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Purchasing Arrangements with the Private Sector to Provide Primary Health Care in Underserved Areas

The health systems of most countries in the region are characterized by the provision of services through both public and private providers, often in parallel or in competition with each other. This has raised the option for governments to purchase services from the private sector, to address gaps in services particularly for the poor and underserved. This policy brief reviews the evidence base of government purchasing primary care services from the private sector.

Advancing the Application of Systems Thinking in Health: A Realist Evaluation of a Capacity Building Programme for District Managers in Tumkur, India

Health systems interventions, such as capacity-building of health workers, are implemented across districts in order to improve performance of healthcare organisations. However, such interventions often work in some settings and not in others. Local health systems could be visualised as complex adaptive systems that respond variously to inputs of capacity building interventions, depending on their local conditions and several individual, institutional, and environmental factors.

Gender and Information Communication Technologies (ICTS) in Nigeria: Challenges and Prospects

The study concludes that to address these gender gaps in ICTs in Nigeria, all hands must be on deck to change women’s attitudes towards ICT use by overcoming technophobia;women should be provided with educational and economic empowerment; government ICT policies and programs must address the needs of women;and the civil society should be part and parcel of this crusade for the betterment of women and the society at large. [from abstract]

Plausible Role for CHW Peer Support Groups in Increasing Care-Seeking in an Integrated Community Case Management Project in Rwanda: A Mixed Methods Evaluation

During national scale up of Integrated Community Case Management (iCCM) in Rwanda, greater improvements in care-seeking were found in the districts where Kabeho Mwana implemented its model than in the rest of the country. Success was attributed to an emphasis on routine data review, intensive monitoring, collaborative supervision, community mobilization, and, in particular, CHW peer support groups. [from introduction]

Continuing Professional Development Training Needs of Medical Laboratory Personnel in Botswana

Laboratory professionals are expected to maintain their knowledge on the most recent advances in
laboratory testing and continuing professional development (CPD) programs can address this expectation. In
developing countries, accessing CPD programs is a major challenge for laboratory personnel, partly due to their
limited availability. An assessment was conducted among clinical laboratory workforce in Botswana to identify and
prioritize CPD training needs as well as preferred modes of CPD delivery. [from abstract]

Balancing Authority, Deference and Trust Across the Public–Private Divide in Health Care: Tuberculosis Health Visitors in Western Maharashtra, India

While concepts such as ‘partnership’ are central to the terminology of private–public mix (PPM), little attention has been paid to how social relations are negotiated among the diverse actors responsible for implementing these inter-sectoral arrangements. India’s Revised National Tuberculosis Control Programme (RNTCP) has used intermediary agents to facilitate the involvement of private providers in the expansion of Directly Observed Therapy, Short-Course (DOTS).

Informing the Scale-Up of Kenya’s Nursing Workforce: A Mixed Methods Study of Factors Affecting Pre-Service Training Capacity and Production

This study used a mixed methods approach with data from the Regulatory Human Resources Information System (tracks initial student enrolment through registration) and the Kenya Health Workforce Information System (tracks deployment and demographic information on licensed nurses) for the quantitative analyses and qualitative data from key informant interviews with nurse training institution educators and/or administrators. [from abstract]

Sauti Za Wananchi “Voice of the People”: Patient's Satisfaction on the Medical Wards at a Kenyan Referral Hospital

Patient’s satisfaction is one indicator of healthcare quality. Few studies have examined the inpatient experiences in resource-scarce environments in sub-Saharan Africa. This paper examines patient’s satisfaction on the public medical wards at a Kenyan referral hospital, we performed a cross-sectional survey focused on patient’s satisfaction with medical information and their relationship with staffing and hospital routine. Ratings of communication with providers, efforts to protect privacy, information about costs, food, and hospital environment were also elicited. [adapted from abstract]

Comparative Assessment of Health Care Delivery Systems of Developing Countries: Pakistan versus Cuba

The healthcare system of developing countries are immersed in the complex issues of governance and financing of health care, human resource inequity and lack of access to quality health services, which are significantly impacting on the delivery of health services to the consumers. This paper will highlight on of health care system of Pakistan and Cuba under the spheres of their health care delivery system, organizational structure, authority and power structure, decision making process, future challenges and their resolutions. [from abstract]

What Elements of the Work Environment Are Most Responsible For Health Worker Dissatisfaction in Rural Primary Care Clinics in Tanzania?

In countries with high maternal and newborn morbidity and mortality, reliable access to quality healthcare in rural areas is essential to save lives. Health workers who are satisfied with their jobs are more likely to remain in rural posts. Understanding what factors influence health workers’ satisfaction can help determine where resources should be focused. Although there is a growing body of research assessing health worker satisfaction in hospitals, less is known about health worker satisfaction in rural, primary health clinics.

Can Vouchers Deliver? An Evaluation of Subsidies for Maternal Health Care in Cambodia

This paper will evaluate the effect of vouchers for maternity care in public health-care facilities on the utilization of maternal health-care services in Cambodia. The study involved data from the 2010 Cambodian Demographic and Health Survey, which covered births between 2005 and 2010. The effect of voucher schemes, first implemented in 2007, on the utilization of maternal health-care services was quantified using a difference-in-differences method that compared changes in utilization in districts with voucher schemes with changes in districts without them.[adapted from abstract]

Using Performance-Based Financing (PBF) to Motivate Health Commodity Supply Chain Improvement at a Central Medical Store in Mozambique

The predominant model of public health commodity supply chains in developing countries is one dominated by a central medical store (CMS). In this model, the CMS plays the pivotal role of procurement, storage and warehousing of all health commodities before they are distributed to the next level in the supply chain. Challenges with technical and organization capacity at the CMS level has led to longstanding difficulties in creating sustainable performance improvements in several countries.

Does More Equitable Governance Lead to More Equitable Health Care? A Case Study Based on the Implementation of Health Reform in Aboriginal Health Australia

There is growing evidence that providing increased voice to vulnerable or disenfranchised populations is important to improving health equity. In this paper we will examine the engagement of Aboriginal community members and community controlled organisations in local governance reforms associated with the Aboriginal Health National Partnership Agreements (AHNPA) in Australia and its impact on the uptake of health assessments. [from abstract]

The Role of Informal Networks in Creating Knowledge Among Health-Care Managers: A Prospective Case Study

Health and well-being services, in common with many public services, cannot be delivered by a single organisation and require co-ordination across several organisations in a locality. There is some evidence, mostly from other sectors, that middle managers play pivotal roles in this co-ordination by developing networks of relationships with colleagues in other organisations. These networks of relationships, established over time, provide contexts in which managers can, collectively, create the knowledge needed to address the challenges they encounter.

Meeting the Support Needs of Patients with Complex Regional Pain Syndrome through Innovative Use of Wiki Technology: A Mixed-Methods Study

Using online discussion forums can have a positive impact on psychological well-being through development of shared group identity and validation of thoughts, feelings and experiences. This may be particularly beneficial to people with complex regional pain syndrome (CRPS), who often become socially isolated, lack mobility and face threats to their sense of identity. We set up a peer-support online forum to identify the nature of support provided and to explore its development over time.

The Joint Annual Health Review 2013

The JAHR 2013 report assesses progress in implementing the tasks laid out in the Five-year health plan 2011–2015, as well as results of implementing the Five-year plan targets and Millennium Development Goals (MDGs). At the same time the report contains an in-depth analysis on “Universal health care coverage”. [from introduction]

Improving Maternal and Newborn Health: Effectiveness of a Community Health Worker Program in Rural Kenya

Volunteer community health workers (CHWs) form an important element of many health systems, and in Kenya these volunteers are the foundation for promoting behavior change through health education, earlier case identification, and timely referral to trained health care providers. This study examines the effectiveness of a community health worker project conducted in rural Kenya that sought to promote improved knowledge of maternal newborn health and to increase deliveries under skilled attendance. [from abstract]

The Impact of Knowledge Management on Organisational Performance

Knowledge management is a process that transforms individual knowledge into organisational knowledge. The aim of this paper is to show that through creating, accumulating, organising and utilising knowledge, organisations can enhance organisational performance. [from abstract]

Universal health coverage: The way forward

Universal health coverage (UHC) is the means to provide accessible and appropriate health services to all citizens without financial hardships. India, an emerging economy with demographic window of opportunity has been facing dual burden of diseases in midst of multiple transitions. Health situation in the country despite quantum improvements in recent past has enormous challenges with urban-rural and interstate differentials. Successful national programs exists, but lack ability to provide and sustain UHC.[from abstract]

The Use of Special and Emergency Hiring Approaches in Health Systems

Special and emergency hiring programs entail the use of processes and mechanisms that are outside of the primary, nationally institutionalized human resource frameworks. Specifically, we sought to assess whether these approaches avert some of the challenges that undercut optimal deployment, long-term retention, and the rational assignment of transfers. Do efforts outside of the “regular” system bypass the P&T challenges of the “normal” system? Why? [from introduction]

Is There Any Role for Community Involvement in the Community-Based Health Planning and Services Skilled Delivery Program in Rural Ghana?

This paper presents findings from a study designed to assess the extent to which community residents and leaders participated in the skilled delivery program and the specific roles they played in its implementation and effectiveness. [from abstract]

Where There is No Psychiatrist: A Mental Health Programme in Sierra Leone

The identification and treatment of mental disorders must be considered an urgent public health priority in low- and middle-income countries. Trained primary health workers can deliver safe and effective treatment for mental disorders as a feasible alternative to ease the scarcity of mental health specialists in developing countries. [from abstract]

The Ottawa Hospital and Ottawa Inner City Health: The Population Health Approach in Action

What does the population health approach in action look like in the health care context? This study looks at applying a population health approach in a health care setting. The study articulates the merits of applying a population health approach and brings to light associated barriers and opportunities. It also features patient- and program-level perspectives and population health insights from senior health care leaders at The Ottawa Hospital who were instrumental in establishing OICH.[from introduction]

Exploring Accountable Care in Canada: Integrating Financial and Quality Incentives for Physicians and Hospitals

[Accountable Care Organ] ACOs are promising vehicles for aligning physician and hospital interests in improving quality and reducing cost. However, successful implementation and realization of the ACO mission requires that attention be paid to supporting capacity building within the ACOs, development of a culture of learning and improvement, as well as rigorous monitoring and evaluation. [from executive summary]

Intimate Partner Violence: How Should Health Systems Respond?

IPV is important to health systems because of the wide-ranging and serious health effects experienced by exposed women, as well as the unique opportunity afforded to healthcare providers to enquire about violence. [from introduction]

Burkina Faso Country Profile: Meeting People's Needs with IA/PMs

Burkina Faso faces a daunting family planning (FP) challenge. While the use of any modern contraceptive method
more than tripled between 1993 and 2006, the unmet need for FP remains high, at 31.1% among married women. Long-acting methods (IUDs and implants)and permanent methods (female sterilization and vasectomy) are the most effective
of all FP methods. However, use of long-acting and permanent methods of contraception (LA/PMs) in Burkina Faso remains
low, at 13% of the overall method mix. [adapted from source]

Pregnancy Tests Increase Contraceptive Clients among Health Workers: Evidence from a Randomized Controlled Trial in Madagascar

One challenge that community health workers face when they provide hormonal contraceptives to new clients is ruling out pregnancy. A randomized controlled trial in Madagascar found that offering the health workers pregnancy tests to distribute for free increases their number of new contraceptive clients. [from introduction]

Factors Influencing Job Satisfaction and Its Relationship on Career Development Among Nursing Staff within a Public Hospital in South Africa

South Africa has a dual health system, namely, the public health sector that includes government health institutions, serving mostly the lower income population and the private health sector that serves those who can afford care from their own income. The public sector is responsible for 82 percent of the population and only accounts for 40 percent of the government health expenditure. The purpose of this study was to evaluate job satisfaction levels among nursing staff within a public hospital in Southern Gauteng. [adapted from abstract]

The Effects of Health Worker Motivation and Job Satisfaction on Turnover Intention in Ghana: A Cross-Sectional Study

The study explored the effects of motivation and job satisfaction on turnover intention and how motivation and satisfaction can be improved by district health managers in order to increase retention of health workers. [from abstract]

Evaluating the Coverage and Cost of Community Health Worker Programs in Nampula Province in Mozambique

In 2012, Pathfinder conducted a study to explore whether CHWs who are intended to promote family planning as part of an integrated package of services do communicate with beneficiaries about family planning, and what actions women take based on these messages. The study also explored whether CHWs are reaching the poor, marginalized and vulnerable, and examined the costs of implementing the CHW component of the SCIP project. [from executive summary]