Service Delivery Capacity Research Articles

Structures for quality assurance and measurements for kidney replacement therapies: A multinational study from the ISN-GKHA.

Optimal care for patients with kidney failure reduces the risks of adverse health outcomes, including cardiovascular events and death. We evaluated data from the third iteration of the International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) to assess the capacity for quality service delivery for kidney failure care across countries and regions. We explored the quality of kidney failure care delivery and the monitoring of quality indicators from data provided by an international survey of stakeholders from countries affiliated with the ISN from July to September 2022. One hundred and sixty seven countries participated in the survey, representing about 97.4% of the world's population. In countries where haemodialysis (HD) was available, 81% (n = 134) provided standard HD sessions (three times weekly for 3-4 h per session) to patients. Among countries with peritoneal dialysis (PD) services, 61% (n = 101) were able to provide standard PD care (3-4 exchanges per day). In high-income countries, 98% (n = 62) reported that >75% of centers regularly monitored dialysis water quality for bacteria compared to 28% (n = 5) of low-income countries (LICs). Capacity to monitor the administration of immunosuppression drugs was generally available in 21% (n = 4) of LICs, compared to 90% (n = 57) of high-income countries. There was significant variability between and within regions and country income groups in reporting the quality of services utilized for kidney replacement therapies. Quality assurance standards on diagnostic and treatment tools were variable and particularly infrequent in LICs. Standardization of delivered care is essential for improving outcomes for people with kidney failure.

Exploring Artificial Intelligence as a Remedy to the Heavy Teaching Workloads Caused by Massification of Ugandan Public Universities

Universities worldwide, particularly public universities in Uganda are facing a dilemma in which their massification has far outstripped the growth of their academic service delivery capacity, especially their actual teaching staff size. Consequently, most lecturers are struggling with heavy teaching workloads resulting from large class sizes of 100 to 300 or more students created by massification per course unit, especially at the undergraduate level. These workloads have overstretched most lecturers’ ability to teach effectively and limited their career growth by keeping them too busy to conduct research and participate in community service. The dilemma is faced at the time when Industry 4.0 has developed Artificial Intelligence (AI), which can execute different tasks, including teaching tasks in much the same way as human beings perform them. Drawing on the AI job replacement theory complemented by UTAUT and TOE, this study employed a cross-sectional questionnaire survey involving 325 respondents (deans, heads of department [HODs] and lecturers) randomly selected from five randomly selected public universities to analyse awareness of the teaching tasks AI can execute to reduce faculty members’ workload without replacing them, acceptance of AI to perform these tasks, and hindrances to its adoption. Findings from the descriptive analysis indicate that at least 74% of the deans, HODs, and lecturers were highly aware of the teaching tasks AI can perform. Most of these respondents accept AI to perform such teaching tasks that do not involve a human touch as an online search for research and lecture content, lecture dictation, student assessment and evaluation, and grading of marks. They, however, did not accept AI to execute teaching tasks that involve the human touch such as lecture planning, facilitating tutorials and discussions, assessing students’ interpersonal weaknesses that affect learning, and feedback provision. These findings allude to a need to adopt AI to execute only the teaching tasks it is accepted to perform and leave to the lecturers all the tasks they do not accept to perform. Adopting AI this way is bound to relieve the teaching workload allocated to lecturers as massification intensifies. The findings indicate, however, that AI adoption is hindered by different factors, including lack of strategic, ethical, and policy guidelines, and lack of funds and skills required to operate it. These findings point to a need for the management of Uganda’s public universities to adopt AI by lobbying the government for more funding, mobilizing necessary funds internally, training faculty members in using AI, and encouraging all of them to accept it by explaining the role it is capable of playing in reducing workloads and erasing their fear that AI could replace them

OTHR-03. DEVELOPMENT OF PANORAMA: AN ASSESSMENT TOOL FOR PEDIATRIC NEURO-ONCOLOGY SERVICE DELIVERY CAPACITY

Abstract BACKGROUND To enhance the quality of care available for children with central nervous system (CNS) tumors across the world, a systematic evaluation of service delivery capacity is needed to identify gaps in pediatric neuro-oncology and prioritize interventions. To that end, we created the PediAtric Neuro-Oncology Resource AssesMent Aid (PANORAMA) tool. METHODS PANORAMA development consisted of three phases: operationalization, consensus building, and piloting. PANORAMA was designed to have domains that capture the elements of the pediatric neuro-oncology care continuum using assessments which were weighted according to their importance. Responses were ordinally scored to reflect adequacy of satisfaction. PANORAMA was revised based on feedback at various phases to improve its relevance, usability, and clarity. RESULTS The operationalization phase identified thirteen domains using 252 questions. The consensus phase included validating the identified domains, questions, and scoring by fifteen experts (six pediatric oncologists, three radiation oncologists, two neurosurgeons, two radiologists, and two pathologists). The validated PANORAMA domains were national context, hospital infrastructure, organization and service integration, human resources, financing, laboratory, neurosurgery, diagnostic imaging, pathology, chemotherapy, radiotherapy, supportive care, and patient outcomes. Seventy-six questions were added during the expert review. PANORAMA was piloted at thirteen institutions in twelve countries, representing diverse patient care contexts. Face validity was assessed using the correlation between the estimated score by respondents and calculated PANORAMA scores for each domain (r = 0.67, p <0.0001). Piloting eliminated two questions. CONCLUSIONS PANORAMA was developed following a systematic approach, leading to a relevant tool to evaluate the core elements of pediatric neuro-oncology service capacity. PANORAMA will be distributed to facilitate quantitative evaluation of institutional services, allowing for prioritization and benchmarking with centers at the local, regional, and international levels.

OTHR-09. HEALTHCARE PROVIDERS’ PERSPECTIVES ON MALAYSIA-SINGAPORE VIRTUAL PEDIATRIC NEURO-ONCOLOGY TUMOR BOARD MEETING

Abstract BACKGROUND Virtual pediatric neuro-oncology tumor board meetings have been reported to be highly beneficial in improving the delivery of high-quality care for childhood central nervous system (CNS) tumors. However, such meetings are lacking in the Asia Pacific region. Hence, we initiated the first pediatric neuro-oncology online platform in the Asia Pacific region in January 2019, and we aimed to describe the participants’ perception of the virtual tumor board meetings. METHODS We retrospectively reviewed all cases from January 2019 to December 2023 and conducted a web-based survey to all participants in December 2023. Centers that presented more than five cases were invited to assess the impact of virtual meetings. RESULTS Fifty-four meetings have been conducted over five years. A total of 160 cases were presented by 20 institutions from six Asian countries, which include Malaysia, Singapore, Philippines, Vietnam, India, and Taiwan. Thirty participants responded to the survey. Majority of them attended the meetings to enhance their knowledge in pediatric neuro-oncology (96.7%), to learn evidence-based management (83.3%), and to build connections with regional colleagues and international experts (53.3%). Almost all concluded that tumor board meetings improved treatment decisions, addressed challenges of complex CNS tumor cases, and promoted continuity of care with appropriate post-surgical chemotherapy administration and surveillance investigations after completion of treatment. The main reason for case discussion was diagnostic difficulties followed by multimodal treatment advice (85.7%). More than 25% of management changes were observed in pathological diagnosis and treatment approaches. All the hospitals reported that the online case discussions improved pediatric neuro-oncology service delivery capacity and increased local team competence. CONCLUSION Virtual pediatric neuro-oncology tumor board meetings facilitated improvement in pathological diagnosis and multimodal treatment approach. The establishment of virtual CNS tumor board meetings is an effective way to seek international expert advice and promote pediatric neuro-oncology education in our region.

Progress towards health equity in Vietnam: evidence from nationwide official health statistics, 2010-2020

IntroductionOne of the ultimate goals of strengthening the health system is to achieve health equity. Vietnam is considered one of the ‘fast-track countries’ to achieve the health-related Millennium Development Goals,...

Policing and politics of law enforcement in Nigeria’s fourth republic

ABSTRACT Historically, policing and law enforcement operations of the Nigeria Police Force have generally been characterised by covert and overt politicisation. Against this background, this article critically analysed the politicisation of policing and law enforcement in Nigeria’s fourth republic. It argues that the influence of politics on the enforcement of the law by the police agency manifests under different guises and circumstances at both the macro and micro levels. Police personnel are not only routinely being used by politicians and the ruling class to further their own personal political gains, the management and operational philosophy of the agency are also often a product of systematic politicisation and power struggles amongst groups. Consequently, the overall service delivery capacity of the Nigeria Police Force is being hampered by politicisation.

Adaptation and validation of the Children’s Surgical Assessment Tool for Rwandan district hospitals

ABSTRACT Background/Aims Paediatric surgical care is a critical component of child health and basic universal health coverage and therefore should be included in comprehensive evaluations of surgical capacity. This study adapted and validated the Children’s Surgical Assessment Tool (CSAT), a tool developed for district and tertiary hospitals in Nigeria to evaluate hospital infrastructure, workforce, service delivery, financing, and training capacity for paediatric surgery, for use in district hospitals in Rwanda. Methods We used a three-round modified Delphi process to adapt the CSAT to the Rwandan context. An expert panel of surgeons, anaesthesiologists, paediatricians, and health systems strengthening experts were invited to participate based on their experience with paediatric surgical or anaesthetic care at district hospitals or with health systems strengthening in the Rwandan context. We used the Content Validity Index to validate the final tool. Results The adapted tool had a final score of 0.84 on the Content Validity Index, indicating a high level of agreement among the expert panel. The final tool comprised 171 items across five domains: facility characteristics, service delivery, workforce, financing, and training/research. Conclusion The adapted CSAT is appropriate for use in district hospitals in Rwanda to evaluate the capacity for paediatric surgery. This study provides a framework for adapting and validating a comprehensive paediatric surgical assessment tool to local contexts in LMICs and used in similar settings in sub-Saharan Africa.

Regaining policy attention for a health insurance capitation payment reform in Ghana: A prospective policy analysis.

Capitation as a provider payment mechanism gained policy attention by the Ghana National Health Insurance Scheme (NHIS) in 2012 and was piloted in the Ashanti Region, Ghana. Recent studies revealed that the policy was suspended in 2017 due to inappropriate policy framing, actor contestations, unclear policy design characteristics, and an unfavorable political context. However, the NHIS still has interest in capitation as a provider payment option. Using the modified political process model, a prospective policy analysis was conducted to explore how to: i) appropriately reframe policy debates; ii) create political opportunities; and iii) mobilize resources to reattract policy attention to capitation in Ghana. Cross-sectional qualitative data were gathered in December, 2019 from semi-structured interviews with a purposive sample of 18 stakeholders and complemented with four community-level focus group discussions with 41 policy beneficiaries in the pilot region. All data were tape-recorded and transcribed. The analysis was thematic, using the NVivo 12 software. The results revealed that an appropriate reframing of the policy requires policy renaming, refinement of certain policy design characteristics (emergency care, capitation rates, choice and assignment of providers) and refocusing policy communication and advocacy on the health benefits of capitation instead of its cost containment intent. To create political opportunities for policy re-implementation, a politically sensitive approach with broader stakeholder consultations should be adopted. Policy advocacy and communication should be evidenced-based and led by politically neutral agents. An equitable capitation policy implementation requires resourcing health facilities, especially the lower-level facilities, with improved infrastructure, consumables, improved information management systems and well-trained personnel to enhance their service delivery capacities. The study concludes that there exists stakeholder interest in the capitation policy in Ghana and calls for an effective reframing, creation of political opportunities, and mobilization of needed resources to regain policy attention.

Development of the pediatric neuro-oncology services assessment aid: An assessment tool for pediatric neuro-oncology service delivery capacity.

To enhance the quality of care available for children with central nervous system (CNS) tumors across the world, a systematic evaluation of capacity is needed to identify gaps and prioritize interventions. To that end, we created the pediatric neuro-oncology (PNO) resource assessment aid (PANORAMA) tool. The development of PANORAMA encompassed 3 phases: operationalization, consensus building, and piloting. PANORAMA aimed to capture the elements of the PNO care continuum through domains with weighted assessments reflecting their importance. Responses were ordinally scored to reflect the level of satisfaction. PANORAMA was revised based on feedback at various phases to improve its relevance, usability, and clarity. The operationalization phase identified 14 domains by using 252 questions. The consensus phase involved 15 experts (6 pediatric oncologists, 3 radiation oncologists, 2 neurosurgeons, 2 radiologists, and 2 pathologists). The consensus phase validated the identified domains, questions, and scoring methodology. The PANORAMA domains included national context, hospital infrastructure, organization and service integration, human resources, financing, laboratory, neurosurgery, diagnostic imaging, pathology, chemotherapy, radiotherapy, supportive care, and patient outcomes. PANORAMA was piloted at 13 institutions in 12 countries, representing diverse patient care contexts. Face validity was assessed by examining the correlation between the estimated score by respondents and calculated PANORAMA scores for each domain (r = 0.67, P < .0001). PANORAMA was developed through a systematic, collaborative approach, ensuring its relevance to evaluate core elements of PNO service capacity. Distribution of PANORAMA will enable quantitative service evaluations across institutions, facilitating benchmarking and the prioritization of interventions.

Capacity Building Efforts on Viral Hepatitis under National Viral Hepatitis Control Program

The “National Viral Hepatitis Control Program” (NVHCP) was launched in India as a stepping stone towards combating viral hepatitis as a public health threat. The program was launched on the occasion of world hepatitis day 2018 with the target of eliminating viral hepatitis by the year 2030. The program has provisions for developing infrastructure, nominating human resources, and building their capacity for successful service delivery. A time-bound cascade of training approaches is being adopted by the program to orient the designated healthcare workers on the standard operating protocols. The training is being conducted following a top-to-bottom approach, where master trainers are first identified and sensitized at the national level under the mentorship of the National Center for Disease Control (NCDC), the master trainers then sensitize the designated healthcare workers at the state level in collaboration with the state National Health Mission (NHM). Here is an outline of the Capacity-building efforts on Viral Hepatitis under NVHCP in Uttarakhand State.

Linking local collaborative governance and public service delivery: mediating role of institutional capacity building

Collaborative governance has received attention among scholars and practitioners for resolving governance issues across the globe. The government of Pakistan emphasizes local collaborative governance practices for resolving complex local problems through efficient public service delivery. This research is planned to examine the impact of local collaborative governance on public service delivery, institutional capacity building and how local collaborative governance influences public service delivery through the mediating mechanism of institutional capacity building. Using collaborative governance theory and collecting data from multisector organizations in the context of Pakistan, the results of this study revealed that local collaborative governance is significantly related to the dimensions of public service delivery and institutional capacity building. This research findings revealed that local collaborative governance engenders public service delivery through the dimensions of institutional capacity building including service capacity, evaluative capacity, and M&O capacity.

Prioritization of zoonoses for multisectoral, One Health collaboration in Somalia, 2023

BackgroundThe human population of Somalia is vulnerable to zoonoses due to a high reliance on animal husbandry. This disease risk is exacerbated by relatively low income (poverty) and weak state capacity for health service delivery in the country as well as climate extremes and geopolitical instability in the region. To address this threat to public health efficiently and effectively, it is essential that all sectors have a common understanding of the priority zoonotic diseases of greatest concern to the country. MethodsRepresentatives from human, animal (domestic and wildlife), agriculture, and environmental health sectors undertook a multisectoral prioritization exercise using the One Health Zoonotic Disease Prioritization (OHZDP) tool developed by the United States CDC. The process involved: reviewing available literature and creating a longlist of zoonotic diseases for potential inclusion; developing and weighting criteria for establishing the importance of each zoonoses; formulating categorical questions (indicators) for each criteria; scoring each disease according to the criteria; and finally ranking the diseases based on the final score. Participants then brainstormed and suggested strategic action plans to prevent, and control prioritized zoonotic diseases. ResultsThirty-three zoonoses were initially considered for prioritization. Final criteria for ranking included: 1) socioeconomic impact (including sensitivity) in Somalia; 2) burden of disease in humans in Somalia); 3) availability of intervention in Somalia; 4) environmental factors/determinants; and 5) burden of disease in animals in Somalia. Following scoring of each zoonotic disease against these criteria, and further discussion of the OHZDP tool outputs, seven priority zoonoses were identified for Somalia: Rift Valley fever, Middle East respiratory syndrome, anthrax, trypanosomiasis, brucellosis, zoonotic enteric parasites (including Giardia and Cryptosporidium), and zoonotic influenza viruses. ConclusionsThe final list of seven priority zoonotic diseases will serve as a foundation for strengthening One Health approaches for disease prevention and control in Somalia. It will be used to: shape improved multisectoral linkages for integrated surveillance systems and laboratory networks for improved human, animal, and environmental health; establish multisectoral public health emergency preparedness and response plans using One Health approaches; and enhance workforce capacity to prevent, control and respond to priority zoonotic diseases.

Strategizing export promotion in Indian telecom sector: empirical evidence using time and frequency analysis

ABSTRACT This study evaluates how foreign direct investment (FDI) impact the Indian telecom manufacturing sector and the exports of telecom products between January 2012 and February 2020. It establishes a long-term non-linear relationship among FDI, exports, and industrial production index that exhibits regime shifts, time-varying, and wavelet coherence under exchange rate volatility. The study revealed that telecom sectoral FDI majorly strengthens the service delivery capacity rather than enhancing the production of telecom products. The policy and regulatory initiatives, mainly focused on ‘import substitution’, may not automatically lead to strengthening of domestic manufacturing and increased participation in the global value chain.

Perceptions of newly graduated social workers’ initial substance misuse treatment service delivery capacities in a Midwestern state

ABSTRACT This article details the findings of a 2020 study that explored how substance misuse treatment program directors rate the initial treatment service delivery capacities of newly graduated, master’s level social workers in a Midwestern state. The study consisted of a cross sectional, quantitative survey of all treatment program directors listed in the state’s Treatment Program Directory. In total, 43 respondents, or 18% of all listed treatment program directors, participated in the study. The results suggest that the surveyed directors believe that Master of Social Work graduates have an initial deficit of substance misuse treatment skills, knowledge, and overall preparedness to deliver treatment services. Recommendations for addressing this deficit include strategically integrating Council on Social Work Education curricular guidelines for substance misuse into MSW programs, and mandating substance misuse training for new social workers. More expansive studies on social workers’ substance misuse service delivery capacities are also recommended.

Examining entry-level social workers’ substance use prevention capacities in a Northeastern State: a field perspective

ABSTRACT This article details the findings of a 2018 study that explored the perceptions of substance misuse prevention program directors on the initial substance misuse prevention knowledge, skills, and service delivery capacities of newly graduated, entry-level social workers in a Northeastern state. The research conducted was composed of a survey of program directors from all state-funded substance misuse prevention programs in the state, with 38% (N = 66) of identified programs represented in the results. In total, the findings of the study identified that the majority of surveyed program leaders believe that entry-level social workers in the state generally lack knowledge of substance misuse prevention concepts and are not initially prepared to provide substance misuse prevention services without moderate to extensive amounts of additional training post-entry into the professional workforce.

Improving Education and Research in Haematology and Blood Transfusion in Africa: Panacea to Improving the Health and Wellbeing of Patients in the Region

Africa bears a heavy burden of diverse diseases which includes blood diseases that overwhelm the healthcare system. A multitude of factors were believed to be responsible for this burden and it includes a lack of trained healthcare workforce, multi-disciplinary research on diseases facing the region, and a dearth of advanced diagnostic and clinical services for haematologic disorders. Measures taken to improve the situation includes increased health budgetary spending which had marginally improved. The improvement thus far achieved in haematology and blood transfusion education and research need to be determined. Three databases, namely Google Scholar, PubMed and Core, were searched for literature on haematology and blood transfusion education and research. About 2616 articles were identified, of which 7 articles were included for the review following screening and eligibility assessment by independent reviewers. The articles reviewed revealed that there was a significant improvement in haematology and blood transfusion education and research. This has translated to an improved health workforce, service delivery and research capacity and profile. However, these gains were not quantifiably presented to judge the real progress against any set standards. To fully understand the progress made and the levels that need to be reached, a comprehensive, multifaceted, and multinational study that explicitly explores the improvement measures taken and their consequential outcome is necessary.

What is needed to improve quality of implant removal services in Nigeria? results of a landscape assessment.

Stunning recent increases in subdermal contraceptive implant use, especially in sub-Saharan Africa, necessitate availability of quality implant removal services. In Nigeria, service delivery capacity and coverage for removal are lacking, despite strong government commitment and rapid uptake; there is a dearth of knowledge about barriers to quality implant removals in Nigeria. To determine access to and quality of contraceptive implant removal services, a landscape assessment was conducted in two states in Nigeria, focusing on four conditions for quality delineated in the Global Implant Removals Task Force framework. This mixed-methods approach integrated results from a desk review, a survey of health facilities and family planning managers, review of implant service statistics, and key informant interviews with providers and diverse stakeholders. Seventy percent of providers (N = 21 of 30) had experienced problems performing implant removal, usually due to deeply inserted implants and equipment shortages. Providers had low confidence in performing removal and poor knowledge of implant removal steps. No facilities assessed had comprehensive equipment required for implant removal. Few facilities maintained systems or referral pathways to support difficult removals; difficult removals are absent from training manuals, and no formal trainings have been conducted. While most facilities collect data on removals, family planning dashboards do not capture it; few facilities use data for quality improvement. This study identified numerous challenges to quality implant removal, including poorly trained providers, inadequate supplies, underutilization of data on removals, and inability to manage difficult removals. As demand for implant removals skyrockets, providers need improved training in implant removal, appropriate job aids, supportive supervision, and effective procurement systems to ensure availability of supplies and equipment for removal. Tracking removals and reasons for removal in information systems and the Family Planning dashboard could sensitize providers to need for implant removals and improve data for decision-making in facilities and health systems.

Effects of the ECHO tele-mentoring program on HIV/TB service delivery in health facilities in Zambia: a mixed-methods, retrospective program evaluation

BackgroundIn the quest to ensure that quality healthcare is provided to all citizens through building healthcare worker capacity and extending reach for expert services, Zambia’s Ministry of Health (MoH) in collaboration with its partners PEPFAR through the CDC and HRSA, began to implement the Extension for Community Healthcare Outcomes (ECHO) tele-mentoring program across the country through the Health Workers for the 21st Century (HW21) Project and University Teaching Hospital HIV/AIDS Project (UTH-HAP). This ECHO tele-mentoring approach was deemed pivotal in helping to improve the human immunodeficiency virus (HIV) service delivery capacity of health care workers.MethodThe study used a mixed method, retrospective program evaluation to examine ECHO participants’ performance in the management of HIV/AIDS patients in all the 10 provinces of Zambia.Case presentationA phenomenological design was applied in order to elicit common experiences of ECHO users through focus group discussions using semi-structured facilitation guides in four provinces (Eastern, Lusaka, Southern and Western) implementing ECHO tele-mentoring approach. These provinces were purposively selected for this study. From which, only participants that had a monthly frequency of ECHO attendance of ten (10) and above were selected. The participants were purposively selected based on the type of cadre as well as facility type so that the final sample consisted of Doctors, Nurses, Midwives, Clinical Officers, Medical Licentiates, Pharmacy and Laboratory Personnel. All sessions were audio recorded and transcribed by the data collectors. A thematic content analysis approach was adopted for analyzing content of the interview's transcripts.ResultsEnhanced knowledge and skills of participants on HIV/TB improved by 46/70 (65.7%) in all provinces, while 47/70 (67.1%) of the participants reported that ECHO improved their clinical practice. Further, 12/70 (17.1%) of participants in all provinces reported that presenter/presentation characteristics facilitated ECHO implementation and participation. While, 15/70(21.4%) of the participants reported that ownership of the program had contributed to ECHO implementation and participation. Coordination, another enabler accounted for 14/70 (20%). Inclusiveness was reported as a barrier by 16/70 (22.8%) of the participants while 6/70 (8.6%) of them reported attitudes as a barrier (8.6%) to ECHO participation. In addition, 34/70 (48.6%) reported poor connectivity as a barrier to ECHO implementation and participation while 8/70 (11.5%) of the participants reported that the lack of ownership of the ECHO program was a barrier. 22/70 (31.4%) reported that increased workload was also a barrier to the program’s implementation.ConclusionConsistent with its logical pathway model, healthcare providers’ participation in ECHO sessions and onsite mentorship contributed to improved knowledge on HIV/TB among health care providers and patient health outcomes. In addition, barriers to ECHO implementation were intrinsic to the program its self, such as coordination, presenter and presentation characteristics other barriers were extrinsic to the program such as poor connectivity, poor infrastructure in health facilities and negative attitudes towards ECHO. Improving on intrinsic factors and mitigating extrinsic factors may help improve ECHO outcomes and scale-up plans.

Who Delivers Maternal and Child Health Services? The Contributions of Public Health and Other Community Partners.

Improving maternal and child health (MCH) care in the United States requires solutions to address care access and the social determinants that contribute to health disparities. Direct service provision of MCH services by local health departments (LHDs) may substitute or complement public health services provided by other community organizations, impacting local service delivery capacity. We measured MCH service provision among LHDs and examined its association with patterns of social service collaboration among community partners. We analyzed the 2018 National Longitudinal Survey of Public Health Systems and 2016 National Association of County and City Health Officials Profile data to measure the LHD provision of MCH services and the types of social services involved in the implementation of essential public health activities. We compared the extensive and intensive margins of social service collaboration among LHDs with any versus no MCH service provision. We then used latent class analysis (LCA) to classify collaboration and logistic regression to estimate community correlates of collaboration. Of 620 LHDs, 527 (85%) provided at least one of seven observed MCH services. The most common service was Special Supplemental Nutrition Program for Women, Infants, and Children (71%), and the least common was obstetric care (15%). LHDs with MCH service provision were significantly more likely to collaborate with all types of social service organizations. LCA identified two classes of LHDs: high (n = 257; 49%) and low (n = 270; 51%) collaborators. Between 74% and 96% of high collaborators were engaged with social service organizations that provided basic needs services, compared with 31%-60% of low collaborators. Rurality and very high maternal vulnerability were significantly correlated with low collaboration among MCH service-providing LHDs. LHDs with direct MCH service provision exhibited greater social service collaboration. Collaboration was lowest in rural communities and communities with very high maternal vulnerability. Over half of MCH service-providing LHDs were classified as low collaborators, suggesting unrealized opportunities for social service engagement in these communities.

Co-curricular Immersion as a Public-Private Capacity Building Activity.

The COVID-19 pandemic exacerbated the already increasing challenge of establishing immersive, co-curricular activities for engineering students, particularly for biomedical-related activities. In the current work, we outline a strategy for co-curricular learning that leverages a private-public partnership in which methods for capacity-building have enabled mutually beneficial outcomes for both organizations. A contemporary issue for many non-profits is identifying effective ways to build capacity for consistent service delivery while at the same time embracing the volunteer activities of students; a challenge is that the lifecycle of a university student is often not aligned (much shorter) with the needs of the non-profit. The public-private partnership simultaneously meets the service motivation of students with the needs of the host. This paper includes two case studies that illustrate the implementation of the methods for capacity-building and related outcomes.