Receiving Health Services Research Articles

Patient safety as a public health problem

Patient safety is an essential component of quality healthcare, which is what the general population is constantly demanding worldwide. Consequently, ensuring quality healthcare should not be a matter of clinical interest only but a public health priority so that all actions planned or implemented may have an impact at all levels and ensure intersectoral support to help the population remain safe when seeking and receiving health services. The definition and implementation of patient safety are currently circumscribed to the institutional setting. This article aims to present data that can help put into perspective the existing gaps pertaining to patient safety definition and fields of action, and conclude that there is room to work in public health in order to close those gaps. This requires understanding the complexities of the interactions between determinants of harm outside the physical setting where care is provided. These include community-level work, incorporation of knowledge from other disciplines in order to account for coverage, access and health outcomes, design strategies to counteract the impact that the absence of effective patient and people safety measures have on the general population and, in particular, on people differentially affected by the social determinants of health.

A Service-Learning Project Based on a Community-Oriented Intelligent Health Promotion System for Postgraduate Nursing Students: Mixed Methods Study.

Service learning (SL) is a pedagogical approach that combines community service with cognitive learning for professionals. Its efficacy in promoting community health has gained broad recognition in nursing education. The application of postgraduate nursing SL programs in community-based intelligent health remains underexplored. Thus, additional investigation is necessary to assess the influence of the SL project based on a community-oriented intelligent health promotion system (SLP-COIHPS) on postgraduate nursing students and health service recipients. This study aims to assess how SLP-COIHPS influences the scientific awareness and research innovation abilities of postgraduate nursing students. In addition, the study sought to examine the experiences of both participating students and health service recipients. We conducted a mixed methods investigation by using web-based surveys and conducting interviews. The web-based surveys aimed to explore the differences in scientific awareness and research innovation capabilities between 2 distinct groups: an experimental group of 23 postgraduate nursing students actively participated in SLP-COIHPS, while 23 postgraduate students (matched one-to-one with the experimental group in terms of grade, sex, and research methods) served as control participants. Semistructured interviews were conducted with 65% (15/23) of postgraduate students and 3% (12/405) of community residents who received health services, aiming to assess the project's impact on them. The community-based intelligent health promotion system installed in intelligent health cabins can be conceptualized as an expert system providing valuable references for student health education. It has the capability to generate comprehensive assessments and personalized health guidance plans. Following training, students were involved in offering health assessments, health education, and related services. Subsequently, after the web-based surveys and semistructured interviews, quantitative data were analyzed using the SPSS (IBM Corp) software package, using 2-tailed t tests and Mann-Whitney U tests; qualitative data underwent analysis using the constructivist grounded theory approach. Postgraduate nursing students participating in this program scored 12.83 (Cohen d>0.8; P<.001) and 10.56 (Cohen d>0.8; P=.004) points higher than postgraduate students in the control group in research awareness and research innovation capability, respectively. On the basis of the qualitative results, postgraduate students reported improvement in this program. Analysis of the interviews revealed a total of 12 subcategories across three primary domains: (1) specialized skills, (2) scientific research ability, and (3) comprehensive qualities. Community residents reported high satisfaction and positive experiences. Analysis of the interviews with community residents identified two primary categories: (1) satisfaction and (2) perceived benefits. SLP-COIHPS had a positive impact on students' development of scientific awareness and research innovation ability. Qualitative study findings also support the further development of practical programs that integrate intelligent health and SL theories in the field of medical education. This includes exploring the potential factors influencing postgraduate nursing students' research capabilities or investigating the long-term effects of the project.

Disparities in catastrophic health expenditure for hospitalization in Urban Kerala, India: Evidence from 75th round of the National Sample Survey

AbstractExisting literature suggests significant disparities in health expenditure incurred by households receiving health services. To determine fair contributions by beneficiaries, it is crucial to understand the existing inequalities in the context of financial protection measures and the factors influencing them. This exploratory study looks at how catastrophic health expenditures (CHE) are distributed across economic groups. The study also casts light on what drives the inequalities in the incidences of CHE. The study uses unit‐level data from the 75th round of the National Sample Survey fielded periodically by the Government of India. It employs logistic regression to study factors affecting CHE. Furthermore, the concentration index and its regression‐based decomposition are employed to have a sense of inequality and the factors driving it. The findings reveal socioeconomic inequality in CHE incidence and highlight the contribution of medical institutions (whether public or private) and consumption expenditure of households to the total inequality. The present study, while critically looking at the pre‐existing inequalities, highlights the shortcomings of health financing in urban areas and calls for a reconsideration of extant policy designs. The study maintains that factors outside the control of the health system may be responsible for disparities in catastrophic medical spending. Therefore, to reduce the burden of catastrophic health spending and its inequalities, future policy measures must take into account both elements within the health system and those outside of it.

Analisis Implementasi Tujuh Langkah Menuju Keselamatan Pasien di Ruang Rawat Inap Rumah Sakit

Patient safety is an absolute thing in the service of a hospital. Services that promote a sense of security and comfort are the hopes of every patient when receiving health services. However, the high number of unexpected events in health services at hospitals become an indication that the implementation of patient safety management, especially the seven steps towards patient safety, is not running well. The research method in this study was descriptive qualitative. The data collection techniques used were interviews, observation, and documentation study. From this study, it was found that the implementation of patient safety management on the seven steps towards patient safety has been carried out in hospitals, but there are still obstacles that resulted in the implementation that is not being maximized. Improvement efforts should be continued to implement the seven steps program towards patient safety optimally.

Facilitators and barriers of mHealth interventions during the Covid-19 pandemic: systematic review

BackgroundWith the spread of Covid-19 disease, health interventions related to the control, prevention, and treatment of this disease and other diseases were given real attention. The purpose of this systematic review is to express facilitators and barriers of using mobile health (mHealth) interventions during the Covid-19 pandemic.MethodsIn this systematic review, original studies were searched using keywords in the electronic database of PubMed until August 2022. The objectives and outcomes of these studies were extracted. Finally, to identify the facilitators and barriers of mHealth interventions, a qualitative content analysis was conducted based on the strengths, weaknesses, opportunities, and threats (SWOT) analysis method with Atlas.ti 8 software. We evaluated the studies using the Mixed Methods Appraisal Tool (MMAT).ResultsIn total, 1598 articles were identified and 55 articles were included in this study. Most of the studies used mobile applications to provide and receive health services during the Covid-19 pandemic (96.4%). The purpose of the applications was to help prevention (17), follow-up (15), treatment (12), and diagnosis (8). Using SWOT analysis, 13 facilitators and 18 barriers to patients’ use of mHealth services were identified.ConclusionMobile applications are very flexible technologies that can be customized for each person, patient, and population. During the Covid-19 pandemic, the applications designed due to lack of interaction, lack of time, lack of attention to privacy, and non-academic nature have not met their expectations of them.

Syrian refugees' experiences while receiving mental health services and psychiatric nursing care: A qualitative study.

This study examined the experiences of Syrian refugees in a community centre in Turkiye as they access mental health services and receive psychiatric nursing care. A qualitative design was adopted in the study. Data were collected from southern Turkiye between November and December 2021. The researchers conducted three semi-structured focus group interviews. Colaizzi's phenomenological method was followed to analyse the qualitative data. A total of 19 Syrian refugees participated in the focus group interviews. Three key themes related to immigrants' experiences of receiving mental health services and nursing care were identified: barriers to receiving mental health services, coping with negative experiences in Turkiye and satisfaction with mental health services. The participants identified the barriers they experienced while receiving health services as those pertaining to language, discrimination and stigmatization. They also mentioned the methods of coping with these negative experiences in Turkiye. Despite their negative experiences, they expressed satisfaction with the mental health services they received, especially psychiatric nursing care. This study determined that Syrian refugees face barriers in accessing and receiving mental health services. They stated that mental health professionals in Turkiye approach them with empathy, particularly those in psychiatric nursing. Healthcare professionals may be trained in culturally sensitive care to increase awareness. Studies have frequently examined the experiences of nurses providing care to refugees, but few have focused on evaluating nursing care from the perspective of refugees. Syrian refugees have reported various obstacles in accessing and receiving mental healthcare services. Health professionals, especially psychiatric nurses in mental health psychosocial support centres, must facilitate the processes to eliminate these obstacles. The consolidated criteria for reporting qualitative research (COREQ) were used. No patient or public involvement.

Prevalence and Antimicrobial Susceptibility Profile of Salmonella and Shigella among Diarrheic Patients Attending Selected Health Facilities in Addis Ababa, Ethiopia.

Diarrhea is one of the important public health problems in developing countries. Salmonella and Shigella species are the major bacterial causal agents of diarrhea. The increasing burden of antimicrobial resistance is posing difficulty in the treatment of these pathogens. This study aimed to assess the occurrence of Salmonella and Shigella in the feces of diarrheic patients receiving health services in Addis Ababa, Ethiopia, and to determine their antimicrobial susceptibility profile. A cross-sectional study involving 13 health centers was conducted where 428 diarrheic patients were recruited. Standard microbiology techniques were used to isolate Salmonella and Shigella from stool samples. In addition, Salmonella isolates were confirmed by polymerase chain reaction (PCR). The Kirby-Bauer disc diffusion method was employed to assess susceptibility to 11 antimicrobials for each of the Salmonella and Shigella isolates. The prevalence of Salmonella and Shigella spp. among diarrheic patients was 8.4%; n = 36 and 5.6%; n = 24, respectively. Thirty (83.3%) of Salmonella isolates were susceptible to all antimicrobials tested, whereas 4 (10.8%) of isolates were resistant to 2 or more antimicrobials and 2 (5.6%) were multidrug resistant. Resistance to ampicillin was recorded in only one (2.7%) of Salmonella isolates; however, resistance to ampicillin was recorded in 12 (50%) of the Shigella isolates. Half of the Shigella isolates (n = 12) were resistant to 2 or more antimicrobials while 5 (20.8%) of them were resistant to 3 or more antimicrobials. The overall rate of resistance to antimicrobials was more common in Shigella compared to Salmonella isolates. In conclusion, Salmonella and Shigella were isolated from the feces of diarrheic patients, with a higher rate of antimicrobial resistance in Shigella isolates, which could make the treatment of shigellosis challenging. Therefore, increasing hygienic practices during food preparation to reduce the burden of Salmonella and Shigella infection and prudent use of antimicrobials are recommended to limit the spread of antimicrobial resistant strains.

An Analysis of the Social Impacts of a Health System Strengthening Program Based on Purchasing Health Services

Access to universal health coverage is a fundamental right that ensures that even the most disadvantaged receive health services without financial hardship. The Democratic Republic of Congo is among the poorest countries in the world, yet healthcare is primarily made by direct payment which renders care inaccessible for most Congolese. Between 2017 and 2021 a purchasing of health services initiative (Le Programme de Renforcement de l’Offre et Développement de l’accès aux Soins de Santé or PRO DS), was implemented in Kongo Central and Ituri with the assistance of the non-governmental organization Memisa Belgium. The program provided funding for health system strengthening that included health service delivery, workforce development, improved infrastructure, access to medicines and support for leadership and governance. This study assessed the social and health impacts of the PRO DS Memisa program using a health impact assessment focus. A documentary review was performed to ascertain relevant indicators of program effect. Supervision and management of health zones and health centers, use of health and nutritional services, the population’s nutritional health, immunization levels, reproductive and maternal health, and newborn and child health were measured using a controlled longitudinal model. Positive results were found in almost all indicators across both provinces, with a mean proportion of positive effect of 60.8% for Kongo Central, and 70.8% in Ituri. Barriers to the program’s success included the arrival of COVID-19, internal displacement of the population and resistance to change from the community. The measurable positive impacts from the PRO DS Memisa program reveal that an adequately funded multi-faceted health system strengthening program can improve access to healthcare in a low-income country such as the Democratic Republic of Congo.

Policy Implementation Analysis of SPM Health Sector for Hypertension Sufferers in South Kalimantan Province, Indonesia in 2022

Hypertension is a major cardiovascular risk factor that causes disability throughout the world and among those who are not aware of their health condition, it is often referred to as the silent killer . The prevalence rate of hypertension in Indonesia is quite high. Based on Riskesdas (2018), South Kalimantan Province shows the highest prevalence of hypertension, but the percentage of hypertension sufferers who receive health services is still low. Banjarbaru City has the lowest percentage, namely 11.3% of the target of 100%. Health services for hypertension sufferers are included in the Minimum Service Standards (SPM) for the Health Sector which are regulated in statutory regulations and government policies. The aim of this research is to analyze the implementation of the SPM policy in the health sector for hypertension sufferers in Banjarbaru City. Qualitative research with a Rapid Assessment Procedure (RAP) research design was conducted from May to June 2023 in Banjarbaru City, South Kalimantan Province. Data collection was carried out through in-depth interviews, observation and document review. The results of the research show that the implementation of the hypertension SPM policy has not been optimal, as can be seen from the SPM achievement report in the health sector in Banjarbaru City which is in the lowest position among 12 types of basic health services. In conclusion, several obstacles in the implementation of SPM for hypertension are recording and reporting hypertension sufferers, low public awareness of carrying out examinations and treatment at community health centers so that the data is not recorded, there is no special budget allocation for SPM for hypertension at community health centers, and the dual duties of health workers so that they are not optimal in achieve a program. Cross-sector collaborative efforts are needed for integrated recording and reporting of hypertensive patient data, submission of hypertension SPM budgets, efforts to invite the community, and fair distribution of tasks for community health center officers.

A study protocol for Project I-Test: a cluster randomized controlled trial of a practice coaching intervention to increase HIV testing in substance use treatment programs

BackgroundPeople with substance use disorders are vulnerable to acquiring HIV. Testing is fundamental to diagnosis, treatment, and prevention; however, in the past decade, there has been a decline in the number of substance use disorder (SUD) treatment programs offering on-site HIV testing. Fewer than half of SUDs in the USA offer on-site HIV testing. In addition, nearly a quarter of newly diagnosed cases have AIDS at the time of diagnosis. Lack of testing is one of the main reasons that annual HIV incidences have remained constant over time. Integration of HIV testing with testing for HCV, an infection prevalent among persons vulnerable to HIV infection, and in settings where they receive health services, including opioid treatment programs (OTPs), is of great public health importance.Methods/designIn this 3-arm cluster-RCT of opioid use disorders treatment programs, we test the effect of two evidence-based “practice coaching” (PC) interventions on the provision and sustained implementation of on-site HIV testing, on-site HIV/HCV testing, and linkage to care. Using the National Survey of Substance Abuse Treatment Services data available from SAMHSA, 51 sites are randomly assigned to one of the three conditions: practice coach facilitated structured conversations around implementing change, with provision of resources and documents to support the implementation of (1) HIV testing only, or (2) HIV/HCV testing, and (3) a control condition that provides a package with information only. We collect quantitative (e.g., HIV and HCV testing at 6-month-long intervals) and qualitative site data near the time of randomization, and again approximately 7–12 months after randomization.DiscussionInnovative and comprehensive approaches that facilitate and promote the adoption and sustainability of HIV and HCV testing in opioid treatment programs are important for addressing and reducing HIV and HCV infection rates. This study is one of the first to test organizational approaches (practice coaching) to increase HIV and HIV/HCV testing and linkage to care among individuals receiving treatment for opioid use disorder. The study may provide valuable insight and knowledge on the multiple levels of intervention that, if integrated, may better position OTPs to improve and sustain testing practices and improve population health.Trial registrationClinicalTrials.gov NCT03135886. Registered on 2 May 2017.

Double burden of vulnerability for refugees: conceptualization and policy solutions for financial protection in Iran using systems thinking approach

IntroductionIran is host to one of the world’s largest and longest-standing refugee populations. Although Iran has initiated a basic health insurance scheme for refugees throughout the country since September 2015, the population coverage of this scheme is very low, and various factors have caused a significant percentage of refugees to still lack insurance coverage and often face financial hardships when receiving health services. In response, this study aimed to understand barriers to insurance coverage among refugees in Iran and propose effective policies that can address persistent gaps in financial protection.MethodsThis qualitative study was conducted in two phases. First, a review of policy documents and interviews with participants were conducted to investigate the common barriers and facilitators of effective insurance coverage for refugees in Iran. Then, a systems thinking approach was applied to visualize the common variables and interactions on the path to achieving financial protection for refugees.ResultsFindings showed that various factors, such as (1) household-based premium for refugees, (2) considering a waiting time to be eligible for insurance benefits, (3) determining high premiums for non-vulnerable groups and (4) a deep difference between the health services tariffs of the public and private service delivery sectors in Iran, have caused the coverage of health insurance for non-vulnerable refugees to be challenging. Furthermore, some policy solutions were found to improve the health insurance coverage of refugees in Iran. These included removing household size from premium calculations, lowering current premium rates and getting monthly premiums from non-vulnerable refugees.ConclusionsA number of factors have caused health insurance coverage to be inaccessible for refugees, especially non-vulnerable refugees in Iran. Therefore, it is necessary to adopt effective policies to improve the health financing for the refugee with the aim of ensuring financial protection, taking into account the different actors and the interactions between them.

Relationship Length of Stay (Los) with Service Quality at the Emergency Room of Pratama Nawacita Datah Dave Hospital

Length of Stay (LOS) in the emergency room is used to see the level of density and clinical workload of nurses. This type of research is quantitative and the population is patients who receive health services in the Emergency Room of Pratama Nawacita Datah Dave Hospital with an average visit in 1 month is 37 people. The characteristics of the respondents were seen from the age of the majority of respondents&gt; 60 years (51.4%), female sex totaling 19 people (51.4%), the diagnosis of disease most of the respondents with hypertension amounted to 17 people (45.9%). The level of Length of Stay (LOS) is mostly from less respondents (59.5%) and service quality is mostly from less respondents (56.8%) There is a relationship between Length of Stay (LOS) and service quality (p value 0.042 &lt; α : 0.05). That means there is a relationship between Length of Stay (LOS) and service quality.

Racial and Ethnic Differences in Openness to Communication From Local Faith-Based Congregations During Public Health Emergencies.

During public health emergencies, people at risk of exposure or illness will likely be presented with extensive information about an unfamiliar topic and be asked to make decisions quickly. In difficult situations, people often turn to trusted leaders, including from their local faith-based congregation (FBC). We examined how people receive, interpret, and respond to health communication information from clergy and lay leaders from their local FBC during public health emergencies. We analyzed responses to 10 questions from a 2021 nationally representative US survey. Porter Novelli designed the survey and administered it to 4510 US adults aged ≥18 years, of whom 3553 people completed the survey. We examined sociodemographic characteristics, trust of health information from clergy and lay leaders, and willingness to engage in health behaviors recommended by their FBC and receive health services through their local FBC. All estimates were weighted. We conducted bivariate analysis with contrast t tests for proportions at α = .05. More than half of adults (55.4%), including 65.8% of non-Hispanic Black and 58.8% of Hispanic or Latino adults, were members of an FBC. Among FBC members, a higher percentage of Hispanic or Latino (29.1%) and non-Hispanic Black (36.3%) adults than non-Hispanic White adults (20.4%) reported trust in their FBC for health information (P < .05). This trust translated into greater intent to engage in health behaviors promoted by the local FBC among non-Hispanic Black respondents (31.4%) compared with non-Hispanic White respondents (22.5%) (P < .05). Public health officials can consider ways to better understand how the cultures and practices of populations being served influence people's health perceptions and behaviors. Collaboration between federal, state, and local public health officials and FBCs can promote health equity during public health emergencies.

Causes of dropout from health insurance program: An experience from Lumbini Province, Nepal

The Health Insurance Program (HIP) in Nepal is experiencing low enrolment and high dropout rates, but the causes of these issues have remained unknown. This study aimed to explore the causes of dropouts of the HIP implemented by the Health Insurance Board, Nepal.We employed an exploratory qualitative research design. We purposefully selected the informants for the data collection who had previously enrolled and currently not renewed their insurance scheme. We gathered qualitative information from 16 in-depth interviews, four key informant interviews, and four focus group discussion in Palpa and Bardia Districts of Lumbini Province, Nepal. The qualitative data were analyzed using thematic analysis.We identified two major themes and nine drop-out-related sub-themes. These were: unnecessary health insurance; negligence to renew; unable to pay the contribution amount; poor cooperation between institutions as well as insurees and insurers; limited coverage and ceiling amount; rigid processes to receive health services; health professionals' behaviors; poor quality healthcare services; inadequate information. Dropout-related factors were associated with personal or individual factors and institutional or policy-related (process-related) factors. The major causes/reasons for dropout include lengthy procedures, poor quality and unsatisfactory services, a lack of knowledge on health insurance norms and procedures, and health professionals' behavior towards insurees during treatment.Information, education, and communication programs related to health insurance are still necessary to make the insurees familiar with the insurance systems and its processes. These factors could be taken into account by policymakers while planning interventions to minimize the low enrollment and high dropout.

Competency and factor associated with recruitment of community public health professional personnel in public health organization in Thailand

Background: The development of health manpower is an important issue for the aim of the population to receive health services with quality, efficiency, and equity. Thus, it is necessary to have a plan to create public health academics who are capable in applying academic knowledge and managing tasks that are assigned to them effectively in planning, evaluation, and research development to be consistent with the changing situations at present. Objectives: This cross-sectional study was aimed to describe the situation, distribution, job characteristics, competency and identify factors associated with recruitment in public health organization of community public health professional in Thailand. Method: A total of 2,085 community public health professional staff were selected by multi-stage random sampling method to response the self-administered structured questionnaire. Multivariable analysis was performed to identify the factors associated with recruitment in public health organization among community public health professional in Thailand. Results: The results indicated that among 2,085 community public health professionals, factors associated with recruitment in public health organizations were; Bachelor of Public Health graduates (AOR=4.81, 95% CI: 2.99-7.76; P-value &lt; 0.001), Bachelor of Science (Public Health) graduates (AOR=3.46, 95% CI: 2.06 – 5.84; P-value &lt; 0.001), working in community hospital (AOR=1.99, 95% CI: 1.43 - 2.75; P-value &lt; 0.001), work characteristics were corresponds with their degrees (AOR=1.67, 95% CI: 1.12 - 2.47; P-value &lt; 0.001), graduated from public health college (AOR=5.27, 95% CI: 3.42 - 8.13; P-value &lt; 0.001), graduated from public university (AOR=3.71, 95% CI: 2.41 - 5.72; P-value &lt; 0.001), graduated from Rajabhat University (AOR=1.37, 95% CI: 1.00 - 2.02; P-value &lt; 0.001), organization had position (AOR=2.49, 95% CI: 2.05 - 3.04; P-value &lt; 0.001), organization employed correspondent with the graduated field (AOR=1.89, 95% CI: 1.17 - 3.04; P-value &lt; 0.001) and employed close to the graduated field (AOR=2.21, 95% CI: 1.43 - 3.40; P-value &lt; 0.001) respectively. Conclusion: Community public health professional personnel suggested that their profession development should be supported by promoting to a higher position with the same position code.

Analysis Of The Influence Of The Hope Family Program (Pkh) On Poverty In Patrang District, Jember District

This study aims to analyze the effect of the Family Hope Program (PKH) on poverty in Patrang District, Jember Regency. The research sample consisted of 40 respondents who were PKH beneficiaries and spread across 8 sub-districts of Patrang District. The analytical tool used is multiple linear regression. Based on multiple linear regression analysis with the t hypothesis test, it was found that the health variable which is one of the family hope programs has a significant effect on poverty in Patrang District, Jember Regency. The more programs related to health, the more it will help poverty. Respondents who are PKH beneficiary participants have received health checks at health facilities, children aged 0-6 years have received immunization facilities, pregnant women have received at least 4 inspections, mothers who have given birth received assistance from health workers at health facilities and postpartum mothers have received postpartum checks. minimum 3 times. The results of the regression analysis with the f test show that the PKH program which consists of health, education and welfare has a simultaneous effect on poverty alleviation. The better the PKH given, the better the poverty. PKH beneficiary respondents have received health services and facilities, educational facilities and PKH assistance can improve their socioeconomic status. The Family Hope Program is a social protection program that provides cash assistance to Very Poor Families (KSM), and members of Very Poor Families (KSM) are required to comply with the terms and conditions that have been set.&#x0D;

THE ECONOMICS OF JABARIK CULTIVATION IN ACHIEVING FOOD SECURITY FOR THE FAMILIES OF SMALL FARMERS IN SOUTH KORDOFAN (KADOUGLI LOCALITY), SUDAN

This study was conducted in the South Kordofan state (Kadugli locality) in June 2019 with the aim of knowledge the role of jabriek in investigation household food security for small farmers in the locality. In obtaining information, the study relied on the primary sources represented in the direct questionnaire with the targeted families, in addition to individual interviews. Information was also collected from scientific references and previous studies related to the study. the study targeted 90 male and female farmers, where it relied on sampling randomly, and the data was analyzed by the (SPSS and Excel). The obtained data were presented and summarized in the form of tables and graphs, which contained percentages. Through the results of the study, it became it turns out that 86.6% are cultivating for self-sufficiency and marketing. We find that 39.6%, 4.2%, and 4.2% of small farmers breeding goats, cows and sheep, respectively, to produce milk and benefit from their derivatives. We also find that 21.2 percent of farmers are interested in planting fruit trees in their homes because of their contribution to providing the product from for food and marketing the surplus, and 66.7% of farmers make an effective contribution to the cultivation of these grasses in educating their children in the various educational stages, and also contributes to receiving health services at a rate of 40.8%. There are two planting loops (summer and winter). In the summer loop, the cereal crops are planted such as sorghum and cash crops such as grunts and sesame, while in the winter loop, vegetables are grown, whether they are leafy, carrot or fruit. When comparing women and men in relying on the implantation of gypsophila, there is a greater percentage of women compared to men. Finally, it became clear that there are cumulative experiences of small farmers in the study area through their familiarity with agricultural operations and pest control methods, and their interest in cultivating improved seeds. The study recommendation:  Encouraging families in (rural and urban) to adopt the cultivation of jabrik and home farming, even if it is in the smallest area.  Training small farmers on organic farming and food processing.  Training them on value chains.  Connecting them to marketing channels and markets

EVALUATION OF DESIGN ELEMENTS INFLUENCING HOW CHILDREN PERCEIVE SPACE IN PEDIATRIC PATIENT ROOMS WORLDWIDE

EVALUATION OF COMPONENTS REGARDING THE PERCEPTION OF SPACE IN PEDIATRIC PATIENT ROOM DESIGN OVER THE WORLD&#x0D; ABSTRACT &#x0D; Hospitals are the very institutions that deal with health issues and create solutions in one's life after birth. Children make up a sizable group receiving health services, as is evident from the health complexes built in their name after the 19th century. The physical layout and spatial arrangement of pediatric hospitals have become more significant as a result of this circumstance. It has been observed that the negative effects and experiences associated with childhood illnesses have an impact on children's quality of life, which, in turn, shapes their personality, behavior, sense of shame, and moral judgments as adults. Therefore, providing designs that will support patients' physical, cognitive, and psychosocial needs and promote their well-being has become essential rather than optional. This research serves as the initial phase of a doctoral study that is currently being conducted at the Department of Architecture, Faculty of Fine Arts and Design, KTO University. Within the parameters of the study, an assessment was made of the design elements that influence how patients perceive their surroundings in pediatric hospitals across the globe and our own country. By using the morphological card technique to examine the patient rooms, spatial readings were made on the design elements that influence spatial perception. The information gathered is anticipated to help determine the frequency of preference for the color, light, texture, form, and size to be used in the design of the pediatric patient room and will serve as a guide for future application examples.&#x0D; Keywords: Child, Design Components, Pediatric Hospital, Perception in Space, Sick Room.

Qualitative evaluation of the health insurance program in Nepal: Expectations beyond limitations

AbstractThe government of Nepal introduced a national health insurance program in 2016 to comply with the constitution and international commitments to ensure universal health coverage by 2030. This qualitative study explores public perceptions and satisfaction concerning the new health insurance program. The study is guided by an interpretive worldview using both in‐depth interviews (IDIs) and focus group discussions (FGDs). Altogether, 34 (28 IDIs and 6 FGDs) events were conducted covering both self‐ and government‐sponsored health insurance enrollees in the new health insurance program. The study found that insurees had larger expectations as well as both favorable and negative perceptions of the program. Positive perceptions included that the program helped to lower the gap between the wealthy and the poor, increase coverage with fewer financial contributions, and make it easier to receive health services financially. Negative perceptions included long waiting times for registration, consultations, laboratory test results, and pharmacy visits, as well as the lack of drugs, inadequate coverage (a low ceiling), low‐quality services, and strict procedures, which combined to make insurees dissatisfied. We noticed that insurees had expectations that went beyond the program's guidelines, such as the expectation that services would be provided without queues and long waits, that additional services and coverage would be provided, and that preference would be shown for patients who lived far from hospitals. Adequate information, education, and communication‐ and process‐related interventions that address these issues may help minimize the insurees' unrealistic expectations and areas of dissatisfaction.

Analysis of the costs incurred by patients with Chagas disease: The experience in endemic municipalities in Colombia

BackgroundOut-of-pocket expenditure (OOP) are key costs (medical and non-medical) that many individuals incur to receive health services. They have been identified as a key access barrier for vulnerable populations, in particular for populations affected by neglected diseases with a chronic progression, such as Chagas disease. It is important to understand the costs of accessing healthcare services that are borne by patients with T. cruzi infection. MethodologyWe prepared a structured survey for patients with T. cruzi infection/Chagas disease who were all treated by the healthcare system in endemic municipalities in Colombia. The results were analyzed according to three categories: 1. The socioeconomic profiling of the patients; 2. The costs of accommodation, food and transportation, in addition to the time spent commuting; and 3. the income losses (money that was not earned due to absence from work) related to treatment at the local primary care hospital or at the high-complexity reference hospital. Main findingsNinety-one patients answered the survey voluntarily. The data revealed that, when treated at the specialized reference hospital, patients spent 5.5 times more on food and accommodation, transportation costs were five times higher, and the loss of earnings was three times higher than when they were treated at the local primary care hospital. Moreover, the amount of time spent on transportation was 4 times higher at the reference hospital. ConclusionsProviding comprehensive healthcare services for Chagas management at local primary healthcare hospitals would allow the most vulnerable patients to save on expenses related to medical and non-medical costs, in turn leading to higher adhesion to treatment thus benefiting the health system as a whole. These findings are in alignment with the WHO's World Health Assembly 2010 Resolution on the importance of treating Chagas at local primary care hospitals, thereby saving patients time and money, allowing for timely care, and promoting access to healthcare.