Strengthening Health Services Research Articles

Improving the healthcare response to migrants landing in Lampedusa through a multimodal strategy.

Abstract Issue Lampedusa island is a crucial Italian entry point for migrants and the only health facility is the outpatient clinic that relies on the helicopter transfer to the mainland for urgencies. When the influx of migrants -and of tourists- increases, the health demand burden rises. Moreover, the plurality of the actors involved in migrants’ reception and assistance makes healthcare organization complex. In 2023, 115.000 arrivals were recorded with an increase of pregnant migrants transferred by helicopter; moreover, the lack of an EMTs-equipped ambulance and coordination gaps between actors were raised. Description of the practice Also paving on law 50/2023, in 2023 INMP and other institutions promoted a multimodal strategy to support healthcare in Lampedusa. A needs assessment grounded on settings and processes field observation and key stakeholders’ structured interviews was designed. Hence, an equipped ambulance service was set in September 2023 and an obstetric triage (ObT) procedure for pregnant migrants was tested. Further, operational protocols for migrants’ health have been drafted and enclosed in a MoU signed between key institutions, and a dedicated Committee monitoring protocol implementation was also set. Results Until now the ambulance has carried out 242 operations, mostly in response to community requests and ObT has led to using helicopter solely for real Ob urgencies. Also, the MoU has improved the coordination between actors, and the monitoring Committee-just settled-has already identified new priorities such as of defining a procedure for pregnant migrants requesting pregnancy termination. Lessons A multimodal strategy based on field assessment, enhancing coordination between actors and rolling-out of shared procedures has improved the effectiveness, efficiency and appropriateness of healthcare in Lampedusa, requiring a slight increase in resources. Remarkably, the healthcare reinforcing results in beneficial also for the general population. Key messages • Massive influx of migrants in Lampedusa has required strengthening health services on the island. • Evidence-based interventions based on needs assessment have improved healthcare for both migrants and the general population.

Optimizing Postpartum Depression Prevention in Primary Health Care Services

Post-partum depression (PPD) is a post-natal disorder that not only impacts the mental health of the mother but also has long-term effects on the development and well-being of the child and family. PPD is a preventable disorder, starting from interventions at primary health care facilities. As one of the developing countries with a PPD incidence of 22% per 100,000 births, PPD is considered an urgent public health issue in Indonesia. In practice, evaluation, and improvement of services at primary health care facilities are needed. This study aims to identify and adapt international intervention strategies to reduce post-partum depression prevalence in Indonesian primary health care. A scoping review analysis method was used, involving previous studies on activities from pregnancy to post-partum that can prevent and reduce post-partum depression. The reviewed articles employed Randomized Controlled Trials or Randomized Clinical Trials (RCT) methods with specific inclusion and exclusion criteria. Data were collected from relevant sources, and a synthesis was conducted on 16 articles that met the inclusion criteria. The results show that direct psychological support activities (through health professionals or groups) and indirect support using digital platforms and applications are effective in reducing depression. Strategies such as digital technology, direct support programs, physical therapy, pharmacological therapy, community involvement, and strengthening health services, particularly post-partum psychological counseling, are recommended to enhance prevention. This research supports the expansion of evidence-based strategies that can be implemented in primary healthcare facilities to address post-partum depression.

Evaluating the Impact and Awareness of the Ayushman Bharat Scheme in Bihar

The Ayushman Bharat Scheme, India's largest health insurance initiative, was launched in 2018 with the goal of achieving Universal Health Coverage as outlined in the National Health Policy 2017. This scheme comprises two components: the National Health Mission, which focuses on strengthening health services and promoting awareness in rural and urban areas, and the National Health Protection Mission, which provides free treatment up to Rs. 5 lakhs for 50 crore individuals from economically disadvantaged families. A survey conducted in four districts of Bihar—Bhagalpur, Banka, Munger, and Khagaria—revealed that rural areas have a higher registration rate (58%) compared to urban areas (37%). Social media (31%) and newspapers (21%) are the primary sources of information about the scheme, while gender participation is relatively balanced, with 44% women and 56% men registered. Despite these positive indicators, issues such as paperwork, Aadhaar card problems, and lack of information hindered some from registering. The scheme received an average rating of 3.83 out of 5, reflecting general satisfaction and strong trust (97%) among respondents, though no respondents had yet used the card. To improve the scheme’s reach and effectiveness, it is recommended to increase awareness through targeted social media and newspaper campaigns, simplify the registration process, expand information dissemination, address technical issues, and encourage active usage of the Ayushman Bharat card.

Women's Welfare, Stunting, and Access to Reproductive Rights: An Overview of The Situation in Indonesia

Stunting, as a global issue, has become a primary concern in Indonesia, with a declining trend in prevalence but still predominant indirect interventions for children under five years old. However, the impact of stunting on pregnant women or mothers of toddlers, who are the closest caregivers to stunted children, is often overlooked. Throughout the pregnancy and child-rearing periods, many reproductive rights of women remain unfulfilled, leading to suboptimal health conditions for both the mother and child. This research aims to describe sexual health rights, gender justice, and their relation to the stunting issue in Indonesia. The research method employed was a literature review accessing online databases, including Google Scholar, using keywords such as “stunting,” “women's rights,” “gender,” and “reproductive health rights.” Out of 700 articles identified, a reselection was conducted using the VoSViewer software to obtain literature relevant to the research theme. This article emphasizes that many health services in Indonesia are not optimal in fulfilling women's rights. Conversely, some health services are even challenging for women to access, indicating the government's negative contribution to fulfilling women's rights. Therefore, preventing stunting requires a broader and more integrative approach, including women's empowerment, reconstructing social norms regarding reproductive health, and strengthening health services that favor women. Consequently, the Indonesian government needs to intensify efforts to ensure the fulfillment of women's reproductive health rights as a strategic step in preventing stunting issues in the future.

IJCM_236A: Out-of-pocket expenditure on healthcare among geriatric population in central Kerala

Background: India is facing dual challenges caused by a rapid increase in burden of non-communicable diseases, marking epidemiological transition and an unprecedented expansion of geriatric population. The elderly faces a higher burden of disease due to a decline in their physical and immune systems, resulting in greater need and utilization of healthcare. The expanding geriatric population is inadequately supported by appropriate healthcare services which is essential for healthy ageing. Out-of-pocket expenditure on health carries significant adverse impacts. In order to lessen the financial burden of out-of-pocket medical expenses, the healthcare needs of the elderly ought to be addressed. Objectives: To assess the healthcare utilization pattern and out-of-pocket expenditure on healthcare among geriatric population in central Kerala. Methodology: A community based cross-sectional study was conducted among 150 elderly individuals, systematically sampled from 5 randomly selected wards of Adat Gram Panchayat in Thrissur district, Kerala. Data on sociodemographic characteristics, healthcare utilization and healthcare expenditure were collected using a pretested, semi-structured questionnaire by one-to-one interview. Appropriate statistical tests were used for analysis. Results: Mean age of respondents was calculated to be 72.64 ± 7.42. Majority (63.3%) preferred to utilize private health facility. 88.7% followed modern system of medicine. 43.3% had availed health insurance. Most commonly reported morbidities among elderly were Diabetes, hypertension and dyslipidaemia. The median direct medical cost was ?3000 (?560, ?4200) while the median direct non-medical cost was ?300 (?200, ?500). The total median out-of-pocket expenditure on healthcare among elderly was ?3550. Conclusion: Increasing burden of chronic diseases in elderly, high private healthcare utilization and suboptimal health insurance coverage leads to an increase in out-of-pocket expenditure on healthcare. Measures should be adopted for strengthening of health services and expanding insurance coverage among elderly, which in turn will reduce burden of out-of-pocket health expenditure.

Knowledge, attitudes and health choices among non-diabetic patients regarding diabetes mellitus

Background: Healthcare workers require better understanding of the current knowledge and behaviours of the local community towards diabetes mellitus (DM) and its prevention before appropriate interventions can be developed to address the gaps. There is currently a paucity of scientific papers on knowledge, attitudes and health choices among the non-diabetic population in a facility setting in South Africa.Methods: In this cross-sectional study, a self-reported questionnaire was administered to 165 adult participants attending the Chiawelo Community Practice from 02 March 2020 to 17 April 2020. The study utilised descriptive statistics, Chi-square testing, univariate logistic regression, and multivariate analysis for variable assessment.Results: Almost half of the participants (49%) had good knowledge of DM, with 60% indicating good attitudes and 52% making good health choices to prevent DM. Participants having received education from clinicians were 5.61 times more likely to develop better attitudes and 3.92 times more likely to adopt better health choices towards DM compared to those who obtained information from media or other sources.Conclusion: The study found that poor knowledge of DM does not necessarily translate into poor attitude towards the disease, which is noteworthy. The study also highlighted the important role of healthcare workers in influencing behaviour change.Contribution: Information from this study can be used to strengthen health services through several clinical governance activities including quality improvement, capacity building, health education and community-oriented promotion, and prevention strategies.

The socioeconomic impact of the COVID-19 lockdown on families affected by childhood respiratory illnesses in Cape Town, South Africa.

The COVID-19 pandemic impacted families globally, directly and indirectly. Children presenting with respiratory illnesses are affected by emerging health systems and socioeconomic changes in the COVID-19 era. We explored the socioeconomic impacts of the COVID-19 lockdown on families with a respiratory illness diagnosed in their child in Cape Town, South Africa. This study was nested in a prospective observational cohort of children presenting with respiratory symptoms presumptive of COVID-19. We conducted 21 semi-structured interviews to explore the socioeconomic impact of the COVID-19 pandemic on families with a child affected by respiratory illnesses. We used case descriptive analysis and thematically organised common and divergent experiences. We found that socioeconomic challenges in low-income communities were exacerbated: 1) loss of pre-COVID sources of income (loss of income, employment and working hours), 2) shrinking employment opportunities due to business closures and strict preventative measures, 3) family network dependence to cope with financial pressures, 4) impact on education, implicating additional pressures due to lack of resources for adequate home schooling and 5) caregivers' mental health and wellbeing being impacted, causing stress and anxiety due to loss of income. This study shows that the COVID-19 lockdown impacted the socioeconomic aspects of families caring for a child with a respiratory illness. Care became more complicated and adversely impacted the family's emotional well-being and health-seeking behaviour. These impacts should be more carefully considered in order to strengthen health services and global health messaging in future pandemics.

Strengthening health service delivery and governance through institutionalizing 'Urban Health Atlas'-A geo-referenced Information Communication and Technology tool: Lessons learned from an implementation research in three cities in Bangladesh.

Urban health governance in Bangladesh is complex as multiple actors are involved and no comprehensive data are currently available on infrastructure, services, or performance either in public and private sectors of the healthcare system. The Urban Health Atlas (UHA)-a novel and interactive geo-referenced, web-based visualization tool was developed in Bangladesh to provide geospatial and service information to decision makers involved in urban health service planning and governance. Our objective was to study the opportunities for institutionalization of the UHA into government health systems responsible for urban healthcare delivery and document the facilitators and barriers to its uptake. This implementation research was carried out during 2017-2019 in three cities in Bangladesh: Dhaka, Dinajpur and Jashore. During the intervention period, six hands-on trainings on UHA were provided to 67 urban health managers across three study sites. Thirty in-depth and twelve key informant interviews were conducted to understand user experience and document stakeholder perceptions of institutionalizing UHA. Capacity building on UHA enhanced understanding of health managers around its utility for service delivery planning, decision making and oversight. Findings from the IDIs and KIIs suggest that UHA uptake was challenged by inadequate ICT infrastructure, shortage of human resources and lack of ICT skill among managers. Motivating key decision makers and stakeholders about the potential of UHA and engaging them from its inception helped the institutionalization process. While uptake of UHA by government health managers appears possible with dedicated capacity building initiatives, its use and regular update are challenged by multiple factors at the implementation level. A clear understanding of context, actors and system readiness is foundational in determining whether the institutionalization of health ICTs is timely, realistic or relevant.

Leave no one behind: Rethinking policy and practice at the national level to prevent mental disorders

The global burden of mental disorders is increasing, in line with the shift from communicable to chronic non-communicable diseases. Mental disorders affect the functioning of individuals, resulting not only in enormous emotional suffering and diminished quality of life, but also in stigma and discrimination. This burden extends to the community and society, with far-reaching economic and social consequences. Even under optimal conditions, treatment alone will never be sufficient to reduce the global burden of mental disorders, so a shift in focus from treatment to prevention of mental disorders should be promoted at the central level in the form of legislation, policy formulation and resource allocation. Universal and selective prevention programs should be prioritized nationally, as they aim to change the risk profile of the entire population and specifically target populations at risk for mental disorders, respectively. In this article, we review the key risk factors for mental disorders and the measures that can be taken at the national level to prevent them, taking into due consideration that prevention efforts can vary based on the audience they are addressing, level of intensity they are providing, and the life phase they target. By adopting a human rights perspective and placing the social determinants of health at the center of our narrative, we maintain that improving mental health cannot be achieved by strengthening health services alone. Coordination across government departments is needed to implement multi-level public health interventions across a wide range of settings, programs, and policies. Focusing on children's mental health and addressing poverty, gender inequality and social discrimination should be absolute priorities for national mental health policies and plans.

Facilitating quality improvement by implementing quality accreditation standards at primary health care centre in Panvel taluka of Raigad district Maharashtra

Background: The Indian public health standard and Kayakalp guidelines are the main driver for continuous improvement in quality and bench mark for assessing the functional and cleanliness status of health facilities. Objectives were to assess PHC on IPHS and Kayakalp standard for continuous quality improvement. To conduct baseline and peer assessment of quality parameters using Indian public health standards and Kayakalp standard at primary health centre. To perform gap analysis and suggest quality improvement measures for meeting accreditation standards. To establish public private partnership for strengthening health services at PHC level. Methods: Descriptive observational study was conducted from September 2022 to June 2023 at Ajiwali PHC-Panvel taluka was selected using simple random sampling technique. Sample size of 83 patients was calculated as per the monthly case load of PHC. IPHS and Kayakalp assessment checklist, patient satisfaction forms were used for the survey. Various statistical tests like frequency, mean, percentage, S.E of difference between two proportions and two means were applied. Results: Kayakalp checklist baseline assessment score was 52.5% while post assessment score 72.5% showing significant improvement. Patient satisfaction survey pre and post assessment shows significant improvement where p value was <0.001 which was highly significant. IPHS survey shows partial improvement in training and quality parameters while other indicator remained the same. Conclusions: Regular quality assessment and accreditation leads to continuous quality improvement. Training and capacity building of PHC staff should be undertaken at regular intervals. Public private partnership modelling for various departments or service delivery components should be undertaken.

Innovative shortcuts and initiatives in primary health care for rural/remote localities: a scoping review on how to overcome the COVID-19 pandemic.

The COVID-19 pandemic has emerged as one of the greatest challenges to societies, world health systems and science in the past century, making it imperative to restructure care networks. Therefore, it is essential to discuss the role and initiatives of primary health care (PHC) to deal with it. However, regarding the response to the pandemic, including the current global effort against COVID-19, the nuances of the rural/remote PHC context in the pandemic is barely visible. Rural and remote communities have differentiated health risks, such as socioeconomic disadvantages, difficulties in mobility and access to health services, in addition to linguistic and cultural barriers. This scoping review aimed to analyze the set of individual and collective initiatives and innovations developed to face the COVID-19 pandemic, within the PHC scope, in rural and remote areas. A scoping review methodology was applied to peer-reviewed articles. Eight databases were searched to identify scientific articles published in English, Spanish and Portuguese, initially from January 2020 to July 2021, complemented by a rapid review of articles published from January 2022 to April 2023. The main focus sought in the literature was the set of initiatives and innovations carried out within the PHC scope in rural and remote locations during the pandemic, as well as the comparison with pre-pandemic situations and between different countries. The bibliographic information of each search result was imported into Rayyan (Intelligent Systematic Review), followed by the screening and eligibility stages, performed independently by two reviewers, with a third reviewer being accessed in case of conflicts. This review included 54 studies, with publications mostly from Australia, Canada, the US and India. The main PHC initiatives were related to access; to the roles of community health workers and health surveillance; and to the importance of placing, retaining and valuing human resources in health. Cultural, equity and vulnerability issues occupy a major place among the initiatives. Regarding the innovations, telehealth and customized communication are highlighted. From an organizational point of view, rural and remote locations showed enormous flexibility to deal with the pandemic and to improve intersectoral activities at the local level. The description of rurality and remoteness is practically coincident with that of the specific populations, present in geographic areas of difficult sociospatial and cultural access. Rarely, there is an index to measure rurality, or its description deals with the need to overcome distances and obstacles. The findings highlight and summarize knowledge about initiatives and innovations developed to face the COVID-19 pandemic, within the PHC scope in rural and remote areas in the world. This review has identified collective, clinical, intersectoral and, mainly, organizational health initiatives. An articulation between different government levels would be paramount in evaluating the implementation of policies and protocols in rural and remote locations for future sanitary crises. Innovations and lessons learned are equally relevant in strengthening health services and systems. This issue calls for considerable further exploration by new reviews and empirical research that seek evidence to assess the sustainability and effectiveness of the implemented measures to face post-pandemic difficulties and other adversities.

Health literacy among fathers and fathers-to-be: a multi-country, cross-sectional survey.

During pregnancy and early fatherhood, men are at higher risk of poor health, exacerbated by low engagement by healthcare services. Yet the transition to fatherhood presents an opportunity for men to improve their health and health behaviours. Health literacy refers to individuals' competence in accessing and applying health information. Poor health literacy is associated with poor health and low help-seeking. The aim of this study was to identify health literacy strengths, needs and profiles among fathers. Men who were expecting a baby ('antenatal') or had become fathers in the past 18 months ('postnatal') were recruited through an international, online paid survey platform. The survey included the nine-scale Health Literacy Questionnaire (HLQ). Of 889 survey respondents (n = 416, 46.5% antenatal; n = 473, 53.5% postnatal), 274 (31.0%) were residing in the USA and 239 (27.0%) in the UK. Relatively higher scores were reported for HLQ scales relating to having sufficient information and finding and understanding this information, as well as social support for health. Relatively lower scores were obtained for scales relating to actively managing one's own health and navigating the health care system. Three scale scores were significantly lower among nulliparous than multiparous men. Seven health literacy profiles were identified. In conclusion, while fathers have some health literacy strengths, they also experience some barriers, particularly first-time fathers. Awareness of diverse health literacy profiles among fathers may assist in developing strategies to strengthen health services' capacity to meet fathers' needs and reduce risks to their health at this critical juncture in families' lives.

HPV vaccine program for cervical cancer prevention: how to increase community acceptance?

Cervical cancer is Indonesia's second leading cause of death and a significant health financing burden. In 2021, there were 36,633 cases, most caused by HPV (95%). This cancer can be prevented with HPV immunization. The Indonesian government is committed to vaccine-preventing diseases and strengthening health services, focusing on prevention. Immunizations are given to girls in grades 5 and 6 of elementary school to achieve a minimum of 90% immunization coverage and reduce cervical cancer. Support from all parties is needed for the success of this program.

A systems approach to strengthening health service delivery in catastrophic injury related disability

A systems approach to strengthening health service delivery in catastrophic injury related disability

The political economy of 'strengthening health services': The view from WHO AFRO, 1951-c.1985.

Our contribution to this special issue examines the early history of international striving for universal health care, from the perspective of the World Health Organisation's (WHO's) Regional Office for Africa (AFRO). The aspiration was repeatedly reframed, from 'strengthening health services' in the 1948 constitution of the World Health Organisation (WHO), to 'Health For All' through primary health care (PHC) in the 1970s, to today's articulations of universal coverage and 'health systems strengthening'. We aim to establish how AFRO supported member states in implementing these policies up to the mid-1980s, and with what degree of success. We also compare AFRO's experience to the established historiographical narrative of global health, as over-fixated on vertical interventions, save for the transitory impact of the PHC movement. Using the archives of WHO in Geneva and AFRO in Brazzaville, we first analyse AFRO's influence and capacity through quantitative financial data. The AFRO nations were net recipients of WHO resources, raising questions about their relative autonomy and voice in the organisation. We then examine AFRO's expenditure, showing that though circumscribed by funds with allocated purposes, there was nonetheless a significant proportion committed to services from the early 1960s, specifically capacity for planning and administration and the nursing, maternal and child health workforce. Counter to expectations though, there was no significant boost to these areas, nor to funding PHC projects, in the 1970s/early 1980s, when disease-specific interventions obtained a larger share. Qualitative sources show that despite its slender resources AFRO accomplished much with respect to training, capacity building and supporting innovative service-delivery, while insisting on African policy input into design and implementation. However country level system-wide planning in health was persistently vulnerable, and the bureaucratic capacity of post-colonial states often weak. Thus AFRO's overall impact was decisively bounded by the global structural inequalities in which it operated.

Innovative Strategies to Strengthen Health Service Delivery for Universal Health Coverage in Africa – A Scoping Literature Review

African nations have failed to achieve the mandate of health for all forty years after Alma Ata declaration. To achieve Universal Health Coverage (UHC), government alone are unable to solve the problems of health service delivery such as lack of good infrastructure, poor management, inter-cadre conflicts, lack of skilled birth attendants amongst others. This review assessed the involvement of non-state actors (private sector/philanthropists) in achieving UHC in Africa. We explored eight databases and search engines using specific search terms. We retrieved and conducted a detailed review of 47 publications comprising published literature and reports focused on private sector/philanthropy involvement in achieving UHC in Africa, and explored the challenges and opportunities. We included both qualitative and quantitative studies published in English. Inequity and a wide gap exist in countries’ health care service delivery due to numerous challenges such as chronic economic instability, bureaucracy, poor healthcare financing, corruption among others. Review of existing literature suggests that as Africa embarks on reforms toward UHC there is a great need for involvement of private sector/philanthropists to support government in addressing challenges facing health care system. The type of involvement revealed were; provision of infrastructure (hospital buildings/facility, good roads), technical support, technological innovations, provision of diagnostic and therapeutic equipment, financial support and other support services. This scoping review showed that private and philanthropist actors’ involvement in healthcare system have huge potentials to improve, restore and maintain health service delivery in African nations. This will accelerate progress towards the achieving UHC by 2030.

OPTIMALISASI STRATEGI PERTOLONGAN PERTAMA PADA GAWAT DARURAT PADA MASYARAKAT DI DESA SUNGAI ALAT KECAMATAN ASTAMBUL

Emergency events can occur anytime and anywhere, and require immediate treatment, because they can be life threatening or cause permanent disability. Emergency events can be caused, among others, by traffic accidents, diseases, fires and natural disasters. One of the three main pillars of the Healthy Indonesia Program is strengthening health services, including strategies to increase access to health services, optimize the referral system and improve the quality of health services, where one way is through the Integrated Emergency Management System Purpose Emergency assistance is expected to reduce the complications of a disease. This service activity is in partnership with Sungai Alat Village, Astambul District. The form of emergency first aid that can be given to prevent complications due to trauma, bleeding and shock is to provide training in first aid methods for trauma, bleeding and shock. The activity began with socialization of activities, followed by strengthening of cadres, training in emergency first aid in cases of bleeding, trauma and shock. Based on these activities, it can be concluded that after conducting emergency first aid training, the majority of participants already know the definition, purpose, benefits, indications and contraindications and procedures for carrying out emergency first aid. In addition, the majority of participants also felt enthusiastic and interested in performing emergency first aid.

Analysis of digital contact tracing technologies employed during COVID-19 Pandemic

Corona virus (COVID-19) is a worldwide pandemic that was first reported in Wuhan, China 2019.The virus claimed lives and negatively changed the mobility patterns of humans. As a measure to control the spread of the virus, Digital Contact Tracing Technologies (DCTTs) were employed to contain the virus. The (DCTTs) are used to track and notify users digitally about their interactions with infected individuals and help strengthen health service systems. The most widely used Digital Contact Tracing Technologies include those that use Global Positioning, Bluetooth, Quick Response (QR) Codes and Wireless Fidelity (Wi-Fi). These technologies depend on monitoring symptoms, mobility of a person, location and proximity of individuals. This paper reviews literature by analyzing the Digital Contact Tracing Technologies (DCTTs) employed for COVID-19 through a desk study. The review highlights the advantages and disadvantages of using these technologies, with an aim of recommending ways in which the technologies can be used to attain maximum benefit.

EXPLORATION OF DISTRICT-LEVEL INNOVATIONS TO ADDRESS MATERNAL AND NEONATAL MORTALITY IN INDONESIA

Background: The Indonesian maternal and neonatal mortality rates remain some of the highest in Southeast Asia. Aims: This study aims to assess and compare district-level innovations that address maternal and neonatal mortality. Methods: This was a qualitative study conducted via four focus group discussions in eight selected districts in November 2021. Data obtained were analyzed using the WHO health system building blocks framework. Results: The study found high variation in districts’ innovations ranging from expansion of service for maternity waiting homes to periodical obstetrician visits at Puskesmas. A majority of districts use a local approach as the basis for innovation. Some innovations are modifications of the national program or initiated purely by District Health Offices, Puskesmas, and the community. Many interventions are based on multisectoral commitment, community participation, and targeting to strengthen health service delivery. Leadership and health financing also have an influence on the implementation of these innovations. Conclusion: The multitude of innovations reflects a high variation in barriers to reducing maternal and neonatal mortality that need to be addressed at the district level. A routine forum to share districts’ best practices is warranted. Additionally, family-based surveillance for neonatal danger signs, monitoring for pregnant women and neonates via WhatsApp, and zoning systems for referrals to healthcare facilities in larger districts are innovations identified in this study that have potential to be replicated in other districts or expanded nationally.

National policy of Ukraine on Rare (Orphan) Diseases

According to the Ministry of Health of Ukraine, 80% of patients with rare diseases in Ukraine die within 5 years due to the lack of systematic diagnosis and qualified treatment. This is more than, for example, 50% in France. As Russia’s military incursion continues to disrupt basic health services, major efforts are needed to restore and strengthen health services, including access to medicines and medical equipment. Under these circumstances, the heroic work of doctors, both on the territory of our country and abroad, who, despite the challenges faced by the community of rare diseases in Ukraine, did not stop for a moment their work to support and help the community of patients with rare diseases and the mobilization of political advocacy and legislation at the national level. Currently, humanitarian organizations and the international community are making maximum efforts to generally protect the most vulnerable segment of the population, which is affected by the conflict, cannot leave and does not have access to humanitarian aid. The current situation should not undermine the reality that the needs of people living with a rare disease are real, enormous and unmet. The creation of legal, economic and administrative mechanisms for the realization of the constitutional rights of the population of Ukraine suffering from rare (orphan) diseases, preservation and strengthening of their health, extension of the period of active longevity and length of their lives is one of the main tasks of the state. So, the article proposes a structured complex political program document aimed at solving the issues of patients suffering from rare (orphan) diseases. During the development and formation of this state policy, the best practices of developed European countries were used. An overview of the state and problems of national regulatory and organizational support in the field of access to treatment for patients with rare (orphan) diseases was also conducted. Scientific achievements of domestic and foreign researchers, statistical data of state authorities, international organizations and own author’s research were taken into account.