Delivery Of Quality Healthcare Services Research Articles

Inpatient Care Service Experience Among Adult Patients Admitted to Arba Minch General Hospital, Southern Ethiopia: Institution-Based Qualitative Study.

Acknowledging patients' experience with the care delivered in healthcare settings is crucial in ensuring the quality of healthcare service delivery. In Ethiopia, qualitative evidence of patients' experience with inpatient care services is limited. This study aimed to explore the experience of inpatient care service among adult patients admitted to Arba Minch General hospital, Southern Ethiopia from April 05-28, 2020. An institution-based qualitative approach was carried out among adult patients discharged from the study hospital. Thirty-one in-depth interviews using a semi-structured interview guide were conducted and audio-recorded data were transcribed verbatim and translated into English. Data were coded, sorted, and themes were developed manually based on the thematic analysis. This study showed that kindness, respecting appointments, and treatment outcomes were the positive experiences highlighted by study participants. Participants reported a lack of drinking water, unpleasant toilet hygiene, lack of bedsheets, and absence of drugs as negative experiences. Therefore, the hospital administration should work on improving the problems mentioned by the participants of this study.

Evaluating Knowledge, Practice, and Barriers to Informed Consent Among Professional and Staff Nurses in South Africa: An Empirical Study

Background: Informed consent (IC) is an ethical and legal obligation protected by constitutional rights to bodily integrity, well-being, and privacy in South Africa. The National Health Act 2003 codified IC regulations, requiring that all healthcare professionals inform patients about diagnosis, risks, benefits, options, and refusal rights while factoring in patients’ language and literacy levels. Objectives: This study’s primary aim was to determine the extent of South African professional/staff nurses’ compliance with current IC regulations and ascertain socio-cultural impediments impacting proper IC practice. Methods: A cross-sectional survey using semi-structured questionnaires was used to evaluate knowledge and practice of IC among nurses in KwaZulu-Natal province. Data were analyzed using SPSS, v.21. Descriptive statistics, chi-squared tests, and content analysis were used to compare nursing domains. Results: Three hundred fifty-five (355) nurses, 92% females, with 1 to 41 years of professional experience, completed this study. Information disclosed by nurses to patients included diagnosis (77%), treatment benefits (71%), risks (69%), recommendations (65%), risks of refusal (80%), and right of refusal (67%). Nurses (80%) felt information disclosure was adequate, while 85% reported that patients understood disclosed information. Conclusions: Nurses practicing in local public hospitals had moderate knowledge of IC regulations. Practical implementation appeared deficient. Barriers to IC included language, workload, time constraints, lack of interpreters, and skewed gender norms in the nursing profession. Nurses require continuing professional education in healthcare law and ethics, a “corps of trained interpreters”, and gender transformation in the nursing profession to improve IC practice and overall quality of healthcare service delivery in South Africa.

Effects of Guideline-based Computerized Provider Order Entry Systems on the Chemotherapy Order Process: a Systematic Review.

Background:Computerized Provider Order Entry (CPOE) systems developed based on clinical guidelines are believed to greatly reduce chemotherapy medication prescription errors.Objective:The present study reviewed the effects of guideline-based CPOEs on the chemotherapy order process.Methods:PubMed, Scopus, Embase, Web of Science, and IEEE Xplore databases published up to 1 June 2020 were systematically searched for studies investigating the effect of guideline-based CPOEs on the chemotherapy order process. Moreover, the bibliography of relevant retrieved publications was also checked.Results:Nineteen articles from the five databases met the eligibility criteria and were reviewed. Eleven out of 19 (58%) articles investigated the effect of CPOEs on medication errors, and other studies examined other aspects of CPOE efficacy, including time required for chemotherapy prescriptions; Safety, policy compliance and communication between health care providers; physicians prescribing behavior; quality and safety of treatment; workflow; direct patient care time; and adherence to guidelines. In addition, 15 out of 19 mentioned the use of specific clinical guidelines.Conclusion:Evidence indicates CPOEs can positively affect the quality of healthcare service delivery for cancer patients, but there is still a dearth of clinical outcome evaluation data about the effects of these systems on patients undergoing chemotherapy. Moreover, there is limited information about guideline compliance errors, which highlights the needs for further research in this area.

DRIVERS, INHIBITORS AND IMPLICATIONS OF EFFECTIVE COMPLAINT MANAGEMENT AMONG HEALTHCARE INSTITUTION IN AN EMERGING ECONOMY: A CASE OF THE UNIVERSITY OF GHANA HOSPITAL.

Purpose: Complaint Management (CM) is significant in improving the quality of healthcare service delivery. There is a dearth of knowledge regarding CM in healthcare service in Ghana. This paper aims at exploring the drivers, inhibitors, implications and influence of leadership on effective CM in healthcare service delivery.
 Methodology: A qualitative methodology was used. Data were collected through in-depth semi-structured interviews with 20 purposively selected informants. Data were transcribed and analysed thematically.
 Findings: The evidence suggests that there are some notable drivers, inhibitors, and implications of CM in healthcare service delivery. The study found that customer complaint, customer satisfaction, customer feedback, customer loyalty, customer retention, quality assurance, competitive advantage, compensation, culture, and speedy recovery are the drivers to effective CM in healthcare service delivery. However, regarding the factors that inhibit effective CM in healthcare service delivery, the study found insufficient skilled personnel, inadequate technology, lack of infrastructure, inadequate resources/funds and lack of oversight responsibility or control, lack of accountability, unresponsiveness, and unacceptance of mistakes/complaint. The study provides insight that effective CM has significant implications on customer satisfaction, customer loyalty, customer retention/commitment, institutional reputation/image, organisational performance, profitability, and good staff attitude. The results of the research corroborate the perception that leadership style influences the effectiveness of CM in healthcare service delivery.
 Recommendation: The study strongly recommend the establishment of CM department with the requisite logistics and accessories to promote effective handling of complaint. Additionally, it endorses training programmes on building strategies to enhance effective CM which will go a long way toward allowing service providers to form strong emotional bonds with their patients. The focus of such a program should be on instilling in frontline staff who deal with disgruntled/dissatisfied customers the necessity of adopting the study's findings into their complaint handling process.

Boosting Job Satisfaction Through Emotional Intelligence: A Study on Health Care Professionals

Emotional intelligence (EI) is possibly one of the most studied psychological factors of the twenty-first century. EI is very much relevant in service industry particularly in management, academics, life sciences or psychology. The purpose of the empirical study is to test the relationship between the defined constructs of EI and job satisfaction ( JS) amongst health care professionals of Delhi NCR region of India. It further tried to understand whether gender moderates the EI and JS relationship. Structured survey was used to solicit response from 260 health care professionals comprising doctors and nurses belonging to different hospitals of Delhi NCR region. Standardised instruments were used to assess the data. Linear and moderated regression were used to test hypotheses developed. The findings suggest that EI constructs significantly impact the level of JS among health care professionals. The result of moderated regression suggested that the relationship of EI and JS is significantly moderated by gender. The construct of EI is relevant in providing high quality health care service delivery to the patients.

Sociodemographic characteristics and patient and family experience survey response biases

Enhancing Patient and Family Experience (PFE) is vital to the delivery of quality healthcare services. Sociodemographic differences affect health outcomes and experiences, but research is limited on biases in PFE survey methodology. We sought to assess survey participation rates across sociodemographic characteristics. This retrospective study analyzed a health system’s ambulatory PFE survey data, collected January 1 – July 31, 2019. Outcomes of interest were rates of survey response, completion, and comments. Predictors included respondent-reported race, ethnicity, language, and measure of social deprivation attached to a respondent’s home address. Addresses were geocoded to census tracts. The tract’s degree of socioeconomic deprivation was defined using the Deprivation Index (DPI). Associations between outcomes and predictors were assessed using the Chi square test. 77,627 unique patient encounters were analyzed. Patients were predominantly White (76%); 5% were Hispanic; and 1% were Spanish-speaking. The overall response, completion, and comment rates were 20.1%, 17.6%, and 4.1%, respectively. There were significant differences across assessed sociodemographic characteristics in response, completion, and comment rates. White patients were most likely to respond, complete, and leave a comment. Spanish-speaking respondents and those living in the most deprived areas were more likely to respond and complete the survey, but less likely to comment than English-speaking respondents and those living in less deprived areas, respectively. PFE survey participation differs across a range of sociodemographic characteristics, potentially introducing noteworthy biases. Health systems should minimize differences in how they collect feedback and account for potential biases when responding to experience data.

Experiences and attitudes of registered nurses towards the implementation of quality improvement programmes at a government hospital in Eswatini

Quality improvement is becoming the cornerstone of effective and efficient delivery of quality healthcare services in recent times. Among other healthcare workers, nurses are the primary implementers of quality improvement programmes (QIPs). Their knowledge, understanding, attitudes and motivation determine the potential effects of the programmes. This study explored the experiences of registered nurses (RNs) towards the implementation of the QIP at a government hospital in Swaziland. The RNs’ attitudes toward the programme were also explored. Non-probability, purposive sampling was used to select the sample that comprised of eight RNs. Data were collected through in-depth, face-to-face interviews to explore and describe the RNs’ experiences and attitudes regarding the implementation of QIPs. A semi-structured interview guide was used to ask questions until data saturation was reached. Data analysis was conducted following Tesch’s method. Ethical considerations were adhered to. The results revealed both negative and positive experiences of the RNs towards QIPs. A negative attitude towards the programme developed due to the manner in which the programmes were introduced to the RNs and their perception of the programme as work overload. However, there was a positive outlook by the RNs towards the programme after they had undergone training on a QIP. The training improved their knowledge, job satisfaction and client outcome. They developed motivation, interest and commitment despite the challenges they encountered. The programme also enhanced the spirit of teamwork among the RNs and the support staff.

Unintended consequences of technology-enabled work activities experienced by healthcare professionals in tertiary hospitals of sub-Saharan Africa

The unintended consequences experienced by healthcare professionals while using health ICTs at points-of-care are disruptive to their work activities. Failure to address these consequences inhibits efforts to support the delivery of quality healthcare services in hospital settings. Hence, the aim of this paper is to identify how unintended consequences disrupt technology-enabled work activities of healthcare professionals in hospital settings. An interpretive stance was adopted to investigate healthcare professionals’ experiences with the use of health ICTs for their work activities through open-ended interview questions, to acquire in-depth information about unintended consequences events. A total of 19 participants were selected using a purposive sampling technique to identify healthcare professionals from two tertiary hospitals with varying levels of technology implementation. The participants included doctors and nurses in clinical departments that use health ICTs for medical imaging, referrals and reporting. Ethics clearance for data collection were granted by the University research ethics committee and the hospitals. Thematic analysis was adopted to identify and interpret patterns that emerged from participants’ responses. Findings indicated that the unintended consequences experienced by healthcare professionals are protracted time to complete tasks; interruption of tasks and workarounds at points-of-care. The unintended consequences are caused by contradictions that result from tensions between contextual conditions that inhibit perceived usefulness, and a lack of fit between tasks of work activities and health ICTs. Hospital managers and health technology vendors should actively consider the likely undesirable experiences or disruptions from feedback recorded during the pilot implementation phase within use contexts.

Government Policy Response to COVID-19 Pandemic in Nigeria

The principal responsibility of any government is to provide for the security and welfare of the citizenry. A major feature of the well-being of the citizenry is quality healthcare service delivery. There is no doubt that the novel COVID-19 pandemic that ravaged the world exposed the vulnerability of citizens to social and economic challenges, thus imposing tremendous stress on governments, globally. In other words, governments were taken to task on their responsibilities. Both developed and developing countries were not spared as casualties cut across the divide. In response to the health challenges and subsequent socio-economic impacts, governments, the world over, adopted various policy measures to address the pandemic. In this paper, the author examined the policy response of the Nigerian government to the pandemic in order to mitigate the harsh negative impacts on the citizenry. The theoretical underpinning of this study is the systems theory as developed by David Easton. The paper is descriptive and therefore adopted secondary data from books, journal articles, magazines, newspapers, as well as other periodicals, both online and offline for discussion and analysis. The study observed that although, the Nigerian government adopted measures and strategies in the fight against the pandemic, the policy strategies and mechanisms were weak and reactionary, even as there were no feedback mechanisms to ascertain policy outcome. The paper, amongst others, therefore recommended that a state of emergency be declared in the economic sector of the country to help revive the economy and improve the well-being of the citizenry, while a robust and workable National Health Insurance Policy be established to address the health needs of the citizens.

Violence against health care workforce in COVID and non COVID times: Analysis of predisposing factors

Background: The prevalence of violence against Health Care Workers (HCW) is showing a rising trend. Various studies have been done in the recent past shows that the prevalence of violence against HCW s ranged from 27.4% to 67%. The present study was done to compare and analyze the underlying causes of violence against HCW in a Non COVID and COVID situation to identify the commonality if any, and to suggest any remedial measures. Methodology: This was cross-sectional analytical design and was carried out in inpatient care areas of a tertiary care hospital. The study subjects comprised of Doctors, Nurses, Group C employees. Data was collected using direct interview method on a standard questionnaire. In addition, various media reports were collected and analyzed through internet. Results: Maximum incidents were experienced in emergency and OPD, where staff patient’s ratio is less. 39.4% incidents were experienced by the staff who were providing care to the Terminally ill patients, Mentally and Physically disabled persons & Psychiatric patients. Suggestion which emerged to reduce WPV are, triage in casualty, availability of trained security guards, CCTV, restricted visiting hours and limited attendants with the patients, improvement in patient amenities etc. Whereas in COVID situation the major reason is the religious and social belief, poor dietary services and lack of hygiene and sanitation. Conclusion: There is an urgent and inescapable requirement that the healthcare administrators should address the underlying precipitating factors of violence, for delivery of quality healthcare services to the patients in a safe environment.

Transforming health: Introduction of new management structure at secondary healthcare of Pakistan

Abstract While public awareness on health issues is increasing, it has become more significant for the public funded health sector to retain the trust of its patients. It is specifically important in a country like Pakistan where the burden of patients in terms of number is compounded by recurring diseases outbreaks. Recent evidence shows that well-thought management systems can ease the pressure on provision of health services to a larger extent than previously anticipated. To address the managerial challenges of secondary care hospitals, health policy planners of the Punjab (Pakistan) had introduced a New Management Structures (NMS) 'team of non-clinical management graduates' under the Revamping Program of District & Tehsil Headquarter D/THQ hospitals in 2016. After 3 years of execution, a study was designed to evaluate the effectiveness and impact of this initiative. 24 in-depth interviews were conducted with the relevant stakeholders and 10 FGDs were conducted with the NMS teams. Thematic analysis & field observations were used to facilitate the presentation of results. The findings show that NMS teams have ensured greater efficiency in management operations of hospitals. Most of the research participants were appreciated for their skills and dedication to work. The hospital and district Health administrators were satisfied with the concept and need of NMS in healthcare system. They claimed that the need for NMS was justified and the intervention has significantly contributed to address the shortcomings inherent in the old management system. However, few stakeholders highlighted the need for further capacity building and robust service structure of NMS teams. The NMS initiative across all secondary hospitals of Punjab has improved the overall quality of healthcare service delivery in D/THQ Hospitals. It can be safely concluded that a specialized workforce in form of NMS is vital in ensuring smooth transition and up-gradation of hospitals under the revamping project Key messages Healthcare delivery is moving towards more specialized skills in terms of both healthcare services and management. NMS is vital in ensuring smooth transition and up-gradation of D/THQ hospitals.

Perceived Quality of Healthcare Services and Patients Satisfaction in Federal Medical Centre Yola, North-East Nigeria

Purpose- The aim of the study is to examine the effect of perceived quality of healthcare service delivery on patient satisfaction in Federal Medical Centre Yola. Design/Methodology- Data were obtained from a sample of one Hundred and Sixty Nine (169) respondents, a self-completion questionnaire was given to in-patients and the patient relatives in Federal Medical Centre Yola, (Descriptive Statistic and Inferential Statistics) was used in analyzing data collected. Findings- Findings of the research revealed that two out of four hypotheses i.e. (Environmental quality and process quality) were supported signifying that quality of healthcare services have significant effects on the patient satisfaction and the remain two (Interaction quality and Cost) has no significant effect on patients satisfaction in Federal Medical Centre Yola, North-East Nigeria. Practical Implications- The study joined perception of patient about hospital services and environment of the hospital toward patient satisfaction using different dimensions. It emphasized the need for Federal Medical Centre Yola administrators, healthcare services institutions, and the government to create a beautiful surrounding within the hospital setting and to provide them with recent facilities and equipment, which will in turn assist in making sure that, the wellbeing of patients will be achieved.

Opportunities and Development of Telemedicine in Response to COVID-19: Experience from Public Sector Medical University

<p>Over the past six months, the world has undergone drastic changes related to unprecedented emergence of deadly virus namely novel Coronavirus, COVID-19. Telemedicine service provides excellent platform for technology based remote patient care in the time of current pandemic crisis. It is emerging as an effective and sustainable solution if current pandemic continues for long time. Telemedicine is revolutionising patient care and help to support the health system of country by reducing the impact of pandemic. There is a need to create the multidisciplinary team of health professionals striving to serve the patients by provision of quality health care service delivery.</p>

Appraisal of Health Maintenance Organisations' Performance in the Nigerian Healthcare Service Sector.

The quality of healthcare service delivery under the existing health maintenance organisations (HMOs) in Nigeria has been a major concern to enrollees who have contested the value received from their respective HMO accredited hospitals under the program. This paper appraised health maintenance organisations' performance in the Nigerian healthcare service sector capturing enrollees' experience on the issues of access, responsiveness, and quality of healthcare service choice to measure the success or failure of the program since inception. The study adopted survey design with three hundred forty enrollees of ten leading HMOs in Nigeria that operate in different parts of Lagos Metropolis. Data collected were analysed with relevant descriptive and inferential statistics while hypotheses tested were at 0.05 level of significance. Findings revealed that HMO accredited hospitals have not ensured adequate access of enrollees to healthcare services, their responsiveness to enrollees' healthcare requests have not been impressive, and quality of healthcare services to enrollees have also not been excellent. Based on the findings, the study recommends that HMOs and government should improve on monitoring the quality of healthcare service delivery at their accredited hospitals and concluded that the performance of the HMOs in the area of healthcare service delivery is not world class when it comes to access, responsiveness, and quality of service delivery.

Mining patient opinion to evaluate the service quality in healthcare: a deep-learning approach

The emergence of social media has created several opportunities for patients to evaluate the quality of healthcare services by posting online reviews. The rich text and photographic information in the online reviews results insights into how patients’ experience with the doctor and their satisfaction with healthcare service delivery. Various studies have performed patients’ opinion analysis using textual contents. This study presents a novel multimodal approach to analyze the patients’ sentiment regarding the quality of healthcare service delivery (high vs. low). In comparison with existing studies, we consider not only the unique textual contents but photographic contents as well from the Yelp.com platform, which is more challenging due to feature extraction. We evaluate the performance of the baseline, and deep learning algorithms across textual cues, visual cues, and the fusion of both text and visual cues. Experimental results indicated that the addition of novel features increases the models’ accuracy to 15.0% across text and visual cues. Furthermore, fusing text and visual contents improve the classification accuracy by at least 12.64% instead of considering the contents alone. Preliminary comparative experiments result show that the deep learning model outperformed all other algorithms. In comparison with several other state-of-the-art methods in the biomedical domain, the proposed model could significantly enhance the performance of the classifier indicating the effectiveness and suitability of the methodology.

Experiences of frontline nurses with adverse medical events in a regional referral hospital in northern Ghana: a cross-sectional study

BackgroundAdverse medical events (AMEs) are threats to delivery of quality healthcare services, particularly in resource-poor settings such as Ghana. In sub-Saharan Africa, 30% of deaths are attributed to AMEs and a significant proportion of these events are not reported. This study explored personal experiences of nurses with AMEs and the constraints to reporting them.MethodsThis is a descriptive cross-sectional study among professional (n = 133) and auxiliary (n = 88) nurses in a regional referral hospital in northern Ghana. A test for differences in experiences of professional and auxiliary nurses was done using Wilcoxon Mann-Whitney test. Ordered logistic regression analysis (proportional odds ratio models) and probit regression were used to ascertain the determinants of staff’s knowledge on AMEs and the odds of exposure, respectively.ResultsOverall, knowledge and awareness level on AMEs was average (mean = 3.1 out of the five-point Likert scale of 1 = “Very poor” to 5 = “Excellent”). Knowledge levels among professional nurses (mean = 3.2) were relatively higher than those among auxiliary nurses (mean = 3.0), (p = 0.006). The predominant type of AME experienced was wrongful documentation (n = 144), and the least experienced type was wrong transfusion of blood and/or intravenous fluids (IVF) (n = 40). Male staff had higher odds of experiencing medical errors relative to female staff, OR = 2.39 (95% confidence interval (CI), 1.34–4.26). Inadequate logistics was the most perceived cause of AMEs. Knowledge on types of AMEs was significantly associated with gender of the respondents, OR = 1.76 (95% CI, 1.05–2.94); moreover, male staff had higher odds of knowing AME post-exposure action than female staff, OR = 1.75 (95% CI, 1.04–2.93).ConclusionKnowledge levels of nursing staff on AMEs were generally low, and even though exposures were high they were not reported. There is the need to integrate AME modules into the pre-service and in-service training curricula for nurses to enhance their knowledge on AMEs; reporting registers for AMEs should be made available in clinical sites and staff incentives given to those who report AMEs. Lastly, protocols on AMEs should form part of the quality assurance value chain for health facilities to promote compliance.

Positioning public nursing colleges in South African higher education: Stakeholders' perspectives.

BackgroundPublic nursing colleges (PNCs) are currently redeploying from provincial departments of health to higher education to become part of a unified higher education system in South Africa. As primary producers of nurses, this migration process needs to be managed carefully, with stakeholders having a common understanding of this process.ObjectivesThis study aimed to explore the stakeholders’ perspectives on the positioning of PNCs in higher education.MethodThe study followed a qualitative grounded theory design. Purposive and theoretical sampling were utilised to achieve a sample size of 40 participants, including representatives from the Department of Higher Education and Training; professional associates; nursing educators; student leaders; nursing leaders; and nurses from the healthcare setting. Data were collected through observations, interviews and document analysis.ResultsIt emerged from the study that the integration of PNCs into higher education is a result of the country’s political and legal context. A number of policy and legal frameworks emerged as contextual conditions that provided a basis for the change. The integration of PNCs into higher education was conceptualised as a functional shift in the governance of colleges; a political tool to transform nursing education; a means to enhance the quality of college-based nursing programmes, and a vehicle for the greater professionalisation of nursing. Conflicting legislation and funding emerged as two issues of concern.ConclusionIntegrating PNCs with higher education came about because of political changes and the resolution of the ruling party to improve the quality of graduates produced, who will in turn improve the quality of healthcare service delivery offered.

State of Health Facilities in Communities Designated for Community-Based Health Insurance Scheme in Nigeria: A Case Study of Kwara and Ogun States

Background: Nigerian Government established National Health Insurance Scheme (NHIS) including Community Based Health Insurance Scheme (CBHIS) to reduce out-of-pocket health expenses of enrollees, strengthen and ensure access to quality healthcare services. The functionality of the schemes however, revolves round health facilities being able to meet the expectation of the enrollees.
 Study Objectives: The study assessed the adequacy of the designated health facilities in offering quality healthcare services to the enrollees or potential enrollees under the CBHIS, and to identify likely challenges.
 Study Design: This is part of a larger prospective cross-sectional study that assessed the implementation of the Community-Based Health Insurance Scheme (CBHIS) in selected local government areas of Kwara in the north central and Ogun in the South Western part of Nigeria.
 Place and Duration of the Study: Health facilities of selected wards from two Local Government Areas in Kwara and Ogun States were assessed between February and May 2015.
 Methods: Semi-structured questionnaires and health facility assessment checklist were used to assess services rendered, storage of drugs and the vaccines, manpower, training opportunities, available infrastructures and perceived challenges to smooth operation of health facilities designated for CBHIS.
 Results: A total of twenty designated health facilities were visited and assessed (Seventeen public and three private). Services claimed to be available at the facilities included clinical, nursing, pharmaceutical and laboratory services. The assessment showed inadequacy of some critical human resources for health. Seventeen of the 20 health facilities (85%) had evidence of recent renovation while 3 (15%) had no evidence of renovation. Twelve (60%) had backup supply of electricity from generator or solar panel. Other challenges that could impede quality healthcare service delivery under the CBHIS were identified.
 Conclusion: The study showed that inadequate personnel, paucity of training opportunities for health workers, poor infrastructures (lack of ambulance services, poor electricity supply and lack of portable water supply) were the main challenges impeding delivery of quality healthcare services to the CBHIS enrollees patronizing the studied facilities.

Effect of Integrated Supportive Supervision on the Quality of Health-Care Service Delivery in Katsina State, Northwest Nigeria.

Background:Katsina State Government in Northern Nigeria introduced integrated supportive supervision (ISS) in primary health centers. The study was guided by the Primary Health Care Performance Initiative Conceptual Framework. The goal of the study was to measure the impact of ISS on the quality of primary health-care delivery. The outcome variables measured include infrastructure, basic equipment, human resources for health, essential drugs, the number of pregnant women screened for HIV, and the number of children receiving immunization.Methods:The study was a cross-sectional survey of 34 health facilities. Kruskal-Wallis nonparametric test followed by Dunn post hoc test and analysis of variance followed by Tukey post hoc test were both employed to compare the mean values of various indicators obtained over 6 visits of the ISS program from July 2018 to December 2018.Findings:The study shows the positive effect of the ISS on infrastructure, human resources for health, essential drugs, and the number of pregnant women screened for HIV (P < .05). Human resources for health and the number of children receiving immunization were both not affected by ISS (P > .05).Conclusion:Integrated supportive supervision need to be embedded into the 3 levels (primary, secondary, and tertiary) of health-care service delivery.Implications:Integrated supportive supervision will strengthen the Katsina State health system, ensure efficient use of the health facility assets and resources utilization, and improve patient/client satisfaction.

Kayakalp – Utility of a novel Indian tool for the assessment of biomedical waste management in a district hospital of Northern India

Introduction: Kayakalp is an innovative initiative launched by the Ministry of Health and Family Welfare as a part of the Swachh Bharat Abhiyan campaign. The primary objective of this venture is the promotion of cleanliness and delivery of quality health-care services through public health facilities in India. This standardized tool was used to evaluate six key parameters of hospital management of a district hospital in northern India. In this study, we present findings of biomedical waste (BMW) management assessment, one of the six assessment domains of the tool. Methods: A cross-sectional observational study was done using Kayakalp assessment tool in a district hospital of a north Indian state in the year 2015. Methods used to assess facility were direct observation, staff interviews, and review of documents. Results were recorded as full, partial, and no compliance for the domain of waste management. Results: The total score for BMW management as per Kayakalp tool was 82 (out of a maximum of 100), with mean score of 8.2 and standard deviation ± 1.48. Overall, there were ten criteria (C1 to C10). The scores were excellent, i.e., 100% for disposal of BMW, solid general waste, and liquid waste management. Minimum score of 60% was seen in the area of sharps management. Conclusion: The standardized approach of the evaluation of public health facilities through Kayakalp tool would help in judging their performance on a uniform pedestal. Such model tools after adjustment to local needs can also be adopted by other nations for the assessment of their health services.