WorldWideScience

Sample records for providing maternity services

  1. Costs of publicly provided maternity services in Rosario, Argentina

    Directory of Open Access Journals (Sweden)

    Borghi Josephine

    2003-01-01

    Full Text Available OBJECTIVE: This study estimates the costs of maternal health services in Rosario, Argentina. MATERIAL AND METHODS: The provider costs (US$ 1999 of antenatal care, a normal vaginal delivery and a caesarean section, were evaluated retrospectively in two municipal hospitals. The cost of an antenatal visit was evaluated in two health centres and the patient costs associated with the visit were evaluated in a hospital and a health centre. RESULTS: The average cost per hospital day is $114.62. The average cost of a caesarean section ($525.57 is five times greater than that of a normal vaginal delivery ($105.61. A normal delivery costs less at the general hospital and a c-section less at the maternity hospital. The average cost of an antenatal visit is $31.10. The provider cost is lower at the health centre than at the hospital. Personnel accounted for 72-94% of the total cost and drugs and medical supplies between 4-26%. On average, an antenatal visit costs women $4.70. Direct costs are minimal compared to indirect costs of travel and waiting time. CONCLUSIONS: These results suggest the potential for increasing the efficiency of resource use by promoting antenatal care visits at the primary level. Women could also benefit from reduced travel and waiting time. Similar benefits could accrue to the provider by encouraging normal delivery at general hospitals, and complicated deliveries at specialised maternity hospitals.

  2. Cultural diversity in the Dublin maternity services: the experiences of maternity service providers when caring for ethnic minority women.

    Science.gov (United States)

    Lyons, Suzi M; O'Keeffe, Frances M; Clarke, Anna T; Staines, Anthony

    2008-06-01

    Ireland has seen an expansion of new migrant communities over the past decade and the country has struggled to cope with this new multi-culturalism, especially within the health services. The maternity services in particular have seen an increase in deliveries from ethnic minority women. Little research has been done exploring this issue with maternity service providers. Using a grounded theory approach, this study sought to explore the experiences, understanding and perspectives of maternity service providers when working with ethnic minority women in the Dublin maternity services during 2002 and 2003. Four themes emerged from the study: Communication difficulties, knowledge and use of services, cultural differences and 'Them and Us'. These encompassed a variety of issues including inadequacy of interpretation services, childcare issues, coping with labour, identification as different and racism. Ethnic minority women are expected to adapt to the system rather than the maternity services being responsive or adapting to the new multi-cultural population. These issues were relevant a decade ago internationally and are still pertinent today for not only Irish services but also for other European countries. There is an opportunity to improve the services for all women by learning from the experience of Dublin maternity service providers.

  3. Accessing maternal and child health services in Melbourne, Australia: Reflections from refugee families and service providers

    Directory of Open Access Journals (Sweden)

    Riggs Elisha

    2012-05-01

    Full Text Available Abstract Background Often new arrivals from refugee backgrounds have experienced poor health and limited access to healthcare services. The maternal and child health (MCH service in Victoria, Australia, is a joint local and state government operated, cost-free service available to all mothers of children aged 0–6 years. Although well-child healthcare visits are useful in identifying health issues early, there has been limited investigation in the use of these services for families from refugee backgrounds. This study aims to explore experiences of using MCH services, from the perspective of families from refugee backgrounds and service providers. Methods We used a qualitative study design informed by the socioecological model of health and a cultural competence approach. Two geographical areas of Melbourne were selected to invite participants. Seven focus groups were conducted with 87 mothers from Karen, Iraqi, Assyrian Chaldean, Lebanese, South Sudanese and Bhutanese backgrounds, who had lived an average of 4.7 years in Australia (range one month-18 years. Participants had a total of 249 children, of these 150 were born in Australia. Four focus groups and five interviews were conducted with MCH nurses, other healthcare providers and bicultural workers. Results Four themes were identified: facilitating access to MCH services; promoting continued engagement with the MCH service; language challenges; and what is working well and could be done better. Several processes were identified that facilitated initial access to the MCH service but there were implications for continued use of the service. The MCH service was not formally notified of new parents arriving with young children. Pre-arranged group appointments by MCH nurses for parents who attended playgroups worked well to increase ongoing service engagement. Barriers for parents in using MCH services included access to transportation, lack of confidence in speaking English and making

  4. 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

  5. Staff experiences of providing maternity services in rural southern Tanzania - a focus on equipment, drug and supply issues

    OpenAIRE

    Penfold, S.; Shamba, D; C Hanson; Jaribu, J; Manzi, F.; T Marchant; Tanner, M; Ramsey, K.; SCHELLENBERG, D.; Schellenberg, JA

    2013-01-01

    Background The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse patient outcomes through delaying care provision. We aim to describe staff experiences of providing maternal and neonatal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Methods Focus gro...

  6. Fragmentation of maternal, child and HIV services: A missed opportunity to provide comprehensive care

    Directory of Open Access Journals (Sweden)

    Lyn J. Haskins

    2016-03-01

    Full Text Available Background: In South Africa, coverage of services for mothers and babies in the first year of life is suboptimal despite high immunisation coverage over the same time period. Integration of services could improve accessibility of services, uptake of interventions and retention in care.Aim: This study describes provision of services for mothers and babies aged under 1 year.Setting: Primary healthcare clinics in one rural district in KwaZulu-Natal, South Africa.Methods: All healthcare workers on duty and mothers exiting the clinic after attending well-child services were interviewed. Clinics were mapped to show the route through the clinic taken by mother–baby pairs receiving well-child services, where these services were provided and by whom.Results: Twelve clinics were visited; 116 health workers and 211 mothers were interviewed. Most clinics did not provide comprehensive services for mothers and children. Challenges of structural layout and deployment of equipment led to fragmented services provided by several different health workers in different rooms. Well-child services were frequently provided in public areas of the clinic or with other mothers present. In some clinics mothers and babies did not routinely see a professional nurse. In all clinics HIV-positive mothers followed a different route. Enrolled nurses led the provision of well-child services but did not have skills and training to provide comprehensive care.Conclusions: Fragmentation of clinic services created barriers in accessing a comprehensive package of care resulting in missed opportunities to provide services. Greater integration of services alongside immunisation services is needed.

  7. Staff experiences of providing maternity services in rural southern Tanzania – a focus on equipment, drug and supply issues

    Science.gov (United States)

    2013-01-01

    Background The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse patient outcomes through delaying care provision. We aim to describe staff experiences of providing maternal and neonatal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Methods Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. Results The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures with potential health risks to themselves as a result. Conclusions Inadequately stocked and equipped facilities compromise the health system’s ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions. PMID:23410228

  8. Staff experiences of providing maternity services in rural southern Tanzania - a focus on equipment, drug and supply issues.

    Science.gov (United States)

    Penfold, Suzanne; Shamba, Donat; Hanson, Claudia; Jaribu, Jennie; Manzi, Fatuma; Marchant, Tanya; Tanner, Marcel; Ramsey, Kate; Schellenberg, David; Schellenberg, Joanna Armstrong

    2013-02-14

    The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries, and raise the risk of adverse patient outcomes through delaying care provision. We aim to describe staff experiences of providing maternal and neonatal care in rural health facilities in Southern Tanzania, focusing on issues related to equipment, drugs and supplies. Focus group discussions and in-depth interviews were conducted with different staff cadres from all facility levels in order to explore experiences and views of providing maternity care in the context of poorly maintained equipment, and insufficient drugs and other supplies. A facility survey quantified the availability of relevant items. The facility survey, which found many missing or broken items and frequent stock outs, corroborated staff reports of providing care in the context of missing or broken care items. Staff reported increased workloads, reduced morale, difficulties in providing optimal maternity care, and carrying out procedures with potential health risks to themselves as a result. Inadequately stocked and equipped facilities compromise the health system's ability to reduce maternal and neonatal mortality and morbidity by affecting staff personally and professionally, which hinders the provision of timely and appropriate interventions. Improving stock control and maintaining equipment could benefit mothers and babies, not only through removing restrictions to the availability of care, but also through improving staff working conditions.

  9. Care decision making of frontline providers of maternal and newborn health services in the greater Accra region of Ghana.

    Directory of Open Access Journals (Sweden)

    Ebenezer Oduro-Mensah

    Full Text Available OBJECTIVES: To explore the "how" and "why" of care decision making by frontline providers of maternal and newborn services in the Greater Accra region of Ghana and determine appropriate interventions needed to support its quality and related maternal and neonatal outcomes. METHODS: A cross sectional and descriptive mixed method study involving a desk review of maternal and newborn care protocols and guidelines availability, focus group discussions and administration of a structured questionnaire and observational checklist to frontline providers of maternal and newborn care. RESULTS: Tacit knowledge or 'mind lines' was an important primary approach to care decision making. When available, protocols and guidelines were used as decision making aids, especially when they were simple handy tools and in situations where providers were not sure what their next step in management had to be. Expert opinion and peer consultation were also used through face to face discussions, phone calls, text messages, and occasional emails depending on the urgency and communication medium access. Health system constraints such as availability of staff, essential medicines, supplies and equipment; management issues (including leadership and interpersonal relations among staff, and barriers to referral were important influences in decision making. Frontline health providers welcomed the idea of interventions to support clinical decision making and made several proposals towards the development of such an intervention. They felt such an intervention ought to be multi-faceted to impact the multiple influences simultaneously. Effective interventions would also need to address immediate challenges as well as more long-term challenges influencing decision-making. CONCLUSION: Supporting frontline worker clinical decision making for maternal and newborn services is an important but neglected aspect of improved quality of care towards attainment of MDG 4 & 5. A multi

  10. Staff experiences of providing maternity services in rural southern Tanzania - a focus on equipment, drug and supply issues

    National Research Council Canada - National Science Library

    Penfold, Suzanne; Shamba, Donat; Hanson, Claudia; Jaribu, Jennie; Manzi, Fatuma; Marchant, Tanya; Tanner, Marcel; Ramsey, Kate; Schellenberg, David; Schellenberg, Joanna Armstrong

    2013-01-01

    The poor maintenance of equipment and inadequate supplies of drugs and other items contribute to the low quality of maternity services often found in rural settings in low- and middle-income countries...

  11. Provider perspectives on constraints in providing maternal, neonatal and child health services in the Lao People's democratic republic: a qualitative study.

    Science.gov (United States)

    Sychareun, Vanphanom; Phommachanh, Sysavanh; Soysouvanh, Soudavanh; Lee, Chaeun; Kang, Minah; Oh, Juhwan; Durham, Jo

    2013-12-27

    To reduce its high maternal and neonatal mortality rate and meet Millennium Development Goals four and five, Lao PDR has adopted a national 'Strategy and Planning Framework of Implementation of Maternal, Neonatal and Child Health Services'. This paper reports on implementation constraints identified in three demonstration sites. The objectives of this paper are to analyse health worker perceptions of the implementation of the strategy and constraints faced during implementation. A qualitative design was used with interviews conducted at health facilities in three demonstration provinces. Data were collected through key interviews with provincial/district hospital providers (n = 27), health centre staff (n = 8) and village health volunteers (n = 10). Data was analysed informed by Hanson et al's health system constraint framework. In each of the demonstration sites, the Maternal, Neonatal and Child Health program was generally well-understood and the different activities were being implemented. Perceived implementation constraints related mainly to a mix of supply and demand factors. Supply-side constraints related to inadequate human resources, poor remuneration, weak technical guidance, minimal supervision and limited equipment. Demand-side constraints related mainly to cost, limited access to transport, cultural practices and language. Other constraints related to broader strategic management and cross-sectoral contextual constraints. Contextual constraints included low levels of limited education, women's position in society and poor transport and communications networks. These factors influenced the implementation process and if not addressed, may reduce the effectiveness of the policy and scale-up. The Lao PDR has a well-defined Maternal, Neonatal and Child Health program. Analysis of the constraints experienced by service providers in implementing the program however, is essential for scaling-up the initiative. To achieve effective implementation

  12. Provider perspectives on constraints in providing maternal, neonatal and child health services in the Lao People’s democratic republic: a qualitative study

    Science.gov (United States)

    2013-01-01

    Background To reduce its high maternal and neonatal mortality rate and meet Millennium Development Goals four and five, Lao PDR has adopted a national ‘Strategy and Planning Framework of Implementation of Maternal, Neonatal and Child Health Services’. This paper reports on implementation constraints identified in three demonstration sites. Methods The objectives of this paper are to analyse health worker perceptions of the implementation of the strategy and constraints faced during implementation. A qualitative design was used with interviews conducted at health facilities in three demonstration provinces. Data were collected through key interviews with provincial/district hospital providers (n = 27), health centre staff (n = 8) and village health volunteers (n = 10). Data was analysed informed by Hanson et al’s health system constraint framework. Results In each of the demonstration sites, the Maternal, Neonatal and Child Health program was generally well-understood and the different activities were being implemented. Perceived implementation constraints related mainly to a mix of supply and demand factors. Supply-side constraints related to inadequate human resources, poor remuneration, weak technical guidance, minimal supervision and limited equipment. Demand-side constraints related mainly to cost, limited access to transport, cultural practices and language. Other constraints related to broader strategic management and cross-sectoral contextual constraints. Contextual constraints included low levels of limited education, women’s position in society and poor transport and communications networks. These factors influenced the implementation process and if not addressed, may reduce the effectiveness of the policy and scale-up. Conclusion The Lao PDR has a well-defined Maternal, Neonatal and Child Health program. Analysis of the constraints experienced by service providers in implementing the program however, is essential for scaling-up the

  13. Providing family-centred care for rare diseases in maternity services: Parent satisfaction and preferences when dysmelia is identified.

    Science.gov (United States)

    Johnson, Judith; Adams-Spink, Geoff; Arndt, Tobias; Wijeratne, Dileep; Heyhoe, Jane; Taylor, Peter

    2016-12-01

    Dysmelia is usually detected prenatally or postnatally in maternity services. The provision of family-centred care for parents at the time of initial diagnosis is crucial to facilitate decision making, access to appropriate services, and the provision of parental care-giving, but no research has investigated parent experiences or preferences in this population. The current research aimed to address this by investigating satisfaction with service, occurrence of signposting and preferences in this group. Two online surveys were conducted. In the first survey (n=417), parents reported whether they were offered signposting information and their level of satisfaction with the service they received when initially diagnosed. In the second survey (n=130), a subgroup of participants who completed the first survey reported their preferences for signposting and health service access after diagnosis. On average, participants were less than satisfied with the service they received and only 27% were offered signposting information. Satisfaction was higher amongst parents who had been offered signposting information. 91% of parents said they would have wanted signposting information and 67% would have wanted access to a support group. There is a need to improve the family-centeredness of care when dysmelia is identified. Offering signposting information to relevant third-sector organisations may increase parent satisfaction and address parent preferences. These findings could have implications for parents of children with other rare diseases identified in maternity services. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  14. Understanding Postpartum Healthcare Services and Exploring the Challenges and Motivations of Maternal Health Service Providers in the Philippines: a Qualitative Study.

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    Yamashita, Tadashi; Suplido, Sherri Ann; Llave, Cecilia; Tuliao, Maria Teresa R; Tanaka, Yuko; Matsuo, Hiroya

    2015-06-01

    Given the shortage of medical professionals in the Philippines, Barangay Health Workers (BHWs) may play a role in providing postpartum healthcare services. However, as there are no reports regarding BHW activities in postpartum healthcare, we conducted this study to understand postpartum healthcare services and to explore the challenges and motivations of maternal health service providers. Focus group interview (FGI) of 13 participants was conducted as qualitative research methodology at Muntinlupa City. The results were analyzed according to the interview guide. The proceedings of the FGI were transcribed verbatim, and researchers read and coded the transcripts. The codes were then used to construct categories. Four important activities were highlighted among 11 analysis codes. These activities were "Assessment of postpartum women's conditions," "Recommendation to visit a health facility," "Measurement of blood-pressure and vitamin intake," and "Providing postpartum health information." Among five analysis codes, we identified three challenges that BHWs face, which were "No current information regarding postpartum care," "Some postpartum women do not want to receive healthcare services from BHW," and "Too many assigned postpartum women." Among five analysis codes, we identified two reasons for continuing BHW activities, which were "Hospitality to help postpartum women and their family in the community" and "Performance of mission in providing BHW services." This study is the first to evaluate BHW activities in postpartum healthcare services. Our results indicate that BHWs play a potentially important role in evaluating postpartum women's physical and mental conditions through home-visiting services. However, several difficulties adversely affected their activities, and these must be addressed to maximize the contributions of BHWs to the postpartum healthcare system.

  15. Healthcare provider's attitude towards disability and experience of women with disabilities in the use of maternal healthcare service in rural Nepal.

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    Devkota, Hridaya Raj; Murray, Emily; Kett, Maria; Groce, Nora

    2017-06-29

    Women with disabilities are less likely to receive maternal healthcare services compared to women without disabilities. While few studies have reviewed healthcare experience of women with disabilities, no studies have been conducted to understand provider's attitude towards disability in Nepal, yet the attitude and behaviour of healthcare providers may have a significant influence on aspects of care and the use of service by women with disabilities. This study examines healthcare provider's attitudes towards disability and explores the experience of women with disabilities in maternal healthcare service utilization during pregnancy and childbirth. The study used mixed method approach. An attitude survey was conducted among 396 healthcare providers currently working in public health facilities in Rupandehi district of Nepal. For additional insight, eighteen in-depth interviews with women with disabilities who used maternal healthcare services in a healthcare facility within the study district in their last pregnancy were undertaken. The Attitude Towards Disabled Persons (ATDP) scale score was used to measure the attitudes of healthcare providers. For quantitative data, univariate and multivariate analysis using ANOVA was used to understand the association between outcome and independent variables and qualitative analysis generated and described themes. Mean ATDP score among healthcare providers (78.52; SD = 14.75), was low compared to the normative score of 100 or higher. Nurses/auxiliary nurse midwives obtained the highest mean score (85.59, SD = 13.45), followed by general clinical health workers (Mean score = 82.64, SD 15.10). The lowest score was obtained by Female Community Health Volunteers (FCHV) (Score = 73.75, SD = 13.40) (P disability (P disability training and who did not was also found statistically insignificant (P > 0.05). This may reflect the small number of individuals, who have had training on disability thus far, or the nature or

  16. Building Service Provider Capabilities

    DEFF Research Database (Denmark)

    Brandl, Kristin; Jaura, Manya; Ørberg Jensen, Peter D.

    In this paper we study whether and how the interaction between clients and the service providers contributes to the development of capabilities in service provider firms. In situations where such a contribution occurs, we analyze how different types of activities in the production process...

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

    Science.gov (United States)

    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

  18. Service Availability and Readiness Assessment of Maternal ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    The Service Availability and Readiness Assessment (SARA) survey was adapted and used to generate information on service availability and the readiness of maternal, newborn and child health facilities to provide basic health care interventions for obstetric care, neonatal and child health in Madagascar. The survey ...

  19. Provider of Services File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it...

  20. Provider of Services File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The POS file contains data on characteristics of hospitals and other types of healthcare facilities, including the name and address of the facility and the type of...

  1. Querying Data Providing Web Services

    OpenAIRE

    Sabesan, Manivasakan

    2010-01-01

    Web services are often used for search computing where data is retrieved from servers providing information of different kinds. Such data providing web services return a set of objects for a given set of parameters without any side effects. There is need to enable general and scalable search capabilities of data from data providing web services, which is the topic of this Thesis. The Web Service MEDiator (WSMED) system automatically provides relational views of any data providing web service ...

  2. Ecosystem services provided by waterbirds.

    Science.gov (United States)

    Green, Andy J; Elmberg, Johan

    2014-02-01

    Ecosystem services are ecosystem processes that directly or indirectly benefit human well-being. There has been much recent literature identifying different services and the communities and species that provide them. This is a vital first step towards management and maintenance of these services. In this review, we specifically address the waterbirds, which play key functional roles in many aquatic ecosystems, including as predators, herbivores and vectors of seeds, invertebrates and nutrients, although these roles have often been overlooked. Waterbirds can maintain the diversity of other organisms, control pests, be effective bioindicators of ecological conditions, and act as sentinels of potential disease outbreaks. They also provide important provisioning (meat, feathers, eggs, etc.) and cultural services to both indigenous and westernized societies. We identify key gaps in the understanding of ecosystem services provided by waterbirds and areas for future research required to clarify their functional role in ecosystems and the services they provide. We consider how the economic value of these services could be calculated, giving some examples. Such valuation will provide powerful arguments for waterbird conservation. © 2013 The Authors. Biological Reviews © 2013 Cambridge Philosophical Society.

  3. Service availability and readiness assessment of maternal, newborn ...

    African Journals Online (AJOL)

    The Service Availability and Readiness Assessment (SARA) survey was adapted and used to generate information on service availability and the readiness of maternal, newborn and child health facilities to provide basic health care interventions for obstetric care, neonatal and child health in Madagascar. The survey ...

  4. Ancillary Services Provided from DER

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, J.B.

    2005-12-21

    Distributed energy resources (DER) are quickly making their way to industry primarily as backup generation. They are effective at starting and then producing full-load power within a few seconds. The distribution system is aging and transmission system development has not kept up with the growth in load and generation. The nation's transmission system is stressed with heavy power flows over long distances, and many areas are experiencing problems in providing the power quality needed to satisfy customers. Thus, a new market for DER is beginning to emerge. DER can alleviate the burden on the distribution system by providing ancillary services while providing a cost adjustment for the DER owner. This report describes 10 types of ancillary services that distributed generation (DG) can provide to the distribution system. Of these 10 services the feasibility, control strategy, effectiveness, and cost benefits are all analyzed as in the context of a future utility-power market. In this market, services will be provided at a local level that will benefit the customer, the distribution utility, and the transmission company.

  5. 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.

  6. Preparing to provide MTM services.

    Science.gov (United States)

    Glenn, Zandra M; Mahdavian, Soheyla L; Woodard, Todd J

    2015-02-01

    Medication Therapy Management (MTM) has been a way for pharmacist to enhance their position as an integral member of the health care team as the need for improved clinical and economic outcomes in relation to the US health care system became apparent. MTM Certificate training programs are provided by numerous organizations. Collaboration Practice Agreements (CPA) are gaining significance as the role of the pharmacist is expanding in the care of patients as part of a multidisciplinary health care team. One major hurdle that many pharmacists are faced with is receiving reimbursement for the services provided. The Medicare Modernization Act of 2003 recognized that pharmacists play an important role in the management of patient care and that pharmacists bring an expertise and knowledge that will help to identify and resolve patient medication therapy problems. © The Author(s) 2014.

  7. Factors affecting maternal health care services utilization in rural ...

    African Journals Online (AJOL)

    admin

    Conclusion: In order to increase utilization of mother health care services and improve maternal health care utilization services in rural Ethiopia critical ... maternal health care services is essential for further improvement of maternal and child ... doctor, nurse, or midwife) at least once during pregnancy, i.e., antenatal care; ...

  8. Ecosystem services provided by birds.

    Science.gov (United States)

    Whelan, Christopher J; Wenny, Daniel G; Marquis, Robert J

    2008-01-01

    Ecosystem services are natural processes that benefit humans. Birds contribute the four types of services recognized by the UN Millennium Ecosystem Assessment-provisioning, regulating, cultural, and supporting services. In this review, we concentrate primarily on supporting services, and to a lesser extent, provisioning and regulating services. As members of ecosystems, birds play many roles, including as predators, pollinators, scavengers, seed dispersers, seed predators, and ecosystem engineers. These ecosystem services fall into two subcategories: those that arise via behavior (like consumption of agricultural pests) and those that arise via bird products (like nests and guano). Characteristics of most birds make them quite special from the perspective of ecosystem services. Because most birds fly, they can respond to irruptive or pulsed resources in ways generally not possible for other vertebrates. Migratory species link ecosystem processes and fluxes that are separated by great distances and times. Although the economic value to humans contributed by most, if not all, of the supporting services has yet to be quantified, we believe they are important to humans. Our goals for this review are 1) to lay the groundwork on these services to facilitate future efforts to estimate their economic value, 2) to highlight gaps in our knowledge, and 3) to point to future directions for additional research.

  9. Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review.

    Science.gov (United States)

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

    2016-12-01

    Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were considered. Fifteen studies describing a range of interventions met the inclusion criteria. Data were extracted on population and intervention characteristics; study design; definitions and data for relevant outcomes; and the contexts and conditions in which interventions occurred. Because most of the included studies focus on antenatal care outcomes, evidence of impact is particularly limited for care seeking for birth and after birth. Evidence in this review is clustered within a small number of countries, and evidence from low- and middle-income countries is notably lacking. Interventions largely had positive effects on uptake of skilled maternity care. Cultural factors are often not the sole factor affecting populations' use of maternity care services. Broader social, economic, geographical and political factors interacted with cultural factors to affect targeted populations' access to services in included studies. Programmes and policies should seek to establish an enabling environment and support respectful dialogue with communities to improve use of skilled maternity care. Whilst issues of culture are being recognized by programmes and researchers as being important, interventions that explicitly incorporate issues of culture are rarely evaluated. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  10. 75 FR 6839 - Technical Service Provider Assistance

    Science.gov (United States)

    2010-02-12

    ... Conservation Service 7 CFR Part 652 RIN 0578-AA48 Technical Service Provider Assistance AGENCY: Natural... Final rule amends the Natural Resources Conservation Service (NRCS) regulations for technical service provider (TSP) provisions under the Food Security Act of 1985. The Food, Conservation, and Energy Act of...

  11. Reforming maternity services in Australia: Outcomes of a private practice midwifery service.

    Science.gov (United States)

    Wilkes, E; Gamble, J; Adam, Ghazala; Creedy, D K

    2015-10-01

    recent legislative changes in Australia have enabled eligible midwives to provide private primary maternity care with fee rebates through Medicare. This paper (1) discusses these changes affecting midwifery practice; (2) describes Australia's first private midwifery service with visiting rights to hospital for labour and birth care since Medicare funding for midwives was introduced in 2010; and (3) compares outcomes with National Core Maternity Indicators. an audit of all client records (n=323) for the survey period from September 2012 to February 2014 was undertaken. Data were extracted and compared with the 10 perinatal indicators using Chi square statistics. this convenience sample of all-risk women was similar to the national birthing population for age and parity. Compared to national indicators, women were significantly more likely to have spontaneous commencement of labour (79.6% versus 54.8%) (χ(2)=79.88, pmidwifery service in Australia since the introduction of access to Medicare for midwives. Maternal and newborn outcomes were statistically better than national rates. Routinely reporting and publishing clinical outcomes needs to become the norm for private maternity care. this private midwifery caseload model has been instrumental in the ground-breaking change to primary maternity services that extends women׳s access to safe midwifery care in Australia. The potential impact of private practicing midwives to align maternity care with the best available evidence is significant. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Critical discourse analysis: understanding change in maternity services.

    Science.gov (United States)

    McIntyre, Meredith; Francis, Karen; Chapman, Ysanne

    2012-02-01

    This paper provides an example of the use of critical discourse analysis (CDA) in the area of maternity care policy and describes the process of CDA as an effective research method for understanding the influences of change in the context of Australian maternity services. CDA is a methodological approach that examines how discourse is formed and given power, as a result of how power is used, who uses it and the context within which this usage takes place. The application of CDA is described in this study for the purpose of examining key-stakeholder use of knowledge and power for the purpose of influencing the direction of the maternity services reform. The CDA theoretical framework guided discourse identification and analysis of the purpose behind the discourse through examination of power relationships between key stakeholders. The use of a theoretical lens in the form of neoliberalism to supplement the theoretical framework facilitated the exposure of forces intrinsic to the maternity care context driving change. © 2012 Blackwell Publishing Asia Pty Ltd.

  13. Maternity care providers' perceptions of women's autonomy and the law.

    Science.gov (United States)

    Kruske, Sue; Young, Kate; Jenkinson, Bec; Catchlove, Ann

    2013-04-04

    Like all health care consumers, pregnant women have the right to make autonomous decisions about their medical care. However, this right has created confusion for a number of maternity care stakeholders, particularly in situations when a woman's decision may lead to increased risk of harm to the fetus. Little is known about care providers' perceptions of this situation, or of their legal accountability for outcomes experienced in pregnancy and birth. This paper examined maternity care providers' attitudes and beliefs towards women's right to make autonomous decisions during pregnancy and birth, and the legal responsibility of professionals for maternal and fetal outcomes. Attitudes and beliefs around women's autonomy and health professionals' legal accountability were measured in a sample of 336 midwives and doctors from both public and private health sectors in Queensland, Australia, using a questionnaire available online and in paper format. Student's t-test was used to compare midwives' and doctors' responses. Both maternity care professionals demonstrated a poor understanding of their own legal accountability, and the rights of the woman and her fetus. Midwives and doctors believed the final decision should rest with the woman; however, each also believed that the needs of the woman may be overridden for the safety of the fetus. Doctors believed themselves to be ultimately legally accountable for outcomes experienced in pregnancy and birth, despite the legal position that all health care professionals are responsible only for adverse outcomes caused by their own negligent actions. Interprofessional differences were evident, with midwives and doctors significantly differing in their responses on five of the six items. Maternity care professionals inconsistently supported women's right to autonomous decision making during pregnancy and birth. This finding is further complicated by care providers' poor understanding of legal accountability for outcomes experienced

  14. Understanding barriers to maternal child health services utilisation ...

    African Journals Online (AJOL)

    This study sought to create better understanding about existing barriers to the use of maternal and child health services in northern Ghana. Using the survey research design, the study integrates outcome and process approaches to assessing barriers to the utilisation of maternal health services. Data were collected through ...

  15. Provider Customer Service Program - Performance Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS is continuously analyzing performance and quality of the Provider Customer Service Programs (PCSPs) of the contractors and will be identifying trends and making...

  16. Data Service Provider Cost Estimation Tool

    Science.gov (United States)

    Fontaine, Kathy; Hunolt, Greg; Booth, Arthur L.; Banks, Mel

    2011-01-01

    The Data Service Provider Cost Estimation Tool (CET) and Comparables Database (CDB) package provides to NASA s Earth Science Enterprise (ESE) the ability to estimate the full range of year-by-year lifecycle cost estimates for the implementation and operation of data service providers required by ESE to support its science and applications programs. The CET can make estimates dealing with staffing costs, supplies, facility costs, network services, hardware and maintenance, commercial off-the-shelf (COTS) software licenses, software development and sustaining engineering, and the changes in costs that result from changes in workload. Data Service Providers may be stand-alone or embedded in flight projects, field campaigns, research or applications projects, or other activities. The CET and CDB package employs a cost-estimation-by-analogy approach. It is based on a new, general data service provider reference model that provides a framework for construction of a database by describing existing data service providers that are analogs (or comparables) to planned, new ESE data service providers. The CET implements the staff effort and cost estimation algorithms that access the CDB and generates the lifecycle cost estimate for a new data services provider. This data creates a common basis for an ESE proposal evaluator for considering projected data service provider costs.

  17. 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.

  18. Using multi-country household surveys to understand who provides reproductive and maternal health services in low- and middle-income countries: a critical appraisal of the Demographic and Health Surveys.

    Science.gov (United States)

    Footman, K; Benova, L; Goodman, C; Macleod, D; Lynch, C A; Penn-Kekana, L; Campbell, O M R

    2015-05-01

    The Demographic and Health Surveys (DHS) are a vital data resource for cross-country comparative analyses. This study is part of a set of analyses assessing the types of providers being used for reproductive and maternal health care across 57 countries. Here, we examine some of the challenges encountered using DHS data for this purpose, present the provider classification we used, and provide recommendations to enable more detailed and accurate cross-country comparisons of healthcare provision. We used the most recent DHS surveys between 2000 and 2012; 57 countries had data on family planning and delivery care providers and 47 countries had data on antenatal care. Every possible response option across the 57 countries was listed and categorised. We then developed a classification to group provider response options according to two key dimensions: clinical nature and profit motive. We classified the different types of maternal and reproductive healthcare providers, and the individuals providing care. Documented challenges encountered during this process were limitations inherent in household survey data based on respondents' self-report; conflation of response options in the questionnaire or at the data processing stage; category errors of the place vs. professional for delivery; inability to determine whether care received at home is from the public or private sector; a large number of negligible response options; inconsistencies in coding and analysis of data sets; and the use of inconsistent headings. To improve clarity, we recommend addressing issues such as conflation of response options, data on public vs. private provider, inconsistent coding and obtaining metadata. More systematic and standardised collection of data would aid international comparisons of progress towards improved financial protection, and allow us to better characterise the incentives and commercial nature of different providers. © 2015 The Authors. Tropical Medicine & International Health

  19. Effectiveness of interventions to provide culturally appropriate maternity care in increasing uptake of skilled maternity care: a systematic review

    OpenAIRE

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

    2016-01-01

    Addressing cultural factors that affect uptake of skilled maternity care is recognized as an important step in improving maternal and newborn health. This article describes a systematic review to examine the evidence available on the effects of interventions to provide culturally appropriate maternity care on the use of skilled maternity care during pregnancy, for birth or in the postpartum period. Items published in English, French and/or Spanish between 1 January 1990 and 31 March 2014 were...

  20. 75 FR 48273 - Technical Service Provider Assistance

    Science.gov (United States)

    2010-08-10

    ... provisions by expanding the definition Technical Service Provider Assistance, which contained an error in the omission of ``Indian Tribe'' in the definition of Technical Service Provider. DATES: Effective Date: This amendment is effective on August 10, 2010. FOR FURTHER INFORMATION CONTACT: Angel Figueroa, Team Leader...

  1. Dynamics of ecosystem services provided by subtropical ...

    Science.gov (United States)

    The trends in the provision of ecosystem services during restoration and succession of subtropical forests and plantations were quantified, in terms of both receiver and donor values, based on a case study of a 3-step secondary succession series that included a 400-year-old subtropical forest and a 23-year history of growth on 3 subtropical forest plantations in Southeastern China. The ‘People's Republic of China Forestry Standard: Forest Ecosystem Service Valuation Norms’ was revised and applied to quantify the receiver values of ecosystem services, which were then compared with the emergy-based, donor values of the services. The results revealed that the efficiencies of subtropical forests and plantations in providing ecosystem services were 2 orders of magnitude higher than similar services provided by the current China economic system, and these efficiencieskept increasing over the course of succession. As a result, we conclude that afforestation is an efficient way to accelerate both the ability and efficiency of subtropical forests to provide ecosystem services. This paper is significant because it examines the dynamics of the provision of ecosystem services by forests over a succession series that spans 400 years. The paper also examines the rate of increase of services during forest restoration over a period of 23 years. The emergy used in ecosystem services provision is compared to the provision of similar services by economic means in the Chinese e

  2. Service Provider Revenue Dependence of Offered Number of Service Classes

    National Research Council Canada - National Science Library

    V. S. Aćimović-Raspopović; V. Radonjić

    2011-01-01

    In this paper possible applications of responsive pricing scheme and Stackelberg game for pricing telecommunication services with service provider as a leader and users acting as followers are analyzed...

  3. Perceived barriers to utilization of maternal health services in rural Cambodia.

    Science.gov (United States)

    Matsuoka, Sadatoshi; Aiga, Hirotsugu; Rasmey, Lon Chan; Rathavy, Tung; Okitsu, Akiko

    2010-05-01

    The aim of this study was to identify the underlying causes of Cambodian women's non-use of maternal health services provided by skilled birth attendants. A qualitative study of 66 reproductive-age women was conducted in Kampong Cham Province, Cambodia. Data were collected through 30 semi-structured interviews and 6 focus groups. We identified 5 barriers to the utilization of maternal health services: (i) financial barriers; (ii) physical barriers; (iii) cognitive barriers; (iv) organizational barriers; and (v) psychological and socio-cultural barriers. The Cambodian Ministry of Health and its development partners should take these barriers into account when promoting the use of maternal health services. These barriers should be addressed proactively. A successful approach to increasing use of maternal health services should involve changes to both service programs and public education. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  4. Maternal Health Care Services Utilization in Tea Gardens of ...

    African Journals Online (AJOL)

    Mubeen

    Background: Since independence, the Government of India has made great efforts to curb maternal mortality and morbidity by introducing ... mortality and morbidity, which is compounded by low utilization of maternal health care services. Aim: The study ...... utilisation in Maharashtra: Associated influences on infant mortality.

  5. Barriers to maternal health service use in Chikhwawa, Southern ...

    African Journals Online (AJOL)

    Abstract. Introduction. Research was conducted to get a community's perspective on the factors contributing to continued maternal and neonatal deaths. The aim of the study was to identify and understand experiences, perceptions and needs of the community on maternal health service utilization. Methods. Qualitative data ...

  6. Client Provider Collaboration for Service Bundling

    Directory of Open Access Journals (Sweden)

    LETIA, I. A.

    2008-04-01

    Full Text Available The key requirement for a service industry organization to reach competitive advantages through product diversification is the existence of a well defined method for building service bundles. Based on the idea that the quality of a service or its value is given by the difference between expectations and perceptions, we draw the main components of a frame that aims to support the client and the provider agent in an active collaboration meant to co-create service bundles. Following e3-value model, we structure the supporting knowledge around the relation between needs and satisfying services. We deal with different perspectives about quality through an ontological extension of Value Based Argumentation. The dialog between the client and the provider takes the form of a persuasion whose dynamic object is the current best configuration. Our approach for building service packages is a demand driven approach, allowing progressive disclosure of private knowledge.

  7. Oregon's mobility needs : social service provider survey

    Science.gov (United States)

    1999-06-01

    In 1998, the Oregon Department of Transportation undertook the Social Services Provider Survey as part of an investigation of the transportation needs of mobility impaired individuals in Oregon. This survey was designed to gain information about the ...

  8. VT Wireless Internet Service Providers 2006

    Data.gov (United States)

    Vermont Center for Geographic Information — (Link to Metadata) The VT Wireless Internet Service Provider (ISP) dataset (WISP2006) includes polygons depicting the extent of Vermont's WISP broadband system as of...

  9. VT Wireless Internet Service Providers 2007

    Data.gov (United States)

    Vermont Center for Geographic Information — (Link to Metadata) The VT Wireless Internet Service Provider (ISP) dataset (WISP2007) includes polygons depicting the extent of Vermont's WISP broadband system as of...

  10. Supercomputing Centers and Electricity Service Providers

    DEFF Research Database (Denmark)

    Patki, Tapasya; Bates, Natalie; Ghatikar, Girish

    2016-01-01

    Supercomputing Centers (SCs) have high and variable power demands, which increase the challenges of the Electricity Service Providers (ESPs) with regards to efficient electricity distribution and reliable grid operation. High penetration of renewable energy generation further exacerbates this pro......Supercomputing Centers (SCs) have high and variable power demands, which increase the challenges of the Electricity Service Providers (ESPs) with regards to efficient electricity distribution and reliable grid operation. High penetration of renewable energy generation further exacerbates...

  11. Determinants of Utilization of Maternal Health Services Among ...

    African Journals Online (AJOL)

    Background: Utilization of health services is a complex behavioral phenomenon, related to the availability, quality and cost of services, social structure, health beliefs and characteristics of the users. Objective: This study was carried out to examine factors influencing the use of maternal health care services amongst traders ...

  12. Logistic service providers and sustainable physical distribution

    Directory of Open Access Journals (Sweden)

    Stef Weijers

    2012-06-01

    Full Text Available Background: Logistic Service Providers main concern was to ensure reliability for a low price (Christopher, 2005. Dutch Logistic Service Providers still have these two aspects at the top of their list, but also have to take in a new aspect: sustainability. 88% Of the investigated Logistic Service Providers have included sustainability in the company's goals. These Logistic Service Providers have developed different strategies to achieve a higher level of sustainability. This paper presents the results of a study into what Logistic Service Providers say what they are doing, or intend to do, to improve sustainability for their transport services. In this way insight is given in the attitude of Dutch Logistic Service Providers towards sustainability and how they intend to translate this into business practise: internal solutions or new methods incorporating external partners. Methods: Various methods of the investigations were used, among which the analysis of the statements about the sustainabilityon the websites of various companies as well as the questionnaire per Internet. The research covered 50 largest logistics companies operating in the Netherlands and 60 companies that competed for the award "Lean and Green" advertised in the Netherlands. In addition, the Internet survey was answered by 41 companies that belong to the network of our university. Results: The investigation has shown that sustainability is handled by the logistics company as an integral part of the corporate strategy. In contrast, shippers depend in the choice of logistics services primarily on such classical aspects as the reliability or the price and the sustainability play a minor role. Conclusions: Trying to find methods to improve the sustainability, Dutch logistics service providers, in the first place, look for solutions that increase the efficiency and therefore the cost reduction potential. Solutions, which require the involvement of clients, were less often

  13. Lesbian co-mothers' experiences of maternity healthcare services.

    Science.gov (United States)

    Cherguit, Jasmina; Burns, Jan; Pettle, Sharon; Tasker, Fiona

    2013-06-01

    This article is a report of a study of lesbian co-mothers' experiences of UK maternity healthcare services. With the increase in fertility provision to lesbian couples, maternity healthcare services are increasingly coming into contact with lesbian co-mothers. Literature highlights the need to investigate donor-conceived lesbian families and an absence of research focusing on the unique experiences of co-mothers in the maternity process. The study followed a qualitative design and interpretative phenomenological analysis methodology. A qualitative study was carried out involving ten lesbian co-mothers, whose children were conceived via anonymous donor insemination to their partners. Data collection took place between May-September 2009. Interpretative phenomenological analysis revealed two main types of co-mothers' experiences, those connected with maternity service structures and interpersonal experiences with maternity care staff. Co-mothers felt excluded by heterocentric organizational service structures. However, the co-mothers' overwhelming experiences with staff were positive and inclusive. Despite this, co-mothers reported that any ambiguous or non-inclusive experiences with professionals left them questioning whether these experiences were due to homophobic attitudes or professional incompetence. The results indicate that these lesbian co-mothers felt predominantly included and accepted by maternity services. Ambiguous interpersonal experiences, however, evoked doubts in this regard. In addition, organizational heterocentric structural barriers remain. Structural service delivery changes could facilitate co-mothers' feelings of inclusion and highlight the important role practitioners have in contributing to co-mothers' experiences. © 2012 Blackwell Publishing Ltd.

  14. Providing Secure Web Services for Mobile Applications

    OpenAIRE

    Kivisaari, Tero

    2015-01-01

    Changing consumer behavior drives the demand for convenient and easy-to-use mobile applications across industries. This also impacts the financial sector. Banks are eager to offer their services as mobile applications to match the modern consumer needs. The mobile applications are not independently able to provide the required functionality; they interact with the existing core business functions by consuming secure Web Services over the Internet. The thesis analyses th...

  15. 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

  16. Providing effective maternity care for women affected by fibromyalgia

    OpenAIRE

    King, Denyse

    2011-01-01

    Fibromyalgia is a condition for which information is not readily accessible in midwifery or obstetric text books. This ‘invisible disability’ can have detrimental implications for all aspects of maternity care. From the physiology and psychology of fibromyalgia during the antenatal through to the postnatal period, this article highlights key issues which can have a hidden but significant impact on the maternity experience
of women with fibromyalgia. The author explores these issues and sugges...

  17. Scalable service architecture for providing strong service guarantees

    Science.gov (United States)

    Christin, Nicolas; Liebeherr, Joerg

    2002-07-01

    For the past decade, a lot of Internet research has been devoted to providing different levels of service to applications. Initial proposals for service differentiation provided strong service guarantees, with strict bounds on delays, loss rates, and throughput, but required high overhead in terms of computational complexity and memory, both of which raise scalability concerns. Recently, the interest has shifted to service architectures with low overhead. However, these newer service architectures only provide weak service guarantees, which do not always address the needs of applications. In this paper, we describe a service architecture that supports strong service guarantees, can be implemented with low computational complexity, and only requires to maintain little state information. A key mechanism of the proposed service architecture is that it addresses scheduling and buffer management in a single algorithm. The presented architecture offers no solution for controlling the amount of traffic that enters the network. Instead, we plan on exploiting feedback mechanisms of TCP congestion control algorithms for the purpose of regulating the traffic entering the network.

  18. Constraints to utilization of maternal health services at the primary ...

    African Journals Online (AJOL)

    ... of drugs (11.1%). Conclusion: This study found that apart from ante-natal care, other maternal health services were underutilized. Funding, good access roads, affordable transportation and appropriately integrated services would boost utilization. Keywords: Accessibility, drugs, education, equipment, funds, transportation ...

  19. Client satisfaction with maternal health services comparism between ...

    African Journals Online (AJOL)

    Background: One principal determinant of uptake and continued utilization of maternal health services is overall client satisfaction. The public and private sectors supply substantial portions of these services in developing countries, but face different challenges. This study aimed at determining the differences in the quality of ...

  20. Socio-demographic determinants of maternal health-care service ...

    African Journals Online (AJOL)

    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 ...

  1. Factors Influencing Self Employment Media Service Providers ...

    African Journals Online (AJOL)

    Multiple regression analysis of our data showed that common business practices and introvert and extrovert personality traits, out of the nine causal variables predicted media self employment providing services among male graduates. Among the females graduates, only common business practices and introvert personality ...

  2. Effectiveness of Reference Services in Providing Students ...

    African Journals Online (AJOL)

    information centre to the community of users. But many have failed to serve this purpose after spending lots of money due to some reason and the other. This survey study is aimed at assessing Effectiveness of Reference Services in Providing Students' Information Needs in. Some Selected Tertiary Institutions in Borno State ...

  3. ACCOUNTING TREATMENTS USED FOR ACCOUNTING SERVICES PROVIDERS

    Directory of Open Access Journals (Sweden)

    ŢOGOE GRETI DANIELA

    2014-08-01

    Full Text Available The theme of our research is the ways of keeping accounting entities that are the object of the provision of services in the accounting profession. This paper aims to achieve a parallel between the ways of organizing financial records - accounting provided by freelancers and companies with activity in the financial - accounting. The first step in our scientific research is to establish objectives chosen area of scientific knowledge. Our scientific approach seeks to explain through a thorough and detailed approach as different sides (conceptual and practical looking projections of accounting issues related to regulatory developments and practices in the field. This paper addresses various concepts, accounting treatments, and books and accounting documents used both freelancers in providing accounting services and legal persons authorized accounting profession. In terms of methodology and research perspective, the whole scientific approach combined with quantitative and qualitative research theoretical perspective (descriptive-conceptual with practice perspective (empirical analyzing the main contributions of various authors (Romanian and foreign to knowledge in the field. Following the survey believe that the amendments to the national legislation will support entities providing accounting services, by cutting red tape on Administrative Burdens, and consequently will increase profitability and increase service quality.

  4. Maternal health services in South Africa

    African Journals Online (AJOL)

    Heads of nursing teaching institutions. Primary care staff. Opinions on service development. Views on reproductive health services and requirements for .... Sexuality education. Infertility investigation. Menopause services. Cervical cancer screen. Table Ill. Time in clinic and time receiving care in the Northern Cape and North ...

  5. Management Standards Integration in Service Providing Organizations

    OpenAIRE

    Anton Persic; Mirko Markic

    2012-01-01

    The purpose of the paper is to define key leadership models, to recognize advantages and benefits, and define influence factors of business success on leadership systems integration in service providing organizations in Slovenia. We use quantitative research with frequent analysis complex questions to present and analyse some factors of leadership standards and build a new regression leadership model of organization. We have sent the questionnaire to 89 organizations, all with certificate sys...

  6. Exploring provider perspectives on respectful maternity care in Kenya: "Work with what you have".

    Science.gov (United States)

    Ndwiga, Charity; Warren, Charlotte E; Ritter, Julie; Sripad, Pooja; Abuya, Timothy

    2017-08-22

    Promoting respect and dignity is a key component of providing quality care during facility-based childbirth and is becoming a critical indicator of maternal health care. Providing quality care requires essential skills and attitudes from healthcare providers, as their role is central to optimizing interventions in maternity settings. In 13 facilities in Kenya we conducted a mixed methods, pre-post study design to assess health providers' perspectives of a multi-component intervention (the Heshima project), which aimed to mitigate aspects of disrespect and abuse during facility-based childbirth. Providers working in maternity units at study facilities were interviewed using a two-part quantitative questionnaire: an interviewer-guided section on knowledge and practice, and a self-administered section focusing on intrinsic value systems and perceptions. Eleven distinct composite scores were created on client rights and care, provider emotional wellbeing, and work environments. Bivariate analyses compared pre- and post-scores. Qualitative in-depth interviews focused on underlying factors that affected provider attitudes and behaviors including the complexities of service delivery, and perceptions of the Heshima interventions. Composite scales were developed on provider knowledge of client rights (Chronbach α = 0.70), client-centered care (α = 0.80), and HIV care (α = 0.81); providers' emotional health (α = 0.76) and working relationships (α = 0.88); and provider perceptions of management (α = 0.93), job fairness (α = 0.68), supervision (α = 0.84), promotion (α = 0.83), health systems (α = 0.85), and work environment (α = 0.85). Comparison of baseline and endline individual item scores and composite scores showed that provider knowledge of client rights and practice of a rights-based approach, treatment of clients living with HIV, and client-centered care during labor, delivery, and postnatal periods improved (p maternity care. Behavior

  7. Problems of providing services to people affected by HIV/AIDS: service providers and recipients perspectives.

    Science.gov (United States)

    Moradi, G; Mohraz, M; Gouya, M M; Dejman, M; Alinaghi, S S; Rahmani, K; Malekafzali-Ardakani, H

    2015-02-25

    This qualitative study aimed to identify the health-care problems of people living with HIV (PLHIV) in 2 large cities: Tehran and Kermanshah. Two main groups of stakeholders - service providers (policy-makers, managers, physicians and counsellors) and service recipients (PLHIV and their relatives) - participated in focus group discussions and in-depth interviews. We identified 24 themes covering the major health problems of PLHIV, including: incomplete and inadequate coverage of health-care services; patients' substance abuse; patients' fear of stigma; occupational burnout of certain service providers; patients' dissatisfaction with some of the services provided by counselling centres/clinics; medical staff's failure to observe confidentiality; and patients' lack of access to required specialized services. The problems and needs identified can inform the design and implementation of health programmes in our country and elsewhere in the Eastern Mediterranean Region.

  8. Cost Calculation Model for Logistics Service Providers

    Directory of Open Access Journals (Sweden)

    Zoltán Bokor

    2012-11-01

    Full Text Available The exact calculation of logistics costs has become a real challenge in logistics and supply chain management. It is essential to gain reliable and accurate costing information to attain efficient resource allocation within the logistics service provider companies. Traditional costing approaches, however, may not be sufficient to reach this aim in case of complex and heterogeneous logistics service structures. So this paper intends to explore the ways of improving the cost calculation regimes of logistics service providers and show how to adopt the multi-level full cost allocation technique in logistics practice. After determining the methodological framework, a sample cost calculation scheme is developed and tested by using estimated input data. Based on the theoretical findings and the experiences of the pilot project it can be concluded that the improved costing model contributes to making logistics costing more accurate and transparent. Moreover, the relations between costs and performances also become more visible, which enhances the effectiveness of logistics planning and controlling significantly

  9. 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

  10. Maternal health services in South Africa

    African Journals Online (AJOL)

    acceptable services are reasonable and minimalist. Women .mVolume 88 No.6 June 1998 SAMJ want to feel attended to, to be treated with care and respect, to deliver in a safe, clean environment and to know that the service can deal with complications. Many problems cited relate to poor communication between health ...

  11. Using multi-country household surveys to understand who provides reproductive and maternal health services in low- and middle-income countries: a critical appraisal of the Demographic and Health Surveys

    Science.gov (United States)

    Footman, K; Benova, L; Goodman, C; Macleod, D; Lynch, C A; Penn-Kekana, L; Campbell, O M R

    2015-01-01

    Objective The Demographic and Health Surveys (DHS) are a vital data resource for cross-country comparative analyses. This study is part of a set of analyses assessing the types of providers being used for reproductive and maternal health care across 57 countries. Here, we examine some of the challenges encountered using DHS data for this purpose, present the provider classification we used, and provide recommendations to enable more detailed and accurate cross-country comparisons of healthcare provision. Methods We used the most recent DHS surveys between 2000 and 2012; 57 countries had data on family planning and delivery care providers and 47 countries had data on antenatal care. Every possible response option across the 57 countries was listed and categorised. We then developed a classification to group provider response options according to two key dimensions: clinical nature and profit motive. Results We classified the different types of maternal and reproductive healthcare providers, and the individuals providing care. Documented challenges encountered during this process were limitations inherent in household survey data based on respondents’ self-report; conflation of response options in the questionnaire or at the data processing stage; category errors of the place vs. professional for delivery; inability to determine whether care received at home is from the public or private sector; a large number of negligible response options; inconsistencies in coding and analysis of data sets; and the use of inconsistent headings. Conclusions To improve clarity, we recommend addressing issues such as conflation of response options, data on public vs. private provider, inconsistent coding and obtaining metadata. More systematic and standardised collection of data would aid international comparisons of progress towards improved financial protection, and allow us to better characterise the incentives and commercial nature of different providers. Objectif Les enqu

  12. Maternal Health Care Services Access Index and Infant Survival in

    African Journals Online (AJOL)

    GB

    ABSTRACT. BACKGROUND: Infant mortality rate in Nigeria is among the highest world-wide. Utilization of modern health care facilities during pregnancy and at delivery reduces infant mortality rate. We examined the relationship between Infant Mortality (IM) and Maternal Health Care Services Access Index (MHCI) in.

  13. Utilization of maternal health services by rural Hausa women in ...

    African Journals Online (AJOL)

    A descriptive study was undertaken to document the level and pattern of utilization of selected maternal health services among rural Hausa women in order to assess progress in PHC implementation. Methods: A cross-sectional descriptive, quantitative study using structured interviewer-administered questionnaire was used ...

  14. Utilization of Maternal Health Services in Urban and Rural ...

    African Journals Online (AJOL)

    OBJECTIVE: This study determined and compared the level and pattern of utilization of maternal services in urban and rural communities in Anambra State. DESIGN AND METHOD: A comparative cross-sectional study was carried out in two local government areas (LGA); Nnewi North (urban) and Dunukofia (rural). A total ...

  15. Barriers to maternal health service use in Chikhwawa, Southern ...

    African Journals Online (AJOL)

    The aim of the study was to identify and understand experiences, perceptions and needs of the community on maternal health service utilization. Methods: Qualitative data was obtained through focus group discussions with community leaders, women, men and youth in the catchment areas of three remote health centres.

  16. Maternal Health Care Services Utilization in Tea Gardens of ...

    African Journals Online (AJOL)

    Subjects and Methods: A cross-sectional study was carried out among 953 recently delivered women residing in tea gardens of Darjeeling district of West Bengal. Utilization of maternal health care services including antenatal care during pregnancy, provision of safe delivery and postnatal care after delivery was assessed ...

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

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

    Malawi has high rates of maternal mortality despite concerted efforts to increase the rate of births at health facilities. In response, the Ministry of Health implemented a Standards-Based Management and Recognition for Reproductive Health initiative to improve the quality of health services. Similar initiatives have proven ...

  18. Maternal Health Care Services Access Index and Infant Survival in ...

    African Journals Online (AJOL)

    Background: Infant mortality rate in Nigeria is among the highest world-wide. Utilization of modern health care facilities during pregnancy and at delivery reduces infant mortality rate. We examined the relationship between Infant Mortality (IM) and Maternal Health Care Services Access Index (MHCI) in Nigeria. Methods: This ...

  19. Service Provider Revenue Dependence of Offered Number of Service Classes

    Directory of Open Access Journals (Sweden)

    V. S. Aćimović-Raspopović

    2011-06-01

    Full Text Available In this paper possible applications of responsive pricing scheme and Stackelberg game for pricing telecommunication services with service provider as a leader and users acting as followers are analyzed. We have classified users according to an elasticity criterion into inelastic, partially elastic and elastic users. Their preferences are modelled through utility functions, which describe users’ sensitivity to changes in the quality of service and price. In the proposed algorithm a bandwidth management server is responsible for performing automatic optimal bandwidth allocation to each user’s session while maximizing its expected utility and the overall service provider’s revenue. The pricing algorithm is used for congestion control and more efficient network capacity utilization. We have analyzed different scenarios of the proposed usage-based pricing algorithm. Particularly, the influence of the number of service classes on price setting in terms of service provider’s revenue and total users’ utility maximization are discussed. The model is verified through numerous simulations performed by software that we have developed for that purpose.

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

    Science.gov (United States)

    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.

  1. Maternal health services in South Africa

    African Journals Online (AJOL)

    achievable. The context of this South African case study is a ... University of the Witswatersrand, Johannesburg. S Fonn ..... Table V. Primary health care workers' listing and ranking of obstacles to quality services prioritised throughout the three provinces. A system of scoring was developed which allowed staff to indicate.

  2. Contingency management: perspectives of Australian service providers.

    Science.gov (United States)

    Cameron, Jacqui; Ritter, Alison

    2007-03-01

    Given the very positive and extensive research evidence demonstrating efficacy and effectiveness of contingency management, it is important that Australia explore whether contingency management has a role to play in our own treatment context. Qualitative interviews were conducted with 30 experienced alcohol and drug practitioners, service managers and policy-makers in Victoria. Interviewees were selected to represent the range of drug treatment services types and included rural representation. A semi-structured interview schedule, covering their perceptions and practices of contingency management was used. All interviews were transcribed verbatim and analysed using N2 qualitative data analysis program. The majority of key informants were positively inclined toward contingency management, notwithstanding some concerns about the philosophical underpinnings. Concerns were raised in relation to the use of monetary rewards. Examples of the use of contingency management provided by key informants demonstrated an over-inclusive definition: all the examples did not adhere to the key principles of contingency management. This may create problems if a structured contingency management were to be introduced in Australia. Contingency management is an important adjunctive treatment intervention and its use in Australia has the potential to enhance treatment outcomes. No unmanageable barriers were identified in this study.

  3. [Use of maternal health services in rural Mexico].

    Science.gov (United States)

    Potter, J E

    1988-01-01

    availability of different types of health services in the community was not a significant predictor of utilization of prenatal services, but existence of a good road was associated with a 30% increase in probability of using medical services and presence in the community of persons speaking only an indigenous language was associated with a 57% decline in probability. Use of prenatal services and hospital delivery were also associated with maternal educational level and housing characteristics. The results appear to indicate the isolation, poverty, and lack of familiarity with western culture constitute important barriers to use of modern maternal health services. The analysis suggests that the policy of providing medical facilities at the community level has had little effect on the extremely disparate use of prenatal care and hospital delivery in rural Mexico.

  4. New consumer services provided by smart metering

    Directory of Open Access Journals (Sweden)

    Daminov Ildar

    2015-01-01

    Full Text Available This paper focuses on the issues of smart metering market and considers different services provided by smart metering from consumer point of view. Firstly, smart metering deployment challenges emerging and conventional tariffs, which modify a consumer behavior and thus, the entire electric energy market can be optimized since the customer is motivated to consume less energy. Secondly, the authors illustrate changes in electricity quality, which have an impact on consumer relations with utility. Additionally, two main indices of grid resilience – SAIDI and SAIFI – are exemplified to reveal the improvement potential of smart metering implementation in certain regions of Russia that also influence the consumer. Finally, in-home display and privacy problem directly reflect the consumer’s behavior, thus the private life rights should not be violated as they are guaranteed by law.

  5. Maternal and neonatal services in Ethiopia: measuring and improving quality.

    Science.gov (United States)

    Canavan, Maureen E; Brault, Marie A; Tatek, Dawit; Burssa, Daniel; Teshome, Ayele; Linnander, Erika; Bradley, Elizabeth H

    2017-06-01

    Maternal and neonatal mortality remains high in low- and middle-income countries, with poor quality of intrapartum care as a barrier to further progress. We developed and tested a method of measuring the quality of maternal and neonatal care that could be embedded in a larger national performance management initiative. The tool used direct observations and medical record reviews to score quality in nine domains of intrapartum care. We piloted and evaluated the tool in visits to the 18 lead hospitals that have responsibility to promote and coordinate quality improvement efforts within a hospital cluster in Ethiopia. Between baseline and follow-up assessments, staff from a national quality collaborative alliance provided hospital-based training on labour and delivery services. Ethiopia has invested in hospital quality improvement for more than a decade and this tool was integrated into existing quality improvement mechanisms within lead hospitals, with the potential for scale-up to all government hospitals. Significant improvements in quality of intrapartum care were detected from baseline (June-July 2015) to follow-up (February-March 2016) in targeted hospitals. The overall mean quality score rose from 65.6 (standard deviation, SD: 10.5) to 91.2 (SD: 12.4) out of 110 items (P < 0.001). The method was feasible, requiring a total of 3 days and two to three trained data collectors per hospital visit. It produced data that detected substantial changes made during 8 months of national hospital quality improvement efforts. With additional replication studies, this tool may be useful in other low- and middle-income countries.

  6. Parental expectations of maternal and child health services.

    Science.gov (United States)

    Bradt, Lieve; Vandenbroeck, Michel; Lammertyn, Jan; Bouverne-De Bie, Maria

    2015-01-01

    This article reports on survey research (N = 1,418) aimed at examining whether parental expectations of maternal and child health (MCH) services are influenced by group characteristics (e.g., socioeconomic status [SES], ethnicity, at risk of poverty) and/or individual parenting context variables (e.g., received social support) in a context where these services are available to all. The findings reveal that parents have different expectations about the technical and relational expertise of MCH nurses. However, the authors found only very weak associations between family characteristics and parental expectations, suggesting that individual differences matter more than SES and other more traditional distinctions. Implications for MCH services are made.

  7. Challenges in providing services in methadone maintenance therapy clinics in China: service providers' perceptions.

    Science.gov (United States)

    Lin, Chunqing; Wu, Zunyou; Rou, Keming; Pang, Lin; Cao, Xiaobin; Shoptaw, Steven; Detels, Roger

    2010-05-01

    The Methadone Maintenance Therapy (MMT) program has been initiated in China since 2004. As of the end of November, 2008, 558 MMT clinics had been established countrywide. The objective of this study was to elucidate the difficulties and challenges as perceived by service providers working in MMT clinics. One service provider from each of the 28 MMT study clinics in Zhejiang and Jiangxi Provinces of China participated in a face-to-face in-depth interview for about 1-2h to describe their perceptions of working in MMT clinics. Qualitative data were analysed using ATLAS.ti. The grounded theory was used to guide the data analysis. Participants identified major problems in providing services in MMT clinics including lack of resources, professional training, and institutional support. Difficulties in pursuit of career, concern for personal safety, low income, heavy working load, and poor opinion of MMT by Chinese society often contributed to greater stress and burnout among the service providers. The MMT programs in China desperately need additional resource allocation and institutional support for the current and perhaps future expansion of the programs. The service providers are in urgent need of professional training to improve the quality of care they can offer MMT clients. Copyright 2009 Elsevier B.V. All rights reserved.

  8. Exploring provider perspectives on respectful maternity care in Kenya: ?Work with what you have?

    OpenAIRE

    Ndwiga, Charity; Charlotte E Warren; Ritter, Julie; Sripad, Pooja; Abuya, Timothy

    2017-01-01

    Background Promoting respect and dignity is a key component of providing quality care during facility-based childbirth and is becoming a critical indicator of maternal health care. Providing quality care requires essential skills and attitudes from healthcare providers, as their role is central to optimizing interventions in maternity settings. Methods In 13 facilities in Kenya we conducted a mixed methods, pre-post study design to assess health providers? perspectives of a multi-component in...

  9. Assessment of provider competence and quality of maternal/newborn care in selected Latin American and Caribbean countries.

    Science.gov (United States)

    Thompson, Joyce E; Land, Sandra; Camacho-Hubner, Alma Virginia; Fullerton, Judith T

    2015-05-01

    To obtain a snapshot of the maternal and newborn care provided by different types of maternal and child health providers in Latin America and the Caribbean (LAC) to 1) better inform advocacy and programmatic strategies and interventions to improve the quality of those services in the region, and 2) determine the need for more rigorous study of the issues. A rapid assessment of 83 health workers providing antepartum, intrapartum, and immediate postpartum and newborn care (within two hours of birth) in eight LAC countries was conducted in November and December of 2011. Health workers were observed by two-person expert maternal/newborn clinician teams using pretested forms based on international quality-of-care standards. A total of 105 care encounters were observed, primarily in urban, public, referral-level settings. Providers of care included obstetricians, midwives, generalist physicians, medical residents, registered nurses, auxiliary nurses, and students of medicine, midwifery, and nursing. Hand washing, as an indicator of quality of antepartum care, was observed in only 41% of the observed encounters. Labor management often lacked certain elements of respectful maternity care across all provider groups. Several clinical tasks of high importance in the identification and prevention of common complications of antepartum, intrapartum, and immediate postpartum/newborn care were not documented as performed during the observation periods. Providers self-reported limited competence (ability to perform to a defined level of proficiency) in manual removal of the placenta, bimanual compression of the uterus, and newborn resuscitation. The findings suggest that 1) the quality of maternal and newborn care and 2) the competence of maternal and child health providers in the diverse selection of LAC countries that were studied require substantial attention.

  10. Irish midwives' experiences of providing maternity care to non-Irish women seeking asylum

    Directory of Open Access Journals (Sweden)

    Tobin CL

    2014-01-01

    Full Text Available Carolyn L Tobin,1 Jo Murphy-Lawless2 1Department of Nursing, College of Health and Human Services, University of New Hampshire, Durham, NH, USA; 2School of Nursing and Midwifery, Trinity College, Dublin, Ireland Background: Immigration and asylum seeking has been an important social and political phenomenon in Ireland since the mid 1990s. Inward migration to Ireland was seen in unprecedented numbers from 1995 onward, peaking in 2002 with 11,634 applications for refugee status. Asylum and immigration is an issue of national and international relevance as the numbers of displaced people worldwide continues to grow, reaching the highest level in 20 years at 45.2 million in 2012. Midwives provide the majority of care to childbearing women around the world, whether working as autonomous practitioners or under the direction of an obstetrician. Limited data currently exist on the perspectives of midwives who provide care to childbearing women while they are in the process of seeking asylum. Such data are important to midwifery leaders, educators, and policy-makers. The aims of this study were to explore midwives' perceptions and experiences of providing care to women in the asylum process and to gain insight into how midwives can be equipped and supported to provide more effective care to this group in the future.Methods: Data were collected via indepth unstructured interviews with a purposive sample of ten midwives from two sites, one a large urban inner city hospital, and the second, a smaller more rural maternity hospital. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using content analysis. Results: Five themes emerged from the data, barriers to communication, understanding cultural difference, challenges of caring for women who were unbooked, the emotional cost of caring, and structural barriers to effective care. Conclusion: Findings highlight a need to focus on support and education for midwives, improved

  11. A National Audit of Smoking Cessation Services in Irish Maternity Units.

    Science.gov (United States)

    Reynolds, C M E; Egan, B; Cawley, S; Kennedy, R; Sheehan, S R; Turner, M J

    2017-06-09

    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.

  12. 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.

  13. 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.

  14. Ethnic disparities in utilisation of maternal health care services in Ghana: evidence from the 2007 Ghana Maternal Health Survey.

    Science.gov (United States)

    Ganle, John Kuumuori

    2016-01-01

    Disparities in utilisation of maternal health care remain a challenge to attainment of the maternal health-related Millennium Development Goals. The objective of this descriptive study was to examine disparities in utilisation of maternal health care among ethnic groups in Ghana. Data from the 2007 Ghana Maternal Health Survey were analysed for disparities in antenatal care (ANC) visit, utilisation of tetanus toxoid immunisation and iron tablets/syrup intake during pregnancy, place of delivery, skilled birth attendance, caesarean section (CS) and post-natal care (PNC) among different ethnic groups. Findings show that the proportion of women who received any form of skilled antenatal, delivery and PNC in the five years (2003-2007) preceding the survey was 96%, 55% and 55%, respectively. Despite the incremental progress Ghana made in improving access to skilled maternal health care services, large gradients of disparities exist. The ethnic difference in utilisation of institutional prenatal care was small; however, fewer births to women from majority ethnic groups such as the Akan (21%) took place at home compared with births to women from minority ethnic groups such as the Ewe (58.8%), Guan (42.7%), Grusi (53.4%), Mole-Dagbani (74.7%) and Gruma (58.8%). The rate of consultation of a skilled health care provider for delivery among the different ethnic groups also ranged from a low of 27% for births to Mole-Dagbani women to a high of 68.8% among births to Akan women. Minority ethnic groups reported lower utilisation levels for most of the components of skilled maternity care in Ghana. However, ethnic disparities in utilisation of all the components of ANC in Ghana were less compared to delivery in health facilities, skilled attendance at birth, use of CS and PNC. Therefore, efforts to promote universal access to skilled maternity care not only should target those sub-populations with significantly low utilisation levels but also must focus on those components of

  15. Switching Service Providers: Reasons, Service Types, and Sequences

    African Journals Online (AJOL)

    In located services, such as restaurants, about half of all switching is based on access to the service; in non-located services, such as credit cards, access problems are minor and service failure is often the reason for switching. The orders of events, or sequences, involved in switching are also examined; different sequences ...

  16. Estrutura de maternidades do Sistema Único de Saúde do Rio de Janeiro: desafio à qualidade do cuidado à saúde The structure of Brazilian National Health Service Maternity Hospitals in Rio de Janeiro: the challenge of providing quality health care

    Directory of Open Access Journals (Sweden)

    Cynthia Magluta

    2009-09-01

    Full Text Available OBJETIVOS: avaliar a estrutura de maternidades pertencentes ao Sistema Único de Saúde (SUS do Estado do Rio de Janeiro. MÉTODO: REalizou-se uma avaliação normativa, com corte transversal de maternidades selecionadas, vinculadas ao SUS no ano de 2005. Foram selecionadas 67 maternidades por amostragem de conveniência. Foram empregados um roteiro de observação e um de entrevistas com chefes de serviço e profissionais. Aspectos da estrutura destes serviços foram analisados, utilizando-se como referência a conformidade com as normas disponibilizadas pelo Ministério da Saúde e preconizadas na literatura. Esses aspectos foram: instalação, equipamentos, equipe de saúde, capacitação de profissionais e disponibilidade de diretrizes clínicas. RESULTADOS: a presença dos requisitos da estrutura avaliados difere entre os estratos de complexidade, sendo menos frequente nas maternidades de menor complexidade. Os aspectos da estrutura física, disponibilidade de diretrizes clínicas e a presença dos profissionais nos serviços foram mais adequados do que a capacitação oferecida pelos serviços. CONCLUSÕES: SÃo necessários investimentos na capacitação dos profissionais, ampliação da disponibilidade de diretrizes clínicas e melhoria da estrutura física, visando qualificar o cuidado perinatal e adequá-lo às regulamentações nacionais.OBJECTIVES: to evaluate the structure of Brazilian National Health Service (SUS maternity hospitals in the State of Rio de Janeiro. METHODS: a normative cross-sectional evaluation was carried out of selected SUS maternity hospitals in the year 2005. Sixty-seven maternity hospitals were selected as a sample for reasons of convenience. Hospitals were observed and interviews conducted with health service managers and health workers. Various aspects of the structure of these services were examined, taking as a point of reference the norms provided by the Ministry of Health and outlined in the literature

  17. Developing Cultural Competence in Human Service Providers.

    Science.gov (United States)

    Krajewski-Jaime, Elvia R.; And Others

    Cultural competence assumes greater importance in the United States as international relations shift and the United States changes its own demographic makeup. Hispanics have significant health care needs and cultural beliefs that influence their acceptance of service. As part of an effort to build cultural competence in undergraduate social work…

  18. Collaboration of midwives in primary care midwifery practices with other maternity care providers.

    Science.gov (United States)

    Warmelink, J Catja; Wiegers, Therese A; de Cock, T Paul; Klomp, Trudy; Hutton, Eileen K

    2017-12-01

    Inter-professional collaboration is considered essential in effective maternity care. National projects are being undertaken to enhance inter-professional relationships and improve communication between all maternity care providers in order to improve the quality of maternity care in the Netherlands. However, little is known about primary care midwives' satisfaction with collaboration with other maternity care providers, such as general practitioners, maternity care assistance organisations (MCAO), maternity care assistants (MCA), obstetricians, clinical midwives and paediatricians. More insight is needed into the professional working relations of primary care midwives in the Netherlands before major changes are made OBJECTIVE: To assess how satisfied primary care midwives are with collaboration with other maternity care providers and to assess the relationship between their 'satisfaction with collaboration' and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics (accessibility). The aim of this study was to provide insight into the professional working relations of primary care midwives in the Netherlands. Our descriptive cross-sectional study is part of the DELIVER study. Ninety nine midwives completed a written questionnaire in May 2010. A Friedman ANOVA test assessed differences in satisfaction with collaboration with six groups of maternity care providers. Bivariate analyses were carried out to assess the relationship between satisfaction with collaboration and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics. Satisfaction experienced by primary care midwives when collaborating with the different maternity care providers varies within and between primary and secondary/tertiary care. Interactions with non-physicians (clinical midwives and MCA(O)) are ranked consistently higher on satisfaction compared with

  19. Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review

    National Research Council Canada - National Science Library

    George, Asha S; Branchini, Casey; Portela, Anayda

    2015-01-01

    ... to increase use of maternity care services. Using inclusion and exclusion criteria defined in a peer-reviewed protocol, we searched published and grey literature from one database of studies on maternal health, two search engines, an internet...

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

    National Research Council Canada - National Science Library

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

    2010-01-01

    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...

  1. A descriptive phenomenology study of newcomers' experience of maternity care services: Chinese women's perspectives

    National Research Council Canada - National Science Library

    Lee, Tsorng-Yeh; Landy, Christine Kurtz; Wahoush, Olive; Khanlou, Nazilla; Liu, Yin-Chun; Li, Chia-Chi

    2014-01-01

    .... The purpose of this study was to explore immigrant Chinese women's experiences in accessing maternity care, the utilization of maternity health services, and the obstacles they perceived in Canada...

  2. Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners.

    Science.gov (United States)

    Mitra, Monika; Smith, Lauren D; Smeltzer, Suzanne C; Long-Bellil, Linda M; Sammet Moring, Nechama; Iezzoni, Lisa I

    2017-07-01

    Women with physical disabilities are known to experience disparities in maternity care access and quality, and communication gaps with maternity care providers, however there is little research exploring the maternity care experiences of women with physical disabilities from the perspective of their health care practitioners. This study explored health care practitioners' experiences and needs around providing perinatal care to women with physical disabilities in order to identify potential drivers of these disparities. We conducted semi-structured telephone interviews with 14 health care practitioners in the United States who provide maternity care to women with physical disabilities, as identified by affiliation with disability-related organizations, publications and snowball sampling. Descriptive coding and content analysis techniques were used to develop an iterative code book related to barriers to caring for this population. Public health theory regarding levels of barriers was applied to generate broad barrier categories, which were then analyzed using content analysis. Participant-reported barriers to providing optimal maternity care to women with physical disabilities were grouped into four levels: practitioner level (e.g., unwillingness to provide care), clinical practice level (e.g., accessible office equipment like adjustable exam tables), system level (e.g., time limits, reimbursement policies), and barriers relating to lack of scientific evidence (e.g., lack of disability-specific clinical data). Participants endorsed barriers to providing optimal maternity care to women with physical disabilities. Our findings highlight the needs for maternity care practice guidelines for women with physical disabilities, and for training and education regarding the maternity care needs of this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Medical Services: Nonphysician Health Care Providers

    Science.gov (United States)

    2000-11-07

    medical supervisors will be dictated by the specialty of the patient population involved (for example, chief, pediatric service for well child physical...of osteopathy ). (2) PAs may write routine orders on inpatients, using DA Form 4256 (Doctor’s Orders). (3) When required, inpatient treatment...which FAP clients may be located. (2) FAP personnel are the primary source of care for clients involved in alleged/substantiated child /spouse abuse

  4. Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    John Kuumuori Ganle

    Full Text Available While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana.A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling's thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers' insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability.Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for

  5. Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study.

    Science.gov (United States)

    Ganle, John Kuumuori; Otupiri, Easmon; Obeng, Bernard; Edusie, Anthony Kwaku; Ankomah, Augustine; Adanu, Richard

    2016-01-01

    While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling's thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers' insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and patient-centred training for healthcare

  6. Health Providers' Perception towards Safe Abortion Service at ...

    African Journals Online (AJOL)

    In Ethiopia, unsafe abortion accounts up to 32% of maternal deaths. The perception of health providers towards safe abortion provision at selected health facilities in Addis Ababa, Ethiopia was assessed. A stratified random sampling was used to select 431 health providers. A cross-sectional study was conducted from ...

  7. Public-sector maternal health programmes and services for rural Bangladesh.

    Science.gov (United States)

    Mridha, Malay Kanti; Anwar, Iqbal; Koblinsky, Marge

    2009-04-01

    Achieving Millennium Development Goal 5 in Bangladesh calls for an appreciation of the evolution of maternal healthcare within the national health system to date plus a projection of future needs. This paper assesses the development of maternal health services and policies by reviewing policy and strategy documents since the independence in 1971, with primary focus on rural areas where three-fourths of the total population of Bangladesh reside. Projections of need for facilities and human resources are based on the recommended standards of the World Health Organization (WHO) in 1996 and 2005. Although maternal healthcare services are delivered from for-profit and not-for-profit (NGO) subsectors, this paper is focused on maternal healthcare delivery by public subsector. Maternal healthcare services in the public sector of Bangladesh have been guided by global policies (e.g., Health for All by the Year 2000), national policies (e.g., population and health policy), and plans (e.g., five- or three-yearly). The Ministry of Health and Family Welfare (MoHFW), through its two wings-Health Services and Family Planning-sets policies, develops implementation plans, and provides rural public-health services. Since 1971, the health infrastructure has developed though not in a uniform pattern and despite policy shifts over time. Under the Family Planning wing of the MoHFW, the number of Maternal and Child Welfare Centres has not increased but new services, such as caesarean-section surgery, have been integrated. The Health Services wing of the MoHFW has ensured that all district-level public-health facilities, e.g., district hospitals and medical colleges, can provide comprehensive essential obstetric care (EOC) and have targeted to upgrade 132 of 407 rural Upazila Health Complexes to also provide such services. In 2001, they initiated a programme to train the Government's community workers (Family Welfare Assistants and Female Health Assistants) to provide skilled birthing care

  8. Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana: A Qualitative Study

    Science.gov (United States)

    Ganle, John Kuumuori; Otupiri, Easmon; Obeng, Bernard; Edusie, Anthony Kwaku; Ankomah, Augustine; Adanu, Richard

    2016-01-01

    Background While a number of studies have examined the factors affecting accessibility to and utilisation of healthcare services by persons with disability in general, there is little evidence about disabled women's access to maternal health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and the challenges they face in accessing skilled maternal health services. The objective of this paper is to explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services in Ghana. Methods and Findings A qualitative study was conducted in 27 rural and urban communities in the Bosomtwe and Central Gonja districts of Ghana with a total of 72 purposively sampled women with different physical, visual, and hearing impairments who were either lactating or pregnant at the time of this research. Semi-structured in-depth interviews were used to gather data. Attride-Stirling’s thematic network framework was used to analyse the data. Findings suggest that although women with disability do want to receive institutional maternal healthcare, their disability often made it difficult for such women to travel to access skilled care, as well as gain access to unfriendly physical health infrastructure. Other related access challenges include: healthcare providers’ insensitivity and lack of knowledge about the maternity care needs of women with disability, negative attitudes of service providers, the perception from able-bodied persons that women with disability should be asexual, and health information that lacks specificity in terms of addressing the special maternity care needs of women with disability. Conclusions Maternal healthcare services that are designed to address the needs of able-bodied women might lack the flexibility and responsiveness to meet the special maternity care needs of women with disability. More disability-related cultural competence and

  9. 25 CFR 20.402 - When are protective services provided?

    Science.gov (United States)

    2010-04-01

    ... AND SOCIAL SERVICES PROGRAMS Services to Children, Elderly, and Families § 20.402 When are protective services provided? Protective services are provided when children or adults: (a) Are deprived temporarily... under the supervision of the Bureau in regard to the use and disbursement of funds in the child's or...

  10. Supercapacitor to Provide Ancillary Services: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Muljadi, Eduard [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Gevorgian, Vahan [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Luo, Yusheng [Idaho National Laboratory; Mohanpurkar, M. [Idaho National Laboratory; Hovsapian, R. [Idaho National Laboratory; Koritarov, V. [Argonne National Laboratory

    2017-10-09

    Supercapacitor technology has reached a level of maturity as a viable energy storage option available to support a modern electric power system grid; however, its application is still limited because of its energy capacity and the cost of the commercial product. In this paper, we demonstrate transient models of supercapacitor energy storage plants operating in coordination with run-of-the-river (ROR), doubly-fed induction generator hydropower plants (HPP) using a system control concept and architecture developed. A detailed transient model of a supercapacitor energy storage device is coupled with the grid via a three-phase inverter/rectifier and bidirectional DC-DC converter. In addition, we use a version of a 14-bus IEEE test case that includes the models of the supercapacitor energy storage device, ROR HPPs, and synchronous condensers that use the rotating synchronous generators of retired coal-powered plants. The purpose of the synchronous condensers is to enhance the system stability by providing voltage and reactive power control, provide power system oscillations damping, and maintain system inertia at secure levels. The control layer provides coordinated, decentralized operation of distributed ROR HPPs and energy storage as aggregate support to power system operations.

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

    Science.gov (United States)

    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

  12. Practical Theology and providing service: The service through love ...

    African Journals Online (AJOL)

    2014-02-12

    Feb 12, 2014 ... Eighteen years after apartheid, South Africa is still a country striving to build a nation and to be healed. Marches and protests against poor public service ... (Rm 5:13). A fundamental principle of the Christian faith is that man is saved through the grace of and by faith in the Triune God, not by deeds.

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

    Science.gov (United States)

    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

  14. Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: A mixed methods study

    NARCIS (Netherlands)

    G. Alcock (Glyn); S. Das (Sushmita); N.S. More (Neena Shah); K. Hate (Ketaki); S. More (Sharda); S. Pantvaidya (Shanti); D. Osrin (David); A.J. Houweling (Tanja)

    2015-01-01

    textabstractBackground: Discussions of maternity care in developing countries tend to emphasise service uptake and overlook choice of provider. Understanding how families choose among health providers is essential to addressing inequitable access to care. Our objectives were to quantify the

  15. External Service Providers to the National Security Technology Incubator

    Energy Technology Data Exchange (ETDEWEB)

    None

    2008-02-28

    This report documents the identification and assessment of external service providers to the National Security Technology Incubator (NSTI) program for southern New Mexico. The NSTI is being developed as part of the National Security Preparedness Project (NSPP), funded by a Department of Energy (DOE)/National Nuclear Security Administration (NNSA) grant to Arrowhead Center, New Mexico State University. This report contains 1) a summary of the services to be provided by NSTI; 2) organizational descriptions of external service providers; and 3) a comparison of NSTI services and services offered by external providers.

  16. 20 CFR 670.720 - Who provides placement services?

    Science.gov (United States)

    2010-04-01

    ... CORPS UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Placement and Continued Services § 670.720 Who... graduates and former students in jobs. Job Corps placement agencies provide placement services under a...

  17. Maternity services and the discharge process: a review of practice in Queensland.

    Science.gov (United States)

    Jenkinson, Bec; Young, Kate; Kruske, Sue

    2014-06-01

    Efforts to increase postnatal support available to women and families are hampered by inadequate referral mechanisms. However, the discharge process in maternity services has received little research attention. To review current discharge practices in Queensland, in order to identify mechanisms to minimise fragmentation in the care of women and families as they transition from hospital-based postnatal care to community-based health and other services. A survey of discharge practices in Queensland hospitals that offer birthing services (N=55) and content analysis of discharge summary forms used by those hospitals. Fifty-two Queensland birthing hospitals participated in the study. Discharge summaries were most commonly sent to General Practitioners (83%), less commonly to Child and Family Health Nurses (CFHNs; 52%) and rarely to other care providers. Discharge summaries were usually disseminated within one week of discharge (87%), but did not capture any information about care provided by domiciliary services. Almost one-fifth (19%) of hospitals did not seek women's consent for the disclosure of their discharge summary and only 10% of hospitals had processes for women to check accuracy. Significant gaps in the content of discharge summaries were identified, particularly in psychosocial and cultural information, and post-discharge advice. The format of discharge summaries diminished their readability. Discharge summaries (format and content) should be consistent, comprehensive and specific to maternity services. Discharge summaries should be generated and disseminated electronically at the time of discharge from the maternity service. Women should review their discharge summaries and direct and consent to its dissemination. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  18. The application of geographic information systems (GIS) in identifying the priority areas for maternal care and services.

    Science.gov (United States)

    Salehi, Fatemeh; Ahmadian, Leila

    2017-07-12

    Improving maternal health is globally introduced as an important health priority. The purpose of this study is to identify the high priority areas which require more maternal health services in Kerman, Iran. This is a descriptive cross-sectional study, performed in 2015. The literatures were first explored in order to extract geographic indicators and sub indicators relevant to the maternal health. Data were collected by the use of a questionnaire designed on the basis of AHP (Analytic Hierarchy Process) method. The validity and reliability of the questionnaire were confirmed by three medical informatics experts and test-retest method, respectively. Data were analyzed by Expert Choice software in order to specify the weight and importance of each indicator. The information were then added to Geographic Information System (GIS) to analyze and create the related maps. Women's access to hospitals plays an important role in identifying high priority areas which need maternal care and services. More than half of the mothers in Kerman have a moderate level of access to maternal care services. There is an association between facilities that are provided for pregnant women and the existence of healthcare centers. Moreover, there is a negative correlation between maternal death and the number of facilities provided for medical care and services for pregnant women. The application of GIS provides us with the capability to identify high priority areas which need maternal care. According to current population policies in Iran and the probable increase in the fertility rate, it is wise to plan proper schedules to improve health care services for pregnant women in Kerman.

  19. Awareness of LGBT aging issues among aging services network providers.

    Science.gov (United States)

    Hughes, Anne K; Harold, Rena D; Boyer, Janet M

    2011-10-01

    Very little research exists examining the interactions between community-based aging service providers and lesbian, gay, bisexual, and transgender (LGBT) older adults. It is unclear whether mainstream aging services acknowledge the needs of this community. We asked direct care providers and administrators in the Michigan aging services network to describe their work with LGBT older adults. We found there are very few services specific to the needs of older LGBT adults and very little outreach to this community. At the agency level, resistance to providing services was found.

  20. Welcoming max: Increasing pediatric provider knowledge of service dogs.

    Science.gov (United States)

    Stace, Laura Britton

    2016-08-01

    Service dogs have been used in the adult population for decades. Recently, there has been a diversification in types of service dogs, specifically for the pediatric population. Although guide dogs and mobility dogs are accepted in society, autism assistance dogs, seizure alert and response dogs and diabetic alert dogs are relatively new. As pediatric service dogs attract more attention, pediatric providers need to be prepared to answer parental inquires regarding service dog use. The pediatric provider is well equipped to identify children who could benefit from a service dog intervention and should be able to make a referral to a reputable service dog provider. This article presents guidance on appropriate patient selection, making a service dog referral, and risks and benefits involved. Pediatric providers are ideally positioned to be leaders in implementing this evolving new assistive technology that can help to alleviate pediatric disabilities for both the patient and family. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Maternity Care Services and Culture: A Systematic Global Mapping of Interventions

    Science.gov (United States)

    Coast, Ernestina; Jones, Eleri; Portela, Anayda; Lattof, Samantha R.

    2014-01-01

    Background A vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect women's use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps. Methods and Findings Searches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1) service delivery models; (2) service provider interventions; (3) health education interventions; (4) participatory approaches; and (5) mental health interventions. Conclusions The map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure

  2. Maternity care services and culture: a systematic global mapping of interventions.

    Directory of Open Access Journals (Sweden)

    Ernestina Coast

    Full Text Available A vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect women's use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps.Searches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1 service delivery models; (2 service provider interventions; (3 health education interventions; (4 participatory approaches; and (5 mental health interventions.The map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure the impact of interventions to

  3. Maternity care services and culture: a systematic global mapping of interventions.

    Science.gov (United States)

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

    2014-01-01

    A vast body of global research shows that cultural factors affect the use of skilled maternity care services in diverse contexts. While interventions have sought to address this issue, the literature on these efforts has not been synthesised. This paper presents a systematic mapping of interventions that have been implemented to address cultural factors that affect women's use of skilled maternity care. It identifies and develops a map of the literature; describes the range of interventions, types of literature and study designs; and identifies knowledge gaps. Searches conducted systematically in ten electronic databases and two websites for literature published between 01/01/1990 and 28/02/2013 were combined with expert-recommended references. Potentially eligible literature included journal articles and grey literature published in English, French or Spanish. Items were screened against inclusion and exclusion criteria, yielding 96 items in the final map. Data extracted from the full text documents are presented in tables and a narrative synthesis. The results show that a diverse range of interventions has been implemented in 35 countries to address cultural factors that affect the use of skilled maternity care. Items are classified as follows: (1) service delivery models; (2) service provider interventions; (3) health education interventions; (4) participatory approaches; and (5) mental health interventions. The map provides a rich source of information on interventions attempted in diverse settings that might have relevance elsewhere. A range of literature was identified, from narrative descriptions of interventions to studies using randomised controlled trials to evaluate impact. Only 23 items describe studies that aim to measure intervention impact through the use of experimental or observational-analytic designs. Based on the findings, we identify avenues for further research in order to better document and measure the impact of interventions to address

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

    Science.gov (United States)

    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.

  5. REGULATION MISUNDERSTANDING: CONVERGENCE COMPLEXITY PROVIDING FAILURES IN TELECOMMUNICATION SERVICES COSTS

    National Research Council Canada - National Science Library

    Emílio José Montero Arruda Filho

    2017-01-01

    .... This study begins by giving the background to voice communication in the telecommunications sector and the misunderstanding of the competitive boundaries between technologies, service providers...

  6. Privately Provided Accommodation Service Quality and Customer Satisfaction

    National Research Council Canada - National Science Library

    Joshua Mugambwa; George William Mugerwa; Wilson Williams Mutumba; Claire Muganzi; Bridget Namubiru; Yusuf Waswa; Isaac Newton Kayongo

    2016-01-01

    .... This research took a case study of Nsamizi Training Institute of Social Development (NTISD) to determine the relationship between privately provided accommodation service quality and customer satisfaction...

  7. Mental Health Service Providers: College Student Perceptions of Helper Effectiveness

    Science.gov (United States)

    Ackerman, Ashley M.; Wantz, Richard A.; Firmin, Michael W; Poindexter, Dawn C.; Pujara, Amita L.

    2014-01-01

    Undergraduate perceptions of the overall effectiveness of six types of mental health service providers (MHSPs) were obtained with a survey. Although many mental health services are available to consumers in the United States, research has indicated that these services are underutilized. Perceptions have been linked to therapeutic outcomes and may…

  8. Nutrition education and counselling provided during pregnancy: effects on maternal, neonatal and child health outcomes.

    Science.gov (United States)

    Girard, Amy Webb; Olude, Oluwafunke

    2012-07-01

    Nutrition education and counselling (NEC) is a commonly applied strategy to improve maternal nutrition during pregnancy. However, with the exception special populations and specific diets, the effect of NEC on maternal, neonatal and child health outcomes has not been systematically reviewed. Using a modified Child Health Epidemiology Reference Group method we systematically reviewed the literature and identified and abstracted 37 articles. We conducted meta-analyses for the effect of NEC on maternal, neonatal and infant health outcomes including gestational weight gain, maternal anaemia, birthweight, low birthweight and preterm delivery. NEC significantly improved gestational weight gain by 0.45 kg, reduced the risk of anaemia in late pregnancy by 30%, increased birthweight by 105 g and lowered the risk of preterm delivery by 19%. The effect of NEC on risk of low birthweight was not significant. The effect of NEC was greater when provided with nutrition support, for example, food or micronutrient supplements or nutrition safety nets. The overall quality of the body of evidence was deemed low for all outcomes due to high heterogeneity, poor study designs and other biases. Additional well-designed research that is grounded in appropriate theories of behaviour change is needed to improve confidence in the effect of NEC. Further, cost-effectiveness research is needed to clarify the added benefit and sustainability of providing NEC with nutritional support and/or safety nets, especially in areas where food insecurity and gender bias may limit women's capacity to adhere to NEC messages. © 2012 Blackwell Publishing Ltd.

  9. Caring for Patients with Service Dogs: Information for Healthcare Providers

    Science.gov (United States)

    Krawczyk, Michelle

    2016-11-29

    People with disabilities use various assistance devices to improve their capacity to lead independent and fulfilling lives. Service dogs can be crucial lifesaving companions for their owners. As the use of service dogs increases, nurses are more likely to encounter them in healthcare settings. Service dogs are often confused with therapy or emotional support dogs. While some of their roles overlap, service dogs have distinct protection under the American Disabilities Act (ADA). Knowing the laws and proper procedures regarding service dogs strengthens the abilities of healthcare providers to deliver holistic, patient-centered care. This article provides background information about use of dogs, and discusses benefits to patients and access challenges for providers. The author reviews ADA laws applicable to service dog use and potential challenges and risks in acute care settings. The role of the healthcare professional is illustrated with an exemplar, along with recommendations for future research and nursing implications related to care of patients with service dogs.

  10. Maternity services for rural and remote Australia: barriers to operationalising national policy.

    Science.gov (United States)

    Longman, Jo; Kornelsen, Jude; Pilcher, Jen; Kildea, Sue; Kruske, Sue; Grzybowski, Stefan; Robin, Sarah; Rolfe, Margaret; Donoghue, Deborah; Morgan, Geoffrey G; Barclay, Lesley

    2017-09-22

    In Australia, many small birthing units have closed in recent years, correlating with adverse outcomes including a rise in the number of babies born before arrival to hospital. Concurrently, a raft of national policy and planning documents promote continued provision of rural and remote maternity services, articulating a strategic intent for services to provide responsive, woman-centred care as close as possible to a woman's home. The aims of this paper are to contribute to an explanation of why this strategic intent is not realised, and to investigate the utility of an evidence based planning tool (the Toolkit) to assist with planning services to realise this intent. Interviews, focus groups and a group information session were conducted involving 141 participants in four Australian jurisdictions. Field notes and reports were thematically analysed. We identified barriers that helped explain the gap between strategic intent and services on the ground. These were absence of informed leadership; lack of knowledge of contemporary models of care and inadequate clinical governance; poor workforce planning and use of resources; fallacious perceptions of risk; and a dearth of community consultation. In this context, the implementation of policy is problematic without tools or guidance. Barriers to operationalising strategic intent in planning maternity services may be alleviated by using evidence based planning tools such as the Toolkit. Copyright © 2017. Published by Elsevier B.V.

  11. Using a quality improvement model to enhance providers' performance in maternal and newborn health care : a post-only intervention and comparison design

    NARCIS (Netherlands)

    Ayalew, Firew; Eyassu, Gizachew; Seyoum, Negash; van Roosmalen, Jos; Bazant, Eva; Kim, Young Mi; Tekleberhan, Alemnesh; Gibson, Hannah; Daniel, Ephrem; Stekelenburg, Jelle

    2017-01-01

    Background: The Standards Based Management and Recognition (SBM-R (R)) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine

  12. Developing interdisciplinary maternity services policy in Canada. Evaluation of a consensus workshop.

    Science.gov (United States)

    Martin, Carmel M; Kasperski, Jan

    2010-02-01

    Four maternity/obstetrical care organizations, representing women, midwives, obstetricians and family doctors conducted interdisciplinary policy research under auspices of four key stakeholder groups. These projects teams and key stakeholders subsequently collaborated to develop consensus on strategies for improved maternity services in Ontario. The objective of this study is to evaluate a 2-day research synthesis and consensus building conference to answer policy questions in relation to new models of interdisciplinary maternity care organizations in different settings in Ontario. The evaluation consisted of a scan of individual project activities and findings as were presented to an invited audience of key stakeholders at the consensus conference. This involved: participant observation with key informant consultation; a survey of attendees; pattern processing and sense making of project materials, consensus statements derived at the conference in the light of participant observation and survey material as pertaining to a complex system. The development of a systems framework for maternity care policy in Ontario was based on secondary analysis of the material. Conference participants were united on the importance of investment in maternity care for Ontario and the impending workforce crisis if adaptation of the workforce did not take place. The conference participants proposed reforming the current system that was seen as too rigid and inflexible in relation to the constraints of legislation, provider scope of practice and remuneration issues. However, not one model of interdisciplinary maternity/obstetrical care was endorsed. Consistency and coherence of models (rather than central standardization) through self-organization based on local needs was strongly endorsed. An understanding of primary maternity care models as subsystems of networked providers in complex health organizations and a wider social system emerged. The patterns identified were incorporated

  13. Why don?t humanitarian organizations provide safe abortion services?

    OpenAIRE

    McGinn, Therese; Casey, Sara E

    2016-01-01

    Background Although sexual and reproductive health services have become more available in humanitarian settings over the last decade, safe abortion services are still rarely provided. The authors? observations suggest that four reasons are typically given for this gap: ?There?s no need?; ?Abortion is too complicated to provide in crises?; ?Donors don?t fund abortion services?; and ?Abortion is illegal?. Discussion However, each of these reasons is based on false premises. Unsafe abortion is a...

  14. An Open Service Provider Concept for Enterprise Complex Automation

    Science.gov (United States)

    Ivaschenko, A. V.; Sitnikov, P. V.; Tanonykhina, M. O.

    2017-01-01

    The paper introduces a solution for IT services representation and management in the integrated information space of distributed enterprises. It is proposed to develop an Open Service Provider as a software platform for interaction between IT services providers and their users. Implementation of the proposed concept and approach is illustrated by an after-sales customer support system for a large manufacturing corporation delivered by SEC “Open Code”.

  15. Framing the future: sme logistics service providers and scenario planning

    NARCIS (Netherlands)

    Stef Weijers; Reinder Pieters; Allan Woodburn; Hans-Heinrich Glöckner

    2013-01-01

    In recent years, the transport industry has encountered numerous challenges. It experienced strong growth, but also many uncertainties. In many cases, logistics service providers were forced to change their strategy. So, the question for logistics service providers arises “how to deal best with

  16. Patient satisfaction with health care services provided at HIV clinics ...

    African Journals Online (AJOL)

    Background: Since the establishment of free HIV/AIDS care and treatment services in Tanzania a lot of research has been done to assess how health care providers discharge their duties in these clinics. Little research however has been done regarding satisfaction of HIV patients with free health care services provided.

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

    Science.gov (United States)

    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.

  18. Maternal Mind-Mindedness Provides a Buffer for Pre-Adolescents at Risk for Disruptive Behavior.

    Science.gov (United States)

    Hughes, Claire; Aldercotte, Amanda; Foley, Sarah

    2017-02-01

    Maternal mind-mindedness, defined as the propensity to view one's child as an agent with independent thoughts and feelings, mitigates the impact of low maternal education on conduct problems in young children (Meins et al. 2013), but has been little studied beyond the preschool years. Addressing this gap, we applied a multi-measure and multi-informant approach to assess family adversity and disruptive behavior at age 12 for a socially diverse sample of 116 children for whom ratings of disruptive behavior at age 6 were available. Each mother was asked to describe her child and transcripts of these five-minute speech samples were coded for (i) mind-mindedness (defined by the proportion of child attributes that were mental rather than physical or behavioral) and (ii) positivity (defined by the proportion of child attributes that were positive rather than neutral or negative). Our regression results showed that, independent of associations with prior adjustment, family adversity, child gender and low maternal monitoring, mothers' mind-mindedness (but not positivity) predicted unique variance in disruptive behavior at age 12. In addition, a trend interaction term provided partial support for the hypothesis that pre-adolescents exposed to family adversity may benefit in particular from maternal mind-mindedness. We discuss the possible mechanisms underpinning these findings and their implications for clinical interventions to reduce disruptive behavior in adolescence.

  19. Implementation research on community health workers' provision of maternal and child health services in rural Liberia.

    Science.gov (United States)

    Luckow, Peter W; Kenny, Avi; White, Emily; Ballard, Madeleine; Dorr, Lorenzo; Erlandson, Kirby; Grant, Benjamin; Johnson, Alice; Lorenzen, Breanna; Mukherjee, Subarna; Ly, E John; McDaniel, Abigail; Nowine, Netus; Sathananthan, Vidiya; Sechler, Gerald A; Kraemer, John D; Siedner, Mark J; Panjabi, Rajesh

    2017-02-01

    To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme. The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation. Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly. We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes.

  20. Implementation research on community health workers’ provision of maternal and child health services in rural Liberia

    Science.gov (United States)

    Luckow, Peter W; Kenny, Avi; White, Emily; Ballard, Madeleine; Dorr, Lorenzo; Erlandson, Kirby; Grant, Benjamin; Johnson, Alice; Lorenzen, Breanna; Mukherjee, Subarna; Ly, E John; McDaniel, Abigail; Nowine, Netus; Sathananthan, Vidiya; Sechler, Gerald A; Kraemer, John D; Siedner, Mark J

    2017-01-01

    Abstract Objective To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme. Methods The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation. Findings Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly. Conclusion We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes. PMID:28250511

  1. Influence of formal maternal education on the use of maternity services in Enugu, Nigeria.

    Science.gov (United States)

    Ikeako, L C; Onah, H E; Iloabachie, G C

    2006-01-01

    Although some previous studies have suggested formal maternal education as the most potent tool for reducing the mortality ratio in Nigeria, other studies found that the depressed Nigerian economy since 1986 has marginalised the benefits of education with the result that educated women stopped making use of existing health facilities because they could not afford the cost of health services. This study was carried out to determine the current influence of formal maternal education and other factors on the choice of place of delivery by pregnant women in Enugu, south-eastern Nigeria. It was a pre-tested interviewer-administered questionnaire study of women who delivered within 3 months before the date of data collection in the study area. In an increasing order of level of care, the outcome variable (place where the last delivery took place) was categorised into seven, with home deliveries representing the lowest category and private hospitals run by specialist obstetricians as the highest category. These were further sub-categorised into non-institutional deliveries and institutional deliveries. Maternal educational level was the main predictor variable. Other predictor variables were sociodemographic factors. Data analysis was by means of descriptive and inferential statistics including means, frequencies and chi2-tests at the 95% confidence (CI) level. Out of a total of 1,450 women to whom the questionnaires were administered, 1,095 women responded (a response rate of 75.5%). A total of 579 (52.9%) of the respondents delivered outside health institutions, while the remaining 516 (47.1%) delivered within health institutions. Regarding the educational levels of the respondents, 301 (27.5%) had no formal education; 410 (37.4%) had primary education; 148 (13.5%) secondary education and 236 (21.5%) post-secondary education. There was a significant positive correlation between the educational levels of the respondents and their husbands (r=0.86, p=0.000). With respect

  2. Socioeconomic inequalities in the uptake of maternal healthcare services in Ethiopia.

    Science.gov (United States)

    Mezmur, Markos; Navaneetham, Kannan; Letamo, Gobopamang; Bariagaber, Hadgu

    2017-05-22

    The progress in coverage of maternal health services in Ethiopia has been rather slow over the past decade and consequently the maternal mortality ratio was very high (673 per 100,000 live births) among the countries in Sub-Saharan Africa and remained constant during 2005-11 period. Earlier studies have mostly focused on determinants of maternal health seeking behavior in Ethiopia. However, little is known about the inequality aspects. This study intends to examine socioeconomic inequalities in the uptake of maternal health services and to identify factors that contribute to such inequalities. Data for the study is drawn from three rounds (year 2000, 2005 and 2011) of the Ethiopian Demographic and Health Surveys (EDHS). Concentration curves and the related concentration index (CI) were used to capture inequalities across the full range of socioeconomic status and highlight trends in the uptake of maternal health services in the country. Decomposition analysis was also employed to identify dominant factors that contribute to inequalities in the uptake of maternal healthcare services. In this study, there is a general improvement in the uptake of maternal health services in Ethiopia over the past decade which is inequitable to the disadvantage of the poor. Inequalities are much larger in care during giving birth than in other maternal healthcare indicators. Furthermore, despite the progress made in reducing inequalities in the uptake of four antenatal care consultation (ANC) and tetanus toxoid (TT) injection, inequalities in access to health facilities for delivery and skilled assistance during delivery have rather widened over the same period. In all the survey years, inequalities in education and media access significantly contribute to inequalities in maternal health service utilization favoring the non-poor. The challenges to improving the uptake of maternal healthcare services in Ethiopia go beyond improving coverage of the maternal health services. Thus

  3. The Perspectives of Young Men and Their Teenage Partners on Maternity and Health Services during Pregnancy and Early Parenthood

    Science.gov (United States)

    Ross, Nicola J.; Church, Stephanie; Hill, Malcolm; Seaman, Pete; Roberts, Tom

    2012-01-01

    This study discusses young couples' interactions with maternity and health services paying particular attention to men's perspectives. Findings are based on research conducted in Scotland with men (aged 16-25) and their teenage partners (aged 16-19). Most young men were very involved in their child's life and provided support and care to their…

  4. Exploring inequalities in access to and use of maternal health services in South Africa

    Directory of Open Access Journals (Sweden)

    Silal Sheetal P

    2012-05-01

    Full Text Available Abstract Background South Africa’s maternal mortality rate (625 deaths/100,000 live births is high for a middle-income country, although over 90% of pregnant women utilize maternal health services. Alongside HIV/AIDS, barriers to Comprehensive Emergency Obstetric Care currently impede the country’s Millenium Development Goals (MDGs of reducing child mortality and improving maternal health. While health system barriers to obstetric care have been well documented, “patient-oriented” barriers have been neglected. This article explores affordability, availability and acceptability barriers to obstetric care in South Africa from the perspectives of women who had recently used, or attempted to use, these services. Methods A mixed-method study design combined 1,231 quantitative exit interviews with sixteen qualitative in-depth interviews with women (over 18 in two urban and two rural health sub-districts in South Africa. Between June 2008 and September 2009, information was collected on use of, and access to, obstetric services, and socioeconomic and demographic details. Regression analysis was used to test associations between descriptors of the affordability, availability and acceptability of services, and demographic and socioeconomic predictor variables. Qualitative interviews were coded deductively and inductively using ATLAS ti.6. Quantitative and qualitative data were integrated into an analysis of access to obstetric services and related barriers. Results Access to obstetric services was impeded by affordability, availability and acceptability barriers. These were unequally distributed, with differences between socioeconomic groups and geographic areas being most important. Rural women faced the greatest barriers, including longest travel times, highest costs associated with delivery, and lowest levels of service acceptability, relative to urban residents. Negative provider-patient interactions, including staff inattentiveness, turning

  5. Male involvement in maternal healthcare through Community- based Health Planning and Services: the views of the men in rural Ghana

    Directory of Open Access Journals (Sweden)

    Bassoumah Bougangue

    2017-09-01

    Full Text Available Abstract Background The need to promote maternal health in Ghana has committed the government to extend maternal healthcare services to the door steps of rural families through the community-based Health Planning and Services. Based on the concerns raised in previous studies that male spouses were indifferent towards maternal healthcare, this study sought the views of men on their involvement in maternal healthcare in their respective communities and at the household levels in the various Community-based Health Planning and Services zones in Awutu-Senya West District in the Central Region of Ghana. Methods A qualitative method was employed. Focus groups and individual interviews were conducted with married men, community health officers, community health volunteers and community leaders. The participants were selected using purposive, quota and snowball sampling techniques. The study used thematic analysis for analysing the data. Results The study shows varying involvement of men, some were directly involved in feminine gender roles; others used their female relatives and co-wives to perform the women's roles that did not have space for them. They were not necessarily indifferent towards maternal healthcare, rather, they were involved in the spaces provided by the traditional gender division of labour. Amongst other things, the perpetuation and reinforcement of traditional gender norms around pregnancy and childbirth influenced the nature and level of male involvement. Conclusions Sustenance of male involvement especially, husbands and CHVs is required at the household and community levels for positive maternal outcomes. Ghana Health Service, health professionals and policy makers should take traditional gender role expectations into consideration in the planning and implementation of maternal health promotion programmes.

  6. Conceptual Models of the Individual Public Service Provider

    DEFF Research Database (Denmark)

    Andersen, Lotte Bøgh; Bhatti, Yosef; Petersen, Ole Helby

    Individual public service providers’ motivation can be conceptualized as either extrinsic, autonomous or prosocial, and the question is how we can best theoretically understand this complexity without losing too much coherence and parsimony. Drawing on Allison’s approach (1969), three perspectives...... are used to gain insight on the motivation of public service providers; namely principal-agent theory, self-determination theory and public service motivation theory. We situate the theoretical discussions in the context of public service providers being transferred to private organizations...... theoretical – to develop a coherent model of individual public service providers – but the empirical illustration also contributes to our understanding of motivation in the context of public sector outsourcing....

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

    African Journals Online (AJOL)

    Conclusion: It is recommended that qualitative research should be conducted in every community to identify traditional beliefs, customs and taboos that may be a deterrent to utilization of skilled maternity care. The information obtained should be used to develop a health communication plan for the community on maternal ...

  8. Providing Educationally Relevant Occupational and Physical Therapy Services

    Science.gov (United States)

    Laverdure, Patricia A.; Rose, Deborah S.

    2012-01-01

    As defined in the Individuals with Disabilities Education Improvement Act, occupational and physical therapists provide services to support students to access, participate, and progress in their educational program within the least restrictive educational environment. Educationally relevant occupational and physical therapy services in school…

  9. Providing Mental Health Services to Arab Americans: Recommendations and Considerations.

    Science.gov (United States)

    Erickson, Chris D.; Al-Timimi, Nada R.

    2001-01-01

    This paper presents background information on the cultural sociopathology of the Arab American experience. It discusses how, in order to effectively deliver services, mental health workers need to be aware of their own biases. It explores ways to provide culturally relevant mental health services to Arab Americans. (JDM)

  10. 20 CFR 631.52 - Selection of service providers.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Selection of service providers. 631.52 Section 631.52 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROGRAMS UNDER TITLE III OF THE JOB TRAINING PARTNERSHIP ACT Substate Programs § 631.52 Selection of service...

  11. Local perception of ecosystem services provided by bats and bees ...

    African Journals Online (AJOL)

    Indigenous perception on ecosystem services provided by honey bees and fruit bats were assessed in Bénin to find out whether the communities value these services and to appreciate if there is any chance to conserve them locally. Farmers were interviewed with questionnaire in three regions of Bénin to report their ...

  12. Redefining the bureaucratic encounter between service providers and service users: evidence from the Norwegian HUSK projects.

    Science.gov (United States)

    Carnochan, Sarah; Austin, Michael J

    2015-01-01

    The HUSK projects, involving collaboration between service users, providers, educators, and researchers, coincided with the reorganization of national government services (NAV). The NAV reorganization brought together employment services, social insurance, and municipal social service benefits, and called for a service model where users would be empowered to influence the provision of services. In this analysis of the HUSK cases the authors focus on the relationship between the service user and the service provider, identifying themes in two broad domains: concepts of the individual that included the service user and the service provider and concepts of the relationship that included power, role, activity, interaction, and communication. Within each theme, the analysis highlights the transition from a traditional or historical state to a new or desired state and draws upon some of the classic literature that frames the encounters between service users and providers.

  13. Privately Provided Accommodation Service Quality and Customer Satisfaction

    Directory of Open Access Journals (Sweden)

    Joshua Mugambwa

    2016-04-01

    Full Text Available Privately provided accommodation is a growing service in Uganda’s higher education sector due to education liberalization and demand for education. This research took a case study of Nsamizi Training Institute of Social Development (NTISD to determine the relationship between privately provided accommodation service quality and customer satisfaction. Specifically, the objectives of the study were (a to find out the relationship between security and NTISD students’ satisfaction with privately provided accommodation, and (b to find out the hierarchical level of importance of NTISD student satisfaction of the three service quality dimensions (reliability, security, and tangibles with privately provided accommodation. Using quantitative and qualitative modes of data analysis and a sample of 300 students from 20 private hostels, this study established a strong positive significant relationship between security and satisfaction regarding privately provided accommodation. This implies that accommodation service providers should increase the quality of security so as to increase the satisfaction of students regarding privately provided accommodation. The study established the hierarchical order of importance from the most important service quality dimension, respectively, as follows: reliability, security, and tangibles. Therefore, private accommodation service managers should pay extra attention to the dimensions in the same order.

  14. Challenging RSD clients’ preferences for foreign service providers

    Directory of Open Access Journals (Sweden)

    Christian Pangilinan

    2012-12-01

    Full Text Available Organisations that provide legal services to refugees and asylumseekers face the challenge of responding ethically to clients’ requeststo be assisted by foreigners as opposed to by nationals in countryoffices.

  15. Dutch logistics service providers and sustainable physical distribution

    NARCIS (Netherlands)

    Onno Omta; Hans-Heinrich Glöckner; Reinder Pieters; Stef Weijers

    2013-01-01

    As environmental concerns becoming increasingly important to logistics service providers, the question arises as to how they can achieve sustainable physical distribution practices while surviving the severe competition in freight transport. This issue is further complicated by the pressures from

  16. Demonstrate provider accessibility with desktop and online services.

    Science.gov (United States)

    2001-10-01

    It's available on personal computers with a CD or through Internet access. Assess instantly the accessibility of your provider network or the most promising areas to establish a health service with new GIS tools.

  17. Evaluating Religious Influences on the Utilization of Maternal Health Services among Muslim and Christian Women in North-Central Nigeria

    Directory of Open Access Journals (Sweden)

    Maryam Al-Mujtaba

    2016-01-01

    Full Text Available Introduction. Uptake of antenatal services is low in Nigeria; however, indicators in the Christian-dominated South have been better than in the Muslim-dominated North. This study evaluated religious influences on utilization of general and HIV-related maternal health services among women in rural and periurban North-Central Nigeria. Materials and Methods. Targeted participants were HIV-positive, pregnant, or of reproductive age in the Federal Capital Territory and Nasarawa. Themes explored were utilization of facility-based services, provider gender preferences, and Mentor Mother acceptability. Thematic and content approaches were applied to manual data analysis. Results. Sixty-eight (68 women were recruited, 72% Christian and 28% Muslim. There were no significant religious influences identified among barriers to maternal service uptake. All participants stated preference for facility-based services. Uptake limitations were mainly distance from clinic and socioeconomic dependence on male partners rather than religious restrictions. Neither Muslim nor Christian women had provider gender preferences; competence and positive attitude were more important. All women found Mentor Mothers highly acceptable. Conclusion. Barriers to uptake of maternal health services appear to be minimally influenced by religion. ANC/PMTCT uptake interventions should target male partner buy-in and support, healthcare provider training to improve attitudes, and Mentor Mother program strengthening and impact assessment.

  18. Providing Multi-Page Data Extraction Services with XWRAPComposer

    Energy Technology Data Exchange (ETDEWEB)

    Liu, Ling; Zhang, Jianjun; Han, Wei; Pu, Calton; Caverlee, James; Park, Sungkeun; Critchlow, Terence J.; Buttler, David; Coleman, Matthew A.

    2008-04-30

    Dynamic Web data sources – sometimes known collectively as the Deep Web – increase the utility of the Web by providing intuitive access to data repositories anywhere that Web access is available. Deep Web services provide access to real-time information, like entertainment event listings, or present a Web interface to large databases or other data repositories. Recent studies suggest that the size and growth rate of the dynamic Web greatly exceed that of the static Web, yet dynamic content is often ignored by existing search engine indexers owing to the technical challenges that arise when attempting to search the Deep Web. To address these challenges, we present DYNABOT, a service-centric crawler for discovering and clustering Deep Web sources offering dynamic content. DYNABOT has three unique characteristics. First, DYNABOT utilizes a service class model of the Web implemented through the construction of service class descriptions (SCDs). Second, DYNABOT employs a modular, self-tuning system architecture for focused crawling of the Deep Web using service class descriptions. Third, DYNABOT incorporates methods and algorithms for efficient probing of the Deep Web and for discovering and clustering Deep Web sources and services through SCD-based service matching analysis. Our experimental results demonstrate the effectiveness of the service class discovery, probing, and matching algorithms and suggest techniques for efficiently managing service discovery in the face of the immense scale of the Deep Web.

  19. Determinants of Maternity Care Services Utilization among Married Adolescents in Rural India

    Science.gov (United States)

    Singh, Prashant Kumar; Rai, Rajesh Kumar; Alagarajan, Manoj; Singh, Lucky

    2012-01-01

    Background Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed. Methodology/Principal Findings Using the data from third wave of National Family Health Survey (2005–06), available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15–19 years) in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994), selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions. Conclusions The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household

  20. Determinants of maternity care services utilization among married adolescents in rural India.

    Directory of Open Access Journals (Sweden)

    Prashant Kumar Singh

    Full Text Available Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed.Using the data from third wave of National Family Health Survey (2005-06, available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15-19 years in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994, selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions.The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start targeting household with married adolescent women belonging to

  1. On the way to universal coverage of maternal services in Iringa rural ...

    African Journals Online (AJOL)

    On the way to universal coverage of maternal services in Iringa rural District in Tanzania. Who is yet to be reached? Manuela Straneo, Piera Fogliati, Ingrid Pellis, Catherine Goodman, Donata Dalla Riva, Firma Kisika, Ezekiel Mpuya, Giovanni Putoto ...

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

    National Research Council Canada - National Science Library

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

    2010-01-01

    .... 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...

  3. Employee motivation in Product-Service-System providers

    DEFF Research Database (Denmark)

    Kreye, Melanie

    2016-01-01

    This research investigates how intrinsic and extrinsic motivation factors contribute to employee motivation in providers of Product-Service Systems (PSS). Employee motivation determines the quality of the delivered service and is thus an area of great importance for PSS providers. We present rich...... case-based data collected through semi-structured interviews, a survey and secondary sources. The analysis showed the particularly high importance of intrinsic and individual motivation factors such as the fulfilling nature of the work and skill development showing the ownership and pride service...... employees took in their work. Further, the organisation needs to set the context of high employee motivation by enabling flexibility and performance feedback. Our research contributes to the literature by providing a first empirical study of employee motivation in PSS providers and thus providing important...

  4. A Proposal of Secure Session Provider Service over NGN

    Science.gov (United States)

    Kaji, Tadashi; Fujishiro, Takahiro; Susaki, Seiichi; Kawai, Eri; Hoshino, Kazuyoshi; Higashino, Teruo

    In these days, telecom operators in the world have been constructing Next Generation Network (NGN). NGN can provide QoS and security guaranteed communication to its users. However, the protection of communication is limited inside NGN. Therefore, when the interconnection between NGN and the Internet will be widely used in near future, it will become an important problem to solve how it protects the communications crossing over NGN and the Internet. This paper proposes a secure communication provider service that protects the confidentiality and integrity of communications crossing over NGN and the Internet by setting up and controlling the IPsec session in cooperation with NGN's call session control function (CSCF). In this service, the secure session control provider (sSCP) server and CSCF authenticate its user as Trusted Third Party on behalf of service providers. In addition, this service provides the ability of fast session establishment because sSCP distributes a security association for IPsec session between the user and service provider via the SIP session protected by NGN.

  5. EV and HP Providing Ancillary Services in the Nordic Region

    DEFF Research Database (Denmark)

    Liu, Zhaoxi; Wu, Qiuwei

    This report covers the analysis of the electric vehicle (EV) and heat pump (HP) providing ancillary services to the power system of the Nordic region including Denmark, Finland, Norway and Sweden. The analysis is to investigate the feasibility of EVs and HPs to serve as demand as frequency reserve...... (DFR) providers in the distribution power system in the four mentioned Nordic countries....

  6. Definitions of Multicultural Competence: Frontline Human Service Providers' Perspective

    Science.gov (United States)

    Caldwell, Leon D.; Tarver, Dolores D.; Iwamoto, Derek K.; Herzberg, Sarah E.; Cerda-Lizarraga, Patricia; Mack, Tabethah

    2008-01-01

    In this qualitative study, the authors explored definitions of multicultural competence given by 99 frontline human service providers. The providers had no formal training in counseling but served in a helping role. Seven thematic definitions emerged: color blindness, client focused, acknowledgment of cultural differences, textbook consistent,…

  7. Impact of a service provider incentive payment scheme on quality of reproductive and child-health services in Egypt.

    Science.gov (United States)

    Huntington, Dale; Zaky, Hassan H M; Shawky, Sherine; Fattah, Faten Abdel; El-Hadary, Eman

    2010-06-01

    A case-control, quasi-experimental study was designed (post-test only) to investigate the effect of a performance-based incentive payment scheme on behaviours of public-sector service providers in delivering a basic package of maternal and child-health services in Egyptian primary healthcare units. The results showed significant improvements in the quality of family-planning, antenatal care, and child-care services as reported by women seen in clinics where the incentive payment scheme was in operation as measured by various indicators, including both technical and inter-personal communication content. An analysis of characteristics of the service providers and clients found no significant or meaningful differences between the study groups, and the facilities of both the study groups were essentially the same. Some findings are suggestive of other influences on behaviours of the service providers not captured by the data-collection instruments of the study. Subsequent to this study, the payment scheme has been rolled out to other districts in Egypt.

  8. Customer satisfaction surveys: Methodological recommendations for financial service providers

    Directory of Open Access Journals (Sweden)

    Đorđić Marko

    2010-01-01

    Full Text Available This methodological article investigates practical challenges that emerge when conducting customer satisfaction surveys (CSS for financial service providers such as banks, insurance or leasing companies, and so forth. It displays methodological recommendations in reference with: (a survey design, (b sampling, (c survey method, (d questionnaire design, and (e data acquisition. Article provides appropriate explanations that usage of: two-stage survey design, SRS method, large samples, and rigorous fieldwork preparation can enhance the overall quality of CSS in financial services. Proposed methodological recommendations can primarily be applied to the primary quantitative marketing research in retail financial services. However, majority of them can be successfully applied when conducting primary quantitative marketing research in corporate financial services as well. .

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

    Science.gov (United States)

    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

  10. Maternal experience of interactions with providers among mothers with milk supply concern.

    Science.gov (United States)

    Flaherman, Valerie J; Hicks, Katherine G; Cabana, Michael D; Lee, Kathryn A

    2012-08-01

    Milk supply concern is the most common reason given by mothers for discontinuing breastfeeding. OBJECTIVES. To describe maternal experiences of interactions with health care providers related to milk supply. Ten focus groups (N = 56 participants) were conducted among mothers who had had milk supply concern in the first month after birth. Group sessions were audio-recorded, transcribed, coded, and analyzed to identify themes. Results. Interactions regarding milk supply concern evoked strong emotions, including gratitude, guilt, disappointment, and fear, and measurement of infant weight was frequently reported as a trigger for these emotions. Some mothers reported that experiencing "pressure" and "guilt" when providers emphasized exclusive breastfeeding led to suboptimal breastfeeding choices. Interactions with providers about milk supply concern evoke strong emotions among mothers. Providers should be aware that how they communicate routine advice regarding infant weight and formula may have unintended consequences, including discontinuation of breastfeeding.

  11. The Restaurant as Hybrid: Lean Manufacturer and Service Provider

    Directory of Open Access Journals (Sweden)

    Christopher Muller

    2013-01-01

    Full Text Available Uniquely positioned as both consumer service providers and tangible finished goods manufacturers, restaurants sell at retail an inventory that is fabricated from raw materials at the site of consumption. This article illustrates how restaurant managers have historically used the fundamentals of just-in-time and lean manufacturing production, often without understanding the power for efficiency and profit each brings. The goal is to encourage restaurateurs to seek a better understanding of where these principles interface with service management theory.

  12. Factors Influencing Mothers’ Utilization of Maternal and Child Care (MCC Services

    Directory of Open Access Journals (Sweden)

    Raquel C. Pambid

    2015-05-01

    Full Text Available The Rapid Reduction of Maternal and Neonatal Mortality is a health system responsive to the needs of all mothers and children. While various efforts are being undertaken to improve the implementation of maternal health program among pregnant women and immunization for children, there is a slow take up of these services. Factors influencing the slow demand for MCC services among mothers and children are not fully known. Factors hindering the delivery of these services need to be probed. This study used the descriptive method of research to describe the responses of mothers about the factors influencing slow availment of Maternal and Child Care Services. There were 396 mothers in Region 1 who willingly participated during focused group discussion. The highly availed services by mothers were: 1. pre-natal service, 2. Immunization, and 3. Family planning. Health services availed by the respondents’ children were: 1. Management of childhood illness, 2. Immunization, and 3. Infant and young feeding. The mothers’ deep concern for her baby’s safety and health; free but limited medical services from competent health workers; inadequate supplies and equipment; distance to the nearest health facility, family income, mothers’ education and dialect for communication influenced delivery of the program. To increase the utilization of MCC services, government hospitals should give free complete MCC services to the poor, the mothers should be informed about the benefits of complete maternal services for her baby and herself, enhance dissemination campaign through leaflets, flyers, pamphlets, and seminars.

  13. 22 CFR 96.14 - Providing adoption services using other providers.

    Science.gov (United States)

    2010-04-01

    ... termination of parental rights and to adoption, if the primary provider verifies consent pursuant to § 96.46(c... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Providing adoption services using other... ACCREDITATION OF AGENCIES AND APPROVAL OF PERSONS UNDER THE INTERCOUNTRY ADOPTION ACT OF 2000 (IAA...

  14. Understanding Climate Service Science: Balancing Users' Needs with Providers' Capabilities

    Science.gov (United States)

    Street, Roger B.; Bley, Dagmar; Manez, Maria

    2013-04-01

    Understanding Climate Service Science: Balancing Users' Needs with Providers' Capabilities The overall strategic objective of the Joint Programming Initiative (JPI)-Climate is to contribute to highly coordinated knowledge development by not only improving the scientific expertise on climate change risks and adaptation options, but also by connecting that knowledge with decision making. Understanding the nature and scope of those providing climate services and the services being provided and understanding userś needs and requirements is critical to realisation of this strategic objective. The main aim of the JPI-Climate Working Group 2 "Researching and advancing Climate Service Development" is to coordinate knowledge development and transfer to improve the climate (change) services to society and within Europe. In order to avoid duplication of efforts and picking on differences in the quality and nature of information being provided from country to country there is a need for a certain degree of consistency of approaches and quality assurance. The JPI-Climate will bring interaction between the emerging national and European climate services initiatives. Climate services produce strongly science-based client-oriented information. They should be built on a good understanding of the stakeholder needs, and provide easy access to up-to-date information and expertise regarding specific policy or research questions. It is evident from experience that such services need (and are perceived) to be salient, credible and legitimate from the perspective of the intended users and providers of those services, and within the supportive research community. Achieving this aim and developing and delivering the required services necessitates the engagement of the spectrum of users and providers, as well as researchers from the physical, natural, engineering, economics and social sciences - the science underpinning climate services. The JPI-Climate, Module 2 Fast Track Activities (FTAs

  15. Do Interventions that Promote Awareness of Rights Increase Use of Maternity Care Services? A Systematic Review: e0138116

    National Research Council Canada - National Science Library

    Asha S George; Casey Branchini; Anayda Portela

    2015-01-01

    ... to increase use of maternity care services. Using inclusion and exclusion criteria defined in a peer-reviewed protocol, we searched published and grey literature from one database of studies on maternal health, two search engines, an internet...

  16. Service Provision for Autism in Mainland China: A Service Providers' Perspective

    Science.gov (United States)

    Sun, Xiang; Allison, Carrie; Auyeung, Bonnie; Matthews, Fiona E.; Murray, Stuart; Baron-Cohen, Simon; Brayne, Carol

    2013-01-01

    Qualitative semi-structured interviews were conducted with service providers regarding the current healthcare provision and education services for children with Autism Spectrum Conditions (ASC) and their families in mainland China. 10 service providers described the current policy and identified unmet needs within current practice. Providers…

  17. Nutrition: Intervention Guidance for Service Providers and Families. Connecticut Birth to Three System, Service Guideline 6.

    Science.gov (United States)

    Connecticut Birth to Three System, Hartford.

    This guide was developed to assist families and service providers in Connecticut with nutrition services for infants and toddlers with disabilities. Individual sections provide information about the following topics: laws and regulations related to nutrition services; eligibility for the Connecticut Birth to Three System and nutrition; nutrition…

  18. Maternal health care service seeking behaviors and associated factors among women in rural Haramaya District, Eastern Ethiopia: a triangulated community-based cross-sectional study.

    Science.gov (United States)

    Kifle, Dereje; Azale, Telake; Gelaw, Yalemzewod Assefa; Melsew, Yayehirad Alemu

    2017-01-13

    Regular utilization of maternal health care services reduces maternal morbidity and mortality. This study assessed the maternal health care seeking behavior and associated factors of reproductive age women in rural villages of Haramaya district, East Ethiopia. Community based cross sectional study supplemented with qualitative data was conducted in Haramaya district from November 15 to Decemeber 30, 2015. A total of 561 women in reproductive age group and who gave birth in the last 2 years were randomly included. Bivariate and multivariate logistic regressions model was used to identify the associated factors. Odds ratios with 95% CI were used to measure the strength of association. Maternal health care service seeking of women was found as; antenatal care 74.3% (95% CI; 72.5, 76.14), attending institutional delivery 28.7% (95% CI; 26.8, 30.6) and postnatal care 22.6% (95% CI; 20.84, 24.36). Knowledge of pregnancy complications, Educational status, and religion of women were found to be significantly associated with antenatal health care, delivery and postnatal health care service seeking behaviours triangulated with individual, institutional and socio-cultural qualitative data. The maternal health care service seeking behavior of women in the study area was low. Educational status of the women, birth order and knowledge about pregnancy complications were the major factors associated with maternal health care service seeking behavior Focused health education with kind and supportive health care provider counseling will improve the maternal health care seeking behaviors of women.

  19. Women with pre-existing diabetes and their experiences of maternity care services.

    Science.gov (United States)

    Stenhouse, Elizabeth; Letherby, Gayle; Stephen, Nicole

    2013-02-01

    the aims of the study were to explore the experience of maternity care services used by women whose pregnancy is complicated by pre-existing diabetes, to gain a deeper understanding of service use and to identify aspects of services that women with pre-existing diabetes would like improved. for women with pre-existing diabetes; pregnancy, birth and the transition to motherhood can be complex and even chaotic. The aim of specialist diabetes care given during pregnancy and delivered by a specialist team of health-care professionals is to optimise pregnancy outcome. However, how health-care professionals within maternity services provide care and support women with pre-existing diabetes during pregnancy and early motherhood has received limited attention. an exploratory study utilising a grounded theory approach was conducted. Data were collected via in-depth interviews with 20 respondents; one-to-one, dyad and group interviews were undertaken to fully explore issues. Analysis was undertaken by sub-groups of the research team with at least two members working on each of them. three themes were identified from interviews: empathic care with care more focused on diabetes not pregnancy; feeling judged by health-care professionals (with nearly all respondents reporting negative encounters of consultation with the specialist team); and the notion of expertise (with respondents reporting feeling frustrated when it seemed health-care professionals did not value their expertise). the study emphasised the importance of the health-care relationship for pregnant women with pre-existing diabetes. For outcomes to be optimised women need to be able to form open and trusting relationships with the health-care team. this study highlights the need for the health-care team not only to provide physical care to optimise outcome but also supportive care to assist women with pregnancies complicated by diabetes to achieve the best possible physical and emotional health and well

  20. Exploring Service-led Growth Trajectories for Analytical Equipment Providers

    DEFF Research Database (Denmark)

    Raja, Jawwad; Frandsen, Thomas; Mouritsen, Jan

    2016-01-01

    This paper examines the dilemmas encountered by advanced analytical equipment providers in developing service-led growth strategies to expand their business in pursuit of more attractive revenue models. It does so by adopting a case based research approach. The findings detail the capabilities...... required to provide advanced services within customers’ R&D functions, while simultaneously attempting to scale these for a production context. The emergent complexities of operating in multiple arenas in order to explore and exploit technologies-along the three trajectories of serviceability, scalability...... and solutions-in different contexts, with a view to expanding markets and developing solution based business models, are discussed. It is argued that analytical equipment providers encounter dilemmas as managing these different trajectories implies different needs in terms of the technological sophistication...

  1. DEVELOPMENT PERSPECTIVES OF LOGISTICS SERVICES PROVIDERS IN POLAND

    Directory of Open Access Journals (Sweden)

    Ewa PŁACZEK

    2015-04-01

    Full Text Available The market of logistics services (TSL in Poland is new, yet already mature. There are a lot of diverse entities operating there that provide various types of logistics services. So far the major goal of business conducted by them has been to generate profit that ensured further development. However, currently a change in the attitude towards business that is aimed for example at management of the company value is observed. And thus the following question should be asked: „What activities are undertaken by logistics services providers for the purpose of achievement of success such as for example improvement of the company attractiveness or growth in the company value?”. To answer the question put in this way, the analysis of activities undertaken by providers of logistics services in Poland is performed. The article presents activities of logistics services providers that are the response to demands of the market – the customer, for the purpose of satisfaction of their individualised needs. We can consider them determinants of further operations that describe possible trends of development.

  2. Marketing in the business activity of logistics service providers

    Directory of Open Access Journals (Sweden)

    Marcin Świtała

    2013-09-01

    Full Text Available Background: This article is a discussion on the role of marketing in the activity of logistics service providers. The strong competition and changing purchasing preferences should motivate the transport, forwarding and logistics sector managers to apply the marketing approach in practice. Methods: Results of direct research, conducted among a targeted group of 100 companies from the transport, forwarding and logistics sector, constitute the source basis. The sample group was divided into three categories of logistics providers: 2PL, 3PL and 4PL. The statistical analysis was based on three different non-parametric tests (Kruskal-Wallis, Chi-square and V Kramer.  Results and conclusions:  Currently, marketing does not play a key role in the activity of logistics services providers. The prevailing opinion is that importance of marketing in the company is average. The respondents have assessed in a similar way their activity compared to the activities of the competition. However, it was found that with the increase of the level of specialization (2PL-4PL, the awareness of impact of marketing on the logistics services sector also increased. The logistics services providers, who offer a wide range of logistics services, asses their competitive position in a better light.  

  3. Federated query services provided by the Seamless SAR Archive project

    Science.gov (United States)

    Baker, S.; Bryson, G.; Buechler, B.; Meertens, C. M.; Crosby, C. J.; Fielding, E. J.; Nicoll, J.; Youn, C.; Baru, C.

    2013-12-01

    The NASA Advancing Collaborative Connections for Earth System Science (ACCESS) seamless synthetic aperture radar (SAR) archive (SSARA) project is a 2-year collaboration between UNAVCO, the Alaska Satellite Facility (ASF), the Jet Propulsion Laboratory (JPL), and OpenTopography at the San Diego Supercomputer Center (SDSC) to design and implement a seamless distributed access system for SAR data and derived data products (i.e. interferograms). A major milestone for the first year of the SSARA project was a unified application programming interface (API) for SAR data search and results at ASF and UNAVCO (WInSAR and EarthScope data archives) through the use of simple web services. A federated query service was developed using the unified APIs, providing users a single search interface for both archives (http://www.unavco.org/ws/brokered/ssara/sar/search). A command line client that utilizes this new service is provided as an open source utility for the community on GitHub (https://github.com/bakerunavco/SSARA). Further API development and enhancements added more InSAR specific keywords and quality control parameters (Doppler centroid, faraday rotation, InSAR stack size, and perpendicular baselines). To facilitate InSAR processing, the federated query service incorporated URLs for DEM (from OpenTopography) and tropospheric corrections (from the JPL OSCAR service) in addition to the URLs for SAR data. This federated query service will provide relevant QC metadata for selecting pairs of SAR data for InSAR processing and all the URLs necessary for interferogram generation. Interest from the international community has prompted an effort to incorporate other SAR data archives (the ESA Virtual Archive 4 and the DLR TerraSAR-X_SSC Geohazard Supersites and Natural Laboratories collections) into the federated query service which provide data for researchers outside the US and North America.

  4. Cytomegalovirus (CMV) infection and pregnancy-potential for improvements in Australasian maternity health providers' knowledge.

    Science.gov (United States)

    Shand, A W; Luk, W; Nassar, N; Hui, L; Dyer, K; Rawlinson, W

    2017-07-11

    To assess the knowledge, practice and attitudes of maternity clinicians regarding congenital cytomegalovirus (CMV). It is the most common congenital infection, and well-recognized cause of neurodevelopmental disability and hearing loss. New consensus recommendations state all pregnant women and health-care providers should be educated about congenital CMV infection and preventive measures. An email questionnaire was distributed in October 2015 to specialists, diplomates (general practitioners), and trainees of the Royal Australian New Zealand College of Obstetricians and Gynaecologists (RANZCOG), and Victorian and New South Wales midwives. 774 responded: (37.3% specialists, 17.3% diplomates, 16.8% trainees, 28.6% midwives). Clinicians had variable knowledge of fetal sequelae, transmission routes and prevention. Overall, 30.2% felt confident about discussing CMV in pregnancy: less than 10% of midwives (7.4%) and less than half of specialists (47.1%, p maternity clinicians lack confidence and knowledge about congenital CMV. Few (<10%) routinely provide advice on prevention. There is urgent need for clinical guidance and patient information to reduce the burden of disease.

  5. Maternal complications and women's behavior in seeking care from skilled providers in North Gondar, Ethiopia.

    Directory of Open Access Journals (Sweden)

    Abebaw Gebeyehu Worku

    Full Text Available BACKGROUND: Maternal complications are morbidities suffered during pregnancy through the postpartum period of 42 days. In Ethiopia, little is known about women's experience of complications and their care-seeking behavior. This study attempted to assess experiences related to obstetric complication and seeking assistance from a skilled provider among women who gave birth in the last 12 months preceding the study. METHODS: This study was a cross-sectional survey of women who gave birth within one year preceding the study regardless of their delivery place. The study was carried out in six selected districts in North Gondar Zone, Amhara Region. Data was collected house-to-house in 12 selected clusters (kebeles using a pretested Amharic questionnaire. During the survey, 1,668 women were interviewed. Data entry was done using Epi Info version 3.5.3 and was exported to SPSS for analysis. Logistic regression was applied to control confounders. RESULTS: Out of the total sample, 476 women (28.5%, 95% CI: 26.4%, 30.7% reported some kind of complication. The most common complications reported were; excessive bleeding and prolonged labor that occurred mostly at the time of delivery and postpartum period. Out of the total women who faced complications, 248 (52.1%, 95% CI: 47.6%, 56.6% sought assistance from a skilled provider. Inability to judge the severity of morbidities, distance/transport problems, lack of money/cost considerations and use of traditional options at home were the major reasons for not seeking care from skilled providers. Belonging to a wealthier quintile, getting antenatal care from a skilled provider and agreement of a woman in planning for possible complications were significantly associated with seeking assistance from a skilled provider. CONCLUSION: Nearly half of the women who faced complications did not use skilled providers at the time of obstetric complications. Cognitive, geographic, economic and cultural barriers were involved

  6. Meeting Basic Needs: Social Supports and Services Provided by Hospice.

    Science.gov (United States)

    Boucher, Nathan A; Kuchibhatla, Maragatha; Johnson, Kimberly S

    2017-06-01

    Describe social goods and services for which hospices assist patients and families and the resources hospices use to do so. Basic social supports and services not routinely covered by insurers may be needed by terminally ill patients and their families. Little is known about hospices' provision of such social supports and services. A 2014-2015 cross-sectional survey of hospices nationwide. Participating hospices had been in operation for at least 3 years and were located in any of the 50 states or District of Columbia. Hospices were surveyed about availability and sources of internal funds and referral to obtain basic social supports for patients. Descriptive statistics, bivariate analysis, and categorization were used to describe hospice practices. Measures included frequency and nature of goods and services provision in the prior year; and extent to which hospices used internal funds or community referral for goods and services. Over 80% (n = 203) reported internal funds covered services not reimbursed by insurers; 78% used funds in last year. Hospices used internal funds for food (81.7%), shelter (57.8%), utility bills (73.5%), and funeral costs (50%). Hospices referred patients/families to community organizations to obtain a similar range of services, including transportation, clothing, linens/towels, furniture/appliances, home repairs, and caregiver support. Hospices are using internal resources and accessing community resources to provide patients with basic social needs not routinely covered by insurance.

  7. A Distributed Service and Business Model for Providing Cloud Computing Service

    OpenAIRE

    Shreya Bhadra; Tirthankar Gayen

    2013-01-01

    Cloud Computing model has enabled IT organizations to serve the users globally. It gives the services like Platform as a Service, Software as a Service and Infrastructure as a Service without users being much aware of the details in which the services are provided. As in File Access System Service the users are not aware of the locations of the files in Clouds. File access seems to them as a single coherent file system. Considering this aspect, this paper is concerned with an effective servic...

  8. Neonicotinoid pesticide exposure impairs crop pollination services provided by bumblebees

    Science.gov (United States)

    Stanley, Dara A.; Garratt, Michael P. D.; Wickens, Jennifer B.; Wickens, Victoria J.; Potts, Simon G.; Raine, Nigel E.

    2015-12-01

    Recent concern over global pollinator declines has led to considerable research on the effects of pesticides on bees. Although pesticides are typically not encountered at lethal levels in the field, there is growing evidence indicating that exposure to field-realistic levels can have sublethal effects on bees, affecting their foraging behaviour, homing ability and reproductive success. Bees are essential for the pollination of a wide variety of crops and the majority of wild flowering plants, but until now research on pesticide effects has been limited to direct effects on bees themselves and not on the pollination services they provide. Here we show the first evidence to our knowledge that pesticide exposure can reduce the pollination services bumblebees deliver to apples, a crop of global economic importance. Bumblebee colonies exposed to a neonicotinoid pesticide provided lower visitation rates to apple trees and collected pollen less often. Most importantly, these pesticide-exposed colonies produced apples containing fewer seeds, demonstrating a reduced delivery of pollination services. Our results also indicate that reduced pollination service delivery is not due to pesticide-induced changes in individual bee behaviour, but most likely due to effects at the colony level. These findings show that pesticide exposure can impair the ability of bees to provide pollination services, with important implications for both the sustained delivery of stable crop yields and the functioning of natural ecosystems.

  9. Trends of Maternal Health Services Implementation in Indonesia (Data Analysis Susenas 2001, 2004 and 2007

    Directory of Open Access Journals (Sweden)

    Ika Dharmayanti

    2015-03-01

    the sample. Result:The study shows that in seven years period (2001–2007, skilled health providers (doctors and midwives are commonly reported as the source of antenatal care. The result showed bivariate analysis from type of residence (urban/rural toward the islands, maternal education, maternal age group, ownership of health insurance, and the socioeconomic played a role in the selection of delivery attendant. Recommendation: Developing cross sectoral cooperation to improvepeople’s lives as well as improved access to health services in rural areas should be very beneficial to the community.Key words: birth attendants, doctors, midwives, traditional birth attendants

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

    Directory of Open Access Journals (Sweden)

    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

  11. Health Worker Opinion/Perception of Health Services provided to ...

    African Journals Online (AJOL)

    Seventy one percent of the health service providers indicated that their patients suffered from body weakness, 86 % indicated that they had patients who suffered from recent loss of body weight, and another 86 % pointed out that their patients had influenza/common cold. Other health complaints reported included unusual ...

  12. Information Services Provided By Special Collections Units In ...

    African Journals Online (AJOL)

    This study assessed the information services provided in special collections unit in federal and state University libraries in Nigeria. One research question was formulated to guide the study. Descriptive survey design was adopted in carrying out the study. A purposive sampling procedure was used to obtain a sample of 178 ...

  13. Location of development NGOs providing HIV and AIDS services to ...

    African Journals Online (AJOL)

    Development Non-Governmental Organisations (NGOs) have been crucial players in HIV and AIDS from the onset of the epidemic in South Africa. We examined development NGOs that provide HIV and AIDS services to young people within the Cape Metropole District of the Western Cape Province, with a view to analyse ...

  14. Concurrent remote management of CPE by multiple service providers

    NARCIS (Netherlands)

    Balemans, H.; Smedt, A. de; Hartog, F.T.H. de; Önnegren, J.

    2006-01-01

    Configuration and management of devices in the home is becoming ever more complex for the user. The trend is, therefore, that it will be performed remotely by network and service providers using dedicated configuration servers. The current remote management architectures do not support an

  15. Assessment of Services Provided By Village Alive Women ...

    African Journals Online (AJOL)

    Assessment of Services Provided By Village Alive Women Association to Rural Women in Ifelodun Local Government Area of Kwara State, Nigeria. ... hardworking Rural women of Nigeria by different NGOs and Voluntary organizations so that they can increase their productivity those government organs or agencies (ADP, ...

  16. Improved Collaborative Transport Planning at Dutch Logistics Service Provider Fritom

    NARCIS (Netherlands)

    Buijs, Paul; Lopez Alvarez, Jose Alejandro; Veenstra, Marjolein; Roodbergen, Kees Jan

    2016-01-01

    We study the collaborative transport planning for two autonomous business units of Fritom, a Dutch logistics service provider. This difficult planning problem does not fit any existing type of vehicle routing problem proposed in the academic literature; therefore, we define a new problem class, the

  17. The State of the Psychology Health Service Provider Workforce

    Science.gov (United States)

    Michalski, Daniel S.; Kohout, Jessica L.

    2011-01-01

    Numerous efforts to describe the health service provider or clinical workforce in psychology have been conducted during the past 30 years. The American Psychological Association (APA) has studied trends in the doctoral education pathway and the resultant effects on the broader psychology workforce. During this period, the creation and growth of…

  18. Veterinary Extension Services Provided To Livestock Farmers In ...

    African Journals Online (AJOL)

    This paper examines the differences in the veterinary services provided by university and ministry based officers to livestock farmers in Oyo State. Simple random sampling technique was used to select veterinary clinics and livestock farmers who visited the clinics. One hundred and twenty five farmers were selected and ...

  19. Allocation of advertising space by a web service provider using ...

    Indian Academy of Sciences (India)

    Internet has emerged as a powerful medium for trade and commerce. Online advertising over the internet has increased more than hundredfold since 2001. In the present work, we address problems faced by online advertisement service providers. In this paper, we propose a multi-slot and multi-site combinatorial auction ...

  20. Methods employed by public libraries in providing services to ...

    African Journals Online (AJOL)

    The study is on methods employed by public libraries in providing services to PLWHA in Benue State, Nigeria. The study area is Benue State , while the study design is descriptive survey. The population comprise d of 14 public librarians. A set of quest ionnaire was structured with 25 items for public librarians. Data was ...

  1. 20 CFR 627.422 - Selection of service providers.

    Science.gov (United States)

    2010-04-01

    ..., business ethics, and fiscal accountability; (6) The necessary organization, experience, accounting and...) Appropriate education agencies in the service delivery area/substate area shall be provided the opportunity to... additional points to proposals received from such organizations as minority business enterprises and women...

  2. Health Worker Opinion/Perception of Health Services provided to ...

    African Journals Online (AJOL)

    of Ni-Cu in the area. This investigation furthermore afforded researchers an opportunity to explore the health services that are provided in the area. The study area ..... Environmental air pollution or ingestion of contaminated phane worms, could ultimately result in allergies, asthma, bleeding tendencies and hypertension.

  3. 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

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

    Science.gov (United States)

    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.

  5. Causes of neonatal and maternal deaths in Dhaka slums: implications for service delivery.

    Science.gov (United States)

    Khatun, Fatema; Rasheed, Sabrina; Moran, Allisyn C; Alam, Ashraful M; Shomik, Mohammad Sohel; Sultana, Munira; Choudhury, Nuzhat; Iqbal, Mohammad; Bhuiya, Abbas

    2012-01-26

    Bangladesh has about 5.7 million people living in urban slums that are characterized by adverse living conditions, poor access to healthcare services and health outcomes. In an attempt to ensure safe maternal, neonatal and child health services in the slums BRAC started a programme, MANOSHI, in 2007. This paper reports the causes of maternal and neonatal deaths in slums and discusses the implications of those deaths for Maternal Neonatal and Child Health service delivery. Slums in three areas of Dhaka city were selected purposively. Data on causes of deaths were collected during 2008-2009 using verbal autopsy form. Two trained physicians independently assigned the cause of deaths. A total of 260 newborn and 38 maternal deaths were identified between 2008 and 2009. The majority (75%) of neonatal deaths occurred during 0-7 days. The main causes of deaths were birth asphyxia (42%), sepsis (20%) and birth trauma (7%). Post partum hemorrhage (37%) and eclampsia (16%) were the major direct causes and hepatic failure due to viral hepatitis was the most prevalent indirect cause (11%) of maternal deaths. Delivery at a health facility with child assessment within a day of delivery and appropriate treatment could reduce neonatal deaths. Maternal mortality is unlikely to reduce without delivering at facilities with basic Emergency Obstetric Care (EOC) and arrangements for timely referral to EOC. There is a need for a comprehensive package of services that includes control of infectious diseases during pregnancy, EOC and adequate after delivery care.

  6. Can Collaboration Provide Integrated Services for Prisoners in Norway?

    Directory of Open Access Journals (Sweden)

    Gunnar Vold Hansen

    2015-12-01

    Full Text Available In this article, my contention is that Norway's criminal justice policy is increasingly based on principles taken from positive criminology. This means that the correctional service places strong emphasis on establishing collaboration with the local authorities (the municipalities in order to offer convicted persons integrated services, both during and after serving their sentences. I also point out that positive criminology's principle of viewing convicted persons as unique individuals with individual problems and resources – problems to which there are rarely clear-cut solutions – means that these problems are perceived as 'wicked problems'. A recommended approach to 'wicked problems' is to establish collaboration between the different service providers involved. The article describes the experiences gained from a pilot project that entailed offering a training programme to convicted persons with substance abuse problems. One of the goals of the project was to link the programme to an offer of integrated services after the sentence had been served. The experiences described in semi-structured interviews with 16 convicted persons, seven correctional service employees and three local authority employees was that it was difficult to put in place such an integrated service package. On this basis, I discuss the reasons why it was so difficult to achieve the desired collaboration, and I outline some proposals for how these challenges can be resolved in future.

  7. SOCIAL AND SOCIETAL BARRIERS IN UTILIZATION OF MATERNAL HEALTH CARE SERVICES IN RURAL PUNJAB, PAKISTAN.

    Science.gov (United States)

    Sarfraz, Mariyam; Tariq, Saira; Hamid, Saima; Iqbal, Nafeesa

    2015-01-01

    The health status of pregnant women depends largely on the quality of the antenatal and delivery services available to them. Maternal mortality remains a major public health problem with antenatal and delivery care utilization remaining low in Pakistan. This study explores the perspectives of rural community members about the antenatal and delivery care services' utilization by the community. A qualitative study was undertaken in the rural community of District Attock. Focus Group Discussions (FGD) were conducted with husbands, married women of child-bearing age with young children and mothers-in-law. Data was analysed manually using content analysis techniques. Majority of the respondents sought antenatal care (ANC) after 3-4 months. They further reported that home was the preferred place of delivery followed by the local "rural health centre". The preferred attendant for delivery was the local Dai (traditional birth attendant). Major limitations to accessing ANC and delivery services were lack of knowledge about ANC, long distance and high transport costs to health care facilities. People had strong beliefs on faith healers (Pirs) and insufficient knowledge about danger signs. Traditional and customary practice as taweez dhaga, saya, purdah, non-availability of health care providers, and lack of trust on young community midwives led to people favouring the home based package of services provided by traditional birth attendants (Dais). The findings of this study indicate that demand side barriers such as lack of knowledge regarding home based care, social barriers, financial constraint and non-acceptability of community midwives (CMW) because services offered by traditional birth attendants (TBA) were more accessible in terms of distance and cost are a major challenge affecting utilization. Efforts towards ensuring the utilization of ANC and delivery services should be targeted towards rural areas and the importance of skilled care should be emphasized. Women

  8. An assessment of essential maternal health services in Kwara state ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    developing setting with high maternal morbidity and mortality indices and to determine if there are differences between public and private health facilities in terms of availability of .... Administer parenteral oxytocic drugs. 3. Administer parenteral anticonvulsants for pre- eclampsia and eclampsia. 4. Perform manual removal of ...

  9. Predictors of maternal health service utilization: a community based ...

    African Journals Online (AJOL)

    For both groups of women, religion, maternal and spouse's education had a positive effect on having skilled delivery. Among the rural women, ANC utilization positively influenced institutional delivery. Predictors of use of skilled delivery were being older, being married or co-habiting and lower parity (rural); being younger ...

  10. Ecosystem services provided by groundwater dependent wetlands in karst areas

    Science.gov (United States)

    Massimo Delle Grazie, Fabio; Gill, Laurence

    2017-04-01

    Ecosystem services provided by groundwater dependent wetlands in karst areas Turloughs are topographic depressions in karst, which are intermittently flooded on an annual cycle via groundwater sources and have substrate and/or ecological communities characteristic of wetlands. Turloughs are designated a Priority Habitat in Annex 1 of the EU Habitats Directive (92/43/EEC) as well as GWDTEs under the Water Framework Directive (WFD). Hydrology is the primary driver of these unique ecosystems and so a rigorous understanding of the flooding regime is required in order to assess their conservation and future sustainability. This research aims to identify and quantify the ecosystem services associated with turloughs, particularly in relation to the need for habitat conservation in the face of external pressures associated with agriculture, road drainage schemes, water supply and wastewater disposal. The research focuses primarily on quantifying the ecosystem functions responsible for producing terrestrial hydrologic and climatic services, as well as intrinsic biodiversity services, and uses this context to lay out a blueprint for a more detailed ecosystem service assessment. These services have been quantified in appropriate units (biophysical or otherwise), based on actual or potential sustainable use levels. Available data and field studies have been used to assess the hydrological conditions necessary to sustain the biodiversity of vegetation as well as to better understand the connections between hydrology and biogeochemical cycles. The benefits of the turlough services have then been analyzed and quantified in appropriate units (ecological, socio-cultural and economic indicators) as well as monetary values. This has been done using the inVEST tool. InVEST includes models for quantifying, mapping, and valuing the benefits provided by terrestrial, freshwater, and marine systems. In particular the Habitat Risk Assessment and the Nutrient Delivery Ratio modules have been

  11. Clinical and perceived quality of care for maternal, neonatal and antenatal care in Kenya and Namibia: the service provision assessment.

    Science.gov (United States)

    Diamond-Smith, Nadia; Sudhinaraset, May; Montagu, Dominic

    2016-08-11

    The majority of women in sub-Saharan Africa now deliver in a facility, however, little is known about the quality of services for maternal and newborn basic and emergency care, nor how this is associated with patient's perception of their experiences. Using data from the Service Provision Assessment (SPA) survey from Kenya 2010 and Namibia 2009, we explore whether facilities have the necessary signal functions for providing emergency and basic maternal (EmOC) and newborn care (EmNC), and antenatal care (ANC) using descriptives and multivariate regression. We explore differences by type of facility (hospital, center or other) and by private and public facilities. Finally, we see if patient satisfaction (taken from exit surveys at antenatal care) is associated with the quality of services (specific services provided). We find that most facilities do not have all of the signal functions, with 46 and 27 % in Kenya and 18 and 5 % in Namibia of facilities have high/basic scores in routine and emergency obstetric care, respectively. We found that hospitals preform better than centers in general and few differences emerged between public and private facilities. Patient perceptions were not consistently associated with services provided; however, patients had fewer complaints in private compared to public facilities in Kenya (-0.46 fewer complaints in private) and smaller facilities compared to larger in Namibia (-0.26 fewer complaints in smaller facilities). Service quality itself (measured in scores), however, was only significantly better in Kenya for EmOC and EmNC. This analysis sheds light on the inadequate levels of care for saving maternal and newborn lives in most facilities in two countries of Africa. It also highlights the disconnect between patients' perceptions and clinical quality of services. More effort is needed to ensure that high quality supply of services is present to meet growing demand as an increasing number of women deliver in facilities.

  12. Effect of child marriage on use of maternal health care services in Pakistan.

    Science.gov (United States)

    Nasrullah, Muazzam; Zakar, Rubeena; Krämer, Alexander

    2013-09-01

    To assess the association between child marriage (before 18 years of age) and maternal health care services use in Pakistan. We limited the data from Pakistan Demographic and Health Survey, 2006-2007, to ever-married females aged 15-24 years with at least one childbirth (n=1,404) to identify differences in prenatal care provision (skilled or unskilled medical care provider), antenatal care (antenatal visits; care at home or a hospital), care at delivery (assistance by unskilled medical care provider), and place of birth by early (younger than 18 years) compared with adult (18 years or older) age at marriage. Associations between child marriage and health care services use were assessed by calculating adjusted odds ratios (OR) using logistic regression models after controlling for demographics, social equity indicators (education, wealth index, rural residence), employment status, and partners' education. Overall, 66.1% of ever-married respondents aged 15-24 years in Pakistan with at least one childbirth were married before the age of 18 years. More than half (61.9%) of females married as children had no formal education, and the majority (71.0%) resided in rural areas. Child marriage was significantly associated with decreased likelihood of any prenatal care (adjusted OR 0.73, 95% confidence interval [CI] 0.534-0.993) and prenatal care by skilled medical care providers (adjusted OR 0.64, 95% CI 0.476-0.871) and increased likelihood of delivery assistance by unskilled medical providers (adjusted OR 1.90, 95% CI 1.435-2.518) and delivery at home (adjusted OR 2.17, 95% CI 1.617-2.915). Efforts to increase the age of marriage and delay childbearing may have population-level effects on reducing disparities between females married as children and adults and improving maternal and child health in Pakistan. II.

  13. Interrelationships of risks faced by third party logistics service providers

    DEFF Research Database (Denmark)

    Govindan, Kannan; Chaudhuri, Atanu

    2016-01-01

    This paper analyses the interrelationships between risks faced by third party logistics service providers (3PLs) in relation to one of its customers using DEMATEL. Novel analysis of both within and between risk categories and generation of threshold value to prioritize risks generate useful...... insights. Results show that arms-length relationship between the customer and the 3PLs has strong influence on other risks and there is a need for collaborative relationships between 3PLs and its customers. Moreover, analysis indicates that the 3PLs need to improve internal processes related to quality...... management, flexibility of its operations and also geographical coverage of their services....

  14. Loads Providing Ancillary Services: Review of International Experience

    Energy Technology Data Exchange (ETDEWEB)

    Heffner, Grayson; Goldman, Charles; Kintner-Meyer, Michael

    2007-05-01

    In this study, we examine the arrangements for and experiences of end-use loads providing ancillary services (AS) in five electricity markets: Australia, the United Kingdom (UK), the Nordic market, and the ERCOT and PJM markets in the United States. Our objective in undertaking this review of international experience was to identify specific approaches or market designs that have enabled customer loads to effectively deliver various ancillary services (AS) products. We hope that this report will contribute to the ongoing discussion in the U.S. and elsewhere regarding what institutional and technical developments are needed to ensure that customer loads can meaningfully participate in all wholesale electricity markets.

  15. Commercial Building Loads Providing Ancillary Services in PJM

    Energy Technology Data Exchange (ETDEWEB)

    MacDonald, Jason; Kiliccote, Sila; Boch, Jim; Chen, Jonathan; Nawy, Robert

    2014-06-27

    The adoption of low carbon energy technologies such as variable renewable energy and electric vehicles, coupled with the efficacy of energy efficiency to reduce traditional base load has increased the uncertainty inherent in the net load shape. Handling this variability with slower, traditional resources leads to inefficient system dispatch, and in some cases may compromise reliability. Grid operators are looking to future energy technologies, such as automated demand response (DR), to provide capacity-based reliability services as the need for these services increase. While DR resources are expected to have the flexibility characteristics operators are looking for, demonstrations are necessary to build confidence in their capabilities. Additionally, building owners are uncertain of the monetary value and operational burden of providing these services. To address this, the present study demonstrates the ability of demand response resources providing two ancillary services in the PJM territory, synchronous reserve and regulation, using an OpenADR 2.0b signaling architecture. The loads under control include HVAC and lighting at a big box retail store and variable frequency fan loads. The study examines performance characteristics of the resource: the speed of response, communications latencies in the architecture, and accuracy of response. It also examines the frequency and duration of events and the value in the marketplace which can be used to examine if the opportunity is sufficient to entice building owners to participate.

  16. Quality of Services and Quality of Life from Service Providers' Perspectives: Analysis with Focus Groups

    Science.gov (United States)

    Jenaro, C.; Vega, V.; Flores, N.; Cruz, M.

    2013-01-01

    Background: Concepts such as support, quality of life and quality of services are customary in services for people with intellectual disabilities. The identification of the different ways of conceiving, prioritising and implementing these concepts by service providers can help to drive changes to achieve better personal outcomes for this…

  17. The relationship between innovation in services and standardization : Emperical evidence of service providers' involvement in standardization

    NARCIS (Netherlands)

    P. Wakke (Paul); K. Blind (Knut); H.J. de Vries (Henk)

    2012-01-01

    textabstractExtant research suggests a positive and bidirectional relation between innovation and standardization. Focusing on the service industries, this paper relates the theory of innovation in services to the participation of service providers in standardization committees. For this purpose, we

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

    African Journals Online (AJOL)

    utilisation of maternal services for black women in the. Orange Free State. Two hundred and forty clusters ... of the world, including South Africa, adequate services of this nature are in operation. One example in .... Review Board of the Faculty of Medicine, University of the. Orange Free State. Of the 237 women who gave ...

  19. Providing Health Care Service-learning Experiences for IPPE Credit

    Directory of Open Access Journals (Sweden)

    Kassandra M. Bartelme, Pharm.D.

    2011-01-01

    Full Text Available Service-learning (SL provides an opportunity for students to learn personal and professional skills while providing a useful service to the community. Many pharmacy education programs use SL within their curriculum because of the benefits to the community, the faculty, the learning institution and the student(s. While SL has been used in schools/colleges of pharmacy for many years, SL that also fulfills IPPE requirements is newer. This paper seeks to promote the use of combined SL/IPPE experiences. It provides an example where students volunteered at federally qualified health centers and also reviews the ACPE Standards related to SL. Schools/colleges of pharmacy are encouraged to design mechanisms for students to participate in combined SL/IPPE experiences as part of their IPPE requirements.

  20. Data as a service a framework for providing reusable enterprise data services

    CERN Document Server

    Sarkar, Pushpak

    2015-01-01

    Data as a Service shows how organizations can leverage "data as a service" by providing real-life case studies on the various and innovative architectures and related patterns. Comprehensive approach to introducing data as a service in any organization. A re-usable and flexible SOA based architecture framework. Roadmap to introduce 'big data as a service' for potential clients. Presents a thorough description of each component in the DaaS reference architecture so readers can implement solutions.

  1. Collaborative business processes for enhancing partnerships among software services providers

    Science.gov (United States)

    Heil Cancian, Maiara; Rabelo, Ricardo; Gresse von Wangenheim, Christiane

    2015-08-01

    Software services have represented a powerful view to support the realisation of the service-oriented architecture (SOA) paradigm. Using open standards and facilitating systems projects, they have increasingly been used as a corporate architectural approach to create interoperable services-based software solutions that can more easily be reused and shared across disparate applications. In the context of software companies, most of them are small firms having enormous difficulties to keep competitive. One strategy to enhance their sustainability is to enlarge partnerships among them at a more valuable level by jointly offering (web) services-based solutions. However, their culture of collaboration is low, and partnerships are usually done with the same companies and sporadically. This article presents an approach to support a more intense collaboration among software companies to attend business opportunities in a more agile way, joining capacities and capabilities which they would not have if they worked alone. This requires, however, some preparedness. From the perspective of business processes, they should understand how to carry out a collaboration more properly. This is essentially what this article is about. It presents a comprehensive list of collaborative business processes and base practices that can also act as a guide for service providers' managers to implement and manage the collaboration along its lifecycle. Processes have been validated and results are discussed.

  2. Public and private maternal health service capacity and patient flows in southern Tanzania: using a geographic information system to link hospital and national census data.

    Science.gov (United States)

    Tabatabai, Patrik; Henke, Stefanie; Sušac, Katharina; Kisanga, Oberlin M E; Baumgarten, Inge; Kynast-Wolf, Gisela; Ramroth, Heribert; Marx, Michael

    2014-12-01

    Background Strategies to improve maternal health in low-income countries are increasingly embracing partnership approaches between public and private stakeholders in health. In Tanzania, such partnerships are a declared policy goal. However, implementation remains challenging as unfamiliarity between partners and insufficient recognition of private health providers prevail. This hinders cooperation and reflects the need to improve the evidence base of private sector contribution. Objective To map and analyse the capacities of public and private hospitals to provide maternal health care in southern Tanzania and the population reached with these services. Design A hospital questionnaire was applied in all 16 hospitals (public n=10; private faith-based n=6) in 12 districts of southern Tanzania. Areas of inquiry included selected maternal health service indicators (human resources, maternity/delivery beds), provider-fees for obstetric services and patient turnover (antenatal care, births). Spatial information was linked to the 2002 Population Census dataset and a geographic information system to map patient flows and socio-geographic characteristics of service recipients. Results The contribution of faith-based organizations (FBOs) to hospital maternal health services is substantial. FBO hospitals are primarily located in rural areas and their patient composition places a higher emphasis on rural populations. Also, maternal health service capacity was more favourable in FBO hospitals. We approximated that 19.9% of deliveries in the study area were performed in hospitals and that the proportion of c-sections was 2.7%. Mapping of patient flows demonstrated that women often travelled far to seek hospital care and where catchment areas of public and FBO hospitals overlap. Conclusions We conclude that the important contribution of FBOs to maternal health services and capacity as well as their emphasis on serving rural populations makes them promising partners in health

  3. Examination of cultural competence in service providers in an early intervention programme for psychosis in Montreal, Quebec: Perspectives of service users and treatment providers.

    Science.gov (United States)

    Venkataraman, Shruthi; Jordan, Gerald; Pope, Megan A; Iyer, Srividya N

    2017-01-26

    To better understand cultural competence in early intervention for psychosis, we compared service users' and service providers' perceptions of the importance of providers being culturally competent and attentive to aspects of culture. At a Canadian early intervention programme, a validated scale was adapted to assess service user (N = 51) and provider (N = 30) perceptions of service providers' cultural competence and the importance accorded thereto. Analyses of variance revealed that the importance of service providers being culturally competent was rated highest by service providers, followed by visible minority service users, followed by white service users. Providers rated themselves as being more interested in knowing about service users' culture than service users perceived them to be. Service users accorded less import to service providers' cultural competence than providers themselves, owing possibly to varied socialization. A mismatch in users' and providers' views on providers' efforts to know their users' cultures may influence mental healthcare outcomes. © 2017 John Wiley & Sons Australia, Ltd.

  4. 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

    successful in meeting their obligations. Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality.

  5. 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

    unable to claim their entitlements and that the duty bearers were not successful in meeting their obligations. Based on the findings of our study, we conclude that to prevent maternal deaths, further concentrated efforts are required for better community education, women's empowerment, and health systems strengthening to provide appropriate and timely services, including emergency obstetric care, with good quality.

  6. 360º Degree Requirement Elicitation Framework for Cloud Service Providers

    Directory of Open Access Journals (Sweden)

    Versha Saxena

    2015-03-01

    Full Text Available Thisstudy addresses the factors responsible for cloud computing adoption in implementing cloud computing for any organization. Service Level Agreements play a major role for cloud consumer as well as for cloud provider. SLA depends on the requirements gathered by the cloud providers and they vary with the type of organizations for which process is being performed such as education, retail, IT industry etc. SLAs for cloud computing involves technical as well as business requirements which makes the gathering of requirements from stakeholders point of view the heterogeneous process. This research work proposes a 360 degree requirement gathering framework, which reduces the complexitiesduring the process of requirement gathering by cloud service providersas well as SLAs more reliant.

  7. Saving mothers and newborns in communities: strengthening community midwives to provide high quality essential newborn and maternal care in Baluchistan, Pakistan in a financially sustainable manner.

    Science.gov (United States)

    Mumtaz, Zubia; Cutherell, Andrea; Bhatti, Afshan

    2014-04-06

    To address it's persistently high maternal mortality rate of 276/100,000 live births, the government of Pakistan created a new cadre of community based midwives (CMW). One expectation is that CMWs will improve access to maternal health services for underserved women. Recent research shows the CMWs have largely failed to establish midwifery practices, because CMW's lack of skills, both clinical and entrepreneurial and funds necessary to develop their practice infrastructure and logistics. Communities also lack trust in their competence to conduct safe births. To address these issues, the Saving Mothers and Newborn (SMNC) intervention will implement three key elements to support the CMWs to establish their private practices: (1) upgrade CMW clinical skills (2) provide business-skills training and small loans (3) generate demand for CMW services using cellular phone SMS technology and existing women's support groups. This 3-year project aims to investigate whether CMWs enrolled in this initiative are providing the essential maternal and newborn health care to women and children living in districts of Quetta, and Gwadar in a financially self-sustaining manner. Specifically the research will use quasi-experimental impact assessment to document whether the SMNC initiative is having an impact on CMW services uptake, financial analysis to assess if the initiative enabled CMWs to develop financially self-sustainable practices and observation methods to assess the quality of care the CMWs are providing. A key element of the SMNC initiative - the provision of business skills training and loans to establish private practices - is an innovative initiative in Pakistan and little is known about its effectiveness. This research will provide emperic evidence of the effectiveness of the intervention as well as contribute to the body of evidence around potential solutions to improve sustainable coverage of high impact Maternal, Neonatal and Child Health interventions in vulnerable

  8. Valuation of pollinator forage services provided by Eucalyptus Cladocalyx

    CSIR Research Space (South Africa)

    De Lange, Willem J

    2013-08-01

    Full Text Available with at the beginning of the pollination season. This shortfall needs to be regained while still servicing the vegetable industry during February and March and the canola industry during August. E.cladocalyx provides a much necessary improvement in colony health.... conferruminata (previously incorrectly known as E. lehmannii in South Africa) August Canola Fynbos (if canola is not available) September Deciduous fruit E. camaldulensis (for those colonies not on deciduous fruit) October Deciduous fruit E. camaldulensis...

  9. Overcoming barriers to access and utilization of maternal, newborn and child health services in northern Nigeria: an evaluation of facility health committees.

    Science.gov (United States)

    Oguntunde, Olugbenga; Surajo, Isa M; Dauda, Dauda Sulaiman; Salihu, Abdulsamad; Anas-Kolo, Salma; Sinai, Irit

    2018-02-09

    Poor quality of health services and socio-cultural dynamics may severely limit utilization of health services. Facility health committees were established in several states in northern Nigeria to reduce these barriers. The committees were charged with mobilizing communities, improving quality of health services, and promoting utilization of maternal and child health services. This study assessed this intervention. To obtain a comprehensive picture of facility health committees' influence on maternal and child health services, we selected 33 facilities in three states in northern Nigeria (Jigawa, Kaduna, Kano) where the intervention was active. For each of these facilities we interviewed committee members (n = 399), conducted focus group discussions with a subset of committee members (18 focus groups), interviewed facility health providers (two providers from each facility), and conducted client exit interviews (n = 501). Facility health committees appear to have a positive influence on quality of maternal and child health services in the selected facilities. Committee members, health providers, and facility clients all agree that the committees have a tangible positive effect. The most important roles of the committees are to mobilize the community and increase demand for maternal and child health services, in a region where demand is very low. Committee activities further improve health services in many ways, including advocacy, community-facility coordination, fund raising, money donation, and problem mitigation. Facility health committees can be invaluable in contributing to improved demand for and access to quality maternal and child health services in health facilities in northern Nigeria. They provide strong linkages between community members and the health facilities, directly work to increase demand for services, and address supply-side challenges that often limit utilization of services in health facilities. The intervention can be improved by more

  10. Handling of the demilitarized zone using service providers in SAP

    Science.gov (United States)

    Iovan, A.; Robu, R.

    2016-02-01

    External collaboration needs to allow data access from the Internet. In a trusted Internet collaboration scenario where the external user works on the same data like the internal user direct access to the data in the Intranet is required. The paper presents a solution to get access to certain data in the Enterprise Resource Planning system, having the User Interface on a system in the Demilitarized Zone and the database on a system which is located in the trusted area. Using the Service Provider Interface framework, connections between separate systems can be created in different areas of the network. The paper demonstrates how to connect the two systems, one in the Demilitarized Zone and one in the trusted area, using SAP ERP 6.0 with Enhancement Package 7. In order to use the Service Provider Interface SAP Business Suite Foundation component must be installed in both systems. The advantage of using the Service Provider Interface framework is that the external user works on the same data like the internal user (and not on copies). This assures data consistency and less overhead for backup and security systems.

  11. Application of Ethics for Providing Telemedicine Services and Information Technology.

    Science.gov (United States)

    Langarizadeh, Mostafa; Moghbeli, Fatemeh; Aliabadi, Ali

    2017-10-01

    Advanced technology has increased the use of telemedicine and Information Technology (IT) in treating or rehabilitating diseases. An increased use of technology increases the importance of the ethical issues involved. The need for keeping patients' information confidential and secure, controlling a number of therapists' inefficiency as well as raising the quality of healthcare services necessitates adequate heed to ethical issues in telemedicine provision. The goal of this review is gathering all articles that are published through 5 years until now (2012-2017) for detecting ethical issues for providing telemedicine services and Information technology. The reason of this time is improvement of telemedicine and technology through these years. This article is important for clinical practice and also to world, because of knowing ethical issues in telemedicine and technology are always important factors for physician and health providers. the required data in this research were derived from published electronic sources and credible academic articles published in such databases as PubMed, Scopus and Science Direct. The following key words were searched for in separation and combination: tele-health, telemedicine, ethical issues in telemedicine. A total of 503 articles were found. After excluding the duplicates (n= 93), the titles and abstracts of 410 articles were skimmed according to the inclusion criteria. Finally, 64 articles remained. They were reviewed in full text and 36 articles were excluded. At the end, 28 articles were chosen which met our eligibility criteria and were included in this study. Ethics has been of a great significance in IT and telemedicine especially the Internet since there are more chances provided for accessing information. It is, however, accompanied by a threat to patients' personal information. Therefore, suggestions are made to investigate ethics in technology, to offer standards and guidelines to therapists. Due to the advancement in

  12. A Study on Librarian Service Providers' Awareness and Perceptions of Library Services for the Disabled

    Directory of Open Access Journals (Sweden)

    Younghee Noh

    2011-12-01

    Full Text Available The purpose of this study is to improve library promotional marketing for the disabled by identifying requirements of public library disability services. This study aimed to investigate librarian service providers' awareness of library programs for the disabled in order to prepare a systematic plan for promoting such library services. Research methods used are a literature analysis and survey. First, the ratio of respondents with experience promoting activities and services for the disabled was less than 50%. Second, regarding methods for promoting library disability services, the respondents used library homepages, press releases, library user guides, library newsletters, and library pamphlets in that order. Third, when asked what kind of PR media the library disability service providers had experience with and how often they use it, library boards and banners were the most common response. Fourth, suggested improvements to the current design and content of PR materials included: clearer word choice (or greater understandability, more detailed descriptions, simpler layouts, and more interesting or eye-catching content in that order. Fifth, the library disability services which are in the most need of public relations were guide information for library disability services, Library and Information Service (DOI services and search services, using alternative materials and the library collection, and aiding the information search. Overall, when evaluating the promotion of disability services in Korea, the library's public relations for disabled services needs to improve because currently neither librarians nor the disabled community they are targeting has frequent or quality experience with it. Thus, the policy department for the library disability services must develop a variety of promotional strategies adjusted for each type of the disability and distribute PR materials to service providers individually, making sure to utilize effective PR

  13. Building capacity in social service agencies to employ peer providers.

    Science.gov (United States)

    Gates, Lauren B; Mandiberg, James M; Akabas, Sheila H

    2010-01-01

    While there is evidence that peer providers are valuable to service delivery teams, the agencies where they work face difficulties in fulfilling the potential of including peers on staff effectively. The purpose of this article is to report findings of a pilot test of a workplace strategy that promoted inclusion of peer providers at social service agencies by building organizational capacity to support people with mental health conditions in peer provider roles. The strategy included training, goal setting and ongoing consultation. Seventy-one peer, non-peer and supervisory staff participated from 6 agencies over a one year period. Goal attainment scaling and data from in-depth interviews about perceptions of differences in the ways in which staff are supported, administered prior to and after the consultation period, were used to assess strategy impact. Most frequently staff set goals to respond to role conflict or a lack of support. Staff that met or exceeded their goals utilized the formal structure of consultation to improve communication among themselves, had leadership that sanctioned changes and felt that their participation was of value to the organization and contributed to their individual development. Strategy participation promoted inclusion by initiating changes to policies and practices that devalued the peer provider role, increased skill sets, and formalized lines of communication for sharing information and understanding related to peer providers. Findings demonstrate that a strategy of training, goal setting and consultation can positively affect perceptions of inclusion, and promote implementation of practices associated with inclusive workplaces.

  14. [Users satisfaction with dental care services provided at IMSS].

    Science.gov (United States)

    Landa-Mora, Flora Evelia; Francisco-Méndez, Gustavo; Muñoz-Rodríguez, Mario

    2007-01-01

    To determine users' satisfaction with dental care services provided at Instituto Mexicano del Seguro Social in Veracruz. An epidemiological survey was conducted in 14 family medicine clinics located in the northern part of the state of Veracruz. The clinics were selected by stratified-random sampling. All users older than 20 years seeking medical or dental care services were interviewed; previously, their informed consent was obtained. We used the 6-items United Kingdom dental care satisfaction questionnaire (Spanish version) where question number four evaluates user satisfaction. From October to December 2005, 3601 users were interviewed. We excluded 279 questionnaires because the age of the interviewees was <20 years. The final analysis included 3322 interviews (92%); 73% were female with an average age of 45 +/- 16 years old. 82% were satisfied with dental care services and 91% never felt like making a complaint. Waiting time of less than 30 minutes and last visit to the dentist in the last year were the only variables related to satisfaction (p = 0.0001). There is a high level of satisfaction regarding dental care services among Mexican Institute of Social Security users. However, it would be possible to increase the level of satisfaction if the waiting time is reduced and the number of dental care users attending twice a year increases.

  15. A research method to explore midwives' views of national maternity service reforms.

    Science.gov (United States)

    Roache, Bridget; Kelly, Jennifer

    2017-10-13

    Priorities of the National Maternity Services Plan (NMSP) are a significant contrast to current standard hospital maternity service provision. This paper demonstrates the applicability of case study methods to explore the views of midwives during a period of midwifery reform. This research aims to highlight key findings and insights surrounding recommended changes facing midwives that can be shared with education providers to incorporate strategies into education programs to ensure contemporary midwifery practice. Exploratory Case Study methodology was employed using ethical processes and designing semi-structured interview questions to explore participants' views. Purposive sampling ensured participants were currently practicing midwives in order to reflect the perspective and intent of this study. Data were analysed and findings presented in categories and subcategories. Case Study methodology enables an in-depth understanding of a phenomenon to be explored within a natural context. The participants of this study formed a single unit of analysis to ensure the research makes a worthwhile contribution to the profession of midwifery. This paper demonstrates that Case Study methodology is a valid research approach to exploring the views of midwives employed in standard care settings during a period of national reform. The rigorous processes and versatility of Case Study methodology ensured a systematic, critical enquiry was undertaken to gain understanding of the views of participants in implementing the NMSP. This understanding is reflective of the real life contexts of midwives to promote understanding and provide a body of knowledge where there is ambiguity and uncertainty. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  16. Disabled women's experiences of accessing and utilising maternity services when they are affected by domestic abuse: a critical incident technique study.

    Science.gov (United States)

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

    2015-08-20

    Women and their babies are entitled to equal access to high quality maternity care. However, when women fit into two or more categories of vulnerability they can face multiple, compound barriers to accessing and utilising services. Disabled women are up to three times more likely to experience domestic abuse than non-disabled women. Domestic abuse may compromise health service access and utilisation and disabled people in general have suboptimal access to healthcare services. Despite this, little is known about the compounding effects of disability and domestic abuse on women's access to maternity care. The aim of the study was to identify how women approach maternity care services, their expectations of services and whether they are able to get the type of care that they need and want. We conducted a qualitative, Critical Incident Technique study in Scotland. Theoretically we drew on Andersen's model of healthcare use. The model was congruent with our interest in women's intended/actual use of maternity services and the facilitators and barriers impacting their access to care. Data were generated during 2013 using one-to-one interviews. Five women took part and collectively reported 45 critical incidents relating to accessing and utilising maternity services. Mapped to the underpinning theoretical framework, our findings show how the four domains of attitudes; knowledge; social norms; and perceived control are important factors shaping maternity care experiences. Positive staff attitude and empowering women to have control over their own care is crucial in influencing women's access to and utilisation of maternity healthcare services. Moreover these are cyclical, with the consequences and outcomes of healthcare use becoming part of the enabling or disabling factors affecting future healthcare decisions.Further consideration needs to be given to the development of strategies to access and recruit women in these circumstances. This will provide an opportunity for

  17. Efficient Job Provisioning for a Cloud Service Provider

    Directory of Open Access Journals (Sweden)

    Sharma Dharmvir

    2016-01-01

    Full Text Available Cloud Computing is a very fast emerging technology as every enterprise is moving fast towards this system. Cloud Computing is known as a provider of dynamic services. It optimizes a very large, scalable and virtualized resource. So lots of industries have joined this bandwagon nowadays. One of the major research issues is to maintain good Quality of Service (QoS of a Cloud Service Provider (CSP. The QoS encompasses different parameters, like, smart job allocation strategy, efficient load balancing, response time optimization, reduction in wastage of bandwidth, accountability of the overall system, etc. The efficient allocation strategy of the independent computational jobs among different Virtual Machines (VM in a Data center (DC is a distinguishable challenge in the Cloud Computing domain and finding out an optimal job allocation strategy guided by a good scheduling heuristic for such an environment is a mape-k loop problem. So different heuristic approaches may be used for better result and in this result we paper we implement worst fit in mape-k and evaluated the results.

  18. Determinants of maternal health care services utilization in Pakistan: evidence from Pakistan demographic and health survey, 2012-13.

    Science.gov (United States)

    Zakar, Rubeena; Zakar, Muhammad Zakria; Aqil, Nauman; Chaudhry, Ashraf; Nasrullah, Muazzam

    2017-04-01

    The aim of this study was to determine the association between maternal utilisation of health-care services and socio-demographic factors among reproductive-age women in Pakistan. We used the sample of ever-married reproductive-age women (n = 7446) from the Pakistan Demographic and Health Survey (PDHS), 2012-13. We measured maternal utilisation of health-care services by using three dependent variables: number of antenatal care (ANC) visits, delivery assistance by a skilled health provider, and delivery in a health-care facility. Around 36.6% of women had made four or more ANC visits, 59% had received assistance from skilled health providers during delivery, and 55.3% had given birth in a health-care facility. On multivariable logistic regression, all three variables were positively associated with education and wealth, and negatively associated with birth order and women's autonomy. Policymakers and health planners may use our findings to develop efficient strategies, particularly for uneducated women and those with poor economic status, to improve the utilisation of maternal health-care services in Pakistan.

  19. Health service providers in Somalia: their readiness to provide malaria case-management

    Directory of Open Access Journals (Sweden)

    Moonen Bruno

    2009-05-01

    Full Text Available Abstract Background Studies have highlighted the inadequacies of the public health sector in sub-Saharan African countries in providing appropriate malaria case management. The readiness of the public health sector to provide malaria case-management in Somalia, a country where there has been no functioning central government for almost two decades, was investigated. Methods Three districts were purposively sampled in each of the two self-declared states of Puntland and Somaliland and the south-central region of Somalia, in April-November 2007. A survey and mapping of all public and private health service providers was undertaken. Information was recorded on services provided, types of anti-malarial drugs used and stock, numbers and qualifications of staff, sources of financial support and presence of malaria diagnostic services, new treatment guidelines and job aides for malaria case-management. All settlements were mapped and a semi-quantitative approach was used to estimate their population size. Distances from settlements to public health services were computed. Results There were 45 public health facilities, 227 public health professionals, and 194 private pharmacies for approximately 0.6 million people in the three districts. The median distance to public health facilities was 6 km. 62.3% of public health facilities prescribed the nationally recommended anti-malarial drug and 37.7% prescribed chloroquine as first-line therapy. 66.7% of public facilities did not have in stock the recommended first-line malaria therapy. Diagnosis of malaria using rapid diagnostic tests (RDT or microscopy was performed routinely in over 90% of the recommended public facilities but only 50% of these had RDT in stock at the time of survey. National treatment guidelines were available in 31.3% of public health facilities recommended by the national strategy. Only 8.8% of the private pharmacies prescribed artesunate plus sulphadoxine/pyrimethamine, while 53

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

    Science.gov (United States)

    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.

  1. Network performance and fault analytics for LTE wireless service providers

    CERN Document Server

    Kakadia, Deepak; Gilgur, Alexander

    2017-01-01

     This book is intended to describe how to leverage emerging technologies big data analytics and SDN, to address challenges specific to LTE and IP network performance and fault management data in order to more efficiently manage and operate an LTE wireless networks. The proposed integrated solutions permit the LTE network service provider to operate entire integrated network, from RAN to Core , from UE to application service, as one unified system and correspondingly collect and align disparate key metrics and data, using an integrated and holistic approach to network analysis. The LTE wireless network performance and fault involves the network performance and management of network elements in EUTRAN, EPC and IP transport components, not only as individual components, but also as nuances of inter-working of these components. The key metrics for EUTRAN include radio access network accessibility, retainability, integrity, availability and mobility. The key metrics for EPC include MME accessibility, mobility and...

  2. Proposition of a multicriteria model to select logistics services providers

    Directory of Open Access Journals (Sweden)

    Miriam Catarina Soares Aharonovitz

    2014-06-01

    Full Text Available This study aims to propose a multicriteria model to select logistics service providers by the development of a decision tree. The methodology consists of a survey, which resulted in a sample of 181 responses. The sample was analyzed using statistic methods, descriptive statistics among them, multivariate analysis, variance analysis, and parametric tests to compare means. Based on these results, it was possible to obtain the decision tree and information to support the multicriteria analysis. The AHP (Analytic Hierarchy Process was applied to determine the data influence and thus ensure better consistency in the analysis. The decision tree categorizes the criteria according to the decision levels (strategic, tactical and operational. Furthermore, it allows to generically evaluate the importance of each criterion in the supplier selection process from the point of view of logistics services contractors.

  3. Ecosystem function and services provided by the deep sea

    Science.gov (United States)

    Thurber, A. R.; Sweetman, A. K.; Narayanaswamy, B. E.; Jones, D. O. B.; Ingels, J.; Hansman, R. L.

    2014-07-01

    The deep sea is often viewed as a vast, dark, remote, and inhospitable environment, yet the deep ocean and seafloor are crucial to our lives through the services that they provide. Our understanding of how the deep sea functions remains limited, but when treated synoptically, a diversity of supporting, provisioning, regulating and cultural services becomes apparent. The biological pump transports carbon from the atmosphere into deep-ocean water masses that are separated over prolonged periods, reducing the impact of anthropogenic carbon release. Microbial oxidation of methane keeps another potent greenhouse gas out of the atmosphere while trapping carbon in authigenic carbonates. Nutrient regeneration by all faunal size classes provides the elements necessary for fueling surface productivity and fisheries, and microbial processes detoxify a diversity of compounds. Each of these processes occur on a very small scale, yet considering the vast area over which they occur they become important for the global functioning of the ocean. The deep sea also provides a wealth of resources, including fish stocks, enormous bioprospecting potential, and elements and energy reserves that are currently being extracted and will be increasingly important in the near future. Society benefits from the intrigue and mystery, the strange life forms, and the great unknown that has acted as a muse for inspiration and imagination since near the beginning of civilization. While many functions occur on the scale of microns to meters and timescales up to years, the derived services that result are only useful after centuries of integrated activity. This vast dark habitat, which covers the majority of the globe, harbors processes that directly impact humans in a variety of ways; however, the same traits that differentiate it from terrestrial or shallow marine systems also result in a greater need for integrated spatial and temporal understanding as it experiences increased use by society. In

  4. Emergency Medical Services Provider Experiences of Hospice Care.

    Science.gov (United States)

    Barnette Donnelly, Cassandra; Armstrong, Karen Andrea; Perkins, Molly M; Moulia, Danielle; Quest, Tammie E; Yancey, Arthur H

    2017-12-04

    Growing numbers of emergency medical services (EMS) providers respond to patients who receive hospice care. The objective of this investigation was to assess the knowledge, attitudes, and experiences of EMS providers in the care of patients enrolled in hospice care. We conducted a survey study of EMS providers regarding hospice care. We collected quantitative and qualitative data on EMS provider's knowledge, attitudes, and experiences in responding to the care needs of patients in hospice care. We used Chi-squared tests to compare EMS provider's responses by credential (Emergency Medical Technician [EMT] vs. Paramedic) and years of experience (0-5 vs. 5+). We conducted a thematic analysis to examine open-ended responses to qualitative questions. Of the 182 EMS providers who completed the survey (100% response rate), 84.1% had cared for a hospice patient one or more times. Respondents included 86 (47.3%) EMTs with Intermediate and Advanced training and 96 (52.7%) Paramedics. Respondent's years of experience ranged from 0-10+ years, with 99 (54.3%) providers having 0-5 years of experience and 83 (45.7%) providers having 5+ years of experience. There were no significant differences between EMTs and Paramedics in their knowledge of the care of these patients, nor were there significant differences (p education on the care of hospice patients. A total of 36% respondents felt that patients in hospice care required a DNR order. In EMS providers' open-ended responses on challenges in responding to the care needs of hospice patients, common themes were family-related challenges, and the need for more education. While the majority of EMS providers have responded to patients enrolled in hospice care, few providers received formal training on how to care for this population. EMS providers have expressed a need for a formal curriculum on the care of the patient receiving hospice.

  5. Evaluating Common Privacy Vulnerabilities in Internet Service Providers

    Science.gov (United States)

    Kotzanikolaou, Panayiotis; Maniatis, Sotirios; Nikolouzou, Eugenia; Stathopoulos, Vassilios

    Privacy in electronic communications receives increased attention in both research and industry forums, stemming from both the users' needs and from legal and regulatory requirements in national or international context. Privacy in internet-based communications heavily relies on the level of security of the Internet Service Providers (ISPs), as well as on the security awareness of the end users. This paper discusses the role of the ISP in the privacy of the communications. Based on real security audits performed in national-wide ISPs, we illustrate privacy-specific threats and vulnerabilities that many providers fail to address when implementing their security policies. We subsequently provide and discuss specific security measures that the ISPs can implement, in order to fine-tune their security policies in the context of privacy protection.

  6. Valuing environmental services provided by local stormwater management

    Science.gov (United States)

    Brent, Daniel A.; Gangadharan, Lata; Lassiter, Allison; Leroux, Anke; Raschky, Paul A.

    2017-06-01

    The management of stormwater runoff via distributed green infrastructures delivers a number of environmental services that go beyond the reduction of flood risk, which has been the focus of conventional stormwater systems. Not all of these services may be equally valued by the public, however. This paper estimates households' willingness to pay (WTP) for improvements in water security, stream health, recreational and amenity values, as well as reduction in flood risk and urban heat island effect. We use data from nearly 1000 personal interviews with residential homeowners in Melbourne and Sydney, Australia. Our results suggest that the WTP for the highest levels of all environmental services is A799 per household per year. WTP is mainly driven by residents valuing improvements in local stream health, exemptions in water restrictions, the prevention of flash flooding, and decreased peak urban temperatures respectively at A297, A244, A104 and A$65 per year. We further conduct a benefit transfer analysis and find that the WTP and compensating surplus are not significantly different between the study areas. Our findings provide additional support that stormwater management via green infrastructures have large nonmarket benefits and that, under certain conditions, benefit values can be transferred to different locations.

  7. Utilisation of antenatal and maternity services by mothers seeking ...

    African Journals Online (AJOL)

    Mothers living less than 5km to a health facility utilised the services better than those living 5 km and beyond (~2=7.57; p=0.0059; df=1). Among the reasons given by the mothers (individual respondents and through Focus Group Discussions) regarding dissatisfaction with the services offered included shortage of drugs and ...

  8. Addressing Needs of Military Families during Deployment: Military Service Providers' Perceptions of Integrating Support Services

    Science.gov (United States)

    Hayden, Seth Christian Walter

    2011-01-01

    Service providers are increasingly recognizing the need to develop effective methods for delivering supporting services to military families during deployment. Research suggests that military families experience increased levels of stress during the cycle of deployment. Bronfenbrenner (1979) conceptualized the family operating within the context…

  9. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers.

    Science.gov (United States)

    Shahid, Shaouli; Durey, Angela; Bessarab, Dawn; Aoun, Samar M; Thompson, Sandra C

    2013-11-04

    Aboriginal Australians experience poorer outcomes from cancer compared to the non-Aboriginal population. Some progress has been made in understanding Aboriginal Australians' perspectives about cancer and their experiences with cancer services. However, little is known of cancer service providers' (CSPs) thoughts and perceptions regarding Aboriginal patients and their experiences providing optimal cancer care to Aboriginal people. Communication between Aboriginal patients and non-Aboriginal health service providers has been identified as an impediment to good Aboriginal health outcomes. This paper reports on CSPs' views about the factors impairing communication and offers practical strategies for promoting effective communication with Aboriginal patients in Western Australia (WA). A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal CSPs from across WA was conducted between March 2006-September 2007 and April-October 2011. CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. Thematic analysis was carried out. Our analysis was primarily underpinned by the socio-ecological model, but concepts of Whiteness and privilege, and cultural security also guided our analysis. CSPs' lack of knowledge about the needs of Aboriginal people with cancer and Aboriginal patients' limited understanding of the Western medical system were identified as the two major impediments to communication. For effective patient-provider communication, attention is needed to language, communication style, knowledge and use of medical terminology and cross-cultural differences in the concept of time. Aboriginal marginalization within mainstream society and Aboriginal people's distrust of the health system were also key issues impacting on communication. Potential solutions to effective Aboriginal patient-provider communication included recruiting more Aboriginal staff, providing appropriate cultural training for CSPs

  10. Health Providers' Perception towards Safe Abortion Service at ...

    African Journals Online (AJOL)

    Erah

    unhygienic condition1. Death due to unsafe abortion accounts a significant proportion (13%) of global maternal mortality. Each year an estimated 36 million to. 53 million abortions are performed worldwide. Of this figure, around 20 million are considered unsafe 1. In ..... Knowledge, Attitude and practice in six Latin America.

  11. "They must understand we are people": Pregnancy and maternity service use among signing Deaf women in Cape Town.

    Science.gov (United States)

    Gichane, Margaret W; Heap, Marion; Fontes, Mayara; London, Leslie

    2017-07-01

    Women with disabilities are at disproportionate risk for adverse pregnancy outcomes, however, there is limited information on their pregnancy histories. This mixed-methods study focuses on signing Deaf women whose access to health care may be compromised by language barriers related to their disability. To describe and compare the pregnancy outcomes and maternity service use of a sample of signing Deaf women of child-bearing age in Cape Town to the population of the Western Cape of South Africa. We interviewed 42 Deaf women selected by non-probability snowball sampling, using a structured questionnaire in South African Sign Language in Cape Town in July 2016. Average parity of the sample was similar to that of the Western Cape population. Most women had one or two children (74%). Thirty-one percent of women had experienced a miscarriage and 19% had terminated a pregnancy. Almost all women (96%) attended at least one antenatal appointment during their pregnancies, and all deliveries occurred at a health facility. Women primarily relied on writing to communicate during antenatal visits and labor/delivery. The majority of women reported communication issues due to limited interpretation services, and some reported experiencing mistreatment from hospital staff. This study provides novel information on the pregnancy histories of Deaf women. While maternal service usage was high, the quality of services were inadequate with reports of linguistic barriers and mistreatment. Findings suggest the need to improve maternity care for Deaf women through implementing interpretation services and providing sensitivity training to health care providers. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Higginbottom, Gina M A; Morgan, Myfanwy; Dassanayake, Jayantha; Eyford, Helgi; Alexandre, Mirande; Chiu, Yvonne; Forgeron, Joan; Kocay, Deb

    2012-05-31

    Canada's diverse society and statutory commitment to multiculturalism means that the synthesis of knowledge related to the health care experiences of immigrants is essential to realize 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 tailoring of services to user needs. We are therefore assessing the experiences of immigrant women in Canada accessing maternity-care services. We are focusing on: 1) accessibility and acceptability (as an important dimension of access) to maternity-care services as perceived and experienced by immigrant women, and 2) the birth and postnatal outcomes of these women. The aim of this study is to use a narrative synthesis, incorporating both a systematic review using narrative synthesis of reports of empirical research (qualitative, quantitative, and mixed-method designs), and a literature review of non-empirically based reports, both of which include 'grey' literature. The study aims to provide stakeholders with perspectives on maternity-care services as experienced by immigrant women. To achieve this, we are using integrated knowledge translation, partnering with key stakeholders to ensure topic relevancy and to tailor recommendations for effective translation into future policy and practice/programming. Two search phases and a three-stage selection process are being conducted (database search retrieved 1487 hits excluding duplicates) to provide evidence to contribute jointly to both the narrative synthesis and the non-empirical literature review. The narrative synthesis will be informed by the previous framework published in 2006 by Popay et al., using identified tools for each of its four elements. The non-empirical literature review will build upon the narrative-synthesis findings and/or identify omissions or gaps in the empirical research literature. The integrated knowledge translation plan will

  13. IMPLEMENTATION OF THE ABC COSTING IN A SERVICES PROVIDER COMPANY

    Directory of Open Access Journals (Sweden)

    Luiz Ricardo Aguena Jacintho Gil de Castro

    2012-12-01

    Full Text Available This paper describes the implementation of the Activity-Based Cost (ABC method in a company of taxes and accounting services and outlines the positive and negative aspects encountered during implementation. It should be taken into account that this work has been developed in the fiscal area of cost verification. Bibliographical references, internal company documents and interviews with industry officials and the administrator responsible for the company were used. In the evolving of operations, the costs of the fiscal area and their main activities have been described monthly and through this information, drivers have been developed and the ABC (Activity-Based Costing method has been adopted. With the implementation it became clear that the system provides better visualization for the decision making process, it also provided learning for the company, so that the method should be used for an undetermined period of time.

  14. Integrating a clinical service line for maternal-child health.

    Science.gov (United States)

    Stichler, J F; Branciforte, L

    1998-01-01

    Clinical integration is a developmental process that calls on the combined resources, expertise, and knowledge of individuals who may be working together for the first time. The process is dependent on the acknowledgment of the value of integration and a shared vision for the service line. By using a strategic thinking and planning process, the service line can be reshaped to function as an integrated system of programs and services that is sensitive to needs at a local level. While the task of integration is not an easy one, the outcomes of the process lead to a synergy that cannot be realized in any other manner.

  15. Implementing the National Service Framework for Long-Term (Neurological) Conditions: service user and service provider experiences.

    Science.gov (United States)

    Sixsmith, Judith; Callender, Matthew; Hobbs, Georgina; Corr, Susan; Huber, Jörg W

    2014-01-01

    This research explored the experiences of service users and providers during the implementation of the National Service Framework (NSF) for Long-Term (Neurological) Conditions (LTNCs). A participatory qualitative research design was employed. Data were collected using 50 semi-structured interviews with service users, 25 of whom were re-interviewed on three occasions. Forty-five semi-structured interviews were also conducted with service providers who worked with individuals with LTNCs. Interviews focused on health, well-being and quality of life in relation to service provision, access and delivery. Data were thematically analysed individually and collaboratively during two data analysis workshops. Three major themes were identified that related to the implementation of the NSF: "Diagnosis and treatment", "Better connected services" and "On-going rehabilitation". Service users reported that effective care was provided when in hospital settings but such treatments often terminated on return to their communities despite on-going need. In hospital and community settings, service providers indicated that they lacked the support and resources to provide continuous care, with patients reaching a crisis point before referral to specialist care. This research highlighted a range of issues concerning the recent UK-drive towards patient-centred approaches within healthcare, as service users were disempowered within the LTNC care pathway. Moreover, service providers indicated that resource constraints limited their ability to provide long-term, intensive and integrated service provision. Our research suggests that many service users with long-term neurological conditions experienced disconnections between services within their National Service Framework care pathway. For health and social care practitioners, a lack of continuity within a care pathway was suggested to be most pertinent following immediate care and moving to rehabilitative care. Our findings also indicate that

  16. Techno-Economic Analysis of BEV Service Providers Offering Battery Swapping Services (Presentation)

    Energy Technology Data Exchange (ETDEWEB)

    Neubauer, J.; Pesaran, A.

    2013-05-01

    Battery electric vehicles (BEVs) could significantly reduce the nation's gasoline consumption and greenhouse gas emissions rates. However, both the upfront cost and the limited range of the vehicle are perceived to be deterrents to the widespread adoption of BEVs. A service provider approach to marketing BEVs, coupled with a battery swapping infrastructure deployment could address both issues and accelerate BEV adoption. This presentation examines customer selection, service usage statistics, service plan fees and driver economics. Our results show it is unlikely that a battery swapping service plan will be more cost-effective than ownership of a conventional vehicle. A battery swapping service plan may be a more cost-effective solution than a directly owned BEV for some single-vehicle, high-mileage consumers. However, other factors not considered in this analysis could decrease the viability of such a service.

  17. 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.

  18. Integration of HIV/AIDS services with maternal, neonatal and child health, nutrition, and family planning services.

    Science.gov (United States)

    Lindegren, Mary Lou; Kennedy, Caitlin E; Bain-Brickley, Deborah; Azman, Hana; Creanga, Andreea A; Butler, Lisa M; Spaulding, Alicen B; Horvath, Tara; Kennedy, Gail E

    2012-09-12

    The integration of HIV/AIDS and maternal, neonatal, child health and nutrition services (MNCHN), including family planning (FP) is recognized as a key strategy to reduce maternal and child mortality and control the HIV/AIDS epidemic. However, limited evidence exists on the effectiveness of service integration. To evaluate the impact of integrating MNCHN-FP and HIV/AIDS services on health, behavioral, and economic outcomes and to identify research gaps. Using the Cochrane Collaboration's validated search strategies for identifying reports of HIV interventions, along with appropriate keywords and MeSH terms, we searched a range of electronic databases, including the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE (via PubMed), and Web of Science / Web of Social Science. The date range was from 01 January 1990 to 15 October 2010. There were no limits to language. Included studies were published in peer-reviewed journals, and provided intervention evaluation data (pre-post or multi-arm study design).The interventions described were organizational strategies or change, process modifications or introductions of technologies aimed at integrating MNCHN-FP and HIV/AIDS service delivery. We identified 10,619 citations from the electronic database searches and 101 citations from hand searching, cross-reference searching and interpersonal communication. After initial screenings for relevance by pairs of authors working independently, a total of 121 full-text articles were obtained for closer examination. Twenty peer-reviewed articles representing 19 interventions met inclusion criteria. There were no randomized controlled trials. One study utilized a stepped wedge design, while the rest were non-randomized trials, cohort studies, time series studies, cross-sectional studies, serial cross-sectional studies, and before-after studies. It was not possible to perform meta-analysis. Risk of

  19. WHO Indicators for Evaluation of Maternal Health Care Services ...

    African Journals Online (AJOL)

    Les indicateurs de lOMS pour lévaluation des services de soin de la santé maternelle, lapplicabilité dans les pays les moins développés: une etude de lErythrée. LOrganisation mondiale de la santé a préconisé un certain nombre dindicateurs du processus pour surveiller leffet des programmes de service de santé sur la ...

  20. Utilization of Services Provided by Village-Based Ethnic Minority Midwives in Vietnam: Lessons From Implementation Research.

    Science.gov (United States)

    Doan, Duong Thi Thuy; Mirzoev, Tolib; Nguyen, Canh Chuong; Bui, Ha Thi Thu

    Global progress in reducing maternal mortality requires improving access to maternal and child health services for the most vulnerable groups. This article reports results of implementation research that aimed to increase the acceptability of village-based ethnic minority midwives (EMMs) by local communities in Vietnam through implementing an integrated interventions package. The study was carried out in 2 provinces in Vietnam, Dien Bien and Kon Tum. A quasi-experimental survey with pretest/posttest design was adopted, which included 6 months of intervention implementation. The interventions package included introductory "launch" meetings, monthly review meetings at community health centers, and 5-day refresher training for EMMs. A mixed-methods approach was used involving both quantitative and qualitative data. A structured questionnaire was used in the pre- and posttest surveys, complemented by in-depth interviews and focus group discussions with EMMs, relatives of pregnant women, community representatives, and health managers. Introductions of EMMs to their local communities by local authorities and supervision of performance of EMMs contributed to significant increases in utilization of services provided by EMMs, from 58.6% to 87.7%. Key facilitators included information on how to contact EMMs, awareness of services provided by EMMs, and trust in services provided by EMMs. The main barriers to utilization of EMM services, which may affect sustainability of the EMM scheme, were low self-esteem of EMMs and small allowances to EMMs, which also affected the recognition of EMMs in the community. Providing continuous support and integration of EMMs within frontline service provision and ensuring adequate local budget for monthly allowances are the key factors that should allow sustainability of the EMM scheme and continued improvement of access to maternal and child health care among poor ethnic minority people living in mountainous areas in Vietnam.

  1. The quality of family relationships and use of maternal health-care services in India.

    Science.gov (United States)

    Allendorf, Keera

    2010-12-01

    Marital quality is well established as a determinant of health in Western contexts, yet the importance of relationship quality to health in non-Western contexts is largely limited to a focus on domestic violence. Using the Women's Reproductive Histories Survey, this study examines whether women with higher-quality family relationships are more likely than others to use maternal health-care services in Madhya Pradesh, India. Results show that among nuclear families, women with better marital relationships are more likely than others to use antenatal care services and to deliver in a health-care facility. Among joint families, women who have better relationships with their in-laws are more likely to use antenatal care services. The results further suggest that women's agency mediates some, but not all, of the effect of relationship quality on use of maternal health-care services.

  2. Maternal health services in South Africa During the 10th anniversary ...

    African Journals Online (AJOL)

    The tenth anniversary of the World Health Organisation's 'Safe Motherhood' initiative is being celebrated this year and the organisation is using the opportunity to assess critically its gains, its strengths and its weaknesses. South Africa has taken some bold steps to address maternal health services, specifically introducing ...

  3. Maternal and Child Health Services in the Context of the Ebola Virus ...

    African Journals Online (AJOL)

    Maternal and Child Health Services in the Context of the Ebola Virus Disease: Health Care Workers' Knowledge, Attitudes and Practices in Rural Guinea. Alexandre Delamou, Sidikiba Sidibé, Alison Marie El Ayadi, Bienvenu Salim Camara, Thérèse Delvaux, Bettina Utz, Abdoulaye II Toure, Sah D. Sandouno, Alioune ...

  4. Data services providing by the Ukrainian NODC (MHI NASU)

    Science.gov (United States)

    Eremeev, V.; Godin, E.; Khaliulin, A.; Ingerov, A.; Zhuk, E.

    2009-04-01

    At modern stage of the World Ocean study information support of investigation based on ad-vanced computer technologies becomes of particular importance. These abstracts are devoted to presentation of several data services developed in the Ukrainian NODC on the base of the Ma-rine Environmental and Information Technologies Department of MHI NASU. The Data Quality Control Service Using experience of international collaboration in the field of data collection and quality check we have developed the quality control (QC) software providing both preliminary(automatic) and expert(manual) data quality check procedures. The current version of the QC software works for the Mediterranean and Black seas and includes the climatic arrays for hydrological and few hydrochemical parameters based on such products as MEDAR/MEDATLAS II, Physical Oceanography of the Black Sea and Climatic Atlas of Oxygen and Hydrogen Sulfide in the Black sea. The data quality check procedure includes metadata control and hydrological and hydrochemical data control. Metadata control provides checking of duplicate cruises and pro-files, date and chronology, ship velocity, station location, sea depth and observation depth. Data QC procedure includes climatic (or range for parameters with small number of observations) data QC, density inversion check for hydrological data and searching for spikes. Using of cli-matic fields and profiles prepared by regional oceanography experts leads to more reliable results of data quality check procedure. The Data Access Services The Ukrainian NODC provides two products for data access - on-line software and data access module for the MHI NASU local net. This software allows select-ing data on rectangle area, on date, on months, on cruises. The result of query is metadata which are presented in the table and the visual presentation of stations on the map. It is possible to see both metadata and data. For this purpose it is necessary to select station in the table of

  5. Hand Washing Practices Among Emergency Medical Services Providers.

    Science.gov (United States)

    Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

    2015-09-01

    Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS) workers, respectively. We designed a survey about hand hygiene practices. The survey was distributed to various national EMS organizations through e-mail. Descriptive statistics were calculated for survey items (responses on a Likert scale) and subpopulations of survey respondents to identify relationships between variables. We used analysis of variance to test differences in means between the subgroups. There were 1,494 responses. Overall, reported hand hygiene practices were poor among pre-hospital providers in all clinical situations. Women reported that they washed their hands more frequently than men overall, although the differences were unlikely to be clinically significant. Hygiene after invasive procedures was reported to be poor. The presence of available hand sanitizer in the ambulance did not improve reported hygiene rates but improved reported rates of cleaning the stethoscope (absolute difference 0.4, p=0.0003). Providers who brought their own sanitizer were more likely to clean their hands. Reported hand hygiene is poor amongst pre-hospital providers. There is a need for future intervention to improve reported performance in pre-hospital provider hand washing.

  6. Maternal health-seeking behavior: the role of financing and organization of health services in Ghana.

    Science.gov (United States)

    Aboagye, Emmanuel; Agyemang, Otuo Serebour

    2013-05-30

    This paper examines how organization and financing of maternal health services influence health-seeking behavior in Bosomtwe district, Ghana. It contributes in furthering the discussions on maternal health-seeking behavior and health outcomes from a health system perspective in sub-Saharan Africa. From a health system standpoint, the paper first presents the resources, organization and financing of maternal health service in Ghana, and later uses case study examples to explain how Ghana's health system has shaped maternal health-seeking behavior of women in the district. The paper employs a qualitative case study technique to build a complex and holistic picture, and report detailed views of the women in their natural setting. A purposeful sampling technique is applied to select 16 women in the district for this study. Through face-to-face interviews and group discussions with the selected women, comprehensive and in-depth information on health- seeking behavior and health outcomes are elicited for the analysis. The study highlights that characteristics embedded in decentralization and provision of free maternal health care influence health-seeking behavior. Particularly, the use of antenatal care has increased after the delivery exemption policy in Ghana. Interestingly, the study also reveals certain social structures, which influence women's attitude towards their decisions and choices of health facilities.

  7. Examining inequalities in uptake of maternal health care and choice of provider in underserved urban areas of Mumbai, India: a mixed methods study.

    Science.gov (United States)

    Alcock, Glyn; Das, Sushmita; Shah More, Neena; Hate, Ketaki; More, Sharda; Pantvaidya, Shanti; Osrin, David; Houweling, Tanja A J

    2015-09-28

    Discussions of maternity care in developing countries tend to emphasise service uptake and overlook choice of provider. Understanding how families choose among health providers is essential to addressing inequitable access to care. Our objectives were to quantify the determinants and choice of maternity care provider in Mumbai's informal urban settlements, and to explore the reasons underlying their choices. The study was conducted in informal urban communities in eastern Mumbai. We developed regression models using data from a census of married women aged 15-49 to test for associations between maternal characteristics and uptake of care and choice of provider. We then conducted seven focus group discussions and 16 in-depth interviews with purposively selected participants, and used grounded theory methods to examine the reasons for their choices. Three thousand eight hundred forty-eight women who had given birth in the preceding 2 years were interviewed in the census. The odds of institutional prenatal and delivery care increased with education, economic status, and duration of residence in Mumbai, and decreased with parity. Tertiary public hospitals were the commonest site of care, but there was a preference for private hospitals with increasing socio-economic status. Women were more likely to use tertiary public hospitals for delivery if they had fewer children and were Hindu. The odds of delivery in the private sector increased with maternal education, wealth, age, recent arrival in Mumbai, and Muslim faith. Four processes were identified in choosing a health care provider: exploring the options, defining a sphere of access, negotiating autonomy, and protective reasoning. Women seeking a positive health experience and outcome adopted strategies to select the best or most suitable, accessible provider. In Mumbai's informal settlements, institutional maternity care is the norm, except among recent migrants. Poor perceptions of primary public health facilities

  8. Data Bookkeeping Service 3 - Providing event metadata in CMS

    CERN Document Server

    Giffels, Manuel; Riley, Daniel

    2014-01-01

    The Data Bookkeeping Service 3 provides a catalog of event metadata for Monte Carlo and recorded data of the Compact Muon Solenoid (CMS) experiment at the Large Hadron Collider (LHC) at CERN, Geneva. It comprises all necessary information for tracking datasets, their processing history and associations between runs, files and datasets, on a large scale of about $200,000$ datasets and more than $40$ million files, which adds up in around $700$ GB of metadata. The DBS is an essential part of the CMS Data Management and Workload Management (DMWM) systems, all kind of data-processing like Monte Carlo production, processing of recorded event data as well as physics analysis done by the users are heavily relying on the information stored in DBS.

  9. Is environmental sustainability a strategic priority for logistics service providers?

    Science.gov (United States)

    Evangelista, Pietro; Colicchia, Claudia; Creazza, Alessandro

    2017-08-01

    Despite an increasing number of third-party logistics service providers (3PLs) regard environmental sustainability as a key area of management, there is still great uncertainty on how 3PLs implement environmental strategies and on how they translate green efforts into practice. Through a multiple case study analysis, this paper explores the environmental strategies of a sample of medium-sized 3PLs operating in Italy and the UK, in terms of environmental organizational culture, initiatives, and influencing factors. Our analysis shows that, notwithstanding environmental sustainability is generally recognised as a strategic priority, a certain degree of diversity in the deployment of environmental strategies still exists. This paper is original since the extant literature on green strategies of 3PLs provides findings predominantly from a single country perspective and mainly investigates large/multinational organizations. It also provides indications to help managers of medium-sized 3PLs in positioning their business. This is particularly meaningful in the 3PL industry, where medium-sized organizations significantly contribute to the generated turnover and market value. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    African Journals Online (AJOL)

    The CFS was cross-sectional by design and for this particular study a total of 1401 women who had at least one live birth in the six years preceding the survey were included. Result: The study revealed that only 26.1 % and 3.3% of the women received antenatal and delivery care services, respectively. The probability of a ...

  11. Socio‑Demographic Determinants of Maternal Health‑Care Service ...

    African Journals Online (AJOL)

    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 ...

  12. Comparison of maternal health services and indicators in three ...

    African Journals Online (AJOL)

    and health care service needs. Analysis. Data collected were entered into Stata version 12 and analyzed using frequency distributionand assessment of means for continuous variables. Comparisons among the three districts were conducted using chi square tests for categorical variables and one way analysis of vari-.

  13. Factors affecting maternal health care services utilization in rural ...

    African Journals Online (AJOL)

    Results: Mother's age at birth, mother's educational level, sex of head of household, household wealth status, employment/work status of mothers, region, religion, birth order and partner's/husband's level of educational were found to be predictors of utilization of delivery care and postnatal care services. Religion and sex of ...

  14. EDITORIAL Reinvigorating maternal health service delivery in Ethiopia

    African Journals Online (AJOL)

    kim

    onset of labor, failure of prior preparation for labor and delivery, health professional's maltreatment of women looking for healthcare services and on the other hand, the friendly home setting and close assistance by neighbors and relatives as factors encouraging women to deliver at home. In connection to this, there are ...

  15. Mental health screenings for couples at churches in Nigeria: a strategy for enhancing community-based maternal mental health services in low-resource settings.

    Science.gov (United States)

    Baumgartner, Joy Noel; Kaaya, Sylvia; Siril, Hellen

    2015-03-01

    The burden of perinatal mental disorders among women in low- and middle-income countries is substantial. The current integration of mental health into maternal, neonatal and child health service platforms is limited, despite global calls to prioritize such service integration. The study by Iheanacho and colleagues (2014) entitled "Integrating mental health screening into routine community maternal and child health activity: experience from a prevention of mother-to-child HIV transmission (PMTCT) trial in Nigeria" provides promising evidence about the feasibility of a church-based strategy for screening pregnant women and their partners for mental health problems through a PMTCT program.

  16. Research Update. Providing Leisure Services for Gays and Lesbians.

    Science.gov (United States)

    Grossman, Arnold H.

    1993-01-01

    There is a paucity of research on leisure services for gays and lesbians. The article highlights research on homosexuals, from various disciplines; it focuses on gay and lesbian youth and notes practical implications for leisure service delivery. (SM)

  17. Motivation and reward systems in service provision: exploring motivators for people providing engineering services

    DEFF Research Database (Denmark)

    Kreye, Melanie; Nandrup-Bus, Troels

    2015-01-01

    It is becoming a distinctive feature for manufacturing firms to compete strategically through service provision. In relation to reward systems the aim of this thesis is to investigate what motivates employees of servitized manufacturing firms when providing engineering services and why. Through...... quantitative and qualitative data collection with an international company within the European healthcare sector, the findings show that key motivating factors were to “delight” the customer and being able to take responsibility and accountability for ones work. Service employees were found to feel proud...

  18. The role of maternity care providers in promoting shared decision making regarding birthing positions during the second stage of labor

    NARCIS (Netherlands)

    Nieuwenhuijze, M.J.; Low, L.K.; Korstjens, I.; Lagro-Janssen, T.

    2014-01-01

    INTRODUCTION: Through the use of a variety of birthing positions during the second stage of labor, a woman can increase progress, improve outcomes, and have a positive birth experience. The role that a maternity care provider has in determining which position a woman uses during the second stage of

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

    African Journals Online (AJOL)

    Result: The study revealed that only 26.1 % and 3.3% of the women received antenatal and delivery care services, respectively. The probability of a woman having an antenatal care for her most recent birth was 0.280, but this was significantly higher if she had received a check-up for her previous birth (0.787). On the other ...

  20. Utilization of maternal health care services in post-conflict Nepal.

    Science.gov (United States)

    Bhandari, Tulsi Ram; Sarma, Prabhakaran Sankara; Kutty, Vellappillil Raman

    2015-01-01

    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. 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. 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. 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.

  1. 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).

  2. The Debate on the Moral Responsibilities of Online Service Providers.

    Science.gov (United States)

    Taddeo, Mariarosaria; Floridi, Luciano

    2016-12-01

    Online service providers (OSPs)-such as AOL, Facebook, Google, Microsoft, and Twitter-significantly shape the informational environment (infosphere) and influence users' experiences and interactions within it. There is a general agreement on the centrality of OSPs in information societies, but little consensus about what principles should shape their moral responsibilities and practices. In this article, we analyse the main contributions to the debate on the moral responsibilities of OSPs. By endorsing the method of the levels of abstract (LoAs), we first analyse the moral responsibilities of OSPs in the web (LoAIN). These concern the management of online information, which includes information filtering, Internet censorship, the circulation of harmful content, and the implementation and fostering of human rights (including privacy). We then consider the moral responsibilities ascribed to OSPs on the web (LoAON) and focus on the existing legal regulation of access to users' data. The overall analysis provides an overview of the current state of the debate and highlights two main results. First, topics related to OSPs' public role-especially their gatekeeping function, their corporate social responsibilities, and their role in implementing and fostering human rights-have acquired increasing relevance in the specialised literature. Second, there is a lack of an ethical framework that can (a) define OSPs' responsibilities, and (b) provide the fundamental sharable principles necessary to guide OSPs' conduct within the multicultural and international context in which they operate. This article contributes to the ethical framework necessary to deal with (a) and (b) by endorsing a LoA enabling the definition of the responsibilities of OSPs with respect to the well-being of the infosphere and of the entities inhabiting it (LoAFor).

  3. An assessment of essential maternal health services in Kwara state ...

    African Journals Online (AJOL)

    La plupart des indicateurs de l'ONU n'ont pas été atteints par les établissements de santé de l'État de Kwara. La disponibilité de services SOU était plus dans le secteur privé, ce qui est statistiquement significatif. Cette étude montre que tous les acteurs impliqués dans la réduction de la mortalité maternelle ont un grand défi ...

  4. Forging New Service Paths: Institutional Approaches to Providing Research Data Management Services

    Directory of Open Access Journals (Sweden)

    Regina Raboin

    2012-01-01

    Full Text Available Objective: This paper describes three different institutional experiences in developing research data management programs and services, challenges/opportunities and lessons learned.Overview: This paper is based on the Librarian Panel Discussion during the 4th Annual University of Massachusetts and New England Region e-Science Symposium. Librarians representing large public and private research universities presented an overview of service models developed at their respective organizations to bring support for data management and eScience to their communities. The approaches described include two library-based, integrated service models and one collaboratively-staffed, center-based service model.Results: Three institutions describe their experiences in creating the organizational capacity for research data management support services. Although each institutional approach is unique, common challenges include garnering administrative support, managing the integration of services with new or existing staff structures, and continuing to meet researchers needs as they evolve.Conclusions: There is no one way to provide research data management services, but any staff position, committee, or formalized center reflects an overarching organizational commitment to data management support.

  5. Providing quality reference services at a special library

    OpenAIRE

    Semertzaki, Eva (Semertzaki-Koutra, Eva)

    2006-01-01

    The paper deals with the traditional vs. modern reference service and with the reference interview and its value. It analyzes new channels of communication: the virtual reference service. It explores the advantages and disadvantages of face-to-face vs. virtual reference and touches issues of user education, information literacy, user satisfaction and evaluation of reference services. Finally, it highlights the competencies of the reference librarian.

  6. Stakeholders' views on maternity care shortcomings in rural Ghana: An ethnographic study among women, providers, public, and quasiprivate policy sector actors.

    Science.gov (United States)

    Ayanore, Martin Amogre; Pavlova, Milena; Biesma, Regien; Groot, Wim

    2017-04-06

    Access to skilled provider and emergency obstetric care is not universal across all districts in Ghana. The lived experiences of 3 stakeholder groups on maternity care shortcomings in 3 rural Ghanaian districts are examined in this study. We applied an ethnographic study approach where field data were collected between March to May 2015 in 3 rural districts of northern Ghana. Data were collected among women with recent births experiences (n = 90), health care providers (n = 16), and policy actors (n = 6). Transcripts were read through to identify similar and divergent stakeholders' views. Significant expressions and experiences of stakeholders on maternity care shortcomings were extracted and evaluated to define key themes. Four themes emerged: social/community factors, payments for health care, facility level factors, and policy level factors. The results show that traditional women's roles divest time for maternity care. Poor transport arrangements, insufficient health workforce, health funding gaps, insurance reimbursements delays, and catastrophic health expenditures on travel and drugs are attested as major barriers across all stakeholder groups in all districts studied. The discussion of the study findings suggests it is important to ascertain the scale of informal payments and their impacts on health access. Investments in health workforce and reliable ambulatory service systems could help address poor referral difficulties in rural areas of the country. Social support for community initiatives that pool funds could provide extra resources and relieve cost access-related challenges for using maternity care in rural settings in Ghana. Copyright © 2017 John Wiley & Sons, Ltd.

  7. A Service Learning Program in Providing Nutrition Education to Children

    OpenAIRE

    Falter, Rebecca A.; Pignotti-Dumas, Karla; Popish, Sarah J.; Petrelli, Heather M.W.; Best, Mark A.; Wilkinson, Julie J.

    2011-01-01

    Objective. To implement a service learning program in nutrition and assess its impact on pharmacy students' communication skills and professionalism and elementary school children's knowledge of nutrition concepts.

  8. A service learning program in providing nutrition education to children

    National Research Council Canada - National Science Library

    Falter, Rebecca A; Pignotti-Dumas, Karla; Popish, Sarah J; Petrelli, Heather M W; Best, Mark A; Wilkinson, Julie J

    2011-01-01

    To implement a service learning program in nutrition and assess its impact on pharmacy students' communication skills and professionalism and elementary school children's knowledge of nutrition concepts...

  9. Why are organisations that provide healthcare services fuzzy?

    Science.gov (United States)

    Hempe, Eva-Maria

    2013-01-01

    Healthcare organisations are an enigma to many people inand outside the service. Organisational fuzziness is a common state, characterised by a lack of clarity, lack of awareness, lack of organisational knowledge, and the reliance on practice and custom instead of transparency. The objective of this study was to obtain a better understanding of what causes this fuzziness and provide an actionable description of fuzzy organisations. Such a description is essential to managing and preventing organisational fuzziness. We used a longitudinal case study in an integrated healthand social care organisation to obtain a thorough understanding of how the organisation functions. These indepth insights allowed the identification of three generators of fuzziness. We found that the three main generators of organisational fuzziness are change, informal organisation and complexity. Organisational fuzziness is thus partly due to the inherent complexities of human systems. However, also continuous change and the inability of the system to adapt its formal structures resulted in structures deteriorating or no longer being appropriate. Existing approaches to explain unclear or absent structures in healthcare organisations by describing these organisations as complex adaptive systems (CAS) are too simplistic. While aspects relating to people and their interactions are indeed complex, fuzziness of structural aspects are often the result of continuous change and insufficient organisational capacity to adapt to it.

  10. Why some physicians envy dentists: the applications service provider.

    Science.gov (United States)

    LeBeau, S A

    2001-03-01

    To summarize, here's what I get from my ASP. My staff and I can access our schedules, patient information, etc, any time and from anywhere--not just from the office PC. All I need is a standard Internet browser and a connection to the Internet. Only authorized personnel have access to my data. My online practice management system is password protected and operates with Verisign SSL--the highest level of Internet security. All information is stored in my secure database, which my ASP backs up and replicates continuously. Dental. PackOnline even operates dual servers. In case one server has a problem, they just switch to the other server, so I never have to worry about "down-time." I can give patients access to their own information online-treatment plans, patient education material, balances, etc, in a highly private and confidential manner. I can share patient information, x-rays, and other materials online with colleagues, specialists, and labs, again in a highly confidential manner. I send out billing, recalls, claims, and more automatically because my ASP has real-time connections to service providers. No more time spent printing, folding, stamping cards, billing, or processing claims. This is a tremendous cost and time saver!

  11. Supplanting ecosystem services provided by scavengers raises greenhouse gas emissions

    Science.gov (United States)

    Morales-Reyes, Zebensui; Pérez-García, Juan M.; Moleón, Marcos; Botella, Francisco; Carrete, Martina; Lazcano, Carolina; Moreno-Opo, Rubén; Margalida, Antoni; Donázar, José A.; Sánchez-Zapata, José A.

    2015-01-01

    Global warming due to human-induced increments in atmospheric concentrations of greenhouse gases (GHG) is one of the most debated topics among environmentalists and politicians worldwide. In this paper we assess a novel source of GHG emissions emerged following a controversial policy decision. After the outbreak of bovine spongiform encephalopathy in Europe, the sanitary regulation required that livestock carcasses were collected from farms and transformed or destroyed in authorised plants, contradicting not only the obligations of member states to conserve scavenger species but also generating unprecedented GHG emission. However, how much of this emission could be prevented in the return to traditional and natural scenario in which scavengers freely remove livestock carcasses is largely unknown. Here we show that, in Spain (home of 95% of European vultures), supplanting the natural removal of dead extensive livestock by scavengers with carcass collection and transport to intermediate and processing plants meant the emission of 77,344 metric tons of CO2 eq. to the atmosphere per year, in addition to annual payments of ca. $50 million to insurance companies. Thus, replacing the ecosystem services provided by scavengers has not only conservation costs, but also important and unnecessary environmental and economic costs.

  12. Key Aspects of Providing Healthcare Services in Disaster Response Stage.

    Science.gov (United States)

    Pourhosseini, Samira Sadat; Ardalan, Ali; Mehrolhassani, Mohammad Hossien

    2015-01-01

    Health care management in disasters is one of the main parts of disaster management. Health in disasters is affected by performance of various sectors, and has an interactive impact on various aspects of disaster management. The aim of this study was to identify the most important themes affecting the healthcare management in disaster. In this qualitative study with a content analysis approach, in-depth interviews in two steps with 30 disaster experts and managers were conducted to collect the data. Eleven themes affecting healthcare management in disasters were identified. These themes were related to human resources management, resources management, victims' management transfer, environmental hygiene monitoring, nutrition management, mental health control, inter-agency coordination, training, technology management, information and communication management, and budget management. Providing effective health care service in disasters requires a comprehensive look at the various aspects of disaster management. Effective factors on the success of healthcare in disaster are not limited to the scope of healthcare. There should be a close relationship and interaction between different sectors of disaster management.

  13. The effects of cultural diversity on providing health services.

    Science.gov (United States)

    Kreitler, S

    2005-01-01

    The purpose of the study was to highlight major aspects and problems of cultural diversity in the context of providing health services, and to suggest means for overcoming problems in this context. The major issues discussed were communication as a culture-dependent process, paradigms of relationships between the health professional and the patient, and the potential of various communication features to serve as barriers or bridges between the patient and the health professional. In order to overcome inhibitory effects of cultural diversity on communication, two theoretical approaches were presented. One approach was grounded in the theory of meaning that deals with processing information, the other in cognitive orientation theory that deals with predicting, understanding and changing behaviours. Results demonstrated how to overcome stereotypes and other communication barriers by means of awareness of meanings and expansion of meanings of the relevant stimuli (e.g., patient), and by means of promoting the production of a motivational disposition grounded in beliefs about oneself, about reality, about norms and about one's goals. In summary it is possible to overcome communication barriers and other difficulties potentially dependent on cultural diversity and produce an environment in which cultural diversity is an advantage rather than a source of problems.

  14. Maternal mortality in Eritrea: Improvements associated with centralization of obstetric services.

    Science.gov (United States)

    Holzgreve, Wolfgang; Greiner, Dorothea; Schwidtal, Peter

    2012-10-01

    To reduce maternal mortality and move more effectively toward achieving Millennium Development Goal (MDG) 5 it is important to learn from positive national experiences and to try to isolate the significant factors that were successful. Maternal mortality in Eritrea is still high, but within the period since the country's independence in 1991, the Eritrean Government has received support to improve maternal health from two German nongovernmental organizations: the Hammer Forum and Archemed. This support has focused on prenatal care, contraception counseling, postabortion care, and most notably the centralization of obstetric and neonatal services in the capital, Asmara, and in the second biggest city, Keren. It is now possible to tentatively evaluate the effect of this approach. National data show that the maternal mortality ratio declined from 998 per 100000 live births in 1995 to 486 in 2010. Although the positive effect of skilled birth attendants in the periphery is also well documented, the centralization of obstetric services in Eritrea seems to have been a major factor in the country's considerable progress toward achieving MDG 5. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  15. Defining, valuing and providing ecosystem goods and services

    Science.gov (United States)

    Thomas C. Brown; John C. Bergstrom; John B. Loomis

    2007-01-01

    Ecosystem services are the specific results of ecosystem processes that either directly sustain or enhance human life (as does natural protection from the sun's harmful ultraviolet rays) or maintain the qualify of ecosystem goods (as water purification maintains the quality of streamflow). "Ecosystem service" has come to represent several related topics...

  16. Sustainable leadership in a Thai healthcare services provider.

    Science.gov (United States)

    Kantabutra, Sooksan

    2011-01-01

    Rhineland leadership practices contrast sharply with the prevailing Anglo/US business model of short-term maximization of profitability, and are said to lead to greater corporate sustainability, at least in highly developed economies. However, the applicability of Rhineland leadership to less developed economies has not yet been demonstrated. This paper sets out to compare the business practices of a social enterprise that delivers healthcare services in Thailand and Avery's 19 sustainable leadership practices derived from Rhineland enterprises. Adopting a case study approach, multi-data collection methods included non-participant observations made during visits to the enterprise, and reference to internal and published documentation and information. Semi-structured interview sessions were held with many stakeholders, including top management, staff, patients and a former consultant. In the Thai healthcare organization studied, evidence was found for compliance with 15 of Avery's 19 sustainable leadership elements, but to varying degrees. The elements were grouped into six core sets of practices: adopting a long-term perspective, staff development, organizational culture, innovation, social responsibility, and ethical behavior. One element was found to be not applicable, and no evidence was found for conformity with Rhineland principles on the remaining three sustainable practices. The paper concludes that Avery's 19 Rhineland practices provide a useful framework for evaluating the corporate sustainability of this Thai enterprise. Healthcare enterprises in Thailand and possibly in other Asian countries that wish to sustain their organizational success could adopt Avery's 19 Sustainable Leadership Grid elements to examine their leadership practices, and adjust them to become more sustainable. The relevance of Rhineland sustainable leadership principles to enterprises in less developed economies remains to be investigated. This study attempts to uncover this unknown.

  17. Determinants of male involvement in maternal and child health services in sub-Saharan Africa: a review

    Directory of Open Access Journals (Sweden)

    Ditekemena John

    2012-11-01

    Full Text Available Abstract Introduction Male participation is a crucial component in the optimization of Maternal and Child Health (MCH services. This is especially so where prevention strategies to decrease Mother-to-Child Transmission (MTCT of Human Immunodeficiency Virus (HIV are sought. This study aims to identify determinants of male partners’ involvement in MCH activities, focusing specifically on HIV prevention of maternal to child transmission (PMTCT in sub-Saharan Africa. Methods Literature review was conducted using the following data bases: Pubmed/MEDLINE; CINAHL; EMBASE; COCHRANE; Psych INFORMATION and the websites of the International AIDS Society (IAS, the International AIDS Conference and the International Conference on AIDS in Africa (ICASA 2011. Results We included 34 studies in this review, which reported on male participation in MCH and PMTCT services. The majority of studies defined male participation as male involvement solely during antenatal HIV testing. Other studies defined male involvement as any male participation in HIV couple counseling. We identified three main determinants for male participation in PMTCT services: 1 Socio-demographic factors such as level of education, income status; 2 health services related factors such as opening hours of services, behavior of health providers and the lack of space to accommodate male partners; and 3 Sociologic factors such as beliefs, attitudes and communication between men and women. Conclusion There are many challenges to increase male involvement/participation in PMTCT services. So far, few interventions addressing these challenges have been evaluated and reported. It is clear however that improvement of antenatal care services by making them more male friendly, and health education campaigns to change beliefs and attitudes of men are absolutely needed.

  18. Techno-Economic Analysis of BEV Service Providers Offering Battery Swapping Services: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Neubauer, J.; Pesaran, A.

    2013-03-01

    Battery electric vehicles (BEVs) offer the potential to reduce both oil imports and greenhouse gas emissions, but high upfront costs, battery-limited vehicle range, and concern over high battery replacement costs may discourage potential buyers. A subscription model in which a service provider owns the battery and supplies access to battery swapping infrastructure could reduce upfront and replacement costs for batteries with a predictable monthly fee, while expanding BEV range. Assessing the costs and benefits of such a proposal are complicated by many factors, including customer drive patterns, the amount of required infrastructure, battery life, etc. The National Renewable Energy Laboratory has applied its Battery Ownership Model to compare the economics and utility of BEV battery swapping service plan options to more traditional direct ownership options. Our evaluation process followed four steps: (1) identifying drive patterns best suited to battery swapping service plans, (2) modeling service usage statistics for the selected drive patterns, (3) calculating the cost-of-service plan options, and (4) evaluating the economics of individual drivers under realistically priced service plans. A service plan option can be more cost-effective than direct ownership for drivers who wish to operate a BEV as their primary vehicle where alternative options for travel beyond the single-charge range are expensive, and a full-coverage-yet-cost-effective regional infrastructure network can be deployed. However, when assumed cost of gasoline, tax structure, and absence of purchase incentives are factored in, our calculations show the service plan BEV is rarely more cost-effective than direct ownership of a conventional vehicle.

  19. Techno-Economic Analysis of BEV Service Providers Offering Battery Swapping Services

    Energy Technology Data Exchange (ETDEWEB)

    Neubauer, J. S.; Pesaran, A.

    2013-01-01

    Battery electric vehicles (BEVs) offer the potential to reduce both oil imports and greenhouse gas emissions, but high upfront costs, battery-limited vehicle range, and concern over high battery replacement costs may discourage potential buyers. A subscription model in which a service provider owns the battery and supplies access to battery swapping infrastructure could reduce upfront and replacement costs for batteries with a predictable monthly fee, while expanding BEV range. Assessing the costs and benefits of such a proposal are complicated by many factors, including customer drive patterns, the amount of required infrastructure, battery life, etc. The National Renewable Energy Laboratory has applied its Battery Ownership Model to compare the economics and utility of BEV battery swapping service plan options to more traditional direct ownership options. Our evaluation process followed four steps: (1) identifying drive patterns best suited to battery swapping service plans, (2) modeling service usage statistics for the selected drive patterns, (3) calculating the cost-of-service plan options, and (4) evaluating the economics of individual drivers under realistically priced service plans. A service plan option can be more cost-effective than direct ownership for drivers who wish to operate a BEV as their primary vehicle where alternative options for travel beyond the single-charge range are expensive, and a full-coverage-yet-cost-effective regional infrastructure network can be deployed. However, when assumed cost of gasoline, tax structure, and absence of purchase incentives are factored in, our calculations show the service plan BEV is rarely more cost-effective than direct ownership of a conventional vehicle.

  20. Industrial Demand Management Providing Ancillary Services to the Distribution Grid

    DEFF Research Database (Denmark)

    Rahnama, Samira; Green, Torben; Lyhne, Casper

    2017-01-01

    delivery. Consumers' involvement requires new entities and infrastructure. A so-called aggregator has been introduced as a new player to manage the services that are offered by the consumption units. This paper describes an industrial scale experimental setup for evaluating a particular type of aggregator......A prominent feature of the future smart grid is the active participation of the consumer side in ancillary service provision. Grid operators procure ancillary services, including regulating power, voltage control, frequency control, and so on, to ensure safe, reliable, and high-quality electricity...

  1. 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.

  2. IMPLEMENTATION OF THE ABC COSTING IN A SERVICES PROVIDER COMPANY

    National Research Council Canada - National Science Library

    Luiz Ricardo Aguena Jacintho Gil de Castro; Fernando de Almeida Santos

    2012-01-01

    This paper describes the implementation of the Activity-Based Cost (ABC) method in a company of taxes and accounting services and outlines the positive and negative aspects encountered during implementation...

  3. Hand Washing Practices Among Emergency Medical Services Providers

    National Research Council Canada - National Science Library

    Bucher, Joshua; Donovan, Colleen; Ohman-Strickland, Pamela; McCoy, Jonathan

    2015-01-01

    Hand hygiene is an important component of infection control efforts. Our primary and secondary goals were to determine the reported rates of hand washing and stethoscope cleaning in emergency medical services (EMS...

  4. Mobile phone in Africa: providing services to the masses

    CSIR Research Space (South Africa)

    Botha, Adèle

    2010-08-31

    Full Text Available and operational considerations associated with creating a middleware platform for mobile services. The platform should be able to support different mobile paradigms (voice, text, multimedia, mobile web, applications) using a variety of communications protocols...

  5. THE ECONOMIC APPROACH OF ECOSYSTEM SERVICES PROVIDED BY PROTECTED AREAS

    Directory of Open Access Journals (Sweden)

    Cirnu Maria

    2015-07-01

    Full Text Available As practice shows us, at the present time ecosystem services are recognized by humanity, but unfortunately are undervalued compared to their full potential. Most of planet's ecosystems are degradated by anthropic activity of humankind. It is almost impossible to say that there are no areas affected by human activity, however, the Protected Areas are a good opportunity, so the assessing of ecosystem services in Protected Areas can be a solution to the problem of economic growth. At present, there are few consistent informations on economic value of ecosystem services in Romania, on the basis of which can be adopted some sustainable financing policies of activities in Protected Areas. The premise from which we start is that a proper management of natural capital will allow biodiversity conservation and human well-being if it find appropriate economic instruments. For this reason, studies of economic research on the contribution of those ecosystem services to the communities welfare may constitute credible means for decision-makers, demonstrating the Protected Areas importance. This paper, based on the study of international and national literature, examines the state of knowledge on the economic and environmental valences of ecosystem services. The growing interest of researchers regarding the economic valuation of ecosystem services related to Protected Areas is visible through the many studies carried out at international level. Although national scientific research relating to ecosystem services is at the beginning, concerns researchers economists and ecologists have been directed toward this recess, of ecosystem services. The reason for we should assign an economic value to ecosystem services is to ensure that their value is included actively in decision-making and is not ignored because "is still available". Briefly, the paper start with an overview of the main definition of ecosystem services. From the point of economic value view, the paper

  6. Targeted Evolution of Embedded Librarian Services: Providing Mobile Reference and Instruction Services Using iPads.

    Science.gov (United States)

    Stellrecht, Elizabeth; Chiarella, Deborah

    2015-01-01

    The University at Buffalo Health Sciences Library provides reference and instructional services to support research, curricular, and clinical programs of the University at Buffalo. With funding from an NN/LM MAR Technology Improvement Award, the University at Buffalo Health Sciences Library (UBHSL) purchased iPads to develop embedded reference and educational services. Usage statistics were collected over a ten-month period to measure the frequency of iPad use for mobile services. While this experiment demonstrates that the iPad can be used to meet the library user's needs outside of the physical library space, this article will also offer advice for others who are considering implementing their own program.

  7. 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.

  8. [Maternal health services and pediatric health services in developing countries demand more resources].

    Science.gov (United States)

    Lundborg, M

    1988-10-19

    This article reports on information presented at a congress of the International Association for Maternal and Neonatal Health held in Lahore, Pakistan, in November 1987. Of the estimated 500,000 maternal deaths/year, 99% occur in the Third World and 3/4 of these are in Asia. Measures suggested at the meeting for reducing this toll included reduced female fertility, access to and popular acceptance of, preventive maternal health care for all, screening and special attention to risk pregnancies, necessary resources for care, and equipment for childbirth including trained personnel, preparation for complications, and transportation to lying-in clinics. Anemia and infections are the diseases which most often affect maternal health, with undernutrition also contributing. Women in the risk zone for children with birth weight 2500 gm are often lighter than 45 kg, shorter than 145 cm and have an upper arm circumference of 20-22 cm. A report from Egypt stated that the method most used for limiting children was prolonged nursing. Normally the nursing period there extends for 18 months. Sterilization of women appeared to be an acceptable family planning method among the Asiatic delegates who participated in the debate. One session discussed the so-called "kangaroo" method of caring for premature babies in Bogota, Colombia. The babies are cared for at home by their mothers and are carried in immediate bodily contact with the mothers. The Bogota method has apparently achieved good survival rates for these children.

  9. Factors influencing utilization of ASHA services under NRHM in relation to maternal health in rural Lucknow

    Directory of Open Access Journals (Sweden)

    Singh Manish

    2010-01-01

    Full Text Available Background: Under National Rural Health Mission (NRHM, ASHA (accredited social health activist has been identified as an effective link to address the poor utilization of maternal and child health (MCH services by rural pregnant women. Objective: To study the factors influencing utilization of ASHA services in relation to maternal health. Study Design: Cross-sectional. Setting: Primary Health Centre (PHC, Sarojininagar, Lucknow and its rural field area. Study Period: September 2007 to August 2008. Study Unit: RDW (recently delivered women were considered as those who delivered a live newborn at PHC Sarojininagar, within a week of interview and belonged to villages within the confines of the PHC being served by ASHA. Materials and Methods: 350 RDW were interviewed at their bedside, by a preformed and pretested schedule and then were followed-up after six weeks. Results: Utilization of ASHA services for early registration was significantly associated with age and religion of RDW. Young, educated and socio-economic class III RDW utilized ASHA services the maximum for early registration. Utilization of ASHA services for adequate ANC or antenatal care (100 iron and folic acid tablets, 2 tetanus toxoid injection and ΃3 antenatal visits was also inversely associated with age of RDW. Young, Hindu, scheduled caste, middle school pass, Class III RDW and those with birth order one had high odds for utilization of ASHA services for adequate ANC. With regard to postnatal check-up, again young RDW with birth order one, Hindu RDW in reference to Muslim and RDW in socio-economic class III had higher likelihood for utilization of ASHA services. Caste-wise scheduled caste (SC and other backward caste (OBC RDW had higher odds for utilization of ASHA services. Educated RDW and those with educated husband had higher odds for utilization of ASHA services for postnatal check-up. Conclusion: Young, educated RDW with low parity, educated husband and belonging to higher

  10. Factors affecting the performance of maternal health care providers in Armenia

    Directory of Open Access Journals (Sweden)

    Voltero Lauren

    2004-06-01

    Full Text Available Abstract Background Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. Each of these factors should be supplied by the organization in which the provider works, and thus, organizational support is considered as an overarching element for analysis. Little research, domestically or internationally, has been conducted on the actual effects of each of the factors on performance outcomes and most PI practitioners assume that all the factors are needed in order for performance to improve. This study presents a unique exploration of how the factors, individually as well as in combination, affect the performance of primary reproductive health providers (nurse-midwives in two regions of Armenia. Methods Two hundred and eighty-five nurses and midwives were observed conducting real or simulated antenatal and postpartum/neonatal care services and interviewed about the presence or absence of the performance factors within their work environment. Results were analyzed to compare average performance with the existence or absence of the factors; then, multiple regression analysis was conducted with the merged datasets to obtain the best models of "predictors" of performance within each clinical service. Results Baseline results revealed that performance was sub-standard in several areas and several performance factors were deficient or nonexistent. The multivariate analysis showed that (a training in the use of the clinic tools; and (b receiving recognition from the employer or the client/community, are factors strongly associated with performance, followed by (c receiving performance feedback in postpartum care. Other – extraneous

  11. 29 CFR 779.388 - Exemption provided for food or beverage service employees.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Exemption provided for food or beverage service employees... Service Establishments Restaurants and Establishments Providing Food and Beverage Service § 779.388 Exemption provided for food or beverage service employees. (a) A special exemption is provided in section 13...

  12. A review of governance of maternity services at South Tipperary general hospital

    LENUS (Irish Health Repository)

    Flory, David

    2015-09-01

    This review of the governance of maternity services at South Tipperary General Hospital has focussed on the systems and processes for assurance of service quality, risk management and patient safety primarily inside the hospital but also in the Hospital Group structure within which it operates. The effectiveness of the governance arrangements is largely determined by the quality of the leadership and management – both clinical and general – which designs, implements, and oversees those systems and processes and is ultimately responsible and accountable.\\r\

  13. Prevention, diagnosis, and treatment of tuberculosis in children and mothers: evidence for action for maternal, neonatal, and child health services

    National Research Council Canada - National Science Library

    Getahun, Haileyesus; Sculier, Delphine; Sismanidis, Charalambos; Grzemska, Malgorzata; Raviglione, Mario

    2012-01-01

    ...), and maternal tuberculosis increases the vertical transmission of HIV. Tuberculosis prevention, diagnosis, and treatment services should be included as key interventions in the integrated management of pregnancy and child health...

  14. The state of emergency obstetric care services in Nairobi informal settlements and environs: Results from a maternity health facility survey

    Directory of Open Access Journals (Sweden)

    Saliku Teresa

    2009-03-01

    Full Text Available Abstract Background Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1 delay in making the decision to seek care; 2 delay in reaching an appropriate obstetric facility; and 3 delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. Methods We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. Results Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden

  15. 77 FR 6122 - Providing Refurbishment Services to Federal Agencies

    Science.gov (United States)

    2012-02-07

    ... refurbished equipment) fit into viable business models for computer refurbishment companies? 4. How do the... process for disposing and recycling of failed equipment. Have all facilities in your recycling and... refurbishment services, including those developed specifically for recycling facilities (e.g., R2 and e-Stewards...

  16. Power system services provided by inverter connected distributed energy resources

    DEFF Research Database (Denmark)

    For the last few years there has been a significant increase of DER units in Denmark, of those units more and more are connected to the power system using inverters. These inverter connected units have the potential to support the electrical power system with various power system services. One...

  17. PROVIDING SERVICEABILITY OF STRUCTURAL BEARING TYPES FOR ROADWAY BRIDGES

    Directory of Open Access Journals (Sweden)

    R. I. Polyuga

    2010-03-01

    Full Text Available In the article the description of structural bearing types for roadway bridges and their classification is given. Special attention is paid to effective bearings with elastomeric materials – rubber, pot, spherical ones. Characteristic defects of structural bearings and demands of serviceability are noticed.

  18. Measuring Perceptual (In) Congruence between Information Service Providers and Users

    Science.gov (United States)

    Boyce, Crystal

    2017-01-01

    Library quality is no longer evaluated solely on the value of its collections, as user perceptions of service quality play an increasingly important role in defining overall library value. This paper presents a retooling of the LibQUAL+ survey instrument, blending the gap measurement model with perceptual congruence model studies from information…

  19. Perancangan Sistem Informasi Penjualan pada Perusahaan Jasa Service Provider

    Directory of Open Access Journals (Sweden)

    Lianawati Christian

    2012-06-01

    Full Text Available Along with the development of technology, every line of business as well as services needs information systems to support the company operations. This research is objected to analyze, identify information needs, repair and design accounting information system of service sales required by the management to support decision making and address the issues in the running system on a service company. Several methods were carried out on this research, such as data collection and information; analyses on the running system; analysesof research findings;, identification of information needs, and identification of system requirements, as well as object-oriented design methods, namely the problem domain analysis, application domain analysis, architecturedesign and component diagram. The results obtained in the form of improvements in the running system which was an application that informs the design of document numbering, filing, and reports. The accountinginformation system of service sales at the studied company produced needed reports timely, completely and accurately that can be utilized by the management in decision-making.

  20. Effectiveness of reference services in providing students' information ...

    African Journals Online (AJOL)

    The main purpose of establishing library in any academic environment is to serve as the information centre to the community of users. But many have failed to serve this purpose after spending lots of money due to some reason and the other. This survey study is aimed at assessing Effectiveness of Reference Services in ...

  1. The status of maternal and newborn care services in Sierra Leone 8 years after ceasefire.

    Science.gov (United States)

    Oyerinde, Koyejo; Harding, Yvonne; Amara, Philip; Kanu, Rugiatu; Shoo, Rumishael; Daoh, Kizito

    2011-08-01

    To conduct a needs assessment for emergency obstetric care (EmOC) to address the unacceptably high maternal and newborn mortality indices in Sierra Leone 8 years after the end of the civil war. From June to August 2008, a cross-sectional survey was conducted of health facilities in Sierra Leone offering delivery services. Assessment tools were local adaptations of tools developed by the Averting Maternal Death and Disability program at Columbia University, New York, USA. There were enough comprehensive EmOC (CEmOC) facilities in the country but they were poorly distributed. There were no basic EmOC (BEmOC) facilities. Few facilities (37% of hospitals and 2% of health centers) were able to perform assisted vaginal delivery (AVD), and 3 potentially BEmOC facilities did not meet the standard only because they did not perform AVD. Severe shortages in staff, equipment, and supplies, and unsatisfactory supply of utilities severely hampered the delivery of quality EmOC services. Demand for maternity and newborn services was low, which may have been related to the poor quality and the high/unpredictable out-of-pocket cost of such services. Significant increases in the uptake of institutional delivery services, the linkage of remote health workers to the health system, and the recruitment of midwives, in addition to rapid expansion in the training of health workers (including training in midwifery and obstetric surgery skills), are urgently needed to improve the survival of mothers and newborns. Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  2. Social accountability for maternal health services in Muanda and Bolenge Health Zones, Democratic Republic of Congo: a situation analysis.

    Science.gov (United States)

    Mafuta, Eric M; Dieleman, Marjolein A; Hogema, Lisanne M; Khomba, Paul N; Zioko, François M; Kayembe, Patrick K; de Cock Buning, Tjard; Mambu, Thérèse N M

    2015-11-23

    The Democratic Republic of the Congo is one of the countries in Sub-Saharan Africa with the highest maternal mortality ratio estimated at 846 deaths per 100,000 live births. Innovative strategies such as social accountability are needed to improve both health service delivery and utilization. Indeed, social accountability is a form of citizen engagement defined as the 'extent and capability of citizens to hold politicians, policy makers and providers accountable and make them responsive to their needs.' This study explores existing social accountability mechanisms through which women's concerns are expressed and responded to by health providers in local settings. An exploratory study was conducted in two health zones with purposively sampled respondents including twenty-five women, five men, five health providers, two health zone officers and eleven community stakeholders. Data on women's voice and oversight and health providers' responsiveness were collected using semi-structured interviews and analysed using thematic analysis. In the two health zones, women rarely voiced their concerns and expectations about health services. This reluctance was due to: the absence of procedures to express them, to the lack of knowledge thereof, fear of reprisals, of being misunderstood as well as factors such as age-related power, ethnicity backgrounds, and women's status. The means most often mentioned by women for expressing their concerns were as individuals rather than as a collective. They did not use them instead; instead they looked to intermediaries, mostly, trusted health providers, community health workers and local leaders. Their perceptions of health providers' responsiveness varied. For women, there were no mechanisms for oversight in place. Individual discontent with malpractice was not shown to health providers. In contrast, health providers mentioned community health workers, health committee, and community based organizations as formal oversight mechanisms. All

  3. Maternal health services uptake and its determinants in public primary health care facilities in edo state, Nigeria.

    Science.gov (United States)

    Alenoghena, I O; Isah, E C; Isara, A R

    2015-03-01

    To assess the uptake of maternal health services; its determinants and the perception of users about these services. A descriptive cross sectional study was carried out in Edo North Senatorial Zone of Nigeria. Respondents were selected using a multi- stage sampling technique. A structured, interviewer administered questionnaire was used to collect data from the respondents. The data were analysed using SPSS version 17. Binary logistic regression model was used to identify predictors of utilization of these services. A total of 342 respondents participated in the study; with 171(50%) from the sub-urban communities and the other half from the rural communities. The utilization of the ANC services was 79% and 81% for the sub-urban and rural communities respectively. As for delivery services, it varied from 60.2% to 81.3% for the sub-urban and rural communities respectively. Family planning services uptake was about the same for both types of communities; being 43.7% for the sub-urban communities and 44.4% for the rural communities. Educational status and type of community were significantly associated with delivery service utilization. The predictors of the antenatal services utilization included: educational status, cost per illness, self assessment of health, clean environment and sources of information on maternal care. Marital status, average income and type of community were the predictors of family planning services utilization. The utilization of maternal services was good; being higher than the national average with the exception of postnatal service, which was completely absent. The major determinants of utilization of maternal health services included educational status and the average monthly income of the respondents. Services were perceived by more than half of the respondents to be generally good. There is need for the provision of the minimum service components of maternal health care services especially postnatal service at the PHC facilities.

  4. Adolescents' informedness about the services provided by Children's helpline

    Directory of Open Access Journals (Sweden)

    V.V. Kovrov

    2014-08-01

    Full Text Available We present the results of studies of informedness about the Children's helpline and access to remote emergency psychological assistance in the case of a difficult life situation in family, school, peer group (violence, conflicts, antivital experiences etc. in students of VII-IX grades of twenty educational organizations of general (complete education in Moscow. We discuss the reasons for reducing the likelihood of using services of the Children's Helpline, psychological barriers – conscious and unconscious – complicating the use of this service. The study showed that the need for psychological assistance, implemented by means of remote consultation, has not been formed in the majority of students in Moscow. We revealed a general rule that awareness of the Children's Helpline, the perception of its effectiveness and the motivation “to call in future” and “to recommend others to call”, are closely interrelated among respondents with experience of such calls.

  5. Sociologist as a Service Provider. Using Psychology to Support Selling

    Directory of Open Access Journals (Sweden)

    N Е Aimautova

    2011-03-01

    Full Text Available The article helms the reader to the results of the sociological services market observation. A basic selling scheme is outlined with the components of interactions space as well as the set of "must-have" psychological skills and competencies essential for the seller highlighted as factors of high priority. The principal stages of the selling process are identified. The notion of "offeror" who meets the desires of the client purchasing sociological services is introduced. The prominent role of psychological selling techniques is emphasized in the guidelines to be abided by the sociologist in order to prevent potential misunderstandings and conflicts as well as to establish new contacts and keep old ties with the client after making a deal.

  6. Considerations for Providing Counseling Services in Second Life

    Directory of Open Access Journals (Sweden)

    Debra P. Russ

    2012-11-01

    Full Text Available Second Life is a multiuser environment that can be found on the Internet. There are hundreds of counselors using Second Life as a service delivery mode. Currently, Second Life remains an unregulated avenue for practice. Counselors considering opening a practice need to investigate the benefits and disadvantages for using this medium. The author will discuss the opportunities, issues, and steps for establishing a counseling practice in Second Life.

  7. Male partners’ views of involvement in maternal healthcare services at Makhado Municipality clinics, Limpopo Province, South Africa

    Directory of Open Access Journals (Sweden)

    Kenneth Nesane

    2016-03-01

    Full Text Available Background: Male partners have a strong influence on pregnant partners’ health and their access to care. Their involvement is critical in the delivery and uptake of maternal healthcare services and improving maternal and child health outcomes.Aim: The study sought to determine male partners’ views on their involvement in maternal healthcare services.Setting: The Makhado Municipality’s Kutama, Madombidzha and Vleifontein clinics.Methods: A qualitative study design, which is exploratory, descriptive and contextual in nature, was used. The population comprised 15 men whose partners had been pregnant within the last 2 years. A non-probability, purposive sampling procedure was used. Data were collected via in-depth individual interviews using a voice recorder and an interview schedule guide. Tesch’s open coding method was used to analyse data.Results: The findings revealed one major theme, namely that maternal health issues are viewed as a woman’sdomain; and three sub-themes: culture and participation in childbirth, male partners’ employment status, and male partners’ unwillingness to participate in maternal health issues.Conclusions: The involvement of male partners in maternal healthcare services, and further research in promoting this activity, should be proposed to policymakers.Keywords: Views, partners, involvement, maternal health care services, antenatal care, labour and postnatal care.

  8. Women's perspectives on maternity services in Sweden: processes, problems, and solutions.

    Science.gov (United States)

    Hildingsson, Ingegerd; Thomas, Jan E

    2007-01-01

    Most measures of health care quality focus on medical outcomes rather than patients' assessments of quality. Drawing on data from a national survey of Swedish women, this study describes women's opinions about what is important to them during pregnancy and birth. This qualitative study is based on responses of 827 pregnant women to an open question completed in the second trimester. In total, 2061 separate statements were analyzed. Using content analysis, these statements were clustered into 4 themes: desirable characteristics of midwife, prenatal care during pregnancy, care during labor and birth, and care after birth. Within those themes, 13 categories were found. Findings suggest areas for improvement in maternity services including: the timing and length of prenatal visits, making parent education classes available to all women, prelabor visits to the maternity ward, continuous information about the progress of labor, flexibility in time of discharge, and postpartum support for families. Women also stated that characteristics of the midwife, such as being supportive, friendly, attentive, respectful, and nonjudgemental, were important. A patient-centered and individualized approach, with women and their partners as the subjects rather than the objects of care, would increase satisfaction and the overall quality of maternity services in Sweden.

  9. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.

    Science.gov (United States)

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region.

  10. 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.

  11. Can she make it? Transportation barriers to accessing maternal and child health care services in rural Ghana.

    Science.gov (United States)

    Atuoye, Kilian Nasung; Dixon, Jenna; Rishworth, Andrea; Galaa, Sylvester Zackaria; Boamah, Sheila A; Luginaah, Isaac

    2015-08-20

    The Ghana Community based Health Planning and Services (CHPS) strategy targets to bring health services to the doorsteps of clients in a manner that improves maternal and child health outcomes. In this strategy, referral is an important component but it is threatened in a rural context where transportation service is a problem. Few studies have examined perceptions of rural dwellers on transportation challenges in accessing maternal health care services within CHPS. Using the political ecology of health framework, this paper investigates transportation barriers in health access in a rural context based on perceived cause, coping mechanisms and strategies for a sustainable transportation system. Eight (8) focus group discussions involving males (n = 40) and females (n = 45) in rural communities in a CHPS zone in the Upper West Region of Ghana were conducted between September and December 2013. Lack of vehicular transport is suppressing the potential positive impact of CHPS on maternal and child health. Consistent neglect of road infrastructural development and endemic poverty in the study area makes provision of alternative transport services for health care difficult. As a result, pregnant women use risky methods such as bicycle/tricycle/motorbikes to access obstetric health care services, and some turn to traditional medicines and traditional birth attendants for maternal health care services. These findings underscore the need for policy to address rural transport problems in order to improve maternal health. Community based transport strategy with CHPS is proposed to improve adherence to referral and access to emergency obstetric services.

  12. Comparison of maternal health services and indicators in three districts of the Volta Region, Ghana.

    Science.gov (United States)

    Nam, Eun Woo; Zakariah, Afisah; Adams, Festus; Jun, Young Suk; Adanu, Richard

    2016-09-01

    Ghana's maternal mortality ratio continues to decline, but is not expected to meet the Millennium Development Goal (MDG) 5 target. The Ghana Health Service and Ministry of Health have displayed a high commitment to the improvement of maternal health in the country. One of the most recent partnerships directed at this is with the Korea International Cooperation Agency. This study was conducted among women between ages 15 and 49 resident in Keta Municipal, Ketu North and Ketu South districts in the Volta Region of Ghana who were pregnant or who had children aged less than five. Ethical approval was obtained from the Ghana Health Service Ethical Review Committee. Data were collected using questionnaires, entered into Stata version 12 and analyzed using frequency distribution and assessment of means. Comparisons among districts were conducted using chi square test and one way analysis of variance (ANOVA). The study covered 630 women whose mean age was 28.4 years. Almost all participants (99.1%) from Ketu North knew where to obtain family planning services. Use of modern contraception was highest in Ketu North with 31% of respondents using a modern method. Delivery in a health facility was highest in Keta Municipal (62.3%) with overall institutional delivery being 57.6%. Delivery by a skilled birth attendant (SBA) was also highest in Keta Municipal. Indicators used to assess maternal health services show a coverage of over 50% but we need to improve institutional delivery, use of modern contraception and education about danger signs in pregnancy. This work was supported by the National Research Foundation of Korea Grant funded by the Korean Government (NRF-2013S1A5B8A01055336) and the Korea International Cooperation Agency(2013).

  13. Using a quality improvement model to enhance providers' performance in maternal and newborn health care: a post-only intervention and comparison design.

    Science.gov (United States)

    Ayalew, Firew; Eyassu, Gizachew; Seyoum, Negash; van Roosmalen, Jos; Bazant, Eva; Kim, Young Mi; Tekleberhan, Alemnesh; Gibson, Hannah; Daniel, Ephrem; Stekelenburg, Jelle

    2017-04-12

    The Standards Based Management and Recognition (SBM-R(©)) approach to quality improvement has been implemented in Ethiopia to strengthen routine maternal and newborn health (MNH) services. This evaluation assessed the effect of the intervention on MNH providers' performance of routine antenatal care (ANC), uncomplicated labor and delivery and immediate postnatal care (PNC) services. A post-only evaluation design was conducted at three hospitals and eight health centers implementing SBM-R and the same number of comparison health facilities. Structured checklists were used to observe MNH providers' performance on ANC (236 provider-client interactions), uncomplicated labor and delivery (226 provider-client interactions), and immediate PNC services in the six hours after delivery (232 provider-client interactions); observations were divided equally between intervention and comparison groups. Main outcomes were provider performance scores, calculated as the percentage of essential tasks in each service area completed by providers. Multilevel analysis was used to calculate adjusted mean percentage performance scores and standard errors to compare intervention and comparison groups. There was no statistically significant difference between intervention and comparison facilities in overall mean performance scores for ANC services (63.4% at intervention facilities versus 61.0% at comparison facilities, p = 0.650) or in any specific ANC skill area. MNH providers' overall mean performance score for uncomplicated labor and delivery care was 11.9 percentage points higher in the intervention than in the comparison group (77.5% versus 65.6%; p = 0.002). Overall mean performance scores for immediate PNC were 22.2 percentage points higher at intervention than at comparison facilities (72.8% versus 50.6%; p = 0.001); and there was a significant difference of 22 percentage points between intervention and comparison facilities for each PNC skill area: care for the newborn

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

    Science.gov (United States)

    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.

  15. Intimate partner violence and utilization of maternal health care services in Addis Ababa, Ethiopia.

    Science.gov (United States)

    Mohammed, Bedru Hussen; Johnston, Janice Mary; Harwell, Joseph I; Yi, Huso; Tsang, Katrina Wai-Kay; Haidar, Jemal Ali

    2017-03-07

    Despite its prominence, intimate partner violence (IPV) against women has received little attention in Ethiopia. And as many of sub-Saharan African countries, maternal health care services utilization remains poor. Full access and utilization of maternal health care services is a key to significant reduction in maternal and child mortality, and eliminate new HIV infection in infants. Identifying the factors that contribute to the poor access and utilization should aid the design of appropriate policy and intervention strategies. Thus the objective of this study was to examine the association between IPV and use of maternal health care services in Addis Ababa, Ethiopia. A cross sectional study on couples (N = 210; male/female pairs) with an infant less than 6 months of age was conducted. The dependent variable was use of maternal health care services and the main independent variable was IPV. Data was collected using face-to-face self-reported questionnaires and analyzed using SPSS version 20.0. Bivariate and multivariate logistic regression models were used to examine the relationship between the dependent and independent variables. The mean age of the women was 28.7 years (SD = 5.4), on average women were 7.4 years (SD = 7.4) younger than their partners. Although most of the women (95.2%) had at least one antenatal care (ANC), only 35 (2%) had ≥4 ANC visits and about half (49.0%) had their first ANC visit within the first trimester. Women who experienced emotional IPV in their relationship were less likely to have their 1(st) ANC within three months of pregnancy (AOR = 0.69; 95%CI = 0.49-0.96). Women who reported physical IPV in their relationship were less likely to use ≥4 ANC (AOR = 0.48; 95%CI = 0.21-0.71), be tested for HIV (AOR = 0.26; 95%CI = 0.09-0.79), have skilled delivery attendant (AOR = 0.31; 95%CI = 0.12-0.98), and deliver in a health facility (AOR = 0.35; 95%CI = 0.14-0.88). Likewise, women

  16. Exploring Social Service Providers' Perspectives on Barriers to Social Services for Early Adjustment of Immigrant Adolescents in South Korea.

    Science.gov (United States)

    Yi, Jaehee; Kim, Min Ah; Kim, Kihyun; Hong, Jun Sung

    2016-10-01

    Recently arrived immigrant adolescents experience difficulties in adjusting to school in South Korea. However, the existing social services do not meet their psychosocial needs. This study investigates the perspectives of social service providers about challenges in providing services for immigrant adolescents early in their adjustments. We conducted qualitative, in-depth interviews with 27 South Korean social service providers. We identified barriers to social services, categorized into three themes: (1) Initial Contact Phase; (2) Service Delivery Phase; and (3) Structural Challenges. We suggest interventions concerning work-related stress for the social service providers, family-level involvement, diversity training, and integrated and collaborative immigration services. An examination of social service providers' challenges in working with immigrant adolescents is a necessary first step toward the development of programs and policies.

  17. Community Mobilization and Awareness Creation for Orofacial Cleft Services: A Survey of Nigerian Cleft Service Providers.

    Science.gov (United States)

    Adebola, Raphael A; Bamgbose, Babatunde O; Adeoye, Joshua B

    2014-01-01

    Background. The opportunity to provide free surgical care for orofacial clefts has opened a new vista and is enhanced by well-informed communities who are aware of the free surgical services available to them. It is the responsibility of cleft care providers to adequately inform these communities via a combination of community mobilization and awareness creation. Methods. This was a nationwide, cross-sectional descriptive study of all orofacial cleft service providers in Nigeria using a structured, self-administered questionnaire. Results. A total of 4648 clefts have been repaired, 50.8% by the ten government-owned and 49.2% by the five nongovernment-owned organizations included in the study. The nongovernment-owned institutions seemed to be more aggressive about community mobilization and awareness creation than government-owned ones, and this was reflected in their patient turnout. Most of the organizations studied would prefer a separate, independent body to handle their awareness campaign. Conclusion. Community mobilization requires skill and dedication and may require formal training or dedicated budgets by government-owned and nongovernment-owned institutions alike. Organizations involved in cleft care provision must take community mobilization and awareness seriously if the largely unmet needs of orofacial cleft patients in Nigeria are to be tackled.

  18. How do Australian maternity and early childhood health services identify and respond to the settlement experience and social context of refugee background families?

    Science.gov (United States)

    Yelland, Jane; Riggs, Elisha; Wahidi, Sayed; Fouladi, Fatema; Casey, Sue; Szwarc, Josef; Duell-Piening, Philippa; Chesters, Donna; Brown, Stephanie

    2014-10-06

    Refugees have poor mental, social and physical health related to experiences of trauma and stresses associated with settlement, however little is known about how refugee families experience maternity and early childhood services. The aim of this study was to explore the responsiveness of health services to the social and mental health of Afghan women and men at the time of having a baby. Participatory methods including community engagement and consultation with the Afghan community and service providers in Melbourne, Australia. Bicultural researchers conducted interviews with Afghan women and men who had recently had a baby. Interviews and focus groups were also conducted with health professionals working in the region. Thirty interviews were conducted with Afghan women and men who had recently had a baby. Thirty-four health professionals participated in an interview or focus group.Afghan women and men reported significant social hardship during the period before and after having a baby in Australia, but were rarely asked about their social health by maternity and early childhood services.Most health professionals recognised that knowledge and understanding of their client's migration history and social circumstances was relevant to the provision of high quality care. However, inquiring about refugee background, and responding to non-clinical needs of refugee families was challenging for many health professionals. Factors that made it more difficult for health professionals to engage with Afghan families in pregnancy included limited understanding of the context of migration, dependency of many Afghan women on their husband for interpreting, short appointments, and the high likelihood of seeing different health professionals at each antenatal visit. Community-based maternal and child health nurses had more scope to work with interpreters, and build relationships with families, providing a stronger foundation for identifying and responding to complex social

  19. Assessment of oral health promotion services offered as part of maternal and child health services in the Tshwane Health District, Pretoria, South Africa

    Directory of Open Access Journals (Sweden)

    Yolanda Kolisa

    2016-03-01

    Full Text Available Objectives: The study aimed to assess the oral health promotion services provided as part of the maternal and child health (MCH services in the Tshwane Health District, Pretoria, South Africa.Methods: The research design was a descriptive cross-sectional study using a modified standard questionnaire. The population was drawn from the parents/caregivers (PCGs and the MCH nurses at seven clinics during June 2012 and June 2013 in Pretoria.Results: The nurses’ response rate was 83%; average age of 37 years. The majority of the nurses (65% were females; 60% were professional nurses. Most (63% of the nurses reported that they provided oral health education (OHE services. A shortage of dental education materials (43%, staff time (48%, and staff training (52% were large constraints to nurses providing OHE. The majority of PCGs (n = 382; mean age 31.5 years had a low education level (76%. About 55% of PCGs received information on children’s oral health from the television and 35% at the MCH clinics. PCGs beliefs were worrying as about 38% believed primary dentition is not important and need not be saved.Conclusion: There is evidence of minimal integration of OHE at MCH sites. Parents’ beliefs are still worrying as a significant number do not regard the primary dentition as important. The MCH site remains an important easily accessible area for integration of oral health services with general health in complementing efforts in prevention of early childhood caries.Keywords: Oral health; Promotion integration

  20. Birthing on Country (in Our Community): a case study of engaging stakeholders and developing a best-practice Indigenous maternity service in an urban setting.

    Science.gov (United States)

    Kildea, Sue; Hickey, Sophie; Nelson, Carmel; Currie, Jody; Carson, Adrian; Reynolds, Maree; Wilson, Kay; Kruske, Sue; Passey, Megan; Roe, Yvette; West, Roianne; Clifford, Anton; Kosiak, Machellee; Watego, Shannon; Tracy, Sally

    2017-04-07

    case example of the experience of setting up one such best-practice, community-engaged and informed partnership model of maternity and child healthcare in south-east Queensland. We share our experience using a World Café to facilitate community engagement, service delivery and workforce planning.What are the implications for practitioners? Health professionals providing maternity care for Aboriginal and Torres Strait Islander families are encouraged to incorporate Birthing on Country principles into their model of care to address the specific needs and demands of the local Indigenous community and improve maternal and infant health outcomes.

  1. Cost of maternal health services in selected primary care centres in Ghana: a step down allocation approach.

    Science.gov (United States)

    Dalaba, Maxwell Ayindenaba; Akweongo, Patricia; Savadogo, Germain; Saronga, Happiness; Williams, John; Sauerborn, Rainer; Dong, Hengjin; Loukanova, Svetla

    2013-07-26

    There is a paucity of knowledge on the cost of health care services in Ghana. This poses a challenge in the economic evaluation of programmes and inhibits policy makers in making decisions about allocation of resources to improve health care. This study analysed the overall cost of providing health services in selected primary health centres and how much of the cost is attributed to the provision of antenatal and delivery services. The study has a cross-sectional design and quantitative data was collected between July and December 2010. Twelve government run primary health centres in the Kassena-Nankana and Builsa districts of Ghana were randomly selected for the study. All health-care related costs for the year 2010 were collected from a public service provider's perspective. The step-down allocation approach recommended by World Health Organization was used for the analysis. The average annual cost of operating a health centre was $136,014 US. The mean costs attributable to ANC and delivery services were $23,063 US and $11,543 US respectively. Personnel accounted for the largest proportion of cost (45%). Overall, ANC (17%) and delivery (8%) were responsible for less than a quarter of the total cost of operating the health centres. By disaggregating the costs, the average recurrent cost was estimated at $127,475 US, representing 93.7% of the total cost. Even though maternal health services are free, utilization of these services at the health centres were low, particularly for delivery (49%), leading to high unit costs. The mean unit costs were $18 US for an ANC visit and $63 US for spontaneous delivery. The high unit costs reflect underutilization of the existing capacities of health centres and indicate the need to encourage patients to use health centres .The study provides useful information that could be used for cost effectiveness analyses of maternal and neonatal care interventions, as well as for policy makers to make appropriate decisions regarding the

  2. The Marketing-Finance Interface Towards Financial Services: with Special Reference to New Services Provided by Futures Exchanges

    NARCIS (Netherlands)

    Pennings, J.M.E.; Wetzels, M.G.M.; Meulenberg, M.T.G.

    1999-01-01

    The financial services industry is one of the fastest growing service industries. The financial services industry includes financial derivatives markets such as options and futures markets. In order to ensure survival, firms providing financial services show a rapid product innovation. However, for

  3. 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.

    Science.gov (United States)

    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

  4. Association Between Maternal and Child Health Handbook and Quality of Antenatal Care Services in Palestine.

    Science.gov (United States)

    Kitabayashi, Harumi; Chiang, Chifa; Al-Shoaibi, Abubakr Ahmed Abdullah; Hirakawa, Yoshihisa; Aoyama, Atsuko

    2017-12-01

    Objectives The Maternal and Child Health (MCH) handbook is an integrated home-based record allowing clients to keep records on the continuum of care for mothers and children. This study aimed to assess associations between MCH handbook ownership and receipt of selected content of antenatal care services in Palestine. Methods Distribution of the MCH handbook in Palestine was launched in 2008. We used an anonymous data set of the Palestinian Family Survey 2010 and analyzed the data of 2026 women who had live births within the past 12 months. Descriptive statistical analysis was conducted to assess differences between MCH handbook holders and non-holders. Multivariable logistic regression models were used to estimate adjusted odds ratios of the effects of MCH handbook use according to proxy indicators of antenatal care quality. Results Accounting for about 60% (n = 1202) of study participants, handbook holders were more likely to be primipara, live in the Gaza Strip, live in refugee camps, and live within a 30-min distance to antenatal care facilities; however, household wealth levels for handbook holders were lower compared with non-holders. Handbook users had significantly higher odds of receiving all three kinds of medical tests and receiving information on five or more health education topics as part of antenatal care. The higher odds remained after adjusting for possible confounding variables, such as household wealth, region, residential area, birth order of the child, frequency of antenatal care, and time required to reach antenatal care facilities. Conclusions for Practice Use of the handbook as a portable checklist possibly promoted providers' higher adherence to the national guideline.

  5. 42 CFR 51.46 - Disclosing information obtained from a provider of mental health services.

    Science.gov (United States)

    2010-10-01

    ... mental health services. 51.46 Section 51.46 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND... a provider of mental health services. (a) Except as provided in paragraph (b) of this section, if a... of mental health services, it may not disclose information from such records to the individual who is...

  6. 41 CFR 302-12.102 - What contracted relocation services may we provide at Government expense?

    Science.gov (United States)

    2010-07-01

    ... relocation services may we provide at Government expense? 302-12.102 Section 302-12.102 Public Contracts and... 12-USE OF A RELOCATION SERVICES COMPANY Agency's Use of a Relocation Services Company § 302-12.102 What contracted relocation services may we provide at Government expense? You may pay for contracted...

  7. 34 CFR 646.4 - What activities and services may a project provide?

    Science.gov (United States)

    2010-07-01

    ...) OFFICE OF POSTSECONDARY EDUCATION, DEPARTMENT OF EDUCATION STUDENT SUPPORT SERVICES PROGRAM General § 646.4 What activities and services may a project provide? A Student Support Services project may provide services such as: (a) Instruction in reading, writing, study skills, mathematics, and other subjects...

  8. 47 CFR 54.613 - Limitations on supported services for rural health care providers.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Limitations on supported services for rural health care providers. 54.613 Section 54.613 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON CARRIER SERVICES (CONTINUED) UNIVERSAL SERVICE Universal Service Support for Health Care Providers § 54.613 Limitations on supported...

  9. Ethics in Providing Tourism Services by Travel Agents in Serbia

    Directory of Open Access Journals (Sweden)

    Ivana Mišković

    2012-07-01

    Full Text Available This paper attempts to answer the usually neglected ethical questions of the interaction between tourism workers and participants in tourism movements and users of tourism services in general. Contact with numerous people in the work place, dynamic work with customers, continuous phone calls and stress due to constant responsibility, are just some of the conditions which tourism workers encounter on the daily basis and which sometimes make them ask themselves: Am I really able to do this job? Will their behaviour with each customer be ethical? Will they be able to hide from the customers their stress, nervousness and mental fatigue? Have all the employees in travel agencies attended the training courses in communication with customers, or does everything depend on their own decisions and home upbringing? Is it worth taking risk and putting agency`s reputation at stake? Which moral dilemmas do the tour guides encounter on the journeys? These are just some of the questions which will be put in the spotlight in this paper. The aim of this paper is to indicate the necessity to establish the codes of conduct for all professionals who are in direct contact with tourists

  10. User-experience surveys with maternity services: a randomized comparison of two data collection models.

    Science.gov (United States)

    Bjertnaes, Oyvind Andresen; Iversen, Hilde Hestad

    2012-08-01

    To compare two ways of combining postal and electronic data collection for a maternity services user-experience survey. Cross-sectional survey. Maternity services in Norway. All women who gave birth at a university hospital in Norway between 1 June and 27 July 2010. Patients were randomized into the following groups (n= 752): Group A, who were posted questionnaires with both electronic and paper response options for both the initial and reminder postal requests; and Group B, who were posted questionnaires with an electronic response option for the initial request, and both electronic and paper response options for the reminder postal request. Response rate, the amount of difference in background variables between respondents and non-respondents, main study results and estimated cost-effectiveness. The final response rate was significantly higher in Group A (51.9%) than Group B (41.1%). None of the background variables differed significantly between the respondents and non-respondents in Group A, while two variables differed significantly between the respondents and non-respondents in Group B. None of the 11 user-experience scales differed significantly between Groups A and B. The estimated costs per response for the forthcoming national survey was €11.7 for data collection Model A and €9.0 for Model B. The model with electronic-only response option in the first request had lowest response rate. However, this model performed equal to the other model on non-response bias and better on estimated cost-effectiveness, and is the better of the two models in large-scale user experiences surveys with maternity services.

  11. Middle Eastern mothers in Sweden, their experiences of the maternal health service and their partner's involvement

    Directory of Open Access Journals (Sweden)

    D Karlsson Elisabeth

    2007-10-01

    Full Text Available Abstract Background Traditional patterns relating to how to handle pregnancy and birth are often challenged due to migration. The purpose of this study was to describe Middle Eastern mothers' experiences of the maternal health care services in Sweden and the involvement of their male partner. Methods Thirteen immigrant mothers from the Middle East who had used the maternal health services in Sweden were interviewed using focus group discussions and individual interviews. These were taped, transcribed and analysed according to Content analysis. Results The four main categories that developed were: • Access to the professional midwife • Useful counselling • Stable motherhood in transition • Being a family living in a different culture Conclusion According to the respondents in this study, understanding the woman's native language or her culture was not vital to develop a good relationship with the midwife. Instead the immigrant woman developed trust in the midwife based on the knowledge and the empathy the midwife imparted. Increasing the amount of first trimester antenatal visits could avoid spontaneous visits to the emergency clinic. There was a greater need for involvement and support by the father during the perinatal period, such as caring for older children and carrying out household chores since the mothers' earlier female network was often lost. Clinical implications There is a need to involve immigrant parents in the available parental education in order to prepare them for parenthood in their new country as well as to explore their altered family situation. Collecting immigrant women and their partner's, experiences of maternal health care services offers a possibility to improve the existing care, both in content, access and availability where the timing of visits and content require further evaluation.

  12. Assessment of Information Sources and Services Provided for the ...

    African Journals Online (AJOL)

    From the parent population of micro and small business enterprises, seven municipal areas of the geopolitical zone were randomly sampled. Research instrument used for collecting data was the questionnaire which was constructed along the theoretical frame of the study. Hypotheses were formulated to provide basis for ...

  13. Preparedness of Lithuanian general practitioners to provide mental healthcare services

    DEFF Research Database (Denmark)

    Jaruseviciene, Lina; Sauliune, Skirmante; Jarusevicius, Gediminas

    2014-01-01

    BACKGROUND: A large unmet need for mental healthcare in Lithuania is partially attributable to a lack of primary care providers with skills in this area. The aim of this study was to assess general practitioners' (GPs) experience in mental healthcare and their perceptions about how to increase th...

  14. 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.

  15. Providing services to trafficking survivors: Understanding practices across the globe.

    Science.gov (United States)

    Steiner, Jordan J; Kynn, Jamie; Stylianou, Amanda M; Postmus, Judy L

    2018-01-01

    Human trafficking is a global issue, with survivors representing all genders, ages, races, ethnicities, religions, and countries. However, little research exists that identifies effective practices in supporting survivors of human trafficking. The research that does exist is Western-centric. To fill this gap in the literature, the goal of this research was to understand practices used throughout the globe with adult human trafficking survivors. A qualitative approach was utilized. Providers from 26 countries, across six different continents, were interviewed to allow for a comprehensive and multi-faceted understanding of practices in working with survivors. Participants identified utilizing an empowerment-based, survivor, and human life-centered approach to working with survivors, emphasized the importance of engaging in community level interventions, and highlighted the importance of government recognition of human trafficking. Findings provide information from the perspective of advocates on best practices in the field that can be used by agencies to enhance human trafficking programming.

  16. Emergency medical service providers' experiences with traffic congestion.

    Science.gov (United States)

    Griffin, Russell; McGwin, Gerald

    2013-02-01

    The population's migration from urban to suburban areas has resulted in a more dispersed population and has increased traffic flow, possibly resulting in longer emergency response times. Although studies have examined the effect of response times on time to definitive care and survival, no study has addressed the possible causes of slowed response time from the point of view of emergency medical services (EMS) first responders. To assess the variables most commonly associated with increased emergency response time as described by the opinions and views of EMS first responders. A total of 500 surveys were sent to randomly selected individuals registered as first responders with the Alabama Department of Public Health, and 112 surveys were returned completed. The survey included questions regarding roadway design, response to emergency calls, in-vehicle technology aimed at decreasing travel time, and public education regarding emergency response. Respondents reported traveling on city streets most often during emergency calls, and encountering traffic more often on interstates and national highways. Traffic congestion, on average, resulted in nearly 10min extra response time. Most agreed that the most effective in-vehicle technology for reducing response time was a pre-emptive green light device; however, very few reported availability of this device in their emergency vehicles. Public education regarding how to react to approaching emergency vehicles was stated as having the greatest potential impact on reducing emergency response time. The results of the survey suggest that the best methods for reducing emergency response times are those that are easy to implement (e.g., public education). Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Internet access and investment incentives for broadband service providers

    OpenAIRE

    Baranes, Edmond; Poudou, Jean-Christophe

    2011-01-01

    This paper studies a model of the Internet broadband market as a platform in order to show how di¤erent pricing schemes from the so-called "net neutrality " can increase economic e¢ ciency by allowing more investment of access providers and enhancing consumers surplus and social welfare. We show that departing from the "net neutrality", where at rates are used, introducing termination fees can increase incentives to invest for the ISP and enhance social surplus. Keywords : Network neutrality,...

  18. Performance Measurement for a Logistics Services Provider to the Polymer Industry

    OpenAIRE

    Tok, King Lai

    2007-01-01

    This management project discusses the form of performance measurement system suitable for a logistics services provider who focuses on providing its services to large multinational petrochemical companies in the polymer industry

  19. Trends and inequities in use of maternal health care services in Bangladesh, 1991-2011.

    Directory of Open Access Journals (Sweden)

    Iqbal Anwar

    Full Text Available Monitoring use-inequity is important to measure progress in efforts to address health-inequities. Using data from six Bangladesh Demographic and Health Surveys (BDHS, we examine trends, inequities and socio-demographic determinants of use of maternal health care services in Bangladesh between 1991 and 2011.Access to maternal health care services has improved in the last two decades. The adjusted yearly trend was 9.0% (8.6%-9.5% for any antenatal care (ANC, 11.9% (11.1%-12.7% for institutional delivery, and 18.9% (17.3%-20.5% for C-section delivery which is above the WHO recommended rate of 5-15%. Use-inequity was significant for all three indicators but is reducing over time. Between 1991-1994 and 2007-2011 the rich:poor ratio reduced from 3.65 to 1.65 for ANC and from 15.80 to 6.77 for institutional delivery. Between 1995-1998 and 2007-2011, the concentration index reduced from 0.27 (0.25-0.29 to 0.15 (0.14-0.16 for ANC, and from 0.65 (0.60-0.71 to 0.39 (0.37-0.41 for institutional delivery during that period. For use of c-section, the rich:poor ratio reduced from 18.17 to 13.39 and the concentration index from 0.66 (0.57-0.75 to 0.47 (0.45-0.49. In terms of rich:poor differences, there was equity-gain for ANC but not for facility delivery or C-section delivery. All socio-demographic variables were significant predictors of use; of them, maternal education was the most powerful. In addition, the contribution of for-profit private sector is increasingly growing in maternal health.Both access and equity are improving in maternal health. We recommend strengthening ongoing health and non-health interventions for the poor. Use-inequity should be monitored using multiple indicators which are incorporated into routine health information systems. Rising C-section rate is alarming and indication of C-sections should be monitored both in private and public sector facilities.

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

    Directory of Open Access Journals (Sweden)

    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

  1. 75 FR 22338 - Reexamination of Roaming Obligations of Commercial Mobile Radio Service Providers

    Science.gov (United States)

    2010-04-28

    ... have on the terms of retail service provided to consumers, how such impacts differ from those resulting... COMMISSION 47 CFR Part 20 Reexamination of Roaming Obligations of Commercial Mobile Radio Service Providers... to data services that are provided without interconnection to the public switched network--including...

  2. Attitudes of Social Service Providers towards the Sexuality of Individuals with Intellectual Disability

    Science.gov (United States)

    Bazzo, Giuseppe; Nota, Laura; Soresi, Salvatore; Ferrari, Lea; Minnes, Patricia

    2007-01-01

    Background: The sexual lives of people with intellectual disability is made complex by the involvement and influence of social service providers, whose beliefs and values have a great impact on the support they provide. We hypothesized that social service providers' role, educational level and service in which they worked could affect attitudes…

  3. Hoe tevreden zijn e-commerce bedrijven met hun dienstverleners? : service providers onder de loep

    NARCIS (Netherlands)

    Weltevreden, Jesse; Abraham, Jorij

    2013-01-01

    In Nederland gevestigde e-commerce bedrijven zijn meer tevreden over hun logistics service provider en affiliatenetwerk, dan over hun payment service provider. Daarnaast zijn ze aanzienlijk meer loyaal aan hun logistics service provider dan aan beide andere e-commerce dienstverleners. Dit blijkt uit

  4. Preliminary Construction of a Service Provider-Informed Domestic Violence Research Agenda

    Science.gov (United States)

    Murray, Christine E.; Welch, Metoka L.

    2010-01-01

    This article presents the results of a statewide survey of domestic violence (DV) service providers that focused on the needs, background characteristics, and opinions of service providers related to research. The survey included an examination of service providers' motivation for working in the field, research background and training, and…

  5. The Canadian birth place study: examining maternity care provider attitudes and interprofessional conflict around planned home birth.

    Science.gov (United States)

    Vedam, Saraswathi; Stoll, Kathrin; Schummers, Laura; Fairbrother, Nichole; Klein, Michael C; Thordarson, Dana; Kornelsen, Jude; Dharamsi, Shafik; Rogers, Judy; Liston, Robert; Kaczorowski, Janusz

    2014-10-28

    Available birth settings have diversified in Canada since the integration of regulated midwifery. Midwives are required to offer eligible women choice of birth place; and 25-30% of midwifery clients plan home births. Canadian provincial health ministries have instituted reimbursement schema and regulatory guidelines to ensure access to midwives in all settings. Evidence from well-designed Canadian cohort studies demonstrate the safety and efficacy of midwife-attended home birth. However, national rates of planned home birth remain low, and many maternity providers do not support choice of birth place. In this national, mixed-methods study, our team administered a cross-sectional survey, and developed a 17 item Provider Attitudes to Planned Home Birth Scale (PAPHB-m) to assess attitudes towards home birth among maternity providers. We entered care provider type into a linear regression model, with the PAPHB-m score as the outcome variable. Using Students' t tests and ANOVA for categorical variables and correlational analysis (Pearson's r) for continuous variables, we conducted provider-specific bivariate analyses of all socio-demographic, education, and practice variables (n=90) that were in both the midwife and physician surveys. Median favourability scores on the PAPHB-m scale were very low among obstetricians (33.0), moderately low for family physicians (38.0) and very high for midwives (80.0), and 84% of the variance in attitudes could be accounted for by care provider type. Amount of exposure to planned home birth during midwifery or medical education and practice was significantly associated with favourability scores. Concerns about perinatal loss and lawsuits, discomfort with inter-professional consultations, and preference for the familiarity of the hospital correlated with less favourable attitudes to home birth. Among all providers, favourability scores were linked to beliefs about the evidence on safety of home birth, and confidence in their own ability

  6. Improving Aboriginal maternal and infant health services in the 'Top End' of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change.

    Science.gov (United States)

    Barclay, Lesley; Kruske, Sue; Bar-Zeev, Sarah; Steenkamp, Malinda; Josif, Cathryn; Narjic, Concepta Wulili; Wardaguga, Molly; Belton, Suzanne; Gao, Yu; Dunbar, Terry; Kildea, Sue

    2014-06-02

    Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity services for remote-dwelling Aboriginal women and their infants in the Top End (TE) of Australia. A mixed-methods health services research program of work was designed, using a participatory approach. The study area consisted of two large remote Aboriginal communities in the Top End of Australia and the hospital in the regional centre (RC) that provided birth and tertiary care for these communities. The stakeholders included consumers, midwives, doctors, nurses, Aboriginal Health Workers (AHW), managers, policy makers and support staff. Data were sourced from: hospital and health centre records; perinatal data sets and costing data sets; observations of maternal and infant health service delivery and parenting styles; formal and informal interviews with providers and women and focus groups. Studies examined: indicator sets that identify best care, the impact of quality of care and remoteness on health outcomes, discrepancies in the birth counts in a range of different data sets and ethnographic studies of 'out of hospital' or health centre birth and parenting. A new model of maternity care was introduced by the health service aiming to improve care following the findings of our research. Some of these improvements introduced during the five-year research program of research were evaluated. Cost effective improvements were made to the acceptability, quality and outcomes of maternity care. However, our synthesis identified system-wide problems that still account for poor quality of infant services, specifically, unacceptable standards of infant care and parent support, no apparent relationship between volume and acuity of presentations and staff numbers with the

  7. Providing Assistive Technology Applications as a Service Through Cloud Computing.

    Science.gov (United States)

    Mulfari, Davide; Celesti, Antonio; Villari, Massimo; Puliafito, Antonio

    2015-01-01

    Users with disabilities interact with Personal Computers (PCs) using Assistive Technology (AT) software solutions. Such applications run on a PC that a person with a disability commonly uses. However the configuration of AT applications is not trivial at all, especially whenever the user needs to work on a PC that does not allow him/her to rely on his / her AT tools (e.g., at work, at university, in an Internet point). In this paper, we discuss how cloud computing provides a valid technological solution to enhance such a scenario.With the emergence of cloud computing, many applications are executed on top of virtual machines (VMs). Virtualization allows us to achieve a software implementation of a real computer able to execute a standard operating system and any kind of application. In this paper we propose to build personalized VMs running AT programs and settings. By using the remote desktop technology, our solution enables users to control their customized virtual desktop environment by means of an HTML5-based web interface running on any computer equipped with a browser, whenever they are.

  8. A decade of progress providing safe abortion services in Ethiopia: results of national assessments in 2008 and 2014.

    Science.gov (United States)

    Dibaba, Yohannes; Dijkerman, Sally; Fetters, Tamara; Moore, Ann; Gebreselassie, Hailemichael; Gebrehiwot, Yirgu; Benson, Janie

    2017-03-04

    Ethiopia has one of the highest maternal mortality ratios in the world (420 per 100,000 live births in 2013), and unsafe abortion continues to be one of the major causes. To reduce deaths and disabilities from unsafe abortion, Ethiopia liberalized its abortion law in 2005 to allow safe abortion under certain conditions. This study aimed to measure how availability and utilization of safe abortion services has changed in the last decade in Ethiopia. This paper draws on results from nationally representative health facility studies conducted in Ethiopia in 2008 and 2014. The data come from three sources at two points in time: 1) interviews with 335 health providers in 2008 and 822 health care providers in 2014, 2) review of facility logbooks, and 3) prospective data on 3092 women in 2008 and 5604 women in 2014 seeking treatment for abortion complications or induced abortion over a one month period. The Safe Abortion Care Model was used as a framework of analysis. There has been a rapid expansion of health facilities eligible to provide legal abortion services in Ethiopia since 2008. Between 2008 and 2014, the number of facilities reporting basic and comprehensive signal functions for abortion care increased. In 2014, access to basic abortion care services exceeded the recommended level of available facilities providing the service, increasing from 25 to 117%, with more than half of regions meeting the recommended level. Comprehensive abortion services increased from 20% of the recommended level in 2008 to 38% in 2014. Smaller regions and city administrations achieved or exceeded the recommended level of comprehensive service facilities, yet larger regions fall short. Between 2008 and 2014, the use of appropriate technology for conducting first and second trimester abortion and the provision of post abortion family planning has increased at the same time that abortion-related obstetric complications have decreased. Ten years after the change in abortion law, service

  9. Counseling about gestational weight gain and healthy lifestyle during pregnancy: Canadian maternity care providers' self-evaluation

    Directory of Open Access Journals (Sweden)

    Ferraro ZM

    2013-09-01

    Full Text Available Zachary M Ferraro,1 Kaitlin S Boehm,1 Laura M Gaudet,2,3 Kristi B Adamo1,4,5 1Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; 2Horizon Health Network, Saint John, New Brunswick, Canada; 3Department of Obstetrics and Gynaecology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; 4School of Human Kinetics, Faculty of Health Sciences, 5Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Introduction: There is discord between the recall of maternity care providers and patients when it comes to discussion of gestational weight gain (GWG and obesity management. Few women report being advised on GWG, physical activity (PA, and nutrition, yet the majority of health care providers report discussing these topics with patients. We evaluated whether various Canadian maternal health care providers can identify appropriate GWG targets for patients with obesity and determine if providers report counseling on GWG, physical activity, and nutrition. Methods: A valid and reliable e-survey was created using SurveyMonkey software and distributed by the Society of Obstetricians and Gynaecologists of Canada listserve. A total of 174 health care providers finished the survey. Respondents self-identified as general practitioners, obstetricians, maternal-fetal medicine specialists, midwives, or registered nurses. Results: GWG recommendations between disciplines for all body mass index categories were similar and fell within Health Canada/Institute of Medicine (IOM guidelines. Of those who answered this question, 110/160 (68.8% were able to correctly identify the maximum IOM GWG recommended for patients with obesity, yet midwives tended to recommend 0.5–1 kg more GWG (P = 0.05. PA counseling during pregnancy differed between disciplines (P < 0.01, as did nutrition counseling during pregnancy (P < 0.05. Conclusion: In

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

    Directory of Open Access Journals (Sweden)

    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

  11. Gender inequality and the use of maternal healthcare services in rural sub-Saharan Africa.

    Science.gov (United States)

    Adjiwanou, Vissého; LeGrand, Thomas

    2014-09-01

    In this study, we measure gender inequality both at individual level by women׳s household decision-making and at contextual level by permissive gender norms associated with tolerance of violence against women and assess their impact on maternal healthcare services utilisation in rural Africa. We apply multilevel structural equation modelling to Demographic and Health Survey (DHS) data from Ghana, Kenya, Tanzania and Uganda to gain better measure and effect of the gender norms construct. The results show that women in Ghana and Uganda, who live in areas where gender norms are relatively tolerant of violence against women, are less likely to use skilled birth attendants and timely antenatal care. In Tanzania, women who live in this type of environment are less likely to attend four or more antenatal visits. In contrast, the effects of a woman׳s decision-making authority on maternal health service use are less pronounced in the same countries. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Utilization of maternal health services in urban and rural communities of Anambra State, Nigeria.

    Science.gov (United States)

    Adogu, P O U; Egenti, B N; Ubajaka, C; Onwasigwe, C; Nnebue, C C

    2014-01-01

    This study determined and compared the level and pattern of utilization of maternal services in urban and rural communities in Anambra State. A comparative cross-sectional study was carried out in two local government areas (LGA); Nnewi North (urban) and Dunukofia (rural). A total of 338 mothers of children aged 0-59 months in each of the two LGAs selected by multistage cluster sampling technique were studied. Data were collected using an interviewer administered questionnaire, analyzed and tests of significance performed with the p-value set at 0.05. Women in the rural area had higher fertility rate (t = 4.53, p post natal care utilization in both localities (chi2 = 0.695, p = 0.405), as most of the women in both localities went for post natal consultation within 6 weeks of delivery. Measures to improve maternal health service utilization especially in rural areas should not only address the issue of access to care, but also improvement in quality of care and women empowerment.

  13. Maternal and neonatal service usage and determinants in fragile and conflict-affected situations: a systematic review of Asia and the Middle-East.

    Science.gov (United States)

    Gopalan, Saji S; Das, Ashis; Howard, Natasha

    2017-03-15

    Fragile and conflict-affected situations (FCS) in Asia and the Middle-East contribute significantly to global maternal and neonatal deaths. This systematic review explored maternal and neonatal health (MNH) services usage and determinants in FCS in Asia and the Middle-East to inform policy on health service provision in these challenging settings. This systematic review was conducted using a standardised protocol. Pubmed, Embase, Web of Science, and selected development agency websites were searched for studies meeting inclusion criteria. Studies were assessed for methodological quality using an adapted evaluation tool. Qualitative and quantitative data were synthesized and pooled odds ratios generated for meta-analysis of service-usage determinants. Of 18 eligible peer-reviewed studies, eight were from Nepal, four from Afghanistan, and two each from Iraq, Yemen, and the Palestinian Territories. Fragile situations provide limited evidence on emergency obstetric care, postnatal care, and newborn services. Usage of MNH services was low in all FCS, irrespective of economic growth level. Demand-side determinants of service-usage were transportation, female education, autonomy, health awareness, and ability-to-pay. Supply-side determinants included service availability and quality, existence of community health-workers, costs, and informal payments in health facilities. Evidence is particularly sparse on MNH in acute crises, and remains limited in fragile situations generally. Findings emphasize that poor MNH status in FCS is a leading contributor to the burden of maternal and neonatal ill-health in Asia and the Middle-East. Essential services for skilled birth attendance and emergency obstetric, newborn, and postnatal care require improvement in FCS. FCS require additional resources and policy attention to address the barriers to appropriate MNH care. Authors discuss the 'targeted policy approach for vulnerable groups' as a means of addressing MNH service usage

  14. Assessing the ecosystem services provided by urban green spaces along urban center-edge gradients.

    Science.gov (United States)

    Chang, Jie; Qu, Zelong; Xu, Ronghua; Pan, Kaixuan; Xu, Bin; Min, Yong; Ren, Yuan; Yang, Guofu; Ge, Ying

    2017-09-11

    Urban green spaces provide various ecosystem services, especially cultural services. Previous assessment methods depend either on hypothetic payments for ecosystems or real payments not directly related to ecosystems. In this paper, we established a method for assessing the cultural ecosystem services in any location in urban area using only two variables, green space (ecosystem) and land rent (real payment). We integrated the cultural and the regulating services into the total ecosystem services because urban green spaces provide almost no provisioning services. Results showed that the same area of green spaces near the center provided much higher cultural services than that near the urban edge; the regulating services accounted for 5% to 40% of the total ecosystem services from the center to the edge of urban area; along the center-edge gradient, there was a threshold out which the ecosystem services were lower than the maintenance cost of green spaces.

  15. SERVICE EVALUATION OF A CYSTIC FIBROSIS HOME INTRAVENOUS ANTIBIOTIC SERVICE PROVIDED BY A NHS FOUNDATION TRUST.

    Science.gov (United States)

    Elsey, Lynn

    2016-09-01

    To evaluate carers' satisfaction with the current service for home reconstitution and administration of intravenous (IV) antibiotics to cystic fibrosis (CF) patients and identify ways of improving this service to reduce treatment burden. A formative evaluation was conducted of all 17 carers who reconstituted and administered the IV antibiotics at home. This was carried out using a cross-sectional survey. A questionnaire of open and closed questions was sent first class with a pre-paid return envelope to the carers. This was followed by a reminder letter after the set return date. Thirteen carers responded giving a response rate of 76.5%. The carers had a mean of 2 children in the household with all having 1 child under the care of the paediatric CF team. They had been receiving IV antibiotics for a mean of 8 years and 7 months and had been administering them at home for a mean of 6 years and 1 month. The majority had administered the antibiotics in the last 3 months.Over half received their drugs from the hospital pharmacy, but one carer highlighted that they did not always receive a full supply of the treatment.Removing the reconstitution step by providing pre-prepared syringes could reduce treatment time by around 18 minutes. Overall this could mean a daily reduction in treatment time of almost two hours for a patient who is on two antibiotics three times a day. The majority of respondents stated that they would prefer pre-filled syringes.The carers felt that they received enough training and felt confident in reconstituting and administering the antibiotics. The majority felt that they should receive regular updates to their training and it was highlighted that they are reassessed at the start of each course. Most of the carers felt that they had an opportunity to discuss the IV antibiotics in the out-patient clinic with the doctors and the nurses but none of them would contact the pharmacist. They felt that they were appropriately contacted in advance to

  16. 42 CFR 433.56 - Classes of health care services and providers defined.

    Science.gov (United States)

    2010-10-01

    ... practitioners, and private duty nurses; (17) Laboratory and x-ray services, defined as services provided in a licensed, free-standing laboratory or x-ray facility. This definition does not include laboratory or x-ray... defined to include facility services only and do not include surgical procedures; (10) Dental services...

  17. Exploring Service Providers' Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia.

    Directory of Open Access Journals (Sweden)

    Sheila Cyril

    Full Text Available Childhood obesity rates have been increasing disproportionately among disadvantaged communities including culturally and linguistically diverse (CALD migrant groups in Australia due to their poor participation in the available obesity prevention initiatives. We sought to explore service providers' perceptions of the key factors influencing the participation of CALD communities in the existing obesity prevention services and the service requirements needed to improve CALD communities' participation in these services.We conducted a qualitative study using focus group discussions involving fifty-nine service providers from a range of services, who are involved in the health and wellbeing of children from CALD groups living in four socioeconomically disadvantaged areas in Victoria, Australia.Thematic analysis of the data showed three major themes including community-level barriers to CALD engagement in childhood obesity prevention services; service-level barriers to the delivery of these services; and proposed changes to current childhood obesity prevention approaches. Integrating obesity prevention messages within existing programs, better coordination between prevention and treatment services and the establishment of a childhood obesity surveillance system, were some of the important changes suggested by service providers.This study has found that low CALD health literacy, lack of knowledge of cultural barriers among service providers and co-existing deficiencies in the structure and delivery of obesity prevention services negatively impacted the participation of CALD communities in obesity prevention services. Cultural competency training of service providers would improve their understanding of the cultural influences of childhood obesity and incorporate them into the design and development of obesity prevention initiatives. Service providers need to be educated on the pre-migratory health service experiences and health conditions of CALD

  18. Delivering Service Quality in Alcohol Treatment: A Qualitative Comparison of Public and Private Treatment Centres by Service Users and Service Providers

    Science.gov (United States)

    Resnick, Sheilagh M.; Griffiths, Mark D.

    2012-01-01

    In the UK, quality of care has now been placed at the centre of the National Health Service (NHS) modernisation programme. To date, there has been little research on the service quality delivery of alcohol treatment services from the perspective of both the service user and service provider. Therefore, this qualitative study explored the…

  19. Improving continence services for older people from the service-providers' perspective: a qualitative interview study.

    Science.gov (United States)

    Orrell, Alison; McKee, Kevin; Dahlberg, Lena; Gilhooly, Mary; Parker, Stuart

    2013-07-30

    To examine in depth the views and experiences of continence service leads in England on key service and continence management characteristics in order to identify and to improve our understanding of barriers to a good-quality service and potential facilitators to develop and to improve services for older people with urinary incontinence (UI). Qualitative semistructured interviews using a purposive sample recruited across 16 continence services. 3 acute and 13 primary care National Health Service Trusts in England. 16 continence service leads in England actively treating and managing older people with UI. In terms of barriers to a good-quality service, participants highlighted a failure on the part of commissioners, managers and other health professionals in recognising the problem of UI and in acknowledging the importance of continence for older people and prevalent negative attitudes towards continence and older people. Patient assessment and continence promotion regardless of age, rather than pad provision, were identified as important steps for a good-quality service for older people with UI. More rapid and appropriate patient referral pathways, investment in service capacity, for example, more trained staff and strengthened interservice collaborations and a higher profile within medical and nurse training were specified as being important facilitators for delivering an equitable and high-quality continence service. There is a need, however, to consider the accounts given by our participants as perhaps serving the interests of their professional group within the context of interprofessional work. Our data point to important barriers and facilitators of a good-quality service for older people with UI, from the perspective of continence service leads. Further research should address the views of other stakeholders, and explore options for the empirical evaluation of the effectiveness of identified service facilitators.

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

    Science.gov (United States)

    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.

  1. 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

  2. 42 CFR 417.554 - Apportionment: Provider services furnished directly by the HMO or CMP.

    Science.gov (United States)

    2010-10-01

    ... by the HMO or CMP. 417.554 Section 417.554 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... Apportionment: Provider services furnished directly by the HMO or CMP. The Medicare share of the cost of covered services furnished to Medicare enrollees by providers that are owned or operated by the HMO or CMP or are...

  3. 26 CFR 301.6223(e)-1 - Effect of Internal Revenue Service's failure to provide notice.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Effect of Internal Revenue Service's failure to... General § 301.6223(e)-1 Effect of Internal Revenue Service's failure to provide notice. (a) Notice group...), the Internal Revenue Service's failure to provide notice to a pass-thru partner entitled to notice...

  4. 25 CFR 171.210 - Where will BIA provide my irrigation service?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Where will BIA provide my irrigation service? 171.210 Section 171.210 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER IRRIGATION OPERATION AND MAINTENANCE Irrigation Service § 171.210 Where will BIA provide my irrigation service? (a) We...

  5. Cooperation between Logistic Service Providers and Shippers on making transportation sustainable

    NARCIS (Netherlands)

    Stef Weijers; Reinder Pieters; Onno Omta; Hans-Heinrich Glöckner

    2011-01-01

    This paper describes Dutch Logistic Service Providers attitudes towards sustainability and how they translate this into business practise. This is done by looking at what Logistic Service Providers say what they are doing or intend to do to improve sustainability for their transport services.

  6. Customer service providers' attitudes relating to customer service and customer satisfaction in the customer-server exchange.

    Science.gov (United States)

    Susskind, Alex M; Kacmar, K Michele; Borchgrevink, Carl P

    2003-02-01

    The authors proposed and tested a model describing the relationship between customer service providers' perceptions and attitudes toward their service-related duties and their customers' perceptions of satisfaction with their service experiences. Results indicated that the perception of having standards for service delivery in an organization is strongly related to line-level employees' perceptions of support from coworkers and supervisors. Perceived support from coworkers was significantly related to service providers' customer orientation, whereas perceived support from supervisors showed a weaker relationship to a customer orientation. Ultimately, service providers' customer orientation was strongly related to customers' satisfaction with service. Finally, a set of post hoc analyses indicated that coworker and supervisory support explained a greater proportion of incremental variance in the model than did perceived organizational support alone.

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    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

  9. 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.

  10. Logistics in providing private accommodation services in Primorsko-goranska county

    OpenAIRE

    Mrnjavac, Edna; Pavia, Nadia; Cerović, Marta

    2014-01-01

    Purpose – The purpose of this study is to find a concept for optimizing cost and revenue from providing private accommodation services. The aim is to display how linking all participants who provide private accommodation services into a logistics network will result in better and higher quality service for the guest and in reduced cost for the private accommodation provider. Design – This study researches private accommodation providers in the Primorsko - Goranska County. Primorsko - Goran...

  11. Improving Access to Maternity Care for Women with Opioid Use Disorders: Colocation of Midwifery Services at an Addiction Treatment Program.

    Science.gov (United States)

    Goodman, Daisy

    2015-01-01

    Perinatal drug and alcohol use is associated with serious medical and psychiatric morbidity for pregnant and postpartum women and their newborns. Participation in prenatal care has been shown to improve outcomes, even in the absence of treatment for substance use disorders. Unfortunately, women with substance use disorders often do not receive adequate prenatal care. Barriers to accessing care for pregnant women with substance use disorders include medical and psychiatric comorbidities, transportation, caring for existing children, housing and food insecurity, and overall lack of resources. In a health care system where care is delivered by each discipline separately, lack of communication between providers causes poorly coordinated services and missed opportunities. The integration of mental health and substance use treatment services in medical settings is a goal of health care reform. However, this approach has not been widely promoted in the context of maternity care. The Dartmouth-Hitchcock Medical Center Perinatal Addiction Treatment Program provides an integrated model of care for pregnant and postpartum women with substance use disorders, including the colocation of midwifery services in the context of a dedicated addiction treatment program. A structured approach to screening and intervention for drug and alcohol use in the outpatient prenatal clinic facilitates referral to treatment at the appropriate level. Providing midwifery care within the context of a substance use treatment program improves access to prenatal care, continuity of care throughout pregnancy and the postpartum, and availability of family planning services. The evolution of this innovative approach is described. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health. © 2015 by the American College of Nurse-Midwives.

  12. SMS for Sexual Health: A Comparison of Service Types and Recommendations for Sexual Health Text Message Service Providers

    Science.gov (United States)

    Willoughby, Jessica Fitts; Muldrow, Adrienne

    2017-01-01

    Objectives: Text message-based interventions may provide sexual health information to young people through a number of service types, from sending information on a regularly scheduled timeline, to providing an automated menu, to allowing young people to connect directly with health educators. While such service types exist, it is not clear which…

  13. 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

  14. 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.

  15. 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.

  16. Sexual and reproductive health services for women with disability: a qualitative study with service providers in the Philippines.

    Science.gov (United States)

    Lee, Kira; Devine, Alexandra; Marco, Ma Jesusa; Zayas, Jerome; Gill-Atkinson, Liz; Vaughan, Cathy

    2015-10-15

    The Philippines has ratified the United Nations Convention on the Rights of Persons with Disabilities and recently passed domestic legislation protecting the sexual and reproductive rights of people with disability. However women in the Philippines continue to report barriers to sexual and reproductive health services, and there is limited empirical evidence available to inform policy makers' efforts to respond. This study aims to contribute to the available evidence by examining service providers' perceptions of disability and their experiences providing sexual and reproductive health services to women with disability. The study was conducted as part of a larger three-year program of participatory action research that aims to improve the sexual and reproductive health of women with disabilities in the Philippines. Fourteen in-depth interviews and two focus group discussions were conducted with a total of thirty-two sexual and reproductive health service providers in Quezon City and Ligao. Qualitative data were analysed to identify key themes in participants' discussion of service provision to women with disability. Analysis of service providers' accounts suggests a range of factors undermine provision of high quality sexual and reproductive health services to women with disability. Service providers often have limited awareness of the sexual and reproductive health needs of women with disability and inadequate understanding of their rights. Service providers have had very little training in relation to disability, and limited access to the resources that would enable them to provide a disability inclusive service. Some service providers hold prejudiced attitudes towards women with disability seeking sexual and reproductive health services, resulting in disability-based discrimination. Service providers are also often unaware of specific factors undermining the health of women with disability, such as violence and abuse. Recent legislative change in the Philippines

  17. Mapping ecosystem services provided by benthic habitats in the European North Atlantic Ocean

    Directory of Open Access Journals (Sweden)

    Ibon eGalparsoro

    2014-07-01

    Full Text Available Mapping and assessing the ecosystem services provided by benthic habitats are a highly valuable source of information for understanding their current and potential benefits to society. The main objective of this investigation is to assess and map the ecosystem services provided by benthic habitats of the European North Atlantic Ocean, in the context of Mapping and Assessment of Ecosystems and their Services (MAES programme, the European Biodiversity Strategy and the implementation of the Marine Strategy Framework Directive. In total, 62 habitats have been analysed in relation to 12 ecosystem services over 1.7 million km2. Results indicated that more than 90% of the mapped area provides biodiversity maintenance and food provision services; meanwhile grounds providing reproduction and nursery services are limited to half of the mapped area. Benthic habitats generally provide more services closer to shore than offshore and in shallower waters. This gradient is likely to be explained by difficult access (i.e. distance and depth and lack of scientific knowledge for most of the services provided by distant benthic habitats. This research has provided a first assessment of the benthic ecosystem services at Atlantic European scale, with the provision of ecosystem services maps and their general spatial distribution patterns. Related to the objectives of this research, the conclusions are: (i benthic habitats provide a diverse set of ecosystem services, being the food provision and biodiversity maintenance services the ones that are more extensively represented. In addition, other regulating and cultural services are provided in a more limited area; and (ii the ecosystem services assessment categories are significantly related to the distance to the coast and with depth (higher near the coast and in shallow waters.

  18. Birth choices in Timor-Leste: a framework for understanding the use of maternal health services in low resource settings.

    Science.gov (United States)

    Wild, Kayli; Barclay, Lesley; Kelly, Paul; Martins, Nelson

    2010-12-01

    The high rate of maternal mortality in Timor-Leste is a persistent problem which has been exacerbated by the long history of military occupation and ongoing political crises since independence in 1999. It is similar to other developing countries where there have been slow declines in maternal mortality despite 20 years of Safe Motherhood interventions. The national Ministry of Health, United Nations (UN) agencies and non-government organisations (NGOs) have attempted to reduce maternal mortality by enacting policies and interventions to increase the number of births in health centres and hospitals. Despite considerable effort in promoting facility-based delivery, most Timorese women birth at home and the lack of midwives means few women have access to a skilled birth attendant. This paper investigates factors influencing access to and use of maternal health services in rural areas of Timor-Leste. It draws on 21 interviews and 11 group discussions with Timorese women and their families collected over two periods of fieldwork, one month in September 2006 and five months from July to December 2007. Theoretical concepts from anthropology and health social science are used to explore individual, social, political and health system issues which affect the way in which maternal health services are utilised. In drawing together a range of theories this paper aims to extend explanations around access to maternal health services in developing countries. An empirically informed framework is proposed which illustrates the complex factors that influence women's birth choices. This framework can be used by policy-makers, practitioners, donors and researchers to think critically about policy decisions and where investments can have the most impact for improving maternal health in Timor-Leste and elsewhere. Copyright © 2010 Elsevier Ltd. All rights reserved.

  19. [Maternal anxiety related to how the pediatrician provided prenatal information about preterm birth].

    Science.gov (United States)

    Dekens, C; Fontaine, C; Carpentier, E; Barcat, L; Gondry, J; Tourneux, P

    2017-11-01

    Women hospitalized for preterm labor require clear information about prematurity. This study assessed whether or not specific written information about prematurity delivered at admission to the unit combined with an oral explanation from a pediatrician would decrease women's anxiety compared to an oral explanation alone. This was a prospective, single-center observational study. Women were included in the high-risk pregnancies department and distributed into two groups: receiving "only oral" information for a prenatal clinical consultation with a senior pediatrician or receiving "combined" oral information+a booklet about prematurity given to the women at admission. The primary endpoint was the change in anxiety-state (before and after the information procedure) evaluated by the State Trait Anxiety Inventory-Y (STAI-Y). The anxiety score before receiving information did not differ between the two groups (STAI-Y-A "combined" group: 46.7±3.0 vs. "only oral" group: 42.7±2.74; P=0.55). After consultation with a pediatrician, the acute anxiety-state score STAI-Y-A decreased significantly in the "combined" group (-6.7±1.9) compared to the "only oral" group (-2.5±4.6; Pinformation from a pediatrician reduced patients' anxiety more than oral information alone. Given that the psychology of the mother interacts with the pregnancy, it is necessary to provide clear and adapted information. Giving a booklet appears to be one of the modalities to improve information. Other modalities such as video documents have to be studied. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  20. 25 CFR 171.305 - Will BIA provide leaching service to me?

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 1 2010-04-01 2010-04-01 false Will BIA provide leaching service to me? 171.305 Section 171.305 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER IRRIGATION OPERATION AND MAINTENANCE Water Use § 171.305 Will BIA provide leaching service to me? (a) We may provide...

  1. 42 CFR 136a.12 - Persons to whom health services will be provided.

    Science.gov (United States)

    2010-10-01

    ... and Who Is Eligible To Receive Care? § 136a.12 Persons to whom health services will be provided. (a... where the woman is not married to the eligible Indian under applicable state or tribal law, paternity... Service funded facilities are available to provide the needed care. When funds are insufficient to provide...

  2. Who wants to deliver public service? Do institutional antecedents of public service motivation provide an answer?

    NARCIS (Netherlands)

    Vandenabeele, W.V.|info:eu-repo/dai/nl/323038816

    2011-01-01

    Public service motivation has rapidly become one of the important concepts in contemporary public administration research. However, until now, research has mainly focused on its measurement and its consequences, whereas relatively ignoring its origins. This study investigates where the antecedents

  3. Women’s perception of quality of maternity services: a longitudinal survey in Nepal

    Science.gov (United States)

    2014-01-01

    Background In the context of maternity service, the mother’s assessment of quality is central because emotional, cultural and respectful supports are vital during labour and the delivery process. This study compared client-perceived quality of maternity services between birth centres, public and private hospitals in a central hills district of Nepal. Methods A cohort of 701 pregnant women of 5 months or more gestational age were recruited and interviewed, followed by another interview within 45 days of delivery. Perception of quality was measured by a 20-item scale with three sub-scales: health facility, health care delivery, and interpersonal aspects. Perceived quality scores were analysed by ANOVA with post-hoc comparisons and multiple linear regression. Results Within the health facility sub-scale, birth centre was rated lowest on items ‘adequacy of medical equipment’, ‘health staff suited to women’s health’ and ‘adequacy of health staff’, whereas public hospital was rated the lowest with respect to ‘adequacy of room’, ‘adequacy of water’, ‘environment clean’, ‘privacy’ and ‘adequacy of information’. Mean scores of total quality and sub-scales health facility and health care delivery for women attending private hospital were higher (p < 0.001) than those using birth centre or public hospital. Mean score of the sub-scale interpersonal aspects for public hospital users was lower (p < 0.001) than those delivered at private hospital and birth centre. However, perception on interpersonal aspects by women using public hospital improved significantly after delivery (p < 0.001). Conclusions Overall, perception of quality differed significantly by types of health facility used for delivery. They rated lowest the supplies and equipment in birth centres and the amenities and interpersonal aspects in the public hospital. Accordingly, attention to these aspects is needed to improve the quality. PMID:24456544

  4. Women's perception of quality of maternity services: a longitudinal survey in Nepal.

    Science.gov (United States)

    Karkee, Rajendra; Lee, Andy H; Pokharel, Paras K

    2014-01-24

    In the context of maternity service, the mother's assessment of quality is central because emotional, cultural and respectful supports are vital during labour and the delivery process. This study compared client-perceived quality of maternity services between birth centres, public and private hospitals in a central hills district of Nepal. A cohort of 701 pregnant women of 5 months or more gestational age were recruited and interviewed, followed by another interview within 45 days of delivery. Perception of quality was measured by a 20-item scale with three sub-scales: health facility, health care delivery, and interpersonal aspects. Perceived quality scores were analysed by ANOVA with post-hoc comparisons and multiple linear regression. Within the health facility sub-scale, birth centre was rated lowest on items 'adequacy of medical equipment', 'health staff suited to women's health' and 'adequacy of health staff', whereas public hospital was rated the lowest with respect to 'adequacy of room', 'adequacy of water', 'environment clean', 'privacy' and 'adequacy of information'. Mean scores of total quality and sub-scales health facility and health care delivery for women attending private hospital were higher (p < 0.001) than those using birth centre or public hospital. Mean score of the sub-scale interpersonal aspects for public hospital users was lower (p < 0.001) than those delivered at private hospital and birth centre. However, perception on interpersonal aspects by women using public hospital improved significantly after delivery (p < 0.001). Overall, perception of quality differed significantly by types of health facility used for delivery. They rated lowest the supplies and equipment in birth centres and the amenities and interpersonal aspects in the public hospital. Accordingly, attention to these aspects is needed to improve the quality.

  5. Immigrant women’s experiences of maternity-care services in Canada: a protocol for systematic review using a narrative synthesis

    Directory of Open Access Journals (Sweden)

    Higginbottom Gina M A

    2012-05-01

    Full Text Available Abstract Background Canada’s diverse society and statutory commitment to multiculturalism means that the synthesis of knowledge related to the health care experiences of immigrants is essential to realize 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 tailoring of services to user needs. We are therefore assessing the experiences of immigrant women in Canada accessing maternity-care services. We are focusing on: 1 accessibility and acceptability (as an important dimension of access to maternity-care services as perceived and experienced by immigrant women, and 2 the birth and postnatal outcomes of these women. Methods The aim of this study is to use a narrative synthesis, incorporating both a systematic review using narrative synthesis of reports of empirical research (qualitative, quantitative, and mixed-method designs, and a literature review of non-empirically based reports, both of which include ‘grey’ literature. The study aims to provide stakeholders with perspectives on maternity-care services as experienced by immigrant women. To achieve this, we are using integrated knowledge translation, partnering with key stakeholders to ensure topic relevancy and to tailor recommendations for effective translation into future policy and practice/programming. Two search phases and a three-stage selection process are being conducted (database search retrieved 1487 hits excluding duplicates to provide evidence to contribute jointly to both the narrative synthesis and the non-empirical literature review. The narrative synthesis will be informed by the previous framework published in 2006 by Popay et al., using identified tools for each of its four elements. The non-empirical literature review will build upon the narrative-synthesis findings and/or identify omissions or gaps in the empirical research literature

  6. Determinants of patterns of maternal and child health service utilization in a rural community in south eastern Nigeria.

    Science.gov (United States)

    Agunwa, C C; Obi, I E; Ndu, A C; Omotowo, I B; Idoko, C A; Umeobieri, A K; Aniwada, E C

    2017-11-13

    Women and children constitute a large proportion of any population. They are the most vulnerable to morbidity and mortality especially in developing countries. In many situations the problem of poor maternal and child health stems from the poor use of available services even when they are not of optimum quality. This study seeks to describe the patterns of utilization of Maternal and Child health (MCH) services in a rural area of Enugu State, and identify factors that are associated with and responsible for determining them. The study used a cross sectional analytic design. Pretested semi structured questionnaires were administered by interviewers to 602 women from a rural community in Enugu state, South east Nigeria. Two focus group discussions (FGDs) involving 8-10 men/ women each were conducted to identify factors affecting service utilization. Chi square analysis was done to identify factors associated with Maternal and Child Health services utilization. Logistic regression was used to identify determinants of utilization patterns. N vivo software was used to analyze findings of the FGDs. The study revealed that increasing age, educational level, monthly income, number of children and occupation of both women and their husbands were associated with increased MCH service utilization. Average monthly income (OR: 1.317, p = 0.048, CI: 0.073-0.986) and number of children (OR: 1.196, p determinants of increased use of child care services while educational level (OR: 0.495, p determined better use of delivery and family planning services respectively. Improved use of MCH services is related to socio economic challenges women face such as illiteracy and low income. Furthermore, the way health facilities and their staff are perceived by rural women affect how they use some of these services and should be considered in programs which seek to reduce maternal and child mortality. Behavioral change programs with high local content need to be implemented within rural

  7. Implementation of the free maternity services policy and its implications for health system governance in Kenya

    Science.gov (United States)

    Smith, Helen

    2017-01-01

    Introduction To move towards universal health coverage, the government of Kenya introduced free maternity services in all public health facilities in June 2013. User fees are, however, important sources of income for health facilities and their removal has implications for the way in which health facilities are governed. Objective To explore how implementation of Kenya’s financing policy has affected the way in which the rules governing health facilities are made, changed, monitored and enforced. Methods Qualitative research was carried out using semistructured interviews with 39 key stakeholders from six counties in Kenya: 10 national level policy makers, 10 county level policy makers and 19 implementers at health facilities. Participants were purposively selected using maximum variation sampling. Data analysis was informed by the institutional analysis framework, in which governance is defined by the rules that distribute roles among key players and shape their actions, decisions and interactions. Results Lack of clarity about the new policy (eg, it was unclear which services were free, leading to instances of service user exploitation), weak enforcement mechanisms (eg, delayed reimbursement to health facilities, which led to continued levying of service charges) and misaligned incentives (eg, the policy led to increased uptake of services thereby increasing the workload for health workers and health facilities losing control of their ability to generate and manage their own resources) led to weak policy implementation, further complicated by the concurrent devolution of the health system. Conclusion The findings show the consequences of discrepancies between formal institutions and informal arrangements. In introducing new policies, policy makers should ensure that corresponding institutional (re)arrangements, enforcement mechanisms and incentives are aligned with the objectives of the implementers. PMID:29177098

  8. The role of health extension workers in improving utilization of maternal health services in rural areas in Ethiopia: a cross sectional study.

    Science.gov (United States)

    Medhanyie, Araya; Spigt, Mark; Kifle, Yohannes; Schaay, Nikki; Sanders, David; Blanco, Roman; GeertJan, Dinant; Berhane, Yemane

    2012-10-08

    Community health workers are widely used to provide care for a broad range of health issues. Since 2003 the government of Ethiopia has been deploying specially trained new cadres of community based health workers named health extension workers (HEWs). This initiative has been called the health extension program. Very few studies have investigated the role of these community health workers in improving utilization of maternal health services. A cross sectional survey of 725 randomly selected women with under-five children from three districts in Northern Ethiopia. We investigated women's utilization of family planning, antenatal care, birth assistance, postnatal care, HIV testing and use of iodized salt and compared our results to findings of a previous national survey from 2005. In addition, we investigated the association between several variables and utilization of maternal health services using logistic regression analysis. HEWs have contributed substantially to the improvement in women's utilization of family planning, antenatal care and HIV testing. However, their contribution to the improvement in health facility delivery, postnatal check up and use of iodized salt seems insignificant. Women who were literate (OR, 1.85), listened to the radio (OR, 1.45), had income generating activities (OR, 1.43) and had been working towards graduation or graduated as model family (OR, 2.13) were more likely to demonstrate good utilization of maternal health services. A model family is by definition a family which has fulfilled all the packages of the HEP. The HEWs seem to have substantial contribution in several aspects of utilization of maternal health services but their insignificant contribution in improving health facility delivery and skilled birth attendance remains an important problem. More effort is needed to improve the effectiveness of HEWs in these regards. For example, strengthening HEWs' support for pregnant women for birth planning and preparedness and

  9. Adolescent Maternal Lifecourse Outcomes: Implications from an Integrated Mental Health Services Approach

    Directory of Open Access Journals (Sweden)

    Beth S. Russell

    2014-06-01

    Full Text Available Family intervention literature on adolescent parenting describes the pathways between outcomes for adolescent mothers and their children and the contexts of the pregnancy itself (e.g., poverty, low or no prenatal care, lower educational attainment. The aim of these descriptions is often to inform intervention designs that promote adaptive functioning for the child, the mother, and the dyad. Mental health services are an important component of many of these interventions; these services may be delivered by a clinician within the organization providing the intervention, or the organization may connect mothers with external mental health services in their communities. Using in-house clinicians rather than external providers may be beneficial by decreasing the high attrition rates common to this population. Although this service delivery approach is theoretically appealing, it has not been subject to rigorous empirical evaluation. In the current randomized study, we examine outcomes for teenage mothers based on two service delivery methods: Integrated Mental Health Services (IMHS and the Standard of Care (SoC which outsources clients’ mental health needs through community referrals. Information about the effectiveness of service delivery strategies can help program providers make decisions about how best to allocate limited funds to provide effective services.

  10. 34 CFR 364.55 - What standards shall service providers meet?

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false What standards shall service providers meet? 364.55 Section 364.55 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE INDEPENDENT LIVING SERVICES...

  11. 34 CFR 365.31 - What are the standards for service providers?

    Science.gov (United States)

    2010-07-01

    ... 34 Education 2 2010-07-01 2010-07-01 false What are the standards for service providers? 365.31 Section 365.31 Education Regulations of the Offices of the Department of Education (Continued) OFFICE OF SPECIAL EDUCATION AND REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION STATE INDEPENDENT LIVING SERVICES...

  12. System and Method for Providing a Climate Data Analytic Services Application Programming Interface Distribution Package

    Science.gov (United States)

    Schnase, John L. (Inventor); Duffy, Daniel Q. (Inventor); Tamkin, Glenn S. (Inventor)

    2016-01-01

    A system, method and computer-readable storage devices for providing a climate data analytic services application programming interface distribution package. The example system can provide various components. The system provides a climate data analytic services application programming interface library that enables software applications running on a client device to invoke the capabilities of a climate data analytic service. The system provides a command-line interface that provides a means of interacting with a climate data analytic service by issuing commands directly to the system's server interface. The system provides sample programs that call on the capabilities of the application programming interface library and can be used as templates for the construction of new client applications. The system can also provide test utilities, build utilities, service integration utilities, and documentation.

  13. Completeness and accuracy of data transfer of routine maternal health services data in the greater Accra region

    NARCIS (Netherlands)

    Amoakoh-Coleman, Mary; Kayode, Gbenga A.; Brown-Davies, Charles; Agyepong, Irene Akua; Grobbee, DE; Klipstein-Grobusch, Kerstin; Ansah, Evelyn K.

    2015-01-01

    Background: High quality routine health system data is essential for tracking progress towards attainment of the Millennium Development Goals 4 & 5. This study aimed to determine the completeness and accuracy of transfer of routine maternal health service data at health facility, district and

  14. The provision of health and social care services for older people by respite providers.

    Science.gov (United States)

    Evans, David

    2013-10-01

    Respite services have been established to support family carers by providing a break from the responsibilities of caregiving. However the literature and anecdotal evidence suggests that respite services offer carers much more than just providing a period of rest. This study was initiated to identify and describe the health and social care services that are offered to family carers and care-recipients by respite services in South Australia. The findings show that respite providers offer a service to both the family carer and care-recipient. Both groups are offered socialisation and engagement opportunities, and care-recipients have access to a diverse range of health care services. The description of respite that emerges from this study is that of a complex service offering much more than just a period of rest from caregiving duties.

  15. Contraceptive service provider imposed restrictions to contraceptive access in Urban Nigeria.

    Science.gov (United States)

    Schwandt, Hilary M; Speizer, Ilene S; Corroon, Meghan

    2017-04-17

    Health service providers can restrict access to contraceptives through their own imposed biases about method appropriateness. In this study, provider biases toward contraceptive service provision among urban Nigerian providers was assessed. Health providers working in health facilities, as well as pharmacists and patent medical vendors (PMV), in Abuja, Benin City, Ibadan, Ilorin, Kaduna, and Zaria, were surveyed in 2011 concerning their self-reported biases in service provision based on age, parity, and marital status. Minimum age bias was the most common bias while minimum parity was the least common bias reported by providers. Condoms were consistently provided with the least amount of bias, followed by provision of emergency contraception (EC), pills, injectables, and IUDs. Experience of in-service training for health facility providers was associated with decreased prevalence of marital status bias for the pill, injectable, and IUD; however, training experience did not, or had the opposite effect on, pharmacists and PMV operator's reports of service provision bias. Provider imposed eligibility barriers in urban study sites in Nigeria were pervasive - the most prevalent restriction across method and provider type was minimum age. Given the large and growing adolescent population - interventions aimed at increasing supportive provision of contraceptives to youth in this context are urgently needed. The results show that the effect of in-service training on provider biases was limited. Future efforts to address provider biases in contraceptive service provision, among all provider types, must find creative ways to address this critical barrier to increased contraceptive use.

  16. A methodology for quantifying and mapping ecosystem services provided by watersheds

    Science.gov (United States)

    Villamagna, Amy M.; Angermeier, Paul L.

    2015-01-01

    Watershed processes – physical, chemical, and biological – are the foundation for many benefits that ecosystems provide for human societies. A crucial step toward accurately representing those benefits, so they can ultimately inform decisions about land and water management, is the development of a coherent methodology that can translate available data into the ecosystem services (ES) produced by watersheds. Ecosystem services (ES) provide an instinctive way to understand the tradeoffs associated with natural resource management. We provide a synthesis of common terminology and explain a rationale and framework for distinguishing among the components of ecosystem service delivery, including: an ecosystem’s capacity to produce a service; societal demand for the service; ecological pressures on this service; and flow of the service to people. We discuss how interpretation and measurement of these components can differ among provisioning, regulating, and cultural services and describe selected methods for quantifying ES components as well as constraints on data availability. We also present several case studies to illustrate our methods, including mapping capacity of several water purification services and demand for two forms of wildlife-based recreation, and discuss future directions for ecosystem service assessments. Our flexible framework treats service capacity, demand, ecological pressure, and flow as separate but interactive entities to better evaluate the sustainability of service provision across space and time and to help guide management decisions.

  17. Service providers' experiences and needs in working with refugees in the Geelong region: a qualitative study.

    Science.gov (United States)

    Jewson, Ashlee; Lamaro, Greer; Crisp, Beth R; Hanna, Lisa; Taket, Ann

    2015-01-01

    Service providers in Geelong, one of the priority locations for the resettlement of refugees in regional Australia, were interviewed to explore their perceptions of the health and wellbeing needs of refugees, and the capacity of service providers in a regional area to meet these. In all, 22 interviews were conducted with health and human service professionals in a range of organisations offering refugee-specific services, culturally and linguistically diverse (CALD) services in general, and services to the wider community, including refugees. The findings revealed that a more coordinated approach would increase the effectiveness of existing services; however, the various needs of refugees were more than could be met by organisations in the region at current resource levels. More staff and interpreting services were required, as well as professional development for staff who have had limited experience in working with refugees. It should not be assumed that service needs for refugees resettled in regional Australia will be the same as those of refugees resettled in capital cities. Some services provided in Melbourne were not available in Geelong, and there were services not currently provided to refugees that may be critical in facilitating resettlement in regional and rural Australia.

  18. The Impact of Quality Service Provided by SRM Hospital on Outpatients

    Directory of Open Access Journals (Sweden)

    Kenneth Amoah-Binfoh

    2015-04-01

    Full Text Available Consumer’s perceptions about the health care services play an important role when choosing a hospital. The quality of service is crucial to both the outpatients and the service providers. The dimensions of the service quality are reliability, responsiveness, assurance, empathy, and tangibles. Customer’s expectations and experiences vary with services. When there is a shortfall between expectation of service level and perception of actual service delivery, it is called customer gap. The causes of customer gap include; not knowing what customers expect, not selecting the right service designs and standards, not delivering to service standards and not matching performance to promises. This paper focuses on the level of service quality rendered by SRM’s hospital, the patient-physicians’ relationship and to examine the pre and post service of outpatients in the SRM’s hospital. A structured questionnaires and interviews were constructed to provide answers to the research questions using a sample size of 50 [employees and outpatients]. It was found out that some outpatients were satisfied with the services rendered by the hospital with reservations for more improvement. It was also found out that, there were gaps between the outpatients’ expectation and perception about the service rendered by the hospital. It was recommended that a competent marketing executive should be employed since marketing is the voice of the healthcare industry.

  19. PTSD among Bosnian refugees: a survey of providers' knowledge, attitudes and service patterns.

    Science.gov (United States)

    Weine, S M; Kuc, G; Dzudza, E; Razzano, L; Pavkovic, I

    2001-06-01

    The objective of this study was to investigate providers' knowledge, attitudes and service provision patterns for Bosnian refugees with PTSD and to consider the overall implications for trauma-related mental health services. A survey instrument was developed and administered to 30 randomly selected service providers working with Bosnian refugees in Chicago. This sample includes primary medical care providers (n = 7), community social service providers (n = 12), and mental health service providers (n = 11). Results showed that knowledge about PTSD is highest in mental health service providers, as is amount of previous training and education about PTSD. Less than half of all providers systematically assess for PTSD, and standardized instruments for PTSD are rarely used. The top three overall recommendations for services were ranked as: 1. Psychotherapy; 2. No intervention; 3. Psychiatric evaluation. In general, less than half of providers hold attitudes toward refugees as suffering from illnesses or mental disorders, or that "something" is wrong with them. Likewise, only half of the providers reported providing education to refugees and their families about the possible mental health consequences of trauma. In conclusion, assessment, intervention and educational activities of providers are not consistent with literature documenting that PTSD is highly prevalent in refugee populations. New training programs, model development, and research initiatives are needed to address the needs of refugees.

  20. Maternal perceptions of underweight and overweight for 6-8 years olds from a Canadian cohort: reporting weights, concerns and conversations with healthcare providers.

    Science.gov (United States)

    McDonald, Sheila W; Ginez, Heather K; Vinturache, Angela E; Tough, Suzanne C

    2016-10-19

    The majority of mothers do not correctly identify their child's weight status. The reasons for the misperception are not well understood. This study's objective was to describe maternal perceptions of their child's body mass index (BMI) and maternal report of weight concerns raised by a health professional. Prospective, community-based cohort. Data were collected in 2010 from 450 mothers previously included in a longitudinal birth cohort. Mothers of children aged 6-8 years reported their child's anthropometric measures and were surveyed concerning their opinion about their child's weight. They were also asked if a healthcare provider raised any concerns regarding their child's body weight. Child BMI was categorised according to the WHO Growth Charts adapted for Canada. Descriptive statistics and bivariate analyses were used to evaluate mothers' ability to correctly identify their children's body habitus. 74% of children had a healthy BMI, 10% were underweight, 9% were overweight and 7% were obese. 80%, 89% and 62% of mothers with underweight, overweight and obese children, respectively, believed that their child was at the right weight. The proportion of mothers who recalled a health professional raising concerns about their child being underweight, overweight, and obese was low (12.5%). The majority of mothers with children at unhealthy weights misclassified and normalised their child's weight status, and they did not recall a health professional raising concerns regarding their child's weight. The highest rates of child body weight misclassification occurred in overweight children. This suggests that there are missed opportunities for healthcare professionals to improve knowledge exchange and early interventions to assist parents to recognise and support healthy weights for their children. 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/.

  1. 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

  2. Couples’ reports of household decision-making and the utilization of maternal health services in Bangladesh

    Science.gov (United States)

    Story, William T.; Burgard, Sarah A.

    2012-01-01

    This study examines the association between maternal health service utilization and household decision-making in Bangladesh. Most studies of the predictors of reproductive health service use focus on women’s reports; however, men are often involved in these decisions as well. Recently, studies have started to explore the association between health outcomes and reports of household decision-making from both husbands and wives as matched pairs. Many studies of household decision-making emphasize the importance of the wife alone making decisions; however, some have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than women making decisions without input or agreement from their partners. Husbands’ involvement in decision-making is particularly important in Bangladesh because men often dominate household decisions related to large, health-related purchases. We use matched husband and wife reports about who makes common household decisions to predict use of antenatal and skilled delivery care, using data from the 2007 Bangladesh Demographic and Health Survey. Results from regression analyses suggest that it is important to consider whether husbands and wives give concordant responses about who makes household decisions since discordant reports about who makes these decisions are negatively associated with reproductive health care use. In addition, compared to joint decision-making, husband-only decision-making is negatively associated with antenatal care use and skilled delivery care. Finally, associations between household decision-making arrangements and health service utilization vary depending on whose report is used and the type of health service utilized. PMID:23068556

  3. Collaboration with Community Mental Health Service Providers: A Necessity in Contemporary Schools

    Science.gov (United States)

    Villarreal, Victor; Castro-Villarreal, Felicia

    2016-01-01

    Schools have played an increasingly central role in providing mental health services to youth, but there are limitations to the services that are available through school-based mental health professionals. Thus, collaboration with non-school-based community mental health providers is oftentimes necessary. As collaboration can address limitations…

  4. 12 CFR 332.13 - Exception to opt out requirements for service providers and joint marketing.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Exception to opt out requirements for service providers and joint marketing. 332.13 Section 332.13 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION... Exception to opt out requirements for service providers and joint marketing. (a) General rule. (1) The opt...

  5. 12 CFR 40.13 - Exception to opt out requirements for service providers and joint marketing.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Exception to opt out requirements for service providers and joint marketing. 40.13 Section 40.13 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT... requirements for service providers and joint marketing. (a) General rule. (1) The opt out requirements in §§ 40...

  6. 12 CFR 716.13 - Exception to opt out requirements for service providers and joint marketing.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Exception to opt out requirements for service providers and joint marketing. 716.13 Section 716.13 Banks and Banking NATIONAL CREDIT UNION ADMINISTRATION... opt out requirements for service providers and joint marketing. (a) General rule. (1) The opt out...

  7. 12 CFR 573.13 - Exception to opt out requirements for service providers and joint marketing.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 5 2010-01-01 2010-01-01 false Exception to opt out requirements for service providers and joint marketing. 573.13 Section 573.13 Banks and Banking OFFICE OF THRIFT SUPERVISION... requirements for service providers and joint marketing. (a) General rule. (1) The opt out requirements in...

  8. 12 CFR 216.13 - Exception to opt out requirements for service providers and joint marketing.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 2 2010-01-01 2010-01-01 false Exception to opt out requirements for service providers and joint marketing. 216.13 Section 216.13 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF... § 216.13 Exception to opt out requirements for service providers and joint marketing. (a) General rule...

  9. 16 CFR 313.13 - Exception to opt out requirements for service providers and joint marketing.

    Science.gov (United States)

    2010-01-01

    ... service providers and joint marketing. 313.13 Section 313.13 Commercial Practices FEDERAL TRADE COMMISSION... Exception to opt out requirements for service providers and joint marketing. (a) General rule. (1) The opt... perform joint marketing, your contractual agreement with that institution meets the requirements of...

  10. Achieving Community Membership through Community Rehabilitation Provider Services: Are We There Yet?

    Science.gov (United States)

    Metzel, Deborah S.; Boeltzig, Heike; Butterworth, John; Sulewski, Jennifer Sullivan; Gilmore, Dana Scott

    2007-01-01

    Findings from an analysis of the characteristics and services of community rehabilitation providers (CRPs) in the early years of the 21st century are presented. Services provided by CRPs can be categorized along two dimensions: purpose (work, nonwork) and setting (facility-based, community). The number of individuals with disabilities present…

  11. Supplemental Educational Services: An Action Science Research Study of Achieving State Standards for Provider Effectiveness

    Science.gov (United States)

    McClintock, Cynthia Collette

    2012-01-01

    Supplemental educational services are designed to contribute tremendous support to local school districts and communities through state-approved provider programs. The state, however, prior to approving supplemental educational services provider programs, must utilize all available resources to assist in the process of screening and approving…

  12. 47 CFR 54.501 - Eligibility for services provided by telecommunications carriers.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Eligibility for services provided by telecommunications carriers. 54.501 Section 54.501 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED... § 54.501 Eligibility for services provided by telecommunications carriers. (a) Telecommunications...

  13. 47 CFR 54.517 - Services provided by non-telecommunications carriers.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 3 2010-10-01 2010-10-01 false Services provided by non-telecommunications carriers. 54.517 Section 54.517 Telecommunication FEDERAL COMMUNICATIONS COMMISSION (CONTINUED) COMMON....517 Services provided by non-telecommunications carriers. (a) Non-telecommunications carriers shall be...

  14. Postsecondary Disability Service Providers' Perceptions about Implementing Universal Design for Instruction (UDI)

    Science.gov (United States)

    Embry, Priscilla B.; Parker, David R.; McGuire, Joan M.; Scott, Sally S.

    2005-01-01

    Sixteen disability service providers from 2-year and 4-year public and private postsecondary institutions were divided into 2 focus groups, each with 8 participants. When asked to share their perspectives on the implementation of Universal Design for Instruction (UDI) on their campus, service providers described strengths and weaknesses of UDI,…

  15. The HLA-G cycle provides for both NK tolerance and immunity at the maternal-fetal interface.

    Science.gov (United States)

    Tilburgs, Tamara; Evans, J Henry; Crespo, Ângela C; Strominger, Jack L

    2015-10-27

    The interaction of noncytotoxic decidual natural killer cells (dNK) and extravillous trophoblasts (EVT) at the maternal-fetal interface was studied. Confocal microscopy revealed that many dNK interact with a single large EVT. Filamentous projections from EVT enriched in HLA-G were shown to contact dNK, and may represent the initial stage of synapse formation. As isolated, 2.5% of dNK contained surface HLA-G. However, surface HLA-G-negative dNK contained internalized HLA-G. Activation of dNK resulted in the disappearance of internalized HLA-G in parallel with restoration of cytotoxicity. Surface HLA-G was reacquired by incubation with EVT. This HLA-G cycle of trogocytosis, endocytosis, degradation, and finally reacquisition provides a transient and localized acquisition of new functional properties by dNK upon interaction with EVT. Interruption of the cycle by activation of dNK by cytokines and/or viral products serves to ensure the NK control of virus infection at the interface, and is illustrated here by the response of dNK to human cytomegalo virus (HCMV)-infected decidual stromal cells. Thus, the HLA-G cycle in dNK can provide both for NK tolerance and antiviral immunity.

  16. "It's just so bloody hard": recommendations for improving health interventions and maternity support services for disabled women.

    Science.gov (United States)

    Guerin, Bernadette M; Payne, Deborah A; Roy, Dianne E; McPherson, Kathryn M

    2017-11-01

    Little is known about the barriers and facilitators to pregnancy, birth and motherhood for disabled women within the New Zealand context. Our study explored this deficit with the aim of improving health care interventions and support for disabled mothers. This paper reports on the third phase of a mixed-methods study. The first two phases used semi-structured individual and focus group interviews with disabled women, and health professionals, involved in maternity and postnatal care and has been reported elsewhere. Phase 3 utilised a modified Delphi technique with both groups of participants to seek consensus on the prioritisation of recommendations from the study. This article focuses on the disabled women's recommendations. In all, 20 disabled women took part in the Delphi phase of the study (28% of the cohort from Phase 1). In total, 11 key recommendations were identified by the disabled women, with the top seven discussed in detail here. Health professionals and health systems could, and arguably should, utilise a matrix of these recommendations to facilitate a review of service responsiveness to disabled women. Implications for Rehabilitation Becoming a mother is a potentially relevant and important rehabilitation issue for women of childbearing age who come into contact with rehabilitation services. Disabled women encounter a range of economic, attitudinal and knowledge barriers in relation to becoming mothers. Centralised sites/sources of information have potential to provide accessible and useful information for disabled women and health professionals.

  17. Female Health Workers at the Doorstep: A Pilot of Community-Based Maternal, Newborn, and Child Health Service Delivery in Northern Nigeria

    Science.gov (United States)

    Uzondu, Charles A; Doctor, Henry V; Findley, Sally E; Afenyadu, Godwin Y; Ager, Alastair

    2015-01-01

    ABSTRACT Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Methods: Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008–2010 (before introduction of the pilot) with data from 2011–2013 (during and after the pilot) to gauge sustainability of the model. Results: Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Conclusion: Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas. PMID

  18. Health care providers' requests to Teratogen Information Services on medication use during pregnancy and lactation.

    Science.gov (United States)

    Gendron, Marie-Pierre; Martin, Brigitte; Oraichi, Driss; Bérard, Anick

    2009-05-01

    Medication use during pregnancy and lactation is prevalent. However, current knowledge of the risks and benefits of medication use during pregnancy and lactation is incomplete as the best available evidence has been obtained from cohort studies of inadvertent exposures and registries. This situation may partly explain health care providers' (HCP) risk perceptions and thus the increasing number of calls to Teratogen Information Services (TIS). The objectives of this study were (1) to identify the medication classes for which HCP are seeking counseling from the IMAGe center, a Quebec TIS; (2) to identify the medical conditions for which medication classes were used during pregnancy and lactation; (3) to identify and quantify predictors of medication information requests during pregnancy and lactation. A retrospective analysis of data was conducted within the population served by the IMAGe center, a TIS based at CHU Ste-Justine in Montreal, Quebec, Canada, that serves the French population of Canada. To be included, calls had to be received between January 1, 2004 and April 30, 2007, and the subject of the call had to be directly associated with the exposure, or not, of a pregnant or breastfeeding woman to medication. Multivariate generalized estimating equation (GEE) regression models were performed to identify the predictors of medication requests. A total of 11, 076 requests regarding medication exposure during pregnancy, 12 055 requests regarding pregnant women before the exposure took place, and 13, 364 requests regarding lactation were included for analyses. Pregnant women were most frequently exposed to antidepressants (17.3), antibiotics (6.3%), and benzodiazepines (5.3%). Prior to drug exposure, the most frequent inquiries by HCP were on antibiotics (11.0%), anti-inflammatory drugs (6.0%), and antiemetics (5.1%). Inquiries concerning lactating women most frequently requested information on the drug classes of antidepressants (10.8%), antibiotics (9.1%), and

  19. A Nationwide Evaluation of Services Provided to Domestic Violence Survivors at Shelters in Bosnia-Herzegovina.

    Science.gov (United States)

    Muftić, Lisa R; Deljkić, Irma; Fansher, Ashley K

    2016-04-27

    The shelter movement in Bosnia-Herzegovina was born out of a tradition of assisting survivors of gender-based violence in the early 1990s during the Bosnian conflict. To date, nine shelters are in existence providing emergency shelter and services to survivors. Little is known about these shelters, or the clients these shelters serve. The purpose of this study is to examine what services are provided to domestic violence survivors by shelters in Bosnia-Herzegovina and who these survivors are. A total of 43 service providers from all existing shelters within the country were surveyed about shelter characteristics, client demographics, and services provided. Findings revealed that the typical Bosnian shelter had been in operation for 11 years and had assisted 64 survivors in the previous year; the majority of whom were married females with minor children who had sought shelter services before. Core services were provided by the majority of shelters, including crisis services, legal and medical advocacy, counseling, and community education. While services were provided to a diverse group of survivors (e.g., children, elderly women, victims of human trafficking), shelters were less likely to be available for male and lesbian, gay, bisexual, and transgender survivors. Implications from these findings, as well as limitations and suggestions for further research, are discussed. © The Author(s) 2016.

  20. Application of 'Process management' methodology in providing financial services of PE 'Post Serbia'

    Directory of Open Access Journals (Sweden)

    Kujačić Momčilo D.

    2014-01-01

    Full Text Available The paper describes application of the methodology 'Process management', in providing of financial services at the post office counter hall. An overview of the methodology is given, as one of the most commonly used qualitative methodology, whereby Process management's technics are described , those can better meet user needs and market demands, as well as to find more effectively way to resist current competition in the postal service market. One of the main problem that pointed out is a long waiting time in the counter hall during providing financial services, which leads to the formation of queue lines, and thus to customer dissatisfaction. According that, paper points steps that should be taken during provide of financial services in a postal network unit for providing services to customers by optimizing user time waiting in line and increasing the satisfaction of all participants in that process.

  1. Facilitators and barriers to participation of private sector health facilities in government-led schemes for maternity services in India: a qualitative study.

    Science.gov (United States)

    Yadav, Vikas; Kumar, Somesh; Balasubramaniam, Sudharsanam; Srivastava, Ashish; Pallipamula, Suranjeen; Memon, Parvez; Singh, Dinesh; Bhargava, Saurabh; Sunil, Greeshma Ann; Sood, Bulbul

    2017-06-22

    Despite provision of accreditation of private sector health providers in government-led schemes for maternity services in India, their participation has been low. This has led to an underutilisation of their presence, resources and expertise for providing quality maternal and newborn health services. This study explores the perception of various stakeholders on expectations, benefits, barriers and facilitators to private sector participation in government-led schemes-specifically Janani Suraksha Yojana (JSY)-for maternity service delivery. Narrative-based qualitative study. Face-to-face in-depth interviews were conducted with study participants. The interviews were transcribed, translated and analysed using a reflexive and inductive approach to allow codes, categories and themes to emerge from within the data. Private obstetricians, government health officials and FOGSI (Federation of Obstetrics and Gynaecological Societies of India) members, Jharkhand and Uttar Pradesh, India. Eighteen purposefully selected private obstetricians from 9 cities across states of Uttar Pradesh and Jharkhand, 11 government health officials and 2 FOGSI members. The major factors serving as barriers to participation of private practitioners in JSY-which emerged on thematic analysis-were low reimbursement amounts, delayed reimbursements, process of interaction with the government and administrative issues, previous experiences and trust deficit, lack of clarity on the accreditation process and patient-level barriers. On the other hand, factors which were facilitators to participation of private practitioners were ease of process, better communication, branding, motivation of increasing clientele as well as satisfaction of doing social service. Factors such as financial processes and administrative delays, mistrust between the stakeholders, ambiguity in processes, lack of transparency and lack of ease in the process of empanelment of private sector are hindering effective public

  2. External Service Providers to the National Security Technology Incubator: Formalization of Relationships

    Energy Technology Data Exchange (ETDEWEB)

    None

    2008-04-30

    This report documents the formalization of relationships with external service providers in the development of the National Security Technology Incubator (NSTI). The technology incubator is being developed as part of the National Security Preparedness Project (NSPP), funded by a Department of Energy (DOE)/National Nuclear Security Administration (NNSA) grant. This report summarizes the process in developing and formalizing relationships with those service providers and includes a sample letter of cooperation executed with each provider.

  3. 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.

  4. Public health care providers and market competition: the case of Finnish occupational health services.

    Science.gov (United States)

    Kankaanpää, Eila; Linnosmaa, Ismo; Valtonen, Hannu

    2011-02-01

    As reforms in publicly funded health systems rely heavily on competition, it is important to know if and how public providers react to competition. In many European countries, it is empirically difficult to study public providers in different markets, but in Finnish occupational health services, both public and private for-profit and non-profit providers co-exist. We studied possible differences in public providers' performance (price, intensity of services, service mix-curative medical services/prevention, productivity and revenues) according to the competitiveness of the market. The Finnish Institute of Occupational Health (FIOH) collected data on clients, services and personnel for 1992, 1995, 1997, 2000 and 2004 from occupational health services (OHS) providers. Employers defray the costs of OHS and apply for reimbursement from the Social Insurance Institution (SII). The SII data was merged with FIOH's questionnaire. The unbalanced panel consisted of about 230 public providers, totalling 1,164 observations. Local markets were constructed from several municipalities based on commuting practices and regional collaboration. Competitiveness of the market was measured by the number of providers and by the Herfindahl index. The effect of competition was studied by ordinary least square regression analysis and panel models. The more competitive the environment was for a public provider the higher were intensity, productivity and the share of medical care. Fixed panel models showed that these differences were not due to differences and changes in the competitiveness of the market. Instead, in more competitive markets public providers had higher unit prices and higher revenues.

  5. “I Am Ready and Willing to Provide the Service … Though My Religion Frowns on Abortion”—Ghanaian Midwives’ Mixed Attitudes to Abortion Services: A Qualitative Study

    Directory of Open Access Journals (Sweden)

    Prince Oppong-Darko

    2017-12-01

    Full Text Available Background: Unsafe abortion is a major preventable public health problem and contributes to high mortality among women. Ghana has ratified international conventions to prevent unwanted pregnancies and provide safe abortion services, legally authorizing midwives to provide induced abortion services in certain circumstances. Objective: The aim of the study was to understand midwives’ readiness to be involved in legal induced abortions, should the law become less restricted in Ghana. Methods: A qualitative study design, with a topic guide for individual in-depth interviews of selected midwives, was adopted. The interviews were tape-recorded and analyzed using content analysis. Results: Participants emphasized their willingness to reduce maternal mortalities, their experiences of maternal deaths, and their passion for the health of pregnant women. Knowledge of Ghana’s abortion law was generally low. Different views were expressed regarding readiness to engage in abortion services. Some expressed it as being sinful and against their religion to assist in abortion care, whilst others felt it was good to save the lives of women. Conclusion: The midwives made it clear that unsafe abortions are common, stigmatizing and contributing to maternal mortality, issues that must be addressed. They made various suggestions to reduce this preventable tragedy.

  6. Pairs of cooperating cleaner fish provide better service quality than singletons.

    Science.gov (United States)

    Bshary, Redouan; Grutter, Alexandra S; Willener, Astrid S T; Leimar, Olof

    2008-10-16

    Service providers may vary service quality depending on whether they work alone or provide the service simultaneously with a partner. The latter case resembles a prisoner's dilemma, in which one provider may try to reap the benefits of the interaction without providing the service. Here we present a game-theory model based on the marginal value theorem, which predicts that as long as the client determines the duration, and the providers cooperate towards mutual gain, service quality will increase in the pair situation. This prediction is consistent with field observations and with an experiment on cleaning mutualism, in which stable male-female pairs of the cleaner wrasse Labroides dimidiatus repeatedly inspect client fish jointly. Cleaners cooperate by eating ectoparasites off clients but actually prefer to cheat and eat client mucus. Because clients often leave in response to such cheating, the benefits of cheating can be gained by only one cleaner during a pair inspection. In both data sets, the increased service quality during pair inspection was mainly due to the smaller females behaving significantly more cooperatively than their larger male partners. In contrast, during solitary inspections, cleaning behaviour was very similar between the sexes. Our study highlights the importance of incorporating interactions between service providers to make more quantitative predictions about cooperation between species.

  7. An Empirical Investigation of Factors Determining the Consumers’ Choice of Mobile Service Providers

    Directory of Open Access Journals (Sweden)

    Vikas Gautam

    2011-12-01

    Full Text Available After the implementation of government policies on globalization and liberalization, the consumers have become more critical about the selection of service providers. Consumers are now very much aware of the alternatives available in relation to services and the provider organizations. Expectations of consumers are rising and the provider organizations should be aware of these expectations. The objective of the present study is to examine the factors responsible for helping the consumers to choose mobile telecommunication service provider among the competitors in the market. The primary statistical techniques used in the study are Exploratory Factor Analysis, and Structural Equation Modeling. The data was collected with the help of structured questionnaire consisting of different questions related to demographics, service quality, product quality and availability, promotion and price in order to study perceptions of consumers. In order to examine these above mentioned variables and to derive meaningful conclusions, use of structural equation modelling was imperative. AMOS (Analysis of Moment Structure version 16.0 was employed in the research to test the underlying hypotheses of the study. Results showed that the paths are significantly related to the casual processes. Price was found to be the most important factor followed by product quality and availability, service quality, and promotion in determining perceptions of customers towards mobile telecommunication services. It is expected that the findings of the study may provide meaningful insights to the service providers and contribute in improving their strategies and marketing operations.

  8. HIV Testing and HIV/AIDS Treatment Services in Rural Counties in 10 Southern States: Service Provider Perspectives

    Science.gov (United States)

    Sutton, Madeline; Anthony, Monique-Nicole; Vila, Christie; McLellan-Lemal, Eleanor; Weidle, Paul J.

    2010-01-01

    Context: Forty percent of AIDS cases are reported in the southern United States, the region with the largest proportion of HIV/AIDS cases from rural areas. Data are limited regarding provider perspectives of the accessibility and availability of HIV testing and treatment services in southern rural counties. Purpose: We surveyed providers in the…

  9. Evaluation of poison information services provided by a new poison information center.

    Science.gov (United States)

    Churi, Shobha; Abraham, Lovin; Ramesh, M; Narahari, M G

    2013-01-01

    The aim of this study is to assess the nature and quality of services provided by poison information center established at a tertiary-care teaching hospital, Mysore. This was a prospective observational study. The poison information center was officially established in September 2010 and began its functioning thereafter. The center is equipped with required resources and facility (e.g., text books, Poisindex, Drugdex, toll free telephone service, internet and online services) to provide poison information services. The poison information services provided by the center were recorded in documentation forms. The documentation form consists of numerous sections to collect information on: (a) Type of population (children, adult, elderly or pregnant) (b) poisoning agents (c) route of exposure (d) type of poisoning (intentional, accidental or environmental) (e) demographic details of patient (age, gender and bodyweight) (f) enquirer details (background, place of call and mode of request) (g) category and purpose of query and (h) details of provided service (information provided, mode of provision, time taken to provide information and references consulted). The nature and quality of poison information services provided was assessed using a quality assessment checklist developed in accordance with DSE/World Health Organization guidelines. Chi-Square test (χ(2)). A total of 419 queries were received by the center. A majority (n = 333; 79.5%) of the queries were asked by the doctors to provide optimal care (n = 400; 95.5%). Most of the queries were received during ward rounds (n = 201; 48.0%), followed by direct access (n = 147; 35.1%). The poison information services were predominantly provided through verbal communication (n = 352; 84.0%). Upon receipt of queries, the required service was provided immediately (n = 103; 24.6%) or within 10-20 min (n = 296; 70.6%). The queries were mainly related to intentional poisoning (n = 258; 64.5%), followed by accidental poisoning

  10. 20 CFR 670.710 - What placement services are provided for Job Corps students?

    Science.gov (United States)

    2010-04-01

    ... Corps students? 670.710 Section 670.710 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR THE JOB CORPS UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Placement and Continued Services § 670.710 What placement services are provided for Job Corps students? (a) Job Corps placement...

  11. A changing landscape: mapping provider organisations for community nursing services in England.

    Science.gov (United States)

    Spilsbury, Karen; Pender, Sue

    2015-01-01

    To scope the provision of community nursing services in England after implementation of the Transforming Community Services Programme. Over the past decade, significant UK policy initiatives have shaped the structure, organisation and responsibilities of community nursing services. Understanding these organisational changes is important in the context of organisations seeking to deliver 'care closer to home'. A systematic mapping exercise to scope and categorise community nursing service organisation provider models. There are 102 provider organisations representing a range of organisational models. Two-thirds of these organisations have structurally integrated with another NHS Trust. Smaller numbers reorganised to form community trusts or community interest companies. Only a few services have been tendered to an accredited willing provider while a small number have yet to establish their new service model. Local discretion appears to have dominated the choice of organisational form. National policies have driven the reorganisation of community nursing services and we have been able to describe, for the first time, these 'transformed' structures and organisations. Providing detail of these 'new' models of service provision, and where these have been introduced, is new information for nurse managers, policy makers and organisational leaders, as well as researchers. © 2013 John Wiley & Sons Ltd.

  12. 42 CFR 136.23 - Persons to whom contract health services will be provided.

    Science.gov (United States)

    2010-10-01

    ... economic and social ties with that tribe or tribes. (b) Students and transients. Subject to the provisions... 42 Public Health 1 2010-10-01 2010-10-01 false Persons to whom contract health services will be provided. 136.23 Section 136.23 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN...

  13. The impact of the business cycle on service providers : Insights from international tourism

    NARCIS (Netherlands)

    Dekimpe, Marnik; Peers, Yuri; van Heerde, H.J.

    For service providers, it is essential to understand how their business is affected by the macroeconomy. This is especially pressing for the tourism sector, the world’s largest export service, because the number of incoming visitors is likely to be strongly determined by the business cycles in the

  14. Superorganism resilience: Eusociality and susceptibility of ecosystem service providing insects to stressors

    Science.gov (United States)

    Insects provide crucial ecosystem services for human food security and maintenance of biodiversity. Therefore, major declines in wild species combined with losses of managed bees have raised concern over the sustainability of their ecosystem services. Recent data suggest that honey bees appear to be...

  15. 20 CFR 641.535 - What services must grantees/subgrantees provide to participants?

    Science.gov (United States)

    2010-04-01

    ... conditions at their community service worksites (OAA sec. 502(b)(1)(J)); (10) Verifying participant income... individuals who only need job search assistance or job referral services. Grantees may provide job search assistance and job club activities to participants who are enrolled in the SCESEP and are assigned to...

  16. Children's Support Services: Providing a System of Care for Urban Preschoolers with Significant Behavioral Challenges

    Science.gov (United States)

    Tewhey, Karen

    2006-01-01

    In this article, the author features the Children's Support Services (CSS) project in Lowell, Massachusetts, which is an interagency, multidisciplinary program that provides young children and their families a range of child development, mental health, and family support services. The CSS project, which was begun in September 2000, addresses the…

  17. The demand attributes of assurance services providers and the role of independent accountants

    NARCIS (Netherlands)

    Knechel, W.R.; Wallage, P.; Eilifsen, A.; van Praag, B.

    2006-01-01

    This study reports on desirable attributes of assurance services providers for assurance services based on responses from a sample of Dutch senior accounting and financial officers. In general, overall expertise and objectivity are perceived as the most important attributes for selecting an

  18. 20 CFR 663.150 - What core services must be provided to adults and dislocated workers?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What core services must be provided to adults... ADMINISTRATION, DEPARTMENT OF LABOR ADULT AND DISLOCATED WORKER ACTIVITIES UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Delivery of Adult and Dislocated Worker Services Through the One-Stop Delivery System § 663...

  19. Application of a Health Service Growth Model to Determine the Management Requirements of Health Service Providers.

    Science.gov (United States)

    1980-09-01

    BACKGROUND AND INTRODUCTION ...... ............. 9 II. APPROACH ......... ...................... 13 Methodology ........ ................... .13 Data...1 N ~12 II. APPROACH Methodology In contemplating which methods were to be used in this study to determine whether a physician or an administrator...system, while sig- nificant, does not have as large a scope. 51 Kaiser is rated highest in provider compensation because the Permanente Medical Group ( PMG

  20. Managing information and knowledge within maternity services: Privacy and consent issues.

    Science.gov (United States)

    Baskaran, Vikraman; Davis, Kim; Bali, Rajeev K; Naguib, Raouf N G; Wickramasinghe, Nilmini

    2013-09-01

    Electronic Patient Records have improved vastly the quality and efficiency of care delivered. However, the formation of single demographic database and the ease of electronic information sharing give rise to many concerns including issues of consent, by whom and how data are accessed and used. This paper examines the organizational and socio-technical issues related to privacy, confidentiality and security when employing electronic records within a maternity service hospital in England. A preliminary questionnaire was administered (n  =  52), in total, 24 responses were received. Sixteen responses were from personnel in the information technology department, 5 from health information department and 3 from midwifery managers. This was followed by a semi-structured interview with representatives from the clinical and technological side. A number of issues related to information governance (IG) have been identified, especially breaches on sharing personal information without consent from the patients have been identified as one immediate challenge that needs to be fixed. There is an immediate need for more robust, realistic, built-in accountability both locally and nationally on data sharing. A culture of ownership and strict adherence to IG principles is paramount. Focused training in the area of data, information and knowledge sharing will bring in a balance of legitimate usage against the individual's rights to confidentiality and privacy.

  1. CE: Original Research: Primary Care Providers and Screening for Military Service and PTSD.

    Science.gov (United States)

    Mohler, Kristin Michelle; Sankey-Deemer, Cydnee

    2017-11-01

    : Background: Most veterans have the option of receiving their health care from the Veterans Health Administration or through primary care providers in the private sector. However, there is some evidence that fewer than half of community-based, private sector primary care and mental health providers screen their patients for military service, particularly in rural areas, leaving these veterans less likely to be screened for posttraumatic stress disorder (PTSD) and other military service-related conditions. To determine whether primary care providers in the private sector are screening patients for military service and subsequent PTSD. We designed and piloted a survey to determine whether primary care providers in a rural Pennsylvania region routinely screen for military service and service-related PTSD. We distributed the survey to a convenience sample of more than 250 primary care providers in central and western Pennsylvania through the U.S. Postal Service, via Facebook, and via work e-mails for those who worked in a local health system. Among 50 eligible respondents, only four (8%) said they screen all their patients for military service, and 20 (40%) reported screening none; only two respondents (4%) screened all their patients who have served in the military for PTSD, and 30 (60%) screened none. Veterans who rely on private sector providers may not receive evidence-based care for military service-related health problems, including PTSD. To improve care for these patients, providers in the private sector should be educated on why all patients should be screened for military service, how to conduct such screening properly, and veterans' general health concerns.

  2. Provider Perception of Pharmacy Services in the Patient-Centered Medical Home.

    Science.gov (United States)

    Albanese, Nicole P; Pignato, Alyssa M; Monte, Scott V

    2017-12-01

    Despite the positive data on clinical outcomes, cost savings, and provider experience, no study has surveyed providers to evaluate what pharmacy services they find to be worthwhile. To determine what clinical, cost/access, and educational pharmacy services providers in a patient-centered medical home (PCMH) consider worthwhile and the perceived barriers to successful pharmacist incorporation. A cross-sectional online survey was distributed to primary care physicians, nurse practitioners, and physician assistants in a PCMH physician group. The survey response rate was 78%. Top-tier clinical services were identified as medication counseling, reconciliation, adherence assessment, polypharmacy assessment, and drug information. Formulary review was the only top-tier cost- or access-related service. Top-tier educational services included new black-boxed warnings, drug market withdrawals, and new drug reviews. Ninety-one percent of providers were comfortable referring to a pharmacist for diabetes medication selection and dose titration, but no other disease state eclipsed 75%. More than twice as many providers found the pharmacy service to be very or extremely valuable when the pharmacist is physically located in the office versus virtual interactions (70% vs 34%). Top-tier clinical, cost/access, and educational services considered worthwhile by providers in a PCMH have been identified. In addition to these services, when developing or evaluating a pharmacy service, special attention should be paid to provider preference for physical location in the office and perceived barriers to the pharmacist availability, concern over complex disease management competency and patient confusion as to the role of the pharmacist.

  3. Maternal obesity support services: a qualitative study of the perspectives of women and midwives

    Directory of Open Access Journals (Sweden)

    Dearden Andy M

    2011-10-01

    Full Text Available Abstract Background Twenty percent of pregnant women in the UK are obese (BMI ≥ 30 kg/m2, reflecting the growing public health challenge of obesity in the 21st century. Obesity increases the risk of adverse outcomes during pregnancy and birth and has significant cost implications for maternity services. Gestational weight management strategies are a high priority; however the evidence for effective, feasible and acceptable weight control interventions is limited and inconclusive. This qualitative study explored the experiences and perceptions of pregnant women and midwives regarding existing support for weight management in pregnancy and their ideas for service development. Methods A purposive sample of 6 women and 7 midwives from Doncaster, UK, participated in two separate focus groups. Transcripts were analysed thematically. Results Two overarching themes were identified, 'Explanations for obesity and weight management' and 'Best care for pregnant women'. 'Explanations' included a lack of knowledge about weight, diet and exercise during pregnancy; self-talk messages which excused overeating; difficulties maintaining motivation for a healthy lifestyle; the importance of social support; stigmatisation; and sensitivity surrounding communication about obesity between midwives and their clients. 'Best care' suggested that weight management required care which was consistent and continuous, supportive and non-judgemental, and which created opportunities for interaction and mutual support between obese pregnant women. Conclusions Women need unambiguous advice regarding healthy lifestyles, diet and exercise in pregnancy to address a lack of knowledge and a tendency towards unhelpful self-talk messages. Midwives expressed difficulties in communicating with their clients about their weight, given awareness that obesity is a sensitive and potentially stigmatising issue. This indicates more could be done to educate and support them in their work with

  4. 75 FR 22263 - Reexamination of Roaming Obligations of Commercial Mobile Radio Service Providers

    Science.gov (United States)

    2010-04-28

    ..., including in rural and remote areas. However, the Commission ] is not persuaded that replacing the current... consumers based on their perception of push-to-talk services as provided in the marketplace. As the...

  5. Customized power quality service provided by converter interfaced microgrids — Voltage harmonics as a study case

    DEFF Research Database (Denmark)

    Meng, Lexuan; Chaudhary, Sanjay K.; Guerrero, Josep M.

    2017-01-01

    Customers may have different power quality requirements, thus, the economic operational strategy can try to provide them with distinctive quality levels as customized service. An optimization based method is proposed in this paper to realize this functionality, offering the possibility...

  6. Dutch Logistics Service Providers and Sustainable Physical Distribution: Searching for Focus

    NARCIS (Netherlands)

    Pieters, R.; Glöckner, H.H.; Omta, S.W.F.; Weijers, S.

    2012-01-01

    As environmental concerns becoming increasingly important to logistics service providers, the question arises as to how they can achieve sustainable physical distribution practices while surviving the severe competition in freight transport. This issue is further complicated by the pressures from

  7. Dutch logistics service providers and sustainable physical distribution : Searching for focus

    NARCIS (Netherlands)

    Onno Omta; Hans-Heinrich Glöckner; Reinder Pieters; Stef Weijers

    2013-01-01

    As environmental concerns becoming increasingly important to logistics service providers, the question arises as to how they can achieve sustainable physical distribution practices while surviving the severe competition in freight transport. This issue is further complicated by the pressures from

  8. Dutch Logistics Service Providers and Sustainable Physical Distribution: Searching for Focus

    NARCIS (Netherlands)

    Pieters, R.; Glöckner, H.H.; Omta, S.W.F.; Weijers, S.

    2013-01-01

    As environmental concerns becoming increasingly important to logistics service providers, the question arises as to how they can achieve sustainable physical distribution practices while surviving the severe competition in freight transport. This issue is further complicated by the pressures from

  9. Equity in maternal- and infant-care services in China: A trend analysis based on residence and area (2000-2014).

    Science.gov (United States)

    Liang, Hong; Fang, Shuai; Liu, Shanshan; Liu, Xinyu; Li, Yanting; Li, Ming; Zhang, Yimin

    2017-07-01

    Equity in maternal- and infant-care services is key to achieving equity in maternal and infant health outcomes. In this study, 12 indicators of maternal and infant services were selected to measure equity in maternal and infant services in China from 2000-2014 using the Theil index and between-group variance, with the result showing that equity has improved steadily and significantly, though serious inequities in premarital and reproductive health services remain. Relatively speaking, equity at the interprovincial level has increased, but equity in urban-rural stratification has improved more, indicating that policies should focus on interprovincial inequities and premarital and reproductive health services. Copyright © 2017 John Wiley & Sons, Ltd.

  10. 49 CFR 40.289 - Are employers required to provide SAP and treatment services to employees?

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 1 2010-10-01 2010-10-01 false Are employers required to provide SAP and... Professionals and the Return-to-Duty Process § 40.289 Are employers required to provide SAP and treatment services to employees? (a) As an employer, you are not required to provide a SAP evaluation or any...

  11. Occupational Safety Management Framework for Healthcare and Social Assistance Service Providers

    OpenAIRE

    Edorisiagbon, James

    2015-01-01

    This thesis focuses on improving safety management for healthcare and social assistance service providers who deliver healthcare for patients and client in Healthcare and Social centers and homes. The quality of these provided services is dependent heavily on attitudes and well-being of its care workers and staff. Therefore, healthcare and social assistant workers’ (HCSA) safety is crucial to the quality of patient care, though it remains a challenge in countries of various levels of developm...

  12. Potential For Plug-In Electric Vehicles To Provide Grid Support Services

    Energy Technology Data Exchange (ETDEWEB)

    Dias, F. G.; Luo, Y.; Mohanpurkar, M.; Hovsapian, R.; Scoffield, D.

    2017-04-01

    Since the modern-day introduction of plug-in electric vehicles (PEVs), scientists have proposed leveraging PEV battery packs as distributed energy resources for the electric grid. PEV charging can be controlled not only to provide energy for transportation but also to provide grid services and to facilitate the integration of renewable energy generation. With renewable generation increasing at an unprecedented rate, most of which is non-dispatchable and intermittent, the concept of using PEVs as controllable loads is appealing to electric utilities. This additional functionality could also provide value to PEV owners and drive PEV adoption. It has been widely proposed that PEVs can provide valuable grid services, such as load shifting to provide voltage regulation. The objective this work is to address the degree to which PEVs can provide grid services and mutually benefit the electric utilities, PEV owners, and auto manufacturers.

  13. Human‐Centered Design: Integrating Services & Systems Around People By Providing A Common Ground for Action

    DEFF Research Database (Denmark)

    Junginger, Sabine

    2014-01-01

    to both professional fields. Yet, how human‐centered design is being practiced and applied depends on the interpretation of the concept, or the “designer’s stance” (Buchanan 2011). In this paper, I trace the shifts in design thinking and the role of people in service engineering and in service design. I...... argue that human-centered design challenges the systems view of service engineers and service designers and requires them to reach out to each other. For this reason, I conclude that for these two disciplines, human-centered design provides a common ground for purposeful action: to arrive at the best......Service engineering and service design, though distinct in their origins, theories, concepts, methods and practices, share that they are both consequential productive arts for people who depend on their outcomes. The ideas, methods and practices of human‐centred design are therefore relevant...

  14. Value-Added Electricity Services: New Roles for Utilities and Third-Party Providers

    Energy Technology Data Exchange (ETDEWEB)

    Blansfield, J. [Inst. for Electric Innovations, Washington, DC (United States); Wood, L. [Inst. for Electric Innovations, Washington, DC (United States); Katofsky, R. [Advanced Energy Economy, Washington, DC (United States); Stafford, B. [Advanced Energy Economy, Washington, DC (United States); Waggoner, D. [Advanced Energy Economy, Washington, DC (United States); Schwartz, L. C. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2017-10-30

    New energy generation, storage, delivery, and end-use technologies support a broad range of value-added electricity services for retail electricity customers. Sophisticated energy management services, distributed generation coupled with storage, and electric vehicle charging are just a few examples of emerging offerings. Who should provide value-added services — utilities or third parties, or both, and under what conditions? What policy and regulatory changes may be needed to promote competition and innovation, to account for utility costs to enable these services, and to protect consumers? The report approaches the issues from three perspectives: utilities, third-party service providers, and consumers: -Jonathan Blansfield and Lisa Wood, Institute for Electric Innovation -Ryan Katofsky, Benjamin Stafford and Danny Waggoner, Advanced Energy Economy -National Association of State Utility Consumer Advocates

  15. RATIONALIZING TRANSPORTATIONS SERVICE: A CASE STUDY ON THE STANDARDIZATION OF LOGISTICS SERVICE PROVIDERS

    Directory of Open Access Journals (Sweden)

    Clayton de Oliveira Pires

    2016-07-01

    Full Text Available Due to high competitiveness on supply chains, small economies tend to become very important to overall costs reduction and represent marketing gains. The aim of this study is to analyze if the rationalization in low value deliveries, lower than R$ 2,000.00, will be able to generate a considerable cut of costs. To perform this exploratory study, company historic was analyzed and surveys were performed with several suppliers. The studies showed it is possible to reduce freight average impact in relation to the sold value at 44.03%. This result points to the advantages in coordinating more rationally the process of hiring transportation providers.

  16. Providing effective trauma care: the potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study).

    Science.gov (United States)

    Beckett, Kate; Earthy, Sarah; Sleney, Jude; Barnes, Jo; Kellezi, Blerina; Barker, Marcus; Clarkson, Julie; Coffey, Frank; Elder, Georgina; Kendrick, Denise

    2014-07-08

    To explore views of service providers caring for injured people on: the extent to which services meet patients' needs and their perspectives on factors contributing to any identified gaps in service provision. Qualitative study nested within a quantitative multicentre longitudinal study assessing longer term impact of unintentional injuries in working age adults. Sampling frame for service providers was based on patient-reported service use in the quantitative study, patient interviews and advice of previously injured lay research advisers. Service providers' views were elicited through semistructured interviews. Data were analysed using thematic analysis. Participants were recruited from a range of settings and services in acute hospital trusts in four study centres (Bristol, Leicester, Nottingham and Surrey) and surrounding areas. 40 service providers from a range of disciplines. Service providers described two distinct models of trauma care: an 'ideal' model, informed by professional knowledge of the impact of injury and awareness of best models of care, and a 'real' model based on the realities of National Health Service (NHS) practice. Participants' 'ideal' model was consistent with standards of high-quality effective trauma care and while there were examples of services meeting the ideal model, 'real' care could also be fragmented and inequitable with major gaps in provision. Service provider accounts provide evidence of comprehensive understanding of patients' needs, awareness of best practice, compassion and research but reveal significant organisational and resource barriers limiting implementation of knowledge in practice. Service providers envisage an 'ideal' model of trauma care which is timely, equitable, effective and holistic, but this can differ from the care currently provided. Their experiences provide many suggestions for service improvements to bridge the gap between 'real' and 'ideal' care. Using service provider views to inform service design

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

    Science.gov (United States)

    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

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

    Directory of Open Access Journals (Sweden)

    Debra Bick

    Full Text Available 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

  19. Assessing Capacity for Providing Culturally Competent Services to LGBT Older Adults

    Science.gov (United States)

    Portz, Jennifer Dickman; Retrum, Jessica H.; Wright, Leslie A.; Boggs, Jennifer M.; Wilkins, Shari; Grimm, Cathy; Gilchrist, Kay; Gozansky, Wendolyn S.

    2014-01-01

    This qualitative, interview-based study assessed the cultural competence of health and social service providers to meet the needs of LGBT older adults in an urban neighborhood in Denver, Colorado, known to have a large LGBT community. Only 4 of the agencies were categorized as “high competency” while 12 were felt to be “seeking improvement” and 8 were considered “not aware.” These results indicate significant gaps in cultural competency for the majority of service providers. Social workers are well-suited to lead efforts directed at improving service provision and care competencies for the older LGBT community. PMID:24798180

  20. Assessing capacity for providing culturally competent services to LGBT older adults.

    Science.gov (United States)

    Portz, Jennifer Dickman; Retrum, Jessica H; Wright, Leslie A; Boggs, Jennifer M; Wilkins, Shari; Grimm, Cathy; Gilchrist, Kay; Gozansky, Wendolyn S

    2014-01-01

    This qualitative, interview-based study assessed the cultural competence of health and social service providers to meet the needs of LGBT older adults in an urban neighborhood in Denver, Colorado, known to have a large LGBT community. Only 4 of the agencies were categorized as "high competency"; 12 were felt to be "seeking improvement" and 8 were considered "not aware." These results indicate significant gaps in cultural competency for the majority of service providers. Social workers are well-suited to lead efforts directed at improving service provision and care competencies for the older LGBT community.

  1. Key Factors of Quality in the Sector of Tourism Services Providers: Case Study: Czech Republic

    Directory of Open Access Journals (Sweden)

    Ida Vajčnerová

    2014-01-01

    Full Text Available The paper summarizes main results of partial research aimed at detection of the key factors affecting quality in the sector of tourism services providers, namely tour operators and travel agencies. A primary questionnaire survey was conducted; the researched factors were distributed in the context of service quality dimensions (Grönroos model; the dimensions were tested in relation to sex, age and education of the respondents (ANOVA; Brown-Forsythe test. Assurance was identified as the most important dimension. The output of the study is determining the significance of individual quality factors from the perspective of a potential customer when selecting a service provider.

  2. Participant and service provider perceptions of an outpatient rehabilitation program for people with acquired brain injury.

    Science.gov (United States)

    Poncet, Frédérique; Pradat-Diehl, Pascale; Lamontagne, Marie-Eve; Alifax, Anne; Fradelizi, Pascaline; Barette, Maude; Swaine, Bonnie

    2017-09-01

    A holistic, intensive and interdisciplinary rehabilitation program for people with acquired brain injury (ABI) was developed at the Pitié-Salpêtrière Hospital, France (5 days/week for 7 weeks). This program, recently demonstrated effective, aimed to optimize the ability of people with ABI to perform activities and improve their participation by using individual and group interventions involving ecologically valid activities inside (e.g., in the gym and kitchen) and outside the hospital. However, the perception of the quality of the program by participants and service providers has not yet been reported. This study had 3 objectives: (1) report the perception of participants (adults with ABI) in terms of service quality of the program, (2) report the strengths, weaknesses, opportunities, and threats (SWOT analysis) of the program as perceived by service providers, and (3) triangulate findings to draw conclusions about the program's quality and provide recommendations for quality improvement. We used a mixed-methods design with a validated questionnaire (Perception of Quality of Rehabilitation Services [PQRS-Montreal]) and interviews (structured around a SWOT analysis) involving program participants and service providers. We included 33 program participants (mean age 43.6 years) and 12 service providers (mean years with program 7.6 years). In general, study participants showed a convergence of opinion about the high quality of the program, particularly regarding the team and its participant-focused approach. Specific aspects of the program were viewed more negatively by both participants and service providers (i.e., addressing sexuality, family involvement and return to work/volunteer work/school). Participant and service provider perceptions of the rehabilitation program under study were generally positive. A reliable and valid questionnaire and interviews helped identify aspects of the program that worked well and those that could be targeted for future quality

  3. Live attenuated influenza vaccine provides superior protection from heterologous infection in pigs with maternal antibodies without inducing vaccine associated enhanced respiratory disease (VAERD)

    Science.gov (United States)

    Control of swine influenza A virus (IAV) in the US is hindered since inactivated vaccines do not provide robust cross-protection against the multiple antigenic variants co-circulating in the field. Vaccine efficacy can be further limited when administered to young pigs that possess maternally deriv...

  4. Residential immersive life skills programs for youth with disabilities: service providers' perceptions of change processes.

    Science.gov (United States)

    King, Gillian; McPherson, Amy; Kingsnorth, Shauna; Stewart, Debra; Glencross-Eimantas, Tanya; Jones-Galley, Kimberlea; Morrison, Andrea; Isihi, Ana Maria; Gorter, Jan Willem

    2015-05-01

    Residential immersive life skills (RILS) programs are designed to equip youth with physical disabilities with the foundational life skills required to assume adult roles. The objective was to determine RILS service providers' perceptions of the active ingredients of the intervention change process. Thirty-seven service providers from various disciplines completed measures to assess expertise status and participated in qualitative interviews. Qualitative themes were derived, and similarities and differences in themes were identified for blinded groups of novices, intermediates, and experts. The three main themes, reflecting change processes, were: (a) creating a supportive program atmosphere with multiple opportunities for learning, (b) using strategies to support, encourage, and engage youth, and (c) intentionally fostering youth experiences of skill development, social interaction, and pride in accomplishment. In contrast to the novices, experts displayed a more holistic perspective and paid attention to higher-order issues such as providing opportunities and enabling youth. The findings indicate how RILS service providers work to create a program atmosphere and employ strategies to intentionally foster particular youth experiences. The findings explicate service providers' theories of practice, the intentional design of RILS program environments to bring about client change, and the value of service provider expertise. Implications for Rehabilitation Service providers of youth independence-oriented life skills programs can intentionally create a learning-oriented and supportive program atmosphere by using non-directive, coaching/guiding, and engagement strategies Youth experiences of skill development, shared experience with others, and pride in accomplishment can be cultivated by providing a range of learning opportunities, including choice making, problem-solving, and skill mastery Compared to more novice service providers, experts discussed managing the

  5. Knowledge, attitudes, and practices of private sector immunization service providers in Gujarat, India.

    Science.gov (United States)

    Hagan, José E; Gaonkar, Narayan; Doshi, Vikas; Patni, Anas; Vyas, Shailee; Mazumdar, Vihang; Kosambiya, J K; Gupta, Satish; Watkins, Margaret

    2018-01-02

    India is responsible for 30% of the annual global cohort of unvaccinated children worldwide. Private practitioners provide an estimated 21% of vaccinations in urban centers of India, and are important partners in achieving high vaccination coverage. We used an in-person questionnaire and on-site observation to assess knowledge, attitudes, and practices of private immunization service providers regarding delivery of immunization services in the urban settings of Surat and Baroda, in Gujarat, India. We constructed a comprehensive sampling frame of all private physician providers of immunization services in Surat and Baroda cities, by consulting vaccine distributors, local branches of physician associations, and published lists of private medical practitioners. All providers were contacted and asked to participate in the study if they provided immunization services. Data were collected using an in-person structured questionnaire and directly observing practices; one provider in each practice setting was interviewed. The response rate was 82% (121/147) in Surat, and 91% (137/151) in Baroda. Of 258 participants 195 (76%) were pediatricians, and 63 (24%) were general practitioners. Practices that were potential missed opportunities for vaccination (MOV) included not strictly following vaccination schedules if there were concerns about ability to pay (45% of practitioners), and not administering more than two injections in the same visit (60%). Only 22% of respondents used a vaccination register to record vaccine doses, and 31% reported vaccine doses administered to the government. Of 237 randomly selected vaccine vials, 18% had expired vaccine vial monitors. Quality of immunization services in Gujarat can be strengthened by providing training and support to private immunization service providers to reduce MOVs and improve quality and safety; other more context specific strategies that should be evaluated may involve giving feedback to providers on quality of services

  6. Is the role of Health Extension Workers in the delivery of maternal and child health care services a significant attribute? The case of Dale district, southern Ethiopia.

    Science.gov (United States)

    Negussie, Abel; Girma, Gedion

    2017-09-11

    The Health Extension Program (HEP) is one of the most innovative community based health program launched by the Ethiopian Federal Ministry of Health to make health services accessible to rural communities by setting-out women Health Extension Workers (HEWs) in rural Health Posts. The HEWs are premised to provide basic, largely preventive, primary health services to rural villages and the program gives special attention to children and mothers. The objective of the study was to assess the contribution made by the Health Extension Workers in maternal and child health care service delivery in Dale district, southern Ethiopia. Using a community based cross-sectional data; the study assessed the status of mother's health service utilization and estimated the role of HEWs in maternal and child health care delivery. Mothers of reproductive age (15-49), having at least one under-five age child, were eligible for the study. The total sample size was 617 and systemic random sampling method was used to select the study subjects from each randomly selected kebeles (lower administrative units). Structured questionnaire was applied to collect data through interviewing of the selected mothers and the data were analysed using SPSS version 16 statistical software. Health Posts are important health care delivery settings and their share from the overall service delivery of ANC, Family planning and child treatment services were pivotal. However, overall service coverage of ANC (four and more visits), delivery and PNC services were low in the district as compared to the national status; and the input from the HEWs, in this regard, was unsatisfactory. The number of home visits was also inadequate for the necessary support of the mothers. The results of the multiple logistic regression indicated that mothers who listen to the radio (AOR 4.62; CI 1.66-12.85) and who had received information about the MCH services by HEWs (AOR 2.09; CI 1.06-4.14) were significantly associated with good

  7. Male Involvement in Maternal Health Planning Key to Utilization of Skilled Birth Services in Malindi Subcounty, Kenya

    Directory of Open Access Journals (Sweden)

    Lilian Nyamusi Nyandieka

    2016-01-01

    Full Text Available Background. In Malindi, rural populations face challenges in accessing skilled birth services. Consequently, the majority of women deliver at home and only seek help when they have complications. This paper reports part findings from a study conducted to assess health priority setting process and its implication on availability, access, and use of emergency obstetric care services in Malindi. Methods. The study utilized qualitative methods to collect data from health personnel and maternal health stakeholders including community members. Source and method triangulation was used to strengthen the credibility of study findings. Data was categorized manually into themes around issues relating to utilization of skilled birth services discussed in this paper. Findings. Various barriers to utilization of skilled birth services were cited. However, most were linked to mwenye (the husband who decides on the place of birth for the wife. Conclusion. Husbands are very influential in regard to decisions on skilled birth service utilization in this community. Their lack of involvement in maternal health planning may contribute as a barrier to utilization of skilled care by pregnant women. There is need to address the mwenye factor in an attempt to mitigate some of the barriers cited for nonutilization of skilled birth services.

  8. A service concept and tools to improve maternal and newborn health in Nigeria and Uganda.

    Science.gov (United States)

    Salgado, Mariana; Wendland, Melanie; Rodriguez, Damaris; Bohren, Meghan A; Oladapo, Olufemi T; Ojelade, Olubunmi A; Mugerwa, Kidza; Fawole, Bukola

    2017-12-01

    The "Better Outcomes in Labor Difficulty" (BOLD) project used a service design process to design a set of tools to improve quality of care during childbirth by strengthening linkages between communities and health facilities in Nigeria and Uganda. This paper describes the Passport to Safer Birth concept and the tools developed as a result. Service design methods were used to identify facilitators and barriers to quality care, and to develop human-centered solutions. The service design process had three phases: Research for Design, Concept Design, and Detail Design, undertaken in eight hospitals and catchment communities. The service concept "Better Beginnings" comprises three tools. The "Pregnancy Purse" provides educational information to women throughout pregnancy. The "Birth Board" is a visual communication tool that presents the labor and childbirth process. The "Family Pass" is a set of wearable passes for the woman and her supporter to facilitate communication of care preferences. The Better Beginnings service concept and tools form the basis for the promotion of access to information and knowledge acquisition, and could improve communication between the healthcare provider, the woman, and her family during childbirth. © 2017 International Federation of Gynecology and Obstetrics. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

  9. Determinants of patterns of maternal and child health service utilization in a rural community in south eastern Nigeria

    Directory of Open Access Journals (Sweden)

    C. C. Agunwa

    2017-11-01

    Full Text Available Abstract Background Women and children constitute a large proportion of any population. They are the most vulnerable to morbidity and mortality especially in developing countries. In many situations the problem of poor maternal and child health stems from the poor use of available services even when they are not of optimum quality. This study seeks to describe the patterns of utilization of Maternal and Child health (MCH services in a rural area of Enugu State, and identify factors that are associated with and responsible for determining them. Methods The study used a cross sectional analytic design. Pretested semi structured questionnaires were administered by interviewers to 602 women from a rural community in Enugu state, South east Nigeria. Two focus group discussions (FGDs involving 8–10 men/ women each were conducted to identify factors affecting service utilization. Chi square analysis was done to identify factors associated with Maternal and Child Health services utilization. Logistic regression was used to identify determinants of utilization patterns. N vivo software was used to analyze findings of the FGDs. Results The study revealed that increasing age, educational level, monthly income, number of children and occupation of both women and their husbands were associated with increased MCH service utilization. Average monthly income (OR: 1.317, p = 0.048, CI: 0.073–0.986 and number of children (OR: 1.196, p < 0.01,CI: 1.563–7.000 were determinants of increased use of child care services while educational level (OR: 0.495, p < 0.001, CI: 1.244–2.164 and age (OR: 0.115, p < 0.001, CI: 0.838–0.948 determined better use of delivery and family planning services respectively. Conclusions Improved use of MCH services is related to socio economic challenges women face such as illiteracy and low income. Furthermore, the way health facilities and their staff are perceived by rural women affect how they use some of these

  10. The services provided to young people through the headspace centres across Australia.

    Science.gov (United States)

    Rickwood, Debra J; Telford, Nic R; Mazzer, Kelly R; Parker, Alexandra G; Tanti, Chris J; McGorry, Patrick D

    2015-06-01

    To describe the services provided to young people aged 12-25 years who attend headspace centres across Australia, and how these services are being delivered. A census of headspace clients commencing an episode of care between 1 April 2013 and 31 March 2014. All young people first attending one of the 55 fully established headspace centres during the data collection period (33,038 young people). Main reason for presentation, wait time, service type, service provider type, funding stream. Most young people presented for mental health problems and situational problems (such as bullying or relationship problems); most of those who presented for other problems also received mental health care services as needed. Wait time for the first appointment was 2 weeks or less for 80.1% of clients; only 5.3% waited for more than 4 weeks. The main services provided were a mixture of intake and assessment and mental health care, provided mainly by psychologists, intake workers and allied mental health workers. These were generally funded by the headspace grant and the Medicare Benefits Schedule. headspace centres are providing direct and indirect access to mental health care for young people.

  11. Keeping confidence: HIV and the criminal law from HIV service providers' perspectives.

    Science.gov (United States)

    Dodds, Catherine; Weait, Matthew; Bourne, Adam; Egede, Siri

    2015-08-08

    We present qualitative research findings about how perceptions of criminal prosecutions for the transmission of HIV interact with the provision of high-quality HIV health and social care in England and Wales. Seven focus groups were undertaken with a total of 75 diverse professionals working in clinical and community-based services for people with HIV. Participants' understanding of the law in this area was varied, with many knowing the basic requirements for a prosecution, yet lacking confidence in the best way to communicate key details with those using their service. Prosecutions for HIV transmission have influenced, and in some instances, disrupted the provision of HIV services, creating ambivalence and concern among many providers about their new role as providers of legal information. The way that participants approached the topic with service users was influenced by their personal views on individual and shared responsibility for health, their concerns about professional liability and their degree of trust in non-coercive health promotion approaches to managing public health. These findings reveal an underlying ambivalence among many providers about how they regard the interface between criminal law, coercion and public health. It is also apparent that in most HIV service environments, meaningful exploration of practical ethical issues is relatively rare. The data presented here will additionally be of use to managers and providers of HIV services in order that they can provide consistent and confident support and advice to people with HIV.

  12. Opportunities and Challenges for Water and Wastewater Industries to Provide Exchangeable Services

    Energy Technology Data Exchange (ETDEWEB)

    Sparn, Bethany [National Renewable Energy Lab. (NREL), Golden, CO (United States); Hunsberger, Randolph [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2015-11-13

    Water and wastewater treatment plants and distribution systems use significant amounts of energy, around 2 - 4% of the total electricity used in the US, and their energy use is projected to increase as populations increase and regulations become more stringent. Water and wastewater systems have largely been disconnected from the electric utilities' efforts to improve energy efficiency and provide energy efficiency and provide grid services, likely because their core mission is to provide clean water and treated wastewater. Energy efficiency has slowly crept into the water and wastewater industry as the economic benefit has become more apparent, but there is still potential for significant improvement. Some of the larger, more progressive water utilities are starting to consider providing grid services; however, it remains a foreign concept to many. This report explores intrinsic mechanisms by which the water and wastewater industries can provide exchangeable services, the benefit to the parties involved, and the barriers to implementation. It also highlights relevant case studies and next steps. Although opportunities for increasing process efficiencies are certainly available, this report focuses on the exchangeable services that water and wastewater loads can provide to help maintain grid reliability, keep overall costs down, and increase the penetration of distributed renewables on the electric grid. These services have potential to provide water utilities additional value streams, using existing equipment with modest or negligible upgrade cost.

  13. Evaluating ecosystem services provided by non-native species: an experimental test in California grasslands.

    Science.gov (United States)

    Stein, Claudia; Hallett, Lauren M; Harpole, W Stanley; Suding, Katharine N

    2014-01-01

    The concept of ecosystem services--the benefits that nature provides to human's society--has gained increasing attention over the past decade. Increasing global abiotic and biotic change, including species invasions, is threatening the secure delivery of these ecosystem services. Efficient evaluation methods of ecosystem services are urgently needed to improve our ability to determine management strategies and restoration goals in face of these new emerging ecosystems. Considering a range of multiple ecosystem functions may be a useful way to determine such strategies. We tested this framework experimentally in California grasslands, where large shifts in species composition have occurred since the late 1700's. We compared a suite of ecosystem functions within one historic native and two non-native species assemblages under different grazing intensities to address how different species assemblages vary in provisioning, regulatory and supporting ecosystem services. Forage production was reduced in one non-native assemblage (medusahead). Cultural ecosystem services, such as native species diversity, were inherently lower in both non-native assemblages, whereas most other services were maintained across grazing intensities. All systems provided similar ecosystem services under the highest grazing intensity treatment, which simulated unsustainable grazing intensity. We suggest that applying a more comprehensive ecosystem framework that considers multiple ecosystem services to evaluate new emerging ecosystems is a valuable tool to determine management goals and how to intervene in a changing ecosystem.

  14. Evaluating ecosystem services provided by non-native species: an experimental test in California grasslands.

    Directory of Open Access Journals (Sweden)

    Claudia Stein

    Full Text Available The concept of ecosystem services--the benefits that nature provides to human's society--has gained increasing attention over the past decade. Increasing global abiotic and biotic change, including species invasions, is threatening the secure delivery of these ecosystem services. Efficient evaluation methods of ecosystem services are urgently needed to improve our ability to determine management strategies and restoration goals in face of these new emerging ecosystems. Considering a range of multiple ecosystem functions may be a useful way to determine such strategies. We tested this framework experimentally in California grasslands, where large shifts in species composition have occurred since the late 1700's. We compared a suite of ecosystem functions within one historic native and two non-native species assemblages under different grazing intensities to address how different species assemblages vary in provisioning, regulatory and supporting ecosystem services. Forage production was reduced in one non-native assemblage (medusahead. Cultural ecosystem services, such as native species diversity, were inherently lower in both non-native assemblages, whereas most other services were maintained across grazing intensities. All systems provided similar ecosystem services under the highest grazing intensity treatment, which simulated unsustainable grazing intensity. We suggest that applying a more comprehensive ecosystem framework that considers multiple ecosystem services to evaluate new emerging ecosystems is a valuable tool to determine management goals and how to intervene in a changing ecosystem.

  15. Eating disorder services for young people in Ireland: perspectives of service providers, service users and the general adolescent population

    OpenAIRE

    McNicholas, F; O’Connor, C; McNamara, N; O’Hara, L

    2015-01-01

    Objectives: This paper illuminates how national eating disorder (ED) policy translates into day-to-day practice by exploring how ED services are experienced by those who deliver and use them. Methods: A mixed-methods approach was used, which combined qualitative and quantitative techniques. The paper collates data from three studies: (i) an interview study exploring the lived experiences of young people with EDs (n =8), their parents (n =5) and their healthcare professionals (n =3); (ii) a na...

  16. Transparency of Mandatory Information Disclosure and Concerns of Health Services Providers and Consumers

    Directory of Open Access Journals (Sweden)

    Yu-Hua Yan

    2017-01-01

    Full Text Available Background: This study analyzed differences between transparency of information disclosure and related demands from the health service consumer’s perspective. It also compared how health service providers and consumers are associated by different levels of mandatory information disclosure. Methods: We obtained our research data using a questionnaire survey (health services providers, n = 201; health service consumers, n = 384. Results: Health service consumers do not have major concerns regarding mandatory information disclosure. However, they are concerned about complaint channels and settlement results, results of patient satisfaction surveys, and disclosure of hospital financial statements (p < 0.001. We identified significant differences in health service providers’ and consumers’ awareness regarding the transparency of information disclosure (p < 0.001. Conclusions: It may not be possible for outsiders to properly interpret the information provided by hospitals. Thus, when a hospital discloses information, it is necessary for the government to consider the information’s applicability. Toward improving medical expertise and information asymmetry, the government has to reduce the burden among health service consumers in dealing with this information, and it has to use the information effectively.

  17. Monitoring consumer satisfaction with the clinical services provided to 'exceptional' children.

    Science.gov (United States)

    Sommers, P A; Nycz, G R

    1978-09-01

    Given recent federal and state legislation mandating all necessary services for children with handicapping conditions, it is incumbent upon the providers of health care services to demonstrate accountability for their services to children with special needs. A procedure to assess the satisfaction of parents and community-based case coordinators with clinical services provided to such children has been demonstrated. By focusing on specific service elements, it is possible to align optimum versus actual consumer satisfaction. Through an analysis of observed variance, the modification of documented weaknesses can decrease the difference between optimum and actual consumer satisfaction levels. This procedure will be continued on a bi-annual, longitudinal follow-up basis to monitor progress. The concept of consumer input into the provision of clinical services is relevant to other developments in the field of health care which place importance on administration accountability. Those health care providers who recognize the value of consumer input and allow for its incorporation into their service programs will be better able to adapt their systems to the emerging trend towards medical accountability. Self-ordered accountability is more meaningful, is easier to understand than government imposed regulations, and can be smoothly blended into an organization's goals and objectives.

  18. Value-added strategy models to provide quality services in senior health business.

    Science.gov (United States)

    Yang, Ya-Ting; Lin, Neng-Pai; Su, Shyi; Chen, Ya-Mei; Chang, Yao-Mao; Handa, Yujiro; Khan, Hafsah Arshed Ali; Elsa Hsu, Yi-Hsin

    2017-06-20

    The rapid population aging is now a global issue. The increase in the elderly population will impact the health care industry and health enterprises; various senior needs will promote the growth of the senior health industry. Most senior health studies are focused on the demand side and scarcely on supply. Our study selected quality enterprises focused on aging health and analyzed different strategies to provide excellent quality services to senior health enterprises. We selected 33 quality senior health enterprises in Taiwan and investigated their excellent quality services strategies by face-to-face semi-structured in-depth interviews with CEO and managers of each enterprise in 2013. A total of 33 senior health enterprises in Taiwan. Overall, 65 CEOs and managers of 33 enterprises were interviewed individually. None. Core values and vision, organization structure, quality services provided, strategies for quality services. This study's results indicated four type of value-added strategy models adopted by senior enterprises to offer quality services: (i) residential care and co-residence model, (ii) home care and living in place model, (iii) community e-business experience model and (iv) virtual and physical portable device model. The common part in these four strategy models is that the services provided are elderly centered. These models offer virtual and physical integrations, and also offer total solutions for the elderly and their caregivers. Through investigation of successful strategy models for providing quality services to seniors, we identified opportunities to develop innovative service models and successful characteristics, also policy implications were summarized. The observations from this study will serve as a primary evidenced base for enterprises developing their senior market and, also for promoting the value co-creation possibility through dialogue between customers and those that deliver service.

  19. What Does Success Look Like in the Forensic Mental Health System? Perspectives of Service Users and Service Providers.

    Science.gov (United States)

    Livingston, James D

    2018-01-01

    Outcomes research in forensic mental health (FMH) has concentrated on reoffending as the principal indicator of success. Defining success in one-dimensional, negative terms can create a distorted view of the diverse objectives of the FMH system. This qualitative study examined the complexity of success from the perspectives of people in the FMH system. Interviews were conducted with 18 forensic service users and 10 forensic service providers. Data were analyzed inductively using thematic analysis to identify predominant themes. The participants conceptualized success as a dynamic process materializing across six different domains in the context of the FMH system: (a) normal life, (b) independent life, (c) compliant life, (d) healthy life, (e) meaningful life, and (f) progressing life. The results indicate that people who provide or use FMH services emphasize a broad range of processes and outcomes, apart from public safety, when they think about success.

  20. The Role of the Central and Kuibyshev Institutes of Maternal and Child Welfare in the Creation of Maternal and Child Health Care Service in the USSR (1922–1940

    Directory of Open Access Journals (Sweden)

    R. S. Serebryany

    2016-01-01

    Full Text Available The article focuses on the role of the State Research Institute of Maternal and Child Welfare as the lead establishment and of the Kuibyshev Regional Scientific-Practical Institute of Maternal and Child Welfare in the creation of maternal and child health care service in the Soviet Union during 1922–1940. It also presents the scientific-practical, educational, organizational-methodological activities of the central and peripheral institutions, their comparative characteristics and contribution to the creation of a broad network of institutions for maternal and child welfare (nurseries, maternity welfare centres, baby food centers, social-legal offices and the reduction of morbidity and mortality of infants and young children.