Sustainable Healthcare Delivery Research Articles

Managing Sustainable Health Care Delivery in the UAE

Managing Sustainable Health Care Delivery in the UAE

Axiomatic Design Based Human Resources Management for the Enterprise Transformation of the Abu Dhabi Healthcare Labor Pool

The quality and reliability of a nation's healthcare system is often driven by the number and diversity of its healthcare professionals. Unfortunately, many developing nations have constrained segments of highly skilled labor and must “import” this human capital. Volatility in key healthcare professions can threaten reliable and sustainable healthcare delivery. This article considers the development of a healthcare human resources sector in a quickly developing nation as an enterprise transformation problem. In this article, the axiomatic design large flexible system modeling framework is used to assess healthcare delivery capability in Abu Dhabi, UAE. Here, each profession type is modeled as a functional requirement, and the physical hierarchy is modeled at individual, healthcare facility, and regional levels. The knowledge base is filled with the associated number of professionals of a given type provided by the corresponding design parameters. The Abu Dhabi case study shows significant volatility in th...

Inequalities in Health: The Role of Health Insurance in Nigeria.

Health financing is a core necessity for sustainable healthcare delivery. Access inequalities due to financial restrictions in low-middle income countries, and in Africa especially, significantly affect disease rates and health statistics in these regions. This paper focuses on the role of a national health insurance cover as a funding medium in Nigeria, highlighting the theoretical premise of health insurance, its driving forces, key benefits and key limitations particular to the country under scrutiny. Emphasis is laid on its overall effect on the pressing public health issue of health inequality.

Challenges of implementing sustainable health care delivery in Nigeria under environmental uncertainty

Introduction: The increasing cost of health care in developed and developing economies has called for a change in the way health activities are implemented. Nigeria is faced with fundamental health care related challenges coupled with recent security issues. Uncertainty prevails as health system dynamics unfolds. Objectives: To explore the relationship between environmental uncertainty and health care delivery system in Nigeria. The study aims at reviewing the dynamics of health care delivery in some developed economies and Nigeria with regard to methods of adaptation of health care under uncertainty, and developing a framework for sustainable health care delivery. Methods: Databases were searched for relevant literatures using the following keywords: environmental and health uncertainty, Nigerian health care system, Nigerian primary health care, health care financing and sustainability. Other keywords used include: US, Europe and China health care dynamics, among others. Scientific databases obtained from the Internet were used including online journals, which were sourced mainly from the Google. Relationships if any were established and a framework for sustainability developed. Results: Environmental uncertainty has a multiplicity of interactions with different aspects of health care system, resulting in poor infrastructural development, inadequate government funding, absence of integrated system for disease prevention and surveillance, policy reversals, security challenges, and unimpressive health indicators in Nigeria. A framework for implementing sustainable health care delivery under uncertainty is proposed. Discussion and conclusion: Uncertainty abounds in the Nigerian health care delivery system; causing further distortion in development of the health sector. Effective mobilization of health care professionals, use of sustainable care plans by government, use of integrated medical intelligence and surveillance systems, accountability, commitment, and above all quality leadership - will minimize uncertainty factors and enhance health care performance and sustainability in Nigeria.

Using mHealth Tools to Improve Rural Diabetes Care Guided by the Chronic Care Model.

Used as an integrated tool, mHealth may improve the ability of healthcare providers in rural areas to provide care, improve access to care for underserved populations, and improve biophysical outcomes of care for persons with diabetes in rural, underserved populations. Our objective in this paper is to present an integrated review of the impact of mHealth interventions for community dwelling individuals with type two diabetes. A literature search was performed using keywords in PubMed to identify research studies which mHealth technology was used as the intervention. Interventions using mHealth have been found to improve outcomes, be cost effective, and culturally relevant. mHealth technology that has been used to improve outcomes include: seeking out health information via the web, access to appointment scheduling and medication refills, secure messaging, computerized interventions to manage a chronic condition, use of a personal health record, use of remote monitoring devices, and seeking support from others with similar health concerns through social networks. Using the validated Chronic Care Model to translate what is known about mHealth technology to clinical practice has the potential to improve the ability of healthcare providers in rural areas to provide care, improve access to care for underserved populations, and improve biophysical outcomes of care for persons with diabetes in rural underserved populations. While these approaches were effective in improving some outcomes, they have not resulted in the establishment of the necessary electronic infrastructure for a sustainable mobile healthcare delivery model.

Internet of Things as Key Enabler for Sustainable Healthcare Delivery

Many errors occurring in healthcare are related to the lack of availability of important patient-related medical information. According to researchers, the use of information and communication technologies (ICTs) hold promise for increasing the accessibility of medical information and it is essential for patient safety. Furthermore, new developments in information and computing technologies will lead to subsequent dramatic changes in the healthcare environment. A vast and multilayered infrastructure of ubiquitous computing technologies and applications is emerging. The current widespread deployment of cell phones, laptops, Wi-Fi, Bluetooth, personal digital assistants (PDAs), and various forms of sensing devices based on digital and radio frequency identification (RFID) technologies penetrate the healthcare environment. The Internet of Things infrastructure allows connections between different entities, such as human beings (patients, medical staff, etc.), medical devices, intelligent wheelchairs, wireless sensors, mobile robots, etc.This paper aims to show how radio frequency identification, multi-agent and Internet of Things technologies can be used to improve people's access to quality and affordable healthcare services, to reduce medical errors, to improve patient safety, and to optimize the healthcare processes.

Putting health policy and systems research on the map

Putting health policy and systems research on the map

Addressing maternal healthcare through demand side financial incentives: experience of Janani Suraksha Yojana program in India.

BackgroundDemand side financing (DSF) is a widely employed strategy to enhance utilization of healthcare. The impact of DSF on health care seeking in general and that of maternal care in particular is already known. Yet, its effect on financial access to care, out-of-pocket spending (OOPS) and provider motivations is not considerably established. Without such evidence, DSFs may not be recommendable to build up any sustainable healthcare delivery approach. This study explores the above aspects on India’s Janani Suraksha Yojana (JSY) program.MethodsThis study employed design and was conducted in three districts of Orissa, selected through a three-stage stratified sampling. The quantitative method was used to review the Health Management Information System (HMIS). The qualitative methods included focus groups discussions with beneficiaries (n = 19) and community intermediaries (n = 9), and interviews (n = 7) with Ministry of Health officials. HMIS data enabled to review maternal healthcare utilization. Group discussions and interviews explored the perceived impact of JSY on in-facility delivery, OOPS, healthcare costs, quality of care and performance motivation of community health workers.ResultsThe number of institutional deliveries, ante-and post-natal care visits increased after the introduction of JSY with an annual net growth of 18.1%, 3.6% and 5% respectively. The financial incentive provided partial financial risk-protection as it could cover only 25.5% of the maternal healthcare cost of the beneficiaries in rural areas and 14.3% in urban areas. The incentive induced fresh out-of-pocket spending for some mothers and it could not address maternal care requirements comprehensively. An activity-based community worker model was encouraging to augment maternal healthcare consumption. However, the existing level of financial incentives and systemic support were inadequate to motivate the volunteers optimally on their performance.ConclusionDemand side financial incentive could enhance financial access to maternal healthcare. However, it did not adequately protect households from financial risks. An effective integration of JSY with similar social protection or financial risk-protection measures may protect mothers substantially from potential out-of-pocket spending. Further, this integrated approach may help upholding more awareness on maternal health rights and entitlements. It can also address maternal health beyond ‘maternal healthcare’ and ensure sustainability through pooled financial and non-financial resources.

Point of care ultrasound for sepsis management in resource-limited settings: time for a new paradigm for global health care

Dear Editor, We applaud the ESICM Global Intensive Care Working Group for its pivotal contribution to the improvement of sepsis management in developing countries [1]. Dunser et al. acknowledge that health-care practices of industrialized nations are not available to the majority of humanity. On the basis of this current reality the authors offer guidelines regarding approaches to the management of sepsis in limited-resource settings. Surprisingly, we found no mention of the use of point-of-care ultrasound (POC-US) [2] beyond a generic recommendation to ‘‘use imaging techniques when available’’ [1]. Since 1985 ultrasonography has been recommended for developing countries by the World Health Organization (WHO) [3], as an inexpensive, rapidly deployable, and portable tool with minimal side effects. This is true today more than ever. Notwithstanding the lack of randomized, controlled trials on POC-US use in the specific setting of sepsis, increasing scientific evidence suggests tremendous potential for this tool in managing critical patients with infectious diseases. POC-US can be of great aid in the diagnosis of infectious diseases in rural areas [4], and generically in the detection of septic foci in febrile states [5]. It has a significant impact on mitigating diagnostic uncertainty in undifferentiated shock, narrowing differential diagnosis [6], and improving the specificity of early recognition of hypovolemia [7] and septic shock cardiovascular patterns [8]. Lung ultrasound has indeed a broad spectrum of established applications in the diagnosis and management of respiratory infectious diseases [9]—the leading cause of childhood mortality in developing countries [10]. The potential of POCUS in sepsis management is wide [11], and includes procedure-guidance applications that are increasingly acknowledged as best practice [12, 13]. With regards to education, innovative ultrasound curricula have been shaped for non-imaging specialists [14]. Short-term POC-US training programs are proven to deliver adequate knowledge and skills to novices [15]. And proof-of-concept studies have been conducted in the screening for infection sources in resource-limited settings of tropical countries [16]. Furthermore, low-cost technology can now provide minimally POC-UStrained operators (paramedics, midwives) with tele-mentoring and second-opinion facilities [17], mitigating the impracticable availability of ‘‘experienced practitioners’’ in all settings. This is of paramount importance for sustainable healthcare delivery where the patient-tophysician ratio is dramatically high. The use of POC-US represents a paradigm shift for improving health-

Johns Hopkins on the chip: microsystems and cognitive machines for sustainable, affordable, personalised medicine and healthcare

Semiconductor technology is contributing to the advancement of biotechnology, medicine and healthcare delivery in ways that it was never envisioned - from chip micro-arrays, to scientific grade CMOS imagers and ion sensing arrays to implantable prosthesis. This exponential growth of sensory microsystems has led to an exponential growth of data. Cognitive machines, i.e. advanced computer architectures and algorithms, are carefully co-designed to extract knowledge from such health data making rational decisions and recommendations for therapies. Nano, micro and macro robotics driven by sophisticated algorithms interface to the human body at different levels and scales, from nano-scale molecules to micron-scale cells to networks and all the way to the scale of organisms. The present era is one where semiconductor technology and the -chip- is the foundation of sustainable and affordable personalised medicine and healthcare delivery.

Evolution of a Sustainable Surgical Delivery Model

For the past 28 years, Operation Smile has mobilized thousands of volunteers to provide life-changing cleft lip, cleft palate, and other facial deformity surgery to more than 150,000 children in countries all over the world. Our mission is to provide surgical care for children with the goal of developing sustainable health care delivery models for surgical services worldwide. For more than a quarter century, we have learned that good judgment comes from experience and that experience comes from bad judgment. However, it has been woven throughout this sometimes painful, always exhilarating growth process in which we have realized that our mission had so much more power than we initially anticipated that it would. Originally, we focused on the face of a child and our ability to provide a surgery that would change that child's life forever. Today, we still stand in awe of the transformative power of this experience, but we have also realized the great power that lies in educating medical professionals and providing state-of-the-art equipment. For us, action took shape in the form of us establishing a business model at home and in each of our partner countries. This included setting up financial reporting systems and creating program models that organized volunteers to provide care for children outside the reach of where surgery was currently available. Through our journey, we have realized that there is power in the healed face of a child. That moment gives us the opportunity to feel the passion for the service we have the privilege to provide. It is that emotion that leads us to action.

Utilization of a mobile medical van for delivering pediatric care in the bateys of the Dominican Republic

BackgroundBateys are impoverished areas of housing for migrant Haitian sugar cane workers in the Dominican Republic (DR). In these regions, preventative health care is almost non-existent, public service accessibility is limited, and geographic isolation prevents utilization of care even by those families with resources. Consequently, the development of a viable mobile system is vital to the delivery of acute and preventative health care in this region.AimsThis study evaluated an existing mobile medical system. The primary goal was to describe the population served, diseases treated, and resources utilized. A secondary goal was to determine qualitatively an optimal infrastructure for sustainable health care delivery within the bateys.MethodsInformation on basic demographic data, diagnosis, chronicity of disease, and medications dispensed was collected on all pediatric patients seen in conjunction with an existing mobile medical system over a 3-month period in the DR. Health statistics for the region were collected and interviews were conducted with health care workers (HCWs) and community members on existing and optimal health care infrastructure.ResultsFive hundred eighty-four pediatric patients were evaluated and treated. Median age was 5 years (range 2 weeks to 20 years), and 53.7% of patients seen were 5 years of age or younger. The mean number of complaints per patient was 2.8 (range 0 to 6). Thirty-six percent (373) of all diagnoses were for acute complaints, and 64% (657) were chronic medical problems. The most common pediatric illnesses diagnosed clinically were gastrointestinal parasitic infection (56.6%), skin/fungal infection (46.2%), upper respiratory tract infections (URIs) (22.8%), previously undiagnosed asthma and allergies (8.2%), and symptomatic anemia (7.2%). Thirty HCWs and community members were interviewed, and all cited the need for similar resources: a community clinic and hospital referral site, health promoters within each community, and the initiation of pediatric training for community HCWs.ConclusionA mobile medical system is a sustainable, efficient mechanism for delivering acute and preventive care in the Haitian bateys of the Dominican Republic. The majority of patients served were 8 years of age or younger with multiple presenting symptoms. A pediatric protocol for identifying the most appropriate drugs and supplies for mobile units in the DR can be created based upon diseases evaluated. Qualitative data from HCWs and community members identified the need for an integrative health care delivery infrastructure and community health promoters versed in pediatric care who can aid in education of batey members and monitor chronic and acute illnesses. We are planning follow-up visits to implement these programs.

Achieving progress in maternal and neonatal health through integrated and comprehensive healthcare services – experiences from a programme in northern Tanzania

BackgroundAn integrated and comprehensive hospital/community based health programme is presented, aimed at reducing maternal and child mortality and morbidity. It is run as part of a general programme of health care at a rural hospital situated in northern Tanzania. The purpose was through using research and statistics from the programme area, to illustrate how a hospital-based programme with a vision of integrated healthcare may have contributed to the lower figures on mortality found in the area. Such an approach may be of interest to policy makers, in relation to the global strategy that is now developed in order to meet the MDGs 4 and 5.Programme settingThe hospital provides reproductive and child health services, PMTCT-plus, comprehensive emergency obstetric care, ambulance, radio and transport services, paediatric care, an HIV/AIDS programme, and a generalised healthcare service to a population of approximately 500 000.Programme description and outcomesWe describe these services and their potential contribution to the reduction of the maternal and neonatal mortality ratios in the study area. Several studies from this area have showed a lower maternal mortality and neonatal mortality ratio compared to other studies from Tanzania and the national estimates. Many donor-funded programmes focusing on maternal and child health are vertical in their framework. However, the hospital, being the dominant supplier of health services in its catchment area, has maintained a horizontal approach through a comprehensive care programme. The total cost of the comprehensive hospital programme described is 3.2 million USD per year, corresponding to 6.4 USD per capita.ConclusionConsidering the relatively low cost of a comprehensive hospital programme including outreach services and the lower mortality ratios found in the catchment area of the hospital, we argue that donor funds should be used for supporting horizontal programmes aimed at comprehensive healthcare services. Through a strengthening of the collaboration between government and voluntary agency facilities, with clinical, preventive and managerial capabilities of the health facilities, the programmes will have a more sustainable impact and will achieve greater progress in the reduction of maternal and neonatal mortality, as opposed to vertical and segregated programmes that currently are commonly adopted for averting maternal and child deaths. Thus, we conclude that horizontal and comprehensive services of the type described in this article should be considered as a prerequisite for sustainable health care delivery at all policy and decision-making levels of the local, national and international health care delivery pyramid.

Sustainable Healthcare Delivery Paradigm for the 21st Century

Sustainable Healthcare Delivery Paradigm for the 21st Century

Community-based antenatal and perinatal interventions and newborn survival

As part of the millennium development goal (MDG) 4 to reduce by two-thirds the mortality rate among children under five, neonatal mortality rate (NMR) needs to be reduced by half. This is a selective review of the literature of the morbidity and mortality patterns among newborns as well as cost-effective interventions and community aspects of newborn care. Documented causes of morbidity and mortality among newborns were examined in the overall context of developing and developed countries. Cost-effective interventions that have been proven to be inexpensive with evidence or potential to save newborns' lives by international agencies concerned with health, journals and other publications were reviewed. Community aspects of newborn care and what is required at the individual, household and community levels to reduce neonatal morbidity and mortality were also reviewed. A score of recent publications by the World Health Organization (WHO), Save-the-Children, United Nations Children's Fund (UNICEF), journals, and other scientific publications reported consistently that neonatal mortality constitute 40-70% of deaths in infancy and that 99% of these deaths occurred in developing countries, with highest neonatal mortality rates (NMRs) in sub-Saharan Africa. The global burden of newborn illness shows that a disparity of up to 30-folds exists between countries with highest and lowest NMRs. Four million babies die in developing countries and about 42% of these deaths are due to infections. Other major causes include perinatal asphyxia (21%), birth injuries (11%), prematurity and low birth weight (10%) and congenital abnormalities (11%). It was also observed that two-thirds of the deaths in the neonatal period occur in the first week; among these deaths, two-thirds occurred within the first 24 hours. Review findings also revealed that an integrated, proven and cost-effective intervention such as the mother-baby packages incorporated into a functional and sustainable healthcare delivery system and improved household practices will save newborns' lives. Reports showed that to achieve meaningful development, neonatal mortality will need to be reduced in developing countries. Programmes that are necessary for the reduction in neonatal morbidity and mortality rates are for countries to employ rational mix of quality clinical services, effective public health measures and inexpensive community-based interventions in public and private sectors and to scale-up known cost-effective interventions.

Vaccination strategies in developing countries.

By 1990 it is hoped that all of the world's infants will have access to immunization services and that these services will then continue indefinitely. The link between people and health services, including immunization, can only be forged and maintained by an effective system of delivery and support to all health workers. A careful choice of strategies for this delivery system and an understanding of local cultural attitudes and behaviour is vital if this link is to be effective. Health workers will have to be trained and then supported in the field by regular contact with their supervisors. They will also need continuous, reliable, predictable and adequate supplies of equipment, drugs, vaccines, fuel and money, including salaries. Immunization is cost effective as a health intervention, but an effective programme of immunization can contribute much more than just vaccines, if it is developed in the context of primary health care (PHC) as originally proposed in 1978 at the conference in Alma Ata.