Service Delivery Network Research Articles

Reimagining health security: Developing a conceptual framework for the Philippines

The COVID-19 pandemic has highlighted global vulnerabilities to emergencies, with the Philippines facing significant challenges as hospitals reached capacity, routine health services were disrupted, and health workers demanded better working conditions. Ranking 57th in the 2021 Global Health Security Index, the Philippines' susceptibility to natural hazards and health crises underscores the urgent need for a robust health security framework. This study developed a conceptual framework to guide health security strategies, policies, and capacity-building efforts, harmonizing the national health security agenda and outlining stakeholder actions through an iterative process involving the review of 78 policies and consultations with 21 stakeholders. The framework is founded on four core principles intrinsic to Filipino identity: Bayanihan (multisectorality), Kalusugan Pangkalahatan (equity and universal health care), Magkakaugnay na Sistema (interoperability), and Pananagutan (accountability). It prescribes six strategic actions: ensuring the accessibility and sustainability of resources, adopting a community-centered approach, enhancing knowledge and information sharing, fostering partnerships and collaboration, establishing a robust implementation system and integrated service delivery network, and strengthening governance. This framework aims to fortify the Philippine health system, making it more resilient and equitable in facing current and future health threats. It calls for active engagement from all stakeholders in implementing these strategies, contributing to a healthier and more secure nation.

Adherence to Clinical Practice Guidelines on the Management of Acute Infectious Gastroenteritis in Children as a Measure of Quality of Care Delivered by a Primary Care Facility in Rural Philippines: A Descriptive Retrospective Study.

This study aimed to describe the pattern of prescription and laboratory use in the management of infectious acute gastroenteritis (AGE) in children seen in a rural service delivery network (SDN) and to determine their adherence to the 2019 Clinical Practice Guidelines on the Management of Acute Infectious Diarrhea in Children and Adults from the Department of Health (DOH). A descriptive retrospective study was done using the electronic medical records (EMR) of patients less than 19 years old seen by the rural SDN from April 2019-2021 and diagnosed with infectious AGE. Data were extracted on diagnostic and therapeutic management. Adherence to strong CPG recommendations focusing on rehydration, zinc supplementation, rational laboratory use, and antibiotic prescription was chosen as indicator of quality of care. Adherence of less than 70% was defined as low. There were 227 infectious AGE cases, with 72% diagnosed under non-specific infectious AGE. Fifty two percent (52%) were prescribed with low-osmolarity oral rehydration solutions (ORS), while 74% were given zinc. Stool analysis was done in 25% of cases while CBC was done in 20%. Top antibiotics given were metronidazole at 44% and cotrimoxazole at 33%. There was low adherence to prescribing low-osmolarity ORS for rehydration (52%) and to deferring routine antibiotic prescription for non-specific infectious AGE cases (24%). Adherence to deferring routine stool analysis and CBC were relatively high at 73% and 70%, respectively while adherence to antibiotic use for indicated cases was high at 95%. Frequency of diagnostics ordered were low resulting to high adherence rates to recommendations concerning judicious laboratory use. Prescription frequency of appropriate antibiotics and interventions for AGE were low, leading to low adherence rates to recommendations concerning rational antibiotic use and prescription of cornerstone therapies for infectious AGE.

Development of a Custom Technical Incident and Spare Part Management System for Effective Telecom Network Service Delivery

Development of a Custom Technical Incident and Spare Part Management System for Effective Telecom Network Service Delivery

Machine Learning-Driven Reconfigurable EONs with Neuromorphic Computing for Network Slicing and On-Demand Service Provisioning: A Review and Survey

Abstract: This paper delves into the substantial potential of integrating advanced technologies within Reconfigurable Elastic Optical Networks (REONs). By leveraging machine learning and neuromorphic computing, these networks can significantly enhance performance, scalability, and efficiency. Machine learning models facilitate dynamic resource management, allowing for the on-demand reconfiguration of optical networks to improve service provisioning and maintain high Quality of Service (QoS). Neuromorphic processors further boost network-slicing capabilities, optimizing bandwidth management and enabling the creation of customized virtual networks. Additionally, the incorporation of neuromorphic computing into REONs contributes to substantial energy savings, a critical factor for sustainable network operations. Techniques such as differential privacy and secure multi-party computation effectively address security and privacy challenges within optical networks. Future research should focus on developing scalable architectures, formulating energy-efficient algorithms, and designing solutions tailored to specific applications to maximize the potential of REONs. In summary, the integration of advanced computing techniques within REONs promises to revolutionize network management and service delivery, equipping future networks to deliver exceptional performance, scalability, and adaptability, thus meeting the evolving demands of modern communication environments.

Efficient resource allocation using whale optimization for cell-free massive MIMO networks in 6G HetNet

The increase in data rate demands has driven the development of Cell-Free massive Multiple-Input Multiple-Output (CFmMIMO) technology in 6G Heterogeneous Networks (HetNets). This paper proposes an integration of Unmanned Aerial Vehicles (UAVs) and Device-to-Device (D2D) communication in CFmMIMO, aiming to enhance network capacity, coverage, and service delivery in next-generation wireless networks. The paper investigates uplink transmission in a network where Access Points (APs) have imperfect channel state information. It considers Cell-free User Equipment (CUE), UAVs, and D2D pairs, deriving closed-form uplink achievable rates for each user type. Moreover, two optimization problems are formulated to enhance user data rates: one focuses on maximizing the sum data rate through pilot assignment, while the other aims to achieve weighted max–min power control through power allocation. Furthermore, to address these problem, we propose a Modified Whale Optimization Algorithm (MWOA) and a novel Pilot Assignment based on Whale Optimization Algorithm (PAWOA). Performance studies demonstrate significant improvements over state-of-the-art algorithms.

The call for an evidence-based integrated funding and service delivery system for newcomers.

As immigration continues to drive Canada's growth, the newcomer serving sector remains pivotal in facilitating newcomers' integration into communities. However, this sector grapples with ongoing challenges, exacerbated by the federal government's priority to increase immigration levels, thereby complicating the settlement landscape. This article examines the funding and service delivery difficulties organizations encounter. It underscores a system that fosters funding competition, impedes interorganizational collaboration, complicates program outcome reporting, and entails high administrative costs. Additionally, it addresses the specific challenges faced by newcomer children, youth, and families settling in Canada. The recommendations emphasize that no single agency can resolve the settlement sector crisis alone. Urgent actions include piloting integrated networks over integrated services and adopting a new Immigration, Refugees and Citizenship Canada funding model that aligns with population and cultural needs. Moreover, eliminating silos is essential to establish a cohesive and efficient service delivery network committed to public outcomes and accountability.

Strengthening cardiac services in Faridabad District: A facility mapping exercise to explore implementation of a hub-and-spoke model.

Background & objectives Improving access to acute cardiac care requires remodelling of existing health systems into a service delivery network with an anchor establishment (Hub) offering a full array of services, complemented by spoke establishments that offer limited services. We assessed the availability of cardiac services in the district of Faridabad in the northern State of Haryana, India and explored the feasibility and challenges of implementing a hub-and-spoke model. Methods In 2019-2020, we listed all the facilities in private and public sectors in the study-district and mapped their geocoordinates with the help of QGIS (Quantum Geographic Information System) software version 3.20. After consent, we assessed the availability of specific cardiac care-related inputs (medicines, technologies and staff) using a checklist by enquiring from the hospital staff. Each facility was classified as L1 (No ECG) to L5 (cardiac catheterization) as per the national guidelines for the management of ST-elevation myocardial infarction (STEMI). Results There were 109 health facilities (66% private) in the district, 1.6 cardiologists and 5.4 coronary care unit beds per 100,000 population (94% private). Only one district hospital running in a public-private partnership mode at the L5 level provided any cardiac services. Private facilities were providing a range of services with a considerable number of them functional at L5. The higher-level facilities were concentrated in the central and urban parts of the district. Only 46 per cent of the ambulances had oxygen cylinders and 14.7 per cent had defibrillators. Interpretation & conclusions Implementation of a hub-and-spoke model for cardiac care in Faridabad district will require significant strengthening of public health services, development of a private-sector participation model, and strengthening of ambulance services.

A comparative analysis of alpha-beta-gamma and close-in path loss models based on measured data for 5G mobile networks

Mobile coverage is crucial for the fifth-generation (5G) network since it affects the network's accessibility and dependability in various locations. With a wider coverage, more people and devices will access the 5G network, allowing them to experience the benefits and capabilities of this important technology. However, the development and construction of the networks need a lot of time and effort to maximize network coverage and service delivery while utilizing the fewest possible infrastructure components. Path loss models are commonly employed to predict network coverage. Therefore, it is expedient to adopt a path loss model that is suitable for the specified geographical area. In this paper, we investigated and analysed two empirical models: the Close-in free space reference distance (CI) model and the alpha-beta-gamma (ABG) model at the low- and mid-spectrum bands. Secondly, the path loss parameters were derived to characterize the two empirical models based on data from the measurement campaign. Finally, Root Mean Square Error (RMSE) was employed for the comparison of the models. It was found that at frequencies 0.9 and 1.8 GHz, the CI model's least RMSE values were 3.6 and 4.1 at location 1 and 4.7 and 4.2 dB at location 2, respectively, outperforming the ABG. However, at 3.4 GHz, the ABG with 3.25 and 1.75 dB outperformed the CI at both locations. For future work, the integration of machine learning techniques to dynamically predict and adapt path loss models in real time based on continuous data collection will be appropriate.

Cost-efficient flow migration for SFC dynamical scheduling in geo-distributed clouds

Combining Network Function Virtualization (NFV) and Software Defined Network (SDN) enables the delivery of network services in a flexible and cost-efficient manner. NFV allows elasticity scheduling of Virtual Network Function (VNF) instances to adopt the dynamic variation of network flows, such as VNF instance scale out or in and load balancing. To implement the elasticity scheduling, existing flows need to be re-routed through the VNF instances. One major problem is how to select appropriate flows for migration to reduce migration cost and improve network performance after migration. In this paper, we propose a Cost-efficient Flow Migration framework, CFM, to jointly optimize flow migration cost and network performance after migration (including flow routing cost and maximum VNF instance load) for flow migration in Service Function Chain manner. Experimental results demonstrate that CFM can reduce flow routing cost after migration by 43%∼62% compared with previous works, while achieving similar flow migration cost in scale out/in scenario. In load balancing scenario, CFM can also reduce flow migration cost by 65%∼79% and flow routing cost after migration by 43%∼79% compared with previous works, while ensuring that the maximum VNF instance load does not significantly increase.

City Diplomacy in Fighting Wicked Problems: Izmir Metropolitan Municipality

Municipalities/local governments are both one of the key actors in tackling wicked problems and the place where these problems are concretely experienced. One of the methods suitable for local governments in tackling wicked problems is networked service delivery. City diplomacy is an effective tool in addressing wicked problems because it brings many cities together with other cities and actors, provides a suitable platform for sharing different information, practices and resources on problems, and offers a more flexible form of governance that allows a transition from hierarchy to networks in the provision of public services. The aim of this study is to identify the impact of city diplomacy on the wicked problems faced by cities. In this context, the study analyses city diplomacy activities through content analysis and identifies their relationship with wicked problems. The study determines the relationship between city diplomacy activities and a number of areas within the scope of wicked problems, determines the impact of city diplomacy activities on local government service areas, and reveals the importance of city diplomacy activities in the management of Covid-19 outbreak, which is considered a wicked problem.

Building a Network Design and Implementation Framework of a Campus Area Network for the Mariano Marcos State University

A framework for network design and implementation is imperative to ensure value in the delivery of network services. Frameworks serve as guides in identifying value propositions to address the changing demands of the organization’s stakeholders. Frameworks prescribe efficient methods and appropriate tools that can be used to ensure that the implementation of a technological innovation addresses the demands, regardless of the changing IT landscape. The demand to deliver an efficient network service requires that the network have optimized levels of scalability, availability, performance, security, and other desirable network goals. These goals have to be prioritized depending on the goals of the organization. A framework for identifying priority service delivery components must be in place in order for the governing body and IT managers of the organization to objectively prescribe appropriate technological solutions to employ. The development of the proposed framework is patterned on Plan Design Implement Operate Optimize network life cycle, anchored on the principles of the service value chain of ITIL and the principles of IT governance using the goals cascade of COBIT. A review of existing studies was carried out to determine the prevailing technical goals and technology enablers that are peculiar to IT service management in a campus environment, specifically the delivery of computer network service. A framework was drawn to serve as a guide to achieving network design goals that are aligned with business goals, compliant with standards, and provide value to customers of state universities and colleges like Mariano Marcos State University.

Artificial Intelligence and Decision-Making in Healthcare: A Thematic Analysis of a Systematic Review of Reviews.

The use of artificial intelligence (AI), which can emulate human intelligence and enhance clinical results, has grown in healthcare decision-making due to the digitalization effects and the COVID-19 pandemic. The purpose of this study was to determine the scope of applications of AI tools in the decision-making process in healthcare service delivery networks. This study used a qualitative method to conduct a systematic review of the existing reviews. Review articles published between 2000 and 2024 in English-language were searched in PubMed, Scopus, ProQuest, and Cochrane databases. The CASP (Critical Appraisal Skills Programme) Checklist for Systematic Reviews was used to evaluate the quality of the articles. Based on the eligibility criteria, the final articles were selected and the data extraction was done independently by 2 authors. Finally, the thematic analysis approach was used to analyze the data extracted from the selected articles. Of the 14 219 identified records, 18 review articles were eligible and included in the analysis, which covered the findings of 669 other articles. The quality assessment score of all reviewed articles was high. And, the thematic analysis of the data identified 3 main themes including clinical decision-making, organizational decision-making, and shared decision-making; which originated from 8 subthemes. This study revealed that AI tools have been applied in various aspects of healthcare decision-making. The use of AI can improve the quality, efficiency, and effectiveness of healthcare services by providing accurate, timely, and personalized information to support decision-making. Further research is needed to explore the best practices and standards for implementing AI in healthcare decision-making.

Promoting research for the fragile Somali health system –

A 3-day conference was held in Garowe from the 30th of January to the 1st of February 2022 under the leadership of the Somali National Institute of Health to strengthen the foundation of health research in the country by promoting strategies for health research capacity building, sharing available evidence for action, and widening research collaborative networks. The conference was also instrumental in concretizing plans for improving the existing Somali Universities’ health research performance. It was jointly organized and supported by the National Institute of Health, the Federal Ministry of Health and Human Services, the Public Health Agency of Sweden, the Somali Swedish Researchers’ Association, and a consortium of Somali and Swedish universities. The Puntland State Ministry of Health hosted the conference. This paper summarizes topics presented at the conference and identifies gaps and opportunities for research capacity strengthening in Somalia, which would generate evidence to inform public health policies. An Organizing Committee for the management and logistics of the conference and a Scientific Committee were established, the latter providing expertise in selecting key research topics and speakers/delegates for the conference. More than 180 participants from academic institutions and the health sector service delivery network attended the conference. Twelve panel presentations and 51 abstracts were delivered, covering health system research priorities. Of the 51 presented abstracts, 35% were on communicable diseases, 26% on reproductive maternal, newborn, child, and adolescent health, 24% were on the health system, and 16% on non-communicable diseases. The conference also highlighted the need to build research capacity to support researchers and institutions to strengthen their research skills, including research methodology, data analysis, interpretation, and scientific writing. Highly relevant findings were presented that had the potential to inform health policy and scale up the community-based health services towards Universal Health Coverage and Sustainable Development Goals.

Our public safety system is a perfect storm.

Public safety results from an effective interaction of three separate systems - public health, mental health, and policing. In too many communities today, the crisis in our mental health system creates the perfect storm. Solving the issues of silo-based care necessitates creating an oversight data management structure supporting cross-sector data integration on all levels ensuring that both operational and technical frameworks exist to maintain the security of client data. Safer communities isn't just about being sophisticated, technologically advanced but using an intensifying laser-focus analysis on harmful criminality, and on stakeholders responsible for delivering to those in need of mental health services. The recommendations note that no one agency can solve the crisis in public safety alone. There is an urgent need for one new coordinating agency - a department in government - to eliminate the silos and act like a well-coordinated and effective service delivery network, with public commitment to outcomes and corresponding public accountability.

Eliminating customer experience pain points in complex customer journeys through smart service solutions

AbstractScholarly understanding of customer journeys has evolved from a linear, single service provider perspective to encompass complex service delivery networks that involve multiple touchpoints governed by various service providers. This intricate setting often gives rise to experiential pain points for customers. To investigate this phenomenon within the context of airport services, our research employs critical incident and problem‐centered interviews as well as an analysis of 7192 online airport reviews. In Studies 1a and 2a, we explore the crucial pain points that travelers encounter throughout their airport journey. Complementing these insights, Studies 1b and 2b assess the impact of the identified pain points on travelers' emotions. Building upon a classification of pain points into information, performance, and hospitality themes, Study 3 further examines how smart service solutions, as new technologies, can address and resolve these pain points, ultimately enhancing the customer experience (CX). By accomplishing these objectives, our work contributes a comprehensive classification scheme for experiential pain points in complex customer journeys to the academic discourse on customer journeys. Furthermore, it establishes a connection to the emerging field of research on the impact of smart service solutions on the CX.

Governance of dependency relationships in mandated networks

ABSTRACT Mandated service delivery networks have become common in both developing and developed worlds; however, our understanding of what makes these arrangements work is still limited. In this study, we draw upon existing business literature, specifically focusing on dependency relationships and resulting opportunism within mandated networks, a critical but often overlooked aspect. Further, within mandated networks characterised by limited autonomy and trust, ways in which network members navigate dependency relationships remain unexplored. We conduct a comparative case analysis, examining network arrangements within India’s National Health Insurance Programme. Based on our findings, we propose that the nature of interdependence among network members and the resultant dependency relationships impact the conduct of network members and, thereby, network performance. If the dependency relationships are not governed effectively, conflict bargaining and opportunistic behaviours get manifested. Contrary to expectation, network performance tends to be higher in jurisdictions where dependency relationships are effectively governed through hierarchical authority. These findings hold significant relevance; as mandated networks are created under the shadow of hierarchy but governed through clan or trust-based mechanisms.

Managing the performance of healthcare networks: a ‘dance’ between control and collaboration

ABSTRACT This qualitative case study examines how the tension between control and collaboration is managed in the relationship between a Network Administrative Organization (NAO) and the 40 inter-organizational service delivery networks it governs using a performance management system. We found that the relationship between the NAO and networks operated as a ‘dance’, with the NAO taking steps to collaborate with and control the networks. We identified three forms of network governance ambidexterity that characterize this dance – structural, goal, and behavioural – and propose a framework of their antecedents, stability, and influencing factors. Network governance ambidexterity may help explain network functioning and performance.

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

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

Multiobjective Optimization of Public Health Service Delivery Networks

Providing an effective health service as a state is equivalent to giving life. Health services, whose pillar is to optimize the supply chain with public policies based on equity, are equal to providing life. Identifying all the variables and characteristics of the services allows the development of a multiobjective model to represent a public health services network. A case of the National Public Network of Colombia has been analyzed, minimizing costs and contributing to the decision making process. In this paper, a multiobjective approach to optimize the National Public Network in Colombia has been proposed. The proposed scheme combines mathematical techniques with managerial aspects related to public network health. Thus, we identify the distribution of services by the municipality to minimize the total cost and maximize coverage. The opening of services is suggested according to the demanding complexity and transport of patients between institutions. The results contrast with the current hospital services of Valle del Cauca in Colombia. The proposed scheme results show a reduction in the transfer of patients with a minimum increase in the costs of hospital services. The service proposal is based on improving access and quality in the provision of services, avoiding du- plication of supply, and generating an impact on the sustainability of the network of Valle del Cauca.

Evolution and lessons from an integrated service delivery network in North West Syria

BackgroundNorthwest Syria (NWS) is a complex and extremely fragile operating environment, with more than 2.8 million people needing humanitarian assistance. To support a common standard of care delivery and enable coordination among the multiple providers in NWS, WHO developed an Essential Health Services package (EHSP) in 2016-17 and subsequently supported a facility network model to deliver the EHSP. This article provides an evaluation of the network to date, aiming to inform further development of the network and draw wider lessons for application of similar approaches in complex emergency settings.MethodsThis mixed method study included document review, participatory, qualitative and quantitative data, gathered in the first half of 2021. Participatory data came from two group model building workshops with 21 funders and implementers. Semi-structured interviews with 81 funders, health professionals and community members were also conducted. Analyses of the workshops and interviews was inductive, however a deductive approach was used for synthesising insights across this and the document review. The final component was a survey of health providers (59 health care professionals) and service users (233 pregnant women and 214 persons living with NCDs) across network and other comparable facilities, analysed using routine descriptive and inferential statistics. Findings across all methods were triangulated.ResultsThe study finds that the network and its accompanying essential service package were relevant to the dynamic and challenging context, with high but shifting population needs and multiple uncoordinated providers. Judged in relation to its original goals of comprehensive, coordinated services, equitable access and efficient service delivery, the data indicate that gains have been made in all three areas through the network, although attribution is challenging, given the complex environment. The context remains challenging, with shifting boundaries and populations displaced by conflict, difficulties in retaining staff, the need to import medicines and supplies across borders, and governance gaps.ConclusionThis study adds to a very limited literature on coordinated network approaches used to raise care quality and improve referrals and efficiency in a complex emergency setting. Although areas of ongoing challenge, including for sustainability, are noted, the network demonstrated some resilience strategies and can provide lessons for other similar contexts.