers/postings documented in the study among high level public health care delivery system managers in Sindh, Pakistan. Human resource policy in government bureaucracies should be developed to stabilize professional positions and improve the performance of the health care delivery system.