'Shedding light' on the challenges faced by Palestinian maternal health-care providers.

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Hassan-Bitar, Sahar; Narrainen, Sheila

2011-04-01

to explore the challenges and barriers faced by Palestinian maternal health-care providers (HCPs) to the provision of quality maternal health-care services through a case study of a Palestinian public referral hospital in the Occupied Palestinian Territory. descriptive qualitative study. The data are from a broader study, conducted in 2005 at the same hospital as part of a baseline assessment of maternal health services. 31 maternal HCPs; nine midwives and 14 nurses and eight doctors. the quality of care provided for women and infants at this Palestinian public hospital is substandard. The maternal HCPs work within a difficult and resource-constrained environment. ISSUES INCLUDE: high workload, poor compensation, humiliation in the workplace, suboptimal supervision and the absence of professional support and guidance. Midwives are perceived to be at the bottom of the health professional hierarchy. there is a need for managers and policy makers to enable maternal HCPs to provide better quality care for women and infants during childbirth, through facilitating the roles of midwives and nurses and creating a more positive and resourceful environment. Palestinian midwives need to increase their knowledge and use evidence-based practices during childbirth. They need to unite and create their own circle of professional support in the form of a Palestinian midwifery professional body. Copyright © 2009 Elsevier Ltd. All rights reserved.

User fees and maternity services in Ethiopia.

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Pearson, Luwei; Gandhi, Meena; Admasu, Keseteberhan; Keyes, Emily B

2011-12-01

To examine user fees for maternity services and how they relate to provision, quality, and use of maternity services in Ethiopia. The national assessment of emergency obstetric and newborn care (EmONC) examined user fees for maternity services in 751 health facilities that provided childbirth services in 2008. Overall, only about 6.6% of women gave birth in health facilities. Among facilities that provided delivery care, 68% charged a fee in cash or kind for normal delivery. Health centers should be providing maternity services free of charge (the healthcare financing proclamation), yet 65% still charge for some aspect of care, including drugs and supplies. The average cost for normal and cesarean delivery was US $7.70 and US $51.80, respectively. Nineteen percent of these facilities required payment in advance for treatment of an obstetric emergency. The health facilities that charged user fees had, on average, more delivery beds, deliveries (normal and cesarean), direct obstetric complications treated, and a higher ratio of skilled birth attendants per 1000 deliveries than those that did not charge. The case fatality rate was 3.8% and 7.1% in hospitals that did and did not charge user fees, respectively. Utilization of maternal health services is extremely low in Ethiopia and, although there is a government decree against charging for maternity service, 65% of health centers do charge for some aspects of maternal care. As health facilities are not reimbursed by the government for the costs of maternity services, this loss of revenue may account for the more and better services offered in facilities that continue to charge user fees. User fees are not the only factor that determines utilization in settings where the coverage of maternity services is extremely low. Additional factors include other out-of-pocket payments such as cost of transport and food and lodging for accompanying relatives. It is important to keep quality of care in mind when user fees are under

Components of Maternal Healthcare Delivery System Contributing to ...

African Journals Online (AJOL)

Components of Maternal Healthcare Delivery System Contributing to Maternal Deaths ... transcripts were analyzed using a directed approach to content analysis. Excerpts were categorized according to three main components of the maternal ...

"Someone's rooting for you": continuity, advocacy and street-level bureaucracy in UK maternal healthcare.

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Finlay, Susanna; Sandall, Jane

2009-10-01

Continuity and advocacy are widely held to be important elements in maternal healthcare, yet they are often lacking from the care women receive. In order to understand this disparity, we draw upon interviews and ethnographic observational findings from The One-to-One Caseload Project, a study exploring the impacts of a caseload model of maternity care within an urban National Health Service provider in Britain. Drawing on Lipsky's (1980) and Prottas's (1979) theories of street-level bureaucracy, this paper attempts to understand how midwives, working on the frontline within caseload and standard care models, manage the competing demands of delivering a personalised service within a bureaucratic organisation. The caseload care model serves as a case study for how a client-centred model of working can assist street-level bureaucrats to manage the administrative pressures of public service organisations and provide their clients with a personalised, responsive service. Nevertheless, despite such benefits, client-centred models of working may have unintended consequences for both health carers and healthcare systems.

The Effect of Armed Conflict on the Utilization of Maternal Health Services in Uganda: A Population-based Study.

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Namasivayam, Amrita; Arcos González, Pedro; Castro Delgado, Rafael; Chi, Primus Che

2017-10-03

Maternal mortality rates can be adversely affected by armed conflict, implying a greater level of vulnerability among women, and is often linked to the lack of or limited access to maternal healthcare during conflict. Previous research in Uganda has shown that armed conflict negatively impacts women's utilization of maternal healthcare services for a multitude of reasons at the individual, health-system and political levels. This study compared aggregated Demographic and Health Surveys data from 13 districts in Northern Uganda, a conflict-affected region, with data from the rest of the country, for the use of maternal healthcare services for the years 1988, 1995, 2000, 2006 and 2011, using statistical analyses and logistic regression. Specific indicators for maternal healthcare utilization included contraceptive use, antenatal care, skilled assistance at birth and institutional delivery. Use of contraception and institutional deliveries among women in Northern Uganda was significantly lower compared to the rest of the country. However, skilled assistance at birth among women in Northern Uganda was significantly higher. The findings in this study show that armed conflict can have a negative impact on aspects of maternal healthcare such as contraceptive use and institutional deliveries; however, other indicators such as skilled assistance at birth were seen to be better among conflict-affected populations. This reiterates the complex nature of armed conflict and the interplay of different factors such as conflict intensity, existing health systems and services, and humanitarian interventions that could influence maternal healthcare utilization. Armed conflict, maternal health utilization, Northern Uganda, contraception, skilled assistance at birth, antenatal care, institutional delivery.

Clinical handover practices in maternity services in Ireland: A qualitative descriptive study.

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Fealy, Gerard; Munroe, Deirdre; Riordan, Fiona; Croke, Eilish; Conroy, Celine; McNamara, Martin; Shannon, Michael

2016-08-01

the objective was to examine and describe clinical handover practices in Irish maternity services. the study design incorporated interviews and focus group discussions with a purposive sample of healthcare practitioners working in Irish maternity services. five maternity hospitals and fourteen co-located maternity units. midwives, obstetricians and other healthcare professionals, specifically physiotherapists and radiologists, midwifery students and health care assistants working in maternity services. the study participants provided nuanced and differentiated accounts of clinical handover practices, which indicated a general absence of formal policy and training on clinical handover and the practice of midwifery and medical teams holding separate clinical handovers based on their separate, respective needs for transferring information and clinical responsibility. Participants spoke of barriers to effective clinical handover, including unsuitable environments, lack of dedicated time and fatigue during duty shift clinical handover, lack of supportive information technology (IT) infrastructure, and resistance of some staff to the adoption of new technologies to support clinical handover. whether internal and external to clinical handover events, the barriers to effective clinical handover represent threats to patient safety and quality of care, since effective clinical handover is essential to the provision of safe quality care. clear and effective communication between collaborating professionals within maternity teams is essential. Copyright © 2016 Elsevier Ltd. All rights reserved.

The (unreceptive experiences of female rape victims who seek healthcare services

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Luciana de Amorim Barros

2015-04-01

Full Text Available OBJECTIVE To know the structure and functioning of healthcare services from the perspective of women who have suffered rape. METHOD A qualitative study conducted with 11 women who experienced rape, monitored in a maternity in the state of Alagoas, Brazil. Data were systematically based on content analysis. RESULTS It allowed for understanding the path taken by women in search of support from health services, as well as the limitations and capabilities of these services. CONCLUSION The assistance received in healthcare services leans towards a revictimization process of women who already carry trauma from the rape. It is necessary to reflect about care practices aimed at sexually victimized women.

Operationalising the Lean principles in maternity service design using 3P methodology.

Science.gov (United States)

Smith, Iain

2016-01-01

The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as "wrap around care" in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements.

Approaches towards improving the quality of maternal and newborn health services in South Asia: challenges and opportunities for healthcare systems.

Science.gov (United States)

Mian, Naeem Uddin; Alvi, Muhammad Adeel; Malik, Mariam Zahid; Iqbal, Sarosh; Zakar, Rubeena; Zakar, Muhammad Zakria; Awan, Shehzad Hussain; Shahid, Faryal; Chaudhry, Muhammad Ashraf; Fischer, Florian

2018-02-06

South Asia is experiencing a dismal state of maternal and newborn health (MNH) as the region has been falling behind in reducing the levels of maternal and neonatal mortality. Most of the efforts are focused on enhancing coverage of MNH services; however, quality remains a serious concern if the region is to achieve expected outcomes in terms of standardised MNH services within healthcare delivery systems. This research consists of a review of South Asian quality improvement (QI) approaches/interventions, specifically implemented for MNH improvement. A literature review of QI approaches/interventions was conducted using the PRISMA guidelines. Online databases, including PubMed, the Cochrane Library and Google Scholar, were searched. Primary studies published between 1998 and 2013 were considered. Studies were initially screened and selected based upon the selection criteria for data extraction. A thematic synthesis/analysis was performed to organise, group and interpret the key findings according to prominent themes. Thirty studies from six South Asian countries were included in the review. Findings from these selected studies were grouped under eight broad, cross-cutting themes, which emerged from a deductive approach, representing the most commonly employed QI approaches for improving MNH services within different geographical settings. These consist of capacity building of healthcare providers on clinical quality, clinical audits and feedback, financial incentives to beneficiaries, pay-for-performance, supportive supervision, community engagement, collaborative efforts and multidimensional interventions. Employing and documenting QI approaches is essential in order to measure the potential of an intervention, considering its cost-effectiveness, feasibility and acceptability to communities. This research concluded that QI approaches are very diverse and cross-cutting, because they are subject to the varied requirements of regional health systems. This high level

Impact of Distance in the Provision of Maternal Health Care Services and Its Accountability in Murarai-II Block, Birbhum District

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Alokananda Ghosh

2016-06-01

Full Text Available The maternal health issue was a part of the Millennium Development Goals (MDGs, Target-5. Now it has been incorporated into Target-3 of 17 points Sustainable Development Goal-2030, declared by the United Nations, 2015. In India, about 50% of newborn deaths can be reduced by taking good care of the mother during pregnancy, childbirth and postpartum period. This requires timely, well-equipped healthcare by trained providers, along with emergency transportation for referral obstetric emergency. Governments need to ensure physicians in the rural underserved areas. The utilisation of maternal healthcare services (MHCSs depends on both the availability and accessibility of services along with accountability. This study is based on an empirical retrospective survey, also called a historic study, to evaluate the influences of distance on the provision of maternal health services and on its accountability in Murarai-II block, Birbhum District. The major objective of the study is to identify the influence of distance on the provision and accountability of the overall MHCSs. The investigation has found that there is a strong inverse relationship (-0.75 between accessibility index and accountability score with p-value = 0.05. Tracking of pregnant women, identification of high risk pregnancy and timely Postnatal Care (PNC have become the dominant factors of the maternal healthcare services in the first Principal Component Analysis (PCA, explaining 49.67% of the accountability system. Overall, institutional barriers to accessibility are identified as important constraints behind lesser accountability of the services, preventing the anticipated benefit. This study highlights the critical areas where maternal healthcare services are lacking. The analysis has highlighted the importance of physical access to health services in shaping the provision of maternal healthcare services. Drawing on empirical observations of operation of public distribution system in

Stakeholders' perspectives on facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea: a qualitative study.

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Chol, Chol; Hunter, Cynthia; Debru, Berhane; Haile, Berhana; Negin, Joel; Cumming, Robert G

2018-01-19

Wars affect maternal health services by destroying health systems. Eritrea experienced two wars with neighbouring Ethiopia. Despite this, the maternal mortality ratio (MMR) in Eritrea fell by 69% from 1590 per 100,000 live births in 1990 to 501 in 2015. This study aimed to examine facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea. Using in-depth interviews and field observations for data collection, this qualitative study was conducted in five healthcare facilities in Asmara, the capital of Eritrea, in February and March 2016. The participants were: women (n = 40), husbands (n = 5), healthcare providers (n = 10), and decision makers (n = 5). There were two perceived facilitators of utilisation of and access to maternal health services: health education (related to the WHO health service delivery building blocks) and improvement in gender equality driven by the role played by Eritrean women as combatants during the War of Independence (1961-1991). The only perceived barrier was poor quality of care due to lack of ultrasound machines, short clinic opening hours, and shortage of healthcare workers (related to the WHO health workforce building block). This study assessed women and their husbands/partners' perceptions and the possible effects of contemporary Eritrean culture and the history of war on the utilisation of and access to maternal health services in the country. As well, we examined healthcare providers' and decision makers' perspectives. The two key facilitators of women's utilisation of and access to maternal health services were health education and women's empowerment driven by their role as combatants during the War of Independence. One main barrier was poor quality of care due to lack of ultrasound machines, short clinic opening hours, and a shortage of healthcare workers. As only a limited number of qualitative studies have been published about maternal health services in war

Immigrant women's experiences of maternity-care services in Canada: a systematic review using a narrative synthesis.

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Higginbottom, Gina M A; Morgan, Myfanwy; Alexandre, Mirande; Chiu, Yvonne; Forgeron, Joan; Kocay, Deb; Barolia, Rubina

2015-02-11

Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. Our focus was on (a) the accessibility and acceptability of maternity-care services for immigrant women and (b) the effects of the perceptions and experiences of these women on their birth and postnatal outcomes. We conducted a systematic review using a systematic search and narrative synthesis of peer-reviewed and non-peer-reviewed reports of empirical research, with the aim of providing stakeholders with perspectives on maternity-care services as experienced by immigrant women. We partnered with key stakeholders ('integrated knowledge users') to ensure the relevancy of topics and to tailor recommendations for effective translation into future policy, practice and programming. Two search phases and a three-stage selection process for published and grey literature were conducted prior to appraisal of literature quality and narrative synthesis of the findings. Our knowledge synthesis of maternity care among immigrants to Canada provided a coherent evidence base for (a) eliciting a better understanding of the factors that generate disparities in accessibility, acceptability and outcomes during maternity care; and (b) improving culturally based competency in maternity care. Our synthesis also identified pertinent issues in multiple sectors that should be addressed to

Maternal healthcare in context: A qualitative study of women's tactics to improve their experience of public healthcare in rural Burkina Faso

DEFF Research Database (Denmark)

Østergaard, Lise Rosendal

2015-01-01

their chances of having a positive experience with public maternal healthcare. The synthesis of the cases shows that, in a context of poverty and social insecurity, women employ five tactics: establishing good relations with health workers, being mindful of their ‘health booklet’, attending prenatal care......Improving the use of public maternal health facilities to prevent maternal death is a priority in developing countries. Accumulating evidence suggests that a key factor in choosing a facility-based delivery is the collaboration and the communication between healthcare providers and women....... This article attempts to provide a fine-grained understanding of health system deficiencies, healthcare provider practices and women's experiences with maternal public healthcare. This article presents findings from ethnographic research conducted in the Central-East Region of Burkina Faso over a period...

[Fostering LGBT-friendly healthcare services].

Science.gov (United States)

Wei, Han-Ting; Chen, Mu-Hong; Ku, Wen-Wei

2015-02-01

LGBT (lesbian, gay, bisexual, transgender) patients suffer from stigma and discrimination when seeking healthcare. A large LGBT healthcare survey revealed that 56% of gay patients and 70% of transgender patients suffered some type of discrimination while seeking healthcare in 2014. The fostering of LGBT-friendly healthcare services is not just an advanced step of gender mainstreaming but also a fulfillment of health equality and equity. Additionally, LGBT-friendly healthcare services are expected to provide new opportunities for healthcare workers. Therefore, proactive government policies, education, research, and clinical practice should all encourage the development of these healthcare services. We look forward to a well-developed LGBT-friendly healthcare system in Taiwan.

Effect of Health Insurance on the Use and Provision of Maternal Health Services and Maternal and Neonatal Health Outcomes: A Systematic Review

Science.gov (United States)

Peterson, Lauren A.; Hatt, Laurel E.

2013-01-01

Financial barriers can affect timely access to maternal health services. Health insurance can influence the use and quality of these services and potentially improve maternal and neonatal health outcomes. We conducted a systematic review of the evidence on health insurance and its effects on the use and provision of maternal health services and on maternal and neonatal health outcomes in middle- and low-income countries. Studies were identified through a literature search in key databases and consultation with experts in healthcare financing and maternal health. Twenty-nine articles met the review criteria of focusing on health insurance and its effect on the use or quality of maternal health services, or maternal and neonatal health outcomes. Sixteen studies assessed demand-side effects of insurance, eight focused on supply-side effects, and the remainder addressed both. Geographically, the studies provided evidence from sub-Saharan Africa (n=11), Asia (n=9), Latin America (n=8), and Turkey. The studies included examples from national or social insurance schemes (n=7), government-run public health insurance schemes (n=4), community-based health insurance schemes (n=11), and private insurance (n=3). Half of the studies used econometric analyses while the remaining provided descriptive statistics or qualitative results. There is relatively consistent evidence that health insurance is positively correlated with the use of maternal health services. Only four studies used methods that can establish this causal relationship. Six studies presented suggestive evidence of overprovision of caesarean sections in response to providers’ payment incentives through health insurance. Few studies focused on the relationship between health insurance and the quality of maternal health services or maternal and neonatal health outcomes. The available evidence on the quality and health outcomes is inconclusive, given the differences in measurement, contradictory findings, and

Effect of Government-Community Healthcare Co-Financing on ...

African Journals Online (AJOL)

BACKGROUND: Effective maternal and child healthcare delivery requires a proper and adequate funding of the health sector. OBJECTIVE: To determine the effect of government-community healthcare co-financing on maternal and child healthcare services' delivery. METHODS: A descriptive, cross-sectional study with an ...

The Cuban National Healthcare System: Characterization of primary healthcare services.

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Keli Regina DAL PRÁ

2015-10-01

Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

'What men don't know can hurt women's health': a qualitative study of the barriers to and opportunities for men's involvement in maternal healthcare in Ghana.

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Ganle, John Kuumuori; Dery, Isaac

2015-10-10

The importance of men's involvement in facilitating women's access to skilled maternal healthcare in patriarchal societies such as Ghana is increasingly being recognised. However, few studies have been conducted to examine men's involvement in issues of maternal healthcare, the barriers to men's involvement, and how best to actively involve men. The purpose of this paper is to explore the barriers to and opportunities for men's involvement in maternal healthcare in the Upper West Region of Ghana. Qualitative focus group discussions, in-depth interviews and key informant interviews were conducted with adult men and women aged 20-50 in a total of seven communities in two geographic districts and across urban and rural areas in the Upper West Region of Ghana. Attride-Stirling's thematic network analysis framework was used to analyse and present the qualitative data. Findings suggest that although many men recognise the importance of skilled care during pregnancy and childbirth, and the benefits of their involvement, most did not actively involve themselves in issues of maternal healthcare unless complications set in during pregnancy or labour. Less than a quarter of male participants had ever accompanied their wives for antenatal care or postnatal care in a health facility. Four main barriers to men's involvement were identified: perceptions that pregnancy care is a female role while men are family providers; negative cultural beliefs such as the belief that men who accompany their wives to receive ANC services are being dominated by their wives; health services factors such as unfavourable opening hours of services, poor attitudes of healthcare providers such as maltreatment of women and their spouses and lack of space to accommodate male partners in health facilities; and the high cost associated with accompanying women to seek maternity care. Suggestions for addressing these barriers include community mobilisation programmes to promote greater male involvement

Coproduction of healthcare service.

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Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans

2016-07-01

Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation.

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Basinga, Paulin; Gertler, Paul J; Binagwaho, Agnes; Soucat, Agnes L B; Sturdy, Jennifer; Vermeersch, Christel M J

2011-04-23

Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026-0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. The P4P scheme in Rwanda had

Factors Influencing Healthcare Service Quality

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Ali Mohammad Mosadeghrad

2014-07-01

Full Text Available Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality.

Evaluation of Maternal Health Service Indicators in Urban Slum of Bangladesh.

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Jolly, Saira Parveen; Rahman, Mahfuzar; Afsana, Kaosar; Yunus, Fakir Md; Chowdhury, Ahmed M R

2016-01-01

A continuous influx of poor people to urban slums poses a challenge to Bangladesh's health system as it has failed to tackle maternal morbidity and mortality. BRAC is the largest non-governmental organisation in Bangladesh. BRAC has been working to reduce maternal, neonatal and under-five children morbidity and mortality of slum dwellers in cities. BRAC has been doing this work for a decade through a programme called MANOSHI. This programme provides door-to-door services to its beneficiaries through community health workers (CHWs) and normal delivery service through its delivery and maternity centres. BRAC started the 'MANOSHI' programme in Narayanganj City Corporation during 2011 to address maternal, neonatal and child health problems facing slum dwellers. We investigated the existing maternal health-service indicators in the slums of Narayanganj City Corporation and compared the findings with a non-intervention area. This cross-sectional study was conducted during 2012, in 47 slums of Narayanganj City Corporation as intervention and 10 slums of Narsingdi Sadar Municipality as comparison area. A total of 1206 married women, aged 15-49 years, with a pregnancy outcome in the previous year were included for interview. Data on socio-demographic characteristics, reproductive and maternal health-care practices like use of contraceptive methods, antenatal care (ANC), delivery care, postnatal care (PNC) were collected through a structured questionnaire. The chi-square test, Student t test, Mann Whitney U-test, factor analysis and log-binominal test were performed by using STATA statistical software for analysing data. The activities of BRAC CHWs significantly improved four or more ANC (47% vs. 21%; pslums compared to comparison slums. Still, about half of the deliveries in both areas were attended at home by unskilled birth attendants, of which a very few received PNC within 48 hours after delivery. The poorest and illiterate women received fewer maternal health services

Inequities in accessibility to and utilisation of maternal health services in Ghana after user-fee exemption: a descriptive study.

Science.gov (United States)

Ganle, John K; Parker, Michael; Fitzpatrick, Raymond; Otupiri, Easmon

2014-11-01

Inequities in accessibility to, and utilisation of maternal healthcare services impede progress towards attainment of the maternal health-related Millennium Development Goals. The objective of this study is to examine the extent to which maternal health services are utilised in Ghana, and whether inequities in accessibility to and utilization of services have been eliminated following the implementation of a user-fee exemption policy, that aims to reduce financial barriers to access, reduce inequities in access, and improve access to and use of birthing services. We analyzed data from the 2007 Ghana Maternal Health Survey for inequities in access to and utilization of maternal health services. In measuring the inequities, frequency tables and cross-tabulations were used to compare rates of service utilization by region, residence and selected socio-demographic variables. Findings show marginal increases in accessibility to and utilisation of skilled antenatal, delivery and postnatal care services following the policy implementation (2003-2007). However, large gradients of inequities exist between geographic regions, urban and rural areas, and different socio-demographic, religious and ethnic groupings. More urban women (40%) than rural, 53% more women in the highest wealth quintile than women in the lowest, 38% more women in the best performing region (Central Region) than the worst (Upper East Region), and 48% more women with at least secondary education than those with no formal education, accessed and used all components of skilled maternal health services in the five years preceding the survey. Our findings raise questions about the potential equity and distributional benefits of Ghana's user-fee exemption policy, and the role of non-financial barriers or considerations. Exempting user-fees for maternal health services is a promising policy option for improving access to maternal health care, but might be insufficient on its own to secure equitable access to

Explorations of the Effect of Experience on Preferences for a Health-Care Service

OpenAIRE

Neuman, Einat; Neuman, Shoshana

2007-01-01

The standard assumption in economic theory is that preferences do not change as a result of experience with the commodity/service/event. Behavioural scientists have challenged this assumption, claiming that preferences constantly do change as experience is accumulated. This paper tests the effect of experience with a health-care service on preferences for maternity-ward attributes. In order to explore the effect of experience on preferences, the research sample was decomposed into three sub-s...

Utilization of healthcare services in postpartum women in the Philippines who delivered at home and the effects on their health: a cross-sectional analytical study.

Science.gov (United States)

Yamashita, Tadashi; Reyes Tuliao, Maria Teresa; Concel Meana, Magdalena; Suplido, Sherri Ann; Llave, Cecilia L; Tanaka, Yuko; Matsuo, Hiroya

2017-01-01

A low ratio of utilization of healthcare services in postpartum women may contribute to maternal deaths during the postpartum period. The maternal mortality ratio is high in the Philippines. The aim of this study was to examine the current utilization of healthcare services and the effects on the health of women in the Philippines who delivered at home. This was a cross-sectional analytical study, based on a self-administrated questionnaire, conducted from March 2015 to February 2016 in Muntinlupa, Philippines. Sixty-three postpartum women who delivered at home or at a facility were enrolled for this study. A questionnaire containing questions regarding characteristics, utilization of healthcare services, and abnormal symptoms during postpartum period was administered. To analyze the questionnaire data, the sample was divided into delivery at home and delivery at a facility. Chi-square test, Fisher's exact test, and Mann-Whitney U test were used. There were significant differences in the type of birth attendant, area of residence, monthly income, and maternal and child health book usage between women who delivered at home and those who delivered at a facility ( P Financial and environmental barriers might hinder the utilization of healthcare services by women who deliver at home in the Philippines. Low utilization of healthcare services in women who deliver at home might result in more frequent abnormal symptoms during postpartum.

Effects of women's autonomy on maternal healthcare utilization in Bangladesh: Evidence from a national survey.

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Haider, Mohammad Rifat; Qureshi, Zaina P; Khan, M Mahmud

2017-12-01

This study aims to construct an index of women's autonomy to analyze its effect on maternal healthcare utilization in Bangladesh. Empirical modeling of the study used instrumental variable (IV) approach to correct for possible endogeneity of women's autonomy variable. Data from the Bangladesh Demographic and Health Survey (BDHS) 2011 was used for the study. Women's autonomy variable was obtained through factor analysis of variables related to autonomy in decision making regarding healthcare, financial autonomy and freedom of movement. Conditional mixed process (CMP) models were fitted for three maternal healthcare indicators: at least four antenatal care (ANC) by trained personnel, institutional delivery and postnatal care (PNC) by trained personnel. Study sample consisted of 8753 women with 5.5 mean years of schooling. Women with no formal education, of Islamic faith, from poorest wealth quintile, residing in rural areas and with low autonomy used the maternal healthcare least. Marginal effect shows that if women's autonomy score is increased by one unit, probability of maternal healthcare utilization will increase by 0.14 for ANC, 0.14 for institutional delivery, and 0.13 for PNC. Women's autonomy is an important driver of maternal healthcare utilization in Bangladesh. Results suggest that women participating in social and economic activities enhances their autonomy. Other factors affecting women's autonomy are female literacy, educational attainment and households' economic status. Copyright © 2017 Elsevier B.V. All rights reserved.

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

Science.gov (United States)

Gopalan, Saji S; Durairaj, Varatharajan

2012-09-15

Demand 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. This 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. The 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. Demand side financial incentive could enhance financial

Utilization of Antenatal HealthCare Services among Fishermen Population in Kanchipuram District, Tamil Nadu: A Cross-sectional Study.

Science.gov (United States)

Danasekaran, Raja; Raja, Pavithra; Ranganathan, Karnaboopathy

2017-01-01

Considering the global and national level commitments in improving the maternal health as well as reducing the maternal mortality, assessment of factors influencing the delivery of antenatal healthcare services becomes essential. The aim is to assess the utilization of antenatal health services and to identify the factors influencing their utilization among women of fishermen population in Kanchipuram district, Tamil Nadu. The cross-sectional study was carried out among the mothers in Kovalam area of Kanchipuram district. Details were collected using a pretested questionnaire and analyzed using statistical software. The study included 284 mothers, of which 35% were illiterates. Nearly 60.21% have got registered with the Government sector, 59.51% of the mothers had three or more antenatal visits, 64.08% have received two doses of tetanus toxoid, and 73.24% have taken iron and folic acid tablets. Factors which were identified to have statistically significant association with better utilization of antenatal health services were age >30 years, higher educational status, skilled workers, those having their first child, and higher socioeconomic class. This study has reported the fact that antenatal healthcare services were not utilized fully by the community and the fishermen population being a special group has to be given the needed attention from the healthcare delivery system.

Saving for delivery through technology: an inquiry into an electronic commitment savings product for maternal healthcare in Kenya.

Science.gov (United States)

van Bastelaer, Thierry; Woodman, Benjamin; Chatterji, Minki; Long, David

2016-10-01

Many women in low-income countries cannot afford maternal healthcare services. Changamka, a Kenyan company, developed an electronic, stored-value card to help pregnant women save for maternal healthcare at a Nairobi hospital. This paper reports results from a mixed-methods process evaluation of the card's implementation. The study found high levels of uptake and identified several benefits of the program, such as facilitating payment for services. The evaluation also identified several challenges. Most users completed only one transaction before discontinuing card use; only 6% of women who acquired the card used it to pay for delivery, and slightly less than 1% used it as it was originally intended-to pay for several antenatal care visits and for delivery. According to respondents, the main reason for this discontinuation was a lack of understanding about how to use the card. Users were, on average, of a higher socioeconomic and educational status than non-card users. Most users obtained the card in their third trimester, and among those who used the card to save for delivery, most started to do so too late in pregnancy to accumulate sufficient savings to pay for that service. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Birthing Centers and Hospital Maternity Services

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... Educators Search English Español Birthing Centers and Hospital Maternity Services KidsHealth / For Parents / Birthing Centers and Hospital Maternity Services What's in this article? Giving Birth at ...

Backcasting to identify food waste prevention and mitigation opportunities for infant feeding in maternity services.

Science.gov (United States)

Ryan-Fogarty, Yvonne; Becker, Genevieve; Moles, Richard; O'Regan, Bernadette

2017-03-01

Food waste in hospitals is of major concern for two reasons: one, healthcare needs to move toward preventative and demand led models for sustainability and two, food system sustainability needs to seek preventative measures such as diet adaptation and waste prevention. The impact of breast-milk substitute use on health services are well established in literature in terms of healthcare implications, cost and resourcing, however as a food demand and waste management issue little has been published to date. This paper presents the use of a desk based backcasting method to analyse food waste prevention, mitigation and management options within the Irish Maternity Service. Best practice in healthcare provision and waste management regulations are used to frame solutions. Strategic problem orientation revealed that 61% of the volume of ready to use breast-milk substitutes purchased by maternity services remains unconsumed and ends up as waste. Thirteen viable strategies to prevent and manage this waste were identified. Significant opportunities exist to prevent waste and also decrease food demand leading to both positive health and environmental outcomes. Backcasting methods display great promise in delivering food waste management strategies in healthcare settings, especially where evidenced best practice policies exist to inform solution forming processes. In terms of food waste prevention and management, difficulties arise in distinguishing between demand reduction, waste prevention and waste reduction measures under the current Waste Management Hierarchy definitions. Ultimately demand reduction at source requires prioritisation, a strategy which is complimentary to health policy on infant feeding. Copyright © 2016 Elsevier Ltd. All rights reserved.

PUBLIC FINANCING OF HEALTHCARE SERVICES

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Agnieszka Bem

2013-10-01

Full Text Available Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ, state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions.

Improving Maternal and Child Healthcare Programme Using Community-Participatory Interventions in Ebonyi State Nigeria

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Chigozie Jesse Uneke

2014-10-01

Full Text Available In Nigeria, the government is implementing the Free Maternal and Child Health Care Programme (FMCHCP. The policy is premised on the notion that financial barriers are one of the most important constraints to equitable access and use of skilled maternal and child healthcare. In Ebonyi State, Southeastern Nigeria the FMCHCP is experiencing implementation challenges including: inadequate human resource for health, inadequate funding, out of stock syndrome, inadequate infrastructure, and poor staff remuneration. Furthermore, there is less emphasis on community involvement in the programme implementation. In this policy brief, we recommend policy options that emphasize the implementation of community-based participatory interventions to strengthen the government’s FMCHCP as follows: Option 1: Training community women on prenatal care, life-saving skills in case of emergency, reproductive health, care of the newborn and family planning. Option 2: Sensitizing the community women towards behavioural change, to understand what quality services that respond to their needs are but also to seek and demand for such. Option 3: Implementation packages that provide technical skills to women of childbearing age as well as mothers’ groups, and traditional birth attendants for better home-based maternal and child healthcare. The effectiveness of this approach has been demonstrated in a number of community-based participatory interventions, building on the idea that if community members take part in decision-making and bring local knowledge, experiences and problems to the fore, they are more likely to own and sustain solutions to improve their communities’ health.

Utilization of maternal health services among adolescent women in Bangladesh: A scoping review of the literature.

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Shahabuddin, A S M; Delvaux, Thérèse; Abouchadi, Saloua; Sarker, Malabika; De Brouwere, Vincent

2015-07-01

To understand the health-seeking behaviour of adolescent women in Bangladesh with respect to the use of maternal health services. Literature review of seven electronic databases: PubMed, ISI Web of Knowledge, PsycINFO, Embase, CINAHL, POPLINE and Global Health. Studies published in English between 1990 and 2013 which describe Bangladeshi adolescent women's healthcare-seeking behaviour during pregnancy, delivery and post-partum were included. Twelve studies were included in this review. 11 used quantitative methods and one used a mixed-methods approach. All studies included married adolescent women only. Women with lower educational levels are less likely to seek skilled maternal health services than those with higher levels of education. Use of maternal health services is also less common among rural married adolescent women than women in urban areas. Being part of the richest bands of wealth, having had previous experiences of childbirth and higher women's autonomy positively influence the use of skilled maternal health services among married adolescent women in Bangladesh. Antenatal care is a key predictor of the use of skilled birth attendants for delivery and post-natal care. Maternal health-related programmes should be designed targeting rural and uneducated married adolescent women in Bangladesh. More qualitative investigations are required to broaden our understanding on maternal health-seeking behaviour of both married and unmarried adolescent women. © 2015 John Wiley & Sons Ltd.

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

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Gopalan Saji S

2012-09-01

Full Text Available Abstract Background Demand 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. Methods This 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. Results The 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

Supply chain dynamics in healthcare services.

Science.gov (United States)

Samuel, Cherian; Gonapa, Kasiviswanadh; Chaudhary, P K; Mishra, Ananya

2010-01-01

The purpose of this paper is to analyse health service supply chain systems. A great deal of literature is available on supply chain management in finished goods inventory situations; however, little research exists on managing service capacity when finished goods inventories are absent. System dynamics models for a typical service-oriented supply chain such as healthcare processes are developed, wherein three service stages are presented sequentially. Just like supply chains with finished goods inventory, healthcare service supply chains also show dynamic behaviour. Comparing options, service reduction, and capacity adjustment delays showed that reducing capacity adjustment and service delays gives better results. The study is confined to health service-oriented supply chains. Further work includes extending the study to service-oriented supply chains with parallel processing, i.e. having more than one stage to perform a similar operation and also to study the behaviour in service-oriented supply chains that have re-entrant orders and applications. Specific case studies can also be developed to reveal factors relevant to particular service-oriented supply chains. The paper explains the bullwhip effect in healthcare service-oriented supply chains. Reducing stages and capacity adjustment are strategic options for service-oriented supply chains. The paper throws light on policy options for managing healthcare service-oriented supply chain dynamics.

32 CFR 728.71 - Ex-service maternity care.

Science.gov (United States)

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Ex-service maternity care. 728.71 Section 728.71... FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other Persons § 728.71 Ex-service maternity... certified by medical authorities that the pregnancy existed prior to entry into service (EPTE), maternity...

Sociocultural barriers to maternity services delivery: a qualitative meta-synthesis of the literature.

Science.gov (United States)

Sumankuuro, J; Crockett, J; Wang, S

2018-04-01

Maternal and neonatal healthcare outcomes in Sub-Saharan Africa (SSA) remain poor despite decades of different health service delivery interventions and stakeholder investments. Qualitative studies have attributed these results, at least in part, to sociocultural beliefs and practices. Thus there is a need to understand, from an overarching perspective, how these sociocultural beliefs affect maternal and neonatal health (MNH) outcomes. A qualitative meta-synthesis of primary studies on cultural beliefs and practices associated with maternal and neonatal health care was carried out, incorporating research conducted in any country within SSA, using data from men, women and health professionals gathered through focus group discussions, structured and semistructured interviews. A systematic search was carried out on seven electronic databases, Scopus, Ovid Medline, PubMed, CINAHL Plus, Humanities and Social Sciences (Informit), EMBASE and Web of Science, and on Google Scholar, using both manual and electronic methods, between 1st January 1990 and 1st January 2017. The terms 'cultural beliefs'; 'cultural beliefs AND maternal health'; 'cultural beliefs OR maternal health'; 'traditional practices' and 'maternal health' were used in the search. Key components of cultural beliefs and practices associated with adverse health outcomes on pregnancy, labour and the postnatal period were identified in five overarching factors: (a) pregnancy secrecy; (b) labour complications attributed to infidelity; (c) mothers' autonomy and reproductive services; (d) marital status, trust in traditional medicines and traditional birth attendants; and (e) intergenerational beliefs attached to the 'ordeal' of giving birth. Cultural beliefs and practices related to maternal and neonatal health care are intergenerational. Therefore, intensive community-specific education strategies to facilitate behaviour changes are required for improved MNH outcomes. Adopting practical approaches such as

Assessing international trade in healthcare services

OpenAIRE

Herman, Lior

2009-01-01

Growing evidence indicates that international trade in healthcare services is growing. Nevertheless, a major literature gap exists with regard to the nature of international healthcare trade and its extent. Taking a comprehensive approach, this research examines the magnitude, directions, patterns of specialisation, growth and other aspects related to international trade in healthcare services. Within this framework, trade is analysed with regard to cross border trade, consumption of healthca...

Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study.

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Islam, Farzana; Rahman, Aminur; Halim, Abdul; Eriksson, Charli; Rahman, Fazlur; Dalal, Koustuv

2015-06-19

Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines. The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health

Data reliability in home healthcare services

NARCIS (Netherlands)

Vavilis, S.; Zannone, N.; Petkovic, M.

2013-01-01

Home healthcare services are emerging as a new frontier in healthcare practices. Data reliability, however, is crucial for the acceptance of these new services. This work presents a semi-automated system to evaluate the quality of medical measurements taken by patients. The system relies on data

The use of digital media by women using the maternity services in a developed country.

Science.gov (United States)

O'Higgins, A; Murphy, O C; Egan, A; Mullaney, L; Sheehan, S; Turner, M J

2014-01-01

The provision of high quality healthcare information about pregnancy is important to women and to healthcare professionals and it is 1 driven, in part, by a desire to improve clinical outcomes,. The objective of this study was to examine the use of digital media by women' to access pregnancy information. A questionnaire was distributed to women attending a large maternity hospital. Of the 522 respondents, the mean age was 31.8 years, 45% (235/522) were nulliparous, 62% (324/522) lived in the capital city and 29% (150/522) attended the hospital as private patients. Overall 95% (498/522) used the internet for pregnancy information, 76% (399/522) had a smartphone and 59% (235/399) of smartphone owners had used a pregnancy smartapp. The nature of internet usage for pregnancy information included discussion forums (70%), social networks (67%), video media (48%), e-books (15%), blogs (13%), microblogs (9%) and podcasts (4%). Even women who were socially disadvantaged reported high levels of digital media usage. In contemporary maternity care women use digital media extensively for pregnancy information. All maternity services should have a digital media strategy.

The use of digital media by women using the maternity services in a developed country.

LENUS (Irish Health Repository)

O'Higgins, A

2014-11-01

The provision of high quality healthcare information about pregnancy is important to women and to healthcare professionals and it is 1 driven, in part, by a desire to improve clinical outcomes,. The objective of this study was to examine the use of digital media by women\\' to access pregnancy information. A questionnaire was distributed to women attending a large maternity hospital. Of the 522 respondents, the mean age was 31.8 years, 45% (235\\/522) were nulliparous, 62% (324\\/522) lived in the capital city and 29% (150\\/522) attended the hospital as private patients. Overall 95% (498\\/522) used the internet for pregnancy information, 76% (399\\/522) had a smartphone and 59% (235\\/399) of smartphone owners had used a pregnancy smartapp. The nature of internet usage for pregnancy information included discussion forums (70%), social networks (67%), video media (48%), e-books (15%), blogs (13%), microblogs (9%) and podcasts (4%). Even women who were socially disadvantaged reported high levels of digital media usage. In contemporary maternity care women use digital media extensively for pregnancy information. All maternity services should have a digital media strategy.

Do experiences and perceptions about quality of care differ among social groups in Nepal? : A study of maternal healthcare experiences of women with and without disabilities, and Dalit and non-Dalit women

OpenAIRE

Devkota, H. R.; Clarke, A.; Murray, E.; Groce, N.

2017-01-01

BACKGROUND: Suboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women's socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit populatio...

Multiple vulnerabilities and maternal healthcare in Vietnam: findings from the Multiple Indicator Cluster Surveys, 2000, 2006, and 2011

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Hoang Van Minh

2016-02-01

Full Text Available Background: Knowledge of the aggregate effects of multiple socioeconomic vulnerabilities is important for shedding light on the determinants of growing health inequalities and inequities in maternal healthcare. Objective: This paper describes patterns of inequity in maternal healthcare utilization and analyzes associations between inequity and multiple socioeconomic vulnerabilities among women in Vietnam. Design: This is a repeated cross-sectional study using data from the Vietnam Multiple Indicator Cluster Surveys 2000, 2006, and 2011. Two maternal healthcare indicators were selected: (1 skilled antenatal care and (2 skilled delivery care. Four types of socioeconomic vulnerabilities – low education, ethnic minority, poverty, and rural location – were assessed both as separate explanatory variables and as composite indicators (combinations of three and four vulnerabilities. Pairwise comparisons and adjusted odds ratios were used to assess socioeconomic inequities in maternal healthcare. Results: In all three surveys, there were increases across the survey years in both the proportions of women who received antenatal care by skilled staff (68.6% in 2000, 90.8% in 2006, and 93.7% in 2011 and the proportions of women who gave birth with assistance from skilled staff (69.9% in 2000, 87.7% in 2006, and 92.9% in 2011. The receipt of antenatal care by skilled staff and birth assistance from skilled health personnel were less common among vulnerable women, especially those with multiple vulnerabilities. Conclusions: Even though Vietnam has improved its coverage of maternal healthcare on average, policies should target maternal healthcare utilization among women with multiple socioeconomic vulnerabilities. Both multisectoral social policies and health policies are needed to tackle multiple vulnerabilities more effectively by identifying those who are poor, less educated, live in rural areas, and belong to ethnic minority groups.

Impact of maternal and neonatal health initiatives on inequity in maternal health care utilization in Bangladesh.

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Haider, Mohammad Rifat; Rahman, Mohammad Masudur; Moinuddin, Md; Rahman, Ahmed Ehsanur; Ahmed, Shakil; Khan, M Mahmud

2017-01-01

Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups

Assessing maternal healthcare inequities among migrants: a qualitative study

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Ligia Moreira Almeida

2014-02-01

Full Text Available Considering pregnancy and motherhood as periods of increased vulnerability in migrant women, to characterize the healthcare provided to this collective, we sought to identify and understand patterns of satisfaction and demand of maternal and child healthcare, assessing women’s perceptions about its quality. The study followed a qualitative methodology (semi-structured interviews for collecting and analysing data (content analysis and was conducted in Porto, the second largest city of Portugal. Participants were 25 recent immigrant mothers from Eastern European countries, Brazil, Portuguese-speaking African countries and six native Portuguese recent mothers (for comparison, contacted through social associations and institutions. Data suggests that healthcare depends not only on accessibility but especially on social opportunities. Equitable public health action must provide individuals and groups the equal opportunity to meet their needs, which may not be achieved by providing the same standard if care to all.

Steering healthcare service delivery: a regulatory perspective.

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Prakash, Gyan

2015-01-01

The purpose of this paper is to explore regulation in India's healthcare sector and makes recommendations needed for enhancing the healthcare service. The literature was reviewed to understand healthcare's regulatory context. To understand the current healthcare system, qualitative data were collected from state-level officials, public and private hospital staff. A patient survey was performed to assess service quality (QoS). Regulation plays a central role in driving healthcare QoS. India needs to strengthen market and institutional co-production based approaches for steering its healthcare in which delivery processes are complex and pose different challenges. This study assesses current healthcare regulation in an Indian state and presents a framework for studying and strengthening regulation. Agile regulation should be based on service delivery issues (pull approach) rather than monitoring and sanctions based regulatory environment (push approach). Healthcare pitfalls across the world seem to follow similar follies. India's complexity and experience is useful for emerging and developed economies. The author reviewed around 70 publications and synthesised them in healthcare regulatory contexts. Patient's perception of private providers could be a key input towards steering regulation. Identifying gaps across QoS dimensions would be useful in taking corrective measures.

Determinants of maternal health services utilization in urban settings of the Democratic Republic of Congo--a case study of Lubumbashi City.

Science.gov (United States)

Abel Ntambue, M L; Françoise Malonga, K; Dramaix-Wilmet, Michèle; Donnen, Philippe

2012-07-10

The use of maternal health services, known as an indirect indicator of perinatal death, is still unknown in Lubumbashi. The present study was therefore undertaken in order to determine the factors that influence the use of mother and child healthcare services in Lubumbashi, Democratic Republic of the Congo. This was transversal study of women residing in Lubumbashi who had delivered between January and December 2009. In total, 1762 women were sampled from households using indicator cluster surveys in all health zones. Antenatal consultations (ANC), delivery assisted by qualified healthcare personnel (and delivery in a healthcare facility) as well as postnatal consultations (PNC) were dependent variables of study. The factors determining non-use of maternal healthcare services were researched via logistic regression with a 5% materiality threshold. The use of maternal healthcare services was variable; 92.6% of women had attended ANC at least once, 93.8% of women had delivered at a healthcare facility, 97.2% had delivered in the presence of qualified healthcare personnel, while the rate of caesarean section was 4.5%. Only 34.6% postnatal women had attended PNC by 42 days after delivery. During these ANC visits, only 60.6% received at least one dose of vaccine, while 38.1% received Mebendazole, 35.6% iron, 32.7% at least one dose of SulfadoxinePyrimethamine, 29.2% folic acid, 15.5% screening for HIV and 12.8% an insecticide treated net.In comparison to women that had had two or three deliveries before, primiparous and grand multiparous women were twice as likely not to use ANC during their pregnancy. Women who had unplanned pregnancies were also more likely not to use ANC or PNC than those who had planned pregnancies alone or with their partner. The women who had not used ANC were also more likely not to use PNC. The women who had had a trouble-free delivery were more likely not to use PNC than those who had complications when delivering. In Lubumbashi, a significant

Towards comprehensive women's healthcare in sub-Saharan Africa: addressing intersections between HIV, reproductive and maternal health.

Science.gov (United States)

Kendall, Tamil; Bärnighausen, Till; Fawzi, Wafaie W; Langer, Ana

2014-12-01

This themed supplement to JAIDS: Journal of Acquired Immune Deficiency Syndromes focuses on the critical intersections between HIV, reproductive, and maternal health services in the health systems of sub-Saharan Africa. The epidemiology of HIV among women of reproductive age on the sub-continent demands a holistic conceptualization and comprehensive approaches to ensure that HIV, reproductive, and maternal health are optimally addressed. Yet, in many instances, the national and global responses to these health issues remain siloed. Women's health needs and new global and national guidelines for HIV treatment raise important policy, programmatic, and operational questions regarding service integration, scale-up, and health systems functioning. In June 2013, the Maternal Health Task Force at the Harvard School of Public Health, the United States Agency for International Development, and the United States Centers for Disease Control and Prevention convened an international technical meeting of researchers, policymakers, and practitioners to discuss the existing evidence base about the interconnections between HIV, reproductive, and maternal health and identify the most important knowledge gaps and research priorities. The articles in this special issue deepen and expand on those discussions by (1) providing empirical evidence about challenges, (2) identifying how improving clinical care and models of service delivery, strengthening health systems, and addressing social dynamics can contribute to better outcomes, and (3) mapping future research directions. Together, these articles underscore that new policy frameworks and integrated approaches are necessary but not sufficient to address health system challenges. Addressing the multiple needs of women of reproductive age who are living with HIV or are at risk of acquiring HIV is a complex undertaking that requires improved access to, utilization and quality of comprehensive women's healthcare. Continued evaluation and

Improving Maternal Healthcare Access and Neonatal Survival through a Birthing Home Model in Rural Haiti

Directory of Open Access Journals (Sweden)

Elizabeth Wickstrom

2007-10-01

Full Text Available High neonatal mortality in Haiti is sustained by limited access to essential maternity services, particularly for Haiti’s rural population. We investigated the feasibility of a rural birthing home model to provide basic prenatal, delivery, and neonatal services for women with uncomplicated pregnancies while simultaneously providing triage and transport of women with pregnancy related complications. The model included consideration of the local context, including women’s perceptions of barriers to healthcare access and available resources to implement change. Evaluation methods included the performance of a baseline community census and collection of pregnancy histories from 791 women living in a defined area of rural Haiti. These retrospective data were compared with pregnancy outcome for 668 women subsequently receiving services at the birthing home. Of 764 reported most recent pregnancies in the baseline survey, 663(87% occurred at home with no assistance from skilled health staff. Of 668 women followed after opening of the birthing home, 514 (77% subsequently gave birth at the birthing home, 94 (14% were referred to a regional hospital for delivery, and only 60 (9% delivered at home or on the way to the birthing home. Other measures of clinical volume and patient satisfaction also indicated positive changes in health care seeking. After introduction of the birthing home, fewer neonates died than predicted by historical information or national statistics. The present experience points out the feasibility of a rural birthing home model to increase access to essential maternity services.

[The Marketing of Healthcare Services in ENT-Clinics].

Science.gov (United States)

Teschner, M; Lenarz, T

2016-07-01

The provision of healthcare services in Germany is based on fundamental principles of solidarity and is highly regulated. The question arises which conditions exist for marketing for healthcare services in ENT-clinics in Germany. The marketing options will be elicited using environmentally analytical considerations. The objectives can be achieved using measures derived from external instruments (service policy, pricing policy, distribution policy or communications policy) or from an internal instrument (human resources policy). The policy environment is particularly influenced by the regulatory framework, which particularly restricts the scope for both the pricing and communications policies. All measures must, however, reflect ethical frameworks, which are regarded as the fundamental premise underlying healthcare services and may be at odds with economic factors. Scope for flexibility in pricing exists only within the secondary healthcare market, and even there only to a limited extent. The significance of price in the marketing of healthcare services is thus very low. If marketing activities are to succeed, a market analysis must be carried out exploring the relevant factors for each individual provider. However, the essential precondition for the marketing of healthcare services is trust. The marketing of healthcare services differs from that of business management-oriented enterprises in other branches of economy. In the future the importance of marketing activities will increase. © Georg Thieme Verlag KG Stuttgart · New York.

Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study.

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Tougher, Sarah; Dutt, Varun; Pereira, Shreya; Haldar, Kaveri; Shukla, Vasudha; Singh, Kultar; Kumar, Paresh; Goodman, Catherine; Powell-Jackson, Timothy

2018-02-01

How to harness the private sector to improve population health in low-income and middle-income countries is heavily debated and one prominent strategy is social franchising. We aimed to evaluate whether the Matrika social franchising model-a multifaceted intervention that established a network of private providers and strengthened the skills of both public and private sector clinicians-could improve the quality and coverage of health services along the continuum of care for maternal, newborn, and reproductive health. We did a quasi-experimental study, which combined matching with difference-in-differences methods. We matched 60 intervention clusters (wards or villages) with a social franchisee to 120 comparison clusters in six districts of Uttar Pradesh, India. The intervention was implemented by two not-for-profit organisations from September, 2013, to May, 2016. We did two rounds (January, 2015, and May, 2016) of a household survey for women who had given birth up to 2 years previously. The primary outcome was the proportion of women who gave birth in a health-care facility. An additional 56 prespecified outcomes measured maternal health-care use, content of care, patient experience, and other dimensions of care. We organised conceptually similar outcomes into 14 families to create summary indices. We used multivariate difference-in-differences methods for the analyses and accounted for multiple inference. The introduction of Matrika was not significantly associated with the change in facility births (4 percentage points, 95% CI -1 to 9; p=0·100). Effects for any of the other individual outcomes or for any of the 14 summary indices were not significant. Evidence was weak for an increase of 0·13 SD (95% CI 0·00 to 0·27; p=0·053) in recommended delivery care practices. The Matrika social franchise model was not effective in improving the quality and coverage of maternal health services at the population level. Several key reasons identified for the absence of

Maternal health research concerns men too | IDRC - International ...

International Development Research Centre (IDRC) Digital Library (Canada)

2018-06-11

Jun 11, 2018 ... At first glance, maternal health only seems to focus on women and children. ... to maternal healthcare and to improve access to and use of services ... a program of visits to the homes of all pregnant women in the project area.

Programmatic correlates of maternal healthcare seeking behaviors ...

African Journals Online (AJOL)

Bernt Lindtjorn

be biased due to variations in some other factors between the exposure groups that influence maternal health seeking behaviors (for example, education, access to services, urbanization, among others). Accordingly, logistics regression models were implemented afterwards to get the unbiased (adjusted) program effects.

The Finnish healthcare services lean management.

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Hihnala, Susanna; Kettunen, Lilja; Suhonen, Marjo; Tiirinki, Hanna

2018-02-05

Purpose The purpose of this paper is to discuss health services managers' experiences of management in a special health-care unit and development efforts from the point of view of the Lean method. Additionally, the aim is to deepen the knowledge of the managers' work and nature of the Lean method development processes in the workplace. The research focuses on those aspects and results of Lean method that are currently being used in health-care environments. Design/methodology/approach These data were collected through a number of thematic interviews. The participants were nurse managers ( n = 7) and medical managers ( n = 7) who applied Lean management in their work at the University Hospital in the Northern Ostrobothnia Health Care District. The data were analysed with a qualitative content analysis. Findings A common set of values in specialized health-care services, development of activities and challenges for management in the use of the Lean manager development model to improve personal management skills. Practical implications Managers in specialized health-care services can develop and systematically manage with the help of the Lean method. This emphasizes assumptions, from the point of view of management, about systems development when the organization uses the Lean method. The research outcomes originate from specialized health-care settings in Finland in which the Lean method and its associated management principles have been implemented and applied to the delivery of health care. Originality/value The study shows that the research results and in-depth knowledge on Lean method principles can be applied to health-care management and development processes. The research also describes health services managers' experiences of using the Lean method. In the future, these results can be used to improve Lean management skills, identify personal professional competencies and develop skills required in development processes. Also, the research findings can be used

Determinants of maternal health services utilization in urban settings of the Democratic Republic of Congo – A Case study of Lubumbashi City

Science.gov (United States)

2012-01-01

Background The use of maternal health services, known as an indirect indicator of perinatal death, is still unknown in Lubumbashi. The present study was therefore undertaken in order to determine the factors that influence the use of mother and child healthcare services in Lubumbashi, Democratic Republic of the Congo. Methods This was transversal study of women residing in Lubumbashi who had delivered between January and December 2009. In total, 1762 women were sampled from households using indicator cluster surveys in all health zones. Antenatal consultations (ANC), delivery assisted by qualified healthcare personnel (and delivery in a healthcare facility) as well as postnatal consultations (PNC) were dependent variables of study. The factors determining non-use of maternal healthcare services were researched via logistic regression with a 5% materiality threshold. Results The use of maternal healthcare services was variable; 92.6% of women had attended ANC at least once, 93.8% of women had delivered at a healthcare facility, 97.2% had delivered in the presence of qualified healthcare personnel, while the rate of caesarean section was 4.5%. Only 34.6% postnatal women had attended PNC by 42 days after delivery. During these ANC visits, only 60.6% received at least one dose of vaccine, while 38.1% received Mebendazole, 35.6% iron, 32.7% at least one dose of SulfadoxinePyrimethamine, 29.2% folic acid, 15.5% screening for HIV and 12.8% an insecticide treated net. In comparison to women that had had two or three deliveries before, primiparous and grand multiparous women were twice as likely not to use ANC during their pregnancy. Women who had unplanned pregnancies were also more likely not to use ANC or PNC than those who had planned pregnancies alone or with their partner. The women who had not used ANC were also more likely not to use PNC. The women who had had a trouble-free delivery were more likely not to use PNC than those who had complications when delivering

Determinants of maternal health services utilization in urban settings of the Democratic Republic of Congo – A Case study of Lubumbashi City

Directory of Open Access Journals (Sweden)

ML Abel

2012-07-01

Full Text Available Abstract Background The use of maternal health services, known as an indirect indicator of perinatal death, is still unknown in Lubumbashi. The present study was therefore undertaken in order to determine the factors that influence the use of mother and child healthcare services in Lubumbashi, Democratic Republic of the Congo. Methods This was transversal study of women residing in Lubumbashi who had delivered between January and December 2009. In total, 1762 women were sampled from households using indicator cluster surveys in all health zones. Antenatal consultations (ANC, delivery assisted by qualified healthcare personnel (and delivery in a healthcare facility as well as postnatal consultations (PNC were dependent variables of study. The factors determining non-use of maternal healthcare services were researched via logistic regression with a 5% materiality threshold. Results The use of maternal healthcare services was variable; 92.6% of women had attended ANC at least once, 93.8% of women had delivered at a healthcare facility, 97.2% had delivered in the presence of qualified healthcare personnel, while the rate of caesarean section was 4.5%. Only 34.6% postnatal women had attended PNC by 42 days after delivery. During these ANC visits, only 60.6% received at least one dose of vaccine, while 38.1% received Mebendazole, 35.6% iron, 32.7% at least one dose of SulfadoxinePyrimethamine, 29.2% folic acid, 15.5% screening for HIV and 12.8% an insecticide treated net. In comparison to women that had had two or three deliveries before, primiparous and grand multiparous women were twice as likely not to use ANC during their pregnancy. Women who had unplanned pregnancies were also more likely not to use ANC or PNC than those who had planned pregnancies alone or with their partner. The women who had not used ANC were also more likely not to use PNC. The women who had had a trouble-free delivery were more likely not to use PNC than those who had

Identifying maternity services in public hospitals in rural and remote Australia.

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Longman, Jo; Pilcher, Jennifer M; Donoghue, Deborah A; Rolfe, Margaret; Kildea, Sue V; Kruske, Sue; Oats, Jeremy J N; Morgan, Geoffrey G; Barclay, Lesley M

2014-06-01

This paper articulates the importance of accurately identifying maternity services. It describes the process and challenges of identifying the number, level and networks of rural and remote maternity services in public hospitals serving communities of between 1000 and 25000 people across Australia, and presents the findings of this process. Health departments and the national government's websites, along with lists of public hospitals, were used to identify all rural and remote Australian public hospitals offering maternity services in small towns. State perinatal reports were reviewed to establish numbers of births by hospital. The level of maternity services and networks of hospitals within which services functioned were determined via discussion with senior jurisdictional representatives. In all, 198 rural and remote public hospitals offering maternity services were identified. There were challenges in sourcing information on maternity services to generate an accurate national picture. The nature of information about maternity services held centrally by jurisdictions varied, and different frameworks were used to describe minimum requirements for service levels. Service networks appeared to be based on a combination of individual links, geography and transport infrastructure. The lack of readily available centralised and comparable information on rural and remote maternity services has implications for policy review and development, equity, safety and quality, network development and planning. Accountability for services and capacity to identify problems is also compromised.

Utilization of healthcare services in postpartum women in the Philippines who delivered at home and the effects on their health: a cross-sectional analytical study

Directory of Open Access Journals (Sweden)

Yamashita T

2017-09-01

Full Text Available Tadashi Yamashita,1 Maria Teresa Reyes Tuliao,2 Magdalena Concel Meana,2 Sherri Ann Suplido,3 Cecilia L Llave,4 Yuko Tanaka,5 Hiroya Matsuo6 1Kobe City College of Nursing, Kobe, Japan; 2Health Department of Muntinlupa, Muntinlupa, Philippines; 3Department of Obstetrics and Gynecology, Philippine General Hospital, Manila, Philippines; 4College of Medicine (CM, University of the Philippine (UP, Manila, Philippines; 5Department of School of Health Sciences, Faculty of Medicine, Tokushima University Graduate School, Tokushima, Japan; 6Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Japan Background: A low ratio of utilization of healthcare services in postpartum women may contribute to maternal deaths during the postpartum period. The maternal mortality ratio is high in the Philippines. The aim of this study was to examine the current utilization of healthcare services and the effects on the health of women in the Philippines who delivered at home. Methods: This was a cross-sectional analytical study, based on a self-administrated questionnaire, conducted from March 2015 to February 2016 in Muntinlupa, Philippines. Sixty-three postpartum women who delivered at home or at a facility were enrolled for this study. A questionnaire containing questions regarding characteristics, utilization of healthcare services, and abnormal symptoms during postpartum period was administered. To analyze the questionnaire data, the sample was divided into delivery at home and delivery at a facility. Chi-square test, Fisher’s exact test, and Mann–Whitney U test were used. Results: There were significant differences in the type of birth attendant, area of residence, monthly income, and maternal and child health book usage between women who delivered at home and those who delivered at a facility (P<0.01. There was significant difference in the utilization of antenatal checkup (P<0.01 during pregnancy, whilst there was no

The maternal and child healthcare needs of new immigrants in Taipei.

Science.gov (United States)

Chen, Mei-Ju; Tang, Chao-Hsiun; Jeng, Huey-Mei; Chiu, Allen Wen-Hsiang

2008-12-01

The primary aim of this study was to evaluate the maternal and child healthcare needs of new immigrants in Taiwan. Results will be used to reflect upon the services which the government is currently providing, and to determine if further investigation may be required to establish whether or not the health care quality currently provided by public health nurses succeeds in meeting the needs of new immigrants. Face-to-face interviews were undertaken by public health nurses on 1,068 women from Mainland China, and a further 1,068 women from other Southeast Asian countries, all of whom were randomly selected from the 12 administrative districts of Taipei. Information on the healthcare information needs of mothers and children (10 items), psychological distress variables, health status and socio-demographic variables of both the new immigrants and their Taiwanese spouses were collected via a structured questionnaire, of which a total of 1,829 completed copies were returned. Chi-square tests were performed to examine differences in both healthcare needs and psychological distress levels amongst different new immigrant ethnic groups. Logistic regressions were subsequently performed with the adjusted odds ratios (ORs) then being calculated to examine the differential effects of the healthcare needs of the different ethnic groups of new immigrants. The needs of the Vietnamese immigrants were found to be significantly different from those of the Mainland Chinese immigrants in all items, with the former needing Chinese communication assistance particularly at those times when they received medical treatment (p Cultural competence in public health nursing education should not be deemphasized in Taiwan. Within the public sector, there is a clear need to create and implement partnerships between the public and private sectors on the overall issue of new immigrants within the community. Results strongly suggest that public health nurses should be aware of how to meet the

The Brotherhood Medical Center: Collaborative Foundation of Maternity and Children’s Healthcare Facility for Displaced Syrians

Science.gov (United States)

Aburas, Rahma; Najeeb, Amina; Baageel, Laila; Mackey, Tim K.

2018-01-01

The United Nations has declared the Syrian conflict, with more than 50% of Syria’s population currently displaced, as the worst humanitarian crisis of the twenty-first century. The Syrian conflict has led to a collapse of infrastructure, including access to critical and lifesaving healthcare services. Women and children account for approximately 75% of internally displaced Syrians and refugees. This population is also particularly vulnerable to poor health outcomes, a condition worsened by lack of access to maternal and child health services. In response to this crisis, a partnership of Saudi and Syrian physicians established a non-profit healthcare facility named the Brotherhood Medical Center (BMC) to serve women and children within a safe area near the Syrian–Turkish border. The project began in September 2014 and was implemented in three phases of establishment, phased construction and formal launch and operation. Currently, the BMC is working at about 70% of its capacity and is run in partnership with the Syrian Expatriate Medical Association. Although there was strong initial support from donors, the BMC continues to face many financial and operational challenges, including difficulties in transferring money to Syria, shortage of medical supplies, and lack of qualified medical personnel. Despite these challenges, the BMC represents a critical model and an important case study of the challenges of delivering healthcare services to underserved populations during an ongoing conflict. However, more robust support from the international community is needed to ensure it continues its important health and humanitarian mission. PMID:29721489

The Brotherhood Medical Center: Collaborative Foundation of Maternity and Children’s Healthcare Facility for Displaced Syrians

Directory of Open Access Journals (Sweden)

Rahma Aburas

2018-04-01

Full Text Available The United Nations has declared the Syrian conflict, with more than 50% of Syria’s population currently displaced, as the worst humanitarian crisis of the twenty-first century. The Syrian conflict has led to a collapse of infrastructure, including access to critical and lifesaving healthcare services. Women and children account for approximately 75% of internally displaced Syrians and refugees. This population is also particularly vulnerable to poor health outcomes, a condition worsened by lack of access to maternal and child health services. In response to this crisis, a partnership of Saudi and Syrian physicians established a non-profit healthcare facility named the Brotherhood Medical Center (BMC to serve women and children within a safe area near the Syrian–Turkish border. The project began in September 2014 and was implemented in three phases of establishment, phased construction and formal launch and operation. Currently, the BMC is working at about 70% of its capacity and is run in partnership with the Syrian Expatriate Medical Association. Although there was strong initial support from donors, the BMC continues to face many financial and operational challenges, including difficulties in transferring money to Syria, shortage of medical supplies, and lack of qualified medical personnel. Despite these challenges, the BMC represents a critical model and an important case study of the challenges of delivering healthcare services to underserved populations during an ongoing conflict. However, more robust support from the international community is needed to ensure it continues its important health and humanitarian mission.

Maternity Care Services Provided by Family Physicians in Rural Hospitals.

Science.gov (United States)

Young, Richard A

The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

Web-based Service Portal in Healthcare

Science.gov (United States)

Silhavy, Petr; Silhavy, Radek; Prokopova, Zdenka

Information delivery is one the most important task in healthcare. The growing sector of electronic healthcare has an important impact on the information delivery. There are two basic approaches towards information delivering. The first is web portal and second is touch-screen terminal. The aim of this paper is to investigate the web-based service portal. The most important advantage of web-based portal in the field of healthcare is an independent access for patients. This paper deals with the conditions and frameworks for healthcare portals

Customer perceived service quality, satisfaction and loyalty in Indian private healthcare.

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Kondasani, Rama Koteswara Rao; Panda, Rajeev Kumar

2015-01-01

The purpose of this paper is to analyse how perceived service quality and customer satisfaction lead to loyalty towards healthcare service providers. In total, 475 hospital patients participated in a questionnaire survey in five Indian private hospitals. Descriptive statistics, factor analysis, regression and correlation statistics were employed to analyse customer perceived service quality and how it leads to loyalty towards service providers. Results indicate that the service seeker-service provider relationship, quality of facilities and the interaction with supporting staff have a positive effect on customer perception. Findings help healthcare managers to formulate effective strategies to ensure a better quality of services to the customers. This study helps healthcare managers to build customer loyalty towards healthcare services, thereby attracting and gaining more customers. This paper will help healthcare managers and service providers to analyse customer perceptions and their loyalty towards Indian private healthcare services.

Impact of service provision platforms on maternal and newborn health in conflict areas and their acceptability in Pakistan: a systematic review.

Science.gov (United States)

Lassi, Zohra S; Aftab, Wafa; Ariff, Shabina; Kumar, Rohail; Hussain, Imtiaz; Musavi, Nabiha B; Memon, Zahid; Soofi, Sajid B; Bhutta, Zulfiqar A

2015-01-01

Various models and strategies have been implemented over the years in different parts of the world to improve maternal and newborn health (MNH) in conflict affected areas. These strategies are based on specific needs and acceptability of local communities. This paper has undertaken a systematic review of global and local (Pakistan) information from conflict areas on platforms of health service provision in the last 10 years and information on acceptability from local stakeholders on effective models of service delivery; and drafted key recommendations for improving coverage of health services in conflict affected areas. The literature search revealed ten studies that described MNH service delivery platforms. The results from the systematic review showed that with utilisation of community outreach services, the greatest impacts were observed in skilled birth attendance and antenatal consultation rates. Facility level services, on the other hand, showed that labour room services for an internally displaced population (IDP) improved antenatal care coverage, contraceptive prevalence rate and maternal mortality. Consultative meetings and discussions conducted in Quetta and Peshawar (capitals of conflict affected provinces) with relevant stakeholders revealed that no systematic models of MNH service delivery, especially tailored for conflict areas, are available. During conflict, even previously available services and infrastructure suffered due to various barriers specific to times of conflict and unrest. A number of barriers that hinder MNH services were discussed. Suggestions for improving MNH services in conflict areas were also laid down by participants. The review identified some important steps that can be undertaken to mitigate the effects of conflict on MNH services, which include: improve provision and access to infrastructure and equipment; development and training of healthcare providers; and advocacy at different levels for free access to healthcare

The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review.

Directory of Open Access Journals (Sweden)

Benjamin M Hunter

Full Text Available Cash transfers and vouchers are forms of 'demand-side financing' that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years.This systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute approach for systematic reviewing. The review protocol for this update was registered with PROSPERO (CRD42015020637.Data from 51 studies (15 more than previous reviews and 22 cash transfer and voucher programmes suggest that approaches tied to service use (either via payment conditionalities or vouchers for selected services can increase use of antenatal care, use of a skilled attendant at birth and in the case of vouchers, postnatal care too. The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care, and for vouchers for maternity care services and birth with a skilled birth attendant. However, effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators. Studies have typically focused on an initial programme period, usually two or three years after initiation, and many lack a counterfactual comparison with supply-side investment. There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes.Future research should use multiple intervention arms to compare cost-effectiveness with similar investment in public services, and should look beyond short- to medium-term service utilisation by examining programme costs, longer-term effects on service utilisation and health outcomes, and the equity of those effects.

The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review.

Science.gov (United States)

Hunter, Benjamin M; Harrison, Sean; Portela, Anayda; Bick, Debra

2017-01-01

Cash transfers and vouchers are forms of 'demand-side financing' that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years. This systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute approach for systematic reviewing. The review protocol for this update was registered with PROSPERO (CRD42015020637). Data from 51 studies (15 more than previous reviews) and 22 cash transfer and voucher programmes suggest that approaches tied to service use (either via payment conditionalities or vouchers for selected services) can increase use of antenatal care, use of a skilled attendant at birth and in the case of vouchers, postnatal care too. The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care, and for vouchers for maternity care services and birth with a skilled birth attendant. However, effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators. Studies have typically focused on an initial programme period, usually two or three years after initiation, and many lack a counterfactual comparison with supply-side investment. There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes. Future research should use multiple intervention arms to compare cost-effectiveness with similar investment in public services, and should look beyond short- to medium-term service utilisation by examining programme costs, longer-term effects on service utilisation and health outcomes, and the equity of those effects.

The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

Science.gov (United States)

Hunter, Benjamin M.; Harrison, Sean; Portela, Anayda; Bick, Debra

2017-01-01

Background Cash transfers and vouchers are forms of ‘demand-side financing’ that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years. Methods This systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute approach for systematic reviewing. The review protocol for this update was registered with PROSPERO (CRD42015020637). Results Data from 51 studies (15 more than previous reviews) and 22 cash transfer and voucher programmes suggest that approaches tied to service use (either via payment conditionalities or vouchers for selected services) can increase use of antenatal care, use of a skilled attendant at birth and in the case of vouchers, postnatal care too. The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care, and for vouchers for maternity care services and birth with a skilled birth attendant. However, effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators. Studies have typically focused on an initial programme period, usually two or three years after initiation, and many lack a counterfactual comparison with supply-side investment. There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes. Conclusion Future research should use multiple intervention arms to compare cost-effectiveness with similar investment in public services, and should look beyond short- to medium-term service utilisation by examining programme costs, longer-term effects on service utilisation and health outcomes, and the equity of those effects. PMID:28328940

Gender Differences in Youth Suicide and Healthcare Service Use.

Science.gov (United States)

Gontijo Guerra, Samantha; Vasiliadis, Helen-Maria

2016-07-01

Healthcare service use among suicide decedents must be well characterized and understood since a key strategy for preventing suicide is to improve healthcare providers' ability to effectively detect and treat those in need. To determine gender differences in healthcare service use 12 months prior to suicide. Data for 1,231 young Quebec residents (≤ 25 years) who died by suicide between 2000 and 2007 were collected from public health insurance agency databases and coroner registers. Healthcare visits were categorized according to the setting (emergency department [ED], outpatient, and hospital) and their nature (mental health vs. non-mental health). Girls were more likely than boys (82.5% vs. 74.9%, p = .011) to have used healthcare services in the year prior to death. A higher proportion of girls had used outpatient services (79.0% vs. 69.5%, p = .003), had been hospitalized (25.7% vs. 15.6%, p suicide decedents who did not receive a mental health diagnosis and healthcare services in the year prior to death. Future studies should focus on examining gender-specific individual and health system barriers among suicide decedents as well as the quality of care offered regarding detection and treatment.

Women's choice of maternal healthcare in Parung, West Java, Indonesia: Midwife versus traditional birth attendant.

Science.gov (United States)

Agus, Yenita; Horiuchi, Shigeko; Iida, Mariko

2018-02-14

In the 1990s, the Indonesian government launched programmes to train traditional birth attendants (TBAs) and increase the number of midwives. To identify and compare the factors that influence women's choice of a midwife or a TBA for maternal healthcare in Indonesia. This study used a descriptive design for comparing women's choice of maternal healthcare. The participants were (1) married women, (2) experienced birth within two years, (3) living in a rural or urban village, and (4) capable of communicating in the Indonesia language. Three instruments were used: (1) traditional belief questionnaire, (2) preference for caregiver questionnaire, and (3) women-centered care (WCC) questionnaire which measured women's perceptions of care that they received during pregnancy. A total of 371 women participated in this study. All these subjects answered based on their most recent birth within the last two years. Of the 371 women, 207 (55.8%) chose a midwife and 164 (44.2%) chose a TBA for giving birth. Women choosing midwives were generally satisfied and perceived receiving WCC. Factors determining choice were (1) women's background, (2) perception of WCC, (3) satisfaction, (4) choice of antenatal care (ANC), (5) family encouragement, and (6) traditional beliefs. The choice of caregivers was determined by not only education, parity, usual source of healthcare payment, and family encouragement but also traditional beliefs. Indonesian women's choice of a midwife instead of a TBA for their maternal healthcare resulted in a higher satisfaction of care and more ANC visits. Copyright © 2018 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

[Tacit and explicit knowledge: comparative analysis of the prioritization of maternal health problems in Mexico].

Science.gov (United States)

Moreno Zegbe, Estephania; Becerril Montekio, Víctor; Alcalde Rabanal, Jacqueline

To identify coincidences and differences in the identification and prioritization of maternal healthcare service problems in Mexico based on the perspective of tacit knowledge and explicit knowledge that may offer evidence that can contribute to attaining the Sustainable Development Goals. Mixed study performed in three stages: 1) systematization of maternal healthcare service problems identified by tacit knowledge (derived from professional experience); 2) identification of maternal healthcare service problems in Latin America addressed by explicit knowledge (scientific publications); 3) comparison between the problems identified by tacit and explicit knowledge. The main problems of maternal health services identified by tacit knowledge are related to poor quality of care, while the predominant problems studied in the scientific literature are related to access barriers to health services. Approximately, 70% of the problems identified by tacit knowledge are also mentioned in the explicit knowledge. Conversely, 70% of the problems identified in the literature are also considered by tacit knowledge. Nevertheless, when looking at the problems taken one by one, no statistically significant similarities were found. The study discovered that the identification of maternal health service problems by tacit knowledge and explicit knowledge is fairly comparable, according to the comparability index used in the study, and highlights the interest of integrating both approaches in order to improve prioritization and decision making towards the Sustainable Development Goals. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Development of Wearable Systems for Ubiquitous Healthcare Service Provisioning

OpenAIRE

Ogunduyile, O.O.; Olugbara, O.O.; Lall, M.

2013-01-01

This paper reports on the development of a wearable system using wireless biomedical sensors for ubiquitous healthcare service provisioning. The prototype system is developed to address current healthcare challenges such as increasing cost of services, inability to access diverse services, low quality services and increasing population of elderly as experienced globally. The biomedical sensors proactively collect physiological data of remote patients to recommend diagnostic services. The prot...

[Utilization of tacit knowledge by maternal healthcare providers: a systematic mapping of the literature].

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Calderón Espinosa, Emmanuel; Becerril Montekio, Víctor; Alcalde Rabanal, Jacqueline; García Bello, Luis

2016-01-01

The search for efficient answers to strengthen maternal health care has included various sources of evidence for decision making. In this article, we present a systematic mapping of the scientific literature on the use of tacit knowledge in relation to maternal healthcare. A systematic mapping was conducted of scientific articles published in Spanish and English between 1971 and 2014 following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Of 793 articles, 30 met the inclusion criteria; 60% were from high-income countries and 66.7% were focused on health professionals. We identified a predominance of qualitative methodologies (62%). Four categories regarding the use of tacit knowledge were generated: proposals to improve the organization of the maternal care system (30%) and to improve the care provided to women during the continuum of pregnancy, childbirth and postpartum (26.7%), determination of health workers' perception and skill levels (26.7%) and the interactions between tacit and explicit knowledge in clinical decision making (16.7%). This mapping shows that tacit knowledge is an emerging, innovative and versatile research approach used primarily in high-income countries and that includes interesting possibilities for its use as evidence to improve maternal healthcare, particularly in middle- and low-income countries, where it needs to be strengthened. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

Socio-Demographic Determinants of Maternal Health-Care Service Utilization Among Rural Women in Anambra State, South East Nigeria

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Emelumadu, OF; Ukegbu, AU; Ezeama, NN; Kanu, OO; Ifeadike, CO; Onyeonoro, UU

2014-01-01

Background: Although, antenatal care (ANC) attendance in sub Saharan Africa is high, however this does not always translate into quality ANC care service utilization. Aim: This study therefore is aimed at exploring pattern of maternal health (MH) services utilization and the socio-demographic factors influencing it in Anambra State, South East Nigeria. Subjects and Methods: A total of 310 women of reproductive age with a previous history of gestation attending ANC services between September, 2007 and August, 2008 in selected Primary Health Centers in Anambra State were studied. Responses were elicited from the study participants using a pre-tested, semi-structured interviewer-administered questionnaire. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 17 (SPSS Inc, Chicago Illinois, USA). Association between socio-demographic characteristics and pattern of utilization of ANC and delivery services was measured using χ2-test, Regression analysis was done to identify factors associated with utilization of MH services. P < 0.05 was assumed to be significant. Results: Use of health facility was 293 (97.0%) and 277 (92,7%) out 302 women for ANC and delivery services respectively. Most women attended their first ANC consultation during the preceding pregnancy was after the first trimester and about 31% (94/298) of them had <4 ANC visits prior to delivery. Socio-demographic factors were found to be significantly associated with places where MH care services are accessed. Parity was found to be associated with timing of ANC booking and number of ANC attendance (χ2 = 9.49, P = 0.05). Odds of utilizing formal health facility for MH services were found to be significantly associated with increasing age (P < 0.01) and educational status of mothers (P < 0.001). Conclusions: The study revealed high maternal service utilization and 10% fetal loss, hence the need to address the gaps of late ANC booking and low ANC visits. PMID:24971212

First-time mothers' experiences of early labour in Italian maternity care services.

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Cappelletti, Giulia; Nespoli, Antonella; Fumagalli, Simona; Borrelli, Sara E

2016-03-01

The aim of this study is to explore first-time mothers' experiences of early labour in Italian maternity care services when admitted to hospital or advised to return home after maternity triage assessment. The study was conducted in a second-level maternity hospital in northern Italy with an obstetric unit for both low- and high-risk women. The participants included 15 first-time mothers in good general health with spontaneous labour at term of a low-risk pregnancy who accessed maternity triage during early labour, and were either admitted to hospital or advised to return home. A qualitative interpretive phenomenological study was conducted. A face-to-face recorded semi-structured interview was conducted with each participant 48-72h after birth. Four key themes emerged from the interviews: (a) recognising signs of early labour; (b) coping with pain at home; (c) seeking reassurance from healthcare professionals; and (d) being admitted to hospital versus returning home. Uncertainty about the progression of labour and the need for reassurance were cited by women as the main reasons for hospital visit in early labour. An ambivalent feeling was reported by the participants when admitted to hospital in early labour. In fact, while the women felt reassured in the first instance, some women subsequently felt dissatisfied due to the absence of one-to-one dedicated care during early labour. When advised to return home, a number of women reported feelings of disappointment, anger, fear, discouragement and anxiety about not being admitted to hospital; however, some of these women reported a subsequent feeling of comfort due to being at home and putting in place the suggestions made by the midwives during the maternity triage assessment. The guidance provided by midwives during triage assessment seemed to be the key factor influencing women׳s satisfaction when advised either to return home or to stay at the hospital during early labour. During antenatal classes and clinics

Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families' Decision-Making About Maternity Services.

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Culhane-Pera, Kathleen A; Sriphetcharawut, Sarinya; Thawsirichuchai, Rasamee; Yangyuenkun, Wirachon; Kunstadter, Peter

2015-11-01

Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into four categories: no ANC/home birth, ANC/home, no ANC/hospital, ANC/hospital. We conducted life-history case studies of 4 women from each category plus their 12 husbands, and 17 elders. We used grounded theory to guide qualitative analysis. Families not using maternity services considered pregnancy a normal process that only needed traditional home support. In addition, they disliked institutional processes that interfered with cultural birth practices, distrusted discriminatory personnel, and detested invasive, involuntary hospital procedures. Families using services perceived physical needs or potential delivery risks that could benefit from obstetrical assistance not available at home. While they disliked aspects of hospital births, they tolerated these conditions for access to obstetrical care they might need. Families also considered cost, travel distance, and time as structural issues. The families ultimately balanced their fear of delivering at home with their fear of delivering at the hospital. Providing health education about pregnancy risks, and changing healthcare practices to accommodate Hmong people's desires for culturally-appropriate family-centered care, which are consistent with evidence-based obstetrics, might improve Hmong women's use of maternity services.

Predictors of Healthcare Service Utilization for Mental Health Reasons

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Marie-Josée Fleury

2014-10-01

Full Text Available This study was designed to identify: (1 predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2 correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care.

Teaching at primary healthcare services within the Brazilian national health system (SUS in Brazilian healthcare professionals' training

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Ramona Fernanda Ceriotti Toassi

2013-06-01

Full Text Available The aim of this study was to analyze the role of teaching at primary healthcare services within the Brazilian National Health System (SUS in dentists' training, at a public university in the south of Brazil. A qualitative methodological approach (case study was used. Interviews were conducted with 12 dentistry students, six dentists who were preceptors working in public primary healthcare services and three teachers connected with this curricular training. Our findings showed that the curricular training in SUS primary healthcare services had an impact on the dentists' education through establishment of bonds, autonomy in problem-solving and multiprofessional teamwork. It was seen that they learned about how healthcare services function, about healthcare and about development of cultural competence. There is a need to maintain constant questioning regarding these practices, and to ensure the presence of infrastructure and qualified professionals for teaching at these services.

Service Availability and Readiness Assessment of Maternal ...

African Journals Online (AJOL)

AJRH Managing Editor

Keywords: Madagascar, Maternal and Child health services, Service availability and readiness assessment, Public health facilities. Résumé ..... Table 2: Percentage of Health Facilities Equipped with Tracer Items for Antenatal Care Services Among Facilities. Providing this ... 32 CSBs, due to its location in a tourist area.

Healthcare operations service redesign and implementation

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Bamford, David; Thornton, H.; Bamford, Jim

2008-01-01

We report on a project that is increasing the effectiveness and efficiency of healthcare\\ud provision by getting “the right patient, the right equipment, the right healthcare worker\\ud to the right place at the right time for the right treatment to be carried out in the right\\ud way.” This is being done through: i) a review of the utilisation and disposition of all\\ud logistics/transport assets and an assessment of future demand/capacity issues and\\ud patterns for healthcare services; ii) the...

Issues in healthcare services in Malaysia as experienced by Japanese retirees.

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Kohno, Ayako; Musa, Ghazali; Nik Farid, Nik Daliana; Abdul Aziz, Norlaili; Nakayama, Takeo; Dahlui, Maznah

2016-05-05

Worldwide, international retirement migration is growing in its popularity and Japanese retirees choose Malaysia as their most preferred destination. This study examines the pertinent issues related to healthcare services as experienced by Japanese retirees in this country. From January to March 2015, we conducted focus group discussions with 30 Japanese retirees who live in Kuala Lumpur and Ipoh. Guided by the social-ecological model, we discovered seven pertinent themes: 'language barriers','healthcare decisions', 'medical check-ups','healthcare insurance', 'nursing and palliative care', 'trust and distrust of healthcare services', and 'word-of-mouth information'. We identified seven pertinent issues related to healthcare services among Japanese retirees in Malaysia, of which four are especially important. These issues are explained as integrated themes within the social-ecological model. Language barriers prohibit them from having difficulty accessing to healthcare in Malaysia, but lack of will to improve their language skills exist among them. For that reason, they rely heavily on word-of-mouth information when seeking for healthcare. As a consequence, some develop feelings of trust and distrust of healthcare services. In addition, we have identified the needs for provide nursing and palliative care among Japanese retirees in Malaysia. Based on the magnitude of the discussion, we concluded that there are four crucial healthcare issues among Japanese retirees; 'language barriers', 'trust and distrust of healthcare services', 'word-of-mouth information' and 'nursing and palliative care'. We propose that further dialogue by healthcare stakeholders should be carried out to improve further the healthcare service provisions for Japanese retirees in Malaysia.

Improving Maternal and Child Health in Underserved Rural Areas of ...

International Development Research Centre (IDRC) Digital Library (Canada)

Maternal and child health is a priority for Nigeria, but there are significant challenges and opportunities at state levels that influence efforts to reduce deaths. This project will contribute to government efforts in Delta State to improve delivery and use of maternal and child healthcare services in three marginalized rural ...

Maternal Health Coping Strategies of Migrant Women in Norway

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Berit Viken

2015-01-01

Full Text Available The aim of the study was to explore the maternal health coping strategies of migrant women in Norway. The ethnic and cultural background of the Norwegian population have become increasingly diverse. A challenge in practice is to adjust maternal health services to migrant women’s specific needs. Previous studies have revealed that migrant women have difficulty achieving safe pregnancies and childbirths. Data were obtained by means of 17 semistructured interviews with women from South America, Europe, the Middle East, Asia, and Africa. Qualitative content analysis was employed. One overall theme is as follows: keeping original traditions while at the same time being willing to integrate into Norwegian society, and four themes emerged as follows: balancing their sense of belongingness; seeking information and support from healthcare professionals; being open to new opportunities and focusing on feeling safe in the new country. The results were interpreted in the light of Bronfenbrenner’s ecological model. To provide quality care, healthcare professionals should focus on the development of migrant women’s capabilities. Adaptation of maternal health services for culturally diverse migrant women also requires a culturally sensitive approach on the part of healthcare professionals.

Healthcare service quality: towards a broad definition.

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Mosadeghrad, Ali Mohammad

2013-01-01

The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers. This study represents an exploratory effort to understand healthcare quality in an Iranian context. In-depth individual and focus group interviews were conducted with key healthcare stakeholders. Quality healthcare is defined as "consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers". Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well-being and satisfaction. This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient-satisfaction levels. This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

Interprofessional education in maternity services: Is there evidence to support policy?

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Davies, Nigel; Fletcher, Simon; Reeves, Scott

2016-11-01

Against a backdrop of poor maternity and obstetric care, identified in the Morecambe Bay Inquiry, the UK government has recently called for improvements and heralded investment in training. Given the complex mix of professionals working closely together in maternity services addressing the lack of joined up continuing professional development (CPD) is necessary. This led us to ask whether there is evidence of IPE in maternity services. As part of a wider systematic review of IPE, we searched for studies related to CPD in maternity services between May 2005 and June 2014. A total of 206 articles were identified with 24 articles included after initial screening. Further review revealed only eight articles related to maternity care, none of which met the inclusion criteria for the main systematic review. The main reasons for non-inclusion included weak evaluation, a focus on undergraduate IPE, and articles referring to paediatric/neonatal care only. Fewer articles were found than anticipated given the number of different professions working together in maternity services. This gap suggests further investigation is warranted.

Maternity care for trafficked women: Survivor experiences and clinicians' perspectives in the United Kingdom's National Health Service.

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Bick, Debra; Howard, Louise M; Oram, Sian; Zimmerman, Cathy

2017-01-01

Although trafficked women and adolescents are at risk of unprotected or forced sex, there is little research on maternity care among trafficking survivors. We explored health care needs, service use and challenges among women who became pregnant while in the trafficking situation in the United Kingdom (UK) and clinicians' perspectives of maternity care for trafficked persons. Cross-sectional survey and qualitative interviews with trafficking survivors recruited from statutory and voluntary sector organisations in England and qualitative interviews with maternity clinicians and family doctors undertaken to offer further insight into experiences reported by these women. Twenty-eight (29%) of 98 women who took part in a large study of trafficking survivors reported one or more pregnancies while trafficked, whose data are reported here. Twelve (42.8%) of these women reported at least one termination of pregnancy while in the trafficking situation and 25 (89.3%) experienced some form of mental health disorder. Nineteen (67.9%) women experienced pre-trafficking physical abuse and 9 (32.%) sexual abuse. A quarter of women were trafficked for sexual exploitation, six for domestic servitude and two for manual labour. Survivors and clinicians described service challenges, including restrictions placed on women's movements by traffickers, poor knowledge on how to access maternity care, poor understanding of healthcare entitlements and concerns about confidentiality. Maternity care clinicians recognised potential indicators of trafficking, but considered training would help them identify and respond to victims. Main limitations include that findings reflect women who had exited the trafficking situation, however as some had only recently exited the trafficking situation, difficulties with recall were likely to be low. More than one in four women became pregnant while trafficked, indicating that maternity services offer an important contact point for identification and care

Predictors of maternal health services utilization by poor, rural women: a comparative study in Indian States of Gujarat and Tamil Nadu.

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Vora, Kranti Suresh; Koblinsky, Sally A; Koblinsky, Marge A

2015-07-31

India leads all nations in numbers of maternal deaths, with poor, rural women contributing disproportionately to the high maternal mortality ratio. In 2005, India launched the world's largest conditional cash transfer scheme, Janani Suraksha Yojana (JSY), to increase poor women's access to institutional delivery, anticipating that facility-based birthing would decrease deaths. Indian states have taken different approaches to implementing JSY. Tamil Nadu adopted JSY with a reorganization of its public health system, and Gujarat augmented JSY with the state-funded Chiranjeevi Yojana (CY) scheme, contracting with private physicians for delivery services. Given scarce evidence of the outcomes of these approaches, especially in states with more optimal health indicators, this cross-sectional study examined the role of JSY/CY and other healthcare system and social factors in predicting poor, rural women's use of maternal health services in Gujarat and Tamil Nadu. Using the District Level Household Survey (DLHS)-3, the sample included 1584 Gujarati and 601 Tamil rural women in the lowest two wealth quintiles. Multivariate logistic regression analyses examined associations between JSY/CY and other salient health system, socio-demographic, and obstetric factors with three outcomes: adequate antenatal care, institutional delivery, and Cesarean-section. Tamil women reported greater use of maternal healthcare services than Gujarati women. JSY/CY participation predicted institutional delivery in Gujarat (AOR = 3.9), but JSY assistance failed to predict institutional delivery in Tamil Nadu, where mothers received some cash for home births under another scheme. JSY/CY assistance failed to predict adequate antenatal care, which was not incentivized. All-weather road access predicted institutional delivery in both Tamil Nadu (AOR = 3.4) and Gujarat (AOR = 1.4). Women's education predicted institutional delivery and Cesarean-section in Tamil Nadu, while husbands

Audit of antenatal services in primary healthcare centres in Jos ...

African Journals Online (AJOL)

Introduction: Maternal mortality remains a big challenge in developing countries including Nigeria where the figures are amongst the highest in the world. The Nigerian government's response in providing primary healthcare centres (PHCs) in all local government areas is commendable but access to quality antenatal care is ...

Home healthcare services in Taiwan: a nationwide study among the older population

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Lai Hsiu-Yun

2010-09-01

Full Text Available Abstract Background Home healthcare services are important in aging societies worldwide. The present nationwide study of health insurance data examined the utilization and delivery patterns, including diagnostic indications, for home healthcare services used by seniors in Taiwan. Methods Patients ≥65 years of age who received home healthcare services during 2004 under the Taiwanese National Health Insurance Program were identified and reimbursement claims were analyzed. Age, gender, disease diagnoses, distribution of facilities providing home healthcare services, and patterns of professional visits, including physician and skilled nursing visits, were also explored. Results Among 2,104,978 beneficiaries ≥65 years of age, 19,483 (0.9% patients received 127,753 home healthcare visits during 2004 with a mean number of 6.0 ± 4.8 visits per person. The highest prevalence of home healthcare services was in the 75-84 year age group in both sexes. Females received more home healthcare services than males in all age groups. Cerebrovascular disease was the most frequent diagnosis in these patients (50.7%. More than half of home healthcare visits and around half of the professional home visits were provided by community home nursing care institutions. The majority of the home skilled nursing services were tube replacements, including nasogastric tubes, Foley catheter, tracheostomy, nephrostomy or cystostomy tubes (95%. Conclusions Nine out of 1,000 older patients in Taiwan received home healthcare services during 2004, which was much lower than the rate of disabled older people in Taiwan. Females used home healthcare services more frequently than males and the majority of skilled nursing services were tube replacements. The rate of tube replacement of home healthcare patients in Taiwan deserves to be paid more attention.

Significant components of service brand equity in healthcare sector.

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Chahal, Hardeep; Bala, Madhu

2012-01-01

The purpose of the study is to examine three significant components of service brand equity--i.e. perceived service quality, brand loyalty, and brand image--and analyze relationships among the components of brand equity and also their relationship with brand equity, which is still to be theorized and developed in the healthcare literature. Effective responses were received from 206 respondents, selected conveniently from the localities of Jammu city. After scale item analysis, the data were analyzed using factor analysis, correlations, t-tests, multiple regression analysis and path modeling using SEM. The findings of the study support that service brand equity in the healthcare sector is greatly influenced by brand loyalty and perceived quality. However, brand image has an indirect effect on service brand equity through brand loyalty (mediating variable). The research can be criticized on the ground that data were selected conveniently from respondents residing in the city of Jammu, India. But at the same time the respondents were appropriate for the study as they have adequate knowledge about the hospitals, and were associated with the selected hospital for more than four years. Furthermore, the validity and reliability of the data are strong enough to take care of the limitations of the convenience sampling selection method. The study has unique value addition to the service marketing vis-à-vis healthcare literature, from both theoretical and managerial perspectives. The study establishes a direct and significant relationship between service brand equity and its two components, i.e. perceived service quality and brand loyalty in the healthcare sector. It also provides directions to healthcare service providers in creating, enhancing, and maintaining service brand equity through service quality and brand loyalty, to sustain competitive advantage.

The Role of Quality Obstetric Care Services on Reducing Maternal ...

African Journals Online (AJOL)

The study recommends that, special initiative should be done to bring changes on reducing maternal mortality, such as ensure essential equipments and ... Enforcement in providing quality of obstetric care services in maternal health services especially in rural areas where majority of people in Tanzania reside is not an ...

Design of an impact evaluation using a mixed methods model--an explanatory assessment of the effects of results-based financing mechanisms on maternal healthcare services in Malawi.

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Brenner, Stephan; Muula, Adamson S; Robyn, Paul Jacob; Bärnighausen, Till; Sarker, Malabika; Mathanga, Don P; Bossert, Thomas; De Allegri, Manuela

2014-04-22

In this article we present a study design to evaluate the causal impact of providing supply-side performance-based financing incentives in combination with a demand-side cash transfer component on equitable access to and quality of maternal and neonatal healthcare services. This intervention is introduced to selected emergency obstetric care facilities and catchment area populations in four districts in Malawi. We here describe and discuss our study protocol with regard to the research aims, the local implementation context, and our rationale for selecting a mixed methods explanatory design with a quasi-experimental quantitative component. The quantitative research component consists of a controlled pre- and post-test design with multiple post-test measurements. This allows us to quantitatively measure 'equitable access to healthcare services' at the community level and 'healthcare quality' at the health facility level. Guided by a theoretical framework of causal relationships, we determined a number of input, process, and output indicators to evaluate both intended and unintended effects of the intervention. Overall causal impact estimates will result from a difference-in-difference analysis comparing selected indicators across intervention and control facilities/catchment populations over time.To further explain heterogeneity of quantitatively observed effects and to understand the experiential dimensions of financial incentives on clients and providers, we designed a qualitative component in line with the overall explanatory mixed methods approach. This component consists of in-depth interviews and focus group discussions with providers, service user, non-users, and policy stakeholders. In this explanatory design comprehensive understanding of expected and unexpected effects of the intervention on both access and quality will emerge through careful triangulation at two levels: across multiple quantitative elements and across quantitative and qualitative elements

How equitable is social franchising? Case studies of three maternal healthcare franchises in Uganda and India.

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Haemmerli, Manon; Santos, Andreia; Penn-Kekana, Loveday; Lange, Isabelle; Matovu, Fred; Benova, Lenka; Wong, Kerry L M; Goodman, Catherine

2018-04-01

Substantial investments have been made in clinical social franchising to improve quality of care of private facilities in low- and middle-income countries but concerns have emerged that the benefits fail to reach poorer groups. We assessed the distribution of franchise utilization and content of care by socio-economic status (SES) in three maternal healthcare social franchises in Uganda and India (Uttar Pradesh and Rajasthan). We surveyed 2179 women who had received antenatal care (ANC) and/or delivery services at franchise clinics (in Uttar Pradesh only ANC services were offered). Women were allocated to national (Uganda) or state (India) SES quintiles. Franchise users were concentrated in the higher SES quintiles in all settings. The percent in the top two quintiles was highest in Uganda (over 98% for both ANC and delivery), followed by Rajasthan (62.8% for ANC, 72.1% for delivery) and Uttar Pradesh (48.5% for ANC). The percent of clients in the lowest two quintiles was zero in Uganda, 7.1 and 3.1% for ANC and delivery, respectively, in Rajasthan and 16.3% in Uttar Pradesh. Differences in SES distribution across the programmes may reflect variation in user fees, the average SES of the national/state populations and the range of services covered. We found little variation in content of care by SES. Key factors limiting the ability of such maternal health social franchises to reach poorer groups may include the lack of suitable facilities in the poorest areas, the inability of the poorest women to afford any private sector fees and competition with free or even incentivized public sector services. Moreover, there are tensions between targeting poorer groups, and franchise objectives of improving quality and business performance and enhancing financial sustainability, meaning that middle income and poorer groups are unlikely to be reached in large numbers in the absence of additional subsidies.

How equitable is social franchising? Case studies of three maternal healthcare franchises in Uganda and India

Science.gov (United States)

Haemmerli, Manon; Santos, Andreia; Penn-Kekana, Loveday; Lange, Isabelle; Matovu, Fred; Benova, Lenka; Wong, Kerry LM

2018-01-01

Abstract Substantial investments have been made in clinical social franchising to improve quality of care of private facilities in low- and middle-income countries but concerns have emerged that the benefits fail to reach poorer groups. We assessed the distribution of franchise utilization and content of care by socio-economic status (SES) in three maternal healthcare social franchises in Uganda and India (Uttar Pradesh and Rajasthan). We surveyed 2179 women who had received antenatal care (ANC) and/or delivery services at franchise clinics (in Uttar Pradesh only ANC services were offered). Women were allocated to national (Uganda) or state (India) SES quintiles. Franchise users were concentrated in the higher SES quintiles in all settings. The percent in the top two quintiles was highest in Uganda (over 98% for both ANC and delivery), followed by Rajasthan (62.8% for ANC, 72.1% for delivery) and Uttar Pradesh (48.5% for ANC). The percent of clients in the lowest two quintiles was zero in Uganda, 7.1 and 3.1% for ANC and delivery, respectively, in Rajasthan and 16.3% in Uttar Pradesh. Differences in SES distribution across the programmes may reflect variation in user fees, the average SES of the national/state populations and the range of services covered. We found little variation in content of care by SES. Key factors limiting the ability of such maternal health social franchises to reach poorer groups may include the lack of suitable facilities in the poorest areas, the inability of the poorest women to afford any private sector fees and competition with free or even incentivized public sector services. Moreover, there are tensions between targeting poorer groups, and franchise objectives of improving quality and business performance and enhancing financial sustainability, meaning that middle income and poorer groups are unlikely to be reached in large numbers in the absence of additional subsidies. PMID:29373681

Instill Lean A3 Thinking into Healthcare IT Services

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Jihong Zeng

2014-08-01

Full Text Available Healthcare information technology is a key enabler for care transformation to provide quality care at low cost and better population health.  Many healthcare organizations have established IT Program Management and adopted ITIL best practice to manage IT services. However, ITIL and traditional project management are heavily process oriented, and neither flexible nor effective enough for swift response to changing business demand. Lean methodologies are increasingly deployed by healthcare providers to improve workflow process management but only has limited use cases documented in healthcare IT service. This paper introduces the Lean A3 Thinking methodology and its value in identifying and eliminating wastes to provide agile and effective solutions in response to customer requests. We present a case study of applying Lean A3 Thinking to improve clinical informatics reporting service. The initial evaluation results are promising and indicate that both ITIL and Lean A3 Thinking focus on customer and service quality, complementing each other well. ITIL provides a framework for ITSM based on a set of best practice to manage IT services. Lean A3 Thinking specifies a set of framework and tools for improving quality of services and processes by eliminating wastes. Proper balance between Lean and ITIL principles for ITSM needs more research and further study.

Health Extension Workers' and Mothers' Attitudes to Maternal Health Service Utilization and Acceptance in Adwa Woreda, Tigray Region, Ethiopia.

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Ruth Jackson

Full Text Available The maternal health system in Ethiopia links health posts in rural communities (kebeles with district (woreda health centres, and health centres with primary hospitals. At each health post two Health Extension Workers (HEWs assist women with birth preparedness, complication readiness, and mobilize communities to facilitate timely referral to mid-level service providers. This study explored HEWs' and mother's attitudes to maternal health services in Adwa Woreda, Tigray Region.In this qualitative study, we trained 16 HEWs to interview 45 women to gain a better understanding of the social context of maternal health related behaviours. Themes included barriers to health services; women's social status and mobility; and women's perceptions of skilled birth attendant's care. All data were analyzed thematically.There have been substantial efforts to improve maternal health and reduce maternal mortality in Adwa Woreda. Women identified barriers to healthcare including distance and lack of transportation due to geographical factors; the absence of many husbands due to off-woreda farming; traditional factors such as zwar (some pregnant women are afraid of meeting other pregnant women, and discouragement from mothers and mothers-in-law who delivered their children at home. Some women experienced disrespectful care at the hospital. Facilitators to skilled birth attendance included: identification of pregnant women through Women's Development Groups (WDGs, and referral by ambulance to health facilities either before a woman's Expected Due Date (EDD or if labour started at home.With the support of WDGs, HEWs have increased the rate of skilled birth attendance by calling ambulances to transfer women to health centres either before their EDD or when labour starts at home. These findings add to the growing body of evidence that health workers at the community level can work with women's groups to improve maternal health, thus reducing the need for emergency

Factors affecting Japanese retirees' healthcare service utilisation in Malaysia: a qualitative study.

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Kohno, Ayako; Nik Farid, Nik Daliana; Musa, Ghazali; Abdul Aziz, Norlaili; Nakayama, Takeo; Dahlui, Maznah

2016-03-22

While living overseas in another culture, retirees need to adapt to a new environment but often this causes difficulties, particularly among those elderly who require healthcare services. This study examines factors affecting healthcare service utilisation among Japanese retirees in Malaysia. We conducted 6 focus group discussions with Japanese retirees and interviewed 8 relevant medical services providers in-depth. Guided by the Andersen Healthcare Utilisation Model, we managed and analysed the data, using QSR NVivo 10 software and the directed content analysis method. We interviewed participants at Japan Clubs and their offices. 30 Japanese retirees who live in Kuala Lumpur and Ipoh, and 8 medical services providers. We identified health beliefs, medical symptoms and health insurance as the 3 most important themes, respectively, representing the 3 dimensions within the Andersen Healthcare Utilisation Model. Additionally, language barriers, voluntary health repatriation to Japan and psychological support were unique themes that influence healthcare service utilisation among Japanese retirees. The healthcare service utilisation among Japanese retirees in Malaysia could be partially explained by the Andersen Healthcare Utilisation Model, together with some factors that were unique findings to this study. Healthcare service utilisation among Japanese retirees in Malaysia could be improved by alleviating negative health beliefs through awareness programmes for Japanese retirees about the healthcare systems and cultural aspects of medical care in Malaysia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Assessment of patient's satisfaction with healthcare services ...

African Journals Online (AJOL)

Assessment of patient's satisfaction with healthcare services obtained from a ... to identify deficiencies and improve on the quality of health services rendered. ... by the doctor or nurse (r = 0.315, p<0.001) and a significant negative correlation ...

Rural women's perspectives of maternity services in the Midland Region of New Zealand.

Science.gov (United States)

Gibbons, Veronique; Lancaster, Gytha; Gosman, Kim; Lawrenson, Ross

2016-09-01

INTRODUCTION Rural women face many challenges with regards to maternity services. Many rural primary birthing facilities in New Zealand have closed. The Lead Maternity Carer (LMC) model of maternity care, introduced in 1990, has moved provision of rural maternity care from doctors to independent midwifery services. Shortages of rural midwives in the Midland region led to rural maternity care being seen as a vulnerable service. AIM To understand the views and experiences of rural women concerning maternity care, to inform the future design and provision of rural maternity services. METHODS Participants were drawn from areas purposively selected to represent the five District Health Boards comprising the Midland health region. A demographic questionnaire, focus groups and individual interviews explored rural women's perspectives of antenatal care provision. These were analysed thematically. RESULTS Sixty-two women were recruited. Key themes emerging from focus groups and interviews included: access to services, the importance of safety and quality of care, the need for appropriate information at different stages, and the role of partners, family and friends in the birthing journey. While most women were happy with access to services, quality of care, provision of information, and the role of family in their care, for some women, this experience could be enhanced. CONCLUSION Midwives are the frontline service for women seeking antenatal services. Support for rural midwives and for local birthing units is needed to ensure rural women receive services equal to that of their urban counterparts.

Enhancing Health-Care Services with Mixed Reality Systems

Science.gov (United States)

Stantchev, Vladimir

This work presents a development approach for mixed reality systems in health care. Although health-care service costs account for 5-15% of GDP in developed countries the sector has been remarkably resistant to the introduction of technology-supported optimizations. Digitalization of data storing and processing in the form of electronic patient records (EPR) and hospital information systems (HIS) is a first necessary step. Contrary to typical business functions (e.g., accounting or CRM) a health-care service is characterized by a knowledge intensive decision process and usage of specialized devices ranging from stethoscopes to complex surgical systems. Mixed reality systems can help fill the gap between highly patient-specific health-care services that need a variety of technical resources on the one side and the streamlined process flow that typical process supporting information systems expect on the other side. To achieve this task, we present a development approach that includes an evaluation of existing tasks and processes within the health-care service and the information systems that currently support the service, as well as identification of decision paths and actions that can benefit from mixed reality systems. The result is a mixed reality system that allows a clinician to monitor the elements of the physical world and to blend them with virtual information provided by the systems. He or she can also plan and schedule treatments and operations in the digital world depending on status information from this mixed reality.

National health insurance subscription and maternal healthcare utilisation across mothers' wealth status in Ghana.

Science.gov (United States)

Ameyaw, Edward Kwabena; Kofinti, Raymond Elikplim; Appiah, Francis

2017-12-01

This study is against the backdrop that despite the forty-nine percent decline in Maternal Mortality Rate in Ghana, the situation still remains high averaging 319 per 100,000 live births between 2011 and 2015. To examine the relationship between National Health Insurance and maternal healthcare utilisation across three main wealth quintiles (Poor, Middle and Rich). The study employed data from the 2014 Ghana Demographic and Health Survey. Both descriptive analysis and binary logistic regression were conducted. Descriptively, rich women had high antenatal attendance and health facility deliveries represented by 96.5% and 95.6% respectively. However, the binary logistic regression results revealed that poor women owning NHIS are 7% (CI = 1.76-2.87) more likely to make at least four antenatal care visits compared to women in the middle wealth quintile (5%, CI = 2.12-4.76) and rich women (2%, CI = 1.14-4.14). Similarly, poor women who owned the NHIS are 14% (CI = 1.42-2.13) likely to deliver in health facility than women in the middle and rich wealth quintile. The study has vindicated the claim that NHIS Scheme is pro-poor in Ghana. The Ministry of Health should target women in the rural area to be enrolled on the NHIS to improve maternal healthcare utilisation since poverty is principally a rural phenomenon in Ghana.

Service models for remote healthcare monitoring systems.

Science.gov (United States)

Moorman, Bridget A

2010-01-01

These scenarios reflect where the future is heading for remote health monitoring technology and service expectations. Being able to manage a "system of systems" with timely service hand-off over seams of responsibility and system interfaces will become very important for a BMET or clinical engineer. These interfaces will include patient homes, clinician homes, commercial/civilian infrastructure, public utilities, vendor infrastructure as well as internal departmental domains. Concurrently, technology is changing rapidly resulting in newer software delivery modes and hardware appliances as well as infrastructure changes. Those who are able to de-construct the complex systems and identify infrastructure assumptions and seams of servicing responsibility will be able to better understand and communicate the expectations for service of these systems. Moreover, as identified in Case 1, prodigious use of underlying system monitoring tools (managing the "meta-data") could move servicing of these remote systems from a reactive approach to a proactive approach. A prepared healthcare organization will identify their current and proposed future service combination use cases and design service philosophies and expectations for those use cases, while understanding the infrastructure assumptions and seams of responsibility. This is the future of technical service to the healthcare clinicians and patients.

Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

Science.gov (United States)

Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

2014-01-01

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

Households' choices of healthcare services in the north west region ...

African Journals Online (AJOL)

Health can either be optimised households' choices between preventive and curative ... In Cameroon like other developing countries, domestic healthcare service is ... specific characteristics such as the reputation of the healthcare providers are ... healthcare can be improved with efficient healthcare support programs and ...

Investigating financial incentives for maternal health: an introduction.

Science.gov (United States)

Stanton, Mary Ellen; Higgs, Elizabeth S; Koblinsky, Marge

2013-12-01

Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives (e.g. performance-based financing, user fees, and various insurance mechanisms) and demand-side incentives (e.g. conditional cash transfers, vouchers, user fee exemptions, and subsidies for care-seeking). At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured

Cultural Competence among Maternal Healthcare Providers in Bahir Dar City Administration, Northwest Ethiopia: Cross sectional Study.

Science.gov (United States)

Aragaw, Amanu; Yigzaw, Tegbar; Tetemke, Desalegn; G/Amlak, Wubalem

2015-09-24

Cultural competency is now a core requirement for maternal health providers working in multicultural society. However, it has not yet received due attention in Ethiopia. This study aimed to determine the level of cultural competence and its associated factors among maternal health care providers in Bahir Dar City Administration, Northwest Ethiopia. Institution based cross-sectional study was carried out using both quantitative and qualitative methods. Maternal health care providers from all health facilities were our study participants. Structured Questionnaire with some modification of Campinha Bacote's tool was used to collect quantitative data from health workers and semi structured guide line was used for qualitative data among women. While quantitative data analysis was done using SPSS, qualitative data was analyzed using open code software. P-value of less than 0.05 was taken to determine statistical significance. Cronbach's alpha was used to test internal reliability and a factor loading of 0.3 or greater was the criterion used to retain items. Two hundred seventy four health workers and seven women were involved in the study. The overall competency level was 57.3 % thought vary in different subscales or stages. Of the cultural competent health workers near to three fourth (73.0 %) were in awareness stage which is the earliest stage of competence in which individuals were aware only their own culture but not the world view of their clients. The voices of mothers in the qualitative assessment also showed discordance in cultural competence with their healthcare providers. Female health workers almost six times [AOR,5.5; 2.71, 11.30] more competent than male providers and those who got in-service training related to maternal care provided services more culturally competent than their counter parts with [AOR,3.5; 1.4, 8.64]. Reliability Cronbach's α coefficient value of cultural competence subscales showed 0.672,0 .719, 0.658, 0.714, and 0.631 for cultural

Integrating complementary and alternative medicine into mainstream healthcare services: the perspectives of health service managers.

Science.gov (United States)

Singer, Judy; Adams, Jon

2014-05-22

Complementary and alternative medicine (CAM) is increasingly included within mainstream integrative healthcare (IHC) services. Health service managers are key stakeholders central to ensuring effective integrative health care services. Yet, little research has specifically investigated the role or perspective of health service managers with regards to integrative health care services under their management. In response, this paper reports findings from an exploratory study focusing exclusively on the perspectives of health service managers of integrative health care services in Australia regarding the role of CAM within their service and the health service managers rational for incorporating CAM into clinical care. Health service managers from seven services were recruited using purposive and snowball sampling. Semi-structured interviews were conducted with the health service managers. The services addressed trauma and chronic conditions and comprised: five community-based programs including drug and alcohol rehabilitation, refugee mental health and women's health; and two hospital-based specialist services. The CAM practices included in the services investigated included acupuncture, naturopathy, Western herbal medicine and massage. Findings reveal that the health service managers in this study understand CAM to enhance the holistic capacity of their service by: filling therapeutic gaps in existing healthcare practices; by treating the whole person; and by increasing healthcare choices. Health service managers also identified CAM as addressing therapeutic gaps through the provision of a mind-body approach in psychological trauma and in chronic disease management treatment. Health service managers describe the addition of CAM in their service as enabling patients who would otherwise not be able to afford CAM to gain access to these treatments thereby increasing healthcare choices. Some health service managers expressly align the notion of treating the whole person

Immigrant women's experience of maternity services in Canada: a meta-ethnography.

Science.gov (United States)

Higginbottom, Gina M A; Hadziabdic, Emina; Yohani, Sophie; Paton, Patricia

2014-05-01

to synthesise data on immigrant women's experiences of maternity services in Canada. a qualitative systematic literature review using a meta-ethnographic approach a comprehensive search strategy of multiple databases was employed in consultation with an information librarian, to identify qualitative research studies published in English or French between 1990 and December 2011 on maternity care experiences of immigrant women in Canada. A modified version of Noblit and Hare's meta-ethnographic theoretical approach was undertaken to develop an inductive and interpretive form of knowledge synthesis. The seven-phase process involved comparative textual analysis of published qualitative studies, including the translation of key concepts and meanings from one study to another to derive second and third-order concepts encompassing more than that offered by any individual study. ATLAS.ti qualitative data analysis software was used to store and manage the studies and synthesise their findings. the literature search identified 393 papers, of which 22 met the inclusion criteria and were synthesised. The literature contained seven key concepts related to maternity service experiences including social (professional and informal) support, communication, socio-economic barriers, organisational environment, knowledge about maternity services and health care, cultural beliefs and practices, and different expectations between health care staff and immigrant women. Three second-order interpretations served as the foundation for two third-order interpretations. Societal positioning of immigrant women resulted in difficulties receiving high quality maternity health care. Maternity services were an experience in which cultural knowledge and beliefs, and religious and traditional preferences were highly relevant as well but often overlooked in Canadian maternity settings. in order to implement woman-centered care, to enhance access to maternity services, and to promote immigrant women

Effects of librarian-provided services in healthcare settings: a systematic review.

Science.gov (United States)

Perrier, Laure; Farrell, Ann; Ayala, A Patricia; Lightfoot, David; Kenny, Tim; Aaronson, Ellen; Allee, Nancy; Brigham, Tara; Connor, Elizabeth; Constantinescu, Teodora; Muellenbach, Joanne; Epstein, Helen-Ann Brown; Weiss, Ardis

2014-01-01

To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes. Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics. Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings. Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient's case. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

An intelligent tele-healthcare environment offering person-centric and wellness-maintenance services.

Science.gov (United States)

Abidi, S S

2001-06-01

Worldwide healthcare delivery trends are undergoing a subtle paradigm shift--patient centered services as opposed to provider centered services and wellness maintenance as opposed to illness management. In this paper we present a Tele-Healthcare project TIDE--Tele-Healthcare Information and Diagnostic Environment. TIDE manifests an 'intelligent' healthcare environment that aims to ensure lifelong coverage of person-specific health maintenance decision-support services--i.e., both wellness maintenance and illness management services--ubiquitously available via the Internet/WWW. Taking on an all-encompassing health maintenance role--spanning from wellness to illness issues--the functionality of TIDE involves the generation and delivery of (a) Personalized, Pro-active, Persistent, Perpetual, and Present wellness maintenance services, and (b) remote diagnostic services for managing noncritical illnesses. Technically, TIDE is an amalgamation of diverse computer technologies--Artificial Intelligence, Internet, Multimedia, Databases, and Medical Informatics--to implement a sophisticated healthcare delivery infostructure.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors.

Science.gov (United States)

Mahmood, Mohammad Afzal; Mufidah, Ismi; Scroggs, Steven; Siddiqui, Amna Rehana; Raheel, Hafsa; Wibdarminto, Koentijo; Dirgantoro, Bernardus; Vercruyssen, Jorien; Wahabi, Hayfaa A

2018-01-01

Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records' review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped.

Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service

OpenAIRE

Oh, Sungyoung; Cha, Jieun; Ji, Myungkyu; Kang, Hyekyung; Kim, Seok; Heo, Eunyoung; Han, Jong Soo; Kang, Hyunggoo; Chae, Hoseok; Hwang, Hee; Yoo, Sooyoung

2015-01-01

Objectives To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. Methods We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functi...

Maternity services in multi-cultural Britain: using Q methodology to explore the views of first- and second-generation women of Pakistani origin.

Science.gov (United States)

Cross-Sudworth, Fiona; Williams, Amanda; Herron-Marx, Sandy

2011-08-01

) importance of information and support from health-care professionals; and (6) importance of midwifery care to women. there were no clear inter generational differences identified, but a breadth of opinion and experience that seemed to be influenced by level of both education and social support was found. Whereas some women had few demands of maternity services, those who had less support and those with language barriers had additional needs. care given should be based on individual need but given within a wider collaborative context in order to support women effectively. Increased maternity service user involvement would also be welcomed for future planning of maternity services. Copyright © 2010 Elsevier Ltd. All rights reserved.

Constructing RBAC based security model in u-healthcare service platform.

Science.gov (United States)

Shin, Moon Sun; Jeon, Heung Seok; Ju, Yong Wan; Lee, Bum Ju; Jeong, Seon-Phil

2015-01-01

In today's era of aging society, people want to handle personal health care by themselves in everyday life. In particular, the evolution of medical and IT convergence technology and mobile smart devices has made it possible for people to gather information on their health status anytime and anywhere easily using biometric information acquisition devices. Healthcare information systems can contribute to the improvement of the nation's healthcare quality and the reduction of related cost. However, there are no perfect security models or mechanisms for healthcare service applications, and privacy information can therefore be leaked. In this paper, we examine security requirements related to privacy protection in u-healthcare service and propose an extended RBAC based security model. We propose and design u-healthcare service integration platform (u-HCSIP) applying RBAC security model. The proposed u-HCSIP performs four main functions: storing and exchanging personal health records (PHR), recommending meals and exercise, buying/selling private health information or experience, and managing personal health data using smart devices.

Constructing RBAC Based Security Model in u-Healthcare Service Platform

Science.gov (United States)

Shin, Moon Sun; Jeon, Heung Seok; Ju, Yong Wan; Lee, Bum Ju; Jeong, Seon-Phil

2015-01-01

In today's era of aging society, people want to handle personal health care by themselves in everyday life. In particular, the evolution of medical and IT convergence technology and mobile smart devices has made it possible for people to gather information on their health status anytime and anywhere easily using biometric information acquisition devices. Healthcare information systems can contribute to the improvement of the nation's healthcare quality and the reduction of related cost. However, there are no perfect security models or mechanisms for healthcare service applications, and privacy information can therefore be leaked. In this paper, we examine security requirements related to privacy protection in u-healthcare service and propose an extended RBAC based security model. We propose and design u-healthcare service integration platform (u-HCSIP) applying RBAC security model. The proposed u-HCSIP performs four main functions: storing and exchanging personal health records (PHR), recommending meals and exercise, buying/selling private health information or experience, and managing personal health data using smart devices. PMID:25695104

A review of national health policies and professional guidelines on maternal obesity and weight gain in pregnancy.

Science.gov (United States)

Schumann, N L; Brinsden, H; Lobstein, T

2014-08-01

Maternal obesity creates an additional demand for health-care services, as the routine obstetric care pathway requires alterations to ensure the most optimal care for obese women of childbearing age. This review examines the extent to which relevant national health documents reflect and respond to the health implications of maternal obesity and excessive gestational weight gain. A targeted search of peer-reviewed publications and grey literature was conducted for each country to identify national health documents, which were subsequently content analyzed according to an adapted framework. A total of 37 documents were identified, including one policy, 10 strategies and 26 guidelines, published within the last 10 years. Out of the 31 countries investigated, only 13 countries address maternal obesity while none address excessive gestational weight gain. We found inconsistencies and gaps in the recommendations to health-care service providers for the management of maternal obesity and weight gain in pregnancy. The findings show that only limited guidance on maternal obesity and gestational weight gain exists. The authors recommend that international, evidence-based guidelines on the management of maternal obesity and excessive gestational weight gain should be developed to reduce the associated health-care and economic costs. © 2014 The Authors. Clinical Obesity © 2014 World Obesity.

Migrants' utilization of somatic healthcare services in Europe - a systematic review

DEFF Research Database (Denmark)

Nørredam, Marie Louise; Nielsen, Signe Smith; Krasnik, Allan

2010-01-01

on the abstracts. Additional searches were conducted via the references of the selected articles. The final number of studies included was 21. Results: The results suggested a diverging picture regarding utilization of somatic healthcare services by migrants compared to non-migrants in Europe. Overall, migrants......Background: Utilization of services is an important aspect of migrants' access to healthcare. The aim was to review the European literature on utilization of somatic healthcare services related to screening, general practitioner, specialist, emergency room and hospital by adult first......-generation migrants. Our study question was: ‘Are there differences in migrants' utilization of somatic healthcare services compared to non-migrants?' Methods: Publications were identified by a systematic search of PUBMED and EMBASE. Appropriateness of the studies was judged independently by two researchers based...

Maternal Healthcare Providers in Uttar Pradesh, India: How to Position Informal Practitioners within the System?

Directory of Open Access Journals (Sweden)

Chesta Sharma

2014-12-01

Full Text Available To understand the knowledge and services of informal providers and to explore their role in addressing the human resource gap in Uttar Pradesh, India, within the context of maternal health.The study is exploratory in nature, conducted in four blocks of four districts of Uttar Pradesh state, India. Semi-structured interviews were conducted with 114 informal providers.More than one-third (38% providers have some formal education and unrecognized degrees. Approximately three-fourths (74% of them have more than 5 years of work experience. They also provide delivery and in-patient services and have basic equipment available. However, they lack essential knowledge about maternal health. They have mixed opinion about their contribution towards maternal health but the only ones available. Therefore, despite lacking requisite knowledge, training and services, they become indispensable due to lack of emergency and timely public health services, and being the only ones existing in the community.Informal sector practitioners are a critical link in reaching out to population for health services in developing countries. As opposed to the general notion, they possess years of formal education, experience, informal trainings along with trust of communities. Thus, it becomes important to accept their presence and manage them to the best of their abilities even for specialized care like maternal health.

Process-oriented integration and coordination of healthcare services across organizational boundaries.

Science.gov (United States)

Tello-Leal, Edgar; Chiotti, Omar; Villarreal, Pablo David

2012-12-01

The paper presents a methodology that follows a top-down approach based on a Model-Driven Architecture for integrating and coordinating healthcare services through cross-organizational processes to enable organizations providing high quality healthcare services and continuous process improvements. The methodology provides a modeling language that enables organizations conceptualizing an integration agreement, and identifying and designing cross-organizational process models. These models are used for the automatic generation of: the private view of processes each organization should perform to fulfill its role in cross-organizational processes, and Colored Petri Net specifications to implement these processes. A multi-agent system platform provides agents able to interpret Colored Petri-Nets to enable the communication between the Healthcare Information Systems for executing the cross-organizational processes. Clinical documents are defined using the HL7 Clinical Document Architecture. This methodology guarantees that important requirements for healthcare services integration and coordination are fulfilled: interoperability between heterogeneous Healthcare Information Systems; ability to cope with changes in cross-organizational processes; guarantee of alignment between the integrated healthcare service solution defined at the organizational level and the solution defined at technological level; and the distributed execution of cross-organizational processes keeping the organizations autonomy.

Viability of healthcare service delivery alternatives for the Australian mining sector.

Science.gov (United States)

Williams, Patricia A H; Giles, Margaret

2012-01-01

The changing and demanding nature of the mining workforce in rural and remote Australia brings unique challenges to the delivery of healthcare services. In an attempt to control costs whilst delivering cost effective and quality healthcare, new models of delivery must be considered. For a workforce that is fly-in/fly-out, the provision of healthcare is problematic given the lack of consistency in location. A cost-benefit framework is analysed comparing three models of service provision using travel to a major location, locum services and remote health monitoring. Ultimately, new models of care must be considered to address the issues of increasing workforce turnover, to cater for rising healthcare costs, and to improve the health of such communities.

Do experiences and perceptions about quality of care differ among social groups in Nepal? : A study of maternal healthcare experiences of women with and without disabilities, and Dalit and non-Dalit women.

Science.gov (United States)

Devkota, Hridaya Raj; Clarke, Andrew; Murray, Emily; Groce, Nora

2017-01-01

Suboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women's socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit population and Dalit population and their peers without disabilities from both non-Dalit and Dalit communities. A cross-sectional survey was conducted among 343 total women that included women with disabilities, Dalits and non-Dalits. Women were recruited for interview, who were aged 15-49 years, had been pregnant within the last five years and who had used maternal care services in one of the public health facilities of Rupandehi district. A 20-item, Likert-type scale with four sub-scales or dimensions: 'Health Facility', 'Healthcare Delivery', 'Inter-personal' and 'Access to Care' was used to measure women's perceptions of quality of care. Chi-square test and t test were used to compare groups and to assess differences in perceptions; and linear regression was applied to assess confounding effects of socio-demographic factors. The mean score was compared for each item and separately for each dimension. All groups, women with disabilities and women without disabilities, Dalit and non-Dalit rated their perceptions and experiences of quality of care lowly in a number of items. While perceived quality of care between women with disabilities and without disabilities in the 'Health Facility' dimension and associated items, was found to differ (phealthcare delivery, interpersonal and personal factors as well as access to services 'low.' Poor service user experiences and perceptions of quality of care undermine opportunities to translate increased healthcare coverage into improved access and outcomes

INCAS—Interactive Teleconsultation Network for Worldwide Healthcare Services

Science.gov (United States)

Castelli, A.; Colombo, C.; Garlaschelli, A.; Pepe, G.

2001-01-01

The INCAS Project arises from the needs of an Italian oil company in order to support the doctors responsible for the healthcare in remote drilling sites. The INCAS telemedicine1 system implements a prototype of teleconsultation medical service allowing for the interactive on-line connection with Italian healthcare reference centres in order to: • provide support to the expatriate doctor with the diagnoses and treatment of routine complaints; • contribute to the general improvement of healthcare in remote areas.

Community participation to design rural primary healthcare services.

Science.gov (United States)

Farmer, Jane; Nimegeer, Amy

2014-03-21

This paper explores how community participation can be used in designing rural primary healthcare services by describing a study of Scottish communities. Community participation is extolled in healthcare policy as useful in planning services and is understood as particularly relevant in rural settings, partly due to high social capital. Literature describes many community participation methods, but lacks discussion of outcomes relevant to health system reconfiguration. There is a spectrum of ideas in the literature on how to design services, from top-down standard models to contextual plans arising from population health planning that incorporates community participation. This paper addresses an evidence gap about the outcomes of using community participation in (re)designing rural community health services. Community-based participatory action research was applied in four Scottish case study communities in 2008-10. Data were collected from four workshops held in each community (total 16) and attended by community members. Workshops were intended to produce hypothetical designs for future service provision. Themes, rankings and selections from workshops are presented. Community members identified consistent health priorities, including local practitioners, emergency triage, anticipatory care, wellbeing improvement and health volunteering. Communities designed different service models to address health priorities. One community did not design a service model and another replicated the current model despite initial enthusiasm for innovation. Communities differ in their receptiveness to engaging in innovative service design, but some will create new models that fit in a given budget. Design diversity indicates that context influences local healthcare planning, suggesting community participation impacts on design outcomes, but standard service models maybe useful as part of the evidence in community participation discussions.

Constructing RBAC Based Security Model in u-Healthcare Service Platform

Directory of Open Access Journals (Sweden)

Moon Sun Shin

2015-01-01

Full Text Available In today’s era of aging society, people want to handle personal health care by themselves in everyday life. In particular, the evolution of medical and IT convergence technology and mobile smart devices has made it possible for people to gather information on their health status anytime and anywhere easily using biometric information acquisition devices. Healthcare information systems can contribute to the improvement of the nation’s healthcare quality and the reduction of related cost. However, there are no perfect security models or mechanisms for healthcare service applications, and privacy information can therefore be leaked. In this paper, we examine security requirements related to privacy protection in u-healthcare service and propose an extended RBAC based security model. We propose and design u-healthcare service integration platform (u-HCSIP applying RBAC security model. The proposed u-HCSIP performs four main functions: storing and exchanging personal health records (PHR, recommending meals and exercise, buying/selling private health information or experience, and managing personal health data using smart devices.

Distribution and utilization of curative primary healthcare services in Lahej, Yemen.

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Bawazir, A A; Bin Hawail, T S; Al-Sakkaf, K A Z; Basaleem, H O; Muhraz, A F; Al-Shehri, A M

2013-09-01

No evidence-based data exist on the availability, accessibility and utilization of healthcare services in Lahej Governorate, Yemen. The aim of this study was to assess the distribution and utilization of curative services in primary healthcare units and centres in Lahej. Cross-sectional study (clustering sample). This study was conducted in three of the 15 districts in Lahej between December 2009 and August 2010. Household members were interviewed using a questionnaire to determine sociodemographic characteristics and types of healthcare services available in the area. The distribution of health centres, health units and hospitals did not match the size of the populations or areas of the districts included in this study. Geographical accessibility was the main obstacle to utilization. Factors associated with the utilization of curative services were significantly related to the time required to reach the nearest facility, seeking curative services during illness and awareness of the availability of health facilities (P < 0.01). There is an urgent need to look critically and scientifically at the distribution of healthcare services in the region in order to ensure accessibility and quality of services. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Service innovation quality in healthcare: Service innovativeness and organizational renewal as driving forces

NARCIS (Netherlands)

Mu, Y.; Bossink, Bart; Vinig, T.

2017-01-01

Drawing on an integration of service-dominant (S-D) logic and the dynamic capabilities approach, this study focuses on the relatively under-researched issue of service innovation quality in healthcare services. We propose a conceptual framework for the relationships between user-induced and

Mobile Cloud-Computing-Based Healthcare Service by Noncontact ECG Monitoring

Directory of Open Access Journals (Sweden)

Ee-May Fong

2013-12-01

Full Text Available Noncontact electrocardiogram (ECG measurement technique has gained popularity these days owing to its noninvasive features and convenience in daily life use. This paper presents mobile cloud computing for a healthcare system where a noncontact ECG measurement method is employed to capture biomedical signals from users. Healthcare service is provided to continuously collect biomedical signals from multiple locations. To observe and analyze the ECG signals in real time, a mobile device is used as a mobile monitoring terminal. In addition, a personalized healthcare assistant is installed on the mobile device; several healthcare features such as health status summaries, medication QR code scanning, and reminders are integrated into the mobile application. Health data are being synchronized into the healthcare cloud computing service (Web server system and Web server dataset to ensure a seamless healthcare monitoring system and anytime and anywhere coverage of network connection is available. Together with a Web page application, medical data are easily accessed by medical professionals or family members. Web page performance evaluation was conducted to ensure minimal Web server latency. The system demonstrates better availability of off-site and up-to-the-minute patient data, which can help detect health problems early and keep elderly patients out of the emergency room, thus providing a better and more comprehensive healthcare cloud computing service.

Refugee children have fewer contacts to psychiatric healthcare services

DEFF Research Database (Denmark)

Barghadouch, Amina; Kristiansen, Maria; Jervelund, Signe Smith

2016-01-01

and psychiatrists in private practice. Results: Between 1 January 1996 and 30 June 2012, 3.5 % of the refugee children accessed psychiatric healthcare services compared to 7.7 % of the Danish-born children. The rate ratio of having any first-time psychiatric contact was 0.42 (95 % CI 0.40–0.45) among refugee boys...... and 0.35 (95 % CI 0.33–0.37) among refugee girls, compared to Danish-born children. Figures were similar for those accessing private psychologists or psychiatrists, emergency room, inpatient and outpatient services. Conclusions: Refugee children used fewer psychiatric healthcare services than Danish...

Toward ubiquitous healthcare services with a novel efficient cloud platform.

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He, Chenguang; Fan, Xiaomao; Li, Ye

2013-01-01

Ubiquitous healthcare services are becoming more and more popular, especially under the urgent demand of the global aging issue. Cloud computing owns the pervasive and on-demand service-oriented natures, which can fit the characteristics of healthcare services very well. However, the abilities in dealing with multimodal, heterogeneous, and nonstationary physiological signals to provide persistent personalized services, meanwhile keeping high concurrent online analysis for public, are challenges to the general cloud. In this paper, we proposed a private cloud platform architecture which includes six layers according to the specific requirements. This platform utilizes message queue as a cloud engine, and each layer thereby achieves relative independence by this loosely coupled means of communications with publish/subscribe mechanism. Furthermore, a plug-in algorithm framework is also presented, and massive semistructure or unstructured medical data are accessed adaptively by this cloud architecture. As the testing results showing, this proposed cloud platform, with robust, stable, and efficient features, can satisfy high concurrent requests from ubiquitous healthcare services.

Innovation in healthcare services – creating a Combined Contingency Theory and Ecosystems Approach

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Engelseth, Per; Kritchanchai, Duangpun

2018-04-01

The purpose of this conceptual paper is to develop an analytical framework used for process development in healthcare services. Healthcare services imply a form of operations management demanding an adapted research approach. This study therefore highlights first in the introduction challenges of healthcare services as a reasoning of this study. It is a type of service that has high societal and therefore ethical concern, but at the same time needs to be carried out efficiently to economise service production resource use. Combined business and ethics concerns need to be balanced in this service supply system. In the literature review that is the bulk of this paper, first, particularities of the service industry processes are considered. This is followed by considering literature on contingency theory to consider the nature of the supply chain context of the healthcare service processes highlighting interdependencies and appropriate technology use. This developed view is then expanded to consider an ecosystems approach to encompass the environment expanding analyses to considering in balanced manner features of business, society and nature. A research model for directing both further researches on the healthcare service industry an innovation of such services in practice is introduced.

Root-Cause Analysis of Persistently High Maternal Mortality in a Rural District of Indonesia: Role of Clinical Care Quality and Health Services Organizational Factors

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Mohammad Afzal Mahmood

2018-01-01

Full Text Available Background. Despite significant reduction in maternal mortality, there are still many regions in the world that suffer from high mortality. District Kutai Kartanegara, Indonesia, is one such region where consistently high maternal mortality was observed despite high rate of delivery by skilled birth attendants. Method. Thirty maternal deaths were reviewed using verbal autopsy interviews, terminal event reporting, medical records’ review, and Death Audit Committee reports, using a comprehensive root-cause analysis framework including Risk Identification, Signal Services, Emergency Obstetrics Care Evaluation, Quality, and 3 Delays. Findings. The root causes were found in poor quality of care, which caused hospital to be unprepared to manage deteriorating patients. In hospital, poor implementation of standard operating procedures was rooted in inadequate skills, lack of forward planning, ineffective communication, and unavailability of essential services. In primary care, root causes included inadequate risk management, referrals to facilities where needed services are not available, and lack of coordination between primary healthcare and hospitals. Conclusion. There is an urgent need for a shift in focus to quality of care through knowledge, skills, and support for consistent application of protocols, making essential services available, effective risk assessment and management, and facilitating timely referrals to facilities that are adequately equipped.

Improvement of maternal health services through the use of mobile phones.

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Noordam, A Camielle; Kuepper, Barbara M; Stekelenburg, Jelle; Milen, Anneli

2011-05-01

To analyse, on the basis of the literature, the potential of mobile phones to improve maternal health services in Low and Middle Income Countries (LMIC). Wide search for scientific and grey literature using various terms linked to: maternal health, mobile telecommunication and LMIC. Applications requiring an internet connection were excluded as this is not widely available in LMIC yet. Few projects exist in this field and little evidence is available as yet on the impact of mobile phones on the quality of maternal health services. Projects focus mainly on the delay in receiving care--that is in recognizing the need and making the decision to seek care--and the delay in arriving at the health facility. This is achieved by connecting lesser trained health workers to specialists and coordination of referrals. Ongoing projects focus on empowering women to seek health care. There is broad agreement that access to communication is one of several essential components to improve maternal health services and hence the use of mobile phones has much potential. However, there is a need for robust evidence on constraints and impacts, especially when financial and human resources will be invested. Concurrently, other ways in which mobile phones can be used to benefit maternal health services need to be further explored, taking into consideration privacy and confidentiality. © 2011 Blackwell Publishing Ltd.

Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service.

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Oh, Sungyoung; Cha, Jieun; Ji, Myungkyu; Kang, Hyekyung; Kim, Seok; Heo, Eunyoung; Han, Jong Soo; Kang, Hyunggoo; Chae, Hoseok; Hwang, Hee; Yoo, Sooyoung

2015-04-01

To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs.

The effect of women's decision-making power on maternal health services uptake: evidence from Pakistan.

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Hou, Xiaohui; Ma, Ning

2013-03-01

A large body of research has explored the links between women's decision making and their uptake of maternal health services, but the evidence so far is inconclusive. This study uses the Pakistan Social and Living Standards Measurement Survey to examine the influence of household decision making on women's uptake of maternal health services. We find that women's decision-making power has a significant positive correlation with maternal health services uptake and that influential males' decision-making power has the opposite effect, after controlling for socio-economic indicators and supply-side conditions. Our findings suggest that empowering women and increasing their ability to make decisions may increase their uptake of maternal health services. They also suggest that policies directed toward improving women's utilization of maternal health services in Pakistan must target men as well as women.

Socioeconomic disparities in maternity care among Indian adolescents, 1990-2006.

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Chandan Kumar

Full Text Available BACKGROUND: India, with a population of more than 1.21 billion, has the highest maternal mortality in the world (estimated to be 56000 in 2010; and adolescent (aged 15-19 mortality shares 9% of total maternal deaths. Addressing the maternity care needs of adolescents may have considerable ramifications for achieving the Millennium Development Goal (MDG-5. This paper assesses the socioeconomic differentials in accessing full antenatal care and professional attendance at delivery by adolescent mothers (aged 15-19 in India during 1990-2006. METHODS AND FINDINGS: Data from three rounds of the National Family Health Survey of India conducted during 1992-93, 1998-99, and 2005-06 were analyzed. The Cochran-Armitage and Chi-squared test for linear and non-linear time trends were applied, respectively, to understand the trend in the proportion of adolescent mothers utilizing select maternity care services during 1990-2006. Using pooled multivariate logistic regression models, the probability of select maternal healthcare utilization among women by key socioeconomic characteristics was appraised. After adjusting for potential socio-demographic and economic characteristics, the likelihood of adolescents accessing full antenatal care increased by only 4% from 1990 to 2006. However, the probability of adolescent women availing themselves of professional attendance at delivery increased by 79% during the same period. The study also highlights the desolate disparities in maternity care services among adolescents across the most and the least favoured groups. CONCLUSION: Maternal care interventions in India need focused programs for rural, uneducated, poor adolescent women so that they can avail themselves of measures to delay child bearing, and for better antenatal consultation and delivery care in case of pregnancy. This study strongly advocates the promotion of a comprehensive 'adolescent scheme' along the lines of 'Continuum of Maternal, Newborn and Child

Service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector.

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Ahmed, Selim; Tarique, Kazi Md; Arif, Ishtiaque

2017-06-12

Purpose The purpose of this paper is to investigate service quality, patient satisfaction and loyalty in Bangladesh's healthcare sector. It identifies healthcare quality conformance, patient satisfaction and loyalty based on demographics such as gender, age and marital status. It examines the differences between public and private healthcare sectors regarding service quality, patient satisfaction and loyalty. Design/methodology/approach The authors distributed 450 self-administered questionnaires to hospital patients resulting in 204 useful responses (45.3 per cent response rate). Data were analysed based on reliability analysis, exploratory factor analysis, independent samples t-tests, ANOVA and discriminant analysis using SPSS version 23. Findings Findings indicate that single patients perceive tangibles, reliability, empathy and loyalty higher compared to married patients. Young patients (⩽20 years) have a higher tangibles, empathy and loyalty scores compared to other age groups. The authors observed that private hospital patients perceive healthcare service quality performance higher compared to patients in public hospitals. Research limitations/implications The authors focussed solely on the Bangladesh health sector, so the results might not be applicable to other countries. Originality/value The findings provide guidelines for enhancing service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector and other countries.

Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey

OpenAIRE

Tarekegn, Shegaw Mulu; Lieberman, Leslie Sue; Giedraitis, Vincentas

2014-01-01

Background Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Met...

Older LGBT people's experiences and concerns with healthcare professionals and services in Ireland.

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Sharek, Danika Burke; McCann, Edward; Sheerin, Fintan; Glacken, Michele; Higgins, Agnes

2015-09-01

The specific healthcare needs and concerns for older lesbian, gay, bisexual and transgender (LGBT) persons have not been explored to any degree within Ireland. The aim of this paper, which is part of a larger study, is to detail older LGBT persons' usage, experiences and concerns with accessing healthcare services, disclosing their LGBT identity to professionals, preferences for care and their suggestions for improvement in services, including nursing services. A mixed methods research design combining quantitative survey and qualitative interview approaches of equal significance was used. 144 respondents completed an 84-item questionnaire concerning their use of healthcare services, experiences and needs. The qualitative phase involved in-depth interviews where 36 participants' experiences and concerns around health services were explored more in-depth. Quantitative data were analysed using descriptive statistics. Qualitative analysis employed the constant comparative process to generate the leading themes. Only one in three participants believed that healthcare professionals have sufficient knowledge of LGBT issues, and less than half (43%) felt respected as an LGBT person by healthcare professionals. Although 26% had chosen not to reveal their LGBT status for fear of a negative response, many positive encounters of coming out to healthcare professionals were relayed in the interviews. LGBT persons have specific concerns around residential care, particularly in relation to the perception that the Irish healthcare services emanate a heteronormative culture. Irish healthcare services need to reflect on how they currently engage with older LGBT persons at both an organisational and practitioner level. Consideration needs to be given to the specific concerns of ageing LGBT persons, particularly in relation to long-term residential care. Healthcare practitioners need to be knowledgeable of, and sensitive to, LGBT issues. © 2014 John Wiley & Sons Ltd.

Performance management of the public healthcare services in Ireland: a review.

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Mesabbah, Mohammed; Arisha, Amr

2016-01-01

Performance Management (PM) processes have become a potent part of strategic and service quality decisions in healthcare organisations. In 2005, the management of public healthcare in Ireland was amalgamated into a single integrated management body, named the Health Service Executive (HSE). Since then, the HSE has come up with a range of strategies for healthcare developments and reforms, and has developed a PM system as part of its strategic planning. The purpose of this paper is to review the application of PM in the Irish Healthcare system, with a particular focus on Irish Hospitals and Emergency Services. An extensive review of relevant HSE's publications from 2005 to 2013 is conducted. Studies of the relevant literature related to the application of PM and of international best practices in healthcare performance systems are also presented. PM and performance measurement systems used by the HSE include many performance reports designed to monitor performance trends and strategic goals. Issues in the current PM system include inconsistency of measures and performance reporting, unclear strategy alignment, and deficiencies in reporting (e.g. feedback and corrective actions). Furthermore, PM processes have not been linked adequately into Irish public hospitals' management systems. The HSE delivers several services such as mental health, social inclusion, etc. This study focuses on the HSE's PM framework, with a particular interest in acute hospitals and emergency services. This is the first comprehensive review of Irish healthcare PM since the introduction of the HSE. A critical analysis of the HSE reports identifies the shortcomings in its current PM system.

Maternity-care: measuring women's perceptions.

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Clark, Kim; Beatty, Shelley; Reibel, Tracy

2016-01-01

Achieving maternity-care outcomes that align with women's needs, preferences and expectations is important but theoretically driven measures of women's satisfaction with their entire maternity-care experience do not appear to exist. The purpose of this paper is to outline the development of an instrument to assess women's perception of their entire maternity-care experience. A questionnaire was developed on the basis of previous research and informed by a framework of standard service quality categories covering the spectrum of typical consumer concerns. A pilot survey with a sample of 195 women who had recent experience of birth was undertaken to establish valid and reliable scales pertaining to different stages of maternity care. Exploratory factor analysis was used to interpret scales and convergent validity was assessed using a modified version of the Client Satisfaction Questionnaire. Nine theoretically informed, reliable and valid stand-alone scales measuring the achievement of different dimensions of women's expectancies of public maternity care were developed. The study scales are intended for use in identifying some potential areas of focus for quality improvement in the delivery of maternity care. Reliable and valid tools for monitoring the extent to which services respond to women's expectations of their entire maternity care form part of the broader toolkit required to adequately manage health-care quality. This study offers guidance on the make-up of such tools. The scales produced from this research offer a means to assess maternity care across the full continuum of care and are brief and easy to use.

The development of safety cases for healthcare services: Practical experiences, opportunities and challenges

International Nuclear Information System (INIS)

Sujan, Mark; Spurgeon, Peter; Cooke, Matthew; Weale, Andy; Debenham, Philip; Cross, Steve

2015-01-01

There has been growing interest in the concept of safety cases for medical devices and health information technology, but questions remain about how safety cases can be developed and used meaningfully in the safety management of healthcare services and processes. The paper presents two examples of the development and use of safety cases at a service level in healthcare. These first practical experiences at the service level suggest that safety cases might be a useful tool to support service improvement and communication of safety in healthcare. The paper argues that safety cases might be helpful in supporting healthcare organisations with the adoption of proactive and rigorous safety management practices. However, it is also important to consider the different level of maturity of safety management and regulatory oversight in healthcare. Adaptations to the purpose and use of safety cases might be required, complemented by the provision of education to both practitioners and regulators. - Highlights: • Empirical description of safety case development at service level in healthcare. • Safety cases can support adoption of proactive and rigorous safety management. • Adaptation to purpose and use of safety cases might be required in healthcare. • Education should be provided to practitioners and regulators

Architecture Design of Healthcare Software-as-a-Service Platform for Cloud-Based Clinical Decision Support Service

Science.gov (United States)

Oh, Sungyoung; Cha, Jieun; Ji, Myungkyu; Kang, Hyekyung; Kim, Seok; Heo, Eunyoung; Han, Jong Soo; Kang, Hyunggoo; Chae, Hoseok; Hwang, Hee

2015-01-01

Objectives To design a cloud computing-based Healthcare Software-as-a-Service (SaaS) Platform (HSP) for delivering healthcare information services with low cost, high clinical value, and high usability. Methods We analyzed the architecture requirements of an HSP, including the interface, business services, cloud SaaS, quality attributes, privacy and security, and multi-lingual capacity. For cloud-based SaaS services, we focused on Clinical Decision Service (CDS) content services, basic functional services, and mobile services. Microsoft's Azure cloud computing for Infrastructure-as-a-Service (IaaS) and Platform-as-a-Service (PaaS) was used. Results The functional and software views of an HSP were designed in a layered architecture. External systems can be interfaced with the HSP using SOAP and REST/JSON. The multi-tenancy model of the HSP was designed as a shared database, with a separate schema for each tenant through a single application, although healthcare data can be physically located on a cloud or in a hospital, depending on regulations. The CDS services were categorized into rule-based services for medications, alert registration services, and knowledge services. Conclusions We expect that cloud-based HSPs will allow small and mid-sized hospitals, in addition to large-sized hospitals, to adopt information infrastructures and health information technology with low system operation and maintenance costs. PMID:25995962

Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service.

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Reeve, Carole; Humphreys, John; Wakerman, John; Carroll, Vicki; Carter, Maureen; O'Brien, Tim; Erlank, Carol; Mansour, Rafik; Smith, Bec

2015-01-01

The aim of this study was to describe the reorientation of a remote primary health-care service, in the Kimberley region of Australia, its impact on access to services and the factors instrumental in bringing about change. A unique community-initiated health service partnership was developed between a community-controlled Aboriginal health organisation, a government hospital and a population health unit, in order to overcome the challenges of delivering primary health care to a dispersed, highly disadvantaged Aboriginal population in a very remote area. The shared goals and clear delineation of responsibilities achieved through the partnership reoriented an essentially acute hospital-based service to a prevention-focussed comprehensive primary health-care service, with a focus on systematic screening for chronic disease, interdisciplinary follow up, health promotion, community advocacy and primary prevention. This formal partnership enabled the primary health-care service to meet the major challenges of providing a sustainable, prevention-focussed service in a very remote and socially disadvantaged area.

E-service learning: A pedagogic innovation for healthcare management education.

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Malvey, Donna M; Hamby, Eileen F; Fottler, Myron D

2006-01-01

This paper proposes an innovation in service learning that we identify as e-service learning. By adding the "e" to service learning, we create a service learning model that is dynamic, mediated by technology, and delivered online. This paper begins by examining service learning, which is a distinct learning concept. Service learning furnishes students with opportunities for applied learning through participation in projects and activities in community organizations. The authors then define and conceptualize e-service learning, including the anticipated outcomes of implementation such as enhanced access, quality, and cost effectiveness of healthcare management education. Because e-service learning is mediated by technology, we identify state of the art technologies that support e-service learning activities. In addition, possible e-service learning projects and activities that may be included in healthcare management courses such as finance, human resources, quality, service management/marketing and strategy are identified. Finally, opportunities for future research are suggested.

Vertical equity of healthcare in Taiwan: health services were distributed according to need

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Wang Shiow-Ing

2013-01-01

Full Text Available Abstract Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health need received more healthcare services, indicating a pro-need character of healthcare distribution, conforming to the meaning of vertical equity. For outpatient service, subjects with the highest health need had higher proportion of ever use in a year than those who had the least health need and consumed more outpatient visits and expenditures per person per year. Similar patterns were observed for emergency services and hospitalization. The concentration indices of utilization for outpatient, emergency services, and hospitalization suggest that the distribution of utilization was related to health need, whereas the preventive service was less related to need. Conclusions The universal coverage plus healthcare networking system makes it possible for healthcare to be utilized according to need. Taiwan’s experience can serve as a reference for health reform.

Dimensions of service quality in healthcare: a systematic review of literature.

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Fatima, Iram; Humayun, Ayesha; Iqbal, Usman; Shafiq, Muhammad

2018-06-13

Various dimensions of healthcare service quality were used and discussed in literature across the globe. This study presents an updated meaningful review of the extensive research that has been conducted on measuring dimensions of healthcare service quality. Systematic review method in current study is based on PRISMA guidelines. We searched for literature using databases such as Google, Google Scholar, PubMed and Social Science, Citation Index. In this study, we screened 1921 identified papers using search terms/phrases. Snowball strategies were adopted to extract published articles from January 1997 till December 2016. Two-hundred and fourteen papers were identified as relevant for data extraction; completed by two researchers, double checked by the other two to develop agreement in discrepancies. In total, 74 studies fulfilled our pre-defined inclusion and exclusion criteria for data analysis. Service quality is mainly measured as technical and functional, incorporating many sub-dimensions. We synthesized the information about dimensions of healthcare service quality with reference to developed and developing countries. 'Tangibility' is found to be the most common contributing factor whereas 'SERVQUAL' as the most commonly used model to measure healthcare service quality. There are core dimensions of healthcare service quality that are commonly found in all models used in current reviewed studies. We found a little difference in these core dimensions while focusing dimensions in both developed and developing countries, as mostly SERVQUAL is being used as the basic model to either generate a new one or to add further contextual dimensions. The current study ranked the contributing factors based on their frequency in literature. Based on these priorities, if factors are addressed irrespective of any context, may lead to contribute to improve healthcare quality and may provide an important information for evidence-informed decision-making.

Stakeholders' views on the strengths and weaknesses of maternal care financing and its reform in Georgia.

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Shengelia, Lela; Pavlova, Milena; Groot, Wim

2017-08-08

The improvement of maternal health has been one of the aims of the health financing reforms in Georgia. Public-private relationships are the most notable part of the reform. This study aimed to assess the strengths and weakness of the maternal care financing in Georgia in terms of adequacy and effects. A qualitative design was used to explore the opinions of key stakeholders about the adequacy of maternal care financing and financial protection of pregnant women in Georgia. Women who had used maternal care during the past 4 years along with health care providers, policy makers, and representatives of international partner organizations and national professional body were the respondents in this study. Six focus group discussions to collect data from women and 15 face-to-face in-depth interviews to collect data from the other stakeholders were conducted. Each focus group discussion consisted of 7-8 women. Two focus group discussions were carried out at each of the target settings (i.e. Tbilisi, Imereti and Adjara). Women were selected in each location through the hospital registry and snowballing method. The evidence shows that there is a consensus among maternal care stakeholder groups on the influence of the healthcare financing reforms on maternal health. Specifically, the privatization of the maternal care services has had positive effects because it significantly improved the environment and technical capacity of the maternity houses. Also, in contrast to other former-soviet republics, there are no informal payments anymore for maternal care in Georgia. However the privatization, which was done without strict regulation, negatively influenced the reform process and provided the possibility to private providers to manipulate the formal user fees in maternal care. Stakeholders also indicated that the UHC programs implemented at the last stage of the healthcare financing reform as well as other state maternal health programs protect women from catastrophic health

Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

Science.gov (United States)

Elmusharaf, Khalifa; Byrne, Elaine; O'Donovan, Diarmuid

2015-09-08

Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective. Common demand side strategies can be grouped into three categories:(i) Financial incentives/subsidies; (ii) Enhancing patient transfer, and; (iii) Community involvement. The main challenges in assessing the effectiveness or efficacy of these interventions or strategies are the lack of quality evidence on their outcome and impact and interventions not integrated into existing health or community systems. However, what is highlighted in this review and overlooked in most of the published literature on this topic is the lack of knowledge about the context in which these strategies are to be implemented. We suggest three challenges that need to be addressed to create a supportive environment in which these demand-side strategies can effectively improve access to maternal health services. These include: addressing decision-making norms, engaging in intergenerational dialogue, and designing contextually appropriate communication strategies.

Determinants of use of maternal health services in Nigeria - looking beyond individual and household factors

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Fatusi Adesegun

2009-09-01

Full Text Available Abstract Background Utilization of maternal health services is associated with improved maternal and neonatal health outcomes. Considering global and national interests in the Millennium Development Goal and Nigeria's high level of maternal mortality, understanding the factors affecting maternal health use is crucial. Studies on the use of maternal care services have largely overlooked community and other contextual factors. This study examined the determinants of maternal services utilization in Nigeria, with a focus on individual, household, community and state-level factors. Methods Data from the 2005 National HIV/AIDS and Reproductive Health Survey - an interviewer-administered nationally representative survey - were analyzed to identify individual, household and community factors that were significantly associated with utilization of maternal care services among 2148 women who had a baby during the five years preceding the survey. In view of the nested nature of the data, we used multilevel analytic methods and assessed state-level random effects. Results Approximately three-fifths (60.3% of the mothers used antenatal services at least once during their most recent pregnancy, while 43.5% had skilled attendants at delivery and 41.2% received postnatal care. There are commonalities and differences in the predictors of the three indicators of maternal health service utilization. Education is the only individual-level variable that is consistently a significant predictor of service utilization, while socio-economic level is a consistent significant predictor at the household level. At the community level, urban residence and community media saturation are consistently strong predictors. In contrast, some factors are significant in predicting one or more of the indicators of use but not for all. These inconsistent predictors include some individual level variables (the woman's age at the birth of the last child, ethnicity, the notion of ideal

[Barriers to the normalization of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts].

Science.gov (United States)

Roig, Francesc; Saigí, Francesc

2011-01-01

Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers' contracts. We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations. The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability. In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers' contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

Effects of Lean Six Sigma application in healthcare services: a literature review.

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Ahmed, Selim; Manaf, Noor H A; Islam, Rafikul

2013-01-01

The healthcare organization is the place where defects and mistakes cannot be tolerated. A simple mistake can cost a human life so defects or mistakes must be eliminated in healthcare service processes. A Lean Six Sigma (LSS) approach is the best option in a healthcare environment for dealing with a critical patient. The LSS methodology optimizes the average reduction of a desired process. The expected results can be reductions in several aspects of healthcare such as patient waiting time in emergency departments, lost charges for billing in patient financial services, delinquent medical records, diagnostic result turnaround times, accounts receivable days, patients' length of stay, or medication errors. This paper mainly discusses the effects of the LSS approach in different hospitals around the world according to the literature review. This review also discusses the relationship between LSS as well as their impacts on healthcare services based on literature review.

Healthcare services consumer behavior in the light of social norms influence

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Daniel Adrian GÂRDAN

2015-03-01

Full Text Available Healthcare services consumers’ behavior represents an multidimensional concept, that implies the cumulative effects of different factors. The process of consumption is very different and complex in the case of healthcare services due to the nature of the needs and consumption motivations on one hand and because of the complexity of the services itself on the other hand. Amongst the factors that are influencing the consumer’s behaviour, the social ones represent a particular type. In the case of healthcare services this is because the social interactions of the patients can contribute to their own perception regarding the post consumption satisfaction, or can influence the buying decision in the first place. The influence of social factors can be analysed on multiple layers – from the effect of the affiliation and adhesion groups to the effect of social norms and regulations.

Integration of prevention of mother-to-child HIV transmission into maternal health services in Senegal.

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Cisse, C

2017-06-01

The objective of this study was to assess the level of integration of prevention of mother-to-child HIV transmission (PMTCT) in facilities providing services for maternal, newborn, and child health (MNCH) and reproductive health (RH) in Senegal. The survey, conducted from August through November, 2014, comprised five parts : a literature review to assess the place of this integration in the health policies, standards, and protocols in effect in Senegal; an analysis by direct observation of attitudes and practices of 25 healthcare providers at 5 randomly-selected obstetrics and gynecology departments representative of different levels of the health pyramid; a questionnaire evaluating knowledge and attitudes of 10 providers about the integration of PMTCT services into MNCH/RH facilities; interviews to collect the opinions of 70 clients, including 16 HIV-positive, about the quality of PMTCT services they received; and a questionnaire evaluating knowledge and opinions of 14 policy-makers/managers of health programs focusing on mothers and children about this integration. The literature review revealed several constraints impeding this integration : the policy documents, standards, and protocols of each of the programs involved do not clearly indicate the modalities of this integration; the programs are housed in two different divisions while the national Program against the Human Immunodeficiency Virus reports directly to the Prime Minister; program operations remains generally vertical; the resources for the different programs are not sufficiently shared; there is no integrated training module covering integrated management of pregnancy and delivery; and supervision for each of the different programs is organized separately.The observation of the providers supporting women during pregnancy, during childbirth, and in the postpartum period, showed an effort to integrate PMTCT into the MNCH/RH services delivered daily to clients. But this desire is hampered by many

Effect of Outsourced Pharmacies of Rural Healthcare Centers on Service Quality in Abharand Soltanieh Counties

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Ali Maher

2016-05-01

Full Text Available Recently, a part of healthcare services has been assigned to the private sector to increase the quality of medical services, increase patient satisfaction and reduce costs. In this regard, the outsourcing approach has been significantly considered for pharmaceutical services provided by healthcare centers. The purpose of this study is to evaluate the effect of outsourced pharmacies of rural healthcare centers on service quality using structural equations modelling. The methodology used was descriptive using correlation by structural equations modelling. The studied population included those patients who provided their medicines from pharmacies of rural healthcare centers in Abhar and Soltanieh counties. The samples included 384 of these patients. Data was collected by outsourcing and service quality questionnaires. A structural equation modelling was used to analyze data by LISREAL software. Results indicated a positive significant effect of outsourced pharmacies of rural healthcare centers on quality of tangibles, reliability, responsiveness, assurance and empathy. findings emphasize the role of outsourcing on quality of services. Outsourced pharmacies of rural healthcare centers of Abhar and Soltanieh counties lead to improved service quality.

Safeguarding and Protecting Children in Maternity Services: Implications for Practice

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Lazenbatt, Anne; Greer, Jean

2009-01-01

This article debates the issues involved in safeguarding and protecting children in maternity services and offers implications for professional practice. Midwives and other staff who work as members of the maternity team have a safeguarding role to play in the identification of babies and children who have been abused, or are at risk of abuse, and…

Healthcare workers' behaviors and personal determinants associated with providing adequate sexual and reproductive healthcare services in sub-Saharan Africa: a systematic review.

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Jonas, Kim; Crutzen, Rik; van den Borne, Bart; Reddy, Priscilla

2017-03-13

Healthcare workers may affect the utilization of sexual and reproductive healthcare (SRH) services, and quality of care thereof, for example by their behaviours or attitudes they hold. This can become a hindrance to accessing and utilizing SRH services, particularly by young people, and thus a better understanding of these behaviours and associated factors is needed to improve access to and utilization of SRH services. A systematic review of literature was conducted to identify studies focusing on healthcare workers' behaviors and personal determinants associated with providing adequate SRH services in sub-Saharan Africa (January 1990 - October 2015). Five databases were searched until 30th October 2015, using a search strategy that was adapted based on the technical requirements of each specific database. Articles were independently screened for eligibility by two researchers. Of the 125-screened full-text articles, 35 studies met all the inclusion criteria. Negative behaviours and attitudes of healthcare workers, as well as other personal determinants, such as poor knowledge and skills of SRH services, and related factors, like availability of essential drugs and equipment are associated with provision of inadequate SRH services. Some healthcare workers still have negative attitudes towards young people using contraceptives and are more likely to limit access to and utilization of SRH by adolescents especially. Knowledge of and implementation of specific SRH components are below optimum levels according to the WHO recommended guidelines. Healthcare workers' negative behaviours and attitudes are unlikely to encourage women in general to access and utilize SRH services, but more specifically young women. Knowledge of SRH services, including basic emergency obstetric care (EmOC) is insufficient among healthcare workers in SSA. A protocol for this systematic review was registered with PROSPERO and the registration number is: CRD42015017509 .

Can the right to health inform public health planning in developing countries? A case study for maternal healthcare from Indonesia.

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D'Ambruoso, Lucia; Byass, Peter; Nurul Qomariyah, Siti

2008-09-09

Maternal mortality remains unacceptably high in developing countries despite international advocacy, development targets, and simple, affordable and effective interventions. In recent years, regard for maternal mortality as a human rights issue as well as one that pertains to health, has emerged. We study a case of maternal death using a theoretical framework derived from the right to health to examine access to and quality of maternal healthcare. Our objective was to explore the potential of rights-based frameworks to inform public health planning from a human rights perspective. Information was elicited as part of a verbal autopsy survey investigating maternal deaths in rural settings in Indonesia. The deceased's relatives were interviewed to collect information on medical signs, symptoms and the social, cultural and health systems circumstances surrounding the death. In this case, a prolonged, severe fever and a complicated series of referrals culminated in the death of a 19-year-old primagravida at 7 months gestation. The cause of death was acute infection. The woman encountered a range of barriers to access; behavioural, socio-cultural, geographic and economic. Several serious health system failures were also apparent. The theoretical framework derived from the right to health identified that none of the essential elements of the right were upheld. The rights-based approach could identify how and where to improve services. However, there are fundamental and inherent conflicts between the public health tradition (collective and preventative) and the right to health (individualistic and curative). As a result, and in practice, the right to health is likely to be ineffective for public health planning from a human rights perspective. Collective rights such as the right to development may provide a more suitable means to achieve equity and social justice in health planning.

Causes of maternal mortality decline in Matlab, Bangladesh.

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Chowdhury, Mahbub Elahi; Ahmed, Anisuddin; Kalim, Nahid; Koblinsky, Marge

2009-04-01

Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality--86.7% and 78.3%--in the ICDDR,B and government service areas respectively. Education of women was a strong predictor

A rapid assessment of the availability and use of obstetric care in Nigerian healthcare facilities.

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Daniel O Erim

Full Text Available BACKGROUND: As part of efforts to reduce maternal deaths in Nigeria, pregnant women are being encouraged to give birth in healthcare facilities. However, little is known about whether or not available healthcare facilities can cope with an increasing demand for obstetric care. We thus carried out this survey as a rapid and tactical assessment of facility quality. We visited 121 healthcare facilities, and used the opportunity to interview over 700 women seeking care at these facilities. FINDINGS: Most of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home. The crude risk of an adverse neonatal outcome did not significantly vary by delivery site or birth attendant, and the occurrence of such an outcome during an in-facility delivery may influence the mother to have her next delivery outside. Such an outcome during a home delivery may not prompt a subsequent in-facility delivery. CONCLUSIONS: In conclusion, reducing maternal deaths in Nigeria will require attention to both increasing the number of facilities with high-quality EmOC capability and also assuring Nigerian women have access to these facilities regardless of where they live.

Application of a Community eS@nté Platform in Maternal and Child ...

International Development Research Centre (IDRC) Digital Library (Canada)

Application of a Community eS@nté Platform in Maternal and Child Health in ... electronic patient files and telehealth can improve medical and healthcare data ... New website will help record vital life events to improve access to services for all.

Situation Analysis of Healthcare Service Delivery using ...

African Journals Online (AJOL)

ISML5

7. No. 1, AARSE 2017 Special Edition, January 2017. 75. Situation Analysis of ... then becomes a major bottleneck to proper planning and policy formulation in healthcare delivery. ... Uganda Annual Health Sector Performance Report for Financial Year 2014/15 ... government's strategy of taking services closer to the people.

Increased healthcare service utilizations for patients with dementia: a population-based study.

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Shiu-Dong Chung

Full Text Available BACKGROUND: The majority of previous studies investigating the health care utilization of people with dementia were conducted in Western societies. There is little information on the economic burden on the healthcare system attributable to dementia in Asian countries. This study thus investigated differences in utilization of healthcare services between subjects with and those without a diagnosis of dementia using Taiwan's National Health Insurance population-based database. METHODS: This study comprised 5,666 subjects with a dementia diagnosis and 5,666 age- and gender-matched comparison subjects without a dementia diagnosis. We individually followed each subject for a 1-year period starting from their index date to evaluate their healthcare resource utilization. Healthcare resource utilization included the number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatments. In addition, we divided healthcare resource utilization into psychiatric and non-psychiatric services. RESULTS: As for utilization of psychiatric services, subjects with a dementia diagnosis had significantly more outpatient visits (2.2 vs. 0.3, p<0.001 and significantly higher outpatient costs (US$124 vs. US$16, p<0.001 than comparison subjects. For non-psychiatric services, subjects with a dementia diagnosis also had significantly more outpatient visits (34.4 vs. 31.6, p<0.001 and significantly higher outpatient costs (US$1754 vs. US$1322, p<0.001 than comparison subjects. For all healthcare services, subjects with a dementia diagnosis had significantly more outpatient visits (36.7 vs. 32.0, p<0.001 and significantly higher outpatient costs (US$1878 vs. US$1338, p<0.001 than comparison subjects. Furthermore, the total cost was about 2-fold greater for subjects with a dementia diagnosis than for comparison subjects (US$3997 vs. US$2409, p<0.001. CONCLUSIONS: We concluded that subjects who had received a clinical dementia diagnosis had

The role of short messaging service in supporting the delivery of healthcare: An umbrella systematic review.

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Househ, Mowafa

2016-06-01

Short messaging service (SMS) messages may present a convenient and cost-effective method to support healthcare interventions. This work assesses the effects of short messaging service on various healthcare interventions found in systematic reviews. The search strategy was based on two key concepts: short messaging service and healthcare delivery. The initial search was conducted in December 2012 and was updated in June 2013. Of the 550 identified references, 13 systematic reviews met the inclusion criteria, of which 8 were published in peer-reviewed journals and 5 were retrieved from the Cochrane library. Data analysis shows that low to moderate research evidence exists on the benefits of short messaging service interventions for appointment reminders, promoting health in developing countries and preventive healthcare. In many interventions, however, there were a few studies that were of high quality, and most of the studies were rated from low to moderate quality or had no rating at all. Healthcare organizations, policy makers, or clinicians using short messaging service messages to support healthcare interventions should (1) implement interventions that have been found to work in healthcare settings, (2) continue evaluating short messaging service interventions that have not been adequately assessed, and (3) improve collaboration between various healthcare entities to develop studies targeted at specific populations to evaluate the long-term impact of short messaging service on healthcare outcomes. © The Author(s) 2014.

A scalable healthcare information system based on a service-oriented architecture.

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Yang, Tzu-Hsiang; Sun, Yeali S; Lai, Feipei

2011-06-01

Many existing healthcare information systems are composed of a number of heterogeneous systems and face the important issue of system scalability. This paper first describes the comprehensive healthcare information systems used in National Taiwan University Hospital (NTUH) and then presents a service-oriented architecture (SOA)-based healthcare information system (HIS) based on the service standard HL7. The proposed architecture focuses on system scalability, in terms of both hardware and software. Moreover, we describe how scalability is implemented in rightsizing, service groups, databases, and hardware scalability. Although SOA-based systems sometimes display poor performance, through a performance evaluation of our HIS based on SOA, the average response time for outpatient, inpatient, and emergency HL7Central systems are 0.035, 0.04, and 0.036 s, respectively. The outpatient, inpatient, and emergency WebUI average response times are 0.79, 1.25, and 0.82 s. The scalability of the rightsizing project and our evaluation results show that the SOA HIS we propose provides evidence that SOA can provide system scalability and sustainability in a highly demanding healthcare information system.

Impact assessment of a maternal health project in a megacity, Nigeria: toward a future with more demand for maternal health services.

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Matsuoka, Sadatoshi; Koga, Sumiko; Suzui, Emiko; Tsukada, Yoshiko; Ohashi, Kazutomo; Johnson, Taiwo

2017-10-01

To improve the quantity and quality of maternal health services in Lagos State, Nigeria having a maternal mortality ratio of 555 per 100 000 live births, a four-year project was implemented since February 2010. The major activity of the project was training for both the service supply and demand sides. This study aimed to examine the impact of the project on coverages and quality of the services in target areas, and guide statewide policies. The Cochran-Armitage test for trend was applied to understand trends in the service coverages during 2009-2013. The same test was performed to analyse trends in the proportions of perineal conditions (i.e. intact or tear) and to evaluate variations in midwives' snkill during 2011-2013. The paired t-test was used to analyse changes in midwives' knowledge. The project interventions contributed to a significant increase in the overall service coverages, including improvements in midwifery knowledge and possibly in their skills. However, the service coverage was still limited as of the termination of the project. To instal the interventions and maximise the effect of them state-wide, it is recommended to undertake five tasks: (i) establishment of public primary health centres offering 24-h maternal health services; (ii) redeployment and recruitment of public health personnel; (iii) expansion of midwifery trainings and continuous education by the local trainers; (iv) review of grass-roots level activities; and (v) scrutiny of barriers to maternal health services. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Improving high quality, equitable maternal health services in Malawi ...

International Development Research Centre (IDRC) Digital Library (Canada)

Improving high quality, equitable maternal health services in Malawi (IMCHA) ... In response, the Ministry of Health implemented a Standards-Based Management and Recognition for Reproductive Health initiative to improve ... Total funding.

Healthcare Services Managers: What Information do They Need and Use?

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Andrew Booth

2008-09-01

Full Text Available Objectives – The purpose of this research project was to gain insight into the information behaviour of healthcare services managers as they use information while engaged in decision-making unrelated to individual patient care. Methods – This small-scale, exploratory, multiple case study used the critical incident technique in nineteen semi-structured interviews. Responses were analyzed using ‘Framework,’ a matrix-based content analysis system. Results – This paper presents findings related to the internal information that healthcare services managers need and use. Their decisions are influenced by a wide variety of factors. They must often make decisions without all of the information they would prefer to have. Internal information and practical experience set the context for new research-based information, so they are generally considered first.Conclusions – Healthcare services managers support decisions with both facts and value-based information. These results may inform both delivery of health library services delivery and strategic health information management planning. They may also support librarians who extend their skills beyond managing library collections and teaching published information retrieval skills, to managing internal and external information, teaching information literacy, and supporting information sharing.

Utilization of maternal health care services in post-conflict Nepal

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Bhandari TR

2015-08-01

Full Text Available Tulsi Ram Bhandari, Prabhakaran Sankara Sarma, Vellappillil Raman Kutty Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India Background: Despite a decade-long armed conflict in Nepal, the country made progress in reducing maternal mortality and is on its way to achieve the Millennium Development Goal Five. This study aimed to assess the degree of the utilization of maternal health care services during and after the armed conflict in Nepal.Methods: This study is based on Nepal Demographic and Health Survey data 2006 and 2011. The units of analysis were women who had given birth to at least one child in the past 5 years preceding the survey. First, we compared the utilization of maternal health care services of 2006 with that of 2011. Second, we merged the two data sets and applied logistic regression to distinguish whether the utilization of maternal health care services had improved after the peace process 2006 was underway.Results: In 2011, 85% of the women sought antenatal care at least once. Skilled health workers for delivery care assisted 36.1% of the women, and 46% of the women attended postnatal care visit at least once. These figures were 70%, 18.7%, and 16%, respectively, in 2006. Similarly, women were more likely to utilize antenatal care at least once (odds ratio [OR] =2.18, confidence interval [CI] =1.95–2.43, skilled care at birth (OR =2.58, CI =2.36–2.81, and postnatal care at least once (OR =4.13, CI =3.75–4.50 in 2011.Conclusion: The utilization of maternal health care services tended to increase continuously during both the armed conflict and the post-conflict period in Nepal. However, the increasing proportion of the utilization was higher after the Comprehensive Peace Process Agreement 2006. Keywords: antenatal care, armed conflict, Nepal, post-conflict, postnatal care, skilled care at birth

'Even when you are afraid, you stay': Provision of maternity care during the Ebola virus epidemic: A qualitative study.

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Jones, Susan; Sam, Betty; Bull, Florence; Pieh, Steven Bagie; Lambert, Jaki; Mgawadere, Florence; Gopalakrishnan, Somasundari; Ameh, Charles A; van den Broek, Nynke

2017-09-01

to explore nurse-midwives understanding of their role in and ability to continue to provide routine and emergency maternity services during the time of the Ebola virus disease epidemic in Sierra Leone. a hermenuetic phenomenological approach was used to discover the lived experiences of nurse-midwives through 66 face to face interviews. Following verbatim transcription, an iterative approach to data analysis was adopted using framework analysis to discover the essence of the lived experience. health facilities designated to provide maternity care across all 14 districts of Sierra Leone. nurses, midwives, medical staff and managers providing maternal and newborn care during the Ebola epidemic in facilities designated to provide basic or emergency obstetric care. the healthcare system in Sierra Leone was ill prepared to cope with the epidemic. Fear of Ebola and mistrust kept women from accessing care at a health facility. Healthcare providers continued to provide maternity care because of professional duty, responsibility to the community and religious beliefs. nurse-midwives faced increased risks of catching Ebola compared to other health workers but continued to provide essential maternity care. future preparedness plans must take into account the impact that epidemics have on the ability of the health system to continue to provide vital routine and emergency maternal and newborn health care. Healthcare providers need to have a stronger voice in health system rebuilding and planning and management to ensure that health service can continue to provide vital maternal and newborn care during epidemics. Copyright © 2017 The Author. Published by Elsevier Ltd.. All rights reserved.

Maternal health service utilization in urban slums of selected towns ...

African Journals Online (AJOL)

Maternal health service utilization in urban slums of selected towns in Ethiopia: Qualitative study. ... Reasons were found to be attributed to individual characteristics, perceived capacities of health facilities and friendliness of service providers and socio-cultural factors including socially sanctioned expectations at community ...

Maternal health service utilization in urban slums of selected towns ...

African Journals Online (AJOL)

EPHA USER33

Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; ... still women in urban settings do not use available maternal health services. Especially ... health services, safe water supplies, poor sanitation and .... selected cities are confined to crowded places, lack of.

Offshoring of healthcare services: the case of US-India trade in medical transcription services.

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Kshetri, Nir; Dholakia, Nikhilesh

2011-01-01

- The issue of offshore outsourcing of healthcare services is a critical but little-examined problem in healthcare research. The purpose of this study is to contribute to filling this void. A library-based study was carried out of the development of the Indian medical transcription offshoring industry. Findings- Cost-saving potential and the degree of outsourceability are higher for medical transcription compared with most services. Offshoring experience, typically in a low-value BPO, helps to enhance productivity and international linkages required for the success of medical transcription. Research limitations/implications - An important area of future research concerns comparing India's factor endowments in medical transcription outsourcing with other services. Further research is also needed to examine how India differs from its regional competitors in terms of factors endowments associated with these services. Another extension would be to investigate the drivers of offshoring of higher value services such as radiological readings. Practical implications - ICT infrastructures needed for outsourcing require much less investment compared with leading capital-intensive industries. The development patterns of the Indian medical and offshoring industries indicate that India may attract higher skilled medical functions in the future. The Indian offshoring industry is shifting its focus from BPO to knowledge process outsourcing (KPO). Developing countries need to shift to greater automation and greater levels of skill training to retain and reinforce their comparative advantages. This paper's greatest value stems from the fact that it examines the drivers of a new but rapidly growing healthcare industry.

Innovating for Maternal and Child Health in Africa teams share early ...

International Development Research Centre (IDRC) Digital Library (Canada)

2017-09-29

Sep 29, 2017 ... As the seven-year Innovating for Maternal and Child Health in Africa (IMCHA) ... delivered babies at home — far from medical care should complications arise. ... can help the healthcare system deliver service to vulnerable populations ... and La Francophonie, announced major funding for an IDRC grantee.

Interventions to Improve Maternal, Newborn, and Child Health in ...

International Development Research Centre (IDRC) Digital Library (Canada)

Maternal and child mortality rates in Mali and Burkina Faso remain unacceptably high and the use of healthcare services in many parts of both countries is limited. ... Le CRDI investit dans des solutions locales aux problèmes auxquels l'Inde est confrontée, comme le stress thermique, la gestion de l'eau et les migrations ...

Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

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Hercos, Benigno Vicente Santos; Berezovsky, Adriana

2017-01-01

To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

A healthcare management system for Turkey based on a service-oriented architecture.

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Herand, Deniz; Gürder, Filiz; Taşkin, Harun; Yuksel, Emre Nuri

2013-09-01

The current Turkish healthcare management system has a structure that is extremely inordinate, cumbersome and inflexible. Furthermore, this structure has no common point of view and thus has no interoperability and responds slowly to innovations. The purpose of this study is to show that using which methods can the Turkish healthcare management system provide a structure that could be more modern, more flexible and more quick to respond to innovations and changes taking advantage of the benefits given by a service-oriented architecture (SOA). In this paper, the Turkish healthcare management system is chosen to be examined since Turkey is considered as one of the Third World countries and the information architecture of the existing healthcare management system of Turkey has not yet been configured with SOA, which is a contemporary innovative approach and should provide the base architecture of the new solution. The innovation of this study is the symbiosis of two main integration approaches, SOA and Health Level 7 (HL7), for integrating divergent healthcare information systems. A model is developed which is based on SOA and enables obtaining a healthcare management system having the SSF standards (HSSP Service Specification Framework) developed by the framework of the HSSP (Healthcare Services Specification Project) under the leadership of HL7 and the Object Management Group.

Patient satisfaction in outpatient healthcare services at secondary level vs. tertiary level

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Velikj-Stefanovska Vesna

2014-01-01

Full Text Available Introduction. Patients satisfaction is a very important part of any clinical practice both for evaluation and improvement of healthcare services. Objective. The aim of this study was to determine patient satisfaction with public outpatient healthcare services at secondary and tertiary level and to assess possible differences between the two levels. Methods. In a quantitative cross-sectional study, a convenient sample of 646 patients who experienced public outpatient healthcare services at the secondary and tertiary level during the last two months were interviewed. Patient satisfaction questionnaires, with statements regarding various aspects of satisfaction, were completed during face-to-face interviews (response rate 84.6%. The research instrument was tested for internal consistency using the Cronbach’s coefficient alpha estimate. Results. The patients were significantly more satisfied in tertiary than in secondary outpatient healthcare facilities in almost all aspects of assessment related to general settings, nurse/administrative staff performance and physician performance (p<0.001. The patients in the secondary healthcare services (SHCS were more satisfied than in the tertiary healthcare services (THCS but only regarding the information on location (83.9% vs.78.3% and possibilities to enter and move inside the department (88.8% vs. 83.3%. Analysis of data for SHCS and THCS showed that there was no significant difference between the mean overall satisfaction scores with regard to patients’ gender, age, marital status, educational level, employment and number of visits. Conclusion. There is a need to improve the current level of patient-provider relationship and communication, as well as that of hospital environment, while special efforts should be made to address the problem of patient waiting time and hospital bureaucracy.

Why (just) information is not enough: The contributions of information services in the management of healthcare information

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Kostagiolas, P.; Lappa, E.

2015-02-01

Information is at the centre of every hospital activity including clinical decisions and healthcare service delivery systems. Although information is an important hospital asset, several issues related to its management and organization needs to be addressed within the hospitals. The management of healthcare information is a strategic goal related to the reduction of healthcare service provision costs, and to the improvement of quality and safety of healthcare services. By discussing the rather obvious necessity for information organization and management in the healthcare domain, this work aims at the role of healthcare information services, i.e. hospital libraries and patient medical records. Finally, a typology of information services' contributions to hospital environment is presented.

Enhanced primary mental healthcare for Indigenous Australians: service implementation strategies and perspectives of providers.

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Reifels, Lennart; Nicholas, Angela; Fletcher, Justine; Bassilios, Bridget; King, Kylie; Ewen, Shaun; Pirkis, Jane

2018-01-01

Improving access to culturally appropriate mental healthcare has been recognised as a key strategy to address the often greater burden of mental health issues experienced by Indigenous populations. We present data from the evaluation of a national attempt at improving access to culturally appropriate mental healthcare for Indigenous Australians through a mainstream primary mental healthcare program, the Access to Allied Psychological Services program, whilst specifically focusing on the implementation strategies and perspectives of service providers. We conducted semi-structured interviews with 31 service providers (primary care agency staff, referrers, and mental health professionals) that were analysed thematically and descriptively. Agency-level implementation strategies to enhance service access and cultural appropriateness included: the conduct of local service needs assessments; Indigenous stakeholder consultation and partnership development; establishment of clinical governance frameworks; workforce recruitment, clinical/cultural training and supervision; stakeholder and referrer education; and service co-location at Indigenous health organisations. Dedicated provider-level strategies to ensure the cultural appropriateness of services were primarily aimed at the context and process of delivery (involving, flexible referral pathways, suitable locations, adaptation of client engagement and service feedback processes) and, to a lesser extent, the nature and content of interventions (provision of culturally adapted therapy). This study offers insights into key factors underpinning the successful national service implementation approach. Study findings highlight that concerted national attempts to enhance mainstream primary mental healthcare for Indigenous people are critically dependent on effective local agency- and provider-level strategies to optimise the integration, adaptation and broader utility of these services within local Indigenous community and

Perceptions of telecare training needs in home healthcare services: a focus group study.

Science.gov (United States)

Guise, Veslemøy; Wiig, Siri

2017-02-23

The implementation and use of telecare requires significant changes to healthcare service organisation and delivery, including new ways of working for staff. Competency development and training for healthcare professionals is therefore required to enable necessary adaptation of clinical practice and ensure competent provision of telecare services. It is however unclear what skills healthcare staff need when providing care at a distance and there is little empirical evidence on effective training strategies for telecare practice. Training should however emphasise the experiences and preferences of prospective trainees to ensure its relevance to their educational needs. The aim of this study was to explore healthcare professionals' perceptions of training related to the general use of telecare, and to identify specific training needs associated with the use of virtual visits in the home healthcare services. Six focus group interviews were held with a total of 26 participants working in the home healthcare services in Norway, including registered nurses, enrolled nurses, physiotherapists, occupational therapists, social workers, health workers, and healthcare assistants. The data material was analysed by way of systematic text condensation. The analysis resulted in five categories relevant to telecare training for healthcare professionals: Purposeful training creates confidence and changes attitudes; Training needs depend on ability to cope with telecare; The timing of training; Training must facilitate practical insight into the patients' perspective; and Training content must focus on the telecare process. Findings are discussed in light of implications for the form and content of a training program for healthcare professionals on how to undertake virtual home healthcare visits. Appropriate preparation and training for telecare use is important for healthcare professionals and must be taken seriously by healthcare organisations. To facilitate the knowledge, skills

Utilization of maternal health services in rural primary health centers ...

African Journals Online (AJOL)

Utilization of maternal health services in rural primary health centers in Sub- Saharan Africa. ... their pregnancies were normal during antenatal care visits, hostile attitude of health workers, poverty and mode of payment. Majority of the PHCs provided antenatal, normal delivery, and post natal services. Rural mothers lacked ...

Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio-economically disadvantaged migrants in Delhi, India.

Science.gov (United States)

Kusuma, Yadlapalli S; Kumari, Rita; Kaushal, Sonia

2013-10-01

To identify the determinants of adequate antenatal care (ANC) utilisation and institutional deliveries among socio-economically disadvantaged migrants living in Delhi, India. In a cross-sectional survey, 809 rural-urban migrant mothers with a child aged below 2 years were interviewed with a pretested questionnaire. Data on receiving antenatal, delivery and post-natal services, migration history and other social, demographic and income were collected. Recent migrants used the services significantly less than settled migrants. ANC was adequate only among 37% (35% of recent migrant women and 39% of settled migrants). Multinomial regression revealed that being a recent migrant, multiparous, illiterate and married to an unskilled worker were significant risk factors for receiving inadequate ANC. Around 53% of deliveries took place at home. ANC seeking has a strong influence on place of delivery: 70% of births to women who received inadequate ANC were at home. Women who are educated, had their first delivery after the age of 20 years and received adequate ANC were more likely to deliver their child in hospital. Post-natal care is grossly neglected among these groups. Migrant women, particularly recent migrants, are at the risk of not receiving adequate maternal healthcare. Because migration is a continuing phenomenon, measures to mitigate disadvantage due to migration need to be taken in the healthcare system. © 2013 John Wiley & Sons Ltd.

Capacity building of skilled birth attendants: A review of pre-service education curricula.

OpenAIRE

Adegoke, Adetoro; Mani, Safiyanu; Abubakar, Aisha; Van Den Broek, Nynke

2013-01-01

OBJECTIVE: to assess the level, type and content of pre-service education curricula of health workers providing maternity services against the ICM global standards for Midwifery Education and Essential competencies for midwifery practice. We reviewed the quality and relevance of pre-service education curricula of four cadres of health-care providers of maternity care in Northern Nigeria.\\ud DESIGN AND SETTING: we adapted and used the ICM global standards for Midwifery Education and Essential ...

Demand-side financing measures to increase maternal health service utilisation and improve health outcomes: a systematic review of evidence from low- and middle-income countries.

Science.gov (United States)

Murray, Susan F; Hunter, Benjamin M; Bisht, Ramila; Ensor, Tim; Bick, Debra

2012-01-01

In many countries financing for health services has traditionally been disbursed directly from governmental and non-governmental funding agencies to providers of services: the 'supply-side' of healthcare markets. Demand-side financing offers a supplementary model in which some funds are instead channelled through, or to, prospective users. In this review we considered evidence on five forms of demand-side financing that have been used to promote maternal health in developing countries: OBJECTIVES: The overall review objective was to assess the effects of demand-side financing interventions on maternal health service utilisation and on maternal health outcomes in low- and middle-income countries. Broader effects on perinatal and infant health, the situation of underprivileged women and the health care system were also assessed. This review considered poor, rural or socially excluded women of all ages who were either pregnant or within 42 days of the conclusion of pregnancy, the limit for postnatal care as defined by the World Health Organization. The review also considered the providers of services.The intervention of interest was any programme that incorporated demand-side financing as a mechanism to increase the consumption of goods and services that could impact on maternal health outcomes. This included the direct consumption of maternal health care goods and services as well as related 'merit goods' such as improved nutrition. We included systems in which potential users of maternal health services are financially empowered to make restricted decisions on buying maternal health-related goods or services - sometimes known as consumer-led demand-side financing. We also included programmes that provided unconditional cash benefits to pregnant women (for example in the form of maternity allowances), or to families with children under five years of age where there was evidence concerning maternal health outcomes.We aimed to include quantitative studies (experimental

The experiences of women with maternal near miss and their perception of quality of care in Kelantan, Malaysia: a qualitative study.

Science.gov (United States)

Norhayati, Mohd Noor; Nik Hazlina, Nik Hussain; Asrenee, Ab Razak; Sulaiman, Zaharah

2017-06-15

Maternal mortality has been the main way of ascertaining the outcome of maternal and obstetric care. However, maternal morbidities occur more frequently than maternal deaths; therefore, maternal near miss was suggested as a more useful indicator for the evaluation and improvement of maternal health services. Our study aimed to explore the experiences of women with maternal near miss and their perception of the quality of care in Kelantan, Malaysia. A qualitative phenomenological approach with in-depth interview method was conducted in two tertiary hospitals in Kelantan, Malaysia. All women admitted to labour room, obstetrics and gynaecology wards and intensive care units in 2014 were screened for the presence of any vital organ dysfunction or failure based on the World Health Organization criteria for maternal near miss. Pregnancy irrespective of the gestational age was included. Women younger than 18 years old, with psychiatric disorder and beyond 42 days of childbirth were excluded. Thirty women who had experienced maternal near miss events were included in the analysis. All were Malays between the ages of 22 and 45. Almost all women (93.3%) had secondary and tertiary education and 63.3% were employed. The women's perceptions of the quality of their care were influenced by the competency and promptness in the provision of care, interpersonal communication, information-sharing and the quality of physical resources. The predisposition to seek healthcare was influenced by costs, self-attitude and beliefs. Self-appraisal of maternal near miss, their perception of the quality of care, their predisposition to seek healthcare and the social support received were the four major themes that emerged from the experiences and perceptions of women with maternal near miss. The women with maternal near miss viewed their experiences as frightening and that they experienced other negative emotions and a sense of imminent death. The factors influencing women's perceptions of

Are Free Maternity Services Completely Free of Costs?

Science.gov (United States)

Acharya, Jeevan

2016-02-01

The Government of Nepal revised free maternity health services, "Aama Surakshya Karyakram", beginning at the start of Fiscal Year 2012/13, which specifies the services to be funded, the tariffs for reimbursement, and the system for claiming and reporting on free deliveries each month. This study was designed to investigate the amount of monetary expenditure incurred by families using apparently free maternity services. Between August 2014 and December 2014, a hospital-based cross-sectional study was conducted at Manipal Teaching Hospital and Western Regional Hospital. Nepalese women were not involved with family finances and had very little knowledge of income or expenditures. Therefore, face-to-face interviews with 384 postpartum mothers with their husbands or the head of the family household were conducted at the time of discharge by using a pre-tested semi-structural questionnaire. The average monthly family income was 19,272.4 NRs (189.01 US$), the median duration of hospital stay was 4 days (range, 2-19 days), and the median patient expenditure was equivalent to 13% of annual family income. The average total visible cost was 3,887.07 NRs (38.1 US$). When the average total hidden cost of 27,288.5 NRs (267.6 US$) was added, then the average total maternity care expenditure was 31,175.6 NRs (305.76 US$), with an average cost per day of 7,167.5 NRs (70.29 US$). The mean patient expenditure on food and drink, clothes, transport, and medicine was equivalent to 53.07%, 9.8%. 7.3%, and 5.6% of the mean total maternity care expenditure, respectively. The earnings lost by respondent women, husbands, and heads of household were 5,963.7 NRs (58.4 US$), 7,429.3 NRs (72.9 US$), and 6,175.9 NRs (60.6 US$), respectively. The free maternity service in Nepal has high out-of-pocket expenditures, and did not represent a system completely free of costs. Therefore, arrangements should be made by hospitals free of cost to provide medicine that is not included as essential during

Effect of free maternal health services on maternal mortality: An experience from Niger Delta, Nigeria

Directory of Open Access Journals (Sweden)

Samuel O Azubuike

2015-01-01

Full Text Available Background: Free maternal health care was launched by Delta State Government in 2007. This development was laudable as poverty has been identified as a big hindrance to accessing health care services among mothers in rural communities. There was need, however, to ascertain the effectiveness of this program. Aim: The study aimed at determining maternal mortality rate (MMR from 2005 to 2009, its correlates, obstetric cause of death and to evaluate the effect of free maternal care on MMR. Methodology: MMRs were computed based on all maternal deaths and live births available in summary health report of Ika South local government area from 2005 to 2009. Correlational analysis was done to determine the correlates of MMRs. Statistical Package for Social Sciences (SPSS version 16 (USA, 2007 was used in the analysis. Results: There was a reduction in MMR from 932/100,000 in 2005 to 604/100,000 in 2009. This reduction negatively correlated (r =−;0.74, P = 0.15 with an increase in antenatal care registration within the period. The gradual increase in proportion of child delivery in health facilities from 59% in 2007 to 74.6% (2288/3065 in 2009 negatively correlated (r =−;0.5, P = 0.4 with a reduction in MMR from 836/100,000 to 604/100,000. The number of skilled staff employed increased by 36.4% (51/140 since 2005 and negatively correlated (r =−;0.34, P = 0.56 with MMR reduction of 328/100,000 since that period, with the employment of nurses being the stronger correlate (r =−;0.48, P = 0.41. Hemorrhage (44% was the leading obstetric cause of death. Conclusion: The study showed that MMR has been on a gradual downward trend since the introduction of free maternal health services in Delta State, Nigeria.

Patterns of maternity care service utilization in Southern Ethiopia ...

African Journals Online (AJOL)

Patterns of maternity care service utilization in Southern Ethiopia: Evidence from a community ... PROMOTING ACCESS TO AFRICAN RESEARCH ... Result: The study revealed that only 26.1 % and 3.3% of the women received antenatal and ...

Applying analytic hierarchy process to assess healthcare-oriented cloud computing service systems.

Science.gov (United States)

Liao, Wen-Hwa; Qiu, Wan-Li

2016-01-01

Numerous differences exist between the healthcare industry and other industries. Difficulties in the business operation of the healthcare industry have continually increased because of the volatility and importance of health care, changes to and requirements of health insurance policies, and the statuses of healthcare providers, which are typically considered not-for-profit organizations. Moreover, because of the financial risks associated with constant changes in healthcare payment methods and constantly evolving information technology, healthcare organizations must continually adjust their business operation objectives; therefore, cloud computing presents both a challenge and an opportunity. As a response to aging populations and the prevalence of the Internet in fast-paced contemporary societies, cloud computing can be used to facilitate the task of balancing the quality and costs of health care. To evaluate cloud computing service systems for use in health care, providing decision makers with a comprehensive assessment method for prioritizing decision-making factors is highly beneficial. Hence, this study applied the analytic hierarchy process, compared items related to cloud computing and health care, executed a questionnaire survey, and then classified the critical factors influencing healthcare cloud computing service systems on the basis of statistical analyses of the questionnaire results. The results indicate that the primary factor affecting the design or implementation of optimal cloud computing healthcare service systems is cost effectiveness, with the secondary factors being practical considerations such as software design and system architecture.

Utilization of maternal health care services among indigenous women in Bangladesh: A study on the Mru tribe.

Science.gov (United States)

Islam, Rakibul M

2017-01-01

Despite startling developments in maternal health care services, use of these services has been disproportionately distributed among different minority groups in Bangladesh. This study aimed to explore the factors associated with the use of these services among the Mru indigenous women in Bangladesh. A total of 374 currently married Mru women were interviewed using convenience sampling from three administrative sub-districts of the Bandarban district from June to August of 2009. Associations were assessed using Chi-square tests, and a binary logistic regression model was employed to explore factors associated with the use of maternal health care services. Among the women surveyed, 30% had ever visited maternal health care services in the Mru community, a very low proportion compared with mainstream society. Multivariable logistic regression analyses revealed that place of residence, religion, school attendance, place of service provided, distance to the service center, and exposure to mass media were factors significantly associated with the use of maternal health care services among Mru women. Considering indigenous socio-cultural beliefs and practices, comprehensive community-based outreach health programs are recommended in the community with a special emphasis on awareness through maternal health education and training packages for the Mru adolescents.

EFFECT OF INDIVIDUAL AND COMMUNITY FACTORS ON MATERNAL HEALTH CARE SERVICE USE IN INDIA: A MULTILEVEL APPROACH.

Science.gov (United States)

Yadav, Awdhesh; Kesarwani, Ranjana

2016-01-01

This study aimed to assess empirically the influence of individual and community (neighbourhood) factors on the use of maternal health care services in India through three outcomes: utilization of full antenatal care (ANC) services, safe delivery and utilization of postnatal care services. Data were from the third round of the National Family Health Survey (2005-06). The study sample constituted ever-married women aged 15-49 from 29 Indian states. Multilevel logistic regression analysis was performed for the three outcomes of interest accounting for individual- and community-level factors associated with the use of maternal health care services. A substantial amount of variation was observed at the community level. About 45%, 51% and 62% of the total variance in the use of full ANC, safe delivery and postnatal care, respectively, could be attributed to differences across the community. There was significant variation in the use of maternal health care services at the individual level, with socioeconomic status and mother's education being the most prominent factors associated with the use of maternal health care services. At the community level, urban residence and poverty concentration were found to be significantly associated with maternal health care service use. The results suggest that an increased focus on community-level interventions could lead to an increase in the utilization of maternal health care services in India.

Labor markets and employment insecurity: impacts of globalization on service and healthcare-sector workforces.

Science.gov (United States)

Ostry, Aleck S; Spiegel, Jerry M

2004-01-01

Global changes in the economies of most developed nations have impacted the way healthcare is organized, even within largely public systems, and the working conditions of healthcare workers. Since the acceleration of globalization in the 1970s, service-sector workers in developed nations have faced high unemployment, increased skill requirements for most jobs, and a rise in non-traditional work arrangements. These secular shifts in service-sector labor markets have occurred against the background of an erosion of the welfare state and growing income inequality. As well, many healthcare systems, including Canada's, were severely downsized and restructured in the 1990s, exacerbating the underlying negative secular trends in the service sector, and worsening the working conditions for many healthcare workers. Globalization has altered the labor market and shifted working conditions in ways that have been unfavorable to many healthcare workers.

Socially-assigned race, healthcare discrimination and preventive healthcare services.

Directory of Open Access Journals (Sweden)

Tracy Macintosh

Full Text Available Race and ethnicity, typically defined as how individuals self-identify, are complex social constructs. Self-identified racial/ethnic minorities are less likely to receive preventive care and more likely to report healthcare discrimination than self-identified non-Hispanic whites. However, beyond self-identification, these outcomes may vary depending on whether racial/ethnic minorities are perceived by others as being minority or white; this perception is referred to as socially-assigned race.To examine the associations between socially-assigned race and healthcare discrimination and receipt of selected preventive services.Cross-sectional analysis of the 2004 Behavioral Risk Factor Surveillance System "Reactions to Race" module. Respondents from seven states and the District of Columbia were categorized into 3 groups, defined by a composite of self-identified race/socially-assigned race: Minority/Minority (M/M, n = 6,837, Minority/White (M/W, n = 929, and White/White (W/W, n = 25,913. Respondents were 18 years or older, with 61.7% under age 60; 51.8% of respondents were female. Measures included reported healthcare discrimination and receipt of vaccinations and cancer screenings.Racial/ethnic minorities who reported being socially-assigned as minority (M/M were more likely to report healthcare discrimination compared with those who reported being socially-assigned as white (M/W (8.9% vs. 5.0%, p = 0.002. Those reporting being socially-assigned as white (M/W and W/W had similar rates for past-year influenza (73.1% vs. 74.3% and pneumococcal (69.3% vs. 58.6% vaccinations; however, rates were significantly lower among M/M respondents (56.2% and 47.6%, respectively, p-values<0.05. There were no significant differences between the M/M and M/W groups in the receipt of cancer screenings.Racial/ethnic minorities who reported being socially-assigned as white are more likely to receive preventive vaccinations and less likely to report

Why (just) information is not enough: The contributions of information services in the management of healthcare information

Energy Technology Data Exchange (ETDEWEB)

Kostagiolas, P., E-mail: pkostagiolas@ionio.gr [Assistant Professor Department of Archives, Library Science and Museology, Ionian University, CORFU 49100 (Greece); Lappa, E., E-mail: evlappa@med.uoa.gr [Director of Medical Library of General Hospital Attikis KAT, Nikis 2 str, 14564 KIFFISIA-ATHENS (Greece)

2015-02-09

Information is at the centre of every hospital activity including clinical decisions and healthcare service delivery systems. Although information is an important hospital asset, several issues related to its management and organization needs to be addressed within the hospitals. The management of healthcare information is a strategic goal related to the reduction of healthcare service provision costs, and to the improvement of quality and safety of healthcare services. By discussing the rather obvious necessity for information organization and management in the healthcare domain, this work aims at the role of healthcare information services, i.e. hospital libraries and patient medical records. Finally, a typology of information services’ contributions to hospital environment is presented.

Why (just) information is not enough: The contributions of information services in the management of healthcare information

International Nuclear Information System (INIS)

Kostagiolas, P.; Lappa, E.

2015-01-01

Information is at the centre of every hospital activity including clinical decisions and healthcare service delivery systems. Although information is an important hospital asset, several issues related to its management and organization needs to be addressed within the hospitals. The management of healthcare information is a strategic goal related to the reduction of healthcare service provision costs, and to the improvement of quality and safety of healthcare services. By discussing the rather obvious necessity for information organization and management in the healthcare domain, this work aims at the role of healthcare information services, i.e. hospital libraries and patient medical records. Finally, a typology of information services’ contributions to hospital environment is presented

Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence.

Science.gov (United States)

Madzimbamuto, Farai D; Ray, Sunanda; Mogobe, Keitshokile D

2013-06-10

The failure to reduce preventable maternal deaths represents a violation of women's right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks. Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman's death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women's lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients' rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques. In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes

Integration of social media with healthcare big data for improved service delivery

Directory of Open Access Journals (Sweden)

Sibulela Mgudlwa

2018-04-01

Full Text Available Background: In the last decade, social media users across the world have crossed 1 billion, making it one of the fastest growing sources of big data. Also, people needing healthcare continue to increase in every society. Through accessibility, communication and interaction between health practitioners and patients, this type of ever-growing, social media subscriber–based platform can be of significant use in improving healthcare delivery to society. However, users encounter serious challenges in their attempts to make use of social media and big data for health-related services. The challenges are primarily caused by factors such as integration, complexity, security and privacy. The challenges are mainly owing to the sensitive nature of the healthcare environment, as a result of personalisation and privacy of information.   Objectives: The objectives of the study were to examine and gain a better understanding of the complexities that are associated with the use of social media and healthcare big data, through influencing factors, and to develop a framework that can be used to improve health-related services to the patients.   Methods: The interpretivist approach was employed, within which qualitative data were collected. This included documents and existing literature in the areas of social media and healthcare big data. To have a good spread of both previous and current state of events within the phenomena being studied, literature published between 2006 and 2016 were gathered. The data were interpretively analysed.   Results: Based on the analysis of the data, factors of influence were found, which were used to develop a model. The model illustrates how the factors of influence can enable and at the same time constrain the use of social media for healthcare services. The factors were interpreted from which a framework was developed. The framework is intended to guide integration of social media with healthcare big data through which

Differential in Utilization of Maternal Care Services in Empowered Action Group States, India (1990-2006

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Jeetendra Yadav

2016-03-01

Full Text Available Background: Low use of maternal care services is one of the reasons why child mortality and maternal mortality is still considerably high in India. Most maternal deaths are preventable if mothers receive essential health care before, during, and after childbirth. In India, the eight socioeconomically backward states referred to as the Empowered Action Group (EAG states; lag behind in the demographic transition and low utilization of maternal health care services. Addressing the maternity care needs of women may have considerable ramifications for achieving the Millennium Development Goal (MDG – 5.Aims & Objectives:  To explore the prevalence, trends and factors associated with the utilization of maternal care services in Empowered Action Group States, India (1990-2006.Material Methods: Data from three rounds of the round of the Demographic and Health Survey (DHS, known as the National Family Health Survey (NFHS of India were analyzed. Bivariate and multivariate-pooled logistic regression model were applied to examine the utilization of the maternal and child health care trends over time.Result: The results from analysis indicate that the full ANC and skilled birth attendant (SBA has increased from 17% and 20% to 25% and35% respectively during the last one and half decade (1990-2006.Conclusion: Various socioeconomic and demographic factors are associated with the utilization of maternal care services in EAG states, India. Promoting the use of family planning, female education, targeting vulnerable groups such as poor, illiterate, high parity women, involving media and grass root level workers and collaboration between community leaders and health care system could be some important policy level interventions to address the unmet need of maternal and child health care services among women. The study concludes that much of these differentials are social constructs that can be reduced by prioritizing the needs of the disadvantaged and adopting

Differential in Utilization of Maternal Care Services in Empowered Action Group States, India (1990-2006

Directory of Open Access Journals (Sweden)

Jeetendra Yadav

2016-03-01

Full Text Available Background: Low use of maternal care services is one of the reasons why child mortality and maternal mortality is still considerably high in India. Most maternal deaths are preventable if mothers receive essential health care before, during, and after childbirth. In India, the eight socioeconomically backward states referred to as the Empowered Action Group (EAG states; lag behind in the demographic transition and low utilization of maternal health care services. Addressing the maternity care needs of women may have considerable ramifications for achieving the Millennium Development Goal (MDG – 5. Aims & Objectives:  To explore the prevalence, trends and factors associated with the utilization of maternal care services in Empowered Action Group States, India (1990-2006. Material Methods: Data from three rounds of the round of the Demographic and Health Survey (DHS, known as the National Family Health Survey (NFHS of India were analyzed. Bivariate and multivariate-pooled logistic regression model were applied to examine the utilization of the maternal and child health care trends over time. Result: The results from analysis indicate that the full ANC and skilled birth attendant (SBA has increased from 17% and 20% to 25% and35% respectively during the last one and half decade (1990-2006. Conclusion: Various socioeconomic and demographic factors are associated with the utilization of maternal care services in EAG states, India. Promoting the use of family planning, female education, targeting vulnerable groups such as poor, illiterate, high parity women, involving media and grass root level workers and collaboration between community leaders and health care system could be some important policy level interventions to address the unmet need of maternal and child health care services among women. The study concludes that much of these differentials are social constructs that can be reduced by prioritizing the needs of the disadvantaged and

A National Audit of Smoking Cessation Services in Irish Maternity Units

LENUS (Irish Health Repository)

2017-06-01

There is international consensus that smoking cessation in the first half of pregnancy improves foetal outcomes. We surveyed all 19 maternity units nationally about their antenatal smoking cessation practices. All units recorded details on maternal smoking at the first antenatal visit. Only one unit validated the self-reported smoking status of pregnant women using a carbon monoxide breath test. Twelve units (63%) recorded timing of smoking cessation. In all units women who reported smoking were given verbal cessation advice. This was supported by written advice in 12 units (63%), but only six units (32%) had all midwives trained to provide this advice. Only five units (26%) reported routinely revisiting smoking status later in pregnancy. Although smoking is an important modifiable risk factor for adverse pregnancy outcomes, smoking cessation services are inadequate in the Irish maternity services and there are variations in practices between hospitals.

Effect of Women's autonomy on maternal health service utilization in Nepal: a cross sectional study.

Science.gov (United States)

Adhikari, Ramesh

2016-05-13

Women's role has been a priority area not only for sustainable development, but also in reproductive health since ICPD 1994. However, very little empirical evidence is available about women's role on maternal health service utilization in Nepal. This paper explores dimensions of women's autonomy and their relationship to utilization of maternal health services. The analysis uses data from the Nepal Demographic and Health Survey, 2011. The analysis is confined to women who had given birth in the 5 years preceding the survey (n = 4,148). Women's autonomy related variables are taken from the standard DHS questionnaire and measured based on decision in household about obtaining health care, large household purchases and visit to family or relative. The net effect of women's autonomy on utilization of maternal health services after controlling for the effect of other predictors has been measured through multivariate logistic regression analysis. The findings indicate only about a half of the women who had given birth in the past 5 years preceding the survey had 4 or more ANC check up for their last birth. Similarly, 40 % of the women had delivered their last child in the health facilities. Furthermore, slightly higher than two-fifth women (43 %) had postnatal check up for their last child. Only slightly higher than a fourth woman (27 %) had utilized all the services (adequate ANC visit, delivered at health institution and post natal check up) for their last child. This study found that many socio-demographic variables such as age of women, number of children born, level of education, ethnicity, place of residence and wealth index are predicators of utilizing the maternal health services of recent child. Notably, higher level autonomy was associated with higher use of maternal health services [adjusted odds ratio (aOR) =1.40; CI 1.18-1.65]. Utilization of maternal health services for the recent child among women is very low. The study results suggest that policy

Dynamic User Interfaces for Service Oriented Architectures in Healthcare.

Science.gov (United States)

Schweitzer, Marco; Hoerbst, Alexander

2016-01-01

Electronic Health Records (EHRs) play a crucial role in healthcare today. Considering a data-centric view, EHRs are very advanced as they provide and share healthcare data in a cross-institutional and patient-centered way adhering to high syntactic and semantic interoperability. However, the EHR functionalities available for the end users are rare and hence often limited to basic document query functions. Future EHR use necessitates the ability to let the users define their needed data according to a certain situation and how this data should be processed. Workflow and semantic modelling approaches as well as Web services provide means to fulfil such a goal. This thesis develops concepts for dynamic interfaces between EHR end users and a service oriented eHealth infrastructure, which allow the users to design their flexible EHR needs, modeled in a dynamic and formal way. These are used to discover, compose and execute the right Semantic Web services.

Organising healthcare services for persons with an intellectual disability.

Science.gov (United States)

Balogh, Robert; McMorris, Carly A; Lunsky, Yona; Ouellette-Kuntz, Helene; Bourne, Laurie; Colantonio, Angela; Gonçalves-Bradley, Daniela C

2016-04-11

When compared to the general population, persons with an intellectual disability have lower life expectancy, higher morbidity, and more difficulty finding and obtaining healthcare. Organisational interventions are used to reconfigure the structure or delivery of healthcare services. This is the first update of the original review. To assess the effects of organisational interventions of healthcare services for the mental and physical health problems of persons with an intellectual disability. For this update we searched CENTRAL, MEDLINE, EMBASE, CINAHL and other databases, from April 2006 to 4 September 2015. We checked reference lists of included studies and consulted experts in the field. Randomised controlled trials of organisational interventions of healthcare services aimed at improving care of mental and physical health problems of adult persons with an intellectual disability. We employed standard methodological procedures as outlined in the Cochrane Handbook of Systematic Reviews of Interventions, in addition to specific guidance from the Cochrane Effective Practice and Organisation of Care (EPOC) Group. We identified one new trial from the updated searches.Seven trials (347 participants) met the selection criteria. The interventions varied but had common components: interventions that increased the intensity and frequency of service delivery (4 trials, 200 participants), community-based specialist behaviour therapy (1 trial, 63 participants), and outreach treatment (1 trial, 50 participants). Another trial compared two active arms (traditional counselling and integrated intervention for bereavement, 34 participants).The included studies investigated interventions dealing with the mental health problems of persons with an intellectual disability; none focused on physical health problems. Four studies assessed the effect of organisational interventions on behavioural problems for persons with an intellectual disability, three assessed care giver burden, and

Understanding barriers to maternal child health services utilisation ...

African Journals Online (AJOL)

The findings also indicate that although health facility delivery is high in the districts surveyed, only the well-to-do non-literate, urbanite women and the ... rural communities included the need to improve the quality of maternal and child health service through the supply of major logistic deficiencies, the need to provide ...

Inequities in utilization of reproductive and maternal health services in Ethiopia.

Science.gov (United States)

Bobo, Firew Tekle; Yesuf, Elias Ali; Woldie, Mirkuzie

2017-06-19

Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index. Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.

Factors affecting access to healthcare services by intermarried Filipino women in rural Tasmania: a qualitative study.

Science.gov (United States)

Hannah, Chona T; Lê, Quynh

2012-10-01

Access to health care services is vital for every migrant's health and wellbeing. However, migrants' cultural health beliefs and views can hinder their ability to access available services. This study examined factors affecting access to healthcare services for intermarried Filipino women in rural Tasmania, Australia. A qualitative approach using semi-structured interviews was employed to investigate the factors affecting access to healthcare services for 30 intermarried Filipino women in rural Tasmania. The study used grounded theory and thematic analysis for its data analysis. Nvivo v8 (www.qsrinternational.com) was also used to assist the data coding process and analysis. Five influencing factors were identified: (1) language or communication barriers; (2) area of origin in the Philippines; (3) cultural barriers; (4) length of stay in Tasmania; and (5) expectations of healthcare services before and after migration. Factors affecting intermarried Filipino women in accessing healthcare services are shaped by their socio-demographic and cultural background. The insights gained from this study are useful to health policy-makers, healthcare professionals and to intermarried female migrants. The factors identified can serve as a guide to improve healthcare access for Filipino women and other migrants.

Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

Science.gov (United States)

Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I

2015-01-01

To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Qualitative ethnographic study. A maternity hospital, Afghanistan. Doctors, midwives and care assistants. Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. The culture of care in an Afghan maternity hospital. A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment-fearing humiliation, blame and the loss of employment. Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. © 2014 Royal College of Obstetricians and Gynaecologists.

Interventions to provide culturally-appropriate maternity care services: factors affecting implementation.

Science.gov (United States)

Jones, Eleri; Lattof, Samantha R; Coast, Ernestina

2017-08-31

The World Health Organization recently made a recommendation supporting 'culturally-appropriate' maternity care services to improve maternal and newborn health. This recommendation results, in part, from a systematic review we conducted, which showed that interventions to provide culturally-appropriate maternity care have largely improved women's use of skilled maternity care. Factors relating to the implementation of these interventions can have implications for their success. This paper examines stakeholders' perspectives and experiences of these interventions, and facilitators and barriers to implementation; and concludes with how they relate to the effects of the interventions on care-seeking outcomes. We based our analysis on 15 papers included in the systematic review. To extract, collate and organise data on the context and conditions from each paper, we adapted the SURE (Supporting the Use of Research Evidence) framework that lists categories of factors that could influence implementation. We considered information from the background and discussion sections of papers included in the systematic review, as well as cost data and qualitative data when included. Women's and other stakeholders' perspectives on the interventions were generally positive. Four key themes emerged in our analysis of facilitators and barriers to implementation. Firstly, interventions must consider broader economic, geographical and social factors that affect ethnic minority groups' access to services, alongside providing culturally-appropriate care. Secondly, community participation is important in understanding problems with existing services and potential solutions from the community perspective, and in the development and implementation of interventions. Thirdly, respectful, person-centred care should be at the core of these interventions. Finally, cohesiveness is essential between the culturally-appropriate service and other health care providers encountered by women and their

Expansion in the private sector provision of institutional delivery services and horizontal equity: evidence from Nepal and Bangladesh.

Science.gov (United States)

Hotchkiss, David R; Godha, Deepali; Do, Mai

2014-07-01

Wealth-related inequity in the use of maternal healthcare services continues to be a substantial problem in most low- and middle-income countries. One strategic approach to increase the use of appropriate maternal healthcare services is to encourage the expansion of the role of the private sector. However, critics of such an approach argue that increasing the role of the private sector will lead to increased inequity in the use of maternal healthcare services. This article explores this issue in two South Asian countries that have traditionally had high rates of maternal mortality-Nepal and Bangladesh. The study is based on multiple rounds of nationally representative household survey data collected in Nepal and Bangladesh from 1996 to 2011. The methodology involves estimating a concentration index for each survey to assess changes in wealth-related inequity in the use of institutional delivery assistance over time. The results of the study suggest that the expansion of private sector supply of institutional-based delivery services in Nepal and Bangladesh has not led to increased horizontal inequity. In fact, in both countries, inequity was shown to have decreased over the study period. The study findings also suggest that the provision of government delivery services to the poor protects against increased wealth-related inequity in service use. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

E-health and healthcare enterprise information system leveraging service-oriented architecture.

Science.gov (United States)

Hsieh, Sung-Huai; Hsieh, Sheau-Ling; Cheng, Po-Hsun; Lai, Feipei

2012-04-01

To present the successful experiences of an integrated, collaborative, distributed, large-scale enterprise healthcare information system over a wired and wireless infrastructure in National Taiwan University Hospital (NTUH). In order to smoothly and sequentially transfer from the complex relations among the old (legacy) systems to the new-generation enterprise healthcare information system, we adopted the multitier framework based on service-oriented architecture to integrate the heterogeneous systems as well as to interoperate among many other components and multiple databases. We also present mechanisms of a logical layer reusability approach and data (message) exchange flow via Health Level 7 (HL7) middleware, DICOM standard, and the Integrating the Healthcare Enterprise workflow. The architecture and protocols of the NTUH enterprise healthcare information system, especially in the Inpatient Information System (IIS), are discussed in detail. The NTUH Inpatient Healthcare Information System is designed and deployed on service-oriented architecture middleware frameworks. The mechanisms of integration as well as interoperability among the components and the multiple databases apply the HL7 standards for data exchanges, which are embedded in XML formats, and Microsoft .NET Web services to integrate heterogeneous platforms. The preliminary performance of the current operation IIS is evaluated and analyzed to verify the efficiency and effectiveness of the designed architecture; it shows reliability and robustness in the highly demanding traffic environment of NTUH. The newly developed NTUH IIS provides an open and flexible environment not only to share medical information easily among other branch hospitals, but also to reduce the cost of maintenance. The HL7 message standard is widely adopted to cover all data exchanges in the system. All services are independent modules that enable the system to be deployed and configured to the highest degree of flexibility

Cross-cultural opening in German outpatient mental healthcare service: an exploratory study of structural and procedural aspects.

Science.gov (United States)

Mösko, Mike-Oliver; Gil-Martinez, Fernanda; Schulz, Holger

2013-01-01

Mental healthcare services need to be sensitive towards the cultural needs of patients. Cross-cultural opening is an organizational process to fulfil these needs. This study aims to provide representative structural and procedural data regarding the use of German outpatient mental healthcare services by allochthonous patients, the diversity of psychotherapists in outpatient mental healthcare service, the cross-cultural encounters of therapists and the cross-cultural sensitivity of psychotherapists working in this healthcare area. Of all public outpatient psychotherapists in Hamburg, 81% (n = 485) participated in this survey. Regarding the distribution of the population in this metropolis, allochthonous therapists were underrepresented. Unlike the overall distribution of foreign inhabitants, the largest groups of immigrant therapists came from England, German-speaking countries and other countries within the European Union. The proportion of allochthonous patients in outpatient mental healthcare service was almost half of the proportion of the allochthonous in the general population. Psychotherapists with a migration background regarded themselves as having a higher level of cross-cultural sensitivity than their native colleagues, especially those who have had fewer cross-cultural encounters. Overall, psychotherapists named different challenges in providing cross-cultural treatment. For the German outpatient mental healthcare service to be more accessible to immigrants and their descendants, a greater number of bilingual psychotherapists must gain access to the mental healthcare service, and more advanced cross-cultural sensitivity training and supervision should be provided. German outpatient psychotherapists are culturally and linguistically diverse. Nevertheless, psychotherapists with a migration background are underrepresented in outpatient mental healthcare services. Patients with a migration background are also underrepresented in the German outpatient mental

Has India's national rural health mission reduced inequities in maternal health services? A pre-post repeated cross-sectional study.

Science.gov (United States)

Vellakkal, Sukumar; Gupta, Adyya; Khan, Zaky; Stuckler, David; Reeves, Aaron; Ebrahim, Shah; Bowling, Ann; Doyle, Pat

2017-02-01

In 2005, India launched the National Rural Health Mission (NRHM) to strengthen the primary healthcare system. NRHM also aims to encourage pregnant women, particularly of low socioeconomic backgrounds, to use institutional maternal healthcare. We evaluated the impacts of NRHM on socioeconomic inequities in the uptake of institutional delivery and antenatal care (ANC) across high-focus (deprived) Indian states. Data from District Level Household and Facility Surveys (DLHS) Rounds 1 (1995-99) and 2 (2000-04) from the pre-NRHM period, and Round 3 (2007-08), Round 4 and Annual Health Survey (2011-12) from post-NRHM period were used. Wealth-related and education-related relative indexes of inequality, and pre-post difference-in-differences models for wealth and education tertiles, adjusted for maternal age, rural-urban, caste, parity and state-level fixed effects, were estimated. Inequities in institutional delivery declined between pre-NRHM Period 1 (1995-99) and pre-NRHM Period 2 (2000-04), but thereafter demonstrated steeper decline in post-NRHM periods. Uptake of institutional delivery increased among all socioeconomic groups, with (1) greater effects among the lowest and middle wealth and education tertiles than highest tertile, and (2) larger equity impacts in the late post-NRHM period 2011-12 than in the early post-NRHM period 2007-08. No positive impact on the uptake of ANC was found in the early post-NRHM period 2007-08; however, there was considerable increase in the uptake of, and decline in inequity, in uptake of ANC in most states in the late post-NRHM period 2011-12. In high-focus states, NRHM resulted in increased uptake of maternal healthcare, and decline in its socioeconomic inequity. Our study suggests that public health programs in developing country settings will have larger equity impacts after its almost full implementation and widest outreach. Targeting deprived populations and designing public health programs by linking maternal and child

Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed.

LENUS (Irish Health Repository)

Elmusharaf, Khalifa

2015-09-01

Universal health access will not be achieved unless women are cared for in their own communities and are empowered to take decisions about their own health in a supportive environment. This will only be achieved by community-based demand side interventions for maternal health access. In this review article, we highlight three common strategies to increase demand-side barriers to maternal healthcare access and identify the main challenges that still need to be addressed for these strategies to be effective.

How equitable is social franchising? Case studies of three maternal healthcare franchises in Uganda and India.

OpenAIRE

Haemmerli, M; Santos, A; Penn-Kekana, L; Lange, I; Matovu, F; Benova, L; Wong, KLM; Goodman, C

2018-01-01

Substantial investments have been made in clinical social franchising to improve quality of care of private facilities in low- and middle-income countries but concerns have emerged that the benefits fail to reach poorer groups. We assessed the distribution of franchise utilization and content of care by socio-economic status (SES) in three maternal healthcare social franchises in Uganda and India (Uttar Pradesh and Rajasthan). We surveyed 2179 women who had received antenatal care (ANC) and/o...

Developing supplemental activities for primary health care maternity services.

Science.gov (United States)

Panitz, E

1990-12-01

Supplemental health care activities are described in the context of the augmented product. The potential benefits of supplemental services to recipients and provider are discussed. The author describes a study that was the basis for (re)developing a supplemental maternity service. The implementation of the results in terms of changes in the marketing mix of this supplemental program is discussed. The effects of the marketing mix changes on program participation are presented.

Directions in healthcare research: pointers from retailing and services marketing.

Science.gov (United States)

Van Rompay, Thomas L J; Tanja-Dijkstra, Karin

2010-01-01

Although the importance of the environment in relation to healing processes has been well established, empirical evidence for environmental effects on patient well-being and behavior is sparse. In addition, few attempts have been made to integrate insights from related fields of research such as retailing and services marketing with findings from healthcare studies. In this paper, relevant findings and insights from these domains are discussed. What insights and findings from retailing and services marketing are (potentially) of interest to the healthcare context, and how should one interpret and follow up on these results in healthcare environments? Research in retailing and services marketing indicates that physical environmental factors (i.e., music and scent) and social environmental factors (i.e., crowded conditions) may affect consumer satisfaction and well-being. In addition, environmental effects have been shown to vary with contextual factors (e.g., the type of environment) and consumer needs (e.g., the extent to which consumers value social contact or stimulation in a specific setting). Although the evidence base for environmental factors in health environments is steadily growing, few attempts have been made to integrate findings from both domains. The findings presented indicate that environmental variables such as music and scent can contribute to patient well-being and overall satisfaction. In addition, findings suggest that these variables may be used to counteract the negative effects resulting from crowded conditions in different healthcare units. Taking into account recent developments in the healthcare industry, the importance of creating memorable and pleasant patient experiences is likely to grow in the years to come. Hence, the finding that subtle and relatively inexpensive manipulations may affect patient well-being in profound ways should inspire follow-up research aimed at unraveling the specifics of environmental influences in health

[Measurement of customer satisfaction and participation of citizens in improving the quality of healthcare services.].

Science.gov (United States)

Degrassi, Flori; Sopranzi, Cristina; Leto, Antonella; Amato, Simona; D'Urso, Antonio

2009-01-01

Managing quality in health care whilst ensuring equity is a fundamental aspect of the provision of services by healthcare organizations. Measuring perceived quality of care is an important tool for evaluating the quality of healthcare delivery in that it allows the implementation of corrective actions to meet the healthcare needs of patients. The Rome B (ASL RMB) local health authority adopted the UNI EN 10006:2006 norms as a management tool, therefore introducing the evaluation of customer satisfaction as an opportunity to involve users in the creation of quality healthcare services with and for the citizens. This paper presents the activities implemented and the results achieved with regards to shared and integrated continuous improvement of services.

[Ophthalmological service quality offered to outpatients of the Public Healthcare System].

Science.gov (United States)

Santos Hercos, Benigno Vicente; Berezovsky, Adriana

2006-01-01

To identify the perception of the ophthalmic service quality provided for outpatients of the public healthcare system as well as to detect which actions should be considered necessary and priority in order to improve its quality. A quantitative descriptive study was carried out on 100 outpatients of the public healthcare system which were submitted to ophthalmic tests at Fundação Hilton Rocha--Belo Horizonte-MG, from July 1st-July 30th 2004. Individual interviews were carried out by giving the interviewees two structured questionnaires adapted from the modified SERVQUAL. This scale is in agreement with the reality of the studied institute. The adapted SERVQUAL scale was submitted to statistical validation and it showed a suitable internal consistency index. In general terms, a slight general dissatisfaction was detected regarding ophthalmological service quality. The interviewees cared more about safety and reliability. A higher degree of dissatisfaction was detected mainly concerning fulfillment of procedures at scheduled appointments related to the execution of services within due time-limits. The institute is supposed to plan as well as carry out actions which lead to a general improvement in the patient's satisfaction regarding service quality and mainly reliability. Service quality monitoring through periodic use of the SERVQUAL scale will not only make it possible to plan highly precise and effective intervention strategies in these and in other healthcare services but it will also allow monitoring the responses to these actions. All these actions will contribute to the improvement of the service in the system as a whole.

Do experiences and perceptions about quality of care differ among social groups in Nepal? : A study of maternal healthcare experiences of women with and without disabilities, and Dalit and non-Dalit women.

Directory of Open Access Journals (Sweden)

Hridaya Raj Devkota

Full Text Available Suboptimal quality of care and disparities in services by healthcare providers are often reported in Nepal. Experience and perceptions about quality of care may differ according to women's socio-cultural background, individual characteristics, their exposure and expectations. This study aimed to compare perceptions of the quality of maternal healthcare services between two groups that are consistently considered vulnerable, women with disabilities from both the non-Dalit population and Dalit population and their peers without disabilities from both non-Dalit and Dalit communities.A cross-sectional survey was conducted among 343 total women that included women with disabilities, Dalits and non-Dalits. Women were recruited for interview, who were aged 15-49 years, had been pregnant within the last five years and who had used maternal care services in one of the public health facilities of Rupandehi district. A 20-item, Likert-type scale with four sub-scales or dimensions: 'Health Facility', 'Healthcare Delivery', 'Inter-personal' and 'Access to Care' was used to measure women's perceptions of quality of care. Chi-square test and t test were used to compare groups and to assess differences in perceptions; and linear regression was applied to assess confounding effects of socio-demographic factors. The mean score was compared for each item and separately for each dimension.All groups, women with disabilities and women without disabilities, Dalit and non-Dalit rated their perceptions and experiences of quality of care lowly in a number of items. While perceived quality of care between women with disabilities and without disabilities in the 'Health Facility' dimension and associated items, was found to differ (p<0.05, this difference was linked to disability status, but was not linked to caste differences. For example, differences in mean scores relating to 'Cleanliness and Facilities', 'Open and Friendliness' and 'Compassion and Kindness' were highly

Marketing analysis of a maternity service by a consumer.

Science.gov (United States)

Crowley-Murphy, M

1996-07-01

Marketing analysis is a means of identifying consumer satisfaction, thus providing a means of exploiting weaknesses in competitors. As part of a graduate midwifery programme a small study was undertaken analysing marketing activities used by one competitor provider of maternity care services. The Marketing mix, Ansoff matrix and Gap analysis were the marketing tools used. Recommendations to midwifery service providers suggest using market research to identify consumer expectations and explore areas of both satisfaction and dissatisfaction.

Mothers with mental health problems: Contrasting experiences of support within maternity services in the Republic of Ireland.

Science.gov (United States)

Higgins, Agnes; Tuohy, Teresa; Murphy, Rebecca; Begley, Cecily

2016-05-01

to explore the views and experiences of women with mental health difficulties, in the Republic of Ireland, accessing and receiving care from publicly-funded maternity care services during pregnancy, childbirth and immediate postnatal period in hospital. in total 20 women with a range of mental health problems were recruited. The women had given birth within maternity services with and without specialist perinatal mental health services. a qualitative descriptive design using in-depth face to face interviews was used to explore women׳s experience. Data were analysed using an inductive thematic process. the study offers valuable insights into the maternity care experiences of women with mental health problems, and highlights the deficits and fragmentation of care in maternity units that do not have a specialist mental health service. Even when the women voluntarily disclosed their difficulties, midwives appeared to lack the knowledge and skills to respond sensitively and responsively. there is a need to expand perinatal mental health services in the Republic of Ireland, so that quality service provision is not dependent on geography. In addition, there is a need for education to address the lack of knowledge and understanding of perinatal mental health problems amongst maternity care practitioners. Copyright © 2016 Elsevier Ltd. All rights reserved.

Urban-rural difference in satisfaction with primary healthcare services in Ghana

Directory of Open Access Journals (Sweden)

Sanni Yaya

2017-11-01

Full Text Available Abstract Background Understanding regional variation in patient satisfaction about healthcare systems (PHCs on the quality of services provided is instrumental to improving quality and developing a patient-centered healthcare system by making it more responsive especially to the cultural aspects of health demands of a population. Reaching to the innovative National Health Insurance Scheme (NHIS in Ghana, surpassing several reforms in healthcare financing has been a milestone. However, the focus of NHIS is on the demand side of healthcare delivery. Studies focusing on the supply side of healthcare delivery, particularly the quality of service as perceived by the consumers are required. A growing number of studies have focused on regional differences of patient satisfaction in developed countries, however little research has been conducted concerning patient satisfaction in resource-poor settings like in Ghana. This study was therefore dedicated to examining the variation in satisfaction across rural and urban women in Ghana. Methods Data for the present study were obtained from the latest demographic and health survey in Ghana (GDHS 2014. Participants were 3576 women aged between 15 and 49 years living in non-institutional settings in Ghana. Summary statistics in percentages was used to present respondents’ demographic, socioeconomic characteristics. Chi-square test was used to find association between urban-rural differentials with socio-economic variables. Multiple logistic regression was performed to measure the association of being satisfied with primary healthcare services with study variables. Model fitness was tested by pseudo R 2. Statistical significance was set at p < 0.05. Results The findings in this study revealed that about 57.1% were satisfied with primary health care services. The urban and rural areas reported 57.6 and 56.6% respectively which showed no statistically significant difference (z = 0.64; p = 0.523; 95

Multimedia communications and services for the healthcare community

Science.gov (United States)

Robinson, James M.

1994-11-01

The NYNEX Media Broadband Service Trials in Boston examined the use of several multiple media applications from healthcare in conjunction with high speed fiber optic networks. As part of these trials, NYNEX developed a network-based software technology that simplifies and coordinates the delivery of complex voice, data, image, and video information. This permits two or more users to interact and collaborate with one another while sharing, displaying, and manipulating various media types. Different medical applications were trialed at four of Boston's major hospitals, ranging from teleradiology (which tested the quality of the diagnostic images and the need to collaborate) to telecardiology (which displayed diagnostic quality digital movies played in synchronicity). These trials allowed NYNEX to uniquely witness the needs and opportunities in the healthcare community for broadband communications with the necessary control capabilities and simplified user interface. As a result of the success of the initial trials, NYNEX has created a new business unit, Media Communications Services (MCS), to deliver a service offering based on this capability. New England Medical Center, as one of the initial trial sites, was chosen as a beta trial candidate, and wanted to further its previous work in telecardiology as well as telepsychiatry applications. Initial and subsequent deployments have been completed, and medical use is in progress.

Mobihealth: Wireless mobile services and applications for healthcare

NARCIS (Netherlands)

Konstantas, D.; Jones, Valerie M.; Bults, Richard G.A.; Herzog, R.

2002-01-01

The MobiHealth IST project aims in the integration of existing and forthcoming technologies in developing and trial new mobile value-added services in the area of healthcare, based on 2.5 (GPRS) and 3G (UMTS) technologies. The target is to develope the means contributing to the reduction of costs in

Home care services for sick children: Healthcare professionals' conceptions of challenges and facilitators.

Science.gov (United States)

Castor, Charlotte; Hallström, Inger; Hansson, Helena; Landgren, Kajsa

2017-09-01

To explore healthcare professionals' conceptions of caring for sick children in home care services. Families often prefer home care to hospital care, and the number of home care services for children is increasing. Caring for children at home has been recognised as challenging for healthcare professionals in home care services used to providing care predominately for adults. An inductive qualitative design. Seven focus group interviews were performed with 36 healthcare professionals from multidisciplinary home care services. Data were analysed stepwise using a phenomenographic analysis. Three description categories emerged: "A challenging opportunity", "A child perspective", and "Re-organise in accordance with new prerequisites." Providing home care services for children was conceived to evoke both professional and personal challenges such as feelings of inadequacy and fear and professional growth such as increased competence and satisfaction. Conceptions of whether the home or the hospital was the best place for care differed. Adapting to the child's care was conceived as important. Cooperation with paediatric departments and a well-functioning team work were important organisational aspects. Providing home care for children was a challenging but rewarding task for healthcare professionals used to care for adults. To provide care with a child perspective was experienced as important even though there were conflicting conceptions of how this should be done. Close cooperation with paediatric departments and teamwork were prerequisites that make up for the low number of paediatric patients and facilitate confidence and competence. A sufficient number of referred children and enabling healthcare professionals to be part of the re-organising and implementation processes might facilitate the home care services for sick children. Enough time and good teamwork must be emphasised. Early referrals, continuous cooperation with paediatric clinics complemented with

The relative importance of service dimensions in a healthcare setting.

Science.gov (United States)

Ramsaran-Fowdar, Rooma Roshnee

2008-01-01

The paper aims to focus on an augmented SERVQUAL instrument that was used to measure private patients' service expectations and perceptions. A questionnaire was administered to 750 and 34 per cent responded. A new service quality instrument called PRIVHEALTHQUAL emerged from the study, based on factor and reliability analysis. The "reliability and fair and equitable treatment" factor was found to be the most important healthcare service quality dimension. Adds to the existing body of research on service quality and demonstrates that SERVQUAL is not a generic service quality measure for all industries.

A Case Study - On Patient Empowerment and Integration of Telemedicine to National Healthcare Services

DEFF Research Database (Denmark)

Urazimbetova, Surayya

Patient empowerment in the digitalized healthcare can be supported by means of telemedicine. As opposed to Electronic Patient Records developed by a few large business suppliers for healthcare professionals, telemedical applications include innovative solutions of small-medium size suppliers...... and are targeted at specific groups of patients (e.g., hip operated or dermatology patients) and their care network. Based on an integration experiment we argue that in order to support the national visions for patient empowerment and connectedness of healthcare at the same time, it is necessary to achieve...... the integration of telemedicine to the national healthcare services on a business logic (functional) integration level. In this paper, (1) we identify the lack of business logic (functional) level integration opportunities for patient oriented telemedical applications with national healthcare services; (2) we...

PRECISE:PRivacy-prEserving Cloud-assisted quality Improvement Service in hEalthcare.

Science.gov (United States)

Chen, Feng; Wang, Shuang; Mohammed, Noman; Cheng, Samuel; Jiang, Xiaoqian

2014-10-01

Quality improvement (QI) requires systematic and continuous efforts to enhance healthcare services. A healthcare provider might wish to compare local statistics with those from other institutions in order to identify problems and develop intervention to improve the quality of care. However, the sharing of institution information may be deterred by institutional privacy as publicizing such statistics could lead to embarrassment and even financial damage. In this article, we propose a PRivacy-prEserving Cloud-assisted quality Improvement Service in hEalthcare (PRECISE), which aims at enabling cross-institution comparison of healthcare statistics while protecting privacy. The proposed framework relies on a set of state-of-the-art cryptographic protocols including homomorphic encryption and Yao's garbled circuit schemes. By securely pooling data from different institutions, PRECISE can rank the encrypted statistics to facilitate QI among participating institutes. We conducted experiments using MIMIC II database and demonstrated the feasibility of the proposed PRECISE framework.

Factors influencing non-utilisation of maternity care services in ...

African Journals Online (AJOL)

Rather, socio-cultural beliefs in the TBA services, low educational status, and husband and family decision (gender influence) were found to be strong determinants of the non-utilization of the maternity centres by expectant mothers in this community. Improving the educational status of women, reducing the waiting time at ...

Service Robotics in Healthcare: A Perspective for Information Systems Researchers?

OpenAIRE

Garmann-Johnsen, Niels Frederik; Mettler, Tobias; Sprenger, Michaela

2014-01-01

Recent advances in electronics and telecommunication have paved the way for service robots to enter the clinical world. While service robotics has long been a core research theme in computer science and other engineering-related fields, it has attracted little interest of Information Systems (IS) researchers so far. We argue that service robotics represents an interesting area of investigation, especially for healthcare, since current research lacks a thorough examination of socio-technical p...

Access to and utilisation of healthcare services by sex workers at ...

African Journals Online (AJOL)

North Star Alliance (North Star) is a public-private partnership providing a healthcare service package in roadside wellness clinics (RWCs) to at-risk populations along transport corridors in sub-Saharan Africa. Objectives. To inform future service development for sex workers and describe North Star's contribution to ...

Facility-Based Maternal Death in Western Africa: A Systematic Review

Directory of Open Access Journals (Sweden)

Nathali Gunawardena

2018-02-01

Full Text Available BackgroundFor exploring maternal death, supply and demand-side factors can be characterized by the three delays model developed by Thaddeus and Maine (1994. The model comprises delay in deciding to seek care (delay 1, delay in reaching the health facility (delay 2, and delay in receiving quality care once at the health facility (delay 3. Few studies have comprehensively dealt with the health systems delays that prevent the receipt of timely and appropriate obstetric care once a woman reaches a health facility (phase III delays. The objective of the present study was to identify facility-level barriers in West African health facilities.MethodsElectronic databases (Medline, cumulative index to nursing and allied health literature, Centre for Agriculture and Biosciences International Global Health, EMBASE were searched to identify original research articles from 1996 to 2016. Search terms (and synonyms related to (1 maternal health care (e.g., obstetric care, perinatal care, maternal health services; (2 facility level (e.g., maternity unit, health facility, phase III, hospital; and (3 Western Africa (e.g., Nigeria, Burkina Faso were combined. This review followed the preferred reporting items for systematic reviews and meta-analyses.ResultsOf the 2103 citations identified, 13 studies were eligible. Studies were conducted in Nigeria, Burkina Faso, Gambia, Guinea, Senegal, and Sierra Leone. 30 facility-level barriers were identified and grouped into 6 themes (human resources, supply and equipment, referral-related, infrastructure, cost-related, patient-related. The most obvious barriers included staff shortages, lack of maternal health services and procedures offered to patients, and lack of necessary medical equipment and supplies in the health-care facilities.ConclusionThis review emphasizes that phase I and phase II barriers are not the only factors preventing women from accessing proper emergency obstetric care. Health-care facilities in Western

[Performance assessment of health services in Catalonia (Spain): evaluation of initial results of the Catalan healthcare service project].

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García-Altés, Anna; Dalmau-Bueno, Albert; Colls, Cristina; Mendivil, Joan; Benet, Josep; Mompart, Anna; Torné, Elvira; Zara, Corinne; Borrell, Carme; Brugulat, Pilar; Guarga, Alex

2009-01-01

Performance assessment of healthcare services is receiving greater attention due to increasing health care expenditures, greater expectations among the population, and the need to obtain results from the invested resources. Taking advantage of the existing experience of the Agència de Salut Pública de Barcelona and the Consorci Sanitari de Barcelona, which compared the healthcare services of Barcelona and Montreal, a grant from the Agència d'Avaluació de Tecnologia i Recerca Mèdiques, and the health planning interest of the Departament de Salut, the performance assessment of the Catalan healthcare service project was started in Catalonia in 2005. This article aims to present the development of the project, to provide some examples that illustrate the kind of numerical and graphical information that could be obtained and the kind of analysis that could be performed, to provide possible explanations for the results shown, and to discuss some limitations and implications. Currently, the added value of this project is that it identifies the extent to which the healthcare system is achieving its objectives, establishes a set of homogeneous indicators that could be used in the future, and is a key tool in the development of the Central de Resultats del Departament de Salut de la Generalitat de Catalunya.

Governance of Service-Oriented Architecture in a Healthcare Organization: A Case Study

DEFF Research Database (Denmark)

Koumaditis, Konstantinos

2015-01-01

The article introduces a service-oriented architecture (SOA) governance framework for successful implementation in a healthcare organization. The proposed framework, based on a rigorous literature review, proposes nine governance elements that should be considered during the SOA implementation...... process. This proposal aims to pinpoint attributes and guidelines for each element required to successfully govern SOA and tackle longstanding healthcare information systems (HIS) implementation challenges. The framework was tested in a healthcare organization and valuable insights are presented herein...

Service user engagement in healthcare education as a mechanism for value based recruitment: An evaluation study.

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Heaslip, Vanessa; Scammell, Janet; Mills, Anne; Spriggs, Ashley; Addis, Andrea; Bond, Mandy; Latchford, Carolyn; Warren, Angela; Borwell, Juliet; Tee, Stephen

2018-01-01

Within the United Kingdom (UK) there is an increasing focus on Values Based Recruitment (VBR) of staff working in the National Health Service (NHS) in response to public inquiries criticising the lack of person-centred care. All NHS employees are recruited on the basis of a prescribed set of values. This is extended to the recruitment of student healthcare professionals, yet there is little research of how to implement this. Involving Service Users in healthcare educational practice is gaining momentum internationally, yet involvement of service users in VBR of 'would be' healthcare professionals remains at an embryonic phase. Adult nurses represent the largest healthcare workforce in the UK, yet involvement of service users in their recruitment has received scant attention. This paper is an evaluation of the inclusion of service users in a VBR of 640 adult student nurses. This study used a participatory mixed methods approach, with service users as co-researchers in the study. The study consisted of mixed methods design. Quantitative data via an online questionnaire to ascertain candidates' perspectives (n=269 response rate of 42%), and academic/clinical nurses (n=35 response rate 34.65%). Qualitative data were gathered using focus groups and one to one interviews with service users (n=9). Data analysis included descriptive statistics and thematic analysis. 4 overarching themes were identified; increasing sense of humanness, substantiating care values; impact of involvement; working together and making it work, a work in progress. The findings from the study highlight that involving service users in VBR of student healthcare professionals has benefits to candidates, service users and local health services. Appreciating the perceptions of healthcare professionals is fundamental in the UK and internationally to implementing service users' engagement in service enhancement and delivery. Findings from this study identify there may be a dissonance between the policy

Quality maternity care for every woman, everywhere: a call to action.

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Koblinsky, Marjorie; Moyer, Cheryl A; Calvert, Clara; Campbell, James; Campbell, Oona M R; Feigl, Andrea B; Graham, Wendy J; Hatt, Laurel; Hodgins, Steve; Matthews, Zoe; McDougall, Lori; Moran, Allisyn C; Nandakumar, Allyala K; Langer, Ana

2016-11-05

To improve maternal health requires action to ensure quality maternal health care for all women and girls, and to guarantee access to care for those outside the system. In this paper, we highlight some of the most pressing issues in maternal health and ask: what steps can be taken in the next 5 years to catalyse action toward achieving the Sustainable Development Goal target of less than 70 maternal deaths per 100 000 livebirths by 2030, with no single country exceeding 140? What steps can be taken to ensure that high-quality maternal health care is prioritised for every woman and girl everywhere? We call on all stakeholders to work together in securing a healthy, prosperous future for all women. National and local governments must be supported by development partners, civil society, and the private sector in leading efforts to improve maternal-perinatal health. This effort means dedicating needed policies and resources, and sustaining implementation to address the many factors influencing maternal health-care provision and use. Five priority actions emerge for all partners: prioritise quality maternal health services that respond to the local specificities of need, and meet emerging challenges; promote equity through universal coverage of quality maternal health services, including for the most vulnerable women; increase the resilience and strength of health systems by optimising the health workforce, and improve facility capability; guarantee sustainable finances for maternal-perinatal health; and accelerate progress through evidence, advocacy, and accountability. Copyright © 2016 Elsevier Ltd. All rights reserved.

WOMEN'S EDUCATION AND UTILIZATION OF MATERNAL HEALTH SERVICES IN AFRICA: A MULTI-COUNTRY AND SOCIOECONOMIC STATUS ANALYSIS.

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Tsala Dimbuene, Zacharie; Amo-Adjei, Joshua; Amugsi, Dickson; Mumah, Joyce; Izugbara, Chimaraoke O; Beguy, Donatien

2017-11-06

There is an abundant literature on the relationship between women's education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the 'equity' lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women's education within different socioeconomic strata in Africa. The most recent Demographic and Health Surveys (DHS) conducted in the Democratic Republic of the Congo, Egypt, Ghana, Nigeria and Zimbabwe were used. In each country, the original sample was stratified into three socioeconomic groups: poor, middle and rich. For each maternal health service utilization variable, the gross and net effects of women's education, controlling for age, parity, religion, marital status, health insurance, access to health facilities, partner's education and current place of residence, were estimated using logistic regression, taking into account the complex sampling design of the DHS. The findings revealed country-specific variations in maternal health service utilization, and for most indicators there was a clear gradient among socioeconomic strata: women living in better-off households exhibited greater access to, and utilization of, maternal health services. Multivariate analyses revealed that women's education had a positive association with type of antenatal care provider, timing and frequency of antenatal care visits, place of delivery and presence of a skilled birth attendant at delivery. Many other factors were found to be significantly associated with maternal health service utilization. For instance, parity had a negative and significant association with timing of first antenatal care visit. Likewise, partner's education was positively and statistically associated with timing of first antenatal care visit. It is argued that an over

Innovation in healthcare services: notes on the limits of field research

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Laís Silveira Costa

Full Text Available Abstract: The contemporary context of population aging, itsthe population's different health and disease characteristics, and the growing incorporation of technologies by healthcare systems have highlighted the need to adjust the healthcare structure as a whole. The defense of a democratic and sustainable system reveals the importance of understanding how changes in healthcare take place. The current article aims to contribute to the understanding of innovation in healthcare services. The study's results indicate that the existence of certain knowledge gaps means that public policies tend to overlook a whole rangeseries of innovations normally associated with social changes, with a consequentwith an impact on human development, social cohesion, equality, and equity, allcentral issues that are central toin the field of collective public healthcare field. The article concludes that the lack of a mature theoretical framework negatively impacts the formulation of such policies, further aggravated in Brazil by growing differences in quality and access between population segments that depend on the public and private healthcare systems.

Communication skills of healthcare professionals in paediatric diabetes services.

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Hambly, H; Robling, M; Crowne, E; Hood, K; Gregory, J W

2009-05-01

To identify training needs in communication skills and to assess training preferences of staff working in paediatric diabetes services, which will inform the development of a learning programme in behaviour change counselling for healthcare professionals. Three hundred and eighty-five staff in 67 UK paediatric diabetes services were sent questionnaires to determine their previous communication skills training, to measure their self-reported view of the importance of and confidence in addressing common clinical problems and to assess the perceived feasibility of training methods to improve skillfulness. Two hundred and sixty-six questionnaires (69%) were returned from 65 services. Sixteen per cent of doctors, nurses and dietitians reported no previous training in communication skills and 47% had received no training since graduating. Respondents rated psychosocial issues as more important to address than medical issues within consultations (t = 8.93, P important component of consultations involving young people with diabetes, but healthcare professionals find it easier to address medical issues. This represents a key training need in communication skills for diabetes professionals. The survey will inform the development of a tailored learning programme for health professionals in UK paediatric diabetes clinics.

Family characteristics and the use of maternal health services: a population-based survey in Eastern China.

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Zhang, Ling; Xue, Chengbing; Wang, Youjie; Zhang, Liuyi; Liang, Yuan

2016-01-01

Despite the benefits of maternal health services, these services are often underutilized, especially in the developing countries. The aim of the present study is to provide insight regarding factors affecting maternal health services use from the family perspective. We use data from the fourth National Health Services Survey in Jiangsu province of Eastern China to investigate the effect of family characteristics on the use of maternal health services. Family characteristics included whether or not living with parents, age of husband, husband's education, and husband's work status as well as family economic status. Demographic variables, social and environmental factors, and previous reproductive history were taken as potential confounders. Multiple logistic regression models were used to examine the independent effects of the family characteristic variables on maternal health service utilization. The data indicate that the percentages of prenatal care, postnatal visits and hospital delivery were 85.44, 65.12 and 99.59 % respectively. Living with parents was associated with less use of prenatal care and husband's age, education and employment status had no effect on the use of prenatal care after adjusting for potential confounding variables. Our findings suggest that maternal health education (especially the role of prenatal care) needs to be extended beyond the expectant mothers themselves to their parents and husbands. The difference of health care delivery as a result of traditional family culture may highlight the differences in factors influencing the use of postnatal visits and those influencing the use of prenatal care; which may be worthy of further study.

Infant and maternal health services in Ceylon, 1900-1948: imperialism or welfare?

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Jones, Margaret

2002-08-01

This article contests a dominant contemporary view that colonial medicine was oppressive and detrimental to welfare; in particular, that infant and maternal welfare services were culturally hegemonic in their imposition of western practices and values on indigenous women. It does so by studying the development of these services in just one British colony--the 'model colony' of Ceylon from 1900 until independence. It shows how, at both a practical and a theoretical level, there was a direct policy transfer from the metropolitan centre to the colony. Moreover, the main justifications for the development of health and welfare services for women and children ran parallel to those used earlier in Britain. By 1948, these services were extensive in Ceylon and contributed to the fall in infant and maternal mortality rates at the end of the colonial period. It concludes by arguing that, just as in the West, these services were contradictory: they could both help maintain the exploitative State and enhance welfare. However, it is ultimately on their ability to improve health and welfare that they should be judged.

SERVICE QUALITY MEASUREMENT: IMPLICATIONS FOR HEALTHCARE SECTOR IN BULGARIA

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VASSILEVA, Bistra; BALLONI, Antonio José

2014-01-01

The aim of the paper is to present the service quality situation in hospitals in North-Eastern Planning Region in Bulgaria. Our intention was to assess the gap between the expected and perceived healthcare service quality in hospitals. To meet these goals we conducted a study using prospective questionnaire provided by the GESITI project (Management of System and Information Technology in Hospitals [GESITI], 2013) and SERVQUAL scale. The results helped us to summarize the challenges for Bulga...

Priorities and strategies for improving disabled women's access to maternity services when they are affected by domestic abuse: a multi-method study using concept maps.

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Bradbury-Jones, Caroline; Breckenridge, Jenna P; Devaney, John; Duncan, Fiona; Kroll, Thilo; Lazenbatt, Anne; Taylor, Julie

2015-12-28

Domestic abuse is a significant public health issue. It occurs more frequently among disabled women than those without a disability and evidence suggests that a great deal of domestic abuse begins or worsens during pregnancy. All women and their infants are entitled to equal access to high quality maternity care. However, research has shown that disabled women who experience domestic abuse face numerous barriers to accessing care. The aim of the study was to identify the priority areas for improving access to maternity services for this group of women; develop strategies for improved access and utilisation; and explore the feasibility of implementing the identified strategies. This multi-method study was the third and final part of a larger study conducted in the UK between 2012 and 2014. The study used a modified concept mapping approach and was theoretically underpinned by Andersen's model of healthcare use. Seven focus group interviews were conducted with a range of maternity care professionals (n = 45), incorporating quantitative and qualitative components. Participants ranked perceived barriers to women's access and utilisation of maternity services in order of priority using a 5-point Likert scale. Quantitative data exploration used descriptive and non-parametric analyses. In the qualitative component of each focus group, participants discussed the barriers and identified potential improvement strategies (and feasibility of implementing these). Qualitative data were analysed inductively using a framework analysis approach. The three most highly ranked barriers to women's access and utilisation of maternity services identified in the quantitative component were: 1) staff being unaware and not asking about domestic abuse and disability; 2) the impact of domestic abuse on women; 3) women's fear of disclosure. The top two priority strategies were: providing information about domestic abuse to all women and promoting non-judgemental staff attitude. These were

Determinants of maternal health service utilization in Ethiopia: analysis of the 2011 Ethiopian Demographic and Health Survey.

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Tarekegn, Shegaw Mulu; Lieberman, Leslie Sue; Giedraitis, Vincentas

2014-05-07

Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Data were drawn from the 2011 Ethiopia Demographic and Health Survey. The dependent variables were use of ANC, skilled delivery attendants and PNC services. The independent variables were categorized as socio-cultural, perceived needs and accessibility related factors. Data analysis was done using SPSS for windows version 20.0. Bivariate and multivariate logistic regression models were used in the analysis. Thirty four percent of women had ANC visits, 11.7% used skilled delivery attendants and 9.7% of women had a postnatal health checkup. Education of women, place of residence, ethnicity, parity, women's autonomy and household wealth had a significant association with the use of maternal health services. Women who completed higher education were more likely to use ANC (AOR = 3.8, 95% CI = 1.8-7.8), skilled delivery attendants (AOR = 3.4, 95% CI = 1.9-6.2) and PNC (AOR = 3.2, 95% CI = 2.0-5.2). Women from urban areas use ANC (AOR = 2.3, 95% CI = 1.9-2.9), skilled delivery attendants (AOR = 4.9, 95% CI = 3.8-6.3) and PNC services (AOR = 2.6, 95% CI = 2.0-3.4) more than women from rural areas. Women who have had ANC visits during the index pregnancy were more likely to subsequently use skilled delivery attendants (AOR = 1.3, 95% CI = 1.1-1.7) and PNC (AOR = 3.4, 95% CI = 2.8-4.1). Utilization of ANC, delivery and PNC services is more among more autonomous women than those whose spending is controlled by other people. Maternal

Responses of Aboriginal and Torres Strait Islander Primary Health-Care Services to Continuous Quality Improvement Initiatives.

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Larkins, Sarah; Woods, Cindy E; Matthews, Veronica; Thompson, Sandra C; Schierhout, Gill; Mitropoulos, Maxwell; Patrao, Tania; Panzera, Annette; Bailie, Ross Stewart

2015-01-01

Indigenous primary health-care (PHC) services participating in continuous quality improvement (CQI) cycles show varying patterns of performance over time. Understanding this variation is essential to scaling up and sustaining quality improvement initiatives. The aim of this study is to examine trends in quality of care for services participating in the ABCD National Research Partnership and describe patterns of change over time and examine health service characteristics associated with positive and negative trends in quality of care. PHC services providing care for Indigenous people in urban, rural, and remote northern Australia that had completed at least three annual audits of service delivery for at least one aspect of care (n = 73). Longitudinal clinical audit data from use of four clinical audit tools (maternal health, child health, preventive health, Type 2 diabetes) between 2005 and 2013 were analyzed. Health center performance was classified into six patterns of change over time: consistent high improvement (positive), sustained high performance (positive), decline (negative), marked variability (negative), consistent low performance (negative), and no specific increase or decrease (neutral). Backwards stepwise multiple logistic regression analyses were used to examine the associations between health service characteristics and positive or negative trends in quality of care. Trends in quality of care varied widely between health services across the four audit tools. Regression analyses of health service characteristics revealed no consistent statistically significant associations of population size, remoteness, governance model, or accreditation status with positive or negative trends in quality of care. The variable trends in quality of care as reflected by CQI audit tools do not appear to be related to easily measurable health service characteristics. This points to the need for a deeper or more nuanced understanding of factors that moderate the

The Social and Economic Factors Influence upon the Healthcare Services Consumers Behaviour

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Daniel Adrian GÂRDAN

2015-06-01

Full Text Available The research in the field of healthcare services consumer behaviour represents a very complex task with multiple implications. The consumer behaviour is much nuanced depending on the type of services or products that we are referring on. In the case of healthcare services, the behaviour is more complex than other services and is influenced mainly by special motivations like the need for a proper health status or the need to recover from a certain disease. The present article is proposing a qualitative type research as an in-depth interview with dentists regarding their perception about the influence that social and economic factors can have upon the consumers’ behaviour. The results of the research suggest that the influence of social factors is very complex, from the simple more intense concern related with dental hygiene and appearance of teeth up to anxious behaviour and isolation in the case of patients with severe dental diseases that have affected their face bones structure or the capacity to chew and speak. These findings shows that the consumers’ behaviour can be shaped by the complex interaction of different factors, and the response from dentists and those in charge with the provision of dental healthcare services can make the difference between a sustainable consumption and a dramatic route of unsatisfied consumers’ expectations.

Managing healthcare information using short message service (SMS) in wireless broadband networks

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Documet, Jorge; Tsao, Sinchai; Documet, Luis; Liu, Brent J.; Zhou, Zheng; Joseph, Anika O.

2007-03-01

Due to the ubiquity of cell phones, SMS (Short Message Service) has become an ideal means to wirelessly manage a Healthcare environment and in particular PACS (Picture Archival and Communications System) data. SMS is a flexible and mobile method for real-time access and control of Healthcare information systems such as HIS (Hospital Information System) or PACS. Unlike conventional wireless access methods, SMS' mobility is not limited by the presence of a WiFi network or any other localized signal. It provides a simple, reliable yet flexible method to communicate with an information system. In addition, SMS services are widely available for low costs from cellular phone service providers and allows for more mobility than other services such as wireless internet. This paper aims to describe a use case of SMS as a means of remotely communicating with a PACS server. Remote access to a PACS server and its Query-Retrieve services allows for a more convenient, flexible and streamlined radiology workflow. Wireless access methods such as SMS will increase dedicated PACS workstation availability for more specialized DICOM (Digital Imaging and Communications in Medicine) workflow management. This implementation will address potential security, performance and cost issues of applying SMS as part of a healthcare information management system. This is in an effort to design a wireless communication system with optimal mobility and flexibility at minimum material and time costs.

Toward a Nationwide Mobile-Based Public Healthcare Service System with Wireless Sensor Networks

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Chien-wen Shen

2016-01-01

Full Text Available This paper describes the development of a nationwide public healthcare service system with the integration of cloud technology, wireless sensor networks, and mobile technology to provide citizens with convenient and professional healthcare services. The basic framework of the system includes the architectures for the user end of wireless physiological examinations, for the regional healthcare cloud, and for national public healthcare service system. Citizens with chronic conditions or elderly people who are living alone can use the wireless physiological sensing devices to keep track of their health conditions and get warning if the system detects abnormal signals. Through mobile devices, citizens are able to get real-time health advice, prompt warning, health information, feedback, personalized support, and intervention ubiquitously. With the long-term tracking data for physiological sensing, reliable prediction models for epidemic diseases and chronic diseases can be developed for the government to respond to and control diseases immediately. Besides, such a nationwide approach enables government to have a holistic understanding of the public health information in real time, which is helpful to establish effective policies or strategies to prevent epidemic diseases or chronic diseases.

Introducing modern technology to promote transparency in health services.

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Islam, Mohammad Shafiqul

2015-01-01

Quantitative indicators show that Bangladeshi maternal and child healthcare is progressing satisfactorily. However, healthcare quality is still inadequate. It is hypothesised that modern technology enhances healthcare quality. Therefore, the purpose of this paper is to investigate how modern technology such as electronic record keeping and the internet can contribute to enhancing Bangladeshi healthcare quality. This study also explores how socio-economic and political factors affect the healthcare quality. This paper is based on a qualitative case study involving 68 in-depth interviews with healthcare professionals, elected representatives, local informants and five focus group discussions with healthcare service users to understand technology's effect on health service quality. The study has been conducted in one rural and one urban service organisations to understand how various factors contribute differently to healthcare quality. The findings show that modern technology, such as the internet and electronic devices for record keeping, contribute significantly to enhancing health service transparency, which in turn leads to quality health and family planning services. The findings also show that information and communication technology (ICT) is an effective mechanism for reducing corruption and promoting transparency. However, resource constraints impact adversely on the introduction of technology, which leads to less transparent healthcare. Progress in education and general socio-economic conditions makes it suitable to enhance ICT usage, which could lead to healthcare transparency, but political and bureaucratic factors pose a major challenge to ensure transparency. This paper can be a useful guide for promoting governance and healthcare quality in developing countries including Bangladesh. It analyses the ICT challenges that healthcare staff face when promoting transparent healthcare. This paper provides a deeper understanding of transparency and healthcare

Patient charges for health services: the opinions of healthcare stakeholders in Bulgaria.

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Atanasova, Elka; Pavlova, Milena; Moutafovа, Emanuela; Kostadinova, Todorka; Groot, Wim

2015-01-01

The reforms of the Bulgarian healthcare sector have been widely discussed, both nationally and internationally. In spite of the reforms, problems with the efficiency, equity and quality in healthcare provision continue to exist in Bulgaria. Among others, the reforms included the implementation of formal patient charges for the use of healthcare services. These were established in the country in 2000. Formal patient charges are applied to all levels of medical services with the exception of emergency care. The aim of this paper is to describe and analyze the attitudes of Bulgarian healthcare stakeholders toward patient charges. The analysis is based on data collected in focus group discussions and in-depth interviews carried out in Bulgaria in May-June 2009. The paper concludes by recommendations for policies related to patient payments. The social sensitivity of these payments requires broad discussion before policy decisions are implemented. There is also a need of a well-thought communication strategy on the issue of patient payments by the Ministry of Health. Copyright © 2013 John Wiley & Sons, Ltd.

Advancing adolescent health and health services in Saudi Arabia: exploring health-care providers' training, interest, and perceptions of the health-care needs of young people

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AlBuhairan FS

2014-09-01

Full Text Available Fadia S AlBuhairan,1–3 Tina M Olsson3,4 1Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 4School of Social Work, Lund University, Lund, Sweden Background: Adolescent health is regarded as central to global health goals. Investments made in adolescent health and health services protect the improvements witnessed in child health. Though Saudi Arabia has a large adolescent population, adolescent health-care only began to emerge in recent years, yet widespread uptake has been very limited. Health-care providers are key in addressing and providing the necessary health-care services for adolescents, and so this study was conducted with the aim of identifying opportunities for the advancement of knowledge transfer for adolescent health services in Saudi Arabia. Methods: This Web-based, cross-sectional study was carried out at four hospitals in Saudi Arabia. Physicians and nurses were invited to participate in an online survey addressing their contact with adolescent patients, and training, knowledge, and attitudes towards adolescent health-care. Results: A total of 232 professionals participated. The majority (82.3% reported sometimes or always coming into contact with adolescent patients. Less than half (44%, however, had received any sort of training on adolescent health during their undergraduate or postgraduate education, and only 53.9% reported having adequate knowledge about the health-care needs of adolescents. Nurses perceived themselves as having more knowledge in the health-care needs of adolescents and reported feeling more comfortable in communicating with adolescents as compared with physicians. The majority of participants were interested in gaining further skills and knowledge in adolescent health-care and agreed or strongly agreed that adolescents have

Healthcare Services Expenditure: A Case Study in Isfahan Province, Iran

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Ferdosi

2015-01-01

Full Text Available Background Determining and understanding of healthcare costs and its financing method is one of the most important subjects understatement of which can cause such major problems as excessive health costs for households due to the high rate of out-of-pocket expenses. Objectives The current study aimed to analyze the healthcare costs and determine the share of Isfahan province, Iran, from the total healthcare costs of the country from 2006 to 2011. Materials and Methods It was a retrospective and descriptive-analytical study. The required statistical data were gathered from statistical yearbooks of the country and the province, the website of the World Bank, the statistics provided by the Healthcare Department of Isfahan and Kashan Universities of Medical Sciences and the statistical data provided by Iran Statistics Center in 2011, all covering the period of six years from 2006 to 2011. Excel software was used for data analysis and computations of the research. Results During this period, the annual growth average of healthcare and treatment costs were 12% and 20%, respectively. The share of the healthcare sector declined from 33% in 2006 to 25.4% in 2011. In other words, healthcare cost per capita, being about one second of the treatment cost per capita, reduced to a third of treatment per capita in 2011. Conclusions Efficient allocation of financial resources in the healthcare system based on specific goals and strategies, coordination of public and private sectors in providing healthcare services, the rising share of the healthcare sector in GDP of the province and the country, and the preference of prevention over treatment measures can affect achieving the healthcare system goals and surmount challenges such as pay-out-of-pocket and rising healthcare costs, particularly the costs of integrated treatment with full performance.

Improving maternity services for Indigenous women in Australia: moving from policy to practice.

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Kildea, Sue; Tracy, Sally; Sherwood, Juanita; Magick-Dennis, Fleur; Barclay, Lesley

2016-10-17

The well established disparities in health outcomes between Indigenous and non-Indigenous Australians include a significant and concerning higher incidence of preterm birth, low birth weight and newborn mortality. Chronic diseases (eg, diabetes, hypertension, cardiovascular and renal disease) that are prevalent in Indigenous Australian adults have their genesis in utero and in early life. Applying interventions during pregnancy and early life that aim to improve maternal and infant health is likely to have long lasting consequences, as recognised by Australia's National Maternity Services Plan (NMSP), which set out a 5-year vision for 2010-2015 that was endorsed by all governments (federal and state and territory). We report on the actions targeting Indigenous women, and the progress that has been achieved in three priority areas: The Indigenous maternity workforce; Culturally competent maternity care; and; Developing dedicated programs for "Birthing on Country". The timeframe for the NMSP has expired without notable results in these priority areas. More urgent leadership is required from the Australian government. Funding needs to be allocated to the priority areas, including for scholarships and support to train and retain Indigenous midwives, greater commitment to culturally competent maternity care and the development and evaluation of Birthing on Country sites in urban, rural and particularly in remote and very remote communities. Tools such as the Australian Rural Birth Index and the National Maternity Services Capability Framework can help guide this work.

Impact of functional somatic symptoms on 5-7-year-olds' healthcare use and costs

DEFF Research Database (Denmark)

Græsholt-Knudsen, Troels; Skovgaard, Anne Mette; Jensen, Jens Søndergaard

2017-01-01

medical services outside the hospital during a 4.5-year follow-up period from the day of assessment. Regression with bootstrap bias-corrected and accelerated CIs were performed. Results: 1018 (76.8%) children had no FSS with primary healthcare use adjusted for other child health problems, maternal...... is a predictor for the child's future primary healthcare use. More research on complex predictive models is needed to further explore the clinical significance of these results, and to contribute to the underpinning of early interventions towards impairing FSS in children....

Women veterans' healthcare delivery preferences and use by military service era: findings from the National Survey of Women Veterans.

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Washington, Donna L; Bean-Mayberry, Bevanne; Hamilton, Alison B; Cordasco, Kristina M; Yano, Elizabeth M

2013-07-01

The number of women Veterans (WVs) utilizing the Veterans Health Administration (VA) has doubled over the past decade, heightening the importance of understanding their healthcare delivery preferences and utilization patterns. Other studies have identified healthcare issues and behaviors of WVs in specific military service eras (e.g., Vietnam), but delivery preferences and utilization have not been examined within and across eras on a population basis. To identify healthcare delivery preferences and healthcare use of WVs by military service era to inform program design and patient-centeredness. Cross-sectional 2008-2009 survey of a nationally representative sample of 3,611 WVs, weighted to the population. Healthcare delivery preferences measured as importance of selected healthcare features; types of healthcare services and number of visits used; use of VA or non-VA; all by military service era. Military service era differences were present in types of healthcare used, with World War II and Korea era WVs using more specialty care, and Vietnam era-to-present WVs using more women's health and mental health care. Operations Enduring Freedom, Iraqi Freedom, New Dawn (OEF/OIF/OND) WVs made more healthcare visits than WVs of earlier military eras. The greatest healthcare delivery concerns were location convenience for Vietnam and earlier WVs, and cost for Gulf War 1 and OEF/OIF/OND WVs. Co-located gynecology with general healthcare was also rated important by a sizable proportion of WVs from all military service eras. Our findings point to the importance of ensuring access to specialty services closer to home for WVs, which may require technology-supported care. Younger WVs' higher mental health care use reinforces the need for integration and coordination of primary care, reproductive health and mental health care.

Healthcare facility commissioning – the transition of clinical services

CSIR Research Space (South Africa)

Van der Watt, R

2016-07-01

Full Text Available structure of bricks and mortar into a functional facility with staff, equipment, medication, supplies, etc. ready to eventually receive patients who need care and cure. Beyond these tangible elements, there are also many intangibles which are required, e... in order for the new facility to deliver the intended clinical services. These include links to the emergency services which brings patients in need of emergency care to the facility, links to other healthcare facilities for more specialized care...

U-Healthcare Center Service in Busan City, South Korea: An Empirical Analysis and the Results of 1 Year of Service.

Science.gov (United States)

Bravo Santisteban, Ramiro D; Youm, Sekyoung; Park, Seung-Hun

2015-10-01

Studies have demonstrated that technological innovation is vital for prosperous economies, and greater technological innovation leads to improved public health indicators. The South Korean government has implemented policies to provide city services using information communication technologies, and ubiquitous healthcare (u-healthcare) wellness is one of these. This article presents the effects of using a u-healthcare center model that proves self-healthcare monitoring can work for the general population. The u-healthcare center has provided service to the public since April 2013. It is equipped with medical devices that evaluate physiological parameters such as weight, body mass index (BMI), blood pressure (BP), pulse rate (PR), and body fat (BF). This article focuses on the analysis of BMI, BP, PR, and BF parameters. Health test results from 12,766 voluntary patients of the u-healthcare center were analyzed during a 1-year period. The four health parameters from each of the four seasons were analyzed and compared, showing statistically significant seasonal differences. A Duncan's post hoc analysis showed that BMI did not differ between spring and summer, whereas BP differed throughout all seasons. Participation of females was higher compared with males, and men's average BMI was statistically higher than that of the women. Some additional significant findings for all participants were as follows: 48.8% scored normal in BMI, 31.7% scored normal-controlled in BP, 90.7% scored normal in PR, and 24.8% scored normal in BF. A survey showed that 96.4% found the u-healthcare center to be generally helpful, and 95.7% responded that they would recommend it. Implementation of u-healthcare projects provides a new public service toward evaluating health parameters, providing historical health information access, promoting self-monitoring, and motivating users to be more aware of their own health status.

Benefits and risks of shared services in healthcare.

Science.gov (United States)

Kennewell, Suzanne; Baker, Laura

2016-05-16

Purpose - The purpose of this paper is to explore the experiences of staff in a large, public health service involved in transitioning support services to a shared services model. It aims to understand their perceptions of the benefits and risks arising from this change. Design/methodology/approach - Thematic analysis of qualitative data from semi-structured interviews with both service provider and customer agency staff was used to identify, analyze and report patterns of benefits and risks within data. Findings - Staff expressed the need for relevant subject-matter-experts to work within customer agencies to facilitate effective communication between the customer agency and shared services provider, reflecting observations found in out-sourcing literature. Research limitations/implications - Results point to significant challenges continuing to occur for shared services in healthcare. Risks identified suggest a more intimate relationship between clinical and support services than previously discussed. Originality/value - Previous discussion of the shared services model has not considered the skills, knowledge and ability required by staff in the customer agency. This research indicates that in the absence of such consideration, the concepts of the shared services model are weakened.

Reducing maternal mortality in Nigeria: the need for urgent changes in financing for maternal health in the Nigerian health system.

Science.gov (United States)

Ebeigbe, P N

2013-06-01

Nigeria's maternal mortality indices are among the worst in the world. Various approaches aimed at combatting the persistently high maternal mortality rates in the past have been ineffective. The objective of this article was to evaluate the fairness and equitability of financing for maternal health in the Nigerian health system. A review of the performance of the Nigerian Health system with regards to financing for maternal healthcare and comparison with other health systems utilising internationally accepted criteria was done. Household out-of -pocket payment was found to be the largest source of health care financing in the Nigerian health system contributing as much as 65.6 % of total health expenditure. This is in sharp contrast to the performance of more effective health systems like that in South Africa where health care is free for pregnant and breast feeding mothers. The result is that South Africa reports less than a tenth of total maternal mortalities reported from Nigeria annually. The current Nigeria health financing system is not equitable and appears to encourage maternal mortalities since it does not cater for the most vulnerable. There is an urgent need for a review of financing of maternal health in Nigeria to achieve universal access to maternal health care. An urgent overhaul of the currently under performing National Health Insurance scheme or adoption of the simpler system based on funding from taxation with universal access for health care including maternal care and services free at the point of access is suggested.

Assessment of the administration of healthcare service delivery in ...

African Journals Online (AJOL)

The study examined the structure and mode of administration in Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria; and also assessed the impact of the structure and mode of administration on the service delivery in the hospital. These were with a view to assessing the administration of healthcare ...

Estimation and Evaluation of Future Demand and Supply of Healthcare Services Based on a Patient Access Area Model

Directory of Open Access Journals (Sweden)

Shunsuke Doi

2017-11-01

Full Text Available Accessibility to healthcare service providers, the quantity, and the quality of them are important for national health. In this study, we focused on geographic accessibility to estimate and evaluate future demand and supply of healthcare services. We constructed a simulation model called the patient access area model (PAAM, which simulates patients’ access time to healthcare service institutions using a geographic information system (GIS. Using this model, to evaluate the balance of future healthcare services demand and supply in small areas, we estimated the number of inpatients every five years in each area and compared it with the number of hospital beds within a one-hour drive from each area. In an experiment with the Tokyo metropolitan area as a target area, when we assumed hospital bed availability to be 80%, it was predicted that over 78,000 inpatients would not receive inpatient care in 2030. However, this number would decrease if we lowered the rate of inpatient care by 10% and the average length of the hospital stay. Using this model, recommendations can be made regarding what action should be undertaken and by when to prevent a dramatic increase in healthcare demand. This method can help plan the geographical resource allocation in healthcare services for healthcare policy.

Barriers and facilitators of access to maternal services for women with disabilities: scoping review protocol.

Science.gov (United States)

Mheta, Doreen; Mashamba-Thompson, Tivani P

2017-05-16

The Sustainable Development Goals (SDGs) emphasises the increasing equitable coverage of quality health care and provision of integrated services as means of reducing maternal mortality. Despite so much effort being placed on improved access to maternity health care, studies show that women with disabilities are being systemically excluded from the mainstream maternal health services. The proposed scoping review aims to map literature on the barriers and facilitators of access to maternal services for women with disabilities. The search strategy for this scoping review study will involve electronic databases including Pubmed, MEDLINE via EBSCOhost, CINAHL Plus with full text via EBSCOhost, Africa-Wide Info via EBSCOhost, JSTOR and Proquest Health and Medical Complete. Articles will also be searched through the "Cited by" search as well as citations included in the reference lists of included articles. A two-stage mapping strategy would be conducted. Stage 1 would be to screen studies through examining their titles. Furthermore, we will screen abstracts of the identified studies descriptively and by focus and method as stipulated by the inclusion and exclusion criteria. In stage 2, we will extract data from the included studies. A parallel screening and data extraction will be undertaken by two reviewers. We will access the quality of the included studies using the mixed methods appraisal tool (MMAT). We will use NVIVO version 10 to extract the relevant outcomes and thematic analysis of the studies. We anticipate to find relevant studies reporting evidence on the barriers and facilitators of access to maternal health services in Sub-Saharan Africa. The evidence obtained from the included studies when summarised will help guide future research. The study findings will be disseminated electronically and in print. In addition, it will be presented at conferences related to sexual reproductive health, maternal health care and reproductive health.

Use of healthcare services in the region of origin among patients with an immigrant background in Denmark

DEFF Research Database (Denmark)

Lokdam, Nicoline; Kristiansen, Maria; Handlos, Line Neerup

2016-01-01

: the perception of availability, in terms of quantity and access; familiarity, conceptualised as feeling comfortable within the healthcare system; perception of quality of services; and finally, the perceived need for a second opinion. All motives emerged simultaneously as push factors, motivating immigrants...... to explore healthcare services abroad, and pull factors, attracting them to their country of origin. Affordability did not emerge as an independent motive but influenced the other factors. Conclusion: The use of healthcare services abroad by patients with an immigrant background constitutes active health...

[Competency requirements for executives in healthcare and social services organizations: Results of a Delphi study].

Science.gov (United States)

Pielach, Martin; Schubert, Hans-Joachim

2018-02-07

Leadership in social services and healthcare organizations is marked by high levels of complexity and contradiction, which cannot be fully explained by politically, economically, and socially induced changes. Rather, it is the particularities of service provision in healthcare and social services that confront executives with specific demands. This study aimed to capture and prioritize required leadership competencies in healthcare and social services organizations. A three-step Delphi study was conducted with executives and managerial staff, who are job holders and thus experts on their occupation. For the first step, an explorative qualitative approach was chosen to record general opinion without prior assumptions. The following two steps weighted and selected the competency requirements in step one using rating- and ranking procedures. Results of the Delphi inquiry imply high relevance of social and personal competencies. Approximately 66 % of the competencies assessed in round three were social and personal competencies. 12 out of the 15 highest rated competencies in Delphi step three can be assigned to these two competency categories. In contrast, the importance of professional as well as methodical competencies was rated as less important. Only two methodical competencies and one professional competency were rated as very important by the panel. Nevertheless, the importance of executive professional and methodical competencies in healthcare and social services organizations is emphasized by high ratings of the competencies "Sector-specific expertise" and "Analytical skills". The methodical competency "Analytical skills" was identified by the Delphi respondents as the most important competency requirement. Social and personal requirements are of primary importance for leadership in healthcare and social services organizations. These results mostly correspond to leadership requirements posited in the literature on leadership skills. Emphasis should be on the

Urban poverty and utilization of maternal and child health care services in India.

Science.gov (United States)

Prakash, Ravi; Kumar, Abhishek

2013-07-01

Drawing upon data from the third round of the National Family Health Survey (NFHS-3) conducted in India during 2005-06, this study compares the utilization of selected maternal and child health care services between the urban poor and non-poor in India and across selected Indian states. A wealth index was created, separately for urban areas, using Principal Component Analysis to identify the urban poor. The findings suggest that the indicators of maternal and child health care are worse among the urban poor than in their non-poor counterparts. For instance, the levels of antenatal care, safe delivery and childhood vaccinations are much lower among the urban poor than non-poor, especially in socioeconomically disadvantageous states. Among all the maternal and child health care indicators, the non-poor/poor difference is most pronounced for delivery care in the country and across the states. Other than poverty status, utilization of antenatal services by mothers increases the chances of safe delivery and child immunization at both national and sub-national levels. The poverty status of the household emerged as a significant barrier to utilization of health care services in urban India.

Economic status, education and empowerment: implications for maternal health service utilization in developing countries.

Directory of Open Access Journals (Sweden)

Saifuddin Ahmed

2010-06-01

Full Text Available Relative to the attention given to improving the quality of and access to maternal health services, the influence of women's socio-economic situation on maternal health care use has received scant attention. The objective of this paper is to examine the relationship between women's economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries.The analysis uses data from the most recent Demographic and Health Surveys conducted in 31 countries for which data on all the 3Es are available. Separate logistic regression models are fitted for modern contraceptive use, antenatal care and skilled birth attendance in relation to the three covariates of interest: economic, education and empowerment status, additionally controlling for women's age and residence. We use meta-analysis techniques to combine and summarize results from multiple countries. The 3Es are significantly associated with utilization of maternal health services. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and almost 5 times higher for women with complete primary education relative to those less educated. The likelihood of using modern contraception and attending four or more antenatal care visits are 2.01 and 2.89 times, respectively, higher for women with complete primary education than for those less educated. Women with the highest empowerment score are between 1.31 and 1.82 times more likely than those with a null empowerment score to use modern contraception, attend four or more antenatal care visits and have a skilled attendant at birth.Efforts to expand maternal health service utilization can be accelerated by parallel investments in programs aimed at poverty eradication (MDG 1, universal primary education (MDG 2, and women's empowerment (MDG 3.

Economic status, education and empowerment: implications for maternal health service utilization in developing countries.

Science.gov (United States)

Ahmed, Saifuddin; Creanga, Andreea A; Gillespie, Duff G; Tsui, Amy O

2010-06-23

Relative to the attention given to improving the quality of and access to maternal health services, the influence of women's socio-economic situation on maternal health care use has received scant attention. The objective of this paper is to examine the relationship between women's economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries. The analysis uses data from the most recent Demographic and Health Surveys conducted in 31 countries for which data on all the 3Es are available. Separate logistic regression models are fitted for modern contraceptive use, antenatal care and skilled birth attendance in relation to the three covariates of interest: economic, education and empowerment status, additionally controlling for women's age and residence. We use meta-analysis techniques to combine and summarize results from multiple countries. The 3Es are significantly associated with utilization of maternal health services. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and almost 5 times higher for women with complete primary education relative to those less educated. The likelihood of using modern contraception and attending four or more antenatal care visits are 2.01 and 2.89 times, respectively, higher for women with complete primary education than for those less educated. Women with the highest empowerment score are between 1.31 and 1.82 times more likely than those with a null empowerment score to use modern contraception, attend four or more antenatal care visits and have a skilled attendant at birth. Efforts to expand maternal health service utilization can be accelerated by parallel investments in programs aimed at poverty eradication (MDG 1), universal primary education (MDG 2), and women's empowerment (MDG 3).

Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens.

Science.gov (United States)

Jat, Tej Ram; Deo, Prakash R; Goicolea, Isabel; Hurtig, Anna-Karin; San Sebastian, Miguel

2015-01-01

Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery-related dimensions of maternal deaths in rural central India using a human rights lens. Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using thematic analysis. The factors associated with maternal deaths were classified by using the 'three delays' framework and were examined by using a human rights lens. All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility. The study highlighted various socio-cultural and service delivery-related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services) were not upheld. The data and analysis suggest that the deceased women and their relatives were unable to claim their entitlements and that the duty bearers were not

Socio-cultural and service delivery dimensions of maternal mortality in rural central India: a qualitative exploration using a human rights lens

Directory of Open Access Journals (Sweden)

Tej Ram Jat

2015-04-01

Full Text Available Background: Despite the avoidable nature of maternal mortality, unacceptably high numbers of maternal deaths occur in developing countries. Considering its preventability, maternal mortality is being increasingly recognised as a human rights issue. Integration of a human rights perspective in maternal health programmes could contribute positively in eliminating avertable maternal deaths. This study was conducted to explore socio-cultural and service delivery–related dimensions of maternal deaths in rural central India using a human rights lens. Design: Social autopsies were conducted for 22 maternal deaths during 2011 in Khargone district in central India. The data were analysed using the matic analysis. The factors associated with maternal deaths were classified by using the ‘three delays’ framework and were examined by using a human rights lens. Results: All 22 women tried to access medical assistance, but various factors delayed their access to appropriate care. The underestimation of the severity of complications by family members, gender inequity, and perceptions of low-quality delivery services delayed decisions to seek care. Transportation problems and care seeking at multiple facilities delayed reaching appropriate health facilities. Negligence by health staff and unavailability of blood and emergency obstetric care services delayed receiving adequate care after reaching a health facility. Conclusions: The study highlighted various socio-cultural and service delivery–related factors which are violating women's human rights and resulting in maternal deaths in rural central India. This study highlights that, despite the health system's conscious effort to improve maternal health, normative elements of a human rights approach to maternal health (i.e. availability, accessibility, acceptability, and quality of maternal health services were not upheld. The data and analysis suggest that the deceased women and their relatives were

Gender differences in the utilization of health-care services among the older adult population of Spain

OpenAIRE

Redondo-Sendino, Áurea; Guallar-Castillón, Pilar; Banegas, José Ramón; Rodríguez-Artalejo, Fernando

2006-01-01

Abstract Background Compared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly. Methods Cross-sectional study covering 3030 subjects, representative of the non-institutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposin...

Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda

Directory of Open Access Journals (Sweden)

Bloom Gerald

2011-03-01

Full Text Available Abstract Background Although a number of intermediate transport initiatives have been used in some developing countries, available evidence reveals a dearth of local knowledge on the effect of these rural informal transport mechanisms on access to maternal health care services, the cost of implementing such schemes and their scalability. This paper, attempts to provide insights into the functioning of the informal transport markets in facilitating access to maternal health care. It also demonstrates the role that higher institutions of learning can play in designing projects that can increase the utilization of maternal health services. Objectives To explore the use of intermediate transport mechanisms to improve access to maternal health services, with emphasis on the benefits and unintended consequences of the transport scheme, as well as challenges in the implementation of the scheme. Methods This paper is based on the pilot phase to inform a quasi experimental study aimed at increasing access to maternal health services using demand and supply side incentives. The data collection for this paper included qualitative and quantitative methods that included focus group interviews, review of project documents and facility level data. Results There was a marked increase in attendance of antenatal, and delivery care services, with the contracted transporters playing a leading role in mobilizing mothers to attend services. The project also had economic spill-over effects to the transport providers, their families and community generally. However, some challenges were faced including difficulty in setting prices for paying transporters, and poor enforcement of existing traffic regulations. Conclusions and implications The findings indicate that locally existing resources such as motorcycle riders, also known as “boda boda” can be used innovatively to reduce challenges caused by geographical inaccessibility and a poor transport network with

Progresses and challenges of utilizing traditional birth attendants in maternal and child health in Nigeria.

Science.gov (United States)

Amutah-Onukagha, Ndidiamaka; Rodriguez, Monica; Opara, Ijeoma; Gardner, Michelle; Assan, Maame Araba; Hammond, Rodney; Plata, Jesus; Pierre, Kimberly; Farag, Ehsan

2017-01-01

Despite advances in modern healthcare, Traditional Birth Attendants (TBA) have continued to be heavily utilized in rural communities in Nigeria. Major disparities in maternal health care in Nigeria remain present despite the goal of the United Nations Millennium Development Goal to reduce maternal mortality by 2015. The objective of this study is to review the contribution of TBAs in the birthing process in Nigeria, and to examine barriers and opportunities for utilizing TBAs in improving maternal and child health outcomes in Nigeria. A literature review of two major electronic databases was conducted using the PRISMA framework to identify English language studies conducted between 2006 and 2016. Inclusion criteria included articles that examined the role of traditional birth attendants as a factor influencing maternal health in Nigeria. The value of TBAs has not been fully examined as few studies have aimed to examine its potential role in reducing maternal mortality with proper training. Eight manuscripts that were examined highlighted the role of TBAs in maternal health including outcomes of utilizing trained versus non-trained TBAs. Specific areas of training for TBAs that were identified and recommended in review including: recognizing delivery complications, community support for TBA practices through policy, evaluation of TBA training programs and increasing collaboration between healthcare facilities and TBAs. Policies focused on improving access to health services and importantly, formal health education training to TBAs, are required to improve maternal health outcomes and underserved communities.

The Association Between Gender Inequalities and Women's Utilization of Maternal Health Services: A Cross-Sectional Survey in Eight South Central Coast Provinces, Vietnam.

Science.gov (United States)

Bui, Ha Thi Thu; Le, Thi Minh; Van Pham, Tac; Doan, Duong Thi Thuy; Nguyen, Duy Anh; Nguyen, Canh Chuong; Duong, Duc Minh

Gender inequalities influence the utilization of maternal health services in Vietnam, but little research has been published. This study, therefore, aimed to explore the association between gender inequalities and women's utilization of maternal health services in Vietnam. The study was conducted in 8 provinces in the South Central Coast region of Vietnam during August 2013 to May 2014. A total of 907 women who delivered a year prior to the date of interview participated in the study. A multiple logistic regression model was used to examine the association between gender inequalities (including sociodemographic determinants of health) and utilization of 4 or more antenatal care (ANC4+) services, institutional delivery, and ever used contraceptive methods. The utilization rate of maternal health services was varied, from 53.9% for ANC4+ to 87.7% for ever used a contraceptive method and 97% for institutional delivery. Ethnicity was identified as the most influential variable out of all sociodemographic determinants of health. Regarding gender inequalities, couple communication was the only variable having significant association with women's utilization of maternal health services. Women's equal role within context of their daily life and relations with their husbands (discussing maternal care with husband and having equal income to husband) supported their use of maternal health services. Therefore, there should be concerted efforts from all relevant stakeholders including the health system to focus on disadvantaged women in planning and delivery of maternal health services, especially to ethnic minority women. Male involvement strategy should be implemented to promote maternal health care, especially during the prenatal and postpartum period. To provide more culturally sensitive and right-based approaches in delivery of maternal health services to disadvantaged women in Vietnam, interventions are recommended that promote male involvement, that is, to engage men in

An authentication scheme for secure access to healthcare services.

Science.gov (United States)

Khan, Muhammad Khurram; Kumari, Saru

2013-08-01

Last few decades have witnessed boom in the development of information and communication technologies. Health-sector has also been benefitted with this advancement. To ensure secure access to healthcare services some user authentication mechanisms have been proposed. In 2012, Wei et al. proposed a user authentication scheme for telecare medical information system (TMIS). Recently, Zhu pointed out offline password guessing attack on Wei et al.'s scheme and proposed an improved scheme. In this article, we analyze both of these schemes for their effectiveness in TMIS. We show that Wei et al.'s scheme and its improvement proposed by Zhu fail to achieve some important characteristics necessary for secure user authentication. We find that security problems of Wei et al.'s scheme stick with Zhu's scheme; like undetectable online password guessing attack, inefficacy of password change phase, traceability of user's stolen/lost smart card and denial-of-service threat. We also identify that Wei et al.'s scheme lacks forward secrecy and Zhu's scheme lacks session key between user and healthcare server. We therefore propose an authentication scheme for TMIS with forward secrecy which preserves the confidentiality of air messages even if master secret key of healthcare server is compromised. Our scheme retains advantages of Wei et al.'s scheme and Zhu's scheme, and offers additional security. The security analysis and comparison results show the enhanced suitability of our scheme for TMIS.

Healthcare service quality: what really matters to the female patient?

NARCIS (Netherlands)

Shafei, Ingy; Walburg, J.A.; Taher, Ahmed F.

2015-01-01

Purpose – This paper aims to develop a model that encompasses the constructs and sub-constructs consumers use in evaluating healthcare service quality (HSQ) in Egypt. Design/methodology/approach – Factor analysis was performed on 40 variables to identify the constructs. Ordinal logistic regression

Has the Janani Suraksha Yojana (a conditional maternity benefit transfer scheme) succeeded in reducing the economic burden of maternity in rural India? Evidence from the Varanasi district of Uttar Pradesh.

Science.gov (United States)

Mukherjee, Saradiya; Singh, Aditya

2018-02-05

One of the constraints in the utilisation of maternal healthcare in India is the out-of-pocket expenditure. To improve the utilisation and to reduce the out-of-pocket expenditure, India launched a cash incentive scheme, Janani Suraksha Yojana (JSY), which provides monetary incentive to the mothers delivering in public facility. However, no study has yet examined the extent to which the JSY payments reduce the maternal healthcare induced catastrophic out-of-pocket expenditure burden of the households. This paper therefore attempts to examine the extent to which the JSY reduces the catastrophic expenditure estimate household expenditure on maternity, i.e. , all direct and indirect expenditure. The study used data on 396 mothers collected through a primary survey conducted in the rural areas of the Varanasi district of Uttar Pradesh state in 2013-2014. The degree and variation in the catastrophic impact of households' maternity spending was computed as share of out-of-pocket payment in total household income in relation to specific thresholds, across socioeconomic categories. Logistic regression was used to understand the determinants of catastrophic expenditure and whether the JSY has any role in influencing the expenditure pattern. Results revealed that the JSY beneficiaries on an average spent about 8.3% of their Annual Household Consumption Expenditure on maternity care. The JSY reimbursement could reduce this share only by 2.1%. The study found that the expenditure on antenatal and postnatal care made up a significant part of the direct medical expenditure on maternity among the JSY beneficiaries. The indirect or non-medical expenditure was about four times higher than the direct expenditure on maternity services. The out-of-pocket expenditure across income quintiles was found to be regressive i.e. the poor paid a greater proportion of their income towards maternity care than the rich. Results also showed that the JSY reimbursement helped only about 8% households

Improving adolescent pregnancy outcomes and maternal health:a case study of comprehensive case managed services.

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Bowman, Elizabeth K; Palley, Howard A

2003-01-01

Our findings indicate how health outcomes regarding adolescent pregnancy and maternal and infant health care are intertwined with a case management process that fosters measures that are social in nature-the provision of direct services, as well as the encouragement of informal social supports systems. They also show how case managed services in a small, nongovernmental organization (NGO) with a strong commitment to its clients may provide the spontaneity and caring which results in a "match" between client needs and the delivery of services-and positive outcomes for pregnant women, early maternal health and infant health. The delivery of such case managed services in a manner which is intensive, comprehensive, flexible and integrated contributes significantly to such improved health outcomes.

The attitudes of healthcare professionals towards women using illicit substances in pregnancy: A cross-sectional study.

Science.gov (United States)

Fonti, Siobhan; Davis, Deborah; Ferguson, Sally

2016-08-01

To assess the attitudes of healthcare professionals towards women who use substances in the maternity setting. Illicit drug use in pregnancy leads to poor maternal and neonatal outcomes. Early access to antenatal care has been shown to improve outcomes however women who use substances in pregnancy have statistically low attendance rates to appointments. Fear of stigma from healthcare professionals is a commonly stated reason for not accessing maternity health services or not disclosing substance use to care givers, however little research has been conducted which assesses stigma from a healthcare perspective. A cross-sectional quantitative research design was implemented using a previously validated attitudinal survey tool to assess the attitudes of healthcare practitioners and final year midwifery students. Ethics approval was sought and granted by the relevant institutions. A total of 147 completed questionnaires were returned. Data was analysed using the Statistical Package for the Social Sciences and parametric testing was undertaken. Participants had largely positive or neutral attitudes towards women who use substances in pregnancy. Most participants agreed or strongly agreed that the care they provide to can make a real difference to outcomes. Midwifery students had significantly lower mean attitude scores, showing more positive attitudes, than any other group tested. This research provides useful insight into the attitudes of healthcare professionals. While larger scale research is needed, the positive findings of this study may work towards reducing fear of stigma as a barrier to care for women. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Effects of user fee exemptions on the provision and use of maternal health services: a review of literature.

Science.gov (United States)

Hatt, Laurel E; Makinen, Marty; Madhavan, Supriya; Conlon, Claudia M

2013-12-01

User fee removal has been put forward as an approach to increasing priority health service utilization, reducing impoverishment, and ultimately reducing maternal and neonatal mortality. However, user fees are a source of facility revenue in many low-income countries, often used for purchasing drugs and supplies and paying incentives to health workers. This paper reviews evidence on the effects of user fee exemptions on maternal health service utilization, service provision, and outcomes, including both supply-side and demand-side effects. We reviewed 19 peer-reviewed research articles addressing user fee exemptions and maternal health services or outcomes published since 1990. Studies were identified through a USAID-commissioned call for evidence, key word search, and screening process. Teams of reviewers assigned criteria-based quality scores to each paper and prepared structured narrative reviews. The grade of the evidence was found to be relatively weak, mainly from short-term, non-controlled studies. The introduction of user fee exemptions appears to have resulted in increased rates of facility-based deliveries and caesarean sections in some contexts. Impacts on maternal and neonatal mortality have not been conclusively demonstrated; exemptions for delivery care may contribute to modest reductions in institutional maternal mortality but the evidence is very weak. User fee exemptions were found to have negative, neutral, or inconclusive effects on availability of inputs, provider motivation, and quality of services. The extent to which user fee revenue lost by facilities is replaced can directly affect service provision and may have unintended consequences for provider motivation. Few studies have looked at the equity effects of fee removal, despite clear evidence that fees disproportionately burden the poor. This review highlights potential and documented benefits (increased use of maternity services) as well as risks (decreased provider motivation and quality

Evaluation of Patient and Medical Staff Satisfaction regarding Healthcare Services in Wuhan Public Hospitals.

Science.gov (United States)

Meng, Runtang; Li, Jingjing; Zhang, Yunquan; Yu, Yong; Luo, Yi; Liu, Xiaohan; Zhao, Yanxia; Hao, Yuantao; Hu, Ying; Yu, Chuanhua

2018-04-17

Satisfaction evaluation is widely used in healthcare systems to improve healthcare service quality to obtain better health outcomes. The aim of this study was to measure employee work satisfaction and patient satisfaction status in Wuhan, China. A cross-sectional study was conducted in 14 medical institutions. The final valid sample comprised a total of 696 medical staff and 668 patients. The overall satisfaction levels of medical staff and patients were 58.28 ± 14.60 (10.47–100.00) and 65.82 ± 14.66 (8.62–100.00), respectively. The factors affecting medical staff satisfaction, ranking in sequence from most to least satisfied, were: the work itself, working environment and atmosphere, hospital management, practicing environment, and job rewards. Patient satisfaction factors, from most to least affecting, were ranked as follows: physician-patient relationship and communication, service organization and facilities, continuity and collaboration of medical care, access to relevant information and support, and healthcare and related services, respectively. The overall satisfaction evaluation of medical staff was average. Healthcare policy makers and medical institution management staff should focus on job rewards and working environment. This would allow them to increase their work happiness and sense of belonging, which in turn would allow them to provide better medical services to patients. The overall patient evaluation was satisfactory, with patients satisfied at all levels of the satisfaction evaluation.

Evaluation of Patient and Medical Staff Satisfaction regarding Healthcare Services in Wuhan Public Hospitals

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Li, Jingjing; Yu, Yong; Liu, Xiaohan; Zhao, Yanxia; Hao, Yuantao; Hu, Ying

2018-01-01

Satisfaction evaluation is widely used in healthcare systems to improve healthcare service quality to obtain better health outcomes. The aim of this study was to measure employee work satisfaction and patient satisfaction status in Wuhan, China. A cross-sectional study was conducted in 14 medical institutions. The final valid sample comprised a total of 696 medical staff and 668 patients. The overall satisfaction levels of medical staff and patients were 58.28 ± 14.60 (10.47–100.00) and 65.82 ± 14.66 (8.62–100.00), respectively. The factors affecting medical staff satisfaction, ranking in sequence from most to least satisfied, were: the work itself, working environment and atmosphere, hospital management, practicing environment, and job rewards. Patient satisfaction factors, from most to least affecting, were ranked as follows: physician-patient relationship and communication, service organization and facilities, continuity and collaboration of medical care, access to relevant information and support, and healthcare and related services, respectively. The overall satisfaction evaluation of medical staff was average. Healthcare policy makers and medical institution management staff should focus on job rewards and working environment. This would allow them to increase their work happiness and sense of belonging, which in turn would allow them to provide better medical services to patients. The overall patient evaluation was satisfactory, with patients satisfied at all levels of the satisfaction evaluation. PMID:29673134

Disparities in mobile phone access and maternal health service utilization in Nigeria: a population-based survey.

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Jennings, Larissa; Omoni, Adetayo; Akerele, Akunle; Ibrahim, Yisa; Ekanem, Ekpenyong

2015-05-01

Mobile communication technologies may reduce maternal health disparities related to cost, distance, and infrastructure. However, the ability of mHealth initiatives to accelerate maternal health goals requires in part that women with the greatest health needs have access to mobile phones. This study examined if women with limited mobile phone access have differential odds of maternal knowledge and health service utilization as compared to female mobile phone users who are currently eligible to participate in maternal mHealth programs. Using household survey data from Nigeria, multivariable logistic regressions were used to examine the odds of maternal knowledge and service utilization by mobile phone strata. Findings showed that in settings with unequal access to mobile phones, mHealth interventions may not reach women who have the poorest maternal knowledge and care-seeking as these women often lacked mobile connectivity. As compared to mobile users, women without mobile phone access had significantly lower odds of antenatal care utilization (OR=0.48, 95%CI: 0.36-0.64), skilled delivery (OR=0.56, 95%CI: 0.45-0.70), and modern contraceptive use (OR=0.50, 95%CI: 0.33-0.76) after adjusting for demographic characteristics. They also had significantly lower knowledge of maternal danger signs (OR=0.69, 95%CI: 0.53-0.90) and knowledge of antenatal (OR=0.46, 95%CI: 0.36-0.59) and skilled delivery care benefits (OR=0.62, 95%CI: 0.47-0.82). No differences were observed by mobile phone strata in uptake of emergency obstetric care, postnatal services, or breastfeeding. As maternal mHealth strategies are increasingly utilized, more efforts are needed to improve women's access to mobile phones and minimize potential health inequities brought on by health systems and technological barriers in access to care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Preventing infant and child morbidity and mortality due to maternal depression.

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Surkan, Pamela J; Patel, Shivani A; Rahman, Atif

2016-10-01

This review provides an overview of perinatal depression and its impacts on the health of mothers, their newborns, and young children in low- and middle-income countries (LMICs). We define and describe the urgency and scope of the problem of perinatal depression for mothers, while highlighting some specific issues such as suicidal ideation and decreased likelihood to seek health care. Pathways through which stress may link maternal depression to childhood growth and development (e.g., the hypo-pituitary axis) are discussed, followed by a summary of the adverse effects of depression on birth outcomes, parenting practices, and child growth and development. Although preliminary studies on the association between maternal depressive symptoms and maternal and child mortality exist, more research on these topics is needed. We describe the available interventions and suggest strategies to reduce maternal depressive symptoms in LMICs, including integration of services with existing primary health-care systems. Copyright © 2016. Published by Elsevier Ltd.

Mental healthcare need and service utilization in older adults living in public housing.

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Simning, Adam; van Wijngaarden, Edwin; Fisher, Susan G; Richardson, Thomas M; Conwell, Yeates

2012-05-01

Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. This study aims to characterize mental illness and its treatment in older adult public housing residents who have many risk factors for anxiety and depression. Cross-sectional study. Public housing high-rises in Rochester, New York. One hundred ninety residents aged 60 years and older. Anxiety and depression were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, GAD-7, and Patient Health Questionnaire. We obtained information on mental healthcare from medication review and self-report. Participants had a median age of 66 years, 58% were women, 80% were black, and 92% lived alone. Many participants (31%) were in need of mental healthcare: 21% had syndromal and 11% had subsyndromal anxiety or depression. Mental healthcare need was associated with younger age; intact cognitive functioning; impairments in instrumental activities of daily living (IADL); more medical illness; decreased mobility; smaller social network size; more severe life events; and increased utilization of medical, human, and informal services. Of those with mental healthcare need, most were not receiving it. Compared with residents receiving mental healthcare, residents with untreated need were more likely to be men and have less IADL impairment, medical illness, severe life events, onsite social worker use, and human services utilization. Mental illness was common and largely untreated in public housing residents. Increasing collaboration between medical, mental, and human services is needed to improve identification, treatment, and ultimately prevention of late-life mental illness in this community setting.

Access to healthcare for disabled persons. How are blind people reached by HIV services?

Science.gov (United States)

Saulo, Bryson; Walakira, Eddy; Darj, Elisabeth

2012-03-01

Disabled people are overlooked and marginalised globally. There is a lack of information on blind people and HIV-related services and it is unclear how HIV-services target blind people in a sub-Saharan urban setting. To explore how blind people are reached by HIV-services in Kampala, Uganda. A purposeful sample of blind people and seeing healthcare workers were interviewed, and data on their opinions and experiences were collected. The data were analysed by qualitative content analysis, with a focus on manifest content. Three categories emerged from the study, reaching for HIV information and knowledge, lack of services, and experiences of discrimination. General knowledge on HIV prevention/transmission methods was good; however, there was scepticism about condom use. Blind people mainly relied on others for accessing HIV information, and a lack of special services for blind people to be able to test for HIV was expressed. The health service for blind people was considered inadequate, unequal and discriminatory, and harassment by healthcare staff was expressed, but not sexual abuse. Concerns about disclosure of personal medical information were revealed. Access to HIV services and other healthcare related services for blind people is limited and the objectives of the National Strategic Plan for HIV/AIDS 2007-2012 have not been achieved. There is a need for alternative methods for sensitisation and voluntary counselling and testing (VCT) for blind people. Copyright © 2011 Elsevier B.V. All rights reserved.

Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study

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Al Chamat Ahmad

2010-10-01

Full Text Available Abstract Background Investigating severe maternal morbidity (near-miss is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities. Methods Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005 including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR, maternal near miss ratio (MNMR, mortality indices and proportion of near-miss cases and mortality cases to hospital admissions. Results There were 28 025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100 000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52% and haemorrhage (34% were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60% while sepsis had the highest mortality index (7.4%. Most cases (93% were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%, primary (5% and secondary (10% healthcare unites and private practices (11%. 26% of near-miss cases were admitted to Intensive Care Unit (ICU. Conclusion Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to

Obstetric near-miss and maternal mortality in maternity university hospital, Damascus, Syria: a retrospective study.

Science.gov (United States)

Almerie, Yara; Almerie, Muhammad Q; Matar, Hosam E; Shahrour, Yasser; Al Chamat, Ahmad Abo; Abdulsalam, Asmaa

2010-10-19

Investigating severe maternal morbidity (near-miss) is a newly recognised tool that identifies women at highest risk of maternal death and helps allocate resources especially in low income countries. This study aims to i. document the frequency and nature of maternal near-miss at hospital level in Damascus, Capital of Syria, ii. evaluate the level of care at maternal life-saving emergency services by comparatively analysing near-misses and maternal mortalities. Retrospective facility-based review of cases of near-miss and maternal mortality that took place in the years 2006-2007 at Damascus Maternity University Hospital, Syria. Near-miss cases were defined based on disease-specific criteria (Filippi 2005) including: haemorrhage, hypertensive disorders in pregnancy, dystocia, infection and anaemia. Main outcomes included maternal mortality ratio (MMR), maternal near miss ratio (MNMR), mortality indices and proportion of near-miss cases and mortality cases to hospital admissions. There were 28,025 deliveries, 15 maternal deaths and 901 near-miss cases. The study showed a MNMR of 32.9/1000 live births, a MMR of 54.8/100,000 live births and a relatively low mortality index of 1.7%. Hypertensive disorders (52%) and haemorrhage (34%) were the top causes of near-misses. Late pregnancy haemorrhage was the leading cause of maternal mortality (60%) while sepsis had the highest mortality index (7.4%). Most cases (93%) were referred in critical conditions from other facilities; namely traditional birth attendants homes (67%), primary (5%) and secondary (10%) healthcare unites and private practices (11%). 26% of near-miss cases were admitted to Intensive Care Unit (ICU). Near-miss analyses provide valuable information on obstetric care. The study highlights the need to improve antenatal care which would help early identification of high risk pregnancies. It also emphasises the importance of both: developing protocols to prevent/manage post-partum haemorrhage and training health

National data system on near miss and maternal death: shifting from maternal risk to public health impact in Nigeria

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Oladapo Olufemi T

2009-06-01

Full Text Available Abstract Background The lack of reliable and up-to-date statistics on maternal deaths and disabilities remains a major challenge to the implementation of Nigeria's Road Map to Accelerate the Millennium Development Goal related to Maternal Health (MDG-5. There are currently no functioning national data sources on maternal deaths and disabilities that could serve as reference points for programme managers, health advocates and policy makers. While awaiting the success of efforts targeted at overcoming the barriers facing establishment of population-based data systems, referral institutions in Nigeria can contribute their quota in the quest towards MDG-5 by providing good quality and reliable information on maternal deaths and disabilities on a continuous basis. This project represents the first opportunity to initiate a scientifically sound and reliable quantitative system of data gathering on maternal health profile in Nigeria. Objective The primary objective is to create a national data system on maternal near miss (MNM and maternal mortality in Nigerian public tertiary institutions. This system will conduct periodically, both regionally and at country level, a review of the magnitude of MNM and maternal deaths, nature of events responsible for MNM and maternal deaths, indices for the quality of care for direct obstetric complications and the health service events surrounding these complications, in an attempt to collectively define and monitor the standard of comprehensive emergency obstetric care in the country. Methods This will be a nationwide cohort study of all women who experience MNM and those who die from pregnancy, childbirth and puerperal complications using uniform criteria among women admitted in tertiary healthcare facilities in the six geopolitical zones in Nigeria. This will be accomplished by establishing a network of all public tertiary obstetric referral institutions that will prospectively collect specific information on

Afraid of delivering at the hospital or afraid of delivering at home : a qualitative study of Thai Hmong families' decision-making about maternity services

OpenAIRE

Culhane-Pera, K.A.; Sriphetcharawut, S.; Thawsirichuchai, Rasamee; Yangyuenkun, W.; Kunstader, P.

2015-01-01

Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into fou...

Construction of HMI Network System for Individualized Maternity Intervention Service against Birth Defects in Community

Institute of Scientific and Technical Information of China (English)

Xu-huai HU

2007-01-01

The paper expounds the community maternity service system against birth defects,from the viewpoint of individualized service in family planning. We have utilized modern information technology to develop health management information (HMI) network with individualized maternity, and to establish the community service system for intervention of birth defects. The service system applied the concept of modern health management information to implementing informational management for screening,treatment, following up, outcome monitoring, so as to provide a base for promotion of health, diagnosis, treatment as well as scientific research, with the prenatal screening of Down's syndrome as a model. The introduction to informational network during the processes of service has been carried out with regards to its composition, function and application, while introducing the effects of computerized case record individualized in prevention, management and research of Down's syndrome.

Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data.

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Saxena, Deepak; Vangani, Ruchi; Mavalankar, Dileep V; Thomsen, Sarah

2013-03-06

Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3) carried out during 2007-2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes - Institutional delivery, antenatal care (ANC), and use of modern contraception - and selected intermediary and structural determinants of health using multiple logistic regression. Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste) has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic education and infrastructural development to begin to remove the structural causes

Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data

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Dileep V. Mavalankar

2013-03-01

Full Text Available Background: Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Methods: Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3 carried out during 2007–2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes – Institutional delivery, antenatal care (ANC, and use of modern contraception – and selected intermediary and structural determinants of health using multiple logistic regression. Results: Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Discussion and conclusions: Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic

Interprofessional teamwork in comprehensive primary healthcare services: Findings from a mixed methods study.

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Bentley, Michael; Freeman, Toby; Baum, Fran; Javanparast, Sara

2018-05-01

This article draws on data from a 5-year project that examined the effectiveness of Comprehensive primary healthcare (CPHC) in local communities. A hallmark of CPHC services is interprofessional teamwork. Drawing from this study, our article presents factors that enabled, or hindered, healthcare teams working interprofessionally in Australian primary healthcare (PHC) services. The article reports on the experiences of teams working in six Australian PHC services (four managed by state governments, one non-government sexual health organisation, and one Aboriginal community-controlled health service) during a time of significant health sector restructure. Findings are drawn from two key methods: an online survey of practitioners and managers (n = 154), and interviews with managers and practitioners (n = 60) from the six study sites. The majority of survey respondents worked with other health professionals in their service to provide interprofessional care to clients. Processes included formal team meetings, case conferencing, referring clients to other health professionals if needed, informal communication with other health professionals about clients, and team-based delivery of care. A range of interrelated factors affected interprofessional work at the services, from contextual, organisational, processual, and relational domains. Funding cuts and policy changes that saw a reorientation and re-medicalisation of South Australian services undermined interprofessional work, while a shared CPHC culture and commitment among some staff was helpful in resisting some of these effects. The co-location of services was a factor in PHC teams working interprofessionally and not only enabled some PHC teams to work more interprofessionally but also created barriers to interprofessional teamwork through disruption resulting from restructuring of services. Our study indicates the importance of decision makers taking into account the potential effects of policy and structural

Graph-Based Semantic Web Service Composition for Healthcare Data Integration.

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Arch-Int, Ngamnij; Arch-Int, Somjit; Sonsilphong, Suphachoke; Wanchai, Paweena

2017-01-01

Within the numerous and heterogeneous web services offered through different sources, automatic web services composition is the most convenient method for building complex business processes that permit invocation of multiple existing atomic services. The current solutions in functional web services composition lack autonomous queries of semantic matches within the parameters of web services, which are necessary in the composition of large-scale related services. In this paper, we propose a graph-based Semantic Web Services composition system consisting of two subsystems: management time and run time. The management-time subsystem is responsible for dependency graph preparation in which a dependency graph of related services is generated automatically according to the proposed semantic matchmaking rules. The run-time subsystem is responsible for discovering the potential web services and nonredundant web services composition of a user's query using a graph-based searching algorithm. The proposed approach was applied to healthcare data integration in different health organizations and was evaluated according to two aspects: execution time measurement and correctness measurement.

Parent participation in decision-making in health-care services for children: an integrative review.

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Aarthun, Antje; Akerjordet, Kristin

2014-03-01

To describe and synthesize previous research on parents' perceptions of their participation in decision making in child health-care services. Health policy in the area of user involvement emphasizes parent participation in decision-making (DM), thus ensuring that services are provided in accordance with their child's needs and enhancing parents' control over their child's health-care services. A systematic literature search, covering the period January 2000 to February 2011, found 18 studies that met the inclusion criteria. The analysis process involved data extraction, reduction, comparison and synthesizing. Three themes emerged: (1) relational factors and interdependence, (2) personal factors and attitudes and (3) organisational factors. Parents highlighted the importance of the parent-health professional relationship, professionals' competence and the possibility of varying the degree of participation in decision making. Challenges involved asymmetry in authority and power, professionals' attitudes and competence and organisational shortcomings in health-care services. Health professionals need to become more aware of their critical role and responsibility in involving parents in DM. Health professionals' attitudes and competence can be improved by knowledge of user involvement and research and facilitating the inclusion of parents in decision making by influencing the culture, routines and resources in the health service. © 2012 John Wiley & Sons Ltd.

[Healthcare value chain: a model for the Brazilian healthcare system].

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Pedroso, Marcelo Caldeira; Malik, Ana Maria

2012-10-01

This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and services; financial; and information.

Reorganisation of healthcare services for children and families: Improving collaboration, service quality, and worker well-being.

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Martinussen, Monica; Kaiser, Sabine; Adolfsen, Frode; Patras, Joshua; Richardsen, Astrid M

2017-07-01

This study is an evaluation of a reorganisation of different services for children and their families in a Norwegian municipality. The main aim of the reorganisation was to improve interprofessional collaboration through integrating different social services for children and their parents. The evaluation was guided by the Job Demands-Resources Model with a focus on social and healthcare workers' experiences of their work, including job demands and resources, service quality, and well-being at work. The survey of the employees was conducted at three measurement points: before (T 1 ) and after (T 2 , T 3 ) the reorganisation took place, and included between 87 and 122 employees. A secondary aim was to examine the impact of different job resources and job demands on well-being (burnout, engagement, job satisfaction), and service quality. A one-way ANOVA indicated a positive development on many scales, such as collaboration, work conflict, leadership, and perceived service quality, especially from T 1 to T 2 . No changes were detected in burnout, engagement, or job satisfaction over time. Moderated regression analyses (at T 3 ) indicated that job demands were particularly associated with burnout, and job resources with engagement and job satisfaction. Perceived service quality was predicted by both job demands and resources, in addition to the interaction between workload and collaboration. The reorganisation seems to have contributed to a positive development in how collaboration, work conflict, leadership, and service quality were evaluated, but that other changes are needed to increase worker well-being. The value of the study rests on the findings that support co-locating and merging services for children and their families, and that collaboration is an important resource for healthcare professionals.

Utilisation of maternity services by black women in rural and urban ...

African Journals Online (AJOL)

An epidemiological survey was undertaken to evaluate the utilisation of maternal services for black women in the. Orange Free State. Two hundred and forty clusters were selected from the rural (fanns) and urban (local authorities) black population and eight households were interviewed in each cluster. Information was ...

Utilisation of maternity services by black women in rural and urban ...

African Journals Online (AJOL)

An epidemiological survey was undertaken to evaluate the utilisation of maternal services for black women in the Orange Free State. Two hundred and forty clusters were selected from the rural (farms) and urban (local authorities) black population and eight households were interviewed in each cluster. Information was ...

Evaluation of socio-economic inequalities in the use of maternal health services in rural western China.

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Li, C; Zeng, L; Dibley, M J; Wang, D; Pei, L; Yan, H

2015-09-01

To describe the use of maternal health services according to the standards of the Chinese Ministry of Health, and assess socio-economic inequalities in usage in rural Shaanxi province, western China. Cross-sectional survey. Principal components analysis was used to measure the economic status of households. A concentration index (CI) approach was used as a measure of socio-economic inequalities in the use of maternal health services, and a decomposable CI was used to identify the factors that contributed to the socio-economic inequalities in usage. In total, 4760 women who had given birth in the preceding three years were selected at random to be interviewed in the five counties. Household wealth index was calculated by constructing a linear index from asset ownership indicators using principal components analysis to derive weights. The CI approach is a standard measure in the analysis of inequalities in health. If the CI for the use of maternal health services is positive, it is pro-rich; if it is negative, it is pro-poor. The decomposition method was used to estimate the contributions of individual factors to CI. The overall CI for five or more prenatal visits was 0.075. The household wealth index was found to make the greatest contribution to socio-economic inequalities for five or more prenatal visits (35.5%), followed by maternal education (28.8%), receipt of a health handbook during pregnancy (12.1%), age group (11.0%), distance from health facility (10.5%), family members (1.5%) and district of residence (0.6%). Socio-economic inequalities in the use of prenatal health services were pro-rich in rural western China. Socio-economic inequalities in hospital delivery and postnatal health check-ups were not evident. Improving household economic status, providing prenatal health services for women with low income and low educational level, providing health handbooks and improving traffic conditions should be promoted as methods to eliminate socio

Human rights and access to healthcare services for indigenous peoples in Africa.

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Durojaye, Ebenezer

2017-09-20

In September 2015, the United Nations adopted the sustainable development goals (SDGs) to address among others poverty and inequality within and among countries of the world. In particular, the SDGs aim at ameliorating the position of disadvantaged and vulnerable groups in societies. One of the over-arching goals of the SDGs is to ensure that no one is left behind in the realisation of their access to health care. African governments are obligated under international and regional human rights law to ensure access to healthcare services for everyone, including indigenous populations, on a non-discriminatory basis. This requires the governments to adopt appropriate measures that will remove barriers to healthcare services for disadvantaged and marginalised groups such as indigenous peoples.

Factors associated with the utilization of institutional delivery services in Bangladesh.

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Yaya, Sanni; Bishwajit, Ghose; Ekholuenetale, Michael

2017-01-01

Bangladesh has made remarkable progress towards reducing its maternal mortality rate (MMR) over the last two decades and is one of the few countries on track to achieving the MMR-related Millennium Development Goals (MDG-5A). However, the provision of universal access to reproductive healthcare (MDG-5B) and the utilization of maternal healthcare services (MHS) such as institutional delivery, which are crucial to the reduction of maternal mortality, are far behind the internationally agreed-upon target. Effective policymaking to promote the utilization of MHS can be greatly facilitated by the identification of the factors that hinder service uptake. In this study, we therefore aim to measure the prevalence of institutional delivery services and explore the factors associated with their utilization in Bangladesh. Data for this study were extracted from the 2011 Bangladesh Demographic and Health Survey (BDHS, 2011); participants were 7,313 women between the ages of 15 and 49 years, selected from both urban and rural households. Data were analyzed using Chi-square analysis, and conditional logistic regression. According to the findings, fewer than one in three women reported delivering at a health facility. The multivariable regression analysis showed that participants from rural areas were 46.9% less likely to have institutional deliveries compared to urban dwellers (OR = 0.531; pdelivery service utilization compared to those aged 15 to 29 years (OR = 1.236; p = 0.006; 95%CI: 1.062-1.437). Moreover, participants with higher educational attainment were about twice as likely to deliver at a standard health facility when compared to those without formal education (OR = 2.081; pservice utilization of institutional delivery facilities compared to those without formal education (OR = 1.709; pdelivery service use, with participants belonging to the highest economic stratum being more likely to receive skilled care compared to the lowest economic stratum (OR = 2

Generation and evaluation of an indicator of the health system's performance in maternal and reproductive health in Colombia: An ecological study.

Science.gov (United States)

Pinzón-Flórez, Carlos Eduardo; Fernandez-Niño, Julian Alfredo; Cardenas-Cardenas, Luz Mery; Díaz-Quijano, Diana Marcela; Ruiz-Rodriguez, Myriam; Reveiz, Ludovic; Arredondo-López, Armando

2017-01-01

To generate and evaluate an indicator of the health system's performance in the area of maternal and reproductive health in Colombia. An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator's score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable. The factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35). The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4). The poorest performance (Q1) occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator's behavior was found to have an association with the unsatisfied basic needs index and women's education (β = -0.021; 95%CI -0031 to -0.01 and β 0.554; 95%CI 0.39 to 0.72, respectively). According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (β = -49.34; 95%CI -77.7 to -20.9); performance was a mediating variable. The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.

Generation and evaluation of an indicator of the health system's performance in maternal and reproductive health in Colombia: An ecological study.

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Carlos Eduardo Pinzón-Flórez

Full Text Available To generate and evaluate an indicator of the health system's performance in the area of maternal and reproductive health in Colombia.An indicator was constructed based on variables related to the coverage and utilization of healthcare services for pregnant and reproductive-age women. A factor analysis was performed using a polychoric correlation matrix and the states were classified according to the indicator's score. A path analysis was used to evaluate the relationship between the indicator and social determinants, with the maternal mortality ratio as the response variable.The factor analysis indicates that only one principal factor exists, namely "coverage and utilization of maternal healthcare services" (eigenvalue 4.35. The indicator performed best in the states of Atlantic, Bogota, Boyaca, Cundinamarca, Huila, Risaralda and Santander (Q4. The poorest performance (Q1 occurred in Caqueta, Choco, La Guajira, Vichada, Guainia, Amazonas and Vaupes. The indicator's behavior was found to have an association with the unsatisfied basic needs index and women's education (β = -0.021; 95%CI -0031 to -0.01 and β 0.554; 95%CI 0.39 to 0.72, respectively. According to the path analysis, an inverse relationship exists between the proposed indicator and the behavior of the maternal mortality ratio (β = -49.34; 95%CI -77.7 to -20.9; performance was a mediating variable.The performance of the health system with respect to its management of access and coverage for maternal and reproductive health appears to function as a mediating variable between social determinants and maternal mortality in Colombia.

Are Husbands Involving in Their Spouses' Utilization of Maternal Care Services?: A Cross-Sectional Study in Yangon, Myanmar.

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Kyi Mar Wai

Full Text Available Husbands can play a crucial role in pregnancy and childbirth, especially in patriarchal societies of developing countries. In Myanmar, despite the critical influence of husbands on the health of mothers and newborns, their roles in maternal health have not been well explored. Therefore, the aim of this study was to identify the factors associated with husbands' involvement in maternal health in Myanmar. This study also examined the associations between husbands' involvement and their spouses' utilization of maternal care services during antenatal, delivery and postnatal periods.A community-based, cross sectional study was conducted with 426 husbands in Thingangyun Township, Yangon, Myanmar. Participants were husbands aged 18 years or older who had at least one child within two years at the time of interview. Face to face interviews were conducted using a pretested structured questionnaire. Factors associated with the characteristics of husband's involvement as well as their spouses' utilization of maternal care services were analyzed by multivariable logistic regression models.Of 426 husbands, 64.8% accompanied their spouses for an antenatal visit more than once while 51.6% accompanied them for a postnatal visit. Husbands were major financial supporters for both antenatal (95.8% and postnatal care (68.5%. Overall, 69.7% were involved in decision making about the place of delivery. Regarding birth preparedness, the majority of husbands prepared for skilled birth attendance (91.1%, delivery place (83.6%, and money saving (81.7% before their spouses gave birth. In contrast, fewer planned for a potential blood donor (15.5% and a safe delivery kit (21.1%. In the context of maternal health, predictors of husband's involvement were parity, educational level, type of marriage, decision making level in family, exposure to maternal health education and perception of risk during pregnancy and childbirth. Increased utilization of maternal health services

Are Husbands Involving in Their Spouses' Utilization of Maternal Care Services?: A Cross-Sectional Study in Yangon, Myanmar.

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Wai, Kyi Mar; Shibanuma, Akira; Oo, Nwe Nwe; Fillman, Toki Jennifer; Saw, Yu Mon; Jimba, Masamine

2015-01-01

Husbands can play a crucial role in pregnancy and childbirth, especially in patriarchal societies of developing countries. In Myanmar, despite the critical influence of husbands on the health of mothers and newborns, their roles in maternal health have not been well explored. Therefore, the aim of this study was to identify the factors associated with husbands' involvement in maternal health in Myanmar. This study also examined the associations between husbands' involvement and their spouses' utilization of maternal care services during antenatal, delivery and postnatal periods. A community-based, cross sectional study was conducted with 426 husbands in Thingangyun Township, Yangon, Myanmar. Participants were husbands aged 18 years or older who had at least one child within two years at the time of interview. Face to face interviews were conducted using a pretested structured questionnaire. Factors associated with the characteristics of husband's involvement as well as their spouses' utilization of maternal care services were analyzed by multivariable logistic regression models. Of 426 husbands, 64.8% accompanied their spouses for an antenatal visit more than once while 51.6% accompanied them for a postnatal visit. Husbands were major financial supporters for both antenatal (95.8%) and postnatal care (68.5%). Overall, 69.7% were involved in decision making about the place of delivery. Regarding birth preparedness, the majority of husbands prepared for skilled birth attendance (91.1%), delivery place (83.6%), and money saving (81.7%) before their spouses gave birth. In contrast, fewer planned for a potential blood donor (15.5%) and a safe delivery kit (21.1%). In the context of maternal health, predictors of husband's involvement were parity, educational level, type of marriage, decision making level in family, exposure to maternal health education and perception of risk during pregnancy and childbirth. Increased utilization of maternal health services was found

Are Husbands Involving in Their Spouses’ Utilization of Maternal Care Services?: A Cross-Sectional Study in Yangon, Myanmar

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Wai, Kyi Mar; Shibanuma, Akira; Oo, Nwe Nwe; Fillman, Toki Jennifer; Saw, Yu Mon; Jimba, Masamine

2015-01-01

Introduction Husbands can play a crucial role in pregnancy and childbirth, especially in patriarchal societies of developing countries. In Myanmar, despite the critical influence of husbands on the health of mothers and newborns, their roles in maternal health have not been well explored. Therefore, the aim of this study was to identify the factors associated with husbands’ involvement in maternal health in Myanmar. This study also examined the associations between husbands’ involvement and their spouses’ utilization of maternal care services during antenatal, delivery and postnatal periods. Methods A community-based, cross sectional study was conducted with 426 husbands in Thingangyun Township, Yangon, Myanmar. Participants were husbands aged 18 years or older who had at least one child within two years at the time of interview. Face to face interviews were conducted using a pretested structured questionnaire. Factors associated with the characteristics of husband’s involvement as well as their spouses’ utilization of maternal care services were analyzed by multivariable logistic regression models. Results Of 426 husbands, 64.8% accompanied their spouses for an antenatal visit more than once while 51.6% accompanied them for a postnatal visit. Husbands were major financial supporters for both antenatal (95.8%) and postnatal care (68.5%). Overall, 69.7% were involved in decision making about the place of delivery. Regarding birth preparedness, the majority of husbands prepared for skilled birth attendance (91.1%), delivery place (83.6%), and money saving (81.7%) before their spouses gave birth. In contrast, fewer planned for a potential blood donor (15.5%) and a safe delivery kit (21.1%). In the context of maternal health, predictors of husband’s involvement were parity, educational level, type of marriage, decision making level in family, exposure to maternal health education and perception of risk during pregnancy and childbirth. Increased utilization

eHealth: Towards a Healthcare Service-Oriented Boundary-Less Infrastructure

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Cristian LELUTIU

2010-09-01

Full Text Available The current paper presents several interoperability features applied to a local distributed information system, CardioNET, meant to improve quality of healthcare services, through the use of the latest medical and IT&C technologies. Modern healthcare systems require a patient-centric vision, where patients must receive medical attention or treatment anytime, regardless of their physical location. The eHealth distributed system we present – CardioNET is based on a SOA producer-consumer model taking a patient centric approach where every hardware, software and medical activities become “services”. The system offers tools for remote interactions between patients, doctors, medical entities (e.g. hospitals, labs and authorities. Based on international standards (IDC10, LOINC, HL7, the system assures interoperability and data exchange in widely accepted XML formats. A logical domain bus, called Pervasive Health Service Bus-pHSB, exchanges HL7 compliant data messages between the integrated elements of the platform, through high level protocols (SOAP/HL7. The paper addresses interoperability problems between medical informational platforms proposing an eHealth architecture composed of: - production systems (nodes: General Practitioner, Analysis Laboratories, Clinics, Hospitals, Home Health Care Units (H-HCU;- portal with specialized web services, registries and shared data repositories – distributed, boundary-less environment for decision support, research and educational activities.

Situation of the Kinh poor and minority women and their use of the Maternal Care and Family Planning Service in Nam Dong Mountainous District, Thuathien-Hue Province, Vietnam.

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Vo Van, T; Hoat, L N; Jan van Schie, T

2004-01-01

This study aimed to determine the barriers to the use of maternal care and family planning (MCFP) services by the disadvantaged Kinh people and Katu ethnic minority people in the remote and mountainous area of Nam Dong District in Central Vietnam. A survey was conducted using a random sample of 420 mothers with at least one child under the age of 5 years. These data were supplemented by interviews with key informants, focus group discussions and observations. Many barriers were identified. The difficulty of the terrain made travel to healthcare centers difficult. The cost of treatment was a barrier for the poorest people. The quality of the services and facilities, as well as the management of these services was perceived to be unsatisfactory. Traditional practices were often described as being contrary to the doctor's advice, and were presented as the reason for unsafe and unassisted home deliveries. Communication was difficult because of the minority languages of the client groups, the prevalence of illiteracy, and the absence of mass communication in this region. Finally, consulting a male healthcare worker was reported to bring the women shame. There is an urgent need for the MCFP services to build both clinical capacity and health promotion activities in a way that is gender sensitive, cognisant of traditional practices and accessible by both illiterate and minority language speaking people.

Links among high-performance work environment, service quality, and customer satisfaction: an extension to the healthcare sector.

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Scotti, Dennis J; Harmon, Joel; Behson, Scott J

2007-01-01

Healthcare managers must deliver high-quality patient services that generate highly satisfied and loyal customers. In this article, we examine how a high-involvement approach to the work environment of healthcare employees may lead to exceptional service quality, satisfied patients, and ultimately to loyal customers. Specifically, we investigate the chain of events through which high-performance work systems (HPWS) and customer orientation influence employee and customer perceptions of service quality and patient satisfaction in a national sample of 113 Veterans Health Administration ambulatory care centers. We present a conceptual model for linking work environment to customer satisfaction and test this model using structural equations modeling. The results suggest that (1) HPWS is linked to employee perceptions of their ability to deliver high-quality customer service, both directly and through their perceptions of customer orientation; (2) employee perceptions of customer service are linked to customer perceptions of high-quality service; and (3) perceived service quality is linked with customer satisfaction. Theoretical and practical implications of our findings, including suggestions of how healthcare managers can implement changes to their work environments, are discussed.

Improving healthcare for Aboriginal Australians through effective engagement between community and health services.

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Durey, Angela; McEvoy, Suzanne; Swift-Otero, Val; Taylor, Kate; Katzenellenbogen, Judith; Bessarab, Dawn

2016-07-07

Effectively addressing health disparities between Aboriginal and non-Aboriginal Australians is long overdue. Health services engaging Aboriginal communities in designing and delivering healthcare is one way to tackle the issue. This paper presents findings from evaluating a unique strategy of community engagement between local Aboriginal people and health providers across five districts in Perth, Western Australia. Local Aboriginal community members formed District Aboriginal Health Action Groups (DAHAGs) to collaborate with health providers in designing culturally-responsive healthcare. The purpose of the strategy was to improve local health service delivery for Aboriginal Australians. The evaluation aimed to identify whether the Aboriginal community considered the community engagement strategy effective in identifying their health service needs, translating them to action by local health services and increasing their trust in these health services. Participants were recruited using purposive sampling. Qualitative data was collected from Aboriginal participants and health service providers using semi-structured interviews or yarning circles that were recorded, transcribed and independently analysed by two senior non-Aboriginal researchers. Responses were coded for key themes, further analysed for similarities and differences between districts and cross-checked by the senior lead Aboriginal researcher to avoid bias and establish reliability in interpreting the data. Three ethics committees approved conducting the evaluation. Findings from 60 participants suggested the engagement process was effective: it was driven and owned by the Aboriginal community, captured a broad range of views and increased Aboriginal community participation in decisions about their healthcare. It built community capacity through regular community forums and established DAHAGs comprising local Aboriginal community members and health service representatives who met quarterly and were

Traditional birth attendants (TBAs) as potential agents in promoting male involvement in maternity preparedness: insights from a rural community in Uganda.

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Turinawe, Emmanueil Benon; Rwemisisi, Jude T; Musinguzi, Laban K; de Groot, Marije; Muhangi, Denis; de Vries, Daniel H; Mafigiri, David K; Katamba, Achilles; Parker, Nadine; Pool, Robert

2016-03-12

Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization's Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context. This study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes. Contrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives' healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care. In this study area, men trust and have confidence in TBAs; closer

Reconceptualising risk: Perceptions of risk in rural and remote maternity service planning.

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Barclay, Lesley; Kornelsen, Jude; Longman, Jo; Robin, Sarah; Kruske, Sue; Kildea, Sue; Pilcher, Jennifer; Martin, Tanya; Grzybowski, Stefan; Donoghue, Deborah; Rolfe, Margaret; Morgan, Geoff

2016-07-01

to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia. 117 health service employees and 24 consumers. examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Access to and utilisation of healthcare services by sex workers at truck-stop clinics in South Africa: A case study

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Fobosi, S. C.; Lalla-Edward, S. T.; Ncube, S.; Buthelezi, F.; Matthew, P.; Kadyakapita, A.; Slabbert, M.; Hankins, C. A.; Venter, W. D. F.; Gomez, G. B.

2017-01-01

Background. Sex worker-specific health services aim to respond to the challenges that this key population faces in accessing healthcare. These services aim to integrate primary healthcare (PHC) interventions, yet most services tend to focus on prevention of HIV and sexually transmitted infections

Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia.

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Widyaningsih, Vitri; Khotijah; Balgis

2017-01-01

Indonesia still faces challenges in maternal health. Specifically, the lack of information on community-level maternal morbidity. The relatively high maternal healthcare non-utilization in Indonesia intensifies this problem. To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to evaluate the extent and determinants of missed opportunities in women with maternal morbidity. We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS 2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were estimated from 43,782 women. We analyzed missed opportunities in women who experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012 (n = 6762). There were significant increases in the crude and adjusted proportion of maternal morbidity from IDHS 2002 to IDHS 2012 (p Indonesia. The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor. This condition is amplified by the concerning missed opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population.

Advancing indigent healthcare services through adaptive reuse: repurposing abandoned buildings as medical clinics for disadvantaged populations.

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Elrod, James K; Fortenberry, John L

2017-12-13

Challenges abound for healthcare providers engaged in initiatives directed toward disadvantaged populations, with financial constraints representing one of the most prominent hardships. Society's less fortunate typically lack the means to pay for healthcare services and even when they are covered by government health insurance programs, reimbursement shortcomings often occur, placing funding burdens on the shoulders of establishments dedicated to serving those of limited means. For such charitably-minded organizations, efficiencies are required on all fronts, including one which involves significant operational costs: the physical space required for care provision. Newly constructed buildings, whether owned or leased, are expensive, consuming a significant percentage of funds that otherwise could be directed toward patient care. Such costs can even prohibit the delivery of services to indigent populations altogether. But through adaptive reuse-the practice of repurposing existing, abandoned buildings, placing them back into service in pursuit of new missions-opportunities exist to economize on this front, allowing healthcare providers to acquire operational space at a discount. In an effort to shore up related knowledge, this article profiles Willis-Knighton Health System's development of Project NeighborHealth, an indigent clinic network which was significantly bolstered by the economies associated with adaptive reuse. Despite its potential to bolster healthcare initiatives directed toward the medically underserved by presenting more affordable options for acquiring operational space, adaptive reuse remains relatively obscure, diminishing opportunities for providers to take advantage of its many benefits. By shedding light on this repurposing approach, healthcare providers will have a better understanding of adaptive reuse, enabling them to make use of the practice to improve the depth and breadth of healthcare services available to disadvantaged populations.

Pelvic floor and anal sphincter trauma should be key performance indicators of maternity services.

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Dietz, H P; Pardey, J; Murray, H

2015-01-01

There is an increasing awareness of maternal somatic birth trauma, which affects many more women than previously thought, primarily in the form of anal sphincter and levator ani tears. Given that such trauma occurs in about one-third of all women giving birth vaginally for the first time, and given that it has serious long-term consequences, it should be audited by all maternity services with a view to providing remedial therapy to delay or prevent subsequent morbidity, and to facilitate practice improvement. The increasing availability of modern imaging equipment and the skills of using it for pelvic floor assessment means that it is now becoming possible to provide such services postnatally.

Design and development of a tele-healthcare information system based on web services and HL7 standards.

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Huang, Ean-Wen; Hung, Rui-Suan; Chiou, Shwu-Fen; Liu, Fei-Ying; Liou, Der-Ming

2011-01-01

Information and communication technologies progress rapidly and many novel applications have been developed in many domains of human life. In recent years, the demand for healthcare services has been growing because of the increase in the elderly population. Consequently, a number of healthcare institutions have focused on creating technologies to reduce extraneous work and improve the quality of service. In this study, an information platform for tele- healthcare services was implemented. The architecture of the platform included a web-based application server and client system. The client system was able to retrieve the blood pressure and glucose levels of a patient stored in measurement instruments through Bluetooth wireless transmission. The web application server assisted the staffs and clients in analyzing the health conditions of patients. In addition, the server provided face-to-face communications and instructions through remote video devices. The platform deployed a service-oriented architecture, which consisted of HL7 standard messages and web service components. The platform could transfer health records into HL7 standard clinical document architecture for data exchange with other organizations. The prototyping system was pretested and evaluated in a homecare department of hospital and a community management center for chronic disease monitoring. Based on the results of this study, this system is expected to improve the quality of healthcare services.

Waiting too long : low use of maternal health services in Kalabo, Zambia

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Stekelenburg, J; Kyanamina, S; Mukelabai, M; Wolffers, [No Value; van Roosmalen, J

OBJECTIVE To determine the level of use of maternal health services and to identify and assess factors that influence women's choices where to deliver in Kalabo District, Zambia. METHODS A cross-sectional descriptive study conducted between 1998 and 2000, with 332 women interviewed using

'If I go with him, I can't talk with other women': Understanding women's resistance to, and acceptance of, men's involvement in maternal and child healthcare in northern Ghana.

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Ganle, John Kuumuori; Dery, Isaac; Manu, Abubakar A; Obeng, Bernard

2016-10-01

Men's involvement in maternal and child healthcare especially in patriarchal societies such as Ghana is increasingly being advocated. While a number of studies have been conducted to explore men's views on their involvement, few studies have examined the perspectives of childbearing women. Based on qualitative focus group discussions that were conducted between January and August 2014 with a total of 125 adult women in seven communities in the Upper West Region of Ghana, this paper examines women's perspectives on men's involvement in maternal and child healthcare. Findings suggest that although many women recognised the benefits of men's involvement, few actually supported greater male involvement. The majority of women expressed negative attitudes and opinions on the involvement of men. These negative attitudes and opinions were framed by three broad factors: perceptions that pregnancy and child care should be a female role while men should be bread winners; women's desire to avoid negative stereotyping; and fears that men's involvement may turn hitherto secure social spaces for women into insecure ones. These narrative accounts largely challenge current programmatic efforts that seek to promote men's involvement in maternal and child healthcare, and suggest that such male involvement programmes are less likely to succeed if the views and concerns of childbearing women are not taken into account. Copyright © 2016 Elsevier Ltd. All rights reserved.

Maternal complication prevention: evidence from a case-control study in southwest Nigeria

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Kayode O. Osungbade

2014-12-01

Full Text Available Background: The importance of strengthening maternal health services as a preventive intervention for morbidities and complications during pregnancy and delivery in developing countries cannot be over-emphasised, since use of prenatal health services improves maternal health outcomes. Aim: This study investigated differences in risk factors for maternal complications in booked and unbooked pregnant women in Nigeria, and provided evidence for their prevention. Setting: The study was carried out in a postnatal ward in a secondary health facility. Methods: This was a case-control study involving booked and unbooked pregnant women who had delivered. Consecutive enrolment of all unbooked pregnant women (cases was done, and one booked pregnant woman (control was enrolled and matched for age with each of these. Both groups were interviewed using a questionnaire, whilst records of delivery were extracted from the hospital files. Findings were subjected to logistical regression at a significance level of p < 0.05. Results: Booked women had a lower median length of labour (10 hours compared to unbooked women (13 hours. More women in the booked control group (139; 35.1% than in the unbooked case group (96; 23.6% reported at least one type of morbidity during the index pregnancy (p = 0.0004. Booking status was associated with a likelihood of spontaneous vaginal delivery. Young maternal age, low education, rural residence and low socio-economic status were associated with less likelihood of using prenatal services. Young maternal age, low education and intervention in the delivery were associated with a likelihood of experiencing a complication of delivery. Conclusion: Strengthening antenatal and secondary healthcare services as short- and mediumterm measures might be cost-effective as a preventive strategy in complications of pregnancy,whilst socio-economic dimensions of health are accorded priority in the long term.

[Analysis of the healthcare service decentralization process in Côte d'Ivoire].

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Soura, B D; Coulibaly, S S

2014-01-01

The decentralization of healthcare services is becoming increasingly important in strategies of public sector management. This concept is analyzed from various points of view, including legal, economic, political, and sociological. Several typologies have been proposed in the literature to analyze this decentralization process, which can take different forms ranging from simple deconcentration to more elaborate devolution. In some instances, decentralization can be analyzed by the degree of autonomy given to local authorities. This article applies these typologies to analyze the healthcare system decentralization process in Cote d'Ivoire. Special attention is paid to the new forms of community healthcare organizations. These decentralized structures enjoy a kind of autonomy, with characteristics closer to those of devolution. The model might serve as an example for population involvement in defining and managing healthcare problems in Cote d'Ivoire. We end with proposals for the improvement of the process.

Health System Competency for Maternal Health Services in Balasore District and Jaleswar Block, Balasore, Odisha, India: An Assessment.

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Dehury, Ranjit Kumar; Samal, Janmejaya

2016-08-01

A competent health system is of paramount importance in delivering the desired health services in a particular community. The broad objective of this study was to assess the health system competency for the maternal health services in Balasore District and Jaleswar block of Balasore district, Odisha, India. A mixed method approach was adopted in order to understand the health system competency for maternal health services in the study area. There was poor accessibility through road, poor electricity connection and piped water for the health care centers in the district. Even, existing Primary Health Centres (PHCs) lack ECG and X-Ray machines for proper diagnostic services which jeopardize the catering of health services. Community Health Centres (CHC) lack basic diagnostic and ambulance services making the tribal pockets inaccessible. The tribal dominated Jaleswar block shows poor performance in terms of total registered Antenatal Checkups (ANC) (only 77%). A gradual decrease in the rate of ANC, from first to fourthcheckup, was observed in the district. Lack of public health infrastructure in general and non-compliance to Indian Public Health Standards (IPHS) in particular, affect the health of tribal women resulting in lack of interest in availing the institutional delivery services and other pertinent maternal health services.

General service and child immunization-specific readiness assessment of healthcare facilities in two selected divisions in Bangladesh.

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Shawon, Md Shajedur Rahman; Adhikary, Gourab; Ali, Md Wazed; Shamsuzzaman, Md; Ahmed, Shahabuddin; Alam, Nurul; Shackelford, Katya A; Woldeab, Alexander; Lim, Stephen S; Levine, Aubrey; Gakidou, Emmanuela; Uddin, Md Jasim

2018-01-25

Service readiness of health facilities is an integral part of providing comprehensive quality healthcare to the community. Comprehensive assessment of general and service-specific (i.e. child immunization) readiness will help to identify the bottlenecks in healthcare service delivery and gaps in equitable service provision. Assessing healthcare facilities readiness also helps in optimal policymaking and resource allocation. A health facility survey was conducted between March 2015 and December 2015 in two purposively selected divisions in Bangladesh; i.e. Rajshahi division (high performing) and Sylhet division (low performing). A total of 123 health facilities were randomly selected from different levels of service, both public and private, with variation in sizes and patient loads from the list of facilities. Data on various aspects of healthcare facility were collected by interviewing key personnel. General service and child immunization specific service readiness were assessed using the Service Availability and Readiness Assessment (SARA) manual developed by World Health Organization (WHO). The analyses were stratified by division and level of healthcare facilities. The general service readiness index for pharmacies, community clinics, primary care facilities and higher care facilities were 40.6%, 60.5%, 59.8% and 69.5%, respectively in Rajshahi division and 44.3%, 57.8%, 57.5% and 73.4%, respectively in Sylhet division. Facilities at all levels had the highest scores for basic equipment (ranged between 51.7% and 93.7%) and the lowest scores for diagnostic capacity (ranged between 0.0% and 53.7%). Though facilities with vaccine storage capacity had very high levels of service readiness for child immunization, facilities without vaccine storage capacity lacked availability of many tracer items. Regarding readiness for newly introduced pneumococcal conjugate vaccine (PCV) and inactivated polio vaccine (IPV), most of the surveyed facilities reported lack of

MATERNAL AND INFANT HEALTH SECTION OF THE DEMOGRAPHIC AND HEALTH SURVEY REPORT OF GHANA

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Samuel adu Gyamfi

2017-02-01

Full Text Available This article is basically a commentary on some sections on infant and maternal healthcare of the 2008 demographic and health survey of Ghana. The attention of both policy makers and academics are drawn to the need to ensure the expansion of the maternal and infant healthcare in Ghana. In same commentary, attention of readers have been drawn to the proclivity of the free maternal health policy to positively shape maternal and infant care in Ghana

Women's maternity care needs and related service models in rural areas: A comprehensive systematic review of qualitative evidence.

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Hoang, Ha; Le, Quynh; Ogden, Kathryn

2014-12-01

Understanding the needs of rural women in maternity care and service models available to them is significant for the development of effective policies and the sustainability of rural communities. Nevertheless, no systematic review of studies addressing these needs has been conducted. To synthesise the best available evidence on the experiences of women's needs in maternity care and existing service models in rural areas. Literature search of ten electronic databases, digital theses, and reference lists of relevant studies applying inclusion/exclusion criteria was conducted. Selected papers were assessed using standardised critical appraisal instruments from JBI-QARI. Data extracted from these studies were synthesised using thematic synthesis. 12 studies met the inclusion criteria. There were three main themes and several sub-themes identified. A comprehensive set of the maternity care expectations of rural women was reported in this review including safety (7), continuity of care (6) and quality of care (6), and informed choices needs (4). In addition, challenges in accessing maternity services also emerged from the literature such as access (6), risk of travelling (9) and associated cost of travel (9). Four models of maternity care examined in the literature were medically led care (5), GP-led care (4), midwifery-led care (7) and home birth (6). The systematic review demonstrates the importance of including well-conducted qualitative studies in informing the development of evidence-based policies to address women's maternity care needs and inform service models. Synthesising the findings from qualitative studies offers important insight for informing effective public health policy. Copyright © 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Effect of a multifaceted social franchising model on quality and coverage of maternal, newborn, and reproductive health-care services in Uttar Pradesh, India: a quasi-experimental study

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Sarah Tougher, MSc; Varun Dutt, PGDip; Shreya Pereira, MSc; Kaveri Haldar, MPP; Vasudha Shukla, PhD; Kultar Singh, PGDip; Paresh Kumar, PGDip; Prof Catherine Goodman, PhD; Timothy Powell-Jackson, PhD

2018-01-01

Background: How to harness the private sector to improve population health in low-income and middle-income countries is heavily debated and one prominent strategy is social franchising. We aimed to evaluate whether the Matrika social franchising model—a multifaceted intervention that established a network of private providers and strengthened the skills of both public and private sector clinicians—could improve the quality and coverage of health services along the continuum of care for matern...

Obstetric violence: a new framework for identifying challenges to maternal healthcare in Argentina.

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Vacaflor, Carlos Herrera

2016-05-01

Argentina has recognized women's right to not be subjected to obstetric violence, the violence exercised by health personnel on the body and reproductive processes of pregnant women, as expressed through dehumanizing treatment, medicalization abuse, and the conversion of natural processes of reproduction into pathological ones. Argentina's legislative decision to frame this abuse and mistreatment of women under the rubric of gender-based violence permits the identification of failures in both the healthcare system and women's participation in society. This article examines how applying the Violence Against Women framework to address issues of abuse and mistreatment of women during maternal health care provides a beneficial approach for analyzing such embedded structural problems from public health, human rights, and ethics perspectives. The framework of Violence Against Women seeks to transform existing harmful cultural practices, not only through the protection of women's reproductive autonomy, but also through the empowerment of women's participation in society. Copyright © 2016 Elsevier Inc. All rights reserved.

Quality of care and its effects on utilisation of maternity services at ...

African Journals Online (AJOL)

Quality of care and its effects on utilisation of maternity services at health centre level. ... in general, 97% with working hours, but only 37% were satisfied with privacy. ... long waiting time (OR 1.6, p = 0.02) and lack of privacy (OR l.5, p = 0.01).

iMAGE cloud: medical image processing as a service for regional healthcare in a hybrid cloud environment.

Science.gov (United States)

Liu, Li; Chen, Weiping; Nie, Min; Zhang, Fengjuan; Wang, Yu; He, Ailing; Wang, Xiaonan; Yan, Gen

2016-11-01

To handle the emergence of the regional healthcare ecosystem, physicians and surgeons in various departments and healthcare institutions must process medical images securely, conveniently, and efficiently, and must integrate them with electronic medical records (EMRs). In this manuscript, we propose a software as a service (SaaS) cloud called the iMAGE cloud. A three-layer hybrid cloud was created to provide medical image processing services in the smart city of Wuxi, China, in April 2015. In the first step, medical images and EMR data were received and integrated via the hybrid regional healthcare network. Then, traditional and advanced image processing functions were proposed and computed in a unified manner in the high-performance cloud units. Finally, the image processing results were delivered to regional users using the virtual desktop infrastructure (VDI) technology. Security infrastructure was also taken into consideration. Integrated information query and many advanced medical image processing functions-such as coronary extraction, pulmonary reconstruction, vascular extraction, intelligent detection of pulmonary nodules, image fusion, and 3D printing-were available to local physicians and surgeons in various departments and healthcare institutions. Implementation results indicate that the iMAGE cloud can provide convenient, efficient, compatible, and secure medical image processing services in regional healthcare networks. The iMAGE cloud has been proven to be valuable in applications in the regional healthcare system, and it could have a promising future in the healthcare system worldwide.

Maternal and child health and family planning service utilization in Guatemala: implications for service integration.

Science.gov (United States)

Seiber, Eric E; Hotchkiss, David R; Rous, Jeffrey J; Berruti, Andrés A

2005-07-01

Does the utilization of modern maternal and child health (MCH) services influence subsequent contraceptive use? The answer to this question holds important implications for proposals which advocate MCH and family planning service integration. This study uses data from the 1995/6 Guatemalan Demographic Health Survey and its 1997 Providers Census to test the influence of MCH service utilization on individual contraceptive use decisions. We use a full-information maximum likelihood regression model to control for unobserved heterogeneity. This model produces estimates of the MCH effect, independent of individual women's underlying receptiveness to MCH and contraceptive messages. The results of the analysis indicate that the intensity of MCH service use is indeed positively associated with subsequent contraceptive use among Guatemalan women, even after controlling for observed and unobserved individual- , household- , and community-level factors. Importantly, this finding holds even after controlling for the unobserved factors that 'predispose' some women to use both types of services. Simulations reveal that, for these Guatemalan women, key determinants such as age and primary schooling work indirectly through MCH service use to increase contraceptive utilization.

Vertical equity of healthcare in Taiwan: health services were distributed according to need

OpenAIRE

Wang, Shiow-Ing; Yaung, Chih-Liang

2013-01-01

Abstract Introduction To test the hypothesis that the distribution of healthcare services is according to health need can be achieved under a rather open access system. Methods The 2001 National Health Interview Survey of Taiwan and National Health Insurance claims data were linked in the study. Health need was defined by self-perceived health status. We used Concentration index to measure need-related inequality in healthcare utilization and expenditure. Results People with greater health ne...

Reducing stigma among healthcare providers to improve mental health services (RESHAPE): protocol for a pilot cluster randomized controlled trial of a stigma reduction intervention for training primary healthcare workers in Nepal.

Science.gov (United States)

Kohrt, Brandon A; Jordans, Mark J D; Turner, Elizabeth L; Sikkema, Kathleen J; Luitel, Nagendra P; Rai, Sauharda; Singla, Daisy R; Lamichhane, Jagannath; Lund, Crick; Patel, Vikram

2018-01-01

Non-specialist healthcare providers, including primary and community healthcare workers, in low- and middle-income countries can effectively treat mental illness. However, scaling-up mental health services within existing health systems has been limited by barriers such as stigma against people with mental illness. Therefore, interventions are needed to address attitudes and behaviors among non-specialists. Aimed at addressing this gap, RE ducing S tigma among H ealthc A re P roviders to Improv E mental health services (RESHAPE) is an intervention in which social contact with mental health service users is added to training for non-specialist healthcare workers integrating mental health services into primary healthcare. This protocol describes a mixed methods pilot and feasibility study in primary care centers in Chitwan, Nepal. The qualitative component will include key informant interviews and focus group discussions. The quantitative component consists of a pilot cluster randomized controlled trial (c-RCT), which will establish parameters for a future effectiveness study of RESHAPE compared to training as usual (TAU). Primary healthcare facilities (the cluster unit, k  = 34) will be randomized to TAU or RESHAPE. The direct beneficiaries of the intervention are the primary healthcare workers in the facilities ( n  = 150); indirect beneficiaries are their patients ( n  = 100). The TAU condition is existing mental health training and supervision for primary healthcare workers delivered through the Programme for Improving Mental healthcarE (PRIME) implementing the mental health Gap Action Programme (mhGAP). The primary objective is to evaluate acceptability and feasibility through qualitative interviews with primary healthcare workers, trainers, and mental health service users. The secondary objective is to collect quantitative information on health worker outcomes including mental health stigma (Social Distance Scale), clinical knowledge (mh

Co-production of healthcare services with immigrant patients

DEFF Research Database (Denmark)

Radl-Karimi, Christina Mathilde; Nicolaisen, Anne; Sodemann, Morten

2018-01-01

’s methodology for scoping reviews. The data will stem from the following databases: PubMed, Scopus, Ovid EMBASE, EBSCO CINAHL, EBSCO PsycINFO, Cochrane Library, and Web of Science. We will also screen the websites of national authorities and research organisations for publications and review the literature...... a new perspective on how to collaboratively create the highest possible value for both the patient and the healthcare system. The concept acknowledges that all services are co-produced and directs attention to the relationship between patient and care provider. Co-production is still a new concept...

Changes in North Carolina maternal health service use and outcomes among medicaid-enrolled pregnant women during state budget cuts.