Public Healthcare Sector Research Articles

Factors Affecting Weight Loss Management among Obese Nurses Working in Public and Private Health Care Sectors

Obesity in the general population have been growing globally in recent years, a trend that has also been seen among nurses. Along with the severe health consequences of obesity, the condition impairs an individual's capacity to work and increases absenteeism rates. It is therefore essential to understand the factors that are producing all of this. Objectives: To explore the barriers of weight loss management among obese nurses. Methods: In this study, an exploratory qualitative study approach was adopted. Data was collected from the 12 study participants who were purposive sampled, semi-structured face-to-face individual interviews were conducted. The audio recordings were translated into English and verbatim transcribed. The analysis was conducted out using the computer-assisted programmer NVIVO-12. NVIVO-12 produced codes that were grouped into sub-themes, and themes. Results: Obstacles to weight loss management among obese nurses were a lack of desire and a change in lifestyle owing to a lack of time, nurses, and resources. Weight management was hindered by the workplace environment and shift changes. Conclusions: The demanding nature of hospital work leads to stress-induced unhealthy eating habits among nurses, hindering their ability to maintain a balanced diet and manage their weight.

Evaluation of Communicable Diseases Surveillance System Structure in Mosul City

Background: One of the most important global public health issues and it is a major source of death for many people around the world. Illnesses caused by infection invasion of the body with specific germs such as viruses, bacteria, funguses, and parasites. Aim(s): Evaluatıng communicable diseases surveillance system structure at Mosul City. Methodology: A descriptive study using an evaluation approach is conducted to evaluate the Communicable Diseases Surveillance System Structure in Mosul City from April 20th 2022 to May 21th 2023. A non-probability multistage sample was adopted of the study, as twenty-three (23) health institutions are chosen and interview is conducted with health staff works in the communicable diseases Surveillance System. Developed evaluation tool (Questionnaire) used to collect the data according to WHO framework (Generic Questionnaire) for monitoring and evaluating surveillance and response system for communicable disease. Results: The outcomes indicate that the most of system's organizational structure component are effective, available and sufficient to implement such system for the benefit of consumers from communicable diseases services’ in relation to patient surveillance manual, personnel, resources and supplies and training. However, the study findings showed that Public Health Department, both healthcare sectors and hospitals, in Mosul City, have much better organizational structure of Communicable Diseases Surveillance System than Main and Family Medicine Primary Healthcare Centers. Conclusion: All hospitals, in Mosul City, have presented an experimental evidence that their organizational structure of the Communicable Diseases Surveillance System is well competent to implement it.

The experience of racial discrimination among ethnic minority healthcare professionals in Ireland

Abstract Background Racial discrimination towards ethnic minorities permeates healthcare systems of many countries. This study aimed to strengthen the understanding of the experience of racial discrimination among ethnic-minority healthcare professionals in Ireland. The objective was to explore the lived experience of racial discrimination and its impact on the health and well-being of nurses and doctors in this local context. Methods Interpretative Phenomenological Analysis was used to explore participants' experiences. Purposive and snowball sampling strategies were used to recruit sixteen ethnic minority nurses and physicians, working in diverse roles across Irish private and public healthcare sectors. In-depth semi-structured interviews were employed to collect data. A brief questionnaire was used to obtain information on participants’ demographic profiles. Findings Ethnic minority healthcare professionals experienced racial discrimination from colleagues, patients, and families; and this discrimination was interpersonal, structural, and institutional. Three core themes, and a number of related sub-themes, were identified; including: (1) Experiences of racial discrimination ((a) overt and subtle, (b) excessive reporting, (c) lack of safe space and trust, (d) being overlooked), (2) Responses to racial discrimination ((a) navigating racism, (b) tolerating in silence, (c) surviving and thriving, (d) seeking support); and (3) Impact of racial discrimination ((a) psychological impacts, (b) physical impacts, and (c) financial impact). Conclusions This study demonstrated that ethnic minority healthcare professionals have experienced racial discrimination in the Irish healthcare setting, which significantly impacted their health and well-being. By giving voice to these healthcare professionals, this study highlighted challenges facing Irish healthcare systems and the need for drastic change.

The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa.

Background Coronavirus (COVID-19) was officially declared a pandemic in March 2020 and has had a major impact on global healthcare services, including radiology. However, little is known about the full impact of COVID-19 on the utilization of diagnostic imaging in Africa's public healthcare sector. Objectives The objective of this study was to compare public sector diagnostic imaging utilization by modality for the whole Western Cape Province (WCP) of South Africa (SA), as well as its metropolitan and rural areas, in 2019 and 2020 in terms of the absolute number of investigations and investigations per 1000 people. Method We performed a retrospective analysis of Western Cape Government Department of Health and Wellness and Stats SA District Council 2021 Mid-Year Population Estimates data. All diagnostic imaging investigations performed in 2019 and 2020 were collated and stratified by imaging modality, geographic region (metropolitan/rural), and calendar year. Data are presented as the total number of investigations and investigations per 1000people. We calculated mammography utilization for women aged 40-70 years and compared data for 2019 and 2020. Results Between 2019 and 2020, the provincial population increased by 1.9%, while total imaging investigations and investigations per 1000 people decreased by 19% (1,384,941 vs. 1,123,508, -261,433) and 20% (262/103 vs. 208/103), respectively. Total numerical decline was highest in plain radiographs (1,005,545 vs. 800,641, -204,904), accounting for more than three-quarters (78%) of the total reduction. Percentage decline was most pronounced for mammography, as utilization was almost halved (15.7/103vs.8.9/103, -43%), whereas computed tomography was the least impacted (17.9/103vs.16.7/103, -12%) with the remaining modalities decreasing between approximately one-quarter and one-fifth (magnetic resonance imaging = 26%, fluoroscopy = 25%, general radiographs = 23%, ultrasound = 16%, chest radiographs = 18%). Proportional metropolitan (-18.7%) and rural decreases (-19.3%) were similar. Conclusion COVID-19 had a substantial impact on WCP imaging services, decreasing overall radiological investigations by almost one-fifth. The greatest impact was on elective investigations, particularly mammography. Although the proportional impact was similar for the metropolitan and rural areas, COVID-19 nonetheless exacerbated existing discrepancies in imaging utilization between the geographical regions.The medium- and long-term clinical impacts of decreased imaging are still to be defined.

Effect of Diversity Management on Organizational Citizenship Behaviour: The Moderating Role of Perceived Organisational Justice

Record has established that there is issue of organisational citizenship behaviour in public health service sector in Taraba State which has affected the functionality of the sector. It is on this note that this study examined the moderating role of perceived organisational justice on the relationship between diversity management and organisational citizenship behavior in public hospital. The study used cross sectional research design and the instrument for collecting data is via questionnaires with the help of research assistants, the population of the study is 1900 and the actual sample for data analysis is 315. The result of the analysis has proven that, individual diversity management has no significant effect on employee organisational citizenship behavior both on direct and on an interacting relationship. However, organisation diversity management has a positive and significant effect on citizenship behaviour both on direct and indirect relationship respectively. Base on the findings of the study it was recommended that management and stakeholders of public health care sector should take both individual and organisation diversity into due consideration at all levels of health sector, so as to motivate employee of this sector to engage on positive behavior such as organisational citizenship behavior which will in turn improve the performance of this sector as a whole.

Assessment of prescription completeness and drug use pattern using WHO prescribing indicators in private community pharmacies in Addis Ababa: a cross-sectional study

BackgroundHealthcare systems in both developing and developed countries were not free from prescription errors. One of the effects of prescription errors is irrational prescribing. According to the estimation of the World Health Organization (WHO), greater than 50% of medicines are prescribed and dispensed irrationally. On the other hand, research on drug use patterns in the private healthcare sector is scarce. This study aimed to assess prescription Completeness and Drug use Pattern using WHO prescribing indicators in Private Community Pharmacies in Lemi-Kura sub-city.MethodsBased on the WHO prescribing indicators, a retrospective cross-sectional technique was employed to examine the completeness and drug-prescription patterns. The study was conducted from April to May 2021. Prescriptions, kept for 1 year that was prescribed from March 2020 to March 2021, by private healthcare sectors, were analyzed. A systematic random sampling technique was employed to select prescriptions obtained from private health facilities. Data were analyzed using SPSS® version 26.0 software.ResultsOf a total of 1000 prescriptions, 1770 drugs were prescribed and the average number of drugs per prescription was 1.77. Prescriptions for two drugs account for 38% of these, while prescriptions for three drugs account for 15%. Age, sex, and card number were written on 99.0%, 99.2%, and 41.8% of prescriptions, respectively. The patient's name was written on every prescription. Even though the availability of other therapeutic information on the prescription made it appear greater, only 44.2% of prescriptions included the dosage form of medications. The generic name was used for the majority of the medications (67.8%). Furthermore, assuming that each prescription was for a single patient, 71% of patients received antibiotics, and 2% received injectable medicines. The National List of Essential Medicines-Ethiopia was used in 99.6% of the prescriptions.ConclusionsOn the basis of the finding of this study, the prescribing and prescription completeness indicator showed deviation from the standard recommended by WHO. This situation could be critical since a similar pattern is reported from public healthcare sectors, which might imply the extent of non-adherence to WHO core drug use standards. Consequently, it could play a considerable role in increasing prescription errors in Ethiopia. Hence, in-service training for prescribers should be provided to improve adherence to basic prescription writing.

Supply Chain Information Systems and Service Delivery of the Public Health Care Sector in the County Governments of Western Region, Kenya

The healthcare sector has undergone significant changes within the past decades, and amidst these changes, attaining efficient and effective healthcare service delivery has remained a distant prospect. This study, therefore, sought to find out the effect of supply chain information systems on service delivery in the public health care sector in the county governments of the western region. The study was anchored on the theory of human service delivery and health network metrics. The study adopted a positivist research philosophy and a descriptive survey research design, and the target population was 284 respondents from the four level 5 county hospitals in the western region. Questionnaires and interview schedules were used for data collection and analyzed using descriptive and inferential statistics. The data was presented using tables. 258 respondents participated in the study, and preliminary data checking, screening, and cleaning were done. Validity and reliability statistics were done, and they indicated that the research instruments were adequate for their purpose. Regression analysis shows that supply chain information systems had a significant effect on service delivery in the public health care sector in the county governments of Western Region, Kenya (t = 6.442, p<0.050). The supply chain information system accounted for 14.0% of the changes in service delivery. The study recommended that in the selection of a hospital information system, it should be cost-effective, integrative, high-performance, reliable, responsive, fast, and sustainable. Beyond the infrastructure for information systems, they should invest time and resources in the training of their staff members.

Implications of the South African National Drug Policy on prescribing patterns: a case study of the Limpopo province

BackgroundThe South African National Drug Policy (SA-NDP) was introduced to promote rational medicine use (RMU). This study evaluates the quality of prescribing in the public healthcare sector in South Africa's Limpopo province following the World Health Organization's (WHO) rational prescribing standards. In addition, the prescribing practices in South Africa were compared to other African countries.MethodsA prospective cross-sectional survey of patients' prescriptions was conducted in Limpopo, South Africa, from October to December 2018. Findings were compared with the WHO reference values (WHO-RV), and the International Network of Rational Use of Drugs (IRDP) tool was used to measure the degree of rational prescribing. The optimal IRDP value was defined as 1. Study findings were compared with results from a previous study conducted in Limpopo and studies from Ethiopia and Eritrea.ResultsSix hundred prescriptions were reviewed. The mean (SD) age was 43.9 ± 24.4 years (females = 56.5%). The average number of drugs prescribed (4.3, IRDP = 0.47) was higher than the WHO-RV (< 2). Generic prescribing (43%, IRDP = 0.43) and medicines prescribed from the essential medicines list (EML) (90%, IRDP = 0.90) were less than the WHO-RV (100%, respectively). Antibiotics (28%, IRDP = 1) and the number of injections prescribed (8%, IRDP = 1) were below the WHO-RV (< 30% and < 20%, respectively). The number of medicines prescribed was higher compared to previous years (4.3 vs. 3.4). Antibiotic prescribing declined (28% vs. 63.4%). Generic prescribing (43% vs. 41.7%) and medicines prescribed from the EML (90% vs. 93.1%) did not improve. A higher number of medicines were prescribed in this study compared to Ethiopia (1.7) and Eritrea (1.8), and a lower number of antibiotics were prescribed compared to Ethiopia (58.2%) and Eritrea (54.5%). Generic prescribing was low compared to Ethiopia (95.6%) and Eritrea (94.9%). All studies showed reduced injection prescribing (6.6–15.9%) and similar prescribing from the EML (90–95%).ConclusionsThere is an increased potential for drug-drug and adverse reactions with the increased number of prescribed medicines; however, the patient's clinical needs may warrant using multiple medicines. There is a need for generic prescribing to reduce medicine expenditure.

Single-Visit Root Canal Treatment: A Systematic Review and Meta-Analysis

Background: Root canal treatment (RCT) is a specialized and one of the most demanded procedures in the public oral health-care sector. Multiple-visit endodontic treatment is considered a conventional method for treating the affected teeth; however, the procedure requires a considerable amount of time to complete the treatment. The recent era is showing an escalating preference of the endodontists as well as the patients toward the single-visit RCT over multiple visits due to some advantages such as the low risk of leakages usually caused by the temporary seal. To the best of our knowledge in this systematic review and meta-analysis, we aim to evaluate the effectiveness of single-visit RCT over multiple-visit RCT in terms of the rate of flare-ups and postoperative pain in both vital and nonvital teeth. Methods: We performed an electronic search through PubMed, MEDLINE Database, Cochrane Central Register of Controlled Trials, Scopus Database, Web of Science, and LILACS Database. A systematic review was performed using the Cochrane handbook and PRISMA statement. The meta-analysis presented in this study was done by applying the random effects model in RevMan 5.4. Results: A total of 106 articles were referred. Out of these, forty articles were selected for analysis in the database, and 22 were excluded because of the absence and irrelevance of required parameters. A total of ten studies were selected for meta-analysis after the complete screening and analysis. The comparison was done between the incidence of postoperative pain among vital and nonvital teeth. The difference in postoperative pain after 24 and 48 h of single-visit RCT among studied groups was found to be nonsignificant with P = 0.49 and 0.20, respectively. Moreover, the majority of studies have shown that there was no difference in the occurrence of pain whether patients were treated through the single visit or multi-visit RCT. Conclusion: Based on the evidence, single-visit RCT appeared to be a safe treatment mode when considered for flare-ups. However, within the limitation of this study, it is also concluded that the incidence of postoperative pain is seen within 24 h of treatment which was found to reduce with the passage of time.

Strategic decisions in healthcare: Impact on goals and enhancing service quality for organizational success

This study underscores the crucial imperatives of governments aiming to establish effective social protection systems: prioritizing human capital development, reinforcing social protection mechanisms, and improving the populace's standard of living. The primary objective is to conduct a comprehensive analysis of central healthcare issues and propose strategic solutions for the advancement of healthcare services. The methodology involves a detailed examination and segmentation of the healthcare sector, tailoring enhancements to specific segments. The article critically examines strategic management nuances within the healthcare sector, offering detailed segmentations and proposals for potential improvements. It extends its focus to advanced healthcare systems worldwide, providing valuable insights for assimilating foreign experiences. The study systematically explores the intricacies of strategic action planning and management in both public and corporate healthcare sectors, including transnational corporations. Findings underscore the imperative of continual development and improvement in healthcare service quality, emphasizing the necessity for judicious strategic decisions to sustain the healthcare market's functionality and vitality. This study is relevant for administrative institutions, organizations, governmental bodies, and corporate entities aiming to enhance decision-making processes and operational aspects while prioritizing healthcare quality.

An integrative framework of health administration and patient satisfaction at health-care centre’s: perspectives of Riyadh, Saudi Arabia

Aim of the present study is to make satisfied the visitors (patients) through the offered services. There are private and public sector health care Centre’s in the Kingdom of Saudi Arabia, particularly in the diplomatic city of Riyadh. However, present study targeted public sector health care centers due to easy access. Later the study conceptualized a theoretical study framework and suggested the hypotheses based on the previous studies and recommendations. Thus, the study investigated the considered hypotheses for the mentioned variables. Total four (4) constructs were considered and four hypotheses were developed. Among 350 participants of the survey, valid responses were counted as 262. The collected data were analyzed through SPSS version 22. Descriptive part also included in the distributed questionnaire in order to obtained the respondents demographics. After analysis of the data, results showed all the hypotheses are having a significant relationship with each other. Findings of this study also important for the practitioners in health care sectors.

Workforce survey of Australian health information management graduates, 2017-2021: A 5-year follow-on study.

Background: Employment outcomes of La Trobe University's 2012-2016 health information manager (HIM) graduate cohort were reported previously. Objectives: To identify the 2017-2021 Australia-based, graduate HIMs' early career employment experiences; identify employment roles and destinations; investigate knowledge and skill sets utilised in professional performance; and compare outcomes with the previous study. Method: A cross-sectional design was utilised. An online survey elicited: demographic data, position-related details and knowledge-skills applied in the workplace. Inter- and intra-cohort comparisons were calculated. Results: Of contactable graduates, 75% (n = 150) completed the survey; 90% (n = 132) had held at least one profession-related position postgraduation; 51% gained employment before final examinations and 92% within 6 months. In their first role, 87% joined the public healthcare sector, 47% had worked in two or more positions and 12.3% in three or more positions. Categorisation of position titles showed that 40% had undertaken "health information management" roles, 14.9% "health classification," 16.6% "data management and analytics," 17.4% "health ICT" and 11.1% "other," roles. Almost two-thirds (64.1%) had utilised three or four of the four professional knowledge-skill domains. There was an increase, from the 2012 to 2016 cohort, in those undertaking "data management and analytics" and "health ICT" roles, and a decrease in "health classification" role uptake. Conclusion: Early-career HIMs have very high employability. They engage throughout health care, predominately in the public health sector. Their mobility reflects national workforce trends. The majority utilise all or most of the professional knowledge-skill domains studied at university.

Preferences for services in a patient’s first six months on antiretroviral therapy for HIV in South Africa and Zambia (PREFER): research protocol for a prospective observational cohort study

Background For patients on HIV treatment in sub-Saharan Africa (SSA), the highest risk for loss from care consistently remains the first six months after antiretroviral (ART) initiation, when patients are not yet eligible for most existing differentiated service delivery (DSD) models. To reduce disengagement from care during this period, we must gain a comprehensive understanding of patients’ needs, concerns, resources, and preferences for service delivery during this period. The PREFER study will use a sequential mixed-methods approach to survey a sample of patients in South Africa and Zambia 0-6 months after ART initiation to develop a detailed profile of patient characteristics and needs. Protocol PREFER is an observational, prospective cohort study of adult patients on ART for ≤6 months at 12 public sector healthcare facilities in Zambia and 18 in South Africa that aims to inform the design of DSD models for the early HIV treatment period. It has four components: 1) survey of clients 0-6 months after ART initiation; 2) follow up through routinely collected medical records for &lt;12 or &lt;24 months after enrollment; 3) focus group discussions to explore specific issues raised in the survey; and 4) in South Africa only, collection of blood samples self-reported naïve participants to assess the prevalence of ARV metabolites indicating prior ART use. Results will include demographic and clinical characteristics of patients, self-reported HIV care histories, preferences for treatment delivery, and predictors of disengagement. Conclusions PREFER aims to understand why the early treatment period is so challenging and how service delivery can be amended to address the obstacles that lead to early disengagement from care and to distinguish the barriers encountered by naïve patients to those facing re-initiators. The information collected by PREFER will help respond to patients’ needs and design better strategies for service delivery and improve resource allocation going forward.

IC Theory and Public Healthcare

The healthcare sector is in crisis worldwide and under pressure from various trends such as digitalization, economic recession, population ageing, and workforce shortfall. This challenges in particular public sector healthcare management’s ability to provide services and meet communities’ growing expectations. Although the value of healthcare organizations is largely based on intellectual capital (IC), such as the experience and skills of professionals, knowledge available through relationships, codified knowledge, and organizational culture, knowledge-related literature in healthcare management has previously focused more on knowledge management activities than on intangibles and their management. Moreover, the public sector is the least examined area in the lC literature. The literature on this specific aspect – IC in public healthcare – has so far focused largely on identifying different aspects of IC rather than recognizing its value in action. To contribute to this knowledge gap, this article studies the role of intellectual capital in public sector healthcare management to elaborate on this critical component of organizational survival, renewal, and performance. This study aims to elucidate what this topical context requires of the application of IC theory and how it can advance the theoretical approach. Based on a literature review and preliminary empirical data gathered through thematic interviews with knowledge management professionals in a public healthcare organization in the throes of major healthcare reform, this article draws on the importance of intellectual capital in the public healthcare sector.

An Empirical Study on Various Healthcare Strategies Followed by Selected Hospitals in Puducherry

India is a prime example of a nation that has seen significant change in the expansion of the global healthcare industry. It is a nation with a wealth of medical expertise and ability, giving it an advantage in the medical industry through a variety of health service offerings. Patients from all over the world come India for treatment due to its medical expertise. However, the rate of development in the Indian medical industry does not reflect the reality that it has faced numerous challenges both historically and currently. Even though India is one of the biggest providers of health care services, it still has many flaws, including unregulated competition, poor service quality, high costs, the dominance of private health care players, insufficient resources, a narrow focus, and a deteriorating public health care sector. Aside from this, it is a common rural-urban imbalance that rural areas have far less access to medical care than metropolitan ones. As a result, there is a considerable demand for health care, yet there are insufficient financial and administrative resources to satisfy it. In this regard, the current study aims to evaluate different healthcare practices used by a chosen hospital in Puducherry.

Healthcare Systems Moving Toward Data Governance-Centered Model: India’s G20 Presidency in the Wake of COVID

The COVID pandemic has had an unprecedented impact on health systems across countries. Both the public and private healthcare sectors have struggled and are still struggling to respond to the impact of the pandemic. The struggle lies in adopting diverse healthcare responses, involving cutting-edge technological tools and innovations in the areas of public health, medicine, and wellness, to make prompt decisions to address the after-effects of the pandemic. In such a scenario, digital health has emerged as a solution for healthcare challenges. It encompasses areas like wearable technology, telehealth and telemedicine, mobile health, health information technology, and personalized medicine (Guo et al., 2020). However, revisiting and reopening the realm of ‘digital health’ in policy and public discourse is an emerging concern (Banner, 2020). As the healthcare world becomes increasingly digitized, care and service providers rely more on data to drive their decision-making. This has made data governance in healthcare a growing interest, as health information becomes an essential tool for diagnosis, treatment planning, and after-care. However, it is now the responsibility of healthcare organizations to guarantee that patient data is handled and managed appropriately to uphold patient privacy and the confidentiality of data governance, as the latter can provide users with a great deal of power.

Costs and duration of orthodontic-surgical treatment with mandibular advancement surgery.

The aim was to analyse the costs and duration of orthodontic-surgical treatment with mandibular advancement in the public health care sector in Finland. The study was conducted as a retrospective registry study in a public district hospital on all nonsyndromic patients that were ethnic Finns and treated with full fixed appliances and mandibular advancement surgery in 2016-2020. The mean treatment duration of the included 45 patients was 28.1 months, including 18.9 months pre and 9.2 months postoperative orthodontics. The median number of visits was 27, including 17 visits before and 9 visits after surgery. The mean total treatment time was 14.5 h. The mean total direct costs per course of treatment were 7574 € to the municipality and 947 € to the patient. The costs positively correlated with the duration of the treatment (rho = 0.71, P = .000), but were not associated to gender or age of patient. The mean surgery time was 78 minutes, and significantly less with an experienced surgeon (P = .002). It was calculated that the mean minimum treatment costs would be 45% of the present total, achievable with a patient with optimum dental arches at the start of treatment. The major limitation of the study is the relatively small number of study subjects. A 55% share of the costs is influenced by case- and operator-dependent factors. This indicates that the complexity and performance of the orthodontic phases of treatment are important determinants in the cost structure.

THE MODERATING ROLE OF PROCUREMENT GOVERNANCE ON THE RELATIONSHIP BETWEEN SUPPLY CHAIN AGILITY AND SERVICE DELIVERY OF THE PUBLIC HEALTH CARE SECTOR IN THE COUNTY GOVERNMENTS OF WESTERN REGION, KENYA.

Supply Chain Management is a crucial activity that entails overseeing the movement of materials form the source, throughput, to the end consumer. However, in this endeavour, there are increased instances of uncertainties i.e. speeds of delivery, flexibility and environmental factors that affect the services rendered to the end consumer. This drives the concept of supply chain agility which focuses on the speeds of response to any changes in the consumer demands. The healthcare sector has undergone significant changes within the past decades. Amidst these changes, attaining efficient and effective healthcare service delivery remains a distant prospect among multiple nations. This study therefore sought to find out the moderating role of procurement governance on the relationship between supply chain agility and service delivery in the Public health care sector in the county governments of the western region. The hypothesis for the study was: - Procurement Governance has no significant influence on the relationship between Supply Chain Agility and Service Delivery of the Public Health care sector in the County Governments of Western Region The study was anchored on three theories, theory of Human Service Delivery, Dynamic Capability Perspectives and Institutional Theory. The study adopted a Positivist research philosophy and a descriptive survey research design and the target population was 284 respondents of the four level 5 county hospitals in the western region. Questionnaires and interview schedules were used for data collection and analyzed using descriptive and inferential statistics. Data was presented using tables, scree plots and scatter plots. The study is of value to researchers and academicians, County government authorities and residents of the four counties. 258 respondents participated in the study and preliminary data checking, screening and cleaning was done. Validity and reliability statistics were done and they indicated that the research instruments were adequate for their purpose. Diagnostic tests were also conducted and none of the variables violated these assumptions. Regression analysis was done for the Supply Chain Agility and service delivery. Supply chain agility accounted for 44.5% of the changes in Service Delivery, but with the introduction of procurement governance as a moderator, the R2 value rose to 59.4% with p˂0.05. This indicated that Procurement Governance was a significant moderator of the relationship. The study recommended that hospitals to should pay attention to three main aspects of procurement governance. First, they should set rules and policies that describe the authoritative position regarding the standards, principles, and objectives of the procurement process. Such standards include transparency and Accountability.

ST-segment elevation myocardial infarction heart of Charlotte one-year (STEMI HOC-1) study: a prospective study protocol

BackgroundST-segment elevation myocardial infarction (STEMI) is a clinically distinguishable yet lethal sequela of ischaemic heart disease (IHD). In sub-Saharan Africa (SSA), death due to acute STEMI is increasing. In South Africa, there is a paucity of data available on the clinical outcomes of acute STEMI within one year for individuals treated in the public healthcare sector. This study primarily seeks to determine the one-year all-cause mortality rate of acute STEMI. The study also assesses the value of serum cardiac biomarkers of myocardial damage and serum uric acid in predicting all-cause mortality in STEMI.MethodsThis is a single-centre observational prospective cohort of all consecutive individuals presenting with an acute STEMI to the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) in Johannesburg, South Africa. Research data will be sourced on admission through electronic medical records, blood laboratory results and coronary angiography reports, and at follow-up through periodic telephonic interviews and standardised echocardiograms. At least 355 eligible participants will be continuously followed over one year, and clinical outcomes will be measured 30 days, three months, six months and one year after the index hospitalisation.DiscussionThis study provides insights into the demographic, risk factors and clinical profiles of individuals with STEMI in South Africa. Its findings may improve the risk stratification, prognostication, and therapeutic management of STEMI patients in our setting. By comparing the clinical outcomes between the different coronary reperfusion strategies, our results may guide clinicians in providing better patient treatment, particularly in sub-Saharan Africa, where access to percutaneous coronary intervention may be limited. Furthermore, the study offers insights into the routine use of baseline serum uric acid as a potential low-cost prognostic biomarker of all-cause mortality in STEMI. Finally, this study’s findings may be of public health significance to local policymakers to aid in reinforcing primary prevention strategies and developing structured referral networks for timely coronary reperfusion of acute STEMI.

Out-of-pocket expenditure and its correlates for institutional deliveries in private and public healthcare sectors in India: findings from NFHS 5

BackgroundIncreased coverage for institutional delivery (ID) is one of the essential factors for improved maternal and child health (MCH). Though, ID increased over time, out-of-pocket expenditure (OOPE) for the care-seeking families had been found to be growing, parallelly. Hence, we estimated OOPE in public and private health centres for ID, along with their sources and attributing factors and compared state and union territory-wise, so that financial risk protection can be improved for MCH related services.MethodsWe used women’s data from the National Family Health Survey, 2019–2021 (NFHS-5). Reproductive aged women (15–49 years) delivering one live child in last 5 years (n = 145,386) in any public or private institutions, were included. Descriptive statistics were presented as frequency and proportions. OOPE, was summarized as median and interquartile range (IQR). To estimate the extent for each covariate’s effect, linear regression model was conducted.ResultsOverall median OOPE for ID was Rs. 4066 (median OOPE: private hospitals: Rs.25600, public hospitals: Rs.2067). Health insurance was not sufficient to slash OOPE down at private facilities. Factors associated significantly to high OOPE were mothers’ education, elderly pregnancy, complicated delivery, birth order of the latest child etc.ConclusionA standard norm for ID should be implemented as a component of overseeing and controlling inequality. Aiding the needy is probably just one side of the solution, while the focus is required to be shifted towards reducing disparity among the health facilities, so that the beneficiaries do not need to spend on essential services or during emergencies.